This chapter discusses the troubling legal and ethical issues raised by admissions to nursing homes. Current practice and the existing legal framework for involuntary admissions are discussed and it is argued that there is a need for safeguards in relation to such admissions in Ireland as these constitute a deprivation of liberty. The chapter also deals with how decisions are made by families and healthcare professionals in relation to possible involuntary nursing home admission. This includes consideration of how a functional assessment of capacity in such cases should be approached and the arguments for and against involuntary admission in the person’s ‘best interests.’

This chapter places our understanding of freedom of information in an international context, by examining the evolution of governmental attitudes towards the relationship between public access to information and the democratic system. By looking at international trends in FOI, the chapter situates Ireland’s experience with FOI more clearly and highlights the significant difference between narrow bureaucratic and primarily administrative approaches to the implementation of FOI, and more ambitious and broader attempts to use FOI as a cornerstone of democratic practice. The chapter illustrates quite clearly evidence for both approaches to FOI in Ireland and outlines the key issue areas where this tension is most evident. After a review of the data available to examine public attitudes towards and uses of FOI in Ireland, the chapter goes on to discuss the broader democratic system in which freedom of information interacts with parliamentary questions, administrative record-keeping, official secrets and other ways in which information is made available (or denied) to people living in Ireland, and the extent to which the overall availability of information promotes (or constricts) democracy in Ireland.

This chapter examines the legal context within which decisions about the end of life are made. It argues that an ethical approach to end-of-life care must be centred on the dying person and that finding ways to ensure that this person’s voice is heard must be core to the development of legal frameworks. In this respect, the law has, to date, been inadequate. It explores the ways decisions about the end of life are made in Ireland and identifies likely changes, including an increased formalisation of dying. Drawing on experiences from the United States and the United Kingdom, it develops arguments regarding the most appropriate decision-making structures within which to consider difficult questions around end-of-life care.

This chapter focuses on two key areas which require further clarity and elaboration in the context of research with children, namely, the requirements for research which does not offer the child the prospect of a direct benefit and the provisions around child assent and parental consent. The chapter examines legal and ethical guidance regarding these issues, setting out areas of uncertainty and ambiguity between the various governing instruments. It argues that the lack of clarity in these areas needs to be addressed in order to provide a robust system of protection for children, parents and those involved in clinical research with children. It makes proposals for reform drawing on the legal, ethical and academic guidance in the area and best practice in other countries.

This chapter examines the role of country of origin in relation to psychiatric admission status in Ireland. Data presented in this chapter demonstrate that schizophrenia is a particular problem in individuals born outside Ireland and living in Dublin’s inner-city, and that this is associated with involuntary admission under the Mental Health Act 2001. The chapter also shows much lower levels of voluntary admissions. The chapter argues that these differences in patterns of help-seeking should be considered in future planning exercises in Ireland’s mental health services. In particular, increased emphasis on the cultural competence of health care-providers would be a good first step in recognising and addressing the differing health needs and practices of individuals from different ethnic groups and cultural backgrounds.

FOI, for a generation of post-Troubles Irish journalists, has unearthed many important stories and allowed journalists to report in the public interest on important investigations. However, restrictions on the Act since 2003 have severely curtailed journalists’ ability to carry out investigations and ensure accountability for the public. Inconsistencies in approach from public bodies have in many cases made the Act almost impossible to use successfully in an accountability role as a reporter. Chronic understaffing at the Office of the Information Commissioner’s office has also meant that, in effect, access delayed is access denied in many instances. Ryan also laments the inability of the FOI regime to implement any system of precedent – and charts his own personal experiences with various public bodies, in which he has requested access to material that both the Information Commissioner and the High Court have previously ruled should be released, but which continues to be denied by decision-makers. He also examines the use of exemptions such as personal information and commercial sensitivity, and demonstrates again how inconsistencies in approach are leading to poor decision-making on FOI by public bodies.

Presents three critical reflections on the initial intentions, contemporary usage and possible evolution of FOI legislation in Ireland by three practitioners well placed to comment. This chapter combines the thoughts and ideas of Eithne FitzGerald, the original minister in charge and champion of FOI in Ireland; John Carroll, a former policy analyst and political adviser with experience of using the Act both in opposition and in government; and Peter Tyndall, the current FOI Information Commissioner and Ombudsman.

Examines the clash between national security and the public interest in Ireland’s FOI legislation. Noting that freedom of information is grounded in the public interest to access information, whereas national security typically tries to restrict information to protect the security of the state, the chapter examines legal and constitutional parameters in which the restriction Introduction of access to information operates. It assesses how Ireland’s FOI legislation measures up against international norms of FOI in this area and examines the challenges to litigating the public interest in such cases where Irish courts have always shown undue deference to the will and arguments of the state. The chapter concludes by arguing that Ireland’s national security restrictions are disproportionate to its security threats, serving rather to stifle democratic debate and effective discussion of government policy.

This chapter identifies the area of decision-making as central to the protection of older people. It addresses the recognition of legal capacity as a central issue to avoid choices being ignored and not respected. The chapter discusses some of the law and policy reforms necessary to meet international human rights standards, as set out in the Convention on the Rights of Persons with Disabilities and the European Convention on Human Rights. Lessons from research in other jurisdictions are highlighted to avoid the pitfalls identified from similar law reform elsewhere.

Ireland’s Mental Health Act 2001 requires that all involuntary admissions for mental disorder be reviewed within twenty-one days by a three-person Mental Health Tribunal. This chapter focuses on key written judgments of the High Court and Supreme Court reviewing decisions of Mental Health Tribunal. Despite some statements to the contrary, the general picture which emerges is that the courts have not engaged in robust supervision of mental health tribunals. Instead, the general tenor of the case-law has been to endorse decisions of tribunals to affirm detentions, and to limit access to the courts to the most extreme violations of procedural rights. The chapter argues that this is a disappointing outcome, in light of the supposed rights-based focus of the Mental Health Act 2001.

This chapter provides an analysis of the state of critical care provision in Ireland and of how the withdrawal or withholding of therapies usually happens. It argues that the withdrawal of life-sustaining therapies is not simply a medical matter, but one with considerable social and political dimensions. It identifies the need for public discourse on the subject and for the development of a public policy on critical care. It argues that the answers to the dilemmas that critical care raise cannot most effectively be attained through the courts, but rather the solution is to be found in a social contract on the use of expensive and resource intensive medical technology.

Freedom of information (FOI) is important because it aims to makes government open, transparent and accountable. FOI legislation is based on the premise that people have the right of access to public documents, save for certain exemptions. The philosophy behind such legislation is that citizens have a ‘right to know’ how and why decisions are made by government in their name. In this respect, it is often argued that FOI legislation also has the potential to lead to more accountable government, less corruption and better democratic outcomes for states. In short, FOI presents a key element in effective political reform. In the aftermath of massive economic, political and social crisis and upheaval in Ireland there is widespread agreement about the need for political reform, but far less consensus about what form this reform should take. This book presents the case for FOI and examines the potential it offers for better government, as well as the limits and constraints to what the most recent FOI legislation might deliver.

This chapter considers why we should care about carers and engages with different theoretical approaches to recognising the caring relationship and the implications of this for those involved in such relationships. In particular the chapter considers an approach grounded in the ethic of care and one based on relational autonomy. The chapter engages with an area of Irish health law where carers are clearly excluded from the legal framework – the mental health system. The mental health system is a useful case-study as it illustrates the complexities around balancing the interests of carers and cared for persons. The chapter concludes that it is important to care about carers, but doing so must be in a manner which continues to respect the distinct individual rights of each of the parties to the caring relationship.

This chapter considers how inconsistencies can be resolved in the context of refusal of medical treatment by young people over sixteen by looking at the roles consent plays in medicine. In some cases the question of whether that refusal should be respected is purely academic – for practical reasons the treatment cannot be given. But where treatment could be provided in the light of such a refusal it is unclear whether it is permissible to do so. This is because it seems inconsistent both to say that a patient can consent to treatment but not refuse it, and to say that we ought to seek consent even where a refusal to provide it may be overridden. The chapter argues that there is a relatively straightforward argument to support the idea that young people can consent to, but not effectively refuse, medical treatment. What will turn out to require further explanation, at least on standard ways of approaching medical ethics, is the idea that it is always morally wrong to give an adult treatment that she refuses.