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This work addresses the legal and ethical justification for paternalistic intervention, by physicians and other health care professionals, in patients' life-ending decisions. Decisionally competent persons have, in general, the right to make their own treatment decisions. This principle arises from the doctrine of informed consent, which gives expression to the liberal democratic ideal of protection of personal autonomy, or self-determination. However, a conflict may arise between an apparent obligation to respect such decision, and an opposing obligation, which may seem no less compelling, to save the patient's life, thereby averting what may be a tragic and irretrievable mistake. Most suicide attempts raise a conflict of this kind, and some refusals of life-sustaining treatment are also troubling in this way. How might such violations of autonomy be justified? For a variety of reasons, those seeking to end their own life are particularly prone to misjudgment about the likelihood of recovering an adequately satisfying life. Under conditions of suffering and dependence, it is not respect but abandonment to leave patients to their own self-determination. It is proposed then that, under certain circumstances, paternalistic intervention is justified to save life, even in the face of a patient's competent refusal of such treatment, on the basis that the person might be making a grievous and irreversible mistake. This thesis sketches the considerations relevant to paternalistic interference in life-ending choices of this kind and proposes a framework for applying such considerations to particular end of life decisions. These principles may also be applied to provide a legal basis for intervention founded upon the common law defence of necessity. Necessity offers an appropriate and legally well grounded basis for protecting medical practitioners from civil or criminal liability for rescuing a dying person or denying a competent person the choice of death, if appropriate c