This week in my Moral Issues class we're talking about assisted suicide and euthanasia. I think the issues related to these topics are complex and multifaceted. On the one hand, I want to be able to choose to die, and I support other people's right to make that decision for themselves. On the other hand, 1) I think the way we respond to such requests can't help but reflect what lives we think are worth living and 2) once new options are on the table, we ask ourselves different questions.
If you wade a bit into thinking about these issues, you come quickly into the nature of autonomy -- or self-directedness. With big decisions like this, we tend to think autonomy is really important. If you choose it for yourself, that's one thing, but if you're pressured or coerced into it, that's something else.
In a way, this is completely intuitive. If a person said they were choosing medical aid in dying, and it was because their children had threatened them with harm for not choosing it, obviously that is not OK, and it seems right to say that the reason it's not OK is that the choice is coerced. It's not free, informed consent.
But as we've written about before, the further you go in thinking about the difference between free and coerced choices, the more confusing things can get. On the one hand, social context can influence choices in problematic ways. If girls don't study math, even though they like it, because of social pressure, or if boys act all tough and mean because they feel like masculine gender norms require it, those choices may not seem autonomous, because they are being influenced.
On the other hand, every choice takes place in social context. How would you begin to disentangle the ones that make you "not yourself"? What would that mean, to be yourself in the absence of a social context?
Even relational theories of autonomy -- theories designed to fit the idea that a person's self can be a socially connected self -- have this problem. Imagine a society in which women are socialized to be deferential, or prioritize the concerns of others. Do deferential preferences and judgments reflect full autonomy on their part? Some theorists -- proceduralists -- say that as long as the process of decision-making is properly reflective, then sure. That's who they are. Other theorists -- substantivists -- say no: if you're socialized to be deferential because of sexist social norms, that is a way of not being fully yourself.
All of this was on my mind recently when one of my graduate students shared with me this very interesting news story about a couple deciding to request medical aid in dying. They were married for 55 years, and wanted to die together, but their request was denied, on grounds that acting together created the possibility that one person was influencing the other. And these decisions must be fully autonomous.
A spokesperson for the Canadian Medical Protective Association said "The legislation is quite clear that the request has to be voluntary and they are not under any influence. … It may well be that one member of the couple is being influenced by the other member of the couple and the reason why they’re agreeing to the pact is not entirely without influence. .. Out of an abundance of caution, it is our advice that you can’t be sure that one member of the couple isn’t under influence, even if both members qualify."
Whatever you think about this decision, the case shows how murky things get when you talk about being autonomous and acting in the absence of "influence" when you're talking about relationships. In one way, of course the two people are influencing one another's decisions. As they should. Imagine two people. The first one says, "I want medical aid in dying. I talked it over with my spouse, and they think it's the right decision too." The second one says, "I want medical aid in dying. Even though we are very close, I haven't talked it over with my spouse, so I don't know what they think -- whether they think it's the right decision." Wouldn't you think it's the second person who has a problem with decision-making?
And yet, clearly the people closest to use can influence us in problematic ways. If a person said, "I want medical aid in dying. I talked it over with my spouse, and they think it's the right decision too. After all, they're going to have their hands full taking care of our children and finding a new spouse and all. So we agreed that the sooner we get my death over with, the better it is for them. And making them happy is my main goal in life." Well -- wouldn't you want to at least talk this over further? It does sound like problematic influence.
Love should make autonomy complicated. Love often means interdependence, and it should. It's hardly surprising that interdependence on others and "being yourself" are hard to tease apart.
I think there are no easy answers. But I also think part of the problem is trying to shoehorn every complex ethical decision into the framework of personal freedom. Yes, freedom is important. But trying to treat each process as ethically neutral, grounded in some unattainable ideal of "personal autonomy," isn't really workable or desirable.