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Understanding Physician-Assisted Suicide and Euthanasia Ethical Positions

Learn about definitions, legal status, and ethical positions regarding Physician-Assisted Suicide (PAS) and Voluntary Active Euthanasia (VAE), including borderline cases and the "Bus Route Analogy."

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Understanding Physician-Assisted Suicide and Euthanasia Ethical Positions

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  1. Physician-Assisted Suicide and Euthanasia I

  2. Definitions: PAS • Patient commits suicide • Reason is due to incurable medical problem • Physician provides patient with the means to commit suicide • Physician knows and intends that patient will use means for that purpose • Physician does nothing directly to cause death

  3. PAS Spectrum • Physician provides patient with the knowledge of how to commit suicide, gives no medication, etc. • Physician writes prescription for necessary drug • Physician is present, hooks up necessary apparatus, patient “pushes button”

  4. Voluntary Active Euthanasia (VAE) • Physician directly administers lethal drug to patient • Patient dies as a result • Purpose is “merciful” (patient suffers from incurable medical condition) • Patient is fully competent • Patient has requested euthanasia

  5. Euthanasia (“good death”)

  6. Legal status • VAE • Illegal in US, most countries • Legally permitted in The Netherlands • PAS • Illegal in Michigan, most states • Legal in Oregon only • Proposal on ballot in Maine • Legally permitted in Netherlands, Germany

  7. Ethical Positions on PAS/VAE • Pro • Respect individual autonomy • Duty to relieve suffering • Con • Wrongness of health professional causing death • Negative social consequences of policy (“slippery slope”)

  8. Ethical positions: Pro • “Civil Rights”-- Basic right of autonomous adult to choose “time and manner of one’s own death” • “Physician discretion”-- Usually wrong to hasten death; in extreme cases physicians may make exception if voluntary choice and irremediable suffering

  9. Ethical positions: Con • In principle opposition • Suicide or killing is always wrong • Always wrong for health professional to kill or aid death • “Slippery slope”-- Maybe individual cases in which justified; but too many risks as general public policy

  10. Drawing the Line • AMA, US Courts: OK to forgo treatment; PAS, VAE are wrong • Oregon: PAS is permissible within strict safeguards; VAE is wrong • Netherlands: PAS, VAE are OK, nonvoluntary or involuntary active euthanasia is wrong

  11. Borderline Cases • Janet Adkins cannot reach the button; asks Dr. Kevorkian’s assistance • Terminal sedation • Patient put in deep coma with no food, respiration • Promised not to awaken from coma • Stopping eating and drinking • Patient intends to die • Physician assists

  12. M. Benjamin’s Bus Route Treat all aggressively Eliminate social undesirables Forgo- patient values Nonvoluntary, great suffering Forgo- terminal VAE PAS

  13. Bus Route Analogy • The quicker you get off the bus, the more friends you leave behind • The longer you stay on the bus, the more undesirable the neighborhood • Same reasons to keep riding to this stop also argue for staying on the bus just one more stop-- and so on • (Almost) no one wants to go to end of line

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