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withholding of 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. Thus

in Ethical and legal debates in Irish healthcare
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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

in Ethical and legal debates in Irish healthcare
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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 12/10/2015 15

in Ethical and legal debates in Irish healthcare
A feminist analysis of the Neary and Halappanavar cases

, 15(5): 643. Morrissey, J. (2012) ‘“The murder of infants”? Symphysiotomy in Ireland, 1944–66’, History Ireland, 20(5): 44. 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

in Ethical and legal debates in Irish healthcare

Academic Press. Programme for Government (2011) Government for National Recovery 2011– 2016. Dublin. Rawls, J. (1999) A Theory of Justice, revised edn. Cambridge, MA: Harvard University Press. Rawls, J. (2005) Political Liberalism, expanded edn. New York: Columbia University Press. 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: Cambridge

in Ethical and legal debates in Irish healthcare
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 of

in Ethical and legal debates in Irish healthcare

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

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

citizen 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

in Ethical and legal debates in Irish healthcare
Open Access (free)

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

in Vaccinating Britain
Open Access (free)

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

in Vaccinating Britain