This article discusses the response of our ethics consultation service to an exceptional request by a patient to have his implantable cardioverter defibrillator removed. Despite assurances that the device had saved his life on at least two occasions, and cautions that without it he would almost certainly suffer a potentially lethal cardiac event within 2 years, the patient would not be swayed. Although the patient was judged to be competent, our protracted consultation process lasted more than 8 months as we (...) consulted, argued with, and otherwise cajoled him to change his mind, all to no avail. Justifying our at times aggressive paternalistic intervention helped us to reflect on the nature of autonomy and the dynamics of the legal, moral, and personal relationships in the clinical decision-making process. (shrink)

The underappreciated moral theorist Benjamin Franklin in his youth made up a list of virtues he felt ought to be followed as sound guides for living one's life. Some of the virtues he prescribed relate to personal behaviour: temperance, order, resolution, frugality, moderation, industry, cleanliness and tranquillity. The rest are social character traits: sincerity, justice, silence, chastity and humility. He never abandoned his faith in those values, teaching them to his son and anyone who cared to read his Poor Richard's (...) Almanack. In his autobiography, Franklin tells us that he kept a diary in which he evaluated, on a daily basis, his success in living up to each virtue.1That Franklin enjoyed a life in which the virtues he extolled were not omnipresent is well known. He would be the first to confess that there were more than a few occasions when he failed to live up to his own moral teaching.1 What is interesting about his virtue ethic is not his personal struggle to conform to it but his belief that moral character is made …. (shrink)