Written by Joseph Moore Earlier this year, Alex Ruck Keene KC (Hon) delivered a Practical Ethics and Law Lecture at the Uehiro Centre on the topic of consent and autonomy-based arguments in medical ethics and law, to which the Centre’s Esther Braun responded. In the course of this enlightening discussion (and in private conversation since),… Read More »Consenting to or Requesting Medical Care?
Written by Anthony Skelton, Lisa Forsberg, and Isra Black
Consider the following two cases:
Cynthia’s blood transfusion. Cynthia is 16 years of age. She is hit by a car on her way to school. She is rushed to hospital. She sustains serious, life-threatening injuries and loses a lot of blood. Her physicians conclude that she needs a blood transfusion in order to survive. Physicians ask for her consent to this course of treatment. Cynthia is intelligent and thoughtful. She considers, understands and appreciates her medical options. She is deemed to possess the capacity to decide on her medical treatment. She consents to the blood transfusion.
Nathan’s blood transfusion. Nathan is 16 years of age. He has Crohn’s disease. He is admitted to hospital with lower gastrointestinal bleeding. According to the physicians in charge of his care, the bleeding poses a significant threat to his health and to his life. His physicians conclude that a blood transfusion is his best medical option. Nathan is intelligent and thoughtful. He considers, understands and appreciates his medical options. He is deemed to possess the capacity to decide on his medical treatment. He refuses the blood transfusion.
Under English Law, Cynthia’s consent has the power to permit the blood transfusion offered by her physicians. Her consent is considered to be normatively (and legally) determinative. However, Nathan’s refusal is not normatively (or legally) determinative. Nathan’s refusal can be overridden by consent to the blood transfusion of either a parent or court. These parties share (with Nathan) the power to consent to his treatment and thereby make it lawful for his physicians to provide it.
Read More »New Publication: ‘Overriding Adolescent Refusals of Treatment’
Written by Ben Davies and Joshua Parker
“COVID-19: Do not resuscitate orders might have been put in place without consent, watchdog says”. This recent headline followed an investigation by the Care Quality Commission into Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) decisions early in the pandemic. In a recent post, Dominic Wilkinson highlights two misconceptions in the coverage of this report, one of which is the ‘consent misconception’.
Dominic’s view is that “there is no ethical requirement…to seek the agreement of patients not to offer or provide a treatment” which a medical professional judges inappropriate. Of course, his position is not that consultation and discussion around CPR is inappropriate, only that consent is not necessary. This is the standard view on consent in this context and, due in part to the Tracey judgment, reflects doctors’ practice. Thus, an important distinction emerges between consenting to the withholding of some treatment, and discussion of that decision. Doctors may be ethically required to discuss a decision without also having an obligation to seek the patient’s consent. The absence of consent, then, does not signal that the DNACPR was unethical, whereas a failure to consult probably will.
By Brian D. Earp (@briandavidearp)
Those who follow my work will know that I have published a number of papers on the ethics of medically unnecessary genital cutting practices affecting children of all sexes and genders (a partial bibliography is at the end of this post). When my writing touches on the sub-set of these practices that affect persons with characteristically female genitalia, primarily women and girls, I have on occasion received some pushback for using the term ‘FGC’ for female genital cutting rather than ‘FGM’ for female genital mutilation (though I have also received words of appreciation, so, I cannot please everyone).
A recent instance of such pushback came from a respected colleague in response to a forthcoming paper of mine in Archives of Sexual Behavior, in which I explicitly argue against the use of ‘mutilation’ in certain contexts, as there is evidence that such stigmatizing language may have adverse effects on the very people who are meant to be helped. The paper, “Protecting Children from Medically Unnecessary Genital Cutting Without Stigmatizing Women’s Bodies: Implications for Sexual Pleasure and Pain” is available as a pre-print here.
Given that this terminological issue is likely to keep coming up, I thought I would share parts of the reply I wrote to my colleague (lightly edited). I certainly don’t expect that everyone will agree with what I say below, but I hope it can shed some light on at least one plausible way of thinking about such difficult matters.
One last thing. In order to understand my reply, you need to know that my colleague argued that my use of ‘FGC’ rather than ‘FGM’ is disrespectful because it goes against the recommendation of the 2005 Bamako Declaration adopted by the Inter-African Committee (IAC) on Traditional Practices Affecting the Health of Women and Children. My answer is immediately below.
Read More »Mutilation or Enhancement? What is Morally at Stake in Body Alterations
The author of the webcomic Left Over Soup proposed a sexual equivalent (or parody?) of Searle’s Chinese Room argument, posing some interesting questions about what it means to have sex, consent and relationships if there is technological mediation:
Tory Grant, the justice minister for New South Wales (NSW) in Australia, has announced the establishment of a task force to investigate the potential for the increased use of anti-libidinal treatments (otherwise known as chemical castration) in the criminal justice system. Such treatments aim to reduce recidivism amongst sexual offenders by dramatically reducing the offender’s level of testosterone, essentially rendering them impotent. The treatment is reversible; its effects will stop when the treatment is ceased. Nonetheless, as I shall explain below, it has also been linked with a number of adverse side effects.
Currently, in New South Wales offenders can volunteer for this treatment, whilst courts in Victoria and Western Australia have the discretion to impose chemical castration as a condition of early release. However, Grant’s task force has been established to consider giving judges the power to impose compulsory chemical castration as a sentencing option. Notably though, New South Wales would not be the first jurisdiction to implement compulsory chemical castration in the criminal justice system. For instance, Florida and Poland also permit compulsory chemical castration of sex offenders.
In the UK, female sterilisation is available on the NHS. However, as the NHS choices website points out:
Surgeons are more willing to perform sterilisation when women are over 30 years old and have had children.
Recent media reports about the experience of Holly Brockwell have detailed one woman’s anecdotal experience of this attitude amongst medics. Ms. Brockwell, 29, explains that she has been requesting sterilization every year since she was 26. However, despite professing a firmly held belief that she does not, has not, and never will want children, her requests have so far been refused, with doctors often telling her that she is ‘far too young to make such a drastic decision’. In this post, I shall consider whether there is an ethical justification for this sort of implicit age limit on consenting to sterilization.Read More »Legally Competent, But Too Young To Choose To Be Sterilized?
The American man who held the Guinness World Record for the most permanent transformations to look like an animal was recently found dead in his Nevada home. The man, known by his Native American name Stalking Cat (SC), had since the age of 23, when he had his first tiger stripe tattooed onto his body, undergone a series of body modification procedures aimed at altering his physical appearance to resemble that of a female tiger. In addition to tattooed tiger stripes across his body and numerous piercings, body modification procedures that SC underwent included having his upper lip surgically split, his ears pointed and earlobes elongated, subdermal silicone implants (to change the shape of his face and to facilitate the wearing of whiskers), and flattening of the nose via septum relocation.
A BBC profile on SC from ten years ago states that SC “travels to Phoenix, Arizona to have his surgery carried out by body modification artist Steve Hayward. Cat cannot go under the surgeon’s knife because it is illegal in the United States for a medical professional to alter someone’s appearance beyond what society deems normal.”
What would happen if a person (who, we stipulate, has capacity to make medical treatment decisions under the Mental Capacity Act 2005) wanted to have a similar range of procedures carried out in this jurisdiction?
Read More »Stalking Cat, tiger body modification, and the limits of consent
The Governor of California, Jerry Brown, has signed a Bill that will ban ‘conversion’ or ‘reparative’ therapies in that State. These are interventions that aim at ‘curing’ homosexuality or at least, controlling homosexual desires. There have been reported cases of exorcisms, shock treatment and aversive therapies not unlike those that were used in Stanley Kubrick and Anthony Burgess’ A Clockwork Orange.Read More »Banning conversion therapies
