1,720,996 research outputs found
Principled effects: The importance of Beauchamp and Childress' Principles of Biomedical Ethics
Full text linkThis chapter explores the significance and the legacy of Principles of Biomedical Ethics, a foundational textbook in bioethics which is now in its eighth edition. After briefly explaining the main thrust of the theory of ethics Tom Beauchamp and James Childress developed, known as principlism, it explores the context in which the first edition of this textbook was published and what made it, initially, so foundational. From there, the chapter explores the indirect pervasive effect that Principles of Biomedical Ethics has had throughout healthcare law and ethics, focusing on areas in which their influence might not be so well known. It ends with an exploration of some of the ways in which the project Beauchamp and Childress engage in can benefit the understanding of bioethics more generally. This includes an exploration of the effect of their mid-level theory and their ‘Borg-like’ qualities, as described by John Arras
An Ethos of Empowerment? Decision-making under the Mental Capacity Act 2005 and the Sexual Lives of Adults with Learning Disabilities
No full textPeople with learning disabilities have long been subject to regimes that have interfered with their autonomy and curtailed their sexual freedom. Paradoxical tropes see them characterised as asexual and innocent, but also hyper-sexual and sexually deviant, all of which are rhetorical devices used to justify restrictive forms of government. The Mental Capacity Act 2005 (MCA) sought to effect a change in treatment, care, and decision-making for people with mental impairments, and it is often described as an ‘empowering’ piece of legislation. The Act covers decisions surrounding sexuality, and it was hoped that the framework would result in increased recognition of capacity to engage in sexual relations. This aim of this thesis, then, is to examine whether the MCA currently empowers adults with learning disabilities to make decisions about sexual relationships and contraceptive care.
First, it seeks to interrogate the theoretical underpinnings of the MCA by exploring how empowerment should best be understood when applying the Act. This is something which, until now, has never been addressed in the literature. It is argued that empowerment needs to be grounded in a dialogical relationship of mutual trust and respect and, rather than being a homogenous construct, empowerment must be defined by P’s (as the protected party in capacity proceedings is called) perspective of what it means to be empowered. It then highlights that the robust implementation of the support principle, P’s wishes being prioritised in the best interest assessment, and P’s meaningful participation in court proceedings are all indicators of empowerment under the MCA.
Next, it examines the perceived tension between the MCA’s aims of empowerment and protection. It utilises Michel Foucault’s governmentality thesis to highlight that the MCA has always been concerned with managing risk, and expose the complex fields of power that decision-makers operate in. It is contended that the governmentality thesis provides a compelling explanation for why negative considerations of risk often supersede empowerment in capacity and best interest assessments.
This thesis then turns to consider whether the test for capacity to engage in sexual relations, specifically, strikes the correct balance between empowerment and protection and concludes that it does not. It is argued that the current threshold of information as propounded by the Supreme Court in A Local Authority v JB [2021] UKSC 52 is set at a level that many people with learning disabilities will be unable to meet. It then identifies that the MCA’s ability to empower decision-making in this area is limited by the fact that best interest assessments cannot be made about decisions to consent to sex. This is, in part, because sexual activity with people who lack capacity because of a ‘mental disorder impeding choice’ is criminalised under the Sexual Offences Act 2003. It is argued that ostensibly consenting, non-exploitative relationships should nevertheless be supported, and that the drafters of the Sexual Offences Act 2003 did not intend for such relationships to be prohibited in practice.
Finally, this thesis explores whether the MCA empowers people with learning disabilities to be in control of their contraceptive care and, again, concludes that it often does not. It identifies continuities of disempowerment from the pre-MCA case law to the post-MCA case law, including prejudicial assumptions about the decision-making capacity of people with learning disabilities, a
lack of support to make decisions about contraception, and the subjugation of P’s knowledge to the knowledge of the judiciary and medical professionals
Learning lessons about how to learn from mistakes:Errors, Medicine and the Law
No full textFirst published in 2001, and with a second edition in 2017, Merry and McCall Smith’s Errors, Medicine and the Law was instrumental in demonstrating how and why traditional culpability-focused legal and regulatory responses to patient harm were failing to improve standards in healthcare. This leading work was characterised by an interdisciplinary international approach to its damning critique of regulatory frameworks which rely on blame as a central response to patient harm. It drew on growing understandings of the scale of harm caused to patients, and the cognitive processes that can lead to such harm, to develop contextualised and transformative accounts of the concepts of error, blame, and accountability in healthcare. These conceptualisations now lie at the heart of much modern patient-safety policy. Errors, Medicine and the Law has, therefore, been at the vanguard of the movement to reform legal and regulatory responses to patient harm, and it remains a crucial critique of those legal frameworks which remain entrenched in blame
Exorcism and Other Spiritual Modes of 'Conversion Therapy':Balancing Religious Liberty and Individual Rights
No full textThe authors explore exorcism and other spiritual modes of 'conversion therapy' in this piece. They start by setting out the parameters of this study, and explain the terminology and the rationale behind it. They then highlight the reasons why introducing secular legal oversight in this arena is complex and sometimes touted by opponents of reform as not merely unworkable, but as an intolerable threat to religious freedom. First, they consider issues which are applicable to all spiritual conversion practices, and are presented as obstacles to legal prohibition, and then address matters which exclusively affect conversion by exorcism. In the process of discussing all these concerns, they engage not only with the reasons why they are being raised, but also their basis for ultimately dismissing each one as an insurmountable obstacle to reform. Finally, they discuss why it is possible to include spiritual conversion practices in secular prohibitions
Feeling pain and shame: the emotional grammar of banning ‘conversion therapy’
Full text linkBanning ‘conversion therapy’ is an emotionally fraught area of law reform, anchored in pain and stigma. Conversion practices function on a logic of pain and shame: proponents weaponise the idea that an LBGT+ person is ‘broken’ and in need of repair or healing. These practices generate pain and suffering, alongside associated emotions of shame, for LBGT+ individuals who endure its stigmatising effects. In response to this, some legislators harness their pain at witnessing such practices along with their shame for not acting sooner while others emphasise their fears of legal regulation that could burden religious freedom and free speech. By examining a British legislative debate for a trans-inclusive ban on conversion therapy, this chapter maps the emotional grammar of the pain and shame at the heart of this reform. Drawing on queer affect theory, this chapter uses emotion methodologically to understand the affective terms through which a conversion therapy ban materialises legislatively in the UK and how this reform purports to end conversion practices. The chapter concludes with a ‘reparative reading’ of law reform – one that critically navigates pain and shame while loosening our attachment to law reform – to consider the limits and possibilities of law to repair homo/bi/transphobic harms
Thinking carefully about organ donation:Janet Radcliffe-Richards’s The Ethics of Transplants: Why Careless Thought Costs Lives
No full textThe most important question raised by organ transplantation has always been how to increase the number of transplantable organs. Numerous solutions have been proposed over the years, such as deemed consent systems and institutional changes like routine referrals. Yet, due to its controversial nature, one possible option remains untested and that is paying the living donor. As a leading scholar in transplantation ethics, Janet Radcliffe-Richards has dedicated over 30 years of her career to exploring why we feel uncomfortable about paying an organ donor and how this restriction ultimately leads to lives being lost. This chapter focuses on the culmination of her work on transplantation, The Ethics of Transplants: Why Careless Thought Costs Lives, which captures one of the most comprehensive analyses of the debates on organ markets. Within this chapter, it is discussed why The Ethics of Transplants is a leading work and how it has influenced our understanding of this contemporary subject. The chapter is concluded by looking beyond Radcliffe-Richards’s contribution to the paid donation scholarship and suggesting that her unique application of moral reasoning might be useful in deconstructing and analysing arguments surrounding xenotransplantation and three-dimensional bioprinted organs as alternative sources for transplantation
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Setting a research agenda for mental capacity law: Mary Donnelly’s healthcare decision-making and the law
No full textThe realisation of human rights in mental health law: Larry Gostin's Ideology of Entitlement: The application of contemporary legal approaches to psychiatry
No full textGoing Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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