Legal Definitions - passive euthanasia

Passive euthanasia refers to the intentional act of allowing a person to die by withholding or withdrawing life-sustaining medical treatment, rather than by actively administering a lethal substance. The intent is to relieve suffering and allow a natural death, often when a person is terminally ill, in an irreversible coma, or has expressed a desire not to prolong life under certain conditions. It involves an omission of action (not starting or stopping treatment) rather than a commission of action (directly causing death).

Here are some examples illustrating passive euthanasia:

• Declining Aggressive Treatment for Terminal Cancer: An elderly patient diagnosed with an aggressive, untreatable form of pancreatic cancer is offered a new, highly toxic chemotherapy regimen that would likely extend their life by only a few weeks but cause severe side effects and diminish their quality of life. After consulting with their family and medical team, the patient decides to decline the chemotherapy and instead opts for palliative care focused on comfort and pain management. The patient subsequently dies from the progression of their disease.

  This is passive euthanasia because the patient, or their authorized decision-maker, chose to withhold a life-prolonging treatment, allowing the underlying illness to take its natural course. No active steps were taken to end the patient's life; rather, a medical intervention was foregone.

• Withdrawing a Ventilator Based on a Living Will: A person suffers a massive stroke that leaves them in an irreversible coma, requiring a mechanical ventilator to breathe. Prior to the stroke, they had executed a legally valid living will (also known as an advance directive) explicitly stating that they did not wish to be kept alive by artificial means if they were in a persistent vegetative state with no hope of recovery. Following the medical team's assessment and in accordance with the living will, the family requests that the ventilator be removed. The patient's breathing ceases shortly after the ventilator is disconnected.

  This scenario illustrates passive euthanasia because an existing life-sustaining treatment (the ventilator) was withdrawn based on the patient's previously expressed wishes. The death resulted from the underlying medical condition once the artificial support was removed, not from an active intervention to cause death.

• Refusing Artificial Nutrition and Hydration: A patient with advanced dementia is no longer able to swallow safely and is at high risk of aspiration pneumonia. Doctors recommend inserting a feeding tube to provide artificial nutrition and hydration. However, the patient's designated healthcare proxy, knowing the patient's long-held belief that they would not want their life prolonged in such a state, decides to refuse the feeding tube. The patient is kept comfortable with mouth care and pain medication, and eventually dies due to complications related to their inability to eat or drink.

  This is an example of passive euthanasia because the decision was made to withhold a life-sustaining medical intervention (artificial nutrition and hydration). The death occurred as a consequence of the natural progression of the illness and the lack of intervention, aligning with the patient's presumed wishes or best interests as determined by their proxy.