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a herd of cows standing on top of a lush green field

We do a lot of work with The Informed Farmer Consultancy in Dublin and had a conversation yesterday with the founder, Anne, on the theme of the recent fuel protests around he country and how this might all play out in the medium to longer term. One theme that deserves a greater lens is that of suicide amongst the Irish farming community. We believe the issue of suicide within the Irish farming community is a significant public health challenge that warrants more forensic attention.&nbsp;<figure id="figure-n60cna8727mnw3bg39"><img id="n60cna8727mnw3bg39" src="https://images.unsplash.com/photo-1493836512294-502baa1986e2?crop=entropy&amp;cs=tinysrgb&amp;fit=max&amp;fm=jpg&amp;ixid=M3wyNjI5NjF8MHwxfHNlYXJjaHw5fHxtZW50YWwlMjBoZWFsdGh8ZW58MHx8fHwxNzc2MDE4MTAxfDA&amp;ixlib=rb-4.1.0&amp;q=80&amp;w=1080" alt="a man holds his head while sitting on a sofa" title="a man holds his head while sitting on a sofa" class="object-cover bg-gray-100 " style="aspect-ratio: 16/9; object-position: center center;" data-corners="default" data-aspect="16:9" data-caption="" data-positionx="undefined" data-positiony="undefined" data-fullwidth="false" data-mce-src="https://images.unsplash.com/photo-1493836512294-502baa1986e2?crop=entropy&amp;cs=tinysrgb&amp;fit=max&amp;fm=jpg&amp;ixid=M3wyNjI5NjF8MHwxfHNlYXJjaHw5fHxtZW50YWwlMjBoZWFsdGh8ZW58MHx8fHwxNzc2MDE4MTAxfDA&amp;ixlib=rb-4.1.0&amp;q=80&amp;w=1080" data-mce-style="aspect-ratio: 16/9; object-position: center center;"></figure>Evidence from a study conducted by the School of Agriculture and Food Science at University College Dublin indicates that approximately 23.4% of Irish farmers are susceptible to suicidal ideation, based on a survey of 256 individuals [1]. On a broader scale, the Republic of Ireland witnesses an average of 26 farmer suicides annually [2].Analysis of coronial data spanning from 2015 to 2018 reveals that male farmers represented 8% of all male probable suicides in the Republic of Ireland [3]. While the overall suicide rate among farmers (31.5 deaths per 100,000) was not significantly higher than that of non-farmers (23.6 per 100,000), a distinct disparity emerges when scrutinising age-specific data [3].A critical concern pertains to older farmers, as evidenced by the stark contrast in suicide rates. Farmers aged over 65 exhibited a rate of 29.2 deaths per 100,000, which is more than twice the rate observed among non-farmers in the same age bracket (14.3 deaths per 100,000) [4]. This disparity underscores the heightened vulnerability of older male farmers to suicide risks.<figure id="figure-rywyj3vqvemnw3c3tv"><img id="rywyj3vqvemnw3c3tv" src="https://images.unsplash.com/photo-1698261227402-eb6ec1366770?crop=entropy&amp;cs=tinysrgb&amp;fit=max&amp;fm=jpg&amp;ixid=M3wyNjI5NjF8MHwxfHNlYXJjaHw0NHx8b2xkZXIlMjBmYXJtZXJzfGVufDB8fHx8MTc3NjAxODE1N3ww&amp;ixlib=rb-4.1.0&amp;q=80&amp;w=1080" alt="a person holding an apple in their hands" title="a person holding an apple in their hands" class="object-cover bg-gray-100 " style="aspect-ratio: 16/9; object-position: center center;" data-corners="default" data-aspect="16:9" data-caption="" data-positionx="undefined" data-positiony="undefined" data-fullwidth="false" data-mce-src="https://images.unsplash.com/photo-1698261227402-eb6ec1366770?crop=entropy&amp;cs=tinysrgb&amp;fit=max&amp;fm=jpg&amp;ixid=M3wyNjI5NjF8MHwxfHNlYXJjaHw0NHx8b2xkZXIlMjBmYXJtZXJzfGVufDB8fHx8MTc3NjAxODE1N3ww&amp;ixlib=rb-4.1.0&amp;q=80&amp;w=1080" data-mce-style="aspect-ratio: 16/9; object-position: center center;"></figure>The prevalence of mental health issues among farmers must be contextualised within a broader framework. Studies consistently highlight alarming rates of mental health challenges within the farming community, including high levels of depression, anxiety, and stress symptoms [1]. Furthermore, sleep disturbances and burnout are prevalent issues among Irish farmers, with significant implications for their mental and physical well-being [6].Various stressors unique to the farming profession contribute to the mental health vulnerabilities of Irish farmers. Financial strain, concerns regarding government policies related to climate change, and apprehensions about farm sustainability are identified as the primary stress-inducing factors impacting farmers [1]. The evolving landscape of agricultural policies and regulations introduces a sense of unpredictability and ambiguity, jeopardising the financial stability and core identity of farmers [7].<figure id="figure-mbitrwpd3mnw3dlmy"><img id="mbitrwpd3mnw3dlmy" src="https://images.unsplash.com/photo-1527847263472-aa5338d178b8?crop=entropy&cs=tinysrgb&fit=max&fm=jpg&ixid=M3wyNjI5NjF8MHwxfHNlYXJjaHw4fHxmYXJtZXJzfGVufDB8fHx8MTc3NjAxODIxN3ww&ixlib=rb-4.1.0&q=80&w=1080" alt="green farm heavy equipment on green field" title="green farm heavy equipment on green field" class="object-cover bg-gray-100 " style="aspect-ratio: 16/9; object-position: center center;" data-corners="default" data-aspect="16:9" data-caption="" data-positionX="undefined" data-positionY="undefined" data-fullWidth="false"/></figure>Given the distinct challenges faced by farmers in accessing mental health services, tailored support mechanisms are imperative. Farmers are considered a hard-to-reach demographic due to occupational constraints, limited regional mental health resources, and the prevailing culture of stoicism and self-reliance in farming communities [8]. Suicide prevention efforts should be tailored to the unique cultural characteristics of the farming population, emphasising education, training initiatives, and community-centered interventions to address the escalating rates of mental health issues and suicide attempts among farmers [8].&nbsp;This is a national issue. An immediate issue.&nbsp;©The ShadowScript Team, April 2026.&nbsp;References [1] R. Martin, “Almost one in four Irish farmers at risk of suicide,” internet, Oct. 2022, [Online]. Available: https://www.irishexaminer.com/farming/arid-40982102.html [2] Up to 26 farmers die by suicide every year - Premium, “Up to 26 farmers die by suicide every year - Premium,” internet, May 2019, [Online]. Available: https://www.farmersjournal.ie/news/news/up-to-26-farmers-die-by-suicide-every-year-466595 [3] Probable suicide among men in farming and agricultural-related occupations in the Republic of Ireland: exploring coronial data. - Drugs and Alcohol, “Probable suicide among men in farming and agricultural-related occupations in the Republic of Ireland: exploring coronial data. - Drugs and Alcohol,” internet, n.d., [Online]. Available: https://www.drugsandalcohol.ie/43136/ [4] Study Highlights Suicide Risk Among Older Male Farmers, “Study Highlights Suicide Risk Among Older Male Farmers,” internet, Sep. 2024, [Online]. Available: https://medpartnership.com/study-highlights-suicide-risk-among-older-male-farmers/ [4] Study Highlights Suicide Risk Among Older Male Farmers, “Study Highlights Suicide Risk Among Older Male Farmers,” internet, Sep. 2024, [Online]. Available: https://medpartnership.com/study-highlights-suicide-risk-among-older-male-farmers/ [6] Overholser, 1. S. Of, O. S. Work, A. Social, T. C. Policy, and Ireland, “How common are sleep issues and burnout in Irish farmers?,” European Journal of Public Health, Oct. 2023, doi: 10.1093/eurpub/ckad160.1572. [7] J. Firnhaber, S. M. Malone, A. D. O’Hagan, S. O’Keeffe, J. McNamara, and S. O’Connor, “‘People that are Supporting [the] Whole Sector are on their Knees’; Uncertainty and Socioeconomic Change are Occupational Stressors for Irish Farmers☆,” Rural sociologist, Jul. 2024, doi: 10.1111/ruso.12554. [8] P. Lundqvist, “The impact of social, economic and environmental determinants on farmers’ mental health – an international perspective,” Ubezpieczenia w Rolnictwie - Materiały i Studia, 2024, doi: 10.48058/urms/82.2024.6.

Fuel Protests and Suicide in the Farming Community in Ireland

a person writing on a notebook with a pen

Introduction: The Poet as Observer Welcome to the internal landscape of Chad Norman as we see it. We're not claiming Chad Norman will agree fully with our analysis, but here it is for what it's worth and we hope some of it resonates with the poet himself! For the uninitiated, entering this collection is like stepping into a sanctuary where the silence is heavy with meaning. This glossary serves as your "decoder ring" for the recurring motifs that populate Norman’s verse. In this world, symbols are far from mere decoration; they are the "intelligence and secrets" shared by non-human teachers. The poet stations himself at the precarious threshold of the pane, using these recurring images as a bridge between our fractured human existence and the stoic, supportive "intelligence" of the wild. To master this lexicon is to understand how the poet navigates "a life between the brackets," moving from the domestic to the divine. This journey begins at the very edge of the hearth, where the physical boundaries of the home meet the ancient, creaking guidance of the world outside.Elemental Boundaries: The Window vs. The Forest Norman frequently positions himself at the boundary of the glass, a vantage point that demands a choice between the safety of observation and the vulnerability of immersion. Stepping away from the safe reflection of the window and into the depth of the hardwoods requires the poet to abandon the role of the passive witness for a state of active, seasonal trust. The Aviary of Trust: Bird Species as Teachers In Norman’s symbology, the aviary is a classroom. Birds are not merely subjects of nature; they are instructors of a "feathered tutelage" that models a life unburdened by the "lies of money" or human anxiety. The Starling: The embodiment of "exclusive talent." Norman elevates the starling as a master of survival that "no human will ever master," noting the specific physical mastery of a fledgling that can "land and rest on a tiny stuffed belly" before returning to the wire. The Crow: The "trusted follower" and "brother" in observation. Crows represent a sacred bond formed outside the reach of human greed. They are the "followers" who wait for "peanuts and cat-food," offering a connection that cannot be bought or captured. The Dove: A symbol of "sanity" and quiet trust. Doves remain unworried by the "illegal" nature of feeding wildlife or the boundaries of human law. They represent a state of grace where hunger is helped to an ending without the noise of human conflict. The Hawk: The "perfection of death." Illustrating the visceral "intelligence of hunger," the hawk reminds us that nature's beauty is surgical. Its presence is marked by "bloodied tiny white feathers impaled on the selected end of a harmless twig," a strike that is as precise as it is necessary. The Cardinal: The "Morning Activist." Linked to the suffering in Ukraine, the cardinal is a symbol of resilience. In No Other Description Than Disbelief, the "blue beak sorting seeds" at a yellow feeder creates a living flag of hope, representing mothers who endure the weight of "winter’s invasion." These feathered teachers offer a specific type of "intelligence", one rooted in immediate survival and seasonal mystery, that stands in stark contrast to the misanthropic fear of the human world. The Political and the Sacred: Historical Symbolism Norman weaves the rot of contemporary history and the weight of ancient motifs into his observations, grounding the ethereal in the grit of human tragedy. The White Poppy: Featured in "Woman Sitting in a Chair Wearing a White Poppy," this is the symbol of Peace at the "border of unknowing." It represents the quiet, seated endurance of women in Syria and Ukraine who must hold the future together while male "leaders" fail as both men and protectors. The Crown of Thorns: In the critique of Bosch’s Another White Christ, the thorns are a symbol of human-imposed suffering. Norman uses this image to expose the "shysters" and "pointy-nosed Pharisees" who attempt to encase the Messiah in devious human motivations, contrasting their greed with the "future promised by the Father." By invoking these heavy human histories, the poet highlights the urgent necessity of returning to the "natural" truth found only in the unpolluted wild. Conceptual Pillars: Trust and Intelligence To truly "grok" Norman’s landscape, one must understand how he redefines these two pillars of the human experience. Key Concepts Intelligence: In the human realm, intelligence is often "the cause of fear" and "misanthropic ways," leading to the destruction of habitats. In the natural world, it is the "intelligence and secrets" shared by non-human teachers that provide the only viable instructions for "how to live this life." Trust: An "annual gift" or "seasonal mystery" that cannot be compelled. It is earned by the "Clapping Man" through the rejection of "human limitations" and the practice of quiet presence. It is the "safety and mystery" offered by the "shelter tree." These concepts serve as the vital tools that allow the poet to exist "between the brackets," navigating a world that is simultaneously broken by man and mended by the forest. The Industrial Shadow: Symbols of Human Failure Contrasting the purity of the aviary are the "pollutants of the spirit" found on "Industrial Ave," representing the ways humanity poisons the very habitat it depends upon. Pollutants of the Spirit Checklist: The Leash &amp; The Cell-phone: Symbols of modern "slavery." They represent a betrayal of companionship, where men "cling" to devices and ignore their "best friends," failing to participate in the "escape" of the walk. The Nut and the Bolt: A "thwarted relationship." The "shiny unused nut" found in a warehouse represents the loss of industry and the "essential dreams" of workers. It is a symbol of a rare connection that will "never know a bolt" and the threads it was meant to wind through. Discarded Masks and Gloves: Symbols of the "tyrant" pandemic. These represent human cruelty through negligence; the "rubber fingers" left on the grass eventually trap other living beings, polluting the planet’s health while humans seek only their own safety. These symbols of industrial rot serve as a stark warning against prioritising "the lies of money" over the sanctity of the soil. Learning to Settle Down Ultimately, the symbology within this collection is a map for "how to live this life." By defining the threshold of the window and listening to the "feathered tutelage" of the birds, the reader learns to navigate a world fractured by the greed of corporations and the failures of history. The poet returns to these images; the "Window," the "Parental Forest," and the "unworried birds" because they are the only entities he finds to be "unquestionably supportive." Unlike the conditional loyalty of human systems or the "grab for money" that ends brotherhoods, nature offers an "annual trust" that persists regardless of our presence. May your journey through these poems be a "seasonal migrant's" flight, free to fly over unnoticed borders and into the "miracle of return." ©The ShadowScript Team, April 2026. *Chad's book is available on Amazon<figure id="figure-7itsoutietmnt7hxxb"><img id="7itsoutietmnt7hxxb" src="https://cdn.durable.co/blocks/22Cxcht4fTNrdqxu1QMeYtGKiNG84cMRv0JorKAfFfNCDVnAEfeBM3y2OmsdT9uX.png" alt="" title="" class="object-cover bg-gray-100 " style="aspect-ratio: 1/1; object-position: center center;" data-corners="default" data-aspect="1:1" data-caption="" data-positionX="undefined" data-positionY="undefined" data-fullWidth="false"/></figure>

The Language of the Brackets: A Literary Glossary of Chad Norman’s Symbology.

There’s a quiet, almost surreal moment happening online right now. You know, one of those shifts that doesn’t announce itself with fireworks but is creeping in, line by line, paragraph by paragraph. And it's worrying.&nbsp;In 2025, something subtle but very significant tipped: AI-generated text reportedly surpassed human-written content for the first time. Not in quality debates or isolated experiments, but in sheer volume and presence. The internet which was, perhaps, once a chaotic, gloriously inconsistent patchwork of human voices, has begun to sound eerily uniform. Robotic. And right in the middle of this shift sits Wikipedia, holding the line like a stubborn lighthouse refusing automation. And we should take notice.&nbsp;I've always loved lighthouses sitting there, doing their thing in the ocean in all weather. Beacons of hope amidst stormy seas and winds and treacherous passages.&nbsp;For decades, Wikipedia has been the internet’s collective brain: definitely messy, frequently argued over, obsessively cited (especially by undergrads), and very human. Thankfully.&nbsp;It has always been less about perfection and more about process; talk pages, edit wars, citations needed. It’s not just information; it’s negotiation. A living record of disagreement slowly resolving into consensus. Now, that model looks almost defiant. Because elsewhere, the tide is rushing the other way.Elon Musk, never one to drift with consensus, is pushing what some are calling “Grokipedia”. An AI-generated counterpart to Wikipedia. The idea is straightforward: instead of humans debating and editing knowledge into shape, let AI synthesise it instantly. No friction, no waiting, no messy human back-and-forth. Just answers. Ok. So, it’s fast. It’s scalable. And, with all things Elon, it's fundamentally different. Wikipedia sort of says, “prove it,” whereas Grokipedia asks us to, “trust the model.” Ooh, the tension.Wikipedia is betting against the current moment. It insists that knowledge should be traceable, argued over, sourced, and crucially written by people who are accountable to one another. It’s slower, more fragile, and increasingly outnumbered. But it carries something the new wave often lacks: provenance. You can follow the thread of how a sentence came to be.AI-generated knowledge, on the other hand, is frictionless. It arrives fully formed, confident, and often uncited in any meaningful way. It doesn’t show it's working. It doesn’t argue with itself in public. It just…presents. And, unfortunately, for most users, that’s enough.Convenience has always been the internet’s strongest gravity. People rarely ask where information comes from if it’s quick, clear, and sounds right and AI leans perfectly into that instinct. It doesn’t just answer questions it removes the need to question the answer. So Wikipedia finds itself in a strange position: wildly popular, trusted by many, and increasingly out of step with how information is being produced. It’s a bit like watching a craftsman in an age of factories.You can feel the tension building. On one side, a human-curated system that values transparency and deliberation. On the other, an AI-driven ecosystem that optimises for speed and scale. Both are powerful. Both are persuasive. But they are not the same thing. The real question isn’t which one is “better.” It’s which one people will choose when they don’t have time to care.Because that’s where this battle will be decided, not in philosophical debates about truth, but in everyday habit formation. In the split-second choice between reading a sourced article or accepting a generated summary. In whether we value the path to knowledge, or just the destination. Wikipedia is, in many ways, swimming upstream. And history isn’t always kind to those who do. But sometimes, the things that endure are the ones that refuse to adapt too quickly. Think lighthouses.&nbsp;For now, the lighthouse is still lit. The edits are still happening. The citations are still being argued over by people who care enough to disagree. But how long will that hold?©Niall MacGiolla Bhuí, PhD March 2026.&nbsp;

From Wikipedia to Grokipedia

If I received a euro for every time I’m asked this question…“Tell me about publishing Advances. I hear I can get a six figure deal and get my book sold to film…”Somewhere between the first conversation and the first contract, when a would-be author leans in and asks the question they’ve been circling all along, “What kind of advance might we be talking about?” my heart flutters. Now, it’s a fair question but I feel it’s also the wrong one to start with.Not because money doesn’t matter. It does to us all. It always has. But in publishing, real publishing, the kind that survives beyond a single season, the advance is less a prize and more a signal. A bet placed early, before the race is even properly understood or run. And like most bets, it tells you more about the bettor than the outcome. There’s a reason why some live in bigger houses than others…Let me begin with the numbers, because they’re useful if only for clearing the fog. A quick internet search reveals the typical advance for an author in Ireland from an independent (indie) or small press is generally modest, with many sources indicating an average in the region of €1,000 to €2,000 per book. While some independent publishers may offer up to €1,500–€1,750 for specialised genres such as children’s books, others may offer lower amounts or even “royalties-only” deals with no upfront payment. Irish publishers often pay advances in installments, such as on signing, on delivery, and on publication. Quite a few small presses offer no advance at all, instead opting for higher royalty percentages.That hasn’t shifted much in the U.S., the U.K., or Ireland in the past decade, despite inflation snapping at everyone’s heels. Mid-list debuts, those books publishers believe in but don’t quite anoint, might land between €15,000 and €50,000. And then there are the lead titles, the ones with marketing budgets that could fund a minor election campaign: €100,000, sometimes stretching north of €1 million if the winds are right and the auction turns theatrical.But…And it’s a very big but…most books don’t earn out their advances. Not in the U.S. (where BookScan still shows a long tail of modest sales), not in the U.K. (where Nielsen figures tell a similar story), and certainly not here in Ireland, where the market is smaller, more intimate, and far less forgiving of overreach. Which means the advance isn’t a reward. It’s a risk allocation. The publisher assumes it. The author lives with it. And this can be a delicate living arrangement.Royalty structures, meanwhile, remain stubbornly traditional and this is where I see so much wiggle from all players in publishing. Hardcovers tend to hover between 10% and 15%. Trade paperbacks fall somewhere in the 6% to 8% range. Ebooks, still the supposed disruptor, have largely settled at 25% of net receipts, a figure that has resisted meaningful change despite years of author advocacy.In Ireland, the Irish Writers Union, suggests a standard ebook royalty should be a flat 25%, though they recommend a sliding scale starting at 25% for the first 4,000 copies and rising to 50% for over 16,000 copies. Now, that’s optimistic re sales…You could argue that nothing has changed but you would be wrong. Because the real shift isn’t in the percentages. It’s in how those percentages are being reached and what sits behind them.In the U.S., we’re seeing a quiet recalibration. Advances for debut literary fiction have tightened, even as celebrity memoirs and “platform-driven” nonfiction continue to command outsized sums. Publishers are no longer just buying manuscripts; they’re buying audiences. A writer with a modest but engaged following can sometimes secure a better deal than a technically superior manuscript without one. It’s not romantic. It is, however, entirely predictable.In the U.K., the consolidation of major houses has had a dual effect: fewer bidders at the top end, but more aggressive positioning for titles that fit clearly into marketable lanes; crime, book club fiction, narrative nonfiction with a hook. Advances haven’t collapsed, but they’ve become sharper and more strategic. Less scattershot enthusiasm, more targeted conviction.I feel Ireland sits in a different rhythm altogether. Advances are generally smaller, but the relationship between publisher and author is often closer, more editorially and design invested. Here, the bet isn’t always about scale; it’s about longevity. A book that sells steadily over years can matter more than one that spikes and quickly disappears. And in a way, that’s where the industry is quietly heading everywhere. Because the real advance now isn’t always financial. It’s infrastructural.It’s whether your publisher knows how to position your book in a market that no longer behaves like a market at all, but more like a series of overlapping conversations. Think of TikTok, in book clubs, across podcasts, through independent bookshops that still, stubbornly, decide what matters. Not us. It’s whether they understand metadata as well as they understand prose. Whether they can keep a book alive six months after publication, not just six weeks. Whether they see the author as a single title or as a body of work. That’s the new currency and it doesn’t fit neatly into a contract clause.Now, my experience is that writers often arrive at the table thinking the advance is the story but it isn’t. The story is what happens after the first cheque clears. How the book is carried, argued for, reintroduced, sustained. Whether it’s allowed to find its readers slowly, or forced into a narrow window and forgotten when it doesn’t immediately perform. A large advance can be a vote of confidence but it can also be a weight. A small advance can feel underwhelming but it can also be a kind of freedom. And, people, neither guarantees anything.So yes, ask about the advance. You’d be foolish not to. But listen just as carefully to everything around it: the cadence of the conversation, the clarity of the plan, the quiet signals of whether this is a house that builds writers or simply acquires them because ultimately, the advance is only the opening line. And publishing, if it’s done properly, is still a long game.*©Niall MacGiolla Bhuí, PhD. March 2026.

Royalties Advances in the Publishing World

The Shifting Legal Landscape of Patient Consent and Institutional LiabilityThis article addresses the critical nature of understanding the modern legal framework for informed consent as presented by Irish solicitor and author, Brian Lynch, in his book, ‘Oxygenation is the Solution. Deaths From Covid-19 And Global Legal Insights for Medical Practice: An Insider’s Perspective’.<figure id="figure-1hfk9zgko8mmahczqc"><img id="1hfk9zgko8mmahczqc" src="https://cdn.durable.co/blocks/0kP7dg9rUaVyOLVCh7phGqlnNgavDoOf1OjYMl17fNvFDQ1L8emSyzML79CtjxPV.jpg" alt="" title="" class="object-cover bg-gray-100 " style="aspect-ratio: 16/9; object-position: center center;" data-corners="default" data-aspect="16:9" data-caption="" data-positionx="undefined" data-positiony="undefined" data-fullwidth="false" data-mce-src="https://cdn.durable.co/blocks/0kP7dg9rUaVyOLVCh7phGqlnNgavDoOf1OjYMl17fNvFDQ1L8emSyzML79CtjxPV.jpg" data-mce-style="aspect-ratio: 16/9; object-position: center center;"></figure>Let me commence by stating that I’m not a medical doctor, rather I’m an editor and researcher so feel free to take any of my observations on Lynch’s book with a grain of salt! And, of course, visit a physician for medical or health advice. I’m not qualified in this field.Having stated the above disclaimer, in his book, Lynch’s key point is that recent jurisprudential shifts across the United States, United Kingdom, and Ireland have decisively moved medical decision-making from a physician-centric model to a patient-centric one, creating new and significant liability risks for healthcare institutions. I agree with him on this point. The long-standing principle of “doctor knows best” has (finally) been legally overturned in favour of the patient’s “right to know,” fundamentally altering the legal duties of clinicians and the institutions that employ them.<figure id="figure-3rtndp8qc3mmahekry"><img id="3rtndp8qc3mmahekry" src="https://cdn.durable.co/blocks/22JTzSHH3ZyU128GDvWt7f9KIdY7lcHi5GnTTLqyQIN4PgxZanxzQdJNALYuZA30.png" alt="" title="" class="object-cover bg-gray-100 " style="aspect-ratio: 16/9; object-position: center center;" data-corners="default" data-aspect="16:9" data-caption="" data-positionx="undefined" data-positiony="undefined" data-fullwidth="false" data-mce-src="https://cdn.durable.co/blocks/22JTzSHH3ZyU128GDvWt7f9KIdY7lcHi5GnTTLqyQIN4PgxZanxzQdJNALYuZA30.png" data-mce-style="aspect-ratio: 16/9; object-position: center center;"></figure>This article will analyse the core legal principles, ethical mandates, and case law precedents that, according to Lynch, define our new medico-legal landscape. Its purpose is to provide actionable guidance for mitigating these risks through the development of robust institutional policies on patient communication and disclosure.Lynch argues that failure to adapt to our new legal reality exposes institutions and their clinical staff to litigation based not on clinical error, but on failures in disclosure and communication and, further, an intervention performed with flawless technical skill can still be deemed an unlawful assault if the preceding consent was invalidated by a failure to inform the patient of all reasonable alternative treatments and material risks. This is both an interesting and provocative perspective for him to take.The Legal Evolution of Informed Consent: From Professional Standard to Patient AutonomyThere’s no doubt that foundational legal principle of informed consent has undergone a radical transformation and understanding this evolution from a standard dictated by medical professionals to one centered on the rights and values of the individual patient is essential for legal counsel, administrators, and clinical leaders to grasp the full scope of their institution’s modern obligations. The following analysis traces the key legal precedents that have reshaped this landscape.<figure id="figure-0acklz8mummahg27i"><img id="0acklz8mummahg27i" src="https://cdn.durable.co/blocks/24ZVukObq597HDYJKearunxjDsx7Wf0vTl8BUcnI5NzBV4WVidjReerJc1ADSKQ4.jpg" alt="" title="" class="object-cover bg-gray-100 " style="aspect-ratio: 16/9; object-position: center center;" data-corners="default" data-aspect="16:9" data-caption="" data-positionx="undefined" data-positiony="undefined" data-fullwidth="false" data-mce-src="https://cdn.durable.co/blocks/24ZVukObq597HDYJKearunxjDsx7Wf0vTl8BUcnI5NzBV4WVidjReerJc1ADSKQ4.jpg" data-mce-style="aspect-ratio: 16/9; object-position: center center;"></figure>The Foundational Shift: The “Reasonable Patient” StandardThe seminal US case Canterbury v. Spence (1972) fundamentally reshaped medical malpractice law by establishing the patient’s “right to know.” The court determined that a physician’s duty extends beyond skillful diagnosis and therapy to include the obligation to communicate all material risks and reasonable alternatives associated with a proposed treatment.This ruling established a crucial shift from a professional standard, where disclosure was judged by what a body of medical experts deemed appropriate, to the “reasonable person test.” Under this new standard, the adequacy of disclosure is measured by what a layperson in the patient’s position would want to know to make an informed decision. This patient-centric model places the court, representing the reasonable patient, as the final arbiter of whether a clinician’s disclosure was legally sufficient.International Jurisprudence: Affirming the Patient-Centered ModelThe principles established in the United States have been unequivocally affirmed and adopted in other common law jurisdictions, creating a consistent international legal standard.United Kingdom: The UK Supreme Court’s 2015 decision in Montgomery v. Lanarkshire Health Board explicitly overturned the long-standing “doctor knows best” principle that had been established by the Bolam case. The court found that a clinician cannot make an objective, purely “medical” view of a patient’s choices and is therefore not in a position to decide what is best for the patient as a matter of clinical judgment alone. The court stated: Ireland: The Irish High Court’s ruling in Geoghegan v. Harris (2000), later affirmed by the Supreme Court in Fitzpatrick v. White (2007), established the “reasonable person test” in Ireland. These cases affirmed the right of the court, rather than medical experts, to determine the adequacy of disclosure regarding treatment options and their associated risks. This solidified the patient’s role as the ultimate decision-maker in their own care. The establishment of these legal principles has created clear duties, but we can all see that their application in daily clinical practice presents specific and recurring challenges for healthcare institutions. And they tend to react quite differently.<figure id="figure-fipqma466cvmmahgp95"><img id="fipqma466cvmmahgp95" src="https://cdn.durable.co/blocks/7SP94zE8JIEZe4AKAGmlAujhxKirKm3yODtDXqgbYutgEZwpG6ApDKCKoN2Ajqfi.png" alt="" title="" class="object-cover bg-gray-100 " style="aspect-ratio: 16/9; object-position: center center;" data-corners="default" data-aspect="16:9" data-caption="" data-positionx="undefined" data-positiony="undefined" data-fullwidth="false" data-mce-src="https://cdn.durable.co/blocks/7SP94zE8JIEZe4AKAGmlAujhxKirKm3yODtDXqgbYutgEZwpG6ApDKCKoN2Ajqfi.png" data-mce-style="aspect-ratio: 16/9; object-position: center center;"></figure>The Duty of Disclosure: Defining and Communicating “Reasonable Alternative or Variant Treatments”Lynch argues that the duty to disclose “reasonable alternative or variant treatments” is the most critical and challenging component of modern consent law for healthcare institutions. The interpretation of “reasonable” is not limited to what is considered standard practice but extends to what a patient would find significant.The Legal Obligation Beyond “Standard of Care”Lynch states that a common and legally perilous mistake is for clinicians to limit their disclosure to treatments considered “standard of care” or those on approved indication lists (e.g., from the US Food and Drug Administration). The legal duty is broader and includes any scientifically plausible treatment that a reasonable person in the patient’s position would consider significant.And here’s the core of Lynch’s book. He states Hyperbaric Oxygen Therapy (HBOT) serves as a key case study. Though it is a scientifically established treatment for hypoxic tissue injury, it is often not disclosed for conditions not on narrow, pre-approved lists, leading to potentially invalid informed consent. The legal principle established in the US case The T.J. Hooper is instructive: “a whole calling may have unduly lagged in the adoption of new and available devices.” His key point? An entire field’s failure to adopt a beneficial technology or treatment does not constitute a legal defense if that technology was available and could have produced a better outcome for the patient. Powerful stuff indeed.&nbsp;Systemic Barriers to Compliant DisclosureSeveral systemic factors create an environment where legally required disclosures are often omitted, exposing institutions to liability.Over-reliance on Flawed Guidelines: Clinical practice guidelines, such as those from Cochrane Reviews or the European Consensus on Crohn’s Disease, can be legally problematic. If these guidelines use overly narrow inclusion criteria (e.g., demanding only Randomised Controlled Trials) that exclude ethically and scientifically valid treatment options, they can mislead clinicians into believing their disclosure duty is narrower than the law requires. This is a particularly contentious point.&nbsp; Regulatory Misinformation: Communications from regulatory bodies can inadvertently create legal risk. A prime example is the US Food and Drug Administration’s “Don’t be Misled” article. The investigative reporting of journalist Duane Pohlman, which highlighted successful uses of HBOT for COVID-19, appeared to influence the FDA to remove the article from its website. Such communications can be legally construed as negligent misrepresentation if they unlawfully dissuade patients and providers from considering viable, scientifically supported treatments, even if those treatments are not yet on an approved list. Professional and Institutional Inertia: The case of Dr. Michael Neary in Ireland, where a surgeon performed numerous unnecessary hysterectomies over many years, illustrates a catastrophic failure of oversight. The inquiry found that collegiality and a systemic failure to question a consultant’s practices enabled non-compliant and harmful practices to persist, creating massive institutional liability. This serves as a stark warning against passive acceptance of established but questionable practices. Lynch goes on to state that these barriers must be addressed through the lens of the overarching ethical frameworks that should guide all medical practice.<figure id="figure-lls3apb4cammahhi0b"><img id="lls3apb4cammahhi0b" src="https://cdn.durable.co/blocks/3430YaIbhYkIb07mym50yWHXuSsJC1EgF0h0JKHvZtc9Y675Qn0MHnNOchJL4FOX.jpg" alt="" title="" class="object-cover bg-gray-100 " style="aspect-ratio: 16/9; object-position: center center;" data-corners="default" data-aspect="16:9" data-caption="" data-positionx="undefined" data-positiony="undefined" data-fullwidth="false" data-mce-src="https://cdn.durable.co/blocks/3430YaIbhYkIb07mym50yWHXuSsJC1EgF0h0JKHvZtc9Y675Qn0MHnNOchJL4FOX.jpg" data-mce-style="aspect-ratio: 16/9; object-position: center center;"></figure>Ethical Mandates and the Legal Limits of “Evidence-Based” JustificationsA common defense for the non-disclosure of alternative treatments is the perceived lack of “high-quality evidence,” typically defined as large-scale Randomised Controlled Trials (RCTs). However, Lynch suggests this defense is legally and ethically flawed. On this point he has both supporters and detractors as one might expect but he develops his argument.The Nuremberg Code: The Prohibition on Unnecessary Human ExperimentationThe demand for RCTs for treatments with established scientific benefits can violate fundamental medical ethics. The Nuremberg Code, the globally accepted standard for human experimentation, states that an experiment should be:“...unprocurable by other methods or means of study, and not random and unnecessary in nature.”As argued by Professor Ruiyong Chen regarding the use of HBOT for COVID-19, it is an ethical violation to place a patient with obvious hypoxia into a control group where they would be deprived of a known beneficial treatment. Insisting on an RCT in such circumstances is not a defense; it is evidence of a failure to adhere to foundational ethical principles.The “Best Available Evidence at the Time” StandardIn a crisis or when dealing with an individual patient’s unique condition, the legal and ethical standard is not to wait for future trials, but to act on the best evidence available at the time. Ireland’s Ethical Framework for Decision-making in a Pandemic codifies this principle, stating that decisions must be based on the “best clinical evidence available at the time.”Under this standard, actionable evidence is not limited to RCTs. It includes:Anecdotal reports and early case series (e.g., n=1 or n=5). Established scientific principles, such as the universal gas laws that prove the efficacy of hyperbaric oxygenation. Clinical experience from other jurisdictions. To withhold disclosure of a treatment supported by this level of evidence while waiting for an RCT is, according to Lynch, to fail the legal duty of care, exposing the institution to significant liability. Failing to adhere to these legal precedents and ethical mandates carries tangible and severe legal consequences. Thoughts on this?Assessing the Consequences of Non-Compliance: A Risk AnalysisThe following material provides a direct risk analysis for administrators and legal counsel, moving from legal theory to the concrete liabilities that arise from failures in the informed consent process. These failures create specific legal claims that can place both individual clinicians and the institution in profound professional and financial jeopardy.Invalid Consent as Unlawful Assault and BatteryLynch observes that medical intervention performed without valid informed consent is not merely an act of negligence. Because the consent is legally void due to a failure of disclosure, the physical act of the intervention can be legally defined as an unlawful assault and battery on the patient. This shifts the legal claim from a question of professional standard of care to a more fundamental violation of the patient’s bodily autonomy, carrying severe legal and reputational consequences.<figure id="figure-f3vevxy9vmmahiepl"><img id="f3vevxy9vmmahiepl" src="https://cdn.durable.co/blocks/22LloSPPv9YKRvPTuBn0UdDWNNSZ4zLHtozEzRUG4EqH3nO35KtGr3KtfBKp10Le.png" alt="" title="" class="object-cover bg-gray-100 " style="aspect-ratio: 16/9; object-position: center center;" data-corners="default" data-aspect="16:9" data-caption="" data-positionx="undefined" data-positiony="undefined" data-fullwidth="false" data-mce-src="https://cdn.durable.co/blocks/22LloSPPv9YKRvPTuBn0UdDWNNSZ4zLHtozEzRUG4EqH3nO35KtGr3KtfBKp10Le.png" data-mce-style="aspect-ratio: 16/9; object-position: center center;"></figure>Liability Arising from the Duty of CandourThe legal “duty of candour” is the professional and institutional obligation to openly and honestly disclose when an adverse event has occurred. The principles affirmed in the Irish Supreme Court case Morrissey v. Ireland create a major area of liability when applied to situations like the one described in a report from Irish anaesthesiologists on iatrogenic cerebral artery gas embolism (CAGE). Their report notes that harm from this avoidable event can be mitigated with HBOT. A failure to disclose the availability of a mitigating treatment like HBOT, either before an elective procedure or after the adverse event, constitutes a breach of the duty of candour, creating enduring legal exposure for the institution.Case Precedent in Direct Liability: Sponenburgh v. County of WayneThe Sponenburgh case serves as a critical cautionary tale for institutional legal strategy. In this case, a hospital was found liable for $3.08 million for failing to use its available HBOT facility for a patient with carbon monoxide poisoning, resulting in permanent brain injury. The hospital’s defenses were systematically dismantled:The claim that HBOT was a “fad” was contradicted by medical literature. The claim that the chamber was for “research only” was impeached by hospital records showing it had been used to treat another patient. The claim that it was “not standard of care” was deemed irrelevant to the duty to use an available and beneficial treatment. Crucially, the victim’s lawyers used a local newspaper article, including a photograph of the new chamber with a caption stating it could treat “victims of poison,” as impeachment evidence. This demonstrates that courts will hold institutions directly liable for failing to utilise available, scientifically sound treatments, regardless of whether they are part of a rigid “standard of care” protocol.Analysing these risks makes it clear that proactive policy change is not optional, but essential for institutional survival in the modern medico-legal environment.<figure id="figure-g878rxp0ermmahj83i"><img id="g878rxp0ermmahj83i" src="https://cdn.durable.co/blocks/10pLRZesjxHKUhCrUH4OeSUZyvGjnBDtSdNA7okeRTwouwEpi5MqQWBQNEqaFPGm.png" alt="" title="" class="object-cover bg-gray-100 " style="aspect-ratio: 16/9; object-position: center center;" data-corners="default" data-aspect="16:9" data-caption="" data-positionX="undefined" data-positionY="undefined" data-fullWidth="false"/></figure>Conclusion: Proactive Disclosure as a Legal ImperativeIt seems reasonable to argue that in the current medico-legal environment, a policy of proactive, transparent, and comprehensive disclosure is not merely an ethical ideal but a fundamental legal requirement. Further, the shift from a paternalistic, physician-led model to one centered on patient autonomy is complete and irreversible. Lynch’s argument that Institutions that fail to adapt their policies and culture to this reality are exposed to significant legal, financial, and reputational risk seems logical. Embracing the patient’s “right to know” and ensuring that all reasonable treatment options are discussed is the single most effective strategy for mitigating liability, building patient trust, and upholding the highest standards of both legal compliance and ethical care. And, this is certainly accurate. Let us all have a hand in deciding our own fates.*©Niall MacGiolla Bhuí, PhD. February 2026.

An Analysis of Medico-Legal Precedents and Ethical Frameworks for Medical Decision-Making

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Millennials and Mental Health In 'Millennials, Mental Health And The Age Of Anxiety', Dr. Niall MacGiolla Bhuí's latest publication, he delivers a timely, thought-provoking exploration of the psychological realities shaping today’s most scrutinised generation. Blending scholarly research, cultural commentary, and personal narrative, this ebook positions itself in global conversations on digital wellbeing, identity, and resilience in an era of hyperconnectivity.<figure id="figure-bii0bzfd6mm93wgq2"><img id="bii0bzfd6mm93wgq2" src="https://cdn.durable.co/blocks/2dJEiM78KdyAVDf6CmxYqGYXyDCHb70Luh8DspKgz39DGFW851B3lKh5UfSXr6oQ.png" alt="" title="" class="object-cover bg-gray-100 " style="aspect-ratio: 1/1; object-position: 50% 25%;" data-corners="default" data-aspect="1:1" data-caption="Millennials, Mental Health And The Age Of Anxiety" data-positionX="50%" data-positionY="25%" data-fullWidth="false"/><figcaption class="body-normal text-gray-500 mt-2">Millennials, Mental Health And The Age Of Anxiety</figcaption></figure> It provides an analysis of millennial mental health together with digital culture and social media effects and psychosocial impacts of hyperconnectivity by examining how economic instability and technological overexposure and curated online identities affect self-esteem and wellbeing and social relationships among millennials who were born between 1981 and 1996 Set against global backdrops such as post-9/11 insecurity, the 2008 financial crash, the COVID-19 pandemic, and the rise of AI, this ebook explores how these seismic events have informed a generation’s sense of purpose, belonging, and identity. The book examines: • The psychological cost of life spent “face-to-screen” and not “face-to-face” • Higher rates of anxiety, depression, and internet addiction (Andreassen et al., 2017) • Concepts like filtered incrementalism, self-esteem, and narcissism in the digital age • The potential of sport, flow, and offline experiences to restore joy, community, and meaning • Global trends in urbanisation, hybrid work, and technology use (UN-Habitat, 2023) Far from ascribing blame to millennials, Dr. MacGiolla Bhuí argues that their struggles are a rational response to unprecedented systemic disruption. This is not just a psychological commentary, it’s a cultural mirror held up to 21st-century living. *Available on Amazon at https://www.amazon.co.uk/dp/B0GQQ2QNHZ

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