The Myth of Autonomy

by Gjergji Evangjeli


In the past month and in the past few years in general, more and more governing bodies have chosen to pass laws allowing those whoa re terminally ill to obtain help from physicians in order to end their lives.  At least here in the U.S., the seemingly arbitrary cutoff for physician-assisted suicide is the determination that the patient has less than six months left to live.  Leaving aside the fact that such determinations have an inherent degree of inaccuracy in predicting how long the patient actually have to live and the fact that prescribing patients medication which contributes in ending their life is a blatant disregard to the Hippocratic Oath, the idea that loss of autonomous function is a viable reason for someone seeking and obtaining medication which will knowingly end their life is deeply flawed.

In order to figure out whether the loss of autonomy makes sense as a criterion for physician-assisted suicide, let us start by considering the group we are most familiar with, college students. Obviously, most college students are physically autonomous, in that they can get to where they need to go and have control over their bodily functions, but that is where—for most of us—autonomy ends. As far as financials, long-distance transportation, and even basic necessities like food and shelter, the vast majority of college students are dependent on either their school or their family. Of course, those who are autonomous on one or more of these categories are only autonomous because they rely on other structures inherent in living in community and society.


From the dawn of human existence, the practice of living in community necessarily implies that each individual is dependent upon the whole. Because of this, one human who is particularly good at some one thing can focus on doing that one thing and trade the goods or services resulting from this skill for other necessities. Thus, every member of any community is dependent on the community as a whole for existence, and if they have some measure of autonomy within the community, it is merely because the dependence to the community is assumed. Thus, we can conclusively say that every person—regardless of his or her physical, mental, or socio-economic status—is first and foremost dependent.


So, with this in mind, we return to the issue of the loss of autonomy for those with terminal illnesses. It is not a matter of dispute that  the people in these cases in question have a higher dependence on their community—be that the family, which is the most immediate community that everyone is a part of, or society at large—yet, they differ in this matter from most other people not in kind, but in degree. Whenever a hard division between two things that differ only in degree exists, the question of arbitrary judgments should come to mind. What is the concrete reasoning for why a person who has only six months to live can choose to end their life as opposed to someone who, say, has one year left? In a more morbid turn, if the underlying issue is pain and increased physical dependence is the underlying criterion, why shouldn’t a person who is severely disabled also be a viable candidate for being assisted in accomplishing the end of their life? Such reasoning does not lead to respect of life, but to disturbing suggestions that some segment of the human community is “life unworthy of life,” whether it does so consciously or whether it is merely an implication of the arguments outlined.


The most popular move for proponents of physician-assisted suicide is, at this point, to argue not from the loss of autonomy, but from the loss of dignity. A person that is so severely ill, they say, will have to suffer some deeply undignified circumstances before they die. Would it not be more reasonable to allow them to end their own life while they are still in control of their bodily functions?


This suggestion has societal norms as its grounding. Why it is undignified that a person who is suffering from illness does not have the same range of activity as one who is not suffering from any illness is beyond the grasp of logic, unless we consider the Western obsession with an eternally unreachable picture of self-reliance and independence.


To fully tease this point out would take far too long, so it must be left for another time. In the meantime, something to ponder from the mouth of Gandalf, “Authority is not given to you, Steward of Gondor, to order the hour of your death. And only the heathen kings, under the domination of the Dark Power, did thus, slaying themselves in pride and despair, murdering their kin to ease their own death.”

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