Article Text

Download PDFPDF

Commentary on ‘expressivism at the beginning and end of life’
  1. Felicia Nimue Ackerman
  1. Department of Philosophy, Brown University, Providence, Rhode Island, USA
  1. Correspondence to Dr Felicia Nimue Ackerman, Brown University, Providence, RI 02912, USA; felicia_ackerman{at}

Statistics from

Death can be good—

I’ll tell you how.

Just have it come

Decades from now.1

Full disclosure: The above poem expresses my outlook, and I have trouble empathising with people who want to die. But that does not make me unable to evaluate objections to the expressivist argument against PAS. Reed sets forth the expressivist argument as follows: ‘[W]hen we allow PAS for individuals who are terminally ill or facing some severe disease or disability, we send a message of disrespect to all individuals who face such adversities in that we imply that they are inferior or their lives are not worth living (or at least less worth living than they otherwise would be) precisely insofar as they are diseased or disabled’.2

The passage of mine that Reed quotes, however, was not intended to set forth an expressivist view. Rather than saying the double standard of selective legalisation ‘send[s] a message of disrespect’,3 it says this double standard in fact involves a systematic devaluation of some people’s lives. I will argue that there are conditions under which this double standard does send a message of disrespect, but first I want to disassociate myself from the expressivist formulations of Coleman and Keown that Reed quotes.

Although the mildness of ‘may’ makes Coleman’s formulation fairly innocuous, it is hardly reasonable for disabled people to take legalised physician-assisted suicide (PAS) to ‘convey the message that suicide is the best way to reclaim their dignity’ [4 p. 228]. Even more problematic is Keown’s formulation that ‘the very fact of decriminalisation [of laws against euthanasia] could easily signal to vulnerable groups, directly or indirectly, not only that they may seek an earlier death, but that they should’ [5 p. 96]. Decriminalising an activity does not generally signal that people should engage in it. If it did, society couldn’t decriminalise anything without falling prey to this objection. This would mean that leaving people legally free to choose whether to engage in an activity could easily signal both that they should engage in it and that they should not. An argument is needed for making decriminalising PAS a special case here. The double standard of allowing an activity for some but not all people is irrelevant. A minimum age for legal alcohol consumption hardly signals that people above that minimum should drink.

Also problematic is Reed’s claim that ‘the decriminalisation of assisted suicide laws for persons who experience significant loss of capabilities express(es) that there is nothing wrong with disabled persons taking their own lives’.6 Decriminalising an activity does not express that there is nothing wrong with it, just that any wrongness involved should be not be subject to criminal penalties. Racial slurs are a recognised example of non-criminal wrongness.

The double standard of legalising PAS for only some people does not in itself signal disrespect for their lives. A prominent rationale for limiting legalisation to the terminally ill is the low likelihood that they ‘would later be grateful if they were prevented from dying’ [7 p. 41]. The less time people have left to live, the less likely they are to change their attitudes towards anything. One rationale for extending selective legalisation to the severely disabled would be that their circumstances and attitudes are also unlikely to change. Since these rationales involve the likelihood of a changed attitude rather than the inherent worth of people’s lives, they may seem to escape the charge of disrespect.

But do they? Not everyone with predictably little time left to live is terminally ill. Consider Death Row inmates who have exhausted their appeals and whose executions are due to occur in under 6 months. Non-disabled people with long life expectancies may also have suicidal desires grounded in conditions that are very unlikely to change, such as poverty, ugliness, menial and gruelling jobs, lack of love. How many impoverished, ugly, unloved, 50-something people with menial and gruelling jobs later come into money, love, better looks, or better jobs? If someone’s attitude towards these circumstances has been stable for years, it may be reasonable to suppose that it, too, is very unlikely to change, or at least that it is no more likely to change than someone’s longstanding attitude towards her disability.

Limiting PAS to the terminally ill and the severely disabled invites the question of why they should get more assistance in escaping misery than the rest of us. As Reed points out, ‘[T]he most common reasons that terminally ill individuals in Oregon choose PAS are that they do not wish to lose autonomy, ‘dignity,’ the ability to engage in normal activities or control of their bodily functions’.8 But what if someone wants PAS because she believes her dignity has been destroyed by poverty, menial work—or having been raped? There was a time when few white people recognised the human dignity of black people. If there are black people nowadays who buy into this, should PAS be legalised for them?

Few people would say yes. In fact, as Sara Ann Ketchum has pointed out in discussion, those who favour PAS for the terminally ill and the severely disabled would be apt to insist that any woman who wanted PAS because she thought being raped had destroyed her human dignity was in desperate need of therapy.

The double standard for allowing PAS thus gives terminally ill and severely disabled people less protection against dignity-based suicidal desires than the rest of us and conveys the disrespectful message of support for such desires only in people in these groups. So my argument strengthens the author’s general case for regarding the expressivist argument as stronger against PAS than against prenatal testing and selective abortion—although, in my view, the expressivist objection is far less important than the objection that the double standard in fact gives terminally ill and severely disabled people less protection than the rest of us against dignity-based suicidal desires.



  • Funding The author has 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.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles