Why Terminal Status Should Not Be a Requirement for Assisted Dying

Updated version with clearer structure and full responses to objections.

Thesis
I argue that voluntary assisted dying can be morally permissible for competent adults with severe, treatment-refractory, non-terminal chronic illness, provided strict safeguards are in place to prevent coercion and impaired decision-making. Terminal status alone should not be a morally necessary boundary if the ethical justification is relief from intolerable suffering combined with respect for autonomy.

Objection 1: Depression and impaired judgment

One challenge to this thesis is that patients may request assisted dying due to treatable depression rather than a stable, informed choice. Critics worry that legalizing access could facilitate deaths that might have been prevented with mental health intervention.

Reply:
While this is a serious concern, it highlights the need for careful assessment rather than outright exclusion. Rigorous capacity evaluations and mental health checks can distinguish between transient suicidal crises and enduring, informed requests. The thesis is compatible with strict safeguards to prevent harm while respecting autonomous choice.

Objection 2: Potential harms to disability communities

Another objection is that allowing assisted dying for non-terminal conditions could signal that disabled lives are less valuable or create subtle social pressure to choose death.

Reply:
Respecting disabled autonomy and protecting the value of disabled lives are not mutually exclusive. Policies can be designed to ensure anti-coercion safeguards, access to supports, and careful eligibility criteria. A blanket prohibition based solely on disability risks undermining individual autonomy without necessarily protecting the community.

Objection 3: Slippery slope concerns

Some argue that expanding eligibility beyond terminal illness could lead to gradual extensions to less severe conditions or socially driven requests.

Reply:
The potential for misuse is a reason for careful oversight, not for dismissing morally defensible cases. Many areas of law and ethics involve criteria that are refined over time (e.g., consent, self-defense). Safeguards and transparent guidelines can contain risks while still respecting legitimate requests.

Objection 4: Suffering is subjective

A further concern is that unbearable suffering is inherently subjective, making eligibility difficult to evaluate consistently.

Reply:
While suffering is partly subjective, medicine already relies on patient-reported experiences for pain, quality-of-life, and psychiatric care. Combining self-report with clinical evaluation, functional assessment, and longitudinal evidence allows ethically informed decisions without excluding those in genuine distress.

Conclusion

After considering objections related to depression, disability ethics, slippery slopes, and the subjectivity of suffering, the thesis still holds: competent adults with severe, treatment-refractory, non-terminal chronic illness can morally request voluntary assisted dying when proper safeguards are in place. Terminal status alone is not a morally necessary criterion for assisted dying if the goal is to relieve intolerable suffering while respecting autonomy.