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April 22/29, 1998

Deciding Life and Death in the Courtroom: Debate and Clarification

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(16):1259-1261. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-16-jac80007

To the Editor.—In his article, Mr Gostin1 makes a mistake common to many, especially in our court system (eg, Quill v Vacco2). Patients from whom artificial hydration and nutrition are removed because it is ineffective do not die of starvation. Rather, they die of the existing pathology that had been circumvented by artificial hydration and nutrition. Moreover, ethical actions are not judged solely by physical results. Rather, they are evaluated by the proximate intention that brings about the physical results. Thus, although the results of assisted suicide and withdrawing ineffective life support are similar from a physical perspective, from an ethical point of view, they are diametrically opposed.