Ethical dilemmas are sufficiently unique and complex that exceptionless rules or precise algorithms are seldom helpful.
This article is in response to the From Our Readers article, “Opposition to Medical Aid in Dying: Deserving Serious Consideration” by John R. Peteet, MD.
John R. Peteet, MD, raises 2 questions about my position that merit clarification. The first is whether the continuity between humans and other animals implies no ethical distinctions. Continuity does not mean sameness. Considering his example of penalties for killing humans versus other animals, the punishments largely do have a parallel continuity. The penalties for the wanton torture or killing of animals are less than for the wanton torture or killing of humans. But they differ in degree, not valance. But to say that ending the life of a dying and suffering pet with the aid of a veterinarian is kind and merciful, whereas facilitating the death of a dying and suffering person who requests it is ethically wrong and should be forbidden constitutes a reversal of values that needs justification. It would be like arguing that the price of a speeding ticket should increase proportional to the magnitude of excessive speed, but over 100 miles an hour there is no fine and perhaps a government rebate is in order. It would be reasonable to ask for a rationale for such a reversal.
As to my criteria for prioritizing autonomy, I do not mean to offer absolute rules that would decide every case. I believe ethical dilemmas are sufficiently unique and complex that exceptionless rules or precise algorithms are seldom helpful. (Hence my preference for virtue-based approaches to ethics over either deontological or utilitarian systems). Nevertheless, I believe the principles I suggested provide a useful heuristic for judging the priority of autonomy in any given ethical choice.
If the most important considerations involve my subjective experience and weighing matters such as my pain, suffering, loss of dignity, the value of my remaining life, the impact on those I love, and compatibility with my overall values, no one is in a better position than me to make those discriminations. In decisions such as the diagnosis and prognosis of my illness, the likely success of available treatments, and my ability to make competent decisions, a physician has a relevant expertise greater than my own. Again, there may be other kinds of considerations in any given situation. Many of our policies on illicit drug abuse, for instance, reflect the huge societal costs as much as concern for the welfare of the drug abuser. To make the same case regarding MAID would require hard data, not just speculation.
Dr Heinrichs is a psychiatrist in Ellicott City, Maryland.