Alex Ruck Keene
Biographic Data
| ID | 6724406 |
|---|---|
| NAME | Alex Ruck Keene |
| GIVEN NAMES | Alex Ruck |
| FAMILY NAME | Keene |
| SIGNATURE | KEENE A R |
| AFFILIATIONS | King's College London |
| ORCID | 0000-0001-8856-8132 |
| VERIFIED | Yes |
| TOTAL WORKS | 20 |
| TOTAL CITATIONS | 1 |
| AUTHOR COUNT | 20 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 2015 |
| LATEST PUBLICATION YEAR | 2026 |
| H-INDEX | 1 |
Why administration of lethal drugs should not be the role of the doctor
The suitability of doctors as agents of assisting dying remains debated, although it is common in many jurisdictions, and forms part of the proposed assisted dying legislation for England and Wales. We examine the established philosophical and legal role of doctors in England and Wales and compare it to the active role required of doctors under proposed assisted dying legislation. For clarity, we refer to the latter role as ‘assisted dying practi…
Is assisted dying a treatment
This paper focuses on the nature of the assisted dying (AD) decision including the object of the mental capacity test. Specifically, we inquire into whether AD is a treatment decision. In Part I, we analyse how the AD decision is characterised in all international AD statutes also analysing what government guidance says when the primary legislation is ambiguous. In Part II, we address the question normatively: firstly, from the perspective of cli…
Involuntary treatment of anorexia nervosa in Ireland: Challenges and changes in the legal framework
Anorexia Nervosa is an eating disorder typified by low body weight, restrictive eating behaviours, and body image distortion. It is associated with significant risk of medical complications, with one of the highest mortality rates of any mental illness. While the majority of patients receive treatment on a voluntary basis, a small proportion of severely ill patients refuse treatment and are treated involuntarily. The legal mechanisms used for inv…
An International Comparison of Psychiatric Advance Directive Policy: Across eleven jurisdictions and alongside advance directive policy
The present work provides a comparative policy review of psychiatric advance directives, considering 1) variation across eleven international jurisdictions and 2) differentiation from other advance directive policy. The aim is to support well-founded legal and clinical practice when it comes to psychiatric advance directives by 1) clarifying the range of present approaches and 2) highlighting differential treatment of those with mental health con…
Questioning our presumptions about the presumption of capacity
All contemporary frameworks of mental capacity stipulate that we must begin from the presumption that an adult has capacity. This presumption is crucial, as it manifests respect for autonomy and guards against prejudice and paternalism on the part of the evaluator. Given its ubiquity, we might presume that we all understand the presumption’s meaning and application in the same way. Evidence demonstrates that this is not the case and that this has…
No consent for brain death testing
The overwhelming weight of legal authority in the USA and Canada holds that consent is not required for brain death testing. The situation in England and Wales is similar but different. While clinicians in England and Wales may have a prima facie duty to obtain consent, lack of consent has not barred testing. In three recent cases where consent for brain death testing was formally presented to the court, lack of consent was not determinative, and…
Can the courts be viewed as an appropriate vehicle to settle clinical unease
This paper is an exploration of the state of ‘clinical unease’ experienced by clinicians in contexts where professional judgement—grounded in clinical knowledge, critical reflection and a sound grasp of the law—indicates that there is more than one ethically defensible way to proceed. The question posed is whether the courts can be viewed as an appropriate vehicle to settle clinical unease by providing a ruling that clarifies the legal and ethica…
Distributed rights protection: The 2000 Hague Convention on the International Protection of Adults and the challenge of securing fundamental rights across borders
Broad concepts and messy realities: Optimising the application of mental capacity criteria
Most jurisdictions require that a mental capacity assessment be conducted using a functional model whose definition includes several abilities. In England and Wales and in increasing number of countries, the law requires a person be able to understand, to retain, to use or weigh relevant information and to communicate one’s decision. But interpreting and applying broad and vague criteria, such as the ability ‘to use or weigh’ to a diverse range o…
Compulsory treatment of physical illness under MHA 1983
Taken together, Sections 145 and 63 of the Mental Health Act 1983 (MHA) provide for treatment without consent of physical illness ancillary to the mental disorder with which a patient presents. On a daily basis, clinicians make both the decision that the Act’s authority can be applied to their patient’s case, and that it should be applied. But in the unusual circumstances where there is uncertainty as to the applicability of the MHA to the ancill…
Insight and equality: A systematic review and meta-analysis of socio-demographic associations
Difficult Capacity Cases—The Experience of Liaison Psychiatrists. An Interview Study Across Three Jurisdictions
Practitioners approaching difficult capacity cases require both clinical skills, e.g., to uncover subtle illness impairing decision-making and to consider interpersonal dynamics, and ethical skills, e.g., to negotiate the role of values and risks in capacity assessment. Education and training programmes should incorporate both aspects and could include the resolution strategies identified in our study. Practitioners, supported by health and socia…
Family members, ambulance clinicians and attempting CPR in the community: The ethical and legal imperative to reach collaborative consensus at speed
Here we present the personal perspectives of two authors on the important and unfortunately frequent scenario of ambulance clinicians facing a deceased individual and family members who do not wish them to attempt cardiopulmonary resuscitation. We examine the professional guidance and the protection provided to clinicians, which is not matched by guidance to protect family members. We look at the legal framework in which these scenarios are takin…
A new kind of paternalism in surrogate decision-making? The case of Barnsley Hospitals NHS Foundation Trust v MSP
The modern legal and ethical movement against traditional welfare paternalism in medical decision-making extends to how decisions are made for patients lacking decisional capacity, prioritising surrogates’ judgment about what patients would have decided over even their best interests. In England and Wales, the Mental Capacity Act 2005 follows this trend of prioritising the patient’s prior wishes, values and beliefs but the dominant interpretation…
Should age matter in Covid-19 triage? A deliberative study
The COVID-19 pandemic put a large burden on many healthcare systems, causing fears about resource scarcity and triage. Several COVID-19 guidelines included age as an explicit factor and practices of both triage and ‘anticipatory triage’ likely limited access to hospital care for elderly patients, especially those in care homes. To ensure the legitimacy of triage guidelines, which affect the public, it is important to engage the public’s moral int…
Isolating residents including wandering residents in care and group homes: Medical ethics and English law in the context of Covid-19
Isolation of patients in psychiatric hospitals in the context of the Covid-19 pandemic: An ethical, legal, and practical challenge
Capacity in the time of Coronavirus
The Pact advance decision-making template: Preparing for Mental Health Act reforms with co-production, focus groups and consultation
BACKGROUND: Advance decision making (ADM) in mental health is supported by stakeholders but faces significant barriers. These must be overcome, not least to support the UK government's commitment to introduce statutory mental health ADM in England and Wales. AIMS: To build understanding and address the gap between aspirations for ADM and actuality, with feasible co-produced ADM resources. METHODS: We used focus groups and consultation to explore …
The role of the Court of Protection in safeguarding
Purpose – The purpose of this paper is to outline how questions relating to capacity arise in the context of safeguarding, and when applications to the Court of Protection are required in relation to those who may lack capacity. It also seeks to provide guidance as to how applications to the Court of Protection should be made so as to ensure that they are determined effectively and in a proportionate fashion. Design/methodology/approach – The pap…
The role of the Court of Protection in safeguarding
Purpose – The purpose of this paper is to outline how questions relating to capacity arise in the context of safeguarding, and when applications to the Court of Protection are required in relation to those who may lack capacity. It also seeks to provide guidance as to how applications to the Court of Protection should be made so as to ensure that they are determined effectively and in a proportionate fashion. Design/methodology/approach – The pap…
The role of the Court of Protection in safeguarding
Purpose – The purpose of this paper is to outline how questions relating to capacity arise in the context of safeguarding, and when applications to the Court of Protection are required in relation to those who may lack capacity. It also seeks to provide guidance as to how applications to the Court of Protection should be made so as to ensure that they are determined effectively and in a proportionate fashion. Design/methodology/approach – The pap…
Isolation of patients in psychiatric hospitals in the context of the Covid-19 pandemic: An ethical, legal, and practical challenge
Capacity in the time of Coronavirus
The Pact advance decision-making template: Preparing for Mental Health Act reforms with co-production, focus groups and consultation
BACKGROUND: Advance decision making (ADM) in mental health is supported by stakeholders but faces significant barriers. These must be overcome, not least to support the UK government's commitment to introduce statutory mental health ADM in England and Wales. AIMS: To build understanding and address the gap between aspirations for ADM and actuality, with feasible co-produced ADM resources. METHODS: We used focus groups and consultation to explore …
Family members, ambulance clinicians and attempting CPR in the community: The ethical and legal imperative to reach collaborative consensus at speed
Here we present the personal perspectives of two authors on the important and unfortunately frequent scenario of ambulance clinicians facing a deceased individual and family members who do not wish them to attempt cardiopulmonary resuscitation. We examine the professional guidance and the protection provided to clinicians, which is not matched by guidance to protect family members. We look at the legal framework in which these scenarios are takin…
A new kind of paternalism in surrogate decision-making? The case of Barnsley Hospitals NHS Foundation Trust v MSP
The modern legal and ethical movement against traditional welfare paternalism in medical decision-making extends to how decisions are made for patients lacking decisional capacity, prioritising surrogates’ judgment about what patients would have decided over even their best interests. In England and Wales, the Mental Capacity Act 2005 follows this trend of prioritising the patient’s prior wishes, values and beliefs but the dominant interpretation…
Should age matter in Covid-19 triage? A deliberative study
The COVID-19 pandemic put a large burden on many healthcare systems, causing fears about resource scarcity and triage. Several COVID-19 guidelines included age as an explicit factor and practices of both triage and ‘anticipatory triage’ likely limited access to hospital care for elderly patients, especially those in care homes. To ensure the legitimacy of triage guidelines, which affect the public, it is important to engage the public’s moral int…
Isolating residents including wandering residents in care and group homes: Medical ethics and English law in the context of Covid-19
Broad concepts and messy realities: Optimising the application of mental capacity criteria
Most jurisdictions require that a mental capacity assessment be conducted using a functional model whose definition includes several abilities. In England and Wales and in increasing number of countries, the law requires a person be able to understand, to retain, to use or weigh relevant information and to communicate one’s decision. But interpreting and applying broad and vague criteria, such as the ability ‘to use or weigh’ to a diverse range o…
Compulsory treatment of physical illness under MHA 1983
Taken together, Sections 145 and 63 of the Mental Health Act 1983 (MHA) provide for treatment without consent of physical illness ancillary to the mental disorder with which a patient presents. On a daily basis, clinicians make both the decision that the Act’s authority can be applied to their patient’s case, and that it should be applied. But in the unusual circumstances where there is uncertainty as to the applicability of the MHA to the ancill…
Insight and equality: A systematic review and meta-analysis of socio-demographic associations
Difficult Capacity Cases—The Experience of Liaison Psychiatrists. An Interview Study Across Three Jurisdictions
Practitioners approaching difficult capacity cases require both clinical skills, e.g., to uncover subtle illness impairing decision-making and to consider interpersonal dynamics, and ethical skills, e.g., to negotiate the role of values and risks in capacity assessment. Education and training programmes should incorporate both aspects and could include the resolution strategies identified in our study. Practitioners, supported by health and socia…
Distributed rights protection: The 2000 Hague Convention on the International Protection of Adults and the challenge of securing fundamental rights across borders
Questioning our presumptions about the presumption of capacity
All contemporary frameworks of mental capacity stipulate that we must begin from the presumption that an adult has capacity. This presumption is crucial, as it manifests respect for autonomy and guards against prejudice and paternalism on the part of the evaluator. Given its ubiquity, we might presume that we all understand the presumption’s meaning and application in the same way. Evidence demonstrates that this is not the case and that this has…
No consent for brain death testing
The overwhelming weight of legal authority in the USA and Canada holds that consent is not required for brain death testing. The situation in England and Wales is similar but different. While clinicians in England and Wales may have a prima facie duty to obtain consent, lack of consent has not barred testing. In three recent cases where consent for brain death testing was formally presented to the court, lack of consent was not determinative, and…
Can the courts be viewed as an appropriate vehicle to settle clinical unease
This paper is an exploration of the state of ‘clinical unease’ experienced by clinicians in contexts where professional judgement—grounded in clinical knowledge, critical reflection and a sound grasp of the law—indicates that there is more than one ethically defensible way to proceed. The question posed is whether the courts can be viewed as an appropriate vehicle to settle clinical unease by providing a ruling that clarifies the legal and ethica…
An International Comparison of Psychiatric Advance Directive Policy: Across eleven jurisdictions and alongside advance directive policy
The present work provides a comparative policy review of psychiatric advance directives, considering 1) variation across eleven international jurisdictions and 2) differentiation from other advance directive policy. The aim is to support well-founded legal and clinical practice when it comes to psychiatric advance directives by 1) clarifying the range of present approaches and 2) highlighting differential treatment of those with mental health con…
Why administration of lethal drugs should not be the role of the doctor
The suitability of doctors as agents of assisting dying remains debated, although it is common in many jurisdictions, and forms part of the proposed assisted dying legislation for England and Wales. We examine the established philosophical and legal role of doctors in England and Wales and compare it to the active role required of doctors under proposed assisted dying legislation. For clarity, we refer to the latter role as ‘assisted dying practi…
Is assisted dying a treatment
This paper focuses on the nature of the assisted dying (AD) decision including the object of the mental capacity test. Specifically, we inquire into whether AD is a treatment decision. In Part I, we analyse how the AD decision is characterised in all international AD statutes also analysing what government guidance says when the primary legislation is ambiguous. In Part II, we address the question normatively: firstly, from the perspective of cli…
Involuntary treatment of anorexia nervosa in Ireland: Challenges and changes in the legal framework
Anorexia Nervosa is an eating disorder typified by low body weight, restrictive eating behaviours, and body image distortion. It is associated with significant risk of medical complications, with one of the highest mortality rates of any mental illness. While the majority of patients receive treatment on a voluntary basis, a small proportion of severely ill patients refuse treatment and are treated involuntarily. The legal mechanisms used for inv…
Political science (13 works) · Psychology (13 works) · Healthcare Decision-Making and Restraints (12 works) · Law (12 works) · Medicine (12 works) · Computer Science (8 works) · Psychiatry (8 works) · Palliative Care and End-of-Life Issues (7 works) · Mental health (6 works) · Legislation (5 works)