Causing, Intending, and Assisting Death

Are there morally compelling differences among allowing a patient to by forgoing treatment, physician-assisted suicide, and active euthanasia? what follows for medical ethics and public policy if these differences do do not exist? Recently, Edmund D. Pellegrino has forcefully restated an old in defense of a compelling difference: in active euthanasia or-assisted suicide, the physician causes the patient's death, while in treatment, the disease causes the patient's death. Similarly, Raymond. Devettere has argued that what makes active euthanasia immoral is that the directly intends the patient's death, while in forgoing treatment, physician does not intend the patient's death. I have two purposes in this. The most obvious is to contend that these two arguments based on and intention fail to do the work we ask of them, but in the end, failure does little to illuminate what public policy ought to be on-assisted suicide or active euthanasia. The less obvious purpose is try to illustrate and develop a key concept in the rediscovery of casuistry a methodology in medical ethics.