Respect for autonomy in medical ethics

Reading Onora O'Neill

Volumn , Issue , 2013, Pages 94-110

  Uniacke, Suzanne ^a,b  

^a UNIVERSITY OF HULL   (United Kingdom)

^b CHARLES STURT UNIVERSITY   (Australia)

Author keywords

[No Author keywords available]

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EID: 84920405652     PISSN: None     EISSN: None     Source Type: Book    
DOI: 10.4324/9780203758793     Document Type: Chapter

References (18)

1. “Withholding and Withdrawing Life-Prolonging Treatments: Good Practice in Decision-making” (2002), Paragraph 32. (Hereafter referred to in the text as the Guidance.)
2. R (on the application of Oliver Leslie Burke) v The General Medical Council Rev 1 [2004] E.W.H.C. Admin 1879 (30 July 2004).
3. Munby J was not concerned with the extent to which, in general, a patient has a right to insist on particular treatment, but rather with a patient's choice of whether or not to receive life-prolonging treatment and with the right to decide “how one chooses to pass the closing days and moments of one's life and how one manages one's own death” (Burke [2004] 63).
4. R (on the Application of Oliver Leslie Burke) v The General Medical Council [2005] E.W.C.A. Civ. 1003 (28 July 2005).
5. Burke [2005] 53.
6. Onora O'Neill, Autonomy and Trust in Bioethics (Cambridge: Cambridge University Press, 2002).
7. We might ask, for instance, what the judges took respecting a person's wishes to imply in Re A (Children) (Conjoined Twins) [2000] 4 All E.R. 961, which ruled on the surgical separation of infant conjoined twins against their parents' explicit wishes. The Court of Appeal emphasised that the parents' wishes deserved great respect. Yet it rejected and overrode the parents' refusal of consent and permitted the hospital to do what the parents did not want.
8. S. Darwall, “Two Kinds of Respect”, Ethics 88 (1977): 36-49. For a discussion of this distinction and other types of respect see http://plato.stanford.edy/entries/respect/.
9. William Frankena, “The Ethics of Respect for Persons”, Philosophical Topics 14 (1986): 149-67.
10. Jeff McMahan, “Killing, Letting Die and Withdrawing Aid”, Ethics 103 (1993): 250-79
11. Suzanne Uniacke, “Absolutely Clean Hands: responsibility for what's allowed in refraining from what's not allowed”, International Journal of Philosophical Studies, 7, 2 (1999): 189-209.
12. O'Neill (2002), chapter 2.
13. On the contrary, for the doctor, compliance respect for a patient's wishes constitutes what Joseph Raz has identified as an exclusionary reason, Joseph Raz, Practical Reason and Norms, 2nd edition (Princeton: Princeton University Press, 1990), pp. 38-43.
14. O'Neill (2002), p. 49.
15. O'Neill (2002), p. 37.
16. O'Neill (2002), p. 37.
17. The relevant part of Munby J's ruling is as follows: “Personal autonomy - the right of self-determination - and dignity are fundamental rights, recognised by the common law and protected by Articles 3 and 8 of the Convention. (8) The personal autonomy which is protected by Article 8 embraces such matters as how one chooses to pass the closing days and moments of one's life and how one manages one's death. (9) The dignity interests protected by the Convention include, under Article 8, the preservation of mental stability and, under Article 3, the right to die with dignity and the right to be protected from treatment, or from a lack of treatment, which will result in one dying in avoidably distressing circumstances. (10) An enhanced degree of protection is called for under Articles 3 and 8 in the case of the vulnerable.” Burke [2004]: 116.
18. My thanks are due to participants in the British Academy conference, “Ethics and Politics Beyond Borders: the work of Onora O'Neill” (24-26 September, 2009), to philosophers at the University of Glasgow, and to Antony Hatzis- tavrou, David Archard and Neil Manson for helpful comments on earlier versions of this paper.