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Show all Right to Die questions

Literary questions for reading groups

For discussion

Q. Was a diary format an appropriate choice for this novel? How else might the author have dealt with Adam’s story?

Q. Joel becomes increasingly involved in Adam and Naomi’s lives as the disease progresses. What do you feel is happening here?

Q. Dr Curtis is seen as a friend and ally by both Adam and Naomi; how does the narrative develop this idea?

Q. What do you think Dr Curtis did in the final scenes? What gives you this sense?

Q. Naomi’s thoughts as she reads the diary after Adam’s death give depth and perspective to Adam’s personal account. How would the story have differed without her input? Would your view of Adam have been different?

Q. Serious issues can weigh a novel down. What techniques has the author used to lighten the tone?

Q. The theme of suicide recurs throughout the book. How psychologically plausible do you find the characters who contemplate it or carry it out?

Q. Would the story have been different if the reader had greater insight into the minds of Dr Curtis or Mavis or Joel?

Q. Lydia is a strong character in the life of Adam; Brendan less so. Discuss their significance in this story.

Moral and ethical questions

Right to Die revolves around the central theme of when and in what circumstances it might be permissible to assist someone to die.

Respect for autonomy

Q. Adam is an intelligent, mentally-competent individual, well aware of the implications of his diagnosis. He believes it is his right to choose the manner and timing of his death. What arguments could you put forward to counter his claim?

Q. He tells Naomi: ‘If Curtis could promise to help me when my time’s up, I’d probably keep going longer because I’d feel secure. If he won’t give that undertaking, I might have to decide sooner while I still have the capacity to do it myself.’ Discuss.

Q. A ‘good life’ with Motor Neurone Disease means one thing to Adam but something different to his neurologist who sees degenerative diseases all the time. What are the implications of this discrepancy?

Q. Adam asks his GP: ‘How will I know when it’s the right time to say enough is enough?’ What factors would weigh for you in such a situation?

Q. How much do the beliefs and opinions of a) his GP b) his neurologist c) his physiotherapist d) his mother, limit Adam’s autonomy? Is this ultimately helpful or unhelpful?

Q. To what extent should couple - or family-autonomy override individual autonomy?

Rights and interests

Q. Naomi, Mavis and Joel all have a personal interest in the timing of Adam’s death. What rights, if any, have they in the matter?

Q. Dr Curtis believes he has a right not to do anything which compromises his own moral principles. Dr Devlin says that patients ‘cannot be allowed to dictate the moral values of medicine.’ Whose rights should take precedence?

Q. Should the next-of-kin be allowed to overrule

1. a patient’s request not to be resuscitated?
2. an advance directive?
3. a wish to donate an organ or the body to medical science?

If so, in what circumstances?

Conflicts between autonomy and paternalism

Q. Even were assisted dying to be legally permissible, Dr Curtis says, he would still be reluctant to help Adam to die when he requests it. Should such paternalism be permissible?

Q. Consider the results if the GP had agreed to Adam’s request for help in dying

1. shortly after diagnosis
2. just before he went to Madeira
3. as soon as he became unable to kill himself.

In your judgement, at what point would that have been the optimal timing?

Confidentiality and the right to know

Q. Dr Curtis is scrupulous about preserving confidences. Neither Adam nor Naomi know the extent of the struggles the other is grappling with. Was this in their best interests?

Q. Naomi makes unilateral decisions about parenthood without reference to Adam because she doesn’t want to further undermine his will to live. Was she right to do so?

Balance of burdens and benefits

Q. Adam has to balance the burdens of his disease against the benefits of staying alive longer. His wife, his writing, completing his novel weigh with him. What things would persuade you to keep going in such a situation?

Ethical issues relating to assisted dying

Q. Adam says he doesn’t want to be cared for so expertly that his dying is ‘strung out way past the point of common sense.’ How far do you feel the availability of good palliative care influences opinion on assisted dying?

Q. Adam sees a huge paradox between abortion on demand and the legal prohibition against assisted dying for patients who are capable of deciding for themselves. Discuss.

Q. Dr Curtis says that causing death is not the same as allowing to die. Do you agree?

Q. What do you think he did in the final stage of Adam’s life? Do you approve of his actions? If not, why not?

Q. Adam’s mother, Mavis, holds strong and immovable religious scruples against assisted dying and suicide. How far should such beliefs govern what is legally permissible?

Q. The Most Reverend Wilberforce J J Kingsley’s thought-for-the-day outlines a distinction between the sanctity of life and the value of life which Adam sees as relevant to his right to die. Do you agree?

Q. The law currently prohibits assisted dying.

1. Should it be changed?
2. If so, what caveats should be applied to minimise the risks?

Q. Should there be criteria set for people who go abroad for assisted death or should the desire for death suffice?

Q. Animals can be put down to prevent or end suffering; humans can’t. Discuss.

Ethical issues related to Motor Neurone Disease

Q. How ethically acceptable do you feel it is to use stem cells from a) an embryo or b) an adult, to treat MND?

Q. Adam’s cousin, Milly, fears she might have inherited the same disease. What are the implications of offering screening to relatives in cases of inherited disorders?

Justice

Q. Adam says it is easier for someone in a persistent vegetative state or on a life support system to be helped to die than for him. ‘Where’s the justice?’ Discuss.

Q What does dignity involve for you?

Q. Adam argues that the money spent on his terminal care would be better spent on patients with some hope of benefit. Is this a sufficiently powerful argument for ending his life?

Virtue

Q. Would you say that Dr Curtis was a virtuous doctor? If not, how would you categorise his response to Adam’s need?

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Show all Vacant Possession questions

Literary questions for reading groups

For discussion

Q. Bill Faraday is the central character in the first part of this book; Geoff Ar chibald takes over. To what extent does this development influence the story?

Q. Neither Viv nor Rhona can contribute to the debate. How real are their characters viewe d through the eyes of their relatives?

Q. Frances Faraday is seen as someone who is less than honest. How does her religious life square with this trait?

Q. How compatible do you feel Rhona and Geoff Archibald were before her suicide attempt?

Q. Why do you feel Geoff chose to keep his suspicions from the police for as long as he did? Were his scruples justifiable in the circumstances?

Q. Bill comes in for strong criticism. Do you think he was a good father?

Q. How big a part does deception play in this book?

Moral and ethical questions

Vacant Possession revolves around the central theme of decision making on behalf of the mentally incompetent.

Proxy decision making

Q. Dr Steven Wilkinson says that it is his responsibility to decide what should be done for Viv Faraday but he looks to the family to guide him as to Viv's own wishes when she was competent to decide.

1. To what extent should the family influence medical decisions?
2. Is there a moral difference between a decision about abortion and a decision about other forms of medical intervention?

Q. Geoff Archibald, and Bill, Frances, Kevin and Euan Faraday all contemplate abortion on behalf of their female relatives who are no longer able to state their own wishes.

1. Should parents, husbands and/or siblings of the mentally incompetent patient have equal rights to contribute to the decision making process?
2. If not, whose voice should take precedence in the event of conflict?
3. Bill Faraday considers Viv's mother and brothers have forfeited their right to a voice because of 'desertion'. Is he right?
4. Should a social father have the same rights to a voice in decision making as a biological father?

Q. Neither Viv nor Rhona specifically contemplated persistent vegetative state or rape prior to lapsing into a comatose state. How far is it relevant to extrapolate their preferences from their stated views on related topics?

Q. Dr Charles Wynne-Hope says ‘I can't make good decisions if I don't care about the patients - if I'm not touched by the effect on the families.’ How far should medical personnel allow their emotions to enter into decision making?

Rights and interests

Q. Does Viv's unborn child have any rights in the circumstances recounted in Vacant Possession?

Q. In the decision about whether or not to abort her fetus, Euan Faraday believes that Viv is not the only member of the family who counts. Is he right? If so, who else should be counted and on what grounds?

Q. Rhona Archibald knows nothing and may be said to have no interests of her own except in so far as they affect others. Can Geoff legitimately ignore what would be her interests if she were mentally competent and aware where these conflict with his own?

Q. Bill has his own private reasons for withholding consent to DNA testing. DS Latimer tells him the law can overrule his refusal. Given all the circumstances should this be permissible?

Disclosure of information

Q. Geoff is infuriated by his GP's unwillingness to share with him information about Rhona which might help him to understand why she attempted to end her life. However, the doctor does agree to divulge confidential information to the medical team caring for her now. Is the GP's position ethically defensible?

Competence to decide

Q. Ten-year-old Ginny is facing a second bone marrow transplant for a recurrence of her leukaemia. Frances Faraday argues that she is not competent to decide for herself whether or not to undergo the procedure.

1. Should such a child be allowed to i) accept or ii) refuse such a procedure?
2. Is there a moral difference in deciding for a course of action which will end in death as distinct from one which offers a hope of life?
3. Does it take a higher level of competence to decide to forgo rather than accept treatment for a potentially fatal illness?
4. Would the eventual outcome of such a decision influence your argument?

Respect for autonomy

Q. Respect for autonomy involves letting competent adults choose for themselves even when their decisions may involve harmful consequences, Dr Wilkinson tells the Faradays. Is this an appropriate delegation of responsibility? Under what circumstances should doctors be permitted to overrule patients/relatives' decisions?

Conflicts between ethical principles

Q. News of a rape in Chivenings could have a potentially disastrous effect on the management and future of the Home.

1. Would Dr Steven Wilkinson be justified in keeping the information quiet to prevent adverse reactions?
2. Is it ever ethically acceptable to sacrifice the good of the individual in the interests of the many?

Q. Dr Steven Wilkinson faces a situation where it appears a rapist is loose in his Home. He briefly contemplates putting the female patients on contraceptives to prevent further pregnancies. Could such a decision be morally justified?

Q. Is it ever ethically defensible to sterilise a mentally incompetent patient to avoid the risk of pregnancy?

Justice

Q. In Geoff's mental rehearsal of the arguments, the judge suggests that it is a waste of courtroom time and taxpayers' money to debate the issues for an insentient woman. Resources should rather be diverted to ensure legal representation for mentally competent but distressed victims of violent assault. Is he right?

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Show all Paternity questions

Literary questions for reading groups

For discussion

Q. This story is predicated on secrets. How justifiable were they?

Q. Judy is a midwife. How much does her work influence developments in her personal life? Do you like her as a person?

Q. Sid Robertson and Jim Burrows are very different characters facing similar situations. How far do their contrasting responses a) fit with their personalities and b) influence the story?

Q. Sian, Declan and Georgina were brought up together by the same parents. What features of their upbringing do you think influenced each of them most?

Q. Declan has a rose-tinted picture of Judy. In what ways is he deluded and how does this influence developments in their relationship? If you were a marriage guidance counsellor what advice would you give them?

Q. In Declan’s shoes would you have responded to Dr Farnham’s revelation in the same way? What are the consequences of Declan’s decision not to tell Judy what he knows?

Moral and ethical questions

Paternity revolves around the central theme of what should be permissible in relation to assisted reproduction involving donated gametes.

Respect for autonomy

Q. When Dan Allanwood donated his sperm for medical use, the prevailing policies and procedures failed to detect the presence of a faulty gene, to prevent inadvertent incest, or to minimise the risk of a serious genetic defect in future offspring. How might the risk of these developments have been minimised?

Q. Until recently artificial insemination in the UK has been predicated on donor anonymity. Real life cases have challenged this practice and the law has now changed. Should sperm donors be

• identifiable?
• traceable?
• paid?

Q. Isobel and Sid Robertson, and Betty Burrows all decided not to tell their children about the artificial insemination. Why did they withhold this information and were they right to do so?

Disclosure of information

Q. Both Declan Robertson and Judy Burrows had the names of their social rather than biological fathers on their birth certificate. Is this practice ethically acceptable?

Q. Georgina Robertson knows she may carry a faulty recessive gene. Just how much should she divulge to any partner with whom she plans to have a child?

Q. Imagine you are a) Sian, b) Declan and c) Georgina Robertson. How much will you tell your own children about their genetic history?

Rights and responsibilities

Q. Judy tells her mother that in cases involving donated gametes, the children's rights should be considered. What are those rights and in the event of conflict, whose needs and rights should take precedence, the donors' or the children's?

Q. Is there a greater moral responsibility attached to donating sperm rather than blood or a kidney?

Conflicts between beneficence and autonomy

Q. Bethany Robertson died because both her parents carried a faulty recessive gene. What are the advantages and disadvantages of gene therapy?

Q. The chaplain, Geoff Frazer, comments on slippery moral slopes in two ways: Slopes are only dangerously slippery if you're not properly prepared or dressed for them … It's up to these official committees - and all of us, I guess - to monitor progress and ensure we don't venture onto slippery slopes unwarily. We must have sufficient resolution and integrity to pull back if we feel there's a danger of it getting too skiddy. We need to have the courage and strength of purpose to know we'll do the right thing when the next moral choice has to be made, not sit there feeling so weak that we say no to any progress. To what extent do you share these views?

Q. While Judy is grappling with the options available to them for creating a child who is free from the serious medical condition from which Bethany died, she hears a professor of medical ethics speaking of "perilous knowledge". How far should people be protected from potentially serious information about their genetic predisposition?

Q. Dr Keith Galloway did not share his suspicions about Judy and Declan with the Robertsons, his concern being only with issues of medical benefit. Dr Henrietta Farnham saw this as paternalistic behaviour. Who is right?

Justice

Q. With resources limited in a state-funded health service

1. Should infertility treatment be freely available to anyone who wants it?
2. Should there be limits set to who may receive it? If so, on what grounds?
3. Do doctors have a moral responsibility for making such choices?

Ethical issues relating to artificial or assisted reproduction

Q. Declan, Georgina and Judy all react differently to news of their origins. Are their reactions equally defensible?

Q. Georgina perceives an ethical difference for medical staff between helping to create a new life and performing other medical procedures. How valid is such a distinction?

Q. Geoff Frazer has views on embryo destruction, infertility treatment, and allocation of resources (Chapter 33). To what extent do you share his conclusions?

Q. Sid and Isobel chose to undergo infertility treatment far from home. What are the advantages and disadvantages of such a course of action?

Q. If Sid and Isobel had elected to adopt a child instead of having infertility treatment, the medical, social and psychological vetting processes would have been much more rigorous than they were for assisted reproduction. Is this difference ethically defensible?

Q. In the case of both the Robertsons and the Burrows, the donor was selected to resemble the social fathers on basic characteristics such as height, colouring, ethnic origin.

1. To what extent and based on which characteristics should couples be given a choice of sperm donor?
2. Is there a slippery slope to the creation of designer babies?

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Show all Double Trouble questions

Literary questions for reading groups

For discussion

Q. Motherhood features strongly in this novel. How good a mother do you think each of the women was?

Q. Nicholas, Donella, Declan and Roberta took a number of different steps to prevent the disclosure of information which they preferred to keep private. They did not anticipate the effect of Graeme Robertson's mental instability. What other chinks do you perceive in this family's armour?

Q. How would you describe the relationship between Nicholas and Donella? Do statements they make themselves on the subject square with your view?

Q. Professor Richard Halley is a powerful man. How much does he influence what happens to his family? Do you approve of his behaviour? Do you like him?

Q. Which characters emerge as having most integrity? How do the others fall short of their standard?

Q. If you were writing the sequel to this story what would happen in it?

Q. Did you anticipate the ending of this story? Can you find cues retrospectively? How did you respond to it? Why?

Moral and ethical questions

Double Trouble revolves around the central theme of what should be permissible in relation to assisted reproduction involving surrogacy.

Respect for autonomy and paternalism

Q. Professor Dick Halley is personally strongly opposed to surrogacy. Is it acceptable that he, as a clinician specialising in helping infertile couples, should refuse to be involved with patients who wish to go down this route?

Q. Donella Halley argues that a surrogate mother had just as much right to terminate a pregnancy as she would have if it were "normally" conceived. Do you think she is right? If not, why not?

Disclosure of information, rights and responsibilities

Q. When the information about Judy and Declan Robertson impinges on the happiness of her own son, Roberta Mansfield/Halley feels differently about it compared with her reaction when the Robertsons were merely patients. To what extent should doctors allow emotion to affect their judgement in decision making?

Confidentiality and the right to know

Q. Even in the face of Donella's direct appeal for information that concerns her and her unborn child, Roberta withholds it. Is this an appropriate interpretation of her duty to maintain medical confidentiality?

Conflicts between beneficence and autonomy

Q. Roberta tries to protect her son from the consequences of genetic inbreeding. Were her actions morally defensible?

Ethical issues relating to artificial or assisted reproduction

Q. Nicholas is very keen to have a child of his own. When he weighs up the pros and cons of infertile couples acquiring a child through assisted means, he comes to the conclusion that there are more arguments in favour than against. How many of his arguments would you be persuaded by?

Q. Imagine you are

1. a social worker considering Nicholas and Heidi for adoption of a child,
2. a fertility specialist considering them for assisted conception.

Would you approve them as prospective parents? To what extent would the criteria you use differ in the two scenarios?

Ethical issues relating to surrogacy

Q. When Nicholas questions his father on the idea that surrogacy is a form of adultery, Dick reassures him that it is not. Is there technically a moral difference between a couple inserting warm semen into the woman in a private bedroom compared with doctors doing the same thing in a medical clinic, as Dick suggests? Does the experience of Nicholas and Donella alter your theoretical view?

Q. What are the advantages and disadvantages of

1. the surrogate mother staying in touch with the commissioning couple?
2. the surrogate mother being a relative?
3. involving a surrogacy agency?

Q. Maintaining secrecy is much more difficult with surrogacy than donor insemination. What steps might Donella and Nicholas have taken to protect themselves from outside criticism?

Q. The two couples begin with strict rules of behaviour to ensure no breaches of propriety and taste. By the fourth attempt several of these minimum requirements are no longer in place. Which basic safeguards do you think are essential in such a transaction?

Justice

Q. Nicholas believes the law is right to give custody of the child to the biological mother in the event of a dispute. Do you agree?