{"id":"https://openalex.org/W7225418133","doi":"https://doi.org/10.1136/jme-2026-112454","title":"When is treatment clinically appropriate? The Townsend v Epsom and St Helier NHS Trust controversy","display_name":"When is treatment clinically appropriate? The Townsend v Epsom and St Helier NHS Trust controversy","publication_year":2026,"publication_date":"2026-11-06","ids":{"openalex":"https://openalex.org/W7225418133","doi":"https://doi.org/10.1136/jme-2026-112454","pmid":"https://pubmed.ncbi.nlm.nih.gov/42994972"},"language":"en","primary_location":{"id":"doi:10.1136/jme-2026-112454","doi":"https://doi.org/10.1136/jme-2026-112454","is_oa":true,"landing_page_url":"https://doi.org/10.1136/jme-2026-112454","pdf_url":"https://jme.bmj.com/content/medethics/early/2026/11/06/jme-2026-112454.full.pdf","source":{"id":"https://openalex.org/S70185877","display_name":"Journal of Medical Ethics","issn_l":"0306-6800","issn":["0306-6800","1473-4257"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-class-a","anvur-scientific","cwts-core","doyens","erih-plus","jufo-3","ki-jl-2","medline","norway-2","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310319945","host_organization_name":"BMJ","host_organization_lineage":["https://openalex.org/P4310319945"],"host_organization_lineage_names":["BMJ"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Medical Ethics","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","pubmed"],"open_access":{"is_oa":true,"oa_status":"hybrid","oa_url":"https://jme.bmj.com/content/medethics/early/2026/11/06/jme-2026-112454.full.pdf","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5055474631","display_name":"Christian A. Gericke","orcid":"https://orcid.org/0000-0002-7834-0406","observed_orcids":["https://orcid.org/0000-0002-7834-0406"]},"institutions":[{"id":"https://openalex.org/I118347636","display_name":"Australian National University","ror":"https://ror.org/019wvm592","country_code":"AU","type":"education","lineage":["https://openalex.org/I118347636"]},{"id":"https://openalex.org/I165143802","display_name":"The University of Queensland","ror":"https://ror.org/00rqy9422","country_code":"AU","type":"education","lineage":["https://openalex.org/I165143802"]},{"id":"https://openalex.org/I4210132479","display_name":"Calvary Hospital","ror":"https://ror.org/041c7s516","country_code":"AU","type":"healthcare","lineage":["https://openalex.org/I4210132479"]}],"countries":["AU"],"is_corresponding":false,"raw_author_name":"Christian A Gericke","raw_affiliation_strings":["Deakin Private Hospital and Calvary Bruce Private Hospital, Canberra, Australian Capital Territory, Australia","School of Medicine and Psychology, Australian National University, Canberra, Australian Capital Territory, Australia","School of Public Health, The University of Queensland, Brisbane, Queensland, Australia"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Deakin Private Hospital and Calvary Bruce Private Hospital, Canberra, Australian Capital Territory, Australia","institution_ids":["https://openalex.org/I4210132479"]},{"raw_affiliation_string":"School of Medicine and Psychology, Australian National University, Canberra, Australian Capital Territory, Australia","institution_ids":["https://openalex.org/I118347636"]},{"raw_affiliation_string":"School of Public Health, The University of Queensland, Brisbane, Queensland, Australia","institution_ids":["https://openalex.org/I165143802"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5064910024","display_name":"Dominic J. C. Wilkinson","orcid":"https://orcid.org/0000-0003-3958-8633","observed_orcids":["https://orcid.org/0000-0003-3958-8633"]},"institutions":[{"id":"https://openalex.org/I165932596","display_name":"National University of Singapore","ror":"https://ror.org/01tgyzw49","country_code":"SG","type":"education","lineage":["https://openalex.org/I165932596"]},{"id":"https://openalex.org/I2802742124","display_name":"John Radcliffe Hospital","ror":"https://ror.org/0080acb59","country_code":"GB","type":"healthcare","lineage":["https://openalex.org/I2802742124","https://openalex.org/I4210127145","https://openalex.org/I4210147381"]},{"id":"https://openalex.org/I40120149","display_name":"University of Oxford","ror":"https://ror.org/052gg0110","country_code":"GB","type":"education","lineage":["https://openalex.org/I40120149"]}],"countries":["GB","SG"],"is_corresponding":true,"raw_author_name":"Dominic Wilkinson","raw_affiliation_strings":["Centre for Biomedical Ethics, National University of Singapore Yong Loo Lin School of Medicine, Singapore","John Radcliffe Hospital, Oxford, UK","Uehiro Oxford Institute, University of Oxford, Oxford, UK"],"raw_orcid":"https://orcid.org/0000-0003-3958-8633","affiliations":[{"raw_affiliation_string":"Centre for Biomedical Ethics, National University of Singapore Yong Loo Lin School of Medicine, Singapore","institution_ids":["https://openalex.org/I165932596"]},{"raw_affiliation_string":"John Radcliffe Hospital, Oxford, UK","institution_ids":["https://openalex.org/I2802742124"]},{"raw_affiliation_string":"Uehiro Oxford Institute, University of Oxford, Oxford, UK","institution_ids":["https://openalex.org/I40120149"]}]}],"institutions":[],"countries_distinct_count":3,"institutions_distinct_count":6,"corresponding_author_ids":["https://openalex.org/A5064910024"],"corresponding_institution_ids":["https://openalex.org/I165932596","https://openalex.org/I2802742124","https://openalex.org/I40120149"],"apc_list":null,"apc_paid":null,"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.0,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":"jme","last_page":"2026"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T13147","display_name":"Ethics and bioethics in healthcare","score":0.7026000022888184,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T13147","display_name":"Ethics and bioethics in healthcare","score":0.7026000022888184,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T14437","display_name":"Ethics and Legal Issues in Pediatric Healthcare","score":0.1785999983549118,"subfield":{"id":"https://openalex.org/subfields/2735","display_name":"Pediatrics, Perinatology and Child Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T13275","display_name":"Medical and Health Sciences Research","score":0.07750000059604645,"subfield":{"id":"https://openalex.org/subfields/3308","display_name":"Law"},"field":{"id":"https://openalex.org/fields/33","display_name":"Social Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/clinical-appropriateness","display_name":"clinical appropriateness","score":0.9440000057220459},{"id":"https://openalex.org/keywords/best-interests","display_name":"best interests","score":0.6690000295639038},{"id":"https://openalex.org/keywords/medical-ethics","display_name":"medical ethics","score":0.4819999933242798},{"id":"https://openalex.org/keywords/resource-allocation","display_name":"resource allocation","score":0.5529999732971191},{"id":"https://openalex.org/keywords/scientific-uncertainty","display_name":"scientific uncertainty","score":0.734000027179718},{"id":"https://openalex.org/keywords/private-care","display_name":"private care","score":0.4020000100135803},{"id":"https://openalex.org/keywords/supreme-court-review","display_name":"Supreme Court review","score":0.39800000190734863}],"concepts":[{"id":"https://openalex.org/C2780549954","wikidata":"https://www.wikidata.org/wiki/Q7830165","display_name":"Townsend","level":2,"score":0.6550999879837036},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.5325999855995178},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.37779998779296875},{"id":"https://openalex.org/C177713679","wikidata":"https://www.wikidata.org/wiki/Q679690","display_name":"Intensive care medicine","level":1,"score":0.31790000200271606},{"id":"https://openalex.org/C17744445","wikidata":"https://www.wikidata.org/wiki/Q36442","display_name":"Political science","level":0,"score":0.3172000050544739},{"id":"https://openalex.org/C2992517282","wikidata":"https://www.wikidata.org/wiki/Q1976740","display_name":"Patient rights","level":3,"score":0.3019999861717224},{"id":"https://openalex.org/C545542383","wikidata":"https://www.wikidata.org/wiki/Q2751242","display_name":"Medical emergency","level":1,"score":0.296999990940094},{"id":"https://openalex.org/C199539241","wikidata":"https://www.wikidata.org/wiki/Q7748","display_name":"Law","level":1,"score":0.2935999929904938},{"id":"https://openalex.org/C118552586","wikidata":"https://www.wikidata.org/wiki/Q7867","display_name":"Psychiatry","level":1,"score":0.2928999960422516},{"id":"https://openalex.org/C15744967","wikidata":"https://www.wikidata.org/wiki/Q9418","display_name":"Psychology","level":0,"score":0.26899999380111694},{"id":"https://openalex.org/C204787440","wikidata":"https://www.wikidata.org/wiki/Q188504","display_name":"Alternative medicine","level":2,"score":0.26829999685287476},{"id":"https://openalex.org/C2778137410","wikidata":"https://www.wikidata.org/wiki/Q2732820","display_name":"Government (linguistics)","level":2,"score":0.26510000228881836},{"id":"https://openalex.org/C512399662","wikidata":"https://www.wikidata.org/wiki/Q3505712","display_name":"Family medicine","level":1,"score":0.26489999890327454},{"id":"https://openalex.org/C95457728","wikidata":"https://www.wikidata.org/wiki/Q309","display_name":"History","level":0,"score":0.26159998774528503},{"id":"https://openalex.org/C187212893","wikidata":"https://www.wikidata.org/wiki/Q123028","display_name":"Pediatrics","level":1,"score":0.2563000023365021}],"mesh":[],"locations_count":2,"locations":[{"id":"doi:10.1136/jme-2026-112454","doi":"https://doi.org/10.1136/jme-2026-112454","is_oa":true,"landing_page_url":"https://doi.org/10.1136/jme-2026-112454","pdf_url":"https://jme.bmj.com/content/medethics/early/2026/11/06/jme-2026-112454.full.pdf","source":{"id":"https://openalex.org/S70185877","display_name":"Journal of Medical Ethics","issn_l":"0306-6800","issn":["0306-6800","1473-4257"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-class-a","anvur-scientific","cwts-core","doyens","erih-plus","jufo-3","ki-jl-2","medline","norway-2","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310319945","host_organization_name":"BMJ","host_organization_lineage":["https://openalex.org/P4310319945"],"host_organization_lineage_names":["BMJ"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Medical Ethics","raw_type":"journal-article"},{"id":"pmid:42994972","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42994972","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of medical ethics","raw_type":"Journal Article"}],"best_oa_location":{"id":"doi:10.1136/jme-2026-112454","doi":"https://doi.org/10.1136/jme-2026-112454","is_oa":true,"landing_page_url":"https://doi.org/10.1136/jme-2026-112454","pdf_url":"https://jme.bmj.com/content/medethics/early/2026/11/06/jme-2026-112454.full.pdf","source":{"id":"https://openalex.org/S70185877","display_name":"Journal of Medical Ethics","issn_l":"0306-6800","issn":["0306-6800","1473-4257"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-class-a","anvur-scientific","cwts-core","doyens","erih-plus","jufo-3","ki-jl-2","medline","norway-2","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310319945","host_organization_name":"BMJ","host_organization_lineage":["https://openalex.org/P4310319945"],"host_organization_lineage_names":["BMJ"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Medical Ethics","raw_type":"journal-article"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","score":0.6240000128746033,"display_name":"Good health and well-being"}],"study_designs":[],"awards":[{"id":"https://openalex.org/G2862864524","display_name":"ANTITHESES: A Discovery Platform for Transformative Inclusivity in Ethics and Humanities Research","funder_award_id":"226801","funder_id":"https://openalex.org/F4320311904","funder_display_name":"Wellcome Trust"}],"funders":[{"id":"https://openalex.org/F4320311904","display_name":"Wellcome Trust","ror":"https://ror.org/029chgv08"}],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7225418133.pdf","grobid_xml":"https://content.openalex.org/works/W7225418133.grobid-xml"},"referenced_works_count":14,"referenced_works":["https://openalex.org/W2025081511","https://openalex.org/W2059998071","https://openalex.org/W2089809545","https://openalex.org/W2105046091","https://openalex.org/W2133393736","https://openalex.org/W2169779484","https://openalex.org/W2255093991","https://openalex.org/W2778700731","https://openalex.org/W2784225765","https://openalex.org/W2897967743","https://openalex.org/W3012690896","https://openalex.org/W4385197054","https://openalex.org/W4404372611","https://openalex.org/W7160240724"],"related_works":["https://openalex.org/W7202365403","https://openalex.org/W2416020094","https://openalex.org/W7225214376","https://openalex.org/W2055338734","https://openalex.org/W2463260358","https://openalex.org/W19359340","https://openalex.org/W2412777693","https://openalex.org/W2433342773","https://openalex.org/W2423599379","https://openalex.org/W2462163107"],"abstract_inverted_index":{"The":[0,74],"recent":[1],"legal":[2],"case":[3],"of":[4,31,83,109,122,151,160,195,227,234],"Townsend":[5],"v":[6],"Epsom":[7,87],"and":[8,114,128,142,199,215],"St":[9],"Helier":[10],"University":[11],"Hospitals":[12],"NHS":[13],"Trust":[14],"(2026)":[15],"(Epsom)":[16],"exposes":[17],"a":[18,26,35,57,138,148,157,180],"key":[19],"ambiguity":[20],"in":[21,86],"medical":[22],"ethical":[23,98],"decision-making.":[24],"In":[25,91],"controversial":[27],"decision,":[28],"the":[29,81,101,120,135,196,237],"Court":[30,76,82,239],"Appeal":[32],"held":[33],"that":[34,60,68,205,230],"National":[36],"Health":[37],"Service":[38],"(NHS)":[39],"body":[40],"cannot":[41],"avoid":[42],"best-interests":[43],"scrutiny":[44],"merely":[45],"by":[46],"labelling":[47],"treatment":[48,67,123,136,182],"as":[49,71],"not":[50,63],"\u2018clinically":[51],"appropriate\u2019.":[52],"This":[53],"judgement":[54],"potentially":[55],"challenges":[56],"long-standing":[58],"view":[59],"doctors":[61],"are":[62],"obliged":[64],"to":[65,96,100,133,164,177,200,204,218],"provide":[66,97],"they":[69],"regard":[70],"clinically":[72],"inappropriate.":[73],"Supreme":[75,238],"will":[77],"soon":[78],"review":[79],"whether":[80,119,134,143,179],"Appeal\u2019s":[84],"approach":[85],"is":[88,183],"legally":[89],"correct.":[90],"this":[92,173],"paper,":[93],"we":[94],"aim":[95],"clarity":[99],"underlying":[102],"contested":[103],"concept.":[104],"We":[105,155,207,223],"distinguish":[106],"three":[107],"categories":[108],"clinical":[110,162],"appropriateness:":[111],"scientific,":[112],"welfare":[113,170,198],"resource.":[115],"Welfare":[116],"appropriateness":[117,130,163],"asks":[118],"benefits":[121],"outweigh":[124],"its":[125],"burdens.":[126],"Scientific":[127],"resource":[129,190],"instead":[131],"relate":[132],"has":[137],"plausible":[139],"physiological":[140],"basis":[141],"providing":[144],"it":[145],"would":[146],"be":[147],"reasonable":[149],"use":[150],"limited":[152],"health":[153],"resources.":[154],"propose":[156],"narrower":[158],"concept":[159,174],"preference-insensitive":[161],"separate":[165],"these":[166],"limits":[167],"from":[168],"patient-relative":[169],"judgements.":[171],"Applying":[172],"requires":[175],"clinicians":[176],"identify":[178],"disputed":[181],"being":[184],"rejected":[185],"based":[186],"on":[187],"evidence,":[188],"fair":[189,213],"allocation,":[191],"or":[192,221],"an":[193],"assessment":[194],"patient\u2019s":[197],"make":[201],"decisions":[202],"appropriate":[203],"reason.":[206],"address":[208],"objections":[209],"concerning":[210],"scientific":[211],"uncertainty,":[212],"rationing":[214],"inequitable":[216],"transfer":[217],"private":[219],"care":[220],"overseas.":[222],"suggest":[224],"several":[225],"implications":[226],"our":[228],"analysis":[229],"may":[231],"apply":[232],"regardless":[233],"which":[235],"decision":[236],"reaches.":[240]},"counts_by_year":[],"updated_date":"2026-11-11T12:16:26.678958","created_date":"2026-11-07T00:00:00"}
