Sophistry and Circumstance at the End of Life


  • Philip Berry Practising physician, London



sedation, autonomy, futility, cirrhosis, liver transplantation, critical care


When life-threatening illness robs a patient of the ability to express their desires, medical personnel must work through the issues of management and prognosis with relatives. Management decisions are guided by medical judgement and the relatives’ account of the patient’s wishes, but difficulties occur when distance grows between these two factors. In these circumstances the counselling process may turn into a doctor-led justification of the medical decision. This article presents two strands of dialogue, in which a doctor, counselling for and against continuation of supportive treatment in two patients with liver failure, demonstrates selectivity and inconsistency in constructing an argument. The specific issues of loss of consciousness (with obscuration of personal identity), statistical ‘futility’ and removal of autonomy are explored and used to bolster diametrically opposed medical decisions. By examining the doctor’s ability to interpret these issues according to circumstance, the author demonstrates how it is possible to shade medical facts depending on the desired outcome.

Author Biography

Philip Berry, Practising physician, London

Philip Berry is a London based physician specializing in gastroenterology and general internal medicine, with a particular interest in critical care and its attendant ethical and communicational challenges. Previous publications have explored the ethics of assisted dying, patient autonomy, suicide and erosive factors affecting the physician–patient relationship.



How to Cite

Berry, P. (2008). Sophistry and Circumstance at the End of Life. Communication and Medicine, 5(1), 81–88.



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