No Man (or Woman) Is an Island?
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EDITORIAL
No Man (or Woman) Is an Island? Michael A. Ashby
Published online: 12 October 2020 # Journal of Bioethical Inquiry Pty Ltd. 2020
Keywords Autonomy . Genetic testing . Truth-telling . Physician-assisted death . Organ donation . Disability . Advance directives . Resource allocation . Responsibility . Pathography
No man is an island entire of itself; every man is a piece of the continent, a part of the main; if a clod be washed away by the sea, Europe is the less, as well as if a promontory were, as well as any manner of thy friends or of thine own were; any man’s death diminishes me, because I am involved in mankind. And therefore never send to know for whom the bell tolls; it tolls for thee. (MEDITATION XVII Devotions upon Emergent Occasions. John Donne [1572–1631]) Ignoring gender and geographical references of its time, these famous words by the English metaphysical poet echo through our times and several of the papers in this issue. In this era marked so heavily in every corner of the world by the COVID-19 pandemic, with nearly 25 million cases and 900,000 deaths, it is all too easy to M. A. Ashby (*) Cancer, Chronic Disease and Sub-Acute Stream, Royal Hobart Hospital, Tasmanian Health Service, School of Medicine, Royal Hobart Hospital, University of Tasmania, Hobart, TAS 7000, Australia e-mail: [email protected]
be overwhelmed by the magnitude of death and diseaserelated suffering that mask the myriad individual journeys of grief, loss, and unaccompanied death. To the fact of death on this scale, is added the anguish of potential avoidability, dying by oneself away from family and friends, and a small funeral or none at all. Apart from showing its empathy and concern, all a journal can do is write: “a writer always writes.” The next edition of Journal of Bioethical Inquiry will be dedicated to the pandemic (Volume 17(4) forthcoming; articles currently available at https://bioethicalinquiry.com/symposiumsocial-and-ethical-implications-of-the-covid-19pandemicpart-1/). Respect for each human life and promotion of the interests and freedom of every person is fundamental and non-negotiable in bioethical inquiry. Autonomy is the most prominent of principles in bioethics and underpins most ethical and legal deliberations. This can almost make it seem like a settled concept, that when the word is deployed everyone knows what it means and will agree. Like all ethical concepts, it can be taken to extremes and autonomy taken to mean that the individual’s wishes, needs, and wants supersede all other considerations. However, as Donne points out, no person exists in a social vacuum, especially at the beginning and end of life, when ethics is most often invoked (and once gain the pandemic, of course, has challenged this head-on everywhere). In several of the articles in this edition, it is seen that autonomy has boundaries and hurdles in both theory and practice. Despite its almost universal pre-eminence and acceptance, it can, and
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should be questioned, and, where necessary, balanced against othe
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