Twenty-Five Years After Quinlan: A Review of the Jurisprudence of Death and Dying

Ethical, Cultural, Social, and Individual Considerations Prior to Transition to Limitation or Withdrawal of Life-Sustaining Therapies

“…Withholding or withdrawal of life-sustaining therapies (WLST) are considered morally [and legally] equivalent and accepted in many countries including Canada, United States, Europe, and Australia (1)(2)(3)(4)(5)(6)(7)(8)(9). In other countries, some permit withholding but not withdrawal of life-sustaining therapies; some permit both, and some permit both and hastening of a foreseeable death (1,10).…”

Are the Distinctions Drawn in the Debate about End-of-Life Decision Making “Principled”? If Not, How Much Does it Matter?

“…[A] medical patient's prerogative -grounded in self-determination and bodily integrity -to reject life-sustaining medical interventions.…attaches no matter how slight the bodily intrusions contemplated, no matter how long the patient's existence could potentially be preserved, and no matter how foolish the patient's decision might seem to health care providers and others. 120 So if and when a right to PAS is established in a case involving a terminally ill patient, presumably on the ground that there is no significant legal or ethical difference between PAS and the right to forgo LSMT, why would we expect the ruling to be limited to the terminally ill?…”

Legal Status of Physician-Assisted Suicide

“…The New Jersey Supreme Court decided to uphold her father's wish to disconnect Quinlan's ventilator, establishing the right to withdraw life-sustaining therapy from consenting adults in certain circumstances. 9 This case, along with Cruzan, not only allowed a patient to refuse lifesustaining treatment, but also allowed a surrogate to make that decision. This principle has been refined to include the right to refuse artificial nutrition and hydration, and the establish-ment of "best interests" standards, allowing a surrogate to substitute judgment in the best interests of an incapacitated patient when the wishes of the patient are unknown.…”

“…However, the courts have generally held that an individual's right to self-determination, including choices about death, outweighs a societal interest in the sanctity of life. 9 Indeed, PAS opponents 11 and the US Supreme Court 12 have already recognized the administration of escalating doses of pain relievers in order to alleviate discomfort as ethically and professionally acceptable, even when administered to achieve "terminal sedation," where the patient is likely to die because of the dosage of medication. Physicians are generally protected in these cases under the established principle of "double effect," wherein one act produces two inseparable effects: one good (relieving pain) and one bad (opiate sedation to the point of death).…”