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Conrad Notes
a timely medical meeting newsletter
PHYSICIAN-ASSISTED SUICIDE (PAS) - ULTIMATE RIGHT
M. Angell, MD, New England Journal of Medicine, Boston, Mass, favors PAS under certain cicumstances but opposes euthanasia. PAS honors patient autonomy and allows the physician to give compassionate palliative care. The public seems to favor PAS by failing to see a difference between withdrawing life support and giving higher doses of intravenous morphine.

PAS and euthanasia We must define both procedures. PAS, according to Angell, consists of prescribing an overdose of a sedative or other medication for a dying patient to take but, only when desired by the patient. In contrast, euthanasia does not require patient approval and puts the physician in charge of direct injection of the lethal agent. In a recent editorial (N Eng J Med 1997;336: 50-53), Angell notes that PAS is "...more active than switching off a ventilator but less active than injecting drugs, hence morally and legally more ambiguous." PAS honors patient autonomy. With assured palliative care, PAS will lessen the moral ambiguity and agony of dying.
Patient rights and physician responsibility Our United States laws, requiring informed consent for any treatment, protect patient rights including self-determination. Respect for patient autonomy continues as a very important principle in medicine along with physician responsibility. PAS honors patient rights and encourages physicians to behave compassionately by providing palliative care.
Comments The Supreme Court must decide whether states can forbid PAS. If the Court agrees that PAS is protected by the Constitution, all states will follow. Allowing PAS in the United States would end some of the current double speak of the physician to the dying patient and family.

For an opposing view, see "Physician-Assisted Suicide (PAS) - Not Needed" in this issue of CONRAD NOTES.

Eugene A. Conrad

Presented at the Annual Meeting of the American Society of Clinical Oncology (ASCO) on May 17-20, 1997
CONRAD NOTES, © 1997 All Rights Reserved
Eugene A. Conrad, PhD, MPH / ISSN 1078 / June 1997

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