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Like other individuals suffering with chronic medical illnesses, he chose suicide as a means of controlling the course of his disease and the circumstances of his death."I am not a suicide freak, but I want to be free," Kosinski told an interviewer in 1979.
While theoretical and/or ethical distinctions between euthanasia and PAS may be subtle to some, the practical distinctions may be significant.
Many terminally ill patients have access to potentially lethal medications, at times even upon request from their physicians, yet do not use these medications to end their own lives (despite the widespread sale of publications such as 5 that describe how to use such techniques).
Conclusions: Psychosocial and psychiatric issues are among the most powerful predictors of desire for death and interest in PAS.
Evaluation and intervention in these areas, particularly depression, is a critical component of compassionate care.
Distinctions between withdrawal of life support and euthanasia/PAS are, in many ways, considerably clearer.
Long-standing civil case law has supported the rights of patients to refuse any unwanted treatment, even though such treatment refusals may cause death.8 On the other hand, patients have not had the converse right to demand treatments or interventions that they desire.
Since patients are allowed to refuse life-sustaining medical interventions (eg, life support, artificial nutrition, and hydration), they are effectively permitted to commit suicide by treatment refusal.
Despite the refutation of this argument by the US Supreme Court, advocates of legalization argue that no ethical difference exists between terminating life-sustaining care and administering lethal medication for the terminally ill patient.
In both cases, the primary goal of the physician can be seen as the prevention of suffering at the end of life through hastening an inevitable death.
Arguments in favor of legalization of PAS are typically premised on the assumption that requests for PAS are a "rational" decision, given the circumstances of terminal illness, pain, increased disability, and fears of becoming (or continuing to be) a burden to family and friends.