Matthew Cavedon
My Cato colleague Dr. Jeffrey Singer recently endorsed New York’s pending legalization of Medical Aid in Dying (MAiD). While his perspective reflects a more conventional libertarian judgment than mine, I want to offer a differing take.
Dr. Singer is a surgeon and a committed libertarian. I agree with many of his positions, including opposing the War on Drugs, supporting a reduced federal role in health policy, and believing in competent adults’ freedom to make their own decisions about recreation and risk. He and I both generally believe that responsible people should enjoy broad liberty over their bodies.
For Dr. Singer, legalizing MAiD is a straightforward libertarian stance. He writes that the principle of people enjoying liberty “so long as they do not infringe on the rights of others” necessarily includes “the freedom to end one’s own life—and to seek medical help in doing so. When a patient is fully informed and gives voluntary, competent consent, the state has no legitimate role in preventing physicians from honoring that decision.”
Here we part ways—and not just for practical reasons. To be sure, concerns about the consequences and context of MAiD give many people pause. Dr. Singer notes that Canada’s experience with MAiD and euthanasia (where doctors, rather than individuals, administer lethal medication) has devolved into making death “just another routine option”—and even created “perverse incentives for physicians and caseworkers to promote euthanasia instead of chronic treatment and support.”
Worries about how to ensure that consent to die is genuine were detailed by Massachusetts doctors in a 2022 legal brief. That lawsuit ended in a decision by that state’s (historically quite liberal) high court unanimously rejecting any constitutional right to MAiD.
But my objection goes beyond the conditions of consent. Contrary to Dr. Singer’s conclusion, even a maximal approach to personal liberty is compatible with a limit in favor of life. That’s because liberty includes within it the ability to change one’s mind in the future.
This is obvious in the political context. Libertarians do not accept any understanding of the social contract that makes people’s grant of authority to a government irreversible (such as Thomas Hobbes’s). As Zack Sorenson says, “If a people lose the ability to withdraw consent from a governmental system, then that system is not consistent with liberty.”
The same is true of the liberty over one’s own labor. While armchair libertarian philosophers like to debate the legitimacy of voluntary slavery, it is absurd to defend on the basis of present liberty the decision to permanently and unconditionally surrender all of one’s future liberty to another. As libertarian thinker Murray Rothbard wrote, no one can “rid himself of his own will, which may change in future years, and repudiate the current arrangement.”
For me, that’s the crux of the matter: libertarianism accepts certain guardrails on people’s present liberty in order to preserve their future liberty, and it’s entirely consistent with that principle to oppose the legalization of MAiD.
Of course, libertarianism undoubtedly also accepts the freedom to limit one’s future liberty. Neither government nor contractual arrangements would be possible otherwise. And a liberty only of fleeting impulses, rather than meaningful commitments, would be impossibly shallow. Dr. Singer doesn’t sully his libertarianism by weighing possible future liberty more lightly than the present liberty to choose to die now, especially for the terminally ill patients New York’s proposal is designed for.
Nor is it my position that the government should forcibly install pacemakers in people and chain them to artificial ventilators until death finally overwhelms everything technology can muster. Just like anyone else, libertarians have to wrestle with tough questions about the imminence of death, the action-omission distinction, and the role of third parties—ones that libertarianism does not definitively resolve in one neat direction.
But that’s my point: libertarians can differ in good faith about life and liberty in the context of life’s end, just like they already do in the context of life’s beginning. Reverence for future liberty provides libertarians with a principled reason to oppose legalizing MAiD, even if others, such as Dr. Singer, arrive at different conclusions.