Various sorts of decisions made about end-of-life medical care are known to culminate in death. They range from the relatively uncontroversial, like the many decisions that are made (with or without the patient's consent) concerning the withdrawal or withholding of life-prolonging measures, sometimes in concert with the use of ‘terminal sedation’; through decisions by patients to refuse artificial nutrition and hydration, kidney dialysis, vital organ transplants, donated blood and life-prolonging surgery; to the controversial, like physician-assisted suicide and voluntary euthanasia; and on to the very controversial, like non-voluntary euthanasia. Even though it will include some reflection about the less controversial modes of bringing about death, this book is chiefly about the more controversial forms of medically assisted death, namely, physician-assisted suicide, voluntary euthanasia, and non-voluntary euthanasia. My central thesis is that there is a strong case for legalising physician-assisted suicide and voluntary euthanasia but that it is neither justifiable nor necessary to do so for non-voluntary euthanasia.

Briefly, when a person (typically, a doctor) carries out an act of euthanasia she brings about the death of another person because she has good reason to believe either that the effects of illness or disability have made the latter's present existence so bad that he would be better off dead, or that, unless she intervenes, illness or disability will lead to such deterioration that a point will soon be reached where he would be better off dead.