Thank you to Drs Scott-Orr and Mela for their interest. It seems to me that there are two issues here. First, should the law be discriminatory between patients with a physical illness and those with a mental illness? I think not and I’m pleased to say the United Nations Convention on the Rights of Persons with Disabilities (2006), to which the UK is a signatory, supports this view. The convention obligates States to (among many other things) ‘take all appropriate measures, including legislation, to modify or abolish existing laws, regulations, customs and practices that constitute discrimination against persons with disabilities’. To explain this further, the UN High Commissioner for Human Rights said, 1
‘Legislation authorizing the institutionalization of persons with disabilities on the grounds of their disability without their free and informed consent must be abolished… This should not be interpreted to say that persons with disabilities cannot be lawfully subject to detention for care and treatment or to preventive detention, but that the legal grounds upon which restriction of liberty is determined must be de-linked from the disability and neutrally defined so as to apply to all persons on an equal basis.’
Second, should the law (for everyone) favour patient autonomy, medically determined best interest or a mixture?
In other words, either everyone, with the capacity to make the decision, should be permitted to ‘die (or rot) with their rights on’ or nobody should. Or the authority to overrule capacitous refusal could be based on a neutral factor such as risk to other people. It should not be dependent on the stigma associated with certain terminology (a mental illness diagnosis).
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