Abstract
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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
CDS has been called ‘slow euthanasia’ by critical debaters (Billings and Block 1996).
Mill does not use the term autonomy, but liberty. His conception of liberty, though, is quite close to the common interpretation of autonomy in bioethics, which is being able to do as one chooses. Kant on the other hand has a much stricter view, where autonomy consists in doing what one ideally ought to do.
We could for instance assume that every infringement of autonomy has some negative value, but that this could be balanced against other valuable things such as preference satisfaction, pleasure or autonomous self-realisation.
See also ten Have’s discussion in the paper “Euthanasia: moral paradoxes” (2001).
Materstvedt (2003) writes that Kant held suicide to be irrational as well as immoral, and Doerflinger uses a Kantian rhetoric in denoting suicide as “the ultimate self-contradiction of freedom”.
Other writers, such as Anderberg (1989: 179–192) and Rhodes (2007), have advanced similar arguments. Rhodes writes that biological human life and dignified life in the Kantian sense are not coextensive. A person who is about to lose her autonomy, for instance due to dementia, could thus will to end her life in accordance with a maxim such as: “In order to avoid degenerating into a ‘‘thing’ that cannot act from the autocracy of the human mind, agents should show respect for their humanity by sacrificing their physical life” (Rhodes 2007:46).
References
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.
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.
Doerflinger, R. 1989. Assisted suicide: Pro-choice or anti-life. The Hastings Centre Report 19: 16–19.
Dworkin, G. 1988. The theory and practice of autonomy. Cambridge: Cambridge University Press.
Eckerdal, G. 2004. Sedation in palliative care—The doctor’s perspective. In Terminal sedation: euthanasia in disguise?, ed. T. Tännsjö, 37–41. Dordrecht: Kluwer.
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.
Hurst, S.A., and A. Mauron. 2006. The ethics of palliative care and euthanasia: exploring common values. Palliative Medicine 20: 107–112.
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.
Materstvedt, L.J., and G. Bosshard. 2009. Deep and continuous palliative sedation (terminal sedation): Clinical-ethical and philosophical aspects. Lancet Oncol 10: 747–748.
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.
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.
Rhodes, R. 2007. A Kantian duty to commit suicide and its implications for bioethics. The American Journal of Bioethics 7: 45.
Tännsjö, T. 1998. Hedonistic utilitarianism. Edinburgh: Edinburgh University Press.
Velleman, J.D. 1999. A right to self-termination. Ethics 109: 606–628.
Vong, G. 2008. In defence of Kant’s moral prohibition on suicide solely to avoid suffering. Journal of Medical Ethics 34: 655–657.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sjöstrand, M., Helgesson, G., Eriksson, S. et al. Autonomy-based arguments against physician-assisted suicide and euthanasia: a critique. Med Health Care and Philos 16, 225–230 (2013). https://doi.org/10.1007/s11019-011-9365-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11019-011-9365-5