It is sometimes held that active euthanasia or physician-assisted-suicide are expressly incompatible with the primary role of physicians as healers and guardians of life.  And while it is held that physicians also have a role, even a duty, to prevent or alleviate unnecessary pain, it is claimed that when that duty conflicts with guarding and extending life, the duty to guard and extend life is and ought to be the stronger, overriding one.

I wish to contend here that it is incorrectly narrow to view the roles of physicians as being the 1) healing or the promotion of (faster) healing and 2) prevention of illness and injury where possible.  Instead, these are specific ways to pursue or achieve the larger, more general and more appropriately considered goal of ending, alleviating, or preventing physical and psychiatric suffering in the most constructive possible way(s).  It is the prevention or remedy of physical and psychiatric suffering in the best and most reasonable way that is, or should be, and should be considered to be, the primary purpose of medicine.  Healing or promoting healing is normally the most reasonable way to achieve that goal, but in cases where healing or creating or extending life conflict with preventing or alleviating suffering, preventing or alleviating suffering should be, and should be considered to be, the paramount duty or overriding obligation.

If healing were the only appropriate goal, physicians and medicine would not need to be interested or involved in alleviating or preventing suffering at all, and they should not treat any patients they cannot heal or improve.  There would be no more need to use anesthetics today then there was prior to their discovery, at  least other than to render patients immobile during precise or delicate surgery if there were no other way to do it effectively.  And insofar as medicine does not cure the common cold, there would be no need to alleviate the discomfort of colds or any illness, and it would be inappropriate for patients to ask for treatments to do that.   But clearly, a role of medical practice is to alleviate unnecessary discomfort where that is possible and harmless to do.  It has even been said that the role of physicians in cases where they have no (speedy) cure or rehabilitative remedy for an injury or illness is to recommend treatments which simply distract the patient from his/her condition while nature takes the time to do the healing.

If I am correct, then justifiable euthanasia, if it exists, is not antithetical to the role of modern medicine and physicians, as it would be if healing is the only or primary goal. If I am correct, one can not use the physician’s role as healer to justify prohibiting physician-assisted suicide in those cases where suffering is not bearable, not able to be alleviated by any means short of euthanasia, not worth enduring and not able to be made worth enduring.  While it is true that physician-assisted suicide conflicts with healing the patient, it does not conflict with alleviating patient suffering of that (essentially unendurable) sort in the best, most constructive, or only possible way when healing is not  possible and is not an option, and where terminal sedation is not as reasonable or fair as active or passive euthanasia. (It is not terrible pain and suffering themselves that justify euthanasia, but possibly their existence without any experiences, or reasonable prospects for an experience of any sort to look forward to, that would make them worth enduring.  See "The Concept of the Right to Physician-Assisted Suicide.")

I am not arguing here that euthanasia/physician-assisted suicide is ever right.  I am simply contending that if it is wrong, that cannot be because it conflicts with the role of medicine and being a physician.  Whether it is the most reasonable way to end or alleviate suffering in any actual, specific cases, or even in any logically conceivable ones, is open to reasonable discussion and determination, but if it is, then it should be permissible.

Moreover, I am not arguing that a particular physician should be required to euthanize patients against the physician’s conscience, if the patient has some other recourse to euthanasia or a physician who will assist.  However, there may be circumstances where it would conceivably be morally wrong for a physician to refuse a patient euthanasia if that means making the patient have to endure unbearable meaningless suffering for no good reason.  It could conceivably be as wrong to refuse euthanasia as to refuse a patient painkillers or anesthetics for no good reason just because the physician thinks in a particular case pain is important to suffer and it is not his/her role to prevent or alleviate it.  There are, of course, instances where pain is wrong to prevent -- as when doing so masks it as a sign of some more serious problem that is important to know or where painkillers would cause more harm than good.  But making someone endure pain or suffering one could end, particularly terrible pain or suffering, for insufficient or no good reason would be as wrong as it would be to inflict torture on someone for insufficient or no good reason.  Omitting to end or prevent unnecessary and unreasonable suffering, when it is easily within your power to do so,  is as morally reprehensible as actively causing unnecessary and unreasonable suffering.  Failing to prevent a toddler from running out into traffic when all you have to do is block its path to the street is as morally culpable as is pushing it off the curb or sidewalk into a busy street.

And this is not a matter of intentionality.  The principle of double-effect which allegedly permits foreseeable harm in the form of unintended collateral damage is unjustified.  Intentions are not what justify acts with foreseeable bad consequences.  If they did, then every act with foreseeable bad consequences would be justified by intending to do whatever good consequence the act might conceivably have.  “Your honor, I did not intend to kill those children I ran over when I drove 60 mph past the stopped school bus with its lights flashing in the residential area;  I was only trying to get to my girlfriend’s house faster. And yes, I did know that I would likely kill one of them; that was clearly foreseeable.  But since I only foresaw it and didn't intend it, my speeding past the stopped bus in that residential area was not wrong.”  There are some right acts with foreseeably harmful consequences, but those acts are right, not because of the intentions of the person committing them, but because failing to do them would, say, cause even more harm or would violate an important right or prior or more important obligation which overrides the harm done.  Therefore, the distinction between terminal sedation (where a dying patient is given sufficient morphine to render him/her unconscious, though it will also hasten their death by shutting down vital systems sooner) and euthanasia is a false one.  Whether one foreseeably hastens death by intending to render a person permanently unconscious in order to end his/her suffering is morally no different from intentionally hastening death to achieve the same end.  The real determining factor when you know your action will hasten the person’s death  is whether it is right to hasten the person’s death or not, and why or why not, and if so, what the best way is, and why.

In line with both these last two paragraphs, once the determination is made that a patient’s death should be allowed to occur to alleviate their suffering, surely active euthanasia is more humane and right than passive, at the point that the suffering to be eliminated is occurring.  If a patient is dying and is at the point where their dying would be best for them, then it is folly to employ a method that will prolong their life, and particularly if it also increases their suffering, through, say starvation and further deterioration and debility.   There is a difference between euthanizing pets and euthanizing people because pets don’t have future plans, dreams, or hopes and expectations they hope to live to see or accomplish, so the following is not meant to be an analogy justifying euthanasia of humans.  But it is meant to be an analogy that justifies active rather than passive euthanasia when euthanasia is right for either human beings or pets:  you would never agree to let an animal -- whose time had come to be put down -- simply starve to death over the coming month, rather than being euthanized as soon as it could be made comfortable and every last thing done for it that you wanted to do in order to give it ‘a proper goodbye’.