THE ADVANCE of medical science has thrown up a raft of difficult ethical and practical issues. Many of them relate to human fertility but important concerns also arise about emergency medicine and end-of-life care. Victims of accidents or strokes or those afflicted with degenerative diseases increasingly may find themselves in a situation where they cannot consent to medical interventions. Medical technology can allow people to be kept alive with the aid of machines for decades with no prospect of recovery. Their own wishes, rights and dignity apart, not only does this leave relatives in a harrowing limbo, but it can place great pressures on medical resources as demands on them grow exponentially.
The courts have also been asked to deal with situations where individuals, for religious or other reasons, refuse to accept treatment considered by their doctors to be life-saving. This has arisen particularly in the case of Jehovah’s Witnesses, for example, who do not accept blood transfusions. In addition, there has been a growing emphasis in recent years on the dignity of the individual, particularly that of people whose capacities have become impaired, and on their entitlement to be consulted to the fullest extent possible on matters concerning them.
All of these issues have been explored in recent reports from the Law Reform Commission (LRC), including one on Vulnerable adults and the lawand last week on Bioethics: Advance Care Directives. The former led to the publication by the Government of the scheme of a Mental Capacity Bill which will result in a fundamental overhaul of our wards of court system. The report on advance care directives is intended to supplement this and to provide for such directives to be given a legislative framework.
If this report is accepted and legislation enacted, people will be able to set out in advance what kind of treatment they would wish to receive or not receive. If they want in certain circumstances to refuse life-saving treatment, this will have to have been put in writing and witnessed. The refusal of treatment on religious grounds will be permitted. The LRC also recommends that a person be encouraged to have medical advice about treatment. Nothing in the proposed legislation would change the existing law with regard to euthanasia and assisted suicide which will remain illegal.
The publication of the report provides a framework for a public debate on these important issues so that any legislation that follows can fully meet patients’ needs.