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Medical Law Case Study

Student’s Name

Institution Affiliate

Course Name

Instructor Name

Date
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Case A

The case is related to the issue of legal consent for medical treatments, especially for

minors under the age of 16. In this case, is it legal and ethical for a medical practitioner to

recommend puberty blockers and cross-sex hormones to teenagers less than sixteen years of age?

Fifteen years old, Elliott (born a baby boy) has approached Dr. Gilroy expressing his intense

feeling of being in the wrong body and his astute wish to grow as a woman. Transgender

children refer to youngsters who have been born with an intrinsic transgender identity that

conflicts with their “assigned sexual orientation” at the time of birth.

The National Health Service (2021) defines consent to treatment as the permission given

by the patient prior to receiving any medical treatment or check-up. The consent can be written

or given verbally. Anyone above the age of 16 has the right to provide their consent to medical

treatment. It’s only possible to override this in the most extreme cases. Young individuals (16 or

17) are believed to have the mental competence to make their own medical decisions unless there

is compelling evidence to decide the contrary (NHS, 2021). The permission of a child under the

age of 16 may be granted in certain circumstances if it is determined that the child has the

intellect, competence, and understanding to comprehend the nature of the treatment. Gillick

competence is a term for this. As a result, someone with parental authority may provide their

permission.

In the Bell vs. Tavistock ruling, the court faced a challenging situation when determining

whether or not a child diagnosed with Gender Dysphoria (GD) under the age of 18 was deemed

able to provide valid consent to puberty blockers. The Tavistock decision was announced on

December 1, 2020, with the decision not bringing about any significant change in the law. Child

consent is legal for children between 16 and 17 (For children under 18). In contrast, consent for
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children under 16, such as Elliot, who is 15, is conditional to their Gillick competency to be

assessed by their medical practitioner (Bell vs Tavistock, 2021). This implies that they must

display adequate awareness and intelligence about the proposed treatment for the medical

process to be legitimate.

When determining a child’s capacity to consent the administration of puberty blockers,

all the Gender Identity Development Services (GIDS) must ensure that the kid is informed of all

known and undiscovered hazards associated with puberty blockers and that the child is examined

individually. In the Bell vs Tavistock case, the judges expressed their dissatisfaction with the

accuracy and validity of the Gillick competence tests done by GIDS (NHS, 2021). They

maintained that children ought to be informed on everything known and unknown dangers

related to puberty blockers, the risks associated with cross-sex hormones, and the possibility of

undergoing gender reassignment surgery; to meet Gillick’s competency. Puberty blockers are a

unique therapy that does not need a kid to advance to CSH or GRS, although they are the initial

stage in the medical treatment process. According to the initial ruling on the Bell vs Tavistock

case, due to the evidence presented by specialists in child cognitive development, the judges

believed that children under the age of 16 could never be Gillick competent to agree to puberty

blockers. This ruling was later overturned for a model of informed consent where patients (even

those under the age of 16) could decide on the best possible decision to take under the

consultation of medical practitioners.

Bell v Tavistock, a judgement of the High Court of Justice of the United Kingdom, has

sparked substantial debate concerning the legality of consent for puberty-blocking medication

therapy for children with gender dysphoria. In Elliott’s case, since Dr Gilroy is dealing with a

suspected gender dysphoria condition, she must develop her approach for assessing Elliott’s
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Gillick competence. The doctor’s referral to Tavistock hospital will be based on her assessment

of Elliott’s ability to display his understanding of the dangers of puberty blockers and the

possibility of gender reassignment surgery.

Case B

This scenario is related to the medical law and ethics of confidentiality. In this case, Luke

is an advocate of Covid-19 vaccinations who went to the extent of making it a company policy

for the personnel to receive Covid-19 vaccines. However, due to his needle-phobia, he did not

get one himself. In the aftermath of Luke’s death due to Covid-19 and speculation regarding his

vaccination status, Luke’s General Practitioner, Dr Wenzel, confirmed these speculations, albeit

to educate other people on the importance of vaccination. Luke’s family accuses Dr Wenzel of

breaching confidentiality. According to the GMC (2022), patient confidentiality can be described

as the legislation that prohibits medical practitioners from disclosing any information revealed to

them by their patients during consultation or treatment. All patients have a genuine expectation

that their personal information will be treated with confidentiality, even though some medical

practitioners may not practice such confidentiality in certain circumstances.

While Dr Wenzel owes no specific legal responsibilities to Mr Luke in this scenario,

there is an ethical obligation necessitating confidentiality continues even after Luke’s death.

According to the Confidentiality Guidance by the General Medical Council (2022), a medical

practitioner may reveal a patient’s personal information without breaching the laws of

confidentiality where it is necessary to disclose information when it is in the patient’s or the

public’s best interest when it is legally mandated, or when the patient grants their consent to the

disclosure. Patients’ approval to disclose personal information is not requested when the

disclosure is mandated by law or is in the public’s best interests. The medical practice in the
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United Kingdom is regulated by the General Medical Council (GMC), which is committed to

upholding confidentiality as a professional obligation (The Aspiring Medics, 2022). It is

recommended by the British Medical Association (BMA) that medical practitioners weigh the

advantages of compromising patient confidentiality against the negative implications of

destroying the patient-doctor professional relationship and jeopardising public reputation in a

discreet service (UKCEN. n.d.). For instance, Section 60 of the Health and Social Care Act 2001

gives an interim authority to guarantee that patient identifying information may be used without

patients’ consent to assist various vital tasks such as clinical audit, record validation, and

research.

Personal information can be revealed in the public interest when doing so would prevent

damage to a larger group of people. Although the patient does not have to express permission to

share their information, they must be made aware of it. The Department of Health has released

detailed advice on using these concepts in various situations. A large number of patient

information disclosures, in this sense, are related to medical research (Medical Law and Ethics,

2022). Patients have the right to object to the use and publication of sensitive data that identifies

them in most cases, and they should be made aware of their rights in this situation. Because some

patients choose not to share information with other medical practitioners involved in providing

health care, it is sometimes necessary to restrict the scope of care provided. In some cases,

specific treatment options are not available, and in sporadic cases, specific treatment options

cannot be provided. Patients must be notified if their choices regarding disclosure impact the

provision of care or treatment for which they are receiving (GMC, 2022). Clinicians can seldom

treat patients safely or ensure continuity of care if they do not have sufficient information about

the patient’s medical state and medical history at their fingertips.

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In this case, Dr. Wenzel disclosed Luke’s personal information in the public’s best

interest. Since Luke had a phobia of needles which prevented him from receiving a Covid-19

vaccine, Dr Wenzel felt that it was appropriate to disclose this information for people to know

the severity of coronavirus, the importance of the vaccine, and the reason why they should not

allow needle-phobia to guide them in their decision-making to receive a vaccine. Therefore,

Luke’s family has no case against Dr Wenzel as he acted in the public’s interest, which is an

exception to disclosing patient information.

Case C

This case relates to medical law and ethics in regards to abortion. Abortion refers to the

action of intentionally terminating a pregnancy before natural delivery and terminating the foetus

in the process. Women’s reproductive rights are becoming increasingly fundamental to their UK

decisions. However, the concept of “rights” does not seem to be represented in the existing

legislative framework. In this context, Karen was distressed after finding out that she was

pregnant due to a miscarriage she had suffered five years ago. She felt that she could not bear to

lose another child and therefore asked Dr Caston to aid her in terminating the pregnancy.

Abortion has always been termed a question of morality, whether it is permissible to terminate a

healthy pregnancy before completing a normal pregnancy and delivery.

According to the Abortion Act of 1967, it is constitutional to have an abortion if it is

executed by a licensed healthcare professional and if it is approved by two medical practitioners

acting in good faith on one (or more) of the following grounds (BBC, 2015): The pregnancy is

not over twenty-four weeks and presents a more significant physical or mental risk to the mother

than if it were to be terminated; the termination is essential to avoid the pregnant lady suffering a

significant and irreversible bodily or mental harm; or that continuing the pregnancy poses a
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greater danger to the mother’s life than aborting the child; or if there is a high probability that the

infant if delivered, would severely suffer physiological or psychological handicap.

A health care professional may legitimately terminate a pregnancy at a National Health

Service hospital, or other authorized facilities, provided two medical practitioners believe in

good faith that the set requirements have been met. Suppose the pregnancy has progressed

beyond the twenty-fourth week. In that case, Optionally, “if the termination is needed to prevent

injury or death to the pregnant woman’s wellbeing, or if it is essential to avoid death or serious

enduring damage to her health, the pregnancy may be terminated.” (BMA, 2021). If pregnancy

has not progressed beyond 24 weeks, it may only be terminated under Section 1(1)(a) of the Act.

The great majority of abortions performed in the UK are performed under this ground.

Early abortion is often considered therapeutically desirable because it is less traumatic for

all parties involved than later abortion due to the decreased chance of complications. It is legal to

terminate a pregnancy at any stage, according to the Abortion Act, “if there is a substantial

chance that the child is born, would suffer from such physical or mental defects as to be severely

handicapped.” (BMA, 2021). Section 4 of the Abortion Act 1967 has a conscientious objection

provision that allows physicians to decline to assist in terminations while still requiring them to

offer the treatment necessary to save the life or avoid significant irreversible harm to a pregnant

woman. Occasionally, a difference may be seen between legal and ethical requirements, and

particular tasks may fall beyond the lawful extent of the conscience clause but fall within its

moral scope (The Law and Ethics of Abortion, 2020).

As a matter of legal precedent, Karen’s choice to terminate her pregnancy must be made

in consultation with two doctors, Dr Cason, and another doctor. Her spouse has no legal

authority to compel or oppose the termination. Therefore, Frank’s attempt to seek an injunction
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from the court to object to Karen’s decision will fail since Karen, as the mother, has the right to

decide in her best interests. Dr Cason has the ethical right of declining to perform an abortion

procedure on Karen on religious grounds and should therefore refer her to another doctor since

the law also necessitates two doctors to agree that the abortion procedure will be in the mother’s

best interest. According to the National Health Service, unless the abortion is required to save the

woman’s life or avoid significant irreversible harm, physicians in the UK are permitted to use

their right of conscientious objection to assisting in pregnancy termination under the legislation

of those countries. Therefore, while Karen might have the constitutional right to terminate her

pregnancy, Dr Cason also has the legal and ethical mandate to decline to perform the procedure

based on his religious beliefs.

Case D

The issue relates to laws and ethics about physician-assisted dying. Lachlan, who worked

at an oil rig, suffered fourth-degree burns from a massive explosion at his workplace. His wife,

unable to cope with the situation, has filed for a divorce, and the future looks bleak for Lachlan.

He has asked Dr Brennan to assist him to die swiftly and painlessly at the local hospital since his

condition does not allow him to travel to Dignitas Clinic, where he can seek assisted death. There

has been substantial discussion about assisted dying in developed nations within the past two

decades. At the same time, there has been a surge in the acceptability of assisted suicide and

euthanasia, generally referred to as “assisted dying,” to encompass both occurrences in most

western European countries. In some of these nations, similar political moves have been made to

amend the criminal guidelines relating to this issue. Such initiatives have prevailed in The

Netherlands and Belgium. A general policy of assisted dying has emerged in Switzerland over
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the past two decades, based on the non-penalisation of selfless support with euthanasia under

Swiss law.

All types of assisted dying are prohibited in the UK. Euthanasia, which refers to when a

physician or another person intentionally terminates a patient’s life, is unlawful and, contingent

on the context, might be lawfully tried as homicide in the form of manslaughter or murder.

Assisted suicide, when a physician or another individual aids or urges a person to terminate their

life, is also unlawful. Assisting or promoting suicide is an obvious criminal misconduct in the

UK. In the absence of specific legislation, assisted suicide in Scotland is governed by the same

rules that apply to murder. “The current legal status regarding assisted suicide in all four

countries is outlined below.” (BMA, 2021). In England and Wales, Section 2 of the Suicide Act

1961 bans any act that ‘encourages or helps the suicide of another, or an attempt by another to

commit suicide. Such an act entails a potential punishment of 14 years’ imprisonment. In

Northern Ireland, assistance in another individual’s suicide is prohibited in s.13 of the Criminal

Justice (Northern Ireland) Act 1966, which extends s.2 of the Suicide Act 1961 to Northern

Ireland. If you aid or encourage someone to take their own life in Scotland, you will not be

prosecuted under the 1961 Suicide Act. The official argument has not been defined by case law,

though it is likely punishable as a homicide.

People who seek to terminate their lives when they think they cannot tolerate additional

agony and distress cannot lawfully get aid to achieve a painless death. The truth of practice is

that physician-assisted suicide and voluntary euthanasia occur (Gregory, 2021). The principle of

individual liberty in issues of consent has been established in the judiciary in that a mentally

competent citizen can decline or select alternative therapies even if death would be the

consequence. Assisted dying is a highly emotional and sensitive issue that generates many ideas
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and attitudes throughout the larger public and the medical community. According to Kennedy

(2017), doctors should be informed of the prospect of legal and professional repercussions, even

if they have not been prosecuted for accompanying patients to take their own lives overseas.

Therefore, while it is normal to be sympathetic to Lachlan’s condition and circumstances,

Dr. Brennan is not permitted by law to assist him in ending his life. While flying overseas to get

assisted suicide from Dignitas Clinic is not unlawful, helping, facilitating, or urging Lachlan to

do so is a criminal offence. Dr Brennan would therefore have to decline Lachlan’s request in a

kind manner without giving him an option to encourage him to end his life.

Case E

The issue in this scenario relates to the case of deceased organ transplantation. Dr Tyler

would like to transplant the organs of five victims travelling to Stratford when involved in an

accident. All of the victims succumbed to their injuries, and Dr Tyler thought their organs would

benefit other patients, especially a female patient severely injured from a gunshot wound.

In the United Kingdom, statute law has primarily shaped the rules regulating the use of

human parts in medicine and science. In terms of organ transplantation, these laws date back to

the Human Tissue Act of 1961. Body parts and tissue removed from dead bodies were regulated

by these laws. “The removal, storage, and use of human corpses and organs for transplantation

are presently governed by current law. The Human Tissue Act 2004 is applied in England,

Wales, and Northern Ireland, while the Human Tissue (Scotland) 2006 applies to Scotland.”

(Woodcock & Wheeler, 2015). These legal sources now differ throughout the United Kingdom.

The Human Tissue Act of 1961 establishes the standards for identifying organs and tissue

donors for transplant. An individual whose body is legitimately in their custody may authorise
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the withdrawal of any specified body part and organ from the body for clinical reasons or health

care training or research after their passing if they have articulated their desire in either orally or

in writing, in the presence of two or more witnesses (Littlejohns et al., 2013). Therefore, to

become a donor, a person must either write or speak to two or more witnesses about their desire

to do so. ‘Opt-in’ is a frequent term for this kind of system. To become an NHS Organ Donor,

one must sign up with NHS UK Transplant on their Organ Donor Registry (Transplant Laws in

the UK, 2003). This is a private, nationwide registry of persons who want to be organ donors if

they pass away. Transplant coordinators may swiftly determine an organ donor’s intent using this

database.

Suppose there is no substantial evidence of this desire, the person legally in the custody

of the deceased body may still authorise the transplantation of any part of the body if they have

no proof to suggest that the dead had voiced a dispute concerning it or that the surviving relatives

are against the decision after making reasonable inquiries (Littlejohns et al., 2013). Several

physicians and legal professionals have expressed that it is vital to establish a clear and

supportive legal framework guiding organ transplantation, particularly given widespread

confusion over permissible actions utilising the deceased body and its organs. Idealistic

regulations should be transparent and facilitative rather than restrictive so that acceptable levels

of organ donation may be achieved while still maintaining suitable levels of public confidence.

This area of law is notoriously contentious due to inherent conflicts between donors’ interests,

possible transplant recipients, transplant and other healthcare professionals. As a result,

legislation in this area is often contentious.

‘ If the deceased refused to permit organ donation before their death, organ donation may

not be permitted. Suppose they agreed that organ removal and donation might be done legally,
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but there is nothing that compels physicians to remove and utilise the organs (Transplant Laws in

the UK, 2003). The dead might have provided oral consent for organ donation before their death,

or a third person can give it; generally, a close family or friend as long as the ‘proper permission’

for the removal of organs and their use for transplantation has been made plain in some form, as

there are no legal requirements in the United Kingdom that the consent must be in writing.

In this case, Dr Tyler will need consent from the family or friends of Dieter (the

exchange student from Australia), while he may only need the permission of the hospital to use

the organs of the other bodies for transplant. Dr Tyler would also be advisable to check with the

National Health Service UK transplant on their donor registry. Suppose any of the victims had

registered as on the registry; this would give Dr Tyler the legal consent to use the organs of the

deceased for transplant.

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References

BBC - Ethics: Abortion. (2015, August 10). Retrieved from

https://www.bbc.co.uk/ethics/abortion
Bell v Tavistock and Portman NHS Foundation Trust [2021] EWCA Civ 1363.
British Medical Association. (2021). Responding to patient requests for assisted suicide. British
Medical Association is the trade union and professional body for doctors in the UK.
Retrieved from
https://www.bma.org.uk/advice-and-support/ethics/end-of-life/responding-to-patient-
requests-for-assisted-suicide
British Medical Association. (2021). The law and ethics of abortion. British Medical Association
is the trade union and professional body for doctors in the UK. Retrieved from
https://www.bma.org.uk/advice-and-support/ethics/abortion/the-law-and-ethics-of-
abortion
General Medical Council. (2022). Confidentiality: good practice in handling patient information.
Retrieved from https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/
confidentiality
Gregory, A. (2021). BMA drops opposition to assisted dying and adopts neutral stance. the
Guardian. Retrieved from https://www.theguardian.com/society/2021/sep/14/bma-drops-
opposition-assisted-dying-adopts-neutral-stance
Kennedy, I. (2017). Despite Charlie Gard’s tragic story, we must respect the process of our
courts. the Guardian. Retrieved from
https://www.theguardian.com/commentisfree/2017/jul/24/charlie-gard-tragic-respect-
courts
Littlejohns, S., Bontoft, H., Littlejohns, P., Richardson, J., & Robertson, A. (2013). Legal and
ethical implications of NICE guidance aimed at optimising organ transplantation after
circulatory death. Clin. Med., 13(4), 340. doi: 10.7861/clinmedicine.13-4-340
Medical Law and Ethics. 2022. Retrieved from http://www.unsystemceb.org/medical-law-
ethics.html
National Health Service. (2021). Children and young people. NHS. Retrieved from
https://www.nhs.uk/conditions/consent-to-treatment/children
The Aspiring Medics. (2022). Breaking Confidentiality. Retrieved from
https://www.theaspiringmedics.co.uk/post/medical-ethics-breaking-confidentiality
The Law and Ethics of Abortion. (2020). BMA views. September 2020. post-ARM update.
British Medical Association. bma.org.uk
Transplant Laws in the UK. (2003, November 12). Retrieved from
https://www.gov.scot/publications/organ-donation-teaching-resource-pack/pages/4
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UKCEN. n.d. Case Studies. Retrieved from

https://www.ukcen.net/main/case_studies/breaching_confidentiality_to_protect_others
Woodcock, T., & Wheeler, R. (2015). Law and medical ethics in organ transplantation surgery.
Ann. R. Coll. Surg. Engl.