Medical Aid in Dying: Different Individuals, Different Choices

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This article is in response to the From Our Readers article, “Comfort Over Death: An Argument Against Medical Aid in Dying” by John R. Peteet, MD.

John R. Peteet, MD, responds to my assertion that religion-derived assumptions cannot generally be changed by logical discussion by suggesting this is true of other assertions, specifically (1) that there is no “meaningful, dignity-implying difference between humans and other intelligent creatures” or (2) prioritizing autonomy compared to other values. Being amenable to rational and logical discussion does not mean that there will always be some “convincing logic that can provide answers” to everyone, or philosophy would have finished its work centuries ago. Rather it simply means that one can articulate coherent reasons supporting a position that in turn can be critically challenged by the reasoning of another such that one might reconsider their original position, in a way that “because God says so” cannot.

Regarding (1), the continuity between humans and other intelligent creatures can be argued based on remarkably similar central nervous systems and shared capacities for affective expression, suffering, bonding/caring, desiring, making inferences, and planning. Differences appear to be continuous, not categorical.

Regarding (2), I do not claim that there is no higher principle than autonomy, nor do I lack appreciation for other values. I would argue that autonomy should take high priority for decisions where: (a) considerable disagreement exists among individuals as to the best choice, and (b) data relevant to making the decision are primarily in the realm of the first-person, subjective experience of the person most directly affected by the decision.

Thus, faced with extensive suffering or loss of dignity in the context of a terminal illness, different individuals will make different choices. The basis for those choices involves weighing first-person data, such as my level of suffering, my sense of what constitutes dignity, my assessment of the impact of my decision on those I love, and what positive I think might come from continuing to live a while longer. None of these can be reasonably assessed from a third-person perspective.

Conversely, deciding whether an individual has a terminal illness, or is competent to make a decision, draws on expert knowledge more accessible to the physician than the patient. Although experts will at times disagree, the relevant data is third-person and in that sense objective. In medical aid in dying assessments, these are the sorts of judgments we should be making, not deciding what is in the best interest of the patient. That should be up to the patient.

Dr Heinrichs is a psychiatrist in Ellicott City, Maryland.