I have tremendous respect for people like Peter Lovrics, who frequently treats severely ill patients in the last stages of life. However, his argument against euthanasia1 - both active and passive - is founded on a misunderstanding of passive euthanasia as it relates to palliative care. He states that the "distinction between good palliative care and euthanasia (active or passive) ... is clear and important." He then argues that "good palliative care makes euthanasia ... unnecessary." Thus, he presents palliative care as a preferred third option that is inconsistent with passive as well as active euthanasia.
No humane person could be against the provision of good palliative care. All patients who are suffering deserve the highest standard of palliative care possible, and they should never be deprived of this when it has been decided to withhold or withdraw curative or supportive treatment. But palliative care and passive euthanasia are not mutually exclusive alternatives. Lovrics writes that he has been in the "difficult situation of withholding or withdrawing care to allow death on numerous occasions." This, of course, is the very definition of passive euthanasia. Palliative care is care that helps minimize pain and suffering, and it is especially important in the context of passive euthanasia.
Many people do not like the term passive euthanasia, probably because they associate the word euthanasia with active euthanasia, which they do not support. The argument I presented in my essay2 is that virtually everyone already supports passive euthanasia - regardless of what they prefer to call it - and that, in certain circumstances, the distinction between passive and active euthanasia is morally irrelevant. When our efforts to relieve suffering with palliative care fail, active euthanasia may be morally permissible and even preferred over passive euthanasia, for it ends the suffering more quickly.
Lovrics believes that the cases I mentioned in my essay "show the importance of continued medical education, awareness and proper training [in palliative care]." I agree. I also think that these cases remind us that palliative care is not only "hard to do well" but also sometimes impossible to do well. When we cannot, despite our best efforts, adequately control the suffering of terminally ill patients who want to die, active euthanasia may be a means to respect their autonomy and relieve their distress.