Does it make clinical sense to equate terminally ill patients who require life-sustaining interventions with those who do not?
A. Alpers and B. Lo
Program in Medical Ethics, University of California, San Francisco, USA. ann_alpers@ucsfdgim.ucsf.edu
Two US courts of appeals have ruled that competent, terminally ill patients
have a constitutional right to physician-assisted suicide. The cases are
now before the US Supreme Court, which is expected to issue a ruling later
this year. This article analyzes the keystone of the courts' ruling: their
assertion that competent, terminally ill patients who are being kept alive
on life support are equivalent to competent, terminally ill patients who do
not require such support. Because the former are permitted to end their
lives by refusing treatment, the courts found that the latter also have a
right to determine the time and manner of their death, through
prescriptions for lethal doses of medication. This article analyzes whether
the courts' thinking is premised on a clinically plausible view of the care
of terminally ill patients. Based on a discussion of common situations
involving terminal illness, we argue that the courts' reasoning is deeply
flawed. The article also analyzes how the implications of the courts'
reasoning might undermine the care of terminally ill patients.
