America’s Suicidal Quest for Autonomy

After weeks of deliberation, California Governor Jerry Brown recently signed into law the “End of Life Option Act.” He signed the bill after it became clear to him what he should do: “I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill. And I wouldn’t deny that right to others.”

Instead of relying on either moral duties or ethical principles of the good, Governor Brown appealed to the right to have options, to exercise autonomy.

Autonomous choice has become the major premise in most public ethical pronouncements. Last year, Brittany Maynard, a terminally ill 29-year-old Californian, relied on autonomy to make her nationwide case for physician-assisted dying. In 2004, New York Times columnist Nicholas Kristof justified the Oregon law by saying autonomy is what makes human life special and determines human dignity. And in 1992, Supreme Court Justice Anthony Kennedy based his legal argument for abortion on the same appeal: “At the heart of liberty is the right to define one’s own concept of existence, of meaning, of the universe, and of the mystery of human life.”

According to the Gallup Values and Beliefs Survey released this past May, 68 percent of Americans support physician-assisted suicide, up 10 percentage points from 2014. Among 18- to 34-year-olds it was even higher (81 percent). According to Medscape, 54 percent of American doctors also support physician-assisted suicide, an increase of 8 percent since 2011.

Autonomy Trumps All 

For thousands of years people have self-euthanized. Those who now want a physician to give them a lethal dose can find an effective way to do it themselves (e.g., overdose on sleeping pills or aspirin and alcohol). The question becomes, “Why is it necessary to create a law to allow physicians to speed a person’s death, when the person can do it himself?”

The promotion of such a law shows the continual victory of a particular ethical assumption: autonomous choice trumps all other ethical premises. To justify their demand for physician-assisted suicide/dying, Governor Brown and others don’t appeal to the intrinsic goodness of human life, a communally shared social good, or even a maximized utility for all. Instead, they merely insist physician-assisted suicide/dying must be an available choice for anyone who prefers that option.

The appeal to the supremacy of autonomy feels self-evident to almost everyone. Personal choice is treated as though it’s unquestionably true and supreme in all arguments. If one can appeal to it, the argument is finished and exceptions are not allowed.

Yet autonomy cannot serve as a self-evident ethical principle; it’s limited only to the individual and cannot describe the same reality to everyone. Frankly, only those with enough social power and emotional strength can act autonomously. Moreover, autonomy in practice is too mercurial. A self-evident ethical principle would explain what we should do in all cases, but autonomy varies from choice to choice.

Simple Argument

One of the reasons the autonomy argument is convincing to so many is that it’s exceedingly simple: “Autonomy is good. Physician assisted suicide/dying is my autonomous choice. Therefore, physician assisted suicide/dying is good.” We can substitute other present concerns (e.g., abortion, same-sex marriage, sexual identity, gun ownership, polygamy, no-fault divorce, materialism, etc.) and reach the same necessarily true conclusion.

For Governor Brown and others it’s now expected that all ethical positions adjust to the imperiousness of this argument. This is why the ancient principle embedded in the Hippocratic Oath of not prescribing lethal drugs—even to those who ask for them—is not only ignored, but sounds positively quaint to modern hearers.

Perhaps the argument’s dominance is that it expresses the individualistic spirit of American society. Central to our Declaration of Independence from an authoritarian, hierarchical English society is the commitment that all are endowed with the inalienable rights of life, liberty, and happiness. Many take this to mean individuals should determine their own dignity, meaning, and mystery of existence.

Such individualism can be channeled toward the greater good when a culture’s shared moral consensus implies corporate responsibility and the flourishing of family and society. But as these community commitments became less prevalent, subjective autonomy—what sociologist Robert Bellah called “expressive individualism”—emerges for many as the only value worth championing as supreme.

More to Come 

At the moment, five states have some form of law approving physician-assisted suicide/dying. That number will grow, undoubtedly, because the insurgency of the autonomy argument will continue to suppress all other ethical arguments.

Those who wish to argue for a moral reality bigger than mere choice should brace for more losses in contemporary society—and for more ridicule for being unloving to those simply wishing to self-determine their destiny. Nevertheless, this eventuality doesn’t mean we should surrender and stop trying to make more promising, more sustainable, more compelling cases.

In time this prevailing ethical argument will fail. Autonomy can never be a moral absolute, for it is vacuous of objective imperatives and equates the good with mere personal choice. Even the Enlightenment philosopher Immanuel Kant didn’t think autonomy itself could lead to ethical duties. For Kant, we must become autonomous (i.e, free rational agents) so that we can know the moral law and act on it with the best possible goodwill. The choice for self-determination, then, doesn’t define the moral law. We learn moral duties by reasoning toward universally applicable maxims, not by merely picking the least painful or most pleasurable option.

As long as people long for fulfillment, not just for themselves but for the corporate whole and for creation itself, they will seek a reality greater than the god of choice. Mere autonomy will never fulfill humanity’s drive for meaningful and lasting relationships. Indeed, it would require a profound altering of human nature to erase this God-embedded drive for more than autonomy.

Our society may take centuries to realize the paucity of the autonomy argument, but that day will come. In the meantime, let’s embody a better way.