Medical Law

INTRODUCTION

The United Nations Convention on the Rights of the Child, which was ratified by Britain in 1991, declared that children have the same inherent dignity and equal rights as adults, but at the same time recognizes that children are born dependent and have a right to protection and guidance.

The Family Law Reform Act of 1969 (FLRA) authorized a 16 and 17 year old individual   to give consent to medical interventions in the same manner as adults. The Children Act of 1989 put more weight on the principle that children’s wishes should be considered and respected whenever possible as against the professional’s perceptions of the child’s best interests, and granted limited rights to refuse medical examination and treatment to children looked after by the local authority (Kennedy & Grubb, 1994).

The Legal Significance of Consent

Before a medical practitioner examines and/or treats a patient, a valid consent must be given by the patient. If the said doctor proceeds with the examination without obtaining consent from the patient, whether express or implied, and done against that person’s will and without any statutory authority to do so, that surgeon may incur civil liability for violation of the tort of trespass against the person and criminal liability in accordance with the provisions of Offences Against the Person Act of 1861. The truth is that most cases covered by this area are brought about due to negligence as the cause of action in the tort or damage committed by the doctor. However, in order for the action to prosper, the claimant must show proof that a valid consent from the patient to allow the medical treatment was absent.

The term consent was best described in the case of Cardozo J, Schoelendorff v New York Hospital 211 N.Y.125 (1914) which provides:

“Every human being of adult years and sound mind has a right to determine what shall be done with his own body;”

 

In order to fully understand the concept of a valid consent to medical treatment given minors over the age of 16, we have to provide the legal basis to support this assertion.

According to “The Family Law Reform Act of 1969 (FLRA) (1969 CHAPTER 46) Section 8: “A minor who is over 16 years of age can give his consent to any surgical, medical or dental treatment without obtaining consent from his parent or guardian. Absence of his consent will constitute as a trespass to his person.

Therefore, as clearly stated in the express provisions of the law, minors who are over 16 years of age are capacited to give consent to any surgical, medical and dental treatment ,sans any parental or guardian’s consent. However, well-settled is the principle in the case of Gillick v West Norfolk & Wisbeck Area Health Authority and Department of Health & Social Security [1985] 3 All ER 402) which came in later ruled otherwise.

The term “Gillick competence” was coined from Lord Scarman’s statement in Gillick case expressed as follows:

“Parental right yields to the child’s right to make his own decisions when he reaches a sufficient understanding and intelligence to be capable in making up his mind on the matter requiring decision”.

 

In other words, the classic definition given by Lord Scarman can be simply interpreted like so:

“…as a matter of law the parental right to determine whether or not their minor child below the age of 16 will have medical treatment terminates if and when the child achieves a sufficient understanding and intelligence to enable him or her to understand fully what is proposed”

 

The Gillick case ratified the lawfulness of a 1980 DHSS circular in exceptional circumstances, which allows a doctor to lawfully give contraceptive advice or treatment to a girl under 16 without her parents’ knowledge or consent. The mother of the young girl objected to the notice which prompted her to file an application to the court to declare that the circular was unlawful. The issue reached the House of Lords where, on a majority judgement, the Lords held that the circular was lawful giving the right to children under 16 years of age to decide on medical treatments for themselves without parental consent.

Wherefore, in view of the foregoing facts and circumstances, well-settled is the rule that adults and minors below 16 years have the power and authority to give consent to any medical, surgical and dental treatment.

A. Consent and minors under the age of 16: Gillick Competence

The legal adviser should advise that Adrianne, aged 15, that although she is Gillick competent and can give consent to a treatment, it does not include the right to refuse medical treatment.

In an analogous case involving similar facts, the recent case of Hannah Jones, the 13-year-old girl from the UK who recently refused to undergo a heart transplantation procedure in 2008 has drawn media crowd and earned a significant amount of criticism. Hannah was diagnosed with leukaemia at the age of four and the chemotherapy administered to treat the disease caused her heart to weaken. Without a transplant, doctors predict that she is likely to die within six months. However, even if the heart transplant was performed, the medication aimed at preventing Hannah’s body rejecting the new heart could cause her leukaemia to return and she may need another transplant within a number of years. There has been a mixed response to the decision of the healthcare team, who almost followed through with legal action to try and force Hannah to undergo the procedure.

Hannah’s decision is described by some reporters as giving terminally ill teens a “right to die”. This raises significant questions in relation to the types of medical treatments minors are able to consent to, and whether the law permits them to refuse treatment where refusal will lead to death. At first glance, Hannah’s story would suggest that this is the case. To describe Hannah’s case as a victory, giving minors a “right to die” seems misguided.[1] However, in 2010, Hannah, after reaching the age of 14, changed her mind and decided to undergo the heart transplant procedure because it is in keeping with her best interests.

In both our given examples of Adrianne’s and Hannah’s cases, the critical issue is in relation to the welfare and for their best interests. Hannah’s or Adrienne’s decision to refuse medical treatment can be overruled by the court, their parents or guardians. This is in consonance with the power of the court to act within the bounds of its inherent jurisdiction, and such power is unlimited; while parents have parental authority over their minor children. Both girls only have the authority to give consent to any medical, surgical and dental treatment, but this does not include the right to refuse a medical treatment if it will be for their best interests.

The Gillick decision laid a precedent granting to a child below 16 the right to determine issues themselves. However, since there exists a conflict between the Gillick decision and the upholding of children’s rights based on FLRA (s8), the courts have significantly withdrawn from both the Gillick ruling and in certain circumstances found in the children’s rights. The High Tribunal has exercised its power within the bounds of its inherent jurisdiction and such power is derived from the sovereign. (Re E [1991] 2 FLRA 585)

This principle was further emphasized in the case of Re R (A Minor) [1991] 4 All ER 177 CA, the court held that a 15-year-old girl lacked insight into her acute psychiatric condition, which prevented her to fully comprehend the requirement of a medication. She was therefore ruled not to be Gillick competent. This may initially appear consistent with the Gillick principle, because she was believed to lack capacity. However, the court pointed out that assuming for the sake of argument that she was adjudged as Gillick competent, she still had no authority to refuse medical treatment.

While in the case of Re W (A Minor) (Medical Treatment: Court’s Jurisdiction) [1992] 4 All E.R. 627, the Higher court settled the distinguishment between two terms, consent and refusal to consent to treatment. Here, W was a 16-year-old patient with the disease anorexia nervosa. She declined to be transferred to a specialist treatment unit but the court overruled this refusal, although, at 16, she seemed to fall under the terms of the Family Law Reform Act 1969 (FLRA). The decision of Balcombe, LJ bears stressing. It quoted the argument of Lord Donaldson in Re R [1991] and highlighted that the FLRA did not cover refusal of treatment, but only included consent to treatment. The court held that a competent child under 18 years of age, whose refusal of treatment might result in “irreparable consequences”, will be required to undergo the treatment even if it is against her will, if any person with parental responsibility consents to that treatment and a doctor considers it obligatory. Wherefore, the moment the child reaches the age of 16, the right to consent was shared with the child’s parents and the court setting aside FLRA (s8).

In addition, the law treats refusal of medical treatment differently from consent to medical treatment. Both the courts and parents can overrule a 16 or 17 year old’s refusal of medical treatment, regardless of the child’s competence.( Re W 1992 3 WLR 758.) Therefore, a parent cannot overrule the 16 or 17 year olds’ consent to treatment in relation to FLRA (s8) but may overrule his/her refusal to treatment. Futhermore, the courts can overturn both consent and refusal. It is without an iota of doubt that it is unfortunate that the law does not provide the 16 or 17 year old with full autonomy. Even where a young person may have the capacity to consent as provided by law, this does not ipso facto connote that he or she has a right to refuse treatment as settled in the cases Re R [1991] and Re W [1992]. Although he or she may apparently possess sufficient understanding to make a decision, the law is crystal clear that recognizes the child’s ability to consent rather than to refuse a treatment.

While it is a well-entrenched rule that capacitated children who can fully understand the implications of a medical treatment have the right to make a decision to accept or refuse a treatment, it is permitted only if it is deemed to be for their best interests. If there is any disagreement in relation to the child’s welfare, the people surrounding him/her may have to seek the assistance of a lawyer and consider going to court. If the capacitated child rejects a treatment, but the doctor says is mandatory, the parents or guardians, or can ask a court to intervene and overrule the child’s refusal. The probability of overriding a competent child’s refusal is likely to happen because of the fact that the child’s welfare shall be the court’s paramount consideration, no matter how mature the child may seem to be.

This is as opposed to the standard of competency of adults who can refuse any medical treatment for reasons that are “rational or irrational or for no reason” as enunciated in the case of Sidaway v.Governors of Bethlem Royal Hospital, [1985] 2 W.L.R. 480. This is in consonance with the doctrine of informed consent which states that the patient is not considered to have given valid consent unless he or she is informed of all material risks and the consequence of each procedure.

It was thus encapsulated by Lord Scarman as follows:

(1) The root premise is the concept that every human being of adult years and of sound mind has a right to determine what shall be done with his own body.

(2) The consent is the informed exercise of a choice, and that entails an opportunity to evaluate knowledgeably the options available and the risks attendant upon each:

(3) the doctor must, therefore, disclose all “material risks”; what risks are “material” is determined by the “prudent patient” test, which was formulated by the court, at p. 787:

 

“a risk is … material when a reasonable person, in what the physician knows or should know to be the patient’s position, would be likely to attach significance to the risk or cluster of risks in deciding whether or not to forego the proposed therapy.”

 

(4) The doctor, however, has what the court called a “therapeutic privilege.” This exception enables a doctor to withhold from his patient information as to risk if it can be shown that a reasonable medical assessment of the patient would have indicated to the doctor that disclosure would have posed a serious threat of psychological detriment to the patient.

In the same vein, adults who are detained under the Mental Health Act 1983 are not necessarily incompetent with regard to all decisions. The case of C, a patient at Broadmoor who was suffering from schizophrenia, and who refused the amputation of his gangrenous foot, paved the way to a legal test of competence in adults, which has taken into consideration the comprehension and retention of relevant information, believing it and weighing it up before finally reaching a decision (Re: C (Adult: Refusal of treatment), [1994].

In summary, English law affords minors the right to consent to, but not to refuse, medical treatment, which suggests a right to agree with your doctors (Dickenson, 1994). However, the decision to refuse medical treatment can have grave consequences, and our society is driven towards the preservation of life. In the past the need for a higher level of understanding if treatment was refused was justified as refusal questions expert opinion and doctors were expected to act in their patients’ best interest (Batten, 1996).This assumption is debatable in the light of recent medical scandals, as is the similar assumption that parents inevitably act with their child’s welfare in mind, particularly for those working in child protection scenarios (Batten, 1996). Paradoxically, the legal system is unwilling to accept the right of a 17-year-old to determine what happens to his or her body, when the age of criminal responsibility now stands at 10 years (Dickenson, 1994). If parents and the courts can overrule competent minors, children are not being granted the “equal and inalienable” rights afforded them by the United Nations Convention on the Rights of the Child.[2]

This was supported in the case of Nielsen v Denmark [1989]:

The European Court of Human Rights held that the informal admission of a 12-year-old boy to a psychiatric hospital was against his wishes but with parental consent, did not constitute to the deprivation of liberty which was contrary to Article 5 of the European Convention on Human Rights. The rationale behind it is that, at 12, he was still of an age when it was natural for his mother to exercise her parental custodial rights in the best interest of her child, even if it was against his wishes.

Wherefore, the full autonomy of children was not granted by the court because the ultimate goal is to protect and nurture the children until they are fully mature to be able to make intelligent decisions for themselves.

B. Capacity to Consent to Medical Treatment

Bessie’ case falls squarely within the bounds of Mental Capacity Act of 2005, which took effect in 2007. The law covers persons who are 16 years of age or older and even those persons with “lacking capacity”, or those who cannot make their own decisions involving acts in connection with care and medical treatment. In the case of Bessie, in the eyes of the law, she is considered an adult without mental capacity. As such, she cannot make an intelligent decision for herself and needs assistance to make her fully comprehend the consequences of refusing to undergo an emergency caesarean section, otherwise, it will endanger her baby’s life.

The Mental Capacity Act 2005 Section 2(1) defines what the absence of capacity is. It means that if, at the time the decision needs to be made, patients are unable to make or communicate the decision because of an “impairment of, or a disturbance in the functioning of, the mind or brain”, they are deemed to be incapable.

The test for capacity is contained in Section 3 of the Mental Capacity Act 2005 which states that a person is unable to make a decision for himself if he is unable to: a) Understand the information relevant to the decision; b) retain that information; c) use or weigh that information as part of the process of making the decision, or d) communicate his decision (whether by talking, using sign language or any other means).

For the purposes of this Act, a person lacks capacity in relation to a matter if at the material time he is incapable of making decision for himself, in relation to the issue on hand because of an impairment of, or a disturbance in the functioning of, the mind or brain. It is irrelevant and immaterial whether or not the impairment or disturbance is permanent or temporary. A lack of capacity cannot be established merely by reference to— (a) a person’s age or appearance or (b) a condition of his, or an aspect of his behaviour, which might lead others to make unjustified assumptions about his capacity.

In the case of Bessie, the doctor advised her to undergo emergency caesarean section for the best interest and safety of her unborn child and her own health. She is considered under the law as an incompetent adult because she cannot fully grasp the entire decision making process which must be compliant to the “best interests” rule. Her present medical condition can cause serious harm and danger to the life and health of her unborn child and immediate medical intervention is a necessity. Hence, she cannot validly refuse the treatment advised to her by her doctor, even if it is contrary to her decision, because it means saving her life and her unborn child. The law allows medical treatment to be administered by medical professional, even without the consent of the incompetent adult if it will work for the best interests of the patient.

The time-honoured “principle of autonomy” should be highlighted as laid down in the case of Airedale NHS Trust v Bland [1993] 1 All ER 821 Lord Keith stated:

“The first point to make is that it is unlawful, so as to constitute both the tort and crime of battery, to administer medical treatment to an adult, who is conscious and of sound mind, without his consent see F v West Berkshire Health Authority (Mental Health Act Commission intervening) [1989] 2 All ER 545, [1990] 2 AC 1. Such a person is completely at liberty to decline to undergo treatment, even if the result of his doing so will be that he will die.”

This seems perfectly clear, but transpired to be more difficult for medical professionals to accept than to understand, as illustrated in the much publicised case of Ms B v An NHS Trust [2002] EWHC 429 (Fam).

As a result of haemorrhaging of the spinal column in her neck, Ms B was paralysed from the neck down and was being kept alive by a ventilator.  She asked the hospital to withdraw ventilation and this was refused.  The doctors considered she did not have capacity to make the decision. She sought judicial review. It was held that she had capacity and so her continued treatment without her consent was unlawful. Dame Elizabeth Butler –Sloss stating:

“…the right of the competent patient to request cessation of treatment must prevail over the natural desire of the medical and nursing profession to try to keep her alive.”

 

Clearly, the principle of autonomy signifies that the competent patient has the right to refuse or choose their treatment as anchored in the Latin maxim “Voluntas aegroti suprema lex.”

However, before the passage of the Mental Capacity Act of 2005, the ruling in the case of R v St George’s Healthcare Trust v S (1998) 44 BMLR 160 was the prevailing jurisprudence. Dame Elizabeth Butler-Sloss ruled that:

“In deciding whether the patient has sufficient mental capacity… it is most important that those considering the issue should not confuse the question of mental capacity with the nature of the decision.”

 

The facts of the case are: S paid the doctor a visit in the late stages of her pregnancy.  The doctor advised that there was a serious problem and said the birth should be induced.  However, S refused to follow the doctor’s advice.  Together with the assistance of an Approved Social Worker and another doctor, the GP sectioned S under s.2, Mental Health Act 1983, for assessment.  S was taken to the local mental hospital and was immediately transferred to the maternity hospital.  The hospital applied to a judge ex parte for permission to perform a caesarean section on S.  The application was granted. But the court later on held that treatment of S without her consent was unlawful.

Since this case was decided before the Mental Capacity Act 2005 came into force in 2007 the test used was that in Re C, J. Thorpe instructs that for the patient offered amputation to save life, there are three stages to the decision: (1) to take in and retain treatment information; (2) to believe it and

(3) to weigh that information, balancing risks and needs.

In the same light, the case of (NHS Trust v T [2004] EWHC 1279 (Fam) held that:

“While a competent patient is entitled to make an irrational decision, such a decision can of itself be evidence of incapacity.”

 

In sum, what makes the outcome of choice “irrational” is that a worthwhile life will be lost and wasted, that could have been otherwise preserved. It will still be the solemn duty of the courts to assess the patient’s competence on the basis of the outcome of the choice that he or she has made.

Since the test in the Mental Capacity Act is based on that in Re C it is reasonable to assume the case would be decided in the same way today. However, the test in Re C is now only of historical interest as it was over turned by the case Re MB.

In contrast to Re C, where a patient with a serious mental illness was found competent to make a particular decision regarding treatment, in Re MB (1997) 38 BMLR 175 (CA) an otherwise mentally competent patient was held to not have the capacity to refuse a particular treatment. This doctrine has lain to rest the conflicting view in Re C case.

MB was pregnant and consented to a caesarean section.  However, she refused to consent to an anaesthetic as she had a fear of needles.  The hospital applied for an order allowing treatment. MB did not have capacity as her fear meant that she was unable to use the information, all she could comprehend was her fear.

Although the court specifically held that St George’s doctrine was still good law, whereas the rest of the cases involving pregnant women no longer are applicable.

The recent case of Rochdale Healthcare NHS Trust v. C [1997] 1 F.C.R. 274. provides a graphic example. In this case, the pregnant woman was refusing consent because of her experience of a previous Caesarean section. Johnson J. overruled the consultant obstetrician’s opinion that the woman was competent without meeting or talking to the woman purely on the basis of her comment that she would rather die than have another Caesarean. It is notable that in all of these cases, where the foetus’s life was still at stake, the court declared the Caesarean section to be lawful.[3]

Speaking extra-judicially, Thorpe L.J. explained the courts’ difficulties and reluctance to defend these women’s right to autonomy. He said: It is, perhaps, easier for an appellate court to discern principle than it is for a trial court to apply it in the face of judicial instinct, training, and emotion … It is simply unrealistic to suppose that the preservation of each life will not be a matter of equal concern to the Family Division judge surveying the medical dilemma. Whatever emphasis legal principle may place upon adult autonomy with the consequent right to choose between treatments, at some level the judicial outcome will be influenced by the expert evidence as to which treatment affords the best chance of the happy announcement that both mother and baby are doing well.[4]

Due to the passage and enactment of Mental Capacity Act of 2005, medical professionals are cloaked with immunity from any criminal or civil liability, if they use their best judgement that such medical treatment to be administered on the patients, who are either incompetent adults or children below 16 years of age, will be for their best interests and welfare. The law presumes that the timely medical intervention is obligatory because they are dealing with a medical emergency and they permitted to do whatever is necessary to try to save lives or prevent serious physical or mental harm. Thus, it was held that the lack of consent from the patient does not make the medical treatment unlawful per se. In proceedings under this Act or any other enactment, before arriving at a resolution on whether or not a person lacks capacity within the meaning of this Act, all circumstances must be decided on the balance of probabilities. Hence, in the case at bar, Bessie’s doctor is mandated under the law to administer the medical treatment because her best interests will be the primordial concern considering that the patient is an incompetent adult.

C. Advance Directive

The previously executed advance directive signed by patient Derek should be completely dispensed with. It is the positive obligation of his consultant, based on paragraph 5.23 of the Code of Practice to the MCA, to ask him to participate in the decision-making process by using practical means to communicate with the him through simple language, speaking at the correct volume and speed, choosing the right words and basic sentence structure, slowly breaking down information point by point and using vivid illustrations and photographs to help the person understand the decision to be made. It will all depend on doctor’s diagnosis of the patient’s condition to visibly identify the best interests of the patient. We are relying on the doctor’s medical expertise by acting swiftly in providing timely and appropriate medical treatment in order to prolong and preserve the patient’s life.

The Mental Capacity Act 2005 (Sections 24, 25 & 26) allows for the creation of advance directives for the refusal of treatment. In the legal perspective, advance directive is commonly known as a “living will”. However, medical professionals are reluctant to follow those individuals whose personal circumstances do not fall squarely within the limitations provided under the law and only a few are sufficiently precise to be enforceable by the courts. These written documents may convey a sense of the individuals’ wishes, which in effect be legally binding upon the patient giving it, provided than an advance directive must satisfy a certain criteria

There are three basic types of criticism levied at advance directives. The first is an attack on the moral authority of the directive. The gist of the criticism is that the person making the directive lacks the authority to bind the incompetent individual because they lack the necessary psychological relationship. The second type of attack is directed at the weighting given to autonomy and the third is focused on the pragmatic difficulties of implementing and relying on advance directives.[5]

Even the courts have been equally expressed their reluctancy to uphold the primacy of self-determination especially in cases where the person’s life is at stake.  Two classic examples of these cases before the enforcement of the Act, are still noteworthy and bear stressing. These are: HE v An NHS Hospital Trust [2003] EWHC 1017 (Fam) and W Healthcare NHS Trust v H [2004] EWCA Civ 1324.

In the former case, the patient had been a Jehovah’s Witness at the time that she had made an advance directive refusing blood products. When the question arose as to whether the directive should be followed, the court held that it should not. The decision was based on the fact that she had recently become engaged to a Muslim and intended to revert to Islam on their marriage. Also, she had, when conscious told relatives that she did not want to die.

According to Munby J:

“…however unhelpful for hard-pressed doctors this seeming platitude may be, it must all depend on the facts. All I would add is that the longer the time which has elapsed since an advance directive was made, and the greater the apparent changes in the patient’s circumstances since then, the more doubt there is likely to be as to its continuing validity and applicability.”

 

In the latter case, the patient was severely physically disabled, due to MS, conscious but no longer able to recognize her family. The percutaneous gastrostomy tube, through which she received nutrition, became dislodged. She had repeatedly given instructions to her family to the effect that she had no wished to be kept alive if she could no longer recognise her daughters. The question for the court was whether this amounted to a valid advanced directive that the tube should not be replaced. The court held that it did not. There was no evidence that she had given a directive that she should be starved to death.

However the prevailing doctrine wherein an advanced directive was effective was illustrated in the case of Re AK (Adult Patient) (Medical Treatment: Consent) [2001] 1 FLR 129.

In the abovementioned case, a 19-year-old boy suffering from MND requested that he have his ventilation removed two weeks after he could no longer communicate. Hughes J held:

“In the present case the expressions of AK’s decision are recent and are made not on any hypothetical basis but in the fullest possible knowledge of impending reality. I am satisfied that they genuinely represent his considered wishes and should be treated as such.”

As a general principle, the law expects doctors to act reasonably in the circumstances in which they find themselves. In an emergency situation, where is it unclear whether or not an unconscious or otherwise the mentally impaired patient has refused treatment in advance, it is reasonable not to delay treatment if it would result in a serious harm or danger to the person’s life or health. While MCA states that an advance decision is not “applicable” if there are “reasonable grounds” for believing that circumstances exist which the person did not anticipate at the time of making the advance decision and which would have affected the decision had she anticipated them. This provision seeks to deal with a commonly invoked criticism of advance decision-making to the effect that fundamental information (for example, information as to the kind of treatments available or the condition in question) may be absent at the time that the patient makes the advance decision and therefore the advance decision is not an “informed” decision. [6]

This raises the question of whether a decision-maker may take account of a person’s past wishes and views if these indicate a clear desire to be allowed to die in the particular circumstances at issue. In such circumstances, it may be argued that the decision-maker’s motivation is not the desire to bring about the death of the person lacking capacity but to fulfil that person’s wishes. Therefore, section 4(5) should not prevent the inclusion of a person’s past wishes (that they be allowed to die) as part of the determination of best interests under section 4(6).[7]

Therefore, given the vulnerability of advance directives under both the Act and the common law, it can be concluded that advance directives or living wills are not effective enough as instruments of self-autonomy to be legally and validly binding upon persons who execute them. It is rather safe to say that they should be given a presumptive weight with an open possibility that there are certain situations when they will completely disregarded. Therefore, it is deemed best if patients appoint a trusted proxy rather than merely rely on an advance directive if it is unacceptable for them to leave their fate in the hands of the medical profession.

 

 

 

Bibliography:

Statutes

Family Law Reform Act 1969 s.8

 

Mental Capacity Act of  2005

 

Offences Against the Person Act 1969

 

United Nations Convention on the Rights of the Child 1991

 

Key Cases:

Airedale NHS Trust v Bland [1993] 1 All ER 821

 

Department of Health and Community Services (NT) v JWB (1992) 175 CLR 218

 

F v West Berkshire Health Authority  [1989] 2 All ER 545, [1990] 2 AC 1

 

Gillick v. West Norfolk and Wisbech Area Health Authority (1986) AC, 112.

HE v An NHS Hospital Trust [2003] EWHC 1017

Ms B v An NHS Trust [2002] EWHC 429 (Fam).

 

NHS Trust v T [2004] EWHC 1279 (Fam

 

Nielsen v Denmark [1989]

 

Schoelendorff v New York Hospital 211 N.Y.125 (1914)

 

Sidaway v. Governors of Bethlem Royal Hospital (1985) AC, 871.

 

Re : AK (Adult Patient) (Medical Treatment: Consent) [2001] 1 FLR 129.

 

R v St George’s Healthcare Trust v S (1998) 44 BMLR 160

 

Re: C (Adult: Refusal of treatment) (1994) I, WLR, 290.

 

Re:E (A Minor) (Medical Treatment) [1991] 2 FLR 585

 

Re: MB (1997) 38 BMLR 175 (CA)

 

Re: R (A minor) (Wardship: Medical Treatment) (1991) 4, All ER 177, CA.

 

Re: W (A minor) (Wardship: Medical Treatment) (1992) 4, All ER 627, CA.

 

Rochdale Healthcare NHS Trust v. C [1997] 1 F.C.R. 274.

W Healthcare NHS Trust v H [2004] EWCA Civ 1324.

Books:

Batten, D. A. (1996)  Informed consent by children and adolescents to psychiatric treatment. Australian and New Zealand Journal of Psychiatry, 30, 623-632.

 

Dickenson, D. (1994) Children’s informed consent to treatment: is the law an ass? Journal of Medical Ethics, 20, 205-206

 

Kennedy, I. & Grubb, A. (1994) Medical Law: Texts with Materials. London: Butterworths, 2000Mason, J.K. and

 

Journals:

 

Lawyers Weekly, November 30, 2008 (http://www.lawyersweekly.com.au/blogs/opinion/archive/2008/11/30/a-minor-s-right-to-refuse.aspx)

 

Lord Justice Thorpe, ‘The Caesarean Section Debate’ [1997] 27 Family Law 663 at 663–664

 

Medical Law Review, Volume 17, Issue 1, pp. 1-29 (http://medlaw.oxfordjournals.org/content/17/1/1.full)

Volume 16, Issue 1, pp.1-22 (http://medlaw.oxfordjournals.org/content/16/1/1.full)

 

The British Journal of Psychiatry (2001) 179: 384-386 (http://bjp.rcpsych.org/cgi/content/full/179/5/384)

 

 


[1] Lawyers Weekly, November 30, 2008

[2] The British Journal of Psychiatry (2001) 179: 384-386

[3] Medical Law Review, Volume 16, Issue 1 pp.1-22

[4] Lord Justice Thorpe, ‘The Caesarean Section Debate’ [1997] 27 Family Law 663 at 663–664

[5] Ibid (3)

[6] Medical Law Review, Volume 17, Issue 1, pp. 1-29

[7] Ibid.(5)

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