Abstract

Today, in our society, there is an increasing interest in granting terminally ill individuals the right to a physician's assistance in bringing about their own deaths. This right is considered, by some, to be an extension of the patient's right to accept or refuse medical treatment, a right that is grounded in respect for the principle of patient autonomy. ;The traditional theories of Engelhardt, Beauchamp and Childress, and Miller, in respect to safeguarding patient autonomy are inadequate to equally protect the self-determination of all individuals in their decision making around the issue of physician-assisted death. Feminist theorists suggest that an exploration of the sociocultural and political contexts within which health care decisions are made will reveal relevant factors that undermine the autonomy of individuals who are members of oppressed groups. ;Based on the definition of oppression put forth by Iris Marion Young, two types of oppression are identified; the gender oppression of women and the socioeconomic, or class, oppression of the homeless. Factors are identified in the context within which physician-assisted death is to be carried out which point to the presence of a basic inequality in the preconditions for autonomy between members of oppressed and non-oppressed groups. Proposed guidelines for the protection of patient autonomy in physician-assisted death fail to address these inequalities with the result that the autonomy of the non-oppressed is protected at the expense of the autonomy of the oppressed. Two case stories are presented which exemplify the ways in which the autonomy of the oppressed can be undermined in this area of health care decision making. ;Education is seen to be a change agent that can be initiated from within the health care system. Suggestions are made for the education of health care professionals that focus on the influence of factors within the health care system itself as well as on specific issues relevant to decision making in physician-assisted death