Autonomy-based arguments against physician-assisted suicide and euthanasia: a critique
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Respect for autonomy is typically considered a key reason for allowing physician assisted suicide and euthanasia. However, several recent papers have claimed this to be grounded in a misconception of the normative relevance of autonomy. It has been argued that autonomy is properly conceived of as a value, and that this makes assisted suicide as well as euthanasia wrong, since they destroy the autonomy of the patient. This paper evaluates this line of reasoning by investigating the conception of valuable autonomy. Starting off from the current debate in end-of-life care, two different interpretations of how autonomy is valuable is discussed. According to one interpretation, autonomy is a personal prudential value, which may provide a reason why euthanasia and assisted suicide might be against a patient’s best interests. According to a second interpretation, inspired by Kantian ethics, being autonomous is unconditionally valuable, which may imply a duty to preserve autonomy. We argue that both lines of reasoning have limitations when it comes to situations relevant for end-of life care. It is concluded that neither way of reasoning can be used to show that assisted suicide or euthanasia always is impermissible.
- Anderberg, T. 1989. Suicide: Definitions, causes, and values. Lund: Lund University Press.
- Beauchamp, T.L., and J.F. Childress. 2001. Principles of biomedical ethics, 5th ed. New York: Oxford University Press.
- Berlin, I. 2002. Two concepts of liberty, reprinted in: Liberty: Incorporating four essays on liberty. Oxford: Oxford University Press.
- Billings, J.A., and S.A. Block. 1996. Slow Euthanasia. Journal of Palliative Care 12: 21–30.
- Brassington, I. 2006. Killing people: What Kant could have said about suicide and euthanasia but did not. Journal of Medical Ethics 32: 571–574. CrossRef
- Cherny, N.I., L. Radbruch, and Board of the European Association for Palliative Care. 2009. European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care. Palliative Medicine 23: 581–593. CrossRef
- Doerflinger, R. 1989. Assisted suicide: Pro-choice or anti-life. The Hastings Centre Report 19: 16–19. CrossRef
- Dworkin, G. 1988. The theory and practice of autonomy. Cambridge: Cambridge University Press. CrossRef
- Eckerdal, G. 2004. Sedation in palliative care—The doctor’s perspective. In Terminal sedation: euthanasia in disguise?, ed. T. Tännsjö, 37–41. Dordrecht: Kluwer. CrossRef
- Gordijn, B., and R. Janssens. 2000. The prevention of euthanasia through palliative care: New developments in The Netherlands. Patient Education and Counselling 41: 35–46. CrossRef
- Hurst, S.A., and A. Mauron. 2006. The ethics of palliative care and euthanasia: exploring common values. Palliative Medicine 20: 107–112. CrossRef
- Husted, J. 1997. Autonomy and the right not to know. In The right to know and the right not to know, eds. Chadwick et al., 55ff. Aldershot: Ashgate publishing company.
- Juth, N. 2005. Genetic information values and rights: The morality of presymptomatic testing. Gothenburg: Acta Universitatis Gothenburgensis.
- Kant, I (eds.). 2002. Groundwork for the Metaphysics of Morals. New Haven, CT, USA: Yale University Press.
- Lindley, R. 1986. Autonomy. Basingstoke: MacMillan.
- Materstvedt, L.J. 2003. Palliative care on the ‘slippery slope’ towards euthanasia? Palliative Medicine 17: 387–392. CrossRef
- Materstvedt, L.J., and G. Bosshard. 2009. Deep and continuous palliative sedation (terminal sedation): Clinical-ethical and philosophical aspects. Lancet Oncol 10: 747–748. CrossRef
- Materstvedt, L. J., Clark, D., Ellershaw, J., Førde, R., Gravgaard, A. M., Müller-Busch, H. C., Porta i Sales, J., Rapin, CH., and EAPC Ethics Task Force. 2003. Euthanasia and physician-assisted suicide: A view from an EAPC ethics task force. Palliative Medicine 17: 387–392.
- Mill, J.S. 1982. On liberty. Harmondsworth: Penguin.
- Morita, T., S. Tsuneto, and Y. Shima. 2002. Definition of sedation for symptom relief: A systematic literature review and a proposal of operational criteria. Journal of Pain and Symptom Management 24: 447–453. CrossRef
- Nell, O. 1975. Acting on principle: an essay on Kantian ethics. New York: Columbia University Press.
- O’Neill, O. 2002. Autonomy and trust in bioethics. Cambridge: Cambridge University Press. CrossRef
- Rhodes, R. 2007. A Kantian duty to commit suicide and its implications for bioethics. The American Journal of Bioethics 7: 45. CrossRef
- Tännsjö, T. 1998. Hedonistic utilitarianism. Edinburgh: Edinburgh University Press.
- Velleman, J.D. 1999. A right to self-termination. Ethics 109: 606–628. CrossRef
- Vong, G. 2008. In defence of Kant’s moral prohibition on suicide solely to avoid suffering. Journal of Medical Ethics 34: 655–657. CrossRef
- Autonomy-based arguments against physician-assisted suicide and euthanasia: a critique
Medicine, Health Care and Philosophy
Volume 16, Issue 2 , pp 225-230
- Cover Date
- Print ISSN
- Online ISSN
- Springer Netherlands
- Additional Links
- Assisted suicide
- Palliative care
- Palliative sedation
- Ethical theory
- Industry Sectors
- Author Affiliations
- 1. Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Berzelius väg 3, 171 77, Stockholm, Sweden
- 2. Centre for Research Ethics and Bioethics, Uppsala University, Husargatan 3, 751 22, Uppsala, Sweden