Medical law and ethics – a smoky debate
It would be very simple to centre a short article on medical law around a well-known topic such as abortion or euthanasia. However, as well as being rather illustrious, it would fail to highlight the most fascinating precept of medical law– the principle of autonomy. Autonomy, for our purposes, can be defined as an individual’s right to govern themselves as they wish. At first glance, it seems right that there should be no limitations on how an individual can exercise autonomy over their own body. Do you agree? The rest of this article shall demonstrate how this seemingly uncontroversial statement produces many complex questions. To do this we shall use a situation involving fictional characters that could quite easily exist.
Anna is a 25 year old woman who does not suffer from any serious medical conditions but she smokes 30 cigarettes a day and has done for years. Some people would opine that Anna’s autonomy should be limited because smoking is an unhealthy habit and will cause her long-term health problems, such as a much higher risk of lung cancer. However, most people would agree that Anna is an adult and can therefore choose to smoke if she so wishes. In this scenario, in exercising her autonomy to smoke cigarettes, she is not impinging upon, or negatively affecting another individual’s autonomy.
Anna is married to Bernard, who is a severe asthmatic. Anna’s excessive smoking triggers violent asthmatic episodes in Bernard every day, requiring him to take much more medication than he should have to. This medication increases Bernard’s risk of contracting pneumonia, developing cholesterol problems, and osteoporosis. Should Anna’s autonomy be limited in this scenario? Most people would agree that Anna’s autonomy should be limited here because of the detrimental effect her smoking could have upon Bernard’s long-term health. However, most people would not feel obliged to ‘step in’ or expect medical professionals to ‘step in’ here either, as Bernard is an adult of sound mind who has chosen to, taken the autonomous decision to, live in the environment that he does.
Anna finds out she is pregnant and continues to smoke regularly. Anna’s doctor informs her that smoking whilst pregnant will damage the health of the baby, Cynthia. Should Anna’s autonomy be limited in this scenario? The vast majority of people would answer yes here. Why? In English law as a general statement, the unborn baby does not have legal rights until it is born. Why, then, do we feel a paternalistic or protective duty to Cynthia, to stop Anna from smoking? It is because we are recognising that Anna’s exercise of autonomy is resulting in harm to another individual, Cynthia. So we can deduce that Anna’s autonomy ought to be limited if, in her exercise of autonomy, she causes harm to another. Perhaps we feel a stronger sense of outrage in harm caused to Cynthia rather than Bernard because Cynthia, being an unborn baby, cannot stand up for herself, or exercise her rights as an autonomous individual.
I hope this short example involving A, B and C has revealed just how many complex questions medical law and the associated ethical issues generate. To find out more, the Journal of Medical Ethics website contains a library of articles on topical medical law issues, http://jme.bmj.com/ Look out for next month’s article on ‘Company law’.
Undergraduate in Law,