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The philosophical problem
Making a decision to withdraw or withhold treatment on behalf of another person is
essentially a value judgement. Veatch explains the influence of values in best interest
determinations.
The value choices that go into a judgement about what is best for
another are so complex and subtle…. unconscious value distortions will
not only influence the clinician's judgement about what is best, but even
influence the very interpretation of the scientific data.
Veatch, 1995, p. 11
Values are the expression of the subjective, human self. They stem from our
experiences, our upbringing, the people around us, our education, our religions, our
cultures, our societies and our emotions. Values are instrumental in guiding ongoing
activities, resolving conflicts and making decisions (Rescher, 1982)
There is a common misperception, however, which claims that personal value
judgements can, and should be, removed from human reasoning and good science
(Loughlin, 1998). This view is influential in medicine and law, resulting in the
mistaken belief that objective value free reasoning is possible and even preferable. This
results in a fundamental philosophical incongruity when best interest determinations are
made using a combination of medical fact centred approaches and positivist legal
process. Best interest determinations which raise complex ethical questions are reduced
to medical facts and clinical judgement, and portrayed as objective and value-free.
Consider the following case.
Re Y [1997] (England)
Y was a 25 year old woman who was severely mentally and physically handicapped.
Y’s sister (the plaintiff) suffered from a bone marrow disorder. For a number of years,
Y’s sister had undergone extensive chemotherapy. There had been a recent
deterioration in her sister’s condition and there was a strong likelihood that her situation
would progress to leukaemia in the next 3 months. The only realistic prospect of
recovery for the plaintiff was a bone marrow transplant operation from a healthy
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