A patients’ role was historically recognised as being considerably limited, arguably nonexistent, in determining what was considered to be their best interests. This essay will engage in a critical analysis of judge-made law relating to the extent of incapacitated patient participation in the assessment of their best interests. In an effort to do so, it will start by assessing the noteworthy judgements which have developed the extent in which an incapacitated patient’s wishes, feelings and views may be taken into account. This evaluation will prove the dynamic shift in societal opinion and medical practice, which developed a paternalistic ‘doctor knows best approach’ of bests interests to a patient centered one instead. Following this, I will engage in a critical case analysis of Peter Jackson J’s antagonistic judgements in A Local Authority v E and the later decision of Wye Valley. This comparison will be used to show how the extent to which the courts have taken into account an incapacitated patient’s wishes has conclusively expanded over time. Finally, I will conclude by analysing what the relevant advantages and disadvantages are of incorporating a patient’s wishes into the best interests test assessment.
Table of Contents
1. Introduction
2. Development of the Common Law
3. Critical Analysis of Peter Jackson J’s Judgements
4. Advantages and Disadvantages of Patient Participation
5. Conclusion
Objectives and Topics
This academic work provides a critical analysis of the extent to which the UK courts take the wishes, feelings, and beliefs of incapacitated patients into account when determining their best interests in medical treatment. It explores the transition from a paternalistic "doctor knows best" approach to a more patient-centered framework, analyzing key judicial precedents and the role of the Mental Capacity Act 2005.
- Evolution of the "best interests" test in English common law.
- Critical review of significant judicial decisions, particularly those involving Advance Directives.
- Evaluation of the impact of the Mental Capacity Act 2005 on judicial decision-making.
- Analysis of the balance between protecting vulnerable patients and respecting individual autonomy.
- Assessment of the benefits and challenges of incorporating patient participation in clinical decision-making.
Excerpt from the Book
Development of the Common Law
The best interest test has always been the benchmark against which lawful medical treatment of an incapacitated patient is judged. What has changed over time, is how the best interests test is assessed, and what factors are weighed into the decision. The first landmark case regarding adults who lacked capacity and what was in their best interest was F v West Berkshire in 1989. The House of Lords held that ‘a doctor can lawfully operate on, or give other treatment to adult patients who are incapable ... of consenting ... provided that the ... treatment concerned is in the best interests of the patient’. What this judgement essentially did was apply the Bolam test to the definition of best interests, which lawfully allows treatment to be administered regardless of the patient’s consent, if it conforms with ‘a reasonable and competent body of professional opinion’. Not only did F empower doctors to decide what was in a patient’s best interest, it also provided no formal restrictions to a doctor’s authority. Lord Goff’s 1990 decision in Re F (Sterilisation) followed suit. There was a stark lack of any mention regarding the patient’s views, values or beliefs, with Lord Goff explicitly saying although it was a necessity to consult other medical professionals, considering the patient’s own thoughts was redundant.
Summary of Chapters
Introduction: Provides the foundation for the analysis by establishing the historical context of incapacitated patient participation and outlining the shift toward patient-centered care.
Development of the Common Law: Traces the legal progression of the "best interests" test, highlighting the move away from the traditional, paternalistic Bolam-based approach toward more modern, inclusive standards.
Critical Analysis of Peter Jackson J’s Judgements: Examines specific legal cases to demonstrate how judicial interpretation, particularly by Peter Jackson J, influences the application of patient wishes in clinical scenarios.
Advantages and Disadvantages of Patient Participation: Discusses the ethical, psychological, and practical implications of including incapacitated patients' views in medical decision-making processes.
Conclusion: Synthesizes the findings of the essay, asserting that despite procedural challenges, the inclusion of patient wishes represents a positive evolution in medical law.
Keywords
Best Interests Test, Incapacitated Patients, Medical Law, Mental Capacity Act 2005, Patient Autonomy, Common Law, Advance Directives, Judicial Decision-making, Informed Consent, Paternalism, Human Rights, Clinical Ethics, Patient Participation, Wellbeing, Bodily Integrity
Frequently Asked Questions
What is the primary focus of this academic paper?
The paper examines how the UK legal system, specifically through its courts, incorporates the perspectives, values, and wishes of patients who lack the mental capacity to make their own medical decisions.
What are the central themes addressed in the text?
The central themes include the evolution of the "best interests" legal standard, the balance between patient autonomy and clinical intervention, and the legislative impact of the Mental Capacity Act 2005.
What is the main research question or goal?
The goal is to critically analyze the extent to which the courts have moved from a paternalistic approach to one that actively considers the incapacitated patient's personal history and stated wishes.
Which scientific or legal methodology does the author employ?
The author uses a critical legal analysis approach, evaluating landmark case law, judicial opinions, and legislative frameworks to track the development of the "best interests" assessment.
What topics are explored in the main body of the work?
The main body covers the historical reliance on the Bolam test, the shift toward "holistic" assessments post-Re A, the application of the Mental Capacity Act, and a comparative analysis of specific judicial decisions.
Which key terms best characterize this work?
The work is defined by concepts such as the "best interests" test, patient autonomy, medical law, the Mental Capacity Act 2005, and judicial interpretation.
How did the Re A (Medical Treatment: Male Sterilisation) case influence legal standards?
It introduced a "holistic" view of benefits and burdens and pioneered the "balance sheet" approach, which remains a vital tool for courts in weighing factors regarding a patient's best interests.
Why does the author discuss the case of Re F (Sterilisation) as a point of contrast?
Re F is used to illustrate the older, more paternalistic legal environment where a patient’s own views, values, and beliefs were considered largely redundant by the court.
What is the significance of the Aintree University Hospitals NHS Foundation Trust v James case?
This case is highlighted for Lady Hale’s focus on the "subjective, decision-specific evaluation" of a patient’s preferences, further solidifying the importance of the individual patient's perspective.
What are the potential drawbacks of including patient participation as discussed?
The author notes challenges such as the difficulty in interpreting the wishes of those who cannot communicate, the potential for manipulation, and the increased complexity and ambiguity in the legal decision-making process.
- Quote paper
- Sara Vincenzotti (Author), 2020, My Way or the Court's way?, Munich, GRIN Verlag, https://www.grin.com/document/903670
