Distinguishing between active and passive euthanasia.

The standard ways of distinguishing between active and passive euthanasia, act versus omission, and removal of ordinary versus removal of extraordinary care, do not have any clear moral significance. We have used particular aspects of the physician-patient relationship to make a morally significant distinction between active and passive euthanasia. Passive euthanasia is defined as the physician's abiding by the rational valid refusal of life-sustaining treatment of a patient or his surrogate decision-maker. Understanding passive euthanasia in this way makes it clear why, everything else being equal, there is no morally significant difference between discontinuing a treatment and not starting it, for example, taking a patient off a respirator versus not putting him on in the first place. It also makes clear why stopping the feeding and hydration of some patients is not merely morally permissible but is morally required. Patients may make a rational valid refusal of food and fluids just as they may of other kinds of life support, and what patients rationally refuse when competent holds its force when they become incompetent. By basing the distinction between active and passive euthanasia on the universally recognized moral force of a rational valid refusal, we have provided a clear foundation for the moral significance of this distinction. Our way of making the distinction preserves for patients the control over their lives that has sometimes been unjustifiably taken from them. It also eases the burden on doctors who no longer are forced to make use of ad hoc and confused distinctions in which they justifiably have little faith.(ABSTRACT TRUNCATED AT 250 WORDS)