Euthanasia Case - Moral Fictions and Medical Ethics - Miller, Truog and Brock

In their journal article Moral Fictions and Medical Ethics, Miller, Truog and Brock challenge the existing societal norms with regard to the moral assessment of the two cases of euthanasia discussed, i.e. withdrawal of life-sustaining treatment and administering a lethal dose of medication. The two cases they reviewed pertain to John and Sam, both quadriplegics as a result of accidents, with the key difference of John still being reliant on a mechanical ventilator, whereas Sam has gained the ability to breathe spontaneously. Both desire a quick and peaceful death by means of euthanasia. The authors used the two subjects to contend that active euthanasia (lethal injection) should also be morally permissible, and consequently legally permissible, since it is no different from passive euthanasia (withdrawal of life-sustaining treatment), which is legally permissible, when the underlying moral fictions are expunged.

Moral fictions, which are motivated false beliefs that uphold entrenched moral views of the society at large, were used to reinforce the authors' argument that established norms regarding withdrawing of life-sustaining treatment are mistaken. The first series of moral fictions they exposed pertain to the description of withdrawing life-sustaining treatment. At present, this practice isn't considered as suicide, but if suicide were taken to be literally aiming at and causing one's own death, it follows that John's request to withdraw life-sustaining treatment is really suicidal, similar to Sam's request for lethal injection. Moreover, the clinicians who accede to these requests engage in the act of assisted suicide.

The second moral fiction refers to the cause of death when life-sustaining treatment is withdrawn. According to medical ethics and the law, it is the illness, i.e. the spinal cord injury and inability to breathe spontaneously in John's case, that causes death and not the act of disconnecting the ventilator. Miller, Truog, and Brock criticize this notion and attribute the cause of death to the act of disconnecting the ventilator. In short, they challenge the status quo that supposes this act is simply "letting die" rather than killing. They use causation to defend this notion: John's death is causally achieved by the withdrawal of the ventilator since he would have continued living if the ventilator were not withdrawn.

So if it is the act of the physician to justifiably withdraw the life-sustaining treatment that causes death, and he is aware of this consequence, it follows that the intention to cause death is present in most cases, except for cases when treatment is withdrawn to determine if the patient can survive without it or in cases when the patient is imminently dying. Although the intention is clearly not of a malicious nature but of a sympathetic one in order to relieve the patient of his predicament, the conventional view is that it is absolutely