Autonomy, life as an intrinsic value, and the right to die in dignity

This essay is based on a lecture presented at the 10th World Congress on Medical Law (Jerusalem, 28 August — 1 September, 1994) and published in Vol. A of the Conference Proceedings under the title “The Right to Die in Dignity”. It was awarded the Gitzelter Prize by the Congress Academic Committee. The author expresses gratitude to Geoffrey Marshall, Sam Lehman-Wilzig, Ray Spier and the anonymous referees ofScience and Engineering Ethics for their valuable suggestions and criticism. The Latin noun dignitas is cognate with the adjective dignus (worthy), from the sanskrit root dic and the Greek root deik, which have the sense of “bringing to light”, “showing”, or “pointing out”. Cf. U. Lowental (1984) Euthanasia: A Serene Voyage to Death, In: Carmi A, ed.,Euthanasia, Springer-Verlag, Berlin: 180–184. Bolam v. Friern Hospital Management Committee (1957), 2 All ER 118. F v. West Berkshire Health Authority (1989) 2 All ER 545, at 546. See alsoRe J (1990) 3 All ER 930. Re J, at 938. Airedale NHS v. Bland (1993) 1 All ER 821. Airedale NHS v. Bland, at 870. Cf. Groswasser Z and Sazbon L (1990) Outcome in 134 Patients with Prolonged Posttraumatic Unawareness,Journal of Neurosurgery 72: 81. Airedale NHS v. Bland (1993) 1 All ER 821, at 862. This is Professor John Finnis’s view, made in Ronald Dworkin’s seminar onAbortion, Dementia and Euthanasia (Oxford University, Hilary 1991). Civil Appeal 506/1988.Yael Scheffer, through Talila Scheffer v. The State of Israel (reasoning published in December 1993), para 6. Geoffrey Marshall contests this view, arguing in his remarks that in some cases it is better to die in adolescence than to die in infancy. For further deliberation see Dworkin (1993)Life’s Dominion, Knopf, New York: 84–89. For opposing opinion see Heyd D (1992)Genethics, University of California Press, Berkeley, Ca., USA. Heyd contends that coming to life is neither a harm nor a gift. The quality of life of the prospective subject cannot play any role in the decision whether to bring him or her to life. Heyd maintains that the existence of people with “restricted lives” can no more be considered “intrinsically undesirable” than the existence of happy people can be considered intrinsically desirable (at 109–110). Perrett R W (1992) Valuing Lives,Bioethics 6, 3: 185–200, at 188. Kuhse H and Singer P (1985)Should the Baby Live? The Problem of Handicapped Infants, Oxford University Press, Oxford, UK, and Kuhse H (1992) Quality of Life and the Death of ‘Baby M’,Bioethics 6, 3: 233–250. Kuhse H, Quality of Life and the Death of ‘Baby M’, p. 250. Rawls J (1973)A Theory of Justice, Oxford University Press, Oxford, UK: esp. pp. 12, 136–142. Kant I,Foundations of the Metaphysics of Morals, trans: Lewis White Beck (1969) Bobbs-Merrill Educational Publishers, Indianapolis, USA. Cf. Dworkin R M, Hard Cases (1975)Harvard Law Review 88, 6: 1057–1109, esp. 1069–1071;Taking Rights Seriously, Duckworth, London (1977), esp. 150–183, 266–278; “Liberalism”, inA Matter of Principle, Clarendon Press, Oxford (1985), 181–204. For further discussion on the notion of autonomy see myThe Boundaries of Liberty and Tolerance: The Struggle Against Kahanism in Israel, University Press of Florida, Gainesville, FL (1994), esp. chap. 1. Dworkin’s terms “concern” and “respect” signal the values of well-being and autonomy, respectively: we ought to show equal concern for each individual’s good and equal respect for the individual’s autonomy. Cf. Buchanan A E, (1989) Assessing the Communitarian Critique of Liberalism,Ethics 99: 879. Nancy Cruzan v. Robert Harmon 760 S.W. 2d 408 (1988); Nancy Cruzan v. Director, Missouri Department of Health 497 U.S. 261 (1990), 110 S. Ct. 2841. In re Storar 52 N.Y.2d 363, 438 N.Y.S.2d 266, 420 N.E.2d 64, cert. denied, 454 U.S. 858, 102 S. Ct. 309, 70 L.Ed.2d 153 (1981). Eichner v. Dillon 426 N.Y.S.2d 517 (1980). Saunders v. State 129 Misc.2d 45, 492 N.Y.S.2d 510, Sup. Ct. (1985). Cf.In re O’Connor, 72 N.Y.2d 517, 531 NE.2d 607, (1988), at 617 (Hancock J.). See alsoDoe v. Wilson, No. 90-364-II, Tenn.Ch.Ct. (16 Feb. 1991). Oral statements were also conceived sufficient to remove life sustaining treatment. SeeSatz v. Perlmutter, 362 So.2d 160 Fla. Dis.Ct.App. (1978);Gray v. Romeo, 697 F. Supp. 580 D.R.I. (1988);Elbaum v. Grace Plaza of Great Neck Inc. 148 A.D.2d 244, 544 N.Y.S.2d 840 (1989);Gammon v. Albany Memorial Hospital, N.Y.Sup. Ct. (3 April 1989). Airedale NHS v. Bland (1993) 1 All ER 821, at 836. CfSidaway v. Bethlem Royal Hospital Governors (1985) 1 All ER 643, esp. at 665–666. Cf,inter alia, In re Spring, Mass. App. 399 N.E.2d 493 (1979), at 493;John F. Kennedy Memorial Hospital Inc. v. Bludworth, 452 So.2d 921, (Fla 1984), at 926;In re L.H.R., 321 SE.2d 716, (Ga 1984), at 723;In re Jobes, 108 NJ 394, 529 A.2d 434, (NJ 1987), at 444–447. The President’s Commission for the Study of Ethical Problems and Biomedical and Behavioral Research,Deciding to Forego Life-Sustaining Treatment (1983) U.S. Government Printing Office, Washington D.C.: 28. Cf.Superintendent of Belchertown v. Saikewicz Mass., 370 N.E.2d 417 (1977), at 430. Rawls J,A Theory of Justice, at 209.