A leading argument for euthanasia is the argument from human autonomy and self-determination. “It’s my life and I can do what I want with it. It’s my choice!” is the oft-heard cry. Today this idea of independence and autonomy is seen as the ultimate trump card to beat off all other considerations.
The emphasis on personal freedom and autonomy is relatively new. It has been growing strongly since the Enlightenment, although most Enlightenment thinkers still condemned suicide. Today autonomy is a main consideration in bio-medical ethics.
But this was not always the case. The pre-Christian Hippocratic Oath made it clear that there were limits to human autonomy: “I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect.” Even if the patient asks for this, the doctor is to realize that this request is wrong and cannot be obeyed.
This plea for personal choice and autonomy is really saying that in this case we all have the right to commit suicide. Whether a doctor assists in this suicide, or we carry it out ourselves, this is what is really at work here. But civilised societies have long had good reason to view suicide as immoral and therefore make it illegal.
Killing another innocent person is murder, and killing oneself is self-murder. Thus for millennia it was regarded morally wrong and was to be deterred by the laws of the land. Suicide has seldom been looked highly upon, and of course is to be distinguished from martyrdom, which is quite different.
And in medicine the whole purpose of the physician is to heal the patient. The wholeness, wellbeing and health of the patient is the aim of the doctor, and killing the patient can hardly be said to line up with those goals. A dead patient receives no benefits. Healing does not take place by extinguishing the patient.
Moreover, personal choices must always be weighed up and balanced against the greater community good. Just as murder is wrong, and a selfish act, so too is suicide. Moreover, the creation of new rights and freedoms often takes away from existing rights and freedoms.
As bioethicist Mark Blocher puts it, “Expanding one freedom often limits another. It does more than simply provide options. . . . Expanding personal freedom to include assisted suicide undermines another right – to remain alive without having to justify one’s existence.”
There is already such a huge problem with suicide amongst young people in the Western world, that any laws giving the OK to physician-assisted suicide will simply compound matters and make things much worse. Indeed, the argument from autonomy, if consistently applied, would mean everyone should have the right to be killed.
As already mentioned above, it will not just be the terminally ill who will demand their ‘rights’ in this regard. As Mark Foreman points out, “if the argument from autonomy is valid and can really stand on its own, then one would have to argue that any anonymous individual at any time has the right to die, and … has the right to ask others to help.”
Joni Eareckson Tada is a quadriplegic who has spent her entire adult life in a wheelchair. If anyone has a right to consider suicide, or physician-assisted suicide (PAS), it is her. But she sees what a selfish and anti-social act this would be: “Society is you. Your actions, your decisions matter. What you do or don’t do has a rippling effect on everyone around you.”
She continues, “Your self-determination to die has strings attached if it adversely affects the rights of others. That’s why more than half the states in our country have laws against aiding a person in suicide. . . . You may want to exercise a right to die, but you cannot ask a physician, whose duty is to heal, to comply with your wishes or even to make a referral. No person, in the name of self-determination, can oblige a doctor to inject him with orphenadrine when it goes against the physician’s oath to heal.”
And euthanasia or PAS are never really “truly autonomous acts, since each involves at least one other individual – an individual who remains behind to struggle with issues of responsibility, morality, guilt, and remorse,” as some leading ethicists put it.
Also, the mantra of choice is quite misleading. Choice in and of itself is not what is important, but the object of one’s choice. Quite often the supposed freedom of choice is really the stuff of coercion. As John Keown puts it, many requests for PAS “are not truly autonomous but result from depression or inadequate palliative care.” And “the value of autonomy lies not in making just any choice but choices which are consistent with a framework of sound moral values.”
Indeed, coercion will come from many quarters once euthanasia is legalised. As Nigel Cameron rightly argues, “Many people can stand to gain when someone dies – financially, emotionally or simply in terms of domestic convenience. The pressures can be subtle and much stronger than those involved realise. They are by no means limited to the narrow area of inheritance. There are several different parties whose suffering a patient’s death may relieve.”
And the argument for a right to suicide is a very strange argument indeed. A person seeks to use his autonomy to end his autonomy! Suicide thus means the end of personal autonomy. It seems to be the ultimate oxymoron to speak about the choice to rob oneself of choice. As Leon Kass points out, “In the name of choice, people claim the right to choose to cease to be choosing beings.”
Or as Arthur Dyck asks, “how can suicide be considered a right, when the freedom to undertake it puts an end to all possibilities to act, to freedom and life, and hence is an act that abolishes these basic rights?” So much for choice and autonomy.
And as J.P. Moreland says, “Suicide is also a self-refuting act, for it is an act of freedom that destroys future acts of freedom; it is an affirmation of being that negates being; it serves a human good (e.g., a painless state) but, as a means to that end, violates other, more basic human goods (e.g., life itself).”
No wonder ethicist Daniel Callahan could speak of “When self-determination runs amok”.
[1060 words]