Professor Desmond O'Neill:

Yes, there is. Sometimes the debate gets phrased in the sense of people not having a say in their death. That is not at all true. What is interesting in this area is that the people who perhaps generate most of the concern about this are the people who deal most with people who are dying. A high priority is given to what the person says and wants. There is never any question of us telling people they cannot have something and that we are happy for them to die in suffering. That is completely not the case.

The key problem relates to disconnecting autonomy from the other principles around it and seeing autonomy as a complete good in itself. One of the key writings to read on this are those by the former chair of UK Human Rights Commission. She is a distinguished philosopher called Onora O'Neill. She has written tellingly about how autonomy has to be embedded with not doing harm, doing good and justice, not only for the person but also for those around that person and for society. We are often asked in healthcare for things that would really cause great challenges. We have moved well away from any sense of what is called paternalism. Edmund Pellegrino talked about the good doctor being a moderate autonomist and a moderate welfarist.

People come to us in trouble and suffering, and we are there to support them. There are obviously asymmetries of knowledge and one of our journeys is to try to correct and get to know each other. Autonomy has to be considered relative to other areas. In the United States, for example, autonomy is about having a gun, and we can see the havoc that wreaks. People say, "It is my right to have a gun." In New Hampshire you can ride a motorbike without a bike helmet. We cannot. We have decided there are limits to autonomy.