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The individualist view tends to take restriction of autonomy as a dyadic matter between two individuals— one who is dominant e.

It also focuses on individual actions or interactions rather than social practices, unless those social practices have been formalized or codified by law, such as sanctions against euthanasia. In the context of medically assisted death, the individualist-minimalist framework focuses on whether people have all the information to make their end-of-life decisions rather than how various forms of medically assisted death may reflect larger structural issues such as health-care delivery, the professional—patient relationship, the ethos of the medical profession, and the definition of extraordinary care.

In arguing for lifting prohibitions on certain forms of medically assisted death, many take it for granted that competent people with all the relevant information should be allowed to make their own decisions regarding whether or how to die. The minimalist notion of autonomy is attractive in a liberal democratic society because it diminishes the possibility of paternalism, especially in situations where power hierarchy dominates the relational structure, such as health care.

Nonetheless, in health care and other arenas, power and domination are not simply or always elements of individual actions. Subscriber: University of British Columbia; date: 27 February Choosing Death technologies are considered mainstream, and what risks are deemed acceptable. While the popular rhetoric regarding patient autonomy leads many to assume that patients determine their desired procedures, health-care systems are structured in such a way that patients do not have much control over their health-care pathway.

Patients routinely behave as they do in the health-care setting partly because of how medicine is practiced or delivered, as determined by clinicians, administrators, politicians, funding agencies, and various regulatory bodies. Larry McAfee and Kenneth Bergstedt, who became quadriplegic after a motorcycle accident and swimming accident in and , respectively, sought court authorization to turn off their respirators years after their accidents.

Subscriber: University of British Columbia; date: 27 February Choosing Death nor Bergstedt was terminally ill or experiencing abrupt physical decline, and they both could live for many more years with respiratory support that had become an integral part of their existence. Since McAfee and Bergstedt were presumably competent adults who were not directly coerced by anyone to choose death, their respective courts appeared to have adopted the individualist-minimalist approach of autonomy and determined that the plaintiffs had the right to refuse artificial methods to extend their lives, which they presumed were full of suffering.

Dan Crews, an Antioch man who became quadriplegic from a car accident at age three, made national news in when he—in his mids—asked his health-care providers to remove his ventilator.

Despite having been paralyzed from the neck down for over twenty years, Crews reported having a happy childhood. However, the trust money ran out because he outlived his life expectancy. Short of having someone generous enough to help pay his medical bills, he wanted help to die so that his family could sell the house and be settled financially.

He explained that anyone in his situation would be depressed. There has not been further media report of his status in the last two years. A right to refuse life-prolonging interventions is important in modern health care and ought to be respected when demanded by competent individuals who have reflected on all their options and found such interventions too burdensome. Such requests by terminally ill patients and their families have become a routine part of discussions about the goals of care at the end of life.

While many simply consider these situations matters of basic civil liberty, I contend that even these situations are often fraught with value-laden and stereotypical assumptions about life with impairments.

Missing in these discussions are the larger social contexts that fail people with impairments and contribute to their suffering. The desire to die on the part of McAfee, Crews, and Bergstedt was embedded within a complex set of social relations, policies, and circumstances that foreclosed preferred independent living options most people without impairment take for granted.

While an altered life is presumably most difficult soon after one becomes impaired, it is important to note that none of these men sought to die soon after becoming quadriplegic. Subscriber: University of British Columbia; date: 27 February Choosing Death continue living what they considered to be a minimally decent life, making death appear the only plausible means to end their despair and suffering. With good nursing support covered under his insurance plan and a van customized with a lift and locks for his wheelchair, McAfee was able to rejoin society—he could ride to the grocery store, the occasional movie, or a basketball game.

However, a few years later his insurance ran out and he was put into institutional care out of state and then shuffled into a hospital because of his restrictive Medicaid coverage. With no hope of ever living in the community and retaining some control over his life, McAfee wanted to die. When the publicity of his ordeal prompted advocates to help make it possible for McAfee to move into an independent care home and work toward getting occupational training so that he could use his engineering talents, he no longer wanted to die, even though his physical condition remained the same,26 suggesting that it was not the impairment itself that caused his despair.

Nonetheless, the court focused on the right to have his respirator disconnected rather than on facilitating his caregiving needs.

An individualist notion of autonomy would likely render these petitions autonomous and thus respectworthy, even though such a minimalist view neglects how oppressive social conditions limit the availability of desired alternatives and might contribute to despair and low quality of life in the first place.

Subscriber: University of British Columbia; date: 27 February Choosing Death imposed too much of a burden—rather, it was the lack of social support for independent living that p. There were no other desirable arrangements available, leading them to think that, even though they were not dying, death was the only option to escape suffering.

It also explores how these desires are labeled, interpreted, and responded to by others in social and legal contexts. Ableism, Relational Autonomy, and the Alleged Desire to Die A look at another court case, brought forth by Elizabeth Bouvia, can shed further light on how a relational approach to autonomy is more equipped in addressing the complexities around the formation of a desire to seek death in an ableist environment.

In , Bouvia, a twenty-six-year-old social work graduate student with severe cerebral palsy and degenerative arthritis, admitted herself to a psychiatric hospital in California as a suicidal patient—she wanted professional help to starve to death. Bouvia had lost her motor functions and was dealing with a miscarriage, financial hardship, and a failing marriage.

Despite her graduate training in social work, she was told that she would never be employable. The court determined that the state had viable interests in preserving life, preventing suicide, protecting third parties, and maintaining the ethical standards of the medical professions.

It denied her judicial assistance to starve herself to death and authorized feeding via a nasogastric tube. In Bouvia went to court again to have her feeding tube removed. The court denied her request, but the Appellate Court overturned the decision.

Nonetheless, as was the situation a few years prior, after Bouvia was granted the right to starve to death she abandoned her plan, this time claiming that she could not stand the pain and was worried that her slow starvation would bring too much grief and guilt to the staff at her facility.

But he had a lot to live for.

McAfee and Bergstedt relied on respiratory support as part of their daily living—such mechanical assistance had become commonplace for them. Subscriber: University of British Columbia; date: 27 February Choosing Death professionals attach words such as radical, extraordinary, and even futile to breathing and feeding supports people use each day, medical professionals and health-care administrators often decide themselves what people with impairments need and define what constitutes excessive needs.

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While many bioethicists and advocates for access to medically assisted suicide frame the debate as matters of clinical decisions that should fall under the rubric of informed consent and refusal, I contend that preferences regarding medically assisted death are not purely, or even primarily, medical decisions.

Crews was worried that his family members would lose all their possessions.

A right to discontinue life-sustaining interventions, especially when these individuals were not terminally ill, does not address these underlying issues of restricted opportunities that are essential to promote autonomy. This paradox reveals tacit ethical judgments that contradict the justifications given for DWDA. They have not concluded—despite the rhetoric—that competent state citizens should be able to decide when to die. If that were the case, then they would not restrict assisted suicide to physically able patients with an arbitrary time left to live.

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Instead, they have concluded that a certain manner of living, ie having death imminent because of disease, is a worthy reason to commit suicide. Neither cluster headaches nor chronic depression nor a general weariness of life nor having seven months to live nor wanting to die with one's sick spouse are worthy reasons.

These States are making the same ethical judgment, they are exercising the same paternalism that made general suicide illegal, now makes PAS illegal in 44 states, and even where PAS is legal, prevents people from helping their loved ones die on their own terms.

Ethical and legal opprobrium for suicide in the USA are relics of Christian theology. When society used to hold that God created life and directed all things by his will, suicide was a final, terrible, and irredeemable rejection of God as both creator and lord.

In our secular society, why does he remain even partially throned? This sins against God For it belongs to God alone to definition broadens the scope of suicide beyond pronounce sentence of death and life In repentance" and likewise it would be wrong for a this definition, Captain Oates' death will count as woman to kill herself "lest she be violated, suicide. Yet, because we may not want to disvalue because she ought not to commit on herself the Captain Oates' conduct, we may feel inclined not very great sin of suicide to avoid the lesser sin of to refer to his death as suicide.

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This position may another. For she commits no sin in being violated be justified on the ground that suicide was not his by force, provided she does not consent". Aqui primary intention but rather that his desire was nas' writing makes plain his conviction that to save his companions' lives and death was an suicide is always and in itself wrong and indirect consequence of that desire.

This kind of furthermore that the wrongness of suicide is not example underlines the fact that since suicide is mitigated by the circumstances or purposes of regarded as morally wrong, our definition of it those committing the act.

This duty not to kill seeks to exclude some acts which we admire, i. This stipulation not to kill oneself is A neutral, relatively value-free definition of justified on grounds which echo Aquinas' Sum- suicide would be more akin to an instrumental mo: But, direct, and the influence of accidental events, Blackstone recognised mitigating circumstances, would not materially alter what counts as suicide.

The advantage of such a definition would be strained to that length In this way suicide will become less death an evil which all living things flee, which value-laden; it cannot of course become totally Aquinas expressed in his Summa is central to value-free.

Our recognition of it as distinct from several other philosophical approaches. Thus, other forms of dying such as homicide, natural Augustine 4th C; claimed that "every living death, already commits us to a value judgement thing flees from death" and Spinoza in the of sorts.

Even if an entirely value-free definition 17th century that "the basis of virtue is the was possible, it could be argued that this is not endeavour to preserve one's being". However, desirable, precisely because we may still wish to Kant 18th C; goes further by attempting communicate in some way our moral view of the to locate his argument against suicide within the act, albeit in an implicit manner.

For Kant, we should act as if the maxim of our actions were to become through our wills "a universal law of nature". Thus, a man who feeling Suicide is always and in itself wrong sick of life takes his own life would be acting The rule forbidding the act of killing oneself has a according to a maxim which said "from self-love I long history in Western thought. It appears in make it my principle to shorten my life if its several different guises in the writings of Aristotle, continuance threatens more evil than it promises Augustine, Aquinas, Kant and Spinoza.

It as pleasure". Kant concludes that if this was a sumes the force of law in Aquinas' Summa universal law of nature the very system of nature Theologica, written in , wherein he sum whose function is to stimulate the furtherance of marises his reasoning in the following way: In addition, suicide would also result being that everything naturally keeps itself contradict Kant's second maxim which says "act in being and resists corruptions so far as it can.

For Kant, a man who value is imposed by us and not granted by a deity. But, for Kant, "a Moreover, Hume's analysis of suicide indicated man is not a thing" to be used simply as a means that the act receives some of its colouring from in this way for he is an end in himself. For him, it could be in our macy of life as life, not simply as a property or interest to take our own life.

It leaves little room for the autonomy of the The meaning of life individual to make his or her own choices and This paper has shown that suicide can be turns life, whatever the quality of it, into a sacred conceived of as morally wrong in and of itself or possession. The propensity in our own time is to that its moral value can be determined only when assert that the value of life, whether it is worth one knows more about the circumstances of it.

In living or not, is open to the judgement of each other words that its value is not categorically bad. This view is in direct opposi Once this position is taken seriously, life as an tion to the belief that suicide is expressly contrary end in itself, as an irreducible good, ceases to to nature.

The sanctity of life becomes a relative matter. Some would argue that life now becomes a means to other goods and its value can be derived solely from these goods. Where is the crime? The question, then, is under what circumstances I have shown that the most consistent argument would it be right to commit suicide. Existentialist against suicide has been that it is contrary to philosophers like Camus and Sartre were parti nature. This argument rests on the assumption cularly interested in exploring the nature of our that human conduct should take as its model freedom, as we experience it in the real world.

In behaviour which is natural, although it is never his philosophical work The Myth of Sisyphus clear what 'natural' means or is, in this context. It Camus argued that even in the face of could simply mean behaviour which has been the meaninglessness of life, and of life's absurd observed in the natural world or which is ity, we human beings have to assert our freedom prevalent in society or canonised by custom.

A and dignity and this by "accepting such a fairly robust rebuttal of this kind of argument was universe" and drawing from it "strength". Camus given by Hume in in his posthumous was particularly aware that he did not "know essay 'Of suicide'.

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In it, Hume sought to under whether this world has a meaning that trans mine superstition and authority as the basis of cends it" but for him man gives his own meaning belief. He showed that all human conduct which to the world by his actions and it was "essential to alters the world in any way was "equally innocent, die unreconciled to the absurdity of the world or equally criminal".Taking such a position for granted, many now extend the autonomy argument to challenge the alleged moral distinction between actively killing a terminally ill or disabled patient and letting such an individual forego life-sustaining procedures, both of which can foreseeably lead to imminent death.

August DOI: A better written book was Daniel Ekeroth's history of Swedish Death Metal, which seems a lot more personal, and intergrates ideas and inspirations among bands much better. Jon Kristiansen. The Act as amended by the Disability Discrimination Act , s 18, includes HIV infection as one of the potential grounds upon which discrimination is prohibited in circum- stances to which the statute applies.

Consent requirements for treatment, advance directives, and hospital policies regarding resuscitation and other aggressive interventions are formalized measures that allow patients more control in health-care and end-of-life planning.