THE PERMISSIBILITY OF SUICIDE IN LIGHT OF THE RIGHT TO REFUSE TREATMENT

[摘要] The thesis advances the argument that the rationale for permitting informed, competent adults to refuse or withdrawal life-saving treatment also supports permitting some individuals to die by suicide if they so choose. This argument will begin by first recounting the consensus that has developed in the United States, which holds that the refusal of life-saving treatment by competent adults can in some circumstances be ethically justified on the grounds of respect for the autonomous decisions and promotion of the individual wellbeing of such persons. This will be followed by an examination of the concept of autonomous decisions-making and the related concept of competence to make such decisions, with consideration of their applicability to determining whether permitting some suicides can be ethically justified. It will then be argued that, in addition to satisfying the criteria of competence, autonomy and personal wellbeing, the decision to die by suicide must also be authentic in order to be permitted. Moreover, consideration will be given to the harms to others that may result from suicide, and sufficient non-harm to others will be proposed as a criterion for judging whether a suicide should be permitted. While the rationality of the decision to die and the presence of terminal or chronic conditions have been considered important in evaluating the permissibility of suicide, I argue that these should not be treated as criteria for judging a suicide’s acceptability. I will argue that applying criteria of competence, respect for autonomy, wellbeing, authenticity, and sufficient non-harm to others is necessary and sufficient for determining whether a suicide ought to be permitted. The implications of this conclusion for clinical practice will then be considered.This will include consideration of the special nature of the clinician-patient relationship, as well as how satisfaction of the five criteria may be evaluated in the clinical setting. Case examples are included to help illustrate how the framework could be employed. Finally, the limitations of the framework will be addressed to consider how doubts about satisfaction of the criteria may be handled and the possibility that dogmatic adherence to the framework could be morally untenable.

[发布机构] the University of Pittsburgh