The legal role of medical professionals in decisions to withhold or withdraw life-sustaining treatment: part 1 (New South Wales)

This is the first article in a series of three that examines the legal role of medical professionals in decisions to withhold or withdraw life-sustaining treatment from adults who lack capacity. This article considers the position in New South Wales. A review of the law in this State reveals that medical professionals play significant legal roles in these decisions. However, the law is problematic in a number of respects and this is likely to impede medical professionals' legal knowledge in this area. The article examines the level of training medical professionals receive on issues such as advance directives and substitute decision-making, and the available empirical evidence as to the state of medical professionals' knowledge of the law at the end of life. It concludes that there are gaps in legal knowledge and that law reform is needed in New South Wales.     

The legal role of medical professionals in decisions to withhold or withdraw life-sustaining treatment: part 2 (Queensland)

This is the second article in a series of three that examines the legal role of medical professionals in decisions to withhold or withdraw life-sustaining treatment from adults who lack capacity. This article considers the position in Queensland, including the parens patriae jurisdiction of the Supreme Court. A review of the law in this State reveals that medical professionals play significant legal roles in these decisions. However, the law is problematic in a number of respects and this is likely to impede medical professionals' legal knowledge in this area. The article examines the level of training medical professionals receive on issues such as advance health directives and substitute decision-making, and the available empirical evidence as to the state of medical professionals' knowledge of the law at the end of life. It concludes that there are gaps in legal knowledge and that law reform is needed in Queensland.     

Legal education in the training of health professionals in Ghana: the need for legislative and curricular reforms

The present paper critically analyses the essence of legal education in the training of medical professionals in Ghana. It argues that health professionals lack the requisite knowledge in law, especially the legal implications of medical malpractice, and calls for legislative and curricular reforms in institutions engaged in the training of health professionals to reflect a legal education component. The authors opine that the basic medical law curriculum should be focused on the kinds of legal problems that physicians encounter most frequently in practice rather than on sensational cases. The authors are of the view that the curriculum should address the clarification of central concepts in law, the ability to apply the concepts, decision‐making procedures, acquisition of legal knowledge in tortuous and criminal matters relevant to the medical profession. This view sets objectives for teaching medical law to medical students and young doctors.     

Passing it on: should health care professionals be permitted to disclose patients' genetic information to their reproductive partners?

This article considers whether Australian law should permit health care professionals to disclose patients' genetic information to their reproductive partners without the patients' consent. The issue is addressed with reference to four genetic disorders (Huntington Disease, Familial Adenomatous Polyposis, Multiple Endocrine Neoplasia Type 2A and Cystic Fibrosis) which illustrate differences in inheritance traits and availability of effective treatments. The article explores the familial nature of these disorders and the notion that genetic information has implications which extend beyond the individual patient to third parties such as reproductive partners. It addresses the opinions of legal academics and regulatory bodies regarding the potential amendment of Australian laws to permit such disclosure. Ultimately, it is submitted that the application of current laws regarding medical information to the needs of genetics is unlikely to generate adequate results. To allow for a more appropriate response to this debate, health care professionals' duties to patients should be qualified when it concerns reproductive partners.     

Expert evidence and medical manslaughter: vagueness in action

This article examines the reliance placed on expert evidence in prosecutions of health professionals for gross negligence manslaughter, where juries must decide whether conduct goes beyond civil negligence and constitutes the crime of involuntary manslaughter. It argues that the test for liability is vague and examines some of the consequences of this. Given the vagueness of the offence, jurors are likely to place great reliance on expert medical evidence. Little is known about how experts negotiate the legal process, empirically speaking: how they approach their task, how they view their role as expert witnesses, and the attitudes, biases, and beliefs that may underpin their testimony. Drawing on the experiences and perceptions often medical experts, this article explores how experts manage the vagueness inherent in the task of interpreting and applying gross negligence. Experts appear to go beyond offering purely medical opinion and enjoy engaging with law and the legal process.     

The doctrine of informed consent: a tale of two cultures and two legal traditions

In this article, the author compares and contrasts the notion of informed consent in medical decision making in the Western legal system with the traditional Jewish biblical legal system. Walter critically examines the philosophical underpinnings of disease and medical healing in both legal systems, and describes the practical consequences that emanate from the different ideologies in terms of the individual's rights of choice of treatment. She explains that the Western system is predicated on notions of individual autonomy and self determination. Patients therefore have the autonomous ability to select and direct their own medical therapy. By contrast, the traditional biblical system of law is based on the concept that the body does not belong to the individual. Instead, the body is given to man by God as a trust to respect and preserve. Therefore, the individual patients "has no absolute right to control his body and ... he has no real decision making power as to medical treatment choices." In the Jewish biblical tradition, consent is not necessary for obviously beneficial or obviously non-beneficial procedures; consent is only necessary in decisions with uncertain outcomes or when making choices between equal options. Patients are encouraged to seek the counsel of religious authorities and to conform to rabbinical interpretations of the traditional Jewish law.     

Wrong about Rights: Public Knowledge of Key Areas of Consumer,Housing and Employment Law in England and Wales

Over many decades, processes of juridification have brought about huge growth in legal rights, responsibilities and protections, yet citizens appear to poorly understand this ‘law thick’ world. This impacts citizens’ capacity to ‘name, blame and claim’ in the legal domain at a time of retreat from public funding of civil legal services. This article examines public knowledge of rights in key areas relating to consumer, housing and employment law. Drawing on data from the 2010–2012 English and Welsh Civil and Social Justice Survey, the article uses responses to a series of hypothetical scenarios to explore public knowledge of rights and characteristics associated with knowledge. Our findings highlight a substantial deficit in individuals’ understanding of legal rights and responsibilities – even among those for whom particular rights and responsibilities have specific bearing. We also consider what these findings mean for public legal education and the efficiency, efficacy and legitimacy of the law.     

General practitioners' perspectives regarding competence and confidentiality in an adolescent with suspected anorexia nervosa: legal and ethical considerations

In Victoria, Australia, the legal position regarding young people's competence to make medical treatment decisions has not been clarified in legislation, and a number of often vague common law decisions must be relied on for guidance. This situation produces a degree of uncertainty about appropriate professional practice, while also potentially impeding young people's rights claims in health care settings. With this in mind, the present research explored general practitioners' competence and confidentiality decisions regarding a 17-year-old female who presented with symptoms of an eating disorder. Questionnaires were sent to a random sample of 500 Victorian general practitioners, of whom 190 responded. After reading a case vignette, general practitioners indicated whether they would find the hypothetical patient competent and if they would maintain her confidentiality. Seventy-three per cent of respondents found the patient competent and most would have maintained confidentiality, at least initially. However, subsequent analysis of the rationales supplied for these decisions revealed a wide diversity in general practitioners' understandings and implementations of extant legal authority. This research highlights the need for general practitioners to be exposed to up-to-date and clinically relevant explanations of contemporary legal positions.     

Virtue and the Law: The Good Moral Character Requirement in Occupational Licensing,Bar Regulation,and Immigration Proceedings

Character plays a crucial role in US law. This article explores flaws in how moral character requirements determine who can work in licensed occupations, who can practice law, and who can immigrate to the United States or become a citizen. Section I summarizes psychological research on character, which raises questions about a central legal premise that individuals have a settled disposition capable of accurately predicting their behavior independent of situational influences. Section II examines the role of moral character as an employment credential. Almost a third of the workforce is covered by licensing laws that typically require proof of good character and often unjustly penalize the seventy million Americans with criminal records. Section III examines the idiosyncratic and inconsistent application of moral character requirements for lawyers. Section IV focuses on similar flaws in immigration contexts. Section V identifies reform strategies to improve the fairness of character‐related decisions in the law.     

Regulation, risk assessment, and the Supreme Court: the case of OSHA's cancer policy

As a case study of policy distortion in the legal and regulatory processes, this article first establishes the incongruities among the political, scientific, and legal issues surrounding OSHA's Cancer Policy and then examines the political consequences of ignoring these incongruities in judicial and administrative decisions about that policy. By delineating the political, scientific, and legal issues involved, we develop a basis for assessing the Supreme Court's difficulties in reviewing the Cancer Policy. These difficulties are related to the issue of regulatory reform, as indicated by the subsequent fate of OSHA's Cancer Policy under the Reagan administration. This article concludes with reflections upon regulatory reform in the light of the current status of OSHA's regulation of workplace carcinogens.     

Review, Revenge and Retreat

The article deals with a wide-ranging legal and political conflict of considerable constitutional significance, the attempt by UK ministers to restrict formal challenge of asylum decisions using a variety of devices and the fierce and partly successful opposition that this engendered. The article examines the legal and administrative roots of the controversy; the anatomy of the government's generalised counter-attack or 'revenge package'; the main juridical elements in the resulting public furore; and the character of the government's eventual retreat. In so doing, it raises, and elaborates on, a series of linked themes: the powerful dynamics of judicial review in this policy domain; the historical sense of a gathering storm in relations between ministers and judges; the practical interplay of rule of law arguments with developments in common law constitutionalism; and an expanded role for legal elements in the political process.     

The medical provision of hydration and nutrition: two very different outcomes in Victoria and Florida

Decisions to withhold or withdraw medical hydration and nutrition are amongst the most difficult that confront patients and their families, medical and other health professionals all over the world. This article discusses two cases relating to lawful withdrawal and withholding of a percutaneous endoscopic gastrostomy tube (PEG) from incompetent patients with no hope of recovery. Victoria and Florida have statutory frameworks that provide for advance directives, however in both Gardner; Re BWV and Schindler v Schiavo; Re Schiavo the respective patients did not leave documented instructions. The article analyses the two cases and their outcomes from legal, medical and ethical perspectives.     

Psychology and legal change

From its inception, research in “law and psychology” has had an explicitly applied focus. In large part, psychologists have studied legal issues and participated as experts in the legal process in order to improve law and enhance the quality of its justice. This article examines whether and how this can be done. A taxonomy of relationships between the two disciplines is presented which characterizes law and psychology research in terms of its potential for legal change. The use of psychology of effect legal change requires a bringing together of both psychological and legal paradigms. But important differences exist between the styles and methods of reasoning, proff, and justfication in psychology and law. The implications of those differences for the use of psychological data in legal change efforts are developed, as are other aspects of “legalism” that may hinder or impede the effectiveness of psychologically oriented law reform. Finally, limitations of a “factual jurisprudence” that derived from the nature of psychological data are examined.     

Medical Samaritans: is there a duty to treat?

This article argues that doctors and other health care professionals should be obliged to provide emergency treatment to those in immediate and nearby need regardless of the absence of any prior professional relationship between the parties. It concludes that the common law should accordingly recognize a specific duty of 'medical rescue'. It examines some of the conventional objections to affirmative duties, finding them unconvincing in this particular context. It draws on two recent appellate decisions, one Australian and the other English, for support, as well as on more general arguments concerning moral sentiment, professional ethics, public expectation, and respect for human rights.     

From European Integration to European Integrity: Should European Law Speak with Just One Voice?

Abstract: This article examines whether and how the moral principle of legal coherence or integrity, which has recently been developed further as a response to disagreement in the national legal context, applies to European law. According to the European integrity principle, all national and European authorities should make sure their decisions cohere with the past decisions of other European and national authorities that create and implement the law of a complex but single European legal order. Only by doing so, it is argued, can the European political and legal community gain true authority and legitimacy in the eyes of the European citizens to whom all these decisions apply. Although European integrity is primarily a product of European integration, it has gradually become one of the requirements of further integration. The article suggests that the principle of European integrity would help dealing with the growing pressure for common European solutions under conditions of increasing diversity. It places disagreement at the centre of European politics, as both an incentive and a means of integration by way of comparison and self‐reflectivity. It constitutes therefore the ideal instrument for a pluralist and flexible further constitutionalisation of the European Union.     

The Legal Position of the Married and Unmarried Father Under English and Dutch Law: Sharing Parenting or Just Going Dutch?

This article addresses the issue of the legal position of the married and unmarried father under English and Dutch law. The legal position under English Law in the UK for the married and unmarried father may be familiar to English family lawyers. The situation for unmarried fathers can be seen as more 'precarious' and less legally secure than that of the married father in terms of the legal recognition of fatherhood and the exercise of parental responsibility. Fathers who are not married to the mothers of their children are not recognised as 'fathers' in law in the same way as the married father. They will possess the automatic parental responsibility that the married father has, as a result of the implementation of new legislation which acts as a 'gateway' to the effective exercise, in legal terms, of 'fathering' activities. Whilst there have been some reforms, this are set in the context of problems and difficulties in regulating unmarried relationships in general. There is disparity in legal treatment between the married and the unmarried relationship, fatherhood in particular, but this distinction shows signs of diminishing, as it has done under Dutch law. In The Netherlands, as in a lot of other European countries, family law has been subject to continual law reforms, as a consequence of social developments. Also decisions of the European Court of Human Rights have forced the Dutch government to adapt legislation. Due to the equality principle, many benefits of marriage are now also granted to unmarried people. Since the extended law reform in 1998 the terms 'legitimate' and 'illegitimate' child – for children born inside and outside of marriage – no longer exist. Instead the term 'family ties' was introduced. This article will discuss the major issues which concern the legal position of the married and the unmarried father under English and Dutch law.     

Intraprofessional Competition and Earnings Inequalities Across a Professional Chasm: The Case of the Legal Profession in Québec,Canada

Intraprofessional rivalry has a long history. This article examines earnings disparities as a dimension of intraprofessional competition among avocats and notaires in the civil law system of Québec, Canada. Drawing on two large‐scale surveys and in‐depth interviews with legal professionals, I examine three competing perspectives of earnings inequalities: human capital, social‐symbolic capital, and organizational‐structural explanations. Through this analysis I seek to examine whether similar causal processes shape earnings across the two spheres of legal practice in Québec. The findings of this study clearly demonstrate that these two professional groups are equipped with differential stocks of capital, and conversion rates differ drastically. Avocats receive greater exchange on their investments in human and social‐symbolic capitals. These disparities are most pronounced in sectors of the profession where jurisdictional frictions abound: among notaires and avocats working as solo practitioners and in small firms within competitive urban contexts. The article concludes with a discussion of theoretical extensions and future directions for the study of legal professionals in civil law systems and blended jurisdictions.     

What medical school did you graduate from? Judicial prescribing of medical treatments

There is much in the literature concerning conflicts between clinicians and the law over who should make decisions in a legal context, such as involuntary hospitalization or patients' competency to make treatment decisions. There is little, however, about judges' trying to impose specific treatment decisions on clinicians. This article addresses that situation and the problems such orders cause.     

The legal basis for ethical withholding and withdrawing of life-sustaining medical treatment in children

Withholding and withdrawing life-sustaining medical treatment are common in paediatric practice, especially in intensive care units. However, not all clinicians apparently adhere to principles in ethical guidelines or to the principles which are to be found in judgments from common law cases arising when doctors and parents dispute treatment. This article examines selected ethical guidelines and compares them to judgments in leading cases. The rationale to forgo treatment is usually the child's "best interests" in both clinical practice guidelines and legal cases but in the former "best interests" may remain ill defined. Although "best interests" must essentially pertain to the individual child, the interests of others are not irrelevant. In legal cases "best interests" of the child are defined in terms such as "burden versus benefit", "futility", "indignity", "intolerability", "prolonging death rather than saving life" and "quality of life". These or like terms should form the basis of ethical decisions in discussions with parents when contemplating withholding or withdrawing life-sustaining treatment.     

Deciding about life-support: a perspective on the ethical and legal framework in the United Kingdom and Australia

This article is concerned with the legal right of health service providers to decide whether to provide life-prolonging treatment to patients. In particular, an examination of recent decisions by the English Court of Appeal in R (Burke) v General Medical Council (Official Solicitor and Others Intervening) [2005] EWCA Civ 1003 and the European Court of Human Rights in Burke v United Kingdom (unreported, ECHR, No 19807/06, 11 July 2006) is provided. An analysis of Australian case law is undertaken together with a consideration of the limits of a patient's legal right of autonomy in relation to choosing life-prolonging medical treatment; the basis upon which such treatment can be legally withdrawn or withheld from an incompetent patient against the patient's earlier expressed wishes that it should be continued or initiated; the concept in ethics and law of a patient's best interests; and the role of courts in adjudicating disputes about the continuation of treatment in light of the recent decisions.