Critical Medical Ethics as an Approach to the Debate About Assisted Suicide by the Example of Germany

Recent literature has seen a growing endorsement of the so-called autonomy-only approach to assisted dying, which rejects suffering as a necessary criterion for access. Proponents argue that this model is most suitable to safeguard individuals against value-based judgments of healthcare professionals about whether their lives are still worth living when it comes to decisions on assisted dying. In this paper, I challenge the assumption that the autonomy-only approach successfully avoids the shortcomings of a joint view at assisted dying that also relies on beneficence-based criteria. Based on the example of Germany, a country that follows the autonomy-only approach towards assisted suicide, I contend that, despite its emphasis on personal freedom, this approach may in practice not truly serve the ideal of autonomy as it claims. Referring to critical medical ethics, I argue that Critical Theory offers the epistemic tools needed to identify underlying social contradictions and to evaluate the concept of autonomy in relation to its real-world application. Drawing on the work of Herbert Marcuse, I highlight the importance of considering how individual needs are shaped and mediated by social conditions in ethical deliberations on assisted dying. I conclude that ethical considerations have to avoid both submitting to short-sighted conceptions of autonomy and taking a paternalistic stance that dismisses individual pledges for assisted suicide if they disagree with supposedly objective reasons.