Indicators of clinical performance

Physician assisted suicide, euthanasia, or withdrawal of treatmentDistinguishing between them clarifies moral, legal, and practical positions T he Supreme Court of the United States has returned the vexing question of physician assisted suicide to state governments.In unanimous rulings last month, Chief Justice Rehnquist, writing for the court, held that there is no fundamental right to assistance in committing suicide 1 and that, legally, distinguishing between refusing life saving medical treatment and requesting assistance in suicide "comports with fundamental legal principles of causation and intent." 2 By its rulings, the Supreme Court invalidated the decisions of two of the American Courts of Appeal.In March 1996 the appeals court for the Ninth Circuit had lifted a ban by Washington state on physician assisted suicide in Compassion in Dying v Washington. 3 That court, which has jurisdiction in 13 western states, including Hawaii, had concluded that "a competent adult ... has a strong liberty interest in choosing a dignified and humane death"-including not just refusal of treatment but also "hastening one's own death."However, the Supreme Court held that the interest in question, which Chief Justice Rehnquist characterised as the "right to commit suicide with another's assistance," is not one of the "fundamental rights and liberties ... 'deeply rooted in this Nation's history and tradition'."