... Griffin [1908] 1 KB 160.....134 Maryland v. Craig (1990) 497 US 836.....102 MB, Re (Medical Tr... more ... Griffin [1908] 1 KB 160.....134 Maryland v. Craig (1990) 497 US 836.....102 MB, Re (Medical Treatment) [1997] 2 FLR 426, [1997] 8 Med LR 217.....152, 157, 192 McCallion v. Dodd ...
International Perspectives on End-of-Life Law Reform, 2021
* The authors acknowledge that within the authorial team there is a diversity of views about what... more * The authors acknowledge that within the authorial team there is a diversity of views about what constitutes optimal end-of-life law. This includes differences in opinion about the various assisted dying models in operation internationally (and about assisted dying generally). The authors would like to acknowledge the helpful research assistance of Emily Bartels.
research. Attrition should be anticipated in studies and may affirm inclusion of the relevant pop... more research. Attrition should be anticipated in studies and may affirm inclusion of the relevant population, but careful reporting is necessitated using a new classification. Eventual implementation requires consideration at all stages of Higginson et al. BMC Medicine 2013, 11:111
Introduction Whilst the majority of seriously ill people express a wish to die at home (79%), onl... more Introduction Whilst the majority of seriously ill people express a wish to die at home (79%), only half of those achieve this. The likelihood of patients remaining at home often depends on availability of able and willing informal carers who take on numerous care tasks, often including the responsibility of assisting patients with oral medications. The role of carers administering subcutaneous injections is not widespread practice in the UK, but has proven to be key in achieving home death in other countries. Aim To determine if carer-administration of as-needed subcutaneous medication for four breakthrough symptoms (pain, nausea, restlessness and noisy breathing) in homebased dying patients is feasible and acceptable in the UK. Methods One hundred adult patients in the last weeks of life who are likely to lose the oral route and have expressed a preference to die at home will be recruited with their carers to an external randomised pilot trial across three UK sites (North Wales, So...
Introduction Whilst the majority of seriously ill people express a wish to die at home (79%), onl... more Introduction Whilst the majority of seriously ill people express a wish to die at home (79%), only half of those achieve this. The likelihood of patients remaining at home often depends on availability of able and willing informal carers who take on numerous care tasks, often including the responsibility of assisting patients with oral medications. The role of carers administering subcutaneous injections is not widespread practice in the UK, but has proven to be key in achieving home death in other countries. Aim To determine if carer-administration of as-needed subcutaneous medication for four breakthrough symptoms (pain, nausea, restlessness and noisy breathing) in homebased dying patients is feasible and acceptable in the UK. Methods One hundred adult patients in the last weeks of life who are likely to lose the oral route and have expressed a preference to die at home will be recruited with their carers to an external randomised pilot trial across three UK sites (North Wales, So...
In the common law world, both the medical and legal professions initially considered gender reass... more In the common law world, both the medical and legal professions initially considered gender reassignment surgery to be unlawful when first practised and discussed in the first half of the twentieth century. While most medical procedures are covered by the medical exception to the law governing serious offences against the person, many doctors and the lawyers they consulted doubted that this exception applied to gender reassignment surgery. In this article I trace the differing and changing interpretations of the medical exception as applied to gender reassignment surgery, and the shift towards legal acceptance in the two common law jurisdictions which led the way in both performing gender reassignment surgery and debating its legality, the United States and the United Kingdom. Although this shift occurred without formal legal intervention through either legislation or judicial decision (for example on a test case), inferences of legality drawn from related civil law decisions bolstered the legal acceptance of gender reassignment surgery. By increasing the suffering of patients and potential patients, the criminal law played both an important and primarily malign role prior to the eventual public, professional and legal acceptance of GRS. A real threat of criminal prosecution Professor of Law, Centre of Medical Law & Ethics, Dickson Poon School of Law, King's College London. I am grateful to the conference participants at 'Transforming wrong(s) into right(s): The power of 'proper medical treatment' held at the University of Manchester, to the Wellcome Trust for a research expenses grant in their medical humanities programme which supported this research, and to the anonymous reviewers of this journal for their extremely helpful comments.
when, by drawing on Häberle, he afffijirms that "human dignity is the anthropologicalcultural basi... more when, by drawing on Häberle, he afffijirms that "human dignity is the anthropologicalcultural basis for a constitutional State" (our translation from the original into English). The idea of the equal dignity of all human beings can be found, among others, in the French Constitution dating back to 1789. In the Italian Constitution the reference to human dignity appears in the fijirst paragraph of art. 3 as "equal social dignity" of citizens and in the second paragraph of art. 41 as limit to the freedom of private economic enterprise which "cannot be carried out … in a way that may cause damage … to human dignity". But the reference to human dignity as the fundamental value of the whole legal system appears in several other Constitutions (see e.g. the Canadian, Danish, Portuguese, Swedish, Swiss, and the American Constitutions). Remember the provision of the German Constitution which in art. 1 states: "Human dignity is inviolable. To respect and protect it is a duty of each power of the State". 16 See art. 2, para. 7, of the United Nations Charter. 17 Fallen within the province of International Law, human rights have "overcome national borders and have become a problem of the international community". See in this sense Claudio Zanghì, Diritti dell'uomo (protezione internazionale dei), in Enciclopedia giuridica Treccani, vol. XI, pp. 1-9, particularly p. 1, followed by Jacques Mourgeon (in Les droits de l'Homme, Paris, 1996, p. 75) who afffijirms: "l'afffijirmation internationale des droits a cessé d'être balbutiante pour être abondante et nette".
<jats:p>Much has been written about whether end-of-life law should change and what that law... more <jats:p>Much has been written about whether end-of-life law should change and what that law should be. However, the barriers and facilitators of such changes – law reform perspectives – have been virtually ignored. Why do so many attempts to change the law fail but others are successful? International Perspectives on End-of-Life Law Reform aims to address this question by drawing on ten case studies of end-of-life law reform from the United Kingdom, the United States, Canada, the Netherlands, Belgium and Australia. Written by leading end-of-life scholars, the book's chapters blend perspectives from law, medicine, bioethics and sociology to examine sustained reform efforts to permit assisted dying and change the law about withholding and withdrawing life-sustaining treatment. Findings from this book shed light not only on changing end-of-life law, but provide insight more generally into how and why law reform succeeds in complex and controversial social policy areas.</jats:p>
The genesis for this book came out of my own personal experience. In 1993, after a postgraduate d... more The genesis for this book came out of my own personal experience. In 1993, after a postgraduate degree in Law, I was working as a law clerk to Mr Justice Frank Iacobucci when the Sue Rodriguez case reached the Supreme Court of Canada. My exposure then to the first attempt to strike down a criminal prohibition on assisted suicide using human rights was the start of my interest in legal change on assisted suicide and euthanasia. I am indebted to Mr Justice Iacobucci for that opportunity. Since that time, I have researched and written quite widely on legal issues at the end of life and in particular on assisted dying (euthanasia and assisted suicide). Before writing this book, I had published articles on the law governing euthanasia in the Netherlands and on the legal framework for end-of-life decision-making in France. I had also written about how rights were used to challenge criminal prohibitions on assisted suicide in the UK, Canada and the USA. I have been privileged to be a member of the St Christopher’s Hospice Clinical Ethics Committee since 2003, from which I have learnt immeasurably about the care of the dying and the ethical and legal problems faced by professionals in the field of palliative care. In 2004, I was invited to submit evidence to and testify before the House of Lords Select Committee on the Assisted Dying for the Terminally Ill Bill about the different legal regimes in jurisdictions which had permitted euthanasia and/or assisted suicide.
Background: There is little guidance on the particular ethical concerns that research raises with... more Background: There is little guidance on the particular ethical concerns that research raises with a palliative care population. Aim: To present the process and outcomes of a workshop and consensus exercise on agreed best practice to accommodate ethical issues in research on palliative care. Design: Consultation workshop using the MORECare Transparent Expert Consultation approach. Prior to workshops, participants were sent overviews of ethical issues in palliative care. Following the workshop, nominal group techniques were used to produce candidate recommendations. These were rated online by participating experts. Descriptive statistics were used to analyse agreement and consensus. Narrative comments were collated. Setting/participants: Experts in ethical issues and palliative care research were invited to the Cicely Saunders Institute in London. They included senior researchers, service providers, commissioners, researchers, members of ethics committees and policy makers. Results: T...
... Griffin [1908] 1 KB 160.....134 Maryland v. Craig (1990) 497 US 836.....102 MB, Re (Medical Tr... more ... Griffin [1908] 1 KB 160.....134 Maryland v. Craig (1990) 497 US 836.....102 MB, Re (Medical Treatment) [1997] 2 FLR 426, [1997] 8 Med LR 217.....152, 157, 192 McCallion v. Dodd ...
International Perspectives on End-of-Life Law Reform, 2021
* The authors acknowledge that within the authorial team there is a diversity of views about what... more * The authors acknowledge that within the authorial team there is a diversity of views about what constitutes optimal end-of-life law. This includes differences in opinion about the various assisted dying models in operation internationally (and about assisted dying generally). The authors would like to acknowledge the helpful research assistance of Emily Bartels.
research. Attrition should be anticipated in studies and may affirm inclusion of the relevant pop... more research. Attrition should be anticipated in studies and may affirm inclusion of the relevant population, but careful reporting is necessitated using a new classification. Eventual implementation requires consideration at all stages of Higginson et al. BMC Medicine 2013, 11:111
Introduction Whilst the majority of seriously ill people express a wish to die at home (79%), onl... more Introduction Whilst the majority of seriously ill people express a wish to die at home (79%), only half of those achieve this. The likelihood of patients remaining at home often depends on availability of able and willing informal carers who take on numerous care tasks, often including the responsibility of assisting patients with oral medications. The role of carers administering subcutaneous injections is not widespread practice in the UK, but has proven to be key in achieving home death in other countries. Aim To determine if carer-administration of as-needed subcutaneous medication for four breakthrough symptoms (pain, nausea, restlessness and noisy breathing) in homebased dying patients is feasible and acceptable in the UK. Methods One hundred adult patients in the last weeks of life who are likely to lose the oral route and have expressed a preference to die at home will be recruited with their carers to an external randomised pilot trial across three UK sites (North Wales, So...
Introduction Whilst the majority of seriously ill people express a wish to die at home (79%), onl... more Introduction Whilst the majority of seriously ill people express a wish to die at home (79%), only half of those achieve this. The likelihood of patients remaining at home often depends on availability of able and willing informal carers who take on numerous care tasks, often including the responsibility of assisting patients with oral medications. The role of carers administering subcutaneous injections is not widespread practice in the UK, but has proven to be key in achieving home death in other countries. Aim To determine if carer-administration of as-needed subcutaneous medication for four breakthrough symptoms (pain, nausea, restlessness and noisy breathing) in homebased dying patients is feasible and acceptable in the UK. Methods One hundred adult patients in the last weeks of life who are likely to lose the oral route and have expressed a preference to die at home will be recruited with their carers to an external randomised pilot trial across three UK sites (North Wales, So...
In the common law world, both the medical and legal professions initially considered gender reass... more In the common law world, both the medical and legal professions initially considered gender reassignment surgery to be unlawful when first practised and discussed in the first half of the twentieth century. While most medical procedures are covered by the medical exception to the law governing serious offences against the person, many doctors and the lawyers they consulted doubted that this exception applied to gender reassignment surgery. In this article I trace the differing and changing interpretations of the medical exception as applied to gender reassignment surgery, and the shift towards legal acceptance in the two common law jurisdictions which led the way in both performing gender reassignment surgery and debating its legality, the United States and the United Kingdom. Although this shift occurred without formal legal intervention through either legislation or judicial decision (for example on a test case), inferences of legality drawn from related civil law decisions bolstered the legal acceptance of gender reassignment surgery. By increasing the suffering of patients and potential patients, the criminal law played both an important and primarily malign role prior to the eventual public, professional and legal acceptance of GRS. A real threat of criminal prosecution Professor of Law, Centre of Medical Law & Ethics, Dickson Poon School of Law, King's College London. I am grateful to the conference participants at 'Transforming wrong(s) into right(s): The power of 'proper medical treatment' held at the University of Manchester, to the Wellcome Trust for a research expenses grant in their medical humanities programme which supported this research, and to the anonymous reviewers of this journal for their extremely helpful comments.
when, by drawing on Häberle, he afffijirms that "human dignity is the anthropologicalcultural basi... more when, by drawing on Häberle, he afffijirms that "human dignity is the anthropologicalcultural basis for a constitutional State" (our translation from the original into English). The idea of the equal dignity of all human beings can be found, among others, in the French Constitution dating back to 1789. In the Italian Constitution the reference to human dignity appears in the fijirst paragraph of art. 3 as "equal social dignity" of citizens and in the second paragraph of art. 41 as limit to the freedom of private economic enterprise which "cannot be carried out … in a way that may cause damage … to human dignity". But the reference to human dignity as the fundamental value of the whole legal system appears in several other Constitutions (see e.g. the Canadian, Danish, Portuguese, Swedish, Swiss, and the American Constitutions). Remember the provision of the German Constitution which in art. 1 states: "Human dignity is inviolable. To respect and protect it is a duty of each power of the State". 16 See art. 2, para. 7, of the United Nations Charter. 17 Fallen within the province of International Law, human rights have "overcome national borders and have become a problem of the international community". See in this sense Claudio Zanghì, Diritti dell'uomo (protezione internazionale dei), in Enciclopedia giuridica Treccani, vol. XI, pp. 1-9, particularly p. 1, followed by Jacques Mourgeon (in Les droits de l'Homme, Paris, 1996, p. 75) who afffijirms: "l'afffijirmation internationale des droits a cessé d'être balbutiante pour être abondante et nette".
<jats:p>Much has been written about whether end-of-life law should change and what that law... more <jats:p>Much has been written about whether end-of-life law should change and what that law should be. However, the barriers and facilitators of such changes – law reform perspectives – have been virtually ignored. Why do so many attempts to change the law fail but others are successful? International Perspectives on End-of-Life Law Reform aims to address this question by drawing on ten case studies of end-of-life law reform from the United Kingdom, the United States, Canada, the Netherlands, Belgium and Australia. Written by leading end-of-life scholars, the book's chapters blend perspectives from law, medicine, bioethics and sociology to examine sustained reform efforts to permit assisted dying and change the law about withholding and withdrawing life-sustaining treatment. Findings from this book shed light not only on changing end-of-life law, but provide insight more generally into how and why law reform succeeds in complex and controversial social policy areas.</jats:p>
The genesis for this book came out of my own personal experience. In 1993, after a postgraduate d... more The genesis for this book came out of my own personal experience. In 1993, after a postgraduate degree in Law, I was working as a law clerk to Mr Justice Frank Iacobucci when the Sue Rodriguez case reached the Supreme Court of Canada. My exposure then to the first attempt to strike down a criminal prohibition on assisted suicide using human rights was the start of my interest in legal change on assisted suicide and euthanasia. I am indebted to Mr Justice Iacobucci for that opportunity. Since that time, I have researched and written quite widely on legal issues at the end of life and in particular on assisted dying (euthanasia and assisted suicide). Before writing this book, I had published articles on the law governing euthanasia in the Netherlands and on the legal framework for end-of-life decision-making in France. I had also written about how rights were used to challenge criminal prohibitions on assisted suicide in the UK, Canada and the USA. I have been privileged to be a member of the St Christopher’s Hospice Clinical Ethics Committee since 2003, from which I have learnt immeasurably about the care of the dying and the ethical and legal problems faced by professionals in the field of palliative care. In 2004, I was invited to submit evidence to and testify before the House of Lords Select Committee on the Assisted Dying for the Terminally Ill Bill about the different legal regimes in jurisdictions which had permitted euthanasia and/or assisted suicide.
Background: There is little guidance on the particular ethical concerns that research raises with... more Background: There is little guidance on the particular ethical concerns that research raises with a palliative care population. Aim: To present the process and outcomes of a workshop and consensus exercise on agreed best practice to accommodate ethical issues in research on palliative care. Design: Consultation workshop using the MORECare Transparent Expert Consultation approach. Prior to workshops, participants were sent overviews of ethical issues in palliative care. Following the workshop, nominal group techniques were used to produce candidate recommendations. These were rated online by participating experts. Descriptive statistics were used to analyse agreement and consensus. Narrative comments were collated. Setting/participants: Experts in ethical issues and palliative care research were invited to the Cicely Saunders Institute in London. They included senior researchers, service providers, commissioners, researchers, members of ethics committees and policy makers. Results: T...
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