In a recent editorial, Carlson and Shahryar1 assert that the discontinuation of dialysis is "a unique form of euthanasia." They are wrong, or at least outdated in their vocabulary, if they equate the withdrawal of life support with euthanasia. Do they really believe that no moral difference exists between withdrawing dialysis and administering a lethal dose of potassium chloride? While some philosophers argue that no difference exists,2 many do not.3,4 Two important moral differences exist between allowing a patient to die and killing a patient: the cause of death and the intent of the physician.
In respect to the cause of death, when death follows a lethal dose of medication, the medication administered by the physician is the efficient cause of the patient's death. When death follows the discontinuation of dialysis, end-stage renal disease is the efficient cause of the patient's death. The physician withdraws a therapy