Euthanasia and Senicide

"Euthanasia" is a word coined from the Greek language (eu, good or noble; thanatos, death) in the seventeenth century by Francis Bacon to refer to an easy, painless, happy death. It has now come to mean the active causation of a patient's death through the injection of a lethal dose of medication. Euthanasia differs from assisted suicide, in which the patient self-administers a lethal dose of a compound, usually prescribed by a physician who knows the patient intends to use it to end his or her life.

Assisted suicide and euthanasia differ from a patient's right to refuse or withdraw from unwanted treatment even if that refusal or withdrawal may cause death. The right to refuse or withdraw from unwanted treatment is based on the principle of informed consent that underlies the practice of medicine. That is it is the right of every patient, whether terminally ill or not, and has nothing per se to do with hastening death.

The difference between the two was affirmed by the U.S. Supreme Court in a case in which proponents of assisted suicide challenged a New York law prohibiting it (Vacco v. Quill). They invoked the equal protection clause of the Fourteenth Amendment to the Constitution to argue that patients denied euthanasia were not being given the same right to hasten death as patients who could do so by choosing to withdraw from life support. The Supreme Court rejected their contention that the right to refuse life-sustaining medical treatment "is nothing more or less than assisted suicide."

The Court based its analysis on intent and causation, two legal principles used to distinguish acts that may have the same result. Under a causation analysis, the Court reasoned that a patient who refuses life-sustaining medical treatment dies from an underlying disease; a patient who self-administers lethal medication prescribed by a physician is killed by the medication. The physician's intent is different in the two situations; a doctor withdrawing or not administering treatment is complying with a patient's wishes, whereas a doctor assisting in a patient's suicide intends that the patient die.

Moreover, a patient who commits suicide with the help of a doctor has the specific intention of ending his or her life; a patient refusing or discontinuing treatment may not. Refusal of life-sustaining treatment is not identical with assisted suicide and everyone, regardless of physical condition, is entitled, if competent, to refuse life-sustaining medical treatment, whereas no one is allowed to assist a suicide. Thus the law applies evenhandedly to all, and protects all equally.