ABSTRACT
In all but the most unusual circumstances, a competent person has the moral and legal right to refuse lifesaving medical treatment (LSMT). Voluntary refusal of care by an informed and competent patient is thought to have very strong moral protection-others would be committing a grave moral wrong if they imposed treatment. What other sorts of refusal by which people can hasten their deaths also gain moral protection? One is refusing food and watervoluntarily stopping eating and drinking (VSED). Others are the extension of refusing LSMT to circumstances of incompetence by advance directive (AD), and a similar extension of VSED by AD. As one moves beyond the refusal of lifesaving medical treatment , and beyond refusal by currently competent patients, how much of the moral justification of the original basic right of a competent patient to refuse LSMT is retained-by VSED, by withholding or withdrawing LSMT according to an AD, and by withholding oral feeding by AD, respectively? Comparative assessment reveals notable moral differences. A comparative assessment also reveals that the moral case for these extensions is relatively strong, allowing people to control the end of their lives not only by refusing LSMT but also by VSED and by advance directives.
