Causing, Intending, and Assisting Death

Abstract

Are there morally compelling differences among allowing a patient to die by forgoing treatment, physician-assisted suicide, and active euthanasia? And what follows for medical ethics and public policy if these differences do or do not exist? Recently, Edmund D. Pellegrino has forcefully restated an old argument in defense of a compelling difference: in active euthanasia or physician-assisted suicide, the physician causes the patient's death, while in forgoing treatment, the disease causes the patient's death. Similarly, Raymond J. Devettere has argued that what makes active euthanasia immoral is that the physician directly intends the patient's death, while in forgoing treatment, the physician does not intend the patient's death. I have two purposes in this article. The most obvious is to contend that these two arguments based on causation and intention fail to do the work we ask of them, but in the end, that failure does little to illuminate what public policy ought to be on physician-assisted suicide or active euthanasia. The less obvious purpose is to try to illustrate and develop a key concept in the rediscovery of casuistry as a methodology in medical ethics.