51 Med. Sci. & L. 1 (2011)

handle is hein.journals/mdsclw51 and id is 1 raw text is: 


Proceedings of the Sixth Northern Region Paediatric Colloquium

Mandy Abbott MBBS MRCPsych* and Corrine Reid MBBS MRCPsycht
*CAMHS,  1st Floor Benton House 136, Sandyford Road, Newcastle upon Tyne NE2 1QE; tCAMHS, Newcastle upon Tyne, UK
Correspondence: Mandy Abbott. Email: mandyabbott@gmail.com

It is apparent that the practice of medicine in today's society can often raise difficult legal and ethical dilemmas. With this in
mind, senior figures from the medical, legal and theological professions have met on a biennial basis in order to discuss
anonymised  case material of such a nature. This provides a valuable forum in which to discuss such dilemmas, enabling the
sharing of knowledge and experience from which we all can learn. To this end, we report the proceedings of the 'Sixth
Northern Region Paediatric Colloquium', which are now the third set of proceedings to be published.

Med  Sci Law 2011; 51: 1-4. DOI: 10.1258/msi.2010.010044

The  Colloquium  was held in March  2009  at Walkergate
Park Hospital, Newcastle upon Tyne, UK. It was attended
by  senior clinicians, legal professionals and religious
leaders from the local community. Four anonymised cases
were  presented, all of which centred on a medico-legal
and/or  ethical dilemma. These cases are described and
key  points arising from the subsequent  discussion are

Case   1
Helen is a 22-year-old psychiatry inpatient with a diagnosis
of schizophrenia. She is pregnant. She has refused any
medical assessment or treatment apart from  allowing an
obstetrician to perform an abdominal examination. From
this she was judged to be within 4-6 weeks  of delivery.
Helen  denies that she is pregnant  declaring that there
'may be a baby' but it is not hers.
  The  consultant psychiatrist considers that Helen lacks
capacity to make  decisions in relation to her impending
labour. It is also thought that a negative outcome for her
fetus would  make  Helen's schizophrenia more  resistant
to treatment and  result in significant detriment to her
long-term  health. The obstetricians are concerned that
Helen  receives medical  treatment that is in  her best
interests and that a  caesarean section is likely to be
needed. They are also concerned about the extent to which
they are permitted to take into account the needs of the
unborn baby.
  In this case the National Health Service Trust applied to
the Court for declarations that Helen lacked capacity to
make  decisions in relation to her impending delivery and
that it was  in Helen's best  interests that a caesarean
section be performed.
  This case raised two main questions:

* If Helen had capacity to make decisions in relation to her
  impending  delivery, could she refuse medical treatment
  including a caesarean section? Would she need to have
  good  reason? Should weight be given to the interests of
  the unborn  child? Where would  this leave her treating
* If Helen lacked capacity to make decisions in relation to
  her impending  labour, how  should the court approach
  the  best interests decision and  again what  weight
  would  be given to the interests of the unborn child?

Prior to the discussion the legal approach was outlined.
Capacity to consent and 'best interests' are explained by
the following statements:

* In general it is a criminal and tortuous assault to perform
  physically invasive medical treatment, however minimal
  the invasion may be, without the patient's consent;
* Every person is presumed to have the capacity to consent
  to or to refuse medical treatment unless and until that
  presumption  is rebutted;
* A  competent woman  who  has the capacity to decide may
  for  religious reasons, other reasons, for rational or
  irrational reasons or for no reason at all, choose not to
  have medical intervention, even though the consequences
  may  be the death or serious handicap of the child she
  bears, or her own death;
* If therefore the competent mother refuses to have the
  medical  intervention, the doctors may not lawfully do
  more  than attempt to persuade her. If that persuasion is
  unsuccessful, there are no further steps towards medical
  intervention to be taken;
* Best interests are not limited to medical best interests but
  include emotional and all other welfare issues. The Court
  attempts to reach an objective view of best interests in the
  light of all the relevant circumstances and evidence avail-
  able to it.

The effects of these legal approaches are as follows:

Medicine, Science and the Law 2011; 51: 1 -4

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