Sir, with all due respect to the authors, I have two main points of contention.1 Firstly, the use of the heavily loaded word 'hesitancy'. This word alone could have a paper devoted to the underlying psychological implications. It is patronising, paternalistic, condescending, suggestive of fear, weakness and ignorance. Its use in this context is entirely inappropriate, disrespectful of self-determination and unprofessional.

Secondly, the tortuous mangling of the four principles set out by Beauchamp and Childress seemingly in an attempt to subordinate autonomy. This is either naïve and ignorant or a crude and frankly insidious attempt to justify a collectivist utilitarian doctrine. It is well established in law and moral theory that the right of self-determination of an autonomous person prevails. This may be over conflicting medical opinion, or the interests of science and society.

There is no 'concept' of prima facie in operation here. The principles are neither dependent nor obligatory but separate, independent considerations providing a framework for ethical decision-making. The rather awkward iteration of beneficence, non-malfeasance and justice may be more simply thought of as, if you are going to do anything at all, then try to do good, don't do bad (first do no harm) and be fair. Neither of these has any bearing on autonomy which, as already stated, has primacy.

Having spent the best part of 40 years upholding this principle, I could never have imagined that mandatory medical treatment would even enter the conversation, let alone the attempt to make it so. This is just part of a widespread and insidious attack on this basic principle and the inherent rights of all people. Mr Raab's proposals for reform to the Human Rights Act into a Bill of Rights ostensibly 'on the face of it' to regain sovereignty has attached to it two slippery concepts of collectivism (Marxism or fascism, take your choice) that with rights come responsibilities including responsibilities to the 'wider public interest'.

Any Bill of Rights is just a recognition and acknowledgement of the inherent rights of all people. We are not given these rights by any person, law or government. Rights do not come with responsibilities for the individual or to the wider public interest. Any curtailment of this is the definition of tyranny. This may seem like a large response to one small letter and one small word, but the devil is in the detail; we ignore it at our peril.