On hastening death without violating legal and moral prohibitions.

Medical management of the dying process has been part of American culture for approximately 150 years. Initially, physicians could do little besides ease the dying process by making the moribund person comfortable, comforting the surrounding loved ones, and perhaps orchestrating any rituals. The patient could not linger long, as infectious diseases and other lethal conditions generally took their toll fairly quickly. It was well into the twentieth century before physicians dealing with fatal afflictions became capable of relieving pain and prolonging life via medications, transfusions, respirators, dialysis machines, and open-heart surgery. Medical science could wondrously extend life, even beyond a point that the dying patient would prefer. Physician management of the dying process then took the form of deciding whether to initiate and how long to maintain life-sustaining medical intervention. Hastening of death by poison or other lethal intervention was beyond the pale, violative of medical mores and punishable as homicide under the criminal law. In the last quarter of the twentieth century, courts established that a competent dying patient legally controls the extent of life-sustaining medical intervention. This recognition rested on both the common law