Debates on Euthanasia and the Right to Die

Philosophical and legal debate over euthanasia turns on several cross-cutting distinctions: active euthanasia, in which a third party directly causes death (for instance, by lethal injection), versus passive euthanasia, in which life-sustaining treatment is withheld or withdrawn, allowing an underlying condition to cause death; and voluntary euthanasia, requested by a competent patient, versus non-voluntary euthanasia, performed on a patient unable to consent (such as one in a persistent vegetative state), versus involuntary euthanasia, performed against a competent patient's wishes — the last of these condemned by essentially all parties to the debate. Physician-assisted suicide is typically distinguished from euthanasia proper in that the physician provides the means (commonly a lethal prescription) but the patient, not the physician, performs the final act. James Rachels, in his widely cited 1975 article "Active and Passive Euthanasia" in the New England Journal of Medicine, argued that the traditional moral and legal distinction between active and passive euthanasia is unsustainable, since allowing a patient to die when one could easily save them can be exactly as culpable as directly killing them, and that focusing on the active/passive distinction — rather than on the patient's actual interests and consent — can lead to worse outcomes, such as prolonging a dying patient's suffering through a slower, more painful passive death.