Physician-assisted suicide (PAS) is better justified by rule utilitarianism than act utilitarianism.

The American Medical Association asserts that PAS “occurs when a physician facilitates a patient’s death by providing the necessary means and/or information to enable the patient to perform the life-ending act.” PAS is banned by most nation-states around the globe. In the United States, PAS is currently legal in Oregon, Vermont, Washington, and Bernalillo County, New Mexico.

Bioethicists debate the acceptability of PAS by applying systematized bodies of abstract norms (moral theories). The principle of utility is the ultimate standard of right and wrong for utilitarian moral theories. Act utilitarianism justifies actions by appealing directly to the principle of utility (thereby disregarding rules if they do not maximize utility in a particular situation), whereas rule utilitarianism justifies actions by appealing directly to rules substantiated by utility (thereby obeying rules even if they do not maximize utility in a particular situation). The concept of utility, however, is controversial, for philosophers disagree about which specific values should be maximized. I agree with a group of utilitarians who argue that the most rational definition of utility is satisfaction of an individual’s subjective preferences.

Thus, I suggest that rule utilitarianism permits PAS only if a set of PAS rules can be prescribed that maximize the overall satisfaction of the subjective preferences of the greatest number of individuals. Pro-PAS rule utilitarians commonly assert that the following principles expounded by Tom Beauchamp and James Childress are rules that accomplish this goal: “a voluntary request by a competent patient, an ongoing patient-physician relationship, mutual and informed decision making by patient and physician, a supportive yet critical and probing environment of decision making, a considered rejection of alternatives, structured consultation with other parties in medicine, a patient’s expression of a durable preference for death, unacceptable suffering by the patient, and use of a means that is as painless and comfortable as possible.”   Anti-PAS rule utilitarians argue that no set of rules can be constructed that simultaneously permit PAS and maximize utility, but these conjectures are speculative in nature.

I also suggest that act utilitarianism permits PAS only if PAS maximizes the overall satisfaction of the subjective preferences of the greatest number of individuals in an individual case. Pro-PAS act utilitarians claim that PAS can therefore be justified in most cases. However, anti-PAS act utilitarians point out that it is easy to construct many scenarios (one example is an atheist with uncontrollable pain from bone metastases from stage 4 prostate cancer accompanied by deeply religious family members who view suicide as an unforgivable sin) in which the overall satisfaction of the subjective preferences of the greatest number of individuals would decrease, thereby eliminating PAS as a justifiable option.

I ultimately conclude that pro-PAS rule utilitarians present the most coherent argument, for pro-PAS act utilitarians do not provide adequate justification for PAS in individual cases in which utility would not be maximized and anti-PAS utilitarians (whether rule-based or act-based) do not satisfactorily answer queries about the clear disutility of condemning competent patients to suffer extraordinarily at the end of life by abolishing direct control over their own bodies.