How Do Assisted Death Ethics Value Human Life?

TL;DR

Assisted death, euthanasia, and abortion involving fetal abnormality cannot be evaluated through one universal principle. Personal liberty can support a competent patient’s choice, while pain avoidance and substituted judgment may address another being’s interests. Each argument must identify whose interests matter, whether preferences are known, and whether consciousness, suffering, dignity, quality of life, or life’s sacredness provides the relevant moral basis.

Transcript

In November 2014, Brittany Maynard, a 29-year-old woman with terminal brain cancer, took her own life surrounded by her loved ones by swallowing a lethal dose of legally prescribed pills. In April 2003, after finding out that their fetus had severe spina bifida and would be born paralyzed, severely brain damaged, and with an exposed spine, Gretchen... Read More

Key Insights

• The abortion debate remains unresolved even if a fetus is assumed to be a person, because personhood does not determine whether disability, expected suffering, parental responsibility, bodily autonomy, or the sacredness of life should control the decision.
• The sanctity-of-life position holds that human life is valuable regardless of disability or perceived quality, and that people should not judge whether another person’s future life is worth living. Consistency may require applying this principle even to an irreversibly unconscious patient.
• Respect for creation can support terminating a wanted pregnancy when parents believe the future child would endure severe suffering. Margaret Olivia Little’s view presents such a decision as potentially grounded in responsibility and concern for the child, rather than disregard for life.
• Personal liberty is relevant when a competent patient decides whether to live or die, but it cannot by itself justify abortion for the fetus’s benefit. Bodily autonomy concerns the pregnant woman’s interests, while preventing fetal suffering makes the fetus’s interests primary.
• Substituted judgment is a standard that asks proxy decision-makers to choose what they believe an incapacitated patient would want, rather than what the proxies themselves prefer. Parents and relatives use it when patients cannot make medical decisions for themselves.
• Substituted judgment is especially difficult for fetuses and infants because they have no discoverable prior opinions. A proxy may therefore rely on the general assumption that sentient beings have an interest in avoiding pain, but disagreement remains about whether that assumption justifies death.
• Non-voluntary euthanasia involving persistent vegetative states is difficult to defend through mercy or pain avoidance because an unconscious patient is not experiencing pain. Liberty also provides little support unless the patient communicated relevant wishes before losing consciousness.
• Voluntary euthanasia and assisted suicide both preserve the patient’s decision to die, but they differ in who performs the final act. In voluntary euthanasia, another person carries it out, while assisted suicide provides means such as prescribed medication that the patient personally takes.

Questions & Answers

Q: What values shape ethical arguments about assisted death?

Ethical arguments about assisted death draw on personal liberty, avoidance of pain, dignity, quality of life, responsibility, personhood, and the sacredness of life. These values can point toward different conclusions because they answer different questions. A sound argument must identify whose interests are primary, whether the person can choose, whether suffering is present, and whether life is considered valuable regardless of its experienced quality.

Q: Why does assuming fetal personhood not settle abortion ethics?

Assuming that a fetus is a person does not settle whether abortion is morally permissible after a fetal abnormality diagnosis. One argument treats the fetus as a disabled person who should not face discrimination. Another asks whether allowing a child to be born into severe suffering makes the parents partly responsible. The disagreement therefore continues over sacred life, suffering, disability, responsibility, and expected quality of life.

Q: How can respect for life support terminating a pregnancy?

Respect for life can support termination when parents understand creating a person as an enormous responsibility and believe the future child would experience severe suffering. Margaret Olivia Little argues that abortion can reflect deep respect for creation rather than disregard for it. On this account, parents may consider sparing a potential child a painful existence to be a selfless decision, although others answer that every life contains pain and can still flourish.

Q: Why is bodily autonomy different from preventing fetal suffering?

Bodily autonomy and preventing fetal suffering focus on different interests. A bodily autonomy argument says a woman should control what happens inside her body. An argument for abortion intended to spare a fetus from suffering instead makes the fetus’s welfare primary. The first is grounded in the pregnant woman’s liberty, while the second requires another justification, such as substituted judgment or the presumed interest of sentient beings in avoiding pain.

Q: What is the standard of substituted judgment?

The standard of substituted judgment allows someone to make medical decisions for a patient who cannot decide independently, including an infant, an unconscious person, or someone with dementia. The proxy is asked to choose what the patient would want, not simply what the proxy prefers. The standard is easier to apply when prior wishes are known and much harder when a fetus or infant has never formed expressible preferences.

Q: Why is substituted judgment difficult for fetuses and infants?

Substituted judgment is difficult for fetuses and infants because they do not yet have opinions that another person can discover and apply. Unlike an adult who previously communicated wishes, they provide no personal evidence about preferred treatment. A proxy can only fall back on a general assumption that sentient beings seek to avoid pain, then judge whether preventing expected suffering serves the fetus’s or infant’s interests.

Q: What is the difference between euthanasia and assisted suicide?

Voluntary euthanasia occurs when a patient willingly decides to die but cannot perform the act and asks another person to carry it out. In assisted suicide, the patient also makes the decision, while assistance may take the form of a doctor providing a prescription. The patient then performs the final act. Both can use liberty arguments because the decision remains centered on the patient’s choice.

Q: Why is non-voluntary euthanasia hard to justify through pain or liberty?

Non-voluntary euthanasia often concerns removing life support from a patient in a persistent vegetative state. Pain avoidance is a weak justification because an unconscious patient is not feeling pain. Liberty is also difficult to invoke unless the patient made relevant wishes known before losing consciousness. Patient-centered reasoning may instead address prior preferences, whether personhood remains, or whether ending mechanical support honors the dignity of the person who once existed.

Summary & Key Takeaways

• Arguments about orchestrated death reflect competing values rather than a simple divide between respecting and disregarding life. Opposition may emphasize life’s sacredness and reject judgments about its future quality. Supporters may instead appeal to personal liberty, avoidance of suffering, dignity, responsibility for a dependent being, or respect for the conditions under which life is created.

• Abortion following a fetal abnormality diagnosis can be defended from different perspectives, but those perspectives must remain distinct. A pregnant woman’s authority over her body is a personal liberty argument. A decision intended to spare the fetus severe suffering concerns the fetus’s interests and may rely on substituted judgment or the assumption that sentient beings seek to avoid pain.

• Euthanasia cases require attention to agency and consciousness. Voluntary euthanasia and assisted suicide can invoke liberty because the patient chooses death, although another person’s role differs. Non-voluntary euthanasia involving irreversible unconsciousness cannot easily rely on present suffering or present choice, so arguments may instead concern prior wishes, dignity, personhood, family, finances, or life’s sacredness.