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June 4, 1997

Does It Make Clinical Sense to Equate Terminally III Patients Who Require Life-Sustaining Interventions With Those Who Do Not?

Author Affiliations

From the Program in Medical Ethics, the Center for AIDS Prevention Studies, and the Division of General Internal Medicine, University of California, San Francisco.

JAMA. 1997;277(21):1705-1708. doi:10.1001/jama.1997.03540450061036

Two US courts of appeals have ruled that competent, terminally ill patients have a constitutional right to physician-assisted suicide. The cases are now before the US Supreme Court, which is expected to issue a ruling later this year. This article analyzes the keystone of the courts' ruling: their assertion that competent, terminally ill patients who are being kept alive on life support are equivalent to competent, terminally ill patients who do not require such support. Because the former are permitted to end their lives by refusing treatment, the courts found that the latter also have a right to determine the time and manner of their death, through prescriptions for lethal doses of medication. This article analyzes whether the courts' thinking is premised on a clinically plausible view of the care of terminally ill patients. Based on a discussion of common situations involving terminal illness, we argue that the courts' reasoning is deeply flawed. The article also analyzes how the implications of the courts' reasoning might undermine the care of terminally ill patients.