PubMed1999
We have shown why it is that withholding medical treatment is not properly considered to be an assisted suicide. We have said nothing about the desirability or need for new legislation to support assisting a patient in a suicide. We have been concerned only to show that any plausible arguments for assisted suicide must stand on their merits and the attempt to justify a practice of assisted suicide by linking it to the withdrawing of medical treatment through an analysis of causation fails. In this closing section we place our discussion in a broader setting and draw out some of the implications of the distinctions we have made. One central point we wish to emphasize is the role of context in discussions of withholding treatment and assisting a suicide. We have noted the difference between the "normative" and "scientific" sense of "cause". The normative sense is used when holding a person responsible, either legally or morally, for what he or she has actually or scientifically caused (the cause-in-fact). When we hold a person responsible for the consequences of his or her actions, we do so in a way that is sensitive to the context of that action. There is no set formula for determining how broad a context must be considered, whether it be a year and a day, or some shorter or longer interval. The determination of context will involve judgments of relevance and reasonableness and will depend on any special relationships that may hold between the parties involved. Finally, we emphasize how essential context is to a determination of causation. If one fails to consider both the scientific and normative dimensions of causation and relies only on the scientific dimension, one ends up with the counter-intuitive judgments that, in the Olson case, the neurosurgeon who withdrew life support for Erickson is the cause of death, and similarly for the example given by Schaffner and the Nancy B. case discussed by Fish and Singer. Our advice is, "Don't go there".