Ruth Campbell

In Montgomery v Lanarkshire Health Board, the Supreme Court has clarified the law in relation to informed consent.1 When seeking consent, doctors must take reasonable steps to ensure that the patient is aware of the material risks of any treatments they offer and of the availability of any reasonable alternatives. Doctors can no longer rely on a responsible body of medical opinion—the Bolam test—when assessing what information they should provide to patients. The patient in the case was an insulin dependent diabetic pregnant woman. Diabetic women frequently have larger than normal babies, which leads to a heightened risk of shoulder dystocia where the baby's shoulders cannot pass through the pelvis. Her consultant did not inform her either of the 9%–10% risk of shoulder dystocia or of the possibility of delivery by caesarean section. During delivery the umbilical cord was occluded and her son was born with cerebral palsy and with a paralysis of the arm resulting from the vigorous manipulation required to deliver him. The court held that the consultant should have informed the patient of the risks of shoulder dystocia and discussed the possibility of a caesarean section. The court also set out doctors’ legal obligations in relation to information provision when seeking consent. Doctors must ‘take reasonable care to ensure that the patient is aware of any material risks involved in any treatment and of any reasonable alternative or variant treatments’.2 A ‘material risk’ is one in which ‘a reasonable person in the patient’s position would be likely to attach significance to the risk, or the doctor is or should reasonably be aware that the particular patient would be likely to attach significance to it’.3 When discussing risk with patients, percentages alone are insufficient. Important factors will include ‘the nature of the risk, …

The Mental Capacity Act (2005) for England and Wales came into force in 2007. It was designed to codify the law in relation to decision making on behalf of adults lacking the capacity to make specified decisions on their own behalf. In 2013, the House of Lords established a Select Committee on the Act in order to explore how well it was achieving its aims and whether any substantive amendments were required.1 In particular the Committee wanted to identify whether the Act was achieving an appropriate balance between enabling adults who may have impaired capacity to make as many decisions as possible and providing protection to those adults who needed it. The British Medical Association (BMA) submitted a written response to the Committee's call for evidence. Although in general strongly supportive of the Act, the BMA raised some concerns about the lack of awareness among front-line health professionals. In addition, the BMA expressed concerns that in some instances, in the absence of a binding advance decision, insufficient weight was given to the prior competent wishes of adults now lacking capacity. The scrutiny committee also invited views on whether the Act was compliant with the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). The Convention requires equal treatment for all disabled people, irrespective of whether their disabilities are physical or mental. Article 12 of the Convention requires that “persons with disabilities have the right to recognition everywhere as persons before the law”.2 It is possible that a right to equal recognition before the law could render the Mental Capacity Act's surrogate decision-making regime unlawful. Along with several other medical bodies, the BMA was invited to give oral evidence to the scrutiny committee. The Committee was particularly interested in identifying what medical bodies could do both to …

At the end of 2015, Northern Ireland's (NI) High Court of Justice ruled that NI abortion legislation breaches Article 8 of the European Convention on Human Rights—the right to respect for private and family life. The law breaches the Convention as it does not enable women to seek abortion for: At the time of writing, it was not known if NI's Department of Justice and Executive would appeal the decision or bring forward legislation to reflect the judgment. In November 2015, the High Court handed down a judgment in a case involving the recording of a do not attempt cardiopulmonary resuscitation (DNACPR) decision for a 28-year-old man who lacked capacity.2 The judgment has raised a number of interesting questions about when it would not be ‘practical and appropriate’ to ‘consult’ those close to the patient of a DNACPR decision, and what might be a ‘compelling obstacle’ to consultation. In the case, a DNACPR decision was made at 3:00 in the morning as the doctor believed that cardiopulmonary resuscitation (CPR) would have no chance of success. The doctor did not think there was imminent risk of a cardiopulmonary arrest but wished to avoid the possibility of nursing staff being obliged to attempt CPR. At the time the decision was made and documented, no one close to the patient was consulted or informed, instead “DNAR. Speak to family in the morning” was recorded. In the judgment, The Honourable Mr Justice Blake concluded that there had been a breach of section 4(7) duty to consult under the Mental Capacity Act 2005 (MCA) and there had been a violation of the procedural duty under …

The relationship of language to cognition, especially in development, is an issue that has occupied philosophers, psychologists, and linguists for centuries. In recent years, the scientific study of sign languages and deaf individuals has greatly enhanced our understanding of deafness, language, and cognition. This Counterpoints volume considers the extent to which the use of sign language might affect the course and character of cognitive development, and presents a variety of viewpoints in this debate. This volume brings the language-thought discussion into a clearer focus, both theoretically and practically, by placing it in the context of children growing up deaf and the influences of having sign language as their primary form of communication. The discussion is also sharpened by having internationally recognized contributors, such as Patricia Siple, Diane Lillo-Martin, and Ruth Campbell, with specialties in varied areas, all converging on a common interest in which each has conducted empirical research. These contributors clarify and challenge the theoretical assumptions that have driven arguments in the language-thought debate for centuries. An introduction by the editors provides a historical overview of the issues as well as a review of empirical findings that have been offered in response to questions about language-thought relations in deaf children. The final chapters are structured in the form of "live" debate, in which each contributor is given the opportunity to respond to the other perspectives presented in this volume.