Euthanasia (Greek, "good death") is the practice of killing a person or animal, in a painless or minimally painful way, for merciful reasons, usually to end their suffering. This article discusses euthanasia in humans; a separate article covers animal euthanasia. Euthanasia is basically synonymous with the phrase "mercy killing."
Euthanasia in the strict sense involves actively causing death. This is in some cases legal in the Netherlands and Belgium, but in no other countries (as of 2005). Euthanasia in a wider sense includes assisting sufferers to commit suicide, in particular physician-assisted suicide; this is legal in a small number of jurisdictions.
Allowing death—e.g. by not providing life support or vital medication—is not considered euthanasia if it is the patient's wish. It is sometimes called passive euthanasia in cases where the patient is unable to make decisions about treatment. Living wills and Do Not Resuscitate orders are legal instruments that make a patient's treatment decisions known ahead of time; allowing a patient to die based on such decisions is not considered to be euthanasia.
Terminal sedation is a combination of medically inducing a deep sleep and stopping other treatment, with the exception of medication for symptom control (such as analgesia). It is considered to be euthanasia by some, but under current law and medical practice it is considered a form of palliative care.
Advocates of euthanasia generally insist that euthanasia should be voluntary, requiring informed consent, and that it should only be used in cases of terminal illness that cause unbearable suffering, or an eventual, complete loss of awareness. Its opponents challenge it on several ethical grounds, including a slippery slope argument that it is the first step towards compulsory euthanasia.
In Nazi Germany the term "euthanasia" (Euthanasie) referred to the systematic killing of disabled children and adults under the T-4 Euthanasia Program. This has tainted the word in German-speaking countries; the alternate term is "Sterbehilfe", which means "help to die."
Types of euthanasia
Apart from the above classifications three types of euthanasia may be identified, depending upon the sentience of the individual.
This is the truest and fullest form of euthanasia wherein the individual requests euthanasia - either during illness or before, if complete incapacitation is expected (coma would be an example). Euthanasia in these cases differs from suicide by existing only within the context of the amelioration of suffering in the process of death. Volition must be informed and free (i.e. not under duress from any third party).
Where an individual lacks sentience (in a coma, for example) and hence cannot decide, or distinguish, between life and death, such a person cannot give consent or cannot give informed consent, and therefore any euthanasia is not voluntary but also not involuntary. Famously notable as "turning off life-support", it is often done when resuscitation is not expected, or after severe brain damage that renders a person incapable of making life decisions. See Terri Schiavo
Where an individual may distinguish between life and death - and may fully realise the difference between them, any medical killing against the person's wishes is involuntary. If, for example, a man knows he is going to experience severe agony, and does not consent to death, euthanasia imposed upon him is legally, classed as murder. Any time that medical personnel determine on behalf of a sentient and responsible individual that his or her life is not worth living, the medical killing of such a person as it is considered to be done for the prevention of suffering is involuntary euthanasia. This is not to be confused with medical killing in cases of capital punishment or as part of genocide.
Arguments for and against euthanasia
Proponents of euthanasia argue that only patients can determine when suffering makes life worse than death and that such persons can and should be allowed to make the decision. Some also argue that terminally ill patients are respected more by having their suffering ended than by being kept alive against their will. Additionally, a utilitarian argument can be made about the harms to the whole of maintaining the individual beyond viability. Philosopher Peter Singer has been one of the most outspoken proponents of euthanasia, arguing from a utilitarian philosophical point of view. Joseph Fletcher used his situational ethics model to view euthanasia as an expression of love.
Many people object to euthanasia on religious grounds. Some believe that their religion absolutely prohibits all forms of killing; others, who may consider capital punishment or self-defense acceptable, nevertheless see euthanasia as usurping decision-making authority that belongs to Creator.
The second type of argument against euthanasia is that it is not prudent to advocate it; that is, eventually we all may be suffering, and if we think ahead, we may think it better if the doctors on whom we depend are not tempted to perform euthanasia. Euthanasia is inherently less complex than palliative care, and training for euthanasia does not qualify a physician to estimate a patient's response to palliation. Like all medical procedures, euthanasia can fail, or bring additional suffering. Some claim that if euthanasia were allowed, doctors might press people into euthanasia to reduce medical costs, or because their family wants them to die. (Many people believe that saving medical costs is a coercive argument that should disqualify a person from giving free consent.) Many doctors argue against euthanasia, as providing death is antithetical to their primary function and training. If, some have argued, a doctor is trained both to cure and kill, then he or she is being told always to judge when to kill, and his or her best efforts at saving life will not be expended.
Legislation and national political movements
Euthanasia was legalized in Australia's Northern Territory, by the Rights of the Terminally Ill Act 1995. However, this law was soon made ineffective by an amendment by the Commonwealth to the Northern Territory (Self-Government) Act 1978. (The powers of the Northern Territory legislature, unlike those of the State legislatures, are not guaranteed by the Australian Constitution.) Three people had already been legally euthanised, however, before the Commonwealth government made this amendment.
After an extensive discussion the Belgian parliament legalised euthanasia in late September 2002. The new legislation, however, institutes a complicated process, which has been criticized as an attempt to establish a bureaucracy of death. Nevertheless, euthanasia is now legal and its proponents in the country hope that it will stop many illegal practises (it is said that several thousand illegal acts of euthanasia have been carried out in Belgium each year).
On January 28, 2005, Marcel Tremblay of Kanata, Ontario held a press conference to announce plans to kill himself, saying his life with pulmonary fibrosis was unbearable. After attending his own living wake, the 78-year-old man committed suicide at 11:51 pm Eastern time. He had previously said he would be surrounded by his wife and adult children while he placed a bag over his head and filled it with helium. Tremblay said that he publicized his suicide plans to help change laws over assisted suicide. His lawyer said police were satisfied that Tremblay had a sound mind and that authorities would not intervene. Canada decriminalized committing suicide and attempting to commit suicide in 1972.
In the early 1990s, 42-year-old Sue Rodriguez, who had amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease), fought to overturn the law against assisted suicide. She lost her court battle, but died by assisted suicide with the help of an anonymous doctor. Under Canada's Criminal Code, assisted suicide is illegal and punishable by up to 14 years in prison.
In the Netherlands the Termination of Life on Request and Assisted Suicide (Review Procedures) Act took effect on April 1, 2002. It legalizes euthanasia and physician assisted suicide in certain circumstances.
The law recognized a practice that had been tolerated for some 20 years. From the time that euthanasia first came to be widely practiced in the Netherlands, it was formally subject to review by boards of doctors in each hospital. The law essentially codified what had already become tolerated practice and unofficial law by judgments in the courts.
The law permits euthanasia and physician assisted suicide when each of the following conditions is fulfilled:
- the patient has asked repeatedly
- the patient's suffering is unbearable with no prospect of improvement
- the doctor has prior to the act consulted a colleague.
- the patient has to be at least 12 years old; patients between 12 and 16 years of age require consent of their parents
The doctor must also report the cause of death to the municipal coroner in accordance with the relevant provisions of the Burial and Cremation Act. A regional review committee assesses whether a case of termination of life on request or assisted suicide complies with the due care criteria. Depending on its findings, the case will either be closed or brought to the attention of the Public Prosecutor. Finally, the legislation offers an explicit recognition of the validity of a written declaration of will of the patient regarding euthanasia (a "euthanasia directive"). Such declarations can be used when a patient is in coma or otherwise unable to state whether they want euthanasia or not.
The legislation has wide support among the socially libertarian Dutch, who have one of the world's highest life expectancies. There is however persistent opposition, mainly organized by the churches.
Euthanasia remains a criminal offense in cases not meeting the law's specific conditions, with the exception of several situations that are not subject to the restrictions of the law at all, because they are considered normal medical practice:
- stopping or not starting a medically useless treatment
- stopping or not starting a treatment at the patient's request
- speeding up death as side-effect of treatment necessary for alleviating serious suffering
Euthanasia of children under the age of 12 remains technically illegal, however Dr. Eduard Verhagen has documented several cases and, together with colleagues and prosecutors, has developed a protocol to be followed in those cases. Prosecutors will refrain from pressing charges if this Groningen protocol is followed.
Statistics and methods
In 2003, in the Netherlands 1626 cases were officially reported of euthanasia in the sense of a physician causing death (1.2 % of all deaths). Usually the sedative sodium thiopental is intravenously administered to induce a coma, and after making sure the patient is in a deep coma, typically after some minutes, a muscle relaxant is administered to stop the breathing and cause death.
Officially reported were also 148 cases of physician assisted suicide (0.1 % of all deaths), usually by drinking a strong barbiturate potion. The doctor is required to be present for two reasons:
- to make sure the potion is not taken by a different person, by accident (or, theoretically, for "unauthorized" suicide or perhaps even murder)
- to monitor the process and be available to apply the combined procedure mentioned below, if necessary.
In two cases the doctor was reprimanded for not being present while the patient drank the potion. They did not realize that this is required.
Forty-one cases were reported to combine the two procedures: usually in these cases the patient drinks the potion, but this does not cause death. After a few hours, or earlier in the case of vomiting, the muscle relaxant is administered to cause death.
By far, most reported cases concerned cancer patients. Also, in most cases the procedure was applied at home.
Note that some medical authorities and investigative reporters claim there are substantial numbers of euthanasias in the Netherlands performed without consultation or official notice - see links below.
Contrary to the rest of the United States, Oregon has legalized physician assisted suicide (but not euthanasia in the sense of a physician or anyone else causing death): residents have voted for it at the Oregon Ballot Measure 16 (1994), and voted against repealing it at the Oregon Ballot Measure 51 (1997). Oregon's law has been attacked by various organizations, and federal government parties that support those organizations, ever since it was first enacted.
Legal Times reports that former Attorney General "John Ashcroft, a longtime opponent of assisted suicide, stated that Oregon's practice violated the Controlled Substances Act because it lacked a 'legitimate medical purpose.'," and physicians who prescribe controlled substances to assist with suicided will have their medical licenses taken away.  The issue of whether the Federal Government or the State of Oregon has jurisdiction over this issue is now before the United States Supreme Court. INSERT: Oregon has passed the Death With Dignity Act.
Statistics and methods
In 2003, in Oregon 42 cases of physician assisted suicide were reported (0.14 % of all deaths), all by drinking a strong barbiturate potion. The doctor is not required to be present, in 12 cases he/she was.
Since 1998, 171 Oregonians have relied on the assisted suicide law.
There were three cases of regurgitation. In each case at least one third of the potion was retained, which caused death anyway, though in one case only after 48 hours.
The time from ingestion to unconsciousness was 1 to 20 minutes (median 4 minutes), the time from ingestion to death 5 minutes to 48 hours (median 20 minutes).
By far, most reported cases concerned cancer patients. Also, in most cases the procedure was applied at home.
A controversial case is that of Terri Schiavo and the legislation inspired by her in Florida, under Governor Jeb Bush.
- For euthanasia
- Against euthanasia
Clinical Problems with the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands, NEJM, February 24, 2000
Consultants or Facilitators? Medical Journal of Australia, 1999 Editorial- Cites original research, including that on alternative palliative care
Wall Street Journal Article on Dutch Euthanasia The article claims that unofficial Euthanasia is performed on as many as sixteen adults per day (90% of adult physician-assisted deaths), and 8% of all infants, often without patient consultation, according to Dutch statistics. This source claims that many old Dutch people are afraid to go to the hospital.
Weekly Standard Article Claiming Unauthorized Euthanasia of Dutch Infants
December 18, 2000 National Review Opinion, Wesley Smith- Cites statistics showing frequent involuntary physician-assisted deaths in the Netherlands.