Does euthanasia and physician-assisted suicide disrespect the disabled?

By Philip Reed.

According to the way people commonly talk, laws and social practices can express certain messages. We might say that a strict immigration policy expresses an unwelcome message and disrespect to immigrants. Or a law that requires employers to provide paid family leave expresses encouragement for people to have children. This idea is perhaps just a particular instance of the general claim that among the purposes of the law are pedagogical ones, instructing citizens on appropriate and inappropriate attitudes and activities.

Two decades ago, some disability rights activists became particularly concerned about the message being expressed by the use of prenatal screening. Prenatal screening allows us to identify a range of diseases and disabilities in an embryo or fetus and take measures to prevent or end the pregnancy. Prenatal screening disrespects existing disabled persons, disability rights supporters insist, because it reduces the value of such persons to their disabling trait and implies the negative belief that the lives of disabled persons are not worth living. This became known as the “expressivist objection” to prenatal screening, and bioethicists have been arguing about it for years.

For example, Down syndrome in Iceland is disappearing because nearly 100% of pregnant women who receive a positive test for the disease terminate their pregnancies. Aside from any wrong that may be done to the individuals who are prevented from being born, the expressivist objection worries about the message that this practice sends to existing individuals with Down syndrome. Is it better if they had never been born? Will society provide the resources necessary for them to live worthwhile lives? Will prenatal screening simply entrench a prejudicial or discriminatory attitude against the disabled more generally?

My paper addresses this debate not by weighing in on the expressivist problem with prenatal screening directly. Instead, my goal is to extend the expressivist concern and show that it parallels an objection that is commonly made against physician-assisted suicide and euthanasia.

Among the strongest opponents of assisted death laws have been disability rights supporters, and among their objections is that these laws express an attitude of disrespect to the disabled, indicating that their lives are less valuable than those who are not disabled. This objection to assisted death has not been labeled “expressivist” by its advocates, but it has the same form and motivation as the expressivist objection against prenatal testing. The goal of my paper is to contrast the effectiveness of various responses to the expressivist objection in both the beginning and end of life scenarios.

The paper will be of interest to anyone who has interest in the expressivist issue with respect to prenatal screening. One way I try to contribute to this debate is by paying attention to the different methods that are proposed for reducing the number of people with a disadvantageous condition.

But the main goal of my paper is to open up a wider discussion about objections to assisted death from concerns about disability rights. Many disability rights scholars are silent on the issue of assisted death, and in a number of cases, such as that of the late Anita Silvers, have explicitly reconciled their disability advocacy with support for assisted death. They have done this despite the disability rights movement in the public policy realm being among the loudest critics of these laws. Would a progressive and leftist politics committed to defending the vulnerable be more consistent if it opposed physician-assisted suicide and euthanasia?


Author: Philip Reed
Affiliations: Professor of Philosophy, Canisius College, Buffalo, NY, USA; Fellow, Romanell Center for Clinical Ethics and the Philosophy of Medicine, University at Buffalo, Buffalo, NY, USA
Competing interests: None

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