Letting Terminal Patients Die

The word euthanasia comes from two Greek words: eu for “good,” and thanatos for “death.” Thus the term means a “good” or “gentle” death.3 Active euthanasia is the overt, deliberate killing of a patient, e.g., by injecting an overdose of morphine or by giving potassium chloride to stop the heart. Passive euthanasia refers to the withdrawing or withholding of treatment, while the disease process takes its course to cause death.4 In other words, the distinction is between killing and letting die, but the intent in both is the patient’s death.

Most would condemn active killing. “Letting die” may seem to be more acceptable, though it can be just as unethical as active killing. Some ethicists would thereby argue that there is no morally relevant distinction between active and passive euthanasia.5 However, this oversimplifies the reality of medical care. “Letting die” may be morally justifiable in medicine if a particular intervention is truly futile, or if a patient or her authorized surrogate refuses it.3 Thus, the medical cause of death does have moral relevance, though not in and of itself. For these reasons, the term passive euthanasia has only added confusion to the ethical debate, and should be discarded.

Another way to look at euthanasia involves three categories: voluntary, nonvoluntary, and involuntary. Voluntary euthanasia is the act of bringing about a competent patient’s death at his request. Nonvoluntary euthanasia means ending the life of an incompetent patient, usually at the request of a family member, as in the Karen Quinlan case. In 1975, the New Jersey Supreme Court granted Miss Quinlan’s father the right to authorize removal of the respirator from his comatose daughter.6 Involuntary euthanasia means taking the life of an competent patient who does not wish to die.7 A moment’s reflection will demonstrate that these are not morally helpful distinctions. As mentioned earlier, the active taking of a patient’s life is usually considered wrong, even if a patient requests it. The focus here is on the agent who gives consent, rather than on the ethical merits of the act of killing or letting die. Physician-assisted suicide is a variation of voluntary active euthanasia, where the agent who causes the death is the patient herself, with means provided by the physician.

Finally, the omission v. commission argument is frequently cited in making a distinction between withholding treatment, i.e., not starting it, versus withdrawing treatment, i.e., stopping an intervention already begun. Historically, the latter has always been more difficult in medicine than the former, though this is probably more psychological than real. Bioethicists Beauchamp and Childress call the distinction “both irrelevant and dangerous.”7

Read it all here.