Biomedical Ethics and Law PhD Research

Annabel Howe

Based in:  Law School
Supervisors:  Phil Bielby, Mike Feintuck

Provisional Thesis Title:  Observing the Embodied Experience of Dementia and Illness in the Interpretation of an Advance Decision under the Mental Capacity Act 2005

Summary of Thesis

Under the Mental Capacity Act 2005, as an extension of the patient's right to self-determination, an individual can make an 'advance decision'.  This allows him (or her) to refuse treatment in advance of losing decisional competence.  It is therefore possible that one can stipulate that if there comes a time when he develops dementia, and that, at this time, he also suffers a life-threatening illness, treatment should be withdrawn or withheld, so that he can die.  This provision tacitly assumes that those values held before dementia are durable throughout alterations in one's embodied experience.  This view is challenged by applying the phenomenological theory of Martin Heidegger and Maurice Merleau-Ponty.  Phenomenology draws attention to the inextricable unity between mind and body, explaining that the life-world is discovered by the embodied subject through actively engaging with it, rearranging and manipulating it, to serve our own intentions.  Worldly entities therefore stand forth as having value and meaning, for us. The value which is given to existence, one's life-world, is therefore intimately bound to embodied experience, how our body feels to us, and what it makes possible.  Thus, conversely, changes to that experience affect how one values his existence.  Illness has the capacity to change how one views his self, his body and his world.  With pain, disease and disability, the embodied experience changes in terms of the scope of its capacities, and its qualitative feel, the experience of pain, for example.  Though the individual with dementia loses his cognitive capacities, including his long-term memory, his ability to value and to feel emotion persists.  Since the person with dementia has exclusive access to his embodied experience of dementia, and any other illness that he is likely to develop with ageing, insofar as he is still able to value, his views and preferences might form a meaningful, even indispensible, contribution to those decisions affecting his medical treatment, alongside the observation of his advance decision. 

James Mullen

Based in:  Law School
Supervisors:  Phil Bielby, Tony Ward

Provisional Thesis Title:  Capacity to Refuse Medical Intervention: An Assessment of the Law Relating to Vulnerable Adult Competence

Summary of Thesis

This thesis is primarily concerned with the conflict which arises, between preserving autonomy and treating a medical condition, when a vulnerable adult is seeking to refuse their consent to a medical intervention being carried out.

In English law there are various ways in which an adult can be treated against their will; the inherent jurisdiction of the Court, the Mental Health Acts and where consent is given on their behalf by a donee in a Lasting Power of Attorney under the Mental Capacity Act.

Approaching the question from a rights-based ethical position (the cautious application of Gewirth's Principle of Generic Consistency) the thesis considers if the balance between individual autonomy and state sanctioned paternalism has been conrrectly struck.  Whilst accepting that in certain circumstances compulsory treatment is necessary the thesis will assess the law against a framework which requires refusal to be respected for as long as possible in order to determine if vulnerable adults are given adequate protection against competent refusals being over-ridden.

such consideration will involve not only assessing the safeguards in each scheme against the framework, but also against each other.  To be consistent with a framework developed from the Principle of Generic Consistency the law must treat an individual equally and must not discriminate on the grounds of status or condition.  Therefore, each scheme must offer equality of protection.

The thesis is expected to conclude by suggesting ways in which the law could be changed in order to maximise the protection it gives to vulnerable adults' refusal of consent to intervention.