When it comes to using patient data from the National Health Service for research, we are often told that it is a matter of trust: we need to trust, we need to build trust, we need to restore trust. Various policy papers and reports articulate and develop these ideas and make very important contributions to public dialogue on the trustworthiness of our research institutions. But these documents and policies are apparently constructed with little sustained reflection on the nature of trust (...) and trustworthiness, and therefore are missing important features that matter for how we manage concerns related to trust. We suggest that what we mean by ‘trust’ and ‘trustworthiness’ matters and should affect the policies and guidance that govern data sharing in the NHS. We offer a number of initial, general reflections on the way in which some of these features might affect our approach to principles, policies and strategies that are related to sharing patient data for research. This paper is the outcome of a ‘public ethics’ coproduction activity which involved members of the public and two academic ethicists. Our task was to consider collectively the accounts of trust developed by philosophers as they applied in the context of the NHS and to coproduce an argumentative position relevant to this context. (shrink)

A dilemma exists when a doctor is faced with a child or young person who refuses medically indicated treatment. The Gillick case has been interpreted by many to mean that a child of sufficient age and intelligence could validly consent or refuse consent to treatment. Recent decisions of the Court of Appeal on a child's refusal of medical treatment have clouded the issue and undermined the spirit of the Gillick decision and the Children Act 1989. It is now the case (...) that a child patient whose competence is in doubt will be found rational if he or she accepts the proposal to treat but may be found incompetent if he or she disagrees. Practitioners are alerted to the anomalies now exhibited by the law on the issue of children's consent and refusal. The impact of the decisions from the perspectives of medicine, ethics, and the law are examined. Practitioners should review each case of child care carefully and in cases of doubt seek legal advice. (shrink)

This article is a review of the 2010 book Collateral Damage by Dan Walter.

‘Law’ said Mr Justice Windeyer of the High Court of Australia, ‘marches with science, but to the rear, and limping a little’. Nowhere is this limping more apparent than in respect of the attempts to keep up with medical science. The media is full of reports of the use of fetal ova to create new life, of the transplant of animal parts into human bodies, of tests involving the consumption of radioactive materials by human subjects. The law's response to these (...) problems has been notable most often by its absence. To some extent, the failure of the law to come to grips with developments is not entirely its own fault. Sometimes the advances made possible by science can only be forseen by those with a scientific background. At other times, however, the law fails by not being flexible enough to be able to create new categories of legal obligations. It tries instead to pigeon-hole radically new ideas within centuries-old categorisations. As anyone who has had experience with packing a large number of outsized objects into a too small suitcase will tell you, squeezing things into inappropriately shaped containers takes time. This is one of the problems apparent in the doctrine of consent; the area of law which attempts to regulate the provision of medical services by a practitioner to a patient. (shrink)

This case conference concerns a child who has been in care following a diagnosis of emotional abuse and a serious incident of physical abuse. She wants to return home again, and her parents, who had previously scapegoated her, now blame the family's previous ills on her sister instead. The Children Act 1989 gives considerable weight to the child's wishes, but what if the child returns home and is re-abused? In this case conference a child psychiatrist, a philosopher and a lawyer (...) discuss the issues of clinicians' responsibilities, moral luck, and child care law. (shrink)