Persons with pre‐dementia have no Kantian duty to die

Abstract

Kantian ethics provides one possible theoretical basis for moral legitimacy regarding issues of right to life and death in bioethics. A prevailing view is that suffering caused by an incurable disease cannot be an orthodox Kantian moral reason for hastening a rational patient's death by physician-assisted suicide or voluntary active euthanasia. 1 This position derives from an indisputable consensus that a rational being has a Kantian duty to preserve his/her life, and it is morally wrong for a person to commit suicide out of self-love (to avoid suffering), for committing suicide to avoid suffering cannot be a universal law of nature 2 and violates one's 'necessary duty to one-self'. 3 However, this position does not comprise an absolute moral principle. In Kantian theory, the motives and reasons for one's actions are the basis for identifying one's morality.In recent years, Kant's discussion of a person's duty to die has attracted increasing attention. Dennis Cooley's argument regarding the Kantian duty for people with pre-dementia 4 to commit suicide is an essential starting point in elaborating these arguments. 5 Cooley 1 See, for example, Kerstein, S. (2019). Hastening death and respect for dignity:

Physician-Assisted Suicide in Dementia: Paradoxes, Pitfalls and the Need for Prudence

“…The principle of “first do no harm” should be kept in mind when approaching this issue; it should be understood from the foregoing discussion that “harm” in this case applies not only to patients or physicians but to the physician-patient relationship, the healthcare system, and even society at large. It is essential to avoid a situation where patients or caregivers are made to believe that dementia is associated with a “duty to die” ( Cholbi, 2015 ; Huang and Cong, 2021 ). What is needed is not advocacy of PAS as a “quick fix” for the complex problems encountered by patients with dementia and their caregivers, but “respecting patients’ humanity and providing them with more care, compassion, and good doctoring.” ( Cohen-Almagor, 2016 ; Hendin et al, 2021 ), and an attitude of neutrality or passivity on the part of the medical profession is, as Sulmasy et al (2018) point out, inappropriate in this context.…”

Dignity, Dementia and Death

“…I also believe it to be central to the question of whether Kantianism sometimes permits or requires suicide when a person knows she will become demented. Huang and Cong (2021) criticize Cooley’s conclusions without considering this suggestion. In my view, they do not pay adequate attention to the notion that post-personhood existence with dementia can be an affront to dignity.…”