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Vol 24 No 6 June/July 2019

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

ISBN13: 9781841139296
Published: February 2009
Publisher: Hart Publishing
Country of Publication: UK
Format: Paperback
Price: £32.99

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Autonomy is a vital principle in medical law and ethics which 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.

Its structure is broadly chronological. It starts before birth (with questions relating to reproductive technology and the ownership of gametes) and ends after death (with the issues relating to the ownership of body parts). On the way it deals with the status of the early embryo and the foetus, the law of abortion, confidentiality, consent, medical litigation, medical research and end-of-life decision-making.

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.

Medical Law
Part 1: Principles
Chapter 1: Autonomy: Challenging the Consensus
Chapter 2: Other Contenders for a Voice
Non-maleficence: Primum Non Nocere: Above All, Do No harm
Professional Integrity
Rights and Duties
Chapter 3: Whose Autonomy?
Part 2: Before Life
Chapter 4: Reproductive Autonomy
Should One Be Required to Reproduce?
Should You Be Entitled to Have a Child?
Applications to Adopt
Applications by Prisoners
Chapter 5: Abortion
Chapter 6: Questions Raised by Reproductive Technology
Part 3: Between Birth and Death
Chapter 7: Confidentiality
What Principles Are Embodied in the Law of Confidentiality?
From Principle to Practice: Egdell, Genetic Counselling and Axon
W v Egdell
Genetic Counselling
The Sue Axon Case
Chapter 8: The Law of Consent
Duty to Prevent Suicide: Reeves v Commissioner of Police for the Metropolis
Autonomy Over One's Genitalia? R v Brown and Others
The Caesarean Section Cases
What Do We Mean When We Say 'I Want . . .'?
What is 'Relevant Information'?
Patient Responsibility
The Limits of Consent
Incidental Findings on Operation
Consent, Biobanks and the Effect of Analysing Consent Questions in ECHR Terms
The Notion of Capacity
Best Interests and Incompetent Adults
Chapter 9: Litigation, Rights and Duties
Chapter 10: Medical Research on Humans
Chapter 11: The End of Life
Part 4: After Death
Chapter 12: Transplantation
Live Donor Homotransplantation
Post-Mortem Homotransplantation
Chapter 13: The Ownership of Body Parts
Tissue From the Living
Tissue From the Living and the Dead
Existing Holdings
Who Can Give Consent?
Chapter 14: Epilogue