Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany
J Med Ethics. 2023 Jul;49(7):497-501. doi: 10.1136/jme-2022-108375. Epub 2022 Sep 7.
In several jurisdictions, irremediable suffering from a medical condition is a legal requirement for access to assisted dying. According to the expressivist objection, allowing assisted dying for a specific group of persons, such as those with irremediable medical conditions, expresses the judgment that their lives are not worth living. While the expressivist objection has often been used to argue that assisted dying should not be legalised, I show that there is an alternative solution available to its proponents. An autonomy-based approach to assisted suicide regards the provision of assisted suicide (but not euthanasia) as justified when it is autonomously requested by a person, irrespective of whether this is in her best interests. Such an approach has been put forward by a recent judgment of the German Federal Constitutional Court, which understands assisted suicide as an expression of the person's right to a self-determined death. It does not allow for beneficence-based restrictions regarding the person's suffering or medical diagnosis and therefore avoids the expressivist objection. I argue that on an autonomy-based approach, assisted suicide should not be understood as a medical procedure but rather as the person's autonomous action.
在一些司法管辖区,不可逆转的医疗状况是获得协助自杀的法律要求。根据表现主义反对意见,允许特定群体的人(如患有不可逆转的医疗状况的人)协助自杀,表达了他们的生命不值得活下去的判断。虽然表现主义反对意见经常被用来论证协助自杀不应合法化,但我表明,其支持者可以采取另一种解决方案。基于自主权的协助自杀方法认为,只要一个人自主请求提供协助自杀(而不是安乐死),就可以认为其是合理的,而不论这是否符合她的最佳利益。德国联邦宪法法院最近的一项判决就提出了这种方法,该判决将协助自杀理解为个人自主决定死亡的权利的表现。它不允许基于仁慈的限制,即关于个人的痛苦或医疗诊断,因此避免了表现主义反对意见。我认为,在基于自主权的方法中,协助自杀不应被理解为医疗程序,而应被视为个人的自主行为。