Although this Paper does make some observations about non-voluntary euthanasia, it does not deal with it systematically, since substitute decision makers would decide on behalf of such patients.
Involuntary euthanasia is rejected in a medical setting, and only referred to in a discussion of the Nazi “euthanasia” projects.
In short, any talk of unilaterally “deciding for (competent) others” that they should die is totally out of place in this discussion.
Assisted dying is a highly controversial and emotive topic. Ethical beliefs about these practices are steeped in religion, and thus interpretations or understandings of the doctrine of the sanctity (special moral value) of human life.
The mere fact that views are personal and strongly held, whether inspired by religion or not, does not justify the suppression of responsible public debate about those views. On the contrary, we have a compelling ethical obligation to address assisted dying in the democratic process, as we did with respect to capital punishment and termination of pregnancy (abortion).
Our public policy should not be driven by partisan religious beliefs – often resting on mistaken assumptions and projections that religion forbids these practices – but rather by our Constitution.
The Bill of Rights in the Constitution is an ethical document that sketches the basic values upon which our democracy is to be built and proposes human rights that we should realise progressively.
So, a key question regarding legalising assisted dying would be its constitutionality. In short, do we have an ethical obligation to decriminalise assisted dying given our constitutional rights?
But would this not put the cart (the law) before the horses (ethics)? Might we not end up legalising a practice that is regarded as fundamentally unethical, similar to legalising abortion which the majority of the population regards as unethical?
Can assisted dying be ethically justified, or do arguments against assisted dying hold more force?
This Paper is, in the first place, concerned with the ethics of legalising end-of-life decisions, including the ethics of legalising assisted dying.
Still, because there are such strongly held and hotly contested ethical views about assisted dying, a persuasive ethical case for assisted dying would reinforce the ethical need for legalising assisted dying. Three key ethical arguments each support the respective cases for and against assisted dying.
Ethical Argument for Assisted Dying
The argument from autonomy and the argument from suffering make the most powerful ethical case for assisted dying. A third argument contends that assisted dying is ethically speaking the same as withholding and withdrawal of potentially life-sustaining treatment, both of which are widely accepted practices.
Implicit in these three ethical arguments for assisted dying is the view that it is not always wrong intentionally to bring about someone’s death, whether by an act or omission. Correspondingly, someone’s right to life does not entail an obligation to live; or someone may have a right to die, given clearly defined circumstances.
We already accept ethical justifications for other forms of causing death, for example, individual self-defence and in a defensive war.
But the three arguments for assisted dying are different because, in the circumstances, the one whose life it is does not regard dying as wrong, nor death as bad, but rather as desirable in defined circumstances.
This is so because suffering has broken the connection between life and good, so that death becomes a good, or in the patient’s best interest.
Personal Autonomy
The argument from personal autonomy or individual self-determination goes as follows: respect for autonomy is a basic ethical principle which asserts that competent persons have a moral right to make their own choices, including choices about their continued life in clearly defined circumstances, and to act upon those choices.
We have an ethical obligation to respect that right. Consequently, medical practitioners, or specified other people, should have the choice to respect people’s autonomous wishes by assisting them with dying, their conscience permitting.
One line of critique against the autonomy argument is that the sanctity (special moral value) of human life outweighs or trumps considerations of autonomy used to justify the taking of human life.
But, surely, the sanctity of human life does not reside in biological human life, but in human life that comes up to a certain standard (quality). Also, human life characterised by uncontrollable pain due to terminal disease, for example, fails to meet that standard, judged by the person whose life it is.
A second critique attacks the notion of autonomy, arguing that ethical debate about assisted dying “assumes an ethic of radical individualism” that is based on a “contractual model of care”.
According to this view, any debate that contemplates the ethical justification of assisting an individual to die is of necessity anti-community, and as such dismissive of the fact of our interconnectedness and interdependence.
This view is surely contradicted by overwhelming anecdotal evidence of cases where requests for assistance with dying are made in a caring, personal setting in which our relationships with, and interdependence on, others are fully recognised and actually constitute the very foundation of a moral obligation to assist with dying.
Appeals to community need to define “community” since we are all at once members of several overlapping communities, from immediate family to the global community. If any one of these communities respects the right of an individual to request assistance with dying in defined circumstances, it does not for that reason cease to be a community.
And even if someone’s request for assistance with dying were to spring from “radical individualism” that is embedded in a contractual rather than caring relationship, that would in no way invalidate the ethical case for respecting personal autonomy.
Moreover, the argument that adequate terminal-pain management would remove the need for assisted dying fails to give due recognition to the personal autonomy of persons in a terminal phase of dying by prescribing to them how they should deal with their suffering induced by pain and distress.
Suffering
Suffering is an emotional response to significant
