Passive Euthanasia and the Withdrawal of Life-Sustaining Therapy in the Sociocultural Discourses of Western Countries and Russia: a Historical and Philosophical Analysis

Passive euthanasia and the withdrawal of life-sustaining treatment (LST) in modern Russian practice are normatively indistinguishable, leading to ethical, legal, and clinical-practical conflicts for intensive care physicians and increasing the moral distress among healthcare staff.

The purpose of this research is to clarify the distinctions between active and passive euthanasia and the cessation of futile life-sustaining treatment, as well as to demonstrate why these distinctions are not taken into account in Russian legislation and professional discourse.

Materials and Methods. The study included foreign and Russian bioethical and legal texts. A qualitative analysis of the historiography was conducted, supplemented by a structural-thematic analysis of the philosophical dilemmas associated with the end of life.

Results. The analysis identified three key lines of demarcation: 1) between active killing and allowing death through the refusal of intervention; 2) between passive euthanasia and the ethical cessation of LST; 3) between the physician's intention to hasten death and the intention to remove medical obstacles to the natural process of dying while being willing to continue assistance if the patient survives. It was shown that the Russian legal norm, which effectively criminalizes any forms of cessation of medical treatment, has developed against the backdrop of insufficient reflection on these distinctions and leads to a discrepancy between normative language and actual clinical practice, where doctors are forced to document treatment provision but often omit or alter it in practice.

Conclusion. The integration into the Russian context of more nuanced criteria for assessing intention, causality, and futility of treatment, developed in Western bioethics, combined with consideration of local sociocultural contexts and religious traditions, is a necessary condition for developing a coherent end-of-life regulation model that reduces moral distress for physicians and enhances patient trust in medical decisions.

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