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Posted on June 30, 2019 at 2:56 AM

In a recent blog post on this site Dom Wilkinson, writing about the case of Vincent Lambert, said this:

If, as is claimed by Vincent’s wife, Vincent would not have wished to remain alive, then the wishes of his parents, of other doctors or of the Pope, are irrelevant. My views or your views on the matter, likewise, are of no consequence. Only Vincent’s wishes matter. And so life support must stop.’

The post was (as everything Dom writes is), completely coherent and beautifully expressed. I say nothing here about my agreement or otherwise with his view – which is comfortably in accord with the zeitgeist, at least in the academy. My purpose is only to point out that if he is right, there is no conceivable justification for a department of medical ethics. Dom is arguing himself out of a job.

If he is right, autonomy is the only ethically relevant principle. There are no queasy questions about identity, personhood or authenticity. And our boundaries are easily defined: we bleed into nobody, and nobody bleeds into us.

By ‘autonomy’ is evidently meant the expressed wishes of the capacitous and the previously expressed or presumed wishes of the incapacitous. If the principle is so self-evidently true for end-of-life situations, it is hard to see why it is not the key that unlocks all problems in clinical ethics. Questions about embryo manipulation evaporate once one observes the benefit that can accrue to already autonomous creatures from the use of non-autonomous creatures. Questions about abortion are similarly trivial. Questions about organ donation and other post-mortem use of tissue are determined in exactly the same way as Dom urges that Lambert’s fate should be decided. There are no remaining philosophical questions. Even resource allocation questions become ethically easy. The value system relevant for the utilitarian calculus is autonomy: one simply has to work out how to maximise the amount of autonomy in the world.

There is still plenty to discuss, of course. But the remaining discussion is for lawyers, public policy makers, and health economists. The lawyers will need to devise procedures to enable capacity to be assessed, to ensure that those all-important wishes have been made freely and expressed with sufficient clarity, and so on. The public policy people will agonise about the tension between individual rights and societal interests. The health economists will create indices for autonomy and plug them into their Bayesian algorithms. But the philosophers’ work is done. It would be kind, but hardly essential, to invite them to meetings (in the Law Faculty) about medical law. But a department of their own? It can’t be justified in these straitened times.





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