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Drawing the line on physician-assisted death
  1. Lynn A Jansen1,
  2. Steven Wall2,
  3. Franklin G Miller3
  1. 1The Center for Ethics in Health Care, Oregon Health & Science University, Portland, Oregon, USA
  2. 2Philosophy, University of Arizona, Tucson, Arizona, USA
  3. 3Weill Cornell Medical College, New York City, New York, USA
  1. Correspondence to Dr Lynn A Jansen, The Center for Ethics in Health Care, Oregon Health & Science University, Portland, OR 97239, USA; jansen{at}


Drawing the line on physician assistance in physician-assisted death (PAD) continues to be a contentious issue in many legal jurisdictions across the USA, Canada and Europe. PAD is a medical practice that occurs when physicians either prescribe or administer lethal medication to their patients. As more legal jurisdictions establish PAD for at least some class of patients, the question of the proper scope of this practice has become pressing. This paper presents an argument for restricting PAD to the terminally ill that can be accepted by defenders as well as critics of PAD for the terminally ill. The argument appeals to fairness-based paternalism and the social meaning of medical practice. These two considerations interact in various ways, as the paper explains. The right way to think about the social meaning of medical practice bears on fair paternalism as it relates to PAD and vice versa. The paper contends that these considerations have substantial force when directed against proposals to extend PAD to non-terminally ill patients, but considerably less force when directed against PAD for the terminally ill. The paper pays special attention to the case of non-terminally ill patients who suffer from treatment-resistant depression, as these patients present a potentially strong case for extending PAD beyond the terminally ill.

  • end-of-life
  • paternalism
  • psychiatry
  • public policy
  • clinical ethics

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  • Contributors LAJ, SW and FGM all participated in drafting this manuscript by making substantial contributions to the writing, editing and revising of the manuscript. All authors also made substantial contributions to the design and conception of the manuscript and provided final approval of the completed manuscript. All authors accept accountability for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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