An autonomy-based approach to assisted suicide: a way to avoid the expressivist objection against assisted dying laws

Abstract

In several jurisdictions, irremediable suffering from a medical condition is a legal requirement for access to assisted dying. According to the expressivist objection, allowing assisted dying for a specific group of persons, such as those with irremediable medical conditions, expresses the judgment that their lives are not worth living. While the expressivist objection has often been used to argue that assisted dying should not be legalised, I show that there is an alternative solution available to its proponents. An autonomy-based approach to assisted suicide regards the provision of assisted suicide (but not euthanasia) as justified when it is autonomously requested by a person, irrespective of whether this is in her best interests. Such an approach has been put forward by a recent judgment of the German Federal Constitutional Court, which understands assisted suicide as an expression of the person’s right to a self-determined death. It does not allow for beneficence-based restrictions regarding the person’s suffering or medical diagnosis and therefore avoids the expressivist objection. I argue that on an autonomy-based approach, assisted suicide should not be understood as a medical procedure but rather as the person’s autonomous action.

Matters of care and the good death – rhetoric or reality?

“…VAD requests are not usually due to refractory physical suffering, like pain, but due to distress associated with diminishing autonomy, dignity or perceived quality of life [40,41]. VAD can also be an expression of autonomy, a decision for a particular type and timing of death [42] where themes of choice, control and dignity predominate [43,44]. The ongoing conflict regarding the unclear or contextual differences between suicide and VAD highlight the challenges in society determining which deaths occurring due to individual's actions and choices are 'good' [40].…”

The many different languages of assisted suicide

“…Looking at the ethical principles, one also finds different approaches here. The autonomy-based approach assumes that AD is justified when a person has an autonomous desire to die irrespective of whether this is in the best interest of the person (13). Therefore, some argue that severe depression, possibly with previous suicide attempts, does not differ from a terminal somatic illness and could be considered an incurable disease state.…”