The distinction between God "causing" or "ensuring" evil and "letting" evil happen is crucial to Arminian theodicy. Roger Olson, for one, constantly resorts to this distinction. It's striking, therefore, that in his sympathetic exploration of physician-assisted suicide, he erases the distinction between killing and letting die:
Some patients simply choose to forego all treatments for their terminal disease and die naturally. Usually this also involves gradually starving to death or dying by dehydration. It can take weeks. Few people blame them or even call it “suicide.” And yet, in a way, it is suicide.
Some years ago I had the privilege of teaching nurses in several cohorts in a “degree completion” program. My course, which they were required to take as part of their studies, was called “Developing a Christian Worldview” and included a unit on Christian ethics. We talked about the ethical issues surrounding death including suicide. One thing that struck me was that almost all the nurses who worked in hospitals agreed that PAS is quite common. They said that in many terminal cases a doctor will order pain medicine in gradually increasing doses that eventually suppress breathing. And that so long as the doses are necessary to alleviate pain, even if they result in death, most district attorneys will not prosecute the doctors or nurses involved. They said it is one of the best kept secrets in the medical profession—given how common it is.
Were my nurse students right? Is it fairly common practice for a doctor to increase a dying patient's pain meds to the point where they suppress breathing with the inevitable result of death?
To me, the line between choosing to forego all medical treatment with the certain result of death and choosing to end one's own life to end extreme suffering is blurry at best.