{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T14:17:20Z","timestamp":1789913840834,"version":"4.0.1"},"reference-count":22,"publisher":"BMJ","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Ethics"],"published-print":{"date-parts":[[2003,2]]},"abstract":"<jats:p>This paper discusses the role of consent in decision making generally and its role in end of life decisions in particular. It outlines a conception of autonomy which explains and justifies the role of consent in decision making and criticises some misapplications of the idea of consent, particular the role of fictitious or \u201cproxy\u201d consents.<\/jats:p><jats:p>Where the inevitable outcome of a decision must be that a human individual will die and where that individual is a person who can consent, then that decision is ethical if and only if the individual consents. In very rare and extreme cases such a decision will be ethical in the absence of consent where it would be massively cruel not to end life in order to prevent suffering which is in no other way preventable.<\/jats:p><jats:p>Where, however, the human individual is not a person, as is the case with abortion, the death of infants like Mary (one of the conjoined twins in a case discussed in the paper), or in the very rare and extreme cases of those who have ceased to be persons like Tony Bland, such decisions are governed by the ethics of ending the lives of non-persons.<\/jats:p>","DOI":"10.1136\/jme.29.1.10","type":"journal-article","created":{"date-parts":[[2003,2,5]],"date-time":"2003-02-05T05:48:21Z","timestamp":1044424101000},"page":"10-15","source":"Crossref","is-referenced-by-count":75,"title":["Consent and end of life decisions"],"prefix":"10.1136","volume":"29","author":[{"given":"John","family":"Harris","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2003,2,1]]},"reference":[{"key":"2024052910382682000_29.1.10.1","unstructured":"This essay draws on thoughts first published in a number of places including my life and death. In: Craig E, ed. Routledge encyclopaedia of philosophy. London: Routledge, 1998 and in my Euthanasia and the value of life, and other essays by myself and John Finnis on euthanasia, in: Keown J, ed. Euthanasia examined: ethical, clinical, and legal perspectives. Cambridge: Cambridge University Press, 1995: 6\u00e2\u0080\u009371."},{"key":"2024052910382682000_29.1.10.2","unstructured":"Lord Mustill in Airedale NHS Trust v Bland [1993] 1 All England Rep 821 HL. I argued for the symmetry of acts and omissions in my The Marxist conception of violence. Philosophy and Public Affairs 1974;3:192\u00e2\u0080\u0093221, and in Violence and responsibility. London: Routledge and Kegan Paul, 1980."},{"key":"2024052910382682000_29.1.10.3","doi-asserted-by":"crossref","unstructured":"See my euthanasia and the value of life, and other essays by myself and John Finnis on euthanasia in Keown J, ed. Euthanasia examined: ethical, clinical, and legal perspectives. Cambridge: Cambridge University Press, 1995: 6\u00e2\u0080\u009371.","DOI":"10.1017\/CBO9780511663444.003"},{"key":"2024052910382682000_29.1.10.4","unstructured":"http:\/\/news.bbc.co.uk\/hi\/english\/uk\/scotland\/newsid_625000\/625680.stm."},{"key":"2024052910382682000_29.1.10.5","unstructured":"I argued against the relevance of the moral distinction between acts and omissions in my Violence and responsibility. London: Routledge and Kegan Paul, 1980. This irrelevance has recently and belatedly been recognised by the highest court in the United Kingdom. See Lord Mustill\u00e2\u0080\u0099s judgment in Airedale NHS Trust v Bland [1993] 1 All England Rep 821 HL."},{"key":"2024052910382682000_29.1.10.6","unstructured":"Quoted in Steiner H. A theory of rights. Oxford: Blackwell, 1994: 258."},{"key":"2024052910382682000_29.1.10.7","unstructured":"Re W [1992] 4 All ER 627."},{"key":"2024052910382682000_29.1.10.8","doi-asserted-by":"crossref","unstructured":"See my Violence and responsibility, London: Routledge and Kegan Paul 1980; The value of life. London: Routledge, 1985 and The concept of the person and the value of life. Kennedy Institute of Ethics Journal 1999;9:293\u00e2\u0080\u0093308.","DOI":"10.1353\/ken.1999.0026"},{"key":"2024052910382682000_29.1.10.9","unstructured":"See The value of life, London: Routledge and Kegan Paul, 1985 and 1992: ch 1."},{"key":"2024052910382682000_29.1.10.10","unstructured":"Dworkin R. Life\u00e2\u0080\u0099s dominion. London: Harper Collins, 1993. See, for example, ch 3."},{"key":"2024052910382682000_29.1.10.11","unstructured":"See The value of life. London: Routledge and Kegan Paul, 1985 and 1992."},{"key":"2024052910382682000_29.1.10.12","unstructured":"My account of this case follows that given in my euthanasia and the value of life: see reference 3."},{"key":"2024052910382682000_29.1.10.13","unstructured":"Re C [1989] 2 All ER 782 and Re J [1990] 3 All ER 930."},{"key":"2024052910382682000_29.1.10.14","unstructured":"Airedale NHS Trust v Bland [1993] 1 All England Rep 821 HL."},{"key":"2024052910382682000_29.1.10.15","unstructured":"Frenchay Healthcare NHS Trust v S, Court of Appeal, judgment, January 14 1994."},{"key":"2024052910382682000_29.1.10.16","unstructured":"Cruzan v Director, Missouri Department of Health, 497, US 261, 1990."},{"key":"2024052910382682000_29.1.10.17","doi-asserted-by":"publisher","DOI":"10.1093\/medlaw\/9.3.221"},{"key":"2024052910382682000_29.1.10.18","unstructured":"Siamese twin parents named. BBC News Online: http:\/\/news.bbc.co.uk\/hi\/english\/health\/newsid_1058000\/1058223.stm posted 6 December 2000."},{"key":"2024052910382682000_29.1.10.19","unstructured":"See also Re A (children) (conjoined twins: surgical separation) 2000. 4 ALL ER 972, per WARD LJ."},{"key":"2024052910382682000_29.1.10.20","unstructured":"Bunyan N. \u00e2\u0080\u009dBright and alert\u00e2\u0080\u009d Jodie makes rapid progress. Daily Telegraph Online: http:\/\/www.lineone.net\/telegraph\/2000\/12\/16\/news\/bright_45.html posted 16 December 2000."},{"key":"2024052910382682000_29.1.10.21","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1093\/medlaw\/9.3.221","volume":"9","year":"2001","journal-title":"Medical Law Review"},{"key":"2024052910382682000_29.1.10.22","unstructured":"Adapted from Herbert Hart\u00e2\u0080\u0099s famous (true?) example in his intention and punishment in his Punishment and responsibility, Oxford: Oxford University Press, 1968."}],"container-title":["Journal of Medical Ethics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jme.29.1.10","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,29]],"date-time":"2024-05-29T17:38:50Z","timestamp":1717004330000},"score":1,"resource":{"primary":{"URL":"https:\/\/jme.bmj.com\/lookup\/doi\/10.1136\/jme.29.1.10"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2003,2]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2003,2,1]]},"published-print":{"date-parts":[[2003,2]]}},"alternative-id":["10.1136\/jme.29.1.10"],"URL":"https:\/\/doi.org\/10.1136\/jme.29.1.10","relation":{},"ISSN":["0306-6800","1473-4257"],"issn-type":[{"value":"0306-6800","type":"print"},{"value":"1473-4257","type":"electronic"}],"subject":[],"published":{"date-parts":[[2003,2]]}}}