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Safeguarding choice at the end of life
  1. Dominic Wilkinson, Associate Editor

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Across the world, in countries with permissive or restrictive existing legislation, debates about Euthanasia and Assisted Suicide (EAS) continue to grip politicians, ethicists, physicians and the wider public.

Early debates about EAS focused on whether it could ever be ethical for a physician to actively cause the death of a patient. However, most contemporary writers, including most of the contributors to this special double issue of the JME appear to accept that such actions could, in some circumstances, be ethical. Current debate is mostly focused instead on which actions are permissible, when they are permissible, and what safeguards are necessary to protect the vulnerable.

There are two separate justifications for EAS. The first of these is based on the autonomy of competent patients, on their right to make important decisions about their own lives. Arguably, a decision about continuing or not continuing your life in the face of severe suffering is the most important decision that you could make. Correspondingly, we have strong autonomy based reasons for permitting that choice. (While some Kantians might claim that a decision to die, and thereby to end one's autonomous agency could not be compatible with autonomy and dignity, Michael Cholbi points out (see page 607) that a sophisticated Kantian position on EAS is neither completely restrictive nor permissive). The second justification for EAS is based on the interests of a patient, and a concern that continued life for some individuals may be so extraordinarily and intensely unpleasant that it would be better for them to die.

Many of the safeguards that have been built into existing or proposed legislation have focused on the autonomy justification for euthanasia, and correspondingly on determining whether a person requesting EAS is competent. (For a discussion of the UK Assisted Dying Bill, proposed by Lord Falconer see page …

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