Assisted Suicide is Compatible with Medical Ethos

patient or the patient’s family; Rietjens and colleagues claim that “terminal sedation was almost always discussed with relatives but not always with the patient” in their study of CDS in Holland (Rietjens et al. 2004, 183). That is, sedation is administered nonvoluntarily, not at the patient’s instigation. And, of course, it may be that CDS is considered as a last resort to relieve pain when it is in the patient’s best interests—which implies that patient preferences are not the prime consideration (possibly because the patient is not able to express them). This is an important point, since it suggests that the barrier between the voluntary and nonvoluntary ending of conscious existence has been broken. This ought not to happen in PAS, properly understood: PAS is physicianassisted suicide, not physician-instigated suicide. Things are different with respect to CDS; the medic’s having taken the initiative seems to be a pervasive characteristic of its administration—which is as we would expect if the AfP is sound. But once the patient’s preferences have been eclipsed by the medic’s decisions, it does not take an enormous leap of imagination to see how, if there is any slippery slope at all, it is greased by CDS. If medics countenance the nonvoluntary and final ending of a person’s consciousness until the point of death (which they do), and if ending someone’s conscious existence is in an important sense comparable to killing them (which it is), there is no obvious reason why the patient should live at all: CDS amounts to extinguishing whatever is important about the patient qua subject-of-a-life, and bare bodily function seems not to be of any great moral import in that context. Once you’re prepared to remove without consent the thing that makes a life important, it’s not obvious that there’s much to hold you back from taking a life without consent. In other words, Raus and colleagues have underplayed their hand: They could, but do not, turn slippery-slope worries against themselves. The moral risks from CDS are, arguably, higher than those of PAS—especially given evidence about the frequency with which CDS is administered with the co-intention of hastening death. Once again, it would appear that CDS is more like nonvoluntary allocide than like PAS, and more like nonvoluntary allocide than PAS is. If we worry about nonvoluntary allocide, then CDS probably ought to worry us for the same reasons. Stressing this kind of argument enhances the rhetorical power of PAS proponents, too. Raus and colleagues’ paper is devoted to repelling arguments made by proponents of CDS, but this implicitly accepts that the moral initiative is held by those making pro-CDS arguments. However, if there are legitimate moral reasons for concern about CDS that do not apply to PAS with respect to the medic’s role, and if CDS and PAS are morally matched from the patient’s perspective, then it means that it could be proponents of CDS who ought to defend themselves. Bluntly, Raus and colleagues are on reasonably firm ground when they express doubts concerning whether the possibility of CDS really does undermine the arguments for PAS, but they could have gone further.