Am I my brother's keeper? Two perspectives on consent

I imagined the ethical dilemma that would soon confront the emergency physician asked to assess Sophie. I doubted that she would readily agree to a psychiatric evaluation. And I figured that she had been in this situation before. Perhaps medication had been prescribed at one time but was lost. Or perhaps she had simply stopped taking it. Since she was not obviously a mortal danger to herself or an explicit threat to others, it is hard to imagine how the physician could justify overriding the legal obligation to obtain Sophie's consent to an evaluation. Any assessment, medical care and even community follow-up would require her explicit agreement. Respecting Sophie's right to autonomy and self-determination, the physician would have to let her go. Somerville's view is a secular and legal one. But Sophie's reference to my obligation as a Jew to "do the right thing" prompted me to examine the issue of consent from a Jewish perspective. In contrast to contemporary mainstream bioethics, in which competence and informed consent form part of the basic vocabulary of the discipline, these notions are rarely discussed in Jewish texts. In his collection of essays, Duty and Healing, the late clinical ethicist Benjamin Freedman wrote that the principle of autonomy, which underlies the concept of informed consent, is not a persuasive factor within Jewish law (Halakha).' In this context, a person is viewed as the temporary custodian of her body, rather than as owning that body and having the right to decide what happens to it. Each person is charged with the duty of safeguarding and preserving her health, as well as the health of others, as if these were precious, borrowed entities that require nurturing and maintenance: What does this mean for Sophie, spotted one week after her visit weaving between 4 lanes of traffic? The more traditional, legalistic view would place the responsibility for making a decision about treatment squarely on Sophie's shoulders, especially if her behaviour was not overtly dangerous to herself or others. Somerville's interpretation of this view is that the freedom to determine one's medical fate takes priority over more stringent conditions for consent, such as insisting that the patient demonstrate a comprehensive understanding of what is happening to her. But there is not much point to knowing the facts without being able to put them in context. When a person suffers from a mental illness that results in confused thinking and a wanton disrega