By Theo Schall
In the wake of terminal brain cancer patient Brittany Maynard’s death via physician-assisted suicide, end-of-life issues are making national headlines. Whereas death was once a sequence of organic events – the slowing of the heart, the cessation of breath – it is now usually a medical process accompanied by technological and pharmaceutical interventions. Even for those with clearly structured moral systems, navigating cutting edge end-of-life ethical issues can be challenging. Patients and families are often hard-pressed to understand the technical terms used by healthcare workers. It can be helpful to clarify the issues at play by understanding how different medical practices relate to one another.

The United States Supreme Court distinguishes between “active” and “passive” forms of aid-in-dying. The withdrawal of life-sustaining treatment is a common form of passive aid-in-dying, sometimes called “unplugging” a patient from machines. Outside of the states where physician-assisted suicide is legal, active measures like a doctor providing a medication are only permissible if the doctor intends to alleviate suffering, but not cause death.

Palliative Care: specialized, supportive medical care for people with serious illness. Includes help with physical symptoms, emotional distress, and practical concerns. Palliative care is intended to improve quality of life for the patient and their family. Palliative care is not only for terminal patients, as it can also be provided along with curative treatment.

Hospice: palliative care for terminal patients. Hospice care begins after treatment of the disease has stopped, when the patient is unlikely to survive for longer than six months.

Withholding/Withdrawing Life Sustaining Treatment: “life support,” which might include a feeding tube or ventilator, is either turned off or never turned on because a mentally competent patient or their appointed representative refuses it. The patient dies (or, in rare cases, survives) without the refused medical intervention. State law and the medical profession near-universally support the practice as legal and ethical.

Physician-Assisted Suicide (also called “assisted death”): a terminally ill, mentally competent patient requests a prescription for a lethal dose of medication. The patient must be able to ask for and administer the medication without assistance. Physician-assisted suicide is legal in Oregon, Washington, and Vermont, and to a lesser degree, New Mexico and Montana.

Euthanasia: a doctor administers a lethal medication, intending to cause the death of a patient. Euthanasia is illegal in the United States and every other country except the Netherlands, Luxembourg, and Belgium.

Medication that May Hasten Death: to alleviate suffering, a terminally ill patient requires doses of pain medication that may impair breathing or otherwise hasten death. Use of such medications is considered a legal, medically accepted practice, as long as the intention is only to relieve suffering and not cause death.

Terminal Sedation (also called “palliative sedation”): a terminally ill, mentally competent patient is sedated to the point of unconsciousness and then allowed to die of the underlying disease, starvation, or dehydration. Terminal sedation is used when normal treatments cannot relieve suffering and often initiated at the same time as withdrawal of life sustaining treatment. The practice is legal in the United States.

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