therapies usually happens, and discuss the evidence for variability. I will argue
that the withdrawal of life-sustaining therapies is not simply a medical matter,
but one with considerable social and political dimensions. As such, there is a
need for public discourse on the subject, as well as the development of a public
policy which might be advanced through the dissemination of institutional and
national end-of-life policies. Intensive care is extremely expensive and public
expenditure on the marginal care it sometimes provides deserves scrutiny.
unhelpful. Legitimate differences exist within both
religious (McDonagh and MacNamara, 2013) and secular traditions (Turner,
2003), and ascribing positions simply on the basis of religious affiliation/
non-affiliation stifles dialogue.
There has tended to be limited political appetite for discussion of ethical
issues in healthcare. This derives in part at least from political timidity, which
was perhaps an inevitable response to the polarised nature of debates around
the introduction of the Eighth Amendment to Bunreacht na hÉireann in 1983
(Hesketh, 1990). Because of
Examining Ireland’s failure to regulate embryonic stem cell research
scientific promise and ethical uncertainty, policy-makers
are left with a difficult task of determining the legal status of the embryo and the
development of ESCR policy. They must choose between affording the embryo
full legal status which may help them avoid a potentially politically damaging
debate on the right to life, or decide to promote the development of science
with a policy that permits the destruction of the embryo. Yet despite numerous reports and judicial pronouncements on this issue, the Irish legislature
DONNELLY 9780719099465 PRINT.indd 150
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Nursing and Midwifery Board of Ireland (2014) Code of Professional Conduct
and Ethics. Dublin.
Oaks, L. (1999) ‘Irish trans/national politics and locating fetuses’, in L. Morgan
and M. Michels (eds), Fetal Subjects: Feminist Positions. Philadelphia:
University of Pennsylvania Press.
O’Toole, E. (2013) ‘The midwife who told the truth in the Savita Halappanavar
abortion case’, Guardian, 19 April.
Purdy, L.M. (1990) ‘Are pregnant women fetal
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Rawls, J. (1999) A Theory of Justice, revised edn. Cambridge, MA: Harvard
Rawls, J. (2005) Political Liberalism, expanded edn. New York: Columbia
REFOCUS (Recovery Experience Forum of Carers and Users of Services)
(2013) Who Cares? Listening to the Needs and Experiences of Carers of People
with Mental Illness. Dublin: College of Psychiatrists of Ireland.
Sandel, M. (1998) Liberalism and the Limits of Justice, 2nd edn. London:
Perspectives from the Neary and Halappanavar cases
business, political and social institutions with
which the organisation may engage’ (Moore, 2005a: 676).
However, it is apparent from his discussion that any structural impediment
to the establishment of excellence in the realisation of the internal practice
can be considered ethically problematic. Moore particularly highlights the
significance of appropriate internal systems and processes for the implementation of virtuous practice. He claims that ‘[t]he task of creating the virtuous
organisation is essentially managerial’ (Moore, 2005a: 677); the establishment
that of the individual midwife who refuses
to perform an abortion, but continues to care for her patients otherwise.
Moreover if that hospital takes public funding on the one hand, but asserts the
private values of a particular religion or secular ethos on the other, this is not
the critical expression of moral freedom, but a kind of macho politics. Such
a hospital is saying that it is entitled to public funding and state support, but
is not publicly accountable. Institutional power needs to be revealed for what
it is, not accepted on its own terms. Similarly, the
An exploration of the role of autonomy in the debate about assisted suicide
can act upon. While substantive theories of autonomy redefine autonomy to
make it compatible with a particular worldview, procedural accounts set limits
on ‘absolute’ autonomy by requiring that all agents mutually recognise one
another’s autonomy. Whatever its flaws, liberalism as a political ideology can
be said to endorse a procedural conception of autonomy, insofar as it ‘rejects a
privileged perspective which might be imposed’ and places constraints on what
May refers to as the ‘social application of personal [or partial] versions of the
good’ (May, 2005
Part II of this book signifies a shift in emphasis for the British vaccination programme. Some of this was due to maturity. By the 1970s, many of the fundamental questions about which vaccines to include and whether the state had a role in protecting the British public had been answered. Citizens had come to accept vaccination for themselves and demand it of others. Other changes were due to political and historical circumstances. Whereas MOHs had played a key role in the administration of immunisation from the 1940s to the 1960s, these
advisers in the government. Faith in vaccination still relied upon the moral and political authority of the scientific and administrative communities that vouched for the safety and efficacy of both the vaccines themselves and the mass immunisation programmes that underpinned them. In the aftermath of the thalidomide or BSE crises, or during major political debates about the viability and future of the welfare state, such authority was dented. Experiences with these crises led to a reappraisal of how vaccinators communicated with the public, producing a greater academic