NHS, mental health, Covid-19 and organ donation…

It is hard to believe this book is now in its 12th iteration. It always was, and in this edition remains, an outstanding text.

There are eight contributors to the book, all based at the university of Edinburgh and drawn from a diverse range of fields in bioethics, law and jurisprudence. This book considers the area where law and science meet in both practical and theoretical aspects. 

The text opens with a review of bio and wider medical ethics, followed by the governance of the health system. Helpfully, the latter considers the four nations of the UK, something that no doubt will have been a feature in the investigation and for counsel in the ongoing Covid inquiries. As the authors note: “Although the core values and principles that underpin the health services are broadly similar, their structures and organisational arrangements differ and are reflective of local healthcare policy and institutional cultures, as well as the need to focus on the (public) health needs of local populations.”

The authors then turn to the regulation of health professionals, resourcing and research, followed by a wider consideration of public health. With the pandemic not that far behind us and the inquiries around it taking evidence, this chapter is particularly relevant as it considers the role of the state and individual during the pandemic and reactions towards it. Again, as the authors conclude: “These are necessarily political exercises that engender deep questions about the role of the state and the appropriate balance to be struck between the betterment of collective health and respect for individual autonomy and liberty.” 

The authors reflect the intersection of law and practice when they note: “The role of law and policy in public health is to police the boundaries of these relationships, and to ensure that reasonable justifications for state actions that encroach on individual rights are offered and are well founded – a function that is complicated by the fact that threats to public health can appear quickly and with potentially devastating regional and global effects.”

Criminal law is discussed within this section of the text. Some may question the role of criminal law in this field. However, while the act of ending life by a nurse or doctor may be seen as murder or culpable homicide in its most clear-cut examples, there are other areas to consider such as the reckless or intentional transmission of potentially life-altering disease. In this situation, reference is made to Kelly v HMA, an unreported case in which an individual was successfully prosecuted for the reckless transmission of HIV through “culpably and recklessly engaging in sexual intercourse to the danger of a woman’s health and life”. The common law allows such flexibility to charging.

Further chapters consider mental health, reproduction, consent to medical treatment, particularly in relation to children, and end of life, including withdrawal of medical treatment and euthanasia. 

The latter topic is one that is increasingly discussed both in the press and by the Scottish and Westminster Parliaments. It is a socially divisive topic. The authors conclude that “it is certain that changes will come about only as a result of extensive argument and with little chance of consensus. One wonders, then, is legislation needed and, if it is, does it have to be as complex and meticulous as recent efforts?” In the chapters on end of life, they conclude that “there is little need for legislation in respect of the incurably or terminally ill adult patient; the great majority of life or death decisions can be – and are – based on good medical practice, which is contained by relatively clear legal and moral guidelines; when put to the test, the euthanasia calculus needs to be enlisted only in the cases of ‘mercy killing’ and physician-assisted or physician-accomplished suicide. We doubt if there is serious, extensive support for the first of these in the UK.”

This is but a snapshot of an excellent text, which is both thought-provoking and secure in equal measure. It provides a balanced yet critical analysis of the tensions that may arise at the junction of law and ethics in the field of medicine and sets out a way forward in some areas particularly relevant within today’s society.

David J Dickson, Solicitor Advocate