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Psychiatrist-in-training Daniel Gorman won the first prize of $1500 in CMAJ's 1998 Logie Medical Ethics Essay Contest with this lively discussion about the 2 types of euthanasia. The entry deadline for the 1999 contest is June 1. Check entry instructions in CMAJ (160:315 [English] or 160:388 [French]) or at www.cma.ca /inside/awards/logie.htm.
Passive euthanasia is defined as allowing a patient to die by withholding treatment, while active euthanasia is defined as taking measures that directly cause a patient's death. The CMA supports the commonly held view that passive euthanasia is morally permissible in certain circumstances while active euthanasia is always wrong. In its policy summary on physician-assisted death, the CMA stated that both euthanasia and assisted suicide fall under this heading and said CMA members "should specifically exclude participation in" either practice. But the definition of physician-assisted death is qualified: "Physician-assisted death, as understood here, does not include the withholding or withdrawal of inappropriate, futile or unwanted medical treatment or the provision of compassionate palliative care, even when these practices shorten life."'
Two recent cases involving physician-assisted death not only illustrate the difference between passive and active euthanasia but also raise the question of whether active euthanasia should sometimes be allowed.
Case 1: Dr. Claudio de la Rocha
In October 1991, Ms. A, who had lung cancer and had been placed on a respirator at the former St. Mary's Hospital in Timmins, Ont., informed family members that she wanted a breathing tube removed so that her suffering would end. They supported her decision and conveyed it to de la Rocha. In accordance with standard practice, he removed the tube and administered 40 mg of morphine in 3 doses to ensure that she did not experience a suffocating feeling. He broke with standard practice, however, by then administering potassium chloride, causing her heart to stop.
In April 1993 he was convicted in criminal court of administering a noxious substance. His sentence was suspended, however, and he was given 3 years' probation. In an April 1995 hearing before the Discipline Committee of the College of Physicians and Surgeons of Ontario he was charged with professional misconduct because of the conviction in court, as well as failure to maintain the standard of practice. He pleaded...