Formulation, deployment, and application of the rationality principle look pointless to many medical ethicists and physicians who daily work with terminal patients. Immersed in the medical, practical, and emotional complexities and vicissitudes that characterize situations in which patients are dying in a protracted and punishing manner, these practitioners see the criterion as an inapplicable abstraction. This perception effectively precludes clinical application of the rationality criterion. Additionally, many medical ethicists and most physicians dismiss the criterion because they see the important question as being whether elective death is ethically permissible, not whether it is rational in a conceptual sense.

But as I have argued, it is a mistake to see the rationality criterion as an inapplicable abstraction or as an unnecessary element because ethical permissibility of elective death presupposes the rationality of the choice to die. It is true, though, that the criterion fosters practitioners' perception of it as inapplicable in practice because its requirements appear too demanding to be applied in actual cases. In this chapter I need to show how the rationality criterion's requirements are tempered by elective-death deliberators' deteriorating circumstances and hence how a measure of latitude is introduced to assessment of their choices to die.

Physicians' and medical ethicists' focus on the ethical permissibility of elective death in terminal illness is not determined only by the nature of the day-to-day decisions they have to make regarding terminal patients' choosing to die. It is mainly determined by present legal and professional constraints on enactment of those patients' choices.