An Alternative to PhysicianAssisted Suicide

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An Alternative to Physician-Assisted
Suicide Bernard Gert, Charles M. Culver, and
K. Danner Clouser
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AN ALTERNATIVE TO PAS I

• According to Gert, Culver, and Clouser (hereafter
  GCC) a dying patient may refuse food and fluids
  to bring about his or her death. Doing so is a
  form of voluntary passive euthanasia (VPE) when
  the patients right to refuse is recognized by
  her physician. VPE is complying with the
  rational refusal of life-saving treatment or food
  and fluids by a competent patient.
• A physicians failure to comply with such a
  refusal is itself morally prohibited, for it is
  an unjustified deprivation of the patients
  freedom.
• Recognizing a patients refusal of food and
  fluids is not killing the patient since there is
  no duty to overrule a rational refusal by a
  competent patient.

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AN ALTERNATIVE TO PAS II

• Refusing food and fluids to bring about the death
  of a terminally-ill patient is an alternative to
  physician-assisted suicide (hereafter PAS) that
  they think significantly weakens arguments in
  favor of legalizing PAS. (Where, in PAS, a
  doctor provides a lethal quantity of sedating
  medication to a patient who subsequently ingests
  it and dies.)
• They do not claim that PAS is in itself morally
  unacceptable, only that it may create a serious
  risk of unwanted deaths. (Death is final, and
  during the time that it takes to die from
  stopping eating and drinking a patient has time
  to change his or her mind.)

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REFUSAL OF TREATMENT AND THE DUTIES OF A PHYSICIAN

• According to GCC, a physician has a duty to
  recognize and respect a patients refusal of
  treatment even when that treatment would save the
  patients life.
• They maintain that the physician has such a duty
  when the patient is competent and informed and so
  understands that, in refusing treatment, he or
  she will die.
• Physicians have this duty since Overruling a
  competent patients rational refusal of
  treatment, including life preserving treatment,
  always involves depriving the patient of freedom,
  and usually involves causing him pain.

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PHYSICIAN DUTIES AND KILLING PATIENTS

• GCC maintain that doctors who have a duty to
  provide life-saving treatment for their patients
  kill their patients if they do not provide that
  treatment.
• Not treating counts as killing only when there
  is a duty to treat in the absence of such a
  duty, not treating does not count as killing.
• Doctors have no duty to treat patients who refuse
  treatment, and it makes no moral difference
  whether the physician stops treating by an act,
  e.g. turning off the respirator, or an omission,
  e.g. not giving antibiotics.

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STOPPING FOOD AND FLUIDS

• GCC say that the discontinuation of fluids
  typically results in unconsciousness in a week,
  and death in two weeks.
• They say that it is not physically unpleasant or
  painful if there is even minimal nursing care.
• However, they then say that it is usually
  painless, and that the time it takes to die is
  short enough that significant relief from pain
  and suffering is gained.
• They admit that there may be psychological
  difficulties that are involved in the longer time
  that it takes to die from stopping food and
  fluids and so some patients may still prefer PAS
  to discontinuing food and fluids.

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GCC AND PAS

• GCC think that refusing food and fluids is a
  better option for patients and society to result
  in patient death than PAS.
• They think that the potential risks of PAS are
  greater than the potential rewards of PAS, and it
  ought not to be legalized for this reason. In
  the real world there are misunderstandings and
  not everyone is completely moral and
  trustworthy.
• They do admit that other people may see things
  differently and think that the rewards of PAS
  outweigh its risks. And they recognize that all
  may not agree with their preference of stopping
  food and fluids over PAS especially as the
  former, in taking longer time, and perhaps in
  involving some suffering, may have psychological
  difficulties that PAS does not.

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GCC VS. PAS AND VAE

• GCC Given present knowledge and technology, one
  can kill a patient or allow a patient to kill
  herself absolutely painlessly within a matter of
  minutes.
• Given that this is the case, should patients who
  would choose either PAS or VAE over a slow death
  from lack of food and fluids (VPE) be denied that
  opportunity by society?