Autonomy and Assisted Suicide: The Execution of Freedom

Article excerpt

For the last two thousand years, most western civilizations have proscribed assisted suicide and other forms of euthanasia as a violation of innocent human life. The Hippocratic Oath, professed by doctors through the centuries, explicitly condemns administering a deadly drug or even suggesting it. Yet in recent decades scholars have criticized this traditional position for violating personal autonomy[1] and precluding beneficent treatment of the suffering.[2] Their appeals to beneficence have not proven decisive, in part because the traditional position counsels beneficence: it permits physicians to alleviate suffering even when their treatment jeopardizes patients' lives. It is rather the concept of personal autonomy, recently ascendant as a principle of human action, that has transformed the social discourse of assisted suicide.

Opponents of euthanasia have not criticized assisted-suicide claims grounded on autonomy. Instead they resort to arguments based on human dignity,[3] the sacredness of life[4] or slippery slopes[5]--one of which directly addresses the potent autonomy claim. This article challenges the argument for autonomy: it distinguishes the descriptive and ascriptive aspects of autonomy and probes whether either can ground a right to assisted suicide or logically delimit such a right. By differentiating these two aspects of autonomy, this discussion manifests the shortcomings of many autonomy-based moral and legal theories.

Autonomy is a protean concept, but most ethicists employ the term in either a descriptive or an ascriptive sense. The descriptive sense of autonomy encompasses those conditions (for example, a choice of options, competence to act)[6] and characteristics (for example, moral authenticity or integrity)[7] that scholars associate with autonomy. These characteristics and conditions are essential components of self-governed action, but they cannot justify acts of assisted suicide (or most other human acts) because they are bereft of normativity: they merely describe necessary conditions of morality, viz., voluntary agency[8] without specifying the moral character of any particular act. If both the virtuous and the vicious can act autonomously, then the mere possession of autonomy neither specifies an agent's moral character nor justifies his acts.

Although the descriptive sense of autonomy is insufficient to justify--either morally or legally--acts of assisted suicide, many scholars use the term in an ascriptive sense by grounding individual rights on autonomy.[9] Ethicists and legal scholars employ the ascriptive sense of autonomy synonymously with liberty in grounding moral or legal claims. For example, the eminent liberal philosopher Joseph Raz claims that personal autonomy "is essentially about the freedom of persons to choose their own lives,"[10] while John Stuart Mill states that the principle of liberty "requires liberty of tastes and pursuits; of framing the plan of our life to suit our own character."[11]

Jurists also identify autonomy with liberty: the Supreme Court asserts that "choices central to personal dignity and autonomy are central to the liberty protected by the Fourteenth Amendment. At the heart of liberty is the right to define one's own concept of existence ...."[12] And writing in defense of a right to euthanasia, the respected legal scholar Ronald Dworkin claims that individuals' right to autonomy is "a right to make important decisions defining their own lives for themselves."[13] Thus in both ethics and law, autonomy and liberty are similarly concerned with an individual's freedom to make important choices for himself, unfettered by social proscriptions. This ascriptive sense of autonomy grounds the claim for a "right" to assisted suicide by guaranteeing an individual's freedom to enlist assistance in his suicide.

Although this purported right has achieved some measure of public support, its autonomy-based justification faces several formidable challenges. …