Schiavo case: Is Withholding Food and Fluid Euthanasia by Omission?

My view of the act of euthanasia is that of a physician or other person administering to the patient who requests to die some chemical which will itself cause the death and the death would not be due to the patient’s underlying illness. My view of the termination of life-support on the request of a patient is that the intent is not to kill the patient but the intent is to follow the patient’s autonomous request. A death following terminating life-support is, therefore, due to the patient’s underlying illness after the life-support is removed. This latter act is called by some “euthanasia by omission or neglect”.

Out of intellectual fairness, I would like to post here an excerpt from an article on the website of the Society for the Protection of Unborn Children. The article is titled “What is Euthanasia by neglect and why is it wrong?” by Anthony Ozimic (SPUC) and Dr John Fleming (SCBI). I strongly advise all my visitors, regardless of their views on this issue, to go to the website to read the entire article. I think in ethics it is always important to keep an “open mind” in all matters and be curious even about views one doesn’t hold. The excerpt from the article follows. ..Maurice.

One popular account of medical ethics, makes appeal to "the four principles":
1. non-maleficence (to avoid harm)
2. beneficence (to do good)
3. autonomy (the right to act freely) and
4. justice (acting fairly towards the patient).

Leaving aside the obvious shortcomings of such an abbreviated approach to medical ethics, we can nevertheless see how euthanasia by neglect violates all four principles:

1. Euthanasia by neglect is maleficent: it causes harm by killing a patient through a very long drawn out process of starvation and dehydration, a process which is uncomfortable and painful for the patient.

2. Euthanasia by neglect cannot be beneficent: A doctor is ethically and legally obliged to act in a patient's best interests. Intentionally killing the patient by neglect of reasonable care can never be in the patient's best interests.

3. Euthanasia by neglect extinguishes the autonomy of patients and diminishes the autonomy of doctors. Autonomy is not an absolute the exercise of which trumps all other considerations.. The patient must exercise his or her right to autonomy in a responsible and ethically sound manner. Both ethics and the law say that, just as we cannot sell ourselves into slavery, we cannot consent to be murdered. This is because the right to life, like the right to liberty, is inalienable. The obligation to respect the right to life extends to respecting one's own life. It is unethical to intentionally deprive oneself of life. Making euthanasia by neglect available to patients would lead to pressure on doctors and nurses to assist suicide and intentionally kill their patients by neglect. The effect of this is to significantly diminish their autonomy to practise their professional arts ethically, and according to their consciences and the Hippocratic Oath. Legalising assisted suicide and intentional killing by neglect of reasonable care turns a class of private citizens into public killers. It changes doctors and nurses from being healers and carers into poisoners and killers.

4. Euthanasia by neglect violates justice, the requirement to treat all patients impartially and to be fair when allocating health care resources. The possibility of euthanasia by neglect would lead to pressure (real or perceived) on the elderly and the chronically ill to cease being a burden on society, on the health service, and on their relatives. Legalising euthanasia by neglect reduces the patient from being an individual to whom the doctor has a professional obligation, into a utile, a unit in a utilitarian system of healthcare rationing, with an implied duty to die if they became too difficult or time-consuming or expensive to treat.