Taking the Right to Die Seriously

Abstract

This article offers a Hohfeldian analysis of the right to die and asks what follows, normatively and institutionally, once the relevant incidents are distinguished. It argues that debates about assisted dying frequently conflate four questions: whether choosing death is morally permitted (licence), whether others must not interfere with that choice (negative claim-right), whether a valid request can alter others’ normative situation (normative power), and whether anyone owes assistance (positive claim-right). The paper maps major objections to the incident they primarily target and shows that many familiar objections to assisted dying bear most directly on duties of assistance rather than on the underlying permission or the claim against interference. Substantively, it defends a universal moral licence to die and, where competence, voluntariness, and adequate information are satisfied, a corresponding negative claim-right against unjustified interference. Its institutional conclusion is more limited than a direct duty on any particular physician to provide assisted death: what can be justified more securely is a right to make a request that must be assessed under public criteria and, in jurisdictions authorising assisted dying, routed to willing and licensed providers. Separating public validity review from plural provision models, the paper argues, can reduce coercion and conscience-based conflict while preserving access.

Introduction

Debates about assisted dying are often conducted as if the phrase “a right to die” named a single, self-explanatory entitlement. It does not. Sometimes the phrase means only that choosing death can be morally permissible; sometimes it means that others must not interfere with that choice; sometimes it means that some person or institution must help to bring about death. Running these positions together obscures both the force of objections and the institutional conclusions that follow from them.

This article offers a Hohfeldian analysis of the right to die in order to disaggregate those claims. Its central thesis is twofold. First, once the relevant incidents are separated, many familiar objections turn out to target different normative positions: some challenge the permissibility of choosing death at all, others challenge a correlative duty of non-interference, and others challenge only duties of assistance. Second, the most defensible practical conclusion is not that every clinician owes assisted death on request, but that competent adults can have a moral licence to die, a corresponding negative claim-right against unjustified interference, and a right to make a request that must undergo public validity review and, in jurisdictions recognising assisted dying, may lead to access to a willing licensed provider.

The paper proceeds in four steps. Section  2 introduces the Hohfeldian framework and explains which incidents are relevant here. Section  3 outlines the main moral justifications for a right to die and clarifies the heterogeneity of the legal arrangements often grouped under that label. Section  4 maps the leading objections to the specific Hohfeldian incident they most directly target. Section  5 then asks which objections, if sound, defeat only a licence, which bear on non-interference, and which concern assistance duties. Section  6 draws the institutional conclusion: taking the right to die seriously requires recognising a licence and a negative claim-right, together with a public process for validating requests and, where assisted dying is lawful, a route to willing and licensed providers.

A Hohfeldian Framework for the Right to Die

Hohfeld’s classic contribution was to show that legal and moral talk about “rights” often compresses distinct normative positions that should be kept separate (Hohfeld 1919). He distinguished claim-rights, liberties, powers, and immunities, together with their correlatives (duties, no-rights, liabilities, and disabilities) and their opposites. For present purposes, not all eight positions need equal attention, but the framework is useful precisely because it prevents us from sliding too quickly from one incident to another.

In this article, we use licence rather than liberty. A licence to die means that choosing death is not morally forbidden. A negative claim-right to die means that others have a duty not to interfere with that choice, absent some special justification. A positive claim-right to die would mean that some person or institution has a duty to provide or arrange assistance in bringing about death. These positions are related, but they are not identical. A person may have a licence without having any claim against interference; may have a claim against interference without having any entitlement to assistance; and may have a route to request assistance without being owed provision by any particular professional.

The positive/negative distinction is not one of Hohfeld’s own basic jural pairs, but it is Hohfeld-compatible. It specifies the content of the correlative duty: a negative claim-right correlates with a duty of forbearance, whereas a positive claim-right correlates with a duty to act, provide, arrange, or facilitate.

A further Hohfeldian idea is also helpful here: power. A request for assisted dying can be understood as an exercise of normative power when, if made under publicly specified conditions, it alters the normative situation of others by triggering duties of assessment, documentation, referral, review, or access. This is important because many legal systems do not grant patients a direct claim to be provided death by a particular physician, but they do recognise that a valid request can activate institutional duties. That is different from both a mere licence and a full positive claim-right.

This framework allows us to ask, of each objection in the assisted dying debate, exactly what it is supposed to defeat. An objection strong enough to show that nobody has a duty to assist does not yet show that choosing death is morally impermissible. Likewise, an argument for respecting autonomous choice does not by itself establish that any given professional must provide the means of death. The sections that follow use these distinctions to clarify what a “right to die” can mean and what follows if we take that analysis seriously.

What can a “Right to Die” Mean?

Having introduced the Hohfeldian framework, this section clarifies the main moral and legal senses in which a right to die is used in assisted-dying debates. The question is not whether one undifferentiated right should be recognised, but which specific incidents including licence, negative claim-right, normative power, or positive claim-right, can be justified. Bioethicists, like jurisdictions, discuss the scope of the right to die, that is, who is eligible (Schuklenk 2022). We argue in favour of such a right to die, understood at minimum as a universal moral licence and negative claim-right, which would apply to anyone who wishes to end their life. Understood in this way, the right to die would be based primarily on the requirement to respect autonomy (Holzman 2024).

Unless otherwise indicated, references below to a right to die refer primarily to a moral licence and, where competence, voluntariness, and adequate information are satisfied, to a negative claim-right against unjustified interference. Whether a valid request also grounds duties of assessment, referral, or provision is a further institutional question. One of the basic starting points for the moral justification of the right to die is an appeal to the principle of autonomy and the right to make personal choices. As long as a person’s exercise of autonomy does not violate the rights of others or cause suffering to others, respect for the person requires recognition of her autonomy (Beauchamp and Childress 2019). With regard to the right to die, the assumption here is that the individual can determine for herself the shape of her life, the length of her life, and how and when it ends. This autonomy-based rationale most directly supports a licence and, when competence and voluntariness are satisfied, a negative claim-right against interference. It does not, without further argument, establish that any particular professional has a positive duty to assist.

Promoting the right to die can take forms such as voluntary euthanasia, where a person requests and receives medical assistance in dying; assisted suicide, where a person is provided with the means to end their own life; as well as complying with a refusal of life-prolonging treatment, where a person turns down offered medical interventions (Young 2024). In addition to respect for autonomy, another important source of the right to die is the concept of human dignity related to the quality of life. The argument from human dignity says that in certain borderline situations of great suffering or loss of autonomy, ending one’s life remains the only way to preserve one’s dignity (Häyry 2004). It also means that a person has the right to decide the time and manner of her death (Cohen-Almagor 2001). For present purposes, dignity- and welfare-oriented considerations function as a second route to the same practical conclusion: continued existence may, by the person’s own lights, fail to serve her interests. The subjective recognition of one’s own life as not worth living is usually associated with the belief that one’s dignity has been lost or significantly diminished. The individual should be guaranteed the right to autonomously decide and determine if and when her life becomes a life not worth living. It is believed here that subjective evaluation of the quality of life is the only criterion that should not be limited by any objective ideas about what a life is and should be like to be worth living (Häyry 1991). The individual has the right to perceive her own life as devoid of value and has the right to end it. This is often expressed as the difficulty of justifying a prohibition on eliminating eradicable suffering when death is, for the agent, the only effective relief.

The metaphysical basis of the right to die rests on the assumption that life is not a value in itself in an absolute sense (Häyry 2025). Life may have the highest value, and in some both colloquial and philosophical sense it does indeed have such a value. But life can also be subjectively devoid of value for a given individual, and can be a source and carrier of suffering and evil. It does not yet follow from the mere fact of existence that existence is a positive value. At most, it is a condition and ground for the realisation of other values, or lack thereof. The right to die can also be seen in analogy with the right to life. Here it is considered that the individual is not obliged to continue living. Sometimes survival involves great effort and requires too much sacrifice (Berlinger et al. 2013).

The above-mentioned potential sources of justification for the right to die relate to moral justification. However, the legal dimension of assisted dying is far more heterogeneous than a simple list of permissive jurisdictions suggests (Kayacan 2022). Switzerland does not create a general statutory right to assisted suicide; rather, assistance is criminal when motivated by selfish ends, while direct active euthanasia remains prohibited (Swiss Federal Office of Justice 2026). The Netherlands, by contrast, regulates euthanasia and physician-assisted suicide through a physician-centred exception to criminal liability under statutory due-care criteria, while making clear that patients do not have a right to euthanasia and physicians are not obliged to provide it (Government of the Netherlands n.d.). Canada embeds medical assistance in dying within a healthcare framework of regulated requests, assessments, monitoring, and access mechanisms rather than a universal entitlement to provision by any particular professional (Health Canada 2023). A right to die can thus be seen as part of a broader debate on balancing individual freedoms with societal norms about life preservation. It raises questions about the moral responsibilities of medical and other professionals who are expected to respect the needs of patients, family members, and the state in respecting or denying such decisions (Häyry 2018).

What are the Main Objections to the Right to Die in Its Various Forms?

The purpose of this section is to identify the main objections and to clarify which element of the right to die they are directed against. The aim is not to decide whether these objections are successful, but to distinguish their target more precisely. Some objections are aimed primarily at duties of assistance and therefore do not necessarily challenge either the underlying licence to die or the negative claim-right against interference. By contrast, objections that deny the moral permissibility of choosing death call into question the basis of the entire view and, if sound, would undermine all further claims built upon it.

Objections to the Licence to Die

Sanctity- and inviolability-of-life arguments primarily target the licence to die, because they deny that intentionally choosing death can ever be morally permissible. If sound, they would also block any downstream claim-rights. However, their first point of attack is the underlying permission itself. One of the most popular arguments is the argument from the sanctity of life. Many opponents argue that life is inherently valuable, and allowing individuals to end it undermines this fundamental principle. In its traditional religious form, the doctrine holds that human life is sacred because it comes from God and should never be intentionally destroyed by human agents, even to relieve suffering (Cohen 1998). There are also secular reinterpretations of this position, often expressed in terms of the “inviolability” of human life, which claim that equal respect for persons requires an especially stringent prohibition on intentionally killing the innocent (Keown 2012). On both religious and secular versions, the sanctity- or inviolability-of-life principle is sometimes taken to entail that any intentional hastening of death is morally impermissible, even with the competent person’s consent.

Objections to the Negative Claim-Right (Non-interference)

By contrast, slippery-slope, vulnerability, disability, and feminist objections usually do not begin by claiming that every choice for death is morally impermissible. Their main concern is that, in real social conditions, others may not always be required simply to stand back. These objections therefore bear most directly on the negative claim-right against interference and on the conditions under which non-interference is justified. They worry that what starts as a right for terminally ill patients might extend to people with less severe conditions or even mental health issues, leading to potential abuse of the system. The more sophisticated versions of the argument distinguish between logical, psychological, and empirical slopes, and between changes at the level of individual decisions and changes at the level of legal rules and social attitudes. The central concern is that changing the law or medical practice in apparently limited ways may, over time, erode inhibitions against killing and normalise increasingly broad categories of permissible assisted deaths. Critics often point to debates about non-voluntary euthanasia or euthanasia on the basis of disability or mental illness as examples of such a feared expansion (Keown 2022).

There is also a concern that vulnerable individuals – such as the elderly, disabled, or those experiencing depression – could feel pressured to opt for assisted dying, either due to societal pressure, feelings of being a burden, or financial reasons. The argument is that legalising the right to die could disproportionately affect people who feel they have no other option. Critics are concerned that euthanasia not only devalues life, but specifically, discriminatorily devalues the lives of selected categories of people (Angell 1988). In this context, the argument from quality of life to euthanasia is also criticised. Proponents of euthanasia referring to quality of life point out that inadequate quality of life by certain standards is an argument for ending it, rather than seeking to improve it by any means (Kuhse and Singer 1985). Opponents fear that such quality-of-life judgements will be applied in biased ways and used to justify hastening the death of those already disadvantaged.

Legalising assisted dying could lead to situations where individuals are coerced into ending their lives, either by family members, caregivers, or societal pressures. Ensuring that decisions are truly voluntary and informed is a concern, as critics fear that safeguards may not always be robust enough. The risk of abuse by medical personnel, who may support the choice of euthanasia even in those patients who are curable, is also pointed out. One consequence of this risk may be a particular fear shared by the elderly, sick and disabled that the doctor caring for them will seek to shorten their lives rather than treat them (Schanker 1993). Opponents of the right to die worry that legalising the right to die may lead to a broader devaluation of life, particularly for people with disabilities or chronic illnesses. They fear it could normalise the idea that some lives are less worth living and increase stigmatization of those who suffer.

An important and internally diverse group of objections comes from feminist bioethics. Rather than invoking sanctity-of-life per se, many feminist authors focus on how structural gender, racial and socio-economic inequalities shape people’s end-of-life choices and the practices that respond to them. They highlight, for example, that women’s wishes are more often discounted, that experiences of being a “burden” are differentially distributed, and that medical aid in dying policies may interact with racism, ableism and poverty in ways that threaten relational autonomy and exacerbate injustice (Wolf 1996; Raymond 1999; Downie 2022). Feminist critics argue that the “generic patient” often assumed in bioethics – without gender, race, or class – obscures the ways in which power relations and caregiving expectations constrain people’s options and may turn a putative “choice” for death into an expression of oppression rather than genuine self-determination. These concerns do not necessarily rule out assisted dying, but they press for careful attention to power relations and to the social preconditions of truly voluntary choice.

Objections to the Positive Claim-Right (Assistance Duties)

Objections grounded in professional integrity, conscientious refusal, and the promise of palliative care bear most directly on duties of assistance. Even if choosing death is not always wrong, and even if some autonomous decisions should not be blocked, it does not yet follow that any particular professional must help to bring about death. Allowing the right to die as part of health care is said to violate the integrity of medical ethics and the integrity of the medical profession (Häyry 2018). The medical profession is traditionally founded on the principle of not to harm others (Beauchamp and Childress 2019). Some medical professionals object to assisted dying, arguing that it contradicts their duty to preserve life and could damage the trust between patients and doctors. At the same time, existing regulatory models show that conscientious non-participation can coexist with duties of information, effective referral or transfer of care, and continuity of non-assisted-dying treatment, which weakens the inference from conscience to institutional non-availability (Health Canada 2023). They may feel that their role is to alleviate suffering through palliative care rather than ending life (Miller 2015; Schuklenk and van de Vathorst 2015).

Some of the opponents of euthanasia and assisted suicide argue that modern palliative care can effectively manage pain and suffering, making the right to die unnecessary. Opponents contend that instead of focusing on the right to die, society should prioritise improving end-of-life care and ensuring access to adequate support (Emanuel 1999). If the patient is guaranteed access to effective and professional medical care and pain management, she may prefer the continuation of life in those situations where, without appropriate medical assistance, she would prefer to shorten suffering by ending life.

These debates reveal persistent tensions between individual autonomy, social values, and the role of medical and other professionals in end-of-life care. From a Hohfeldian perspective, these tensions must be analysed at different normative levels: the move from a licence to die to a negative claim-right against interference is one step, whereas the move to a duty to assist is another. Each step gives rise to distinct objections.

Assessing the Objections by Incident

This section assesses whether the objections discussed above undermine the specific Hohfeldian incident at which they are directed. Its aim is narrower: to ask whether the objections discussed above undermine the specific Hohfeldian claim they are meant to challenge. This makes it possible to reach more differentiated conclusions. An objection may be strong enough to rule out a duty to assist without thereby showing that a person has no licence to die or no claim against interference.

Reply to Objections to the Licence

All arguments against the right to die have their counter-arguments. The sanctity- or inviolability-of-life view deserves more careful treatment than a simple appeal to religious dogma. In its strongest contemporary formulations, it is defended both theologically and in secular legal–moral terms as the claim that it is always wrong intentionally to kill innocent human beings and that equal respect for persons requires a robust presumption against any practice that appears to license such killing (Keown 2012). At the same time, Helga Kuhse’s classic critique shows how the sanctity-of-life doctrine, when interpreted as an absolute prohibition, sits uneasily with widely accepted medical practices, such as withdrawing futile treatment or administering high doses of opioids that foreseeably hasten death (Kuhse 1987). Once one acknowledges the ubiquity of quality-of-life judgements in clinical practice, and the permissibility of forgoing life-sustaining treatment in some cases, the absolute prohibition on intentionally hastening death becomes difficult to sustain without inconsistency. The point is not that sanctity- or inviolability-based arguments are merely religious or question-begging. It is that, once exceptions and accepted end-of-life practices are acknowledged, they require an additional argument for why autonomous assisted dying must remain categorically excluded. Our approach builds on this line of argument: we take seriously the equal value of persons, but deny that this commits us to the view that mere biological life must always be preserved, regardless of the person’s own assessment of her interests and dignity.

Reply to Objections to the Negative Claim-Right

The slippery-slope objection should be framed more carefully than it often is in public debate. The relevant empirical question is not whether assisted dying regimes develop over time – they plainly do – but whether legalisation predictably results in the kind of uncontrolled expansion or discriminatory abuse alleged by the strongest versions of the objection. The evidence suggests a more qualified view. Although reported cases may rise over time, such increases do not in themselves demonstrate a wrongful slide, since their significance depends on reporting practices, legal design, and demographic composition (Lewis 2007; Lerner and Caplan 2015; Hamarat and Wels 2025). Recent Canadian federal monitoring also highlights both improvements in reporting and continuing data limitations, while recent Belgian research emphasises the need for demographic adjustment in interpreting long-term trends. The better conclusion is therefore institutional rather than absolutist: the possibility of drift gives reason for safeguards, transparent reporting, and periodic review, but not, by itself, for rejecting the permissibility of assisted dying in principle.

In responding to allegations that a right to die would especially threaten vulnerable people, including disabled people, it is important to distinguish the specific alleged threats. Using the example of people with disabilities, Ben Colburn counters four arguments against the right to die. The argument from inflicting harm on people with disabilities is not supported by the facts – people with disabilities are neither euthanised more often nor against their will than people without disabilities. Two further arguments, of disrespect and threats to autonomy, Colburn presents as related. He shows that, in practice, proponents of these arguments show a lack of respect for people with disabilities, deeming them incapable of recognising what they themselves find valuable in life, as well as lacking the ability to make autonomous decisions.The fourth counter-argument that health care and palliative care are threatened is not borne out by reality, as both coexist with the right to die. Nor does the right to euthanasia undermine trust in doctors (Colburn 2022). Respect for people with disabilities requires recognition of their rights to autonomous decisions, including respect for their desire to end their lives, free from paternalism (Riddle 2017). Esther Braun and co-authors argue that excluding people with mental illnesses from the right to assisted suicide would discriminate against them compared to people with somatic illnesses, so they have a right to die based on the criteria of beneficence and autonomy (Braun et al. 2024). Mentally ill people continue to be stigmatised and treated paternalistically, contrary to the anti-paternalistic tendencies of medical ethics and medicine toward patients without mental illness (Schuklenk 2019).

At this point the Hohfeldian distinction matters: even if some cases warrant paternalistic delay, scrutiny, or temporary prevention, that is consistent with – indeed required by – a competence- and voluntariness-sensitive negative claim-right. The negative claim-right is not a demand for instantaneous compliance; it is a demand that interference be justified by identifiable defects in voluntariness, information, or decision-making competence (Beauchamp and Childress 2019), rather than by disagreement with the request’s content.

Feminist bioethics offers unique insights into the situation of vulnerable people and pays attention to the dynamics of power structures. While some people may feel the effect of being a burden, it depends on the social and political context (Roest et al. 2020). Feminist authors have rightly warned that assisted dying regimes may be especially risky for those who are already disadvantaged, including women, racialised minorities, disabled people and the poor (Wolf 1996; Downie 2020). But these vulnerabilities should be treated as reasons to redesign institutions, not simply as reasons to deny competent persons access to assisted dying as such. When systems are attentive to these background injustices – by supporting caregivers, addressing poverty, monitoring differential patterns of access, and ensuring non-discriminatory health care – a carefully regulated right to die need not exacerbate inequality and may enhance the agency of those whose choices have historically been ignored. On this interpretation, feminist insights support a context-sensitive right to die for even the most vulnerable people, provided that their requests are scrutinised with particular attention to relational pressures and structural disadvantage.

Many of these objections are autonomy-centred: they hold that requests to die may be compromised by coercion, misinformation, depression, dependency, or structural pressure. Some, but not all, also rely on a further concern about the special moral status or inviolability of human life, whether in religious or secular form (Keown 2012; Uniacke 1994). Criteria such as unbearable suffering, incurability, irreversibility, or terminal illness need not always express an inviolability premise; they may also function as safeguards, proxies for objective need, or ways of connecting assisted dying to medical practice. The role of this premise is evidenced by the fact that opponents of the right to die, as well as its conservative supporters, often emphasise the need to meet, in addition to the criterion of autonomy and informed consent, the criterion of unbearable suffering and the irreversibility and incurability of the disease. The Hohfeldian point is that these justifications should be kept separate: autonomy-based safeguards qualify the negative claim-right, whereas substantive eligibility criteria restrict either the licence itself or the conditions of assistance. Thus, even if patient autonomy is guaranteed, which sceptics usually do not believe, focusing either on the lack of full autonomy or the influence of external pressure, they still do not want to allow a person interested in the right to die to make such a decision solely as a result of his or her own wishes. This thus shows the strength of the belief in the sanctity and inviolability of life and the difficulty of accepting that there are individuals who no longer wish to continue their existence.

Reply to Objections to the Positive Claim-Right

The weakness of another counter-argument against the right to die referring to a lack of integrity and conflicting with the ethos of the medical profession is that it deals with subjective opinions, which are characterised by diversity in almost every group surveyed on almost every topic. While some physicians oppose assisted suicide due to concerns about the degradation of values in the public sphere and the threat to moral integrity (McDougall et al. 2022), many others argue in favour of the right to die in the name of respect for patients’ rights, as well as the desire to relieve their suffering (Lindblad et al. 2024). Moreover, even if some health professionals should not be required to participate in assisted dying on grounds of conscience, this does not settle whether access should be implemented through other willing providers. That issue concerns the provision model, not the validity of the request. Possible models include provision by willing physicians, mixed medical systems, or carefully licensed non-medical providers (Kipke 2015; Savulescu and Schuklenk 2017). This, however, is a question about the provision model, not about who determines whether a request is valid. Validity should remain subject to public criteria and independent review; pluralism may enter only at the stage of lawful provision. On our view, however, non-medical assistance in dying would have to be subject to licensing, oversight, and quality control comparable to that applied to medical providers; commercial operators would be authorised only if they respected the same stringent requirements of voluntariness, competence, and informed consent.

In the case of the counterarguments from palliative care and the risk of abuse, their essence is the assumption that this law will not respect patient autonomy, that is, it considers at least certain groups of patients to be non-autonomous. Thomas Søbirk Petersen and Morten Dige show that this is not the case, since the terminally ill are competent subjects of decision-making, and the legality of euthanasia does not create social pressure affecting the non-autonomous, pro-euthanasia decisions of the dying (Petersen and Dige 2023). We should respect the will of patients, especially as it relates to assisted dying, which is voluntary. There is also no correlation between the legalisation of the right to die and the deterioration of standards and reduced access to palliative care in these jurisdictions (Colburn 2025).

A much more common issue concerns the problems and dilemmas of seriously ill people, as well as the doctors treating them, in relation to the refusal of persistent therapy. Discontinuation of medical procedures that prolong unjustified suffering, procedures that are expensive, risky, extraordinary or disproportionate to the expected results may be justified in many situations. Refusal of persistent therapy may sometimes be clearly expressed by the patient herself, if she is conscious and able to express her opinion; sometimes it must be made jointly by a competent team of doctors – one does not intend to cause death in this way, it is assumed that in this case it cannot be prevented. If the patient remains without contact with the environment, the decision may be made by previously authorised persons, always with respect for the reasonable will and legitimate interests of the patient. The use of painkillers by physicians to relieve the suffering of the dying, even at the cost of shortening their life, may be morally consistent with human dignity if death is intended neither as an end nor as a means, but is merely foreseen and tolerated as inevitable. However, Jukka Varelius points out that there is no moral or practical difference between active and passive euthanasia, so active euthanasia should not be limited to terminally ill people only (Varelius 2016).

The result is a differentiated normative picture. Sanctity- and inviolability-of-life objections, if sound, defeat the licence to die at its foundation. Vulnerability-based objections work differently: they do not simply negate the negative claim-right, but qualify its scope by making competence, voluntariness, information, and background pressure morally salient. Objections from professional integrity, conscience, and palliative care bear most directly on duties of assistance. The advantage of the Hohfeldian framework is that it allows these conclusions to remain distinct rather than treating them as if they stood or fell together.

What Would Taking the Right to Die Seriously Entail?

Taking the analysis seriously requires keeping separate three institutional questions: what must be permitted, what must not be obstructed, and what, if anything, must be provided. Once these are separated, the normative picture becomes clearer than in many debates conducted under the undifferentiated label of a “right to die” (Häyry 1994, 138–42).

Natural-law and orthodox Kantian views reject the initial licence to die; the present argument proceeds instead from autonomy-respecting and anti-paternalist premises (Finnis 2011; Kant 1998; Häyry 2022; Mill 1869). First, within autonomy-respecting ethical models that do not impose a duty to survive longer than one wishes, competent adults can be understood to have a moral licence to die. The point is not that every decision for death is wise or admirable. It is that choosing death is not, as such, morally forbidden whenever the choice is genuinely the person’s own and does not rest on mistake, coercion, or incapacity. This conclusion does not depend on the claim that every life lacking certain goods is objectively not worth living. It depends, rather, on the more modest proposition that persons normally have primary authority over the shape, duration, and ending of their own lives. To be sure, this conclusion will be rejected by natural-law views and by orthodox Kantian interpretations, which deny or sharply restrict a licence to die (Finnis 2011; Häyry 2022; Kant 1998), although recent Kantian scholarship has argued that the issue is more complex than Kant’s own absolute prohibition might suggest (Dowie 2022). By contrast, autonomy-centred and liberal-utilitarian approaches are more hospitable to the view that persons may determine for themselves whether continued existence serves their good or coheres with their values (Häyry 1994; Mill 1869).

Second, where the conditions of competence, voluntariness, and adequate information are met, the licence is strong enough to ground a negative claim-right against unjustified interference. If a person is morally permitted to die, and the decision does not itself wrong others in a way that defeats that permission, it is difficult to see why others should retain a general liberty coercively to prevent that choice (Häyry 1994, 138–42). This does not mean that every expression of a wish to die must be taken at face value. A person may be temporarily prevented, delayed, or questioned when there is good reason to doubt decision-making capacity, when coercion or manipulation is suspected, or when essential information is missing. But such intervention must be justificatory and defeasible. The Hohfeldian point is that the burden now lies on the interferer: disagreement with the substance of the choice is not enough. In this respect, the argument remains close to the Millian thought that liberty should not be restricted merely because others regard a person’s choice as imprudent or morally mistaken (Mill 1869).

Third, a request for assistance can be understood as the exercise of a normative power. When made under publicly specified conditions, the request changes the normative situation of others even before any assistance is provided. It can trigger duties of assessment, documentation, referral, review, and protection against arbitrary obstruction. This is an important part of taking the right to die seriously, because it explains how a person may have more than a bare licence to seek death even where no particular clinician is under a direct duty to end life. In other words, the move from licence to negative claim-right does not yet entail a fully fledged positive claim-right, but it can still justify an institutional structure in which valid requests must be received and processed rather than simply ignored (Häyry 1994, 138–42).

The assistance question is more demanding. This is where the move from non-interference to assistance requires an additional institutional argument. The preceding argument does not establish that every physician, or every healthcare professional, has a personal duty to provide assisted death on request. Concerns about conscience, professional integrity, role morality, and institutional diversity show why that stronger claim is difficult to defend and, in many jurisdictions, unnecessary for practical access. The more defensible conclusion is narrower but still substantial: persons who make a valid request should have a right to have that request received, assessed under public criteria focused on competence, voluntariness, and adequate information rather than substantive agreement with the choice, and, where the legal system authorises assisted dying, connected to a willing and qualified provider. The correlative duty is therefore best understood as falling primarily on institutions, not on each individual clinician.

The correlative duties therefore fall primarily on institutions rather than on individual professionals. A publicly accountable system should provide a validity review focused on competence, voluntariness, and adequate information; procedures for appeal or second review in difficult cases; a mechanism ensuring that conscientious refusal by one provider does not block access; and transparent monitoring of patterns of use, refusal, and inequality. Contemporary MAID regimes already illustrate the importance of centralised oversight of requests, assessments, and provisions as a condition of institutional accountability (Health Canada 2023). The positive dimension of the right to die is best conceived not as a universal duty borne by every doctor, but as an institutional duty to maintain a lawful route to assessment and, where authorised, to provision. This conclusion is also easier to reconcile with outcome-oriented approaches, which can support institutional assistance where it reduces suffering, respects stable preferences, and yields better consequences than leaving people to secrecy, violence, or solitary suicide, while still leaving open the empirical and policy question of how provision should be organised in particular societies (Sidgwick 1981; Godwin 1985; Häyry 1994).

At this point, the diversity of legal models becomes important. One jurisdiction may confine provision to public healthcare institutions. Another may permit provision by willing medical professionals within regulated healthcare settings. A third may, in principle, authorise carefully licensed non-medical providers, provided that the same demanding standards of competence, voluntariness, informed consent, reporting, and oversight are met. These are questions about the mode of provision, and therefore conceptually downstream from the validity decision. The state should control validity review through a public and transparent process; provision, by contrast, may be public, mixed, or licensed-private, so long as safeguards are robust and access is real.

Separating validity review from provision has two advantages. First, it reduces the risk of coercion, because the body that determines whether a request is valid is institutionally distinct from the body that carries it out. Second, it reduces conscience-based conflict, because respect for autonomous requests does not require every professional to become a provider. This institutional separation also responds more directly to feminist and disability critiques than a simple appeal to individual choice. It creates space to examine background pressures, structural disadvantage, and possible discriminatory effects without turning those concerns into blanket reasons for denying competent persons any route to assisted dying.

Palliative care remains essential within this framework. Recognising a right to die does not weaken the duty to provide excellent symptom control, psychosocial support, disability support, and non-abandonment. On the contrary, any request to die should be considered against a background in which reasonable alternatives have genuinely been made available and discussed. Yet the availability of palliative care does not by itself defeat the claim that some people, even when well supported, may autonomously judge continued life to be contrary to their interests or values.

What, then, would it mean to take the right to die seriously? It would mean refusing the assumption that the relevant questions are settled simply by invoking either autonomy or the sanctity of life. More specifically, it would mean recognising at least a universal moral licence to die and a corresponding negative claim-right against unjustified interference, and then building institutions around a further right to request assessment and, where lawful, access to willing licensed assistance. This conclusion is less sweeping than the claim that any particular physician owes death to any requester, but it is more demanding than a merely symbolic permission. It requires publicly accountable review, genuine routes of access, and continuing scrutiny of coercion, inequality, and abuse. That, we suggest, is the most defensible way of taking the right to die seriously (Häyry 1994, 138–42).

Funding

Konrad Szocik: This work was supported by the National Science Centre, Poland (UMO-2024/53/B/HS1/01295).

Declarations

Conflict of interest

The Authors declare no conflict of interests.