Bioethics for Clinicians: Euthanasia and Assisted Suicide by James Lavery, Bernard
Dickens, Joseph Boyle, and Peter Singer
WHAT ARE EUTHANASIA AND ASSISTED SUICIDE?
Euthanasia is a deliberate act taken by a person with the intention of ending the life of
another person to relieve their suffering where the act is the cause of death. Euthanasia may be
voluntary, involuntary, or nonvoluntary, depending on (a) the competence of the recipient, (b)
the act-wish consistency, and (c) recipient awareness.
WHY ARE EUTHANASIA AND ASSISTED SUICIDE IMPORTANT?
There is considerable disagreement about whether euthanasia and assisted suicide are
ethically distinct from decisions to forgo life-sustaining treatments. At the heart of the debate is
the ethical significance given to the intentions of the actor.
Supporters of euthanasia reject that there is an ethical distinction between these acts and
acts of forgoing life-sustaining. Opponents of euthanasia claim that death is a predictable
consequence of the morally justified withdrawal of life-sustaining treatment. Although they
recognize the importance of self-determination, they see this right as irrelevant to social policy.
Supporters of euthanasia believe that these acts benefit terminally ill patients by relieving their
The Criminal Code of Canada prohibits euthanasia under its homicide provisions. The
consent of the person whose death is intended does not alter the criminal nature of these acts.
However, despite the reaffirmation by the court, there has been a clear trend toward leniency at
The CMA continues to uphold the position that members should not participate in
euthanasia and assisted suicide.
In Canada, more than 75% of the general public support voluntary euthanasia and
assisted suicide in the case of patients who are unlikely to recover from their illness. But roughly
equal numbers oppose these practices for patients with reversible conditions, elderly disabled
people, and elderly people with only minor ailments.
Results of a survey indicate that 24% of Canadian physicians would be willing to practise
euthanasia, and 23% would be willing to assist if these acts were legal.
Active and Passive Euthanasia by James Rachels
The statement adopted by the American Medical Association in 1973:
“The intentional termination of the life of one human being by another is contrary to that
which the medical profession stands for. The cessation of the employment of extraordinary
means to prolong the life of the body when there is irrefutable evidence that biological death is
imminent is the decision of the patient and/or his immediate family. The advice and judgment of
the physician should be freely available to the patient and/or his immediate family”
The author proposes that if the doctor is focused on a humanitarian effort, then VAE is
not an inhumane way to relieve the patient‟s suffering. In some cases, doctors refusing to inject lethal substances to end the misery of the patient have acted in a non-humanitarian way by
withdrawing treatment and prolonging suffering. He says that this presents a good ground for
rejecting the doctrine that there is a moral distinction between killing and letting die.
One reason why so many people think that there is an important moral difference
between active and passive euthanasia is that they think killing someone is morally worse than
letting someone die. The Smith and Jones example illustrates that there is no moral distinction
between killing and letting die. The bare difference between killing and letting die does not make
a moral difference. If a doctor lets a patient die, he is in the same “moral boat” as a doctor who
gives a lethal injection.
Many people find this hard to accept because many cases of killing are clearly
impermissible. One hardly hears of cases of letting die except when the humanitarian efforts of a
doctor are deemed futile.Media portrayals of killing and letting die place them in a negative and
positive light,respectively. However, it doesn‟t mean that one is worse than the other, but that
other factors contribute to the different attitudes.
The acts and omissions distinction draws a number of points. The first is that it is not
exactly correct to say that in passive euthanasia the doctor does nothing. In either case, an action
is performed. The decision to let a patient die is subject to the moral appraisal in the same way
that a decision to kill him would be subject to moral appraisal: it may be wise or unwise. In
either case, the doctor has decided that death is no greater evil than continued existence.
Voluntary Active Euthanasia by Dan W. Brock
The prominent debate in biomedical ethics surrounds that of forgoing life-sustaining
treatment. This has led to the author supporting both VAE and physician-assisted suicide. In the
recent bioethics literature some have endorsed physician-assisted suicide but not euthanasia. Are
they sufficiently different that the moral arguments for one often do not apply to the other? The
only difference that need exist between the two is the person who actually administers the lethal
dose. In each, the physician plays a necessary role. However, it might be held that the moral
difference is that in euthanasia the physician kills the patient, but in PAS, the patient kills
THE CENTRAL ETHICAL ARGUMENT FOR VOLUNTARY ACTIVE EUTHANASIA
The central ethical argument for euthanasia is centred on two fundamental ethical values.
These values are autonomy and individual well-being.
Autonomy is valuable because it permits people to live in accordance with their own
conception of a good life. In exercising self-determination, people take responsibility for their
lives. Thus, most people are very concerned about the nature of the last stage of their lives
because of their desire to maintain dignity and control during this period.
Individual well-being is another main value that supports euthanasia. It might seem that
individual well-being conflicts with a person‟s self-determination when the person requests
euthanasia. Life itself is a central good for persons. But when a competent patient decides to
forgo life-sustaining treatment, they have decided that the best life possible for them is worse
than no life at all.
The value of self-determination does not entitle patients to compel physicians to act
contrary to their own moral or professional values. If performing euthanasia became legally
permissible but conflicted with a physician‟s professional responsibilities, the care of a patient who requested euthanasia should be transferred to another. Most opponents do not deny that self-
determination and well-being support euthanasia in some cases.
EUTHANASIA IS THE DELIBERATE KILLING OF AN INNOCENT
The claim that any individual instance of euthanasia is a case of deliberate killing of an
innocent person is correct. Euthanasia is clearly killing, and the patient‟s death is deliberate even
if the physician‟s actions are in respect to the patient‟s wishes. In the context of medicine, the
ethical prohibition against deliberately killing the innocent derives some of its plausibility from
the belief that nothing in the currently accepted practice of medicine is deliberate killing. The
belief that doctors do not in fact kill requires the corollary belief that forgoing life-sustaining tx
is not killing.
The difference between a greedy son and a physician is that: (1) the physician acts with
the patient‟s consent whereas the son does not, (2) the physician acts with a good motive, and
(3) the physician acts in a social role. Both the physician and the greedy son act in a manner
intended to cause death, do cause death, and so both kill.
There are two other reasons why the conclusion that stopping life support is killing is
resisted. The first reason is that killing is often understood as unjustified causing of death.