Archive for February, 2013|Monthly archive page

Assisted Dying: Philosophical, Legal and Practice Perspectives

In 2013, Death and dying on February 25, 2013 at 9:00 am

On Wednesday 20th February 2013, sponsored by the International Centre for Nursing Ethics, School of Health and Social Care and the School of Law at the University of Surrey, four experts from different disciplines debated issues related to assisted dying. Focusing on the related themes of autonomy and dignity at the end of life each panel member spoke for ten minutes and offered their own perspective on the topic. The presentations were then followed by a lively debate between the panellists after which the floor was opened up to questions from audience members.

Ray Tallis, former Professor of Geriatric medicine and recently described as ‘one of the top living polymaths’ opened the discussion with an entreaty to autonomy. He argued that the wishes of those who are terminally ill and seek an assisted death ought to be respected and that the law should be reformed to permit that. Hazel Biggs, Professor of Health Care Law at the University of Southampton, then outlined some of the legal aspects of the debate. She explained that the law does not explicitly support autonomy or dignity, other than through the legal right to consent to or refuse medical treatment and used various examples of assisted dying to reveal deep inconsistencies in the legal approach to end of life decision-making. Barry Quinn, MacMillan Consultant Lead Nurse at Ashford and St Peter’s Hospital NHS Trust then introduced some practical perspectives, arguing that today death is remote from the living and encouraging everyone in the audience to think about ways in which they might be with the dying so that people at the end of life feel less alone and better cared for. David Albert Jones, Director of the Anscombe Bioethics Centre and Research Fellow at Blackfriars Hall, Oxford continued the debate on autonomy drawing on philosophical theory to support his argument that in some respects personal autonomy ought properly to be limited.

The animated debate that the individual presentations provoked, demonstrate that assisted dying remains a controversial and emotive topic that is never far from the public consciousness. Such discussions are invaluable in generating informed public opinion.

More information can be found here.

Event: Caring for Patients not Systems: Reflections on the Mid-Stafford Inquiry

In 2013, Meetings on February 25, 2013 at 8:30 am

The Centre for Law, Ethics and Globalisation (CLEG) at Southampton Law School and Hickman and Rose Solicitors in collaboration with the Centre for Health Ethics and Law (HEAL) invite you to their first joint annual event: a discussion and Q&A with Robert Francis QC, in discussion with Prof. Jonathan Montgomery.

We are proud to host Robert Francis QC, the chairman of the Mid-Stafford Inquiry, for an evening concerning the legal aspects of his Report and in conversation with Jonathan Montgomery, Professor of Health Care Law of Southampton Law School. The Inquiry Report, published on 6 February, raises fundamental questions about the culture of the NHS, professional and managerial values and how to ensure that caring for patients is the first and paramount concern of health services. It provides an opportunity to reconsider the values of humanity and dignity and how to promote them. There will be a question and answer session with the audience. The Report can be found at http://www.midstaffspublicinquiry.com/report.

The discussion will be chaired by Daniel Machover, Partner, Head of Civil Litigation, Hickman and Rose and hosted by Professor Adam Wheeler, Provost, Southampton University. Further details can be found here, and to book a place email Jo Hazell at J.L.Hazell@soton.ac.uk. Bookings will close on 25 February 2013.

JME Editor’s Choice: John Coggon on Elective Ventilation

In 2013, Death and dying, Public Ethics on February 21, 2013 at 7:27 am

The latest issue of the Journal of Medical Ethics (JME) is a special issue focused on ‘Elective Ventilation’. John Coggon’s paper – which he delivered as a HEAL seminar last year – has been selected as the Editor’s Choice, hence it is open access and can be read in full here.

Abstract This paper examines questions concerning elective ventilation, contextualised within English law and policy. It presents the general debate with reference both to the Exeter Protocol on elective ventilation, and the considerable developments in legal principle since the time that that protocol was declared to be unlawful. I distinguish different aspects of what might be labelled elective ventilation policies under the following four headings: ‘basic elective ventilation’; ‘epistemically complex elective ventilation’; ‘practically complex elective ventilation’; and ‘epistemically and practically complex elective ventilation’. I give a legal analysis of each. In concluding remarks on their potential practical viability, I emphasise the importance not just of ascertaining the legal and ethical acceptability of these and other forms of elective ventilation, but also of assessing their professional and political acceptability. This importance relates both to the successful implementation of the individual practices, and to guarding against possible harmful effects in the wider efforts to increase the rates of posthumous organ donation.

Taking Complaints Seriously

In 2013, Care, NHS on February 7, 2013 at 10:11 am

The Francis Report carries a powerful chapter explaining how NHS complaints procedures developed over the past decade, and in some ways have moved backwards. It makes a series of recommendations for improvement, including the need for independent advocacy and arms-length investigations and the transparency of complaints data to commissioners and local authority scrutiny committees. These system reform should not detract from the crucial observations about failures in governance. Even without changes the NHS could, and should, have done better.

The Report quotes the Chair of the Trust as denying that complaints were her personal business – ‘A complaint that’s investigated properly and resolved is then put to bed and doesn’t need to come to the attention of the hierarchy in the organisation, actually’ (para 3.22). The Board appeared to receive statistical reports but not to have examined the substance of the complaints. Robert Francis points out that ‘such an approach completely ignored the value of complaints in informing the Board of what was going wrong, and what, if anything, was being done to put it right’ (para 3.33).

Patterns of complaints are an important barometer of difficulties, especially when patterns are monitored (which wards come up frequently, the substance of the complaint – all too often staff attitudes – and changes over time) and are correlated with other measures of stress (staff sickness, data from staff surveys showing lack of confidence in leadership or the quality of care). Plenty of other data sources exist to help organisations assess how safe they are, including the National Reporting and Learning System which generates organisational reports on the rate of reporting incidents. Staff surveys report on the perception of how likely they are to make reports. There is plenty of data to support organisations in picking up problems early if they are prepared to look for it. Many of these data are available to commissioners and the public – you can look up your local organisations’ profiles through the link.

These data enable problems to be identified, but do not tell you how your organisation responds. Boards should satisfy themselves that the responses are appropriate and expect reports to detail not just whether complaints were upheld but also what has changed as a result. Further, Board members are wise to see a sample of complaints responses if they wish to understand the culture of their organisation. I have seen resistance to giving a straight answer, defensive protection of staff, and an institutional reluctance to say sorry – all displayed in draft letters that needed correction before being sent. You learn a lot from seeing your organisation through the eyes of those it has failed to serve well. There is no substitute for meeting and listening to them.

Jonathan Montgomery reflects on his experience of serving on NHS Boards for two decades in the light of the Mid-Staffs Report.

Francis Report – a catalogue of shame

In 2013, Care, NHS on February 6, 2013 at 2:40 pm

The Report of the Inquiry into the Mid-Staffordshire Scandal was published today. In his statement, Robert Francis QC said ‘This is a story of appalling and unnecessary suffering of hundreds of people. They were failed by a system which ignored the warning signs and put corporate self interest and cost control ahead of patients and their safety. I have today made 290 recommendations designed to change this culture and make sure that patients come first.’

The scale of the failures in Patient Care had been exposed by the earlier Inquiry, the focus here is how it could be that the failures went unnoticed, unchallenged and unaddressed for so long. The Report makes it clear that there was a major failure of governance from the Trust board, whose members have already been removed from office. However, the problems are deeply rooted in a cultural malaise in which the quality of care for patients ceased to be the primary focus of the organisation. Too many people, not just managers and professionals, tolerated unacceptable standards of care. The systems designed to give voice to patient perspectives failed. Performance management lost sight of patient care in a focus on financial control and high level targets. Regulatory oversight was both fragmented and unco-ordinated.

This is a crisis of values and requires sober reflection, acceptance of responsibility and concerted action to create a common purpose around high quality patient care. As the Report says, a ‘culture of caring requires a displacement of a culture of fear with a culture of openness, honesty and transparency’ Para 1.180.

Robert Francis will be in Southampton on 4 March to reflect on the Report and its significance at the inaugural Hickman & Rose/Centre for Law, Ethics and Globalisation lecture. We look forward to exploring it with him.