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the degree of suffering, nor the incurable condition of the person
killed, is a defence to a charge of murder. Advocates of voluntary
euthanasia propose that this law be changed so that a doctor
could legally act on a patient's desire to die without further
suffering. Doctors have been able to do this quite openly in the
Netherlands, as a result of a series of court decisions during the
1980s, as long as they comply with certain conditions. In Germany,
doctors may provide a patient with the means to end her
life, but they may not administer the substance to her.
The case for voluntary euthanasia has some common ground
with the case for non-voluntary euthanasia, in that death is a
benefit for the one killed. The two kinds of euthanasia differ,
however, in that voluntary euthanasia involves the killing of a
person, a rational and self-conscious being and not a merely
conscious being. (To be strictly accurate it must be said that this
is not always so, because although only rational and self-conscious
beings can consent to their own deaths, they may not be
rational and self-conscious at the time euthanasia is contemplated
- the doctor may, for instance, be acting on a prior written
request for euthanasia if, through accident or illness, one's rational
faculties should be irretrievably lost. For simplicity we
shall, henceforth, disregard this complication.)
We have seen that it is possible to justify ending the life of a
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human being who lacks the capacity to consent. We must now
ask in what way the ethical issues are different when the being
is capable of consenting, and does in fact consent.
Let us return to the general principles about killing proposed
in Chapter 4. I argued there that killing a self-conscious being
is a more serious matter than killing a merely conscious being.
I gave four distinct grounds on which this could be argued:
The classical utilitarian claim that since self-conscious beings
are capable of fearing their own death, killing them has worse
effects on others.
2 The preference utilitarian calculation that counts the thwarting
of the victim's desire to go on living as an important reason
against killing.
3 A theory of rights according to which to have a right one must
have the ability to desire that to which one has a right, so that
to have a right to life one must be able to desire one's own
continued existence.
4 Respect for the autonomous decisions of rational agents.
Now suppose we have a situation in which a person suffering
from a painful and incurable disease wishes to die. If the individual
were not a person - not rational or self-conscious -
euthanasia would, as I have said, be justifiable. Do any of the
four grounds for holding that it is normally worse to kill a person
provide reasons against killing when the individual is a person
who wants to die?
The classical utilitarian objection does not apply to killing that
takes place only with the genuine consent of the person killed.
That people are killed under these conditions would have no
tendency to spread fear or insecurity, since we have no cause
to be fearful of being killed with our own genuine consent. If
we do not wish to be killed, we simply do not consent. In fact,
the argument from fear points in favour of voluntary euthanasia,
for if voluntary euthanasia is not permitted we may, with good
cause, be fearful that our deaths will be unnecessarily drawn
out and distressing. In the Netherlands, a nationwide study
commissioned by the government found that 'Many patients
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want an assurance that their doctor will assist them to die should
suffering become unbearable: Often, having received this assurance,
no persistent request for euthanasia eventuated. The
availability of euthanasia brought comfort without euthanasia
having to be provided.
Preference utilitarianism also points in favour of, not against,
voluntary euthanasia. Just as preference utilitarianism must
count a desire to go on living as a reason against killing, so it
must count a desire to die as a reason for killing.
Next, according to the theory of rights we have considered,
it is an essential feature of a right that one can waive one's
rights if one so chooses. I may have a right to privacy; but I
can, if I wish, film every detail of my daily life and invite the
neighbours to my home movies. Neighbours sufficiently intrigued
to accept my invitation could do so without violating
my right to privacy, since the right has on this occasion been
waived. Similarly, to say that I have a right to life is not to say
that it would be wrong for my doctor to end my life, if she does
so at my request. In making this request I waive my right to
life.
Lastly, the principle of respect for autonomy tells us to allow
rational agents to live their own lives according to their own
autonomous decisions, free from coercion or interference; but
if rational agents should autonomously choose to die, then respect
for autonomy will lead us to assist them to do as they
choose.
So, although there are reasons for thinking that killing a selfconscious
being is normally worse than killing any other kind
of being, in the special case of voluntary euthanasia most of
these reasons count for euthanasia rather than against. Surprising
as this result might at first seem, it really does no more
than reflect the fact that what is special about self-conscious
beings is that they can know that they exist over time and will,
unless they die, continue to exist. Normally this continued existence
is fervently desired; when the foreseeable continued ex-
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