In my previous article, I deconstructed an argument for euthanasia that is based on the “need” to end unbearable pain. In this second part, I will address another argument, which focused on the concept of personal autonomy. Under this argument, supporters of euthanasia argue that a person should be allowed to request an end to their life.

Understandably, this line of reasoning might initially be depicted as logical. Individuals are free to decide about their fate, even if other members of society do not support their choices, as long as they do not harm anyone.

Personal autonomy (however relevant to other issues) in this case rests on the claim that euthanasia is a solitary act. That deviates far from truth; in fact, others are deeply involved. Doctors act to prescribe or administer the lethal drug, the legislative body decides if, and under what circumstances allow for euthanasia. Medical professionals have to relinquish the most basic principles which order them to protect every human life and turn to a judge who decides whose life is still worth living and whose can be legally ended. That should alarm even those with a very liberal attitude, if we take into account that according to some studies physicians accurately estimated the duration of the patient’s survival in only 34% of the cases.[1]

When the first laws legalizing euthanasia were introduced, their proponents claimed that it would be restricted to the most extreme cases only, but now the slippery slope seems inevitable. In the Netherlands, euthanasia and assisted suicide are possible in some situations even for people with an intellectual disability and/or autism spectrum disorder.[2] In Belgium, euthanasia for people who are not terminally ill, such as those suffering from psychiatric disorders or dementia is legal and its number is increasing.[3] The patient’s consent in these very delicate situations remains highly controversial.

Prof. Boer was convinced that a good law combined euthanasia review procedure can prevent it, but after having reviewed thousands of euthanasia cases, he completely changed his mind. “Cases have been reported in which a large part of the suffering of those given euthanasia or assisted suicide consisted in being aged, lonely or bereaved. Some of these patients could have lived for years or decades. Pressure on doctors to conform to patients – or in some cases relatives – wishes can be intense.” – he said, speaking to the Daily Mail.[4]

Indeed, in some situations “a right to die” (which doesn’t exist in international law) might become, in the perception of vulnerable individuals, “a duty to die”. Those who are dependent on the others might feel like a burden and after hearing even implicit suggestions, ask to end their life for the alleged sake of their caregivers. The arguments for euthanasia touching upon economics are still considered unpalatable for the vast majority of people but can become a factor in future in the decision-making process for politicians.

To see that states and communities are developing suicide prevention programs is always a sign of hope. However, it must be alarming to realize that they could coexist with assisted suicide and euthanasia clinics. That would boil down to making ourselves judges of who deserves which program, and has nothing to do with the idea of personal autonomy.

[1] Debbie Selby et al., Clinician Accuracy When Estimating Survival Duration: The Role of the Patient’s

Performance Status and Time-Based Prognostic Categories, 42 J. PAIN & SYMPTOM MGMT. 578 (2011).

[2] Tuffrey-Wijne, I., Curfs, L., Finlay, I. et al. Euthanasia and assisted suicide for people with an intellectual disability and/or autism spectrum disorder: an examination of nine relevant euthanasia cases in the Netherlands (2012–2016). BMC Med Ethics 19, 17 (2018).

[3] Dierickx, Sigrid et al. “Euthanasia for people with psychiatric disorders or dementia in Belgium: analysis of officially reported cases.” BMC psychiatry vol. 17,1 203. 23 Jun. 2017, doi:10.1186/s12888-017-1369-0