Justification of a voluntary vaccination policy in England and Wales rests on tenuous foundations. Two arguments against voluntary vaccination are gaining ground. The first is that globalisation necessitates preparedness strategies for pandemics. Assuming sufficient supply, compulsory vaccination of adults and children constitutes a potential policy option in the context of a severe, vaccine-preventable pandemic outbreak. The second argument is that children have a right to preventive medicine and thus to vaccination. The influence of the UN Convention on the Rights of the Child and its emphasis on parents as the trustees of their children's best interests, and the increasingly global nature of our collective and individual responsibilities with respect to the transmission of vaccine-preventable disease present challenges to the right to refuse vaccination on our own behalf and on behalf of our children. Exploring methods of compulsion and persuasion utilised across Europe, the USA and Australia, this paper argues that necessity and proportionality must be reassessed, and national public health law and policy setting out a graduated and proportionate approach to compulsory vaccination developed as a matter of priority.

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This paper addresses, from a socio-legal perspective, the question of the significance of law for the treatment, care and the end-of-life decision making for patients with chronic disorders of consciousness. We use the phrase 'chronic disorders of consciousness' as an umbrella term to refer to severely brain-injured patients in prolonged comas, vegetative or minimally conscious states. Based on an analysis of interviews with family members of patients with chronic disorders of consciousness, we explore the images of law that were drawn upon and invoked by these family members when negotiating the situation of their relatives, including, in some cases, the ending of their lives. By examining 'legal consciousness' in this way (an admittedly confusing term in the context of this study,) we offer a distinctly sociological contribution to the question of how law matters in this particular domain of social life.

Recent judgments in England and Wales have confirmed and extended the High Court's inherent jurisdiction to make declarations about interventions into the lives of 'vulnerable', rather than simply 'mentally incapacitated' adults. We argue that this shift is problematic because of the ways that the 'vulnerable adult' has been constructed in order to justify such interventions. The accounts of vulnerability drawn upon in the constructive process highlight the person's inherent characteristics and/or the circumstances within which that person might be denied the ability to make a free choice. Such an approach parallels the public policy protection of 'vulnerable adults' from abuse in care services and the statutory protection of 'vulnerable witnesses' in the criminal justice system, and is built on an external and objective assessment of being 'at risk', rather than an understanding of the subjective experience of being vulnerable. We argue that this imbalance might act to disempower the 'vulnerable adult' by reducing that person's life to a series of risk factors that fail, first, to place him/her at the heart of the decision to intervene, and, secondly, to engage adequately with the experiences through which that person ascribes meaning to his/her life.

Following the Gillick case in 1986, it was recognised that mature minors were owed a duty of confidentiality in respect of their medical information. Subsequent cases confirmed that the duty was also owed to non-competent children, including infants, but without explaining the basis for finding the existence of such a duty and its scope. It is particularly unclear when and upon what legal basis a doctor could disclose information to parents when their child wished to keep it confidential. This paper will examine the law of confidentiality as it applies to children, identifying issues which are problematic. Developments in the law of personal confidences which have taken place as a result of the Human Rights Act 1998, and the recognition of Article 8 rights as part of the law, will be reviewed and analysed from the perspective of the duty of confidence owed to children in respect of their medical information. Finally, the paper will offer an explanation of a basis for disclosure to parents which minimises violations of a minor's autonomy.

Patient autonomy is one of the central values in medical ethics. It is generally understood as recognition of patients' rights as free individuals answerable only to themselves. This emphasis on the individual leaves open the question of the position of the patients' 'loved ones', that is of families and significant others. The authors examine this question in three areas of law and medical ethics. Organ donation offers an example of preference given by medical ethics to family views, notwithstanding an expressed wish of the deceased to donate, and the legal position protecting such a request. Decisions concerning the treatment of incompetent patients illustrate consideration for the family in medical ethics, but hesitations in both law and ethics in accepting family views once expressed. And the tension between the interests of patients and family members over the access to genetic information usually results in respecting the patient's right to confidentiality. This individualistic perception of autonomy, as adopted by medical law, overlooks the patient's relationships with others and is too narrow to face the complexities of human lives.

This paper considers the written statements provided to the Bristol Inquiry by parents whose children underwent cardiac surgery at the Bristol Royal Infirmary between 1984 and 1995, seeking to learn from their experiences, opinions, feelings and expectations. The law regulating the relationship between healthcare professional, parent and child is considered in light of these accounts. The limitations of the existing law are such that a new legal framework is required which fosters the relationship between healthcare professional, parent and child, supporting them in the shared endeavour of caring for the child. Of central importance within this new framework would be recognition of each child as a distinct individual and of the expertise which parents can contribute to the care of their child.

Organ retention has been with us for millennia. Walk into virtually any cathedral and many a church in Europe and you will find an array of retained organs or tissue, allegedly originally the property of assorted saints, or even of God, and almost certainly collected without proper informed consent and retained in less than secure conditions. In our own time the complexities of organ collection, retention and use have proliferated. The events at Alder Hey Children's Hospital and the debates about the ethics of biobanking all over the world have dramatically highlighted the complexity, the difficulty and the moral importance of these issues. Some of these issues have to do with the question of who can give permission for or consent to such removal and retention. Other issues involve consideration of whose rights or interests are engaged when cadaver organs and tissue are removed and retained, just what in particular is the nature, extent and force of those rights or interests, and how they are to be balanced against other moral considerations. These questions are the subject of this paper. We will not, however, here be concerned with the issues of genetic privacy, the security of genetic information.

Court decisions concerning the life and death of patients become more and more frequent in the context of medical practice. One of the most controversial decisions in this area in recent years has been the decision of the Court of Appeal in Re A (Conjoined Twins: Medical Treatment), authorising the separation of conjoined twins. This paper will argue that the decision was flawed both on legal and moral grounds and that its potential implications for future cases are more far-reaching than the judgment itself suggests.

This paper considers the written statements provided to the Bristol Inquiry by parents whose children underwent cardiac surgery at the Bristol Royal Infirmary between 1984 and 1995, seeking learn from their experiences, opinions, feelings and expectations. The law regulating the relationship between healthcare professional, parent and child is considered in light of these accounts. The limitations of the existing law are such that a new legal framework is required which fosters the relationship between healthcare professional, parent and child, supporting them in the shared endeavour of caring for the child. Of central importance within this new framework would be recognition of each child as a distinct individual and of the expertise which parents can contribute to the care of their child.