Seminar 1 – Medical Ethics

1. Should law reflect ethical theories and principles? If so, which ones
and how should they be accommodated? If not, why not?

2. Is it important to try to formulate a moral theory which will lead to

adopting a consistent approach across a range of moral issues, or is it
more important to do what is morally ‘right’ in each particular
context?

3. Do patients have responsibilities with regards to their health? If

so, what are they? If not, why not?
 ‘Medical Ethics is one-sided. It dwells on the ethical obligations
of doctors to the exclusion of those of patients’’ - H. Draper and T.
Sorrell, ‘‘Patients’ Responsibilities in Medical Ethics’’ (2002)
 My right to make my own decisions about whether to accept
treatment, and to conform to medical advice not to go to work
and risk spreading a potentially deadly disease, must be subject
to a duty not to endanger others’ health, not do harm
 Reciprocal ethical obligations extend into every area of our
lives – e.g. a single parent not harming themselves to protect
the interests of the child, but should ethical obligations
translate to legal obligations?
 R v Dica - Enforces the fundamental principle of do no harm,
while at the same time illustrating the difficulties inherent in
translating ethical responsibilities into legal obligations
 There is no good samartian rule in criminal law
 ‘In estranged families, do obligations come into play? I would argue that
a family member holding information crucial to the good health of his or
her relatives owes an ethical obligation to consider sharing that
 information.Should the law enforce such an obligation, and if so how?’ -
DO NO HARM—DO PATIENTS HAVE RESPONSIBILITIES TOO? MARGARET BRAZIER
 Unhealthy lifestyle choices and disease? Obligation to refrain?
 Those who take such risks are more disadvantaged so therefore
still deserving of treatment? – e.g. Low socio-economic status
and obesity (cannot afford healthy food)/ lack of information or
education on healthy life choices /mental disorder/addiction?

Scenarios for discussion in the seminar

1. D has body dysmorphic disorder. This is a recognised condition
which causes people to feel that a part of their body is alien to them,
and they wish to have it removed. D detests their legs and asks a
doctor to remove them. (Adapted from I Goold, J Herring, Great
Debates in Medical Law and Ethics (Palgrave, 2018), 2)
 Court of Appeal in R. (on the application of Burke) v. General Medical
Council. 81 ... a patient cannot demand that a doctor administer a
treatment which the doctor considers is adverse to his clinical needs
Autonomy and the right of self-determination do not entitle the patient
to insist on receiving a particular medical treatment, regardless of the
nature of the treatment. In so far as a doctor has a legal obligation to
provide treatment this cannot be founded simply upon the fact that the
patient demands it. The source of the duty lies elsewhere.

2. A vaccine for a highly infectious, currently untreatable disease has

been developed. To test whether the vaccine is effective, healthy
volunteers will be injected with the vaccine (which has not yet been
tested on humans) and then exposed to the highly infectious,
untreatable disease. The volunteers will then need to be exposed to
others who have not been vaccinated.
3. A teenager with profound learning disabilities is admitted to
hospital. They are undressed ready for a surgical procedure and are
lying on a trolley covered by a sheet. The sheet falls off them and
they are left naked on the trolley for several hours in full view of
other patients and visitors, who do nothing but look at the naked
teenager. The teenager enjoys the attention.
 ‘The reason why, for example, being left semi-naked on a hospital trolley
is experienced as humiliation, and thus as a violation of dignity, is that
the patient has standards of public decency that they strive to maintain
in their daily lives, and which they are here being forced to abandon …
dignity is the inherent capacity for upholding one’s principles’ – Suzy
Killmister Dignity: not such a useless concept (2010)
 Regardless of whether the teenager is sentient to his breach of dignity, it
is better thought of as an objective standard of dignity - As an innate
right, infringements to dignity are to be viewed on an objective basis, in
which someone’s dignity may be injured without their awareness of it.
Lord Devlin’s words in Rookes v Bernhard – ‘proper feelings of dignity
[emphasis added]’ – are to be understood as a standard of what the
reasonable person would consider an affront to dignity; an objective test
(John Murphy, ‘The Nature and Domain of Aggravated Damages’)
 McBride and Bagshaw do not agree that the test of an infringement of
dignity is objective, citing the decision of Ministry of Defence v Meredith
and Lord Carswell’s comments in Ashley v Chief Constable of Sussex
Police, that as the claimant in that case was deceased and therefore
insentient to the infringement, it was ‘more than a little difficult to see
how such damages can be in question’