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A_Medical_Law.book Page i Tuesday, September 12, 2017 9:57 AM
Medical Law in Ireland
Third Edition
A_Medical_Law.book Page ii Tuesday, September 12, 2017 9:57 AM
This book is dedicated to the memory of my grandparents, Margaret

and John Mills, and with love and thanks (as ever) to Grace, Sorcha, Anna,
Emily, Conall and Alice – SM.
This book is dedicated to my parents, Kitty and Gus, who sparked an interest
in complex ethical debates, which ultimately led me to the field
of Medical Law – AM.
A_Medical_Law.book Page iii Tuesday, September 12, 2017 9:57 AM
Third Edition
by
SIMON MILLS
MB, BCh, BAO, BA (Dubl), BCL (NUI), MICGP,
Barrister-at-Law (of King’s Inns), MSc (Lond), MFF&LM
and
ANDREA MULLIGAN
LLB (Dub), LLM (Harv), PhD (Dub),
Barrister-at-Law
A_Medical_Law.book Page iv Tuesday, September 12, 2017 9:57 AM
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Foreword
Because there are few areas of law more complex or demanding than medical
law, it is perhaps not surprising that in recent times it has become the preserve of
specialist solicitors and barristers. And it is these professionals, as well as
members of the judiciary and academics practising in the area, who will be the
principal beneficiaries of Medical Law in Ireland, a truly comprehensive legal
text authored by Simon Mills BL and Andrea Mulligan BL.
It is not an overstatement to say that Medical Law in Ireland (the third edition
of a work formerly known as Clinical Practice and the Law) is extremely broad
in its canvas covering as it does clinical negligence, the regulation of health care
professionals, assisted human reproduction, abortion and coroners’ inquests, to
mention but some of the areas of law and practice treated to extensive
consideration. In fact, it is difficult to imagine the circumstances in which those
who practice in this area might have to go beyond this text for guidance.
Whilst a consideration of comparative law and how courts in other
jurisdictions have dealt with various issues of medical law is of considerable
value, what lawyers are most concerned to establish is how the Irish courts, at
any particular time, are likely to interpret and apply relevant domestic legal
principles and statutory provisions. That being so, what is particularly unique
about this work is that it takes as its starting point the current state of Irish law in
relation to each area considered, thus providing the clearest and most up to date
possible guidance for practitioners as to how a court in this jurisdiction will
likely approach any issue of medical law or practice as may present for its
determination. In this respect, the text is invaluable as it is only with the benefit
of a thorough understanding of Irish law that the practitioner may hope to best
protect the interests of their client.
Another feature of Medical Law in Ireland which makes it particularly
valuable is that, where relevant, the authors commence their consideration of
each area of law by identifying relevant points of principle or material statutory
provisions before moving on to discuss how these impact upon the day-to-day
practice of lawyers and those in medical practice (a further commendable
feature of this work is that the authors identify, by reference to the recent case
law, how the courts expect such principles to be applied in practice by those
charged with the care of persons who require medical treatment or advice).
Notwithstanding the fact that this text is replete with a consideration of the
legal issues most recently considered by the courts in this jurisdiction, it is
nonetheless an immensely practical guide for anyone aspiring to practice in this
area as may be discerned from the inclusion of a chapter which guides the
practitioner as to the steps required to “run” a medical negligence action. This
chapter alone will likely be the saviour of many a solicitor or barrister who
A_Medical_Law.book Page vi Tuesday, September 12, 2017 9:57 AM
might otherwise fall prey to the pitfalls so often encountered in the course of
litigation of this type, which is invariably both onerous and complex.
Lest anyone reading this foreword should be left with the mistaken
impression that Medical Law in Ireland is something of a silver bullet when it
comes to resolving every legal uncertainty which has heretofore existed in the
area of medical law and practice, nothing could be further from the truth. In
considering the legal complexity of many of the areas addressed, such as those
which concern assisted human reproduction, law at the end of life, abortion law
and the manner in which those who sustain catastrophic injury should be
compensated, the authors have thoughtfully and appropriately highlighted the
adverse consequences for the patient and practitioner of the apparent reluctance
of government to make the type of serious policy decisions required to regulate
some of these difficult areas. Let us hope, as the authors propose, that those
charged with responsibility for such decisions will, regardless of the fact that
those decisions will undoubtedly be both challenging and unlikely to meet with
universal approval, have the courage to take the steps necessary to bring greater
certainty to these areas of particular complexity and sensitivity.
It has been a privilege and a pleasure for me to read this remarkably
comprehensive text dealing with the state of medical law in Ireland as it is today.
Whilst Medical Law in Ireland is an extremely scholarly work, it does not suffer
from being overly academic. The fact that this work covers in detail all of the
essential areas of medical law in terms of both principle and practice, and
provides, as it does, supporting analysis via the most recent decisions of the Irish
courts, will undoubtedly make it the “go to” text for all who practice, or aspire to
practice, in this area of law for many years to come. Like the solicitors,
barristers, academics and students to whom I have earlier referred, I too will be
keeping this work close at hand, a position it well deserves.
Judge Mary Irvine

Court of Appeal
27 July 2017
A_Medical_Law.book Page vii Tuesday, September 12, 2017 9:57 AM
Preface
The book formerly known as Clinical Practice and the Law was showing its age
and, more than that, it increasingly struggled to meet the requirements of the
twin audiences for which had been originally conceived: lawyers and clinicians.
This successor title amplifies a trend started by the last edition of Clinical
Practice … and moves decisively in the direction of being predominantly a
lawyers’ book: aimed at students, practitioners and academics working in the
field of medical law. Nonetheless we hope that it will remain accessible and
useful for non-legal readers and we have tried to bear that in mind when dealing
with sometimes-complex legal questions.
Medical Law in Ireland is, as the title suggests, first and foremost a law
book. Although both authors have strong roots and an abiding interest in the
field of bioethics and we are both mindful that – as Earl Warren once said –
“… law floats on a sea of ethics”, we have made a conscious decision to focus
on legal issues. There are, of course, some exceptions: the law in the areas of
abortion, assisted reproduction and assisted dying is so intimately tied up with
moral considerations that it can scarcely be contemplated that there would not
be some engagement with the ethics of those areas. But the emphasis throughout
is on the reality of the law’s demands, on recent legal developments and – again,
where relevant – on considerations of where law may (or should) go in future.
The work involved in this revision necessitated stripping the book back to its
basics and starting again. The attentive reader may note some passages that have
survived the metamorphosis, but we hope the account of medical law in Medical
Law in Ireland will be at once more thorough, more analytical and – ultimately –
more useful than formerly. One inescapable consequence of a different emphasis
is that some chapters from previous editions, which had been of more clinical
application, have fallen by the wayside, while other areas have been greatly
expanded: there are now, for example, three chapters dealing with different
aspects of consent and two dealing, respectively, with principles and more
practical aspects of clinical negligence.
Families and loved ones are – as anyone who as ever tried to write a book will
readily confess – long-suffering witness to the authorial process. SM is
enormously grateful to Grace, Sorcha, Anna, Emily, Conall and Alice for their
forbearance and he looks forward to renewing his acquaintance with them once
more. SM is also thankful to his devils over the lifetime of this and previous
revisions, whose hard work and good humour have unfailingly made this slow
task a little easier: Jennifer Knape BL, Victoria Kilfeather BL, Catherine
McGauran BL, Brendan Glynn BL, Jack Nicholas BL, Hugh Madden BL,
Ciaran Joyce BL, Dr Miriam Delahunt BL and, of course, Dr Andrea Mulligan
BL who made the journey from devil to co-author.
A_Medical_Law.book Page viii Tuesday, September 12, 2017 9:57 AM
AM is enormously grateful for the support of the School of Law, Trinity

College Dublin, which provided a research grant for the writing of this book.
AM is also indebted to the LLB and LLM students of the School of Law, whose
challenging (and occasionally perplexing) questions keep her constantly
interested in the study and practice of medical law. Thanks are due to AM’s
masters in the field of medical law, Sara Antoniotti BL and Simon Mills BL, for
their thorough training in the practitioner’s role, and to the latter for trusting her
as a co-author. AM is hugely grateful to her ever-supportive parents, to her
uncles and aunts (both official and unofficial), to her urban family, and
especially to Cian O Concubhair for always believing in this and many other
projects.
We have benefitted, as do all barristers from working with and learning from
very many colleagues: a number of those colleagues have given of their wisdom
over our time as barristers and much of that wisdom is to be found in the pages
that follow. In particular, we are grateful to Niall Nolan BL, who was kind
enough to read the chapters on mental health law.
We have endeavoured to state the law as it stood at July 2017.
About the authors
Simon Mills
MB, BCh, BAO, BA (U Dubl), BCL (NUI), MSc (Lond.), Barrister-at-Law
Simon Mills is a former doctor (qualifying in medicine from TCD in 1993) and
now a practising barrister (since 2002) specialising in all aspects of clinical law,
with a particular interest in clinical negligence, coroners’ inquests and
professional regulatory law. He holds an MSc Degree in Medical Ethics from
Imperial College London. He is External Examiner in Medical Law at the Law
Society of Ireland and a former Chairperson of Mental Health Tribunals.
Andrea Mulligan
LLB (Dub), LLM (Harv), PhD (Dub), Barrister-at-Law
Andrea Mulligan is a practising barrister with specialisations in medical law,
public law, and data protection law. She is an Assistant Professor at the School
of Law, Trinity College Dublin where she lectures modules in Medical Law and
Law and Bioethics. She holds an LLM from Harvard Law School, and a PhD
from Trinity College Dublin, where her research focused on the legal regulation
of assisted reproduction and surrogacy.
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Contents
Foreword ...................................................................................................................... v
Preface ........................................................................................................................ vii
Contents ......................................................................................................................... i
Table of Cases ............................................................................................................... i
Table of Legislation ....................................................................................................... i
Chapter 1 Introduction
The Field of Medical Law ............................................................................................ 1
Medical Law, Medical Ethics and Bioethics ................................................................ 1
Medical Law and the Intersection of Public and Private Law ...................................... 2
The Journey from Deference to Autonomy .................................................................. 3
A (Very) Brief History of Medical Law and Legal Medicine ...................................... 4
The dawn of legal medicine ................................................................................ 5
The ‘western’ world ............................................................................................ 6
Other developments in the sixteenth and seventeenth centuries ....................... 10
The eighteenth century onwards ........................................................................ 11
Chapter 2 Regulation of Healthcare Professionals
Introduction ................................................................................................................ 13
The Scope and Purpose of Statutory Professional Regulation ................................... 14
What is a healthcare professional? .................................................................... 14
Purpose of regulation ......................................................................................... 14
Statutory and non-statutory professions ............................................................ 15
Statutory regulation of healthcare professions: the common features .............. 16
Structures and Functions of Professional Regulatory Bodies: an Overview .............. 17
What are the regulatory bodies? ........................................................................ 17
Structures of the regulatory bodies .................................................................... 18
General functions of regulators ......................................................................... 19
Disciplinary Procedures: the Common Framework ................................................... 24
Complaints ......................................................................................................... 26
Preliminary proceedings and investigatory powers ........................................... 36
Inquiry stage ...................................................................................................... 39
Decision on sanction ......................................................................................... 47
Confirmatory and/or appeal stage ..................................................................... 49
Chapter 3 Medical Records and Access to Records
Introduction ................................................................................................................ 53
Clinical Recordkeeping .............................................................................................. 53
The importance of the clinical record ................................................................ 53
Accurate note-keeping ....................................................................................... 55
Access to and Ownership of Notes ............................................................................. 59
Who owns the records? ..................................................................................... 59
i
Statutory Regimes and the Right of Access to Clinical Records ................................60

Data protection law ............................................................................................61
Freedom of information .....................................................................................70
Retention of Records ...................................................................................................80
Health Information and Patient Safety Bill 2015 ...............................................82
Chapter 4 Medical Confidentiality
Introduction .................................................................................................................83
The need for confidentiality ...............................................................................84
The Legal Basis for Confidentiality ............................................................................85
The Constitution .................................................................................................85
Human rights law ...............................................................................................88
Common law sources .........................................................................................90
Professional guidelines ......................................................................................91
When does a Matter become Confidential? ................................................................91
The nature of the information ............................................................................91
Nature of the encounter in which the information is imparted ..........................92
Nature of any disclosure ....................................................................................92
When is information not confidential? ..............................................................92
Who is Bound by the Duty of Confidentiality? ..........................................................96
A distinction between confidentiality and ‘legal privilege’ ...............................96
Circumstances in which Confidentiality may be Breached ........................................97
The operation of law and the legal system .........................................................98
‘Need to know’: the scope of any disclosure ...................................................109
Is There an Obligation to Disclose Information to Prevent Harm? ..........................110
Risk of violence being visited by A upon B ....................................................111
Risk of A passing infection to B ......................................................................112
Whether there is a duty to warn/protect in Irish law ........................................113
Confidentiality after Death ........................................................................................114
Legal Remedies for Breach of Confidence ...............................................................117
Rights-based litigation .....................................................................................117
Tort ...................................................................................................................118
Contract ............................................................................................................118
Equity ...............................................................................................................119
Damages ...........................................................................................................120
Whistleblowing .........................................................................................................120
Chapter 5 Consent to Medical Treatment (I) – Principles
Introduction ...............................................................................................................123
Consequences of Acting without Consent ................................................................123
Battery/trespass to the person ..........................................................................123
Negligence .......................................................................................................123
The Essential Elements of Consent ...........................................................................124
Voluntariness and Consent to Treatment ..................................................................125
The right to refuse treatment ............................................................................127
Information and Consent ...........................................................................................133
ii
Contents
The duty to disclose: from deferring to clinical judgment

to vindicating patients’ rights .......................................................................... 133
Informed consent in Ireland ............................................................................ 136
Causation and informed consent in negligence ............................................... 141
Practicalities of Consent ........................................................................................... 142
The form of consent ........................................................................................ 142
Implied consent ............................................................................................... 143
Express consent ............................................................................................... 144
Who should obtain consent? ............................................................................ 145
Timing of consent ............................................................................................ 145
Withdrawal of consent ..................................................................................... 145
Chapter 6 Consent to Medical Treatment (II) – Mental Capacity
Introduction .............................................................................................................. 147
Existing Position on Decision-Making Capacity ..................................................... 147
The test for capacity ........................................................................................ 149
Consent where mental capacity is lacking ...................................................... 151
Proposed Statutory Arrangement for Decision Making ........................................... 163
Definitions and preliminaries .......................................................................... 164
Assisted decision making ................................................................................ 167
Co-decision making ......................................................................................... 167
Decision-making representatives and role of the courts ................................. 169
Persons who cannot act or who will be disqualified from acting .................... 171
Role of the Decision Support Service ............................................................. 172
Review of existing wards of court ................................................................... 174
Enduring Powers of Attorney: the current position and ADMA 2015 ............ 175
Advance healthcare decisions ......................................................................... 177
Jurisdiction and life-sustaining treatment ........................................................ 177
Chapter 7 Consent to Medical Treatment (III) – Minors
Introduction .............................................................................................................. 179
Minors Who are Over 16 Years of Age .................................................................... 179
Refusal of treatment by over-16s .................................................................... 180
What constitutes ‘treatment’ under the 1997 Act? .......................................... 182
Minors Who are Under 16 Years of Age .................................................................. 183
Refusal of treatment by parents ....................................................................... 183
The right of under-16s to give or withhold consent ........................................ 189
Treatment Refusal and the Unborn ........................................................................... 193
Chapter 8 Negligence (I) – Principles
Introduction .............................................................................................................. 197
Criminal negligence ........................................................................................ 197
The tort of negligence ...................................................................................... 198
Duty of Care ............................................................................................................. 198
Scope of duty of care ....................................................................................... 199
Vicarious liability ............................................................................................ 213
Qualifications to the duty of care .................................................................... 217
iii
The Standard of Care ................................................................................................217

Are all clinicians ‘professionals’ for the purpose of negligence
claims? .............................................................................................................218
The Dunne test for clinical negligence ............................................................219
Causation ...................................................................................................................235
Traditional causation: The ‘but for’ test ..........................................................235
Developments in causation? ............................................................................237
Res ipsa loquitur in clinical negligence cases ..................................................242
Breaking the chain of causation: novus actus interveniens .............................244
Harm or Damage .......................................................................................................247
Foreseeability of damage .................................................................................247
Controversial areas of damage: wrongful pregnancy and wrongful
life ....................................................................................................................248
Aspects of Defence Considerations in Clinical Negligence Actions ........................250
Contributory negligence ...................................................................................250
Failure to mitigate loss .....................................................................................253
Illegality ...........................................................................................................253
Statute of Limitations .......................................................................................254
Delay ................................................................................................................255
Chapter 9 Clinical Negligence (II) – Aspects of Practice and Procedure
Introduction ...............................................................................................................259
Prior to Issuing Proceedings .....................................................................................259
Statute of Limitations .......................................................................................259
Identifying the correct defendant .....................................................................268
Expert evidence prior to proceeding ................................................................268
Personal Injuries Assessment Board – is authorisation required? ...................269
Commencing Proceedings .........................................................................................272
Letter of claim ..................................................................................................273
Personal injuries summons ..............................................................................274
Aspects of the Progress of Proceedings ....................................................................276
Particulars of pleadings and defence ................................................................276
Medical assessment of a plaintiff .....................................................................278
Section 17 offers ..............................................................................................279
Mediation .........................................................................................................280
Exchange of expert reports ..............................................................................280
Joinder of additional parties .............................................................................281
Discovery and Other Means of Access to Clinical Records .....................................281
Discovery .........................................................................................................281
Other rights of access to clinical records .........................................................285
Admissibility of medical records as evidence in clinical negligence
cases .................................................................................................................285
Lodgements and Tenders ..........................................................................................286
Tenders by State bodies ...................................................................................287
Other offers to settle proceedings ....................................................................287
Reform of the Law Relating to Practice and Procedure:
Pre-action Protocols ............................................................................................288
iv
Contents
Apologies ......................................................................................................... 290

Damages ................................................................................................................... 290
General damages ............................................................................................. 290
Special damages .............................................................................................. 293
Periodic payment orders .................................................................................. 295
Exemplary damages ........................................................................................ 298
Damages in fatal injuries cases ....................................................................... 299
Other Aspects of Claims that May Arise in Clinical Negligence Cases .................. 299
Battery and trespass ......................................................................................... 299
Loss of consortium .......................................................................................... 300
Conclusion: Alternatives to Clinical Negligence ..................................................... 300
Chapter 10 Expert Evidence
Introduction .............................................................................................................. 301
What is Expert Evidence? ........................................................................................ 301
The Requirement for Expert Evidence Prior to Commencing Proceedings ............. 302
Statute of Limitations and the requirement for expert opinion ....................... 304
Obligation to provide a report? ....................................................................... 305
The Proper Expert ..................................................................................................... 305
Sourcing an expert witness .............................................................................. 306
Instructing an expert ........................................................................................ 306
Contents of expert reports ............................................................................... 308
Aspects of Practice and Procedure Relating to Experts ........................................... 310
Exchange of expert evidence prior to trial ...................................................... 310
Expert Evidence in Court ......................................................................................... 314
General principles ............................................................................................ 314
2016 rules for experts ...................................................................................... 314
Securing the attendance of clinical experts for trial ........................................ 315
Civil liability for refusal to testify ................................................................... 315
Liability of Expert Witnesses for their Testimony ................................................... 316
Chapter 11 Mental Health Law (I) – Civil Aspects
Introduction .............................................................................................................. 319
Mental Health Act 2001 – An Overview of Structures ............................................ 319
Mental Health Commission ............................................................................. 319
Voluntary Admission of Mental Health Patients ...................................................... 320
Managing the voluntary patient who wishes to leave an approved
centre ............................................................................................................... 321
Gap in the law? Patients lacking the capacity to consent to detention ............ 323
Involuntary Admissions of Adults ............................................................................ 325
Rationale for involuntary admissions .............................................................. 325
Statutory criteria for admission ....................................................................... 326
Process of involuntary admission .................................................................... 328
Renewal orders ................................................................................................ 336
Limitations on treatment ................................................................................. 337
Involuntary admission of children ................................................................... 338
Oversight functions of the Mental Health Tribunals ....................................... 340
v
A_Medical_Law.book Page vi Tuesday, September 12, 2017 9:57 AM
Treatment of the psychiatric patient ..........................................................................347

Voluntary patients ............................................................................................347
Involuntary patients .........................................................................................347
Human Rights Law and Mental Health .....................................................................349
Article 3 – Prohibition of torture .....................................................................349
Article 5 – Right to liberty and security ...........................................................349
Article 6 – Right to a fair trial ..........................................................................350
Article 8 – Right to respect for private and family life ....................................350
Involuntary Psychiatric Treatment and Detention other
than under the Mental Health Act 2001 ..............................................................351
Testamentary Capacity ..............................................................................................353
What constitutes a ‘sound mind’? ....................................................................354
Chapter 12 Mental Health Law (II) – Criminal Aspects
Introduction ...............................................................................................................361
The Defence of Insanity ............................................................................................361
Criminal Law (Insanity) Act 2006: not guilty by reason of insanity ...............362
The operation of the 2006 Act .........................................................................364
Consequence of the ‘insanity’ verdict ..............................................................370
Fitness to Plead (Fitness to be Tried) ........................................................................373
Provisions of Criminal Law (Insanity) Act 2006 (as amended) ......................373
Role of the Mental Health (Criminal Law) Review Board:
Review of Detention ............................................................................................381
Nature of review to be conducted ....................................................................381
Conditional orders that may be made ..............................................................385
Temporary releases and transfers .....................................................................386
Where an order for detention is struck down ............................................................387
Diminished responsibility .........................................................................................388
Purpose of diminished responsibility verdict ...................................................388
Infanticide .................................................................................................................390
Automatism ...............................................................................................................391
Chapter 13 Abortion
Introduction ...............................................................................................................393
A note on points of view ..................................................................................393
The Ethics of Abortion ..............................................................................................394
Arguments focusing on the status of the foetus ...............................................394
Arguments centring on the woman’s right of autonomy .................................397
The Development of Abortion Law in Ireland ..........................................................399
Legal protection of the foetus in Ireland: from common law
to Constitution ..................................................................................................399
Parsing Article 40.3.3º: Constitutional adjustments ........................................403
Case law since Attorney General v X ...............................................................404
The European Court of Human Rights intervenes: A, B and C
v Ireland ...........................................................................................................407
Abortion in Ireland: The Current Legal Position ......................................................410
The provision of information: the 1995 Act ....................................................410
vi
A_Medical_Law.book Page vii Tuesday, September 12, 2017 9:57 AM
Contents
The Protection of Life during Pregnancy Act 2013 ........................................ 410

Application of the 2013 Act: Ms Y ................................................................. 413
Circumventing Irish abortion law .................................................................... 414
Potential Reform of Irish Abortion Law .................................................................. 414
The Law on Abortion in Great Britain ..................................................................... 415
Chapter 14 Assisted Human Reproduction
Introduction to Assisted Human Reproduction ........................................................ 417
Techniques and terminology ........................................................................... 418
From treating infertility to enhancing reproductive control: technological
developments ................................................................................................... 419
Clinical difficulties associated with assisted reproduction .............................. 421
Aspects of the Regulatory Environment ................................................................... 422
Human tissues and cells legislation ................................................................. 422
Medical Council Guidelines ............................................................................ 423
International Conventions and Declarations ................................................... 424
Family law and assisted human reproduction ................................................. 425
The Report of the Commission on Assisted Human Reproduction ................ 426
Regulating Human Embryos .................................................................................... 427
The moral status of the embryo ....................................................................... 427
Legal protection of the human embryo ........................................................... 429
Defining the unborn: Roche v Roche ............................................................... 431
Frozen embryo disposition disputes ................................................................ 434
Donor-Assisted Human Reproduction ..................................................................... 437
Establishing parental status prior to the 2015 Act ........................................... 438
JMcD v PL and the rights of known donors .................................................... 439
The Children and Family Relationships Act 2015 and the Attribution
of parental status .............................................................................................. 440
Anonymous donation ...................................................................................... 441
Ensuring compliance with the 2015 Act ......................................................... 444
Surrogacy .................................................................................................................. 444
Commercial surrogacy .................................................................................... 445
Parental status and surrogacy .......................................................................... 446
Assisted Reproduction and the European Court of Human Rights .......................... 448
Chapter 15 End of Life
Introduction .............................................................................................................. 451
The Withdrawal of Treatment .................................................................................. 451
Competent patients .......................................................................................... 452
Incompetent patients ........................................................................................ 453
Do Not Attempt Resuscitation Orders ...................................................................... 462
What are ‘DNAR’ Orders? .............................................................................. 462
Law and guidance on DNAR Orders .............................................................. 463
Planning for the End of Life: Advance Care Directives and
Powers of Attorney ............................................................................................. 467
Advance decisions about medical treatment ................................................... 467
Enduring power of attorney at the end of life ................................................. 479
vii
A_Medical_Law.book Page viii Tuesday, September 12, 2017 9:57 AM
Euthanasia and Assisted Suicide ...............................................................................480

Ethical arguments on euthanasia and assisted suicide .....................................481
Assisted suicide in Ireland ...............................................................................485
Assisted suicide in the UK and the right to die under the ECHR ....................488
Regulatory models for assisted suicide ............................................................492
Non-voluntary euthanasia ................................................................................495
Chapter 16 Coroners Law and Other Issues arising after Death
Introduction ...............................................................................................................497
When Does Death occur? ..........................................................................................497
Brain stem death ..............................................................................................498
Death Certificates and the Registration of Death ......................................................499
Registration of death ........................................................................................500
The Coroner ..............................................................................................................501
Basic elements of the coroner’s role ................................................................502
Brief history of the coroner’s office .................................................................503
Coroner’s Inquests – Practice and Procedure ...........................................................507
Duty of the coroner to hold an inquest .............................................................508
Considerations may lead to an inquest being held – the purpose of
an inquest .........................................................................................................510
Post mortems and other investigations ............................................................511
The nature and scope of an inquest ..................................................................512
Conduct of the inquest .....................................................................................520
The conclusion of the inquest ..........................................................................527
The Retention and Use of Body Tissues after Death ................................................531
The Dunne Inquiry/Madden Report .................................................................532
Working group on post-mortem practice .........................................................533
UK law .............................................................................................................534
Organ Transplantation ...............................................................................................534
Cremation ..................................................................................................................536
Chapter 17 Clinical Research on Humans and Animals
Introduction ...............................................................................................................539
Clinical Research ......................................................................................................539
Ethical aspects of clinical research on human subjects ...................................539
Regulation of clinical research on human subjects in Ireland .........................545
Clinical Research on Animal Subjects ......................................................................555
Overview of ethical issues in clinical research on animal subjects .................555
Regulation of clinical research on animal subjects in Ireland .........................556
Testing of cosmetic products on animals .........................................................559
Data Protection Law and Clinical Research .............................................................559
Chapter 18 Genetics and the Regulation of Human Tissues and Cells
The Regulation of Human Cells and Tissues ............................................................563
Tissue establishments .......................................................................................564
Procurement of human tissues and cells ..........................................................565
Enforcement .....................................................................................................566
viii
A_Medical_Law.book Page ix Tuesday, September 12, 2017 9:57 AM
Contents
Genetics .................................................................................................................... 566

A very brief introduction to genetics ............................................................... 567
Genetic testing and screening .......................................................................... 569
Genetic discrimination .................................................................................... 570
Genetic privacy ................................................................................................ 571
Pre-implantation genetic diagnosis, sex selection and tissue typing ............... 572
Therapeutic genetics ........................................................................................ 573
Embryonic stem cell research .......................................................................... 574
Index ........................................................................................................................ 577
ix
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Table of Cases
A
A (A Minor) and B (A Minor) v A Health and Social Services Trust
[2010] NIQB 108 ............................................................................................. 8.111
A (A Minor) (Disclosure of Medical Records to GMC), Re [1999] 1 FCR 30,
(1999) 47 BMLR 84, [1998] 2 FLR 641 ........................................................... 4.47
A (Medical Treatment: Male Sterilisation), Re [2000] 1 FLR ................................ 6.10
A and B v Eastern Health Board [1998] 1 IR 464 ................................................. 13.29
A Health Authority v X [2001] EWCA Civ 2014 ................................................... 4.47
A Local Authority v E [2012] EWHC 1639 (CoP) ................................................. 5.19
A v X (Disclosure: Non-party Medical Records) [2004] EWHC 447 .................... 4.36
A, B and C v Ireland (Appl 23379/05) Decision of the Grand Chamber,
16 December 2010 ........................................................................................... 13.34
A(A) v Medical Council [2003] IESC 70, [2003] 4 IR 302,
[2004] 1 ILRM 372 ............................................................................................ 2.65
AA v FF [2015] 142 ................................................................................................ 6.48
AA v Medical Council [2002] 3 IR 1, [2001] IEHC 211 ........................................ 2.42
AB v CD [2011] IEHC 543 ................................................................................... 10.35
AB v CD [2016] IEHC 541 ............................................................... 6.04, 15.04, 15.36
AB v Glasgow and West of Scotland Blood Transfusion Service
(1989) 15 BMLR 91 ................................................................................. 4.40, 4.46
AB v Leeds Teaching Hospital Trust [2004] EWHC 644 ..................................... 16.60
ABC v St George’s Healthcare NHS Foundation Trust [2017] EWCA 336 ........ 18.22
AB v Clinical Director of St Loman’s Hospital (3 May 2017), HC....................... 11.49
Adamcik [1977] 3 CCC (2d) 1 (BC CC) ............................................................... 12.14
Aerts v Belgium (1998) 29 EHRR 50 ................................................................... 11.56
Aintree University Hospitals NHS Foundation Trust v James [2013] UKSC 67,
[2013] All ER (D) 339 ..................................................................................... 15.17
Airedale NHS Trust v Bland [1993] AC 789, [1993] 1 All ER 821 ............ 6.09, 15.17
............................................................................................................... 15.36, 15.74
AK (Medical Treatment – Consent), Re [2001] 1 FLR 129 ................................. 15.49
Akpekpe v Medical Council [2013] IEHC 38 ......................................................... 2.74
Alcock v Chief Constable of South Yorkshire Police [1992] 1 AC 310 ................. 8.15
Aleksanyan v Russia (2008) 52 EHRR 18 ............................................................ 11.55
Allinson v General Council of Medical Education and Registration
(1894) 1 QB 750 ................................................................................................ 2.32
AM, Re [2017] IEHC 184 ...................................................................................... 11.61
AM v Kennedy [2007] IEHC 136, [2007] 4 IR 667 ............11.28, 11.32, 11.42–11.44
AMC v St Luke’s Hospital Clonmel [2007] IEHC 65,
[2007] 2 IR 814 .......................................................................... 11.21, 11.32, 11.42
An Bord Altranais v Ní Cheallaigh [1997] IEHC 186 ............................................ 2.49
Anachebe v Medical Council [2000] IEHC 193 ............................................ 2.14, 2.74
Andaloc v Iarnród Éireann and others [2014] 3 IR 516 .......................................... 9.76
i
Anderson v St Francis-St George Hospital, Inc 671 NE 2d (Ohio SC) .................15.48

Appleton v El-Safty [2007] EWHC 631 ..................................................................8.12
Appleton v Garrett 34 BMLR 23 (QBD) .................................................................5.05
AR v Clinical Director of St Brendan’s Hospital [2009] IEHC 143 ..........11.32, 11.44
Armstrong v Eastern Health Board [1990] 10 JIC 0501,
(5 October 1990), HC..................................................................... 8.73, 8.76, 8.114
Armstrong v Moffatt [2013] 1 IR 417, [2013] IEHC 148 .......................................9.34
Ashingdane v United Kingdom (1985) 7 EHRR 528 ............................................11.55
Ashworth Hospital Authority v Mirror Group Newspapers
[2002] 1 WLR 2033 ...........................................................................................4.76
Atlantic Shellfish Ltd v The County Council of the County of Cork
[2015] IEHC 570 ................................................................................................9.40
Attorney General (Society for the Protection of Unborn Children
(Ireland) Ltd) v Open Door Counselling [1988] IR 593 .........................4.10, 13.26
Attorney General for South Australia v Brown [1960] AC 432 ............................12.17
Attorney General v Guardian Newspapers (No 2) [1988] 3 WLR 776 ..........4.45–4.47
Attorney General v Guardian Newspapers [1990] 1 AC 109 ..................................4.21
Attorney General v Lee [2000] 4 IR 298 ...............................................................16.47
Attorney General v X [1979] IR 73 .......................................................................13.25
Attorney General v X [1992] 1 IR 1 ............................................... 13.18–13.28, 14.40
Attorney-General v Mulholland and Foster [1963] 2 QB 477 ........................4.30, 4.45
AVS v NHS Foundation Trust [2011] EWCA 7 ...................................................15.45
AX v Mental Health Tribunal [2014] IEHC 592 ........................................11.43, 11.45
B
B (A Child) [2003] EWCA Civ 1148, [2003] 73 BMLR 152 .................................7.12
B (A Minor) (Wardship: Medical Treatment), Re [1981] 1 WLR 1421,
[1990] 3 All ER 927 .................................................................. 15.15–15.16, 15.30
B (Adult: Refusal of Medical Treatment), Re [2002] 2 All ER 449,
[2002] 1 FLR 1090 ................................................................. 6.04, 6.20, 6.24–6.25
B (Nancy) v Hôtel-Dieu de Québec (1992) 86 DLR (4th) 385 .............................15.36
B v Clinical Director of Our Lady’s Hospital Navan [2007] IEHC 403,
[2010] 3 IR 426 .....................................................................................11.06, 11.29
B, Re [1981] 1 WLR 1421 .......................................................................................7.11
B(A) v Commissioner of An Garda Síochána [2013] IEHC 88 ............................12.23
...............................................................................................................12.32, 12.47
B(J) v Mental Health (Criminal Law) Review Board
[2008] IEHC 303, [2011] 2 IR 15 .........................................................12.36, 12.44
Babula v Waltham Forest College [2007] EWCA Civ 174,
[2007] ICR 1026 ........................................................................................4.82–4.84
Baby AB, Re: Children’s University Hospital, Temple Street v CD and EF
[2011] IEHC 1, [2011] 1 IR 665 ........................................................................7.10
Baby B, Re (28 December, 2007), HC ....................................................................7.10
Baby O v Minister for Justice [2002] 2 IR 169 .......................................................5.23
Bailey v Ministry of Defence [2008] EXCA Civ 1361 ...........................................8.92
Baker v Kaye [1997] IRLR 219 ...............................................................................8.12
Bank of Ireland v Lady Lisa Ireland Ltd [1992] 1 IR 404 .......................................9.30
ii
Table of Cases
Banks v Goodfellow (1870) LR 5 QB 549 ................................................ 11.64, 11.65

Barnett v Chelsea and Kensington Hospital Management Committee
[1969] 1 QB 428 ....................................................................................... 8.28, 8.84
Barry v Health Service Executive [2015] IEHC 791 .............................................. 9.74
Barry v Medical Council [1997] IEHC 204, [1998] 3 IR 368 ................................ 2.51
Barry v Medical Council [2007] IEHC 74 ..................................................... 2.33, 2.75
Barry v National Maternity [2016] IESC 41 ........................................................... 9.66
Beadling v Sirotta (1964) 197 A 2d 857 (New Jersey) ........................................... 8.12
Beatty v Rent Tribunal [2005] IESC 66, [2006] 2 IR 191 .................................... 16.48
Belchertown State School (Superintendent of) v Saikewicz
370 NE 2d 417 (1977) ....................................................................................... 6.12
Bellante v Fitzgerald [2017] IEHC 410 .................................................................. 9.31
Bellis, Re, Polson v Parrott 45 TLR 452 ............................................................... 11.65
Bennett v Cullen [2014] IEHC 574 ......................................................................... 9.61
Best v Wellcome Foundation Ltd [1993] 3 IR 421 ...................................... 8.85, 10.02
Betesh v US (1974) 400 F Supp 238 (DC District Court) ....................................... 8.12
BF v Clinical Director of Our Lady’s Hospital, Navan [2010] IEHC 243 ........... 11.07
Bingham v Crowley [2008] IEHC 453 .................................................................... 9.31
Bingham v Farrell [2010] IEHC 74 ....................................................................... 16.40
Bird v Luckie (1850) 8 Hare 301 .......................................................................... 11.66
Birmingham DC ex p O [1982] 2 All ER 356 ......................................................... 4.56
Birmingham DC v O [1983] 1 All ER 497 (HL) ........................................... 4.24, 4.52
Blackhall (Agnes), dec’d, Re (28 June 1996), HC, (1 April 1998), SC ................ 11.69
Blackhall v Blackhall (28 June 1996), HC ............................................................ 11.63
Blanchfield v Harnett [2002] 3 IR 207, [2002] 2 ILRM 435 .................................. 2.64
Blehein v Minster for Health and Children [2004] IEHC 374 .............................. 11.16
Bluck v Information Commissioner 2007 WL 4266111 ......................................... 4.69
Blyth v Birmingham Waterworks Co (1956) 11 Ex Ch 781 ................................... 8.02
Bohan v Finn (1994) DPIJ (Trinity and Michaelmas Terms) 61 (HC) ................. 8.115
Bohrmann [1938] 1 All ER 271 ............................................................................ 11.67
Bolam v Friern Hospital [1957] 2 All ER 118, [1957] 1 WLR 582
................................................................................................1.06, 8.49, 8.66, 8.70
Bolger v O’Brien [1999] 2 IR 431 .......................................................................... 9.12
Bolitho v City and Hackney Health Authority [1996] 4 All ER 771 ...................... 8.66
Bolitho v City and Hackney Health Authority [1998] AC 232 ............................... 1.06
Bolton v Blackrock Clinic (20 December 1994), HC ............................................. 8.43
Bolton v Blackrock Clinic (23 January 1997), SC ......................................... 5.43–5.48
Bolton v Law Society [1994] 1 WLR 512 .............................................................. 2.32
Boodoo v General Medical Council [2004] EWHC 2712 (Admin) ........................ 2.41
Borges v Fitness to Practise Committee [2004] 1 IR 103,
[2004] IESC 9 ........................................................................................... 2.44, 2.60
Boyse v Rossborough (1857) 6 HLC 2 ................................................................. 11.65
Brady v Hopper 751 F 2d 329 .................................................................................. 4.61
Bratty v Attorney General for Northern Ireland [1963] AC 386 .......................... 12.52
Breen v Williams (1996) 70 AJLR 772 ................................................................... 3.13
Breeze v Ahmad [2005] EWCA Civ 223 .............................................................. 10.25
Brennan v An Bord Altranais [2010] IEHC 193 ................................... 2.34, 2.56, 2.74
iii
Brennan v Fitzpatrick and others [2001] IESC 201 ...............................................8.121

Brennan v Western Health Board [1999] IEHC 162 .............................................8.122
Breslin v Corcoran [2003] 2 IR 203 ......................................................................8.104
British Steel Corporation v Granada Television Ltd [1981] 1 All ER 417 .............4.33
Brogan v Bennett [1955] IR 119, 87 ILTR 189 .......................................................8.52
Browne v CIÉ [1967] IR 319 ...................................................................................9.53
Brushett v Cowan (1987) 40 DLR (4th) 488, affd (1990) 69 DLR
(4th) 743 ...........................................................................................................8.113
Buck v Bell 274 US 200 (1927) at 207 ..................................................................18.12
Buckley v Governors of the National Maternity Hospital
(21 December 1998), HC, [1999] WJSC-SC 543 (HC) ...................................8.122
Buckley v O’Herlihy [2010] IEHC 51 .....................................................................5.52
Bula Ltd v Tara Mines (No 6) [2000] 4 IR 412 ..............................................2.61–2.62
Bull v Devon Area Health Authority [1989] EWCA Civ J0202–7,
(1993) 4 Med LR 117 ................................................................................8.47, 8.80
Burgess [1991] 2 QB 92 ........................................................................................12.07
Butler v Regan [2004] IEHC 326 ....................................................... 8.11, 8.122, 9.64
Byrne v An Taoiseach [2011] 1 IR 190 .................................................................16.34
Byrne v Geraghty [2010] IEHC 154 ......................................................................16.55
Byrne v O’Brien [2007] IEHC 351 ...............................................................8.119, 9.13
Byrne v Ryan [2007] IEHC 207, [2009] 4 IR 542 ..................... 8.31, 8.39–8.40, 8.107
C
C (A Baby), Re [1996] 2 FCR 569 ........................................................................15.30
C (A Minor) (Evidence: Confidential Information), Re (1991)
7 BMLR 138 .......................................................................................................4.53
C (A Minor), Re [1998] 1 FCR 1 ...........................................................................15.30
C (Adult: Refusal of Medical Treatment), Re [1994] 1 WLR 290
....................................................................................................... 5.18, 6.06, 15.36
C (Wardship: Medical Treatment), Re [1990] Fam 26 ..........................................15.30
C (Welfare of Child: Immunisation), Re [2003] EWCA Civ 1148 .........................7.14
C v AJ Cairns [2003] Lloyd’s Rep Med 90 .............................................................4.54
C v Clinical Director of St Brigid’s Hospital (13 March, 2009), SC .....................11.11
C v North Western Health Board [1997] Irish Law Log Weekly 133 .....................4.65
C v Wren (1987) 35 DLR (4th) 419 .........................................................................7.21
Cabazon v Westinghouse Electrical Irl Ltd t/a Thermoking (Europe) Ltd
(1994) DPIJ (Hilary and Easter Terms) 104 (HC) ...........................................8.115
Caffrey v North Eastern Health Board (10 February 1995), HC ........ 8.75, 8.85, 10.13
Cahill v Dental Council [2001] IEHC 97 ............................................. 2.34, 2.70, 2.75
Calascione v Dixon (1993) 19 BMLR 97 (CA) .......................................................8.15
Calderbank v Calderbank [1975] 3 All ER ..............................................................9.55
Callanan v Geraghty [2007] IEHC 419, [2008] 1 IR 399 ......................................16.26
Calvelli v Italy, ECHR, 17 January 2002, 32967/96 .............................................16.36
Campbell v MGN Ltd [2004] UKHL 22, [2004] 2 AC 457 ...........................4.25, 4.33
.......................................................................................................... 4.47, 4.75, 4.80
Canning-Kishver v Sandwell and West Birmingham Hospitals NHS Trust
[2008] EWHC 2384 (QB) ..................................................................................8.92
iv
Table of Cases
Canterbury v Spence (1972) 464 F 2d 772 (District of Columbia

Circuit Court of Appeals) .................................................................................. 5.35
Carey v WH Ryan Ltd [1982] IR 179 ..................................................................... 9.53
Carroll v Law Society (No 2) [2003] 1 IR 284 ....................................................... 2.61
Carroll v Lynch [2002] IEHC 58, [2003] IEC 32 ................................................... 8.73
Carroll v Mater Misericordiae Hospital [2011] 2 IR 411, [2011] IEHC 231 .......... 9.25
Cartwright v Cartwright (1793) 1 Phillim 100 ...................................................... 11.70
Casey v Medical Council [1999] IEHC 171, [1999] 2 IR 534,
[1999] 2 ILRM 481 ................................................................................... 2.66, 2.71
Cassidy v Ministry of Health [1951] 2 KB 343 ...........................8.29, 8.36, 8.41, 8.96
Cassidy v Shannon Castle Banquets [1999] IEHC 245 .......................................... 2.62
Cattanach v Melchior [2003] HCA 38, (2003) 215 CLR 1.................................... 8.108
CC v Clinical Director of St Patrick’s Hospital (No 1) [2009] IEHC 13
.............................................................................................................. 11.26, 11.44
CC v Clinical Director of St Patrick’s Hospital (No 2) [2009] IEHC 47,
[2009] 3 IR 350 ..................................................................................... 11.06, 11.40
Chambers v Kenefick [2005] IEHC 402, [2007] 3 IR 526 ..................................... 9.31
Chantrey Martin v Martin [1953] 2 QB 286 .................................................. 4.30, 4.45
Chatterton v Gerson [1981] QB 432 ..................................................................... 15.50
Chester v Afshar [2004] UKHL 41, [2005] AC 134 ....................................... 5.50, 8.89
Child and Family Agency v AM (a minor) [2016] IEHC 749 ............ 7.03–7.04, 11.36
Child and Family Agency v Q [2016] IEHC 335 .................................................. 11.36
Children’s University Hospital Temple Street v CD and EF
[2011] IEHC 1 ................................................................................................... 5.19
CK v An Bord Altranais [1990] 2 IR 396 ............................................................... 2.75
Clark v MacLennan [1983] 1 All ER 416 ............................................................... 8.62
Clarke v HSE, Minister for Health [2014] IEHC 419 ........................................... 12.43
Cleary v Cowley [2002] WJSC-HC 1114 ............................................. 8.15, 8.65, 8.73
Clunis v Camden & Islington Health Authority [1997] EWCA Civ 2918,
(1998) 40 BMLR 181, [1998] 2 WLR 902, [1998] 3 All ER 180,
[1998] PNLR 262, [1998] QB 978 .................................................................. 8.116
CO’S v Her Honour Judge Alice Doyle [2013] IESC 60, [2013] 1 IR 556 ............ 7.12
Coco v AN Clark (Engineering) Ltd [1969] RPC 41 .............................................. 4.20
Cohen v General Medical Council [2008] LS Law Medical 246,
[2008] EWHC 581 (Admin) .............................................................................. 2.56
Coleman Harvey v DePuy International Ltd [2016] IEHC 382 .............................. 9.34
Colman v General Medical Council [2005] EWCA 433.......................................... 4.81
Collins v FBD Insurance [2013] IEHC 137 ............................................................ 3.37
Collins v Hertfordshire County Council [1947] 1 KB 598 ................................... 8.101
Collins v Mid-Western Board [2000] 2 IR 154 ............................8.30–8.33, 8.72, 8.74
Conley v Strain [1998] 1 IR 628 .................................................................. 8.99, 10.28
Connolly v Casey [1998] IEHC 90,[1999] IESC 76, [2000] 1 IR 345 ...... 10.05–10.06
Connolly v Health Service Executive [2013] IEHC 131 ........................................ 9.30
Conole v Redbank Oyster Co [1976] IR 191 (SC) .................................................. 8.99
Conroy, Re (1985) 486 A 2d 1209 ........................................................................ 15.50
Conway v Irish National Teachers Organisation [1991] 2 IR 305 .......................... 9.73
Cook v Carroll [1945] 1 IR 515 .............................................................................. 4.30
v
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The Umbilical Cord Blood Controversies in Medical Law

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Medical Law in Ireland

This book is dedicated to the memory of my grandparents, Margaret

Medical Law in Ireland

Bloomsbury Publishing Plc

© Bloomsbury Professional Ltd 2017

British Library Cataloguing-in-Publication Data

ISBN: HB: 978 184766 950 6

Judge Mary Irvine

AM is enormously grateful for the support of the School of Law, Trinity

About the authors

Medical Law in Ireland

Statutory Regimes and the Right of Access to Clinical Records ................................60

The duty to disclose: from deferring to clinical judgment

Medical Law in Ireland

The Standard of Care ................................................................................................217

Apologies ......................................................................................................... 290

Medical Law in Ireland

Treatment of the psychiatric patient ..........................................................................347

The Protection of Life during Pregnancy Act 2013 ........................................ 410

Medical Law in Ireland

Euthanasia and Assisted Suicide ...............................................................................480

Genetics .................................................................................................................... 566

Index ........................................................................................................................ 577

Medical Law in Ireland

Anderson v St Francis-St George Hospital, Inc 671 NE 2d (Ohio SC) .................15.48

Banks v Goodfellow (1870) LR 5 QB 549 ................................................ 11.64, 11.65

Medical Law in Ireland

Brennan v Fitzpatrick and others [2001] IESC 201 ...............................................8.121

Canterbury v Spence (1972) 464 F 2d 772 (District of Columbia

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