Table Of Content1
Second edition
0
A 30-year-old Polish lady is admitted in labour. This is 0
her first pregnancy and she is full term. She is in a lot
C
of pain, her liquor is stained with meconium and the
a
trace of her baby’s heart is classified as pathological.
s
Her grasp of English is limited. You have been asked e
to obtain her consent for a caesarean section… s
i
n
100 Cases in Clinical Ethics and Law explores legal and
ethical dilemmas through 100 clinical scenarios typical of C
those encountered by medical students and junior doctors in
l
i
the emergency or outpatient department, on the ward or in a n
community setting. Covering issues such as consent, capacity, withdrawal of treatment, i
c
confidentiality and whistle-blowing, each scenario has a practical problem-solving
i a
n element, encouraging readers to explore their own beliefs and values including those 100
l
that arise as a result of differing cultural and religious backgrounds. Answer pages E
highlight key points in each case, providing advice on how to deal with the emotive t
h
C issues that occur when practising medicine and guidance on appropriate behaviour.
ic Cases
Making speedy and appropriate decisions, and choosing the best course of action
l s
i to take as a result, is one of the most important and challenging parts of training to
n become a doctor. These true-to-life cases will teach students and junior doctors to a
n
recognize ethical and legal dilemmas as they arise, and to respond appropriately.
i
c d
Key features:
a L
a
• Succinct case studies presented in an easy-to-read format
l • Questions at the end of each case prompt readers to consider their options and w
E what action they should take
• Answer pages then guide readers through the clinical considerations and associated
t in
legal and ethical issues
h
• Information boxes highlight relevant legislation and key points summaries reinforce
i learning, ideal during exam revision
c
• Includes input from consultants, lawyers, religious leaders and healthcare professionals eSe
s dc
The author team: itioon
a nd
Carolyn Johnston LLB LLM MA PhD, Adviser in Medical Law and Ethics, School of
n Medical Education, Faculty of Life Sciences & Medicine, King’s College London; Senior J Clinical Ethics
Lecturer, Kingston University; and Member of the Institute of Medical Ethics Education o
d h
Steering Group, UK
n
s
Penelope Bradbury MBBS MA BSc MRCGP, GP Partner at The Witterings Medical Centre t
o
L
and GP Associate in Accident and Emergency Medicine, UK n and Law
a a
100 Cases Series Editor: n
w d
Janice Rymer MD FRCOG FRANZCOG FHEA, Dean of Student Affairs, Lead for Twinned B
Institutions and Professor of Gynaecology, King’s College School of Medicine, London, UK r
a
d
b
K26634 u
ry Carolyn Johnston
ISBN: 978-1-4987-3933-7
6000 Broken Sound Parkway, NW
Suite 300, Boca Raton, FL 33487 90000
Penelope Bradbury
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an informa business New York, NY 10017
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www.crcpress.com Abingdon, Oxon OX14 4RN, UK 9 781498 739337 Series editor: Janice Rymer
www.crcpress.com
100
Cases
in
Clinical Ethics
and Law
Second Edition
100 CASES 100
Series Editor: Janice Rymer
Cases
100 Cases in Clinical Ethics and Law, Second Edition
Carolyn Johnston and Penelope Bradbury
2015
100 Cases in Obstetrics and Gynaecology, Second Edition
Cecilia Bottomley and Janice Rymer
2014
in
100 Cases in Clinical Pathology
Eamon Shamil, Praful Ravi and Ashish Chandra
Clinical Ethics
2014
100 Cases in Surgery, Second Edition
and Law
James Gossage, Bijan Modarai, Arun Sahai, Richard Worth and Kevin G Burnand
2013
100 Cases in Clinical Medicine, Third Edition Second Edition
P John Rees, James Pattison, and Christopher Kosky
2013
100 Cases in Acute Medicine
Carolyn Johnston LLB LLM MA PhD
Kerry Layne, Henry Fok and Adam Nabeebaccus
2012 Adviser in Medical Law and Ethics, School of Medical Education
Faculty of Life Sciences & Medicine, King’s College London
100 Cases in Orthopaedics and Rheumatology Senior Lecturer, Kingston University
Parminder J Singh and Catherine Swales Member of the Institute of Medical Ethics Education Steering Group, UK
2012
Penelope Bradbury MBBS MA BSc MRCGP
100 Cases in Radiology GP Partner at The Witterings Medical Centre
Robert Thomas, James Connelly and Christopher Burke GP Associate in Accident and Emergency Medicine, UK
2012
100 Cases in Dermatology 100 Cases Series Editor:
Rachael Morris-Jones, Ann-Marie Powell and Emma Benton
Janice Rymer MD FRCOG FRANZCOG FHEA
2011
Dean of Student Affairs and Lead for Twinned Institutions
Professor of Gynaecology
100 Cases in Psychiatry
King’s College School of Medicine
Subodh Dave, Nisha Dogra and Barry Wright
London, UK
2010
100 Cases in General Practice
Anne Stephenson, Martin Mueller and John Grabinar
2009
100 Cases in Paediatrics
Joseph Raine, Aubrey Cunnington and Joanna Walker
2009
Boca Raton London New York
CRC Press is an imprint of the
Taylor & Francis Group, an informa business
100
Cases
in
Clinical Ethics
and Law
Second Edition
Carolyn Johnston LLB LLM MA PhD
Adviser in Medical Law and Ethics, School of Medical Education
Faculty of Life Sciences & Medicine, King’s College London
Senior Lecturer, Kingston University
Member of the Institute of Medical Ethics Education Steering Group, UK
Penelope Bradbury MBBS MA BSc MRCGP
GP Partner at The Witterings Medical Centre
GP Associate in Accident and Emergency Medicine, UK
100 Cases Series Editor:
Janice Rymer MD FRCOG FRANZCOG FHEA
Dean of Student Affairs and Lead for Twinned Institutions
Professor of Gynaecology
King’s College School of Medicine
London, UK
Boca Raton London New York
CRC Press is an imprint of the
Taylor & Francis Group, an informa business
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 2016 by Carolyn Johnston and Penelope Bradbury
CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
Version Date: 20151016
International Standard Book Number-13: 978-1-4987-3934-4 (eBook - PDF)
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CONTENTS
Foreword ix
Introduction xiii
Contributors xv
Glossary of Terms xvii
Section 1 Ethical Principles 1
Case 1: Principlism 1
Case 2: Consequentialism 3
Case 3: Deontology 5
Case 4: Virtue Ethics 7
Case 5: Casuistry 9
Case 6: Narrative Ethics 11
Case 7: Rights and Duties 13
Section 2 Ethics and Law in Clinical Practice: How to Deal with
an Ethical Dilemma in Clinical Practice 15
Section 3 Ethics and Law in Clinical Practice: Beginning of Life 17
Case 8: In Vitro Fertilisation 17
Case 9: Same-Sex Parenting 21
Case 10: Surrogacy 23
Case 11: Pre-Implantation Genetic Diagnosis 25
Case 12: Moral Status of the Foetus 27
Case 13: Termination of Pregnancy 29
Case 14: Conscientious Objection 33
Case 15: Pre-Natal Injury 35
Case 16: Neonatal Care: Legal and Ethical Issues 37
Section 4 Ethics and Law in Clinical Practice: Children and Adolescents 41
Case 17: Parental Responsibility and Consent 41
Case 18: Parental Refusal of Treatment 43
Case 19: Request for Non-Therapeutic Treatment 45
Case 20: Assessing Competence in Children 47
Case 21: Underage Contraception 49
Case 22: Adolescent Refusal of Life-Sustaining Treatment 53
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Contents
Case 23: Non-Engagement with Therapeutic Medication 57
Case 24: Withholding Information from a Child 59
Section 5 Ethics and Law in Clinical Practice: Consent, Capacity and
Refusal of Treatment 61
Case 25: Valid Consent to Treatment 61
Case 26: Adult Capacity to Consent to Treatment 65
Case 27: Consent and HIV 69
Case 28: Consent and Coercion 73
Case 29: Examination under Anaesthesia 75
Case 30: Refusal of Treatment 77
Case 31: Consent and Emergencies 79
Case 32: Assessment of Best Interests 81
Case 33: Deprivation of Liberty 85
Section 6 Ethics and Law in Clinical Practice: Confidentiality 89
Case 34: Confidentiality 89
Case 35: Confidentiality and Children 93
Case 36: Access to Healthcare Information 95
Case 37: Confidentiality and HIV 99
Case 38: Use of Interpreters 103
Case 39: Disclosing Genetic Information 105
Case 40: Genetic Testing of Children for Adult-Onset Conditions 107
Section 7 Ethics and Law in Clinical Practice: Negligence 109
Case 41: Standard of Care and Negligence 109
Case 42: Provision of Information 111
Case 43: Out of Your Depth 115
Case 44: Reporting Concerns 117
Case 45: Making Mistakes and Incident Forms 119
Case 46: Complaints 121
Section 8 Ethics and Law in Clinical Practice: Mental Health 123
Case 47: When to Section a Patient under the Mental Health Act 123
Case 48: Appropriate and Effective Treatment under the Mental Health Act 125
Case 49: Medical Treatment for Patients with a Mental Health Disorder 127
Case 50: Conflict in Treatment Aims 131
Case 51: Treatment for Eating Disorders 133
vi
Contents
Case 52: Personal Identity 135
Case 53: Self-Harm 137
Case 54: Covert Medication 139
Section 9 Ethics and Law in Clinical Practice: Public Health 143
Case 55: Patients’ Responsibility for Health and Resource Allocation 143
Case 56: Managing Patient Expectations 147
Case 57: Requests for Expensive Medical Treatment 151
Case 58: Prophylactic Surgery 153
Case 59: Screening Programmes 155
Case 60: Childhood Immunisation 159
Case 61: Professional Responsibility to Discuss Obesity 161
Case 62: Incentives for Treatment and Health Promotion 165
Case 63: Front-Line Staff and Flu Immunisation 169
Case 64: Overseas Visitors 173
Section 10 Ethics and Law in Clinical Practice: Organ Donation 175
Case 65: Organ Donation 175
Case 66: Posthumous Organ Donation 179
Case 67: Is there a Market for Living Organ Donors? 181
Case 68: Social Media and Organ Donation 183
Section 11 Ethics and Law in Clinical Practice: End of Life 185
Case 69: The Distinction between Acts and Omissions at the End of Life 185
Case 70: Quality of Life and Sanctity of Life Judgements 189
Case 71: Basic Care and Medical Treatment at the End of Life 193
Case 72: Provision of Futile Treatment 195
Case 73: Assisted Suicide 197
Case 74: Advance Decisions 201
Case 75: Advance Decisions and Attempted Suicide 205
Case 76: Do Not Attempt Cardiopulmonary Resuscitation Orders 209
Case 77: Brainstem Death 213
Case 78: After Death – Coroners and Cremation Forms 217
Section 12 Duties of a Doctor 221
Case 79: Compassion and Resilience 221
Case 80: Good Samaritan Acts 223
vii
Contents
Case 81: Delegation and Handover 227
Case 82: Professional Responsibility toward an Abusive Patient 229
Case 83: Discharge against Medical Advice 233
Case 84: Child Safeguarding 235
Case 85: Treating Friends and Relatives 237
Case 86: Professionalism and Social Media 239
Case 87: Doctors and DVLA Regulations 241
Case 88: The Role of Clinical and Research Ethics Committees 243
Section 13 Faith, Values and Culture 245
Case 89: Medicalisation of Human Experience 245
Case 90: Jehovah’s Witnesses and Blood Transfusions 249
Case 91: Ramadan and Professional Responsibility 251
Case 92: Female Genital Mutilation 253
Case 93: Childhood Male Circumcision 257
Case 94: Disclosure of Diagnosis and Cultural Relativism 259
Case 95: Cultural Considerations in Post Mortem Examination 261
Case 96: Requests to see a ‘British’ Doctor 263
Case 97: Chaperones 265
Case 98: Professional Boundaries 267
Case 99: Ethical Issues on Elective 269
Case 100: Professional Experience of Illness 271
Resources 275
viii
