"A perfection of means, and confusion of aims": finding the essence of autonomy in assisted death laws.

Abstract

This article explores whether the principles of autonomy and self-determination are indeed at the root of the assisted death laws currently in place in a number of jurisdictions. It is written to appeal to a very broad audience and to those who wish to become better informed about the legal aspects of the assisted death debate.The article first provides a comprehensive and comparative examination of the assisted death laws in the jurisdictions that have promulgated express legislation to regulate assisted death - The Netherlands, Belgium, Luxembourg, Oregon and Washington and also includes an examination of Switzerland, which does not currently have express legislation but does have a long legal history concerning the practice of assisted death. This approach has been taken in order to provide the reader with information cogent to the evolution of the assisted death laws that can enable the reader throughout the discussion, to formulate his or her own opinions with respect to the essence of these laws and the different principles and policies at play in their development and legal manifestation.The concept of autonomy is explored throughout and offers the author’s reflection on the extent to which this principle has been applied or incorporated into the respective laws and explores how each jurisdiction has framed the assisted death conflict and the limits to autonomy that arise from each unique construction. Of particular interest here is the varying treatment and relevance of the “suffering” requirement and the interplay between medicine, suffering and autonomy.The article next summarizes the specific role that autonomy plays, relative to other competing principles in the respective assisted death laws in order to test the durability of the autonomy principle in advancing the assisted death movement.The article concludes by drawing attention to the apparent inverse relationship between the expression of autonomy and the scope of the assisted death remedies available to the individual wishing to die. The article ultimately describes the expression of autonomy as a function of the negotiation between physician and patient and calls for a deeper discussion as to what is or should be the appropriate role of physicians in the art of dying.The paper also cautions against the direct importation of assisted death regulatory frameworks from other jurisdictions given their respective heterogeneous foundations.