Isra Black

The Terminally Ill Adults (End of Life) Bill, introduced into the UK Parliament in October 2024, would decriminalise medical assistance in suicide provided to people with a terminal illness in England and Wales. We consider three key aspects of the Bill: its terminal illness restriction, its mental capacity provisions, and its procedural regime. While partial decriminalisation of physician assisted death in England and Wales would be welcome, we note that the limited scope of access to suicide assistance may result in the continuation of unlawful, but infrequently prosecuted assisted death practices: suicide assistance by loved ones and cross-border access to assisted suicide in Switzerland in non-terminal cases. And the burdensome nature of the Bill’s procedural regime may cause even terminally ill individuals to seek alternative means of assistance to die.

In this chapter we examine the ethical case for using Motivational Interviewing (MI) in healthcare settings. First, we discuss ethical reasons that favor using MI in healthcare settings. Second, we consider two ethical challenges with respect to using MI in medical practice: the appropriate use challenge and the proficiency challenge. These challenges do not represent a decisive ethical objection to MI use in Medicine, but ought to shape and inform the decision to use MI (and its ongoing practice) in healthcare settings. Our chapter also includes a medical trainee’s insights on the value of learning MI and the ethical practice of MI.

This chapter engages with ethical challenges of using motivational interviewing (MI) and MI-based interventions in HIV care. The chapter firrst outlines two general ethical worries in respect of MI use. The authors argue that the relational and technical components of MI provide insufficient ethical action guidance and ethical safeguards, respectively. It is necessary to consider factors external to the method of MI to establish the ethical permissibility of its applications. The authors subsequently consider the ethics of MI in the context of HIV care, specifically in relation to pre-exposure prophylaxis, medication adherence, and disclosure of HIV/AIDS diagnosis/prognosis. This framework for discussion of these specific issues may be relevant to other applications of MI in HIV care.

Morbidity arising from unprepared bereavement is a problem that affects close personal relations of individuals at the end-of-life. The bereavement studies literature demonstrates that a lack of preparedness for a loved one’s death is a risk factor for secondary psychological morbidity among survivors. Short awareness time of death negatively correlates to preparedness for bereavement. The absence of disclosure of end-of-life diagnosis and prognosis to close personal relations (‘death talk’) between patients and loved ones, or health professionals and loved ones, may contribute to short awareness time of death. To increase awareness time of death, we might attempt to increase patient first-personal disclosure of end-of-life diagnosis and prognosis to loved-ones, and/or patient consent to health professional disclosure of the same. Interventions based on motivational interviewing in end-of-life care whose aim is to facilitate death talk, either by the patient directly, or by a health professional with the patient’s consent, may offer a part solution to the problem of unprepared bereavement. This paper evaluates the ethical permissibility of such interventions. We consider two ethical objections to using motivational interviewing in this way: first, that it is inappropriate for practitioners to seek disclosure as an outcome in this setting; second, that aiming at disclosure risks manipulating individuals into death talk. While it need not be impermissible to direct individuals toward disclosure of end-of-life diagnosis/prognosis, the objection from manipulation implies that it is pro tanto ethically preferable to use motivational interviewing in a nondirective mode in death talk conversations. However, insofar as non-directive motivational interviewing requires more advanced skills, and thus may be more difficult to learn and to practise, we advance that it may be ethically permissible, all things considered, to employ directional, or specific outcome-oriented, motivational interviewing. Motivational interviewing interventions in end-of-life care whose aim is to facilitate death talk, either by the patient directly, or by a health professional with the patient’s consent may be ethically permissible, all things considered.

This chapter makes a pro tanto case for the moral permissibility of assisted death. It is pro tanto in the sense that my principal interest is the all else being equal moral evaluation of the dimension of assisted death that comprises one individual, who wishes to die with assistance, and another, who either grants or refuses to grant the former’s wish and who provides assistance or does not provide assistance respectively. Put another way, this is not a case for assisted death all things considered. Specifically, I shall not consider the detail of other-regarding matters relevant to the all things considered moral permissibility of assisted death. In making a pro tanto moral case for assisted death only, I have a substantive aim: to set out a universal foundation for the moral permissibility of assisted death, which in turn contributes to discussion of the all things considered moral permissibility of assisted death, and which structures (in part) the institutionalisation of assisted death in law or policy.

This article engages with the legal regulation of end-of-existence decisionmaking for novel beings, specifically assisted nonexistence for such entities. I explain the concept of a legal model for assisted death by reference to the substantive features of legal regimes in three jurisdictions in which assisted suicide or euthanasia is lawful. I consider how these models might fit novel beings who may require or prefer assistance to end their own existence by reference to the constituent features—abstract legal ingredients—that models for assisted death share. I argue that extant models may block some novel beings’ access to end-of-existence assistance or fail to track what matters to them. I then examine the merits of adopting a universal model for assisted nonexistence, that is, a legal framework whose substantive features capture the end-ofexistence concerns of both human and novel beings. Consideration of a unified legal framework may illuminate the discussion of assisted nonexistence for humans and novel beings. However, I argue that while novel beings may have similar interests to humans, they may be relevantly different also. The prima facie case for adopting a one regime to rule us all approach to assisted nonexistence may be defeated by reasons for divergent regulation.

This contribution has two objectives. The first is descriptive: I provide a brief account of the legal status of a variety of end of life decisions or interventions in England and Wales, including refusal of life-prolonging medical treatment, stopping of eating and drinking (SED), withdrawal or withholding of life-prolonging treatment, euthanasia and assisted suicide. To help set the law in a clinical context, I have included a series of hypothetical cases that a cancer specialist might find challenging if encountered in real life. The second objective is more critical: I consider the legal basis for medicine in England and Wales and attempt to identify the grounds on which physician-assisted death might be argued to be lawful or unlawful compared with other medical interventions.

This article considers the content of the right to refuse life-prolonging medical treatment under the European Convention on Human Rights (ECHR), as well as the supervision by the European Court of Human Rights (ECtHR) of domestic legal regimes for refusing life-prolonging treatment. I argue, employing doctrinal and philosophical analyses, that developments in the Convention jurisprudence with regard to the protection of private life under article 8 ECHR imply a substantively extensive right to refuse life-prolonging treatment, both contemporaneously and in advance. Moreover, I suggest that there is sufficient consensus among Council of Europe Member States on the right to refuse life-prolonging treatment to engage ECtHR supervision of states’ legal frameworks for such refusals. In addition, or in the alternative, I advance that the Strasbourg court may scrutinise Member States’ legal arrangements for refusals of life-prolonging treatment in virtue of the positive obligations to secure respect for private life that inhere in article 8 ECHR.

This chapter contributes to the reimagining of health law by making progress towards its theorisation. We engage in discussion of health law's nature, so as to facilitate future work on its purpose, as well as its substantive interaction with criminal and other domains of law. Drawing principally on the resources of the philosophy of criminal law—particularly R A Duff's The Realm of Criminal Law—we sketch desiderata of a theory of health law, against which we might develop thicker, normative or prescriptive accounts. We begin by distinguishing different ways in which one may give an account of some social entity. We then detail our preferred methodological approach to developing an account of health law—that of rational reconstruction and institutional analysis. Finally, we develop the elements of an analytical account of health law—its objects, processes and actors, and outcomes.

Consider the following proposition. Call it the asymmetry of capacity thesis. 'For a set of options, the functional decision- making capacity required to choose any one option may differ to the functional decision- making capacity required to choose any other option.' In this contribution, I consider the existence of, and normative support for, the asymmetry of capacity thesis in English law. In particular, I take an interest in one specification of the proposition: a legal doctrine holding that an individual may have the capacity to consent to a medical intervention and yet lack the capacity to refuse the same. I advance two main arguments. First, I develop scepticism as to whether legal authority exists for the asymmetry of capacity thesis in the adolescent medical treatment case law (where it is thought to have emerged). Second, I argue that nether of two prominent ways of explaining and justifying the asymmetry of capacity ­thesis—the risk-relative account of capacity, and Stephen Gilmore and Jonathan Herring’s distinction between refusal of consent and refusal of treatment—succeed.

In "Treating Adolescents Differently", Anthony Skelton, Isra Black, and Lisa Forsberg develop a well-being-based justification of the asymmetrical treatment of adolescent consent and refusal in the context of health-care to justify the differential and paternalistic treatment of adolescents more generally. The core of Skelton, Black, and Forsberg’s view is a variabilist theory of what is fundamentally and non-instrumentally prudentially good for adolescents, which includes the prudential value of what they call shielding—or the value of being insulated from full responsibility for their choices. This theory of well-being, they argue, explains why adolescents may be treated differentially and paternalistically in numerous domains. It is good for them to be shielded because it allows for a variety of freedom from making certain kinds of decisions in the absence of a safety net provided by others in supportive and caring relationships. Skelton, Black, and Forsberg argue that their account of the justification of differential and paternalistic treatment of adolescents has attractive implications for a range of cases and holds up well in the face of philosophical criticism.

We explore the ethics of using motivational interviewing, an evidence-based, client-centred and directional counselling method, in conversations with next of kin about deceased solid organ donation. After briefly introducing MI and providing some context around organ transplantation and next of kin consent, we describe how MI might be implemented in this setting, with the hypothesis that MI has the potential to bring about a modest yet significant increase in next of kin consent rates. We subsequently consider the objection that using MI in this context would be manipulative. Although we cannot guarantee that MI would never be used in a problematically manipulative fashion, we conclude that its use would, nevertheless, be permissible as a potential means to increase next of kin consent to deceased solid organ donation. We propose that MI be trialled in consent situations with next of kin in nations where there is widespread public support for organ donation.

This article is about the information relevant to decision-making capacity in refusal of life-prolonging medical treatment cases. We examine the degree to which the phenomenology of the options available to the agent—what the relevant states of affairs will feel like for them—forms part of the capacity-relevant information in the law of England and Wales, and how this informational basis varies across adolescent and adult medical treatment cases. We identify an important doctrinal phenomenon. In the leading authorities, the courts appear to count the first-personal phenomenology of the available options among the information that adolescents seeking to refuse life-prolonging treatment must understand and appreciate in order to possess capacity; adults are not held to this (higher) standard. We evaluate this differential treatment in light of philosophical work on transformative choice—decisions involving options whose sensory character, and effect on our values and preferences, are grasped only through experience itself.

Some form of assisted dying (voluntary euthanasia and/or assisted suicide) is lawful in the Netherlands, Belgium, Oregon, and Switzerland. In order to be lawful in these jurisdictions, a valid request must precede the provision of assistance to die. Non-adherence to the criteria for valid requests for assisted dying may be a trigger for civil and/or criminal liability, as well as disciplinary sanctions where the assistor is a medical professional. In this article, we review the criteria and evidence in respect of requests for assisted dying in the Netherlands, Belgium, Oregon, and Switzerland, with the aim of establishing whether individuals who receive assisted dying do so on the basis of valid requests. We conclude that the evidence suggests that individuals who receive assisted dying in the four jurisdictions examined do so on the basis of valid requests and third parties who assist death do not act unlawfully. However, further research on the elements that may undermine the validity of requests for assisted dying is warranted. More research on the reasons why requests for assisted dying are refused is also desirable.

The purpose of the introduction to Consenting Children is to acquaint readers with the themes explored in the volume, to provide readers with a summary of the chapters comprising it, and to situate its contributions. Our ambition is for the volume’s contributions to lay the groundwork for future engagement in the legal and philosophical literature with the controversies raised by arguments about children’s autonomy, responsibility, and well-being, and the myriad interactions between them. We anticipate that the chapters in this volume will serve as an indispensable critical reference for scholars working in the broad range of disciplines dealing with the treatment of children. We hope, further, that the volume demonstrates the potential of the study of children to generate insights into thinking about consent, autonomy, responsibility, and well-being more broadly.

Evidence from jurisdictions that allow assisted dying is frequently used in the debate about assisted dying in the UK, since it provides important information about how assisted suicide and voluntary euthanasia work in practice. However, in order to interpret these data meaningfully, it is essential that they are understood in the context of the different legal and regulatory frameworks in operation in these countries. The Commission on Assisted Dying has commissioned this expert briefing paper in order to help unpick these complexities, and identify evidence for the effectiveness of the various legal safeguards that have been employed in jurisdictions that allow assisted dying. In the briefing paper the authors identify and explain the features of the legal regimes that regulate assisted dying in four target jurisdictions: the Netherlands, Belgium, Oregon and Switzerland. They explore the evidence for the effectiveness of individual safeguards in each of these regimes in turn. Then they evaluate the evidence for the effectiveness of each safeguard, drawing on a detailed examination of the evidence, and, where possible, make recommendations on how these regimes could implement and regulate assisted dying more effectively.

Children are treated differently compared to adults in many domains, including in health care, education, employment, and criminal justice. The differential treatment of children—to adults, and in the case of younger children and adolescents, to each other—makes it both practically and theoretically important to examine the justification of when and why this treatment is permissible. Because the justifications of children’s differential treatment typically appeal to foundational normative considerations—matters of autonomy, responsibility, and well-being—they provoke considerable controversy and disagreement in law and ethics, especially, though not exclusively in the contexts of health care, sexual relations, and criminal justice. Consenting Children brings together philosophers and academic lawyers to grapple with these matters and domains and to share disciplinary and interdisciplinary insights and understanding. The volume’s contributors engage in deep and fruitful discussions of children’s consent and responsibility, decision-making capacity and best interests, as well as the role, powers, and duties of parents and state institutions. The volume lays the groundwork for future engagement in the legal and philosophical literature with the controversies raised by children’s autonomy, responsibility, and well-being, and the myriad interactions between them concerning children’s consent.

Adolescents are routinely treated differently to adults, even when they possess similar capacities. In this article, we explore the justification for one case of differential treatment of adolescents. We attempt to make philosophical sense of the concurrent consents doctrine in law: adolescents found to have decision-making capacity have the power to consent to—and thereby, all else being equal, permit—their own medical treatment, but they lack the power always to refuse treatment and so render it impermissible. Other parties, that is, individuals who exercise parental responsibility or a court, retain the authority to consent on an adolescent’s behalf. We explore four defences of the doctrine. We reject two attempts to defend the asymmetry in the power to consent to and refuse medical treatment by reference to transitional paternalism. We then consider and reject a stage of life justification. Finally, we articulate a justification based on the distinctiveness of adolescent well-being.

In Gross v Switzerland, the European Court of Human Rights held by 4-3 majority that Switzerland had violated the right to decide when and how to die included in the right to respect for private and family life under Article 8 of the European Convention on Human Rights. To comply with the ruling, Switzerland must issue guidance detailing the circumstances (if any) under which physicians may lawfully prescribe lethal medication to competent individuals who have a voluntary and settled wish to die, yet whose suffering is not the product of a medical condition likely to result in death in the near future.

This article examines the reporting requirements in four jurisdictions in which assisted dying (euthanasia and/or assisted suicide) is legally regulated: the Netherlands, Belgium, Oregon and Switzerland. These jurisdictions were chosen because each had a substantial amount of empirical evidence available. We assess the available empirical evidence on reporting and what it tells us about the effectiveness of such requirements in encouraging reporting. We also look at the nature of requirements on regulatory bodies to refer cases not meeting the legal criteria to either prosecutorial or disciplinary authorities. We assess the evidence available on the outcomes of reported cases, including the rate of referral and the ultimate disposition of referred cases.