ASSISTED DYING

Assisted Dying

Assisted Dying

Introduction

Derived from the Greek eu (good) and thanatos (death), euthanasia is the practice of painlessly causing the death of those who suffer from painful or incurable diseases or disorders. It is sometimes referred to as mercy killing. In euthanasia, someone else causes the death of the suffering individual. In the closely related practice of assisted suicide, however, the suffering individual takes his or her own life, aided by one or more assistants.

Euthanasia and assisted suicide are both forms of voluntary homicide, but they differ from other varieties of voluntary homicide (such as murder or manslaughter) inasmuch as their principal objective is not to inflict pain, but to alleviate it (by ending a life of suffering). This incongruous coupling of deliberate homicide and a benevolent motive creates thorny legal and ethical puzzles.

Argument

In the United Kingdom, euthanasia is illegal in all states and punishable as murder. However, two states, Oregon and Washington, have legalized assisted suicide under certain circumstances. Several other countries have legalized euthanasia and/or assisted suicide. But while medical societies in other countries have approved euthanasia and assisted suicide for physicians, the American Medical Association (AMA) has concluded that physicians must not perform euthanasia or participate in assisted suicide. Instead, the AMA believes that if physicians diligently attend to matters of respect for patient autonomy, good communication, support, and adequate pain control, public demand for euthanasia and assisted suicide may decrease dramatically.

Sometimes death is not the primary goal of an affirmative medical action, but is nevertheless a foreseeable consequence, such as when a physician provides a patient with progressively higher doses of painkillers with the full knowledge that the drugs will depress respiration and inhibit the gag reflex, thereby hastening the death of the patient. But because the physician's paramount objective is the palliation of pain, not the death of the patient, this is not considered to be active euthanasia. Instead, it is called the principle of double effect. Although the law usually holds people accountable for the reasonably foreseeable consequences of their actions, physicians who act to alleviate pain (and in so doing accelerate or cause the deaths of their patients) are not viewed as ethically or legally responsible for such deaths.

Conceptually, these three typologies may be helpful in allocating responsibility in cases of euthanasia and assisted suicide. In actual practice, however, meaningful distinctions prove to be elusive. For example, suggesting that disconnecting a respirator is passive (since once disconnected, the patient's condition—and not the action of the physician—is responsible for his death) obscures the fact that disconnecting the respirator requires a physical act. Characterizing the result as passive euthanasia may prove legally important, and may provide psychological comfort to those involved in the decision, but the analysis is one more of form than of substance. The question remains as to why a patient—who has a disease that will quickly end his life upon withdrawal of treatment—is allowed to die, while another patient with a slower-acting condition must endure a protracted life of ...