Do no harm—do patients have responsibilities too?

Cambridge Law Journal

Volumn 65, Issue 2, 2006, Pages 397-422

  Brazier, Margaret ^a  

^a UNIVERSITY OF MANCHESTER   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

EID: 43249156532     PISSN: 00081973     EISSN: 14692139     Source Type: Journal    
DOI: 10.1017/S0008197306007161     Document Type: Article

References (123)

1. [2000] Lloyds Rep. Med. 355.
2. Lloyds Rep. Med. at p. 367.
3. Secretary of State for the Home Department v. Robb [1995] Fam. 127.
4. Mental Health Act 1983, s. 63. It must be acknowledged that the courts have incrementally adopted an extraordinarily broad definition of what constitutes treatment for mental disorder
5. see B. v. Croydon Health Authority [1995] Fam. 133, CA
6. Tameside and Glossop Acute Services Trust v. CH [1996] 1 F.L.R. 762.
7. Re C (adult: refusal of treatment) [1994] 1 W.L.R. 290. See now the Mental Capacity Act 2005, s. 2.
8. For a full analysis of the several aspects of the judgment see P. Fennell (Commentary), R. v. Ashworth Hospital Authority ex p. Brady (2000) 8 Medical Law Review 251.
9. 7 Medical Law Review, at p. 365.
10. Medical Law Review, at p. 366.
11. S. Foster, “Force Feeding, Self-determination and the Right to Rie” (2000) 150 N.L.J. 857.
12. See, for example, the speech of Lord Diplock in Sidaway v. Board of Governors of Bethlem Royal and the Maudsley Hospital [1985] A.C. 871, 894–895.
13. And see M. Brazier, “Patient Autonomy and Consent to Treatment: The Role of the Law?” (1987) 7 L.S. 169.
14. T.L. Beauchamp and J. F. Childress, Principles of Biomedical Ethics, 5th ed. (Oxford 2001).
15. See, for example, K. Clouser and B. Gert, “A Critique of Principalism” (1996) 15 Journal of Medical Philosophy 219.
16. For a more measured judgment of “principalism” see J. Savulescu et al. “Festschrift Edition of the Journal of Medical Ethics in Honour of Raanan Gillon” (2003) 29 Journal of Medical Ethics 265–312.
17. H. Draper and T. Sorrell, “Patients’ Responsibilities in Medical Ethics” (2002) 16 Bioethics 335–352.
18. And see J.K. Mason and G.T. Laurie, Law and Medical Ethics, 7th ed. (Oxford 2005) at pp. 4–10.
19. Law and Medical Ethics at p. 335.
20. See Campbell v. Mirror Group Newspapers Ltd. [2004] 2 A.C. 457, H.L. and
21. see P. Case, “Confidence Matters: The Rise and Fall of Informational Autonomy in Medical Law” (2003) 11 Medical Law Review 208.
22. See C.E. Schneider, The Practice of Autonomy: Patients, Doctors and Medical Decisions (Oxford 1998)
23. cited in G.M. Stirrat and R. Gill, “Autonomy in Medical Ethics After O'Neill” (2005) 31 Journal of Medical Ethics 127–130.
24. O. O'Neill Autonomy and Trust in Bioethics (Cambridge 2002).
25. And see O. O'Neill, “Some Limits of Informed Consent” (2003) 29 Journal of Medical Ethics 4–7;
26. O. O'Neill, A Question of Trust (Cambridge 2002).
27. R. Faden and T. Beauchamp (in collaboration with N.M.P. King), A History and Theory of Informed Consent (Cambridge 1986) p. 7.
28. See Autonomy and Trust in Bioethics, note 18 above, at p. 22.
29. See in particular Re T (Adult: Refusal of Medical Treatment) [1993] Fam. 95, 102, CA, Airedale
30. NHS Trust v. Bland [1993] A.C. 789, HL
31. St George's NHS Hospital Trust v. S [1999] Fam. 26, C.A.
32. Daniel Callahan “Can the Moral Commons Survive Autonomy?” (1996) Hastings Centre Report 41–42.
33. For example, the “respect agenda”, the key theme of the Queen's Speech in May 2005: see The Times 18 May, 2005.
34. Reflecting perhaps a tentative endorsement of communitarian medical ethics, see D. Callahan, “Principalism and Communitarianism” (2003) 29 Journal of Medical Ethics 287.
35. David Hume “Of Suicide” in Essays, Moral, Political and Literary, ed. Eugene Miller (Indianapolis 1985), 577–589.
36. Donoghue v. Stevenson [1932] A.C. 562, 580.
37. See R. Gillon Philosophical Medical Ethics (Chichester 1996) especially Chapter 5
38. “The Function of Criticism” (1981) 283 B.M.J. 1633.
39. Thomas Percival, Medical Ethics (1808)
40. see C.D. Leake (ed.), Percival's Medical Ethics (Baltimore 1927).
41. An attack which is well justified and substantiated by simply considering the brevity and contents of the advice offered to medical practitioners by the General Medical Council in 1985; see GMC “Bluebook”, Professional Conduct: Fitness to Practise (April 1985).
42. See BMA, Philosophy and Practice of Medical Ethics (1988), p. iii noting that “the word Etiquette has virtually disappeared from current usage” and preferring the term ‘Professional Behaviour'.
43. See Draper and Sorrell, note 14 above, 340–341.
44. Patients’ Rights and Responsibilities (Patient Liaison Group, 2001) RCS (www.rcseng.ac.uk).
45. See Clerk and Lindsell on Torts, 19th ed. (London 2006), pp. 383–414.
46. See Smith v. Littlewoods Organisation Ltd. [1987] A.C. 241, 271; and
47. see A. McCall Smith “The Duty to Rescue and the Common Law”, in M. Menlowe and A. McCall Smith (eds.), The Duty to Rescue (Aldershot 1993)
48. B. S. Markesinis “Negligence, Nuisance and Affirmative Duties of Action” (1989) 105 L.Q.R 104 119–124;
49. J. Ratcliffe (ed.), The Good Samaritan and the Law (Garden City 1966).
50. General Medical Council Good Medical Practice (GMC 2001), par.
51. [9]: “In an emergency, wherever it may arise, you must offer anyone at risk the assistance you could reasonably be expected to provide.”
52. See M. Brazier and J. Harris, “Public Health and Private Lives” (1996) 4 Medical Law Review 171.
53. See S. H. Bronitt, “Spreading Disease and the Criminal Law” [1994] Crim. L. R. 21
54. K. M. Smith, “Sexual Etiquette, Public Interest and the Criminal Law” [1991] 42 N.I.L.Q. 309.
55. Pursell v. Horn (1832) 8 A. & E. 602.
56. [1888] 22 Q.B.D. 23
57. and see Hegarty v. Shine (1878) 14 Cox C.C. 124.
58. (Unreported). See M. Mulholland, ‘Public Nuisance—a New Use for an Old Tool’ (1995) Professional Negligence 70.
59. (2001) High Court of Judiciary, Glasgow; discussed in J. K. Mason and G. T. Laurie, note 14 above, 34–36.
60. And see J. Chalmers “The Criminalisation of HIV Transmission” (2002) 28 Journal of Medical Ethics 160.
61. [2004] Q.B. 1257
62. C.A. For an excellent critical analysis of R.v. Dica see M. Weait, “Criminal Law and the Sexual Transmission of HIV: R.v.Dica” (2005) 68 M.L.R. 121–139.
63. [1994] 1 A.C. 212, H.L.
64. R. v. Dica [2004] Q.B. 1257, 1271.
65. Q.B. at 606.
66. See R.V. Ireland; R.V. Burstow [1998] A.C. 147 H.L.
67. The draft Bill moulders on the shelves of the Home Office; see A. Ashworth, Principles of Criminal Law, 4th ed. (Oxford 2003), 338–339. The government rejected Law Commission proposals that new offences of intentional and reckless injury should include both intentional and reckless disease transmission; see Offences Against the Person and General Principles (Law Com. 218, 1993) and the government's response Violence: Reforming the Offences Against the Person Act 1861 (Home Office, 1998). And see Weait, note 43 above, at 129–30.
68. J. R. Spencer, “Liabilility for Reckless Infection” (2004) 154 N.L.J. 384, 448
69. “Retrial for Reckless Infection” (2004) 154 N.L.J. 762.
70. See (inter alia) R. Porter, “History Says No to the Policeman's Response to AIDS” (1986) 293 B.M.J. 1589
71. P. Old and J. Montgomery, “Law, Coercion and Public Health” (1992) 304 B.M.J. 851. And see the extensive literature cited by Weait, note 43 above, at footnote 1.
72. See, for example, the discussion in R. Bennett, H. Draper and L. Frith, “Ignorance is Bliss? HIV and Moral and Legal Duties to Forewarn” (2000) 26 Journal of Medical Ethics 9.
73. Difficulties exacerbated by the subsequent decision in R.V. Konzani [2005] EWCA Crim 706
74. see H. Law, “Court of Appeal: Offences Against the Person: Reckless Transmission of HIV” (2005) 69 Journal of Criminal Law 385.
75. See generally G.T. Laurie, Genetic Privacy: A Challenge to Medico-Legal Norms (Cambridge 2002), especially at pp. 104–113.
76. See Human Genetics Commission. Inside Information: Balancing interests in the use of personal genetic data (May 2002)
77. D. Bell and B. Bennett, “Genetic Secrets and the Family” (2001) 9 Medical Law Review 130
78. L. Skene, “Genetic Secrets and the Family: A Response to Bell and Bennett” (2001) 9 Medical Law Review 162
79. R. Gilbar, “Medical Confidentiality Within the Family” (2004) 18 International Journal Journal of Law, Policy and the Family 195.
80. See O'Neill, “Some Limits of Informed Consent”, note 18 above.
81. And see Human Genetics Commission, note 61 above, para. [4.1].
82. But note that it cannot be shown to be unequivocally beneficial to inform the “at risk” relative especially if there is no action the latter can then take to minimise the risk that the disease materialises: G. T. Laurie, Human Genetics Commission. 264–274 and 239–240.
83. The Law Commission in their proposals on reform of offences against the person suggested that criminal liability should not necessarily be confined to diseases serious in themselves. Reckless transmission of more minor illnesses such as ordinary influenza or the common cold might properly attract liability if the accused knew that the victim was especially susceptible to serious harm should he contract that illness, e.g. a cancer patient whose immune system is compromised during chemotherapy; see Law Commission Report No. 218 (note 48 above). And see J. Harris and S. Holm, “Is there a Moral Obligation not to Infect Others?” (1995) 311 B.M.J. 1215.
84. Public Health (Control of Diseases) Act 1984, s. 17.
85. See Brazier and Harris, op cit. note 37 above.
86. See A. Grubb (ed.), Kennedy and Grubb s Medical Law, 3rd ed. (London 2000), 909.
87. See “TB Timebomb Infects 12” The Mail on Sunday 8 May, 2005.
88. See Caparo Industries plc v. Dickman [1990] 2 A.C. 605, 617–18. And see note 33 above.
89. See note 65 above in “Obligations Arising from Genetic Information Negligence and the Protection of Familial Interests”, 117–120.
90. And should a claimant successfully overcoming the formidable obstacles of establishing a duty of care and proving breach would she fall at the final hurdle of causation? Disclosure of the risk of cancer by her sister does no more than reduce the risk of the claimant will avoid the disease. She would have to prove that she would have acted on that information to reduce her risk; see Chester v. Afshar [2005] 1 A.C. 139. And then she will have to establish that her “lost chance” to avert the relevant injury rendered it more likely than not she had been informed of the risk, she would have avoided injury
91. see Gregg v. Scott [2005] UKHL 2
92. 2005] 2 A.C. 176, H.L.
93. W.v. Egdell [1990] Ch. 359, C.A.
94. G.T. Laurie, note 60 above, 267–272.
95. And see G. Laurie, “Obligations Arising from Genetic Information, Negligence and the Protection of Familial Interests” (1999) 11 C.F.L.Q. 109
96. K. Offit et al, “The ‘Duty to Warn’ a Patient's Family Members About Hereditary Disease Risks” (2004) 292 J.A.M.A. 1469.
97. C. Ngwena and R. Chadwick, “Genetic Diagnostic Information and the Duty of Confidentiality: Ethics and the Law” (1993) 1 Medical Law International 73.
98. X.v. Y [1988] 2 All E.R. 648.
99. See (inter alia) Human Genetics Commission, note 61 above, at para. [43]. Nuffield Council on Bioethics, Genetic Screening: Ethical Issues (Nuffield Council on Bioethics, 1993), para. [5.29]. G. T. Laurie, note 60 above, at 271–72.
100. See Pate v. Threlkel 661 So 2d 752 (Fla. 1970).
101. Though note Safer v. Estate of Pack 677 A.2d 1188 (N.J. 1996), discussed in G.T. Laurie, So. 268–9.
102. [2005] EWCA (Civ) 1003.
103. Caesarean Section: National Collaborating Centre for Women's and Children's Health (RCOG Press, April 2004).
104. S. Paterson-Brown, O. Amu, S. Rajendran and I. Bolaji, “Should Doctors Perform an Elective Caesarean Section On Request?” (1998) B.M.J. 462
105. and see The Independent 23 February 2004.
106. See Re MB (An Adult: Medical Treatment) (1997) 8 Med. L. R. 217
107. St George's Healthcare NHS Trust v. S [1999] Fam. 26, C.A.
108. See M. Brazier and N. Glover, “Does Medical Law have a Future?” in D. Hayden (ed.), Laws Futures (Oxford 2000).
109. Graphically explained in L. Miller, “Two Patients or One? A Problem of Consent in Obstetrics” (1993) 1 Medical Law International 97.
110. And see the emphasis on the implications of Caesarean surgery for women in Winnipeg Child and Family Services (Northwest Area) v. GDP [1997] 3 S.C.R. 925 (Canada).
111. [2002] 2 All E.R. 449.
112. All E.R. at p. 461.
113. See in relation to abortion, S. Sheldon, Beyond Control: Medical Power and Abortion Law
114. See I. Kennedy, The Unmasking of Medicine (London 1981), 92–93.
115. See General Medical Council Good Medical Practice, note 35 above, para. [5]. Note that the GMC is currently consulting in relation to a new draft of Good Medical Practice including possible definitions of conscientious objection; see Ethics Briefings (2006) 32 Journal of Medical Ethics 123–124.
116. Re Wyatt [2005] EWHC 2293 (Fam), para. [35].
117. Law Com. 231, para. [5.34]. And see K. Stern, “Advance Directives” (1994) 2 Medical Law Review 57, 66.
118. (1993) 5 Cal 4th 725.
119. See Airedale NHS Trust v. Bland [1993] A.C. 789, 881–2, per Lord Browne-Wilkinson.
120. R. (on the application of Pretty) v. Director of Public Prosecutions [2002] 1 A.C. 800, H.L.
121. Pretty v. United Kingdom [2002] 2 F.L.R. 45, E.C.H.R. 99
122. F.L.R. at p. 349.
123. F.L.R. at pp. 348–349.