New York has made medical aid in dying available for terminally ill patients with less than six months to live, with an unusual safeguard: patients must record their oral request on audio or video. This requirement highlights the law’s dependence on patient choice, with proponents arguing that giving people the choice to end their lives on their own terms empowers them.
The recording helps prove that the choice was the patient’s, but this thinking assumes that more choice means more autonomy, and more autonomy is better. However, philosopher David Velleman argued a few decades ago that this assumption is too simple.
Velleman challenged the premise that having an option is always beneficial, arguing that sometimes, simply having an option can be harmful, even if it’s never exercised.
He used the example of a new teacher offering free tutoring to a quiet student, which can make the student doubt himself and suffer from lost confidence. In this scenario, the offer of tutoring can alter the situation for the worse, even if the student ultimately benefits from accepting it.
Medical aid in dying can create a dynamic where the availability of the option transforms the meaning of continued existence. When death becomes a medically sanctioned option, remaining alive can begin to look less like the status quo and more like a choice that requires justification.
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Without medical aid in dying, people may enjoy, endure, or cope with life without having to choose it, but with the option available, choosing not to die becomes different from living without having to choose. The availability of medical aid in dying changes the situation and forces patients to take responsibility for a decision that previously belonged to circumstance.
This is the burden hidden inside the language of choice, where patients may lose the ability to simply continue living and must instead justify their decision to stay alive. For some people, this burden may be enough to change how they experience their remaining life.
They may ultimately benefit from choosing medical aid in dying, even though they would have been better off not having had to confront the choice in the first place. This concern is not with helping people die, but with asking them to choose whether to die.
While many patients may welcome the option of a swift and painless death, the challenge is how to make it available to those who would benefit from it without burdening those who would have been better off never confronting the choice.
Medical aid in dying is a complex issue that requires careful consideration of the burden of choice and the need for access, including considerations of life expectancy and end-of-life care.