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.
to grasp the breadth of the issues involved, we need an introduction to the key concepts that inform them: citizenship, ‘race’ and racialisation, and the state. After discussing those concepts, I suggest that the Citizenship Act (2005) racialised Irish nationality: i.e. it gave primary preference to bloodlines as its principal criterion for belonging, thus dividing Irish children into two categories with differential access to the rightsandresponsibilities accruing to citizens, Irish children and ‘Irish-born children’ (‘IBC’). 1 If the new citizenship rules were
the arguments for and against involuntary admission in the
person’s ‘best interests’.
Quasi-voluntary admission to nursing homes
There are a number of aspects– each on a continuum from the acceptable
to the unacceptable– to decision-making in such cases that might call into
DONNELLY 9780719099465 PRINT.indd 117
uestion the voluntariness of the person’s decision to go into a nursing home.
These include lack of involvement in planning, lack of choice and pressure
Lack of involvement in
Patient autonomy and responsibilities within
the patient–doctor partnership: two sides of
the same unequal coin?
Asim A. Sheikh
The autonomous patient has the ability to engage with a healthcare provider in
relation to his or her health on a wide range of issues. This ability and control
are central to a patient’s autonomy and self-determination. This chapter will
consider whether this ability confers both rightsandresponsibilities upon
patients. It asks whether the language and idea of the healthcare provider and
healthcare receiver (‘doctor
that treatment without their consent. Because of this close connection between
consent and refusal the Law Reform Commission in its 2011 Report on Children
and the Law: Medical Treatment recommended that ‘legislation should clearly
provide that, in general, a person who is 16 or 17 years of age is presumed to
have the capacity to consent to, and refuse, health care treatment’ (Law Reform
Commission, 2011: 92), and that as a result in general terms ‘a 16 and 17 year
old would not be subject to any
practice backgrounds in
ethics, law and medicine. From these conversations, it became clear that the
Irish health system is confronted by a range of challenges, both emerging and
recurring, and that, because the system is fluid and dynamic, these cannot be
DONNELLY 9780719099465 PRINT.indd 2
resolved by simple or one-dimensional solutions. This understanding informs
the chapters in this book.
The book has four parts, organised around four interlinking themes: context and care; rightsandresponsibilities; regulating research; and
An exploration of the role of autonomy in the debate about assisted suicide
In what follows I will examine briefly the role played by the concept of
autonomy in Fleming v. Ireland and Others  IEHC 2;  IESC 19,
followed by an analysis of the salient autonomy-based arguments used on both
sides of the assisted suicide debate. I will conclude by contrasting philosophical theories of autonomy with the more pared-down account of autonomy
generally found in the bioethics literature.
DONNELLY 9780719099465 PRINT.indd 55
The role of autonomy in Fleming v. Ireland and Ors
not age itself that creates a specific focus but the
diminishing physical and mental capacities associated with ageing. The World
Health Organisation defines ageing as the ‘process of progressive change in the
biological, psychological and social structures of individuals’ (WHO, 1999: 4).
It needs to be understood that not all older people have disabilities although the
majority of people with disabilities are over 65 years. The Office for the High
DONNELLY 9780719099465 PRINT.indd 101
Commissioner for Human
ciples of reciprocal justice. The essential reason for this lies in New
Labour’s insistence that rightsandresponsibilities should balance. I want
to examine citizenship in more detail later on, but New Labour’s point is
that because social goods are the product of social cooperation, then those
who share those goods are obligated to make a roughly proportionate contribution to the productive activities of that society or to demonstrate why
they cannot. Hence the doctrine that has constantly informed their welfare
reforms – work for those who can, security
considered – and many ideas about regulation that we
have not explored. But we hope that it will provide a method of cultural
exchange, give some interesting perspectives and stimulate further debates
on issues relating to science, freedom of research and individual rightsandresponsibilities.
1 www.un.org/en/universal-declaration-human-rights (last accessed 26 October
2 www.ohchr.org/EN/ProfessionalInterest/Pages/CESCR.aspx (last accessed 26
3 www.europarl.europa.eu/charter/pdf/text_en.pdf (last accessed 26 October 2017).