| Summary: | Disclosing a value system in a living will could be in your best interests: Whilst doctors are recognised for being expert in medical matters they are nevertheless generally required by law to obtain the consent of a competent adult patient prior to administering a medical treatment.1 The need for consent underpins the right of a competent adult patient to refuse treatment, even life preserving treatment. Accordingly, bodily inviolability is a fundamental principle of law and violation of it, even for benevolent reasons, is prima facie punishable. Instead of which a competent patient has a right to self-determine what shall happen to their own body. In this way the subjective decision-making standards and methods of a competent patient inform, and are made determinative, of any decision to accept or reject a medical treatment. It is against this general background that the comments of Lord Goff in the case of Bland should be considered. There he suggested that the best interests test should comprise of something more than purely professional appraisal of a person’s medical welfare.2 To confine the test in this way, he said, would be inconsistent with the primacy given to the principle of self-determination and would ‘downgrade the status of the incompetent person by placing a lesser value on [their] intrinsic worth and vitality’.3 So as the title to this thesis suggests I am primarily concerned with legal provisions governing medical treatment decision-making processes in respect of formerly competent adult patients. More specifically it questions whether the values, beliefs and preferences of members of this patient group should be more favourably promoted, i.e. used and made determinative, in medical treatment decision-making processes concerning them based on contemporary understanding and application of the moral principle of autonomy. Naturally this depends on whether a person’s value system can be accurately ascertained, recorded and protected to ensure that it is most fully promoted and respected in the future should a loss of decision-making capacity leave them unable to determine matters contemporaneously. Accordingly, the premise underlying this thesis is that the autonomous values, beliefs and preferences of a formerly competent person should be ascertained and recorded so that they can be understood and used by others to determine whether, and if so what, medical treatment is in the actual best interests of the patient. Essentially bodily integrity would be safeguarded if a surrogate decision-maker was able to determine what the patient would decide if they were competent to make that choice. A situation that is most desirable if we are not to downgrade the moral status of this particular group of incompetent patients. 1.The term generally has been used to denote the fact that the inviolability of persons is a fundamental principle of law and in a medical context this means that the administration of a medical treatment is dependent on some form of legal authority. As the primacy of the moral principle of autonomy is established in law doctors must obtain legal consent prior to administering a medical treatment. However, there are circumstances where the law remains paternalistic and medical treatment can be administered on the basis of an alternative legal authority, for example, the Mental Health Act 2007. 2. Airedale NHS Trust v Bland [1993] 1 All ER 821 HL. 3. Airedale NHS Trust v Bland [1993] 1 All ER 821 HL.
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