In the matter of Stephen Dawson: right v. duty of health care.

In cases like that of Stephen Dawson the ethics of proxy decision-making are at stake. As long as patients are persons they have rights, the incompetent ones no less than those who are competent. The only difference is that in the case of incompetent persons the rights must be exercised by proxy. The import of the Stephen Dawson case is that by this precedent Canadian law now radically alters the status of incompetent minors in such a way that their rights are curtailed in two fundamental ways. First, the parameter of qualitative considerations that is available to any other person is removed from the armory of the decision-making criteria of incompetent minors and can no longer be employed by the proxy decision-makers. Second, what are rights in the case of competent individuals--the right to life and the right to health care--become duties. Ethically this dénouement is deplorable. The medical profession now not only faces the pragmatically unenviable task of having to save or sustain all incompetent minors so long as medical science will permit but will have to do so even at the cost of quality of life. I shall pass over in silence the ethics of the resource-allocation problem that now arises. As a medical ethicist I can only hope that the medical profession will soon see fit to challenge this decision on a formal basis.