Reflecting on the year 2020
2020, what a year! Although I imagine many will be happy to see the end of this year due to the ongoing phenomenal impact of Covid-19, a lot has occurred in the realms of medical ethics and law. As we move into the new year, it is interesting to reflect on the year we are leaving behind. Below exemplifies important cases and changes that have occurred in 2020 that have forever impacted the ethics and legal aspects of medicine. This is by no means an exhaustive list.
- Organ donation laws changed in England in May 2020 to an opt-out system.
This change in law now means that there is presumed consent for organ donation, requiring individuals to opt out if they wish not to donate their organs.
This raises issues of consent, autonomy, religious objections and ownership of one’s body.
https://www.organdonation.nhs.uk/uk-laws/organ-donation-law-in-england/
- XX v Whittington Hospital NHS trust (April, 2020)
A landmark case dealing with the issue of surrogacy, which decided in a case where a hospital trust’s negligence resulted in a woman’s inability to conceive naturally, that the trust should be responsible for losses flowing from this mistake. This extends to include the cost of commercial surrogacy arrangements abroad, even though commercial surrogacy arrangements are unlawful in the UK. This clarified concepts regarding reproductive medical law.
https://www.supremecourt.uk/cases/uksc-2019-0013.html
- A teenager Jehovah witness patient refusal to have life saving blood transfusions
A teenage patient who had Sickle cell anaemia refused blood transfusions on religious grounds. Her decision was ultimately overruled despite her being ‘wise beyond her years’.
This case concerned issues regarding autonomy, consent, religious objections, paternalism and minors refusing/consenting to treatment and the conflicting principles of non-maleficent and beneficence.
(An article produced by Prof Dominic Wilkinson beautifully discusses the ethical issues involved within this case)
- Tavistock and Portman NHS foundation trust v. Quincy Bell and Mrs A
It was decided in a high court case that children 16 year and younger, are unlikely to be able to consent to taking puberty blocking medication in the pursuit of gender reassignment. Even cases of individuals under 18 will likely require court authorisation. Again this case raises issues of consent, autonomy, paternalism and minors consenting to treatment.
News article discussing here:
- NHS Foundation Trust v MC (2020)
A case concerning altruistic stem cell donations. This concerned whether a young incapacitous patient with a background of a learning disability (MC), who was unable to consent to bone marrow/stem cell donation, should be able to donate her stem cells to her mother. It was considered that it would be in MC’s best interest for her mother, who suffered from leukaemia, to have her life extended, as it would ultimately benefit the MC. Considerations were made concerning best interests, both directly and indirectly. This considered issues of best interests, consent and mental capacity.
Case summary from Bevan Brittan below:
- ABC v St George’s Healthcare NHS Foundation Trust others [2020]
This landmark case concerned the decision of doctors to withhold information surrounding a patient’s diagnosis of Huntington’s disease, an incurable debilitating neurological disease, from the patient’s daughter as per the patient’s request. This is despite Huntington’s disease having a 50% chance of inheritance. The patient’s daughter (ABC) went on to have her own child and later tested positive for the Huntington’s disease gene, after her father’s diagnosis was accidentally disclosed to her. (It is unknown yet whether her child has the Huntington disease gene).
This case broaches topics including confidentiality, a clinician duty of beneficence and non-maleficience, a clinician’s duty of care and reproductive and genetic ethics.
Case summary by 1 COR chambers:
News article:
https://www.bbc.co.uk/news/health-50425039
- A finally… last but by no means least Covid-19 and the host of ethical issues that arise from this pandemic. Whether this may concern the ethics surrounding resource allocation, vaccination ethics, research ethics surrounding challenge trials, clinicians’ professional duties, public health and nationalism ethics and many more.
For a wider breadth of discussion on these points, check out our covid-19 ethics resource page here.
What do you believe has been the biggest developments over the year 2020? What area of medical ethics and law will you be interested to see develop in the year 2021?