PAPER CODE NO.

LAW 051

EXAMINER

DEPARTMENT :

Prof M Jones
Law

TEL. NO

0151-794 2821

JANUARY 2010 EXAMINATIONS

MEDICAL LAW AND ETHICS I (LAW 051)

TIME ALLOWED: Two Hours

INSTRUCTIONS TO CANDIDATES
Answer TWO questions: FIVE questions on the paper.

Candidates may bring into the examination room unannotated copies of Blackstones
Statutes on Medical Law.
Candidates whose first language is not English are permitted to take into the examination room
an authorised copy of one of the following monolingual dictionaries: Oxford Paperback
Dictionary; Collins Pocket English Dictionary; Collins Paperback Dictionary.

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1.

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On Monday morning you walk into your office and find that the local hospital urgently
needs your advice in each of the following cases:
(a)

Jenny is a 2 week old baby with severe brain damage, cared for in the
intensive care unit of the local hospital. She is unlikely ever to walk, speak or
to be able to care for herself. In the absence of an infection or other illness her
life expectancy is about nine years. She has contracted pneumonia. Antibiotic
treatment will probably cure the pneumonia but without it there is a 70%
likelihood that she will die within a week or so. The doctors who are treating
her decide it would be inappropriate to provide antibiotics and that treatment
will be confined to keeping her comfortable. Jennys parents are devoutly
religious and insist that she must be treated.

(b)

Sylvia, aged 32, is 25 weeks pregnant. Doctors have identified a problem

with the baby, and want to administer a drug to Sylvia in order to promote the
babys growth to a stage where it can more safely be delivered by Caesarean
section. Sylvia has refused the drugs. She has also said that the treatment
would be pointless, in any event, because she is not going to agree to a
Caesarean section delivery.

(c)

Vanessa is 20 years old and has anorexia nervosa. She is being treated as an
in-patient because her weight has fallen to a dangerously low level. Yesterday
she fainted while in the bathroom and has badly cut her face. She is advised
that she needs stitches in the wound, but she is refusing, saying she would
prefer to let the wound heal by itself.

Advise the hospital as to the legal and ethical principles that apply in each of these
cases.

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2.

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Answer BOTH parts of the question:

(a)

Dr Sparks has been involved with clinical trials of Morbidistat, a new antiobesity drug. Phase I and Phase II trials have produced positive results which
suggest that Morbidistat poses a smaller risk of permanent damage to the liver
than other available anti-obesity drugs. Dr Sparks team are proposing to
conduct new trials involving research subjects aged between 10 and 15 who
are suffering from obesity. Dr Sparks believes that this research is vital as
otherwise it is not possible to gauge the drugs suitability for younger patients.
Advise Dr Sparks team on the legal and ethical principles raised by their
proposed trials.

AND
(b)

3.

Outline the common law standard of disclosure as it applies to adults with

capacity volunteering for medical research in England and Wales and critically
evaluate the extent to which recent measures have improved upon this.

...It is unlawful ... to administer medical treatment to a patient, who is conscious and
of sound mind, without his consent...
To what extent is this statement true when applied to patients under the age of 18?

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4.

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The Darling familys general practitioner is Dr Slightly. Mr Darling died ten years ago
of Huntingtons disease, aged 58, leaving a widow and a son, Peter. Peter is married to
Wendy. They have both been to see Dr Slightly as they are expecting to have a baby in
six months time. Mrs Darling does not want her deceased husbands condition
disclosed to his family as she does not want her son, Peter, to live in fear of a disease
that cannot presently be cured.
John, 15, another of Dr Slightlys patients, was hospitalised following seizures
suspected to be caused by diabetes. Blood tests were taken during his stay in hospital
and the results revealed that diabetes was the probable cause of the seizures and also
that John had been taking illegal and highly addictive drugs. The test results were
communicated to Dr Slightly who advised Johns parents that John should commence
insulin injections. He did not disclose Johns drug use to them. John refuses to take
insulin injections as he does not accept he is ill and he is fed up of people interfering
in his life.
Advise Dr Slightly as to the legal and ethical issues raised by the above scenarios.
(NB - Huntingtons disease is a hereditary condition which usually manifests itself in
middle age (35-50). If a patient has the defective gene which causes Huntingtons
disease, there is a 1 in 2 chance that his or her offspring will inherit the same gene.
Although there is no cure for the disease, the foetus can be screened for the disease.)

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5.

ANSWER EITHER (a) OR (b) (DO NOT ANSWER BOTH PARTS)

(a)

In legal terms, the patient's consent to the treatment may be valid once he or
she is informed in broad terms of the nature of the procedure which is
intended. But the choice is, in reality, meaningless unless it is made on the
basis of relevant information and advice. Because the choice to be made calls
for a decision by the patient on information known to the medical practitioner
but not to the patient, it would be illogical to hold that the amount of
information to be provided by the medical practitioner can be determined from
the perspective of the practitioner alone or, for that matter, of the medical
profession (Rogers v Whitaker, High Court of Australia)
The function of the law is to protect the patient's right to choose. If it is to
fulfil that function it must ensure that the duty to inform is respected by the
doctor. It will fail to do this if an appropriate remedy cannot be given if the
duty is breached and the very risk that the patient should have been told about
occurs and she suffers injury (Chester v Afshar per Lord Hope)
With reference to the relevant caselaw, comment on both of these statements
in relation to the doctors duty in English Law to disclose information to the
patient.

OR
(b)

Sandra, age 33, is epileptic and significantly overweight. She takes

medication (Epiright) for her epilepsy, but the control she achieves over the
condition varies and she still occasionally suffers from epileptic seizures
during which she sometimes loses consciousness. Sandra visited her general
practitioner, Teresa, because she had not had a period for three months. Teresa
examined Sandra and concluded that the absence of Sandras periods was
probably a side-effect of the Epiright, the dosage of which had been increased
five months earlier. Three months after seeing Teresa, Sandra, who had been
putting on weight, realised that she might be pregnant and so went back to her
general practitioner. Teresa confirmed that Sandra was six months pregnant.
She immediately advised Sandra to change her epilepsy medication, because
of the known risk to the baby of taking Epiright when pregnant. The new
medication (Interstran) was not as effective in controlling Sandras seizures
and a few weeks later she had a major seizure in which she lost consciousness,
fell and broke her left leg and arm. When the baby was born it was found to
be suffering from significant brain damage, which was probably caused by the
Epiright. It is known that uncontrolled epileptic seizures when pregnant carry
a risk of injury both to the mother and the baby.

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Sandra says that had she known that there was a risk that her baby could have
been damaged by the medication she would have opted for a termination of
the pregnancy.
Advise Sandra whether she has any claim for negligence against Teresa, both
in respect of her own losses and on behalf of the baby.
[Ignore any possible product liability claim against the manufacturers of the
medication]

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