Jack Hughes

This book is challenging and sets itself up as “going against the stream”. But which stream? Perhaps there is a distinction between the stream in medical ethics and the stream in clinical practice. One impressive feature of the book is the detail of the references and footnotes. This gives me the impression that Jeffery is swimming in the stream of academic medical ethics. It is also true that he has first hand experience of clinical practice, but I suspect it is the flow towards euthanasia in the literature that alarms him (page 10). Whereas in practice, however slow moving and stagnant in so many places, my perception is that the tide runs towards person centred care based on a compassionate commitment to meeting individual needs. In the National Health Service (NHS) nursing home for people with severe dementia with which I am involved, the talk is not of euthanasia, but of engendering the sort of holistic view and palliation found in hospices. One substantial argument put forward by Jeffery concerns the ethical basis for foregoing treatment. He argues that decisions, in order to be ethical and compassionate, must be based on the need to avoid disproportionate treatment. His concern is that using “substituted judgments” or criteria such as “best interests” and “quality of life” might not necessarily show respect for life and might be subjective. Instead, “disproportionate treatment” stresses the …