Our bodies, our lives, our right to decide? : reproductive freedom, self-directed dying, and women's autonomy

Abstract

Statement of Problem: Autonomy is a key and evolving concept in American identity. As the bioethical concept of patient autonomy develops and the elderly population in the U.S. grows, end-of-life decisions including self-directed dying are increasingly a matter of public debate. This study explores how veterans of the reproductive freedom movement view, and might be inclined to shape, the right-to-die movement. Methods: Similarities between the abortion movement in the 1960s and early 1970s and the right-to-die movement today were very briefly described to ten women who then participated in oral history interviews. Interviewees were 1) of childbearing age before Roe v. Wade, and 2) supportive of women's access to abortion. Women were asked open-ended questions about their own life experiences and their thoughts about self-directed dying. Results: Interviewees described their experiences with the deaths of loved ones, their personal and professional interactions with the health care system, and their opinions about self-directed dying. Conclusions: Women's personal and cultural backgrounds influenced their understanding of autonomy and the role it can, or should, play in individuals' lives. Commitment to women's self-determination was a shared core value for reproductive freedom veterans that informed their thinking about self-directed dying, but they expressed more concerns about the limitations and potential dangers of personal autonomy in relation to decisions about assisted dying than in relation to decisions about abortion. If engaged more fully, such women might emerge as a force not only to support but also to shape the right-to-die movement. Women who consider assisted dying to be a priority issue may be likely to support somewhat expanding the conditions under which individuals can receive aid in dying. Whether or not they regard assisted dying as important or even desirable, however, women interviewed regard related end-of-life issues, such as advance directives and support for care givers, as important concerns. Taken together, interviewees' input suggests that an inclusive right-to-die movement might place the specific issue of assisted dying in the context of a wider end-of-life movement addressing medical and social justice concerns that could increase the ability of all to live and die as they see fit.