Discretionary Death: Its Patterns and Professional, Legal, and Ethical Challenges
CIES Centro de investigação e estudos de sociologia ISCTE - Lisbon University Institute Lisboa, Portugal
Debates about end of life decisions such as withdrawal and withholding of life support, euthanasia and assisted suicide revolve around notions of natural deaths contrasting to unnatural deaths. The paper identifies an alternative in-between class of situations entailing neither natural death nor unnatural death characterized as discretionary death, where legitimized human discretion in allowing or precipitating death is exercised. The discretion concerns the moment of death, and the way death is brought about (by withholding or withdrawing life support, by regulating the dosage of opiates or by other "double effect" actions).
These developments concerning death and dying challenge the notion of stable boundaries between "letting nature run its course " and "ending life" through human agency.
It is argued that the emergence of discretionary death and its normative regulation are of profound social and cultural significance in contemporary history, since they imply the formation of new conceptions, understandings, and representations of death. These developments, while initially set in motion in modern medicine through technological innovations ("life support systems"), now have a momentum of their own in the context of increased patient autonomy and initiative -- and this sets the stage for the increasing considerations of voluntary euthanasia and assisted suicide. New and difficult professional, legal, and ethical challenges and controversies have been emerging -- although unevenly across the European landscape.