Healthcare Decision-Making and the Law Autonomy, Capacity and the Limits of Liberalism

This analysis of the law's approach to healthcare decision-making critiques its liberal foundations in respect of three categories of people: adults with capacity, adults without capacity and adults who are subject to mental health legislation. Focusing primarily on the law in England and Wales, the analysis also draws on the law in the United States, legal positions in Australia, Canada, Ireland, New Zealand and Scotland and on the human rights protections provided by the ECHR and the Convention on the Rights of Persons with Disabilities. Having identified the limitations of a legal view of autonomy as primarily a principle of non-interference, Mary Donnelly questions the effectiveness of capacity as a gatekeeper for the right of autonomy and advocates both an increased role for human rights in developing the conceptual basis for the law and the grounding of future legal developments in a close empirical interrogation of the law in practice.

Introduction; 1. Autonomy: variations on a principle; 2. Autonomy in the law; 3. Capacity: the gatekeeper for autonomy; 4. Capacity assessment in practice; 5. Autonomy, rights and decision-making for people lacking capacity; 6. Treatment for a mental disorder: a case apart; Conclusion.

This analysis of the ethical and legal basis for healthcare decision-making provides detailed analysis of the legal position in England and Wales together with substantial discussion of comparative material, especially from the United States, and a strong human rights focus. It is intended for lawyers, ethicists and medical professionals.

Dr Mary Donnelly is a Senior Lecturer at the Law Faculty, University College Cork, where she teaches medical law at undergraduate and postgraduate levels.