UK Medical Law - Essay Example

UK Medical Law Courts Determine Best Interests The purpose of this study is to question why court decisions, as a result of using their inherent jurisdiction, is the final determination in the question of withholding or withdrawal of medical treatment in respect of children and neonates. To enable us to assess the validity of this position we have studied the judgement made in the case of LJ Wall, Wyatt v Portsmouth Hospital NHS Trust [2005] EWCA Civ 1181 para 112, and undertaken further research, both in the legal and medical field. We have found that “best interest” determination by courts are in most cases the only resolution the only way to reach a solution between the often-found conflict between the practical and qualitative views of the physician and the more emotion responses from parents. UK Medical Law Courts Determine Best Interests Is it fair that decisions by the courts are the concluding answer in cases where they have inherent jurisdiction? In the case of children and neonates should it be the case that courts are the final valid judgements on “best interests?” Who is best placed to make the decision to withhold or withdraw from children or neonates? In assessing these questions, and more importantly the answers, we have studied both sides of the argument. Most dictionaries have difficulty in defining the phrase ‘Inherent Jurisdiction’. When using the terms in a legal context, particularly regarding a courts decision. When that decision relates to children and neonates, it means that the courts have an essential power, which they are charged to use in the best interests of the person in question. This is an immensely difficult role to fill, especially when that decision is the choice of whether to withhold or withdraw treatment. With regard to the decision makers in the case of withholding/withdrawal of medical treatment from children and neonates, there are only three groups of people who can even contemplate being part of the process. 1) The physician – medical profession 2) The parent – to include in rare cases the patient themselves 3) The courts – if those in one and two cannot agree or have a serious dispute. In the case of the physicians, the process by which they would arrive at an opinion leading to an answer is, partly of necessity, a more detached and clinical approach than that of the parents. They come to their conclusions regarding the question of withdrawal of medical treatment based upon facts, experience, medical history and their own in-depth medical examinations and observations of the individual patient. Usually the levels of pain patients endure, life expectancy and quality of life will influence their conclusion. It is, in the end, a judgement call, especially in view of the almost continual advances in medical sciences. ‘The ability to treat disease and to sustain life by artificial means is continually advancing. At the same time there is increasing recognition of the need to acknowledge when limits have been reached in any individual patient and continued treatment is no longer in that patients best interests. This requires both medical and ethical considerations to be taken into account.’ (Street et al 2000) In most circumstances of the particular nature being studied here, the parents, relatives or young patients will, in the main, lack the knowledge and historical evidence that is available to the medical profession and, no matter how much explaining the medical professionals give, together with advice and comfort, there is often a situation within the kin of the patient where the emotional and sometimes almost physical attachment makes it difficult to fully comprehend the explanations given. However, there is an advantage that parents have and this is that they know the patient intimately. This gives them the advantage when it comes to patient reaction, no matter how intense the medical problem. The other important factor in many parents decision process is their beliefs. Some have strong views about the intervention of medicine. In many instances requiring what in essence is often a decision of life, the family and medical profession do come to a conclusion, which is equitable to both. It is those occasions when there is a serious divergence of opinion, an impasse, where there is a need to seek a final decision maker. This is why some cases lead to the courtroom. The purpose of the courts is to intercede on the occasions when there is an impasse regarding the question of withdrawal or withholding of medical treatment. Their task is to listen to the evidence from both sides, assimilate that evidence, and add to it the knowledge the opinions of other experts in the field. Armed with all this information, they then have the difficult task of pronouncing judgement, making a decision. The courts do have the advantage over the physicians and parents in that their deliberations are detached and private. There is not the constant day-to-day pressure of seeing the other party always there questioning. Having said that the decision making process, as the decision itself, is not an easy task. ‘…the courts high respect for the sanctity of human life imposes a strong presumption in favour of taking all steps capable of preserving it, save in exceptional circumstances. The problem is to define those circumstances.’ L.J. Taylor (2000) Results The conclusion we have reached as a result of our studies, is that it is right for courts to be the final determining factor and decision maker in the complex cases or whether medical treatment should be withheld or withdrawn. In the majority of cases both sides will have a trust in the courts that might not have been present between each other. In some ways there is often a sense of relief from one or both sides, that they have been relieved of the difficult and sometimes harrowing prospect of making the judgement call themselves. Discussions The decision-making process in cases like those studied here, are never easy. One reservation we have with the court procedure is that, because it is used for a variety of social situations, including crime, when a case like this is brought in front of them, the whole style of the process can be a little adversarial in structure and nature. It would serve good purpose if the government could create a system for cases like this that would provide a more sympathetic structure and environment. References Street, K. Ashcroft, R. Henderson, J. and Campbell, A. (2000). The decision making process regarding the withdrawal or withholding of potential life-saving treatments in a childrens hospital. The Journal of Medical Ethics. Transcript of case LJ Wall, Wyatt v Portsmouth Hospital NHS Trust [2005] EWCA Civ 1181 para 112 Transcript of the case. A (Children), Re [2000] EWCA Civ 254 (22 September 2000) Read More