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

I am wondering what is happening to the concept of death in the age of the Internet. We know that we are finite beings. Death, we say, is a fact of life. To deal with this fact, or in other words, to deal with our knowledge of our finitude, we are told, we aspire to leave traces in this world so that our afterlife continues. Every major religion and belief systems has something to say about the afterlife. As we understand our finitude, we are drawn to leave traces of ourselves such as doing good (or evil) deeds, create (or destroy) works of art and science, or produce and raise children.

To leave these traces is a reflection of that understanding of finitude. By giving meaning to life, which remains forever mysterious, we deal with that mystery and leaving traces of ourselves is a way of doing that. To put it in another (perhaps in a lighter) way, we not only constantly engage in ‘reputation management’, as consulting spinners might put it, in this life but also after our own death.

One might object to this idea of being human as either ethnocentric (i.e., Western) or an ideology of the creative classes. For millennia many humans came and went without a trace, one might say. But that doesn’t negate that their understanding of their finitude has always driven humans. The ways and means of leaving traces are unequal but always present. In fact, social historians have been working hard to recover the traces of those ordinary men and women who did not have the means or ways to preserve or maintain traces of their lives. The Internet provides new ways and means of leaving traces. I don’t know how many millions of people are on it. But quite a few are leaving traces via various ways and by now well-known means. There are rapidly increasing traces of lives on the Internet. From wedding and travel pictures, diaries and video clips to announcements and just about anything else you can imagine traces of lives are being recorded. People move from site to site, avatar to avatar, identity to identity and keep expanding their traces in texts, audio and video.

Without prejudice to the quality or meaning of such traces it is good to remember that the ways of leaving traces about oneself was for long limited to mostly educated or wealthier (sometimes both) classes.

But the Internet may change all that. I am curious about the traces that we leave on the Internet because it is fairly new and because the generation that participated in its creation and formation is relatively young and is yet to experience finitude. As such the number of dead people on the Internet is small and so to are the traces that can be investigated.

Once in a while when an exceptional or unusual death occurs many journalists and others turn to these traces to assemble together some meaning about the life that has just disappeared. It is not even correct to say that it has disappeared. The person may be deceased but life on the Internet remains through its traces. All those texts, videos, images, and audio begin to take on new meaning now that their creator has deceased. Beyond assembling together a meaning from these traces I am wondering how will this experience affect our concept of death? The posthumous fame or infamy that awaits us on the basis of traces we have left is a curious thing. I wonder if the newly emerging sites such as Internet memorial walls and Internet cemeteries are early responses to assemble our own traces to be made available upon our death—a kind of Internet autobiography?

About the author

Engin F Isin is professor in politics and international studies and director of the Centre for Citizenship, Identities and Governance at the Open University.

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