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

By Heyer, Katharina | Law & Society Review, March 2011 | Go to article overview

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


Heyer, Katharina, Law & Society Review


Choosing Life, Choosing Death: The Tyranny of Autonomy in Medical Ethics and Law. By Charles Foster. Portland, OR: Hart Publishing, 2009. 189 pp. $45.00 paper.

Autonomy grew up as a street fighter, and was blooded in some genuinely noble battles against medical paternalism. But like so many rulers with this sort of pedigree, it has quickly forgotten its democratic roots, and grown fat and brutal in power.

(Preface, ix)

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. While autonomy has fought the good battle in the patients rights movement, articulating important concepts of informed consent, advance directives, confidentiality and reproductive rights, it has, according to Foster, become an ''orthodoxy that is policed with terrifying vigour'' (p. 4). He seeks to temper this tyranny with other well-established principles of medical ethics, such as beneficence, nonmaleficence, and justice.

As a barrister and a professor in medical ethics at Oxford University, Foster is uniquely situated to expose the ways that the autonomy principle has been celebrated in the academy but then fails to deliver on its own principles when applied on the ground. It is the lived practice of autonomy that reveals its messy underbelly. This surely is the strength of this slim volumeFit is replete with court cases, primarily from the United Kingdom and the European Court of Human Rights, but it also cites landmark cases from the United States, describing the ways that the autonomy principle can obscure the complexities and contradictions of people's own assessment of their best interest and that of their loved ones.

Foster proceeds chronologically, beginning with questions that occur before birth (reproductive autonomy), between birth and death (such as informed consent, confidentiality, capacity, medical research on human participants, advance directives, and physicianassisted suicide), and then ending with questions that occur after death, such as transplants and ownership of body parts. Each question cites landmark cases, demonstrating the great gulf between autonomy on the books (primarily Article 8 of the European Convention of Human Rights) and in action (in the hospital, the genetic database company, the courtroom).

The limits of autonomy are explored in useful detail in the largest section of the book dealing with informed consent, which Foster calls ''the fundamentalist heartland of traditional autonomy'' (p. 82). Here, he critically examines the practice of giving minors access to reproductive health services without parental consent, the practice of giving medically necessary C-sections to women who had withdrawn their consent, the duty to prevent suicide by prisoners, and the right to sustain serious injury during consensual sadomasochism. Related are issues of capacity (was the woman with the needle phobia refusing the C-section temporarily incapacitated to refuse her consent?) and confidentiality (is there a duty to honor a patient's request for confidentiality not to reveal a genetically carried disease to family members who may be potential carriers?). Medical ethicists have long cast a critical glance on the notion of informed consentFsuggesting that what people want most from doctors is the ability to trust them (O'Neill 2002)Fand Foster's case studies usefully link readers to this work.

When it comes to reproductive autonomy, however, Foster's critique is curiously lacking. He begins his attack with a case of two British women claiming a right to reproduce by using stored embryos without their sperm-providing partners' consent (in one case the husband was deceased; in the other case, the ex-boyfriend objected). …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

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

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.