Is there a moral difference between passive euthanasia and physician-assisted suicide?
General Reference (not clearly pro or con)
Gerald Dworkin, PhD, Professor of Philosophy at the University of California, wrote in his chapter "The Nature of Medicine" which appeared in the 1998 book Euthanasia and Physician-Assisted Suicide: For and Against:
"Among physicians the most frequently heard argument against physician-assisted suicide is one about the nature of the medical profession. It is argued that the norms of medicine prohibit a physician from ever acting with the intent to kill a patient or to aid him in killing himself. For this reason it is essential, they believe, to maintain a sharp distinction between allowing patients to die [passive euthanasia], say by the refusal to initiate cardiopulmonary resuscitation (CPR), and acts of assisted suicide."
Is there a moral difference between passive euthanasia and physician-assisted suicide?
Yale Kamisar, JD, Professor Emeritus of Law at the University of Michigan Law School, in his chapter "The Rise and Fall of the 'Right' to Assisted Suicide" that appears in the 2002 book The Case Against Assisted Suicide: For the Right to End-of-Life Care, wrote:
"Although the right to terminate artificial life-support systems [passive euthanasia] and the right to enlist the assistance of another in committing suicide can be, and have been, lumped together under the rubric of 'right to die,' the two 'rights' are different in important respects. As the New York State Task Force on Life and Law noted, the so-called right to die should mean only, and until recently meant only, 'a right against intrusion,' a right to resist 'a direct invasion of bodily integrity, and in some cases, the use of physical restraints, both of which are flatly inconsistent with society's basic conception of personal dignity.' To be sure, a total prohibition against assisted suicide does close an 'avenue of escape,' but, unlike a refusal to honor a competent patient's request to terminate life-sustaining treatment, it does not force one into 'a particular, all-consuming, totally dependant and indeed rigidly standardized life: the life of one confined to a hospital bed, attached to medical machinery, and tended to by medical professionals'."
Frances M. Kamm, PhD, Harvard University Professor, explained in her essay "Physician-Assisted Suicide, Euthanasia, and Intending Death" that appeared in the 1998 book Physician-Assisted Suicide: Expanding the Debate:
"If a machine providing life-saving treatment belongs to the person who stops it, then even if he leaves it and returns to stop it, he is letting die [passive euthanasia] in stopping his aid. Does this mean that one will have killed whenever one stops a machine belonging to someone else (which one is not running)? No, for if one has the permission either of the machine's owner or the person receiving aid to stop it, and one is then seen as their agent carrying out their will, one will be letting die...
...Only a killing introduces an original cause which induces death, rather than merely removing the barrier to a cause of death that is or will be present...
If a doctor actively assists an active sucide (either by, for example, giving lethal drugs or giving drugs to facilitate a patient's suicidal act), he assists in killing...
The fact that the doctor must terminate treatment and we must allow termination of treatment, even when the patient and his doctor intend his death, does not show that it is permissible to... assist [the patient] in killing himself, or required of us to allow these acts, when the patient and doctor intend his death. "
Ezekiel J. Emanuel, MD, PhD, Chair of the Department of Clinical Bioethics at the National Institutes of Health, in his 2000 article "A Time to Die: The Place for Physician Assistance," that appeared in the Journal of Health Politics, Policy and Law argued:
"Frequently, people indicate that their support for...PAS [physician-assisted suicide] is based on the fact that they would not want to live 'hooked up to machine' or 'when it's hopeless:' Advocates of euthanasia and PAS encourage such thinking when they elide the moral and legal distinctions between intentionally ending a life through an intervention, such as an injection of muscle relaxants, and stopping medical treatments [passive euthanasia]...
In June 1997 the U.S. Supreme Court made quite clear that these actions are legally distinct. There is a constitutional right to refuse medical treatments and even have a proxy exercise that refusal, while, by a vote of 9 to 0, the Court clearly stated that there is no constitutional right for either euthanasia or PAS. There is also a moral distinction. The safeguards we think appropriate and necessary for permitting euthanasia or PAS are not necessary for terminating medical care... Such differences in safeguards bespeak different moral evaluations about stopping medical interventions and actively injecting a patient with a life-ending drug."
R.G. Frey, PhD, Professor of Philosophy at Bowling Green State University, in his chapter "Distinctions in Death" that appears in the 1998 book Euthanasia and Physician-Assisted Suicide: For and Against, argued:
"It has been widely remarked that passive euthanasia is relatively common in our hospitals (or in the homes of patients), and doctors do not all that reluctantly shy away from conceding that they take part in withdrawing treatment at the request of terminally ill patients. Yet...few doctors indeed concede that they supply, at the request of their terminally ill patients, pills that produce death. In the former case, the patient is on a life-support system, which the doctor may permissibly, at the request of the patient, withdraw; in the latter case, the patient is not on a life-support system, and the doctor may not permissibly, at the request of the patient, supply pills that produce death. It seems little short of incredible that the fact that a terminally ill patient is or is not on a life-support system could so transform cases, morally, when both cases show quite clearly that patient and doctor are acting together to bring about the patient's death at the instigation of the patient...
Withdrawing feeding tubes and starving the patient to death is permissible, supplying the patient with a pill that produces death is not. Yet both sorts of assistance assuredly produce death, and both sorts involve the patient and doctor acting together to produce that death. Notice, too, that both sorts of assistance are compatible with being rendered with the intention of relieving the patient's suffering. How can there be a moral difference between them, with these things the case?"
Lance K. Stell, PhD, Charles A. Dana Professor of Philosophy at Davidson College, in his chapter "Physician-Assisted Suicide: To Decriminalize or to Legalize, That is the Question," that appeared in the 1998 book, Physician Assisted Suicide: Expanding the Debate, claimed:
"The ideas that 'letting nature take its course' is inherently different from causing death and that a physician's abating life-sustaining treatment [passive euthanasia] at patient request is inherently different from physician-assisted suicide are philosophically untenable. One way to cause death is to 'let' nature take its course. One way for physicians to assist suicide, while remaining within their professional capacities, is for them to write orders that withhold or withdraw life-sustaining treatment at patient request. The latter claim implies only that it is possible for physicians to assist suicide by acting within their well-recognized authority to abate life-sustaining treatment at patient request. It does not imply that their abating life-sustaining treatment at patient request amounts to, constitutes, is equivalent to assisted suicide. To refute my modest claim, one would have to prove that it is not possible for physicians to assist suicide in this way. Further, I will argue that physician-assisted suicide (already effectively decriminalized) should be fully and formally decriminalized. It should not be 'legalized-but-strictly-regulated' unless such a regime would extend to medically managed, physician-facilitated deaths generally."
The U.S. 9th Circuit Court of Appeals, in the majority opinion from Compassion in Dying v. Washington (1996), wrote:
"...We see no ethical or constitutionally cognizable difference between a doctor's pulling the plug on a respirator [passive euthanasia] and his prescribing drugs which will permit a terminally ill patient to end his own life [physician-assisted suicide]. In fact, some might argue that pulling the plug is a more culpable and aggressive act on the doctor's part and provides more reason for criminal prosecution. To us, what matters most is that the death of the patient is the intended result as surely in one case as in the other. In sum, we find the state's interests in preventing suicide do not make its interests substantially stronger here than in cases involving other forms of death-hastening medical intervention. To the extent that a difference exists, we conclude that it is one of degree and not of kind."