This chapter provides empirical evidence about everyday attitudes concerning euthanasia. These attitudes have important implications for some ethical arguments about euthanasia. Two experiments suggested that some different descriptions of euthanasia have modest effects on people’s moral permissibility judgments regarding euthanasia. Experiment 1 (N = 422) used two different types of materials (scenarios and scales) and found that describing euthanasia differently (‘euthanasia’, ‘aid in dying’, and ‘physician assisted suicide’) had modest effects (≈3 % of the total variance) on permissibility judgments. These (...) effects were largely replicated in Experiment 2 (N = 409). However, in Experiment 2, judgments about euthanasia’s moral permissibility were best predicted by the voluntariness of the treatment. Voluntariness was a stronger predictor than some demographic factors and some domain general elements of moral judgments. These results help inform some debates about the moral permissibility of euthanasia (e.g., the slippery slope argument) suggesting that some of the key premises of those arguments are unwarranted. (shrink)

David Shaw's response to Hugh McLachlan's criticism of his proposed new perspective on euthanasia is ineffectual, mistaken and unfair. It is false to say that the latter does not present an argument to support his claim that there is a moral difference between killing and letting die. It is not the consequences alone of actions that constitute their moral worth. It can matter too what duties are breached or fulfilled by the particular moral agents who are involved.

A governing principle in medical ethics is respect for patient autonomy. This principle is commonly drawn upon in order to argue for the permissibility of assisted dying. In this paper I explore the proper role that respect for patient autonomy should play in this context. I argue that the role of autonomy is not to identify a patient’s best interests, but instead to act as a side-constraint on action. The surprising conclusion of the paper is that whether or not it (...) is in the best interests for the patient to die is a morally objective matter. This allows for the possibility that it can be in the best interests of the patient to die even if she autonomously considers it to be in her best interest to continue living. I argue that concerns about ‘mandatory’ euthanasia can be met when patient autonomy is respected as a side-constraint on action. Ultimately, this means that assisted dying is permissible, not because the autonomous patient views her suffering to be unbearable, but because it is in her objective best interests and she permitted it via her consent. (shrink)

In an article recently published in the Journal of Medical Ethics, I assessed the position that voluntary euthanasia and physician-assisted suicide can be appropriate only in cases of persons who are suffering unbearably because they are ill or injured, not in cases of unbearably distressed persons whose suffering is caused by their conviction that their life will never again be worth living. More precisely, I considered one possible way of defending that position, the argument that the latter kind of distress—to (...) which I referred to as existential suffering—does not qualify as grounds for VE and PAS because doctors are not experts on questions pertaining to the meaning, value and purpose of life: existential questions, as I called them. I maintained that cases of VE and PAS related to illness and injury involve existential questions relevantly similar to those faced in connection with existential suffering. Therefore, I concluded, if VE and PAS based on suffering arising from illness or injury falls within the domain of medical expertise, it is consistent that VE and PAS cannot be denied in cases of purely existential suffering by maintaining that the professional expertise of doctors does not extend to existential questions.1The article inspired some interesting discussion. Robert Young offered two reasons for thinking that its argument is of limited practical significance.2 Julian Savulescu maintained that, within current medical ethics and human rights, there already is a method of assisted suicide: voluntary palliated starvation , which allows that existential distress can sometimes provide grounds for assisted dying and which could fall within the limits of the law.3 The discussion by Young and Savulescu suggest that my argument, or rather the nature of the project of which it is purported to be a part, could benefit from some clarification. That …. (shrink)

In this chapter, I consider the idea that physician-assisted death might come into question in the cases of psychiatric patients who are incapable of making autonomous choices about ending their lives. I maintain that the main arguments for physician-assisted death found in recent medical ethical literature support physician-assisted death in some of those cases. After assessing several possible criticisms of what I have argued, I conclude that the idea that physicianassisted death can be acceptable in some cases of psychiatric patients (...) who lack autonomy ought to be taken into account in assessing the moral and legal acceptability of physician-assisted death. (shrink)