The force of Arras’ argument is not necessarily that euthanasia is wrong on deontological grounds, i.e., because killing is wrong, but rather, that it is pernicious because it causes consequences antithetic to what its supporters claim: viz., that it yields less relief of suffering, less patient autonomy, corrupts the practice of medicine, and causes a decline in the quality of palliative care.
Of these, I believe that the “corruption” argument carries particular weight, since proponents of PAS like Ronald Dworkin (who coauthored the well-known “Physicians’ Brief”) seek to artificially constrain (in my view) the scope of a physician’s responsibility within the context of a physician-as-agent argument. The social consequences of PAS, let alone outright euthanasia, are antagonistic to society’s interests since any killing of a patient by a physician inexorably undermines the role of the physician as healer. Arras argues, I believe correctly, that the social risks of legalization are serious and highly predictable.
Another bioethicist, Hilary Bok, answers Dworkin by stating that physicians are indeed agents for their patients, but that this agency is bound by a professional conscience that has rejected the killing of dying patients overwhelmingly and across generations. Trying to undermine this with an autonomy argument, I find, impoverishes our common understanding of society’s interest in protecting the integrity of the medical profession.
More generally, the capacity to commit suicide does not imply a moral or legal right to do so. The fact that we no longer punish suicide, or attempted suicide, as a criminal matter does not mean that we approve of these acts, or recognize that notions like “self-determination” and “personal autonomy” extend this far; nor that society’s interest in preserving life is somehow diminished.