Choosing Life, Choosing Death: The Tyranny of Autonomy in Medical Ethics and Law

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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

Reviews

...fresh, clear and eminently readable...This is a short book, passionately argued, which all those interested in medical law, and the rights and duties of patients and doctors, should read. You may disagree: you won't be bored. Bio-Science Law Review Vol 10, Issue 3, 2009 This is certainly a useful book for people wishing to understand some of the legal background in key areas of medical law...it is also worthy of consideration in its own right by anyone seeking an alternative perspective on autonomy in health care ethics. Vincent Mitchell Nursing Ethics 16 (6), 2009 This book provides an accessible critique of the principle of 'autonomy' in the context of medical law. As a lawyer himself, Charles Foster succinctly summarises the various legal issues arising, as the title suggests, from conception to death. Antony Blackburn-Starza BioNews Newsletter 5th January 2010 This book is an important challenge to the dominance of autonomy in medical ethics and law ... [it] will ... be a useful and thought-provoking resource for those studying or teaching medical law and ethics. Mark Campbell Triple Helix Easter 2010 This is an important addition to the ongoing ethical, as well as medico-legal debate regarding autonomy. Foster's work provides an excellent point of departure for those new to the area, as well as a rich source of reference material for subsequent investigations. Doug Morrison Medical Law Review June 2010 Are you a hirsute medical lawyer, with a low blood pressure and writer's block Then this is the book for you. You will not have to read too many pages before your blood will be boiling, you will be pulling out your hair, and grabbing your keyboard to type a furious riposte. .. This book is a powerful challenge to the role that autonomy plays in medical law and ethics. The book demonstrates a wide-ranging understanding of the law. Few authors could hope to make as many sharp points as Foster does in such a short space of time. This must be the most fast-paced and easy-to-read book on the topic. For that reason it may well be of interest to students and no doubt lecturers will enjoy setting their chapters for students to read in order to provoke a response. Therein lies the strength of this book. It is a book that demands a reaction. Jonathan Herring Legal Studies Volume 30, No 2 Charles Foster's book provides a welcome addition to the literature by confronting some of these premises in the context of English medical law. Katri Lohmus Social and Legal Studies 19 (3) 2010 Charles Foster minces no words. Choosing Life, Choosing Death is a comprehensive and passionately argued attack against the "tyranny of autonomy" in medical ethics and law. Katharina Heyer The Journal of Law and Society Volume 45, Issue 1

Author Bio

Charles Foster is a Barrister at Outer Temple Chambers, London, and teaches medical law and ethics at the University of Oxford. He is the author, editor or a contributor to many books and hundreds of other publications: www.charlesfoster.co.uk