32 LAW, MED. & ETHICS 220 (Apr. 2006).
It would be naive to think that euthanasia, in either the voluntary active euthanasia (VAE) sense, or in the more passive sense of physician assisted suicide (PAS), does not happen. It would even be naive to think that it does not occur in a non-voluntary form. It would be equally naive, however, to think it could be controlled through governmental regulation. The efficiency paradigm includes pain management, foregoing life-sustaining treatment, terminal sedation, PAS, and VAE. In this paradigm, there is no mention of intention or the moral integrity of the physician. There is little mention of patient intention, and then only in terms of autonomy. The actions are only assessed in terms of the final effect: death.
In the face of a failing body, all that is left is transcendence. The efficiency paradigm runs the risk of rendering transcendence in human living and dying meaningless, for there is no transcending the conditions of life's material or efficient possibilities. By institutionalizing the metaphysics of efficiency toward death, we frame all human dying, and thereby living, as impossible of meaning. That is why there is no much disgust with the increased technologisation of medicine. The efficient social apparantus for death induciton will become just that, a further mechanization of human living. The physician serves merely an instrumental role.
By accepting mere efficiency in the physician's action, one is precluding something altogether more spiritual. One precludes that dimension often referred to as the therapeutic relationship. That is to say, sometimes healing occurs in empathically...