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Drawing the line on physician-assisted death

Lynn A Jansen1, Steven Wall2, Franklin G Miller3

  • 1The Center for Ethics in Health Care, Oregon Health & Science University, Portland, Oregon, USA.

Journal of Medical Ethics
|November 23, 2018
PubMed

Insights

Physician-assisted death (PAD) should be restricted to the terminally ill. Arguments from fairness-based paternalism and the social meaning of medicine support limiting PAD, especially for non-terminally ill patients.

Area of Science:

  • Medical Ethics
  • Bioethics
  • Legal Medicine

Background:

  • Physician-assisted death (PAD) is a growing medical practice with expanding legal acceptance.
  • Determining the appropriate scope of PAD is a pressing ethical and legal challenge.
  • Current debates involve PAD for both terminally ill and non-terminally ill patient groups.

Purpose of the Study:

  • To present an argument for restricting PAD to terminally ill patients.
  • To explore the ethical considerations of fairness-based paternalism and the social meaning of medical practice in relation to PAD.
  • To analyze the implications of these principles for extending PAD to non-terminally ill populations.

Main Methods:

  • Philosophical argumentation
  • Ethical analysis
  • Legal interpretation
  • Case study analysis (treatment-resistant depression)

Main Results:

  • The principles of fairness-based paternalism and the social meaning of medicine provide a strong ethical basis for limiting PAD to the terminally ill.
  • These principles are less compelling when applied to proposals for extending PAD to non-terminally ill patients.
  • The case of non-terminally ill patients with treatment-resistant depression presents a significant challenge to this restriction.

Conclusions:

  • A principled argument exists for restricting PAD to the terminally ill, grounded in fairness and the societal role of medicine.
  • Extending PAD beyond the terminally ill, particularly to those with conditions like treatment-resistant depression, requires careful ethical consideration.
  • The debate on PAD necessitates a nuanced understanding of medical ethics, patient autonomy, and societal values.

Keywords:
clinical ethicsend-of-lifepaternalismpsychiatrypublic policy

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