Vulnerable patients are at an increased risk of harm or exploitation in healthcare. Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. Clinicians have an important role in supporting vulnerable patients and upholding their autonomy. This article explores practical issues of capacity, autonomy and beneficence as they apply to some of the most common vulnerable groups that UK paramedics may encounter: children, older people, those with a mental illness and persons with a disability.
Criminal law balances community protection from children who commit criminal offences against supporting children to behave appropriately. Existing Australian law applies the rebuttable presumption of doli incapax to children from 10 years of age and then applies full criminal responsibility to children from 14 years of age. Imposing full criminal responsibility on older children is problematic because it does not account for their cognitive development, social and environmental risk factors and maturity. Extending doli incapax to older children is one response to address the challenges of older children's criminal culpability but it does not go far enough to protect children from the harms of the criminal justice system.
The presumption of doli incapax is a legal safeguard for children who contravene the criminal law. Four distinct thresholds emerge from the application of doli incapax across the Australian jurisdictions: actual knowledge that the offending conduct was ‘seriously wrong’; actual knowledge that the offending conduct was ‘wrong’; capacity to know that the offending conduct should not occur; and capacity to know that the offending conduct was ‘seriously wrong’. This article explores differences in the four doli incapax thresholds and suggests a uniform approach to the presumption is required to correct the jurisdictional inconsistency.
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