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 h ave a corollary right to physician-assisted suicide (PAS) on request. However, there are important moral and legal distinctions between pati ents' 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 ac tions, such as assistance in suicide, simply because they have been re quested by patients. In deciding how to respond to patients' requests, physicians should use their judgment about the medical appropriatenes s of the request. The morality of PAS is debatable but it remains ille gal in most jurisdictions. Advocates of legalizing PAS should fully un derstand three issues: (1) that such legalization would have a negativ e effect on the practice of palliative care and on the physician-patie nt relationship; (2) that legalization of voluntary euthanasia will fo llow the legalization of PAS; and (3) that involuntary euthanasia inev itably follows the legalization of voluntary euthanasia, as has occurr ed in the Netherlands over the past 12 years. Rather than suffer the h arms resulting from legalizing PAS, our society should maintain its il legality and make an expanded effort to improve physicians' training a nd abilities to provide palliative care.