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Dr Campbell presents proponents of euthanasia with a dilemma.¹ Only voluntary euthanasia is permissible; involuntary euthanasia is always impermissible. The question of allowing euthanasia arises most frequently when patients are terminally ill and experiencing great pain. But in these cases, he argues, if patients request euthanasia, their decision “is not freely chosen but is compelled by the pain”.² It is easy to exaggerate the problem here; patients may have periods when they are pain-free and affirm repeatedly their desire that death be hastened. Putting this aside, however, what should we conclude if euthanasia performed on patients who are suffering greatly is not voluntary?

Dr Campbell concludes: “If the request to end one's life is not made freely, then it is doubtful that such requests ought to be followed”.² An advance directive will not help, we are …