This chapter examines the legal context within which decisions about the end of life are made. It argues that an ethical approach to end-of-life care must be centred on the dying person and that finding ways to ensure that this person’s voice is heard must be core to the development of legal frameworks. In this respect, the law has, to date, been inadequate. It explores the ways decisions about the end of life are made in Ireland and identifies likely changes, including an increased formalisation of dying. Drawing on experiences from the United States and the United Kingdom, it develops arguments regarding the most appropriate decision-making structures within which to consider difficult questions around end-of-life care.
The relationship between the courts and mental health tribunals
Ireland’s Mental Health Act 2001 requires that all involuntary admissions for mental disorder be reviewed within twenty-one days by a three-person Mental Health Tribunal. This chapter focuses on key written judgments of the High Court and Supreme Court reviewing decisions of Mental Health Tribunal. Despite some statements to the contrary, the general picture which emerges is that the courts have not engaged in robust supervision of mental health tribunals. Instead, the general tenor of the case-law has been to endorse decisions of tribunals to affirm detentions, and to limit access to the courts to the most extreme violations of procedural rights. The chapter argues that this is a disappointing outcome, in light of the supposed rights-based focus of the Mental Health Act 2001.
This chapter examines the role of country of origin in relation to psychiatric admission status in Ireland. Data presented in this chapter demonstrate that schizophrenia is a particular problem in individuals born outside Ireland and living in Dublin’s inner-city, and that this is associated with involuntary admission under the Mental Health Act 2001. The chapter also shows much lower levels of voluntary admissions. The chapter argues that these differences in patterns of help-seeking should be considered in future planning exercises in Ireland’s mental health services. In particular, increased emphasis on the cultural competence of health care-providers would be a good first step in recognising and addressing the differing health needs and practices of individuals from different ethnic groups and cultural backgrounds.
A feminist analysis of the Neary and Halappanavar cases
This chapter offers a feminist reading of two Irish cases that raise important ethical and legal concerns: the unnecessary peripartum hysterectomies at Our Lady of Lourdes Hospital Drogheda and the tragic death of Savita Halappanavar in October 2012. Key to this feminist analysis is a desire to understand the mechanisms by which the voices and concerns of the women at the centre of these cases were ignored, marginalised and trivialised. The chapter addresses the cultural dis-ease with women’s bodies and reproductive autonomy and the excess of epistemic and moral authority vested in doctors and religious leaders and the correlated lack of authority invested in women patients and midwives.
The chapter considers the ownership of newborn screening cards (also known as Guthrie cards) and the blood spots retained on them, the role of consent to the use of these cards and relevant data protection provisions which have resulted in challenges to their retention. The issues raised here also have relevance for biobanks and other existing archives of retained biological samples in hospitals and research facilities as similar questions arise in relation to those collections. The chapter recommends that legislation be introduced to exempt the newborn screening card collection from data protection legislation and to put in place a clear and robust governance framework to ensure that individual rights are protected to the greatest extent possible. These recommendations are also relevant to other collections of biological samples in which a strong argument exists for their retention for diagnostic purposes as well as for public health.
This chapter considers why we should care about carers and engages with different theoretical approaches to recognising the caring relationship and the implications of this for those involved in such relationships. In particular the chapter considers an approach grounded in the ethic of care and one based on relational autonomy. The chapter engages with an area of Irish health law where carers are clearly excluded from the legal framework – the mental health system. The mental health system is a useful case-study as it illustrates the complexities around balancing the interests of carers and cared for persons. The chapter concludes that it is important to care about carers, but doing so must be in a manner which continues to respect the distinct individual rights of each of the parties to the caring relationship.