Intended for healthcare professionals

Education And Debate

Tragic choices and the role of administrative law

BMJ 2000; 321 doi: (Published 08 July 2000) Cite this as: BMJ 2000;321:105
  1. Cameron Stewart, lecturer (
  1. Division of Law, Macquarie University, NSW 2109, Australia
  • Accepted 11 May 2000

Chris Ham's article on tragic choices in health care highlights the increasing need for transparency and fairness in medical decision making.1 Although Ham argued on ethical grounds for greater accountability in resource allocation, there is a growing body of law that is beginning to regulate this area. Administrative law is a branch of public law that deals with judicial review of decisions made by government bodies. Traditionally, this area of law has had little impact on medical decision making. However, as the healthcare system becomes increasingly bureaucratised, greater levels of dissatisfaction may force some patients to seek redress for their complaints through the avenue of administrative law. The case of Child B was an example of such a complaint.1 Even though the Child B case was a failure, these types of claims are beginning to increase in frequency. The United Kingdom leads the way in this area, and it is the only country in the Commonwealth where administrative law is having a major impact on medical decision making. The basic principles of administrative law are, however, shared by all common law jurisdictions, and other countries (particularly Australia and New Zealand) are now seeing similar claims arise. 2 3 There is a pressing need for medical decision makers to familiarise themselves with the basic principles of administrative law.

Summary points

Administrative law has a practical relevance to medical decision making

It allows judges to review decisions on the grounds that they are unlawful, procedurally unfair, or unreasonable

The types of medical decisions that the courts will review are growing—they include decisions that unfairly discriminate between patients, blanket policies not to treat particular conditions, and decisions to not provide promised services

Medical decision makers need to become familiar with the principles of administrative law to avoid litigation


This article is the result …

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