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J Med Ethics doi:10.1136/medethics-2013-101379
  • Editorial

A simple solution to the puzzles of end of life? Voluntary palliated starvation

  1. Julian Savulescu
  1. Correspondence to Professor Julian Savulescu, Faculty of Philosophy, The Oxford Uehiro Centre for Practical Ethics, Suite 8, Littlegate House, Oxford OX1 1PT, UK; julian.savulescu{at}philosophy.ox.ac.uk
  • Received 22 January 2013
  • Accepted 12 February 2013
  • Published Online First 18 July 2013

Should people be assisted to die or be given euthanasia when they are suffering from terminal medical conditions? Should they be assisted to die when they are suffering but do not have a ‘diagnosable medical illness?’ What about assisted dying for psychiatric conditions? And is there a difference morally between assisted suicide, voluntary active euthanasia and voluntary passive euthanasia?

These are deep questions directly addressed or in the background of the productive discussion between Varelius and Young.1 ,2 Their focus is whether doctors should assist people to die who are ‘tired of life’ and experiencing ‘existential suffering’. An example was Edward Brongersma, an 86-year-old man, who was tired of life but with no serious medical condition, who was assisted by Dr Philip Sutorius to commit suicide in 1998. In the Netherlands, where euthanasia is legal, the Dutch Supreme Court ruled in 2002 that this was wrong because (m)edical expertise, by its nature, does not extend to questions and complaints that do not have a sick- ness or ailment—mental or physical—as their source.3

Sutorius was convicted, but not punished.

Robert Young, considering this case, concurs, concluding, a physician may justifiably consider that an individual who is ‘tired of life’ should consult a non-medical, professional counsellor, and if that produces no change in outlook, choose suicide. Outside Switzerland, an individual who makes that choice has to then be determined enough to do so unassisted (notwithstanding that the consequences for others may be distressing).2

I will argue that there is, within current medical ethics and human rights, a method of assisted suicide which could fall within the limits of the law. But first I will review some recent cases involving requests for dying. I will then discuss an alternative which some may argue addresses these cases, and those of …

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