Autonomy, Suicide and Euthanasia

2006 Makoto Suzuki

Suicide, Euthanasia and the Autonomy of Others

In

the following, the discussion focuses on moral considerations based on the autonomy of would-be suicides themselves. So, at the beginning, let me mention that suicides might affect others rational and autonomous pursuits of ends, and thus might be unjustified or justified for that reason.

E.g., when a person has dependents, or when the person promises to do something that is prevented by his or her suicide E.g., when a spy promises to commit suicide when she knows she will be used for the enemy

Two Potentially Conflicting Considerations

1. 2.

Protect the rational and autonomous capacity of persons Dont hinder, but rather help their rational and autonomously pursuing their ends In many cases of suicide and euthanasia, these two considerations seem to conflict with each other. On the one hand, except when a persons autonomous capacity has been already destroyed, suicide and euthanasia destroy it. On the other hand, if a person intends suicide and euthanasia given all relevant information, then it might be the rational and autonomous pursuit of an end to be not prevented, but rather helped. Thus, except when a persons rational capacity is already lost and there is a living will, it is not plain whether suicide and euthanasia are permissible.

Kant holds that killing oneself is always irrational. Thus, he does not take preventing suicide or euthanasia to be problematic for the second consideration. However, it seems to many people that in certain situations it is not irrational to pursue suicide or euthanasia. Consider:

Response 1: Kant

The suicide of Captain Oates (Beauchamp, p.79) A spy committing suicide not to reveal very important secret information under the torture by his or her enemy. (B, p.91) Persons in the Treblinka concentration camp, whom the Nazi threatened to kill cruelly if he or she failed to exterminate their fellow prisoners by opening the gas valves (B, p.94) An Eskimo who cant work though resources are limited (B, p.95) A person who has an incurable and very painful disease. (Rachels on Jonathan Swift and Jack on pp.45-6) A person who is in the later stage of an incurable and deteriorating kind of illness, e.g., Alzheimers disease, Lou Gehrigs disease (see Beauchamp, p. 102) etc. A person who is terminally ill and is paralyzed (B, p.107)

Response 2: Autonomy Right to Dispose of Ones Life

In modern literature, it is more common to admit the right to commit suicide and have euthanasia because of the second consideration: dont hinder, but rather help persons rational and autonomously pursuing their ends. This view takes suicide and euthanasia to be permissible if the person rationally and autonomously decides to do so. On this view, the first consideration (protect the rational and autonomous capacity of persons) can still justify others stopping suicide and euthanasia forcibly in order to check whether he or she rationally and autonomously chooses it based on adequate information; however, if he or she actually turns out to do so, it is unjustified in stopping the person forcibly (e.g., by coercive institutionalization). After the check, only discussion and persuasion are permissible.

Response 3: Some More Nuanced View

The

second response permits suicide and euthanasia even when suicide is not for the sake of others, and the persons life does not fall below a certain threshold of gross, irremediable or uncompensated suffering.

However, you might think that the first consideration (protect the rational and autonomous capacity of persons) prohibits suicide and euthanasia at least when they are committed for not so serious reasons. There are two questions for this view. First, where is the line between serious and not so serious reasons? Second, even if it is wrong for one to commit suicide for not so serious reasons, it is OK for government to intervene and make it illegal?

Suicide Prevention

Even if the second response is justified, we are required to stop the following sorts of suicides: Suicides attempted by irrational or non-autonomous persons (e.g., teenage suicides, or suicides by mentally unstable or delusional persons); Suicides that are attempted by rational and autonomous persons, but are not the results of careful deliberation and comparison with alternatives to the suicides (e.g., impulsive suicides under the strain of temporary crisis or under the influence of drugs or alcohol); and Suicides planed on inadequate information on the consequences of taking or not taking suicides.

Continued

It seems that the majority of actual suicides satisfy one of these descriptions. (Beauchamp, 97-8) If we should protect persons rational and autonomous capacities, we should stop them by force or reporting the suicide threats to those in position to help prevent those acts.

A question: sometimes you come to know a persons intention to commit suicide only because you promise to keep it confidential before the person beings to talk. Is it permissible to report that suicide threat?

The same considerations will recommend or even might require that we get sensitive to the hints of peoples intentions to commit suicide, and listen to their problems sympathetically and be supportive.

Justification of Temporal Intervention into Rational and Autonomous Suicide

If we know that a persons suicides are the rational and autonomous pursuits of his or her end based on adequate information, the second response prohibits us from stopping them. Even the third response prohibits us from stopping such rational and autonomous suicides for serious reasons. However, in many cases we do not know whether the intended suicides fit the description. To protect the rational and autonomous capacities of a person, we are then justified in stopping would-be suicides for a while only to check whether their suicides fit the above description.

Assisting Suicide and Euthanasia

If the second or third response is justified, then there will be cases where it is recommended, or even obligatory, for some person to assist suicide or perform euthanasia on request. These are the cases the second consideration (Dont hinder, but rather help their rational and autonomously pursuing their ends) wins the day. Even if the second response is justified, a person can only be recommended or required to help only that sort of suicides which is the rational and autonomous pursuit of a persons end based on adequate information. If the third response is justified, a stricter condition the reason for suicide is serious is added.

Assisting Suicide and Euthanasia on Request

Of course, the assistance (e.g., giving a would-be suicide painless life-shortening drugs, or informing him of it) or painless euthanasia (killing or letting die a person without pain) is neither always necessary, nor something everyone can provide. However, if a would-be suicide needs it and you can provide it, then you are sometimes morally recommended or even required to provide it in order to help their rational and autonomously pursuing his or her ends. Whether and how to legalize it is another question, which I postpone to the time when we discuss the legalization of active euthanasia.

Assignment
Read

James Rachels, Active and passive euthanasia in Library Reserve Steinbock, The Intentional Termination of Life in Library Reserve James Rachels, Euthanasia from pp. 30-55 in the text