Dr. Mark Komrad:

I understand that the principle of autonomy is a core concept around which we have been orbiting here - self-determination and the right to decide how one dies. In these practices, it is really a kind of pseudo-autonomy or, heteronomy, as the term has been developed, because at the end of the day it really is up to the physician to decide what the prognosis is, whether there are other treatments, whether they accept the patient is suffering sufficiently, whether they think the patient has capacity and whether they think they should refer to a psychiatrist. The bottom line is that this still is the power of the physician. The idea that it is completely about self-determination is a simplification.

Also, let us remember that many kinds of coercions exist, not necessarily all of the explicit coercions but the implicit coercions of poverty, inadequate health access, the coercion of circumstance, and of despair. We are seeing an increasing number of deaths of despair in the United States. Autonomy is one of many values we have in our society. Another value is the common good and there are many challenges to the common good by giving individuals this particular privilege.

Speaking of privilege, a very important question for Ireland is whether Ireland wants to have this actually done in the house of medicine. What are the problems of outsourcing this and calling it a medical procedure, putting it in the hands of physicians and allowing physicians to make these decisions? There are very profound implications in the entire history of medical ethics of being able to now enter into the house of medicine where there is the opportunity to take a patient's life rather than coming away from it. That speaks to the common good.