The limits of autonomy in arguments about assisted death.

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The bioethical principle of respect for autonomy is central to all arguments and campaigns for the moral permissibility and legalization of assisted death (AD) that I know of. Health professionals and politicians owe people, as a matter of respect, a right to make their own informed decisions about significant aspects of their life. Choices about the shape of our deaths seem obviously to belong to these. The question, of course is whether this right should be unrestricted.
A libertarian interpretation puts no restriction on autonomous choice provided it does not harm others: no other concerns can trump respect for autonomy. A libertarian would of course insist that a choice of AD should be genuinely autonomous, i.e. well-informed and voluntary, but in that case it is not the state’s or anybody else’s business to prevent a person from being assisted in dying, provided such assistance is also given on a well-informed and voluntary basis.
Judging from the regulations in countries that have legalized AD and the public debate about AD, almost nobody adhere to a strong libertarian interpretation of the status of autonomy. In legal regulations, a number of restrictions other than safeguarding genuine voluntariness and sufficient information are put in place, most notably conditions about “unbearable suffering”, “no prospect of improvement”, “terminal illness”, “grave and incurable condition” etc. What makes questions about AD interesting and challenging to most (non-libertarian) people is that AD may well be the right thing in isolated cases, but other concerns than respect for autonomy seems to have bearing on the issue.
I want to sketch a couple of ways to account for this and focus on one that seems to me central but somewhat neglected.
In Beauchamp and Childress’ four principles approach to bioethics, respect for autonomy is a principle on a par with the other three: beneficence, non-maleficence, and justice. A standard account of the AD predicament is to interpret it as a conflict between the principles of respect for autonomy and non-maleficence. One reason for skepticism is that for some terminal patients, AD seems to be less harmful than the alternatives.
Many opponents of AD favour arguments based on ideas of an inviolable dignity of all human lives as a counterbalance to concern for autonomy. But this tend to lead to a strictly prohibitive position on AD rather than a qualified tolerance.
I argue that a particular interpretation of the Kantian ideas of self-regarding duties and respect for humanity in persons does a better job. It involves on the one hand scepticism toward the voluntarism involved in the typical libertarian position and on the other hand a cautious position towards assisted death rather than an all-out denial. My ambition is to explicate this alternative, dignity-based view by showing how it accounts for important moral obligations and how it leads to a more plausible, nuanced view of assisted death than the alternatives.
Publikationsdato16 maj 2019
Antal sider9
StatusUdgivet - 16 maj 2019
BegivenhedBioethics and Political Philosophy: Nordic Perspectives: Workshop on Autonomy - Stocholms universitet, Stockholm, Sverige
Varighed: 16 maj 201917 jun. 2019


WorkshopBioethics and Political Philosophy: Nordic Perspectives
LokationStocholms universitet