Amel Alghrani

GENDER AND PARENTHOOD: THE CASE FOR REALIGNMENT

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Healthcare scandals in the NHS: crime and punishment

The Francis Report into failures of care at Mid Staffordshire NHS Foundation Trust Hospital documented a series of ‘shocking’ systematic failings in healthcare that left patients routinely neglected, humiliated and in pain as the Trust focused on cutting costs and hitting government targets. At present, the criminal law in England plays a limited role in calling healthcare professionals to account for failures in care. Normally, only if a gross error leads to death will a doctor or nurse face the prospect of prosecution. Doctors and nurses caring for patients under the Mental Health Act 1983 and the Mental Capacity Act 2005 may however be prosecuted for wilful neglect of a patient. In the light of the Francis Report, this article considers whether the criminal offence of wilful neglect should be extended to a broader healthcare setting and not confined to mental healthcare.

What is it? Whose is it? Re-positioning the fetus in the context of research

The Cambridge Law Journal / Volume 70 / Issue 01 / March 2011, pp 51 82 DOI: 10.1017/S0008197311000171, Published online: 15 March 2011 Link to this article: http://journals.cambridge.org/abstract_S0008197311000171 How to cite this article: Amel Alghrani and Margaret Brazier (2011). WHAT IS IT? WHOSE IT? REPOSITIONING THE FETUS IN THE CONTEXT OF RESEARCH?. The Cambridge Law Journal, 70, pp 51-82 doi:10.1017/S0008197311000171 Request Permissions : Click here

The Human Fertilisation and Embryology Act 2008: a missed opportunity?

Regulating reproduction is no easy feat. In the past three decades we have witnessed a reproductive revolution and great strides have been made to alleviate the effects of infertility. Reproductive advances such as in-vitro fertilisation (IVF), sex selection, reproductive cloning and embryo selection for the purpose of creating “saviour siblings” have all emerged as part of a rapid and ever-changing branch of medicine, each promising to upset the status quo and transform human reproduction. Following much activity in this area, the lengthy process of updating the legislation is now complete. The Human Fertilisation and Embryology Act 2008 (HFE Act 2008) received Royal Assent on 13 November 2008. The majority of the HFE Act 2008’s amendments will come into force in October of this year, with the exception of the provisions pertaining to parenthood, which commenced in April 2009. Welcoming Royal Assent, Professor Lisa Jardine, Chair of the Human Fertilisation and Embryology Authority, stated: > “This is a momentous day for the HFEA and for those with fertility problems. The regulatory system that has served us so well has been renewed. Parliament has provided a clear framework for the future and a solid base on which to regulate 21st century practice within 21st century law.”1 However, as scientific endeavours into developments such as artificial gametes, womb transplantation and ectogenesis continue apace, it could be argued that Jardine was perhaps overly optimistic about the achievements of the new legislation. The HFE Act 2008 is an amending statute, and as Jackson2 notes “much of the regulatory architecture” in the 1990 legislation “remains intact”. In retaining the architecture of the 1990 legislation, and merely amending or adding certain provisions, has the government missed an ideal opportunity to consider how to equip the regulatory framework for the next phase/era of assisted reproduction? The next …

Editorial: The Mental Capacity Act 2005—Ten Years On

More than a decade has passed since the Mental Capacity Act (MCA) received royal assent. Described as a ‘visionary piece of legislation’, the MCA was a significant landmark on the legal landscape. It represented a triumph of autonomy by recognising that, as far as possible, people should play an active role in decisions about their welfare. At the core of the MCA is the fundamental principle that a person must be assumed to have decision-making capacity unless it is established that he lacks it. The law, therefore, assumes that everyone has the ability to act and take decisions in accordance with their own interests, and affords primacy to individual priorities over paternalistic imperatives. Where a person (‘P’) lacks capacity—whether for reasons of learning disability, dementia, brain injury, or some other impairment of or disturbance in the functioning of the mind or brain—the MCA permits decision-makers to act on behalf of P in accordance with his ‘best interests’. This means that, among other things, decision-makers must take into account P’s past and present wishes and feelings, his beliefs and values, and any other factors that P would be likely to consider, in order to act in a way which would likely give expression to P’s autonomy. In this way, the MCA seeks to empower people to make

Uterus transplantation: does procreative liberty encompass a right to gestate?

The latest innovation in the arena of assisted reproductive technologies is uterine transplantation (UTx), described as ‘a new type of quality of life enhancing, as well as a lifegiving transplantation’.2 The world’s first live birth of a child after uterus transplant occurred using a female living donor and recipient in Sweden in 2013.3 The primary purpose of UTx is to restore fertility in female patients with uterus factor infertility (UFI), which it is claimed affects approximately 1.5 million women worldwide.4 In his insightful paper, ‘Other women’s wombs: uterus transplants and gestational surrogacy’,5 Robertson notes the ‘important ethical and legal concerns’6 this advance raises and examines some of the ‘medical, ethical, legal, and policy issues that arise’.7 The focus of the paper is onUTx inwomen to restore fertility. ComparingUTx and gestational surrogacy, Robertson argues ‘if UTx becomes safe and effective, the case for offering UTx to all womenwith UFI is strong’.8 One key question that remains unclear is whether procreative liberty encompasses a right to ‘gestate’, and controversially, if there is such a right, whether it is restricted to women suffering fromUFI. Whilst Robertson

Uterus transplantation in and beyond cisgender women: revisiting procreative liberty in light of emerging reproductive technologies

ABSTRACT Whilst internationally a growing body of literature is emerging on uterus transplantation as the latest advance in assisted reproductive technology, much of this has been devoted to responding to the ethical questions raised by this procedure in the context of its immediate purpose, to restore fertility in cisgender women. Very few have addressed whether it can be claimed that there is a right to gestate under the umbrella of procreative liberty, nor whether such a right, if it does exist, applies not only to cisgender women, but also transgender and gender variant individuals and cisgender men. In honour of Professor Robertson, I advance the debate further by examining the arguments put forward in his last paper and whether the right to gestate extends beyond cisgender women.

Yes, uterus transplants should be publicly funded!’

Williams and Wilkinson provide an interesting paper on the latest breakthrough in the arena of assisted reproductive technologies, namely uterus transplants (UTx). The authors ask the important question of whether once UTx becomes safe enough to be offered as clinical treatment for those suffering from absolute uterine factor infertility (AUFI), publicly funded healthcare systems (such as the UK National Health Service (NHS)) should bear the financial cost of the procedure. Rather than arguing the case for why UTx should be publicly funded, the authors instead focus on arguments on why the state should not fund UTx. They address three arguments against publicly funding UTx: (1) UTx should not be publicly funded because doing so would be inconsistent with the governments’ obligations to prevent climate change and environmental pollution; (2) UTx should not be funded as it does not treat a disorder and is not medically necessary and (3) public funding for UTx should be denied because of the availability of cheaper alternatives to parenthood, such as adoption and surrogacy. They argue all three are tenuous and conclude that the case for ruling out public funding for UTx is weak. I concurred with the excellent …

When criminal law encounters bioethics:: a case of tensions and incompatibilities or an apt forum for resolving ethical conflict?’

Whilst health care professionals and scientists have been subject to civil law and professional regulation for some time, in this jurisdiction at least, questions of medical and scientific malpractice and cases involving bioethical dilemmas are increasingly coming before the criminal courts. This growing trend seems to have proceeded in the absence of very much at all by way of legal scrutiny, or jurisprudential analysis. Of course, some may consider the use of the criminal law as a forum to resolve bioethical dilemmas as both inevitable and wholly appropriate. Medical practice, biotechnologies and scientific research all have a major impact on our lives and whilst they can bring and have brought us great benefits, we do not have to look too far back into the past to recall the atrocities that have been committed in the name of medical and scientific advancement. This volume offers balanced arguments that will help the reader form a reasoned view on the ethical legitimacy of the invocation and use of the criminal law to regulate medical practice and issues of bioethics. It aims to shed light on the question of who should define what constitutes ethical, and thus lawful medical practice? The judges, the doctors and scientists or someone else? To this end, it analyses how effectively the criminal justice system can, and does operate as a forum for resolving ethical conflict in the delivery of health care? Key questions that are addressed include: How does the criminal law regulate controversial bioethical areas? Is the use of the criminal law in these areas appropriate or desirable? What effect, positive or negative does the use of the criminal law have when regulating bioethical conflict? Can the law accommodate morally controversy? The volume explores criminal law in theory and in practice and the broad field of ‘bioethics’ rather than the narrower terrain of medical ethics. Whilst numerous chapters focus on criminal law within the specific context of health care, others address scientific research and biotechnologies.