HEAL UoS

Posts Tagged ‘Gillick’

MMR, Patients’ Beliefs, and Legal Coercion

In 2013, Case of the week, Key Legal Concepts, Vaccination on October 21, 2013 at 7:00 am

Over the last week or so, there’s been a lot of media coverage of a case in which Theis J, sitting in the High Court, issued a declaration that two sisters aged 15 and 11 should receive the MMR vaccination. Although the courts will (rightly) tell us that any such decision concerning the MMR vaccine is applicable only to the particular case under issue, some observers may now sense a trend developing in the jurisprudence on this question.

In the particular case, various stock health care law issues arise: what should practitioners and the courts do in the face of practical disagreement between parents?; how much weight should be given to the views of ‘mature minors’?; can practical problems legitimately interfere with a principled, ‘coercive’, legal decision? (it has been reported that, despite the judgment, the vaccinations have not been given)

A further question, raised in the case, and which causes continuous tension in English health care law concerns the treatment of patients’ (and, for minors, their parents’) beliefs. It is interesting to assess this from a wide range of angles, but here let us focus on two ways that beliefs are expressed in health care decisions.

First, we may find challenges to a patient’s conclusions on a decision, brought by reference to the quality of the reasoning that led to those conclusions. Sometimes, the courts set aside patients’ expressed wishes because of patients’ apparently faulty logic. In the recent MMR case it was noted that whilst the 15 year old child objected to the vaccination on ethical grounds (she is a vegan and says she objects to the products within the vaccine being introduced to her body), she had voiced no such objection to, hypothetically, receiving treatments that also seem to offend her vegan principles, should she fall ill. This apparent inconsistency contributed to the reasons for finding her beliefs less than compelling.

Where judges decide carefully and openly (when is it otherwise?), many will argue that it is proper—especially in the case of child patients—that the courts should not uphold a patient’s ‘rights’ to harm herself, with harm judged even by the patient’s own standards; that we can legitimately, in some circumstances, protect people from their own harmful and inconsistent reasoning.

Yet a second challenge regarding beliefs, which we also find in health care law and which is much harder to resolve, is found in cases where courts essentially disregard a belief by virtue of its very content. Here, we don’t face a flaw in the patient’s process of reasoning. In theory, English health care law aims to be deferential on belief systems; legal principle tells us that generally the basis of our decisions is not for the courts or carers to question. Yet sometimes, ‘the science’, or ‘common sense’, or ‘basic reason’ seem to lead to compelling reasons to disregard a patient’s views.  In these instances, it can be much harder, on terms consistent with legal principle, to frame a judgment that sets aside the patient’s (or parent’s) decision. If such a judgment is to enjoy legitimacy, the law needs to develop coherent means of accommodating such an approach explicitly, for children and for adults.

John Coggon

Experimenting on children?

In 2013, Meetings, Research ethics on October 9, 2013 at 7:51 am

Of course the real title of this blog post is, or should be, something along the lines of ‘today’s HEAL meeting: discussing the NCOB’s consultation on ‘Children and clinical research’: a ‘vulnerable’ group and a lacuna in the law?

On 7 August 2013, the Nuffield Council on Bioethics launched its consultation on the ethical issues arising from involving children in clinical research. As noted by the NCOB, there is a lack of clarity around some questions regarding children’s participation in clinical research. For example, there is no reported case law on whether Gillick competency  applies in a clinical research setting, although the legal position for clinical trials for new medicines IS clearly laid out in the relevant regulations (see further MHRA for links to the different versions of the regs and further context), such that children under 16 cannot – in law – make their own decisions about participating in a clinical trial (consent of a parent with parental responsibility is required).

There are complicating factors, including practical and financial issues – ie what will companies fund, in the short and long term? And, more obviously, questions about ‘best interests’ for the children in question – when children have been and are perceived as  a ‘vulnerable’ group (on vulnerability in health care, see further Biggs and Jones, forthcoming 2014, and 2013).

The call for evidence can be be read at http://www.nuffieldbioethics.org/children-and-research/children-and-research-call-evidence. We’re meeting in rm 2055, Law, Highfield, from 3.15pm today, and looking forward to a great discussion.

Caroline Jones

Injecting contraception in schools?

In 2012, News, Reproduction, Testing project on November 6, 2012 at 9:00 am

This is a guest post by Emma Nottingham.

The Daily Telegraph has conducted a survey which revealed that contraceptive injections are being offered in a range of schools across the UK in including Bristol, Northumbria, Peterborough, CountyDurham, the West Midlands and Berkshire. The front page story has expressed concern that school girls as young as thirteen are being given the contraceptive injection at school, without their parents’ knowledge. Statistics revealed that school nurses have given the contraceptive jab or implant to girls between the ages of 13 and 16 more than 900 times in the last two years. The medical profession, including school nurses are bound by rules on confidentiality.

Outrage was expressed by parents in Southampton earlier this year after finding out that children were being given the contraceptive implant in schools without their consent, as part of a wider government initiative to reduce the number of teenage pregnancies. The contraceptive implant works to prevent pregnancy by releasing the hormone progesterone into the bloodstream from a 4cm rod which is inserted into the arm and is effective for up to three years. The contraceptive injection is effective for three months.

The issue of under-16 year olds’ competency to consent to contraceptive advice and treatment without parental consent was settled in the case of Gillick v Wisbech and West Norfolk Health Authority and another [1985] 3 All ER 402, after Victoria Gillick took legal action against the Department of Health and Social Security in response to their 1980 circular on family planning which endorsed confidential contraceptive advice and treatment for under-16 year olds.

Despite the legal settlement of this issue 27 years ago, under-16 year olds’ access to contraceptive treatment without parental consent remains controversial, particularly in light of the advancement in medical technology which offers a wider variety of treatments to females, such as the implant and contraceptive injection, which were not available at the time of Gillick.

 

Southampton’s ‘Gillick’?

In 2012, Reproduction, Testing project on February 27, 2012 at 9:37 pm

Just a quick post: Earlier this month news ‘broke’ of young women being offered contraceptive advice and services in Southampton, prompting comment in the local media. This evening, an interview with Prof. Roger Ingham, Director of the Centre for Sexual Health Research, was shown on the BBC One programme Inside Out South, in a section of the programme dedicated to this story (first 5 mins of the programme, available on iPlayer for the next week). Such debates are, of course, not new – see GillickThe Government has announced plans to publish a new sexual health policy document in 2012, but whether either its publication or the concerns of parents will lead to further legal challenges remains to be seen.