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Law and Ethics in Children's Nursing
Abstract
Law and Ethics in Children's Nursing is an important and practical guide on the legal and ethical spects of child healthcare that enables nurses to understand the legal and ethical principles that underpin everyday nursing practice. It explores the concept of childhood and children's rights, the extent to which their rights are upheld in a variety of settings, and the relationship between law and ethics and how they interact in resolving problems and dilemmas that commonly arise in practice. With case studies, learning outcomes and scenarios throughout, Law and Ethics in Children's Nursing places the care and treatment of children in a legal and ethical framework, and explores the way in which legal and ethical aspects of children's nursing differ from those of adults. It explores general principles such as autonomy and consent, confidentiality, accountability and negligence. It then goes on to look at specialist areas such as abortion, sterilisation, research, mental health, organ donation, child protection and death.
... Direct interaction with young patients and their parents necessitates high levels of scienti c and ethical competence (14). Ethical care for children involves comprehensive knowledge, attention to physical and psychosocial development, effective communication with children and their families, adherence to children's rights, and collaboration with relevant professionals (15). A Swedish study indicated that less than one-third of pediatric nurses felt they could consistently provide good ethical care(16). ...
Introduction: Recognizing the significance of moral distress in pediatric settings and the potential of a valid and reliable tool to identify its occurrence and aid in developing preventive strategies, this study aimed to design and evaluate the psychometric properties of a moral distress instrument specifically for nurses in pediatric wards. Method A mixed-methods approach with a sequential exploratory design, based on Creswell’s methodology, was employed. The study was conducted in three phases from 2024 to 2025 in Mazandaran Province: (1) a qualitative phase to clarify the key concept, (2) item development for the instrument, and (3) an experimental phase involving psychometric evaluation. The initial qualitative phase explored nurses’ experiences of moral distress in pediatric wards using a phenomenological approach. Lived experiences were gathered through in-depth, structured, and semi-structured interviews with 12 nurses from hospitals in Tehran and Babol, and analyzed using Van Manen’s method. In the second phase, instrument items were developed, and validation processes, including face validity, content validity, and construct validity (using exploratory factor analysis), were conducted. Reliability was assessed through internal consistency and stability. Findings: Following the initial phase, a pool of 76 preliminary items was generated. After assessing face and content validity, the number of items was reduced to 22. The content validity index for the overall instrument (S-CVI/Ave) was 0.89, indicating acceptable validity. Exploratory factor analysis, using the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy and Bartlett’s test of sphericity, was performed on the 22 items. The analysis identified three factors accounting for the majority of the variance (53.64%). The KMO statistic was 0.711, and Bartlett’s test yielded P = 0.000. Cronbach’s alpha and the Intraclass Correlation Coefficient (ICC) were 0.814, indicating good internal consistency and reliability of the instrument. Conclusion Moral distress among nurses can lead to burnout, increased patient safety risks, and reduced quality of care. This instrument can assist healthcare managers and policymakers in assessing moral distress in pediatric nurses and implementing necessary support interventions.
... Criminal and civil laws are the most common laws used in dealing with deviation in nursing practice (7) . Criminal law attempts to protect the public from harm by threatening punishment or punishing those who commit crimes (8) . Violation of any law governing the practice of any licensed profession may be a crime even if no actual harm occurred (9) . ...
Background: The expanded scope of nursing practice has brought increased responsibility and legal accountability, along with it, increased exposure to liability. Moreover, with the explosion of societal knowledge, ordinary people know more about their health and the roles of health team members. Therefore, nurses are in need of education about the legal aspects of practicing their profession. Aim: The study aims toassess nurses' knowledge of legal liability concerning their clinical nursing practice. Results: The results revealed that the majority of nurses had poor/inadequate to fair/moderate levels of knowledge of the legal liability of their clinical practices. In specific, nurses' knowledge in relation to assault was the most deficit dimension followed by false imprisonment, battery, carrying out physician order, employment of nursing students, and dealing with suit prone patients. Conclusion and Recommendations: The present study confirmed that there is a greater potential risk on nurses working in the study hospitals to be liable as they do not have the basic knowledge of laws and regulations governing their practice. Also, it implies that there is a need for continued and intensified efforts to ensure that nurses acquire knowledge necessary about the legal aspects and issues of nursing practice.
... Children under the age of 16 years need to demonstrate what is known as 'Gillick competence' before they can provide valid consent (Hendrick 2010). The principle of Gillick competence arose from the case of Victoria Gillick, who attempted to prevent GPs and healthcare professionals providing contraceptive and sexual health advice to children under the age of 16 years without first obtaining permission from the parent or guardian (Gillick v West Norfolk & Wisbech Area Health Authority [1986]). ...
Consent to treatment is a common, albeit complex, aspect of nursing practice. Over the past few years, laws have been strengthened to provide increased recognition of patient autonomy. This has meant that there is a greater onus placed on nurses to understand how consent is obtained from patients, the elements required to ensure any consent is valid, and how to proceed when it has been determined that a patient does not have the mental capacity to consent to treatment. This article explores some of the legal considerations that nurses should keep in mind when seeking consent from a patient.
... Individuals in critical care units or psychiatric settings, or individuals who are incarcerated, might have diminished capacity for decision-making and asserting their rights. This is also true of children or individuals who are not considered to be competent in the legal sense (Committee on Bioethics, 2006;Hendrick, 2010). It is in these circumstances that human rights are vulnerable to violation and that ethical issues will emerge. ...
... Based on the findings of this study, the dignity of the patients is also maintained when their autonomy is respected and the personnel refrains from displaying excessive compassion, tells the truth about the disease, and provides quality of care. Findings of the study by Hendrick 56 and Baillie and Matiti 57 showed that safeguarding autonomy is another aspect of maintaining human values and is the fundamental principle of patient-centered and ethical care contributing to the preservation of a patient's dignity. The participants in this study expressed that they would feel more valued if the patient and his or her family could get involved in the care program and medical treatment. ...
Background
Since “dignity” is one of the fundamental rights of every patient, consideration for patients’ dignity is essential. Unfortunately, in many cases, especially in cancer patients, dignity is not fully respected. Dignity is an abstract concept, and there are only a few comprehensive studies on the dignity of cancer patients in Iran.
Research objective
This study aimed to evaluate the perception of Iranian cancer patients on human dignity.
Research design
A qualitative research approach was used as the study design. The data were collected through individual semi-structured interviews and analyzed using the qualitative content analysis method.
Participants and research context
This study was conducted on cancer patients in internal medicine wards in Iran. The data were gathered through semi-structured interviews from May 2017 to February 2018.
Ethical considerations
The study protocol was approved by the Research Ethics Committee of medical universities located in Southwest of Iran. The ethical principles were carefully followed throughout the study.
Findings
Based on the results of the interviews, 3 main themes and 11 categories were determined. The main themes were identified as the “personal space and privacy,” “respect for human values,” and “moral support.”
Discussion
The results of the present study showed the necessity of care for cancer patients in a respectful manner. The key elements in such care were the preservation of their personal space and privacy, respect for their values, and the provision of adequate moral support. These measures will have a positive effect on the perception of such patients on human dignity.
Conclusion
Considering the special care required by cancer patients, the Iranian healthcare and hygiene managers should design and implement a care plan that includes the ethical principles related to human dignity.
... Consent may be express or implied. 15 The clearest cases of consent are what we may call 'express' or 'explicit' consent, as when a patient signs a consent form or an organ donor register. In these cases, providing that certain conditions are met (for instance that the patient is competent, informed and not under duress) it is quite clear that consent has been given and is normatively binding. ...
This paper defends an 'opt-out' scheme for organ procurement, by distinguishing this system from 'presumed consent' (which the author regards as an erroneous justification of it). It, first, stresses the moral importance of increasing the supply of organs and argues that making donation easier need not conflict with altruism. It then goes on to explore one way that donation can be increased, namely by adopting an opt-out system, in which cadaveric organs are used unless the deceased (or their family) registered an objection. Such policies are often labelled 'presumed consent', but it is argued that critics are right to be sceptical of this idea-consent is shown to be an action, rather than a mental attitude, and thus not something that can be presumed. Either someone has consented or they have not, whatever their attitude to the use of their organs. Thankfully, an opt-out scheme need not rest on the presumption of consent. Actual consent can be given implicitly, by one's actions, so it is argued that the failure to register an objection (given certain background conditions) should itself be taken as sign of consent. Therefore, it is permissible to use the organs of someone who did not opt out, because they have-by their silence-actually consented.
Background & Aim: Nurses, as direct providers of patient care, face higher levels of psychological
stress in the workplace compared to other healthcare professionals. Nurses working in pediatric wards,
where they interact with children and their families, experience increased levels of moral distress. This
study was designed to explore the experiences of nurses working in pediatric units regarding moral
distress.
Materials & Methods: This qualitative study was conducted using interpretive phenomenological
analysis between 2023 and 2024. Twelve nurses with moral distress experiences were selected through
purposive sampling from hospitals of Babol and Tehran Universities of Medical Sciences. Data were
collected through semi-structured and individual interviews and analyzed simultaneously using Van
Manen's approach.
Results: The findings include three main themes and seven subthemes including moral distress related
to colleagues (lack of competence, physician-centered), hospital policies (lack of personnel, high
workload, and lack of proper equipment), psychological stress following moral distress (negative effects
following the sudden death of a child, feeling of insufficiency, and helplessness).
Conclusion: According to the study's findings, reducing moral distress by enhancing clinical knowledge
and experience, fostering self-confidence, providing organizational support, managing nurses'
workloads, and paying attention to nurses' emotions can be beneficial. Also, designing and organizing
educational programs and workshops to help reduce nurses' distress by identifying stressful conditions
and minimizing exposure to moral dilemmas.
Background: As direct and continuous providers of patient services, nurses are more exposed tovarious types of psychological stress in the work environment compared to other members of the health system. Nurses working in pediatric wards are in contact with children, and their families are more exposed to moral distress.This study aimed to investigate Iranian nurses’ understanding of moral distress in pediatric wards.
Methods: This qualitative study was conducted through inductive content analysis in 2023-2024. Data were collected through semi-structured and individual interviews and analyzed simultaneously and continuously using Graneheim and Lundman’s approach.
Twelve participants among nurses with moral distress experiences were selected through purposive sampling from Babol and Tehran Universities of Medical Sciences.
Results: The study findings include four main classes and eight subclasses: 1) moral distress related to colleagues (doctor and nurse colleagues), 2) moral distress related to parents (conflict with children’s rights and distrust in nurses), 3) moral distress related to organizational factors (lack of manpower and proper equipment), and 4) psychological tensions following moral distress (mental conflict and exhaustion).
Conclusion: The findings demonstrate the need for mechanisms by managers and officials to hold educational programs and workshops to help reduce moral distress levels in nurses. To this end, it is necessary to identify the stressful conditions caused by nursing care in this ward and reduce nurses’ exposure to stress in moral dilemmas.
Online sexual exploitation is an important safeguarding concern and cases are likely to be under-reported. Fiona Bullock discusses the law and the role school nurses can play in prevention and early intervention.
The purpose of this study was to determine how pediatric nurses decide on ethical issues in sample cases and how they evaluate those issues in terms of ethical principles, as well as to determine the problem-solving approaches that they recommend in this regard. Qualitative methods were used in this study and the data was collected from 100 pediatric nurses using a demographic data form and an open-ended questionnaire. The demographic data form included questions about the characteristics of nurses and their participation in decisions made about ethical issues. Whereas the open-ended questionnaire consisted of questions regarding sample cases, which were developed by the investigators using current literature. Forty-four percent of the pediatric nurses reported an attempt to solve ethical issues that they encountered through their professional experiences using personal values. On the other hand, 53 % of the pediatric nurses stated that their decisions were sometimes taken into consideration in the treatment plan of their own patients, while 49 % reported that they could not participate in decision-making regarding patients’ discharge. Seventy-six percent of the pediatric nurses did not define the ethical issues in the three sample cases. However, in other cases, most of the nurses evaluated ethical issues correctly and recommended correct approaches. No statistically significant difference was found between their educational backgrounds, professional experiences, the ethical issues that they evaluated, and the approaches recommended for problem solving. It is recommended that nurses receive more undergraduate and in-service ethics training in order to develop appropriate approaches toward the ethical issues they will encounter during their professional lives.
Background:
Consideration of patient autonomy is an essential element in individualized, patient-centered, ethical care. Internal and external factors associated with patient autonomy are related to culture and it is not clear what they are in Iran. The aim of this study was to explore contextual factors affecting the autonomy of patients in Iranian hospitals.
Materials and methods:
This was a qualitative study using conventional content analysis methods. Thirty-four participants (23 patients, 9 nurses, and 2 doctors) from three Iranian teaching hospitals, selected using purposive sampling, participated in semi-structured interviews. Unstructured observation and filed notes were other methods for data collection. The data were subjected to qualitative content analysis and analyzed using the MAXQDA-10 software.
Results:
Five categories and sixteen subcategories were identified. The five main categories related to patient autonomy were: Intrapersonal factors, physical health status, supportive family and friends, communication style, and organizational constraints.
Conclusions:
In summary, this study uncovered contextual factors that the care team, managers, and planners in the health field should target in order to improve patient autonomy in Iranian hospitals.
Opt‐in strategies only take organs from those who have specifically consented to donation, whereas opt‐out strategies treat everyone as a willing donor unless they exempt themselves. Both strategies allow individuals (or their next of kin) power to determine what happens to their cadaveric organs; the difference between them is the ‘default’ treatment of someone who has expressed no wish either way. Opt‐out strategies are likely to increase donation rates, because those who do not register a preference either way will be treated as donors. Opt‐out strategies are often called ‘presumed consent’ and critics contend that this is unjustifiable. In fact, numerous other justifications for such a policy are available, for instance it may be that those who do not opt out thereby tacitly consent to the use of their organs.
Key Concepts
Opt‐in donation strategies means no one's organs are used without their consent.
Opt‐out donation strategies mean that everyone is treated as a donor unless they specifically refuse.
Few countries operate ‘pure’ opt‐in or opt‐out strategies, because consent is usually sought from next of kin.
It is difficult to measure or predict the effects of a change in policy, but likely that an opt‐out strategy will procure more organs than an opt‐in strategy.
An opt‐out strategy should not be identified with ‘presumed consent’.
There are a variety of possible justifications for an opt‐out strategy, including tacit consent and normative consent.
‘Tacit consent’ means that one's consent is implied by one's silence.
Tacit consent does not necessarily meet the conditions of informed consent.
Michael Rawlins and Andrew Dillon start their defence of Nice in fine polemical style, unfortunately polemics is all they have to offer. They totally fail to justify the Nice proposals on dementia treatments nor do they make any more plausible than formerly their use of the notorious QALY. They say:
Harris’s recent editorial, It’s not NICE to discriminate, is long on both polemic and invective – but short on scholarship. He offers nothing to illuminate the debate about allocating healthcare in circumstances of finite resources; he has no understanding of the quality adjusted life year (QALY) and its use in health economic evaluation; and he makes ill-researched, unsubstantiated and offensive charges against the Institute and its advisory bodies.
Accusations are easy to make, difficult to substantiate. There are a number of claims here, only one of which is true. It is true that my editorial was robust, polemical if you like, but editorials are not the same as research papers and these are important issues which deeply affect real lives. Although Rawlins and Dillon affect to take the high ground their own article contains even more vigorous and much more personal invective than my editorial, I make no complaints. But as to the rest of what they say, well, let’s just see!
They claim I offer nothing to illuminate resource allocation and that I have no understanding of the QALY. Both of these claims may well be true, but nothing they say goes any way to support these claims or even towards making them plausible. I have studied and written about the QALY for almost 20 years1,2,3,4,5,6,7,8,9,10,11,12,13,14,15 and Rawlins and Dillon show no evidence of any awareness or indeed any understanding of the issues, whether …
This article argues that resistance to the Human Rights Act has built up in the context of disputes relating to children and that such resistance is founded in the attachment of the courts to the welfare or paramountcy principle as currently conceived-the principle that the child's welfare automatically prevails over the rights of other family members. It argues that the failure to take account of Convention arguments could only be a legitimate stance if there was no conflict between the demands of the welfare principle and those of the Convention guarantees, but that in fact the approach of the European Court of Human Rights differs considerably from that of the UK courts since it seeks to balance the rights of different family members. The article goes on to argue that, taking account of the Strasbourg stance and of the already established domestic recognition of the presumptive equality of competing qualified Convention rights, it is time to accept the adoption of a new model of judicial reasoning in the context of disputes over children-the 'parallel analysis' or 'ultimate balancing act'.
The paper examines conceptual barriers to incorporation of children’s rights – understood in the context of the European Convention for the Protection of Human Rights and Fundamental Freedoms 1950, the Human Rights Act 1998 and the United Nations Convention on the Rights of the Child 1989 – in the law of England and Wales. It identifies traditions in law and policy on children and young people, and competing political imperatives which militate against effective implementation of children’s rights to protection and provision, but suggests that participative rights pose fewer problems. It argues that the scope for further judicial development is limited in the absence of substantial changes in the legislative framework. It then examines rights-based reasoning in administrative practice and considers the impact here of ideological differences between the UK Government and the Welsh Assembly Government. It considers the scope for differential implementation within the evolving devolution settlement, and the potential impact of such difference on child law and practice in the ‘single jurisdiction’ of England and Wales. It concludes by arguing for greater attention to executive as well as legislative and judicial functions, and to extra-judicial mechanisms, for promoting rights-based decision making.
The use of the Quality Adjusted Life-Year (QALY) as a measure of the benefit obtained from health care expenditure has been attacked on the ground that it gives a lower value to preserving the lives of people with a permanent disability or illness than to preserving the lives of those who are healthy and not disabled. The reason for this is that the quality of life of those with illness or disability is ranked, on the QALY scale, below that of someone without a disability or illness. Hence we can, other things being equal, gain more QALYs by saving the lives of those without a permanent disability or illness than by saving the lives of those who are disadvantaged in these ways. But to do so puts these disadvantaged people under a kind of double jeopardy. Not only do they suffer from the disability or illness, but because of it, a low priority is given to forms of health care that can preserve their lives. This, so the objection runs, is unjust or unfair. This article assesses this objection to the use of QALYs as a basis for allocating health care resources. It seeks to determine what is sound in the double jeopardy objection, and then to show that the defender of QALYs has an adequate response to it.
There is a growing body of writing, for instance from the nursing profession, espousing an approach to ethics based on care. I suggest that this approach is hopelessly vague and that the vagueness is due to an inadequate analysis of the concept of care. An analysis of 'care' and related terms suggests that care is morally neutral. Caring is not good in itself, but only when it is for the right things and expressed in the right way. 'Caring' ethics assumes wrongly that caring is good, thus it can tell us neither what constitutes those right things, nor what constitutes the right way.
Prolonging neonatal life
The paradox that medicine’s success breeds medicine’s problems is well known to readers of the Journal of Medical Ethics . Advances in neonatal medicine have worked wonders. Not long ago, extremely premature birth babies, or those born with very serious health problems, would inevitably have died. Today, neonatologists can resuscitate babies born at ever-earlier stages of gestation. And very ill babies also benefit from advances in neonatal intensive care. Infant lives can be prolonged. Unfortunately, several such babies will not survive for long whatever is done for them. Others will live to leave hospital, but face severe health problems. Doctors have gained the ability to prolong neonatal life. But should they always do so? This question is central to the recent report of the Nuffield Council on Bioethics, Critical care decisions in fetal and neonatal medicine .1 In many quarters, the report received a very positive response, commended in The Lancet as “thoughtful, sensitive and sensible” and welcomed by the premature baby charity BLISS. Critics attacked on both flanks. The report goes too far—ushering in a culture of “throw away babies”. Or it does not go far enough—failing to endorse the Dutch precedent to sanction active neonatal euthanasia.
One of the key recommendations of the report is that guidelines be developed in relation to the institution of intensive neonatal care. It is these guidelines, which have been savaged by some parts of the media. The BMA called them “blanket rules” smothering clinical discretion. The guidelines on resuscitation at birth apply to babies born at the borderline of viability, that is, at or before a gestational age of 25 weeks 6 days. The earlier the baby is born, the lower are the chances that he/she will survive to leave hospital. Before 21 weeks 6 days, none of …
This paper examines the law relating to healthcare resource allocation in England. The National Health Service (NHS) Act 1977 does not impose an absolute duty to provide specified healthcare services. The courts will only interfere with a resource allocation decision made by an NHS body if that decision is frankly irrational (or where the decision infringes the principle of proportionality when a right under the European Convention on Human Rights (ECHR) is engaged). Such irrationality is very difficult to establish. The ECHR has made no significant contribution to domestic English law in the arena of healthcare provision. The decision of the European Court in the Yvonne Watts case establishes that, in relation to the question of entitlement to seek treatment abroad at the expense of the NHS, a clinical judgment about the urgency of treatment trumps an administrative decision about waiting list targets. That decision goes against the grain of domestic law about healthcare allocation, but is not likely to have wide ramifications in domestic law.
This book provides an essential one-stop introduction to the key concepts, issues, policies and practices affecting child welfare, with particular emphasis on the changing nature of the relationship between child welfare and social policy. No other book brings together such a wide selection of material to form an attractive and indispensable teaching and learning resource. Child welfare and social policy provides readers with an historical overview of child welfare in England and Wales; high quality contributions from leading authorities in the field; discursive introductions to each section that set individual chapters in the broader context of childhood studies and case study material to bring discussions to life.Key topics covered include morality and child welfare; relations between law, medicine, social work, social theory and child welfare; children’s rights and democratic citizenship and children as raw material for ‘social investment’. Child welfare and social policy is invaluable reading for students and academics in social policy, sociology, education and social work. It is also a useful resource for health and social work professionals wishing to follow current debates in theory and practice.
The Mental Capacity Act (2005) governs decision-making processes on behalf of adults who are unable to give informed consent, whether they lose mental capacity at some point in their lives due to illness or injury or where the incapacitating condition has been present since birth. Legal Aspects of Mental Capacity will assist practitioners in understanding the basic provisions of the Act and how it applies to their professional responsibilities. It is also intended to be of assistance to the many carers who find themselves in the position of needing to make decisions on behalf of mentally incapacitated relatives and friends. Each chapter sets out the basis provisions, followed by a series of scenarios dealing with practical concerns which are discussed in the light of the new legislation. A practical guide to the provisions of the Mental Capacity Act 2005 Easily accessible for those with no legal background Includes scenarios illustrating different legal points Explores the background to the legislation, including determination of capacity and the definition of best interests Legal Aspects of Mental Capacity is an essential resource for all healthcare and social services professionals, patient services managers and carers working with those who lack the capacity to make their own decisions.
This article evaluates criticisms that have been made of the principle contained in section 1 of the Children Act 1989 that the welfare of the child should be the courts' paramount consideration in resolving disputes over a child's upbringing. In particular, it considers the complaints that the principle is unpredictable in its application, that it fails to adequately protect children's rights and that it does not pay sufficient attention to the interests of others. It is argued that these objections are not as strong as may at first appear and, that by adopting a relationship-based approach to welfare, it is possible to provide a powerful defence of the principle.
Delineates the moral and legal rights of children, including the right to be regarded as a person in the family, at school, and before the law; the right to receive parental love and affection; the right to be supported, maintained, and educated; and the right to be treated fairly by all authority figures. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In a previous paper in this journal I responded to Professor John Keown’s criticisms of the British Medical Association guidance on withholding and withdrawing life-prolonging treatment, arguing that the sanctity of life principle he endorses is indefensible as a juridical and moral guide. Professor Keown replied recently, also in this journal, alleging that I wrongly caricatured the sanctity of life position he supports, which continues to illuminate the proper decision-making path in relation to the withdrawal or withholding of life-sustaining medical treatment. In this present paper it is submitted that Keown’s riposte is misconceived and disguises the true nature of the sanctity of life stance, which both rests upon unconvincing premisses and tends towards unacceptable repercussions, thus leading to its inevitable and rightful rejection.
This article examines recent health policy developments in England in relation to children’s rights under Article 12 and 13 of the United Nations Convention on the Rights of the Child (UNCRC). It draws on practice and research literature to explore evidence regarding: children’s participation both within decisions about their own care and concerning the development of health services, their access to mechanisms that allow them a voice, the provision of and need for accessible information, and factors which prevent or facilitate children's participation. This paper does not explore in detail issues concerning children’s consent or competence to participate, for authoritative accounts on these subjects, see for example, Alderson and Montgomery, 1996; Alderson, 2000; British Medical Association, 2001; Department of Health, 2001a.
The term children is used to describe children and young people and does not specify an age range thus reflecting the variation and ambiguity of age range within much of the literature on children’s participation.
This paper is an examination of how research ethics committees have evolved from being advisory committees to more formal regulatory authorities. It is argued that the role of ethics committees should be broader than simple ethical review. Inconsistency in outcome should not be taken to signal failure. Procedural fairness is of the utmost importance. Nor should ethics committees be seen to diminish the ethical responsibilities of researchers themselves.
Children of all ages should be active partners in decision making, including decisions on whether to participate in research studies. With appropriate engagement techniques and information material, children as young as two years of age can indicate assent or dissent as part of the ongoing process of agreement to research. This guidance for researchers working with young children includes practical approaches to establishing rapport, checking that the child has understood what involvement in the study means, and ensuring they can signal withdrawal of agreement.
This paper discusses the attempt in this issue of the journal by Peter Singer, John McKie, Helga Kuhse and Jeff Richardson, to defend QALYs against the argument from double jeopardy which I first outlined in 1987. In showing how the QALY and other similar measures which combine life expectancy and quality of life and use these to justify particular allocations of health care resource, remain vulnerable to the charge of double jeopardy I am able to clarify some of the central issues concerning the value of life. In particular, the idea that the value of a life varies with its life expectancy and with its quality, understood in terms of its richness, variety, success etc, is subjected to special examination. It is shown how defenders of QALYs are committed to the view that so far from all lives being of equal value, all lives are necessarily of subtly different value. The paper then analyses the use to which the notorious 'veil of ignorance' has been put both by Singer et al and by others and shows how this device of John Rawls's cannot do the work so often assigned to it. The paper then considers the issue of hypothetical consent and the role that it can play in justifying disposing of the lives of people who have not in fact consented to their lives being disposed of in particular ways. Finally, the paper makes some points about the comprehensive nature of the data collection and storage which would be required by QALY advocates and points out the independent problems attaching to licensing such comprehensive collection and use of personal data.
The fetus is characterized as a "human organism" which, according to both the "stage" and "process" ontological theories, is a partly but not fully real individual human being. Abortion deprives the fetus of a future full-fledged human life, and this susceptibility to loss entitles it to certain moral rights, though not to the entire range of rights accorded a fully human being. Therefore, as the fetus becomes more fully human, the seriousness of abortion approaches that of infanticide.
This paper explores difficulties around consent in the context of organ retention and return. It addresses the proposals of the Independent Review Group in Scotland on the Retention of Organs at Post Mortem to speak of authorisation rather than consent. Practical problems about whose consent determines disputes in relation to organ retention are explored. If a young child dies and his mother refuses consent but his father agrees what should ensue? Should the expressed wishes of a deceased adult override the objections of surviving relatives? The paper suggests much broader understanding of the issues embedded in organ retention is needed to provide solutions which truly meet families' and society's needs.
Following the Gillick case in 1986, it was recognised that mature minors were owed a duty of confidentiality in respect of their medical information. Subsequent cases confirmed that the duty was also owed to non-competent children, including infants, but without explaining the basis for finding the existence of such a duty and its scope. It is particularly unclear when and upon what legal basis a doctor could disclose information to parents when their child wished to keep it confidential. This paper will examine the law of confidentiality as it applies to children, identifying issues which are problematic. Developments in the law of personal confidences which have taken place as a result of the Human Rights Act 1998, and the recognition of Article 8 rights as part of the law, will be reviewed and analysed from the perspective of the duty of confidence owed to children in respect of their medical information. Finally, the paper will offer an explanation of a basis for disclosure to parents which minimises violations of a minor's autonomy.
The doctrine that it is wrong to end the existence of something because it is a human life (unless special circumstances obtain) I call “the standard view.” I argue that attempts by proponents of abortion choice to avoid the implications of the standard view by suggesting that we don't know when life begins or by suggesting that fetuses are only potential lives fail. Nevertheless, opponents of abortion choice should not base their arguments on the standard view, for the standard view is false. I propose a substitute for the standard view that avoids the difficulties with it, that explains why most people believe that the standard view is true and that also underwrites opposition to abortion choice.
Consent and confidentiality are increasingly important in clinical practice. However, the dilemmas faced by mental health practitioners can be highly complex and difficult to resolve. This difficulty is compounded by the fact that consent and confidentiality are subject to several different types of legislation based on different principles, and many of the policies which are formulated for general medical practice may not fit well with the mental healthcare context. The ethical principles, evidence base, legal context, developmental considerations and clinical context relevant to each situation must all be integrated, in consultation with children and adolescents and their parents, in order to arrive at a treatment plan which is sensitive to the views of all, developmentally appropriate for the children and adolescents, and responsive to changes in the situation or attitudes. We offer some practical approaches, including clinical practice algorithms, to consider the issues of consent and confidentiality in the child and adolescent mental healthcare setting.
