Patient L’s Autonomy
‘Patient L’ is a man in a vegetative state, under the care of Pennine Acute Hospitals Trust. The Trust has placed a Do Not Rescuscitate order in his notes, yet his family claim that he himself would want to be revived if his condition deteriorated, because of his faith in Islam. The court of protection has now decided in favour of the Trust.
The Trust’s claim is that it is in Patient L’s best interests to be allowed to die, whereas Patient L himself – if we are to believe his family (and there seems little reason not to) – would almost certainly disagree.
But in fact whether he would agree or not isn’t what is primarily important in this case, since the central question is not whether the treatment is in his best interests. In our current medical culture, it is standard to seek informed consent from a patient, allowing him or her to make a decision about her own interests and whether she wishes to promote them or not. Of course, in this case it is impossible for Patient L to consent, and he appears not to have written a living will in any form. But the next-best option is surely not to treat the patient in the light of some conception of interests of the doctors’ own, especially one which the patient himself would probably not have accepted. It is to ask what he would have wanted had he been asked. And here the patients’ relatives’ views are crucial.
The distinction between acts and omissions might be introduced at this point. The Trust is proposing not some form of treatment, but the withdrawal of treatment. But it is clear that, whatever the moral weight of this distinction in other cases, it is not especially important in the case of DNR orders. Patients or their relatives are, and should be, consulted before such decisions are taken (this appears not to have been done in the case of Patient L).
Nor need we see an important practical conflict here between autonomy and interests. Autonomy – the running of one’s own life – might plausibly itself be seen as an interest; and there are plausible long-standing liberal arguments that respecting autonomy is instrumentally valuable, since people can – especially in the context of widespread reasonable and conscientious disagreement – be assumed to be the best judges of their own interests.