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Substituting a Judgment of Best Interests: Dignity and the Application of Objective Principles to PVS Cases in the U.K.

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image of European Journal of Health Law

The mêlée that surrounded the last days of Terri Schiavo's life was reminiscent of a classical Greek tragedy. Much like Antigone, Ms. Schiavo became enmeshed in irresistible and opposite forces, resolved to use her situation as an arena for the determination of political and legal issues as diverse as the exercise of states' rights, the extent of individual rights, the role of the judiciary, the re-opening of the abortion debate, and the regulation of stem cell research. As Europeans watched the drama unfold, the forces at play in the United States clashed head-on, in a rhetorically inflammatory spectacle which, on this side of the Atlantic, left many aghast. Most unsettling was the prospect of individuals wielding the power of state and national legislatures in what was, ultimately, an intensely personal affair.

In the United Kingdom, the struggle was a stark reminder of the differences, not only between British and American political culture, but between our approaches to legal issues which present themselves at the end of life. The existence of well-established procedures and principles, and the extensive involvement of neutral third parties and the courts in pursuit of an objective determination of an individual patient's 'best interests', are key to the conclusion that Terri Schiavo's case would have been handled at least as effectively and efficiently as it was by the courts in Florida and the United States. That issues of consent and capacity can be determined by British courts on the basis of generally applicable principles leads to the subsequent conclusion that a 'best interests' determination leaves significantly less scope for conflict than the individualistic, much more personal and determinative construct of the 'substituted judgment' test in the United States.


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