Typical philosophical discussions of physician-assisted death (“pad”) have focused on whether the practice can be permissible. We address a different question: assuming that pad can be morally permissible, how far does that permission extend? We will argue that granting requests for pad may be permissible even when the pad recipient can no longer speak for themselves. In particular, we argue against the ‘competency requirement’ that constrains pad-eligibility to presently-competent patients in most countries that have legalized pad. We think pad on terminally ill, incapacitated patients can be morally permissible in cases where advance directives or suitable surrogate decision-makers are available, and should be legally permissible in such cases as well. We argue that this view should be accepted on pain of inconsistency: by allowing surrogate decision-makers to request withdrawal of life-sustaining care on behalf of patients and by allowing patients to request pad, we rule out any plausible justification for imposing a competency requirement on pad.
Purchase
Buy instant access (PDF download and unlimited online access):
Institutional Login
Log in with Open Athens, Shibboleth, or your institutional credentials
Personal login
Log in with your brill.com account
Amarasekara, Kumar, and Mirko, Bagaric. “Moving from Voluntary Euthanasia to Non-Voluntary Euthanasia: Equality and Compassion,” Ratio Juris 17, no. 3 (2004): 398–423.
Appelbaum, Paul S. “Assessment of Patients’ Competence to Consent to Treatment,” New England Journal of Medicine 357, no. 18 (2007): 1834–40.
Auriemma, Catherine L., Christina A., Nguyen, and Rachel, Bronheim. “Stability of End-of-Life Preferences: A Systematic Review of the Evidence.” Journal of the American Medical Association Internal Medicine 174, no. 7 (2014): 1085–1092.
Bernfort, Lars, Björn, Gerdle, Magnus, Husberg, and Lars-Åke, Levin. “People in states worse than dead according to the eq-5d UK value set: Would they rather be dead?” Quality of Life Research 27 (2018): 1827–1833.
Brock, Dan W. “Voluntary Active Euthanasia,” The Hastings Center Report 22, no. 2 (1992): 10–22.
Buchanan, Allan and Dan M., Brock. Deciding for Others: The Ethics of Surrogate Decision-Making. Cambridge: Cambridge University Press (1989).
Davis, J.K. “Precedent autonomy and subsequent consent.” Ethical Theory and Moral Practice 7 (2004): 267–291.
Davis, J.K. “Precedent autonomy, advance directives, and end-of-life care.” In Steinbock, B. (ed.) The Oxford Handbook of Bioethics. Oxford University Press, New York (2009): 349–374.
Dworkin, Ronald. “Autonomy and the Demented Self.” Millbank Quarterly, 64, no. 2 (1986): 4–16.
Dworkin, Ronald Life’s Dominion: An Argument About Abortion, Euthanasia and Individual Freedom. New York: Knopf, 1993.
Emanuel, Ezekiel J., Bregje D., Onwuteaka-Philipsen, and John W., Urwin. “Attitudes and Practices of Euthanasia and Physician-Assisted Suicide in the United States, Canada, and Europe.” Journal of the American Medical Association 316, no.1 (2016): 79–90.
Enoch, David. “Hypothetical Consent and the Value(s) of Autonomy.” Ethics 128 (October 2017): 6–36.
Foot, Philippa. “Killing and Letting Die.” In Abortion, Moral and Legal Perspectives, edited by Patricia, Hennessy and Jay L., Garfield, 355–82. Amherst: University of Massachusetts Press, 1984.
Golden, Marilyn and Tyler, Zoanni. “Killing Us Softly: The Dangers of Legalizing Assisted Suicide.” Disability and Health Journal 3 (2010): 16–30.
Hanvey, Louise, Carolyn, Taylor, and Doris, Barwich. “What Do Canadians Think of Advance Planning? Findings From an Online Opinion Poll.” BMJ Supportive & Palliative Care (2013): 1–8.
Kamm, F. M. Intricate Ethics: Rights, Responsibilities, and Permissible Harm. Oxford University Press. Accessed May 16, 2007.
Keown, John. Euthanasia, Ethics and Public Policy: An Argument Against Legalization. Cambridge: Cambridge University Press (2002).
Kuhse, Helga. “Some Reflections on the Problem of Advance Directives, Personhood, and Personal Identity.” Kennedy Institute of Ethics Journal 9 (1999).
Lacey, Heather P., Dylan M., Smith, and Peter A., Ubel. “Hope I Die Before I Get Old: Mispredicting Happiness Across the Adult Lifespan.” Journal of Happiness Studies 7 (2006): 167–182.
Liberto, Hallie. “Normalizing Prostitution versus Normalizing the Alienability of Sexual Rights: A Response to Scott A. Anderson.” Ethics 120, no. 1 (2009): 138–145.
Liberto, Hallie. “The Problem with Sexual Promises.” Ethics 127, no. 2 (January 2017): 383–414.
Lillehammer, Hallvard. “Voluntary Euthanasia and the Logical Slippery Slope Argument,” Cambridge Law Journal 61, no. 3 (2002): 545–550.
Manninen, Bertha A. “A Case for Justified Non-Voluntary Active Euthanasia: Exploring the Ethics of the Groningen Protocol,” Journal of Medical Ethics, 32 no. 11 (2006): 643–651.
Menzel, Paul T. and Bonnie, Steinbock. “Advance Directives, Dementia, and Physician-Assisted Death,” The Journal of Law, Medicine and Ethics, 41 no. 2 (2013): 484–500.
Miller, David Gibbes, Rebecca, Dresser, and Scott Y. H., Kim. “Advance euthanasia directives: A Controversial case and its ethical implications.” Journal of Medical Ethics 45 (2019): 84–89.
Pandit, J. J. et al. “5th National Audit Project (nap5) on Accidental Awareness during General Anaesthesia: Summary of Main Findings and Risk Factors.” BJA: British Journal of Anaesthesia 113, no. 4 (October 1, 2014): 549–59. https://doi.org/10.1093/bja/aeu313.
Prentiss, Mairin. “‘I wanted to make it to Christmas’: Woman calls for assisted dying law changes.” cbc, November 1, 2018. https://www.cbc.ca/news/canada/nova-scotia/audrey-parker-assisted-dying-legislation-1.4887472.
Quinn, Warren S. “Actions, Intentions, and Consequences: The Doctrine of Doing and Allowing.” The Philosophical Review 98, no. 3 (1989): 287–312.
Rao, Jaya K., Lynda A., Anderson, Feng-Chang, Lin, and Jeffrey P., Laux. “Completion of Advance Directives Among U.S. Consumers.” American Journal of Preventative Medicine 46, no. 1 (2014): 65–70.
Reed, Philip. “Expressivism at the Beginning and End of Life.” Journal of Medical Ethics 46 (2020): 538–544.
Savulescu, Julian. “End-of-Life Decisions,” Medicine 33 no. 2 (2005): 11–15.
Shalowitz, David I., Elizabeth, Garrett-Mayer, and David, Wendler. “The Accuracy of Surrogate Decision Makers.” Archives of Internal Medicine 166 (March 2006): 493–497.
Smith, Dylan M., Ryan L., Sherriff, Laura, Damschroder, George, Loewenstein, and Peter A., Ubel. “Misremembering colostomies? Former patients give lower utility ratings than do current patients.” Health Psychology 25, no. 6 (2006): 688–695.
Sumner, L.W. Assisted Death: A Study in Ethics and Law. Oxford: Oxford University Press, 2011.
van Wijmen, et al. “Stability of end-of-life preferences in relation to health status and life-events: A Cohort study with a 6-year follow-up among holders of an advance directive.” PLoS ONE 13, no. 12 (2018): 1–14.
Walasek, Lukasz, Gordon D. A., Brown, and Gordon D., Ovens. “Subjective well-being and valuation of future health states: Discrepancies between anticipated and experienced life satisfaction.” Journal of Applied Social Psychology 49, no. 12 (September 2019): 746–754.
Wrigley, A. “Moral authority and proxy decision-making,” Ethical Theory and Moral Practice 18 (2015): 631–647.
Young, Robert. Medically Assisted Death. Cambridge: Cambridge University Press, 2007.
All Time | Past 365 days | Past 30 Days | |
---|---|---|---|
Abstract Views | 803 | 198 | 10 |
Full Text Views | 85 | 3 | 0 |
PDF Views & Downloads | 210 | 11 | 0 |
Typical philosophical discussions of physician-assisted death (“pad”) have focused on whether the practice can be permissible. We address a different question: assuming that pad can be morally permissible, how far does that permission extend? We will argue that granting requests for pad may be permissible even when the pad recipient can no longer speak for themselves. In particular, we argue against the ‘competency requirement’ that constrains pad-eligibility to presently-competent patients in most countries that have legalized pad. We think pad on terminally ill, incapacitated patients can be morally permissible in cases where advance directives or suitable surrogate decision-makers are available, and should be legally permissible in such cases as well. We argue that this view should be accepted on pain of inconsistency: by allowing surrogate decision-makers to request withdrawal of life-sustaining care on behalf of patients and by allowing patients to request pad, we rule out any plausible justification for imposing a competency requirement on pad.
All Time | Past 365 days | Past 30 Days | |
---|---|---|---|
Abstract Views | 803 | 198 | 10 |
Full Text Views | 85 | 3 | 0 |
PDF Views & Downloads | 210 | 11 | 0 |