‘Autonomy’

This freedom, applied to one’s own body, and even one’s own life, is by necessity limited. Three examples, from minor to major, illustrate the kind of limitations we have on our autonomy, for our own good as well as that of others:

• Doctors have for decades frequently refused to prescribe antibiotics at a patient’s request for relatively trivial conditions because to do so would produce general resistance to those drugs, which would prove profoundly injurious to people in the future, particularly those who seriously need antibiotic medication. This shows that the subordination of individual patient autonomy for the common good of the wider patient community is a normative principle in medicine.

• Someone who experiences body integrity dysphoria (BID) would be able to procure the removal of a healthy limb (such as a leg which they felt was superfluous). The legal reality, however, is that a doctor who acceded to such a request would be prosecutable under the customary law offence of ‘grave and criminal assault’, and certainly struck off the Jersey Register of Medical Practitioners. This is because the actions of a medical practitioner are meant to be conditioned to the objective good of their patient, regardless of the subjective desires the patient may have about the condition of their body. Amputating a healthy leg, arm, digit, or any other appendage or organ, would be antithetical to the health and welfare of any patient. Instead, their dysphoria would be considered a pathology needing treatment.

• As an extreme example: the case of the voluntary victim, Bernd-Jurgen Brandes, a 43-year-old German man who in 2001 answered the online advertisement of another man, 42-year-old Armin Meiwes, for a “well-built male prepared to be slaughtered and then consumed”. Brandes went to Meiwes’s home, where Meiwes proceeded to kill and eat Brandes for their mutual sexual gratification. Brandes consented entirely ‘voluntarily’ to his own demise, so if autonomy were truly absolute such an arrangement would be entirely legal and morally uncontroversial. Indeed, Meiwes’s lawyers at his trial attempted a defence partially on the grounds that his actions formed a kind of euthanasia. Instead, there is no jurisdiction on Earth where Meiwes would not be convicted of murder and (at least) sentenced to life imprisonment, as he eventually was in 2006 in his native Germany, as was ‘Detlev G.’ a former German police officer in a similar case in 2015.

If ‘autonomy’ were absolute on a bodily level, it would mean that the cases of limitation above would not apply, and the same logic applies in consideration over the autonomy of individuals who wish to decide the timing and nature of the end of their own life. On a social level, if personal autonomy in this area were absolute, then it would be considered a violation of individual sovereignty to rescue (prevent) someone attempting suicide from the ledge of a tall building, from a train platform, or from a waterway. Instead, we consider such actions heroic, not coercive.

Clearly, individual autonomy is not (and cannot rationally be) seen as an absolute principle, whether in medicine or in any other sphere of social existence, but one which is heavily contingent on what is good for the health and broader personal welfare of the individual autonomous actor, let alone that of others.

Another reason why ‘autonomy’ is inappropriately invoked in this context is that whilst autonomous choice involves one actor, assisted suicide (as with any medicalised interaction) involves two: the patient and the doctor. In medicine, just as the claim that ‘autonomy’ even means sovereign choice over one’s body is simply untrue, the idea that it involves an ability to access any medical benefit at all simply is not a credible proposition, as the example above of access to antibiotics illustrates.

This is an important point to consider in light of the dangers of assisted suicide to the most vulnerable of patients.