Doubtless many of you will have heard by now of Kerrie Wooltorton, who, apparently depressed by her fertility problems, drank anti-freeze, called an ambulance, and handed a living will to staff at A&E. Her story is reported by the Telegraph under the headline “Suicide woman allowed to die because doctors feared saving her would be assault”
Miss Wooltorton, 26, who was suffering depression over her inability to have a child, drank poison at home and called an ambulance. However, she remained conscious and handed doctors a letter saying she wanted medical staff only to make her comfortable and not to try to save her life.
Doctors said her wishes were “abundantly clear” and although it was a “horrible thing” there had been no alternative but to let her die.
They feared they would be charged with assault if they treated her because they believed she understood what she was doing and was mentally capable of refusing treatment.
It is, by anyone’s standards, an incredibly sad case – and one can only speculate how hard it must have been for the doctors treating Ms Wooltorton to accede to her request. I think that, from a legal point of view, what they did was straightforwardly correct (and, as the BBC tells it, the coroner thought so too: “Any treatment… in the absence of her consent would have been unlawful”). Wooltorton was competent at the time, and her refusal of treatment ought to have been treated as definitive while she was still conscious. And while the obligation in respect of incapable adults is to act in their best interest – which would have meant intervening to save the patient’s life in many cases – the fact that Wooltorton had so recently and so capably made it clear that she did not want intervention, leads me to suspect that there’s not really room to doubt that her refusal ought to stand.
(The Telegraph goes on to suggest that “[this] is thought to be the first time someone has used a living will to commit suicide”, which I think isn’t quite right; she used a living will not to have her suicide bid stymied; this isn’t quite the same as suicide by refusal of treatment. But that’s a minor quibble.)
From an ethical point of view, I think that the doctors did the right thing in this case – but this is because it’d’ve been hard for them not to. By this, what I mean is that the story tells us something – actually, a couple of things – important about the nature of moral decisionmaking.
Primary among these things is that moral problems are problems. This sounds tautologous, but that doesn’t mean that it’s a trivial statement. It’s worth remembering that moral deliberation comes into its own not when deciding whether or not to do the right thing – what kind of question would that be? – but when deciding which of a range of differing and exclusive options, each of which has a claim to be right, good, or justified, ought to draw us. Moral dispute, in this picture, is not about criticising people for being immoral, but for having made a mistake in their evaluation of which option is the most pressing in a given situation. For example, the doctors in this case had a very good moral reason to intervene based in beneficence, and a very good moral reason not to intervene based in self-determination. Quite possibly, given Ms Wooltorton’s history of suicide attempts, doctors would have wondered whether it was really worth striving to save her. (They might disavow such thoughts, but I think that there’s nothing unforgivably unworthy about entertaining them; what counts is whether they’re given proper consideration.) For all these options, and for more besides, a defensible case could have been made. The medics had to wade through a number of possible options they’d’ve identified, each of which had some kind of claim to be the right one. Saving lives could be the right thing. Letting someone die could be. And they had to perform this moral task against the clock, too.
How we choose between these candidates will often be formed by our methodological and metaethical commitments. One could be rationalist about decisions, or one might be more inclined to allow emotional considerations to play a part, and each of these options might generate an answer, or a kind of answer. But there’s still a problem to solve about which approach one should choose and – more importantly – what the standard is by which to choose. Bluntly, a lot comes down to choosing between the right and the good, because though the good thing and the right thing might be the same in many cases, there’ll also be times when they come apart. (For example, a doctor in the Wooltorton case might think that intervening would be optimific, but that abiding by the refusal would be right.) Yet it’s hard to see how we can say that one ought to be concerned for the right over the good (or vice versa) without either begging the question (“It’s good to be good”) or undermining our own position fatally (“You should be concerned with goodness because it’s just the right conern…”). It’s also tempting to think that the two might be incommensurable anyway – in which case, a preference for rightness over goodness (or goodness over rightness) looks to be the kind of thing that can entertain arbitrariness. And that looks like an itchy position to occupy.
Now, we might think that this is precisely where guidelines and principles come into their own – they help us cut through the noise. However, the point here is that following some kind of decisionmaking rubric would not have solved the moral problem – it’d’ve meant pretending that there was no such thing, and that you can determine what to do by putting all the variables into a morality machine and turning the handle. Moreover, guidelines and principles have to be justified somehow, so the puzzle has only really been deferred.
And I think, too, that we ought not to lose sight of the fact that Wooltorton’s story is a story about people. Adverting to guidlines, principles and rubrics might be an “efficient” way of doing ethics, but it’s also banal. The doctors who saw her in A&E were in a tragic situation, in the truest sense. And there’s a sense in which trying to be dispassionate about a tragic situation does nothing but belittle it.