The personal autonomy argument exposed

The child never asked to die. Unable to speak, the child could not describe its suffering or participate in a decision tied to his or her existence. And yet, a review committee in the Netherlands has found that the doctor “acted with ‘due care’” in ending a child’s life at the request of the parents.

If the central premise of the argument for medical aid in dying is personal autonomy, how should we evaluate a case in which the person whose life is ended cannot request it?

According to the report from the Netherlands committee, the child was born at 26 weeks and suffered extensive brain damage, cerebral palsy, difficulties swallowing and breathing, and repeated seizures. Though almost two years old, the child was developmentally six weeks old. At the parents’ request, the doctor administered medication to end the child’s life in late 2025.

Under Dutch law, euthanasia (the legal term in the Netherlands) is permitted only at the patient’s request, and should be voluntary and well considered. Because the child could not request the procedure, it fell under a separate framework that went into effect in 2024. Under that provision, the doctor and parents (and “if possible” the child) all agree that there is no alternative but to terminate the child’s life.

The case illustrates the limits of the arguments so often advanced that the decision is one of personal autonomy. Rather, in a case where a child can’t make the request, autonomy had to be replaced by the decision of others that continued life was not in the patient’s best interests. Rather than honoring a choice (as the language so often goes), a determination is made about whether this person’s life is worth sustaining. That shift is dangerous for all who are dependent on caregivers.

Defenders of MAiD in the United States and other nations may claim this case is different from the proposals that have been passed recently. While true legally, the case as an extreme example highlights the deeper problem. In this context, questions of autonomy are fundamentally questions of who has the authority to end a life. While many defenders of MAiD say that it rests with the individual person as a moral agent, the actions of this Dutch doctor show that it can just as easily be a decision made about that person. In that instance, personal autonomy is no longer the guiding principle, but the determination of those in authority that death rather than life best serves the interest of the patient.

The case shifts the conversation from whether someone can choose death, to whether some people possess the authority to choose death for someone else.

In reading the report of the committee, it is very evident that the child was suffering, and the likelihood of a better outcome was minimal. Had the doctors only discontinued treatments that were prolonging life or extraordinary interventions, the case would be a tragic instance of the role that palliative care often plays in medicine. However, the doctor did not simply cease medical treatment but chose to intervene with the goal of ending the baby’s life. There is a categorical difference in recognizing that medical intervention is futile and intentionally using medicine to cause death.

The evaluation of the attending physician was not shared with every doctor who reviewed the case. The initial group of external physicians reviewing the case did not believe the suffering that the child experienced met the standard because the suffering was not continuously unbearable. Instead, they suggested palliative care, which was tried and ultimately rejected after it produced additional side effects. Later, another doctor would agree with the prognosis of the attending physician that there was unbearable suffering and no hope of change.

Clearly, even the experts applying the same standard can disagree over whether suffering is unbearable and whether reasonable alternatives exist. In a case involving an irreversible action where the patient cannot consent, this kind of disagreement ought to prevent the action, not prompt another medical opinion.

In the absence of the voice of the patient, we are left with the judgments and evaluations of others. The committee and doctors all spoke not only of pain and suffering, but of the child’s lifelong dependence, severe developmental issues, and inability to have positive experiences. Those are evaluations of whether life is good enough. They are assessments about what kinds of life are worth living, a decision that always ends with the powerful deciding that some people are better off dead.

The assertion of autonomy is not sufficient to make an action morally right. But if arguments offered for MAiD are grounded in personal choice, then the absence of that choice should be decisive. Autonomy cannot be invoked to legitimate a practice and then set aside when the patient lacks the capacity to exercise it.

The Christian account of human dignity doesn’t begin with autonomy, but with creatureliness and dependence. As creatures created by God, we are all dependent in one way or another. As such, our worth does not rise or fall with our capacity to think or exercise decision-making, our development, or our physical limitations. Just because a person cannot speak, doesn’t mean that society bears less of an obligation to protect him and recognize his worth.

Medicine can (and will) acknowledge that treatment has its limits. Families may decline further interventions and allow death by natural means. But there is a world of difference between eliminating suffering, ceasing medical treatments, and terminating the patient.