This paper criticises the current approach of the courts to the problem of patients who refuse life-saving medical treatment. Recent judicial decisions have indicated that, so long as the patient satisfies the minimal test for capacity outlined in Gillick, the courts will not be concerned with the substantive grounds for the refusal. In particular, a 'rationality requirement' will not be imposed. This paper argues that, whilst this approach may accord with our desire to uphold the autonomy of a patient who (...) refuses treatment on religious grounds, it fails to address the problem of the deluded decision-maker whose refusal is based on wrongheaded reasons (and where talk of autonomy is a disservice). The difficulty can be overcome, however, by recognising that the two patients in fact inhabit at distinct realms-the non-rational and the irrational. The test for capacity, at least in the context of life-saving treatment, should revert accordingly to the older concept of 'sound mind', to disallow refusals of an irrational (as opposed to a non-rational) nature. (shrink)

This paper defends the acts/omissions distinction which underpins the present law on euthanasia, from various criticisms, and aims to show that it is supported by fundamental principles. After rejecting arguments that deny the coherence and/or legal relevance of the distinction, the discussion proceeds to focus on the causal relationship between the doctor and the patient's death in each case. Although previous analyses, challenging the causal efficacy of omissions generally, are shown to be deficient, it is argued that in certain cases (...) of causing death by omission the causal authorship of the doctor lapses. The final part of the paper examines why this should be morally significant and proposes an answer in terms of the principle of equality. Assuming all other factors are equal, the infringement of this principle provides an additional reason against actively killing a patient, which is not present in cases of passively letting die. (shrink)

The judgment handed down in the case of Ms B confirms the right of the competent patient to refuse medical treatment even if the result is death. The case does, however, raise some interesting legal points. The facility for conscientious objection by doctors has not previously been explicitly recognised in case law. More importantly perhaps is that the detailed inquiry by the court into Ms B’s reasons for refusing treatment, apparently as a precondition for finding her competent, seems to contradict (...) earlier case law where it has been asserted that competent patients can refuse treatment for no reason at all. (shrink)

This article examines some of the contributions to the contemporary debate over the question of whether there is an important distinction to be made between the natural and the human sciences. In particular, the article looks at the arguments that Charles Taylor has put forward for the recognition of a radical discontinuity between these forms of science and then examines Richard Rorty's objections to Taylor's distinction and argues that Rorty misunderstands the reasons for this distinction and thereby misses the political (...) implications of failing to make such a distinction. In this regard, some arguments made by Anthony Giddens and John O'Neill, respectively, around Alfred Schutz's "postulate of adequacy" are used to show how the social sciences must be conceived so as to avoid consequences inimical to the reproduction and maintenance of participatory, democratic institutions. Additionally, the article uses O'Neill's argument that the Schutzian conceptualization of interpretive sciences can be critical in a way that Giddens and Jürgen Habermas require, while including a translation and accountability principle, to demonstrate how we ought to respect participatory, democratic forms. (shrink)