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Jennifer's here said to me, How did you get into this? I said, Well, I fell into that.

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I had information I had never had. Of course, in bioweapons they didn't exist.

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Can have it. And how did I get into the issue of nutrition fluid?

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Jenny asked, and I said, Well, that was in the great American style. There was a court case and I.

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Testifying that this morning afternoon did grand rounds of Radcliff and the physician who was introducing the question

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had to do with removing artificial of nutritional fluid from a patient who wanted to starve himself to death.

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And she said, We have never seen a case like this.

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So I said, Well, I have bad news for you in discussing this issue since the 16th century, and we have a long history of it.

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And there are, as you can imagine, long, long cases in the United States on this.

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It began there and it hasn't ended. It did go on.

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Pretty much that issue has been resolved legally, at least the United States.

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The question is, how did this all happen?

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Well, Americans, Alexis de Tocqueville writing in the 1930 1830s and democracy America came to the United States and observed it instead.

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These Americans had a really strange way of behaving. He wasn't the first to observe that.

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No, the last. But he said what they do is they make all of life's moral dilemmas transform into legal problems and run the courts.

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They tell us what we should think, and the judges are not terribly desires, he says.

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I tell you, when you talk to judges, the last thing in the world to get a medical case.

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In fact, in one of the famous case we had in Boston, Brophy case about nutrition of fluid.

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The judge in the probate court was so reluctant to hear it that after six weeks, he still hadn't responded by disappearing.

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And I told the attorney to go to the appeals court and inform them,

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and the appellate judge said, Why are you here three months after this emergency order?

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Because I feel as though the judge in the appeals court picked up the phone call.

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The trial judge said he was scheduled for Monday morning.

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What do you think the trial judge is going to do?

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He didn't want to hear it so much. The easiest way not to hear it. He went on vacation.

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He was subsequently removed from the bench by the Supreme Court on the grounds that he absolutely refused to hear cases involving controversy.

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It's sort of like being a firefighter. I'm not going to have smoke coming out of it.

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This is not a fire. But that's what we have.

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The first of these cases occurred in Calif, in the United States.

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And part of it is in Pellegrino wrote a wonderful little article years ago in JAMA, said,

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You can divide all of medical history into three parts from the apocalypse to 1960, from 1960 to 1990.

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Whatever happened from 1990 on, from 1990 until just chaos prior.

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But the first part, he said, from the properties to about 1960 was really kind of not 1950.

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Nothing much changed. And there was very little that the physician could do.

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And so they used very little. Everything you could do was that little black bag that marked off the position and you couldn't do much.

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And most people died of overwhelming sepsis. Life expectancy, about 40 years old or so.

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And this whole question about the use of artificial cushion fluid and making people's lives just like never occurred.

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Why not? Because you couldn't. We didn't have any way to feed them.

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In fact, if you used a simple IV, how long can that be useful?

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As this thing to sustain was still fresh and hours, days, hours, not very long.

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And then they had the simple little flexible, relatively cut down the nose of the patient.

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Isaac Hale But we didn't really have permanent nutrition until your lifetime and

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when it originally came and could only be done by surgeons in the hospital.

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So we had one set of viewers masters who could do it, but it wasn't a common procedure.

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And without those lipids and fats, you couldn't really sustain the individual for very long pretty for us.

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So we knew we had patients, this technology. And Pellegrino rightly said the technology came in and it changed everything.

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And now that we have this technology, the question is granted, it can be done, should it be done?

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And the technology is such that the battery, which I suppose is second from those can concerned for life.

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It should be a so-called declaration of euthanasia in 1980.

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And Part four says we have to protect patients now from the potential abuse that occurs from this technology.

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We have this technology and part of this great technology we can stave off.

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That's what we can't restrain the function of the degraded existence. And then comes the question over here.

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And the question is, do you want it?

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Would you want it? And the big question, of course, was the current equivalent case.

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And what happens if you were in persistent vegetative state?

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Just imagine what that means. Yes. Yes. Can see she so that you are unconscious.

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And if in permanent vegetative state you'll ever see regain awareness of yourself or your environment.

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Yeah. And it takes three months if it's. To make that assessment.

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Well in the UK in six months and six for the investigation.

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Well I suppose you pay for the parts of the media.

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So yes, if it's a well diagnosed. And then comes the question, how long can you maintain the individual in this form?

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Well, the old record was 37 years, 111 days. It's now being surpassed by somebody in Florida.

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And comes a question if, in fact, you were to suffer. And most of these have been.

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Kevin in Cleveland was 20 years old. So they're not necessarily ancient, although most people slip into peace out of Alzheimer's.

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If you could be in a well diagnosed persistent vegetative state and we know it could maintain you, and what do you feel?

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If I was if I was in TV, I hope I feel now. But if it was PBS, I hope I feel nothing.

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And now I feel about this place. That's what they don't. Rather just tell us if you can believe them.

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Uh, but they say there's no. There's no sensation. You have no experience of anything.

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It's been unconscious. And now the difference of PBS person unconsciousness in a coma.

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It used to be called terminal coma as the old phrase.

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And the term persistent vegetative state was devised by Fred Clement, NYU, in 1972.

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And it's a pejorative sort of term. People don't like pickled vegetables, but he said they have no conscious activity.

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That's what he was describing. Uh, and apparently they have no sensation.

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They're not responsive to pain. And you can make hay this way for 30 seconds, but there's no suffering.

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This is important because one witness said, well, you could stop if the patient is in pain of such terror because it would be inhumane to continue.

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Well, if you're not afraid of any, you this great game continue living and there's no pain.

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So when you want it made, you said.

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I think a sanction might have dignity to my family, the NHS.

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Look at all these people. How many of them would want to maintain this way and we could do it?

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We have one. I should say them. You say 37 years.

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But that's not the median. It's not the media. It's the. I said it was the longest recorded to date.

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Yes. Yes. I just got an accurate amount of the same saying.

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So when you say 5000 people. You don't say this off the front of us and say, oh, yes, definitely.

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His name was Roger Bannister. Yeah. So but and so we don't ask how far you can rule on that because that's a matter of opinion difference.

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Well, but he doesn't say it isn't to me, but the world doesn't care what's important to you.

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No, but if we if we're talking about. Well, anyhow, what if you want to give a lecture, there's a lecture schedule, you can sign up, put it up.

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But how many of you would want to be maintained in this when the average life expectancy is about a year?

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But you could go for three years and we have no way of knowing when we start.

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How long you like to watch? You also do that for medical technology.

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We stand for seven years. No, we don't. But we make bad decisions when.

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But seven years from now. No, we make the decision in the in the now.

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Let's do that now. I live with this. And there's been.

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If those directors and they can say, oh, what a foolish bet that was about the fact that I can take you.

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Surely we have to make the decision before we go in this state.

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We have to work out those decisions. Yes. Or or at least have articulated some views on that becomes a problem?

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Well, not necessarily. Then we've got nice ways judges can find ways to do it going it old British law for it I about those

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maybe but you can be kept this way and the question is should you would you want it to be done?

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Now the first of these cases that actually came up was quite dramatic and occurred in California as a legal case.

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Now, there were no legal cases before that because, in fact, you couldn't sustain these.

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We didn't have the technology to do it. So what's the question now behind the technology?

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The question was great. We had ordered to be used.

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And then comes the question, whose position is it? And that's always to be quite the two big questions of career and bioethics.

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One, whose decision is it and on what standard is that decision going to be made?

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Well, the first of these cases occurred in California.

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As many as two of her clients were. And he went to the hospital for a simple ileostomy closure.

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It was uneventful. So 20 minutes.

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And before he went in, he said to his family, his wife and his seven adult children, if anything goes wrong, I don't want to be another Karen.

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And clearly, she proceeded the longest way.

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And she's she's maintained with the feeding tube for almost a year.

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When finally decision was made not by Alex, when she had a motive and she died.

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He had the surgery. It was successful.

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And when he was in the recovery room, the nurse moving somebody even from the ICU to another room and he suffers in unwitnessed cardiac arrest.

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And the data for successful resuscitation with unwitnessed cardiac arrest in elderly patients is dismal.

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And the doctors said, we've got his heart beating again, but he's unconscious and we don't anticipate that he ever will be conscious again.

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Probably a little quick for that assessment, but that's what they said.

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The wife of the seven children said he told us beforehand he wouldn't like being kept this way.

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So sure, off the ventilator, in the hallway that was shot.

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But guess what? They didn't do a CO2 test.

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And he Reynoso now was decisive, but he said he didn't want to be somebody who is currently unconscious.

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They maintain the captain, but with the Navy feeling, too.

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And. One of the songs said to nurses police is the question is why stop everything?

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She said, Oh, you've got to talk with Dr. Natal, the chief of surgery.

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So Dr. Natal said that's acceptable and signed an order to remove the feet.

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He had written signed the order for the removal of the ventilator. And here's where the problem came.

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You moving to education? And you usually order a missing machine when move.

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She puts a little vaporous vapour. To prevent a mucus plug from blocking.

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Yeah. What's that?

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They just switched machines. They just switched machine up. Great.

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Somebody has got to stop reading. Huge device usually works, but when it doesn't.

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Well, the upshot of it was that the nursing supervisor came the next morning and sees a young resident and.

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Says, Where's the listening machine at standard nursing practice of standard protocol.

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Now, you've been a resident, you could call registrars, etc.

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And as the head nurse who was the supervisor on duty for the weekend, says to you, Young Dr. Wilkinson, why have you not used the standard protocol?

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What would you tend to do? Do what they say. You do what they say.

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And guess who comes in 20 minutes later? The chief of surgery, who says?

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Dr. Wilkinson, have you pronounced Mr. Herman dead yet? And you say, No, no.

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In fact, I put the mystery machine, this machine up.

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Tell me what happens in British Hospital when the chief of surgery finds that the resident has done just the opposite?

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What he told me. Yeah.

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And the first thing you must file. Who is this? Who gave this order?

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So there was a fight between the nurse. And so she decides she's going to get him.

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And after they remove the feeding tube. He survived for seven days and his families in attendance.

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And the nurse goes to this journey and she raises two questions.

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One is in food and water and ordinary means. And two is every patient came to ordinary care.

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And your answer would be. No patient is all right.

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No, no patient is order. Well, they're just talking about the treatment itself.

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I'm an administrator of ordinary extraordinary care.

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What do those words mean in the idea? Because a terribly misused, confused and abused.

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And in fact, we've argued in the president's commission that they should simply no longer be used and no longer useful in public discourse.

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And they came out of 16th century moral theology.

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And the question was this where we went into Dr. Wilkinson this morning, what are you obliged to do to keep.

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Your right. Do you have any obligations to sustain your life?

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Not if you have. Well, that's the modern secular back of the 16th century.

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Go back to go back to 16th century medieval Oxford.

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You owe it to God. It was theologically. It was to God.

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And if you failed, in your view, to God, what was the theological understanding of what the consequences were till you went ahead?

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Now, if, in fact, I told you that if you didn't utilise certain resources, certain procedures to sustain your life, you'd go to [INAUDIBLE].

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The first question. Mm hmm.

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What was the question?

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If you understood that your failure to utilise those procedures to sustain your life that you required, what would be your first question?

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What excuses? Yeah, yeah, yeah, yeah.

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And so the theologians are on to well, what, what? Excuse me, what do you think would excuse.

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Well, I mean, I think that it's sort of it's futile. Well, I suppose as your mother was writing this for me, never used that f word.

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It doesn't solve it. Yes. It's just that this is sort of in the guise of the right direction.

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I think it does. The first is, and I'll use this example of use this morning, supposing, in fact,

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you had a rare disease that could be cured if you went into outer space.

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Mm hmm. A is a physically possible thing to do that to go into outer space.

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Mm. Yes, it is.

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Yes. So you just have to know.

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Right. Okay. Yeah. You have to go to the moon.

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Yeah. Now, is there a way for you to get there other than being an astronaut?

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No. Oh, yes, there is. Hey, hey, hey, hey.

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Rush. Food will be required for us to meet in the Oval Office.

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And you? A trip to the other space. And the place is.

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$1,000,000. $5.5 million.

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Are you going? I have the money. What's that?

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If I had the money, I can do you over. That's the question. Do you have the ability to do this?

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Well, yes. Yes, I think it's the right.

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I have $5 million now. So you are not obliged to invite you can't be obliged to do your show?

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Yes. And what else would make?

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For example, now you didn't live through the American Civil War,

182
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but you've seen the movies and it was great slaughter battlefields and the people gave their lives.

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Shattered Ryan. Cannonball. What's the medical remedy for that?

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You're not a philosophy student.

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Well, I don't know if. Did I decapitated ex or something?

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Well, they don't call it the Catholic League. With every takeaway he'd like that stricken from the right now.

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Here comes the great question. What would you call surgeons in the UK?

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Never met one. Well, I had other insurgents.

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Who? What's their title?

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Consultant Now Mr. Jackson, Dr. Wilkinson and Mr. Brown.

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Mr. Brown is a surgeon and skill columnist.

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Now, why did you go missing? Because you know for sure.

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Yeah. Evidence for a decapitation attack.

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Why aren't they followed in packages of great expectations?

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Number one hypocrisy is talking about what's what's the role of the physician has to be lower position was threefold

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to mediate such reverse disease processes where possible and not conformance to medical treatment on the Dalai Lama.

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Because they're dying. Yeah, because a little man come back.

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Because they. If they die, they're going to die.

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And what happens if you treat them and they die? But it was actually Xavier.

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Xavier. What are we going to say about Xavier? I think trade me.

201
00:20:01,260 --> 00:20:05,550
No, you treat them. Then they all got off. I mean, that is just always.

202
00:20:06,090 --> 00:20:09,480
Yeah. Resources all the way. So what about you?

203
00:20:11,060 --> 00:20:14,460
I mean, this stupid.

204
00:20:17,040 --> 00:20:20,820
You don't know what you're doing and what happens to your business. I go.

205
00:20:21,210 --> 00:20:27,810
You go, bro. So he's. He's very careful. You tell him don't jeopardise your profession by doing things that don't work.

206
00:20:30,540 --> 00:20:37,510
Now. And that's why physicians never went into surgery, because it wasn't going to be successful.

207
00:20:38,020 --> 00:20:42,900
They weren't going to be able to now get the surgery.

208
00:20:44,900 --> 00:20:53,200
To people with knowledge source. Yeah, I do.

209
00:20:53,620 --> 00:20:56,380
Oh, you do? Do I? The butcher.

210
00:20:56,440 --> 00:21:09,100
The butcher's who cuts the leg off for when and chops the butcher doesn't get the sword or have a bath when they used to have the barber of.

211
00:21:10,050 --> 00:21:14,710
Sweetheart. That's ridiculous. So they were the that.

212
00:21:16,900 --> 00:21:20,840
Now. They're going to amputate that legs.

213
00:21:21,980 --> 00:21:26,810
What are they used for? An anaesthetic. I don't know anything.

214
00:21:29,200 --> 00:21:36,130
It didn't have if it had not been devised. In fact, you know, in the Ethiopian mass hospital these days are still there.

215
00:21:36,340 --> 00:21:44,879
They even happened not so long ago. So what happens when the budget comes along?

216
00:21:44,880 --> 00:21:51,600
We just saw the impact this on. What are you going to do as the patient?

217
00:21:51,750 --> 00:21:55,050
Yeah, I'll probably want to do it.

218
00:21:56,400 --> 00:22:02,330
You go to die for them. You're going to die doing it. But if you don't do it, you're going to die with blood.

219
00:22:03,290 --> 00:22:13,140
Lots of pain. Lots of pain. And the way to stop you from screaming and making the bother, which is very unhappy, is to actually bite the bullet.

220
00:22:13,160 --> 00:22:16,819
You know what that means? Well, I know what it means, figuratively.

221
00:22:16,820 --> 00:22:22,430
But what does it mean for you? You got to face up to it instead of.

222
00:22:23,400 --> 00:22:31,770
I could take them and they're not going to use a modern bullet made up brass because the purpose in fighting it was put in and squeezed out of.

223
00:22:32,820 --> 00:22:37,080
The purpose of it was bigger from screaming, which is what you can do is not.

224
00:22:38,430 --> 00:22:42,780
And if we let you scream at your own fault, then it would bother you.

225
00:22:42,780 --> 00:22:53,429
But you wouldn't achieve this. But you can scream as loudly now, you know, I, you know,

226
00:22:53,430 --> 00:23:01,260
I would say bite the bullet to keep you from screaming in the ear of the person is trying to amputate your leg in maintenance or pain.

227
00:23:01,530 --> 00:23:06,330
So were you required because it was so painful? No. Awesome, which was very burdensome.

228
00:23:06,660 --> 00:23:11,730
If they told you to move to another country. Nobody.

229
00:23:13,510 --> 00:23:20,370
My old age or something or. Even if it wasn't very painful, it wasn't right costume.

230
00:23:20,370 --> 00:23:25,080
It wasn't very realistic if it didn't offer a substantial benefit to you as a person.

231
00:23:27,580 --> 00:23:33,900
Why would you do? And that's where it all started, back with the apocalypse.

232
00:23:34,080 --> 00:23:42,750
And then by the 16th century, living in the U.S. and said the same principles apply and they said we don't have to do what would excuse you from it.

233
00:23:42,750 --> 00:23:53,100
It's too costly for one's customers or too burdensome or too painful or didn't offer substantial expectation of benefit to.

234
00:23:55,080 --> 00:24:02,040
Then we come over to Jenny and she's now her PVS condition and she says this would happen

235
00:24:02,310 --> 00:24:07,260
despite the fact you're going to find this hospital in the nation and we know where that is.

236
00:24:10,570 --> 00:24:16,300
No, I think. Oh, I imagine you would.

237
00:24:16,380 --> 00:24:20,230
Oh, so I come from Cardiff. I'm trained to say.

238
00:24:23,350 --> 00:24:28,080
Oh, they. Right here we are. And.

239
00:24:28,330 --> 00:24:32,740
But things could go wrong. And so you would say, if they all go wrong, I don't want this.

240
00:24:33,280 --> 00:24:46,140
And now comes the question. Is it determined to withhold the feeding tube that we have here and we can place a smile without a great deal of pain?

241
00:24:46,780 --> 00:24:50,940
We have anaesthesia. We don't have to give you a bullet to give you some anaesthesia.

242
00:24:50,950 --> 00:24:57,290
We can easily insert this into your abdomen and or give you a side of the abdomen.

243
00:24:57,320 --> 00:25:01,960
Because if you get pregnant, do all that and.

244
00:25:05,100 --> 00:25:16,200
Now, the big question today at Netflix is here's a man who's 54 years old who said, I want to die and I want to die by not eating and I want pain.

245
00:25:16,200 --> 00:25:24,210
Relief from pain. And the doctor said one question, can you with an advanced directive?

246
00:25:25,940 --> 00:25:32,190
You can't. What would we have a duty to follow to say, I don't want food and water.

247
00:25:34,780 --> 00:25:42,550
Or as we have now, artificial attrition fluids. And we know we know perfectly well how long you can live without food and water.

248
00:25:42,730 --> 00:25:48,040
We learned all this from the Nazi experiments. How long can you go without food?

249
00:25:49,620 --> 00:25:54,480
He's a part of the British spirit, which leads weeks and weeks, 54 days.

250
00:25:55,500 --> 00:26:00,720
You live off the fact that the land is for. But how long without fluids?

251
00:26:01,500 --> 00:26:06,450
Two or three weeks. Yeah, 77 days, you know, like 5 to 7 days.

252
00:26:06,930 --> 00:26:16,890
So the question, when the Germans are putting supplies in the lifeboats, would you put food in their.

253
00:26:22,320 --> 00:26:25,440
Not if you didn't think people would be collected and picked up in that time.

254
00:26:25,480 --> 00:26:29,550
They were just. If we don't get it within 50 days, what can we do?

255
00:26:30,120 --> 00:26:40,950
What can we do, sir? They could eat fish, but the meat that's been known to have used with aeroplanes crashing and stuff like that.

256
00:26:41,580 --> 00:26:46,080
But you can look at this law and with Mr. Herbert, the question came.

257
00:26:47,300 --> 00:26:50,990
He now has a feeding tube inserted and the family has to move.

258
00:26:51,320 --> 00:26:57,380
And it is then the nurse who was appalled is when the district attorney said, this is murder.

259
00:27:00,580 --> 00:27:09,740
What do you think? Murder. Where? The medical. Oh, she's now using the famous mother.

260
00:27:09,920 --> 00:27:13,790
This is a random trip. And you were a baker with.

261
00:27:18,020 --> 00:27:33,110
This is a well-known trick in medical schools can only help those who told us so, which is all we can do about it.

262
00:27:33,110 --> 00:27:38,760
We be get. But that's the thing with telemedicine,

263
00:27:38,930 --> 00:27:49,530
where you get to see who's coming around this big fight and it will make you and I told Resurfaces

264
00:27:49,790 --> 00:27:53,960
there was an article in the Journal of the American Medical Association called The Fine Art of Poop.

265
00:27:54,020 --> 00:27:58,460
Pooping is a technical term in medicine, meaning when you use that term,

266
00:28:01,520 --> 00:28:05,270
you know, it means to to offer one's services, maybe for the prospect of money.

267
00:28:06,050 --> 00:28:10,090
Well, that's somebody else's. That's another word we pay.

268
00:28:10,100 --> 00:28:18,139
Yeah. Yeah. But for somebody else's services to be in medicine was when the consultant came along.

269
00:28:18,140 --> 00:28:24,620
And you ask questions of the residents to see whether they know anything about this, you know?

270
00:28:26,960 --> 00:28:32,200
And so you put them on the spot by asking these questions. And there were really clear rules about it.

271
00:28:32,210 --> 00:28:38,100
You never, ever questioned the chief resident. You don't embarrass him in front of his.

272
00:28:38,510 --> 00:28:43,310
Okay. And then came the question, how do you avoid getting caught?

273
00:28:43,460 --> 00:28:43,840
And was.

274
00:28:47,060 --> 00:29:00,060
But when the nurse went to the district attorney, the question is including a lot of ordinary means and is everybody kind of the ordinary kid?

275
00:29:00,390 --> 00:29:08,550
The district said, yes, they are. Yet nobody is talking about an election first degree murder.

276
00:29:08,790 --> 00:29:16,480
You had great theories. What do you think? The reason? The district. But what we saw was a double murder of the patient wife.

277
00:29:18,510 --> 00:29:22,740
Well, private detention or. Well, that's how it is.

278
00:29:22,980 --> 00:29:26,670
Why did you the most powerful. Menswear.

279
00:29:27,690 --> 00:29:32,920
Well. They did that because in the absence of.

280
00:29:35,190 --> 00:29:45,330
It costs money. They realised they had a shoot out and he's out of the system by mistake.

281
00:29:45,420 --> 00:29:48,570
He could be here. How long? Ten years.

282
00:29:48,600 --> 00:29:52,470
Ten years? Four years? Three years. And who's going to pay for all that?

283
00:29:53,430 --> 00:29:57,300
The hospital. So bury the evidence.

284
00:29:57,390 --> 00:30:05,000
Get rid of stuff. And the lawyers, and they had 11 lawyers on the case.

285
00:30:05,540 --> 00:30:09,709
We knew they murdered them. We knew they killed them. We knew we'd get them off.

286
00:30:09,710 --> 00:30:14,090
Fellows, we didn't have going to do it. How you feel?

287
00:30:14,090 --> 00:30:18,560
Strongly. How do you defend what the doctors did? Killing the patient to save money?

288
00:30:20,020 --> 00:30:24,700
Well, not to the doctors. But it was up to him and what he told his family.

289
00:30:25,150 --> 00:30:29,430
Didn't like it now. You can. Do you have that in writing?

290
00:30:30,840 --> 00:30:38,600
In practice in a court of law will recognise adequate pianists might take over the course of recognised.

291
00:30:39,570 --> 00:30:45,660
I've seen books that have I've seen cool to have like notes to say oh it would have been so much nicer if they put it in writing.

292
00:30:45,660 --> 00:30:49,560
But blame the patient. Yep. Blame the family.

293
00:30:49,820 --> 00:30:55,600
Yep. How are we going to mount a defence as to what the doctor did?

294
00:30:57,980 --> 00:31:04,980
How about the patient's wishes? Well, supposing the patient said to you, I want to go out in a burst of glory.

295
00:31:05,000 --> 00:31:08,420
I don't want to go quietly slip into that. Good night.

296
00:31:08,720 --> 00:31:13,470
I want to have you put your in test tests.

297
00:31:14,420 --> 00:31:21,260
I want to have a test come with a magnitude 57 and blow my brains out against this white wall and let that let me down.

298
00:31:22,400 --> 00:31:26,900
But this patient wasn't asking you to do something. He was asking you not to do something.

299
00:31:27,650 --> 00:31:31,790
Not to use intrusive medicine on him to prolong your dying.

300
00:31:32,570 --> 00:31:36,710
And then comes the big fight is food and water medicine.

301
00:31:37,190 --> 00:31:39,440
If it's shoved into a tube in the stomach. Yes.

302
00:31:40,580 --> 00:31:49,040
And certainly they're not having the usual sensory inputs and the pleasure that you're still burping and bringing up acid.

303
00:31:50,030 --> 00:31:56,660
You may say it's painless to put it in. I've seen the pain it causes patients who have to put up with it who just can't.

304
00:31:58,680 --> 00:32:07,650
So the argument was made. Did the first question, did Mr. Herbert have a moral obligation to undergo this intervention?

305
00:32:10,340 --> 00:32:16,610
There's two separate questions because does the patient have an obligation to receive data but also to the docs?

306
00:32:16,610 --> 00:32:20,630
I have an obligation to write those. But first, the first one is the patient.

307
00:32:21,410 --> 00:32:26,740
And does the patient have an obligation to accept any medical treatment that you propose?

308
00:32:26,770 --> 00:32:30,260
Only theological, non theological, non theological sin as God.

309
00:32:30,800 --> 00:32:34,710
So how many of you wrote a wonderful book? Whatever happened to simplicity?

310
00:32:34,840 --> 00:32:39,350
To live in this secular, pluralistic society of England?

311
00:32:39,950 --> 00:32:48,890
This fellow sin is not a coming from it, but that sin is come from in terms of his.

312
00:32:48,930 --> 00:32:53,990
But yeah. Thank you, Jesus. Yeah. So.

313
00:32:55,890 --> 00:33:03,390
If you or Tom, if he has a what's one? Oh, he has a freedom to choose the freedom to determine the course of one's own life.

314
00:33:04,260 --> 00:33:09,360
You have to have capacity for that. Well, by definition, these patients do have capacity.

315
00:33:09,420 --> 00:33:17,190
Oh, you don't have to have capacity. Let's look forward to the big question that comes most of these patients.

316
00:33:17,490 --> 00:33:20,610
What percent of you have a written advanced directive?

317
00:33:22,420 --> 00:33:26,380
Two, three. Poor, poor. Appalling is right.

318
00:33:27,250 --> 00:33:35,980
But England is different from America. I mean, you told me that they better have it in writing or they have no protection.

319
00:33:36,730 --> 00:33:45,400
The audio relatives is they can represent your wishes and the cheapest the the medical practitioners listen.

320
00:33:45,400 --> 00:33:49,420
But in the end, they end up making a medical decision because that is easy of the answer.

321
00:33:49,990 --> 00:33:55,569
The only one message we call upon to make, well, they get nervous.

322
00:33:55,570 --> 00:33:59,590
They ought to be charged with murder, do they? And they read about this case in California.

323
00:33:59,800 --> 00:34:06,490
And there are just as many. Well, prosecutors in the UK is around United States.

324
00:34:06,670 --> 00:34:12,840
So everyone goes with the least restrictive option, which by prolonging the dying process.

325
00:34:12,850 --> 00:34:16,880
Sure, it's easier. It's easy to say expensive.

326
00:34:17,870 --> 00:34:22,429
But it was protecting the world. But. It's not much more expensive.

327
00:34:22,430 --> 00:34:29,440
The lawyers have about perhaps a third of the costs.

328
00:34:29,440 --> 00:34:36,110
Some of them are always very costly to go to take these cases because these cases overall case of first impressions,

329
00:34:36,410 --> 00:34:39,260
the lawyer says, I don't know, it's going to happen. A lot of research here.

330
00:34:39,530 --> 00:34:47,599
What do you think a lawyer would tell you if you had a relative who's now in a persistent vegetative state in a feeding tube?

331
00:34:47,600 --> 00:34:51,690
You like food, you say this would cost about one point.

332
00:34:52,760 --> 00:34:54,890
In the US. I have no income in the UK.

333
00:34:55,490 --> 00:35:00,770
In the UK it's the responsibility of the clinical commissioning group to take that bill and then have clear guidelines.

334
00:35:01,330 --> 00:35:08,510
You're not meant to pay. It cost the health board in the fin whales a big reckoning with a lot of money,

335
00:35:08,600 --> 00:35:14,720
a lot of but less actually than sustaining that person so that she's got saving, which is a bit of a problem.

336
00:35:18,500 --> 00:35:23,690
The patient, though, came to one. What's his obligation to undergo this medical intervention?

337
00:35:23,840 --> 00:35:27,710
But he had specifically said, if you want to know the answer, if he doesn't have one,

338
00:35:28,220 --> 00:35:35,060
if he has some obligation to undergo what claimed as a physician had to impose it.

339
00:35:36,570 --> 00:35:40,650
What do you need in order to touch a patient consent?

340
00:35:40,800 --> 00:35:45,660
Consent. This is old, old, old English.

341
00:35:45,660 --> 00:35:48,950
There goes back to 1767.

342
00:35:48,970 --> 00:35:54,870
It is Slater versus Bateman Stapleton. And in this case it's a marvellous case.

343
00:35:56,040 --> 00:36:06,150
Mr. Baker was a surgeon and Mr. Slater broke his leg and came and the treatment for a broken leg was compression and the small.

344
00:36:07,020 --> 00:36:12,389
But Mr. Baker had a great idea that he had a better way of doing it called extension.

345
00:36:12,390 --> 00:36:17,430
So he invented this little machine that he thought. But in order to test out his machine, what did he need?

346
00:36:18,180 --> 00:36:25,560
Some weight victims with a broken leg. Now, if you sit around waiting at Rancho Hospital for a broken leg to come in, you might.

347
00:36:27,060 --> 00:36:31,450
I'm sure you know what I mean. I mean, you know.

348
00:36:33,510 --> 00:36:38,969
So it wasn't the best way of getting a broken leg. When you made the leg broken.

349
00:36:38,970 --> 00:36:46,830
So they take me. I love this thing to bring an old age and they put the carry and the surgeon take the patient's knee and they give it a crack.

350
00:36:47,490 --> 00:36:50,820
And I always use one of my students say, what would you say?

351
00:36:52,200 --> 00:36:55,259
They say, We know what you would say, but don't use those words.

352
00:36:55,260 --> 00:36:59,490
I told you. In fact, the patient reportedly says, Why now?

353
00:36:59,940 --> 00:37:04,170
What nature have you come to? The British have a five way of speaking.

354
00:37:05,730 --> 00:37:08,910
So he's been right and then he sues.

355
00:37:09,450 --> 00:37:13,950
And the defence was he was at St Bartholomew's Hospital still there.

356
00:37:14,760 --> 00:37:18,600
He was the first surgeon at St Bartholomew's. He had a great reputation.

357
00:37:18,600 --> 00:37:27,360
He gave lectures all over the country, published lots of articles and how grateful to accuse him of not knowing what he was doing.

358
00:37:30,000 --> 00:37:33,420
The court looked and said, we know what he was doing. What was he doing?

359
00:37:34,410 --> 00:37:37,650
Patient wasn't treating the patient. Treating a patient.

360
00:37:38,040 --> 00:37:45,660
He was testing an experimental procedure. But what do you need for that consent?

361
00:37:46,470 --> 00:37:54,960
Now, interestingly, the word that you usually use when you talk about consent usually put an adjective in front of it, which is informed.

362
00:37:55,530 --> 00:37:59,250
But the British didn't do that. They got consent.

363
00:37:59,850 --> 00:38:08,310
You're a physician? Yeah. Yeah. It's kind of like, well, if you got negative, it's true or not.

364
00:38:09,030 --> 00:38:19,980
Well, we just have a handful extreme cases, and now they put a little injection in and they come to do an anaesthetic because of the injection.

365
00:38:20,910 --> 00:38:27,460
So what do you think will happen if you come along with this nice, big, bold needle and you stop with a little prick?

366
00:38:27,480 --> 00:38:32,430
So what might the patient want to do? Something. No country, you know.

367
00:38:33,350 --> 00:38:43,760
Full of impact. So you tell them what you're going to do so that he can not pull away, not far away, and you might have somebody else hold a hand out.

368
00:38:44,060 --> 00:38:52,280
But you tell him and you say, look, this is going to hurt. So but the whole concern is to have the patient cooperate.

369
00:38:52,790 --> 00:38:56,510
It's not to say that was the old English way.

370
00:38:57,440 --> 00:39:01,190
Remember, it's like what he says. But what do you tell the patient?

371
00:39:02,980 --> 00:39:08,150
The property says, tell the patient nothing on his or her present or future conditions.

372
00:39:08,210 --> 00:39:15,740
Why not? They might mistake or attempts to think no one might get it home.

373
00:39:16,140 --> 00:39:23,420
No problem. Without trauma, psychological trauma, they might say, oh, my God, I'm right.

374
00:39:23,430 --> 00:39:30,570
I'm not I'm safe here. I won't be amputated, you know, decapitated or whatever, you know.

375
00:39:31,220 --> 00:39:40,430
And he doesn't get the good thing that so you don't tell him lest he get all this so-called therapeutic exception later and runs away.

376
00:39:41,030 --> 00:39:44,690
I'm not going to do it. So the company says you've come to the doctor.

377
00:39:45,020 --> 00:39:48,470
And here's a different question. Why do you go to a doctor?

378
00:39:48,620 --> 00:39:52,189
Now, Jenny, you don't take every problem that you have to the doctor.

379
00:39:52,190 --> 00:39:56,739
You know, know if you ever get a little if you do you lots of people.

380
00:39:56,740 --> 00:40:01,190
Are you paper burn? Yes. Yeah, yeah, yeah.

381
00:40:01,640 --> 00:40:06,220
What do you do when you get a bit. I say actually ignore it, you know.

382
00:40:06,230 --> 00:40:09,910
So you just bleed out usually in some fights.

383
00:40:09,910 --> 00:40:13,819
So yeah, I could have put a Band-Aid on.

384
00:40:13,820 --> 00:40:18,570
I can see that's probably the right answer. What the kids do, they suck.

385
00:40:18,650 --> 00:40:22,910
They suck. What do you catch it? They like it. They really know what to do.

386
00:40:22,910 --> 00:40:27,830
Cats and kids know that, you know, there's something in saliva that is magical for healing.

387
00:40:28,400 --> 00:40:31,430
It is the best anticoagulant in your head is about.

388
00:40:33,480 --> 00:40:42,640
And I'm just new to me. That's why we have some of our I now.

389
00:40:42,960 --> 00:40:46,430
If you broke your leg, would you live it? No. No.

390
00:40:47,130 --> 00:40:50,700
Would you actually go to San Diego? I absolutely would.

391
00:40:51,720 --> 00:40:56,850
Why do you go with a broken leg now? We have a friend, a dummy.

392
00:40:56,850 --> 00:41:02,220
Do we not? Yes. Yeah. And his speciality is paediatrics.

393
00:41:02,280 --> 00:41:06,240
Media, neonatology. Yeah. Do you want a neonatologist to look at your broken?

394
00:41:06,450 --> 00:41:12,629
No. Although if he was the only person in the room, I certainly use the same person room.

395
00:41:12,630 --> 00:41:20,370
You use the internet. You're just trying to make a point.

396
00:41:21,660 --> 00:41:25,770
Yeah. You say you go to him now. Why would you go to an orthopaedic surgeon?

397
00:41:26,700 --> 00:41:31,980
I think they have the skills to help me make a pain anyway and restore me to function.

398
00:41:32,220 --> 00:41:37,620
And you trust that when you meet up with him or her that the name is not chipped?

399
00:41:39,180 --> 00:41:45,959
I probably do a little bit of Googling and a little bit of research, and I probably take a family member with me and I'm a bit suspicious.

400
00:41:45,960 --> 00:41:50,710
So but yes, basically you go to the Ahab if you want to be viable.

401
00:41:51,780 --> 00:41:55,970
Yep. I usually did it with my do.

402
00:41:58,950 --> 00:42:06,390
And. Then comes the question, what can you.

403
00:42:07,700 --> 00:42:11,150
If there's anything I want to say, I have no capacity.

404
00:42:12,860 --> 00:42:20,739
That's so. You have to assume capacity in the UK until proven otherwise.

405
00:42:20,740 --> 00:42:26,330
And so you've just got to assume I have to make my own decisions to refuse to refuse.

406
00:42:27,580 --> 00:42:31,420
Let me give you a case that we recently had at Mass General Hospital.

407
00:42:31,420 --> 00:42:34,690
You know, that is actually reckless of the United States. Yeah.

408
00:42:35,230 --> 00:42:38,230
And the woman comes in, a 29 year old woman.

409
00:42:39,850 --> 00:42:43,090
She's got a long history of asthma and she has as an attack.

410
00:42:43,930 --> 00:42:50,170
She called her sister and the sister calls the mass general and purportedly says, we have no record in this.

411
00:42:51,160 --> 00:42:59,260
We have my sister doesn't want the ventilator and can you possibly have a ventilator if you come and purportedly live here?

412
00:42:59,430 --> 00:43:05,169
So she comes and she meets with the resident technical consultant who's 7:00 in the morning.

413
00:43:05,170 --> 00:43:14,139
And you come to air in handy, Amy, because the E.R., let's say we watch the programs.

414
00:43:14,140 --> 00:43:30,290
We know she's in communications and the consultant says you have a very severe asthmatic attack and we need to put you in middle age.

415
00:43:30,490 --> 00:43:36,070
I don't want it. And she then runs to the doors.

416
00:43:37,520 --> 00:43:41,090
There it is.

417
00:43:41,270 --> 00:43:48,440
She needs a ventilator. Maybe you can bear asthmatic attack.

418
00:43:49,040 --> 00:43:53,290
So how do you insert a ventilator in the patient?

419
00:43:53,300 --> 00:43:59,910
And most of the way. She didn't look that sedately.

420
00:44:00,840 --> 00:44:03,990
Well, easier. Cheaper.

421
00:44:04,500 --> 00:44:07,800
You can't. Do you think she can refuse treatment?

422
00:44:08,670 --> 00:44:13,090
She's refused it. And so he tackles.

423
00:44:13,110 --> 00:44:19,860
Well, he's been well sorted out in a straitjacket.

424
00:44:20,310 --> 00:44:26,460
And then put the feeding tube in. And 45 minutes later, she's fine and she leaves.

425
00:44:26,790 --> 00:44:30,120
Well, you say thank you. Probably no good.

426
00:44:31,080 --> 00:44:34,890
And it gets really complicated because to desperation is another attack.

427
00:44:35,340 --> 00:44:42,620
And. If you just go to a hostile community, trust me, or we can go to the other pieces you trust,

428
00:44:42,680 --> 00:44:49,610
you can pick things you believe that he or she knows something about, and you trust that they're going to act in your behalf.

429
00:44:49,910 --> 00:44:54,330
We hope that as you recognise it, that.

430
00:44:55,580 --> 00:45:03,380
Well, supposing, in fact, Jenny, you're so sophisticated and you said you have this broken leg and you say to the of the surgeon,

431
00:45:03,920 --> 00:45:09,790
I would really like to be doctor. You know, that is, you know, distinctive.

432
00:45:10,400 --> 00:45:14,710
That's quite funny. They told. What do you what did you say to him?

433
00:45:14,720 --> 00:45:19,520
Face what you did with when you go in like this.

434
00:45:19,690 --> 00:45:23,540
Oh. What do you want ancient pigeon to.

435
00:45:24,050 --> 00:45:32,000
Yeah. And you say to the orthopaedic surgeon, I would like you to rotate my femur 14 degrees to the right.

436
00:45:33,230 --> 00:45:36,890
I can't make them do anything they don't think is right.

437
00:45:37,150 --> 00:45:41,120
I can refuse subjects like to me, but I can ask them to do something.

438
00:45:41,270 --> 00:45:45,320
I can do what I can, and they can ignore which which I hope they would.

439
00:45:45,350 --> 00:45:50,090
I mean, actually, given what happens with cosmetic surgery, there was a question mark over that.

440
00:45:50,440 --> 00:45:59,330
Oh, yeah. So you have the question, what obligation does the patient have to undergo the nutrition of fluids?

441
00:46:00,500 --> 00:46:04,639
No, none. And it became clear that he had stated that he didn't want this.

442
00:46:04,640 --> 00:46:08,270
The wife and seven adult children all saying this is what he said.

443
00:46:09,080 --> 00:46:16,740
The quote, believes this and. Mysterious.

444
00:46:17,250 --> 00:46:22,410
He thinks it's murder. And then windows. Windows, presumably. And the argument before the court was very simple.

445
00:46:22,680 --> 00:46:27,900
He had no obligation. He didn't want it. He had no obligation to undergo it if he declined it.

446
00:46:28,080 --> 00:46:35,650
What requisite position have to impose it on? The answer is sanctity of life.

447
00:46:36,310 --> 00:46:41,060
The only potential future of poverty.

448
00:46:41,080 --> 00:46:48,700
He was willing to admit that he might be a new person. His only justifications that really have merit are.

449
00:46:50,730 --> 00:46:57,210
What's that mean? Well, the emergency is occurring, the emergency situation.

450
00:46:57,390 --> 00:47:01,390
That's what the doctor at the National Park. It's just an emergency situation.

451
00:47:01,390 --> 00:47:05,310
And she would die if she didn't get it. So be prepared for punishment.

452
00:47:05,400 --> 00:47:09,810
Just to be clear. Has is it in this case, the patient has.

453
00:47:10,830 --> 00:47:16,770
Sex to somebody that he doesn't want to pay an edge but is not formally refused treatment.

454
00:47:16,770 --> 00:47:23,910
So there's nothing to say. He said, No, if I have to get this alone, it's just that it's not something that he would like.

455
00:47:25,200 --> 00:47:31,290
Because there's a difference, I think. You mean he didn't use words of contrition, but he wasn't he didn't have a specific case.

456
00:47:31,290 --> 00:47:34,799
Might it just this is not the kind of thing you talk about.

457
00:47:34,800 --> 00:47:39,180
That, in fact, is what the chief justice of United States Supreme Court at the time, Mr. Rehnquist,

458
00:47:39,180 --> 00:47:45,270
argued in one of these cases, say the patient didn't say she didn't want the official fluids, she didn't want heroic means.

459
00:47:45,780 --> 00:47:49,130
Who would think of food and water as heroic means? Exactly.

460
00:47:49,950 --> 00:47:56,790
And so authorised. But that was in the present early on.

461
00:47:57,300 --> 00:48:00,600
But in this case, it was clear that this was they had contemplated.

462
00:48:00,600 --> 00:48:07,950
This is not something. Yes. And so the jury magistrate dismissed it.

463
00:48:07,950 --> 00:48:14,040
And the appeals court, the same appeals court, the same three judges that you had in the Conroy just did have a chance to look at that.

464
00:48:14,260 --> 00:48:20,400
That's really Strong said. He said. These judges said what the doctor did was monstrous.

465
00:48:21,660 --> 00:48:26,069
How dare the doctor? Or they also attacked these judges.

466
00:48:26,070 --> 00:48:31,170
Three appeals court judges attacked the lower court judges, saying the court has no authority,

467
00:48:31,170 --> 00:48:36,450
the judge has no authority who makes the decisions over your body and on what basis?

468
00:48:36,450 --> 00:48:40,610
And the basis is, of course, two to we have two arguments.

469
00:48:40,620 --> 00:48:49,500
One is privacy, which is the right to be left alone, the right to be free of unwanted government or outside intervention in your life.

470
00:48:49,950 --> 00:48:58,040
And the other is consent. You have a right to be free of unwanted touching your right to be free to be left alone and.

471
00:49:00,260 --> 00:49:02,750
Very old case back in 1940.

472
00:49:03,200 --> 00:49:10,970
Anybody who touches a patient without the consent of a patient commits an assault for which they shall be liable in damages.

473
00:49:12,080 --> 00:49:16,970
So you have very, very clear articulated rationales as to why this would happen.

474
00:49:21,360 --> 00:49:28,049
When this case went to the appeals court. Very strong compliance and patient has absolutely no obligation to undergo that.

475
00:49:28,050 --> 00:49:31,080
The physician proposes you go to the physician. Why?

476
00:49:31,200 --> 00:49:40,140
And interestingly, the board of trustees of the American Medical Association got into a big dispute over maternal foetal conflicts and saying,

477
00:49:40,500 --> 00:49:48,570
what's the role of the physician? The obstetrician was really, really interested in saying, who is the patient, the obstetrician.

478
00:49:50,800 --> 00:49:54,880
No Napster music. Yes, we have.

479
00:49:55,330 --> 00:49:59,410
That's right. You've never seen lies? I've never seen it.

480
00:49:59,530 --> 00:50:07,030
Subscription? That's correct. Professional delivering a baby.

481
00:50:08,110 --> 00:50:15,790
Well, you know, confession. God. So right now I have not seen.

482
00:50:16,960 --> 00:50:21,670
Yes, you might have seen. That's why we have correctly asked that.

483
00:50:24,840 --> 00:50:30,030
If the obstetrician is dealing with a pregnant woman. The features of the obstetrician.

484
00:50:33,350 --> 00:50:37,330
The I don't know why they said that. Obviously, I didn't want any.

485
00:50:37,850 --> 00:50:43,940
And for you, you know, and supposing there's a conflict between.

486
00:50:45,980 --> 00:50:59,350
So what do we do? Each time we go to court, usually, usually to go to court case for it.

487
00:50:59,360 --> 00:51:03,310
Here was a case in the District of Columbia Russian High School.

488
00:51:03,680 --> 00:51:06,910
A woman is in her 23rd week, pretty busy.

489
00:51:07,020 --> 00:51:12,280
She has cancer and she said she would deliver the baby by C-section.

490
00:51:12,400 --> 00:51:20,500
It's about 28 weeks, but in the 24th week, the assessment was she was going to die in the next 24 to 48 hours.

491
00:51:21,340 --> 00:51:27,669
And they said, oh, we've got to do the C-section. So the obstetric consultant doesn't go to get the consent.

492
00:51:27,670 --> 00:51:32,330
Whom do they send the message? The registrar, the staff.

493
00:51:32,590 --> 00:51:37,600
And she says, I don't want it. Now. They've got an awful dilemma on their hands.

494
00:51:38,050 --> 00:51:45,130
Here they are. They believe that this foetus from 3 to 4 weeks was potentially could survive.

495
00:51:45,490 --> 00:51:49,900
Mom says she doesn't want the C-section. You can't deliver it vaginally.

496
00:51:52,340 --> 00:51:57,260
What do you do? Nothing. It's been so long. Oh, Jack dominates this.

497
00:51:57,290 --> 00:52:06,360
Well, I wouldn't go that. Court ordered caesarian.

498
00:52:06,510 --> 00:52:13,590
And that's what that court orders said when she got to local justice.

499
00:52:13,740 --> 00:52:20,760
I know you do all kinds of strange things. Sometimes they imagined that she suddenly lost capacity.

500
00:52:21,040 --> 00:52:24,630
Yes. Yes. But not always.

501
00:52:24,950 --> 00:52:30,839
Not always. And in this particular case, they went to court and they were ordered to do the C-section.

502
00:52:30,840 --> 00:52:33,810
The baby died in 2 hours. Mom died the next day.

503
00:52:34,530 --> 00:52:42,750
And another family in great American tradition, for instance, on the grounds that you had no right to do this.

504
00:52:46,280 --> 00:52:52,350
What do you think the appeals court said? What's that?

505
00:52:52,600 --> 00:52:56,070
James might write a big check. That's right.

506
00:52:56,910 --> 00:53:00,930
And change your policy in the hospital. And then go home and.

507
00:53:02,310 --> 00:53:09,200
Who became really concerned about issues in the American public years ago and got to college.

508
00:53:09,840 --> 00:53:21,120
So they wrote a policy position that says the role of the physician is to be a counsellor and consultant to provide information to the patient.

509
00:53:21,720 --> 00:53:25,020
And that is the extent of his or her obligations.

510
00:53:25,110 --> 00:53:32,280
And having done that, the physician bears no responsibility for the decision that the well-informed woman makes.

511
00:53:32,760 --> 00:53:38,640
What were they actually? What was their policy about protecting the physician from potential liability?

512
00:53:39,060 --> 00:53:47,910
And if you say that she has a fiduciary duty to both the foetus and the mother, then what a miss.

513
00:53:47,910 --> 00:53:54,870
That is what she needed to say. You know, whatever she says and what we've come down to very much.

514
00:53:57,600 --> 00:54:07,140
Is that at least confident if you look at the non-competition to say competition, have a right to decline in all unwanted medical interventions.

515
00:54:07,320 --> 00:54:13,860
And the question then becomes, is unofficial Trishna fluid a medical intervention or is it just ordinary food?

516
00:54:14,550 --> 00:54:25,350
And the issue today was about ordinary food. And certainly every quarter file jurisdiction, including in the U.K.,

517
00:54:25,740 --> 00:54:32,690
has said that artificial treatment fluids are many medical treatments to be assessed as any other medical treatment.

518
00:54:32,700 --> 00:54:36,150
And what way do you assess whether or not to utilise an intervention?

519
00:54:36,960 --> 00:54:41,730
The risks and the risks and benefits simply we do this with respirators.

520
00:54:41,970 --> 00:54:49,950
And, in fact, the the the appellate court the three judge panel had a very interesting comment when they looked at and most of these judges would say,

521
00:54:50,100 --> 00:54:53,280
I don't know anything about medicine. Why are you asking me?

522
00:54:54,360 --> 00:55:01,920
I gave a talk recently on new forms of reproduction to a group of cheap judges of the United States state courts.

523
00:55:02,430 --> 00:55:08,430
And chief justice of the court in California said, I don't even know what you're talking about.

524
00:55:08,430 --> 00:55:13,320
We were talking about foetal ovary transplants is I don't even know what it means.

525
00:55:13,770 --> 00:55:24,420
Does it mean we can have babies? What do you think I said to him, say what about it?

526
00:55:27,570 --> 00:55:29,100
I said, Judge, I don't think you know,

527
00:55:29,100 --> 00:55:37,589
the birds and the bees are what you go to these and you ask these questions and they will they will make decisions.

528
00:55:37,590 --> 00:55:44,729
Some of them are terrible, you see. But in fact, George Anderson writes in the New England Journal of Medicine says,

529
00:55:44,730 --> 00:55:48,870
Most trial judges haven't the slightest idea what they're talking about.

530
00:55:48,870 --> 00:55:51,510
He totally and but they do have an idea.

531
00:55:51,690 --> 00:56:00,810
If you talk to trial judges, superior court judges, they say, I'm going to have to face who in the courtroom, the crying mother.

532
00:56:02,410 --> 00:56:10,610
The spouse, the family. And I know perfectly well that no matter what I will, the losing side will do well to appeal.

533
00:56:11,180 --> 00:56:16,040
So let the judges upstairs handle it. They don't have to see the crying mug.

534
00:56:18,330 --> 00:56:24,750
So the easy way out is to say, look, do you want to keep going?

535
00:56:27,190 --> 00:56:34,110
Know, Trump is if you read the concurring opinion on the in the Bouvier case that this is cruel beyond imagining making

536
00:56:34,130 --> 00:56:44,020
patients suffer for six more months just so that we can kick the can down the field of equal judges worse than doctors.

537
00:56:44,030 --> 00:56:49,430
What we've done here is that they could leave expert judges and take these cases through them.

538
00:56:49,580 --> 00:56:55,610
And of course, protection, which might be a more efficient system we do that is called a protection.

539
00:56:55,730 --> 00:57:02,210
It shows that, yes, it's a lot better than this.

540
00:57:04,010 --> 00:57:07,309
And they are the things I would say.

541
00:57:07,310 --> 00:57:12,920
And yet there's a way they are. There have been lots of these cases.

542
00:57:12,920 --> 00:57:21,499
And the real issue that comes up is how do you make decisions for the now incompetent who never, in fact, made any statements?

543
00:57:21,500 --> 00:57:29,209
But in this town, including she's 20 years old, she, in fact, made some comments that the trial judge in the Supreme Court in New Jersey,

544
00:57:29,210 --> 00:57:33,710
which is really even cooler, said those were casual comments of an 18 year old.

545
00:57:34,220 --> 00:57:40,610
And we don't give much credibility. But later in the congregations, we made a mistake we should give credibility to.

546
00:57:41,300 --> 00:57:45,630
But what do you do for the Net? A company that's so difficult?

547
00:57:48,620 --> 00:57:53,010
They do this, you know, this a philosophy. So, yeah.

548
00:57:53,050 --> 00:57:57,980
Yeah. Here we have this problem. We have no idea what she will do.

549
00:57:58,160 --> 00:58:01,890
She's never said anything, you know? No.

550
00:58:01,900 --> 00:58:07,920
Have you? As far as I suppose you use up a single incident.

551
00:58:08,390 --> 00:58:15,140
Okay. Well, the school system in the state. Who would be testimony as to what you, in fact have said opposition.

552
00:58:16,180 --> 00:58:20,800
But I've been combative that. So now about how I can assess that current.

553
00:58:21,930 --> 00:58:25,320
Well, probably like next of kin person responsible. Yeah.

554
00:58:25,830 --> 00:58:32,250
You have some you have some family life and you talk to them about these issues.

555
00:58:33,330 --> 00:58:39,650
Um, yeah. So how we make decisions.

556
00:58:39,880 --> 00:58:43,440
Okay. You just heard what the New Jersey Supreme Court is to say.

557
00:58:43,680 --> 00:58:54,210
Look, we've done a survey, and of all this from this study, sometimes it depends on how many said he or she would like to have.

558
00:58:57,770 --> 00:59:07,550
Very small percentage. What? So the court said if she reaches a state, we can presume.

559
00:59:08,560 --> 00:59:12,100
But she would act as a vessel running. The majority of people would do it.

560
00:59:12,100 --> 00:59:17,230
So coalition forces course it and so it me be that she's reasonable as we would with

561
00:59:18,160 --> 00:59:22,090
James he's a reasonable individual and he would do with a reasonable person would do.

562
00:59:22,780 --> 00:59:26,979
But then along comes the next case was Mr. Safe,

563
00:59:26,980 --> 00:59:37,450
which was a patient who was in a states which was like an IQ of about ten and had never had a conscious, articulated thought in his life.

564
00:59:38,610 --> 00:59:42,770
How do you rate your decision for him? You can't use the Russian person because he's never been Russian.

565
00:59:44,660 --> 00:59:50,309
Well, I don't want to. I mean, he's never he's never actually been rational in himself.

566
00:59:50,310 --> 00:59:56,310
But I mean, what I understand to be values. Well, that's the question that we face with this.

567
00:59:56,700 --> 01:00:04,170
And they want these pictures that went to the British court, an old, old British case called exponent, white bread, a lunatic.

568
01:00:04,530 --> 01:00:05,910
The British don't mince words.

569
01:00:07,980 --> 01:00:16,950
And this was a very wealthy man in the UK and he gave $10,000 to the Norwegians, first order £10,000 to the second daughter.

570
01:00:17,700 --> 01:00:21,480
Then he goes mad. That's the word they use here, isn't it?

571
01:00:22,230 --> 01:00:27,300
And under your statutes, all of his assets now can be used only for what?

572
01:00:28,390 --> 01:00:31,810
His purposes. Third dog comes along.

573
01:00:31,810 --> 01:00:35,810
There's no alienation. Does she get $10,000?

574
01:00:38,870 --> 01:00:42,120
£10,000. Hmm.

575
01:00:43,680 --> 01:00:48,540
Help! Help! Help! Save his colleagues. Are you asking me questions?

576
01:00:48,660 --> 01:00:53,129
No. We're not going to get into the publication of the court protection and argue that that would have been his intention.

577
01:00:53,130 --> 01:00:57,600
And there was no nation. And you make a statutory well on that basis or something.

578
01:00:57,690 --> 01:01:00,540
And what they did was they used the so-called standard.

579
01:01:00,690 --> 01:01:06,870
And the nomenclature is terribly misleading because it says substitute judgement doesn't mean the court substituted his judgement.

580
01:01:07,860 --> 01:01:13,350
It means and this is the exact words they used. I love these words and I use them to have a speak for justice.

581
01:01:14,040 --> 01:01:18,000
But the role of the court is, to quote, Don, the mental mark of the incompetent.

582
01:01:19,650 --> 01:01:21,720
I said something our courts do all the time.

583
01:01:24,660 --> 01:01:39,540
That is, they see themselves, for one, which I know is if they were reasonable, conscious, see themselves as unconscious and never been reasonable.

584
01:01:40,260 --> 01:01:45,200
What would they want? And this was whether or not to give this patient given chemotherapy.

585
01:01:45,540 --> 01:01:52,590
Well, you know, the vast majority of people who were not compromised medically left the chemo.

586
01:01:52,650 --> 01:01:55,650
Why do they like the chemo? They know it could be painful.

587
01:01:59,820 --> 01:02:05,870
Why do they like it? You don't think it's worth going for? They have to come through the other side and they can manage the process.

588
01:02:06,180 --> 01:02:13,950
They can manage within the limits of the body because they live in hope that they will get better.

589
01:02:15,240 --> 01:02:19,889
What will the sick, which is never they fight it struggle, not understand what's happening to him.

590
01:02:19,890 --> 01:02:24,810
It'll feel like torture. You will feel the pain. How would you if you could see yourself?

591
01:02:25,820 --> 01:02:28,820
Agreed to suffer pain without any expectation of.

592
01:02:29,720 --> 01:02:32,540
No, no. So that's what they came up with to substitute judgement.

593
01:02:32,870 --> 01:02:42,980
Now, the New York Court of Appeal, this high school in New York, just in fact, is a fairy tale, total fabrication, judicial fantasy nonsense.

594
01:02:43,730 --> 01:02:51,270
Now there is a good default position there. What's the default position that you would have if we don't know this walk?

595
01:02:53,030 --> 01:02:56,960
We don't want to take risks. At least rational. What the rational person suggested.

596
01:02:57,110 --> 01:03:01,230
Well. Clear and convincing evidence from patient incompetent.

597
01:03:01,470 --> 01:03:09,480
The only rationale for withdrawing is if he had said this or wrote it down.

598
01:03:09,480 --> 01:03:13,770
That is what happened. Then we have evidence of what he would have wanted.

599
01:03:13,950 --> 01:03:21,900
But in the absence of that, it is a charade to attribute a physician to this non-responsive patient.

600
01:03:24,460 --> 01:03:30,540
So you have. Three options which when you add in those three.

601
01:03:30,560 --> 01:03:34,890
Yeah. So I would say rational process of conjecture or clear evidence.

602
01:03:35,310 --> 01:03:38,780
Why try clear and convincing evidence first? Probably you would not.

603
01:03:39,120 --> 01:03:43,439
Who not protected under that standard. You just have to think. Children, children.

604
01:03:43,440 --> 01:03:48,209
All children are confident that they quote unquote in cold like nights.

605
01:03:48,210 --> 01:03:51,640
It would be classified incompetent at the time that I had the statements.

606
01:03:51,660 --> 01:03:55,010
Yeah. The other problem.

607
01:03:57,680 --> 01:04:09,559
The Normandy. Those who don't know that have written for the slope for which people like you know that well and you haven't

608
01:04:09,560 --> 01:04:15,740
done it you in good company 96% of people in England and Wales that to take advantage of this decision.

609
01:04:15,750 --> 01:04:21,290
Right. Well that 30% rate and under Zambia's standard, they're all going to get treated with only one of them.

610
01:04:21,530 --> 01:04:25,790
Yes. And that's just happening in the world. But I think our time has expired.

611
01:04:26,360 --> 01:04:30,080
So autonomy is reaching its corners now.

612
01:04:30,260 --> 01:04:34,760
There's been a distinct imbalance of power here.

613
01:04:34,760 --> 01:04:41,600
All the questions have come from from China. So now is your chance to redress the balance and feel free.

614
01:04:41,810 --> 01:04:45,290
So feel free to pose, Joe, the tricky questions.

615
01:04:46,160 --> 01:04:54,950
And we we could we could do the revision of your your straw poll and who in this room would

616
01:04:55,070 --> 01:05:01,100
choose it in in the setting of being permanently unconscious to have a feeding tube in,

617
01:05:01,100 --> 01:05:02,569
to be kept alive,

618
01:05:02,570 --> 01:05:14,629
perhaps in the hope that technology improves and you sign my name and so to speak, and perhaps people who would choose not to be kept alive,

619
01:05:14,630 --> 01:05:23,750
we had people being fierce, people who would like to be kept alive with being kept in between.

620
01:05:24,020 --> 01:05:27,100
Yeah, I know. You just know that. Yeah.

621
01:05:27,590 --> 01:05:29,720
Okay. Well, I think they've done thoroughly.

622
01:05:30,050 --> 01:05:38,120
Probably you're playing into the at least people's views that that ethics isn't necessarily just a question of what what people view that.

623
01:05:38,360 --> 01:05:46,970
You've got a question for John. Yeah. It's it's related. So so there's one question about what you do yourself versus what you do for somebody else.

624
01:05:48,050 --> 01:06:05,150
So if you said if you had a child with an accident and was in a coma and probably wouldn't survive, then you were holding on some jobs that they lose.

625
01:06:07,310 --> 01:06:11,990
How many people would would withdrawal particularly to Peter?

626
01:06:12,620 --> 01:06:17,480
Are you are you now the parent or the position of the parents?

627
01:06:17,810 --> 01:06:23,090
SIMON So well, we could we could have that we could have had that poll.

628
01:06:23,090 --> 01:06:32,810
So we could say so imagine you're a parent of a child who is unconscious, presumed long lasting, but there's some hope.

629
01:06:33,290 --> 01:06:43,180
You hold onto some more small chances of recovery if you want that artificial nutrition to be continued for your child in that setting.

630
01:06:44,760 --> 01:06:50,060
So to look at the same old same sequence out both for you wouldn't you wouldn't choose.

631
01:06:53,630 --> 01:07:01,610
So you will choose a feeding tube for your child in that setting, and you would use that to your child.

632
01:07:04,150 --> 01:07:14,020
So there's a couple of things. No, no. And let me let me show you how far we can go with this, to how much authority you want to give to pirates.

633
01:07:14,020 --> 01:07:21,410
And this is a big, big question. We changed everything changed around 1990 and up until 1990.

634
01:07:21,430 --> 01:07:29,590
All of the bioethics questions had to do with withdrawing ventilators, dialysis, oxygen, pressure, fluid.

635
01:07:29,830 --> 01:07:34,059
But by 1990, we had two things happen, at least in the United States.

636
01:07:34,060 --> 01:07:39,400
You had the Supreme Court saying that the competent patient has a right to decline any and all and wanted,

637
01:07:39,400 --> 01:07:42,580
and the various states could set up whatever evidentiary standard they want.

638
01:07:42,970 --> 01:07:53,740
And that's legitimate. And then you came to the question of how are you going to do it for the non-combatant patient?

639
01:07:54,280 --> 01:07:57,790
And we have a huge variety of standards in the states.

640
01:07:57,850 --> 01:08:04,000
New Jersey has rationing, of course. They then shifted later in the cholera cases saying, Oh, there are three ways.

641
01:08:04,090 --> 01:08:07,930
One, if they make a clear statement, that's the best.

642
01:08:08,290 --> 01:08:12,730
Two, if they have no values that we can learn from their family.

643
01:08:13,210 --> 01:08:18,250
And three, if they were in intractable pain, that would be such as to be inhumane.

644
01:08:18,760 --> 01:08:26,350
But that doesn't apply to anybody in PBS, does it? And in fact, it reduces the patient only to be a pain avoider.

645
01:08:28,190 --> 01:08:32,120
But Jenny had other reasons why she didn't want to be maintained this way.

646
01:08:32,870 --> 01:08:36,860
Effect on my family. Yes. I don't think I'm an island.

647
01:08:36,890 --> 01:08:41,860
I think my moral judgements are part of the network and my personhood.

648
01:08:42,440 --> 01:08:47,670
No man is an island unto itself. You know, there she is. She had a little cloud of your phone.

649
01:08:47,690 --> 01:09:00,110
And see, I have a list for. John Dutton's American division decision that in 1954, as a freshman in college, he ever never forgot.

650
01:09:01,260 --> 01:09:07,760
And do you have any person say to you. Okay, so coming from it, I obviously had no medical background.

651
01:09:08,540 --> 01:09:17,390
I the main question I have, one of the scenarios it's drawn out is what on earth is meant by the idea of a vegetative state and like,

652
01:09:17,630 --> 01:09:21,110
are there different grades of degrees of consciousness?

653
01:09:21,110 --> 01:09:25,250
And why on earth is there a reference like vegetative? Like where did that come from?

654
01:09:25,520 --> 01:09:31,250
The term came from Fred Plumb, who was a neurologist at NYU.

655
01:09:31,670 --> 01:09:38,600
And what you observed was producing coma and his condition.

656
01:09:38,930 --> 01:09:44,750
And he noticed said after about two weeks, the people who were in coma have a different behavioural pattern.

657
01:09:45,050 --> 01:09:48,830
They have wake sleep cycle he would call those don't get waves in cycles.

658
01:09:50,300 --> 01:09:56,470
I know but they don't track condition when that was the whole big thing about shadow performance.

659
01:09:56,570 --> 01:10:01,100
Oh she's responding for some clicking crying but.

660
01:10:02,030 --> 01:10:12,920
That was a two hour, 24 hour period. And so persistent vegetative state be defined as the state of.

661
01:10:13,670 --> 01:10:18,200
And it takes six months signifying this.

662
01:10:19,650 --> 01:10:26,240
And it depends on whether it was a. Ischaemic episode or forms of trauma.

663
01:10:26,240 --> 01:10:37,400
Trauma takes longer to designate, but the expectation is certainly after a period of time, there's going to be no there's no respect for a patient.

664
01:10:37,670 --> 01:10:42,230
Now, sometimes it is diagnosed. You have what's called a locked in syndrome, which the patient.

665
01:10:43,160 --> 01:10:51,530
They really see cancer patients eyes track, but they can't speak to Pakistan and they communicate through a signboard, an alphabet.

666
01:10:52,190 --> 01:10:56,780
I saw one of these, David Mack in Minneapolis and we in conversation.

667
01:10:57,200 --> 01:11:05,230
What do you think he said? HD and HD.

668
01:11:05,280 --> 01:11:10,330
Help me. What's the next? Yeah.

669
01:11:10,480 --> 01:11:13,660
I know what you want to do.

670
01:11:16,600 --> 01:11:21,100
So he's. Yeah. Okay. Well, that complicates things. Yeah, he's conscious.

671
01:11:21,250 --> 01:11:26,240
Mm hmm. Got to take it back.

672
01:11:27,170 --> 01:11:35,660
Your boss and Rush, you had a question such as what's interesting about substitution thing is that it's not the patient making the decision.

673
01:11:36,500 --> 01:11:42,050
It's we're making decision about the patient. And it's the doctors who have to execute that decision.

674
01:11:42,060 --> 01:11:45,710
And I. I struggle with that. Who's.

675
01:11:46,910 --> 01:11:50,330
Judgement of a substitute teacher. And do you see what I'm saying?

676
01:11:50,750 --> 01:11:53,960
Yes, but we kept the language terribly confusing. Great.

677
01:11:55,190 --> 01:12:02,659
And really is. Is there any way of discerning what is in the case they had?

678
01:12:02,660 --> 01:12:09,730
Was this man who has. You can't win.

679
01:12:09,970 --> 01:12:15,730
And he's never been. How. Would he want the chemotherapy if he could speak?

680
01:12:16,240 --> 01:12:19,560
And we know he's never been and he never will be. Exactly.

681
01:12:19,580 --> 01:12:27,970
Because it strikes me that you're making a decision about his care and you're creating a fiction to justify your action.

682
01:12:28,090 --> 01:12:35,020
That's exactly what they did. I mean, they said it is a fiction, but what's the only alternative is to take you say here and say to him,

683
01:12:36,430 --> 01:12:41,650
we're going to put this feeding tube into you and keep you here and it and you're going to resist it.

684
01:12:42,280 --> 01:12:45,640
Well, we're going to give you cheap therapy. You're going to resist that.

685
01:12:45,940 --> 01:12:50,890
And they said the only way we're going to be able to provide you with the chemotherapy is to do what?

686
01:12:53,280 --> 01:12:58,380
Every time he comes near, you strike out to him. So you put him in.

687
01:12:58,710 --> 01:13:03,450
Tie your hands now. So we need to restrain Russia, but we want to do it.

688
01:13:04,200 --> 01:13:08,490
Well, I don't know, because I think you could use a different tone.

689
01:13:08,860 --> 01:13:16,679
Well, we use a standard of you. Would you really want to be tied down and subjected to what's causing you suffering when

690
01:13:16,680 --> 01:13:21,120
you have no understanding and no capacity to understand what the purpose of it is?

691
01:13:21,180 --> 01:13:25,760
If I was having chemo and there was a potentially cruel leukaemia.

692
01:13:25,890 --> 01:13:34,440
Yeah, the treatment was probably yeah. He had at least the haematologist had he had a 30% chance of remission from 3 to 8 months.

693
01:13:35,100 --> 01:13:40,530
So it's, I don't know if it was a complete cure back to normal life, but I would say, okay,

694
01:13:40,710 --> 01:13:45,770
if it's a little bit of benefit, the price of being held down like that doesn't say what.

695
01:13:45,780 --> 01:13:52,820
And it's a risk benefit thing, but it's not. If you can tell me what you're actually doing is weighing the benefits and risks,

696
01:13:52,830 --> 01:13:57,150
but reasonable person, stop trying to do that for this patient who's not.

697
01:13:57,210 --> 01:14:00,240
That's exactly what they were doing. I know. But the point is.

698
01:14:00,840 --> 01:14:06,690
Well, the alternative is saviours. And I'll give you the the companion case was story in New York.

699
01:14:07,050 --> 01:14:13,170
He was another profoundly compromised individual I.Q. of an eight month old.

700
01:14:13,950 --> 01:14:17,190
His mother visited him every single day since 1942.

701
01:14:17,430 --> 01:14:26,340
This is in the 1980s. And he got cancer of the kidneys.

702
01:14:27,370 --> 01:14:32,890
And was losing blood and he was losing one unit of blood every eight days or so.

703
01:14:34,090 --> 01:14:38,740
And the mother and he resisted the blood transfusions because how do you transfuse blood?

704
01:14:39,290 --> 01:14:42,550
You completely put neatly. And he didn't like the needle.

705
01:14:43,330 --> 01:14:47,080
So his mother said, what are you giving him blood transfusions for?

706
01:14:47,440 --> 01:14:51,419
Stop. No blood transfusions.

707
01:14:51,420 --> 01:14:55,290
Ordinary. Extraordinary. And now you know why those words no longer, sir.

708
01:14:55,740 --> 01:15:00,670
But what's the proportional benefit burden that accrues to this patient trust? That's the actual arithmetic that's going on.

709
01:15:00,670 --> 01:15:07,680
And it seems. And the New York Court of Appeals, the highest court following it, said,

710
01:15:07,680 --> 01:15:12,089
we're not going to go with that fantasy out of Massachusetts about substantive

711
01:15:12,090 --> 01:15:18,870
judgement unless we have clear evidence from this man when he was competent.

712
01:15:18,930 --> 01:15:20,400
Now, when was this man ever competent?

713
01:15:21,690 --> 01:15:33,960
So our rule in New York was everybody who has not made a public statement or will get everything possible to stay life as long as possible.

714
01:15:34,920 --> 01:15:38,070
Now, that's a different statement. That's what they came up with.

715
01:15:38,190 --> 01:15:43,440
So what they do here is they use a best interest. Just doesn't mean you have to do everything you have to.

716
01:15:43,460 --> 01:15:46,770
It's a different but it's been more flexible in that sense.

717
01:15:47,040 --> 01:15:53,280
It really depends on who the judge is. Exactly. And do you really want to have Russian roulette with.

718
01:15:55,350 --> 01:15:58,140
Jenny, you've got a question and we're almost out of time.

719
01:15:59,280 --> 01:16:05,429
I just wanted to ask if you could comment on on the role of religion here and are we individuals

720
01:16:05,430 --> 01:16:10,830
who should be making autonomous choices and other bigger issues here and what the Catholic Church?

721
01:16:12,060 --> 01:16:17,100
Well, first of all, I wrote an article one time against Bob, which called Autonomy Run Amok.

722
01:16:17,130 --> 01:16:25,530
I think that the notion that we are autonomous entities in the mills, in a sense is a fantasy, total fiction.

723
01:16:26,190 --> 01:16:29,370
I used an example today with talking to Dominic. I said yes.

724
01:16:29,370 --> 01:16:33,600
In fact, over his mind and his body. Every human is sovereign.

725
01:16:35,730 --> 01:16:39,090
I asked Dominic what would be different about Dominic?

726
01:16:40,920 --> 01:16:48,330
I said, I can just use myself. I wouldn't be five foot six, I wouldn't be bottle and I wouldn't need glasses.

727
01:16:50,310 --> 01:16:58,680
Can I change any rules? So we don't have that to be solved in this economy that we have.

728
01:16:59,250 --> 01:17:03,660
And then the other fallacy is that we're all absolutely independent.

729
01:17:03,960 --> 01:17:09,480
We're sort of like zig zag. And we're sort of like like blitzing free floating monads.

730
01:17:09,510 --> 01:17:12,630
You know what those are? Yes, I know it is.

731
01:17:14,070 --> 01:17:17,890
Are you one of them? Oh, well, no, no, no.

732
01:17:18,960 --> 01:17:24,030
And so and the great theory about the monads is that they never interact.

733
01:17:24,030 --> 01:17:28,320
They never touch the never. But your life is totally involved in physical.

734
01:17:30,320 --> 01:17:39,950
And so you say that in an adequate assessment when purely economy and part of of where we've gone when we adopted

735
01:17:40,130 --> 01:17:47,600
this idea that we will just use the economy is that everyone thinks that he or she is absolutely sovereign.

736
01:17:47,780 --> 01:17:56,420
And not only we have we have very clear directions in the evolution of this absolute right to decline unwanted medical interventions.

737
01:17:56,780 --> 01:18:03,050
Everybody understands that. But that quickly morphed over about 1990 when we solved the problem of.

738
01:18:04,160 --> 01:18:08,870
You don't have to have dialysis to. If I am sovereign, what does that mean?

739
01:18:09,320 --> 01:18:12,560
I can demand. I can demand anything I want. And you must.

740
01:18:12,770 --> 01:18:19,370
And I'll give you the furthest, most example that it's an ongoing case right now in the United States called Jahi McMath.

741
01:18:19,370 --> 01:18:22,400
She's bringing it and meets all of the criteria.

742
01:18:22,610 --> 01:18:28,580
And the judge in the superior court in California declared that she's legally dead and the coroner issued a death certificate.

743
01:18:28,760 --> 01:18:34,520
The parents say, we don't believe she's dead and we don't believe that judges or doctors should determine who's dead.

744
01:18:34,700 --> 01:18:38,269
Only parents can decide whether the children are alive or dead. Try that.

745
01:18:38,270 --> 01:18:43,400
In the UK population, you know, that's 6.6 million.

746
01:18:43,630 --> 01:18:47,720
You want to have 6 million people deciding whether on Jenny is alive or dead in the attic.

747
01:18:48,470 --> 01:18:51,530
Think of the public health problems we've had from that.

748
01:18:54,010 --> 01:19:02,260
Yeah. And in fact, one of the great constraints upon the right to demand is you can do whatever you want,

749
01:19:02,260 --> 01:19:08,680
provided that your actions don't present an immediate, clear and present danger to the public health, safety, welfare.

750
01:19:08,920 --> 01:19:14,680
For example, if you had contagious tuberculosis and you free to just do what you want, get on an aeroplane.

751
01:19:16,290 --> 01:19:20,290
You can be. Yeah. So you don't have absolute freedom.

752
01:19:20,680 --> 01:19:26,590
So that idea that we have, that we're totally autonomous entities is just a fantasy.

753
01:19:27,340 --> 01:19:32,110
But what about the other question that Jenny asked about the role of religious traditions

754
01:19:32,110 --> 01:19:36,280
or the views of religious traditions on this question of whether individuals.

755
01:19:36,280 --> 01:19:39,310
So should a good Catholic just accept the feeding tube?

756
01:19:39,550 --> 01:19:43,870
Would would a good Catholic be allowed to refuse the feeding tube?

757
01:19:45,670 --> 01:19:50,049
Well, I've spent my whole life dedicated to being a Catholic,

758
01:19:50,050 --> 01:19:57,400
and my events director says if I'm ever in an institution that believes that you must have a feeding tube inserted,

759
01:19:57,610 --> 01:19:59,830
please transfer me immediately to a hospital.

760
01:20:06,090 --> 01:20:15,300
And you had for 500 years a consistent moral tradition in the Catholic Church that feeding and in fact this historically you go back to.

761
01:20:18,160 --> 01:20:21,430
To the solo dignitary Victoria.

762
01:20:21,430 --> 01:20:31,330
And then we're talking about in the relaxing, which is the holiday I suppose in fact some opinions and packages.

763
01:20:33,540 --> 01:20:38,180
And you could live another 20 years if you ate Partridge.

764
01:20:39,340 --> 01:20:44,930
But what do we know about packages? Live in palm trees they live in.

765
01:20:46,790 --> 01:20:55,760
They're expensive. But I'll give you the prime example. Another good example, supposing, in fact, we're now living in a society which doesn't have.

766
01:20:57,600 --> 01:21:07,290
A big social welfare net. And you run a farm and you show Exxon's how you pay for it and.

767
01:21:10,910 --> 01:21:15,650
One of the members of the family gets sick and the solution is Jewish penicillin.

768
01:21:15,800 --> 01:21:20,730
And if a Jewish consumer, what you need. Chicken.

769
01:21:21,160 --> 01:21:24,160
Chicken. Chickens. And so we did.

770
01:21:24,340 --> 01:21:29,230
So the chicken today, you get the chicken soup and the industry is what happens to our.

771
01:21:30,930 --> 01:21:36,570
It's not my life. I'm a vegetarian. You're asking me bidets, don't you?

772
01:21:36,630 --> 01:21:39,640
I do. And where do we get the eggs? Chicken.

773
01:21:39,660 --> 01:21:43,540
And if we use them all for chicken soup, we don't get any eggs.

774
01:21:43,560 --> 01:21:48,510
And then we all stop. So are you morally obliged to do that?

775
01:21:48,990 --> 01:21:52,440
No. No. So if.

776
01:21:52,440 --> 01:21:56,730
If in the 15th century, they talk about chickens and eggs.

777
01:21:57,990 --> 01:22:06,719
How much more so? Speaking as grass roots and vegetables. Well, we then we've ended that talk on the question of the chicken and the egg,

778
01:22:06,720 --> 01:22:17,400
which which is perhaps a fitting and challenging into to a great discussion,

779
01:22:17,400 --> 01:22:29,100
an exploration of both the profound and and absurd and absurd and simpler ethical questions around nutrition, hydration, obligations.

780
01:22:29,100 --> 01:22:34,980
I'm chicken. I'd like you to join me in thanking Professor John Paris for a fascinating evening.

781
01:22:35,040 --> 01:22:35,520
Thank you very.