Euthanasia

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Euthanasia (from Greek: ευθανασία -ευ, eu, "good", θάνατος, thanatos, death) is the practice of terminating the life of a person or animal in a painless or minimally painful way.

Laws around the world vary greatly with regard to euthanasia and are constantly subject to change as cultural values shift and better palliative care or treatments become available. It is legal in some nations, while in others it may be criminalized. Due to the gravity of the issue, strict restrictions and proceedings are enforced regardless of legal status. Euthanasia is a controversial issue because of conflicting moral feelings both for the individual and between different cultures, ethnicities, religions and other groups. The subject is explored by the mass media, authors, film makers and philosophers, and is the source of ongoing debate and emotion. Euthanasia of humans as a topic is often highly-charged. Terminology, religions and laws change over time, geographically and globally, causing a great deal of confusion.

[edit] Terminology

It is often difficult to discuss euthanasia because there are so many different varieties:

[edit] Euthanasia by means

There is passive, non-aggressive, and aggressive. Passive euthanasia is withholding common treatments (such as antibiotics, drugs, or surgery) or giving a medication (such as morphine) to relieve pain, knowing that it may also result in death (principle of double effect). Passive euthanasia is currently the most accepted form as it is currently common practice in most hospitals. Non-aggressive Euthanasia is the practice of withdrawing life support and is more controversial. Aggressive Euthanasia is using lethal substances or force to kill and is the most controversial means.^[1][2]

[edit] Euthanasia by consent

There is involuntary, non-voluntary, and voluntary. Involuntary euthanasia is euthanasia against someone’s will and equates to murder. This kind of euthanasia is almost always considered wrong by both sides and is rarely debated. Non-voluntary euthanasia is when the person is not competent to or unable to make a decision and it is thus left to a proxy like in the Terri Schiavo case. This is highly controversial, especially because multiple proxies may claim the authority to decide for the patient. Voluntary euthanasia is euthanasia with the person’s direct consent, but is still controversial as can be seen by the arguments section below.^[2]

[edit] Other designations

There are also the designations of mercy killing, animal euthanasia, and physician-assisted suicide which is a term for aggressive voluntary euthanasia.^[1]

[edit] History

The term euthanasia comes from the Greek words “eu” and “thanatos” which combined means “good death”. Hippocrates mentions euthanasia in the Hippocratic Oath, which was written between 400 and 300 B.C. The original Oath states: “To please no one will I prescribe a deadly drug nor give advice which may cause his death.”^[3] Despite this, the ancient Greeks and Romans generally did not believe that life needed to be preserved at any cost and were, in consequence, tolerant of suicide in cases where no relief could be offered to the dying or, in the case of the Stoics and Epicureans, where a person no longer cared for his life.^[2]

The English Common Law from the 1300’s until today also disapproved of both suicide and assisting suicide. However, in the 1500s, Thomas More, in describing a utopian community, envisaged such a community as one that would facilitate the death of those whose lives had become burdensome as a result of "torturing and lingering pain".^[2] In 1828, euthanasia was explicitly outlawed in the U.S. Support grew in the 1900’s for euthanasia, however. Societies were formed in England in 1935 and in the U.S.A. in 1938 to promote aggressive Euthanasia. In 1937, doctor-assisted euthanasia was declared legal in Switzerland as long as the person ending the life has nothing to gain.^[1][3]

In 1939, Nazis, in what was code named Action T4, euthanized children under three who exhibited mental retardation, physical deformity, or other debilitating problems whom they considered "life unworthy of life”. This program was later extended to include older children and adults.^[3]

In 1977, California legalized living wills and other states soon followed suit. In 1990, Dr. Jack Kevorkian, a Michigan physician, became infamous for encouraging and assisting people in committing suicide which resulted in a Michigan law against the practice in 1992. Kevorkian was tried and convicted in 1999 for a murder displayed on television.^[1][3] In 1990, the Supreme Court approved the use of non-aggressive euthanasia.^[4]

In 1994, Oregon voters approved doctor-assisted suicide and the Supreme Court allowed such laws in 1997.^[2] The Bush administration failed in its attempt to use drug law to stop Oregon in 2001.^[1] In 1999, non-aggressive euthanasia was permitted in Texas.

In 1993, the Netherlands decriminalized doctor-assisted suicide, and in 2002, restrictions were loosened. During that year, physician-assisted suicide was approved in Belgium. An Australian province approved a euthanasia bill in 1995, but that was overturned by Australia’s legislative branch in 1997.^[1][2][3]

Most recently, amid government roadblocks and controversy, Terri Schiavo, a Floridian who was believed to have been in a vegetative state since 1990, had her feeding tube removed in 2005. Her husband had won the right to take her off life support, which he claimed she would want but was difficult to confirm as she had no living will and the rest of her family claimed otherwise.^[1]

[edit] Arguments for and against Voluntary Euthanasia

[edit] Reasons given for Voluntary Euthanasia:

• Choice: Choice is a fundamental democratic principle and is the basis of the Free Enterprise system.^[2]
• Financial: It is a burden to keep people alive past the point they can contribute to society. See also Utilitarianism.
• Quality of Life: The pain and suffering a person feels during a disease can be incomprehensible, even with pain relievers, to a person who has not gone through it. Even without considering the physical pain, it is often difficult for patients to overcome the emotional pain of losing their independence. Society should not be able to force them to endure such hardship.^[2] The German Government of the late 1930s and early 1940s used this argument in the form of the mentally ill having lives without living.
• Resources: Today in many countries there is a shortage of hospital space. The energy of doctors and hospital beds could be used for people whose lives could be saved instead of continuing the life of those who want to die which increases the general quality of care and shortens hospital waiting lists.

[edit] Reasons given against Voluntary Euthanasia:

• Hippocratic Oath: Every doctor must swear upon some variation of it, and the original version explicitly excludes euthanasia.
• Moral: Some people consider euthanasia of some or all types to be morally unacceptable.^[2] This view usually treats euthanasia to be a type of murder and voluntary euthanasia as a type of suicide, the morality of which is the subject of active debate.
• Theological: Many religions and modern religious interpretations explicitly regard both euthanasia and suicide as sinful acts (see Religious views of suicide).
• Competence: Euthanasia can only be considered "voluntary" if a patient is mentally competent to make the decision, i.e., has a rational understanding of options and consequences. Competence can be difficult to determine or even define.^[2]
• Necessity: If there is some reason to believe the cause of a patient's illness or suffering is or will soon be curable, the correct action is sometimes considered to be attempting to bring about a cure or engage in palliative care.^[2]
• Wishes of Family: Family members often desire to spend as more time with their loved ones before they die.
• Pressure: All the arguments listed for voluntary euthanasia can be used by hospital personnel to form a terrible and continuing psychological pressure on people to consent to voluntary euthanasia. In countries with social systems like those in Britain, the hospital personnel would have targets to meet. Some people people find this a terrifying prospect.^{[citation needed]}

[edit] Influence of various factors on opinion regarding euthanasia

The examples and perspective in this article or section may not represent a worldwide view of the subject. Please improve this article or discuss the issue on the talk page.

[edit] 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. Using the results from past General Social Surveys performed, some patterns can be found. 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) and Catholics were more opposed to euthanasia than non-affiliates and the other religious groups.

Moderate Protestants (including Lutherans and Methodists)showed mixed views concerning end of life decisions in general. Both of these groups showed less support than non-affiliates, but were less opposed to it than conservative Protestants. Moderate Protestants are less likely to take a literal interpretation to Bible than their conservative counterparts, and some leaderships tend to take a less oppositional view on the issue. Despite the fact that the Catholic Church has come out in firm opposition to physician-assisted suicide, they share the nearly same level of support as moderate Protestants.

The liberal Protestants (including some Presbyterians and Episcopalians) were the most supportive of the groups. In general, they had looser affiliations with religious institutions and their views were similar to those of non-affiliates. Within all these groups, religiosity (identified as being frequency of church attendance and self-evaluation) also affected their level of opposition towards euthanasia. Individuals who attended church regularly and more frequently and considered themselves more religious were found to be more opposed than to those who had a lower level of religiosity.^[5]

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 caring for the terminally ill, one is forbidden to treat a patient so as to bring on death faster than would occur if the disease were allowed to run its natural course.^[6]

Jainism is worth of mention when it comes to this topic, as Mahavira Varadhman, it's founder, is unique in explicitly allowing suicide.

In Hinduism, death has been referred to both as the ultimate truth and as one of the stages in human life. In the Bhagavad Gita, Lord Krishna urges Arjuna to fulfill his destiny or Dharma, and not to worry about consequences as death levels all: whatever you give and take, you do it on this earth. In Hindu mythology, some humans were given the right to choose the time of their deaths. This was awarded to only the most pure in heart, suggesting that Hinduism does not disapprove of euthanasia.

[edit] Ethnicity

In the specific case of euthanasia, recent studies have shown European-Americans to be more accepting than African-Americans. They are also more likely to have advance directives and to use other end of life measures.^[7] African-Americans are almost 3 times more likely to oppose euthanasia than European-Americans. The main reason for this discrepancy is attributed to the lower levels of trust in the medical establishment.^[8] Researchers believe that past history of abuses towards minority in medicine (such as the Tuskegee Syphilis Study) have made minority groups less trustful of the level of care they receive. Studies have also found that there are significant disparities in the medical treatment and pain management that European-Americans and other Americans receive.^[9]

Among African-Americans, education correlates to support for euthanasia. African-Americans without a four-year degree are twice as likely to oppose euthanasia than those with at least that much education. Level of education, however, does not significantly influence other racial groups in the US. Some researchers suggest that African-Americans tend to be more religious, a claim that is difficult to substantiate and define.^[10] Only African and European Americans have been studied in extensive detail. Although it has been found that non European-American groups are less supportive of euthanasia than European-Americans, there is still some ambiguity as to what degree this is true.

[edit] Gender

The research has not found sex to be a significant factor in predicting opinion about euthanasia. However, some studies have shown that there are differences in views between males and females. A recent Gallup Poll found that 84% of males supported euthanasia compared to 64% of females.^[11] Some cite the prior studies showing that women have a higher level of religiosity and moral conservatism as an explanation. Within both sexes, there are differences in attitudes towards euthanasia due to other influences. For example, one study found that African-American women are 2.37 times more likely to oppose euthanasia than European-American women. African-American men are 3.61 times more likely to oppose euthanasia than European-American men.^[12]

[edit] Country examples

[edit] 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. More generally, article 115 of the Swiss penal code, which came into effect in 1942 (having been written in 1937), considers assisting suicide a crime if and only if the motive is selfish. The code does not give physicians a special status in assisting suicide; however, they are most likely to have access to suitable drugs and the medical establishment have prohibited highly liberal physicians from prescribing deadly drugs further. When an assisted suicide is declared, a police inquiry may be started. Since no crime has been committed in the absence of a selfish motive, these are mostly open and shut cases. Prosecution happens if doubts are raised on the patient's competence to make an autonomous choice. This is rare.

Article 115 was only interpreted as legal permission to set up organisations administering life-ending medicine in the 1980s, 40 years after its introduction.

These organisations have been widely used by foreigners - most notably Germans - as well as the Swiss. Around half of the people helped to die by the organisation DIGNITAS have been Germans.

[edit] United States

Main article: Euthanasia in the United States

Euthanasia is illegal in most of the United States. A recent Gallup Poll survey showed that 60% of Americans supported euthanasia.^[13] Attempts to legalize euthanasia and assisted suicide resulted in ballot initiatives and legislation bills within the United States in the last 20 years. For example, Washington voters saw Ballot Initiative 119 in 1991, California placed Proposition 161 on the ballot in 1992, Michigan included Proposal B in their ballot in 1998, and Oregon passed the Death with Dignity Act.

[edit] The Netherlands

In 2002, The Netherlands legalized euthanasia. The law codified a twenty year old convention of not persecuting doctors who have committed euthanasia in very specific cases, under very specific circumstances. The Ministry of Public Health, Wellbeing and Sports claims that this practice "allows a person to end their life in dignity after having received every available type of palliative care."^[14]

[edit] Legal framework

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 very specific cases, under very specific circumstances. The law was proposed by Els Borst, the D66 minister of Health. The procedures codified in the law had been a convention of the medical community for over twenty years.

The law allows medical review board to suspend prosecution of doctors who performed euthanasia 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. 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, if the conditions are not met 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 a 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 (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. Prosecutors will refrain from pressing charges if this Groningen protocol is followed.

[edit] Practice in The 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). Usually the sedative sodium thiopental is intravenously administered to induce a coma. Once it is certain that the patient is in a deep coma, typically after some minutes, Pancuronium is administered to stop the breathing and cause death.

Officially reported were also 148 cases of physician assisted dying (0.14% of all deaths), usually by drinking a strong (10g) 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 said they had not realized that this was 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.

[edit] Social debate within The Netherlands

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 from the orthodox protestant Political Reformed Party and the ChristianUnion, which call for more attention for palliative care and the eventual illegalization of the procedure.

In 1992, Huib Drion, a member of the Dutch high court proposed to develop and legalize a drug, which is now known as Drion's pill. This fictional drug would be a set of 2 pills. The first pill could be taken without any harm; the second pill would have to be taken a couple of days later (and only then would work). This would give the patient the time to think things over. The main goal of this drug would be to allow people who have unbearable psychological suffering to end their life, especially old people who feel their life is finished. The drug was never developed. The proposal, however, indirectly started up the discussion of euthanasia in Netherlands.

[edit] Australia

Euthanasia was legalised in Australia's Northern Territory, by the Rights of the Terminally Ill Act 1995. Soon after, the law was voided 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. However, before the Commonwealth government made this amendment, three people had already been legally euthanised. The first person was a taxi driver, Bob Dent, who died on 22 September 1996.

Although it is a crime in most Australian states to assist in euthanasia, prosecutions have been rare. In 2002, relatives and friends who provided moral support to an elderly woman who committed suicide were extensively investigated by police, but no charges were laid. The Commonwealth government subsequently tried to hinder euthanasia with the passage of the Criminal Code Amendment (Suicide Related Materials Offences) Bill 2004. In Tasmania in 2005 a nurse was convicted of assisting in the death of her elderly mother and father who were both suffering from illnesses. She was sentenced to two and a half years in jail but the judge later suspended the conviction because he believed the community did not want the woman put behind bars. This sparked debate about decriminalising euthanasia.

[edit] 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. According to proponents, the legislation incorporated a complicated process, which has been criticized as an attempt to establish a "bureaucracy of death".

[edit] The United Kingdom

On November 5, 2006, Britain's Royal College of Obstetricians and Gynaecologists submitted a proposal to the Nuffield Council on Bioethics calling for consideration of permitting the euthanasia of disabled newborns.^[15] 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.

In contrast there is increasing evidence that doctors in the UK are hardening their attitude against euthanasia or physician assisted suicide:

• UK doctors are particularly cautious about decisions to shorten life.^[16]
• Compared with countries where euthanasia is illegal (eg. Italy, Sweden, Denmark), UK doctors are more open about discussing end-of-life decisions (ELD) with patients and relatives.^[16]
• Compared with countries where euthanasia or physician assisted suicide is legal (eg. Belgium, Netherlands, Switzerland), UK doctors are the same or more likely to report discussions on ELD with medical and nursing colleagues.^[16]
• 94% of UK specialist doctors in palliative care are against a change in the law.^[17]
• In 2006 both the Royal College of Physicians and the Royal College of General Practitioners voted against a change in the law.

[edit] Euthanasia protocol

See Lethal Injection for more information.

A machine that can facilitate euthanasia through heavy doses of drugs. It is possible in this image to see the laptop screen that leads the user through a series of steps and questions, to the final injection, which is done by motors controlled by the computer. This series of questions is supposedly to prevent unprepared users from undergoing Euthanasia.^[18]

Euthanasia can be accomplished either through an oral, intravenous, or intramuscular administration of drugs. In individuals who are incapable of swallowing lethal doses of medication, an intravenous route is preferred. The following is a Dutch protocol for parenteral (intravenous) administration to obtain euthanasia:

Some people approve of some forms of euthanasia in principle, but fear that if some forms of euthanasia are legalized other forms of euthanasia that they do not support will come into practice.

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. Some people raise issues regarding stereotypes of disability that can lead to non-disabled or less disabled people overestimating the person's suffering, or assuming it to be unchangeable when it could be changed. For example, many disability rights advocates responded to Tracy Latimer's murder by pointing out that her parents had refused a hip surgery that could have greatly reduced or eliminated the physical pain Tracy experienced. Also, they point out that a severely disabled person need not be in emotional pain at their situation, and claim that the emotional pain, if present, is due to societal prejudice rather than the disability, analogous to a black person wanting to die because they have internalized negative stereotypes about being black.

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.

Others respond to this argument by pointing out that if a nondisabled person attempts suicide, all measures possible are taken to save their lives. Suicidal people are often given involuntary medical treatment so that they will not die. 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.

[edit] See also

• Dr John Bodkin Adams, Eastbourne, England doctor, accused of murder in 1957 but claimed euthanasia. Acquitted.
• Derek Humphry - President of the World Federation of Right to Die Societies.
• Diane Pretty
• Doctor Kevorkian
• Final Exit (book)
• Kaishakunin - Assists in the Japanese ritual seppuku (suicide)
• Karen Ann Quinlan and Terri Schiavo - Cases of persistent vegetative state
• Killick Millard - Founder of the Voluntary Euthanasia Legalisation Society in Great Britain
• Principle of double effect
• Terry Wallis
• Action T4 - Nazi Germany's program to kill disabled people, justified as "euthanasia"

[edit] References

[edit] External links

[edit] Neutral

• Euthanasia and Religion - various religious views of euthanasia
• The Ethics of Euthanasia - a UK site that looks at the issues, case studies and ethical and Christian responses
• Religion and Ethics - Euthanasia - many views of euthanasia, for, against, and religious, from the BBC
• Euthanasia ProCon.org - "Should euthanasia be legal?" - Pros, cons, history, laws, polls, and biographies of key players in debate
• Issue Guide on the Right to Die - Analysis of public opinion and policy alternatives from Public Agenda Online
• Dutch Ministry of Foreign Affairs - FAQ brochures explaining Dutch policy on euthanasia (English)
• Ministry of Health, Welfare and Sport - Information on Dutch euthanasia legislation (English)

[edit] Support

• Stanford Encyclopedia of Philosophy entry
• - Euthanasia World Directory international information on voluntary euthanasia, assisted suicide, and self-deliverance
• Final Exit Network provides guides to self-deliverance for the terminally and hopelessly ill to end their suffering
• Compassion & Choices - provides education, support and advocacy for the choice-in-dying movement
• Dignity in Dying - leading campaigning organisation promoting patient choice at the end of life
• World Federation of Right To Die Societies
• Assisted Suicide
• Suicide & Euthanasia- Presents pro-choice arguments from a Biblical perspective.
• Voluntary Euthanasia- Atheist Foundation of Australia Inc
• A defense of euthanasia
• Pro Euthanasia Dr Philip Nitschke - (Australian) Euthanasia law reform advocacy website, currently based in New Zealand.
• Euthanasia and the Right to Life
• Euthanasia Clinic - Roger Graham. Founder of Assisted Euthanasia Society of Paradise (AESOP), expelled from Cambodia for proposing Euthanasia Tourism, advocate for a Compassionate Law, an activist for Euthanasia since 1971.

[edit] Opposition

• Is Killing Kind?
• Christian Study on euthanasia
• www.carenotkilling.org.uk - Care, NOT Killing: a UK alliance promoting palliative care, opposing euthanasia and assisted suicide
• euthanasia.com
• National Right to Life articles on euthanasia
• International Task Force against Euthanasia- many resources
• Non-religious arguments against euthanasia
• A Papal encyclical dealing with a number of issues of life and death including euthanasia
• A brief presentation of the issue and the Christian Catholic viewpoint on it
• an essay on cyberessays.com
• The Rosicrucian Fellowship's viewpoint: Suicide and Euthanasia