Vermont Ethics Network
64 Main Street,Room 25,
Montpelier, VT 05602-2951
(802) 828-2909, Fax (802) 828-6558, ethics@vtethicsnetwork.org
For
a discussion of “Physician-assisted suicide” Some definitions and questions about language. (supplied by Dr. Arnold Golodetz for VEN Annual Meeting discussion 10/14/03.) |
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The Vermont Ethics Network does not have a position on Physician Assisted Suicide. These materials are presented to help the people of Vermont engage in a dialogue about this important ethical issue. |
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| Physician-assisted suicide (PAS): A
suicide facilitated by a physician’s
action(s), usually by the provision of a prescription for a potentially
lethal drug, knowing that the patient might use that drug at some
future time to end his life. The physician does not participate in
the actual administration of the drug. |
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| Physician aid-in-dying (PAD): An
alternative term used by persons who claim that in the situation
of terminally ill persons “suicide” is
an inappropriate term. However, the term could be used to conflate
PAS with every other way in which physicians seek to ease the process
of dying, such as Palliative Care. |
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| Euthanasia: Literally
means “a
good death” (a peaceful
or “tame” death). The word itself does not specify how
that is to be achieved. “ Euthanasia” in common usage means ending someone’s life with merciful intent, to relieve expressed or perceived suffering. In a more extreme sense, it means extinguishing “life not worthy to be lived”, on a political and ideologic basis – the “Nazi” sense. In the medical context, euthanasia means – a direct action taken by a physician with the primary intent of ending life. The paradigmatic case would be the injection of a substance that would immediately stop heart action. Two forms are: • Voluntary euthanasia – undertaken at the explicit, concurrent request of a competent patient. • Non-voluntary euthanasia – undertaken pursuant to advance directive or surrogate decision, the patient no longer being competent. [ “Involuntary” euthanasia means the ending of life without either patient or surrogate decision, usually for social policy purposes, as in Nazi Germany.] Voluntary and non-voluntary euthanasia is illegal everywhere in the United States and almost everywhere else. Note that, given these definitions, the proposed VT law does NOT license euthanasia The term “active euthanasia” covers the above meanings. One sometimes hears the term “passive euthanasia” applied to the discontinuance of life-support at the patient’s request, but that is a misnomer, since it is not the direct, intentional ending of life. |
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| Right to Die: The
popular use of the term implies that one has a right to determine
the time and manner of one’s death, but
it is not clear where the “right” comes from. There is
no such thing explicit in any form of U.S. law. However, proponents
claim a basis in “natural law”, invoking concepts of “liberty”, “autonomy” and “privacy”.
Given this way of thinking, the question remains “Is this right
a negative right, meaning one should be left alone to end one’s
own life, or a positive right, meaning an there is an obligation
on society to provide the help needed for directly ending life?”.
And if there is such a positive right, can society limit it to the
terminally ill, or can it be invoked by anyone who is tired of life? |
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| Right to Refuse Treatment: In
contrast, there is a firmly established right under the U.S. Constitution
that a competent adult can refuse
any offer of medical treatment for his own reasons (with rare exceptions),
and not just in “terminal” situations. And it is almost
as clear that this right can be exercised via advance directives.
(But note that in the non-terminal situation, there would often be
reason for doubting “competence” and thus for the exercise
of “weak paternalism” on the part of family and attendant
physicians.) |
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| “Death With Dignity”: Proponents
of laws permitting PAS use this label, suggesting that dignity
resides in having and
using a “right to die”. |
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Palliative Care (PC): The literal meaning in the medical context is “Care whose primary purpose is the relief of suffering”. As such, PC has a place in the care of almost any medical problem, at any stage of life, and is generally referred to as symptom-relief. However, given a situation in which the preservation of life is no longer a goal and relief of suffering is the predominant goal (“Palliative Care Only” or “Comfort Care Only”), PC becomes what can be called the comprehensive care of the dying, usually by a specially skilled multidisciplinary team, most often in hospice. |
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| Some legal points: Vermont has no statutory law forbidding suicide or assistance in suicide. (Some states do). However, the Attorney-General has some discretionary capability under common law for bringing an action against a physician who assists in suicide. Also, the physician is at some risk of federal action under the Controlled Substances Act. A clear act of euthanasia would classify as homicide. |
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