Kevorkian's ignorance about this episode suggests he may not have taken adequate steps to ensure that her decision was uncoerced. But the second consideration seems more important in this matter, both for the evaluation of the Curren case and for the issue of assisted suicide in general. The principle of autonomy holds a central place in medical ethics. The latter is independence in its purest state, and is, for Dworkin, a lofty ideal. 2. a conception of autonomy which excludes factors such as loyalty and love severs ethics from its foundation in human experience.
Substantive independence requires that our decisions and actions are entirely our own.
Clearly this ideal is impossible, since we speak and think using socially-acquired linguistic signs, laden with the values of our intellectual ancestors. Our personal aims are even more prone to the influence of others, as they generally derive largely from our membership in one social group or another. Even automatic, unthinking actions are to a degree socially-conditioned, as Pavlov and Skinner have demonstrated. Substantive independence is incompatible with the experience of being human. Most contemporary ethicists believe that ethics aims at human flourishing and that human knowledge must be sought in human experience.