Assisted dying and autonomy as an end in itself: a response to Donaldson

Braun has recently argued in this journal that an autonomy-based approach to assisted dying avoids the expressivist objection, namely that limiting access to assisted dying to those with irremediable suffering contains the implicit judgement that this suffering makes their life less worthy of living. Contrastingly, the autonomy-based approach would remove these beneficence-based constraints and allow assisted dying to be provided to anyone who requests it. In short, this provision would be shorn of any objective judgement and instead be provided according to the patient's subjective, autonomous preferences. Against this, Donaldson has argued that Braun's apparently autonomy-based approach does not escape the expressivist objection. Instead, because a doctor may acquiesce to or decline a request, their participation necessarily implies a judgement that a particular patient's assisted death is a good (or not bad) thing. This judgement by the doctor, like beneficence-based limits on eligibility, necessarily implies that the patient's life is less worthwhile. In this paper, I argue, contra Donaldson, that the autonomy-based approach advanced by Braun can still avoid the expressivist objection. Specifically, I argue that Donaldson implicitly adopts a particular conception of autonomy's value-the catalytic approach-which considers autonomy only in terms of the goals its exercise pursues. Here, I propose a plausible alternative-the intrinsic approach-which considers autonomy as valuable as its own end. This approach contends that a doctor can provide assisted suicide based on a commitment to respecting a patient's autonomy, without endorsing their assisted death as a worthwhile end.