In 1993, Professor of Jurisprudence, Ronald Dworkin of Oxford University and Professor of Law at New York University, delivered the Georgetown Law Center’s thirteenth Annual Philip A. Hart Memorial Lecture: "Life’s Dominion: An Argument About Abortion and Euthanasia." Dworkin is Professor of Philosophy and Frank Henry Sommer Professor of Law at New York University. He received B.A. degrees from both Harvard College and Oxford University, and an LL.B. from Harvard Law School and clerked for Judge Learned Hand. He was associated (...) with a law firm in New York (Sullivan and Cromwell) and was a professor of law at Yale University Law School from 1962-1969. He has been Professor of Jurisprudence at Oxford and Fellow of University College since 1969. He has a joint appointment at Oxford and at NYU where he is a professor both in the Law School and the Philosophy Department. He is a Fellow of the British Academy and a member of the American Academy of Arts and Sciences. Professor Dworkin is the author of many articles in philosophical and legal journals as well as articles on legal and political topics in the New York Review of Books. He has written Taking Rights Seriously (1977), A Matter of Principle (1985), Law’s Empire (1986), Philosophical Issues in Senile Dementia (1987), A Bill of Rights for Britain (1990), Life’s Dominion (1993), and Freedom’s Law (1996). (shrink)

Autonomy is a concept that holds much appeal to social and legal philosophers. Within a medical context, it is often argued that it should be afforded supremacy over other concepts and interests. When respect for autonomy merely requires non-intervention, an adult’s right to refuse treatment is held at law to be absolute. This apparently simple statement of principle does not hold true in practice. This is in part because an individual must be found to be competent to make a valid (...) refusal of consent to medical treatment, and capacity to decide is not an absolute concept. But further to this, I argue that there are three relevant understandings of autonomy within our society, and each can demand in differing cases that different courses of action be followed. Judges, perhaps inadvertently, have been able to take advantage of the equivocal nature of the concept to come tacitly to decisions that reflect their own moral judgments of patients or decisions made in particular cases. The result is the inconsistent application of principle. I ask whether this is an unforeseen outcome or if it reflects a wilful disregard for equal treatment in favour of silent moral judgments in legal cases. Whatever the cause, I suggest that once this practice is seen to occur, acceptable justification of it in some cases is difficult to find. (shrink)

This book is a critical, forward-looking and interdisciplinary text. Its chief aim is to advance understanding of medical law by reference both moral theory and the regulatory context. The first chapter seeks to map competing approaches within moral objectivism and outline the pressures created by the impact of market forces and medical tourism, political interests, medical and professional interests, changing perceptions of medicine, developing technologies, limited resources and the impact of increasingly direct (international and domestic) recognition of human rights. Chapters (...) 2 to 16 apply the analytical tools presented in chapter 1 to the topics of medical law and seek to demonstrate the need for a moral epistemology of the type defended in chapter 17. (shrink)

Recently, commentators close to and within the UK government have claimed that patient choice can increase equity in the context of the National Health Service. This article critically examines the basis for this claim through analysis of recent speeches and publications authored by secretaries of state for health and their policy advisers. It is concluded that this claim has not developed prospectively from an analysis of the causes of healthcare inequity, or even with a consistent normative definition of equity. The (...) limited justification that is “framed in causal explanations” of inequity has suffered from an apparent disregard of the available evidence. (shrink)

The cases of Diane Pretty and Ms B. raise crucial issues about decision-making and autonomy at the end of life. Ms B. was permitted her wish to die rather than live permanently dependent upon a ventilator because her case was constructed as one about withholding consent to medical treatment, which every adult with capacity has a right to do. Mrs Pretty, however, sought active intervention to end her life. Requiring assistance to die, and claiming that this was her human right, (...) she sought an assurance that her husband would not be prosecuted if he helped her. Her claim was rejected and the assurance refused. The cases prompt questions about the nature of autonomy, the influence of others and the different way sin which medical and legal decisions are made. (shrink)

Background There is broad international agreement from clinicians and academics that healthcare rationing should be undertaken as explicitly as possible, and the BMA have publicly supported the call for more accountable priority setting for some time. However, studies in the UK and elsewhere suggest that clinicians experience a number of barriers to rationing openly, and the information needs of patients at the point of provision are largely unknown. Methodology In-depth interviews were undertaken with NHS professionals working at the community level (...) of provision, and with patients and professionals receiving or providing treatment for morbid obesity and breast cancer (n=52). Results Nearly all patients wanted to know about healthcare rationing and had high expectations of their clinical professionals to provide all relevant information about treatment options. However, professionals did not always understand these information requirements, and cases of implicit rationing were common. The existence of relevant national guidance was not always known about, meaning that patients were often reliant on other sources of information about treatment options, which included the popular media, the internet, patient advocacy groups and informal networks of support. Discussion Clinical professionals need to understand patients' need for detailed information when it comes to rationing, and to understand that they are the main gateway for this to be provided. However, disclosure could be distressing for both patients and professionals, and thus the most sensitive and acceptable ways to make this information available requires further investigation. (shrink)