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THE CASE FOR LEGALIZED EUTHANASIA FRANKLIN G. MILLER* andJOHN C. FLETCHERt The recent referendum to legalize voluntary, active euthanasia in Washington state, which was narrowly defeated, has stimulated increased public discussion of this troubling ethical issue. In this paper we examine two recent statements against euthanasia, which together pose a seemingly formidable array of considerations against legalizing physician assistance of patients who request to die owing to terminal illness and unbearable suffering. One way to test a controversial moral position such as the legalization of euthanasia, which departs from the tradition of social morality and from traditional medical ethics, is to weigh the merit of the arguments against it. We offer a critique of these arguments and a different ethical view of the issues. In the last part of this paper, we recommend guidelines for a public policy framework to minimize abuses in social experiments with beneficent voluntary euthanasia that are approved by referenda or state legislatures. Such a framework was lacking in the Washington initiative and also to an extent in the Netherlands , where the practice of physician-performed euthanasia has become institutionalized but remains technically illegal. "Always to Care, Never to Kill" Under the heading "Always to Care, Never to Kill," thirteen1 Jewish and Christian theologians, philosophers, and legal scholars issued a The authors are grateful to RichardJ. Bonnie andJames F. Childress for their searching and thoughtful reviews; and to Mary Faith Marshall, Edward M. Spencer, Paul A. Lombardo , Thomas H. Hunter, and Edward W. Hook for their critical and helpful comments. *Instructor, Medical Education, University of Virginia. tProfessor, Internal Medicine, and professor, Religious Studies, University of Virginia. Correspondence address: Center for Biomedical Ethics, Box 348 Health Sciences Center , University of Virginia, Charlottesville, Virginia 22908. 'The authors include: Hadley Arkes, Amherst College; Matthew Berke, First Things Magazine; Midge Decter, Institute on Religion and Public Life; Rabbi Marc Gellman, Hebrew Union College; Robert George, Princeton University; Pastor Paul Hinlicky, Lu-© 1993 by The University of Chicago. All rights reserved. 0031-5982/93/3602-0815$01.00 Perspectives in Biology and Medicine, 36, 2 ¦ Winter 1993 159 strong statement against euthanasia, published in The Wall StreetJournal [I]. The authors' argument condemns the practice of euthanasia by appeals to "religious wisdom," "moral wisdom," "political wisdom," and "institutional wisdom." We consider seven assertions that the authors make in defense of their position. 1."Although it may sometimes appear to be an act of compassion, killing is never caring."—It is widely considered humane treatment of animals "to put them out of their misery" when they sustain incurable, disabling injuries or diseases. Why is compassionate treatment of animals not compassionate when applied to humans? To kill innocent humans against their will or without their consent would be profoundly immoral. Killing incompetent patients who have never expressed a clear wish to be killed is prima facie morally wrong, even if they are terminally ill. But the issue at stake in the Washington referendum was the permissibility of killing competent patients who request to die owing to suffering from an incurable condition. Why is this "never caring"? Admittedly, caring may be misplaced. But to kill another who requests to be relieved of suffering may be an act of compassion or caring, whether or not it is considered morally legitimate. Caring is tacitly defined by the authors as conformity with traditional morality. 2.There is a profound moral distinction ("deeply embedded in our moral and medical traditions") between hilling and allowing to die.—James Rachels has vigorously attacked the moral significance of this distinction. According to Rachels, "If a doctor lets a patient die, for humane reasons, he is in the same moral position as if he had given the patient a lethal injection for humane reasons" [2]. Rachels's argument may go too far, and he does not address adequately why some physicians consider physicianperformed euthanasia morally objectionable under all circumstances. It seems highly dubious, however, that there is a morally decisive distinction between killing patients and allowing them to die, such that the former is always wrong and the latter is justified when the burdens of treating a terminally ill patient outweigh the benefits to the patient. Indeed, there may be cases when killing...

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