Law & Ethics

CMJ | 30 Nov 2013 | Law & Ethics

Introduction

Quand tu sauras mon crime et le sort qui m’accable,
Je n’en mourrai pas moins, j’en mourrai plus coupable.

Jean Racine (1639–1699), Phèdre1

Phèdre is a tragedy which explores the relationship between moral culpability and responsibility for one’s actions by examining the incestuous love of a queen for her step-son, a passion that is apparently imputed to her by a vengeful deity. What is fascinating for the purposes of our discussion is the dynamic interplay between the portrayals of Phèdre’s infatuation both as an illness and simultaneously as a crime, for this is essentially the same question we must consider in deciding to what extent a malady excuses behaviour that contravenes society’s judicial expectations. While this was doubtless an intriguing consideration for a seventeenth century French dramatist, it is all the more pertinent for us today given the extent of medicalisation that has occurred in recent decades across many spheres of society. In terms of psychiatry, this may be illustrated merely with reference to the DSM, which between its first edition in 1952 and the fourth revision fifty-two years later has more than tripled the number of conditions it identifies, taking the total from 112 to more than 370 today [1]. This inexorable rise has led certain commentators to question the extent to which this phenomenon is justified, particularly where it impinges on the realm of moral accountability. This is exemplified in an article by the sociologist Frank Furedi entitled The seven deadly personality disorders, in which he describes how all of those vices that the Catholic Church once taught to be mortal sins are now considered by Western culture to be addictive illnesses, with the sole exception of pride, which is thought to be a virtue, the helpful antidote to low self-esteem [2]. This issue is one of eminent importance to the forensic psychiatrist, who may be obliged to stand as an expert witness and give evidence on a defendant’s mental state, potentially obviating the accusation that they had the mens rea for a crime. This is particularly the case in homicide, where mental illness can reduce a verdict from murder to manslaughter, but it is of more general significance in the verdict of ‘not guilty by reason of insanity’. Thus, this essay shall concern itself with a consideration of the current theories on which medico-legal practice seems to be predicated, before examining a possible alternative to this model and the congruence of this with a broader philosophical perspective, concluding with some speculation as to the implications of this concept for clinical practice and for society.

CMJ | 3 Nov 2013 | Law & Ethics

Abstract

This paper attempts four things:
(1) to identify uncertainties and ambiguities in English law and medical guidance concerning the circumstances in which a competent adolescent patient who refuses a clinically indicated treatment can be overruled by a court of law in their own best interests;
(2) to clarify the nature and sources of two opposing attitudes towards the matter of the extent and limits of an adolescent patient’s right to refuse clinically indicated treatment;
(3) to argue for the need to set up in hospitals a Liaison and Mediation Service to facilitate communication between an adolescent who refuses treatment and their doctors with a view to developing, if possible, an agreed decision; and
(4) to outline a widened conception of an adolescent’s best interests which includes, besides the restoration of their health, respect for their personality and autonomy, acknowledgement of their right to be informed about the treatment proposed to them, recognition of their capacity to gain considerable understanding of the nature and consequences of the treatment and any alternatives, and also acceptance by doctors and judges of their ability to make their own decisions which is commensurate to the degree of intellectual and emotional maturity they have attained.

CMJ | 9 May 2012 | Law & Ethics

‘I’m sorry, but the diagnosis is as we feared, would you like us to proceed with palliative treatment?’

This is the news that we as doctors dread to deliver and that our patients dread to receive. So what happens when you have to say this to the parents of a one-day old baby, seemingly entirely healthy aside from a distinct bluish tinge around the toes and fingers? When are we able to suggest that their baby is unlikely to live a happy fulfilled life, so it is probably best that we just keep her comfortable and let her slip away before it becomes too hard?

CMJ | 20 Feb 2011 | Law & Ethics

The European Court of Human Rights recently ruled on a case involving suspected child abuse. This article highlights the way in which articles 3 and 8 of the European Convention of Human Rights are applied by the courts, and the significance of the Act for medical professionals who suspect abuse.

CMJ | 29 Sep 2010 | Law & Ethics

A recent BBC documentary, ‘Between life and death’ followed the moving stories of three patients at the Addenbrooke’s Neurological Critical Care Unit, a leading centre of its kind in the world [1]. These patients were all involved in road traffic accidents that left them deeply brain damaged and dependent on life support machines.