mental incapacity, disability and rights

Question 1

what do we mean by a right *

Answer 1

rights are a special form of moral claim - legal or moral rights

legal right - line in law that allows things to happen

moral - because i am a person i have rights

Question 2

should 2 identical patients other than their nationalities have different positions on the transplant list

Answer 2

no - the decision should be done solely on medical info

Question 3

should a pt with downs have the same chance of a transplant as a healthy pt when both would have the same survival rates

Answer 3

yes - the person with downs has the same right as everyone else

no - perhaps less compliant post-op, argue that their life is less valuable so less worth saving

Question 4

what counts as a right *

Answer 4

who decides

we all agree basic rights not to be killed or tortured

however - we do kill people who are a threat

there is no consensus that rights exist or whether they are rhetorical tools

Question 5

what are negative and positive rights and examples *

Answer 5

negative - about what people may not do to us eg kill, injure or steal

positive - what others must provide for us - education, autonomy, healthcare

positive rights are redundant in a society without the resources to fund it

Question 6

examples of how far positive rights could go *

Answer 6

right to housing

welfare

fertility treatment - if right to healthcare, why is this not included

right to good physical and mental health

Question 7

what is the problem with having rights *

Answer 7

it means that it is someone elses’ duty to provide those things - especially positive rights eg healthcare

also - are rights more certified than just things that people want

without the institutions to deliver health they are more like an empty entitlement or aspiration

Question 8

if a person (X) with a mental age of 2 is the only bone marrow match for her sister, should she be used to take the marrow

when she sees her sister it brings her joy but this is infrequent *

Answer 8

consequentialist argument - yes - cause more benefit than harm so should be done. However, then could arguably take from anyone who is a match

rights protect vulnerable people from utilitarianism

X has the same rights as her sister - so the operation should only be done if it benefits her

X has a right to freedom from harm - she would be given pain and not be able to understand why

X has a right to freedom from interference - bodily integrity

welfare of the family - if X doesnt give marrow and eldest sister dies - mum will have to look after oldest sister’s child and will be less able to look aftyer X

Question 9

how do we decide what the best interests are for patients w/o capacity *

Answer 9

burden of treatment

prognosis

alturism - if dont have the capacity to be alturistic then can you argue that it is in someones best interest

QOL - subjective

osychological impact

expressed wishes - get feeling overall if they want treatment

welfare of family

previously expressed wishes

individual rights

Question 10

what are previously expressed wishes *

Answer 10

what is said now affects the future decisions made about you

Question 11

what is the precedent right to decide *

Answer 11

if a person loses autonomy through acquired mental disability, eg head injury/dementia should there be a precedent right (when autonomous) to determine future treatment or non-treatment

Question 12

how do advanced decisions fit into the mental capacity act *

Answer 12

advance decisions drawn up when an individual is mentally competant are legally binding

it follows that there is a legal right to rrefuse treatment if mental capacity is lost ion the future

Question 13

describe Margo’s logo *

Answer 13

person see pt with dementia - always read book upside down

seemed happy

Question 14

describe Ronald Dworkin’s view on precedent *

Answer 14

need to consider the interests of a person who has become demented - not just the person who is demented

critical interests include being able to shape how our lives go on as a whole

to deny the right to determine the manner of our death would violate our respect for autonomy

Question 15

describe Rebecca Dresser’s view on precedent *

Answer 15

it is difficult for people to make decisions about something they dont know about

there is ni opportunity to discuss any changes in treatment that may come about eg if new treatment comes available

the person who has become demented may be a different person prior to the dementia - they have no recollection of the past

minimally invasive treatment should be administered irrespective of an AD if the person appears content and active

Question 16

what are the legal grounds for abortion *

Answer 16

it is a criminal offence unless

• the pregnancy is <24weeks and the risks to the physical and mental health of the women or children in her family are greater if the pregnancy continued
• at any stage if
  
  • it is to prevent grave and permenant injury to the mother
  • continuing preg would involve a greater risk to the life of a pregnant women than the termination would (pregnancy is generally mroe risky than abortion)
  • substantial risk of serious physical or mental handicap

Question 17

what are the rights regarding abortion and disability*

Answer 17

an abortion can be performed at any stage on the grounds of serious disability

few conditions are so awful that people sya that they are better off dead

downs syndrome accounts for 20% of the aboritions performed on the grounds of a serious handicap

does the current law imply that those with a disability have a lesser claim on the right to life

Question 18

ethical issues regarding abortion and disability *

Answer 18

it is arguing that because people suffer they wopuld be better off having not been born - however people with a disability seem to live a fulfilled life

also by aborting we say that the people alive with these conditions have less fulfilling lives

is it different than terminating the baby based on sex or hair colour

do they reinforce prejudice against those with a disability

Question 19

is disability a social construct *

Answer 19

arguably disability is only a problem because society fails to support those with a disability

parents of people with disabilities are more concerned about the social stigma than the physical limitations

parents worry about who will look after their child when they die

Question 20

how does disability affect maternal rights *

Answer 20

reality of a disabled child is that it puts immentse physical, emotional and financial strain on parents

other children in family might suffer as a result of this

therefore a women should have the right to choose to terminate

Question 21

how does having a disabled foetus affect autonomy *

Answer 21

as moral agents mothers should make morally acceptible decisions

autonomous decisions should be respected as long as they are morally acceptible

autonomous choice requires that we are given a reasonable range of options

if society fails to ensure justice and provide an adequate level of support for those with disability, does a women have a reasonable choice of options and therefore does she have true autonomy

Question 22

has the law around abortion and disability got it wrong *

Answer 22

is it discriminatory

Question 23

has the law on advanced decisions got it wrong *

Answer 23

is there too much weight on precedent autonomy

Question 24

what is the relationship between law and ethics *

Answer 24

in liberal democrats, not all that is considered immoral is illegal

nor everything that is unlawful is unethical

therefore the law might mot be the best way to promote ethical behaviour

Question 25

describe alec bourne’s effect on the law *

Answer 25

he was a gynaechologist

aborted a girl age 14 who had been raped at a time when it was legal only to save the mothers life

he argued that aborting this child saved the life of the girl who had been raped

laws changed becasue at this point the law was unethical

Question 26

role of drs with the law *

Answer 26

we must work with the law, but also be critical of it