The problem of physician-assisted suicide

With the increasing acceptance of the right of patients to refuse life-sustaining treatment, some have argued that terminally ill patients have a corollary right to physician-assisted suicide (PAS) on request. However, there are important moral and legal distinctions between patients' refusals of therapy and requests for certain actions. Physicians must stop life-sustaining therapy when that therapy has been validly refused by patients. But physicians have no similar duty to provide actions, such as assistance in suicide, simply because they have been requested by patients. In deciding how to respond to patients' requests, physicians should use their judgment about the medical appropriateness of the request. The morality of PAS is debatable but it remains illegal in most jurisdictions. Advocates of legalizing PAS should fully understand three issues: (1) that such legalization would have a negative effect on the practice of palliative care and on the physician-patient relationship; (2) that legalization of voluntary euthanasia will follow the legalization of PAS; and (3) that involuntary euthanasia inevitably follows the legalization of voluntary euthanasia, as has occurred in the Netherlands over the past 12 years. Rather than suffer the harms resulting from legalizing PAS, our society should maintain its illegality and make an expanded effort to improve physicians' training and abilities to provide palliative care.