1. Bits of law… ALEX, POPPY, RAJNI, JAKE

2. Types of law…

3. 3 sources of law?  Common-law  ‘judge-made law’  Statute- law  ‘parliament-made’ law  European law  esp. European Convention on Human Rights

4. Common law  Advantages  Slow changes  Fits with other law  Sensitive issues considered outside political arena  Disadvantages  Piece-meal - cases must arise - no “grand scheme”  Conservative  Retrospective  No community consultation  Uncertain – standard like “reasonable”

5.  Advantages  Paramount - overrides common law  Clear and conclusive  Prospective  Carefully planned - systematic  Public – participatory  Reflects community attitudes  Disadvantages  Inflexible  Difficult to change  Hard for rapid change areas like biotechnology Statute law

6.  Advantages  Embeds ethical principles  Avoids conflict between domestic and international law  Enforcement of individual human rights  Better policy outcomes  Disadvantages  Too much power to judges  Only imposed against government and public authorities  Subject to Parliamentary sovereignty European law

7. Capacity and Consent…

8. Do they have capacity? Mental Capacity Act (2005)  Understanding of information  Retention of information  Ability to use/weigh information as part of the decision-making process  Ability to communicate their decision

9. Is their consent valid? Consent For consent to be valid “it must be given voluntarily by an appropriately informed person (the patient or where relevant someone with parental responsibility for a patient under 18) who has the capacity to consent to the intervention in question”  Capacity  Information  Decision-making  Voluntariness

10. Who can consent?  For an adult with capacity?  Only the adult themselves  For minors?  16-17 year olds  Capacity assumed from age 16  Gillick-competent under 16 year olds  A Person/Local authority with Parental Responsibility  A Court

11. Children Act (1989) Case-law Rulings HTTPS://WWW.YOUTUBE.COM/WATCH?V=QH2SWSVRRMO

12.  The welfare of the child should be the paramount concern.  Someone with parental responsibility can consent to/refuse treatment when the child is not deemed competent. Only one parent (or the court) needs to consent.  A competent child’s refusal of treatment can be overruled by the parent/guardian/court. The Children Act (1989) (all you need to know)

13.  When the clinician assesses an under 16 child’s competency, they can justify  This is generally referred to as Gillick competency and was established by a specific legal case.  Originally this term applied only to contraception, but is now used for child competency in general. Gillick Competency

14.  The same case that established Gillick competency also established the Fraser guidelines.  The are mainly applied when a doctor gives an under-16 contraception, but also tend to be applied to competency in general.  A doctor could proceed to give advice and treatment provided he is satisfied in the following criteria… Fraser Guidelines

15. 1. That the girl (although under 16 years of age) will understand his advice; 2. That he cannot persuade her to inform her parents or to allow him to inform the parents that she is seeking contraceptive advice; 3. That she is very likely to begin or to continue having sexual intercourse with or without contraceptive treatment; 4. That unless she receives contraceptive advice or treatment her physical or mental health or both are likely to suffer; 5. That her best interests require him to give the contraceptive advice, treatment or both without the parental consent.”

18. Human Fertilisation & Embryology Act 1990 (2008)

19.  Criteria:  Condition of the affected child should be severe or life threatening to justify Pre- implantation Genetic Diagnosis  Embryos conceived should be themselves at risk from condition of existing child  All other possibilities of treatment and sources of tissue should have been done  Intention should be to take only cord blood for purposes of treatment, and not other tissues or organs  Embryos should not be genetically modified to provide a tissue match

20. Case Study on Saviour Siblings – Zain Hashmi Three year old boy suffering from beta- thalassemia. Death without bone marrow transplant. a)Condition of the affected child should be severe or life threatening to justify PGD Both parents were beta-thalassemia carriers. a)Embryos conceived should be themselves at risk from condition of existing child Regular blood transfusions a)All other possibilities of treatment and sources of tissue should have been done Pre-implantation genetic diagnosis (PGD) to select embryo free of disease AND conduct tissue typing to identify perfect blood match so that umbilical cord blood can be used to save Zain’s life a)Intention should be to take only cord blood for purposes of treatment, and not other tissues or organs - a)Embryos should not be genetically modified to provide a tissue match

21. Justified!

22. Questions…

23. What 4 things are required for capacity to be present? 1. Understanding of information 2. Retention of information 3. Ability to use/weigh information as part of the decision-making process 4. Ability to communicate their decision

24. What 4 things are required for valid consent? 1. Capacity 2. Information 3. Decision-making 4. Voluntariness

25. A 14 year old girl comes to you, asking to go on the pill. What 5 things should you be confident of before giving her contraceptive treatment? 1. She will understand your advice 2. You cannot persuade her to inform her parents or to allow you to inform the parents 3. She is very likely to have sexual intercourse with or without contraceptive treatment 4. Unless she receives contraceptive advice or treatment her physical or mental health are likely to suffer 5. It is in her best interests that you give contraceptive treatment without her parent’s knowledge