This paper explores some of the values that underpin health care and how these relate more specifically to the values and ethics of palliative care. The paper focuses on the concept of autonomy because autonomy has emerged as a foundational concept in contemporary health care ethics and because this is an opportunity to scratch the surface of this concept in order to reveal something of its complexity, a necessary precaution when applying the concept to the context of palliative care. The (...) paper begins with a theoretical discussion of autonomy exploring an aspect of its contemporary meaning and relevance to health care. The second part of the paper focuses more closely on how the principle of respect for autonomy can be applied in the context of palliative care. In this section an ethical framework is employed to explore a practical application of this principle within a broader context of respect for persons. (shrink)

I contrast Robert Veatch's recent liberal vision of medical decision‐making with a more rationalist liberal model. According to Veatch, physicians are biased in their determination of what is in their patient's overall interests in favour of their medical interests. Because of the extent of this bias, we should abandon the practice of physicians offering what they guess to be the best treatment option. Patients should buddy up with physicians who share the same values —‘deep value pairing’. The goal of choice (...) is maximal promotion of patient values. I argue that if subjectivism about value and valuing is true, this move is plausible. However, if objectivism about value is true — that there really are states which are good for people regardless of whether they desire to be in them — then we should accept a more rationalist liberal alternative. According to this alternative, what is required to decide which course is best is rational dialogue between physicians and patients, both about the patient's circumstances and her values, and not the seeking out of people, physicians or others, who share the same values. Rational discussion requires that physicians be reasonable and empathic. I describe one possible account of a reasonable physician. (shrink)

"Palliative Care Ethics should interest all those who care for the terminally ill: especially doctors, nurses, social workers, and the clergy. The well-illustrated central theme applies to every area of health care: that technical expertise must be controlled by humane non-technical judgement."--BOOK JACKET.

This is a substantially updated edition of the established guide to this key debate in modern political philosophy.

Was society’s response adequate in the cases of Mrs Pretty and Ms B?On the 11th of May, less than two weeks after losing her final legal appeal, Mrs Diane Pretty died, under sedation and in the care of a hospice. It was not the end she had pursued through the English High Court, the Court of Appeal, the House of Lords, and the European Court of Human Rights. Paralysed by motor neurone disease and unable to take her own life, Mrs (...) Pretty wanted her husband to be allowed to help her to die when they decided the time had come. But in England, assisting suicide is a crime, although suicide itself no longer is, and the English courts refused Mrs Pretty’s request to grant her husband legal immunity. In turning to the European Court of Human Rights, Mrs Pretty argued that the English courts’ refusal had violated the European Convention on Human Rights.The European court, however, judged that there had been no violation. The right to life could not be construed as conferring a “right to die”, and consequently the state could not be required to “sanction actions intended to terminate life” in order to protect Mrs Pretty from the “inhuman or degrading treatment” to which she claimed the law on assisted suicide subjected her. The right to respect for private life , moreover, had to be exercised “in accordance with the law” of the state concerned. “States were entitled to regulate through the operation of the general criminal law activities which were detrimental to the life and safety of other individuals”; and such activities were what the English law against assisting suicide was designed to prevent. Exceptions to this law could not be allowed without undermining the …. (shrink)