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For a discussion
of “Physician-assisted suicide” – Some
Definitions (supplied by Dr. Arnold Golodetz for VEN Annual Meeting discussion 10/14/03.) |
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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. | |
| 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. | |
| Euthanasia | |
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:
Note that, given these definitions, the proposed VT law does
NOT license euthanasia |
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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? | |
| Right to Refuse Treatment | |
| 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.) | |
| “ Death With Dignity” | |
| Proponents of laws permitting PAS use this label, suggesting that dignity resides in having and using a “right to die”. | |
| Palliative Care (PC) | |
| 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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