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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.

Mary Keys

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 12/10/2015 15:59 118 Rights and responsibilities ­ uestion the voluntariness of the person’s decision to go into a nursing home. q These include lack of involvement in planning, lack of choice and pressure from others. Lack of involvement in

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

6 Patient autonomy and responsibilities within the patient–doctor partnership: two sides of the same unequal coin? Asim A. Sheikh Introduction 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 rights and responsibilities upon patients. It asks whether the language and idea of the healthcare provider and healthcare receiver (‘doctor

in Ethical and legal debates in Irish healthcare
Tom Walker

PRINT.indd 71 12/10/2015 15:59 72 Rights and responsibilities 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

in Ethical and legal debates in Irish healthcare
Abstract only
Mary Donnelly and Claire Murray

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 12/10/2015 15:59 Introduction 3 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; rights and responsibilities; regulating research; and

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

Irish courts. In what follows I will examine briefly the role played by the concept of autonomy in Fleming v. Ireland and Others [2013] IEHC 2; [2013] 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 12/10/2015 15:59 56 Rights and responsibilities The role of autonomy in Fleming v. Ireland and Ors

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

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 12/10/2015 15:59 102 Rights and responsibilities Commissioner for Human

in Ethical and legal debates in Irish healthcare
The case of Universal Health Insurance – by competition
Cliona Loughnane

-problematised through economic discourses which emphasise individual rights and responsibilities and the need to ration care in order to make the most of the healthcare system for all (Joyce, 2001). While once government may have sought to compensate for the operation of the market, now it seeks to redefine the social arena on market principles (Veitch, 2010). It will be argued that UHI-C emphasised the lack of health insurance amongst all the population and the lack of market efficiency in healthcare as the ‘problem’ of the Irish health system. In this way the policy obscured the

in Reframing health and health policy in Ireland
Open Access (free)
Balance, malleability and anthropology: historical contexts
Chris Millard

dimension, as ‘selves’ correspond to dominant economic ideologies. Hand argues – persuasively – that the ‘individualisation of risk in this period enabled the state to reframe individuals as a new type of health citizen incorporated into a balanced conception of rights and responsibilities … persuading the individual to act as a self-conscious and self-regulated consumer … establishing a new social contract with the state’. Ayesha Nathoo, in Chapter 6 , carves out a space for ‘assessment of the consequences of teaching individuals to cultivate relaxed, balanced selves

in Balancing the self
Visualising obesity as a public health concern in 1970s and 1980s Britain
Jane Hand

by a variety of actors including government, scientists and the mass media. While different models of balance were promoted, they all relied on some form of self-regulation – some reworking of how selfhood was related to healthiness and disease prevention. The individualisation of risk in this period enabled the state to reframe individuals as a new type of health citizen incorporated into a balanced conception of rights and responsibilities. This meant persuading the individual to act as a self-conscious and self-regulated consumer engaged in healthful behaviours

in Balancing the self