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Assisted death is an umbrella term for a death that requires an intentional act or omission on the part of a second person. There are five categories of assisted death.
Withholding of potentially life-sustaining treatment is the failure to start treatment that has the potential to sustain the life of a person (for example, not providing cardiopulmonary resuscitation to a person having a heart attack).
Withdrawal of potentially life-sustaining treatment is the stopping of treatment that has the potential to sustain the life of a person (for example, removing a feeding tube from a person in a persistent vegetative state).
Potentially life-shortening symptom relief is pain- or suffering-control medication given in amounts that may but are not certain to shorten a person’s life (for example, ever-increasing levels of morphine necessary to control an individual’s pain from terminal cancer where the morphine is known to potentially depress respiration even to the point of causing death, but it is not known precisely how much is too much as the levels are slowly increased).
Assisted suicide is the act of intentionally killing oneself with the assistance (i.e., the provision of knowledge or means) of another (for example, a person is bedridden with ALS, also known as Lou Gehrig’s disease, and her sister brings her a lethal dose of a barbiturate ground up in a glass of orange juice, and the bedridden person drinks it through a straw).
Euthanasia is an act undertaken by one person with the motive of relieving another person’s suffering and the knowledge that the act will end the life of that person (for example, a person is bedridden with ALS and her physician gives her a lethal injection of potassium chloride).
It has been widely accepted for some time that the withholding and withdrawal of potentially life-sustaining treatment are both legally and ethically acceptable. Indeed, courts, legislatures, and professional health-care bodies have recognized that patients have a right to refuse treatment and that free and informed refusals made by competent individuals (or substitute decision makers on behalf of individuals) should be respected. However, two areas of significant tension remain. First, there is debate about whether artificial hydration and nutrition are different from other forms of treatment (e.g., cardiopulmonary resuscitation) and therefore should be treated differently. Second, there is debate about whether health-care professionals have the authority to unilaterally withhold or withdraw potentially life-sustaining treatment—for example, where the family of a patient in a persistent vegetative state believes that ongoing treatment is what the patient would have wanted or is in the patient’s best interests, while the health-care team claims that the treatment would be “futile.” Can the health-care team proceed against the family’s wishes and stop treatment? This is a question that has not yet been settled in either law or in ethics.
It has also been widely accepted that the provision of potentially life-shortening symptom relief can be appropriate end-of-life care. However, there is still a great deal of uncertainty at the margins. That is, how much medication is too much? When does symptom relief shade into euthanasia? Are there limits on when such symptom relief is appropriate? For example, does a patient need to be terminally ill or could potentially life-shortening symptom relief be provided to someone with a chronic illness? There is also growing controversy over the practice of total or terminal sedation (sedation to the point of unconsciousness). The practice is controversial largely because it creates a physical dependence on artificial hydration and nutrition, which can then be withheld, leading to certain death.
Both assisted suicide and euthanasia are clearly illegal in the United States (with the notable exception of Oregon, which has legalized physician-assisted suicide). Many books and articles have been written about the legal and ethical arguments for and against decriminalization of euthanasia and assisted suicide. Opponents frequently emphasize beliefs about the sanctity of life, dignity, and slippery slopes. Proponents frequently emphasize beliefs about autonomy and dignity and reject slippery-slope arguments. A sharp divide can be found on the issue of whether there is a valid moral distinction between the withholding and withdrawal of potentially life-sustaining treatment, and the provision of potentially life-shortening symptom relief on the one hand and euthanasia and assisted suicide on the other. Public opinion is certainly split but, with consistency over a significant period of time, a strong majority of Americans support both euthanasia and assisted suicide.
- Dworkin, Gerald, R. G. Frey, and Sissela Bok. 2004. Euthanasia and Physician-Assisted Suicide (For and Against). Cambridge, MA: Cambridge University Press.
- Oregon Department of Human Services. 2006. Eighth Annual Report on Oregon’s Death with Dignity Act. Portland, OR: Office of Disease Prevention and Epidemiology. www.oregon.gov/dhs/ph/pas/docs/year8.pdf.
- Rubin, Susan. 1998. When Doctors Say No: The Battleground of Medical Futility. Bloomington: Indiana University Press.
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