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Euthanasia
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Euthanasia (from Greek: εὐθανασία, lit. 'good death': εὖ, eu, 'well, good' + θάνατος, thanatos, 'death') is the practice of intentionally ending life to eliminate pain and suffering.[1][2]
Different countries have different euthanasia laws. The British House of Lords select committee on medical ethics defines euthanasia as "a deliberate intervention undertaken with the express intention of ending a life to relieve intractable suffering".[3] In the Netherlands and Belgium, euthanasia is understood as "termination of life by a doctor at the request of a patient".[4] The Dutch law, however, does not use the term 'euthanasia' but includes the concept under the broader definition of "assisted suicide and termination of life on request".[5]
Euthanasia is categorised in different ways, which include voluntary, non-voluntary, and involuntary.[6] Voluntary euthanasia is when a person wishes to have their life ended and is legal in a growing number of countries. Non-voluntary euthanasia occurs when a patient's consent is unavailable, (e.g., comatose or under a persistent-vegetative state,) and is legal in some countries under certain limited conditions, in both active and passive forms. Involuntary euthanasia, which is done without asking for consent or against the patient's will, is illegal in all countries and is usually considered murder.
As of 2006[update], euthanasia had become the most active area of research in bioethics.[7] In some countries, divisive public controversy occurs over the moral, ethical, and legal issues associated with euthanasia. Passive euthanasia (known as "pulling the plug") is legal under some circumstances in many countries. Active euthanasia, however, is legal or de facto legal in only a handful of countries (for example, Belgium, Canada, Uruguay and Switzerland), which limit it to specific circumstances and require the approval of counsellors, doctors, or other specialists. In some countries—such as Nigeria, Saudi Arabia, and Pakistan—support for active euthanasia is almost nonexistent.
Definition
[edit]Current usage
[edit]As of 2024, dictionary definitions focus on euthanasia as the act of killing someone to prevent further suffering. There is no sense of whether the person agrees or is proactive in the situation.[8][9]
Past discussions on key elements
[edit]In 1974 euthanasia was defined as the "painless inducement of a quick death".[10] However, it is argued that this approach fails to properly define euthanasia, as it leaves open a number of possible actions that would meet the requirements of the definition but would not be seen as euthanasia. In particular, these include situations where a person kills another, painlessly, but for no reason beyond that of personal gain, or accidental deaths that are quick and painless but not intentional.[11][12]
Another approach incorporated the notion of suffering into the definition.[11] The definition offered by the Oxford English Dictionary incorporates suffering as a necessary condition with "the painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma",[13] This approach is included in Marvin Khol and Paul Kurtz's definition of it as "a mode or act of inducing or permitting death painlessly as a relief from suffering".[14] Counterexamples can be given: such definitions may encompass killing a person suffering from an incurable disease for personal gain (such as to claim an inheritance), and commentators such as Tom Beauchamp and Arnold Davidson have argued that doing so would constitute "murder simpliciter" rather than euthanasia.[11]
The third element incorporated into many definitions is that of intentionality: the death must be intended rather than accidental, and the intent of the action must be a "merciful death".[11] Michael Wreen argued that "the principal thing that distinguishes euthanasia from intentional killing simpliciter is the agent's motive: it must be a good motive insofar as the good of the person killed is concerned."[15] Similarly, Heather Draper speaks to the importance of motive, arguing that "the motive forms a crucial part of arguments for euthanasia, because it must be in the best interests of the person on the receiving end."[12] Definitions such as those offered by the House of Lords Select committee on Medical Ethics take this path, where euthanasia is defined as "a deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering."[3] Beauchamp and Davidson also highlight Baruch Brody's "an act of euthanasia is one in which one person ... (A) kills another person (B) for the benefit of the second person, who actually does benefit from being killed".[16]
Draper argued that any definition of euthanasia must incorporate four elements: an agent and a subject; an intention; causal proximity, such that the actions of the agent lead to the outcome; and an outcome. Based on this, she offered a definition incorporating those elements, stating that euthanasia "must be defined as death that results from the intention of one person to kill another person, using the most gentle and painless means possible, that is motivated solely by the best interests of the person who dies."[17] Prior to Draper, Beauchamp and Davidson had also offered a definition that included these elements. Their definition specifically discounts fetuses to distinguish between abortions and euthanasia:[18]
In summary, we have argued ... that the death of a human being, A, is an instance of euthanasia if and only if (1) A's death is intended by at least one other human being, B, where B is either the cause of death or a causally relevant feature of the event resulting in death (whether by action or by omission); (2) there is either sufficient current evidence for B to believe that A is acutely suffering or irreversibly comatose, or there is sufficient current evidence related to A's present condition such that one or more known causal laws supports B's belief that A will be in a condition of acute suffering or irreversible comatoseness; (3) (a) B's primary reason for intending A's death is cessation of A's (actual or predicted future) suffering or irreversible comatoseness, where B does not intend A's death for a different primary reason, though there may be other relevant reasons, and (b) there is sufficient current evidence for either A or B that causal means to A's death will not produce any more suffering than would be produced for A if B were not to intervene; (4) the causal means to the event of A's death are chosen by A or B to be as painless as possible, unless either A or B has an overriding reason for a more painful causal means, where the reason for choosing the latter causal means does not conflict with the evidence in 3b; (5) A is a nonfetal organism.[19]
Wreen, in part responding to Beauchamp and Davidson, offered a six-part definition:
Person A committed an act of euthanasia if and only if (1) A killed B or let her die; (2) A intended to kill B; (3) the intention specified in (2) was at least partial cause of the action specified in (1); (4) the causal journey from the intention specified in (2) to the action specified in (1) is more or less in accordance with A's plan of action; (5) A's killing of B is a voluntary action; (6) the motive for the action specified in (1), the motive standing behind the intention specified in (2), is the good of the person killed.[20]
Wreen also considered a seventh requirement: "(7) The good specified in (6) is, or at least includes, the avoidance of evil", although, as Wreen noted in the paper, he was not convinced that the restriction was required.[21]
In discussing his definition, Wreen noted the difficulty of justifying euthanasia when faced with the notion of the subject's "right to life". In response, Wreen argued that euthanasia has to be voluntary and that "involuntary euthanasia is, as such, a great wrong".[21] Other commentators incorporate consent more directly into their definitions. For example, in a discussion of euthanasia presented in 2003 by the European Association of Palliative Care (EPAC) Ethics Task Force, the authors offered: "Medicalized killing of a person without the person's consent, whether nonvoluntary (where the person is unable to consent) or involuntary (against the person's will), is not euthanasia: it is murder. Hence, euthanasia can be voluntary only."[22] Although the EPAC Ethics Task Force argued that both non-voluntary and involuntary euthanasia could not be included in the definition of euthanasia, there is discussion in the literature about excluding one but not the other.[21]
Historical use
[edit]"Euthanasia" has had different meanings depending on usage. The first apparent usage of the term "euthanasia" belongs to the historian Suetonius, who described how the Emperor Augustus, "dying quickly and without suffering in the arms of his wife, Livia, experienced the 'euthanasia' he had wished for."[23] The word "euthanasia" was first used in a medical context by Francis Bacon in the 17th century to refer to an easy, painless, happy death, during which it was a "physician's responsibility to alleviate the 'physical sufferings' of the body." Bacon referred to an "outward euthanasia"—the term "outward" he used to distinguish from a spiritual concept—the euthanasia "which regards the preparation of the soul."[24]
Classification
[edit]Euthanasia may be classified into three types, according to whether a person gives informed consent: voluntary, non-voluntary and involuntary.[25][26]
There is a debate within the medical and bioethics literature about whether or not the non-voluntary (and by extension, involuntary) killing of patients can be regarded as euthanasia, irrespective of intent or the patient's circumstances. In the definitions offered by Beauchamp and Davidson and, later, by Wreen, consent on the part of the patient was not considered one of their criteria, although it may have been required to justify euthanasia.[11][27] However, others see consent as essential.
Voluntary euthanasia
[edit]Voluntary euthanasia is conducted with the consent of the patient.[28] Active voluntary euthanasia is legal in Belgium, Luxembourg and the Netherlands. Passive voluntary euthanasia is legal throughout the US per Cruzan v. Director, Missouri Department of Health. When the patient brings about their own death with the assistance of a physician, the term assisted suicide is often used instead. Assisted suicide is legal in Switzerland and the U.S. states of California, Oregon, Washington, Montana and Vermont.
Non-voluntary euthanasia
[edit]Non-voluntary euthanasia is conducted when the consent of the patient is unavailable.[28] Examples include child euthanasia, which is illegal worldwide but decriminalised under certain specific circumstances in the Netherlands under the Groningen Protocol. Passive forms of non-voluntary euthanasia (i.e. withholding treatment) are legal in a number of countries under specified conditions.
Involuntary euthanasia
[edit]Involuntary euthanasia is done without asking for consent or against the patient's will.[28] It is considered murder and is illegal in all countries.
Passive and active euthanasia
[edit]Voluntary, non-voluntary and involuntary types can be further divided into passive or active variants.[29] Passive euthanasia entails the withholding treatment necessary for the continuance of life.[3] Active euthanasia entails the use of lethal substances or forces (such as administering a lethal injection), and is more controversial. While some authors consider these terms to be misleading and unhelpful, they are nonetheless commonly used. In some cases, such as the administration of increasingly necessary, but toxic doses of painkillers, there is a debate whether or not to regard the practice as active or passive.[3]
History
[edit]
Euthanasia was practiced in Ancient Greece and Rome: for example, hemlock was employed as a means of hastening death on the island of Kea, a technique also employed in Massalia. Euthanasia, in the sense of the deliberate hastening of a person's death, was supported by Socrates, Plato and Seneca the Elder in the ancient world, although Hippocrates appears to have spoken against the practice, writing "I will not prescribe a deadly drug to please someone, nor give advice that may cause his death" (noting there is some debate in the literature about whether or not this was intended to encompass euthanasia).[30][31][32]
Early modern period
[edit]The term euthanasia, in the earlier sense of supporting someone as they died, was used for the first time by Francis Bacon. In his work, Euthanasia medica, he chose this ancient Greek word and, in doing so, distinguished between euthanasia interior, the preparation of the soul for death, and euthanasia exterior, which was intended to make the end of life easier and painless, in exceptional circumstances by shortening life. That the ancient meaning of an easy death came to the fore again in the early modern period can be seen from its definition in the 18th century Zedlers Universallexikon:
Euthanasia: a very gentle and quiet death, which happens without painful convulsions. The word comes from ευ, bene, well, and θανατος, mors, death.[33]
The concept of euthanasia in the sense of alleviating the process of death goes back to the medical historian Karl Friedrich Heinrich Marx, who drew on Bacon's philosophical ideas. According to Marx, a doctor had a moral duty to ease the suffering of death through encouragement, support and mitigation using medication. Such an "alleviation of death" reflected the contemporary zeitgeist, but was brought into the medical canon of responsibility for the first time by Marx. Marx also stressed the distinction of the theological care of the soul of sick people from the physical care and medical treatment by doctors.[34][35]
Euthanasia in its modern sense has always been strongly opposed in the Judeo-Christian tradition. Thomas Aquinas opposed both and argued that the practice of euthanasia contradicted our natural human instincts of survival,[36] as did Francois Ranchin (1565–1641), a French physician and professor of medicine, and Michael Boudewijns (1601–1681), a physician and teacher.[31]: 208 [32] Other voices argued for euthanasia, such as John Donne in 1624,[37] and euthanasia continued to be practised. In 1678, the publication of Caspar Questel's De pulvinari morientibus non-subtrahend, ("On the pillow of which the dying should not be deprived"), initiated debate on the topic. Questel described various customs which were employed at the time to hasten the death of the dying, (including the sudden removal of a pillow, which was believed to accelerate death), and argued against their use, as doing so was "against the laws of God and Nature".[31]: 209–211 This view was shared by others who followed, including Philipp Jakob Spener, Veit Riedlin and Johann Georg Krünitz.[31]: 211 Despite opposition, euthanasia continued to be practised, involving techniques such as bleeding, suffocation, and removing people from their beds to be placed on the cold ground.[31]: 211–214
Suicide and euthanasia became more accepted during the Age of Enlightenment.[32] Thomas More wrote of euthanasia in Utopia, although it is not clear if More was intending to endorse the practice.[31]: 208–209 Other cultures have taken different approaches: for example, in Japan suicide has not traditionally been viewed as a sin, as it is used in cases of honor, and accordingly, the perceptions of euthanasia are different from those in other parts of the world.[38]
Beginnings of the contemporary euthanasia debate
[edit]In the mid-1800s, the use of morphine to treat "the pains of death" emerged, with John Warren recommending its use in 1848. A similar use of chloroform was revealed by Joseph Bullar in 1866. However, in neither case was it recommended that the use should be to hasten death. In 1870 Samuel Williams, a schoolteacher, initiated the contemporary euthanasia debate through a speech given at the Birmingham Speculative Club in England, which was subsequently published in a one-off publication entitled Essays of the Birmingham Speculative Club, the collected works of a number of members of an amateur philosophical society.[39]: 794 Williams' proposal was to use chloroform to deliberately hasten the death of terminally ill patients:
That in all cases of hopeless and painful illness, it should be the recognized duty of the medical attendant, whenever so desired by the patient, to administer chloroform or such other anaesthetic as may by-and-bye supersede chloroform – so as to destroy consciousness at once, and put the sufferer to a quick and painless death; all needful precautions being adopted to prevent any possible abuse of such duty; and means being taken to establish, beyond the possibility of doubt or question, that the remedy was applied at the express wish of the patient.
— Samuel Williams (1872), Euthanasia Williams and Northgate: London.[39]: 794
The essay was favourably reviewed in The Saturday Review, but an editorial against the essay appeared in The Spectator.[40] From there it proved to be influential, and other writers came out in support of such views: Lionel Tollemache wrote in favour of euthanasia, as did Annie Besant, the essayist and reformer who later became involved with the National Secular Society, considering it a duty to society to "die voluntarily and painlessly" when one reaches the point of becoming a 'burden'.[40][41] Popular Science analyzed the issue in May 1873, assessing both sides of the argument.[42] Kemp notes that at the time, medical doctors did not participate in the discussion; it was "essentially a philosophical enterprise ... tied inextricably to a number of objections to the Christian doctrine of the sanctity of human life".[40]
Early euthanasia movement in the United States
[edit]
The rise of the euthanasia movement in the United States coincided with the so-called Gilded Age, a time of social and technological change that encompassed an "individualistic conservatism that praised laissez-faire economics, scientific method, and rationalism", along with major depressions, industrialisation and conflict between corporations and labour unions.[39]: 794 It was also the period in which the modern hospital system was developed, which has been seen as a factor in the emergence of the euthanasia debate.[43]
Robert Ingersoll argued for euthanasia, stating in 1894 that where someone is suffering from a terminal illness, such as terminal cancer, they should have a right to end their pain through suicide. Felix Adler offered a similar approach, although, unlike Ingersoll, Adler did not reject religion. In fact, he argued from an Ethical Culture framework. In 1891, Adler argued that those suffering from overwhelming pain should have the right to commit suicide, and, furthermore, that it should be permissible for a doctor to assist – thus making Adler the first "prominent American" to argue for suicide in cases where people were suffering from chronic illness.[44] Both Ingersoll and Adler argued for voluntary euthanasia of adults suffering from terminal ailments.[44] Dowbiggin argues that by breaking down prior moral objections to euthanasia and suicide, Ingersoll and Adler enabled others to stretch the definition of euthanasia.[45]
The first attempt to legalise euthanasia took place in the United States, when Henry Hunt introduced legislation into the General Assembly of Ohio in 1906.[46]: 614 Hunt did so at the behest of Anna Sophina Hall, a wealthy heiress who was a major figure in the euthanasia movement during the early 20th century in the United States. Hall had watched her mother die after an extended battle with liver cancer, and had dedicated herself to ensuring that others would not have to endure the same suffering. Towards this end she engaged in an extensive letter writing campaign, recruited Lurana Sheldon and Maud Ballington Booth, and organised a debate on euthanasia at the annual meeting of the American Humane Association in 1905 – described by Jacob Appel as the first significant public debate on the topic in the 20th century.[46]: 614–616
Hunt's bill called for the administration of an anesthetic to bring about a patient's death, so long as the person is of lawful age and sound mind, and was suffering from a fatal injury, an irrevocable illness, or great physical pain. It also required that the case be heard by a physician, required informed consent in front of three witnesses, and required the attendance of three physicians who had to agree that the patient's recovery was impossible. A motion to reject the bill outright was voted down, but the bill failed to pass, 79 to 23.[39]: 796 [46]: 618–619
Along with the Ohio euthanasia proposal, in 1906 Assemblyman Ross Gregory introduced a proposal to permit euthanasia to the Iowa legislature. However, the Iowa legislation was broader in scope than that offered in Ohio. It allowed for the death of any person of at least ten years of age who suffered from an ailment that would prove fatal and cause extreme pain, should they be of sound mind and express a desire to artificially hasten their death. In addition, it allowed for infants to be euthanised if they were sufficiently deformed, and permitted guardians to request euthanasia on behalf of their wards. The proposed legislation also imposed penalties on physicians who refused to perform euthanasia when requested: a 6–12-month prison term and a fine of between $200 and $1,000. The proposal proved to be controversial.[46]: 619–621 It engendered considerable debate and failed to pass, having been withdrawn from consideration after being passed to the Committee on Public Health.[46]: 623
After 1906 the euthanasia debate reduced in intensity, resurfacing periodically, but not returning to the same level of debate until the 1930s in the United Kingdom.[39]: 796
Euthanasia opponent Ian Dowbiggin argues that the early membership of the Euthanasia Society of America (ESA) reflected how many perceived euthanasia at the time, often seeing it as a eugenics matter rather than an issue concerning individual rights.[44] Dowbiggin argues that not every eugenist joined the ESA "solely for eugenic reasons", but he postulates that there were clear ideological connections between the eugenics and euthanasia movements.[44]
1930s in Britain
[edit]The Voluntary Euthanasia Legalisation Society was founded in 1935 by Charles Killick Millard (now called Dignity in Dying). The movement campaigned for the legalisation of euthanasia in Great Britain.
In January 1936, King George V was given a fatal dose of morphine and cocaine to hasten his death. At the time he was suffering from cardio-respiratory failure, and the decision to end his life was made by his physician, Lord Dawson.[47] Although this event was kept a secret for over 50 years, the death of George V coincided with proposed legislation in the House of Lords to legalise euthanasia.[48]
Nazi Euthanasia Program
[edit]
A 24 July 1939 killing of a severely disabled infant in Nazi Germany was described in a BBC "Genocide Under the Nazis Timeline" as the first "state-sponsored euthanasia".[49] Parties that consented to the killing included Hitler's office, the parents, and the Reich Committee for the Scientific Registration of Serious and Congenitally Based Illnesses.[49] The Telegraph noted that the killing of the disabled infant—whose name was Gerhard Kretschmar, born blind, with missing limbs, subject to convulsions, and reportedly "an idiot"— provided "the rationale for a secret Nazi decree that led to 'mercy killings' of almost 300,000 mentally and physically handicapped people".[50] While Kretchmar's killing received parental consent, most of the 5,000 to 8,000 children killed afterwards were forcibly taken from their parents.[49][50]
The "euthanasia campaign" of mass murder gathered momentum on 14 January 1940 when the "handicapped" were killed with gas vans and at killing centres, eventually leading to the deaths of 70,000 adult Germans.[51] was a campaign of mass murder by involuntary euthanasia in Nazi Germany. Its code name Aktion T4 is derived from Tiergartenstraße 4, a street address of the Chancellery department which recruited and paid personnel associated with the program.[50] Professor Robert Jay Lifton, author of The Nazi Doctors and a leading authority on the T4 program, contrasts this program with what he considers to be a genuine euthanasia. He explains that the Nazi version of "euthanasia" was based on the work of Adolf Jost, who published The Right to Death (Das Recht auf den Tod) in 1895. Lifton writes:
Jost argued that control over the death of the individual must ultimately belong to the social organism, the state. This concept is in direct opposition to the Anglo-American concept of euthanasia, which emphasizes the individual's 'right to die' or 'right to death' or 'right to his or her own death,' as the ultimate human claim. In contrast, Jost was pointing to the state's right to kill. ... Ultimately the argument was biological: 'The rights to death [are] the key to the fitness of life.' The state must own death—must kill—in order to keep the social organism alive and healthy.[52]
In modern terms, the use of "euthanasia" in the context of Aktion T4 is seen to be a euphemism to disguise a program of genocide, in which people were killed on the grounds of "disabilities, religious beliefs, and discordant individual values".[53] Compared to the discussions of euthanasia that emerged post-war, the Nazi program may have been worded in terms that appear similar to the modern use of "euthanasia", but there was no "mercy" and the patients were not necessarily terminally ill.[53] Despite these differences, historian and euthanasia opponent Ian Dowbiggin writes that "the origins of Nazi euthanasia, like those of the American euthanasia movement, predate the Third Reich and were intertwined with the history of eugenics and Social Darwinism, and with efforts to discredit traditional morality and ethics."[44]: 65
1949 New York State Petition for Euthanasia and Catholic opposition
[edit]On 6 January 1949, the Euthanasia Society of America presented to the New York State Legislature a petition to legalize euthanasia, signed by 379 leading Protestant and Jewish ministers, the largest group of religious leaders ever to have taken this stance. A similar petition had been sent to the New York Legislature in 1947, signed by approximately 1,000 New York physicians. Roman Catholic religious leaders criticized the petition, saying that such a bill would "legalize a suicide-murder pact" and a "rationalization of the fifth commandment of God, 'Thou Shalt Not Kill.'"[54] The Right Reverend Robert E. McCormick stated that:
The ultimate object of the Euthanasia Society is based on the Totalitarian principle that the state is supreme and that the individual does not have the right to live if his continuance in life is a burden or hindrance to the state. The Nazis followed this principle and compulsory Euthanasia was practiced as a part of their program during the recent war. We American citizens of New York State must ask ourselves this question: "Are we going to finish Hitler's job?"[54]
The petition brought tensions between the American Euthanasia Society and the Catholic Church to a head that contributed to a climate of anti-Catholic sentiment generally, regarding issues such as birth control, eugenics, and population control. However, the petition did not result in any legal changes.[44]
Debate
[edit]Historically, the euthanasia debate has tended to focus on a number of key concerns. According to euthanasia opponent Ezekiel Emanuel, proponents of euthanasia have presented four main arguments: a) that people have a right to self-determination, and thus should be allowed to choose their own fate; b) assisting a subject to die might be a better choice than requiring that they continue to suffer; c) the distinction between passive euthanasia, which is often permitted, and active euthanasia, which is not substantive (or that the underlying principle–the doctrine of double effect–is unreasonable or unsound); and d) permitting euthanasia will not necessarily lead to unacceptable consequences. Pro-euthanasia activists often point to countries like the Netherlands and Belgium, and states like Oregon, where euthanasia has been legalized, to argue that it is mostly unproblematic.
Similarly, Emanuel argues that there are four major arguments presented by opponents of euthanasia: a) not all deaths are painful; b) alternatives, such as cessation of active treatment, combined with the use of effective pain relief, are available; c) the distinction between active and passive euthanasia is morally significant; and d) legalising euthanasia will place society on a slippery slope,[55] which will lead to unacceptable consequences.[39]: 797–8 In fact, in Oregon, in 2013, pain was not one of the top five reasons people sought euthanasia. Top reasons were a loss of dignity, and a fear of burdening others.[56]
In the United States in 2013, 47% nationwide supported doctor-assisted suicide. This included 32% of Latinos and 29% of African-Americans.[56] Some US disability rights organizations have also opposed bills legalizing assisted suicide.[57]
A 2015 Populus poll in the United Kingdom found broad public support for assisted dying; 82% of people supported the introduction of assisted dying laws, including 86% of people with disabilities.[58]
An alternative approach to the question is seen in the hospice movement which promotes palliative care for the dying and terminally ill. This has pioneered the use of pain-relieving drugs in a holistic atmosphere in which the patient's spiritual care ranks alongside physical care. It 'intends neither to hasten nor postpone death'.[59]
Legal status
[edit]The examples and perspective in this section may not represent a worldwide view of the subject. (November 2011) |


Eligibility for euthanasia varies across jurisdictions where it is legal.[63] Some countries such as Belgium and the Netherlands allow euthanasia for mental illness.[64]
West's Encyclopedia of American Law states that "a 'mercy killing' or euthanasia is generally considered to be a criminal homicide" and is normally used as a synonym of homicide committed at a request made by the patient.[65][66]
The judicial sense of the term "homicide" includes any intervention undertaken with the express intention of ending a life, even to relieve intractable suffering.[67][66][68] Not all homicide is unlawful.[69] Two designations of homicide that carry no criminal punishment are justifiable and excusable homicide.[69] In most countries this is not the status of euthanasia. The term "euthanasia" is usually confined to the active variety; the University of Washington website states that "euthanasia generally means that the physician would act directly, for instance by giving a lethal injection, to end the patient's life".[70] Physician-assisted suicide is thus not classified as euthanasia by the US State of Oregon, where it is legal under the Oregon Death with Dignity Act, and despite its name, it is not legally classified as suicide either.[71] Unlike physician-assisted suicide, withholding or withdrawing life-sustaining treatments with patient consent (voluntary) is almost unanimously considered, at least in the United States, to be legal.[72] The use of pain medication to relieve suffering, even if it hastens death, has been held as legal in several court decisions.[70]
Some governments around the world have legalized voluntary euthanasia but most commonly it is still considered to be criminal homicide. In the Netherlands and Belgium, where euthanasia has been legalized, it still remains homicide although it is not prosecuted and not punishable if the perpetrator (the doctor) meets certain legal conditions.[73][74][75][76]
In a historic judgment, the Supreme Court of India legalized passive euthanasia. The apex court remarked in the judgment that the Constitution of India values liberty, dignity, autonomy, and privacy. A bench headed by Chief Justice Dipak Misra delivered a unanimous judgment.[77] Common Cause (India) was the main petitioner in the case, filed in 2005 [78].
Health professionals' sentiment
[edit]A 2010 survey in the United States of more than 10,000 physicians found that 16.3% of physicians would consider halting life-sustaining therapy because the family demanded it, even if they believed that it was premature. Approximately 54.5% would not, and the remaining 29.2% responded "it depends".[79] The study also found that 45.8% of physicians agreed that physician-assisted suicide should be allowed in some cases; 40.7% did not, and the remaining 13.5% felt it depended.[79]
In the United Kingdom, the assisted dying campaign group Dignity in Dying cites research in which 54% of general practitioners support or are neutral towards a law change on assisted dying.[80] Similarly, a 2017 Doctors.net.uk poll reported in the British Medical Journal stated that 55% of doctors believe assisted dying, in defined circumstances, should be legalised in the UK.[81]
In 2019, the World Medical Association issued a statement during its 70th Assembly declaring itself opposed to euthanasia and assisted suicide.[82]
Religious views
[edit]Christianity
[edit]Broadly against
[edit]The Roman Catholic Church condemns euthanasia and assisted suicide as morally wrong. As paragraph 2324 of the Catechism of the Catholic Church states, "Intentional euthanasia, whatever its forms or motives, is murder. It is gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator". Because of this, per the Declaration on Euthanasia, the practice is unacceptable within the Church.[83] The Orthodox Church in America, along with other Eastern Orthodox Churches, also opposes euthanasia stating that "euthanasia is the deliberate cessation of human life, and, as such, must be condemned as murder."[84]
Many non-Catholic churches in the United States take a stance against euthanasia. Among Protestant denominations, the Episcopal Church passed a resolution in 1991 opposing euthanasia and assisted suicide stating that it is "morally wrong and unacceptable to take a human life to relieve the suffering caused by incurable illnesses."[84] Protestant and other non-Catholic churches which oppose euthanasia include:
- Assemblies of God[85]
- The Church of Jesus Christ of Latter-day Saints[86]
- Church of the Nazarene[87]
- Evangelical Lutheran Church in America[88]
- Presbyterian Church in America[89]
- Lutheran Church–Missouri Synod[90]
- Reformed Church in America[91]
- Salvation Army[92]
- Seventh-day Adventist Church[85]
- Southern Baptist Convention[93]
- United Methodist Church[84]
Partially in favor of
[edit]The Church of England accepts passive euthanasia under some circumstances, but is strongly against active euthanasia, and has led opposition against recent attempts to legalise it.[94] The United Church of Canada accepts passive euthanasia under some circumstances, but is in general against active euthanasia, with growing acceptance now that active euthanasia has been partly legalised in Canada.[95] The Waldensians take a liberal stance on euthanasia and allow the decision to lie with individuals.[96][97]
Islam
[edit]Euthanasia is a complex issue in Islamic theology; however, in general it is considered contrary to Islamic law and holy texts. Among interpretations of the Qur'an and Hadith, the early termination of life is a crime, be it by suicide or helping one commit suicide. The various positions on the cessation of medical treatment are mixed and considered a different class of action than direct termination of life, especially if the patient is suffering. Suicide and euthanasia are both crimes in almost all Muslim majority countries.[98]
Judaism
[edit]There is much debate on the topic of euthanasia in Judaic theology, ethics, and general opinion (especially in Israel and the United States). Passive euthanasia was declared legal by Israel's highest court under certain conditions and has reached some level of acceptance. Active euthanasia remains illegal; however, the topic is actively under debate with no clear consensus through legal, ethical, theological and spiritual perspectives.[99]
Hinduism
[edit]Although there is no absolute consensus, Hinduism generally views euthanasia as a serious act that conflicts with core principles such as Dharma (duty), Karma (actions and their consequences), and Ahimsa (non-violence).[100]
See also
[edit]- All pages with titles beginning with Euthanasia in – lists many countries with notable positions
- All pages with titles beginning with Assisted suicide in – lists some countries with notable positions
- List of deaths from legal euthanasia and assisted suicide
Notes
[edit]- ^ Portugal: Law not yet in force, awaits regulation to be implemented. The law legalizing euthanasia, Law n.º 22/2023, of 22 May,[60] states in Article 31 that the regulation must be approved within 90 days of the publishing of the law, which would have been 23 August 2023. However, the regulation has not yet been approved by the government. On 24 November 2023, the Ministry of Health stated that the regulation of the law would be the responsibility of the new government elected in the 10 March 2024 elections.[61] The law, according to its Article 34, will only enter into force 30 days after the regulation is published.
References
[edit]- ^ Kuhse, Helga. "Euthanasia Fact Sheet". The World Federation of Right to Die Societies. Archived from the original on 5 August 2017. Retrieved 6 July 2017.
'Euthanasia' is a compound of two Greek words – eu and thanatos meaning, literally, 'a good death'. Today, 'euthanasia' is generally understood to mean the bringing about of a good death – 'mercy killing,' where one person, A, ends the life of another person, B, for the sake of B."
- ^ "Voluntary Euthanasia". Stanford Encyclopedia of Philosophy. Metaphysics Research Lab, Stanford University. Archived from the original on 11 June 2019. Retrieved 7 May 2019.
When a person performs an act of euthanasia, she brings about the death of another person because she believes the latter's present existence is so bad that he would be better off dead, or believes that unless she intervenes and ends his life, his life will very soon become so bad that he would be better off dead.
- ^ a b c d Harris, NM. (October 2001). "The euthanasia debate". J R Army Med Corps. 147 (3): 367–70. doi:10.1136/jramc-147-03-22. PMID 11766225.
- ^ Euthanasia and assisted suicide Archived 19 July 2011 at the Wayback Machine BBC. Last reviewed June 2011. Accessed 25 July 2011. Archived from the original
- ^ Carr, Claudia (2014). Unlocking Medical Law and Ethics (2nd ed.). Routledge. p. 374. ISBN 9781317743514. Retrieved 2 February 2018.
- ^ Voluntary and involuntary euthanasia Archived 5 September 2011 at the Wayback Machine BBC Accessed 12 February 2012. Archived from the original
- ^ Borry P, Schotsmans P, Dierickx K (April 2006). "Empirical research in bioethical journals. A quantitative analysis". J Med Ethics. 32 (4): 240–45. doi:10.1136/jme.2004.011478. PMC 2565792. PMID 16574880.
- ^ "Dictionary.com | Meanings & Definitions of English Words". Dictionary.com.
- ^ "EUTHANASIA | English meaning - Cambridge Dictionary".
- ^ Kohl, Marvin (1974). The Morality of Killing. New York: Humanities Press. p. 94. ISBN 9780391001954., quoted in Beauchamp & Davidson (1979), p 294. A similar definition is offered by Blackburn (1994) with "the action of causing the quick and painless death of a person, or not acting to prevent it when prevention was within the agent's powers."
- ^ a b c d e Beauchamp, Tom L.; Davidson, Arnold I. (1979). "The Definition of Euthanasia". Journal of Medicine and Philosophy. 4 (3): 294–312. doi:10.1093/jmp/4.3.294. PMID 501249.
- ^ a b Draper, Heather (1998). "Euthanasia". In Chadwick, Ruth (ed.). Encyclopedia of Applied Ethics. Vol. 2. Academic Press.
- ^ "euthanasia". Oxford Dictionaries. Oxford University Press. April 2010. Archived from the original on 21 August 2011. Retrieved 26 April 2011.
- ^ Kohl, Marvin; Kurtz, Paul (1975). "A Plea for Beneficient Euthanasia". In Kohl, Marvin (ed.). Beneficient Euthanasia. Buffalo, New York: Prometheus Books. p. 94., quoted in Beauchamp & Davidson (1979), p 295.
- ^ Wreen, Michael (1988). "The Definition of Euthanasia". Philosophy and Phenomenological Research. 48 (4): 637–53 [639]. doi:10.2307/2108012. JSTOR 2108012. PMID 11652547.
- ^ Brody, Baruch (1975). "Voluntary Euthanasia and the Law". In Kohl, Marvin (ed.). Beneficient Euthanasia. Buffalo, New York: Prometheus Books. p. 94., quoted in Beauchamp & Davidson (1979), p 295.
- ^ Draper, Heather (1998). "Euthanasia". In Chadwick, Ruth (ed.). Encyclopedia of Applied Ethics. Vol. 2. Academic Press. p. 176.
- ^ Beauchamp, Tom L.; Davidson, Arnold I. (1979). "The Definition of Euthanasia". Journal of Medicine and Philosophy. 4 (3): 303. doi:10.1093/jmp/4.3.294. PMID 501249.
- ^ Beauchamp, Tom L.; Davidson, Arnold I. (1979). "The Definition of Euthanasia". Journal of Medicine and Philosophy. 4 (3): 304. doi:10.1093/jmp/4.3.294. PMID 501249.
- ^ Wreen, Michael (1988). "The Definition of Euthanasia". Philosophy and Phenomenological Research. 48 (4): 637–40. doi:10.2307/2108012. JSTOR 2108012. PMID 11652547.
- ^ a b c Wreen, Michael (1988). "The Definition of Euthanasia". Philosophy and Phenomenological Research. 48 (4): 637–53 [645]. doi:10.2307/2108012. JSTOR 2108012. PMID 11652547.
- ^ Materstvedt, Lars Johan; Clark, David; Ellershaw, John; Førde, Reidun; Boeck Gravgaard, Anne-Marie; Müller-Busch, Christof; Porta i Sales, Josep; Rapin, Charles-Henri (2003). "Euthanasia and physician-assisted suicide: a view from an EAPC Ethics Task Force". Palliative Medicine. 17 (2): 97–101. CiteSeerX 10.1.1.514.5064. doi:10.1191/0269216303pm673oa. PMID 12701848. S2CID 1498250.
- ^ Philippe Letellier, chapter: History and Definition of a Word, in Euthanasia: Ethical and Human Aspects By Council of Europe
- ^ Francis Bacon: The Major Works by Francis Bacon, edited by Brian Vickers, p. 630.
- ^ Perrett RW (October 1996). "Buddhism, euthanasia and the sanctity of life". J Med Ethics. 22 (5): 309–13. doi:10.1136/jme.22.5.309. PMC 1377066. PMID 8910785.
- ^ LaFollette, Hugh (2002). Ethics in practice: an anthology. Oxford: Blackwell. pp. 25–26. ISBN 978-0-631-22834-9.
- ^ Wreen, Michael (1988). "The Definition of Euthanasia". Philosophy and Phenomenological Research. 48 (4): 637–53. doi:10.2307/2108012. JSTOR 2108012. PMID 11652547.
- ^ a b c Jackson, Jennifer (2006). Ethics in medicine. Polity. p. 137. ISBN 0-7456-2569-X.
- ^ Rachels J (January 1975). "Active and passive euthanasia". N. Engl. J. Med. 292 (2): 78–80. doi:10.1056/NEJM197501092920206. PMID 1109443. S2CID 46465710.
- ^ Mystakidou, Kyriaki; Parpa, Efi; Tsilika, Eleni; Katsouda, Emanuela; Vlahos, Lambros (2005). "The Evolution of Euthanasia and Its Perceptions in Greek Culture and Civilization". Perspectives in Biology and Medicine. 48 (1): 97–98. doi:10.1353/pbm.2005.0013. PMID 15681882. S2CID 44600176.
- ^ a b c d e f Stolberg, Michael (2007). "Active Euthanasia in Pre-ModernSociety, 1500–1800: Learned Debates and Popular Practices". Social History of Medicine. 20 (2): 206–07. doi:10.1093/shm/hkm034. PMID 18605325. S2CID 6150428.
- ^ a b c Gesundheit, Benjamin; Steinberg, Avraham; Glick, Shimon; Or, Reuven; Jotkovitz, Alan (2006). "Euthanasia: An Overview and the Jewish Perspective". Cancer Investigation. 24 (6): 621–9. doi:10.1080/07357900600894898. PMID 16982468. S2CID 8906449.
- ^ Zedlers Universallexikon, Vol. 08, p. 1150, published 1732–54.
- ^ Markwart Michler (1990). "Marx, Karl, Mediziner". Neue Deutsche Biographie (in German). Vol. 16. Berlin: Duncker & Humblot. pp. 327–328. (full text online).
- ^ Helge Dvorak: Biographisches Lexikon der Deutschen Burschenschaft. Vol. I, Sub-vol. 4, Heidelberg, 2000, pp. 40–41.
- ^ "Historical Timeline: History of Euthanasia and Physician-Assisted Suicide," Archived 5 July 2012 at the Library of Congress Web Archives Euthanasia – ProCon.org. Last updated on: 23 July 2013. Retrieved 4 May 2014.
- ^ Mannes, Marya (1975). "Euthanasia vs. the Right to Life". Baylor Law Review. 27: 69.
- ^ Otani, Izumi (2010). ""Good Manner of Dying" as a Normative Concept: "Autocide", "Granny Dumping" and Discussions on Euthanasia/Death with Dignity in Japan". International Journal of Japanese Sociology. 19 (1): 49–63. doi:10.1111/j.1475-6781.2010.01136.x.
- ^ a b c d e f Emanuel, Ezekiel (1994). "The history of euthanasia debates in the United States and Britain". Annals of Internal Medicine. 121 (10): 796. CiteSeerX 10.1.1.732.724. doi:10.7326/0003-4819-121-10-199411150-00010. PMID 7944057. S2CID 20754659.
- ^ a b c Nick Kemp (7 September 2002). Merciful Release. Manchester University Press. ISBN 978-0-7190-6124-0. OL 10531689M. 0719061245.
- ^ Ian Dowbiggin (March 2007). A Concise History of Euthanasia: Life, Death, God, and Medicine. Rowman & Littlefield. pp. 51, 62–64. ISBN 978-0-7425-3111-6.
- ^ "Euthanasia". Popular Science. May 1873.
- ^ Pappas, Demetra (1996). "Recent historical perspectives regarding medical euthanasia and physician assisted suicide". British Medical Bulletin. 52 (2): 386–87. doi:10.1093/oxfordjournals.bmb.a011554. PMID 8759237.
- ^ a b c d e f Dowbiggin, Ian (2003). A merciful end: the euthanasia movement in modern America. Oxford University Press. pp. 10–13. ISBN 978-0-19-515443-6.
- ^ Dowbiggin, Ian (2003). A merciful end: the euthanasia movement in modern America. Oxford University Press. p. 13. ISBN 978-0-19-515443-6.
- ^ a b c d e Appel, Jacob (2004). "A Duty to Kill? A Duty to Die? Rethinking the Euthanasia Controversy of 1906". Bulletin of the History of Medicine. 78 (3): 610–34. doi:10.1353/bhm.2004.0106. PMID 15356372. S2CID 24991992.
- ^ Ramsay, J H R (28 May 2011). "A king, a doctor, and a convenient death". British Medical Journal. 308 (1445): 1445. doi:10.1136/bmj.308.6941.1445. PMC 2540387. PMID 11644545.
- ^ Gurney, Edward (1972). "Is There a Right to Die – A Study of the Law of Euthanasia". Cumberland-Samford Law Review. 3: 237.
- ^ a b c Genocide Under the Nazis Timeline: 24 July 1939 Archived 5 August 2011 at the Wayback Machine BBC Accessed 23 July 2011. Quotation: "The first state-sanctioned euthanasia is carried out, after Hitler receives a petition from a child's parents, asking for the life of their severely disabled infant to be ended. This happens after the case has been considered by Hitler's office and by the Reich Committee for the Scientific Registration of Serious and Congenitally Based Illnesses, whose 'experts' have laid down the basis for the removal of disabled children to special 'paediatric clinics'. Here they can be either starved to death or given lethal injections. At least 5,200 infants will eventually be killed through this programme".
- ^ a b c Irene Zoech (11 October 2003). "Named: the baby boy who was Nazis' first euthanasia victim". Telegraph.co.uk. Archived from the original on 8 September 2017. Retrieved 4 July 2017.
- ^ Genocide Under the Nazis Timeline: 14 January 1940 Archived 5 August 2011 at the Wayback Machine BBC Accessed 23 July 2011. Quotation: "The 'euthanasia campaign' gathers momentum in Germany, as six special killing centres and gas vans, under an organisation code-named T4, are used in the murder of 'handicapped' adults. Over 70,000 Germans will eventually be killed in this act of mass murder – it is the first time poison bas will be used for such a purpose".
- ^ Basic Books 1986, 46
- ^ a b Michalsen A, Reinhart K (September 2006). ""Euthanasia": A confusing term, abused under the Nazi regime and misused in present end-of-life debate". Intensive Care Med. 32 (9): 1304–10. doi:10.1007/s00134-006-0256-9. PMID 16826394. S2CID 21032497.
- ^ a b The Moncton Transcript. "Ministers Ask Mercy Killing." 6 January 1949.
- ^ Wesley J. Smith (1997). Forced Exit (Forced exit ed.). New York: Times Books. ISBN 978-0-8129-2790-0. OL 1006883M. 0812927907.
- ^ a b "The vulnerable will be the victims: Opposing view". Usatoday.com. Archived from the original on 9 September 2017. Retrieved 4 July 2017.
- ^ Gorman, Anna (30 June 2015). "Why Disability-Rights Advocates Are Fighting Doctor-Assisted Suicide". The Atlantic. Archived from the original on 1 July 2015. Retrieved 27 May 2023.
- ^ "Dignity in Dying Poll – Populous" (PDF). Archived from the original (PDF) on 8 November 2016. Retrieved 4 August 2018.
- ^ "Position statement on hospice care and assisted dying (assisted suicide) and recommendations" (PDF). Hospice UK. Retrieved 11 March 2021.
- ^ "Law n.º 22/2023, of 22 May, published on the 1st Series of Diário da República, n.º 101, of 25 May 2023, in Portuguese, retrieved 25 May 2023".
- ^ Caeiro, Tiago (24 November 2023). "Eutanásia não avança para já. Ministério da Saúde deixa regulamentação para o próximo governo" [Euthanasia is not moving forward for now. Ministry of Health leaves regulation to the next government]. Observador (in Portuguese). Archived from the original on 2 December 2023. Retrieved 14 January 2024.
- ^ Colombo, Asher D.; Dalla-Zuanna, Gianpiero (25 January 2024). "Data and Trends in Assisted Suicide and Euthanasia, and Some Related Demographic Issues". Population and Development Review. 50 (1): 233–257. doi:10.1111/padr.12605. hdl:11585/955009. Fig. 1.
- ^ Davis, Nicola (15 July 2019). "Euthanasia and assisted dying rates are soaring. But where are they legal?". the Guardian. Archived from the original on 26 March 2021. Retrieved 6 May 2024.
- ^ Scopetti, Matteo; Morena, Donato; Padovano, Martina; Manetti, Federico; Di Fazio, Nicola; Delogu, Giuseppe; Ferracuti, Stefano; Frati, Paola; Fineschi, Vittorio (18 May 2023). "Assisted Suicide and Euthanasia in Mental Disorders: Ethical Positions in the Debate between Proportionality, Dignity, and the Right to Die". Healthcare. 11 (10). MDPI AG: 1470. doi:10.3390/healthcare11101470. ISSN 2227-9032. PMC 10218690. PMID 37239756.
- ^ West's Encyclopedia of American Law, Vol. 4. West Publishing Company. 1998. p. 24. ISBN 9780314201577.
- ^ a b Carmen Tomás Y Valiente, La regulación de la eutanasia en Holanda, Anuario de Derecho Penal y Ciencias Penales – Núm. L, Enero 1997
- ^ Harris, N. (1 October 2001). "The Euthanasia Debate". Journal of the Royal Army Medical Corps. 147 (3): 367–370. doi:10.1136/jramc-147-03-22. PMID 11766225. S2CID 298551.
- ^ Manoj Kumar Mohanty (August 2004). "Variants of homicide: a review". Journal of Clinical Forensic Medicine. 11 (4): 214–18. doi:10.1016/j.jcfm.2004.04.006. PMID 15363757.
- ^ a b "the definition of homicide". Dictionary.com. Archived from the original on 3 March 2016. Retrieved 4 July 2017.
- ^ a b "Physician-Assisted Suicide: Ethical Topic in Medicine". depts.washington.edu. Archived from the original on 13 April 2017. Retrieved 4 July 2017.
- ^ Taylor, Bill (7 July 2017). "Physician Assisted Suicide" (PDF). Archived from the original (PDF) on 4 December 2004. Retrieved 7 July 2017.
- ^ ""Legal Aspects of Withholding and Withdrawing Life Support from Critically Ill Patients in the United States and Providing Palliative Care to Them", Am. J. Respir. Crit. Care Med., Volume 162, Number 6, December 2000". Archived from the original on 13 August 2003.
- ^ Oluyemisi Bamgbose (2004). "Euthanasia: Another Face of Murder". International Journal of Offender Therapy and Comparative Criminology. 48 (1): 111–21. CiteSeerX 10.1.1.631.618. doi:10.1177/0306624X03256662. PMID 14969121. S2CID 32664881.
- ^ Concluding observations of the Human Rights Committee : Netherlands. 27 August 2001
- ^ Carmen Tomás Y Valiente, La regulación de la eutanasia en Holanda, Anuario de Derecho Penal y Ciencias Penales – Núm. L, Enero 1997
- ^ R Cohen-Almagor (2009). "Belgian euthanasia law: a critical analysis". J. Med. Ethics. 35 (7): 436–39. CiteSeerX 10.1.1.508.6943. doi:10.1136/jme.2008.026799. PMID 19567694. S2CID 44968015.
- ^ "Euthanasia and beyond: on the Supreme Court's verdict SC Constitution Bench holds passive euthanasia, living wills permissible". The Hindu. Karnataka. 9 March 2018. Archived from the original on 5 June 2018. Retrieved 9 March 2018.
- ^ "Euthanasia and the Right to Die with Dignity". Supreme Court Observer.
- ^ a b Leslie Kane, MA. "Exclusive Ethics Survey Results: Doctors Struggle With Tougher-Than-Ever Dilemmas". Medscape.com. Archived from the original on 14 August 2017. Retrieved 6 July 2017.
- ^ "Public opinion – Dignity in Dying". Archived from the original on 14 May 2019. Retrieved 3 August 2018.
- ^ "Assisted dying case 'stronger than ever' with majority of doctors now in support". 7 February 2018. Archived from the original on 15 May 2019. Retrieved 3 August 2018.
- ^ "WMA Declaration on Euthanasia and Physician-assisted Suicide". October 2019.
- ^ Congregation for the Doctrine of the Faith (5 May 1980). "Declaration on Euthanasia". www.vatican.va. Archived from the original on 16 June 2023. Retrieved 27 May 2023.
- ^ a b c "The Orthodox Christian view on Euthanasia". www.orthodoxchristian.info. Archived from the original on 12 August 2017.
- ^ a b "Assemblies of God (USA) Official Web Site – Medical: Euthanasia, and Extraordinary Support to Sustain Life". ag.org. Archived from the original on 14 August 2017.
- ^ "21. Selected Church Policies and Guidelines". ChurchofJesusChrist.org. Archived from the original on 21 October 2014. Retrieved 16 July 2019.
- ^ "The Church of the Nazarene, Doctrinal and Ethical Positions". www.crivoice.org. Archived from the original on 8 November 2017.
- ^ "Error" (PDF). Archived (PDF) from the original on 18 April 2016. Retrieved 28 March 2018.
- ^ "What Are Christian Perspectives on Euthanasia and Physician-Assisted Suicide? - Euthanasia - ProCon.org". euthanasia.procon.org. Archived from the original on 15 August 2017.
- ^ "LCMS Views – Frequently Asked Questions – The Lutheran Church—Missouri Synod". www.lcms.org. Archived from the original on 14 August 2017.
- ^ "General Synod Statements: Physician-Assisted Suicide – Reformed Church in America". www.rca.org. Archived from the original on 19 March 2017.
- ^ "The Salvation Army International – Positional Statement: Euthanasia and Assisted Suicide". www.salvationarmy.org. Archived from the original on 14 August 2017.
- ^ "Southern Baptist Convention > Resolution on Euthanasia And Assisted Suicide". www.sbc.net. Archived from the original on 9 October 2017.
- ^ Why the Church of England Supports the Current Law on Assisted Suicide. Dr Brendan McCarthy Archbishops' Council Church House, London 2015
- ^ Submission to The Special Joint Committee on Physician-Assisted Dying. Rev. Jordan Cantwell Moderator of The United Church of Canada. 2016
- ^ Ozzano, L.; Giorgi, A. (2015). European Culture Wars and the Italian Case: Which side are you on?. Routledge Studies in Religion and Politics. Taylor & Francis. p. 178. ISBN 978-1-317-36548-8. Archived from the original on 13 May 2023. Retrieved 5 May 2023.
- ^ Garnier, T. (2022). From God to Climate Change: The journey of Albert Garnier's 30-year mission in China to scientist son Ben's fight with the riddle of the world. Paragon Publishing. p. 135. ISBN 978-1-78222-969-8. Archived from the original on 13 May 2023. Retrieved 5 May 2023.
- ^ Islamic Perspectives, Euthanasia (Qatl al-raḥma). Abulfadl Mohsin Ebrahim. Journal of the Islamic Medical Association of North America 2007 Volume 4.
- ^ Death and Euthanasia in Jewish Law: Essays and Responses. W Jacob and M. Zemer. Pitsburg and Tel Aviv. Rodef Shalom Press. 1995
- ^ "BBC - Religions - Hinduism: Euthanasia, assisted dying and Suicide". www.bbc.co.uk. Retrieved 22 December 2024.
Further reading
[edit]- Fry-Revere, Sigrid (2008). "Euthanasia". In Hamowy, Ronald (ed.). The Encyclopedia of Libertarianism. Thousand Oaks, CA: SAGE Publications, Cato Institute. pp. 156–58. doi:10.4135/9781412965811.n98. ISBN 978-1412965804. LCCN 2008009151. OCLC 750831024.
- Nitschke, Philip; Fiona Stewart; Philip Nitschke; Fiona Stewart (2006). The Peaceful Pill Handbook. Exit International US Ltd. ISBN 978-0-9788788-0-1.
- Rachels, James (1986). The end of life: Euthanasia and Morality. Oxford University Press. ISBN 978-0-19-286070-5.
- Torr, James D. (2000). Euthanasia: opposing viewpoints. San Diego: Greenhaven Press. ISBN 978-0-7377-0127-2.
External links
[edit]
Media related to Euthanasia at Wikimedia Commons
The dictionary definition of euthanasia at Wiktionary
Quotations related to Euthanasia at Wikiquote- Physician assisted death from The Hastings Center
Euthanasia
View on GrokipediaDefinitions and Terminology
Etymology and Core Concepts
The term euthanasia derives from the ancient Greek words eu (εὖ), meaning "good" or "well," and thanatos (θάνατος), meaning "death," literally translating to "good death" or "easy death."[10][11] This etymological sense originally connoted a peaceful or painless passing, as reflected in its earliest English usage around 1644 to describe a gentle end without agony.[10] By the mid-19th century, particularly following Samuel D. Williams's 1870 essay advocating medical intervention for terminal patients, the term evolved to encompass deliberate acts inducing death to alleviate intractable suffering, shifting from passive description to active practice.[11][12] At its core, euthanasia refers to the intentional termination of a person's life by another party, typically a physician, with the primary aim of relieving profound, unrelievable suffering from conditions such as terminal illness or severe disability.[13][14] This act presupposes a judgment that the individual's continued existence imposes net harm exceeding the value of life itself, often framed philosophically as preferring non-existence over persistent pain.[14] Unlike suicide, which involves self-infliction, euthanasia entails external agency, distinguishing it from assisted suicide where the patient self-administers a lethal means provided by another.[13] Core distinctions include active euthanasia (direct causation of death, e.g., via lethal injection) versus passive forms (withholding life-sustaining interventions, allowing natural death), though the former raises sharper ethical questions about intent and causality.[14][15] These concepts hinge on empirical assessments of suffering's severity and consent's validity, yet debates persist over whether "good death" aligns with etymological ideals or masks broader societal valuations of life.[13]Classifications and Distinctions
Euthanasia is classified primarily by the method of inducing death and the presence of patient consent. Active euthanasia entails a direct, intentional act by another person to cause death, such as administering a lethal injection or drug overdose.[16] Passive euthanasia, by contrast, involves the deliberate withholding or withdrawal of life-sustaining treatments, such as mechanical ventilation or nutrition, with the foreseeable consequence of death from the underlying condition; this classification is debated, as some definitions require explicit intent to end life for it to qualify as euthanasia, distinguishing it from routine end-of-life care decisions.[17][16] Classifications based on consent further delineate types: voluntary euthanasia occurs at the explicit, informed request of a competent patient; non-voluntary euthanasia applies to cases where the patient lacks capacity to consent, such as infants, those in persistent vegetative states, or severely demented individuals; and involuntary euthanasia proceeds against the patient's known wishes.[18] These consent-based categories apply to both active and passive forms, though voluntary active euthanasia is the most commonly discussed in legal contexts.[18] A key distinction separates euthanasia from physician-assisted suicide (or assisted dying), where a third party—typically a physician—provides the means for death (e.g., prescribing lethal drugs), but the patient performs the final self-administrative act; in euthanasia, the third party directly executes the lethal intervention.[16][18] This procedural difference influences legal frameworks, with some jurisdictions permitting assisted suicide but prohibiting euthanasia, reflecting varied emphases on patient autonomy versus provider involvement.[18] Professional bodies like the World Medical Association explicitly differentiate euthanasia from withholding futile treatments, underscoring that the former involves intentional life-ending acts beyond mere palliation.[16]Historical Context
Pre-Modern Perspectives
In ancient Greece, the term euthanasia—derived from eu ("good") and thanatos ("death")—originally denoted a natural, painless, or honorable end to life rather than deliberate intervention to hasten dying. Physicians adhered to the Hippocratic Oath, composed around 400 BCE, which explicitly prohibited administering deadly drugs or advising their use to patients wishing to end their lives, establishing medicine's ethical stance against active euthanasia.[19] While some dramatists and philosophers, such as those in Euripides' works, explored suicide as a response to suffering or dishonor, the majority rejected active euthanasia, viewing it as disruptive to familial and social obligations.[19] Roman perspectives evolved in a more permissive direction during the Hellenistic and Imperial periods, where euthanasia could describe a luxurious or suffering-free death achieved through self-willed means. Stoic thinkers like Seneca (c. 4 BCE–65 CE) endorsed rational suicide via methods such as hemlock ingestion or venesection to evade intolerable pain or degradation, as detailed in his Epistulae Morales.[20] Emperors occasionally exercised a right to assisted death for the terminally ill or condemned, but physicians maintained a marginal role, avoiding direct participation to evade legal repercussions for homicide.[21] Infanticide of deformed newborns was practiced under the lex Cornelia (81 BCE), justified as preserving societal strength, though distinct from adult euthanasia.[22] Pre-Christian Jewish tradition, rooted in Torah commandments against murder (Exodus 20:13) and the sanctity of life as God's domain, uniformly opposed euthanasia and suicide. Rabbinic texts, such as the Talmud (compiled c. 200–500 CE), mandated efforts to prolong life in terminal cases and forbade any act accelerating death, even to alleviate suffering, equating it to bloodshed.[23] Early Christianity inherited and intensified these prohibitions, emphasizing divine authority over life and death. Church Fathers like Tertullian (c. 155–240 CE) and Augustine (354–430 CE) denounced suicide and mercy killing as violations of natural law and usurpations of God's will, as articulated in Augustine's City of God (Book I), where he argued that even unbearable suffering must be endured for spiritual merit.[24] This stance permeated medieval theology, with canon law under Gratian's Decretum (c. 1140 CE) classifying intentional death-hastening as homicide, punishable by excommunication.[22] In other ancient civilizations, evidence is sparser but indicative of restraint. Ancient Egyptian medical papyri, such as the Ebers Papyrus (c. 1550 BCE), focused on prolonging life through remedies without references to euthanasia, aligning with pharaonic views of death as a transition overseen by gods.[25] Hindu scriptures permitted sallekhana—voluntary fasting to death by advanced ascetics in texts like the Manusmriti (c. 200 BCE–200 CE)—as a non-violent purification, but condemned active killing or assistance for non-spiritual motives.[26] Confucian China prioritized filial duty and harmony, implicitly discouraging euthanasia, though historical records note rare imperial mercy killings without doctrinal endorsement.[22]Modern Advocacy and the Nazi Association
In the early 20th century, advocacy for euthanasia emerged within broader eugenics and public health discourses, emphasizing the relief of suffering for the incurably ill while reducing perceived societal burdens. In the United States, debates intensified, culminating in a 1906 Ohio legislative bill to permit physicians to end the lives of terminally ill patients at their request, though it failed amid opposition from medical and religious groups.[27] Similar efforts appeared in Britain, where physician C. Killick Millard, influenced by wartime observations of prolonged agony, helped found the Voluntary Euthanasia Legalisation Society in 1935 to lobby for safeguards permitting competent adults to request lethal assistance from doctors.[28] In Germany, the intellectual groundwork was laid by jurist Karl Binding and psychiatrist Alfred Hoche in their 1920 treatise Die Freigabe der Vernichtung lebensunwerten Lebens (Permitting the Destruction of Life Unworthy of Life), which classified certain mentally ill and disabled individuals as "ballast existences" whose elimination—without consent—could free resources for the productive, framing it as a rational, cost-saving measure rather than mere compassion.[29] Binding argued legally for state authorization of such killings for those deemed incapable of meaningful existence, while Hoche provided psychiatric justification, estimating significant institutional costs and advocating gassing as an efficient method.[30] These ideas resonated amid post-World War I economic strains and eugenics popularity, predating Nazi rule but aligning with racial hygiene concepts promoted by figures like Binding's contemporaries. The Nazi regime operationalized and expanded these notions into state policy, launching Aktion T4 in October 1939 as a centralized euthanasia program targeting institutionalized children and adults with physical or mental disabilities.[31] Authorized by Adolf Hitler via a backdated September 1, 1939, directive, the program deceived families with claims of transfers to better facilities while using carbon monoxide gas chambers at six killing centers—initially modeled on Hoche's suggestions—to murder victims selected by medical panels based on criteria like low IQ or chronic illness.[31] By August 1941, when publicly halted amid Catholic-led protests and over 70,000 documented killings, Aktion T4 had refined extermination logistics later applied to the Holocaust, with informal "wild euthanasia" continuing via starvation, overdose, or shooting, pushing total disabled deaths to an estimated 200,000–300,000 by war's end.[31][32] The Nazi association persists in critiques of contemporary euthanasia advocacy, as opponents cite Aktion T4's progression from "mercy" for the suffering to involuntary elimination of the "unworthy"—echoing Binding and Hoche's devaluation of lives based on utility—as evidence of a causal pathway from permissive laws to abuse, particularly under state oversight where safeguards erode.[33] Proponents counter that Nazi actions stemmed from totalitarian ideology and absent consent mechanisms, distinct from modern voluntary models restricted to terminally competent adults, though empirical reviews of programs like the Netherlands' since 2002 reveal expansions to non-terminal cases, including psychiatric patients, raising parallels to early 20th-century scope creep absent robust empirical validation of irreversibility claims.[34] This linkage underscores tensions between autonomy arguments and historical precedents where utilitarian rationales justified non-consensual acts, with sources like U.S. Holocaust Memorial Museum documentation highlighting how pre-Nazi advocacy supplied ideological cover without anticipating scale.[31]Post-World War II Developments and Legal Milestones
Following World War II, the Nazi regime's systematic euthanasia program, which killed an estimated 200,000 to 300,000 individuals deemed "unfit," led to a profound global stigma against active euthanasia, reinforcing its criminalization in most countries and associating it with eugenics and state-sponsored murder rather than individual choice. Public opinion in North America, for example, shifted sharply against the practice in the 1940s due to these associations, with advocacy groups facing marginalization until the 1960s. Advances in medical technology, such as ventilators and artificial nutrition, prolonged dying processes and sparked bioethical debates on patient autonomy, initially focusing on passive euthanasia—withholding or withdrawing treatment—rather than active intervention. Landmark U.S. cases established legal precedents for refusal of care: in 1976, the New Jersey Supreme Court in In re Quinlan permitted the removal of a ventilator from comatose patient Karen Ann Quinlan at her family's request, affirming a constitutional right to privacy in medical decisions for incompetent patients; this was upheld by the U.S. Supreme Court in Cruzan v. Director, Missouri Department of Health (1990), which recognized competent adults' rights to refuse life-sustaining treatment like feeding tubes, though requiring clear evidence of prior wishes.[34][35] Active euthanasia and physician-assisted suicide (PAS) remained prosecutable offenses, but de facto tolerance emerged in jurisdictions like the Netherlands through court rulings applying a "medical necessity" defense. In the 1970s, Dutch physicians performed euthanasia cases, with courts acquitting practitioners under guidelines emphasizing unbearable suffering and patient consent; by the early 1990s, annual reported cases exceeded 2,000, prompting formal prosecution review procedures in 1998 that rarely led to charges if protocols were followed. This culminated in the Netherlands' Termination of Life on Request and Assisted Suicide (Review Procedures) Act of 2002, the first national law explicitly legalizing voluntary active euthanasia and PAS for competent adults with unbearable suffering from incurable conditions, requiring second opinions and reporting to review committees. Belgium followed with its Euthanasia Act in 2002, permitting similar practices for terminally ill patients, later expanded in 2014 to include children with parental consent and intractable conditions.[36][37][38] Other early legalizations distinguished between active euthanasia (physician-administered lethal drugs) and PAS (patient self-administration with aid). Australia's Northern Territory passed the Rights of the Terminally Ill Act in 1995, authorizing voluntary euthanasia for competent adults with terminal illness, but it was overturned federally in 1997 after nine uses. Oregon's Death with Dignity Act, voter-approved in 1994 and implemented in 1997 after U.S. Supreme Court challenges, legalized PAS but not active euthanasia, limiting prescriptions to terminally ill patients with six months' prognosis. Colombia's 1997 Constitutional Court ruling decriminalized euthanasia for terminal cases, leading to regulatory guidelines by 1998, though full legislation followed in 2015. Canada's Supreme Court struck down PAS bans in Carter v. Canada (2015), enabling the Medical Assistance in Dying (MAID) framework via Bill C-14 in 2016, which includes both euthanasia and PAS for grievous, irremediable conditions. By 2020, reported euthanasia deaths in permissive jurisdictions numbered in the thousands annually, with expansions in some areas to non-terminal psychiatric suffering raising concerns over safeguard erosion.[34]61034-4/abstract)| Jurisdiction | Year | Key Milestone | Scope |
|---|---|---|---|
| United States (Oregon) | 1997 | Death with Dignity Act effective | PAS for terminal adults; active euthanasia prohibited[39] |
| Netherlands | 2002 | Termination of Life on Request Act | Active euthanasia and PAS for unbearable suffering[37] |
| Belgium | 2002 | Euthanasia Act | Active euthanasia for terminal/incurable; expanded to minors in 2014[40] |
| Canada | 2016 | Bill C-14 (MAID) | Euthanasia and PAS for irremediable conditions; mental illness eligibility deferred[34] |
Methods of Euthanasia
Pharmacological Approaches in Humans
Pharmacological euthanasia in humans primarily employs intravenous administration of high-dose barbiturates to induce coma, followed by neuromuscular blocking agents to cause respiratory arrest and paralysis, with potassium chloride sometimes added to ensure cardiac standstill.30339-7/fulltext) In the Netherlands, guidelines from the Royal Dutch Medical Association recommend thiopental (1,000–2,000 mg) or propofol for initial sedation, succeeded by a paralytic such as pancuronium (10–20 mg) or rocuronium (50–100 mg).[41] Belgium follows analogous protocols, favoring barbiturates like pentobarbital combined with muscle relaxants, administered directly by physicians in active euthanasia cases.30339-7/fulltext) These multi-drug sequences aim to minimize consciousness during the process, though single-drug barbiturate overdoses are occasionally used when paralytics are unavailable.[42] In physician-assisted suicide, where patients self-administer lethal medications, oral barbiturates predominate. Oregon's Death with Dignity Act reports secobarbital (9–15 grams) or pentobarbital (10–15 grams) as standard prescriptions, ingested as a solution to induce coma and respiratory failure, typically resulting in death within 30 minutes to 3 hours.[43] Complications include regurgitation, failure to lose consciousness, or extended survival times exceeding 24 hours in rare instances, with anti-emetics like metoclopramide often co-prescribed to reduce vomiting risks.[44] Empirical data reveal non-negligible failure rates and complications. A 2000 Dutch study of 103 euthanasia cases identified problems in 24%, including prolonged time to death (18%) and inadequate coma induction (7%), sometimes necessitating additional doses or alternative methods like suffocation.[44] In Flanders, Belgium, surveys indicate barbiturates and relaxants are used in over 90% of reported euthanasia acts, yet doses vary widely due to lack of standardized legislation, contributing to occasional technical difficulties such as difficult venous access.[45] These issues underscore causal challenges in achieving reliable, rapid unconsciousness and cessation of vital functions, with peer-reviewed analyses questioning the protocols' efficacy compared to veterinary applications.[46]Techniques for Animals
The American Veterinary Medical Association (AVMA) Guidelines for the Euthanasia of Animals classify euthanasia methods based on their acceptability, emphasizing rapid loss of consciousness and death with minimal pain or distress.[47] Injectable chemical agents, particularly barbiturates like pentobarbital sodium, represent the preferred technique for most companion animals, including dogs and cats, due to their reliability in inducing unconsciousness within seconds followed by cardiac and respiratory arrest.[47][48] These agents are administered intravenously at doses far exceeding those used for anesthesia, typically 2 to 3 times the lethal dose to ensure efficacy even with vascular collapse.[47] Veterinarians commonly precede barbiturate injection with a sedative, such as acepromazine or xylazine, to alleviate anxiety and facilitate restraint, though this step is optional and not required for the euthanasia process itself.[48][49] Commercial euthanasia solutions, such as Euthasol, combine pentobarbital sodium (typically 390 mg/mL) with phenytoin sodium (50 mg/mL) to accelerate cardiac arrest and prevent recovery, often including a dye like rhodamine B for identification.[50] For animals where intravenous access proves difficult, such as fractious cats or large livestock, intracardiac or intraperitoneal injections serve as alternatives, though the latter delays onset by 10-20 minutes due to slower absorption.[47][51] Inhalation methods, including carbon dioxide (CO2) chambers, find application in laboratory settings for small rodents or neonatal animals, achieving unconsciousness via hypoxia within 2-5 minutes at concentrations exceeding 40%.[47] Physical techniques, deemed acceptable under specific conditions, include cervical dislocation for birds and small mammals under 200 grams, which severs the spinal cord and causes immediate insensibility, or penetrating captive bolt guns for ruminants and horses, delivering a high-velocity projectile to destroy brain tissue.[47] Gunshot to the brain serves as a field method for large or wild animals when chemical agents are unavailable, requiring precise anatomical targeting to ensure instantaneous unconsciousness.[47] These non-chemical approaches prioritize operator training to minimize variability in humaneness, as improper execution can prolong suffering.[47] For aquatic species like fish, acceptable methods encompass immersion in buffered tricaine methanesulfonate (MS-222) at concentrations of 250-500 mg/L or overdose with clove oil (eugenol), both inducing anesthesia followed by respiratory failure.[47] Post-euthanasia verification involves checking for absence of heartbeat, respirations, and corneal reflex, often confirmed by physical means like thoracic compression or electrical monitoring in research contexts.[47] Regulatory oversight, such as through institutional animal care committees, mandates adherence to these guidelines to ensure welfare standards.[52]Comparative Efficacy and Risks
In veterinary euthanasia, intravenous administration of pentobarbital (typically 1-2 mL per 4.5 kg body weight for dogs, or higher doses up to 13 mL for 45 kg animals) induces coma within seconds and cardiac arrest within 1-5 minutes, with near-100% efficacy when vascular access is achieved, as failures primarily stem from technical issues like poor vein location rather than drug ineffectiveness. Complications, such as prolonged agitation or incomplete sedation prior to injection, occur in under 5% of cases with proper pre-euthanasia anxiolytics, though intraperitoneal routes in small animals carry higher misinjection risks (6-20%) leading to delayed or painful death. These methods prioritize rapid cessation of consciousness to minimize distress, supported by standardized guidelines from bodies like the American Veterinary Medical Association. Human euthanasia protocols, legalized in jurisdictions like the Netherlands and Belgium, commonly use high-dose barbiturates (e.g., thiopental 1-2 g followed by pentobarbital 2 g or secobarbital 9-15 g orally) or multi-drug sequences including muscle relaxants and potassium chloride, aiming for unconsciousness in under 5 minutes and death within 10-30 minutes. Efficacy is high for physician-administered intravenous euthanasia, with completion rates exceeding 95%, but complications arise in 2-7% of cases, including failure to induce coma (requiring additional doses), longer-than-expected time to death (>1 hour in rare instances), or technical difficulties like vomiting or vascular collapse. Physician-assisted suicide, involving self-ingestion, shows lower reliability, with 7-15% complication rates including regurgitation, survival after ingestion, or awakening post-coma. These issues are documented in Dutch surveys, where procedural problems mirror those in capital punishment lethal injections, potentially prolonging awareness or suffering if not swiftly addressed. Comparatively, veterinary methods exhibit superior procedural reliability due to involuntary administration, higher relative dosing without consent barriers, and routine pre-sedation, resulting in fewer failures to achieve rapid, humane death than human protocols, which contend with patient variability, ethical constraints on dosing, and self-administration risks in assisted cases. Risks in animal euthanasia center on handling distress (mitigated by 80-90% success in chemical immobilization for fractious subjects), while human applications face amplified scrutiny from review committees, with 0.2-1% of Dutch cases (e.g., 10 out of 6,091 in 2016) deemed non-compliant due to procedural lapses or inadequate palliation alternatives. Multi-drug human cocktails, like the three-drug sequence of barbiturate, paralytic, and cardiotoxic agent, introduce risks of paralysis without prior unconsciousness if sequencing fails, a concern absent in single-agent veterinary pentobarbital use.| Aspect | Veterinary (IV Pentobarbital) | Human Euthanasia (IV Barbiturates/Combinations) | Human Assisted Suicide (Oral) |
|---|---|---|---|
| Time to Unconsciousness | <30 seconds | 30 seconds-5 minutes | 5-15 minutes (variable) |
| Time to Death | 1-5 minutes | 5-30 minutes | 30 minutes-4 hours |
| Complication Rate | <5% (injection-related) | 2-7% (coma failure, prolongation) | 7-15% (regurgitation, survival) |
| Primary Risks | Agitation pre-injection | Technical failure, awareness if sequenced wrong | Ineffective ingestion, partial recovery |
Ethical and Philosophical Debates
Pro-Euthanasia Arguments: Autonomy and Suffering Relief
Proponents of euthanasia argue that the principle of patient autonomy justifies the practice, positing that competent individuals have an inherent right to self-determination over their bodies and lives, including the choice to end them when facing terminal conditions. This view draws from ethical frameworks emphasizing personal liberty, where denying euthanasia infringes on an individual's capacity to make decisions aligned with their values, particularly when life becomes burdensome due to illness.41832-X/fulltext)[53] For instance, philosophers and bioethicists contend that autonomy extends to end-of-life choices, akin to rights in informed consent or refusal of treatment, allowing patients to avoid unwanted prolongation of existence.[53] In practice, this autonomy argument is invoked for cases of advanced disease where patients, after informed evaluation, request euthanasia to preserve control amid diminishing capacities. Studies of euthanasia requests highlight that autonomy-driven decisions often stem from a desire to dictate the timing and manner of death, preventing perceived losses of dignity or dependence on others.[54] Empirical data from legalized settings, such as the Netherlands, indicate that over 90% of euthanasia cases from 2002 to 2022 involved patients explicitly citing autonomous choice alongside medical criteria, with physicians verifying decisional capacity through multiple consultations.[18] Advocates maintain that safeguards like psychiatric assessments ensure requests reflect genuine volition rather than transient despair, countering critiques of impaired judgment.[54] Relief from suffering forms a complementary rationale, with proponents asserting that euthanasia mercifully terminates intractable physical or psychological pain unresponsive to palliative measures. In terminal illnesses like advanced cancer, where up to 30% of patients report severe, unrelieved symptoms despite optimal care, euthanasia is framed as an extension of beneficence—acting in the patient's best interest by ending futile endurance.[55] Prospective assessments in Belgium and the Netherlands reveal that "unbearable suffering" in approved cases frequently encompasses not only pain but also cumulative effects like respiratory failure or neurological decline, with 70-80% of requesters describing suffering as medically untreatable.[55] This argument holds that withholding euthanasia prolongs avoidable torment, prioritizing compassionate cessation over absolute preservation of life.[18]Anti-Euthanasia Arguments: Sanctity of Life and Intrinsic Value
The sanctity of life principle asserts that human life possesses an inherent, inviolable value that prohibits its deliberate termination, positioning euthanasia as a fundamental moral violation regardless of intent or circumstances.[56] This doctrine, historically rooted in Judeo-Christian theology—where life is viewed as a divine gift and humans as bearers of God's image (Imago Dei)—extends to secular bioethics by emphasizing life's status as an absolute good, not contingent on subjective qualities like productivity or absence of suffering.[56] Opponents argue that endorsing euthanasia erodes this sacred boundary, treating life as disposable and fostering a cultural shift toward instrumental valuation, where existence is weighed against utility.[57] Philosophically, the intrinsic value of life derives from its nature as a bonum per se—a good in itself—independent of external ends such as pleasure, autonomy, or relief from pain.[57] Natural law theorists, drawing from Thomas Aquinas, contend that euthanasia contravenes primary precepts of self-preservation and the ordered pursuit of human flourishing, as intentionally ending life disrupts the teleological orientation toward life's continuance even amid hardship.[58] In this framework, suffering does not diminish life's worth but tests human resolve to honor its absolute dignity; permitting euthanasia, even voluntarily, equates to rejecting life's inherent telos and inviting arbitrary judgments on whose existence merits continuation.[57] Kantian ethics reinforces this by grounding human dignity in rational autonomy, which demands treating persons as ends-in-themselves rather than means to alleviate distress.[59] Euthanasia, whether active or assisted, instrumentalizes the individual by prioritizing subjective suffering over the categorical imperative against self-destruction or aiding in one's demise, thereby undermining the universal respect owed to rational beings irrespective of capacity or condition.[59] Critics of euthanasia from this perspective warn that conflating personal choice with moral permissibility ignores the non-negotiable duty to preserve life, as autonomy cannot license actions that negate the very foundation of dignitary worth.[59] Empirical and logical extensions of these arguments highlight risks to vulnerable populations: if life's value is not intrinsic but quality-dependent, then the disabled, elderly, or depressed become susceptible to devaluation, as evidenced by historical precedents where utilitarian assessments justified harm.[57] Proponents of intrinsic value counter that experiential potential—rather than mere physical viability—underpins life's worth, rendering euthanasia unjustifiable even in cases of profound impairment, since subjective quality metrics lack objective universality and invite coercion or error.[60] Ultimately, these positions maintain that affirming life's sanctity safeguards societal norms against commodification, preserving moral consistency by rejecting any exception that normalizes intentional killing.[56]Empirical Critiques: Coercion, Depression, and Safeguard Failures
Empirical analyses of euthanasia practices reveal vulnerabilities in patient decision-making, particularly among those experiencing coercion, undiagnosed depression, or inadequate application of safeguards. In jurisdictions such as the Netherlands, Belgium, and Canada, where euthanasia has been legalized, studies indicate that subtle forms of coercion—stemming from familial, economic, or social pressures—pose risks to autonomous choice, especially for elderly or disabled individuals reliant on caregivers. Although overt coercion remains rare and understudied, with prevalence unknown due to limited case histories, expansions of eligibility to non-terminal conditions amplify concerns about undue influence, as patients may perceive euthanasia as a means to alleviate burdens on family or society.[61][62] Depression frequently underlies euthanasia requests, often going undetected despite its capacity to distort rational assessment of end-of-life options. A systematic review of high-quality studies from the Netherlands and Oregon determined that 8-47% of patients requesting euthanasia or physician-assisted suicide (PAS) displayed depressive symptoms, while 2-17% of completed cases involved such symptoms; these figures suggest that psychiatric evaluation is inconsistently applied, potentially allowing treatable conditions to precipitate irreversible decisions.[63] In end-of-life cancer patients, standardized assessments revealed depressed individuals were four times more likely to request euthanasia, underscoring how untreated mood disorders can mimic intolerable suffering rather than reflect enduring, voluntary preferences.[64] Physicians report low rates of formal depression screening—only 2% in some surveys—exacerbating the risk that requests stem from reversible despair rather than irremediable physical agony. Depression is medically regarded as a treatable illness responsive to interventions like medication adjustments, cognitive behavioral therapy, inpatient treatment, or support groups; many who felt hopeless have recovered and regained meaning in life through professional help.[65][66] Safeguard protocols, intended to ensure voluntary and informed consent, demonstrate empirical shortcomings through documented non-compliance. In the Netherlands, Regional Euthanasia Review Committees (RTEs) evaluated over 5,600 cases from 2003-2005 and identified 15 instances of failure to meet due care criteria, primarily due to insufficient independent consultation or verification of unbearable suffering.[37] More recent data from 2024 RTE reports noted six euthanasia deaths lacking due care, including cases where physicians omitted required psychiatric consultations despite evident mental health factors.[67] These lapses, while comprising a small fraction of total procedures (approximately 0.1-0.5% annually), highlight systemic gaps in enforcement, such as reliance on self-reported notifications and inconsistent second opinions, which official monitoring may undercount due to selective disclosure or interpretive leniency.[68] Comparative analyses across jurisdictions further indicate that procedural guarantees frequently falter in practice, particularly for psychiatric cases, where social risk factors like isolation or economic strain erode protections against hasty approvals.[69]Legal Frameworks
Regulations for Human Euthanasia by Jurisdiction
Human euthanasia, including active euthanasia (administration of lethal drugs by a physician) and physician-assisted suicide (provision of means for self-administration), is legally permitted under strict conditions in select jurisdictions as of October 2025. These laws generally mandate that patients be adults of sound mind experiencing unbearable suffering from a serious, irremediable condition, with voluntary and informed requests confirmed through multiple assessments and consultations. Oversight often involves reporting to review committees to ensure compliance, though empirical data indicate variable adherence and scope creep in practice.[70][71] In jurisdictions without explicit legalization, such as most of the United States and European countries, active euthanasia remains prohibited under homicide or manslaughter statutes, with assisted suicide decriminalized or tolerated in limited forms.[72] Netherlands: Euthanasia and assisted suicide have been regulated since the Termination of Life on Request and Assisted Suicide (Review Procedures) Act entered into force on April 1, 2002. Physicians may perform the procedure only if the patient, aged 12 or older (with parental involvement for minors under 16), makes a voluntary and well-considered request based on enduring unbearable suffering without prospect of improvement, typically from a medical condition but increasingly including psychiatric cases. For primarily psychiatric conditions, such as treatment-resistant depression or personality disorders, the physician must consult an independent psychiatrist to verify the patient's decision-making capacity, the unbearableness of suffering, and the absence of viable treatment alternatives, alongside the standard consultation with another independent doctor. Due care requires the physician to inform the patient of alternatives, consult at least one independent doctor, and verify capacity; cases are reviewed post-facto by regional committees, with non-compliance potentially leading to prosecution despite the law's exemption from criminal liability. In 2023, over 9,000 cases were reported, representing 5% of deaths, with expansions to dementia via advance directives permitted under 2020 guidelines but requiring ongoing capacity assessment.[70][73] Belgium: The Belgian Act on Euthanasia, effective September 2002, permits physicians to administer lethal drugs or provide self-administration means to adults and emancipated minors experiencing constant, intolerable physical or psychological suffering from an incurable disorder caused by serious illness or accident. Psychological suffering from psychiatric disorders, such as severe depression or other treatment-refractory mental illnesses, is explicitly included without a requirement for terminal physical conditions or limited life expectancy; eligibility demands repeated voluntary requests, confirmation of capacity, and agreement from two physicians, including an independent one, often involving psychiatric expertise to assess incurability and unbearableness. A 2014 amendment removed age limits for children with terminal conditions, requiring parental consent and psychological evaluation. Requests must be voluntary, repeated, and documented; two physicians must agree, with cases reported to a federal commission for review. Unlike neighboring Netherlands, Belgium explicitly includes non-terminal mental suffering without a life-expectancy requirement, leading to 3,000 annual cases by 2023, including expansions to psychiatric disorders and early dementia.[74][75] Canada: Medical Assistance in Dying (MAiD) was legalized under Bill C-14 in June 2016, expanded by Bill C-7 in 2021 to remove the "reasonably foreseeable natural death" criterion, allowing access for irremediable conditions causing grievous suffering regardless of terminal status. Eligible adults (18+) must have decision-making capacity, provide informed consent, and undergo two independent assessments; procedures can be clinician-administered (euthanasia) or self-administered. Mental illness as sole condition was delayed from 2023 to March 17, 2027, amid concerns over safeguards, with advance requests under consultation as of 2025. In 2023, MAiD accounted for 4.7% of deaths (15,300 cases), with Track 2 (non-terminal) comprising 17% and rising. Provincial regulations vary, but federal law mandates reporting to Health Canada.[71][76] Switzerland: Assisted suicide has been permissible under Article 115 of the Penal Code since 1942, provided it lacks selfish motives and the patient self-administers the lethal substance (typically sodium pentobarbital prescribed by a physician). Active euthanasia is illegal. Non-profit organizations like Dignitas and Exit facilitate for competent adults, including foreigners, without residency requirements, though Swiss Medical Association guidelines emphasize unbearable suffering and capacity verification via psychiatric evaluation if needed. No terminal illness mandate exists, enabling "suicide tourism" (over 1,200 foreigners annually by 2023); cases are investigated by prosecutors, with rare prosecutions.[77][78] Spain: The Organic Law for the Regulation of Euthanasia, effective June 25, 2021, authorizes physicians to perform euthanasia or assisted suicide for adults with serious, chronic, or incurable diseases causing intolerable suffering, or conditions significantly impairing dignity. Requests require written consent, two medical confirmations of eligibility, and evaluation by a multidisciplinary committee; cases are logged in a national registry. Mental disorders alone do not qualify, but neurodegenerative diseases like dementia do if criteria met. By 2023, 600 procedures occurred, with regional variations in implementation.[79] New Zealand: The End of Life Choice Act 2019, enacted after a 2020 referendum, took effect November 7, 2021, allowing physician-assisted death for residents aged 18+ with terminal illness expected to cause death within six months and unbearable suffering that cannot be alleviated. Two doctors must confirm eligibility, capacity, and voluntariness; coercion checks and 14-day reflection periods apply. Mental illness or disability alone disqualifies; the procedure is self- or clinician-administered. In the first year, 315 cases occurred, reviewed by the Ministry of Health. A 2025 review assesses expansions.[80][81] Australia: Voluntary assisted dying (VAD) laws vary by state and territory, with all jurisdictions except the Northern Territory legalizing by 2025. Victoria pioneered in 2019, followed by Western Australia (2021), Tasmania, South Australia, Queensland, New South Wales (2023), and Australian Capital Territory (effective November 3, 2025). Common requirements include residency, age 18+, terminal illness with six-month prognosis (12 for neurodegenerative), decision-making capacity, and witnessing of requests; most mandate self-administration, though practitioner administration is allowed in some (e.g., Queensland). Safeguards involve multiple assessments and reporting to oversight bodies. Federal law prohibits euthanasia in territories, but state laws prevail. Usage remains low, under 1% of deaths.[82][83] United States: Active euthanasia is illegal nationwide, but physician-assisted suicide (self-administration) is authorized in 11 jurisdictions: Oregon (1997 Death with Dignity Act), Washington, Montana (court ruling), Vermont, California, Colorado, District of Columbia, Hawaii, New Jersey, Maine, New Mexico, and Delaware (effective 2025). Eligibility requires terminal illness with six-month prognosis, residency, competency, and voluntary written/oral requests witnessed and confirmed by two physicians; no mental illness sole basis. Annual reports show 500-600 cases, primarily in Oregon (0.6% of deaths in 2023). Other states criminalize assistance, with 18 considering bills in 2025.[84][85]| Jurisdiction | Active Euthanasia Allowed | Assisted Suicide Allowed | Key Eligibility Criteria | Year Legalized |
|---|---|---|---|---|
| Netherlands | Yes | Yes | Unbearable suffering, no improvement prospect; age 12+ | 2002 |
| Belgium | Yes | Yes | Intolerable suffering from incurable condition; no age limit | 2002 |
| Canada | Yes | Yes | Grievous irremediable condition; mental illness delayed to 2027 | 2016 (expanded 2021) |
| Switzerland | No | Yes | Self-administration; no terminal requirement | 1942 |
| Spain | Yes | Yes | Serious incurable disease causing intolerable suffering | 2021 |
| New Zealand | Yes | Yes | Terminal illness, 6-month prognosis | 2021 |
| Australia (states) | Varies (some yes) | Yes | Terminal, 6-12 month prognosis | 2019-2025 |
| US select states | No | Yes | Terminal, 6-month prognosis | 1997+ |
Veterinary Euthanasia Practices and Oversight
Veterinary euthanasia involves the intentional, humane termination of an animal's life to prevent suffering, typically performed by licensed veterinarians using methods that induce rapid unconsciousness followed by death. The American Veterinary Medical Association (AVMA) establishes standards through its Guidelines for the Euthanasia of Animals (2020 edition), which classify methods as acceptable, conditionally acceptable, or unacceptable based on criteria including reliability, minimal pain, and operator safety; these guidelines are reviewed every 5–10 years and adopted widely in professional practice.[47][86] Injectable barbiturates, particularly sodium pentobarbital at doses of 100–200 mg/kg intravenously, remain the most common and preferred method for companion animals like dogs and cats, causing central nervous system depression, coma, and respiratory/cardiac arrest within 10–30 seconds.[51][48] Pre-euthanasia sedation with agents such as acepromazine or dexmedetomidine (0.01–0.05 mg/kg) is often employed to minimize distress, especially in fractious patients.[48] For larger animals or field conditions, such as livestock or wildlife, conditionally acceptable alternatives include intracardiac pentobarbital injection (if the animal is anesthetized), captive bolt guns delivering kinetic energy to disrupt brain function, or non-penetrating/percussive blows for neonates; gunshot to the brain is permitted for free-ranging or untamed species when chemical methods are infeasible, targeting specific anatomical sites to ensure immediate insensibility.[47][51] Inhaled agents like carbon dioxide (for rodents or small birds at 40–70% displacement rates) or isoflurane serve as adjuncts or primaries in controlled settings, though they require specialized equipment to avoid distress from dyspnea.[47] Physical methods such as cervical dislocation or decapitation are restricted to small animals under 200 grams due to potential for pain if improperly executed.[47] Verification of death—via absence of heartbeat, respiration, corneal reflex, and response to stimuli—is mandatory post-procedure, often confirmed by two-step assessment after a 5–10 minute waiting period.[47] Oversight in the United States operates primarily through state veterinary medical boards, which license practitioners and enforce standards under veterinary practice acts requiring euthanasia to align with animal welfare principles and professional ethics; federal involvement is limited to research animals under the Animal Welfare Act (1966, amended), where Institutional Animal Care and Use Committees (IACUCs) mandate AVMA-compliant methods and training.[87][88] Euthanasia solutions like pentobarbital are regulated by the FDA as new animal drugs, with products such as Fatal-Plus® approved specifically for veterinary use since the 1970s, subject to controlled substance scheduling under the DEA due to abuse potential.[89] In animal shelters, states like New York certify euthanasia technicians via training programs emphasizing AVMA techniques, restricting administration to supervised personnel to prevent inhumane practices.[90] Non-compliance can result in license revocation, as seen in disciplinary actions by state boards for botched procedures causing prolonged suffering.[91] Internationally, oversight mirrors U.S. models but varies by jurisdiction; for instance, Canada's Canadian Council on Animal Care (CCAC) endorses AVMA guidelines for research and adopts similar humane criteria, while the European Union's Directive 2010/63/EU requires competent personnel and method validation for laboratory animals, prohibiting certain physical techniques without justification.[92][93] Professional bodies like the World Small Animal Veterinary Association promote global harmonization, emphasizing training and distress minimization, though enforcement relies on national veterinary councils.[94] Challenges include pentobarbital shortages, as in 2021–2022, prompting temporary reliance on alternatives like T-61 (embutramide-based, now phased out in some regions due to welfare concerns), underscoring the need for supply chain resilience in oversight frameworks.[89]International Variations and Human Rights Considerations
Active euthanasia is legal under regulated conditions in a limited number of countries, primarily those permitting it for patients experiencing unbearable suffering from serious, incurable illnesses, though eligibility criteria differ markedly. The Netherlands legalized voluntary euthanasia and physician-assisted suicide on April 1, 2002, allowing it for competent adults with persistent, intolerable suffering not necessarily terminal, with over 8,000 cases reported annually by 2023.[72] Belgium followed in 2002, extending access to minors since 2014 under parental consent and psychological evaluation for those over 12, encompassing both physical and psychiatric conditions.[95] Canada enacted Medical Assistance in Dying (MAiD) in 2016, initially for terminal cases but expanded in 2021 to non-terminal chronic conditions, with plans for mental illness eligibility postponed to 2027 amid concerns over assessment accuracy; by 2023, MAiD accounted for 4.1% of deaths.[96] Other nations include Colombia (via 2014 Constitutional Court ruling for terminal patients), Spain (2021 organic law for serious, incurable diseases), Portugal (2023 decriminalization for unbearable suffering), Luxembourg (2009), New Zealand (2021 referendum for terminally ill adults), and Ecuador (2024 court decision).[6] In contrast, assisted suicide without direct physician administration is permitted in Switzerland (since 1942, foreigner-inclusive), Germany (2020 Federal Court ruling decriminalizing organized assistance), and select Australian states (e.g., Victoria since 2019) and U.S. jurisdictions (e.g., Oregon's Death with Dignity Act since 1997, limited to terminal residents).[95][97] Most countries, including the United Kingdom, France (as of late 2025 proposals), Japan, and the vast majority of Asia, Africa, and the Middle East, prohibit active euthanasia, treating it as homicide punishable by imprisonment.[98]| Jurisdiction | Legal Status | Key Eligibility Criteria | Year Enacted |
|---|---|---|---|
| Netherlands | Active euthanasia and assisted suicide | Unbearable suffering, competent adult | 2002[72] |
| Belgium | Active euthanasia and assisted suicide | Unbearable suffering, includes minors and psychiatric | 2002 (minors 2014)[95] |
| Canada | Active euthanasia and assisted suicide (MAiD) | Grievous/irremediable condition, expanded to non-terminal | 2016 (expansion 2021)[96] |
| Switzerland | Assisted suicide only | No direct causation of death by physician | 1942[97] |
| Oregon, USA | Assisted suicide only | Terminal illness, resident adult | 1997[72] |
Empirical Outcomes and Case Studies
Data from the Netherlands (2002–Present)
Since the enactment of the Euthanasia Act in 2002, Dutch physicians have been required to notify cases of euthanasia or physician-assisted suicide (PAS) to review committees, which assess compliance with six due care criteria, including unbearable suffering without prospect of improvement and informed consent.[105] Reported cases numbered 1,882 in 2002, constituting approximately 1.3% of total deaths that year.[106] By 2005, reports reached about 1,885 euthanasia cases and 120 PAS, or 1.8% of deaths combined.[38] The volume of reported cases has increased markedly over time, reflecting broader acceptance and demographic aging. In 2010, euthanasia accounted for 2.8% of deaths in surveyed cases, with actual notifications around 3,136.[107] This rose to 4.4% by 2017, with 6,585 notifications.[108] Recent figures show 7,666 cases in 2021 (4.5% of deaths), 9,068 in 2023 (5.4%), and 9,958 in 2024 (5.8%), the latter marking a 10% year-over-year increase amid total deaths of 172,049.[109][110][111] Euthanasia constitutes the majority of these (over 90%), with PAS comprising the rest; combined, they represent over 5% of annual deaths in recent years, up from under 2% post-legalization.| Year | Reported Cases (Euthanasia + PAS) | Percentage of Total Deaths |
|---|---|---|
| 2002 | 1,882 | ~1.3% [106] |
| 2005 | ~2,000 | 1.8% [38] |
| 2010 | ~3,136 | 2.8% [107] |
| 2017 | 6,585 | 4.4% [108] |
| 2021 | 7,666 | 4.5% [109] |
| 2023 | 9,068 | 5.4% [110] |
| 2024 | 9,958 | 5.8% [111] |
