The current issue of Bioethics (vol. 29, no. 7, September 2015) has a number of pieces that will be of likely interest to What’s Wrong? readers. One article, in particular, managed to draw critical fire even before it was published. In “Why Not Commercial Assistance for Suicide?: On the Question of Argumentative Coherence of Endorsing Assisted Suicide,” Roland Kipke argues that defending the legalization of assisted suicide commits one to defending the legalization of commercial assisted suicide in particular, a result that most defenders of assisted suicide are reluctant to accept. You can see an early reaction to Kipke’s paper in the National Review here and, thanks to a special arrangement with Wiley, you can enjoy free access to the article itself here as What’s Wrong?‘s featured journal article of the month for October.
Professor Kipke has generously offered to respond to questions or comments that What’s Wrong? readers might have after reading his article. Simply submit a comment below if you would like to participate. He also provided this brief precis and explanation of the genesis of the paper: “Advocates of assisted suicide want its approval limited to certain cases. Other cases should be excluded, for example commercial assistance for suicide. I have always wondered: is this a plausible position? The specific occasion for this article was the German debate on suicide assistance, but the question is relevant for any debate on assisted suicide: Should not one who advocates physician-assisted suicide in autonomous patients advocate much more? My concern is not at all to defend commercial assistance for suicide, but only to raise the question of whether there are good arguments for the position that advocates physician-assisted suicide while rejecting commercial assistance for suicide. There are none.”
(image: suicide booth)
What's Wrong? 
Thank you for featuring Roland Kipke’s paper and organizing this discussion. I enjoyed the paper very much, and I have to admit that I have discussed this issue with the author before. So I have only a couple of minor remarks about which I would love to hear more from the author and also start a discussion.
Let me note at the beginning that I share many of Roland’s points. I think that he is right in saying that there are very good arguments for commercial assisted suicide (CAS) and very poor arguments against it (as well as in favor of physician-assisted suicide, PAS, only), and that once you are in favor of the permissibility of assisted suicide (AS), you have good reasons to organize its provision through markets. For me, then, the most natural response to Roland’s conclusion is to agree with him and simply allow CAS. There might be several ways to come to this conclusion, even for those who think that the idea of CAS runs counter to some of their firmly held beliefs. One is based on the idea of a reflective equilibrium (RE) as a guide to our moral reasoning. RE tells us that when we try to find normative standpoints on a given question, or more theoretically, when we want to find a theory of X, we should proceed by both reasoning from premises to conclusions (deductively, inductively), and comparing these results with other firmly held beliefs, principles, judgments or intuitions. During that process, we will constantly re-order and revise our theories and other beliefs so as to finally reach a coherent conclusion. Sometimes we revise the argumentative reasoning, at other times we abandon some of our principles or intuitions. In the case of CAS we might say that whereas our intuitions are against legalizing CAS, in light of Roland’s argument we are forced to abandon our rejection of CAS and finally allow it. This would constitute a major step in the mind of a PAS-proponent-and-CAS-opponent, and it would, to quote Roland, “no longer be the same position”. But this fact alone would not be relevant on the way towards a coherent system of ethics.
However, there is one crucial assumption in Roland’s essay that I want to raise some doubts about. Roland thinks that we need to be coherent when it comes to an ethical position on any given topic (here: assisted suicide). He starts off by assuming that proponents of PAS typically or oftentimes reject CAS, but notes that (1) CAS might even be a better way of organizing AS, and that (2) criticisms raised against CAS do not provide us with good reasons to reject CAS. But in light of the RE as guide to our reasoning we are not determined to immediately bring coherence to our thinking. In the case of AS, for instance, we might well hold on to PAS and continue to reject CAS and be inconsistent. Perhaps we have not found a striking argument yet, but this does not mean that there is none. We might even reject the idea that ethics must be a coherent whole, consisting of mutually compatible norms and judgments. Moreover, perhaps our ethical thinking, our ethical compass, is such that it allows for some level of incoherence. Roland has not given us a reason to assume that we need to be “rational” in the sense of coherent. What he has given us are very good reasons to prefer CAS over PAS. But there is nothing in his paper that should convince us that we absolutely need to be coherent in his sense. He simply assumes that we need to and want to be coherent. But in ethics we often hold diverging and incompatible views, and sometimes we even lack the knowledge of why this is so. But this provides us with reasons to think harder, or to simply accept it, and not necessarily to revise our belief system to make it more coherent. Of course, once we can come up with a justification for why we accept A but reject B, this system will exhibit the feature of being coherent. What I would like to take into doubt is the idea that if we detect an incoherence, we need to revise our beliefs immediately.
There are further points which we might address during the debate, but which I do not want to fully elaborate now. For instance, I think that once you accept that people are legitimately opposing CAS while accepting PAS, we might further strengthen this position by critizicing some of the arguments Roland raises against opponents of CAS, opening up a path towards rejecting CAS (to which I personally do not agree). In a post over at my own blog (http://andreaswolkenstein.com/2015/10/03/commercially-assisted-suicide-whats-wrong-with-it-if-at-all/) I elaborate a bit on this point and also provide some hints towards a solution. I also think that we should examine whether it is reasonable to compare PAS with CAS in the first place, as PAS might be seen as a special form of CAS and not something of a different kind.
It might well be that I missed Roland’s argument, or that there is any other flaw in my reasoning. Be it as it may, I am in any case looking forward to learning about whether and why this is so.
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Andreas Wolkenstein wrote that in light of my argument “we are forced to abandon our rejection of CAS and finally allow it”. However, this is only one possible solution. The other possible solution is to question the second branch of the incoherent position. That means to scrutinize the intuitions and arguments in favor for PAS. The value of the reflection on CAS is that we are forced to reflect the arguments in favor for PAS – not only on the level of the usual arguments of personal autonomy, slippery-slope-arguments and the like, but on the level of the underlying and mostly implicit assumptions of a good society. So, Andreas’ conclusion is not only not necessary, but it seems to me also too simple.
Andreas poses another and more fundamental question: if the claim is right that we have to strive for coherent ethical positions. I wonder if the conviction that we do not (always) have to strive for this coherence fits to Andreas’ position regarding the first point where he argues on the basis of the coherence principle. However, more decisive is that I do not see how to think rationally about ethical problems and philosophical problems in general if we abandon the goal of argumentative coherence. If we may accept an argument on one issue and reject the same argument on another, similar issue without overriding arguments – then we actually do not argue for something but only collect disconnected sentences. To abandon the requirement of coherence is the same as abandoning the claim of rationality.
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