Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)




Dr. W. Waluchow


This thesis is an investigation of the moral responsibility of physicians in assisted death. I begin with a discussion of the problem that drives the debate concerning end of life decision making. I conclude that the problem faced by those attempting to make decisiosn at the end of life is the bad death. A bad death is marked by a long, debilitating, incapacitating, dying process. Given the problem of the bad death, I discuss what responsibilities the physician might have toward a dying patient. I conclude that the responsibility of a physician is to the wellness of his or her patient, whether that patient is dying or not. For the dying patient, continued existence, or a bad death may count as harm, and a good death as a benefit. Since promoting wellness for a patient means maximizing the benefits and minimizing (or eliminating) the harms, wellness for a dying patient might mean the avoidance of the bad death and the active pursuit of the good death, which I call death management. Since the physician's responsibility is to promote wellness, the physician has a responsibility to promote the good death for a dying patient. Much of my argument hangs on the concept of "dying". I argue for a particular definition of dying and the conceptual distinction between death management and suicide. I defend the claim that physicians have a responsibility to provide death management against the moral difference thesis which holds that it is morally worse to actively kill someone than to merely let that person die. I argue against this thesis and defend instead the moral equivalence thesis which holds that there is no moral difference between bare acts and bare omissions. I also discuss the doctrine of double effect, which represents a potential challenge to my argument. However, I show that the doctrine of double effect is, in fact, not applicable to cases of death management. I condlude with a brief look at some of the concerns should death management become a social policy or legally sanctioned practice. My replies are necessarily brief, but sufficient to show that these concerns are not fatal to the legitimacy of death management.

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