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This work explores controversial dilemmas which meet at the intersection of medicine, philosophy and law - questions concerning killing and not killing which are faced daily in health care. They embrace euthanasia, abortion, and the care of the elderly, demented, mentally ill, children, and those in a persistent vegetative state. The author identifies a crisis both in ethics and in empowerment as people face often necessarily wretched choices. He seeks a framework of guidance for practical decision-making and focuses on two key issues. First, who decides on an individual's quality of life, and thus on our health care treatments? Second, how can patients be empowered with a structure to enable choice, self-realization, self-reflection and self-responsibility?;John Spiers offers a fundemantal choice between health care experienced as hierarchy and control, and the alternative of choice and self-responsibility. He argues that health care must rely on patients deciding how much power they have, not on professionals deciding how much to grant them.