Drawing the line on physician-assisted death

Lynn A. Jansen, Steven Wall, Franklin G. Miller

Drawing the line on physician-assisted death


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.

Jansen LA, Wall S, Miller FG. Drawing the line on physician-assisted death. J Med Ethics. 2019;45:190-197.

Changing the Conversation About Brain Death

The American Journal of Bioethics, 14:8, 9-14 (2014) DOI: 10:1080/15265161.2014.925154

Robert D. Truog, Franklin G. Miller

  • We seek to change the conversation about brain death by highlighting the distinction between brain death as a biological concept versus brain death as a legal status. The fact that brain death does not cohere with any biologically plausible definition of death has been known for decades. Nevertheless, this fact has not threatened the acceptance of brain death as a legal status that permits individuals to be treated as if they are dead. The similarities between “legally dead” and “legally blind” demonstrate how we may legitimately choose bright-line legal definitions that do not cohere with biological reality. Not only does this distinction bring conceptual coherence to the conversation about brain death, but it has practical implications as well. Once brain death is recognized as a social construction not grounded in biological reality, we create the possibility of changing the social construction in ways that may better serve both organ donors and recipients alike.[Full text]



American ethicists assert that moral norm against killing is unnecessary

Walter Sinnott-Armstrong (Duke University) and Franklin G. Miller (National Institutes of Health) have published a paper titled, “What makes killing wrong?”  Their conclusion is that killing is wrong because it causes total disability, and that the moral rule against killing is superfluous.  After asserting that current organ transplant practice involves taking vital organs from people who are still alive (as they understand that term) they suggest that more organs could be made available for transplant if the requirement for donor death were dropped and replaced with the criterion of total disability.  In the course of the paper they suggest that religious beliefs should not inform medical ethics “in any religiously diverse society,” which would appear to imply that medical professionals should be expected to adopt the views they propose.  The paper illustrates, at several points, how conflicts of conscience may arise during end-of-life decision making and organ transplantation.