What do the ethicists say about such a thing? Not all agree, of course, but it turns out that it is fairly easy to derive an ethical argument in favor of involuntary euthanasia from the starting point of upholding individual autonomy. That argument goes like this: the principle of autonomy demands that patients be allowed to refuse medical therapy; refusal of therapy is the ethical equivalent of voluntary euthanasia; since voluntary euthanasia is a right of individuals with intractable suffering, it follows that it would be unethical to withhold euthanasia from suffering individuals who are incapacitated, just because they are unable to give their permission. Hence, involuntary euthanasia is ethical for suffering patients who are unable to give their permission.
Where this leaves us is at a place where others can decide for an individual both what constitutes intractable suffering, and when that individual is too incompetent to make such a determination for him or herself. Where these "others" end up drawing the line on whether a person's existence is of value or whether a person is competent, of course, can be influenced by all sorts of external factors.
In Nazi Germany, for instance, those external factors included a belief in the purity of the Arian race, and that belief led to horrible excesses. We don't have that belief today.
What we dohave is a hidden but undeniable imperative to ration health care, which means that potentially beneficial care is going to have to be withheld from <i style="mso-bidi-font-style:normal]somebody, <i style="mso-bidi-font-style:normal]somewhere. Can we be sure that, once we start down the road of allowing patients to choose death, we will be able to withstand <i style="mso-bidi-font-style: normal]ourexternal influences, and stay our hands from ending the suffering of some who might not be so sure of their choice, or who are incapable of making a choice - especially when, by so doing, we will make more health care available to others?
Let us personalize this issue a bit.
Imagine yourself at age 75 in a hospital bed for the third time this year with coronary artery disease. Your cardiologist walks in, smiling.
If physician-assisted suicide and euthanasia are still illegal, you can be reasonably sure he's smiling with confidence. He still thinks he can help you, and his smile tells you so. You relax. You feel better already.
But what if they <i style="mso-bidi-font-style: normal]arelegal? What would his smile mean then? He still might be smiling with confidence, of course. But maybe he's smiling as a means of beginning a conversation with you about some choices. Maybe he's about to pull up a chair, shake his head a bit, and say, "Well, you know, things don't look so good this time, Charlie." He'll pause, smiling wider now. "But the good news is, we can make it all pretty easy on you."
Or worse, he might not say anything. He might leave you guessing about how hard he's really working to make you well. You've even heard - well, you've heard they don't always <i style="mso-bidi-font-style:normal]tellyou beforehand.
It's hard to imagine anything more destructive to the trust between a doctor and a patient than knowing that your doctor, at some point, may shift from trying to cure you to trying to usher you into the next life as cheaply as possible (by encouraging suicide, by offering euthanasia, or by simply doing the euthanasia because you're so incompetent you can't see it's the only thing to do).
If people want to commit suicide, and if the ethicists agree that assisted suicide is entirely okay, then let the ethicists do the assisting. I have relatively little to say against ethicist-assisted suicide.
But leave the doctors out of it.
