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Confronting complexities

The Irish health system is confronted by a range of challenges, both emerging and recurring. In order to address these, it is essential that spaces are created for conversations around complex ethical and legal issues. This collection aims to provide a basis for ongoing engagement with selected issues in contemporary Irish health contexts. It includes contributions from scholars and practitioners across a range of disciplines, most particularly, ethics, law and medicine.

The focus of the collection is interdisciplinary and the essays are situated at the intersection between ethics, law and medicine. Important issues addressed include admission to care homes; assisted suicide; adolescent decision-making; allocation of finite resources; conscientious objection; data protection; decision-making at the end of life; mental health; the rights of older people; patient responsibilities; stem cell research; the role of carers; and reproductive rights. From these discussion, the collection draws out the following interlinking themes, addressing difference; context and care; oversight and decision-making; and, regulating research.

The essays are theoretically informed and are grounded in the realities of the Irish health system, by drawing on contributors’ contextual knowledge.

This book makes an informed and balanced contribution to academic and broader public discourse.

Perspectives from the Neary and Halappanavar cases
Heike Felzmann

This chapter considers two high profile Irish inquiries: the Lourdes Hospital Inquiry on the Neary case and the Health Information and Quality Authority (HIQA) Report on University Hospital Galway and the care of Savita Halappanavar from an organisational ethics perspective. The chapter outlines the significance of systemic factors in both cases and draws on literature from organisational clinical ethics and business ethics to provide a framework for thinking about the wider ethical responsibilities of healthcare organisations. It outlines how organisational structures are directly implicated in the facilitation of ethical actions by members of the organisation.

in Ethical and legal debates in Irish healthcare
Tom Walker

This chapter considers how inconsistencies can be resolved in the context of refusal of medical treatment by young people over sixteen by looking at the roles consent plays in medicine. In some cases the question of whether that refusal should be respected is purely academic – for practical reasons the treatment cannot be given. But where treatment could be provided in the light of such a refusal it is unclear whether it is permissible to do so. This is because it seems inconsistent both to say that a patient can consent to treatment but not refuse it, and to say that we ought to seek consent even where a refusal to provide it may be overridden. The chapter argues that there is a relatively straightforward argument to support the idea that young people can consent to, but not effectively refuse, medical treatment. What will turn out to require further explanation, at least on standard ways of approaching medical ethics, is the idea that it is always morally wrong to give an adult treatment that she refuses.

in Ethical and legal debates in Irish healthcare
Barry Lyons

This chapter provides an analysis of the state of critical care provision in Ireland and of how the withdrawal or withholding of therapies usually happens. It argues that the withdrawal of life-sustaining therapies is not simply a medical matter, but one with considerable social and political dimensions. It identifies the need for public discourse on the subject and for the development of a public policy on critical care. It argues that the answers to the dilemmas that critical care raise cannot most effectively be attained through the courts, but rather the solution is to be found in a social contract on the use of expensive and resource intensive medical technology.

in Ethical and legal debates in Irish healthcare
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Mary Donnelly and Claire Murray
in Ethical and legal debates in Irish healthcare
Mary Keys

This chapter identifies the area of decision-making as central to the protection of older people. It addresses the recognition of legal capacity as a central issue to avoid choices being ignored and not respected. The chapter discusses some of the law and policy reforms necessary to meet international human rights standards, as set out in the Convention on the Rights of Persons with Disabilities and the European Convention on Human Rights. Lessons from research in other jurisdictions are highlighted to avoid the pitfalls identified from similar law reform elsewhere.

in Ethical and legal debates in Irish healthcare
An exploration of the role of autonomy in the debate about assisted suicide
Louise Campbell

This chapter provides an analysis of the main ethical issues which arise in the debate about assisted suicide, with particular attention to the role played by the concept of autonomy in the discussion. The concept of autonomy plays a prominent role in justifying claims that a terminally-ill person should have a right to determine the point at which his or her life should end. However, opponents of assisted suicide argue both that such claims distort the meaning of autonomy and that autonomy should not be prioritised when its exercise threatens the rights or interests of healthcare professionals, family members or others. The chapter attempts to determine whether the concept of autonomy is capable of supporting the arguments on both sides of the discussion which rely on it. It examines briefly the evolution of the concept of autonomy in healthcare generally and analyses the role played by arguments from autonomy in support of, and against, the permissibility of assisted dying/suicide. It provides a critique of the use of the concept of autonomy on both sides of the debate and examine the implications of this critique for the validity of the concept of autonomy in healthcare more generally.

in Ethical and legal debates in Irish healthcare
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Examining Ireland’s failure to regulate embryonic stem cell research
Ciara Staunton

This chapter discusses the legal and ethical issues that arise in regulating embryonic stem cell research in Ireland. It outlines three approaches Irish policy makers may take to the difficult ethical debate: a restrictive approach, a permissive approach or an intermediate approach. The chapter analyses the current status of embryonic stem cell research in Ireland. It argues that although the Irish courts seem to support the intermediate approach, the lack of legislative guidance has left the embryo without legal protection. The chapter advocates a national discussion on the status of the embryo in order to develop a regulatory framework that both protects the embryo and accommodates embryonic stem cell research.

in Ethical and legal debates in Irish healthcare
Shaun T. O’Keeffe

This chapter discusses the troubling legal and ethical issues raised by admissions to nursing homes. Current practice and the existing legal framework for involuntary admissions are discussed and it is argued that there is a need for safeguards in relation to such admissions in Ireland as these constitute a deprivation of liberty. The chapter also deals with how decisions are made by families and healthcare professionals in relation to possible involuntary nursing home admission. This includes consideration of how a functional assessment of capacity in such cases should be approached and the arguments for and against involuntary admission in the person’s ‘best interests.’

in Ethical and legal debates in Irish healthcare
Two sides of the same unequal coin?
Asim A. Sheikh

This chapter asks whether the language and idea of the doctor-patient partnership, which embraces the notion of patient autonomy, is one which also places responsibilities on patients as well as on healthcare providers.

This chapter outlines the duties and responsibilities of doctors and the development of the understanding of the doctor-patient relationship as one of partnership. It analyses the implications of this, looking at the legal responsibilities of the autonomous patient in the context of an action for medical negligence.

in Ethical and legal debates in Irish healthcare