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E-grāmata: Law, Ethics and Compromise at the Limits of Life: To Treat or not to Treat? [Taylor & Francis e-book]

(University of Bristol, UK)
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A conflict arises in the clinic over the care of a critically ill, incapacitated patient. The clinicians and the patient’s family confront a difficult choice: to treat or not to treat? Decisions to withdraw or withhold life-sustaining treatment feature frequently in the courts and in the world's media, with prominent examples including the cases of Charlotte Wyatt, in the UK, and Terri Schiavo, in the USA. According to legislation like the Mental Capacity Act 2005, the central issues are the welfare (or ‘best interests’) of the patient, alongside any wishes they might have conveyed, via an ‘advance directive’ or through the appointment of a ‘lasting power of attorney’.

Richard Huxtable argues that the law governing both welfare and wishes frequently fails to furnish clinicians and families with the guidance they require. However, he finds this unsurprising, given the competing ethical issues at stake. Huxtable proposes that there is a case for ‘principled compromise’ here, such that the processes for resolving principled disputes take precedence. He argues for greater ethical engagement, through a reinvigorated system of clinical ethics support, in which committees work alongside the courts to resolve the conflicts that can arise at the limits of life.

Providing a comprehensive account of the law pertaining to children and adults alike, and distinctively combining medico-legal and bioethical insights, this book engages scholars and students from both disciplines, as well as informing clinicians about the scope (and limits) of law at the limits of life.

Acknowledgements xiii
List of abbreviations
xv
Table of reported cases
xvii
Introduction 1(10)
1 Judging law and ethics at the limits of life
11(22)
1.1 Conflicts in the clinic: the case of David Glass
11(3)
1.2 Judging law: rationality and the rule of law
14(8)
1.2.1 Judging law from within
14(2)
1.2.2 Criteria for rational law
16(2)
1.2.3 Fuller and the rule of law
18(3)
1.2.4 Taking stock: criteria for judging law
21(1)
1.3 Judging ethics
22(7)
1.3.1 Judging ethics from within (law): immanent critique
22(3)
1.3.2 Judging ethics from outside (law): judgments, principles and theories
25(4)
1.4 Conclusion: (not) just law
29(4)
2 Law at the limits of life: children, welfare and best interests
33(18)
2.1 Conflicts in the clinic: the case of Charlotte Wyatt
33(3)
2.2 Best interests, welfare and the law
36(13)
2.2.1 Criminal beginnings?
37(2)
2.2.2 Civil proceedings?
39(10)
2.3 Conclusion: in the child's best interests?
49(2)
3 Law at the limits of life: adults, incapacity and precedent autonomy
51(24)
3.1 Conflicts in the clinic: the case of Terri Schiavo
51(3)
3.2 Best interests, incapacity and precedent autonomy
54(18)
3.2.1 Best interests and the persistent vegetative state
55(7)
3.2.2 Best interests beyond the persistent vegetative state
62(3)
3.2.3 Advance directives
65(6)
3.2.4 Lasting powers of attorney
71(1)
3.3 Conclusion: autonomy or welfare?
72(3)
4 The limits of law at the limits of life: to treat or not to treat?
75(28)
4.1 Conflicts in the clinic: to treat or not to treat?
75(1)
4.2 Taking exception to exceptions: a duty to treat?
76(4)
4.3 In the patient's best interests?
80(10)
4.3.1 Treating like cases alike?
80(4)
4.3.2 Objective rule(s)?
84(1)
4.3.3 Know-ability and perform-ability?
85(5)
4.4 Respecting autonomy?
90(5)
4.5 Subjective judgments? From law to ethics at the limits of life
95(6)
4.6 Conclusion: problems painting unicorns with Odysseus
101(2)
5 Calculating the value of life at the limits of life
103(20)
5.1 Looking for values in English law
103(1)
5.2 The value of life in English law
104(5)
5.3 Calculating the value of life
109(11)
5.3.1 The intrinsic value of life: the disutility of futility?
109(5)
5.3.2 The instrumental value of life: worthless lives?
114(2)
5.3.3 The self-determined value of life: autonomy unbound?
116(4)
5.4 Subjective judgments or objective judgments?
120(2)
5.5 Conclusion: beyond conflict?
122(1)
6 A case for compromise at the limits of life
123(20)
6.1 Beyond conflict in the clinic: towards compromise
123(2)
6.2 Contemplating compromise
125(2)
6.3 Criticising compromise
127(5)
6.4 Cause to compromise: six reasons to compromise
132(3)
6.5 Constructing compromise: three virtues of compromising
135(5)
6.6 Conclusion: compromise in theory and practice
140(3)
7 Crafting compromise: courts or clinical ethics committees?
143(22)
7.1 Conflicts in the clinic revisited: to treat or not to treat?
143(1)
7.2 Viewing values in the court
144(9)
7.2.1 For the courts as vehicles of values
145(1)
7.2.2 Against the courts as vehicles of values
146(2)
7.2.3 Law and ethics in the courts and beyond
148(5)
7.3 Viewing values in clinical ethics support
153(10)
7.3.1 For the ethics support of clinical ethics support
153(6)
7.3.2 Against the ethics support of clinical ethics support
159(4)
7.4 Conclusion: compromise in court or clinical ethics committee?
163(2)
8 Committees, courts and compromise at the limits of life
165(18)
8.1 Reconstructing clinical ethics support
165(1)
8.2 The products of clinical ethics consultation: issuing consistent guidance
166(2)
8.3 The processes of clinical ethics consultation: observing due process
168(4)
8.4 Expertise in clinical ethics consultation: exhibiting ethical expertise
172(5)
8.5 Conclusion: clinical ethics committees, courts and compromise
177(6)
Bibliography 183(16)
Index 199
Richard Huxtable is Reader in Medical Ethics & Law and Deputy Director of the Centre for Ethics in Medicine, University of Bristol. His many publications include Euthanasia, Ethics and the Law: From Conflict to Compromise (Routledge-Cavendish, 2007) and (with Dickenson & Parker) The Cambridge Medical Ethics Workbook (CUP, 2nd edn, 2010). A longstanding contributor to clinical ethics support, Richard is also a Trustee of the National Council for Palliative Care and chair of its Ethics Forum.