Gráinne McMahon | 30 Jan 2024

The fourth edition of Medicine, Ethics and the Law by Deirdre Madden is a must-have for legal practitioners in the medical space. Gráinne McMahon speaks to Deirdre about the book, which examines the relationship between medicine, ethics and the law in Ireland. It provides a comprehensive and accessible analysis of the main legal and ethics and issues in healthcare and the relationship between doctors and patients by examining the relevant case law and legislative provisions in Ireland and, where appropriate, in other jurisdictions, and by looking at important academic contributions to the field.

Deirdre, huge congratulations on your new book. You must be delighted with it?

Thank you very much, I am very pleased to see it in print after all the hard work.

The book examines the relationship between medicine, ethics and the law in Ireland. Can you tell us a little bit about this fourth edition?

The fourth edition follows the style and structure of the three previous editions with an examination of ethical and legal issues arising in different aspects of medical practice and healthcare more generally. Since the first edition 20 years ago, healthcare has become more complex and there has been a huge increase in legislation, case law and academic commentary on areas such as assisted reproduction, surrogacy, decision-making capacity and so on, so as well as updating the text on existing topics, this edition aims to describe these new aspects as comprehensively as possible to give the reader a good understanding of the relevant issues as well as pointing out other sources of further information.

This edition includes a glowing foreword from Mr Justice Twomey…

I am so grateful to Judge Twomey for his kind words and recommendation of the book. Some of his own judgments in relation to novel cases such as confidentiality and refusal of treatment during pregnancy are featured in the book so he was an obvious choice for me to ask him to write the foreword and I am delighted he accepted the invitation.

This edition references not just relevant case law, legislative provisions and academic analysis from Ireland, but also from other jurisdictions, which will be of immense use to practitioners. Has the nature of this area of law become more international in recent years?

I think as academics we always want to look at how other jurisdictions handle legal issues so that we can learn from each other both in terms of good examples of legislation and sometimes how not to do things! We must also be mindful of cases in the European Court of Human Rights in areas such as privacy, reproduction, protection of family and identity rights as these may impact the development of Irish law in relation to surrogacy and assisted dying. 

There have been some significant decisions in recent times in this area and they are covered in the book. Would you tell us about some of those?

By comparison to the earlier editions of this book when there was a scarcity of legislation and case law in Ireland on medical law, this area of law has grown significantly in the last decade with the enactment of legislation such as the Assisted Decision-Making (Capacity) Act 2015, the Children and Family Relationships Act 2015, Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023, and proposed legislation on the regulation of assisted human reproduction for the first time in this jurisdiction. There have also been recent Supreme Court decisions in recent years such as those in 2023 in relation to surrogacy that are quite interesting as they demonstrate significant judicial understanding and empathy for people who create a family in this way and are thwarted by the current lack of legislation in trying to establish legal parentage and citizenship in relation to their children. These decisions clearly show the frustration of the court in facing the difficulty of trying to uphold the rights of children and their parents in the absence of clear policy or legislation.

You have quite an esteemed career to date: a PhD in assisted human reproduction; you have chaired the Ethics Committee of the Medical Council, you have lectured on medical law and ethics in Ireland and the US; you have worked as an Expert Reviewer on ethics for the European Commission and as Chair of Ireland’s Commission on Patient Safety and Quality Assurance, to name but a few of your accomplishments. Do you like the variety of your roles?

In addition to teaching and researching in the School of Law at UCC for 30 years, I am very fortunate to have had the support of the Dean in enabling me to pursue a diversity of other roles which have enabled me to see the law in action and to contribute to the practical application and implementation of the law in healthcare settings. I particularly enjoy multi-disciplinary work with clinicians, ethicists, scientists, researchers, public policy makers etc as this facilitates huge learning opportunities and a real-world exposure to finding legal and ethical solutions to problems facing the healthcare system, patients, and healthcare practitioners.

The text has a section on the allocation of scarce resources during the very recent Covid-19 pandemic. How important did you think it was to include this in the book?

I think it was important to include reference to the pandemic because it gave us the opportunity to reflect on the appropriate and ethical use of scarce resources in healthcare, the importance of public trust, the need to support research and good science, and how policy makers should make decisions in public health emergencies. The pandemic has taught us many lessons about the need for preparedness for the future and I think the allocation of healthcare resources is one of the issues that all societies need to discuss and try to reach consensus on.

You also cover whether there is a right to a good death. Can you tell us about that?

Death is a topic many of us struggle to think about and discuss but when we do confront our own mortality and the way we wish to die, most of us hope for a peaceful, pain-free death in the comfort of our own homes surrounded by those we love. It has been argued that there has been an increasing medicalisation of dying, an inexorable rush to hospital to try to avoid death as long as possible which results in people dying in environments which are full of machines, bright lights, hustle and bustle, and noise. I think we need to really focus on what the individual person’s priorities are as their life begins to draw to a close and to try to fulfil their wish for a good death as much as possible. This will also facilitate an easier grieving process for those who are left behind who will have better memories of a gentler passing. 

In addition, the book covers areas such as whether there is a legal right to reproduce, whether surrogacy amounts to exploitation of women, the conflicts of interest that arise in health research, whether there are property rights in reproductive material and the unique legal position of conjoined twins. It really is a fascinating landscape to be writing about?

I have been fascinated by medical law and ethics for over 30 years and am happy to still find it as engaging as when I started. I hope my enthusiasm and interest in the area shows in my teaching and my writing as I would love to pass on the baton to the next generations of academics, lawyers and practitioners who will keep working on making healthcare safer, better, more equitable and respectful of ethical principles.

How did you enjoy the writing process – it’s a fourth edition so you are well used to writing for Bloomsbury Professional at this stage!

To be truthful, I usually dread the start of the writing process as it seems like a massive mountain to climb but once I get started, I always love immersing myself in the research, finding new ways to think about topics, reading what brilliant colleagues have written about the issues and trying to communicate all of this to a variety of readers in a way that makes sense. The support I receive from Bloomsbury is always fantastic; they are patient, understanding and very professional which is exactly what authors need.

How beneficial do you think this new title will be for practitioners?

I hope the book will be useful as a resource for practitioners in this area as it updates previous editions in a way that is easy to follow, synopsises large amounts of information and provides additional references for those who may wish to read further into the topics.

Available Now: Medicine, Ethics and the Law by Deirdre Madden