Book review: CHARLES FOSTER, Choosing Life, Choosing Death: The Tyranny of Autonomy in Medical Ethics and Law. Oxford and Portland, OR: Hart Publishing, 2009, 189 pp., ISBN: 9781841139296 £22.50
| Date | 01 September 2010 |
| DOI | 10.1177/09646639100190030803 |
| Published date | 01 September 2010 |
| Subject Matter | Articles |
References
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ronmental Scan of New Zealand Agencies. Wellington: Ministry of Women’s Affairs.
Jan Jordan,
Victoria University of Wellington, New Zealand
CHARLES FOSTER, Choosing Life, Choosing Death: The Tyranny of Autonomy in Medical
Ethics and Law. Oxford and Portland, OR: Hart Publishing, 2009, 189 pp., ISBN:
9781841139296 £22.50.
Autonomy is the cornerstone of medical ethics, the guiding, and by far the most
significant value to have influenced the evolution of contemporary medical law (Mason
and Laurie, 2010). Given thisstatus, the concept of autonomy is starting to attract (slowly,
but ever more potently) the criticism that it is being deployed by academics and judges
alike as something given, self-evident even. Autonomy’s function and meaning seem
to be clear to everyone, and the caricature of an atomistic, rights-bearing patient tends
to be accepted with no questions asked. In the pursuit of empowering patients and dimin-
ishing the power of doctors, autonomy, says Kenneth Veitch (2007), hasbecome a rheto-
rical device, the very obviousness of its meaning rendering detailed inquiry superfluous.
Against this backdrop, Charles Foster’s book provides a welcome addition to the litera-
ture by confronting some of these premises in the context of English medical law.
Choosing Life, ChoosingDeath is not about challenging the caricature of the atomistic,
right-bearing patient itself – ‘everyone who is anyone knows what autonomy means, and
it means the straightforward libertarianism of John Stuart Mill, Peter Singer and Julian
Savulescu’ (p. 3). In fact the book adopts wholeheartedly and colourfully the allegedly
dominant picture of an ‘icy self-determinist’ autonomy which ‘talks about people’s life
plans as if they are demonstrable documents’ (p. x) and is ‘ruthless in its suppression
of any other contenders for a voice in medical ethics debates’ (p. ix). Nevertheless, this
‘intellectual fascism nestling at the core of the traditional notion of autonomy’ leads
Fosterto question and challengeautonomy’s holdingof the casting votein all ethical debates
in medicaldecision-making (p. 9). In otherwords the book is ‘an assault on the presumption
that autonomy ought to be the only voiceheard in medical ethics and law’ (p. ix).
With this purpose in mind Foster begins by outlining the elements of his critique in
Chapter 1: ‘Autonomy:Challenging the Consensus’. This is followed in Chapter 2, by the
suggestionof non-maleficence, beneficence,justice and professionalintegrity as principles
that should contribute considerably more to medical ethics and decision-makingthan they
currently do. Considering that a prominent part of Foster’s thesis is built on the argument
that medical lawand ethics need to engage far morewith these other principles (instead of
solely relyingon autonomy to ‘avoid some sinister results’),the chapter is regrettably short
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