Physician assisted suicide, euthanasia, or withdrawal of treatment

BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7101.137 (Published 19 July 1997) Cite this as: BMJ 1997;315:137

Distinguishing between them clarifies moral, legal, and practical positions

  1. Larry R Churchilla, Professor of social medicine,
  2. Nancy M P King, Associate professor of social medicineaa
  1. a University of North Carolina, Chapel Hill, NC 27599-7240, USA

    The Supreme Court of the United States has returned the vexing question of physician assisted suicide to state governments. In unanimous rulings last month, Chief Justice Rehnquist, writing for the court, held that there is no fundamental right to assistance in committing suicide1 and that, legally, distinguishing between refusing life saving medical treatment and requesting assistance in suicide “comports with fundamental legal principles of causation and intent.”2

    By its rulings, the Supreme Court invalidated the decisions of two of the American Courts of Appeal. In March 1996 the appeals court for the Ninth Circuit had lifted a ban by Washington state on physician assisted suicide in Compassion in Dying v Washington.3 That court, which has jurisdiction in 13 western states, including Hawaii, had concluded that “a competent adult … has a strong liberty interest in choosing a dignified and humane death”—including not just refusal of treatment but also “hastening one's own death.” However, the Supreme Court held that the interest in question, which Chief Justice Rehnquist characterised as the “right to commit suicide with another's assistance,” is not one of the “fundamental rights and liberties … “deeply rooted in this Nation's history and tradition'.”

    Unequal rights

    Also, in April 1996 the appeals court for the Second Circuit, which includes Massachusetts, Vermont, and New York, had ruled in Quill v Vacco that the New York statutes criminalising assisted suicide for the terminally ill were unconstitutional in their effect on terminally ill people.4 The appeals court had reasoned that, because existing laws allow terminally ill people to request removal of life sustaining medical interventions and to receive palliative drugs that may hasten death, those who wish to hasten their death but are not dependent on life sustaining technology are treated unequally.

    Hence, the court held that equal protection under …

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