The Case for an Autonomy-Centred View of Physician-Assisted Death

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ORIGINAL RESEARCH

The Case for an Autonomy-Centred View of Physician-Assisted Death Jeremy Davis & Eric Mathison

Received: 21 March 2019 / Accepted: 3 April 2020 # This is a U.S. Government work and not under copyright protection in the U.S.; foreign copyright protection may apply 2020

Abstract Most people who defend physician-assisted death (PAD) endorse the Joint View, which holds that two conditions—autonomy and welfare—must be satisfied for PAD to be justified. In this paper, we defend an Autonomy Only view. We argue that the welfare condition is either otiose on the most plausible account of the autonomy condition or else is implausibly restrictive, particularly once we account for the broad range of reasons patients cite for desiring PAD, such as “tired of life” cases. Moreover, many of the common objections to an autonomy only view fail once we understand the extent of the autonomy condition’s requirements— in particular, the importance of one’s values for autonomous choices. If our view is correct, then the scope of permissible PAD is broader than is currently accepted in both the philosophical literature and the law and therefore poses an important challenge to the current consensus on justified PAD.

Keywords Physician-assisted death . Euthanasia . Autonomy . Welfare . End-of-life

J. Davis (*) United States Military Academy, Department of English and Philosophy, 607 Cullum Road, West Point, NY 10996, USA e-mail: [email protected] E. Mathison Baylor College of Medicine, BCM Jewish Institute for Research, Houston, TX 77030, USA e-mail: [email protected]

Introduction The view that physician-assisted death (PAD) is permitted under certain conditions receives wide support in both the philosophical literature and, increasingly, among the public in general, at least in many Western countries. Despite this growing consensus, there is still considerable disagreement concerning which conditions must be satisfied for PAD to be permissible. The most popular view in the philosophical literature on PAD is known as the Joint View (De Haan 2002; Sumner 2011, 2017). This view holds that PAD is permissible only when two conditions are satisfied—namely, autonomy and welfare. Much of the current philosophical disagreement concerning PAD centres on how best to understand these two conditions; but it is generally thought that some form of both of these conditions must be satisfied for PAD to be permissible. In this paper, we challenge this approach by articulating the ethical foundations of the view that autonomy, properly understood, is the only necessary condition for permissible PAD. We argue that an Autonomy Only view is plausible and boasts certain advantages that the Joint View lacks. On the Autonomy Only view, an autonomous request for PAD is sufficient for its moral permissibility. Moreover, we argue that, once we have in place a reasonable view of what the autonomy condition requires, many of the familiar or intuitively plausible objections to an Autonomy Only view fail. At a minimum, then, philosoph