The painless ending of life, usually as an act of mercy to relieve chronic pain or suffering. It has been advocated by pressure groups such as Exit (UK) and the Hemlock Society (USA), and by some physicians as a dignified death for the elderly who have lost the will or desire to live. Since the 1980s, several cases of doctor-assisted suicide (the death of a terminally ill patient, through taking lethal drugs provided by a doctor), and associated notions such as medicide (medically assisted suicide), have been given publicity, and fuelled the medical ethical debate. During the 1990s, several US states made these practices illegal. In 1996 Australia's Northern Territory legalized euthanasia, but the law was repealed after nine months. The Netherlands made doctor-assisted death legal in 2002, followed by Belgium, the first countries to sanction the practice.
For mercy killings not performed on humans, see animal euthanasia. For the program to kill people with disabilities in Nazi Germany, see Action T4.Euthanasia (from Greek: ευθανασία -ευ, eu, "good", θανατος, thanatos, "death") is the practice of terminating the life of a person or an animal because they are perceived as living an intolerable life, in a painless or minimally painful way either by lethal injection, drug overdose, or by the withdrawal of life support. Euthanasia is a controversial issue because of conflicting religious and humanist views.
Terminology
Euthanasia of humans as a topic is often highly-charged—emotionally, politically, and morally.
Following the broad definition of euthanasia as outlined by James Rachels, euthanasia may employ methods a patient off life support. Both active and passive euthanasia can be voluntary,
nonvoluntary or involuntary. (See Karl Binding and Alfred Hoche for one of the first uses of the three types of euthanasia.)
Physician assisted dying is where doctors provide a prescription for a terminally ill patient to hasten their death. This is seen as morally distinct from euthanasia because the physician does not cause the patient's death but gives the patient choice of the time and circumstances of his or her own death.
Responding to requests from Oregon patients and their families, the Oregon Health Division changed their usage in October 2006 from "physician-assisted suicide" to "physician-assisted death."
Voluntary euthanasia occurs with the fully informed request of a decisionally-competent adult patient or that of their surrogate (proxy).
Nonvoluntary euthanasia occurs without the fully informed consent and fully informed request of a decisionally-competent adult patient or that of their surrogate (proxy).
Involuntary euthanasia occurs over the objection of a patient or their surrogate (proxy). If a patient slated for euthanasia changes his or her mind at the last minute, the doctor is categorically required by law to honor that wish. It is considered to be euthanasia by some, but under current law and medical practice it is considered a form of palliative care.
Mercy Killing is a term used for some cases of euthanasia. Typically it refers to euthanasia by a someone other than a doctor, such as a parent, who perceives the individual to be suffering.
Eugenics described as euthanasia
In Nazi Germany the term euthanasia was misused for the T-4 Euthanasia Program, which was actually a eugenics project. Since it was not for the benefit of the victims, it does not fit the definition of euthanasia as merciful. It has nevertheless tainted the word, especially in German-speaking countries, as one of the main advocates of euthanasia in Germany after World War II was Werner Catel, a leading Nazi doctor directly involved in T-4.
Legislation and national political movements
The United Kingdom
On November 5, 2006, Britain's Royal College of Obstetricians and Gynaecology submitted a proposal to the Nuffield Council on Bioethics calling for consideration of permitting the euthanasia of disabled newborns. The report does not address the current illegality of euthanasia in the United Kingdom, but rather calls for reconsideration of its viability as a legitimate medical practice: "We would like the working party to think more radically about non-resuscitation, withdrawal of treatment decisions, the best interests test and active euthanasia as they are ways of widening the management options available to the sickest of newborns."
Australia
Euthanasia was legalized in Australia's Northern Territory, by the Rights of the Terminally Ill Act 1995.
Although it is a crime in most Australian states to assist in euthanasia, prosecutions have been rare. The Commonwealth government subsequently tried to hinder euthanasia with the passage of the Criminal Code Amendment (Suicide Related Materials Offences) Bill 2004. This sparked debate about decriminalising euthanasia.
Belgium
The Belgian parliament legalized euthanasia in late September 2002. Proponents of euthanasia state that prior to the law, several thousand illegal acts of euthanasia were carried out in Belgium each year.
The Netherlands
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 assistance in dying 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 permits euthanasia and physician assisted dying when each of the following conditions is fulfilled:
the patient's suffering is unbearable with no prospect of improvement the patient's request for euthanasia must be voluntary and persist over time (the request can not be granted when under the influence of others, psychological illness or drugs) the patient must be fully aware of his/her condition, prospects and options there must be consultation with at least one other independent doctor who needs to confirm the conditions mentioned above the death must be carried out in a medically appropriate fashion by the doctor or patient, in which case the doctor must be present. the patient is at least 12 years old (patients between 12 and 16 years of age require the 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. 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 a 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.
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 (futile) treatment stopping or not starting a treatment at the patient's request speeding up death as a 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. The drug was never developed, the proposal however indirectly started up the discussion of euthanasia in Netherlands.
In 2003, in the Netherlands, 1626 cases were officially reported of euthanasia in the sense of a physician assisting the death (1.2% of all deaths).
Officially reported were also 148 cases of physician assisted dying (0.14% of all deaths), usually by drinking a strong (10g) barbiturate potion.
In two cases the doctor was reprimanded for not being present while the patient drank the potion.
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.
By far, most reported cases concerned cancer patients.
Switzerland
In Switzerland, deadly drugs may be prescribed to a Swiss person or to a foreigner, where the recipient takes an active role in the drug administration.
United States
Early History
The first major effort to legalize euthanasia in the United States arose alongside the eugenics movement in the early years of the twentieth century.
Oregon
Oregon Ballot Measure 16 in 1994 established Oregon's Death with Dignity Act, which legalizes physician-assisted dying with certain restrictions, making Oregon the first U.S. state and one of the first jurisdictions in the world to officially do so.
Texas
In 1999, the state of Texas passed the Texas Futile Care Law.
On March 15, 2005, six month old infant Sun Hudson was the first person to die under the law.
In December 2005, doctors removed Tirhas Habtegiris, a young woman and legal immigrant from Africa, from life support against her family's wishes.
Euthanasia protocol
Euthanasia can be accomplished either through an oral, intravenous, or intramuscular administration of drugs. The following is a Dutch protocol for parenteral (intravenous) administration to obtain euthanasia:
| Intravenous administration is the most reliable and rapid way to accomplish euthanasia and therefore can be safely recommended. |
Ethics
There are a number of conflicting beliefs about euthanasia. Different aspects of euthanasia are supported by different people. Some people argue against euthanasia based on the belief that only God should choose when someone dies. Some people approve of some forms of euthanasia in principle, but fear a "slippery slope" that will result in support of other forms of euthanasia they are opposed to. With regards to nonvoluntary euthanasia, the cases where the person could consent but was not asked are often viewed differently from those where the person could not consent. With regards to voluntary euthanasia, many people argue that 'equal access' should apply to access to suicide as well, so therefore disabled people who cannot kill themselves should have access to voluntary euthanasia. This argument states that it is due to societal prejudice, namely that disabled people are of lower worth and that any unhappiness must be due to the disability, which results in greater support of voluntary euthanasia by disabled people than suicide by nondisabled people. As leading medical ethicist Professor Richard Hare (1971) said, "We shall begin by doing it because the patient is in intolerable pain but we shall end up doing it because it is Friday afternoon and we want to get away for the weekend"
Perceptions
In the last 20 years, some states in the United States of America have faced voter ballot initiatives and "legislation bills" attempting to legalize euthanasia and assisted suicide.
While many people are aware of the ongoing debates concerning the issue of euthanasia and assisted suicide, it has been unclear where the majority of public opinion stands in the United States. A recent Gallup Poll survey did show that 75% of Americans supported euthanasia. Further research, however, has shown that there are significant differences in levels of support for euthanasia across distinct social groups.
Religion
Some of the differences in public attitudes towards the right to die debate stem from the diversity of religion in the United States. The United States contains a wide array of religious views, and these views seem to correlate with whether euthanasia was supported. Respondents that did not affiliate with a religion were found to support euthanasia more than those who did.
Of the religious groups that were studied, which were mostly Christian in this particular study, conservative Protestants (including Southern Baptists, Pentecostals, and Evangelicals) were more opposed to euthanasia than non-affiliates and the other religious groups.
Moderate Protestants (including Lutherans and Methodists) and Catholics showed mixed views concerning end of life decisions in general. Within all these groups, religiosity (identified as being frequency of church attendance and self-evaluation) also affected their level of opposition towards euthanasia.
In Theravada Buddhism, a monk can be expelled for praising the advantages of death, even if they simply describe the miseries of life or the bliss of the after-life in a way that might inspire a person to commit suicide or pine away to death.
In Hinduism, death has been referred to both as the ultimate truth and as one of the stages in human life. This was awarded to only the most pure in heart, suggesting that Hinduism does not disapprove of euthanasia.
Philosophy
Friedrich Nietzsche, in The Twilight of the Idols, calls for euthanasia, writing, "To die proudly when it is no longer possible to live proudly.
Ethnicity
On many social and religious issues, Blacks are more conservative than Caucasians . In the specific case of euthanasia, recent studies have shown Caucasians to be more accepting than Blacks. Blacks are almost 3 times more likely to oppose euthanasia than Caucasians.
Among Blacks, education correlates to support for euthanasia. Blacks without a four-year degree are twice as likely to oppose euthanasia than those with at least that much education. Although it has been found that non-Caucasian groups are less supportive of euthanasia than Caucasians, there is still some ambiguity as to what degree this is true.
Gender
The research has not found gender to be a significant factor in predicting opinion about euthanasia. A recent Gallup Poll found that 84% of males supported euthanasia compared to 64% of females. Within both genders, there are differences in attitudes towards euthanasia due to other influences. For example, one study found that Black women are 2.37 times more likely to oppose euthanasia than Caucasian women. Black men are 3.61 times more likely to oppose euthanasia than Caucasian men.
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