By Ben Colburn

I am an academic philosopher. In recent years I have been working with end of life practitioners, using my ideas about the importance of individual autonomy to address some tough questions about the predicaments we face as we approach our deaths. We’ve been trying to work out how to support people’s autonomy in the face of physical and mental decline, pain, suffering, and other aspects of the end of life. You can see the results of one such collaboration at tracingautonomy.net, where Jeni Pearson and Kirsty Stansfield (of the Prince & Princess of Wales Hospice in Glasgow) have created a set of tools to help identify threats and opportunities for autonomy in palliative care settings.

One thing that’s crucial is ensuring that people can make voluntary choices about what happens to them in their end of life care. An obvious further question to ask is therefore: should people have a choice about their death itself? Many proponents of a right to assisted dying think so. If someone wants to die, so the argument goes, we don’t respect their autonomy if we prevent them, including by preventing them seeking help if they need it.

Thinking about this argument in the context of my broader work on autonomy at end of life, I realised that there’s a gap. The familiar argument focuses only on the person who wants to die. But what about the person who doesn’t want to die? Is there a reason (aside from the fear that they might change their mind) for them to support assisted dying?

My answer is ‘yes’. Having this option is good for us even if we don’t want to pursue it. Knowing that we have this option changes the character of our range of choices as a whole. In the face of ill health and decline, it can be transformative for someone to know that they have a (potentially) acceptable escape, even if – suitably empowered and encouraged by that knowledge – they choose not to take it.

In my recent paper I explain the details of how this fits with the underpinning philosophy, but I think the point is made most vividly by Melanie Reid, a columnist for The Times who has been very substantially paralysed since 2010. In a 2012 column entitled ‘I choose, fiercely, to live – but only for now’, Reid wrote:

I will be very blunt. Most mornings I contemplate suicide, briefly examining the concept in a detached, intellectual way. […]

And every day I stare at my toes and say to myself: “Nope, got to keep going, got to keep fighting.” Because I choose, fiercely, to live for the people who love me; and will continue to do so until such point as they understand I cannot carry on. I hope that moment, if or when it comes, is many years away.

[…] Knowing that I have a choice is a huge comfort to me; it sustains me on the days when I make the mistake of looking too far in the future. But the point is, I am blessed precisely because I have a choice.

Reid is talking here of the choice she has (unlike many others) of using the Dignitas clinic in Switzerland, and there to use the limited movement in her hands to trigger her death without implicating anyone else. In the article I reflect on the effect for Reid of her having this option:

If she lacked it, she would be compelled to endure the horrible experiences she described. She would be trapped. Her continuing would not contribute to her autonomy because it would not be voluntary. By contrast, as Reid describes it, having the option of assisted dying changes things: now she makes an active choice to live, in the knowledge that there is a way out if she needs it. The option of assisted dying comforts her, and also liberates her from the fear of being trapped, pained, and powerless. In my terms, it secures her ongoing voluntary control, by guaranteeing an acceptable alternative, and thereby upholds her autonomy.

I think this adds an important new voice to our societal deliberation about laws on assisted dying. One need not want to die (or fear one day wanting to) for there to be reason to support legalizing euthanasia. Even those like Melanie Reid who ‘choose, fiercely, to live’ stand to be benefited by the presence of a legal option which can help secure the voluntariness with which they choose the other options open to them. This ability to speak to the interests of all citizens, including those who are certain that they don’t want to take the option of assisted dying, is an under-used resource for those seeking to build a wider constituency of support for legal reform.

Paper title: Autonomy, voluntariness, and assisted dying

Author(s): Ben Colburn

Affiliations: University of Glasgow

Competing interests: None

Social media accounts of post author(s):@autonomaniac