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1. Critically consider whether duties are more important than rights in…

- - - - only disclose substantial / material risks
        
        ensures fit for purpose as would waste time and resources to run through all minor risks
        
        would waste doctor's time to sit and list all irrelevant risks , then to wait for patient to take more time to decide
        
        also even if not significant enough distress to qualify as therapeutic exception, there is no need to disctress patients unnecessarily over minute and irrelevant risks
      - qualified duty which makes it more important in ensuring services fit for purpose
    - - duty of care (and therefore duty to disclose) overrides patient confidentiality
        
        where relating to the health of the TP, ensures fit for purpose as if had disclosed information about father then would have reduced need for resources when her and her child's health (if carries gene) reduces later
      - duty extends to TP's
    - - = duty to not disclose risks that would detrimentally harm the patients health
      - Emma Cave
      - Rob Haywood
      - Sheila McLean
      - link to argument
        
        to detrimentally harm their health would lead to more use of resources
        
        but also would not be in accordance with the guidelines from WMA - preserving sanctity of life? trying best to help their health at all times
      - Montgomery
  - - - emphasises that court is a neutral person
      - so court plays large role in assessing and balancing best interests for the medical service and the people
      - dont have a selfish opinion about the individual themselves
      - but court's dont know anything about medical stuff so need to combine this with medical opinions and therefore works well with doctors duties and cannot stand alone
      - link to Elizabeth Wick's article in sem 3 - vital role played by court application in ensuring that voice of incapacitated patient is heard and explicitly considered by a neutral person
    - - duty of CCG's PCT's
        
        Clondiff
        
        can't argue exceptional case based on social factors - is this fair? why not just put social factors into consideration? should patient's rights to treatment be more important here than the doctors duties to allocate resources?
        
        Ross
        
        link to AC
        
        to have tests for cost-efficiency that benefit society whilst enabling individuals to get sufficient treatment
        
        PCT / CCG guidelines
      - NICE guidelines
    - - to pass legislation which passes duties onto doctors
        
        NHS Act
        
        duties of doctors
        
        MCA 2005 Act
        
        capacity
      - to pass legislation which has limitations on who gets what treatment
        
        to control resource allocation
        
        and to protect patient welfare and autonomy?
  - - - if the purpose of healthcare services is to provide the best treatment for each individual that is possible and regard patient autonomy and patient welfare as primary factor then this is ensuring healthcare services are fit for purpose
      - if the purpose of the healthcare services is to ensure theres enough for the entire of society then this test and these types of cases are not important for ensuring healthcare services are fit for purpose
  - - - deciding if patient was in a VS or MCS was crucial to deciding whether had prospect of recovery and therefore best interest test
    - - on the other hand if no capacity and no quality of life then treatment discontinued - good for resources and individual
        
        so overall good for ensuring fit for purpose?
  - - - art 8 engaged and not justified where doctors placed DNAPR notice by a patient despite family's non-consent
      - post Montgomery have a right to know what's going on in your body and give informed consent
      - link to argument?
- - - - however they may be most important but not what ensures the service is fit for purpose
        
        since the patients take treatment from choices offered to them (do not get to choose what's not offered to them), the doctors and people with duties can therefore be considered important in ensuring that they only offer limited options to ensure the services maintain fit for their purpose
        
        patients will take what they can get
        
        doctors duties keep the patients in check
        
        therefore maintaining the service to be fit for purpose
  - - - Glass
      - Charlie
      - rights to parents to choose for their children
    - - patient s do not have a right to choose when to die but the doctor has a duty to recognise when it may be in their best interests to remove treatment - but not when it is in their best interests to have treatment which would actively cause death - euthanasia - due to the legal distinction between passively removing treatment and actively providing treatment
      - if patients did have a right to choose when to die then this right would help services be fit for purpose only if the cost / energy spent on euthanasia is less than the cost / energy spent in providing a comfortable life
      - so not clear whether they are actually helping services be fit for purpose or not
  - - - right to refuse treatment actually would make services more fit for purpose - frees up more resources in the cases where life saving treatment is what is being refused
      - so here the doctor's duties to preserve sanctity of life where patient does not want to live does not make services fit for purpose
- - - - duty to disclose information
      - duty to care for patients
      - duty to manage NHS resources effectively
        
        NHS money on treatments
        
        doctors' time
        
        to list all possible treatment options and safety risks would a) take lots of time for the doctor to go through, b) take lots of time for the patient to decide, c) potentially put patient under too much stress hearing about possible adverse effects that have v small chance of occurring
    - - to provide safe drugs to ensure good health to patients
    - - to safeguard patients' wellbeing
  - - - right to make informed decision
      - right to refuse treatment
  - - - just cost-effectiveness of drugs? or time efficiency? or finite resource efficiency?
        
        overall about ensuring there is enough beds and enough doctors and enough treatment for as many people as possible - so society more important than individual
        
        as if a treatment no longer cost effective or time effective for an individual patient, then will be discontinued so the resources can be saved for the public at large
    - - focus moved from doctor discharging duties to patient and their rights
        
        moved away from paternalistic 'doctor knows best' paternalism
        
        towards increase in recognition of patient autonomy
        
        increase in recognition of 'best interests' for individual patients
        
        in these cases, resources are not being considered - does this mean the purpose is leaning towards individuals here more than society?
      - scientific developments
        
        more medication and better standard of living = longer lives
        
        so increasing need to be more tactful with use of limited resources and money
        
        increasing population
        
        ageing Population - older people = more ill and frail and require more healthcare help
    - - want to be able to provide great treatment to individual patients within reason - not treatment that is ridiculously expensive with not much point
- - - - shifting in modern services more towards patient-centric