1. Homer The Odyssey, XII, ‘Scylla and Charybdis’, ch 11. 1–260, (Penguin, Harmondsworth, translated by E V Rieu, 1991 revised edn. by Peter V Jones 179–86).

2. Carl Elliott ‘Meaning What You Say’ in Linda Emanuel (advisory editor), Advance Directives: Expectations, Experience and Future Practice (1993) 4(1) Journal of Clinical Ethics 61 at 61. Whether what Elliott describes as ‘uncontroversial’ can, without more, be agreed upon is of course contested; see Fish, Stanley Doing What Comes Naturally (Oxford, Clarendon Press, 1989)CrossRefGoogle Scholar and There's No Such Thing as Free Speech (…and it's a good thing too) (New York and Oxford, Oxford University Press, 1994) for celebrated introductions to one body of the literature.

3. Several studies have shown how patients change their minds about decisions; see Linda Emanuel ‘Advance Directives: What Have We Learned So Far?’, op cit, 8 at 9, n 18. Of course, one must be careful here to distinguish between competence and sincerity, to which I return, below.

4. Alan Wertheimer ‘Two Questions about Surrogacy and Exploitation’ (1991) Philosophy & Public Affairs 211–241 at 237. Thus, we may hold that expressed wishes should be enforced even when they will do the person harm (or lead to their death). Alternatively, we may say that there are good reasons to depart from their wishes when it will do them harm. I do not enter that particular argument here.

5. ‘Why I Don't Have a Living Will’ in Alexander Capron (ed) ‘Medical Decision Making and the “Right to Die” after Cruzan’ (1991) 19 Law Medicine & Health Care 101 at 104.

6. [1993] 1 All ER 821, [1993] 2 WLR 316.

7. Allen Buchanan ‘Advance Directives and the Personal Identity Problem’ (1988) 17 Philosophy & Public Affairs 277; a person who takes an interest in the well-being of others can use an advance directive to contribute to their own well-being in two ways: (i) while still competent, the author's anxiety about the distress to which loved ones will be subjected in making difficult decisions without guidance will be reduced; (ii)‘… there is a sense in which our interests can survive us. I have an interest in how my family will fare after my death, and that interest survives me in the sense that whether or not it is satisfied will depend on events that occur after I am gone. An advance directive can help me ensure that my “surviving interests” are satisfied.’ (at 278, nl). And see Dworkin, Ronald Life's Dominion: An Argument about Abortion and Euthanusia (London, Harper Collins, 1993)Google Scholar. at 193 and Nancy Jecker. ‘Being a Burden on Others’ in Emanuel, (advisory ed) op cit, 16 at 19.

8. The Report of the House of Lords Select Committee on Medical Ethics (London, HMSO, 1994) HL Paper, 21–1, (hereafter, ‘The House of Lords Report’ or the ‘Select Committee’) at paras 186–203.

9. For a recent consideration see Dworkin, op cit, and the Report of the House of Lords Select Committee on Medical Ethics (London, HMSO, 1994) HI., Paper, 21–1, rejecting arguments in favour of legalisation of euthanasia in the United Kingdom.

10. A full account of the role of law and medical practice at the end of life would, of course, have to consider the practice and scope of euthanasia or physician-assisted suicide, and the role of health care proxies, without which there may exist only a partial understanding of the place of the advance directive. Both these are canvassed in the House of Lords Report.

11. Patrick Devlin ‘Medicine and Law’ in his Samples of Lawmaking (Oxford, Clarendon Press, 1962) 83 at 103.

12. This phrase comes from Gabriel Garcia Marquez Love in the Time of Cholera, (Penguin 1988 edn) (trans Edith Grossman), at 10.

13. Ivan Illich Limits to Medicine: Medical Nemesis: The Expropriation of Health (Harmondsworth, Penguin 1976 edn) at 210. And see Frederick Nietzsche ‘The Twilight of the Idols’16 The Complete Works of Frederick Nietzsche, 1 at 88, quoted in Dworkin Life's Dominion at 212.

14. Ludwig Wittgenstein Tractatus Logico-Philosophicus (London and New York, Routledge, 1922, trans C K Ogden, reprinted 1992), 6.4311. Developments in modem technology may cause us to question whether Wittgenstein's description remains accurate.

15. Hanfling, Oswald Life and Meaning: A Reader (Oxford, Basil Blackwell, 1987) 2.Google Scholar

16. ‘Medical Futility: CPR’ in Lee, Robert and Morgan, Derek (eds), Death Rites: Law and Ethics at the End of Life (London, Routledge, 1994) 72–90Google Scholar. The Royal College of Nursing in evidence to the House of Lords Select Committee on Medical Ethics suggested that‘… many people are not necessarily afraid of death, but are afraid of the manner of death’ (quoted, HL Papers, 21–1, para 187).

17. ‘The Indignity of “Death with Dignity”’ (1974) Hustings Center Studies 47.

18. Robert Pearlman, Kevin Cain, Donald Patrick, Malka Appelbaum-Maizel, Helene Starks, Nancy Jecker and Richard Uhlmann, ‘Insights Pertaining to Patient Assessments of States Worse than Death’ in Linda Emanuel (advisory ed), op cit, 33 at 34. Compare HL Papers 21–1 at para 194.

19. Ibid at 39.

20. Ibid at 35.

21. Tom Scanlon ‘Partisan for Life’New York Review of Books, 15 July 1993. 45 at 48–49.

22. Beyond the New Right: Markets, Government and the Common Environment (London, Routledge, 1993) 167.

23. Ibid 169.

24. Ibid 171.

25. The Law Commission, Consultation Paper No 129, Mentally Incapacitated Adults and Decision Making: Medical Treatment and Research (London, HMSO, 1993) 29, n 18.

26. Ibid.

27. Ibid.

28. HL Paper 21–1, op cit, para 181.

29. A term I use throughout to mean the person (patient or otherwise) who indicates certain pre-emptive concerns about their care.

30. The observation of the BMA Ethics Committee here is pertinent: ‘Although it is sometimes assumed that such examples occur more frequently in textbooks than in reality, the enquiries which the Association receives from members indicate that appropriate treatment of Jehovah's Witnesses is not merely a matter of academic concern, but rather of deep soul searching’ (Medical Ethics Today, 161).

31. Airedale NHS Trust v Bland [1993] 1 All ER 821, [1993] 2 WLR 316.

32. Cruzan v Director, Missouri Department of Health 491 US 261 (1990), discussed extensively in Dworkin, op cit; see also, Peter Alldridge ‘Who Wants to Live Forever?’ in Robert, G. and Morgan, Derek , eds, Death Rites: Law and Ethics at the End of fife (London, Routledge, 1994) 11–36.Google Scholar

33. As Tony Hope commenting on a draft of this paper put it: ‘advance directives are being used in too blanket a way and to solve too many problems at once. They seem to be part of a current obsession that difficult issues in medical ethics can almost always be solved with reference to patient autonomy.’

34. For an eloquent, critical asscssment of the House of Lords' speeches in Bland see John Finnis ‘Bland: Crossing the Rubicon’ (1993) 109 LQR 329–37.

35. I am grateful to Tony Hope for the clarification of this argument. And see LYM ‘Why I Don't Have a Living Will’ in Alexander Capron (ed) ‘Medical Decision Making and the “Right to Die” after Cruzan’ (1991) 19 Law Medicine & Health Care 101 at 102.

36. Being a Burden on Others' in Alexander Capron (ed), op cit, 16 at 19.

37. Ibid at 19.

38. Re J (A Minor) [1992] 4 All ER 614, R v Secretary ofState for Social Services exp Hincks [1992] 1 BMLR 93; R v Secretary of State for Social Services exp Walker [1993] 3 BMLR R v Central Birmingham Health Authority ex p Collier (6 January 1988, unreported).

39. Eg Re J (A Minor) [1992] 4 All ER 614 - court would not force a doctor to treat a child in a way contrary to hidher clinical judgment.

40. See Lawrence Schneiderman, Robert Kaplan, Robert Pearlman and Holly Teetzel ‘Do Physicians’ own Preferences for Life-Sustaining Treatment Influence their Perceptions of Patients' Preferences?’ in Linda Emanuel (advisory ed), op cit, 28 at 30–31; ‘Our data… suggest that physicians are hampered not only by flawed communication, but also by limits to their ability to be empathic - that is to imagine their patients’ feelings and ideas.'

41. The proposals of the House of Lords Select Committee represent a retrenchment from that common law position; see the discussion, below, at text accompanying note 74.

42. Re T (Adult: Refusal of Medical Treatment) [1992] 4 All ER 649, [1992] 3 WLR 782, 9 BMLR 46.

43. Airedale NHS Trust v Bland [1993] 1 All ER 821, [1993] 2 WLR 316.

44. In addition to his oral evidence at first instance, see also Keith Andrews ‘Managing the Persistent Vegetative State’ (1992) 305 British Medical Journal (29 August) 486–87.

45. The traditional formulation of the now hopelessly misused negligence standard as articulated in Bolam v Friern Hospital Management Committee [1957] 2 All ER 118.

46. Life's Dominion (London, Harper Collins, 1993) 180.

47. For a comprehensive review to 1991 see Judith Areen ‘Advance Directives under State Law and Judicial Decisions’ in Alexander Capron (ed), op cit, 91 at 93–97.

48. Patient Self Determination Act 1990, effective from 1 December 1991, see Omnibus Reconciliation Act 1990, PL 101–508, ss 4206,4751, 104 Stat 1388. For a recent update on States' positions in respect of advance directive provisions, see Judith Areen ‘Advance Directives Under State Law and Judicial Decisions’ in Capron (ed), op cit, 91–100.

49. Cruzan v Director, Missouri Department of Health 497 US 261 (1990).

50. 211 NY I25 (1914) at 129–30.

51. Dworkin, op cit, at 187–88.

52. Ibid.

53. Larry Gostin ‘Life and Death Choices after Cruzan’ in Alexander Capron (ed), (1991) 19 Law Medicine & Health Care 9 at 9.

54. Skinner v Oaklahoma ex rel, Williamson 316 US 535 (1942).

55. Gostin, op cit, 10.

56. Ibid.

57. These are reviewed in Linda Emanuel ‘Advance Directives: What Have We Learnt So Far?’ in Linda Emanuel (advisory ed), op cit, 12.

58. Dworkin, op cit, at 254 n 1. And see HL Papers, 21–1, op cit, at para 185.

59. Joanne Lynn ‘Why I Don't Have a Living Will’ in Alexander Capron (ed), op cit, 101 at 102.

60. Emanuel, op cit, 12.

61. Joanne Lynn, op cit, 101 at 102. I do not deal here with the mechanics of making and executing an advance directive, but we live increasingly in the surveillance society and the global village, panoptic places and societies in which our every move is watched, clocked, date-coded and time-recorded. To be seriously considering the written living will, devoid as Lynn rightly says of passion and pathos, is like uttering fables on papyrus while the presses of Gutenberg stand idle.

62. HL Paper, 21–1, op cit, paras 183, 184.

63. HL Paper, 21–1, op cit, para 183.

64. Montgomery ‘Power over Death: The Final Sting’ in Robert G Lee and Derek Morgan (eds) Death Rites: Law and Ethics at the End of Life (London, Routledge. 1994) 37–53.

65. British Medical Association Euthanasia (London, BMA, 1988). para 236, cited in Montgomery, op cit, 38.

66. The Living Will (London, Edward Arnold, 1988), 35.

67. British Medical Association. Statement About Advance Directives, (London, BMA, 1992). 4.

68. British Medical Association Medical Ethics Today: Its Practice and Philosophy (London, BMJ Publishing Group, 1993), 12. House of Lords Select Committee, para 188–89. Perhaps if this objection is to shape the future scope and development of advance directives it would be better if in the majority of cases these were known as ‘advance planning directives’, the ongoing conversational basis of the choices being ernphasised.

69. Ibid 161.

70. Opcit, at 101.

71. Op cit, at 102.

72. ‘Power Over Death: The Final Sting’ in Robert Lee and Derek Morgan, (eds) Death Rites: Law and Ethics at the End of Life (London, Routledge, 1994) 37–53, cited House of Lords Report, para 211.

73. House of Lords Select Committee para 188, citing BM A evidence at 35. So much of this discussion proceeds as though a central feature to be taken into account here was not power and balance in the relationship, and as though information - let alone judgments -could be assigned to a value-neutral vacuum.

74. BMA evidence, quoted in the House of Lords Report at 189.

75. HL Papers, 21–1 at 265.

76. Ibid.

77. And here the value of a central registration system might be displayed, with advance directives available for recall on CD-Rom.

78. Ibid.

79. See a rare consideration of this important question in K. V. Irerson. ‘Forgoing Hospital Care: Should Ambulance Staff always Resuscitate? (1991) 17 Journal of Medical Ethics pp 19–24.

80. Cited House of Lords Report at 196.

81. Ibid.

82. Opcit, at 12.

83. See F G Ingelfinger ‘Arrogance’ (1980) 304 New England Journal of Medicine 1507–11; ‘I do not want to be in the position of the shopper at the Casbah who negotiates and haggles with the physician about what is best, I want to believe that my physician is acting under a higher moral principle than a used car dealer. I'll go further than that. A physician who merely spreads an array of vendibles in front of his patient and then says “Go ahead, you choose, it's your life” is guilty of shirking his duty, if not malpractice.’ Cited in John Saunders, op cit, 81.

84. The work particularly of Phillipe Arits is associated with a critical history of this development; see, inter alia his The Hour of Our Death (New York, Vintage Books, 1982).

85. Re T (Adult: Refusal of Medical Treatment) [1992] 4 All ER 649, [1992] 3 WLR 782, 9 BMLR 46.

86. Airedale NHS Trust v Bland [1993] 1 All ER 821, 119931 2 WLR 316.

87. An edited version of trial judge Ognall J's summing up to the jury is reported at 12BMLR 38–49, and is the subject of commentary by Andrew Grubb at [1993] 1 Med Lav Rev 232.

88. This limitation in respect of medical treatment is, of course, important; if a procedure is medical treatment its disposition, commencement and termination is a matter of clinical judgment and insofar as an advance directive concerns medical treatment and care, it can only make directions which fall within that scope. It cannot impose a binding obligation on anyone to do something which would be unlawful or contrary to public health, such as excluding basic care.

89. Re T [1992] 4 All ER 649 at 653 per Lord Donaldson. I do not deal here with the question of whether choice has, by definition, to have a minimum content, such that as a matter of logic it is inappropriate for Donaldson to write of ‘non-existent’ reasons.

90. Re T [1992] 3 WLR 782 at 797.

91. As Andrew Grubb points out the anticipatory refusal thus has three elements; competence, scope and undue influence; see Grubb (1993) 1 Med Law Rev 83 at 85–7.

92. Malene v Shulman (1990) 67 DLR (4th) 321, Fleming v Reid (1991) 82 DLR (4th) 298.

93. And which seems to have been critical in the setting of the terms of reference if not the establishment of the House of Lords Select Committee (of which Mustill was a member) to consider these issues.

94. At 892b-d.

95. 52 NY 2d 363 (1981).

96. [1993] 1 All ER 821 Lord Keith at 860a-b.

97. [1993] 1 All ER 821 Lord Goff at 866b-e. For the Court of Appeal's consideration of this point see Lord Justice Butler-Sloss [1993] 1 All ER at 843a, Sir Thomas Bingham at 835–36 and Lord Justice Hoffman at 852–54.

98. Emanuel op cit at 11.

99. Ibid.

100. For a good introductory discussion of the general principles involved see Paul Appelbaum and Thomas Grisso ‘Assessing Patients’ Capacities to Consent to Treatment' (1988) 319 New England Journal of Medicine 1635–38. More comprehensive is P S Appelbaum, C W Lidz and A Meisel Informed Consent: Legal Theory and Clinical Practice (New York, Oxford University Press, 1987). passim.

101. Emanuel op cit 11.

102. Ibid.

103. [1994] 1 All ER 819.

104. Ibid at 822c.

105. Ibid at 823h. my emphasis.

106. Re R (Wardship: Consent to Treatment) [1992] Fam 11 at 26.

107. 9 BMLR 22.

108. A test drawn from Chatterfan v Gerson [1981] 1 All ER 257 in respect of consent sufficient to avoid an allegation of battery.

109. Re T 9 BMLR 46 at 50–51, per Lord Donaldson.

110. Ibid.

111. BMLR 46 at 50–51.

112. I use this term to encompass written directives and those committed to some other permanent form.

113. Ibid.

114. 9 BMLR at 59.

115. Cf the BMA's Medical Ethics Today, op cit at 162.

116. (1993) 1 Med Law Rev at 87.

117. See the Termination of Medical Treatment Bill, House of Lords Bill 70, introduced by Lord Alport on 25 February 1992, and the more extensive and considered Medical Treatment (Advance Directives) Bill, House of Lords Bill 73, introduced by Lord Allen of Abbeydale and given its first reading 16 March 1993.

118. In its Consultation Paper No 129, Mentally Incapacitated Adults and Decision-Making: Medical Treatment and Research (London, HMSO, 1993). Pts V and VI. A full consideration of these proposals is beyond the scope of this present paper.

119. See Law Commission, op cit pp 28–33.

120. Ibid 41; this is based on an argument by Andrew Grubb (1993) 1 Med Law Rev at 85) that a public policy prohibition on the refusal of nursing care should be enshrined in order to protect the interests of health professionals and other patients who would be affected by such a refusal.

121. bid 4142.

122. Ibid 42.

123. See E L Schucking ‘Death at a New York Hospital’ (1985) 13 Law, Medicine & Health Care cited also Gostin at 11.

124. A prominent example here is the Canadian province of Ontario, which in 1992 enacted the Consent to Medical Treatment Act which makes provision, inter aha, in s 12 for advance directives such that a person may, while capable, express wishes with respect to treatment in a power of attorney, in a prescribed form, in another written form, orally, or in any other manner.

125. Law Commission, op cit 31–2.

126. Ibid 36.

127. Ibid 44–45.

128. HL Papers 21–1. paras 181–215 and 263–67.

129. Ibid para 265. At the request of the Colleges, the British Medical Association convened a Working Party in September 1994 to draft a preliminary version of that Code.

130. Ibid para 264.

131. Ibid

132. Ibid para 264; emphasis added.

133. Bolam v Friern Hospital Management Committee [1957] 2 All ER 118.

132. Ibid para 264; emphasis added.

133. Bolam v Friern Hospital Management Committee [1957] 2 All ER 118.

134. Ibid para 264; emphasis added.

135. Ibid emphasis added.

136. Joanne Lynn op cit, 102 has warned that ‘…the issues that have become conventional to deal with in extended-version living wills are but a frail reflection of the concerns that very sick patients actually express. In fact, some of their real concerns have almost completely lost a place in the discussion of any kind of formal advance directives. Many patients are concerned about the emotional, physical and financial burdens that their prolonged existence might entail for family. So often one hears, “I don't want to be a burden”, and so often we fail to have the ability, within this culture, to acknowledge and explore that sentiment.’

137. This point is explicitly endorsed by a number of the judges in the cases of both Bland and Re T, see above. This assumption and the objections to which it may be subject are explored in Buchanan, op cit, n 51.

138. Although I have not adequately dealt with this question in this version, attention will need to be addressed to the concerns raised by the arguments of Allen Buchanan, ‘Advance Directives and the Personal Identity Problem’ (1988) 17 Philosophy & Public Affuirs 277–302.

139. See Law Commission, op cit, 42, emphasis added.

140. [1993] 1 All ER 821 at 861 g. I have to their evident bewilderment tried to explain this bizarre nomenclature to European colleagues. Unsuccessfully.

141. See [1993] 1 All ER 821 at 847b. citing the majority opinion of Abrams J in the Massachusetts Supreme Court in Guardianship of June Doe 411 Mass 512 (1992). Later in her judgment she seems to suggest that an incompetent person might have the same interests as a competent one; ‘We all of course recognise that a patient unable to choose cannot himself exercise his right of self-determination and he cannot make the irrational decision he might notionally have made if in possession of his faculties. But not to be able to be irrational does not seem to me to be a good reason to be deprived of a rational decision which could be taken on his behalf in his best interests … A mentally incompetent patient has interests to be considered and protected …’ (at 848a-b).

142. At 4926.

143. R L Stephens ‘Duties to the Incompetent: A Specific Examination of the Morality of Dealing with Patients in a Persistent Vegetative State’, 12–13; unpublished MA thesis on file at University College Swansea. I am grateful to Dr Stephens for permission to quote from this thesis.

144. Notice that Brennan speaks of the ‘right to have the feeding tube withdrawn’; only Stephens of the ‘right to refuse’.

145. I am grateful to Hugh Upton for his clarification of the views I have attempted to present in this paragraph. Whether he would recognise them is another matter.

146. Buchanan, op cit, 278.

147. Ibid 279.

148. Ibid.

149. Ibid 280. Although this question did not arise in the case of Tony Bland, who had made no anticipatory choice, the thrust of Buchanan's objection here can be tested by asking what, in crude philosophical terms, we might make of this observation by Sir Stephen Brown in the Family Division of the High Court; ‘… Anthony Bland is in a condition known as the persistent vegetative state. He has no feeling, no awareness, nor can he experience anything relating to his surroundings. To his parents and family he is “dead. His spirit has left him and all that remains is the shell of his body …The fact that Anthony Bland's existence will terminate [when nasogastric feeding is withdrawn] does not in my judgment alter the reality that the true cause of death will be the massive injuries which he sustained in what has been described as the Hillsborough disaster’ ([1993] 1 All ER 821 at 832d,h).

150. ‘Life, Death and Incompetent Patients: Conceptual Infirmities and Hidden Values in the Law’ (1986) 28 Arizona Law Rev 379.

151. Ibid cited in Buchanan 281–82.

152. Buchanan, op cit, 282. A more radical formulation of the indeterminacy of personal identity is suggested in Allan Hutchinson ‘Identity Crisis: The Politics of Interpretation’ (1992) 26 New England Law Review 1173; ‘… by taking identity as something to be recovered and fixed, identity politics seems to freeze in place the positionality of people and reduce the options for personal and collective transformation … For the postmodernist, the recognition of identity constitutes only a starting point, not an achievement, ambition or program.’ (at 1212–13).

153. Buchanan, op cit, 294, discussing Derek Parfitt Reusom and Persons (Oxford, OUP, 1986).

154. Ibid 300–01.

155. Ibid 301.

156. Joanne Lynn ‘Why I Don't Have a Living Will’ (1991) 19 Law Medicine & Hea Care 101 at 101. This recalls the point made by Montgomery and Grubb, above, that more precise the instructions given in an advance directive, and the more precise grounds for triggering its implementation, the greater the likelihood that a general intent to avoid life sustaining procedures or treatments will be defeated. To this extent, liv wills are in danger of being submerged into the Chancery Division mentality of charita intention and the cy-pres doctrine.

157. Elliott, op cit, at 61.

158. Lynn, op cit, at 102.

159. Hutchinson, op cit, at 1188.

160. Ibid 1192, note omitted.

162. Leon Kass ‘Is There a Right to Die?’ (1993) 23(1) Hustings Center Report 34 at 34.

163. Ibid.

164. Dworkin Life's Dominion (London, Harper Collins, 1993).

165. Ibid 211. As Tom Scanlon, puts it in his review, ‘Partisan for Life’, New York Review of Books, 15 July 1993, 45 at 48–49. ‘If experience is all that matters to our interests then we should be indifferent about what is done to us under [various] conditions. But most people are not indifferent. In order to make sense of what many people say about life and death, then, we must allow that the quality of a life can depend not only on the quality of the experience that makes it up but also the degree to which that life meets certain critical standards … People differ in the particular standards that they want their lives to meet- in what Dworkin calls their “critical interests”—but almost everyone recognises some standards of this kind and many people care greatly about meeting them … But this depends on what the person's critical interests are. Dworkin suggests that being kept alive in some circumstances can be contrary to a person's best interests not only when it is painful but also simply because it is so incompatible with the way that person wanted her life to go, and to end.’

166. Ibid 25.

167. Of course, there are many who argue that the sacred value which these lives have is not confined to human animals and, for some, not enjoyed by all human animals.

168. Dworkin, op cit, 216.

169. Gray, op cit, at 171.

170. John Finnis ‘Bland: Crossing the Rubicon’ (1992) 109 LQR 329–37.

171. Lynn, op cit, at 102.

172. Thomas Finucane, Brock Beamer, Robert Roca and Claudia Kawas ‘Establishing Advance Medical Directives with Demented Patients: A Pilot Study’ in Emanuel (advisory ed), op cit, 51 at 51.

173. See Emanuel, op cit, at 13 n 55.

174. ‘A Death of One's Own’ in J Bell and S Mendus (eds), Philosophy and Medical Welfare (London, Sage 1988) at 14.

175. Gostin, op cit, at 11.

176. Re F (mental patient: sterilisation) [1990] 2 AC 1.

177. Re S [1992] 4 All ER 671.

178. Re T [1992] 4 All ER 649.

179. Re J [1992] 4 All ER 614.

180. Paul Ramsey ‘Death's pedagogy’ (1974) 20 Commonwealth 497.

181. Gabriel Garcia Marquez Love in the Time of Cholera, (Penguin 1988 edn) (trans Edith Grossman), at 348. For an example of what might be meant by this in the current context see, for example, B D Cohen Karen Ann Quinlun: Dying in an Age of Eternal Life (New York, Nash Publications, 1976) and Robert and Peggy Stinson The Long Dying of Baby Andrew (Boston, Little Brown, 1983).

182. Since this article was accepted for publication I have accepted an invitation to chair the BMA committee drafting the recommended Code of Practice. Nothing in this article reflects the views of that committee nor suggests directions which the committee may follow.