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Archive for September, 2013|Monthly archive page

Forthcoming HEAL events

In 2013, Meetings on September 30, 2013 at 11:50 am

Just a brief post today with two dates for your diaries:

1.  We will be discussing the Nuffield Council on Bioethics’ consultation on Children and Research, accessible here, on Wednesday 9 October, from 3.15pm until 5.15pm in room 2055/4, Highfield campus.

2. Jonathan Montgomery  will be speaking on ‘What is Medical Law “For”?’, from 4-6pm on Wednesday 30 October in 2007/4, Highfield campus. Sadly Jonathan is leaving us Southampton to move to the Faculty of Laws at UCL this autumn, so this is his last seminar as a fully-fledged HEAL member (but he will, of course, retain strong links to HEAL and the School, not least through our ongoing Hidden Lawmakers programme).

 

Caroline Jones

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BMA Medical Book Awards: Commendation for Coggon!

In 2013, Gratuitous self-promotion, Public Ethics, Publications on September 23, 2013 at 7:52 am

On Tuesday 17th September 2013 the BMA Medical Book Awards were hosted in the Great Hall of the BMA. John Coggon’s book ‘What makes health public?’ was highly commended in the Health and Social Care category.

Cover   What Makes Health Public? 
The book is a critical monograph on public health and philosophy. It also works as a foundational resource for people working in or studying public health ethics. It is presented in three parts: Part I examines core concepts in public health, explaining what is meant, respectively, by ‘health’, ‘public’ and ‘the public’, ‘public health’, ‘public health policy’, and ‘public health law and ethics’. Part II explains why public health law and ethics require understanding of political philosophy, and demonstrates how political theory applies to health ethics and policy. Part III offers a presentation and defence of the author’s preferred political morality, explaining how the theory is developed and its implications for evaluations of potential and existing public health policy. It demands a reconceptualisation of mainstream bioethics, and reframes ethical analysis so that it can apply to contemporary problems in health policy and practice. Its objectives are both theoretical and practical. Public health ethics is a relatively new, and rapidly growing, area of study. As a practical, policy concern, it is also receiving much greater attention than has historically been the case. The book bridges gaps between literatures from a great range of sources, and brings together a wide span of discourses from policy, public and professional ethics, practice, and different academic disciplines. Its originality and importance come in its detailed, comprehensive analysis and definition of a new field of study, and its arguments for how the study of public health ethics is best undertaken. The book’s depth, breadth, and relevance make it stand out as an original contribution that will be of enduring relevance.

“The book’s chief strength is placing public health interventions, which are often seen as un- or a-political, firmly within a normative liberal framework, thereby exposing the value-loaded claims of a discipline that often sees itself as neutral or non-normatively scientific. The book makes a significant contribution to reflection on the normative basis of public health interventions. Nobody working in this field — the ethics and politics of public health interventions — can afford not to be familiar with it. It is excellent.”

The programme and list of awards winners can be read here.

 

Caroline Jones (John is far too modest to write this himself!).

What is ‘proper medical treatment’?

In 2013, Conferences, Key Legal Concepts on September 18, 2013 at 7:52 am

It makes a big difference to the legal, social, and to many minds moral acceptability of interventions to know that they are—or are not—‘proper medical treatment’. In English medical law, even for people who aren’t found to lack decision-making capacity, consent alone is insufficient to make an intervention lawful; it has, according to some external standard, to constitute treatment that serves a person’s interests. But where does medicine find its legitimacy? What about a medical act attracts legal protection when a qualitatively identical act undertaken by a non-medic would not be deemed to serve someone’s interests, and be criminal? How far can ‘medicalisation’ legitimise what would otherwise be beyond the pale; assisted dying, cosmetic procedures, and so on?

In an impressive, wide-ranging series of discussions at a conference I attended last week, some of the key questions were raised and explored about how we understand ‘proper medical treatment’, and challenges were made to the reverence that we might offer it. The meeting, organised by Sara Fovarague and Alex Mullock, was built on the theme “Transforming wrong(s) into right(s): The power of ‘proper medical treatment’”. The legitimacy—or as Margot Brazier suggested on Thursday perhaps the magic—of medicine, forestalling prosecutions for what would on their face be criminal acts, is found in the legal concept of the ‘medical exception’. But to be proper, it is insufficient simply that treatment is given by a doctor, or even that its provision is recognised and endorsed in the professional opinion of a number of doctors. Coming to a clear understanding of ‘proper’ is as hard as coming to a clear understanding of ‘medical’. Yet these terms have crucial importance in practice.

I was lucky enough to be a discussant on a panel with speakers Julian Sheather and Cam Donaldson, who respectively interrogated the theme from political and economic perspectives. Julian demonstrated how political ends can be achieved through medicalisation, even in the face of serious objections from the profession itself, whilst Cam provoked interesting questions about how a health economist might assess the idea of ‘proper’ in proper medical treatment. Cam also made clear how important it is to include a health economics perspective in these ethical and legal debates.

Reflecting on the ideas from a legal perspective, I would question—regardless of whether we are convinced by the moral weight of designating something ‘proper medical treatment’—how much conceptual grip we can get on the idea of medical treatment by looking at what judges, practitioners, and policy-makers have to say. If the NHS is to afford what amounts to a right to healthcare, and if we are to recognise the importance of healthcare practitioners’ expertise, it seems inevitable—and right—that we should conceive of robust central cases of medical treatment. But at the fringes, there will be fuzzy, contestable claims about whether something should be seen as proper treatment or not. In those instances, we may look to decided cases and existing regulations, but the bases of their rationales will be wide and varied: for example, tax law cases based on European Union law; individual claims for intervention based on the European Convention on Human Rights.

A strong degree of coherence is needed if we are to enjoy a healthcare system whose legal and ethical rationale is not arbitrary. Yet too constraining a rationale will stifle innovation, and damage protections of plural values that healthcare law protects. A project aimed at understanding ‘proper medical treatment’ is an important one. At its end, I wonder if an exhaustive definition will necessarily be the best one.

John Coggon, Southampton Law School.

ESRC Sponsored seminar: Criminalizing Contagion – legal and ethical challenges of disease, transmission and the criminal law

In 2013, Meetings on September 10, 2013 at 7:00 am

Today we are exploring ideas around the legal and ethical challenges of disease, transmission and the criminal law, during the second in a four part series of seminars funded by the ESRC on Criminalizing Contagion, a joint project between Southampton Law School and Manchester Law School, led by David Gurnham, Catherine Stanton and Hannah Quirk.

In the morning session, Dr John Coggon spoke on ‘Epistemic and communicative duties in public health ethics’, followed by Prof Maggie O’Neill of Durham Uni speaking on ‘Transgressive imaginations: sex work, abjection and contagion.’ The final part of the opening session was a paper by the BBC South Health Correspondent David Fenton, who gave us an insider’s take on the media & reporting in his paper on ‘Reporting pandemics – a perspective from inside the Newsroom.’ All papers gave rise to an engaging, interesting and lovely round of questions and discussion, which continued over lunch.

This afternoon’s session on ‘Evaluating Law’s Responses’ will begin with
Dr Lucy Stackpool-Moore, SOAS, on ”The intention may not be cruel … But the impact may be’: understanding the legislators’ motives and wider public attitudes to a draft HIV Bill in Malawi’, followed by Mr Peter Greenhouse, Consultant in Sexual Health and BSHH, Media Committee Chairman, speaking on ‘Herpes and the Law: a misuse of process?’.

It has been a fascinating day, and it will be very interesting to see how the project unfolds in the final two seminars in the series. More news on that here in the future!