Abstract

Consider a case of a patient receiving life-supporting treatment. With appropriate care the patient could be kept alive for several years. Yet his latest prognosis also indicates that his mental abilities will deteriorate significantly and that ultimately he will become incapable of understanding what happens around and to him. Despite his illness, the patient has been eager to live. However, he finds the prospect that he is now faced with devastating. He undergoes an unconscious process that results in his finding himself with a preference to die. Consequently, he requests his doctor to stop the treatment that she is providing. Other things being equal, standard medical ethics and the legislations of most Western countries allow the doctor to adhere to the patient’s request if it is autonomous. While its origins can be traced back to at least J.S. Mill’s work on women’s rights, unconscious alteration of one’s preferences in light of the options available for one has figured, for example, in recent discussion on female oppression and social choice theory. Yet the topic has not received attention in the debate on voluntary euthanasia. The inattention is unfortunate because the central problem with such adaptation has been taken to be that it undermines personal autonomy. This motivates the main question examined in this chapter, i.e. the problem of whether a request for euthanasia based on an adaptive preference is autonomous.