Kerrie Wooltorton, who drank poison and refused life saving treatment, made choices that were challenging for those around her. She decided that she no longer wanted to live her life and took steps to end it. She also decided that, whilst she wanted to be cared for as she died, she did not want life saving or life prolonging intervention, even if this was available.
Neither of these decisions are in themselves unusual, but taken together they do illustrate the demanding aspects of respecting someone’s decisions about the course of their own life. The principle of respecting someone’s choices about their own life is commonly referred to in medical ethics as respect for autonomy, and it is a guiding principle in the way that medicine is practised in the UK today.
It is respect for someone’s autonomy that requires informed consent to be sought before any treatment or interventions can be given, and it is this consent that Kerrie Wooltorton withheld.
Consent to treatment can be given or withheld by any competent adult, and there is nothing to suggest that Kerrie was not competent – she fully understood the implications of her actions, and the clinicians involved took great pains to check this.
What’s important to stress here is that when someone makes a decision to refuse treatment, their reasons don’t have to make sense to anyone else, and they don’t have to be in favour of life over death.
Difficult situations such as this one have arisen before – and will do so again. In 2002, a 40 year old woman known as Ms B went to the High Court to have her ventilator turned off, following a car accident that left her unable to breathe without mechanical assistance. [This case was featured in the British Medical Journal].
The judge in the case, Dame Elizabeth Butler-Sloss, ruled that Ms B’s doctors were wrong to refuse to discontinue treatment (in this case the ventilator) against Ms B’s wishes, even though this would lead to her death.
In an even more challenging case, a contributor to The Open University course Death and Dying talks about how difficult it was to respect the decision of someone she was caring for to refuse medication which might save his life, as he did not want drug companies to profit from his illness. To many people this will seem to be an unreasonable decision, but this does not make it any less valid.
The fact that Kerrie Wooltorton wrote an advance directive, or living will, does not really alter the facts of this case. One of the concerns that is sometimes expressed about advance directives is that they may become out of date, the person involve might change their mind or treatment options might change.
This was not the case for Kerrie – her decision was made at the time of her suicide. In fact, it is likely that she didn’t need her advance directive as she was able to communicate her wishes directly at the time. (An advance directive is intended to convey someone’s wishes about treatment and care should they become unable to communicate these themselves.)
In this respect, this case isn’t about advance directives or living wills at all, it’s about someone making decisions that other people find distressing and difficult to respect.
Find out more
“Unlawfully treated” woman to move to new unit
by C Dyer, C in the British Medical Journal 2002, 324:7340 p753
Discover more about The Open University's Death And Dying course.
Derek Matravers talks to Rebekah Ley, Convenor of the clinical ethics committee for Addenbrookes Hospital
