I’m not sure any decision is truly “free”. A well person, free of all extraneous ill effects, who made a choice to die is probably not well, in fact. (A wholly well person always chooses life.)
Sure. Free will is a controversial subject. But I’m talking pragmatically here and comparing to as free a choice as we can make it. Even the most free choice may be predetermined. That’s a given. Of course if we say that free will is an illusion this whole discussion is moot as is a ton of other stuff - patient informed consent process, criminal law, etc.
The suicidal young person - most cases - suffers a treatable condition such as depression or something worse. We treat that condition recognising it is treatable, and freed from it, suicide will no longer be sought.
In most cases the the dying patient can be treated in a similar way. We recognise that the underlying condition is terminal and untreatable but its effects on the psyche need not be. And even if its effects cannot be removed, the choice is still not free. The patient is coerced into the death wish, through conscious and subconscious factors.
The terminally ill patient suffering in some way that fails to be mitigated by treatment, or for whom palliative care is not effective (and with objective evidence that there is no prospect of improvement) may make a decision to die and there does not seem to be a logical basis to reject the decision as tainted or invalid. The only basis seems to be a moral conviction about sanctity of life.
There is of course a logical basis.
The decision making processes and things which influence how the decision is made are tainted by the condition itself. It’s corrupted so to say. Which is my whole point. When it comes to such an important decision, we should surely want as much certainty as possible. What if the patient didn’t really want to die? What if the indignity or bouts of pain were in fact tolerable?
It’s similar to the philosophical question of whether we’re a brain in a vat or whether solipsism is true. One can assert we’re not because we see other people and experience the world. But we do so through our mind. If our mind is corrupted and deluded to think we’re typing stuff on a forum while we’re really a brain in a vat, so is everything and nothing is reliable. Are our senses reliable? Well we can’t know because we can’t get outside our senses. In the same way if the thing which is doing the deciding whether the pain is worth bearing or not is corrupted it can’t make a free choice.
So OK you can also say well that’s tough and just accept that the choice will not really be free, but a coerced choice. I’m fine with that, but then drop the talk of a free choice or of patient autonomy. This patient is no more autonomous than a depressed suicidal person or an anorexia nervosa patient is when deciding whether to diet/die or not. I think people either don’t think about these issues or just brush them off. Depending on one’s value system and attention to detail, one may or may not find this persuasive. After all, “the person is suffering!!!1” and so we should do all we can. If it makes us feel happier and we can present a pseudo-free choice for this patient thus absolving ourselves of responsibility - we do. Although we wouldn’t consider letting a manic bipoplar person gamble with his last bit of money.