This chapter explains the law surrounding consent for the medical treatment of children, when children can give consent themselves, who can give consent of their behalf and when a refusal of consent should be respected. It also considers guidelines relevant for the practice of restraint in paediatric anaesthesia. Finally, it discusses the unique features of the ethics of research involving children, including the levels of risk that are deemed acceptable.

Chapter 10 As the French Revolution became increasingly violent, there was an growing backlash in Britain against the celebration of liberty as independence. One response, popular among a number of conservative churchman, took the form of reviving the claim that all subjects have a duty of non-resistance and passive obedience. But a different although no less hostile response came from a number of self-styled ‘liberal’ legal and political writers who saw themselves as equally opposed to conservatives and revolutionaries. This group has been little studied, but the aim of this chapter is to show that they were of central importance in discrediting the ideal of liberty as independence. They accepted the Hobbesian view that most of our natural rights must be given up in the name of peace, and that the rights remaining to us as subjects of states must basically take the form of the silence of the law. Although the ideal of liberty as independence continued to be celebrated by early British socialists, the liberal writers paved the way for the explicitly Hobbesian commitments of the early utilitarians, who finally succeeded in turning the claim that liberty cannot mean anything other than exemption from restraint into a new orthodoxy.

Chapter 8 focuses on how the strand of legal argument traced in Chapter 7 was deployed by a number of pro-imperialist writers in England in reply to Price, Paine and the American colonists in 1776. The first to take up the claim that liberty is nothing other than absence of restraint were the lawyers John Lind and Richard Hey, and they were soon followed by a large number of other critics of Price, among whom the most prominent were Adam Ferguson, John Welsey and later William Paley. The chapter focuses in particular on three objections generally raised against Price’s account of liberty. The first was that his definition confuses the state of being unfree with that of merely lacking security for the liberty you possess. The second was that he connects liberty with an unviable concept of inalienable natural rights. The third was that, by defining liberty as absence of dependence, and then equating dependence with slavery, he commits himself to a morally indefensible definition of slavery. He forgets that slaves are not merely subject to the will of their masters, but that the chief horror of slavery is that they are also regarded as being their master’s property.

Chapter 7 begins with the reaction that followed from Price and Paine’s defence of the colonial cause. They agreed with the colonists that to live in dependence on the arbitrary will of someone else is what it means to be a slave, and consequently agreed that the colonists must have a natural right to free themselves from their servitude, if necessary by force. This was the moment when a large number of pro-imperial spokesmen came forward to claim that the colonists and their supporters were failing to understand what it means to speak of possessing or losing one’s liberty. They objected that we are not rendered unfree if we are merely subject to someone else’s will; we are only rendered unfree if we are restrained from acting in some particular way. Generally this definition of liberty has been seen as an invention of the late eighteenth century. But as this chapter shows, it arose out of a long tradition of legal and political argument that originated with Hobbes, Pufendorf and their followers. We already find it present in England in the early eighteenth century, and the pro-imperialist writers now brought it to the forefront of debate.

Conclusion: a reckoning. Liberty used to be defined as absence of dependence. Nowadays it is usually defined as absence of restraint. But the underlying aim of this book has been to establish that there are several reasons for thinking that the ideal of liberty as independence is to be preferred. We gain from it a better sense of how the mere fact of living in subjection -- whether or not we are restrained -- takes away our liberty. We also gain from it a more helpful way of thinking about fundamental rights. Rather than conceiving of them as universal moral claims, there may be good reasons for preferring to think of them as the creation of specific independent communities. Above all, the ideal of liberty as independence helps us to see the importance of cherishing the value of autonomy in relationships between states as well as individual citizens. It is difficult to see how the requirements of justice can be met in the absence of a commitment to the ideal of liberty as independence.

INTRODUCTION. When and why did it come about that one prevailing way of understanding what it means to be free was replaced by a strongly contrasting account that came to be no less widely accepted, and still remains dominant? The argument of the book is that, in Anglophone political theory, the change happened quite suddenly in the closing decades of the eighteenth century. Before that time it was generally agreed that what it means to be free is that you are not subject to, or dependent on, the arbitrary will and power of anyone else. Liberty was equated with independence. But by the early nineteenth century it had come to be generally accepted that liberty simply consists in not being restrained from acting as you choose. What prompted the change, the book argues, was not the imperatives of commercial society, as has often been argued. Rather it was a growing anxiety, in the face of the American and French Revolutions, about the democratic potential of the ideal of liberty as independence.

This is a general introduction to the book, explaining that the purpose of the book is to provide a concise but detailed explanation of the core rules of international humanitarian law. The contents of each chapter are summarised. It explains that the book looks at the major areas of IHL, putting them in historical context, so as to better understand how the law has evolved. This book also examines the current challenges for and pressures on the existing law, as IHL rules adopted in the time of cavalry and bayonets must adapt to deal with issues like drones, cyber warfare and autonomous weaponry. It notes that the third edition has been updated to reflect new developments in the law of armed conflict up to May 2023.

This chapter explores the evolving use of rapid tranquillisation (RT) through the years, examining the complexities surrounding its definition and the factors that need consideration before, during and after its administration. Every acute disturbance experienced by a patient is different and a multidisciplinary approach with good communication is key. The chapter discusses the use of covert medication in

RT, the SafeWards approach to creating engaging and meaningful ward programmes for patients, laws for governing the use of restrictive procedures, and the medications used for RT and their routes of administration along with their potential side effects.

The Mental Capacity Act (MCA) 2005 came into force in 2007 and covers England and Wales. It provides a statutory framework for anyone over the age of 16 who lacks capacity to make decisions for themselves, for whatever reason. The MCA was drafted by the Law Commission partly in response to the increased prevalence of dementia and the lack of legislation to deal with the challenges of so many people living longer and losing their ability to make decisions. It is the loss of ability to make decisions, because of the disease, which makes the key link between providing care and treatment with the application of the law. This is why the MCA is perhaps the most important of all the pieces of legislation we consider. The practical applications of the Act will be dealt with in more detail in the chapters to follow. More detailed guidance can be found in the Mental Capacity Act 2005: Code of Practice (for England and Wales), revised in 2022. We include some of the main amendments to the Code at the end of this chapter and these are also covered in the relevant sections of the book.

When undertaking any intervention for an individual, you must be mindful of the legal authority or justification for the act. By intervention, we mean the full gamut of medical treatments or any act that relates to the care or welfare of that person. In this chapter, we will first consider the general legal principles that apply in almost any setting, but we have then divided the subsequent sections based on the location where care is predominantly provided (i.e. a domestic/home situation, care home or hospital). Although this is somewhat arbitrary, it broadly correlates with the progressive deterioration of the clinical state and in the transitions from living at home, to hospital or care home and through to the end of life. It therefore allows us to consider some situation-specific questions and how the law applies in negotiating the moves between locations or care settings.

The illegal killing of George Floyd led to Black Lives Matter protests around the world and energised the call for discrimination to be addressed in society. In this chapter we explore evidence of mental health inequalities in those from BAME communities and acknowledge that some groups in society, who may or may not identify as BAME, such as asylum seekers travellers and the LGBTQ+ community, also face discrimination. We mention the theory of intersectionality, racial gaslighting and the detrimental impact of austerity on health outcomes. Readers are reminded of the historical reports into the deaths of Michael Martin, Joseph Watts and David ‘Rocky’ Bennett and of the 2002 Sainsburys Centre review which identified a ‘circle of fear’. The finding of the independent review of the MHA and the recently published rapid review of ethnic health disparities by the NHS Race and Health Observatory are highlighted. NHS England and NHS Improvement’s Advancing Mental Health Equalities Strategy, the RCPsych equality action plan, and The Patient and Carers Race Equalities Framework (PCREF) are explained. Stereotyping of black males and the disproportionate use of force (including tasers), is discussed and the authors call for the implementation of mandatory training covering the nature of discrimination.

Violence and aggression never present themselves in a vacuum, yet this is typically the way policymakers approach the subject, its prevention and its management. Although guidelines exist in different sectors, too often little or no consideration is given to many of the wider issues in play, particularly the use of restraint when it becomes necessary. Despite the long-standing call for a common set of guidelines, we are only now looking at the introduction of the Restraint Reduction Network training standards, and it seems that anything approaching a set of common guidelines that all settings can embrace is a long way off. The aim of any good guidance seeking to influence practices in the prevention and management of violence and aggression should be to minimise the need for any restrictive intervention but where necessary to apply techniques as safely as possible within the relevant legislative framework. Certain staff in healthcare settings need to receive training to increase the organisation’s capacity and capability to deal with potentially violent situations without recourse to external agencies, such as police, who operate to a different set of standards to those within healthcare settings and who use techniques that healthcare staff would not wish to see used in their settings.