Search

Actions of pregnant women can cause harm to their future children. However, even if the possible harm is serious and likely to occur, the law will generally not intervene. A pregnant woman is regarded as an autonomous person who is entitled to make her own decisions. A fetus in-utero has no legal right to protection. In striking contrast, the child, if born alive, may sue for injury in-utero; and the child is entitled to be protected by being removed from her parents if necessary for her protection. Indeed, there is a legal obligation for health professionals to report suspected harm, and for authorities to protect the child’s wellbeing. We ask whether such contradictory responses are justified. Should the law intervene where a pregnant woman’s actions risk serious and preventable fetal injury? The argument for legal intervention to protect a fetus is sometimes linked to the concept of ‘fetal personhood’ and the moral status of the fetus. In this paper we will suggest that even if the fetus is not regarded as a separate person, and does not have the legal or moral status of a child, indeed, even if the fetus is regarded as having no legal or moral status, there is an ethical and legal case for intervening to prevent serious harm to a future child. We examine the arguments for and against intervention on behalf of the future child, drawing on the example of excessive maternal alcohol intake.

• Since their discovery in 2007, human induced pluripotent stem (iPS) cells have been widely championed as the future for regenerative medicine. • By differentiating iPS cells into specialised cells for transplantation, it may be possible to replace diseased cells and “cure” patients of various chronic degenerative conditions, including Parkinson’s disease. • Such putative iPS cell-based therapies would avoid the need to procure transplantable cells from (and in the process, destroy) human embryos, and could be administered to patients without immunosuppressive therapy. • In reality, however, the optimism surrounding iPS cell research has outpaced progress to date and likely emanates, in part, from the “moral panic” surrounding human embryo research. • At such an early stage of development, questions remain about whether iPS cells are strictly equivalent to human embryonic stem cells as a source of transplantable cells. The Heerey Committee considered this point in its recent review of the Commonwealth legislation governing embryo research and human cloning and its Report (tabled in federal Parliament in July 2011) recommended that embryonic stem cell research should continue in Australia. • In addition, there are many ethical issues which will need to be considered when enrolling vulnerable patients in trials of iPS cell therapy given the uncertain benefits and risks involved. • In the rush to embrace iPS cell therapy, there is a real risk that the public may overrate the benefits and expect imminent translation to the clinic.

Since the late 1970s, the capacity of assisted reproductive technologies to reorder the beginnings of life has generated robust, sometimes heated social debate. The new repertoires of in vitro fertilisation (IVF) and oocyte donation abruptly expanded the number of potential participants in the creation of a child and radically redistributed the spaces in which ovulation, conception, pregnancy, and birth took place. They propelled existing understandings of the origins of life, women’s reproductive rights, and the structure of the family into potential disarray and hence demanded systematic social deliberation and new legislative frameworks to manage the fallout. In the late 1990s, the creation of the first human embryonic stem cell line (Thomson et al. 1998) and the first mammalian clone (Campbell et al. 1996) galvanised a similarly robust social response. Abruptly, the entities associated with the beginnings of biographical human life, particularly embryos and oocytes, could be diverted from their developmental pathways and transformed into potential sources of therapeutic tissues for patients suffering degenerative conditions. For many people, such developments were profoundly unsettling, and after protracted debate and consultation, many governments in the Organisation for Economic Co-operation and Development (OECD) have tried to broker regulatory compromises that facilitate some degree of stem cell research yet give expression to the special status of the embryo and the need for donor protections

This article is concerned with the legal right of health service providers to decide whether to provide life-prolonging treatment to patients. In particular, an examination of recent decisions by the English Court of Appeal in R (Burke) v General Medical Council (Official Solicitor and Others Intervening) [2005] EWCA Civ 1003 and the European Court of Human Rights in Burke v United Kingdom (unreported, ECHR, No 19807/06, 11 July 2006) is provided. An analysis of Australian case law is undertaken together with a consideration of the limits of a patient's legal right of autonomy in relation to choosing life-prolonging medical treatment; the basis upon which such treatment can be legally withdrawn or withheld from an incompetent patient against the patient's earlier expressed wishes that it should be continued or initiated; the concept in ethics and law of a patient's best interests; and the role of courts in adjudicating disputes about the continuation of treatment in light of the recent decisions.

250

C1 - Journal Articles Refereed

In the UK, public access to emerging biotechnologies is largely regulated by three government bodies that operate at arm's length from democratically elected representatives: the Human Fertilisation and Embryology Authority (HFEA), the National Institute for Health and Care Excellence (NICE), and the Medicines and Healthcare Products Regulatory Agency (MHRA). Purposefully situated beyond traditional lines of electoral accountability, how can these independent bodies (commonly referred to as 'quangos') conceptualize and demonstrate their accountability to the public in regulating technically complex and morally controversial technologies? After articulating this general theoretical tension between independent and accountable decision-making in the arm's length context, I illustrate how it generates distinct, practical challenges within the HFEA, NICE and the MHRA. To navigate this general tension and address its practical ramifications, I invoke political theories of public reason and deliberative democracy, as well as recent attempts to apply these theories to the governance of biotechnologies. Through a critical analysis of these accounts, I articulate a new framework for 'public accountability as reciprocity' in the arm's length context. Its four, process-oriented conditions, of 1) reciprocal reasoning, 2) acceptance of deliberative disagreement, 3) voting, and 4) fostering the means of deliberative resistance, affirm the goal of identifying mutually acceptable reasons for collective decisions, but take seriously the fact that characteristics of emerging biotechnologies will often confound such attempts. Taken together, these conditions provide a more theoretically robust and normatively legitimate approach than existing accounts, notably 'accountability for reasonableness.' Next, I translate the theoretical claims of this framework into practice, illustrating how its conditions may be fruitfully applied towards the resolution of the practical challenges identified within the HFEA, NICE, and MHRA. In the HFEA, public accountability as reciprocity provides a robust approach to moral reasoning in the body's deliberations and resituates the role of public consultation. In NICE, it suggests a justifiable and properly tailored role for patient involvement in technology appraisals. Finally, in the MHRA, it explains why a growing number of devices defy the institution’s traditional assessments of safety and effectiveness and offers reforms to its regulatory boundaries. I conclude with a set of policy recommendations for creating and operating arm's length bodies, as well as an account of broader contributions to the literature on public reasoning, the concept of 'ethics expertise,' and the practice of patient and public involvement.