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Expressivism at the beginning and end of life
  1. John Keown
  1. Kennedy Institute of Ethics, Georgetown University, Washington, DC 20057, USA
  1. Correspondence to Dr John Keown, Kennedy Institute of Ethics, Georgetown University, Washington, DC 20057, USA; ijk2{at}

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Philip Reed’s interesting and welcome comparison of the expressivist case against, on the one hand, prenatal testing and abortion and, on the other, physician-assisted suicide (PAS) and voluntary active euthanasia (VAE), indicates the relevance of the expressivist case against the latter and its resilience to criticisms of the expressivist case against the former.

Advocates of PAS/VAE commonly argue that they should be lawful out of respect for autonomy: everyone has the right to choose a physician-hastened death if they meet specified conditions such as ‘terminal illness’ or ‘unbearable suffering’. The focus on autonomy is distracting, for the real work of justifying PAS/VAE is done by the argument that life with the conditions specified is not ‘worth living’. Legalisation endorses, and expresses, the judgement that it is reasonable for people with those conditions to think their lives no longer worth living and obtain medical help to end them. Were the justification to respect autonomy, why limit the choice?

It is small wonder, in light of the discriminatory nature of such a judgement, that disability groups have been outspoken opponents of legalisation. As society’s ‘canaries in the coalmine’ they have warned of the …

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  • Contributors JK is the sole author of the comment.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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