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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
The role of law
Mary Donnelly

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.

in Ethical and legal debates in Irish healthcare
The relationship between the courts and mental health tribunals
Darius Whelan

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.

in Ethical and legal debates in Irish healthcare
The role of country of origin
Brendan D. Kelly

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.

in Ethical and legal debates in Irish healthcare