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 in the strict sense involves actively causing death. This is in some cases legal in the Netherlands (see below), but in few other countries. Euthanasia in a wider sense includes assisting someone to commit suicide, in particular physician_assisted suicide (PAS).
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 never considered euthanasia. In some cases, a patients' religion must be taken into account, for example Jehovah's Witnesses are not allowed to accept blood transfusions for themselves or their loved ones, and cannot be resuscitated, as both of these are against their beliefs.
Terminal sedation is a combination of medically inducing a deep sleep and stopping other treatment. 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. Its opponents challenge it on several ethical grounds, including a slippery slope argument that it is the first step towards compulsory euthanasia.
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.
Where an individual may distinguish between life and death _ and may fully realise the difference between them, any medical killing is involuntary. If, for example, a man is going to experience severe agony and does not consent to death, euthanasia imposed upon him is ethically and morally, if not legally, forbidden as murder.
In Nazi Germany the term "euthanasia" (Euthanasie) referred to the systematic killing of deformed children and mentally ill 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." 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 end 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 religious people are said to object to euthanasia, however we will only cover Christians. Christians object that it is not "loving" to kill someone, and that pain medications are good enough that suffering is preventable if doctors have the will. One's life is regarded as being derived from God and thus it is either God's to take, or that destroying it is an offense to God. Further, in most Western nations the prohibition on killing is considered a Australia's Northern Territory, by 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). (disputed — see talk page)
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. (http://www.cbc.ca/story/canada/national/2005/01/28/assisted-suicide-050128.html) 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, legalizing euthanasia and PAS in certain circumstances, took effect on April 1, 2002.
The law permits euthanasia and PAS 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 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.
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
- at the patient's request stopping or not starting a treatment
- speeding up death as side-effect of treatment necessary for alleviating serious suffering
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 unofficial law by judgments in the courts.
The legislation has wide support among the socially libertarian Dutch, who have one of the world's highest life expectancies.
Statistics and methods
In 2003, in the Netherlands 1626 cases were 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.
Officials report 148 cases of PAS (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.
In the United States, the most common form of euthanasia is withholding tube-feeding to elderly and incapacitated patients. This is generally considered an abuse when the patient might recover. These patients die protracted deaths by dehydration. However, it is so common in some areas that the family must actively prevent it, or it will occur. (disputed — see talk page)
Contrary to the rest of the United States, Oregon has legalized PAS (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.
A currently controversial case is that of Terri Schiavo and the legislation inspired by her in Florida, under Governor Jeb Bush.
Statistics and methods
In 2003, in Oregon 42 cases were reported of PAS (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.
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.
- For euthanasia
- euthanasia.com (http://www.euthanasia.com/)
- World Federation of Right To Die Societies (http://www.worldrtd.net/)
- Assisted Suicide (http://www.assistedsuicide.org/)
- End of Life Choices (http://www.endoflifechoices.com/)
- Against euthanasia
- National Right to Life articles on euthanasia (http://www.nrlc.org/euthanasia/)
- International Task Force against Euthanasia (http://www.internationaltaskforce.org/)- many resources
- Ministry of Justice brochure on euthanasia and PAS (http://www.justitie.nl/english/Images/23_35490.pdf) (PDF)
- Ministry of Health on euthanasia and PAS (http://www.minvws.nl/en/themes/euthanasia/)
- Joint annual report 2003 of the Regional Euthanasia Review Conmmittees (http://www.toetsingscommissieseuthanasie.nl/pdf/jaarverslag2003_engels.pdf) (PDF)
- Right to Die-NL (http://www.nvve.nl/english/) - Dutch union for voluntary termination of life NVVE
- NRC Handelblad April 14, 2001 interview of Els Borst: Transparency in Euthanasia (http://www.internationaltaskforce.org/holbors.htm)- Note that this is from an anti-euthanasia web site, but claims to be merely a translation of a Dutch article (http://www.nrc.nl/W2/Nieuws/2001/04/14/Vp/01a.html). Els Borst is a prominent Dutch advocate of Euthanasia.
- Clinical Problems with the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands, NEJM, February 24, 2000 (http://content.nejm.org/cgi/content/abstract/342/8/551?hits=20&where=fulltext&andorexactfulltext=and&searchterm=complications+from+assisted+suicide&sortspec=Score%2Bdesc%2BPUBDATE_SORTDATE%2Bdesc&excludeflag=TWEEK_element&searchid=1100279357113_6876&FIRSTINDEX=0&journalcode=nejm)
- Consultants or Facilitators? Medical Journal of Australia, 1999 Editorial (http://www.mja.com.au/public/issues/apr19/hendin/hendin.html)- Cites original research, including that on alternative palliative care
- Wall Street Journal Article on Dutch Euthanasia (http://opinionjournal.com/editorial/feature.html?id=95000390) 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 (http://www.weeklystandard.com/Content/Public/Articles/000/000/004/616jszlg.asp)
- December 18, 2000 National Review Opinion, Wesley Smith (http://www.nationalreview.com/comment/comment121800d.shtml)- Cites statistics showing frquent involuntary phsyician-assisted deaths in the Netherlands.
- Oregon's Death with Dignity Act (State Website) (http://www.ohd.hr.state.or.us/chs/pas/pas.cfm)