The purpose of this paper is to explain and evaluate Brocks central argument for the permissibility of physician-assisted suicide

(PAS) and voluntary active euthanasia (VAE). Brocks position is that he believes assisted suicide and euthanasia are morally permissible through two fundamental ethical values individual self-determination (autonomy) and well-being. Brocks primary focus is on the morality issue instead of legal policy, and he chooses to support this central ethical argument by comparison to a similar analogy, that of consensus on patients rights to decide about life sustaining treatment. Brock introduces the central argument using several assumptions that help frame support for comparison to his analogy. First, he begins by questioning the differences between assisted suicide and euthanasia. He recognizes that, although the publics primary moral concern is of assisted suicide and not euthanasia, he believes they are not significantly different in the moral sense. In both cases, the deciding factor to die has already been made, leaving only the difference of determining who actually administers the lethal dose, or the last action. Furthermore, Brock responds to the argument in which the doctor kills the patient in euthanasia whereas the patient kills himself in assisted suicide, by saying in which both doctor and patient are responsible in both acts. Brock supports his argument through analogy by determining whether differences exist between assisted suicide (and euthanasia) and foregoing life support treatment (LST). Brock wants to know if they are both morally and legally permissible, and uses three supporting premises to determine whether or not differences exist between them.

To present his case, Brock lays out his three supporting premises by comparison to his analogy of PAS to removing LST. In his first premise, Brock asserts that assisted suicide and euthanasia are not morally dissimilar to the foregoing of life support treatment. For his second premise, Brock asserts that if the denial of life support treatment is morally permissible, then assisted suicide and euthanasia are also permissible. In his third and last premise, Brock argues that assisted suicide and euthanasia are, indeed, morally permissible. In the first premise, Brock uses two positions to offer that assisted suicide (and euthanasia) is not morally dissimilar to foregoing life support treatment. First, he suggests that there is no difference because he believes they both perform the same action of killing. Brocks second position is that there is no moral difference between them. Opponents of assisted suicide object to Brocks first argument, believing there is a difference between assisted suicide (and euthanasia) and foregoing of life support treatment. (194) Opponents believe assisted suicide and euthanasia are deliberate acts of killing innocent people, while stopping of life support treatment is a mere response of respecting ones wish to be allowed to die. Opponents of Brocks second position believe the differences are also morally relevant, an argument similar to Devine and killing fetuses. Brock responds using a similar analogy that is both different and irrelevant. Opponents hold the common view that assisted suicide is killing while forgoing LST is allowing to die (ATD). Brock responds that the difference between killing

and ATD is the difference between acts and omissions. He further argues that removing LST is an act, and is therefore, justified killing. (196) He asserts there is no difference between the deliberate action of assisted suicide and allowing one to die by foregoing of life support treatment, since they are both considered killing. Brock believes the common view that stopping LST is not killing is a mistaken one. In the case of the greedy son, disabling the life support device is considered killing because it is an act, not an omission. The difference between who performs the act, the physician or the greedy son, is irrelevant. Opponents to this idea, that removing LST is killing, object based on the understanding of what physicians do. It is held that physicians do not kill; yet, physicians justifiably remove LST; therefore, removing LST cannot be considered killing, and must be considered allowing to die. Brock offers the argument that, since physicians do remove LST, which is an act and therefore killing, then some killings are ethically justified (196). Brock states that those who accept the argument that the difference between killing and allowing to die is a matter of act versus omission will have to conclude that there is no moral difference between killing and allowing to die, because there is no real difference between an act and an omission. He substantiates this conclusion with the pair of cases of the patient in ICU. (197) Base on this premise, the moral permissibility of PAS/VAE must be based on other factors besides killing versus allowing to die.

For the second premise of the central argument, Brock believes that if denying life support is permissible, then denying assisted suicide (and euthanasia) is also permissible. Opponents believe stopping life support is thought of as allowing to die instead of killing, because people assume that whatever the physician does cannot be killings. Their objection to Brock's second premise is offered by two responses. The first is that the act of killing is wrong and is morally unjustified. Brock believes this is inaccurate because opponents believe the common use of the word killing is always associated with murder. This also includes ethically justified cases, such as stopping life support. Opponents also object because killing is psychologically uncomfortable. For example, in situations of stopping life support, shifting responsibilities (of killing) away from the physician to the fatal or lethal process helps make the resulting death more bearable. Brock counters the opponents objections by asserting that assisted suicide (and euthanasia) and foregoing life support treatment are both killing, regardless of whether an action is involved (in the case of someone pushing a button), or (not in the case of allowing one to die by omission). Brock believes there is no moral difference between assisted suicide and euthanasia and stopping life support. If opponents continue to discount both of Brocks two arguments, their response is logically limited to first determine that killing is morally worse than allowing to die, and second, what makes killing wrong, in lieu of allowing to die. Using the first response, opponents will assert the notion that killing deprives a victim of his/her life. What this means is that people have a need to retain control

of themselves and their future. This need is referred to as a great good and is considered part of the fundamental moral value of well being. Killing deprives a person of that great good. (194) Brock counter-responds with two additional positions by analogy, suggesting first, the act of killing cannot be morally worse than allowing to die if there are conflicting moral values of well-being (great good) and individual self determination (retaining control). The analogy Brock uses is based on the case whereby an apparently competent patient is in control and makes an informed decision to refuse life sustaining treatment. The conflict arises when the physician doesn't agree or doesnt understand the patients desire to live and is morally forced to decide between respecting either the patients selfdetermination or the patients well-being. In Brocks second position, in cases where a patient foregoes LST, Brock believes life is no longer regarded as a great good by the patient. He justifies his position because the killing of ones self is not any worse than allowing one to die. Typically, in cases of assisted suicide and euthanasia, decisions are made by individuals having sound moral values of self-determination and well being. Brock, therefore, does not believe there is a conflict between the fundamental moral values. He suspects it may have something to do with individual rights. Brock believes people have a moral right not to be killed. The right, he argues, however, can be waived. Brock believes that waver can occurs in cases of assisted suicide, but not within the current scope of his central argument.

In conclusion, Brock interconnects PAS with VAE with no significant, intrinsic moral difference. Next, he connects PAS/VAE with LST because first, there is no difference between killing and allowing to die, and second, some killing is justified. Brock argues that PAS/VAE is not morally wrong because: one, selfdetermination and well-being must be respected. When they are in conflict, selfdetermination carries more weight (if it passes a test of reasonableness), Secondly, the right of person not to be killed can be waived.