Autonomy is a vital principle in medical law and ethics. It occupies a prominent place in all medico-legal and ethical debate. But there is a dangerous presumption that it should have the only vote, or at least the casting vote. This book is an assault on that presumption, and an audit of autonomy's extraordinary status. This book surveys the main issues in medical law, noting in relation to each issue the power wielded by autonomy, asking whether that power can be (...) justified, and suggesting how other principles can and should contribute to the law. It concludes that autonomy's status cannot be intellectually or ethically justified, and that positive discrimination in favour of the other balancing principles is urgently needed in order to avoid some sinister results. 'This book is a sustained attack on the hegemony of the idea of autonomy in medical ethics and law. Charles Foster is no respecter of authority, whether of university professors or of law Lords. He grabs his readers by their lapels and shakes sense into them through a combination of no-nonsense rhetoric and subtle argument that is difficult to resist.' Tony Hope, Professor of Medical Ethics, Oxford University 'This book is unlikely to be in pristine state by the time you have finished reading it. Whether that is because you have thrown it in the air in celebration or thrown it across the room in frustration will depend on your perspective. But this book cannot leave you cold. It is a powerful polemic on the dominance of autonomy in medical law, which demands a reaction. Charles Foster sets out a powerful case that academic medical lawyers have elevated autonomy to a status it does not deserve in either ethical or legal terms. In a highly engaging, accessible account, he challenges many of the views which have become orthodox within the academic community. This will be a book which demands and will attract considerable debate.' Jonathan Herring, Exeter College, Oxford University 'This is a learned, lively and thought-provoking discussion of problems central to the courts' approach to ethical issues in medical law. What principles are involved? More significantly, which really underlie and inform the process of seeking justice in difficult cases? Charles Foster persuasively argues, and demonstrates, that respect for autonomy is but one of a number of ethical principles which interact and may conflict. He also addresses the sensitive issue of the extent to which thoughts and factors which go to influence legal decisions may not appear in the judgments.' Adrian Whitfield QC. 'Introducing the Jake La Motta of medical ethics. Foster is an academic street-fighter who has bloodied his hands in the court room. He provides a stinging, relentless, ground attack on the Goliath of medical ethics: the central place of autonomy in liberal medical ethics. This is now the first port of call for those who feel that medical ethics has become autonomized.' Julian Savulescu, Uehiro Chair in Practical Ethics, University of Oxford. "This important book offers a robust challenge to anyone, whether lawyer or 'ethicist', who sees respect for autonomy as the only game in town. It argues eloquently and effectively that, on the one hand, despite the reverence paid to it by judges, in practice the law, even in the context of consent, weaves together a number of moral threads of which autonomy is merely one, in the pursuit of a good decision. It argues on the other hand, that were the day-to-day practice of law to be guided primarily by respect for autonomy, this would be wrong. Foster concludes that whilst, 'any society that does not have laws robustly protecting autonomy is an unsafe and unhappy one', so too would be a society in which too much emphasis was placed on respect for autonomy at the expense of other important moral principles. This is essential reading for anyone interested in the role of autonomy and indeed of medical ethics, in the law." Michael Parker, Professor of Bioethics, University of Oxford. (shrink)

In English law there is a strong (though rebuttable) presumption that life should be maintained. This article contends that this presumption means that it is always unlawful to withdraw life-sustaining treatment from patients in permanent vegetative state (PVS) and minimally conscious state (MCS), and that the reasons for this being the correct legal analysis mean also that such withdrawal will always be ethically unacceptable. There are two reasons for this conclusion. First, the medical uncertainties inherent in the definition and diagnosis (...) of PVS/MCS are such that, as a matter of medical fact, it can never be established, with the degree of certainty necessary to rebut the presumption, that it is not in the patient’s best interest to remain alive. And second (and more controversially and repercussively), that even if permanent unconsciousness can be unequivocally demonstrated, the presumption is not rebutted. This is because there is plainly more to human existence than consciousness (or consciousness the markers of which can ever be demonstrated by medical investigations). It can never be said that the identity of the patient whose best interests are at stake evaporates (so eliminating the legal or ethical subject) when that person ceases to be conscious. Nor can it be said that the best interests of an unconscious person do not mandate continued biological existence. We simply cannot know. That uncertainty is legally conclusive, and (subject to resource allocation questions and views about the relevance of family wishes and the previously expressed wishes of the patient) should be ethically conclusive. (shrink)

Knowledge is generally a good thing. People who know lots of bits of information are generally admired. Some of them win prizes in TV competitions. If you were offered the gift of having an entire encyclopedia wired into your brain, you would probably accept, without thinking. But we should be wary of assuming that all knowledge is good. Too much knowledge can inhibit rather than enable thought.

Over the last quarter of a century, English medical law has taken an increasingly firm stand against medical paternalism. This is exemplified by cases such as Bolitho v City and Hackney Health Authority, Chester v Afshar, and Montgomery v Lanarkshire Health Board. In relation to decision-making on behalf of incapacitous adults, the actuating principle of the Mental Capacity Act 2005 is respect for patient autonomy. The only lawful acts in relation to an incapacitous person are acts which are in the (...) best interests of that person. The 2005 Act requires a holistic assessment of best interests. Best interests are wider than ‘medical best interests’. The 2018 judgment of the Supreme Court in An NHS Trust v Y from patients in prolonged disorders of consciousness ) risks reviving medical paternalism. The judgment, in its uncritical endorsement of guidelines from various medical organisations, may lend inappropriate authority to medical judgments of best interests and silence or render impotent non-medical contributions to the debate about best interests—so frustrating the 2005 Act. To minimise these dangers, a system of meditation should be instituted whenever it is proposed to withdraw life-sustaining CANH from patients with PDOC, and there needs to be a guarantee of access to the courts for families, carers and others who wish to challenge medical conclusions about withdrawal. This would entail proper public funding for such challenges. (shrink)

Volume 24, Issue 8, August 2024, Page 119-120.

Property-based models of the ownership of body parts are common. They are inadequate. They fail to deal satisfactorily with many important problems, and even when they do work, they rely on ideas that have to be derived from deeper, usually unacknowledged principles. This article proposes that the parent principle is always human dignity, and that one will get more satisfactory answers if one interrogates the older, wiser parent instead of the younger, callow offspring. But human dignity has a credibility problem. (...) It is often seen as hopelessly amorphous or incurably theological. These accusations are often just. But a more thorough exegesis exculpates dignity and gives it its proper place at the fountainhead of bioethics. Dignity is objective human thriving. Thriving considerations can and should be applied to dead people as well as live ones. To use dignity properly, the unit of bioethical analysis needs to be the whole transaction rather than the doctor-patient relationship. The dignity interests of all the stakeholders are assessed in a sort of utilitarianism. Its use in relation to body part ownership is demonstrated. Article 8 of the European Convention of Human Rights endorses and mandates this approach. (shrink)

Garland, Morain, and Sugarman's (2023) proposal is ethically attractive. But (assuming that ethics and medical law should have a close relationship with one another) it is legally seismic. It requi...

​Rosamond Rhodes contends, by reference to seven examples, that medical ethics is distinctly different from non-medical ethics. Each of those examples, on proper examination, illustrates precisely the opposite contention. It is clear not only that medical ethics relies on the same principles as non-medical (and indeed non-professional) ethics, but that it should so rely. A distinctively medical ethics would be dangerous: it would divorce ethical medical decision-making from the patients whom medicine exists to serve.

We are very grateful to Richard Ashcroft 1 and Andrew McGee 2 for their thoughtful and articulate criticisms of our views. 3 Ashcroft has disappointingly low aspirations for the law. Of course he is right to say that the law is not a ‘self-sufficient, integrated and self-interpreting system of doctrine’. The law is often philosophically incoherent and internally contradictory. But it does not follow from this that all areas of the law are philosophically unsatisfactory. And if that were true, the (...) response should not be Ashcroft’s contemptuous despair, but a determination to make it better. Ashcroft would say that such idealism is unrealistic in the light of the very nature of ‘the Law’: ‘...a complex assemblage of institutions, rules, accredited persons, practices and systems’. That isa radically ‘legal realist’ position and is plainly unsustainable. We can demonstrate its unsustainability while demonstrating both that he is wrong... (shrink)

The question a judge has to ask in deciding whether or not life-sustaining treatment should be withdrawn is whether the continued treatment is lawful. It will be lawful if it is in the patient’s best interests. Identifying this question gives no guidance about how to approach the assessment of best interests. It merely identifies the judge’s job. The presumption in favour of the maintenance of life is part of the job that follows the identification of the question.The presumption is best (...) regarded as a presumption of law. It has long been recognised as part of the way in which the English law discharges its obligations under Article 2 of the European Convention on Human Rights (the right to life). But even if it is a ‘mere’ evidential presumption it cannot, on the facts of most cases involving applications for the withdrawal of life-sustaining treatment from patients in prolonged disorders of consciousness, be rebutted. (shrink)

There is a strong presumption in favour of the maintenance of life. Given sufficient evidence, it can be rebutted. But the epistemic uncertainties about the best interests of patients in prolonged disorders of consciousness ("PDOC") and the wishes that they should be presumed to have are such that, in most PDOC cases, the presumption cannot be rebutted. It is conventional and wrong (or at least unsupported by the evidence) to assume that PDOC patients have no interest in continued existence. Treatment (...) withdrawal/continuation decisions should focus on the patient as he or she actually is, and should not unjustifiably assume that the premorbid patient continues to exist unchanged, and that the actual patient has the same interests as the premorbid patient and would make the same decisions in relation to treatment as the premorbid patient would have done. (shrink)

Volume 19, Issue 10, October 2019, Page 50-51.

This book is an assault on the notion that it is empirically accurate and legally and philosophically satisfactory to see humans as atomistic entities. It contends that our welfare is inextricably entangled with that of others, and accordingly law and ethics, in determining our best interests, should recognise the central importance of relationality, the performance of obligations, and (even apparently injurious) altruism.

The “doctrine of double effect” has a pleasing ring to it. It is regarded by some as the cornerstone of any sound approach to end-of-life issues and by others as religious mumbo jumbo. Discussions about “the doctrine” often generate more heat than light. They are often conducted at cross-purposes and laced with footnotes from Leviticus.

Volume 20, Issue 3, March 2020, Page 77-79.

This paper contends that the conventional ethical and legal ways of analysing the wrong involved in the misuse of human body parts are inadequate, and should be replaced with an analysis based on human dignity. It examines the various ways in which dignity has been understood, outlines many of the criticisms made of those ways , and proposes a new way of seeing dignity which is exegetically consonant with the way in which dignity has been historically understood, and yet avoids (...) the pitfalls which have led to dignity being dismissed by many as hopelessly amorphous or incurably theological. The account of dignity proposed is broadly Aristotelian. It defines dignity in terms of human thriving, and presupposes that it is possible, at least in principle, to determine empirically what makes humans thrive. It contends that humans are quintessentially relational animals, and that it is not possible to define humans as atomistic entities. One important corollary of this is that when using dignity/thriving as a criterion for determining the ethical acceptability of a proposed action or inaction, one should ask not merely how the dignity interests of the patient would be affected, but how the dignity interests of all stakeholders would be affected. The business of ethics is then the business of auditing all those interests, and determining the course of action which would maximise the amount of thriving in the world. (shrink)

The idea of the Good Life – of what constitutes human thriving, is, implicitly, the foundation and justification of the law. The law exists to hold societies together; to hold in tension the rights of individuals as against individuals, the rights of individuals as against various types of non-humans such as corporations, and the rights of individuals individuals as against the state. In democratic states, laws inhibit some freedoms in the name of greater, or more desirable freedoms. The only justification (...) for law is surely that it tends to promote human thriving. But what is the Good Life? What does it mean to live a thriving life? There has been no want of discussion, at least since the great Athenians. But surprisingly, since human thriving is its sole raison d’etre, the law has been slow to contribute to the conversation. This book aims to start and facilitate this conversation. It aims to: -make lawyers ask: ‘What is the law for?’, and conclude that it is to maximise human thriving -make lawyers ask: ‘But what does human thriving mean?’ -make judges and advocates ask: ‘How can a judgment about the best interests of a patient be satisfactory unless its basis is made clear?’. (shrink)

Multinational companies commonly and increasingly undertake their research in low and middle-income countries through commercial clinical research organizations (CROs). The involvement of these scientific middle men complicates the application of the theories of justice. We examine those complexities, and conclude that while the difficulties are not immune to analysis in terms of these theories, the theories have to be deployed in new ways in order to be useful in the new commercial world.

Doernberg and Truog (2023) propose a complex scheme for identifying the ethical issues at stake in various medical situations.The complexity of their scheme illustrates the difficulties that arise...

Martin was a twenty-nine-year-old anthropologist working on animism in Siberia when a bear leaped on her. He raked her with his claws, put her head into his mouth, and was about to crush her skull when she stabbed him with her ice axe. He loped off into the woods, carrying part of Martin's lower jaw and, if Martin is right, half of her soul—but leaving half of his soul in return. Martin lay bleeding in the snow. She managed to fashion (...) a tourniquet that slowed the bleeding from her leg. Miles away, a friend was fishing. He fell backward and blacked out. When he came to, he knew that something bad had happened to Martin.But was it bad?It certainly seemed so for a while. A Russian helicopter lifted her to hospital. Her wounds were treated, but the hospital seemed more brutal than the bear. She was strapped to the bed, unable to move her arms or legs. She wheezed through a tracheostomy tube. A malevolent nurse rammed food agonizingly into her with a syringe. Copulating doctors and nurses moaned and grunted in the side room next to her. Her jaw was roughly screwed together. On the plane back to France, the low cabin pressure reopened her scars. Her weeping mother dabbed at the blood with a tissue. In the French hospital, Martin took off her bandages in front of the mirror and wept “for my bear, for my old, lost face.”She had been invaded. She was now half-human, half-bear, a Siberian friend had told her: “He didn't want to kill you, he wanted to mark you. Now you are medka, she who lives between the worlds.” To be healed, she had to forgive the bear, for she would not otherwise forgive herself. At night she went “underground” to “speak to my bear.” Her head was “a ball scored with swollen red-claw marks and sutures. I am nothing like myself anymore, and yet I've never looked more like my own spirit; it has been imprinted on my body.”The invading bear had created a bridgehead into her. Other entities followed. The most immediately dangerous were bacteria and surgical scalpels. The surgeons did not know what they were toying with: “My body has become a territory where Western surgeons parley with Siberian bears. Or rather, where they try to establish communication.”The surgeons never did establish communication, and so their sort of healing would not work. Martin knew that she would only find healing in her “lair” in the Siberian forest, from those “who know bears and the questions they bring with them, who still speak with them in their dreams, who know that nothing happens by chance.” And so back she went.There was no epiphany. But there was the quiet healing that comes from recruiting all the agencies in the tundra; in distilling agency itself and dripping it over her wounds. And asking the right questions can heal too. The right questions are questions that are too big for answers.What is this book about? Martin is clear that what did not happen was that “a bear attack[ed] a French anthropologist somewhere in the mountains of Kamchatka.” What did happen was that “a bear and a woman [met] and the frontiers between two worlds implode[d].... Mythical time meets reality; past time joins the present moment; dream meets flesh.”Eye of the Wild poses an unnerving set of fundamental questions about what it means to say, as we all blithely do: “I am”—about how many souls we can accommodate, how we can broker a respectful or at least tolerable conversation between them; about our porosity to the cosmos we comfortingly assert is out there. This book is plangent, frigid, and chilling. It is a mosaic of jagged fragments that, viewed in the right light, perhaps add up to the scarred face of a young woman, all the lovelier for the scars. Yet the fragments do not add up to a proposition, for this is a book about what happens when you are brave enough to go to a place where no proposition could ever land. (shrink)

Lewis was not, and is not, very popular in the academy. I think there are three reasons.First, he did not stick to his subject, which was medieval and Renaissance literature. He wrote highly successful children's books, theological works, and articles accessible to nonspecialists, and was an acclaimed broadcaster. All this allowed his critics to suggest that he was not a proper academic, because proper academics do not throw their nets so wide.Second, he was good at everything he did (except perhaps (...) some areas of philosophy: he was famously bested by Elizabeth Anscombe when he ventured onto her home ground). This was perhaps the most infuriating thing about him. The justification for academic superspecialization is that one cannot do more than one thing really well. But Lewis did. He was a better Renaissance scholar than those who criticized him, moaned about him in the Oxford cloisters, and blackballed him for appointments. He is relentlessly readable; therefore (said his detractors) his scholarship must be shoddy.Lewis infuriates me too. Often, when I think I have had an original thought in some domain a million miles from Renaissance literature, I discover not only that Lewis had had that thought already, but had explicated it, seeing angles I never noticed, and more often than not he had exploded it, using a tenth of the words I used, and all in devastatingly simple prose that would entertain and illuminate the most uninterested plumber.And third, of course, he was a Christian, which was then becoming an unforgivable sin, as it remains now in the humanities (though not the physical sciences or mathematics). The usual (stated) objection to academic Christians is that their theological commitment precludes objectivity, but Lewis's academic writing (notably his English Literature in the Sixteenth Century: Excluding Drama [1954]) was so good that that indictment could not stick, and his opponents descended into incoherent fulmination about superannuated paradigms.These reasons help to explain the chilly reception (or, more often, nonreception) by self-billed “serious thinkers” of Lewis's “space trilogy”: Out of the Silent Planet, Perelandra, and That Hideous Strength (hereafter THS). In relation to THS there is another reason: the novel is about them. No, about us. Lewis's view of us is just too keen, his diagnosis too alarming.The main concerns of THS are dehumanization, the role of institutions in that dehumanization, and the desire of individuals to be part of an esoteric circle. More broadly, it concerns the nature of evil. Its debt to the Divine Comedy and to Charles Williams, Lewis's fellow Inkling, are clear.The central character is a young academic, Mark Studdock. We all know him. His education had been “neither scientific nor classical—merely ‘Modern.’ That left him pathetically manipulable. The severities both of abstraction and of high human tradition had passed him by: and he had neither peasant shrewdness nor aristocratic honour.” Studdock was “a man of straw, a glib examinee in subjects that require no exact knowledge.” He stood for nothing; he weighed nothing.Humans are not supposed to be weightless. We will do anything to convince ourselves that we have mass. Many of our strategies are counterproductive. Some are disastrous and lead to dissolution. Studdock's strategy is one of the commonest and most catastrophic: he tries to get to the center of things—to the “Inner Ring” whose geography is described by Lewis in his 1944 lecture (and later essay) of that name. At some level, at least occasionally, Studdock knows the stupidity of this ambition, but he closes his eyes and his mind. And he begins to be used by forces far greater than any he had dreamed of.The book opens with a merciless (and horribly entertaining) account of academic politics. Read it and cringe in recognition: the mechanics of toadyism; the devices for getting your own way with a committee (put the real business in coded form at the end of an agenda, to be dealt with on a hot day after lunch); infuse everything with an appeal to self-interest, but never put it quite like that, for fear of awakening long-dormant altruism. Obfuscate: do not call the sale of an ancient woodland in which Merlin's body lies “the sale of Bragdon Wood” but the sale of “the area coloured pink on the plan.” Learn to talk like the bursar of Studdock's college, for each of his sentences was “a model of lucidity: and if his hearers found the gist of his whole statement less clear than the parts, that may have been their fault.” As a manual for getting your own way in institutions, The Prince is artless and benign beside THS.Studdock becomes a pawn in a big and diabolical game. A vast organization, the National Institute for Coordinated Experiments, known, of course, as “NICE” (never underestimate the importance of an acronym), which turns out to be the instrument of dark supernatural forces, is becoming a state within a state. It is unaccountable. That is its tagline, indeed: it will be free of the red tape that inhibits the research of more conventional institutions. And who can define with sufficient exactitude the difference in principle between tedious administrative red tape and moral stricture? If you are in with the NICE, anything goes.The NICE's project is the unmaking of everything that is quintessentially human and, eventually, everything that is biological. Life itself is just too unhygienic. Beauty is a joke. Sentiment a delusion. Love merely a result of chemical interactions in the brain. Nothing signifies.The NICE has a handful of opponents—a raggedy bunch (including a bear) under the direction of Ransom, who has traveled outside planet Earth in the previous two books in the trilogy. The company, it turns out, is the remnant of the old Arthurian kingdom of Logres, which has always been in tension, if not war, with the modern kingdom of Britain: “Haven't you noticed that we are two countries? After every Arthur, a Mordred; behind every Milton, a Cromwell: a nation of poets, a nation of shopkeepers: the home of Sidney—and of Cecil Rhodes.” They recruit Studdock's wife, Jane, who can spy clairvoyantly on the NICE, and then a revived Merlin comes from his tomb to their aid.THS is strong meat. Many will balk at its supernaturalism, and perhaps in particular its complementarian view of the relationship between the sexes. But hear Lewis out: you might not agree with him, but he is always interesting. When I read THS thirty years ago, I thought it a ripping yarn. It still is. But now I see it as prescient, prophetic, and profoundly important. It should be on every university reading list, for every subject, and no one should be allowed to hold any kind of public office until they have shown that they have assimilated its lessons. (shrink)

Medical Ethics, Law and Communication at a Glance presents a succinct overview of these key areas of the medical curriculum. This new title aims to provide a concise summary of the three core, interlinked topics essential to resolving ethical dilemmas in medicine and avoiding medico-legal action. Divided into two sections; the first examines the ethical and legal principles underpinning each medical topic; while the second focuses on communication skills and the importance of good communication. Medical Ethics, Law and Communication at (...) a Glance offers an accessible introduction to the fundamentals of good medical practice, and will provide indispensable support for undergraduate medical students and nurses, as well as newly qualified healthcare professionals. (shrink)

A radically immersive exploration of three pivotal moments in the evolution of human consciousness, asking what kinds of creatures humans were, are, and might yet be.

If the law is to regulate the lives of those who suffer from depression, it is vital that lawyers understand the condition. This edited collection outlines the questions that arise from cases of depression by drawing together viewpoints from lawyers, philosophers, clinicians, and first-hand accounts from sufferers.

The English law on abortion is examined through four lenses manufactured by the principle of dignity. Those lenses are embodiment, relationality, story and a transactional, rather than an atomistic, approach to the ascertaining of the relevant interests. It is contended that this approach gives more nuanced, humane, intellectually satisfactory and pastorally satisfactory answers than those generated by the existing law. It is further argued that only this dignity-based approach is compatible with that mandated by Article 8 of the ECHR.

This book is an examination of how the law understands human identity and the whole notion of 'human being'. On these two notions the law, usually unconsciously, builds the superstructure of 'human rights'. It explores how the law understands the concept of a human being, and hence a person who is entitled to human rights. This involves a discussion of the legal treatment of those of so-called "marginal personhood" (e.g. high functioning non-human animals; humans of limited intellectual capacity, and fetuses). (...) It also considers how we understand our identity as people, and hence how we fall into different legal categories: such as gender, religion and so on. The law makes a number of huge assumptions about some fundamental issues of human identity and authenticity - for instance that we can talk meaningfully about the entity that we call 'our self'. Until now it has rarely, if ever, identified those assumptions, let alone interrogated them. This failure has led to the law being philosophically dubious and sometimes demonstrably unfit for purpose. Its failure is increasingly hard to cover up. What should happen legally, for instance, when a disease such as dementia eliminates or radically transforms all the characteristics that most people regard as foundational to the 'self'? This book seeks to plug these gaps in the literature. (shrink)

There are two main and several subsidiary difficulties with this paper.1The first main problem is that the authors, in calling for a revolution in the way that withdrawal of treatment cases are dealt with, fail to recognise that their desired revolutionary utopia is the ordinary workaday world of the law courts.The English law in relation to the administration of treatment to children, and the withdrawal of treatment from them, is straightforward: the only lawful treatment is that which is in the (...) child's best interests. The Children Act 1989 ) puts it slightly differently, but synonymously: the welfare of the child is the paramount consideration. Yes, the views of those holding parental responsibility are sought, but those views do not determine where the child's best interests lie. This is often misunderstood. One hears people talk about a parental veto on proposed treatment or a withdrawal of treatment. There is no such veto. There is a de facto presumption that a parent's views on what is in their child's best interests will coincide with what those best interests are, but that presumption is rebuttable, and is very commonly rebutted, for instance, as the authors note, in many Jehovah's Witness cases. …. (shrink)

Though she does not put it in these terms, Specker Sullivan’s (2022) article is an important and timely reminder that bioethics is a branch of philosophy; that philosophy is, literally, philo-sophy...

This article examines whether social media users can validly consent to their own use of social media. It argues that, whether or not social media use is analogous to public health interventions, there is an obligation to provide users with information about risks and benefits, and absent that provision, there is no valid consent. Many or most users, in any event, do not have the capacity to consent, according to the criteria for capacity articulated in the ‘four abilities’ model: the (...) ability to express a choice, the ability to understand the facts pertinent to the decision in question, the ability of a subject to believe that the information applies to them, and the ability to reason—in the sense of being able to consider and weigh (with reference to the patient’s own concerns, circumstances, and values) the main possible outcomes of the decision to opt for the intervention and the decision to opt not to undergo it. Even if an individual social media user is capacitous according to these criteria, many will fail to be judged capacitous if (as it is argued should be the case), a further criterion, identified by Jennifer Hawkins must be satisfied, namely that the individual can look after their own interests at least as well as most other people can. It follows from this consideration that not only can regulation of social media (in the form of a ban) be justified under Mill’s harm principle, but that non-regulation cannot be justified. (shrink)

Dementia is a topic of enormous human, medical, economic, legal and ethical importance. Its importance grows as more of us live longer. The legal and ethical problems it raises are complex, intertwined and under-discussed. This book brings together contributions from clinicians, lawyers and ethicists – all of them world leaders in the field of dementia – and is a comprehensive, scholarly yet accessible library of all the main (and many of the fringe) perspectives. It begins with the medical facts: what (...) is dementia? Who gets it? What are the current and future therapeutic and palliative options? What are the main challenges for medical and nursing care? The story is then taken up by the ethicists, who grapple with questions such as: is it legitimate to lie to dementia patients if that is a kind thing to do? Who is the person whose memory, preferences and personality have all been transformed by their disease? Should any constraints be placed on the sexual activity of patients? Are GPS tracking devices an unpardonable interference with the patient's freedom? These issues, and many more, are then examined through legal lenses. The book closes with accounts from dementia sufferers and their carers. It is the first and only book of its kind, and the authoritative text. (shrink)

This book is about the respective roles of intuition and reasoning in ethics. It responds to a number of well-known philosophers and psychologists, and proposes a new perspective – radical in its moderation. It examines in depth the work of the philosopher Joshua Greene and the psychologist Jonathan Haidt. With the so-called empirical turn in ethics, much work has been done to try to isolate the role of reason and intuition in forming our moral judgements, with Haidt and Greene leading (...) the research programmes and attracting much of the professional and public attention, and many others following. The current view – shared by both camps – is that intuition is largely the driver of our moral judgements – a view summed up in Haidt’s slogan ‘intuition first, strategic reasoning second’. Haidt believes we have to live with this and accept it. Greene does not: he contends that our intuitions, while suitable for the environments in which we evolved, are worthless in the modern, global, technological age, and to avoid ethical disaster we must learn to adopt reason as the arbiter of moral truth. This book steers a middle course between these two positions and is therefore of great interest to philosophers and psychologists alike. (shrink)

The law tends to think that there is no difficulty about identifying humans. When someone is born, her name is entered into a statutory register. She is ‘X’ in the eyes of the law. At some point, ‘X’ will die and her name will be recorded in another register. If anyone suggested that the second X was not the same as the first, the suggestion would be met with bewilderment. During X's lifetime, the civil law assumed that the X who (...) entered into a contract was the same person who breached it. The criminal law assumed that X, at the age of 80, was liable for criminal offences ‘she’ committed at the age of 18. This accords with the way we talk. ‘She's not herself today’, we say; or ‘When he killed his wife he wasn't in his right mind’. The intuition has high authority: ‘To thine own self... (shrink)