Sarah, aged 42, lives with her partner Leo, 46, and Leo’s Aunt Fiona, who owns the house they live in. Sarah works as manager of a local garden centre. Since the death of her parents, two years ago, Sarah has responsibility for her brother Marcus. Marcus is 28 years old and has learning difficulties. He is now in residential care at ‘Reed House’, forty miles away, and returns home for one weekend each month. Leo works as a senior nurse in the Accident and Emergency department of Chelmbridge County Hospital. Fiona is 74 years old and is relatively healthy for her age but takes med

Sarah, aged 42, lives with her partner Leo, 46, and Leo’s Aunt Fiona, who owns the house they live in. Sarah works as manager of a local garden centre. Since the death of her parents, two years ago, Sarah has responsibility for her brother Marcus. Marcus is 28 years old and has learning difficulties. He is now in residential care at ‘Reed House’, forty miles away, and returns home for one weekend each month. Leo works as a senior nurse in the Accident and Emergency department of Chelmbridge County Hospital. Fiona is 74 years old and is relatively healthy for her age but takes medication for high blood pressure and a chronic heart defect. Six months ago Sarah underwent an operation to relieve chronic pain in her right shoulder. She was operated on by consultant orthopaedic surgeon, Dr Clarke, at the Stonebridge County Hospital. Since the operation Sarah has started to experience numbness in her lower right arm and this has had an impact on the physical aspects of her work and her keyboard abilities.

Sarah remembers Dr Clarke telling her the risks associated with the procedure but does not recall any mention of numbness. She has also discovered that the procedure has only been adopted by a small number of surgeons in the UK. Sarah is very concerned that she may have to relinquish her managerial position at the Garden Centre if these symptoms continue. Sarah has said that if she had been told of the risk of numbness, she would have sought a second opinion and taken more time to make a decision. Sarah’s brother Marcus has settled very well at ‘Reed House’, a residential home for adults with learning disabilities. He is outgoing and sociable, however, he has the intellectual capacity of a four to five year old child and has mild epilepsy. Marcus has become very close to Diana, a fellow resident at ‘Reed House’, and has told staff that he ‘loves Diana and wishes to marry her’. The senior manager, Dr Smith, who is responsible for Marcus’s care has spoken to Sarah to express her concern over the relationshi​‌‍‍‍‌‍‌‍‍‌‌‌‌‌‍‍‍‍‌‌​p as she fears the couple may become sexually active. This has resulted in Marcus and Diana requiring more supervision than is usual. Although Sarah is happy for Marcus to continue the relationship with Diana, she is very worried that Diana may become pregnant and Marcus would be unable to understand the risks involved. Sarah and Leo have discussed the possibility of Marcus undergoing a vasectomy operation as they want him to experience close relationships in as normal a way as possible.

Although Fiona is generally healthy, she is aware that she is at high risk of suffering a stroke. She would like to make sure that if she were to become incapacitated that she would not be given invasive lifesaving treatment. Fiona has heard that there is a way of putting her end of life wishes in writing, to ensure they are complied with, and considers that this would put her mind at rest. Leo was on duty this morning at Chelmbridge Hospital Accident and Emergency Department. He was called to treat Philip Soper, a 43-year-old man and prominent member of the local Council. Philip presented with a serious stab wound to the abdomen. Philip is insisting that he accidently stabbed himself with a kitchen knife at home. Philip is well known locally for promoting family values. Daisy Wallis, the paramedic in attendance, said that Philip was picked up in the ‘red light’ district, and the incident was phoned in by an anonymous caller. At first, Philip was reluctant to go to hospital but Daisy explained that his condition was very serious.

There have been other incidents in the area, including 2 stabbings in the past three months. Philip has stated that he does not want the police involved nor does he wish his family to be informed. Unknown to Leo and, upset by what she perceives as Philip Soper’s hypocrisy, Daisy Wallis contacted a Sunday newspaper to tell them about Mr Soper being found injured in the red-light district. Daisy believes that this is something that the public have a right to know about. To prove the truth of her story, she photocopied and passed on to the newspaper, a copy of Philip’s medical notes, detailing the incident. The newspaper contacted Philip but he refused to comment on the story and is finding the situation extremely distressing. He believes that he as an absolute right to confidentiality with respect to his treatment.

1. Advise Sarah as to any action that she may bring against Dr Clarke and the Stonebridge Hospital Trust.

2. Explain the law surrounding non-therapeutic sterilisation of people with learning disabilities and consider the likelihood of Sarah obtaining a declaration from the court, for such a procedure, with respect to Marcus.

3. Advise Fiona, of the steps that she should take to ensure that her end of life wishes, with respect to refusal of life prolonging treatment, are carried out.

4. On the issue of confidentiality, explain the procedure to be followed by Leo and other healthcare professionals when a person presents at hospital with an injury such as that which Philip Soper has sustained.

5. Advise Philip Soper: a) Of any action he may take against the hospital and the Sunday newspaper; b) the remedies available to him; and c) any defences that may be raised by those ​‌‍‍‍‌‍‌‍‍‌‌‌‌‌‍‍‍‍‌‌​involved in the alleged breach.

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