Dominic Wilkinson is to be congratulated on producing this symposium on elective ventilation (EV). One critical issue in this debate is whether EV is against the interests of the patient. Indeed, the Department of Health guideline in 1994 claiming it was not in the best interests of the patient (and therefore unlawful) killed the practice. Several of the papers in this symposium consider whether EV can be construed to be in the patient's broader (or I will say, ‘global’) interests. De Lora1 argues that we have an interest in our organs being donated. Similarly, Coggon2 argues that interests include the desire to donate to organs, though McGee and White3 disagree.

One can distinguish between global interests and narrow medical interests. A person's global interests are to have a life with as much well-being as possible. Medical interests relate to the treatment and prevention of disease or injury. Clearly these diverge, as when a person engages in some risky activity for a higher goal, such as mountaineering or driving a car. What matters most is one's well-being, or global interests, and when these conflict with medical interests, they should trump them.

One even more striking example of the …