Braun, E.
Journal of Medical Ethics
2023;49:497-501
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.
Conclusion
Assuming that the expressivist argument is valid, it only applies to (partly) beneficence-based approaches to assisted dying that require irremediable suffering. An autonomy-based approach to assisted suicide, as put forward by the German Federal Constitutional Court, avoids the expressivist objection. It understands
assisted suicide as an act justified by autonomy and does not imply objective judgments of whether the person’s life is worth living. I have argued that on an autonomy-based approach, assisted suicide should not be understood as a medical intervention but rather as an autonomous action that does not invoke
traditional medical principles such as beneficence.
Said differently:
The article argues that an autonomy-based approach to assisted suicide can avoid the expressivist objection against assisted dying laws. The expressivist objection is the claim that assisted dying laws send the message that suicide is a good thing, which could lead to more people committing suicide. The author argues that this objection is not valid because autonomy is a fundamental value that should be respected, even if it means allowing people to die. (Autonomy > beneficence)
