Voices carry?:the voice of bioethics in the courtroom and voice of law in bioethics

This paper explores the interaction between bioethics and law in the theatre of the courtroom, with particular reference to English law. No matter what some judges say, the courtroom has long been a location in which law and bioethics interact, not least in seminal health care law cases such as Re A (Minors) (Conjoined Twins: Separation [2000] and R v Arthur [1981]. Judge-made law has made some positive contributions to the shaping of bioethics as a discipline, providing a real-world testing ground for moral arguments, issuing the judicial ‘products’ with which bioethics engages, and emphasising the importance of observing due process. At the same time, the courtroom is an adversarial arena, not always ideally suited to the resolution of ethical conflict, and its concern with actions that satisfy attainable standards can fall short of the aspirations set in philosophical ethics. Indeed, sometimes the judges misinterpret or wholly neglect the ethical dimensions of the case at hand. So much of what judges do involves orchestrated framing, the manipulation of legal concepts, interpretation (of the facts of the case, the story of legal precedent and of the particular ethical dilemma) and translation (of ethical issues into law's discourse). Whether they like it or not, the judges are interpreting and responding to the voice of bioethics alongside the voice of the law in their attempts to reach the 'right' judgment and in the face of the theatre surrounding cases involving bioethical controversy. The end result may be distorting because bioethical theory is misinterpreted or the voice of bioethics becomes obscured because of the drama of the case. But this is not to claim that bioethics has some access to the ‘right’ or ‘true’ response to the case at hand. Indeed, neither bioethics nor law can necessarily claim superiority or access to the ‘truth’ of the matter. We nevertheless argue that each will be likely to gain greater insight by opening a dialogue with the other, telling and re-telling the story, so that the voices of one forum can carry over into the other

Core information sets for informed consent to surgical interventions:baseline information of importance to patients and clinicians

BackgroundConsent remains a crucial, yet challenging, cornerstone of clinical practice. The ethical, legal and professional understandings of this construct have evolved away from a doctor-centred act to a patient-centred process that encompasses the patient’s values, beliefs and goals. This alignment of consent with the philosophy of shared decision-making was affirmed in a recent high-profile Supreme Court ruling in England. The communication of information is central to this model of health care delivery but it can be difficult for doctors to gauge the information needs of the individual patient. The aim of this paper is to describe ‘core information sets’ which are defined as a minimum set of consensus-derived information about a given procedure to be discussed with all patients. Importantly, they are intended to catalyse discussion of subjective importance to individuals.Main bodyThe model described in this paper applies health services research and Delphi consensus-building methods to an idea orginally proposed 30 years ago. The hypothesis is that, first, large amounts of potentially-important information are distilled down to discrete information domains. These are then, secondly, rated by key stakeholders in multiple iterations, so that core information of agreed importance can be defined. We argue that this scientific approach is key to identifying information important to all stakeholders, which may otherwise be communicated poorly or omitted from discussions entirely. Our methods apply systematic review, qualitative, survey and consensus-building techniques to define this ‘core information’. We propose that such information addresses the ‘reasonable patient’ standard for information disclosure but, more importantly, can serve as a spring board for high-value discussion of importance to the individual patient.ConclusionThe application of established research methods can define information of core importance to informed consent. Further work will establish how best to incorporate this model in routine practice

Core information sets for informed consent to surgical interventions:baseline information of importance to patients and clinicians

Abstract Background Consent remains a crucial, yet challenging, cornerstone of clinical practice. The ethical, legal and professional understandings of this construct have evolved away from a doctor-centred act to a patient-centred process that encompasses the patient’s values, beliefs and goals. This alignment of consent with the philosophy of shared decision-making was affirmed in a recent high-profile Supreme Court ruling in England. The communication of information is central to this model of health care delivery but it can be difficult for doctors to gauge the information needs of the individual patient. The aim of this paper is to describe ‘core information sets’ which are defined as a minimum set of consensus-derived information about a given procedure to be discussed with all patients. Importantly, they are intended to catalyse discussion of subjective importance to individuals. Main body The model described in this paper applies health services research and Delphi consensus-building methods to an idea orginally proposed 30 years ago. The hypothesis is that, first, large amounts of potentially-important information are distilled down to discrete information domains. These are then, secondly, rated by key stakeholders in multiple iterations, so that core information of agreed importance can be defined. We argue that this scientific approach is key to identifying information important to all stakeholders, which may otherwise be communicated poorly or omitted from discussions entirely. Our methods apply systematic review, qualitative, survey and consensus-building techniques to define this ‘core information’. We propose that such information addresses the ‘reasonable patient’ standard for information disclosure but, more importantly, can serve as a spring board for high-value discussion of importance to the individual patient. Conclusion The application of established research methods can define information of core importance to informed consent. Further work will establish how best to incorporate this model in routine practice