The case of the Belgian twins should be permitted as legitimate grounds for assisted suicide. However, prima facie, this may not be very evident, partly due to the manner with which the article presented the situation. By focusing on the Belgian twins being brothers, specifying the individual with whom the other does not wish to live without, and declaring the illness they faced, the article made the situation so specific that readers likely found it difficult to empathize with the case (that is, exactly, imagine themselves as one of the individuals, and attempt to understand the reason for their decision). It is more appropriate to discuss cases slightly more generally (at least at first), so that one’s natural empathy and imagination may be able to play a role in determining a proposition’s feasibility. For example, one ought to reexamine the case noting that it is equivalent to two independent individuals deciding that they don’t desire to live after discovering that a genetic ailment will soon express, and affect their quality of life indefinitely. Their reason being that this ailment will significantly inhibit their relationship with their family members, spouse, children, or some significant-other.
We can begin to see why this is a legitimate case by examining Dworkin’s opinion on euthanasia, that is: “it is a form of tyranny to force someone to endure unendurable suffering at the end of life merely for the sake of someone else's values.” While the twins in this case were not near the end of life, Dworkin does observe that to restrict one’s choice in manner of death, is to infringe on their right to autonomy (hence his use of the word “tyranny”). So, it should follow that one’s choice in time of death is also protected by their autonomy, as a manner of death could even be considered to be the time at which it occurs (early, mid-age, late, etc). Therefore, as autonomy should be upheld so long as free choices do not lead to serious interpersonal harm (such as murder), an individual’s choice of the manner and the time of their death should be respected.
It’s possible that individuals may object, claiming that such a case is not legitimate because blindness inflicted at mid-age is neither severely debilitating (that is, on the order paralysis) nor is it promptly terminal (that is, on the order of developed AIDS or cancer), and thus does not warrant an assisted early death. However, we must appeal to the subject on determining “severely debilitating”, as it can be seen that the qualifications depend on the individual: the violinist may not be devastated by blindness, and the painter not by deafness, but certainly the reverse could be considered by both to be utterly destructive to their being, even not worth living with, and justifiably so. Thus, it should be understood that “severely debilitating” must be judged by the individual.
A recipe for properly determining a proper reason for death is not possible (that is, determining good reasons from poor); as the choice of time and manner of death lies within one’s autonomy, and thus no exterior judgement is assured to accurately represent the desires of an individual. However, a method of encouraging introspection may be an effective, and a practical balance between autonomy and paternalism. That is, in cases which do not express immediate urgency (such as long-term terminal illnesses), the patient would be required to demonstrate consistency of mind (i.e. they are certain they wish assisted suicide) over the course of 90 days. During this period, the patient would also be required to explore alternatives, such as depression medication and therapy.