DPhil in Medical Law: Q and A with Dr Cressida Auckland

DPhil in Medical Law: Dr Cressida Auckland Dr Auckland

Why did you choose Oxford? 

I chose Oxford primarily because of the academics available to supervise me there (Imogen Goold and Jonathan Herring), but having completed my undergraduate degree there, I also loved the city and the university.

Did teaching and lecturing help your DPhil research?

While it didn’t help the contents of my research, teaching did give me more structure and provided an important distraction from my DPhil, which I think benefited my research hugely. Focussing on one piece of work for three years can make you lose perspective on it, so the need to think about something else for a change; to have time-sensitive deadlines to work too, and pressing student issues to address, definitely helped provide greater structure to the three years, and stopped me becoming too obsessive about the DPhil!

What was the title of your DPhil research and what was your research about?

My DPhil was entitled ‘The Cusp of Capacity: Empowering and protecting people in decisions about treatment and care’. It examined the operation of the capacity threshold both conceptually, and in the way it is applied by doctors and judges in practice. It argued that the test for capacity contained in the Mental Capacity Act 2005 fails to accurately distinguish those who are capable of autonomous decision-making from those who are not, relying on too narrow a conception of autonomy which prevents it from capturing impairments in the content of the person’s beliefs or values, rather than their decision-making processes. It therefore advocated introducing a new ‘authenticity’ limb to the test that asks whether the person’s values or beliefs are the product of an illness or disorder.

If the test cannot reliably distinguish autonomous from non-autonomous, the law’s cliff-edge approach is difficult to justify. Yet, the provisions on best     
interests are currently framed in a way that provides doctors and care-workers with very little support should they wish to make a decision which carries an     element of risk to the person. I therefore proposed a new framework to encourage decision-makers to prioritise the wishes of the individual, through a   
rebuttable presumption that their wishes be determinative of their best interests unless giving effect to them would expose the person to a serious risk of 
significant harm.   

Who was your supervisor? 

 Imogen Goold and Jonathan Herring. 

How did you think of your DPhil research topic? 

Initially through discussions with academics on my Masters course, but the focus of the DPhil changed considerably over the course of the three years, in large part prompted by the helpful comments I received during my DPhil upgrade viva.

How has your DPhil research continued to feature in your current research interests and projects?
Much of my research now focusses on mental capacity and end of life decision-making, and so my DPhil research provides important context for this. During my DPhil I also had the opportunity to consider specific issues which can arise in different ways when considering decision-making at the end of life, for example exploring different conceptualisations of autonomy, or what is meant by harm, or dignity, which I draw on frequently in my research. Most directly, I am currently completing a monograph which, while substantially different from it, had its genesis in the DPhil and includes much of my research from it.  
How has your DPhil has helped you in your career?  
My DPhil was (perhaps obviously) essential to getting my job, as an Assistant Professor in Medical Law at the LSE. I was very fortunate to be offered a job while completing my DPhil, and this would never have been possible without my DPhil, but perhaps most importantly, without the encouragement and support of my supervisors. But the process of writing the DPhil (and receiving feedback on it from my supervisors) also hugely enhanced my ability to evaluate my own work, and to understand when things are working and when they are not, and why that is. I now feel much more confident in my ability to assess whether an article or chapter is good, which is crucial given that the main difference between research now and then, is that no one is duty-bound to read my work and tell me if it sounds crazy!