This paper reviews the ethical foundations of decisions to suspend life-sustaining nutrition and hydration for seriously ill and permanently comatose patients, and also examines three legal cases in this area (Barber, Bouvia, and Brophy). The cause of such patients' deaths is examined, and the current consensus that it is the underlying illness which is the identifiable cause is criticized. I argue that the responsible cause in such cases is typically the physician's decision to suspend food and/or water, made with the deliberate concurrence of the patients, families and/or courts. I also argue that with proper safeguards this is both a reasonable policy and one that should be interpreted as a general surrogate for rational, medically assisted suicide.