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Medicine and Public Policy |

Assisted Suicide Compared with Refusal of Treatment: A Valid Distinction?

Franklin G. Miller, PhD; Joseph J. Fins, MD; Lois Snyder, JD, University of Pennsylvania Center for Bioethics Assisted Suicide Consensus Panel
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From the University of Virginia, Charlottesville, Virginia; New York, New York; and University of Pennsylvania Center for Bioethics, Philadelphia, Pennsylvania.


This paper was developed by the Assisted Suicide Consensus Panel as part of the Finding Common Ground Project of the University of Pennsylvania Center for Bioethics. The paper was authored on behalf of the Panel by Franklin G. Miller, PhD; Joseph J. Fins, MD; and Lois Snyder, JD. Members of the Assisted Suicide Consensus Panel were Arthur L. Caplan, PhD (Chair); David A. Asch, MD, MBA; Rev. Ralph Ciampa; Kathy Faber-Langendoen, MD; Joseph F. Fins, MD; John Hansen-Flaschen, MD; Barbara Coombs Lee, FNP, JD; Franklin G. Miller, PhD; Sally J. Nunn, RN; David Orentlicher, MD, JD; Timothy E. Quill, MD; Elliot Rosen, EdD; James A. Tulsky, MD; and Lois Snyder, JD (Project Director). Barbara Coombs Lee, David Orentlicher, and Timothy E. Quill dissented from the paper. Primary clinical staff to the Panel was Jason Karlawish, MD. Additional staffing was provided by Jennifer Klocinski.

Grant Support: The Walter and Elise Haas Fund and the Wallace Alexander Gerbode Foundation supported the development of this paper and the Finding Common Ground Project on Assisted Suicide.

Requests for Single Reprints: Lois Snyder, JD, Center for Bioethics, University of Pennsylvania Health System, 3401 Market Street, Suite 320, Philadelphia, PA 19104-3308; e-mail, lsnyder@mail.acponline.org.

Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints@mail.acponline.org.

Current Author Addresses: Dr. Miller: 3910 Underwood Street, Chevy Chase, MD 20815.

Dr. Fins: Weill Medical College of Cornell University, 525 East 68th Street, Box 297, New York, NY 10021.

Ms. Snyder: Center for Bioethics, University of Pennsylvania Health System, 3401 Market Street, Suite 320, Philadelphia, PA 19104-3308.


Ann Intern Med. 2000;132(6):470-475. doi:10.7326/0003-4819-132-6-200003210-00008
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The continuing debate over the deeply controversial issue of physician-assisted suicide has been complicated by confusion about how this practice resembles or differs from refusal of life-sustaining treatment. Perspectives on ethics and policy hinge on the contested issue of whether a valid distinction can be made between assisted suicide and withdrawal of treatment. This paper uses three illustrative cases to examine leading arguments for and against the recognition of a fundamental distinction between these practices. The first case involves assisted suicide by ingestion of prescribed barbiturates, the second involves withdrawal of artificial nutrition and hydration, and the third involves a decision to stop eating and drinking. On theoretical and practical grounds, this paper defends the position that there is a valid distinction between assisted suicide and refusal of treatment.

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