WHAT'S THE DIFFERENCE?

Euthanasia and physician assisted suicide

What’s the difference?

In the past decade I have gained significant understanding about attitudes towards euthanasia and Physician assisted suicide in the United States, as well as the practices themselves.

One of the problems plaguing the field of euthanasia and PAS is vague and emotionally laden definitions. The term euthanasia without a qualifying phrase means voluntary active euthanasia; that is, the physician intentionally ends the patient's life at the patient's request and with the patient's full informed consent. This is the intervention that has been the subject of intense public debate and controversy. Only a few people argue for nonvoluntary active euthanasia, which is generally viewed as wrong. On the other hand, PAS refers to the physician's act of providing medication, a prescription, information, or other interventions to a patient with the understanding that the patient intends to use them to commit suicide.

The terms "passive" euthanasia and "indirect" euthanasia are occasionally heard; these are incorrect terms because they are not really types of euthanasia. Passive euthanasia is the practice of terminating life-sustaining treatments, such as respirators and artificial nutrition. I can still recall the case of the Florida woman Terry Schiavo . For centuries these practices have been deemed ethical and legal. Similarly, administering opiates or other interventions that pose the risk of death, so-called indirect euthanasia or palliative sedation, is deemed ethical. Since the discovery of ether anesthesia and hypodermic morphine in the 19th century, medical societies have endorsed their use for terminally ill patients even if the patients die from respiratory depression, as long as the intention was pain relief. Again, these are not cases of euthanasia, and the term should not be associated with them; it only confuses nonexperts like us. The question is, what is the difference? I simply cannot distinguish between the two.

For the sake of argument, I would favor permitting or legalizing euthanasia and /or PAS for the following reasons: First, it is argued that individual autonomy justifies euthanasia and/or PAS. If autonomy means that individuals have the right to pursue their own personal view of what kind of life is best, including when and how to die, then to respect autonomy requires permitting individuals to decide when it is better to end their lives by euthanasia or PAS than to continue living.

Secondly, beneficence means furthering the well-being of individuals. This also supports permitting euthanasia and/or PAS. In some cases, living creates more pain and suffering than death. In these cases, ending a painful life will actually relieve more suffering and thereby produce more good. In fact, just the reassurance of having the option of euthanasia or PAS, even if people do not use it, can provide "psychological insurance" and be beneficial.

Thirdly, in my opinion, euthanasia and PAS are not different from terminating life-sustaining treatments, which is recognized as ethically justified. In both cases, the patient consents to die, in both cases the physician intends to end the patient's life and takes some action to cause this to happen; the final result is the patient's death. If there is no difference in patient consent, physician intention, or the final result, there can be no difference in the ethical justification.

Finally, the supposed "slippery slope" that would result from permitting euthanasia and/or PAS is not necessarily likely. Some say permitting euthanasia or PAS will undermine the physician-patient relationship or lead to forced euthanasia is completely speculative and not borne out by the available data, and therefore should not govern public policy.

MOHAMED