1. Doctors Opposing Circumcision: An Appeal for Misha

Comment #32803 by elstuarto on April 18, 2007 at 9:40 am

Clarification for Yorker:

After the Gillick ruling in 85 minors were able to consent to their own treatment. The change in law was brought about when a Mrs Gillick challenged the right of a girl to obtain contraception without the consent of an adult.
It was argued that any doctor who did prescribe contraception to a minor would be complicit in aiding the criminal act of having sex with a minor. It was also argued that a minor would not be able to fully comprehend the implications of taking contraception and could not give informed consent. The treatment would therefore be treatment without consent, effectively an assault. This argument reached the House of Lords where it was decided that:

"As a matter of law the parental right to determine whether or not their minor child below the age of sixteen will have medical treatment terminates if and when the child achieves sufficient understanding and intelligence to understand fully what is proposed." (Scarman)

The Lords decided that parental rights only existed so far as to safeguard the best interests of a minor. Thus a moral objection to your 15 yr old daughter being on the pill held no weight in law as it could be reasonably argued that witholding contraception from her would not be in her best interests.

It was assumed for a period of time that if someone was competent to give consent (according to the Scarman guideline)
then they would also be competent to refuse treatment.

A case was brought to court where a 15 year old girl, who had been deemed "Gillick competent" refused antipsychotic treatment. Her parents argued that they should be able to forcibly treat her and Lord Donaldson decided in their favour, saying:

"Lord Scarman was discussing the parent's right to determine whether or not their minor child below the age of 16 will have medical treatment ... a right of determination is wider than a right of consent... I do not understand Lord Scarman to be saying that, if a child was 'Gillick competent' ... the parents ceased to have a right of consent as contrasted with ceasing to have a right of determination, i.e. a veto. In a case in which the 'Gillick competent' child refuses treatment, but the parents consent, that consent enables treatment to be undertaken lawfully."
This has been controversial, and not all law lords agree.

Current Department of Health Guidelines say this:
"Where a child is refusing treatment which his or her parents want to accept, and the consequences of refusal are potentially very serious (for example the foreseeable death of the child), you should consider seeking a court ruling on what would be in the best interests of the child"

So it seems that if this situation arose in the UK (to my knowledge it never has) then it would be up to an individual clinician to alert the courts, who would then make a decision on the matter.

Incidentally it is only England where the Donaldson ruling applies. In Scotland competent minors still do have the right to refuse to consent to medical treatment.

2. Doctors Opposing Circumcision: An Appeal for Misha

Comment #32762 by elstuarto on April 18, 2007 at 7:50 am

A clarification..

Above I wrote:
"in the UK children may give or refuse consent independantly"
Which isn't quite correct.

Children may give consent independently if they are Gillick competent, however Lord Donaldson ruled in the Court of Appeal after Gillick that the responsible adult still had a veto over a Gillick competent minors refusal to accept medical treatment. The ruling applied to competent children refusing psychiatric treatment.

So if you're under 18 you can consent to your own treatment, but you can't refuse it.

Sorry about that, I was sort of on autopilot when I wrote it.

3. Doctors Opposing Circumcision: An Appeal for Misha

Comment #32754 by elstuarto on April 18, 2007 at 7:08 am

Following on from what I had written before I have had a quick look on the web and found the Oregon GMC equivalent body is the Oregon Board of Medical Examiners.
The website is:

http://oregon.gov/BME/

This organisation investigates complaints against Oregon doctors and has the power to revoke a licence to practice medicine in that state.

I am concerned that the lawyers have suggested the way to stop this procedure is for the boy to "physically" refuse to undergo it.

I wonder if that would mean that to save his foreskin this boy actually has to undergo an udignified and demeaning physically violent struggle against whoever was attempting to anaesthetise him or wheel his trolley into theatre. If that is the only way his refusal can be aknowleged then it is a disgrace. The lawyers have said nothing about whether a verbal refusal would be aknowleged.

As a principle in medicine it's an assault to force someone to undergo treatment unless it's lifesaving or they're deranged or incompetent to give consent.
Adults can give consent for minors to undergo medical procedures, but here in the UK children may give or refuse consent independantly if they are deemed to be competent to do so under the guidelines drawn up after the Gillick case of 1985.

One of the arguments I put forward in the Molly/Misbah case was that a child of 12 may not be competent to make an informed decision about her future in Pakistan, and pragmatically her competence ought to be measured by child psychologist using criteria similar to that of Gillick.
The flip side to this of course is that an 11 yr old boy might not be judged competent enough by similar criteria to refuse circumcision.

Several countries have adopted the Gillick guidelines as law but I don't think the USA is one of them. I'd be interested in finding out whether the USA has an equivalent. Does anyone know?

4. Doctors Opposing Circumcision: An Appeal for Misha

Comment #32682 by elstuarto on April 18, 2007 at 2:40 am

A pedantic correction:

The body responsible for disciplining, registering and striking off doctors in the UK is the General Medical Council (GMC).

The BMA are a body of doctors that listens to and represents the interests of its members, and draws up guidelines for good medical practice. It also publishes a journal of medical research.

I believe that the AMA has a similar function to the BMA. The responsility for dealing with complaints against doctors lies in the hands of an individual states own panel of medical experts.

5. Send The God Delusion to your MP

Comment #19420 by elstuarto on January 27, 2007 at 4:18 am

I think it's a good idea.

Unfortunately i live near Gainsborough and my MP is Edward Leigh. He's the chairman of the socially conservative "cornerstone" group of MP's, outspoken catholic and committed opponent of stem cell research, contraception, abortion and equality for gay's and cohabiting couples.

I don't think he'd read it.

Perhaps I could hit him over he head with a copy instead?