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Medical Law
This page intentionally left blank
CORE TE X T SERIES

Medical Law
JONATHAN HERRING
Fellow in Law
Exeter College, University of Oxford

Series Editor
NICOL A PADFIELD
Fitzwilliam College, Cambridge

1
3
Great Clarendon Street, Oxford OX2 6DP
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Preface

This book is designed to provide the reader with an accessible and stimulating
account of medical law and ethics. There are few areas of law which are as fast
moving as this. Rarely a day passes when there is not a story in the newspapers
which is of relevance to medical law and ethics. Also, there are few areas which
arouse such intense passions as the ones discussed in this book. As students of
medical law, however, it is important to take a cool, hard look at the issues. The
excitement of the debate can mean that some students are unable to provide
an accurate summary of the law. This book, therefore, contains plenty of case
summaries, so that you can demonstrate to the examiner your knowledge of
the case law. There are also clear statements of the key statutory principles so
that you can discuss these in exams.

I hope that having read through the chapters in this book you will want to read
more about some of the topics. There is plenty of further reading that you can
look into. I have deliberately not sought to present a particular view. Quite the
opposite, in most chapters I have presented the key arguments in the debates
in the form of different ‘Speakers’ arguing over a case. You will need to think
through the issues for yourself. Better still, discuss them with your friends.
There is nothing better for clarifying your own views than talking them through
with others.

In the writing of this book I was grateful for the support and help of many
colleagues and friends, including Sandra Fredman, Charles Foster, Imogen
Goold, and George P. Smith. An especial thank you to Philip Moore for his
excellent proof reading. Above all I thank my wife Kirsten Johnson and my chil-
dren, Laurel, Joanna, and Darcy for their love and patience.

Jonathan Herring
This page intentionally left blank
Contents

Table of cases xvii

Table of statutes xxiii
Table of secondary legislation xxvi
Table of international instruments xxvii

1 Key ethical and legal principles 1

2 Rationing and delivery of health care 19

3 Medical negligence 43

4 Consent 63

5 Confidentiality 95

6 Regulation of abortion and pregnancy 121

7 Assisted reproduction 149

8 Organ donation and the ownership of body parts 177

9 Ending life 209

10 Mental health 239

11 Medical research 263

Index 283
This page intentionally left blank
Detailed contents

Table of cases xvii

Table of statutes xxiii
Table of secondary legislation xxvi
Table of international instruments xxvii

1 Key ethical and legal principles 1

Introduction 1

Grand theories 2
Consequentialism 2
Deontology 4
An ethic of care 5

Applying the theories 7

Key ethical principles 8

Autonomy 8
The principle of non-malfeasance 10
The principle of beneficence 12
Justice 13
Balancing the principles 13

Intersecting medical ethics and law 14

CONCLUSION 16
FURTHER RE ADING 16
SELF-TEST QUESTIONS 17

2 Rationing and delivery of health care 19

An introduction to rationing 19
Must we ration? 20
Who rations? 20
The law on rationing 21
European Union law 22
Judicial review 23
x | Detailed contents

Analysis of the courts’ approach 27

Ethical approaches to rationing 28

The NHS Constitution 31

The structure of the NHS 35

The Care Quality Commission 35
Strategic Health Authorities 35
Primary Care Trusts (PCTs) 36
Special health authorities 36
Local authorities 36
NHS Trusts 36
General practitioners 37

The health/social care divide 37

The provider/purchaser distinction 38
Decentralization 39
Targets 39
Choice 39

CONCLUSION 41
FURTHER RE ADING 41
SELF-TEST QUESTIONS 42

3 Medical negligence 43

Introduction 43

Legal wrongs 44

Criminal law 44

The law of the tort of negligence 45

The duty of care 46
Breach of the duty 46

Debates over Bolam 49

Causation 51
The burden of proof 51
Loss of a chance 52
Debates over the loss of a chance cases 54

Damages 56

Reduction of award 57

The problems with the current system 58

No-fault schemes for medical negligence 58

 Detailed contents | xi

Regulation by professional bodies and the NHS 59

CONCLUSION 60
FURTHER RE ADING 60
SELF-TEST QUESTIONS 61

4 Consent 63

Introduction: the requirement of consent 64

Is it ever permissible to treat a patient without consent? 65
The principle of autonomy 66
Who must consent? 67
What is consent? 67
Children 71
Where the court must determine disputes over treatment
for children 75

The limits of consent? 75

Failure to provide information 76

What must be disclosed? 76
The right not to know 81

The treatment of those lacking capacity 81

Advance decision 82
Lasting powers of attorney (LPAs) 84
Deputies 84
Other carers 85
Limits on the power of decision-makers 85
Best interests 86
What is not to be considered when assessing best interests 90
Use of force 90

Ethical issues surrounding autonomy 91

CONCLUSION 92
FURTHER RE ADING 92
SELF-TEST QUESTIONS 93

5 Confidentiality 95

Introduction 95

Equity 96

Human rights 99
xii | Detailed contents

Contract law 101

Tort law 101

Property 102

Criminal law 102

Statutory obligation 102

Professional regulation 103

Denying breach of confidentiality 103

Loss of confidentiality 103
Consent to disclosure 104
Anonymized information 104

Justification 106
Consent 106
Proper working of the hospital 106
A threat of serious harm to others 107
Assisting police investigations 109
Press freedom 109
Specific statutory provisions 111
Other public interests 111

Data protection 113

Keeping safe 114
Children and confidentiality 115
Dead patients 116
Access to records 116
Ethical arguments 117

CONCLUSION 118
FURTHER RE ADING 119
SELF-TEST QUESTIONS 119

6 Regulation of abortion and pregnancy 121

Introduction 121

Contraception 122
The distinction between contraception and abortion 122
Contraception and children 123
Contraception and those lacking capacity 124
Sterilization 125
 Detailed contents | xiii

Adults lacking capacity 125

Tort and failed contraception 129

Abortion 132
The legal structure 132
The criminal offences 132
The Abortion Act 1967 134
Grounds for abortion 135
Legal actions to prevent abortion 138

Abortion and those lacking capacity 138

Debates on the abortion law 139

The legal status of the fetus 139

Abortion ethics 143

CONCLUSION 147
FURTHER RE ADING 147
SELF-TEST QUESTIONS 148

7 Assisted reproduction 149

Introduction 149

Assisted reproduction 149

Activities which are unlawful 150
Activities only permitted with a licence 151
Activities which do not require a licence 151

The role of consent 151

Restrictions on access to treatment 153

Parentage 156
Mothers 156
Husbands and civil partners 156
Partners 156
Sperm donors 157
Comments on the allocation of parenthood 157
Donor anonymity 158

Surrogacy 160
What should the law on surrogacy be? 163

Preimplantation genetic diagnosis 165

Saviour siblings 166
xiv | Detailed contents

Hybrids 168
Embryo research 169
Cloning 170
Genetic enhancement 171

Reproductive autonomy 172

CONCLUSION 172
FURTHER RE ADING 173
SELF-TEST QUESTIONS 174

8 Organ donation and the ownership of body parts 177

Introduction: the Human Tissue Act 2004 177

When the Human Tissue Act 2004 applies 179

Storage without consent 182

Criminal offences under the Human Tissue Act 184

Organ donation 186

Living organ donors 186
Ethical issues 189
Organs from the dead 189
The distribution of organs 191

Ethical issues and reform 192

The wishes of the deceased 194

Selling organs 195

The body as property 197

Xenotransplantation 203

CONCLUSION 205
FURTHER RE ADING 205
SELF-TEST QUESTIONS 207

9 Ending life 209

Introduction 209

The definition of death 210

The criminal law 211

Murder 211
Defences 211
 Detailed contents | xv

Loss of control 212

Necessity 212
Manslaughter 213

Suicide 214

Refusal of treatment 221

The Human Rights Act 1998 222

Persistent vegetative state (PVS) 225

Other adults 227
Children 227

The ethical issues 230

CONCLUSION 235
FURTHER RE ADING 236
SELF-TEST QUESTIONS 237

10 Mental health 239

Introduction 239

Admission under the Mental Health Act 1983 240

Section 2: admission for assessment 240
Section 4: emergency admission 241
Section 3: admission for treatment 242
Treatment 244

Codes of practice 246

Special regulation for brain surgery and

electro-convulsive therapy 248

Discharge under the MHA 248

Community treatment order 250

Guardianship 251

Informal treatment 251

Dangerousness 254

Paternalism 255
Rejecting the justifications for the Mental Health Acts 255

The debates over the future of mental health care 256

Critics of mental health 257

Mental health and criminal liability 258

xvi | Detailed contents

CONCLUSION 259
FURTHER RE ADING 259
SELF-TEST QUESTIONS 261

11 Medical research 263

Introduction: background to the regulation of research 263

Experimental treatment or research? 264

Declaration of Helsinki 265
General legal principles 266
Research which is unlawful 266

Consent 267
Informed consent 268
Duress 270
Withdrawal 271
Payment 271

Research Ethics Committees (RECs) 272

Placebo 274

Research involving children 275

Incompetent adults 276

An obligation to participate? 279

CONCLUSION 280
FURTHER RE ADING 280
SELF-TEST QUESTIONS 281

Index 283
Table of cases

Cases reported in case summaries are listed in bold.

A, Re [1992] 3 Med LR 303 . . . 9.2 Associated Provincial Picture Houses

A (Conjoined Twins), Re [2001] Fam v Wednesbury Corporation [1948] 1
147 (CA) . . . 9.7 KB 223 . . . 2.8
A (Medical Treatment: Male Attorney-General’s Reference (No. 3
Sterilisation), Re [2000] 1 FCR of 1994) [1997] 3 WLR 421 . . . 6.55,
193 . . . 6.17 6.56
A and B v Leeds Teaching Hospitals
NHS Trust; Cardiff and Vale B, Re [1987] 2 All ER 206 . . . 6.11,
NHS Trust [2004] EWHC 644 6.13, 6.14
(QB) . . . 8.3, 8.72 B, Re [1990] 3 All ER 927 . . . 9.38
A County Council v (1) SB (2) MA B (Adult: Refusal of Treatment),
(3) AA [2010] EWHC 2528 Re [2002] EWHC 429
(Fam) . . . 5.37 (Fam) . . . 1.27, 9.19
A Hospital v SW [2007] EWHC 425 B (Consent to Treatment: Capacity), Re
(Fam) . . . 9.32 [2002] EWHC 429 (Fam) . . . 4.18
A Local Authority v Mrs A and Mr A B (Role of Biological Father), Re
[2010] EWHC 1549 (Fam) . . . 6.8 [2007] EWHC 1952 (Fam) . . . 7.28
A Primary Care Trust v AH [2008] B v Croydon Health Authority [1995]
EWHC 1403 (Fam) . . . 4.54 Fam 13 . . . 10.15
A Trust v H (An Adult) [2006] EWHC Bailey v Ministry of Defence [2008]
1230 (Fam) . . . 6.10 EWCA 883 . . . 3.23
Able v AG [1984] QB795 . . . 9.12 Barnett v Chelsea and Kensington
AC v Berkshire West PCT [2010] HMC [1968] 1 All ER 1068 . . . 3.22
EWHC 1162 (Admin) . . . 2.9, 2.10, Bazley v Wesley Monash IVF [2010]
2.11 QSC . . . 8.76
Ahsan v University Hospitals Leicester BBC v Harper Collins Publishers Ltd
NHS Trust [2006] EWHC 2624 and Ben Collins [2010] EWHC
(QB) . . . 4.55 2424 (Ch) . . . 5.19
Airedale NHS Trust v Bland [1993] Birch v University College London
AC 789; [1993] 1 All ER 821 . . . 9.2, Hospital NHS Trust [2008] EWHC
9.29, 9.32, 9.34 2237 (QB) . . . 3.12
Ashworth Security Hospital v MGN Bolam v Friern HMC [1957] 2 All ER
[2000] 1 WLR 515 . . . 5.1 267 . . . 3.9, 3.10, 3.11, 3.15, 3.16, 3.18,
Associated Newspapers Ltd v His 3.19, 3.45, 4.29, 4.30, 6.12, 6.21, 11.4
Royal Highness the Prince of Wales Bolitho v City and Hackney HA [1997]
[2006] EWCA Civ 1776 . . . 5.30 4 All ER 771 . . . 3.9, 3.10, 3.18, 3.24
xviii | Table of cases

Bolton NHS Trust v O [2002] EWHC Dobson v North Tyneside Health

2871 (Fam) . . . 4.17 Authority [1996] 4 All ER
Bravery v Bravery [1954] 1 WLR 714 . . . 8.73
1169 . . . 6.3 Doodeward v Spence (1908) 6 CLR
Brown v Scarborough and North 406 . . . 8.74
East Yorkshire NHS Trust [2009] Dorset County Council v EH [2009]
EWHC 3103 (QB) . . . 3.11 EWHC 784 (Fam) . . . 4.54
Burke v United Kingdom (Application Douglas v Hello! [2007] UKHL
No. 19807/06) (ECtHR, 11 July 21 . . . 5.9
2006) . . . 9.28 DPP v Smith [2006] EWHC 94
Burnev A [2006] EWCA Civ (Admin) . . . 8.73
24 . . . 3.12
E, Re [1993] 1 FLR 386 . . . 4.22, 4.26
C, Re [1990] Fam 39 . . . 5.36 Evans v Amicus Healthcare Ltd [2004]
C, Re [1998] LL Rep Med 1 . . . 9.37 3 All ER 1025 . . . 7.7
C (Adult: Refusal of Treatment), Re Eve, Re [1986] 2 SCR 388 (Supreme
[1994] 1 WLR 290 . . . 4.14 Court of Canada) . . . 6.18
C v S [1988] QB 135 . . . 6.50
Campbell v MGN [2004] UKHL F (A Mental Patient: Sterilisation), Re
22 . . . 5.4, 5.8, 5.11, 5.14, 5.19, [1990] 2 AC 1 . . . 6.12
5.30, 5.43 F (In Utero), Re [1988] Fam 122 . . .
Centre for Reproductive Medicine 6.55
v Mrs U [2002] EWHC 36 Frenchay Healthcare NHS Trust v S
(Fam) . . . 7.10 [1994] 1 WLR 604 . . . 9.31
Charlotte Wyatt Litigation [2005]
EWCA Civ 1181 . . . 9.37 G (Adult Incompetent: withdrawal of
Chatterton v Gerson [1981] 1 All ER Treatment), Re (2001) 65 BMLR
257 . . . 4.16 6 . . . 9.34
Chester v Afshar [2004] UKHL 41; G v E (By His Litigation Friend the
[2004] 4 All ER 587 . . . 3.28, 3.31, Official Solicitor) [2010] EWHC
4.30, 4.34, 4.37 2512 (Fam) . . . 4.47
Collins v Wilcock [1984] 3 All ER Gillick v West Norfolk Area Health
374 . . . 4.7 Authority [1986] AC 112 . . . 4.20,
Common Services Agency v Scottish 4.21, 4.22, 4.23, 4.24, 4.25, 5.36,
Information Commissioner [2008] 6.7, 8.38, 11.33, 11.34
UKHL 47 . . . 5.22 Glass v UK [2004] 1 FCR 553
(ECtHR) . . . 4.26, 9.37
D v An NHS Trust Hospital [2005] Goodwill v BPAS [1996] 2 All ER
EWHC 2439 . . . 9.32 161 . . . 3.8, 6.20
DH NHS Foundation Trust v PS Gregg v Scott [2005] UKHL 2 . . . 3.25,
[2010] EWHC 1217 (Fam) . . . 4.54 3.31, 3.32, 3.34, 3.35
Dickson v UK[2008] 1 FLR 1315 Groom v Selby (2002) 64 BMLR
(ECtHR (GC)) . . . 7.13 47 . . . 6.24
 Table of cases | xix

H (A Health Worker) v Associated MM, Re [2007] EWHC 2003

Newspapers Ltd [2002] LL Rep (Fam) . . . 4.12, 4.51
210 . . . 5.30 M’Naghten’s Case [1843–60] All ER
Halushka v University of Rep 229 . . . 10.45
Saskatchewan (1965) 53 DLR (2d) Moore v Regents of the University
436 . . . 11.17 of California (1990) 793 P 2d
HE v A Hospital NHS Trust [2003] 479 . . . 8.77, 8.81
EWHC 1017 . . . 4.42 Morris v University Hospitals
Herczegfalvy v Austria (1993) 15 EHRR Birmingham NHS Trust
437 . . . 10.16 (Birmingham County Court, 27
HL v UK [2005] 81 BMLR January 2009) . . . 3.11
131 . . . 10.28 Mosley v News Groups Newspapers
Hotson v E Berkshire AHA [1987] AC [2008] EWHC 687 (QB) . . . 5.7
750 . . . 3.25 MH v Secretary of State for Health
[2005] UKHL 60 . . . 10.7
J (A Minor) (Wardship: Medical MS v Sweden (Application No.
Treatment), Re [1990] 3 All ER 20837/92) (ECtHR, 27 August
930 . . . 9.35 1997) . . . 5.10
Janaway v Salford AHA [1989] AC Murray v Big Pictures [2008] EWCA
537 . . . 6.49 446 . . . 5.14, 5.30
Jepson v CC of West Mercia [2003]
EWHC 3318 . . . 6.50, 6.54 N (A Child), Re [2007] EWCA Civ
1053 . . . 7.39
KB (Adult) (Mental Patient: Medical NHS Trust v A (A Child) [2007]
Treatment), Re (1994) 19 BMLR EWHCA 1696 (Fam) . . . 1.33
144 . . . 10.15 NHS Trust v J [2006] EWHC 3152
(Fam) . . . 9.33
L, Re [2008] EWCA Civ 1388 . . . 7.28 NHS Trust v MB [2006] EWHC 507
LC, Re [1997] 2 FLR 258 . . . 6.13, 6.14 (Fam) . . . 9.41
Leeds Teaching Hospital v A [2003] 1 Norfolk and Norwich Healthcare
FLR 1091 . . . 7.25 (NHS) Trust v W [1996] 2 FLR
Lewis v Secretary of Health for 613 . . . 10.15
Health [2008] EWHC 2196
(QB) . . . 5.38 P, Re [2009] EWHC 163 (Ch) . . . 4.53
P (A Minor) (Wardship: Sterilisation),
Marriott v West Midlands HA [1999] Re [1989] 1 FLR 182 . . . 6.14
LL Rep Med 453 . . . 3.11 Palmer v Tees Health Authority [2000]
MB, Re [1997] 2 FLR 426 . . . 6.55 PIQR 1 . . . 5.28
McFarlane v Tayside Health Board Parkinson v St James and Seacroft
[1999] 3 WLR 1301 . . . 6.23, 6.24, University Hospital NHS Trust
6.27 [2002] QB 266 . . . 6.24
McKennit v Ash [2006] EWCA Civ Paton v BPAS [1979] QB 276; [1978] 2
1714 . . . 5.9 All ER 992 . . . 6.36, 6.50, 6.55
xx | Table of cases

Pearce v United Bristol Healthcare R v Secretary of State for Social Services

NHS Trust (1998) BMLR ex p Hincks (1980) 1 BMLR
118 . . . 4.30 93 . . . 2.5
Pretty v UK [2002] FCR 976 . . . 9.22, R v Smith [1974] 1 All ER 376 . . . 6.36
9.24, 9.25, 9.26 R v Tabassum [2000] EWCA 90;
[2000] Lloyd’s Rep Med 404; [2000]
Quintavalle v HFEA [2005] UKHL 2 Cr App R 328 . . . 1.11, 3.5, 4.4, 4.16
28 . . . 7.51 R v Welsh [1974] RTR 478 . . . 8.73
R v Woollin [1998] 4 All ER
R, Re [1991] 4 All ER177 . . . 4.22, 4.23 103 . . . 9.4
R (Adult: Medical Treatment), Re R (Axon) v Secretary of State for
(1996) 31 BMLR 127 . . . 9.34 Health [2006] QB 539; [2006]
R v A [2010] EWCA Crim EWHC 37 (Admin) . . . 4.25, 5.32,
1949 . . . 6.31 5.36
R v Adams [1957] Crim LR 365 . . . 9.4 R (B) v Ashworth Hospital Authority
R v Adomako [1995] 1 AC 171 . . . 9.8 [2005] 2 All ER 289 . . . 10.15
R v Bourne [1939] 1 KB 687 . . . 6.33 R (B) v Haddock [2006] EWCA
R v Bournewood and Mental Health 961 . . . 10.17
NHS Trust ex p L [1998] 3 All ER R (B) v SS [2005] EWHC 86
289 . . . 10.28 (Admin) . . . 10.16
R v Brown [1993] 2 All ER 75 . . . 4.28 R (Booker) v NHS Oldham [2010]
R v Brown [1994] 1 AC 212 . . . 11.8 EWHC 2593 (Admin) . . . 2.42
R v Cambridge HA ex p B [1995] 2 All R (Burke) v GMC [2005] 3 FCR
ER 129 . . . 2.10 169 . . . 1.27, 9.23, 9.27
R v Cocker[1989] Crim LR 740 . . . 9.6 R (Jenkins) v HM Coroner for
R v Croydon Health Authority (1997) Portsmouth and South East
40 BMLR 40 . . . 3.40 Hampshire and Cameron and
R v Department of Health ex p Source Finn [2009] EWHC 3229
Informatics Ltd [2001] QB 424; (Admin) . . . 9.20
[2000] 1 All ER 786 . . . 5.15, 5.21, R (Munjaz) v Ashworth Hospital
5.22, 5.23 Authority [2005] UKHL 58 . . .
R v Derbyshire HA ex p Fisher [1997] 10.18
Med LR 327 . . . 2.9 R (N) v Dr M [2003] 1 WLR
Rv Ethical Committee of St Mary’s 562 . . . 10.16
Hospital ex p Harriott [1988] 1 FLR R (Otley) v Barking and Dagenham
512 . . . 11.27 NHS PCT [2007] EWHC 1927
R v Kelly [1998] 3 All ER 714 . . . 8.73 (Admin) . . . 2.10
R v North and East Devon HA ex p R (Pretty) v DPP [2002] 1 AC
Coughlan [2001] QB 213 . . . 2.9 800 . . . 9.22
R v NW Lancashire HA ex p A, G and R (Purdy) v DPP [2009] UKHL
D . . . 2.9 45 . . . 9.12, 9.15, 9.22, 9.24, 9.50
R v Rathery [1976] RTR 478 . . . 8.73 R (Rogers) v Swindon Primary Care
R v Richardson [1999] QB 444; (1998) Trust [2006] EWCA Civ 329 . . . 2.9,
43 BMLR 21 . . . 3.5, 4.4 2.10, 2.13
 Table of cases | xxi

R (Ross) v West Sussex Primary Smith v Tunbridge Wells HA [1994] 5

Care Trust [2008] EWHC 2252 Med LR 334 . . . 4.32
(Admin) . . . 2.9, 2.10 South Glamorgan CC v B [1993] 1 FLR
R (S) v Plymouth CC [2002] 1 FLR 673 . . . 4.22
1177 . . . 5.32 SS (Adult: Medical Treatment), Re
R (John Smeaton on behalf of the [2002] 1 FCR 73 . . . 6.51
SPUC) v Secretary of State for St George’s Healthcare NHS Trust
Health [2002] 2 FCR 193 . . . 6.3, 6.6 v S [1998] 3 All ER 673; (1998) 44
R (Stevens) v Plymouth [2002] EWCA BMLR 160 . . . 4.2, 4.7, 6.55
Civ 388 . . . 5.4 Stephens v Avery [1988] Ch 449 . . . 5.3
R (Stone) v South East Coast Strategic
Health Authority [2006] All ER (D) T (Adult: Refusal of Treatment), Re
144 (Jul) . . . 5.32 [1992] 4 All ER 649 . . . 4.19
R (von Brandenburg) v East London T, Re [1997] 2 FCR 363 . . . 9.39
and the City Mental Health NHS T v B [2010] EWHC 1444
Trust [2004] 2 AC 280 . . . 10.23 (Fam) . . . 7.23
R (Watts) v Bedford PCT [2004] Tabet v Gett [2010] HCA 12 . . . 3.26
EWCA 166 . . . 2.6 Tameside and Glossop Acute
Rabonev Pennine Care NHS Trust Services Trust v CH [1996] 1 FCR
[2009] EWHC 1827 (QB) . . . 9.18 753 . . . 10.15
Rees v Darlington NHS Trust [2004] Tarasoff v Regents of the University
AC 309 . . . 6.24 of California (1976) 131 Cal Rptr 14
Robb v Home Office (1994) 22 BMLR (Cal Sup Ct) . . . 5.28
43 . . . 4.7
Vo v France [2004] 2 FCR 577 . . . 6.57
S, Re [1993] 1 FLR 376 . . . 4.22
S (Parental Order), Re [2009] EWHC W, Re [1992] 4 All ER 627 . . . 4.23
2977 (Fam) . . . 7.38 W v Egdell [1990] 1 All ER
S and S (Protected Persons), Re, [2009] 835 . . . 5.27
WTLR 315 . . . 4.53 West Bromwich Albion v Wl-Safty
S v St George’s Healthcare NHS Trust [2006] EWCA Civ 1299 . . . 3.8
[1998] 3 WLR 936 . . . 9.19 Wilsher v Essex AHA [1988] 1 All ER
Savage v South Essex Partnership 871 . . . 3.23
[2010] EWHC 865 (QB); [2008] Winnipeg Child and Family Services
UKHL 274 . . . 4.7, 9.18 (Northwest Area) v G (DF) [1997] 3
Schloendorff v Society of NY Hospital, SCR 925 . . . 6.58
105 NE 92 (NY 1914) . . . 4.61
Sidaway v Bethlem RHG [1985] 1 All X (Adult Sterilisation), Re [1998] 2 FLR
ER 643 . . . 4.29, 4.30, 4.33 1124 . . . 6.13
Simms v Simms [2003] 1 All ER X and Y (Foreign Surrogacy), Re
669 . . . 11.4 [2008] EWHC 3030 (Fam) . . . 7.38
SL (Adult Patient), Re [2002] FLR X v Y [1988] 2 All ER 649 . . . 5.30
389 . . . 6.12
SL v SL [2000] 2 FCR 452 . . . 6.14 Y, Re [1997] 2 FCR 172 . . . 1.30, 8.40
xxii | Table of cases

Y (Mental Incapacity: Bone Marrow Z (Local Authority: Duty), Re [2004]

Transplant), Re [1996] 2 FLR EWHC 2817 (Fam) . . . 9.18
330 . . . 7.57 Z (Medical Treatment: Hysterectomy),
Y (Mental Patient: Bone Marrow Re [2000] 1 FCR 274 . . . 6.14
Donation), Re [1997] 2 FCR Z v Finland (1997) 25 EHRR
172 . . . 4.57 371 . . . 5.10
Yearworth v North Bristol NHS Trust
[2009] EWCA Civ 37 . . . 8.74, 8.75,
8.76, 8.81
Table of statutes

Extracted statutes are listed in bold.

Abortion Act 1967 . . . 6.6, 6.30, 6.32, s 8 . . . 4.20

6.33, 6.34, 6.35, 6.47, 6.48, 6.49, Forced Marriage (Civil Protection) Act
6.50, 6.54 2007 . . . 5.37
s 1(1)(a) . . . 6.38, 6.43 Freedom of Information Act
s 1(1)(b) . . . 6.43 2000 . . . 5.39
s 1(1)(c) . . . 6.44 Freedom of Information (Scotland) Act
s 1(1)(d) . . . 6.45 2002
s 1(2) . . . 6.40 s 15 . . . 5.22
s 1(4) . . . 6.47
s 4 . . . 6.48, 6.49 Health Act 2009
Access to Health Records Act 1990 s 2 . . . 2.23
s 3(1)(f) . . . 5.39 Health and SocialCare Act
Adoption and Children Act 2002 2008 . . . 3.50
s 1 . . . 7.38 Health and Social Care (Community
Health and Standards) Act
Children Act 1989 . . . 5.37, 6.10 2003 . . . 2.32
s 1 . . . 11.33 Homicide Act 1957
s 4 . . . 4.24 s 2 . . . 9.5, 10.46
Sch 1 . . . 7.23 s 2(1) . . . 10.46
Community Care Act 1990 . . . 2.31 s 2(1A) . . . 10.46
Computer Misuse Act 1990 . . . 5.16 s 2(1B) . . . 10.46
Coroners and Justice Act 2009 . . . 9.5 Human Fertilisation and Embryology
Crimeand Disorder Act 1998 Act 1990 . . . 4.49, 7.2, 7.3, 7.4, 7.5,
s 115 . . . 5.29 7.6, 7.7, 7.8, 7.10, 7.11, 7.21, 7.23,
7.25, 7.38, 7.60, 7.61, 8.75
Data Protection Act 1998 . . . 5.17, s 2 . . . 7.4
5.22, 5.34 s 3 . . . 7.4
s 8 . . . 5.39 s 3(2) . . . 7.4
Sch 2 . . . 5.34 s 3(3) . . . 7.4
Sch 3 . . . 5.34 s 4 . . . 7.5
s 4(2) . . . 7.4
Equality Act 2010 . . . 5.39 s 4(3) . . . 7.4, 7.59
s 4A . . . 7.59
Family Law Reform Act 1969 s 13(5) . . . 7.11
s 1 . . . 4.20 s 28 . . . 7.25
xxiv | Table of statutes

s 30 . . . 7.38 s 33 . . . 8.36
s 30(7) . . . 7.38 s 34A . . . 8.52
Sch 2 . . . 7.4, 7.47, 7.66 s 53 . . . 8.8
Sch 2, para 3(4) . . . 7.66 Sch 1 . . . 8.7, 8.12, 8.16
Sch 3 . . . 7.7 Sch 1, Pt I . . . 8.7, 8.12, 8.14
Human Fertilisation and Embryology Sch 1, Pt II . . . 8.7, 8.12, 8.18
Act 2008 . . . 4.49, 7.2, 7.3, 7.4, 7.5, Sch 2, Pt II . . . 8.15
7.6, 7.7, 7.10, 7.11, 7.12, 7.21, 7.23,
7.25, 7.26, 7.58, 7.59, 7.60, 7.61, Infant Life (Preservation) Act
7.64, 8.75 1929 . . . 6.32
s 33 . . . 7.20 s 1 . . . 6.32
s 35 . . . 7.21 s 1(1) . . . 6.32
s 41 . . . 7.23
s 42 . . . 7.21 Local Government Act 1972
s 44 . . . 7.22 s 222 . . . 9.18
s 54 . . . 7.38
s 58(2) . . . 7.22 Mental Capacity Act 2005 . . . 4.1, 4.14,
Sch 3, para 1ZA(d) . . . 7.51 4.39, 4 42, 4.47, 4.57, 4.58, 5.25, 6.8,
Human Rights Act 1998 . . . 4.19, 4.25, 6.10, 8.40, 9.13, 9.18, 9.34, 10.1,
5.11, 8.3, 9.21, 9.27, 9.32, 11.7 10.28, 11.40
s 7 . . . 5.11 s 1 . . . 4.39, 4.48
Human Tissue Act 1961 . . . 8.3 s 1(2) . . . 4.11
Human Tissue Act 2004 . . . 8.1, 8.4, s 1(4) . . . 4.11, 4.18
8.5, 8.10, 8.25, 8.26, 8.27, 8.41, s 2(1) . . . 4.11
8.62, 11.25 s 2(3) . . . 4.11
s 1 . . . 8.7, 8.16, 8.17, 8.28, 8.43 s 3(1) . . . 4.13
s 1(1) . . . 8.7, 8.28 s 4 . . . 8.35
s 1(2) . . . 8.28 s 4(3) . . . 4.51
s 1(3) . . . 8.28 s 4(5) . . . 4.59
s 1(7)–(9) . . . 6.19 s 5 . . . 4.47
s 2 . . . 8.10 s 9 . . . 4.45
s 3 . . . 8.9 s 15 . . . 6.10
s 5 . . . 8.28 s 19 . . . 4.47
s 5(1) . . . 8.28, 8.48 s 24 . . . 4.40
s 5(2) . . . 8.30 s 25(2)(c) . . . 4.41
s 5(7) . . . 8.48 s 25(4)(c) . . . 4.41
s 7 . . . 8.22 s 26 . . . 4.44
s 27(4) . . . 8.9, 8.46 s 26(2) . . . 4.44
s 32 . . . 8.36, 8.62, 8.63 s 27 . . . 4.49
s 32(1) . . . 8.36, 8.62 s 30 . . . 11.39
s 32(2) . . . 8.36, 8.63 ss 30–34 . . . 11.37, 11.38
s 32(3) . . . 8.36 Sch A1 . . . 10.30
s 32(6) . . . 8.36 Sch A1, para 1 . . . 10.30
s 32(7) . . . 8.64 Sch A1, para 12(1) . . . 10.30
 Table of statutes | xxv

Mental Health Act 1983 . . . 4.7, 5.27, National Health Service Act
6.10, 6.51, 9.18, 10.1, 10.2, 10.4, 2006 . . . 2.4
10.11, 10.15, 10.18, 10.19, 10.20, s 1 . . . 2.4
10.22, 10.24, 10.28, 10.31, 10.37, s 2 . . . 2.4
10.38, 10.39 s 3 . . . 2.4
Pt IV . . . 10.14 s 251(1) . . . 5.31
s 1(2) . . . 10.4 National Health Service Act 1977
s 1(3) . . . 10.4 s 5(1)(b) . . . 6.4
s 2 . . . 10.2, 10.3, 10.6, 10.7, 10.8, National Health Service Act
10.9, 10.23 2008 . . . 2.26
s 2(2) . . . 10.3,10.5 National Health Service Redress Act
s 3 . . . 9.18, 10.2, 10.5, 10.9, 10.10, 2006 . . . 3.44
10.13, 10.23
s 3(2) . . . 10.10 Offences Against the Person Act
s 4 . . . 10.2, 10.8, 10.9, 10.29 1861 . . . 4.4
s 8 . . . 10.27 s 47 . . . 3.5, 4.4
s 17A . . . 10.24 s 58 . . . 6.31
s 17A(5) . . . 10.24 s 59 . . . 6.31
s 17B(2) . . . 10.25
Public Health (Control of Disease)
s 17B(3) . . . 10.26
Act1984 . . . 4.7, 5.31
s 17E . . . 10.24
s 17E(1) . . . 10.24 Sexual Offences Act 2003
s 37 . . . 10.47 s 73 . . . 4.20, 6.7
s 57(1) . . . 10.20 Suicide Act 1961 . . . 9.10
s 57(2) . . . 10.20 s 2 . . . 9.10
s 58 . . . 10.21 s 2(1) . . . 9.10
s 58A . . . 10.21 s 2(1A) . . . 9.10
s 63 . . . 10.14, 10.15 s 2(1B) . . . 9.10
s 64 . . . 10.29 s 2(4) . . . 9.12
s 64(d) . . . 10.29 Surrogacy Arrangements Act 1985
s 118 . . . 10.18 s 1 . . . 7.36
s 145 . . . 10.12 s 1A . . . 7.37
Mental Health Act 2007 . . . 10.24,
10.29, 10.38 Theft Act 1968 . . . 8.73, 8.74
Table of secondary legislation

Extracted legislation is listed in bold.

Human Fertilisation and Embryology Medicines for Human Use (Clinical

Authority (Disclosure of Donor Trials) Regulations 2004
Information) Regulations 2004 (SI 2004/1031) . . . 11.14, 11.23,
(SI 2004/1511) . . . 7.27 11.35, 11.37, 11.43
Human Fertilisation and Embryology Sch 1, Pt I, para 3(1) . . . 11.14
(Research Purposes) Regulations Sch 1, Pt 5 . . . 11.44
2001 (SI 2001/188) . . . 7.61
Human Fertilisation and Embryology Prescription Only Medicines (Human
(Special Exceptions) Regulations 1991 Use) Amendment (No. 3) Order 2000
(SI 1991/1588) . . . 7.5 (SI 2000/3231) . . . 6.6
Human Tissue Act 2004 (Persons
who Lack Capacity to Consent and
Transplants) Regulations 2006
(SI 2006/1659) . . . 8.11
Table of international instruments

Extracted instruments are listed in bold.

Convention on Human Rights and Art 5(4) . . . 10.28

Biomedicine, concerning Biomedical Art 6 . . . 5.37
Research . . . 11.9 Art 8 . . . 4.12, 4.19, 4.25, 4.47,
Protocol, Art 6(2) . . . 11.9 5.10, 5.32, 5.36, 6.14, 7.13,
9.15, 9.16, 9.24, 9.27, 9.37,
Declaration of Helsinki . . . 11.5, 11.6, 10.18, 11.7
11.9, 11.15 Art 8(1) . . . 5.8, 9.12, 9.15, 10.18
para 6 . . . 11.5 Art 8(2) . . . 5.8, 912, 10.18
para 21 . . . 11.9 Art 9 . . . 4.19, 9.26
para 24 . . . 11.12, 11.20 Art 10 . . . 5.30, 5.32
para 26 . . . 11.19 Art 14 . . . 9.26
para 28 . . . 11.34 European Union Treaty (EU)
para 31 . . . 11.31 Art 22 . . . 2.6
Art 49 . . . 2.6
European Convention on Human
Rights . . . 5.11, 5.14, 6.57, 9.21, 9.27, Treaty on the Functioning of the
9.37, 10.16 European Union (TFEU)
Art 2 . . . 2.10, 6.57, 9.17, 9.18, 9.22, Art 56 . . . 2.6
9.23, 9.24, 9.27, 10.35
Art 3 . . . 4.4, 6.14, 9.23, 9.27, 9.32, United Nations Convention on the
10.16, 10.18, 11.7 Rights of Persons with Disabilities
Art 5 . . . 10.7, 10.18, 10.28 Art 14, para 1(b) . . . 10.40
This page intentionally left blank
 1
Key ethical and legal principles

SUMMARY

In this chapter, we will start with some of the grand ethical approaches
that can be taken to medical issues. By ‘grand theories’ I mean theories
of general application that can be used to deal with any kind of ethical
issue. Then we shall look at some of the more specific ethical principles
that are said to govern the issues. We shall then consider some of the key
legal principles, before considering how law and ethics interact in this area.
Finally, we shall examine some of the key overarching issues for medical
lawyers and ethicists.

Introduction
1.1 Before getting down to the nitty gritty of particular issues in medical law, this
chapter will start by looking at some of the basic legal and ethical principles
involved when considering issues to do with medicine. You are no doubt aware
of the fierce debates over issues such as euthanasia which have been going on
for decades. We seem to be no nearer a consensus on those issues today than we
were centuries ago. But there are issues still of considerable significance which
receive little attention in the media. Do we own our bodies? Can medical con-
fidences ever be broken? Do patients owe responsibilities or just have rights? So
there is a lot more to medical law and ethics than abortion and euthanasia. We
will start by looking at some of the general approaches to ethical issues that have
been proposed.
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