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Euthanasia – Wikipedia

Euthanasia (from Greek: ; “good death”: , eu; “well” or “good” , thanatos; “death”) is the practice of intentionally ending a life to relieve pain and suffering.[1][2]

There are different euthanasia laws in each country. 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 it under the broader definition of “assisted suicide and termination of life on request”.[5]

Euthanasia is categorized in different ways, which include voluntary, non-voluntary, or involuntary. Voluntary euthanasia is legal in some countries. Non-voluntary euthanasia (patient’s consent unavailable) is illegal in all countries. Involuntary euthanasia (without asking consent or against the patient’s will) is also illegal in all countries and is usually considered murder.[6] As of 2006, euthanasia is the most active area of research in contemporary bioethics.[7] In some countries there is a divisive public controversy over the moral, ethical, and legal issues of 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 (ex. Belgium, Canada, Switzerland) and is limited to specific circumstances and the approval of councilors and doctors or other specialists. In some countries such as Nigeria, Saudi Arabia and Pakistan, support for active euthanasia is almost non-existent.

Like other terms borrowed from history, “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.”[8] 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 conceptthe euthanasia “which regards the preparation of the soul.”[9]

In current usage, euthanasia has been 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 which 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 incorporates 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 being 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 that 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; a 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 includes 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 in 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]

Euthanasia may be classified into three types, according to whether a person gives informed consent: voluntary, non-voluntary and involuntary.[23][24]

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 as one of their criteria, although it may have been required to justify euthanasia.[11][25] However, others see consent as essential.

Voluntary euthanasia is conducted with the consent of the patient. 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 his or her 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 is conducted when the consent of the patient is unavailable. Examples include child euthanasia, which is illegal worldwide but decriminalised under certain specific circumstances in the Netherlands under the Groningen Protocol.

Involuntary euthanasia is conducted against the will of the patient.

Voluntary, non-voluntary and involuntary types can be further divided into passive or active variants.[26] 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 the 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]

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 Marseilles. 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).[27][28][29]

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 , bene, well, and , mors, death.[30]

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 between the theological care of the soul of sick people from the physical care and medical treatment by doctors.[31][32]

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,[33] as did Francois Ranchin (15651641), a French physician and professor of medicine, and Michael Boudewijns (16011681), a physician and teacher.[28]:208[34] Other voices argued for euthanasia, such as John Donne in 1624,[35] 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”.[28]:209211 This view was shared by others who followed, including Philipp Jakob Spener, Veit Riedlin and Johann Georg Krnitz.[28]: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.[28]:211214

Suicide and euthanasia became more accepted during the Age of Enlightenment.[34] Thomas More wrote of euthanasia in Utopia, although it is not clear if More was intending to endorse the practice.[28]:208209 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.[36]

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.[37]: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.

The essay was favourably reviewed in The Saturday Review, but an editorial against the essay appeared in The Spectator.[38] 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’.[38][39] Popular Science analyzed the issue in May 1873, assessing both sides of the argument.[40] 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”.[38]

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.[37]: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.[41]

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, Alder 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.[42] Both Ingersoll and Adler argued for voluntary euthanasia of adults suffering from terminal ailments.[42] Dowbiggin argues that by breaking down prior moral objections to euthanasia and suicide, Ingersoll and Adler enabled others to stretch the definition of euthanasia.[43]

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.[44]:614 Hunt did so at the behest of Anna S. 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.[44]:614616

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.[37]:796[44]:618619

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 612 month prison term and a fine of between $200 and $1,000. The proposal proved to be controversial.[44]:619621 It engendered considerable debate and failed to pass, having been withdrawn from consideration after being passed to the Committee on Public Health.[44]: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.[37]: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.[42] 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.[42]

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.[45] 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.[46]

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”.[47] 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.[47] The Telegraph noted that the killing of the disabled infantwhose 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”.[48] While Kretchmar’s killing received parental consent, most of the 5,000 to 8,000 children killed afterwards were forcibly taken from their parents.[47][48]

The “euthanasia campaign” of mass murder gathered momentum on 14 January 1940 when the “handicapped” were killed with gas vans and killing centres, eventually leading to the deaths of 70,000 adult Germans.[49] 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 deathmust killin order to keep the social organism alive and healthy.[50]

In modern terms, the use of “euthanasia” in the context of Action 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”.[51] 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.[51] 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.”[42]:65

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. 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.'”[52] 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?'”[52]

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.[42]

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 principlethe doctrine of double effectis 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,[53] which will lead to unacceptable consequences.[37]:797-8 In fact, in Oregon, in 2013, pain wasn’t one of the top five reasons people sought euthanasia. Top reasons were a loss of dignity, and a fear of burdening others.[54]

In the United States in 2013, 47% nationwide supported doctor-assisted suicide. This included 32% of Latinos, 29% of African-Americans, and almost nobody with disabilities.[54]

West’s Encyclopedia of American Law states that “a ‘mercy killing’ or euthanasia is generally considered to be a criminal homicide”[55] and is normally used as a synonym of homicide committed at a request made by the patient.[56]

The judicial sense of the term “homicide” includes any intervention undertaken with the express intention of ending a life, even to relieve intractable suffering.[56][57][58] Not all homicide is unlawful.[59] Two designations of homicide that carry no criminal punishment are justifiable and excusable homicide.[59] 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”.[60] 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.[61] 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.[62] The use of pain medication to relieve suffering, even if it hastens death, has been held as legal in several court decisions.[60]

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.[63][64][65][66]

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.[67]

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”.[68] 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.[68]

In the United Kingdom, the pro-assisted dying group Dignity in Dying cite conflicting research on attitudes by doctors to assisted dying: with a 2009 Palliative Medicine-published survey showing 64% support (to 34% oppose) for assisted dying in cases where a patient has an incurable and painful disease, while 49% of doctors in a study published in BMC Medical Ethics oppose changing the law on assisted dying to 39% in favour.[69]

The Roman Catholic Church strongly opposes and condemns euthanasia and assisted suicide as morally wrong. The Catholic Church states that, “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, the practice is unacceptable within the Church.[70] The Orthodox Church in America, along with other Eastern Orthodox Churches, also opposes euthanasia stating that it must be condemned as murder stating that, “Euthanasia is the deliberate cessation to end human life.”[71]

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 is “morally wrong and unacceptable to take a human life to relieve the suffering caused by incurable illnesses.” [71] Other Protestant churches which oppose euthanasia include:

The Church of England accepts passive euthanasia under some circumstances, but is strongly against active euthanasia, and has led opposition against recent attempt to legalise it.[81] 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.[82].

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 Koran 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.[83]

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.[84]

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Euthanasia – Wikipedia

Euthanasia | law | Britannica.com

Euthanasia, also called mercy killing, act or practice of painlessly putting to death persons suffering from painful and incurable disease or incapacitating physical disorder or allowing them to die by withholding treatment or withdrawing artificial life-support measures. Because there is no specific provision for it in most legal systems, it is usually regarded as either suicide (if performed by the patient himself) or murder (if performed by another). A physician may, however, lawfully decide not to prolong life in cases of extreme suffering, and he may administer drugs to relieve pain even if this shortens the patients life. In the late 20th century, several European countries had special provisions in their criminal codes for lenient sentencing and the consideration of extenuating circumstances in prosecutions for euthanasia.

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ethics: Abortion, euthanasia, and the value of human life

A number of ethical questions are concerned with the endpoints of the human life span. The question of whether abortion or the use of human embryos as sources of stem cells can be morally justified was exhaustively discussed

The opinion that euthanasia is morally permissible is traceable to Socrates, Plato, and the Stoics. It is rejected in traditional Christian belief, chiefly because it is thought to contravene the prohibition of murder in the Ten Commandments. The organized movement for legalization of euthanasia commenced in England in 1935, when C. Killick Millard founded the Voluntary Euthanasia Legalisation Society (later called the Euthanasia Society). The societys bill was defeated in the House of Lords in 1936, as was a motion on the same subject in the House of Lords in 1950. In the United States the Euthanasia Society of America was founded in 1938.

The first countries to legalize euthanasia were the Netherlands in 2001 and Belgium in 2002. In 1997 Oregon became the first state in the United States to decriminalize physician-assisted suicide; opponents of the controversial law, however, attempted to have it overturned. In 2009 the Supreme Court of South Korea recognized a right to die with dignity in its decision to approve a request by the family of a brain-dead woman that she be removed from life-support systems.

The potential of modern medical practice to prolong life through technological means has provoked the question of what courses of action should be available to the physician and the family in cases of extreme physical or emotional suffering, especially if the patient is incapable of choice. Passively doing nothing to prolong life or withdrawing life-support measures has resulted in criminal charges being brought against physicians; on the other hand, the families of comatose and apparently terminal patients have instituted legal action against the medical establishment to make them stop the use of extraordinary life support.

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Euthanasia | law | Britannica.com

Euthanasia – ProCon.org

Proponents of euthanasia and physician-assisted suicide (PAS) contend that terminally ill people should have the right to end their suffering with a quick, dignified, and compassionate death. They argue that the right to die is protected by the same constitutional safeguards that guarantee such rights as marriage, procreation, and the refusal or termination of life-saving medical treatment.

Opponents of euthanasia and physician-assisted suicide contend that doctors have a moral responsibility to keep their patients alive as reflected by the Hippocratic Oath. They argue there may be a “slippery slope” from euthanasia to murder, and that legalizing euthanasia will unfairly target the poor and disabled and create incentives for insurance companies to terminate lives in order to save money.

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CORE QUESTION

Definitions

Law and Public Policy

Euthanasia in Practice

Physician Involvement in Euthanasia and PAS

American Healthcare System

Religious Concerns

Moral Differences in Forms of Assisted Dying

End-of-Life Legal Documents

Palliative Care

“Slippery Slope” Argument

Special Groups

Historical Issues

Opponents of euthanasia and physician-assisted suicide contend that doctors have a moral responsibility to keep their patients alive as reflected by the Hippocratic Oath. They argue there may be a “slippery slope” from euthanasia to murder, and that legalizing euthanasia will unfairly target the poor and disabled and create incentives for insurance companies to terminate lives in order to save money.

PROS & CONS BY CATEGORY

CORE QUESTION

Definitions

Law and Public Policy

Euthanasia in Practice

Physician Involvement in Euthanasia and PAS

American Healthcare System

Religious Concerns

Moral Differences in Forms of Assisted Dying

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Euthanasia – ProCon.org

Euthanasia in the United States – Wikipedia

Euthanasia is illegal in most of the United States. Assisted suicide/assisted death is legal in Washington DC [1] and the states of Pennsylvania,[2] California, Colorado, Oregon, Vermont, Hawaii, and Washington;[3][4] its status is disputed in Montana. The key difference between euthanasia and assisted suicide is that in cases of assisted suicide, the individual receives assistance, but ultimately voluntarily causes their own death. In euthanasia the individual does not directly end their life, but another person acts to cause the individual’s death.[5]

Debates about the ethics of euthanasia and physician-assisted suicide date from ancient Greece and Rome. After the development of ether, physicians began advocating the use of anesthetics to relieve the pain of death. In 1870, Samuel Williams first proposed using anesthetics and morphine to intentionally end a patient’s life. Over the next 35 years, debates about euthanasia raged in the United States which resulted in an Ohio bill to legalize euthanasia in 1906, a bill that was ultimately defeated.[6]

Euthanasia advocacy in the U.S. peaked again during the 1930s and diminished significantly during and after World War II. Euthanasia efforts were revived during the 1960s and 1970s, under the right-to-die rubric, physician assisted death in liberal bioethics, and through advance directives and do not resuscitate orders.

Several major court cases advanced the legal rights of patients, or their guardians, to practice at least voluntary passive euthanasia (physician assisted death). These include the Karen Ann Quinlan case (1976), Brophy and Nancy Cruzan cases. More recent years have seen policies fine-tuned and re-stated, as with Washington v. Glucksberg (1997) and the Terri Schiavo case. The numerous legislative rulings and legal precedents that were brought about in the wake of the Quinlan case had their ethical foundation in the famous 1983 report completed by the Presidents Commission for the Study of Ethical Problems in Medicine, under the title “Deciding to Forgo Life-Sustaining Treatment” (Angell, Marcia. “How to Die in Massachusetts.” The New York Review of Books. 21 February 2013: 60.3. Web. 14 Jul. 2014.). The Commission sustained in its findings that it was morally acceptable to give up a life-supporting therapy and that withholding or withdrawing such a therapy is the same thing from an ethical stand-point, while artificial feeding and other life-supporting therapy are of the same importance for the patients and doctors. Before this report, to withdraw a medical therapy was regarded as much more serious decision than not to start a therapy at all, while artificial feeding was viewed as a special treatment. By 1990, barely a decade and a half after the New Jersey Supreme Courts historic decision, patients were well aware that they could decline any form of medical therapy if they simply choose to do that either directly or by expressing their wish via appointed representative.

In a 2004 article in the Bulletin of the History of Medicine, Brown University historian Jacob M. Appel documented extensive political debate over legislation to legalize physician-assisted suicide in both Iowa and Ohio in 1906. The driving force behind this movement was social activist Anna S. Hall. Canadian historian Ian Dowbiggen’s 2003 book, A Merciful End, revealed the role that leading public figures, including Clarence Darrow and Jack London, played in advocating for the legalization of euthanasia.

In the 1983 case of Barber v. Superior Court, two physicians had honored a family’s request to withdraw both respirator and intravenous feeding and hydration tubes from a comatose patient. The physicians were charged with murder, despite the fact that they were doing what the family wanted. The court held that all charges should be dropped because the treatments had all been ineffective and burdensome. Withdrawal of treatment, even if life-ending, is morally and legally permitted. Competent patients or their surrogates can decide to withdraw treatments, usually after the treatments are found ineffective, painful, or burdensome.[7]

On May 31, 2013, the Maine state legislature rejected decriminalization of physician assisted suicide and voluntary euthanasia (95-43).

In the United States legal and ethical debates about euthanasia became more prominent in the Karen Ann Quinlan case who went into a coma after allegedly mixing tranquilizers with alcohol, surviving biologically for 9 years in a “persistent vegetative state” even after the New Jersey Supreme Court approval to remove her from a respirator. This case caused a widespread public concern about “lives not worth living” and the possibility of at least voluntary euthanasia if it could be ascertained that the patient would not have wanted to live in this condition.[8]

In 1999, the state of Texas passed the Advance Directives Act. Under the law, in some situations, Texas hospitals and physicians have the right to withdraw life support measures, such as mechanical respiration, from terminally ill patients when such treatment is considered to be both futile and inappropriate. This is sometimes referred to as “passive euthanasia”.

In 2005, a six-month-old infant, Sun Hudson, with a uniformly fatal disease thanatophoric dysplasia, was the first patient in which “a United States court has allowed life-sustaining treatment to be withdrawn from a pediatric patient over the objections of the child’s parent”.[9]

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, Oregon passed the Death with Dignity Act in 1994, and Michigan included Proposal B in their ballot in 1998.

Reflecting the religious and cultural diversity of the United States, there is a wide range of public opinion about euthanasia and the right-to-die movement in the United States. During the past 30 years, public research shows that views on euthanasia tend to correlate with religious affiliation and culture, though not gender.

In one recent study dealing primarily with Christian denominations such as Southern Baptists, Pentecostals, and Evangelicals and Catholics tended to be opposed to euthanasia. Moderate Protestants, (e.g., 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. Respondents that did not affiliate with a religion were found to support euthanasia more than those who did. The liberal Protestants (including some Presbyterians and Episcopalians) were the most supportive. In general, liberal Protestants affiliate more loosely with religious institutions and their views were not similar to those of non-affiliates. Within all groups, religiosity (i.e., self-evaluation and frequency of church attendance) also correlated to opinions on euthanasia. Individuals who attended church regularly and more frequently and considered themselves more religious were found to be more opposed to euthanasia than to those who had a lower level of religiosity.[10]

Recent studies have shown white Americans to be more accepting of euthanasia than black Americans. They are also more likely to have advance directives and to use other end-of-life measures.[11] African Americans are almost 3 times more likely to oppose euthanasia than white Americans. Some speculate that this discrepancy is due to the lower levels of trust in the medical establishment.[12] Select researchers believe that historical medical abuses towards minorities (such as the Tuskegee Syphilis Study) have made minority groups less trustful of the level of care they receive. One study also found that there are significant disparities in the medical treatment and pain management that white Americans and other Americans receive.[13]

Among African Americans, education correlates to support for euthanasia. Black 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.[12] Only black and white Americans have been studied in extensive detail. Although it has been found that minority groups are less supportive of euthanasia than white Americans, there is still some ambiguity as to what degree this is true.

A 2005 Gallup Poll found that 84% of males supported euthanasia compared to 64% of females.[14] 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 black American women are 2.37 times more likely to oppose euthanasia than white American women. African American men are 3.61 times more likely to oppose euthanasia than white American men.[15]

In “Gender, Feminism, and Death: Physician-Assisted Suicide and Euthanasia” Susan M. Wolf warns of the gender disparities if euthanasia or physician-assisted suicide were legal. Wolf highlights four possible gender effects: higher incidence of women than men dying by physician-assisted suicide; more women seeking physician-assisted suicide or euthanasia for different reasons than men; physicians granting or refusing requests for assisted suicide or euthanasia because of the gender of the patient; gender affecting the broad public debate by envisioning a woman patient when considering the debate.[16]

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Euthanasia in the United States – Wikipedia

Euthanasia | definition of euthanasia by Medical dictionary

euthanasia[uthah-nazhah]

1. an easy or painless death.

1. A quiet, painless death.

2. The intentional putting to death of a person with an incurable or painful disease intended as an act of mercy.

[eu- + G. thanatos, death]

1. an easy or painless death.

2. mercy killing; the deliberate ending of life of a person suffering from an incurable disease.

The act or practice of ending the life of a person or animal having a terminal illness or a medical condition that causes suffering perceived as incompatible with an acceptable quality of life, as by lethal injection or the suspension of certain medical treatments.

Etymology: Gk, eu, good; thanatos, death

2 an easy, quiet, painless death.

1. The intentional putting to death of a person with an incurable or painful disease, intended as an act of mercy.

[eu- + G. thanatos, death]

The act of putting a person or animal to death painlessly or allowing them to die by withholding medical services, usually because of a painful and incurable disease. Mercy killing is another term for euthanasia.

n the act of facilitating death in a terminally ill patient, whether by deliberate activity, such as the administration of drugs that hasten death (known as active euthanasia), or passive, as in the withholding of life-extending treatment (passive euthanasia).

1. A quiet, painless death.

2. The intentional putting to death of a person with an incurable or painful disease intended as an act of mercy.

[eu- + G. thanatos, death]

(thnzh), n an act of deliberately bringing about the death of a person who is suffering from an incurable disease or condition; also called mercy killing. Active euthanasia is illegal in most jurisdictions; passive euthanasia, or the withholding of some life support systems, has legal standing in some jurisdictions.

1. an easy or painless death.

2. the deliberate ending of life of an animal suffering from an incurable disease; called also mercy killing, to put down, to put to sleep.

For the individual animal intravenous injection of a massive dose of barbiturate is best. Any narcotizing drug creates difficulties if the carcass is to be disposed of for pet meat. In those cases shooting with a bullet or captive bolt pistol is recommended because of the speed of the despatch. For large numbers of animals at a pound or shelter, injection procedures are still superior to the bulk methods which all have the fallibility of poorly managed and supervised machinery. Carbon monoxide is very fast but dangerous to the operators of the cabinet. Electrocution cannot be performed en masse and gassing with carbon monoxide or lowering of the atmospheric pressure are not really quick enough. Small laboratory animals are still despatched by a sharp blow to the head and birds by guillotine or separation of the cervical vertebrae.

uses mains electrical current passed through the subject’s body via clips applied to the skin of the ear and the tail. Not much employed because of danger to human operators, likelihood of equipment failure and need for close contact with device.

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Euthanasia | definition of euthanasia by Medical dictionary

Euthanasia – Wikipedia

Euthanasia (from Greek: ; “good death”: , eu; “well” or “good” , thanatos; “death”) is the practice of intentionally ending a life to relieve pain and suffering.[1][2]

There are different euthanasia laws in each country. 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 it under the broader definition of “assisted suicide and termination of life on request”.[5]

Euthanasia is categorized in different ways, which include voluntary, non-voluntary, or involuntary. Voluntary euthanasia is legal in some countries. Non-voluntary euthanasia (patient’s consent unavailable) is illegal in all countries. Involuntary euthanasia (without asking consent or against the patient’s will) is also illegal in all countries and is usually considered murder.[6] As of 2006, euthanasia is the most active area of research in contemporary bioethics.[7] In some countries there is a divisive public controversy over the moral, ethical, and legal issues of 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 (ex. Belgium, Canada, Switzerland) and is limited to specific circumstances and the approval of councilors and doctors or other specialists. In some countries such as Nigeria, Saudi Arabia and Pakistan, support for active euthanasia is almost non-existent.

Like other terms borrowed from history, “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.”[8] 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 conceptthe euthanasia “which regards the preparation of the soul.”[9]

In current usage, euthanasia has been 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 which 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 incorporates 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 being 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 that 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; a 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 includes 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 in 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]

Euthanasia may be classified into three types, according to whether a person gives informed consent: voluntary, non-voluntary and involuntary.[23][24]

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 as one of their criteria, although it may have been required to justify euthanasia.[11][25] However, others see consent as essential.

Voluntary euthanasia is conducted with the consent of the patient. 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 his or her 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 is conducted when the consent of the patient is unavailable. Examples include child euthanasia, which is illegal worldwide but decriminalised under certain specific circumstances in the Netherlands under the Groningen Protocol.

Involuntary euthanasia is conducted against the will of the patient.

Voluntary, non-voluntary and involuntary types can be further divided into passive or active variants.[26] 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 the 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]

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 Marseilles. 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).[27][28][29]

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 , bene, well, and , mors, death.[30]

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 between the theological care of the soul of sick people from the physical care and medical treatment by doctors.[31][32]

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,[33] as did Francois Ranchin (15651641), a French physician and professor of medicine, and Michael Boudewijns (16011681), a physician and teacher.[28]:208[34] Other voices argued for euthanasia, such as John Donne in 1624,[35] 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”.[28]:209211 This view was shared by others who followed, including Philipp Jakob Spener, Veit Riedlin and Johann Georg Krnitz.[28]: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.[28]:211214

Suicide and euthanasia became more accepted during the Age of Enlightenment.[34] Thomas More wrote of euthanasia in Utopia, although it is not clear if More was intending to endorse the practice.[28]:208209 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.[36]

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.[37]: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.

The essay was favourably reviewed in The Saturday Review, but an editorial against the essay appeared in The Spectator.[38] 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’.[38][39] Popular Science analyzed the issue in May 1873, assessing both sides of the argument.[40] 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”.[38]

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.[37]: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.[41]

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, Alder 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.[42] Both Ingersoll and Adler argued for voluntary euthanasia of adults suffering from terminal ailments.[42] Dowbiggin argues that by breaking down prior moral objections to euthanasia and suicide, Ingersoll and Adler enabled others to stretch the definition of euthanasia.[43]

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.[44]:614 Hunt did so at the behest of Anna S. 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.[44]:614616

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.[37]:796[44]:618619

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 612 month prison term and a fine of between $200 and $1,000. The proposal proved to be controversial.[44]:619621 It engendered considerable debate and failed to pass, having been withdrawn from consideration after being passed to the Committee on Public Health.[44]: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.[37]: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.[42] 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.[42]

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.[45] 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.[46]

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”.[47] 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.[47] The Telegraph noted that the killing of the disabled infantwhose 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”.[48] While Kretchmar’s killing received parental consent, most of the 5,000 to 8,000 children killed afterwards were forcibly taken from their parents.[47][48]

The “euthanasia campaign” of mass murder gathered momentum on 14 January 1940 when the “handicapped” were killed with gas vans and killing centres, eventually leading to the deaths of 70,000 adult Germans.[49] 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 deathmust killin order to keep the social organism alive and healthy.[50]

In modern terms, the use of “euthanasia” in the context of Action 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”.[51] 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.[51] 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.”[42]:65

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. 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.'”[52] 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?'”[52]

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.[42]

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 principlethe doctrine of double effectis 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,[53] which will lead to unacceptable consequences.[37]:797-8 In fact, in Oregon, in 2013, pain wasn’t one of the top five reasons people sought euthanasia. Top reasons were a loss of dignity, and a fear of burdening others.[54]

In the United States in 2013, 47% nationwide supported doctor-assisted suicide. This included 32% of Latinos, 29% of African-Americans, and almost nobody with disabilities.[54]

West’s Encyclopedia of American Law states that “a ‘mercy killing’ or euthanasia is generally considered to be a criminal homicide”[55] and is normally used as a synonym of homicide committed at a request made by the patient.[56]

The judicial sense of the term “homicide” includes any intervention undertaken with the express intention of ending a life, even to relieve intractable suffering.[56][57][58] Not all homicide is unlawful.[59] Two designations of homicide that carry no criminal punishment are justifiable and excusable homicide.[59] 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”.[60] 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.[61] 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.[62] The use of pain medication to relieve suffering, even if it hastens death, has been held as legal in several court decisions.[60]

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.[63][64][65][66]

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.[67]

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”.[68] 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.[68]

In the United Kingdom, the pro-assisted dying group Dignity in Dying cite conflicting research on attitudes by doctors to assisted dying: with a 2009 Palliative Medicine-published survey showing 64% support (to 34% oppose) for assisted dying in cases where a patient has an incurable and painful disease, while 49% of doctors in a study published in BMC Medical Ethics oppose changing the law on assisted dying to 39% in favour.[69]

The Roman Catholic Church strongly opposes and condemns euthanasia and assisted suicide as morally wrong. The Catholic Church states that, “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, the practice is unacceptable within the Church.[70] The Orthodox Church in America, along with other Eastern Orthodox Churches, also opposes euthanasia stating that it must be condemned as murder stating that, “Euthanasia is the deliberate cessation to end human life.”[71]

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 is “morally wrong and unacceptable to take a human life to relieve the suffering caused by incurable illnesses.” [71] Other Protestant churches which oppose euthanasia include:

The Church of England accepts passive euthanasia under some circumstances, but is strongly against active euthanasia, and has led opposition against recent attempt to legalise it.[81] 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.[82].

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 Koran 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.[83]

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.[84]

Read the original here:

Euthanasia – Wikipedia

Euthanasia – ProCon.org

Proponents of euthanasia and physician-assisted suicide (PAS) contend that terminally ill people should have the right to end their suffering with a quick, dignified, and compassionate death. They argue that the right to die is protected by the same constitutional safeguards that guarantee such rights as marriage, procreation, and the refusal or termination of life-saving medical treatment.

Opponents of euthanasia and physician-assisted suicide contend that doctors have a moral responsibility to keep their patients alive as reflected by the Hippocratic Oath. They argue there may be a “slippery slope” from euthanasia to murder, and that legalizing euthanasia will unfairly target the poor and disabled and create incentives for insurance companies to terminate lives in order to save money.

PROS & CONS BY CATEGORY

CORE QUESTION

Definitions

Law and Public Policy

Euthanasia in Practice

Physician Involvement in Euthanasia and PAS

American Healthcare System

Religious Concerns

Moral Differences in Forms of Assisted Dying

End-of-Life Legal Documents

Palliative Care

“Slippery Slope” Argument

Special Groups

Historical Issues

Archived Notices

Last updated on 6/13/2018 9:52:49 AM PST

Opponents of euthanasia and physician-assisted suicide contend that doctors have a moral responsibility to keep their patients alive as reflected by the Hippocratic Oath. They argue there may be a “slippery slope” from euthanasia to murder, and that legalizing euthanasia will unfairly target the poor and disabled and create incentives for insurance companies to terminate lives in order to save money.

PROS & CONS BY CATEGORY

CORE QUESTION

Definitions

Law and Public Policy

Euthanasia in Practice

Physician Involvement in Euthanasia and PAS

American Healthcare System

Religious Concerns

Moral Differences in Forms of Assisted Dying

End-of-Life Legal Documents

Palliative Care

“Slippery Slope” Argument

Special Groups

Historical Issues

Archived Notices

Last updated on 6/13/2018 9:52:49 AM PST

See the rest here:

Euthanasia – ProCon.org

Euthanasia – Wikipedia

Euthanasia (from Greek: ; “good death”: , eu; “well” or “good” , thanatos; “death”) is the practice of intentionally ending a life to relieve pain and suffering.[1][2]

There are different euthanasia laws in each country. 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 it under the broader definition of “assisted suicide and termination of life on request”.[5]

Euthanasia is categorized in different ways, which include voluntary, non-voluntary, or involuntary. Voluntary euthanasia is legal in some countries. Non-voluntary euthanasia (patient’s consent unavailable) is illegal in all countries. Involuntary euthanasia (without asking consent or against the patient’s will) is also illegal in all countries and is usually considered murder.[6] As of 2006, euthanasia is the most active area of research in contemporary bioethics.[7] In some countries there is a divisive public controversy over the moral, ethical, and legal issues of 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 (ex. Belgium, Canada, Switzerland) and is limited to specific circumstances and the approval of councilors and doctors or other specialists. In some countries such as Nigeria, Saudi Arabia and Pakistan, support for active euthanasia is almost non-existent.

Like other terms borrowed from history, “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.”[8] 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 conceptthe euthanasia “which regards the preparation of the soul.”[9]

In current usage, euthanasia has been 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 which 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 incorporates 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 being 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 that 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; a 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 includes 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 in 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]

Euthanasia may be classified into three types, according to whether a person gives informed consent: voluntary, non-voluntary and involuntary.[23][24]

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 as one of their criteria, although it may have been required to justify euthanasia.[11][25] However, others see consent as essential.

Voluntary euthanasia is conducted with the consent of the patient. 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 his or her 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 is conducted when the consent of the patient is unavailable. Examples include child euthanasia, which is illegal worldwide but decriminalised under certain specific circumstances in the Netherlands under the Groningen Protocol.

Involuntary euthanasia is conducted against the will of the patient.

Voluntary, non-voluntary and involuntary types can be further divided into passive or active variants.[26] 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 the 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]

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 Marseilles. 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).[27][28][29]

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 , bene, well, and , mors, death.[30]

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 between the theological care of the soul of sick people from the physical care and medical treatment by doctors.[31][32]

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,[33] as did Francois Ranchin (15651641), a French physician and professor of medicine, and Michael Boudewijns (16011681), a physician and teacher.[28]:208[34] Other voices argued for euthanasia, such as John Donne in 1624,[35] 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”.[28]:209211 This view was shared by others who followed, including Philipp Jakob Spener, Veit Riedlin and Johann Georg Krnitz.[28]: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.[28]:211214

Suicide and euthanasia became more accepted during the Age of Enlightenment.[34] Thomas More wrote of euthanasia in Utopia, although it is not clear if More was intending to endorse the practice.[28]:208209 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.[36]

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.[37]: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.

The essay was favourably reviewed in The Saturday Review, but an editorial against the essay appeared in The Spectator.[38] 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’.[38][39] Popular Science analyzed the issue in May 1873, assessing both sides of the argument.[40] 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”.[38]

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.[37]: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.[41]

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, Alder 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.[42] Both Ingersoll and Adler argued for voluntary euthanasia of adults suffering from terminal ailments.[42] Dowbiggin argues that by breaking down prior moral objections to euthanasia and suicide, Ingersoll and Adler enabled others to stretch the definition of euthanasia.[43]

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.[44]:614 Hunt did so at the behest of Anna S. 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.[44]:614616

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.[37]:796[44]:618619

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 612 month prison term and a fine of between $200 and $1,000. The proposal proved to be controversial.[44]:619621 It engendered considerable debate and failed to pass, having been withdrawn from consideration after being passed to the Committee on Public Health.[44]: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.[37]: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.[42] 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.[42]

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.[45] 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.[46]

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”.[47] 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.[47] The Telegraph noted that the killing of the disabled infantwhose 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”.[48] While Kretchmar’s killing received parental consent, most of the 5,000 to 8,000 children killed afterwards were forcibly taken from their parents.[47][48]

The “euthanasia campaign” of mass murder gathered momentum on 14 January 1940 when the “handicapped” were killed with gas vans and killing centres, eventually leading to the deaths of 70,000 adult Germans.[49] 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 deathmust killin order to keep the social organism alive and healthy.[50]

In modern terms, the use of “euthanasia” in the context of Action 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”.[51] 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.[51] 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.”[42]:65

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. 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.'”[52] 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?'”[52]

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.[42]

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 principlethe doctrine of double effectis 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,[53] which will lead to unacceptable consequences.[37]:797-8 In fact, in Oregon, in 2013, pain wasn’t one of the top five reasons people sought euthanasia. Top reasons were a loss of dignity, and a fear of burdening others.[54]

In the United States in 2013, 47% nationwide supported doctor-assisted suicide. This included 32% of Latinos, 29% of African-Americans, and almost nobody with disabilities.[54]

West’s Encyclopedia of American Law states that “a ‘mercy killing’ or euthanasia is generally considered to be a criminal homicide”[55] and is normally used as a synonym of homicide committed at a request made by the patient.[56]

The judicial sense of the term “homicide” includes any intervention undertaken with the express intention of ending a life, even to relieve intractable suffering.[56][57][58] Not all homicide is unlawful.[59] Two designations of homicide that carry no criminal punishment are justifiable and excusable homicide.[59] 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”.[60] 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.[61] 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.[62] The use of pain medication to relieve suffering, even if it hastens death, has been held as legal in several court decisions.[60]

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.[63][64][65][66]

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.[67]

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”.[68] 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.[68]

In the United Kingdom, the pro-assisted dying group Dignity in Dying cite conflicting research on attitudes by doctors to assisted dying: with a 2009 Palliative Medicine-published survey showing 64% support (to 34% oppose) for assisted dying in cases where a patient has an incurable and painful disease, while 49% of doctors in a study published in BMC Medical Ethics oppose changing the law on assisted dying to 39% in favour.[69]

The Roman Catholic Church strongly opposes and condemns euthanasia and assisted suicide as morally wrong. The Catholic Church states that, “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, the practice is unacceptable within the Church.[70] The Orthodox Church in America, along with other Eastern Orthodox Churches, also opposes euthanasia stating that it must be condemned as murder stating that, “Euthanasia is the deliberate cessation to end human life.”[71]

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 is “morally wrong and unacceptable to take a human life to relieve the suffering caused by incurable illnesses.” [71] Other Protestant churches which oppose euthanasia include:

The Church of England accepts passive euthanasia under some circumstances, but is strongly against active euthanasia, and has led opposition against recent attempt to legalise it.[81] 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.[82].

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 Koran 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.[83]

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.[84]

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Euthanasia – Wikipedia

Euthanasia – ProCon.org

Proponents of euthanasia and physician-assisted suicide (PAS) contend that terminally ill people should have the right to end their suffering with a quick, dignified, and compassionate death. They argue that the right to die is protected by the same constitutional safeguards that guarantee such rights as marriage, procreation, and the refusal or termination of life-saving medical treatment.

Opponents of euthanasia and physician-assisted suicide contend that doctors have a moral responsibility to keep their patients alive as reflected by the Hippocratic Oath. They argue there may be a “slippery slope” from euthanasia to murder, and that legalizing euthanasia will unfairly target the poor and disabled and create incentives for insurance companies to terminate lives in order to save money.

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Definitions

Law and Public Policy

Euthanasia in Practice

Physician Involvement in Euthanasia and PAS

American Healthcare System

Religious Concerns

Moral Differences in Forms of Assisted Dying

End-of-Life Legal Documents

Palliative Care

“Slippery Slope” Argument

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Last updated on 5/16/2018 9:07:37 AM PST

Opponents of euthanasia and physician-assisted suicide contend that doctors have a moral responsibility to keep their patients alive as reflected by the Hippocratic Oath. They argue there may be a “slippery slope” from euthanasia to murder, and that legalizing euthanasia will unfairly target the poor and disabled and create incentives for insurance companies to terminate lives in order to save money.

PROS & CONS BY CATEGORY

CORE QUESTION

Definitions

Law and Public Policy

Euthanasia in Practice

Physician Involvement in Euthanasia and PAS

American Healthcare System

Religious Concerns

Moral Differences in Forms of Assisted Dying

End-of-Life Legal Documents

Palliative Care

“Slippery Slope” Argument

Special Groups

Historical Issues

Archived Notices

Last updated on 5/16/2018 9:07:37 AM PST

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Euthanasia – ProCon.org

Euthanasia | law | Britannica.com

Euthanasia, also called mercy killing, act or practice of painlessly putting to death persons suffering from painful and incurable disease or incapacitating physical disorder or allowing them to die by withholding treatment or withdrawing artificial life-support measures. Because there is no specific provision for it in most legal systems, it is usually regarded as either suicide (if performed by the patient himself) or murder (if performed by another). A physician may, however, lawfully decide not to prolong life in cases of extreme suffering, and he may administer drugs to relieve pain even if this shortens the patients life. In the late 20th century, several European countries had special provisions in their criminal codes for lenient sentencing and the consideration of extenuating circumstances in prosecutions for euthanasia.

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ethics: Abortion, euthanasia, and the value of human life

A number of ethical questions are concerned with the endpoints of the human life span. The question of whether abortion or the use of human embryos as sources of stem cells can be morally justified was exhaustively discussed

The opinion that euthanasia is morally permissible is traceable to Socrates, Plato, and the Stoics. It is rejected in traditional Christian belief, chiefly because it is thought to contravene the prohibition of murder in the Ten Commandments. The organized movement for legalization of euthanasia commenced in England in 1935, when C. Killick Millard founded the Voluntary Euthanasia Legalisation Society (later called the Euthanasia Society). The societys bill was defeated in the House of Lords in 1936, as was a motion on the same subject in the House of Lords in 1950. In the United States the Euthanasia Society of America was founded in 1938.

The first countries to legalize euthanasia were the Netherlands in 2001 and Belgium in 2002. In 1997 Oregon became the first state in the United States to decriminalize physician-assisted suicide; opponents of the controversial law, however, attempted to have it overturned. In 2009 the Supreme Court of South Korea recognized a right to die with dignity in its decision to approve a request by the family of a brain-dead woman that she be removed from life-support systems.

The potential of modern medical practice to prolong life through technological means has provoked the question of what courses of action should be available to the physician and the family in cases of extreme physical or emotional suffering, especially if the patient is incapable of choice. Passively doing nothing to prolong life or withdrawing life-support measures has resulted in criminal charges being brought against physicians; on the other hand, the families of comatose and apparently terminal patients have instituted legal action against the medical establishment to make them stop the use of extraordinary life support.

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Euthanasia | law | Britannica.com

Euthanasia and Physician -Assisted Suicide legal …

[Greek, good death.] The term normally implies an intentional termination of life by another at the explicit request of the person who wishes to die. Euthanasia is generally defined as the act of killing an incurably ill person out of concern and compassion for that person’s suffering. It is sometimes called mercy killing, but many advocates of euthanasia define mercy killing more precisely as the ending of another person’s life without his or her request. Euthanasia, on the other hand, is usually separated into two categories: passive euthanasia and active euthanasia. In many jurisdictions, active euthanasia can be considered murder or Manslaughter, whereas passive euthanasia is accepted by professional medical societies, and by the law under certain circumstances.

Hastening the death of a person by altering some form of support and letting nature take its course is known as passive euthanasia. Examples include such things as turning off respirators, halting medications, discontinuing food and water so as to allowing a person to dehydrate or starve to death, or failure to resuscitate.

Passive euthanasia also includes giving a patient large doses of morphine to control pain, in spite of the likelihood that the painkiller will suppress respiration and cause death earlier than it otherwise would have happened. Such doses of painkillers have a dual effect of relieving pain and hastening death. Administering such medication is regarded as ethical in most political jurisdictions and by most medical societies.

These procedures are performed on terminally ill, suffering persons so that natural death will occur sooner. They are also commonly performed on persons in a persistent vegetative state; for example, individuals with massive brain damage or in a coma from which they likely will not regain consciousness.

Far more controversial, active euthanasia involves causing the death of a person through a direct action, in response to a request from that person. A well-known example of active euthanasia was the death of a terminally ill Michigan patient on September 17, 1998. On that date, Dr. Jack Kevorkian videotaped himself administering a lethal medication to Thomas Youk, a 52-year-old Michigan man with amyotrophic lateral sclerosis. CBS broadcast the videotape on 60 Minutes less than a week later. Authorities subsequently charged Kevorkian with first-degree premeditated murder, criminal assistance of a suicide, and delivery of a controlled substance for administering lethal medication to a terminally ill man. There was no dispute that the dose was administered at the request of Mr. Youk, nor any dispute that Mr. Youk was terminally ill. A jury found Kevorkian guilty of second-degree murder in 1999. He was sent to prison.

Somewhat of a hybrid between passive and active euthanasia is physician-assisted suicide (PAS), also known as voluntary passive euthanasia. In this situation, a physician supplies information and/or the means of committing suicide (e.g., a prescription for lethal dose of sleeping pills, or a supply of carbon monoxide gas) to a person, so that that individual can successfully terminate his or her own life.

Physician-assisted suicide received greater public attention after Dr. Kevorkian, a retired pathologist from Michigan, participated in his first such procedure in 1990. Kevorkian set up a machine that allowed a 54-year-old woman suffering from Alzheimer’s disease (a degenerative neurological condition) to press a button that delivered a lethal poison into her veins. Kevorkian went on to assist in the suicides of dozens of individuals suffering from terminal, debilitating, or chronic illnesses. In 1992, Michigan passed an assisted-suicide bill (Mich. Comp. Laws 752.1021) that was specifically designed to stop Kevorkian’s activities, but technicalities and questions as to its constitutionality delayed its implementation, thus allowing Kevorkian to continue assisting suicidesoften in direct opposition to court injunctions.

Kevorkian was charged with murder several times but was not initially found guilty. When murder charges were brought against him for his first three assisted suicides, for example, they were dismissed because Michigan, at that time, had no law against assisted suicide. In 1994, Kevorkian was tried and found not guilty of assisting in the August 1993 suicide of Thomas W. Hyde Jr. In December 1994, however, Michigan’s supreme court ruled in People v. Kevorkian, 447 Mich. 436, 527 N.W. 2d 714, that there is no constitutional right to commit suicide, with or without assistance, and upheld the Michigan statute that made assisted suicide a crime. The following year, the U.S. Supreme Court refused to hear Kevorkian’s appeal from the state supreme court’s ruling.

Observers disagree about the humanity of Kevorkian’s activities. Some see him as a hero who sought to give suffering people greater choice and dignity in dying. Others point to his lack of procedural precautions and fear that the widespread practice of assisted suicide will lead to the unnecessary death of people who could have been helped by other means, including treatment for depression. Many opponents of assisted suicide find the same faults in the practice that they see in other forms of euthanasia. They envision its leading to a devaluation of human life and even to a genocidal killing of vulnerable or so-called undesirable individuals.

The U.S. Supreme Court has made two important rulings on assisted suicide. In washington v. glucksberg, 521 U.S. 702, 117 S.Ct. 2258, 138 L.Ed.2d 772, 65 (1997), three terminally ill patients, four physicians, and a non-profit organization had brought action against the state of Washington for Declaratory Judgment, that a statute banning assisted suicide violated due process clause. On June 26, 1997, the Supreme Court unanimously upheld the right of states to prohibit assisted suicide, holding that: (1) asserted right to assistance in committing suicide was not a fundamental liberty interest protected by due process clause, and (2) Washington’s ban on assisted suicide was rationally related to legitimate government interests. In Vacco v. Quill, 521 U.S. 793, 117 S.Ct. 2293, 138 L.Ed.2d 834 (1997), physicians challenged the constitutionality of New York statutes making it a crime to aid a person in committing suicide or attempting to commit suicide. The Supreme Court held that New York’s prohibition on assisting suicide did not violate the equal protection clause of the Fourteenth Amendment.

The term involuntary euthanasia is used to describe the killing of a person who has not explicitly requested aid in dying. This term is most often used with respect to patients who are in a persistent vegetative state and who probably will never recover consciousness.

Euthanasia is a divisive topic, and different interpretations of its meaning, practice, and morality abound. Those who favor active euthanasia and a patient’s right to die, do not acknowledge a distinction between active and passive euthanasia. They assert that the withdrawal of life-sustaining treatment cannot be distinguished in principle from affirmative steps to hasten a patient’s death. In both situations, they argue, a person intends to cause the patient’s death, acts out of compassionate motives, and causes the same outcome. In their view, turning off a life-sustaining respirator switch and giving a lethal injection are morally equivalent actions.

Opponents of active euthanasia argue that it undermines the value of, and respect for, all human life; erodes trust in physicians; desensitizes society to killing; and contradicts many people’s religious beliefs. Moreover, they maintain that the intentions and natures of active and passive euthanasia are not essentially the same. In active euthanasia, a person directly intends to cause death and uses available means to achieve this end. In passive euthanasia, a person decides against using a certain form of treatment and then directs that such treatment be withdrawn or withheld, accepting but not intending the patient’s death, which is caused by the underlying illness.

While people cite differing reasons for choosing to end their own lives, those suffering from a terminal illness typically state that a serious disorder or disease has adversely affected their quality of life to the point where they no longer wish to continue living. Under such circumstances, patients may have been diagnosed with a degenerative, progressive illness such as ALS, Huntington’s disease, multiple sclerosis, AIDS, or Alzheimer’s disease. Patients with such illnesses often fear, with good reason, a gradual loss of the quality of life in the future as the disease or disorder progresses, or they might already have lost a good deal of their independence and thus might require continuous care. Some feel that this loss of autonomy causes an unacceptable loss of personal dignity. Others realize that they will be dying in the near future and simply want to have total control over the process. Some point out that in addition to physical considerations, they do not want to diminish their assets by incurring large medical costs as their death approaches. They feel that they ought to have the option to die sooner and to pass on their assets to their beneficiaries.

Imagine that you are suffering from a disease that is terminal, debilitating, and very painful. Should you have the right to die when you wish rather than live in continued agony? Should your doctor be legally free to help you take your own life, perhaps by prescribing some pills and telling you their fatal dosage? Or should the law forbid anyoneincluding doctorsto assist in the suicide of another human being? These are just some of the questions that surround the issue of physician-assisted suicide, a widely debated ethical issue in modern medicine.

Physician-assisted suicide is a form of voluntary euthanasia. In other words, it involves a patient voluntarily acting to end his or her life. Physician-assisted suicide differs from conventional suicide in that it is facilitated by a physician who confirms the patient’s diagnosis, rules out conditions such as depression that may be clouding the patient’s judgment, and finally provides the means for committing suicide. Such action usually consists of taking a lethal overdose of prescription medication. However, the over 130 patients who were assisted by Dr. Jack Kevorkian between 1990 and 1998 chose to press a button which delivered a lethal poison into their veins, or to put on a mask that emitted carbon monoxide into their lungs. Assisted suicide is a felony offense in most states and is also expressly forbidden in the American Medical Association’s (AMA’s) Code of Medical Ethics. In 1999, Kevorkian was found guilty of second-degree murder in an assisted suicide case. He was sentenced to serve 10 to 25 years.

The debate surrounding physician-assisted suicide in the United States has been influenced by medical practices in other countries, particularly the Netherlands, which legalized both active euthanasia and physician-assisted suicide, in April 2001 (effective 2002). Physician-assisted suicide in the Netherlands is conducted within strict guidelines that include the following requirements: the patient’s request for assisted suicide must be voluntary, the patient must be experiencing intolerable suffering, all other alternatives for treatment must have been explored, and the physician must consult another independent physician before proceeding. A study commissioned by the Dutch government indicated that, in 2001, about 3,500 deaths, or 2.5 percent of the 140,000 death cases that were reported in the Netherlands that year, occurred by active euthanasia. The study, known as the Remmelink Report, defined euthanasia as the termination of life at the patient’s request. Figures also indicated that 300 deaths, or 0.2 percent, were caused by physician-assisted suicide.

In the United States, the debate on legalizing assisted suicide began in earnest in the 1970s. On one side of the debate have been Patients’ Rights groups who have lobbied for what they call the right to dieor the right to choose to die, as some have clarified it of terminally ill patients. The strongest opposition to the legalization of physician-assisted suicide has come from physicians’ groups such as the AMA and from religious groups that are morally opposed to the practice.

One person who has done much to make the case for physician-assisted suicide is Derek Humphry, a former journalist who founded the Hemlock Society, in 1980, after seeing the pain and suffering his first wife experienced when she died from cancer. In 2003, the organization changed its name to End-of-Life Choices, which encompasses more clearly the issues supported by its members. With a new name and a new motto, “Dignity Compassion Control,” the organization continues to advocate for the right of terminally ill people to choose voluntary euthanasia, or what Humphry has termed self-deliverance.

Humphry has written several books on the subject of voluntary euthanasia, including Jean’s Way (1978), which recounts his struggle to assist his wife’s death in 1975; Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying (1991), a controversial book that gives detailed advice on how terminally ill people may take their own life; and Lawful Exit: The Limits of Freedom for Help in Dying (1993), which contains Humphry’s own recommendations for legislation that would legalize physician-assisted suicide and active voluntary euthanasia. In Humphry’s words, the “right to choose to die” is “the ultimate civil liberty.”

Humphry presents physician-assisted suicide as a merciful, dignified option for people whose illness has eroded their quality of life beyond the limits of tolerance. He also points out that what he calls beneficent euthanasia occurs every day in medical facilities as physicians make decisions regarding the end of life. Others, including some medical ethicists, go so far as to claim that a decision to withhold antibiotics, oxygen, or nutrition from a terminally ill patient is no less “active” a form of euthanasia than is administering a fatal dose of morphine. Indeed, they see the common practice of withholding life support as more open to potential abuse than the practice of physician-assisted suicide. The former, they argue, is a less visible, less easily regulated decision. Proponents of physician-assisted suicide also claim that diseases kill people in far more cruel ways than would any means of death that a physician might provide for an irreversibly ill patient. As a result, they see the action of assisting in suicide as entirely compatible with the physician’s duty to the patient.

However, Humphry has been an open critic of Kevorkian’s work. He has described Kevorkian’s theory and practice of assisted suicide as open-ended euthanasia. Noting Kevorkian’s lack of precautionary measures such as the use of waiting periods and second opinions, Humphry sees any wider application of Kevorkian’s methods as potentially leading to abuse and tragedy. “The thinking people in our movement are appalled by it,” Humphry said. “If you have Kevorkian’s type of euthanasia, it will be a slippery slope. Kevorkian’s is a recipe for skiing down a glacier.”

Detractors of physician-assisted suicide also use the familiar “slippery slope” argument, proposing that once physician-assisted suicide is legalized, other forms of euthanasia will more likely be practiced as well. They see assisted suicide as potentially leading to situations in which elderly, chronically ill, and handicapped people, along with others, are killed through active, nonvoluntary euthanasia. Related to this idea is the view that widespread practice of physician-assisted suicide might claim the lives of those whose intolerable suffering is caused by treatable depression. They point out that terminally ill people or others in pain are often also suffering from depression, and that despite their illness, their feelings of hopelessness can often be addressed through means such as counseling and antidepressant medication.

The Catholic Church is one of many religious organizations that opposes euthanasia and assisted suicide. In Pope John Paul II’s words, medical killings such as those caused by assisted suicide are “crimes which no human law can claim to legitimize.” Basing its arguments on passages from the Bible, Catholic theology has for many centuries opposed all forms of suicide. Catholicism argues that innocent human life may not be destroyed for any reason whatsoever.

The debate over physician-assisted suicide eventually reached the Supreme Court. In 1994, an advocacy group known as Compassion in Dying filed two lawsuits (Compassion in Dying et al v. Washington and Quill et al v. Vacco) challenging the constitutionality of state laws banning assisted dying in Washington and New York. Compassion in Dying won in the District Court in Washington. Chief Judge Barbara Rothstein wrote, “There is no more profoundly personal decision, nor one which is closer to the heart of personal liberty, than the choice which a terminally ill person makes to end his or her suffering and hasten an inevitable death.” In New York, Compassion in Dying lost and filed an appeal in the Second Circuit.

In 1995, Washington’s Compassion ruling was overturned by the Ninth Circuit Court of Appeals, reinstating the anti-suicide law. In 1996, however, after reconsideration, the Ninth Circuit Court of Appeals issued a reversal decision in Compassion v. Washington. That decision held that assisted dying was protected by liberty and privacy provisions of the U.S. Constitution. The majority wrote that, “Those who believe strongly that death must come without physician assistance are free to follow that creed, be they doctors or patients. They are not free, however, to force their views, their religious convictions, or their philosophies on all the other members of a democratic society, and to compel those whose values differ with theirs to die painful, protracted, and agonizing deaths.”

In April 1996, the Second Circuit joined the Ninth in recognizing constitutional protection for assisted dying in the Quill case, holding that the New York statutes criminalizing assisted suicide violate the equal protection clause of the Fourteenth Amendment. However, on June 26, 1997, the U.S. Supreme Court reversed both the Ninth and Second Circuit Court in washington v. glucksberg, 521 U.S. 702, 117 S.Ct. 2258, 138 L.Ed.2d 772 (1997) and Vacco v. Quill, 521 U.S. 743, 117 S.Ct. 2293, 138 L.Ed.2d 834 (1997). The Court ruled that state laws against assisting a suicide are not unconstitutional, but also stated that patients have a right to aggressive treatment of pain and other symptoms, even if the treatment hastens death. The Court wrote, “Throughout the Nation, Americans are engaged in an earnest and profound debate about the morality, legality and practicality of physician assisted suicide. Our holding permits this debate to continue, as it should in a democratic society.”

Ultimately then, the voters and representatives of the states and the legal system itself will have to decide whether or not physician-assisted suicide will be legalized. Regardless of what side prevails in the debate, the exchange of ideas that it creates may lead to a greater understanding of the difficult choices surrounding death in our time.

Cohen-Almagor, Raphael. 2001. The Right to Die With Dignity: An Argument in Ethics, Medicine, and Law. New Brunswick, N.J.: Rutgers Univ. Press.

End of Life Choices. Available online at (accessed August 25, 2003).

Hendin, Herbert. 2002. “The Dutch Experience.” Issues in Law & Medicine (spring).

Death and Dying; Physicians and Surgeons.

Some patients who decide that they wish to commit suicide are unable or unwilling to accomplish the act without assistance from their physician. Physician-assisted suicide helps them to die under conditions, and at the time, that they wish. PAS is currently legal in the U.S., only in the state of Oregon, under severe restrictions. In other states, a terminally ill patient who wishes to die must continue living until their body eventually collapses, or until a family member or friend commits a criminal act by helping them to commit suicide.

Traditional Christian beliefs concerning all forms of suicide were well documented by Thomas Aquinas during the thirteenth century. He condemned all suicide (whether assisted or not) on the theory that it violated one’s natural desire to live. Among European writers, Michel de Montaigne was the first major dissenter on this issue. During the sixteenth century, he wrote a series of essays arguing that suicide should be a matter of personal choice, a human right. He concluded it to be a rational option under certain circumstances.

Attempting to commit suicide was once a criminal act. It has been decriminalized for many decades in most jurisdictions. However, assisted suicide remains a criminal act throughout the United States, with the exception of the state of Oregon. In that state, it is permitted under tightly controlled conditions.

In 1994, voters in the state of Oregon approved a ballot measure that would have legalized euthanasia under limited conditions. Under the Death With Dignity law, a person who sought physician-assisted suicide would have to meet certain criteria:

Under the proposed law, a person who met all requirements could receive a prescription of a barbiturate that would be sufficient to cause death. Physicians would be prohibited from inducing death by injection or carbon monoxide.

The National Right to Life Committee, supported by the Roman Catholic Church, obtained a court Injunction to delay implementation of the measure. The law stalled in the appeals process. In the meantime, the measure was not enacted. In 1997, there was a second public Referendum, and the law was enacted. Within 24 hours of the announcement of the results, state officials had forms for physicians to record instances of assisted suicide. These were later distributed to physicians in the state. The form is entitled “Request for Medication to End My Life in a Humane and Dignified Manner.”

Immediately after the law was affirmed, Thomas Constantine, the administrator of the federal Drug Enforcement Administration (DEA), wrote a policy statement which said that prescribing drugs to help terminally ill patients kill themselves would be a violation of the Controlled Substances Act. Nevertheless, on March 26, 1998, a woman in her mid-eighties died from a lethal dose of barbiturates, which had been prescribed by her doctor under the Oregon law. She was the first person to publicly use the law to commit suicide. She had been fighting breast cancer for 20 years and recently had been told by her doctor that she had less than two months to live. She had been experiencing increased difficulty breathing. She made a tape recording in which she stated, “I’m looking forward to it. I will be relieved of all the stress I have.” Her personal doctor would not help her end her life, so she turned to an advocacy group, Compassion in Dying. That group located a doctor to assist her. She fell into a deep sleep about five minutes after taking the lethal dose of pills, and she died peacefully about 25 minutes later. Attorney General Janet Reno officially reversed Constantine’s ruling a few weeks later, stating that doctors who use the law to prescribe lethal drugs to terminally ill patients will not be prosecuted and that drug laws were intended to block illegal trafficking in drugs, not to cover situations like the Oregon suicide law.

Despite significant controversy, by the end of 1998, one prediction of the anti-choice forces had not materialized: there was no rush of people to Oregon to seek an easy end to life. While it was predicted that many would take advantage of the law, of the 23 terminally ill individuals who applied to end their own lives in 1998, 15 committed suicide, usually within a day of receiving the prescription. Six died from their illnesses without using the medication. Two remained alive at the end of 1998. From 1998 to 2002, 129 people have opted for physician assisted suicide.

In early 2001, Oregon state senator Ron Wyden wrote Attorney General john ashcroft asking that the george w. bush administration not mount an attack on the state law permitting assistance in suicide. Ashcroft wrote a letter to Asa Hutchinson, chief of the Drug Enforcement Administration. He declared that assisting a terminally ill patient to commit suicide is not a “legitimate medical purpose” for federally controlled drugs. He said that physicians who use drugs to help patients die face suspension or revocation of their licenses to prescribe federally controlled drugs. This was contrary to the position taken by Janet Reno, his predecessor. The attorney general of Oregon, Hardy Myers, quickly initiated a lawsuit to have the Ashcroft’s directive declared unconstitutional. The federal district court in Oregon issued a temporary injunction, which prevents the federal government from enforcing Ashcroft’s interpretation of the Controlled Substances Act (CSA). The state of Oregon requested that the court block the federal department of justice from taking legal action against Oregon doctors who prescribe medication to help their patients commit suicide. A federal judge ruled in favor of the state law in 2002, and the Department of Justice appealed the decision to the U.S. Court of Appeals for the Ninth Circuit. Both sides have stated that they will appeal the decision if they lose.

According to the online website, Euthanasia.com, 35 states have legislated against assisted suicide, while nine other states have cited it as a crime under Common Law. Still more states have introduced or passed statutes criminalizing assisted suicide. These statutes forbid a person to knowingly assist or aid another in committing suicide. Some also prohibit soliciting, advising, or encouraging another to commit suicide. Some statutes penalize assisted suicide under guidelines established for murder or manslaughter, whereas others make it a unique offense with separate penalties. Few courts have interpreted the assisted-suicide statutes, because prosecutions for assisted suicide are rare. In cases of assisted suicide, a state usually prosecutes individuals for murder or manslaughter. The Ohio state supreme court, however, ruled in 1996 that assisted suicide is not a crime.

Behuniak, Susan M. 2003. Physician-Assisted Suicide: The Anatomy of a Constitutional Law Issue. Lanham, Md.: Rowman & Littlefield.

Dyck, Arthur J. 2001. When Killing Is Wrong: Physician-Assisted Suicide and the Courts. Cleveland, Ohio: Pilgrim Press.

Euthanasia.com. Available online at (accessed November 10, 2003).

Palmer, Larry I. 2000. Endings and Beginnings: Law, Medicine, and Society in Assisted Life and Death. Westport, Conn.: Praeger.

Death and Dying.

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Euthanasia and Physician -Assisted Suicide legal …

Euthanasia – ProCon.org

Proponents of euthanasia and physician-assisted suicide (PAS) contend that terminally ill people should have the right to end their suffering with a quick, dignified, and compassionate death. They argue that the right to die is protected by the same constitutional safeguards that guarantee such rights as marriage, procreation, and the refusal or termination of life-saving medical treatment.

Opponents of euthanasia and physician-assisted suicide contend that doctors have a moral responsibility to keep their patients alive as reflected by the Hippocratic Oath. They argue there may be a “slippery slope” from euthanasia to murder, and that legalizing euthanasia will unfairly target the poor and disabled and create incentives for insurance companies to terminate lives in order to save money.

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Definitions

Law and Public Policy

Euthanasia in Practice

Physician Involvement in Euthanasia and PAS

American Healthcare System

Religious Concerns

Moral Differences in Forms of Assisted Dying

End-of-Life Legal Documents

Palliative Care

“Slippery Slope” Argument

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Historical Issues

Archived Notices

Last updated on 5/16/2018 9:07:37 AM PST

Opponents of euthanasia and physician-assisted suicide contend that doctors have a moral responsibility to keep their patients alive as reflected by the Hippocratic Oath. They argue there may be a “slippery slope” from euthanasia to murder, and that legalizing euthanasia will unfairly target the poor and disabled and create incentives for insurance companies to terminate lives in order to save money.

PROS & CONS BY CATEGORY

CORE QUESTION

Definitions

Law and Public Policy

Euthanasia in Practice

Physician Involvement in Euthanasia and PAS

American Healthcare System

Religious Concerns

Moral Differences in Forms of Assisted Dying

End-of-Life Legal Documents

Palliative Care

“Slippery Slope” Argument

Special Groups

Historical Issues

Archived Notices

Last updated on 5/16/2018 9:07:37 AM PST

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Euthanasia – ProCon.org

Euthanasia | law | Britannica.com

Euthanasia, also called mercy killing, act or practice of painlessly putting to death persons suffering from painful and incurable disease or incapacitating physical disorder or allowing them to die by withholding treatment or withdrawing artificial life-support measures. Because there is no specific provision for it in most legal systems, it is usually regarded as either suicide (if performed by the patient himself) or murder (if performed by another). A physician may, however, lawfully decide not to prolong life in cases of extreme suffering, and he may administer drugs to relieve pain even if this shortens the patients life. In the late 20th century, several European countries had special provisions in their criminal codes for lenient sentencing and the consideration of extenuating circumstances in prosecutions for euthanasia.

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ethics: Abortion, euthanasia, and the value of human life

A number of ethical questions are concerned with the endpoints of the human life span. The question of whether abortion or the use of human embryos as sources of stem cells can be morally justified was exhaustively discussed

The opinion that euthanasia is morally permissible is traceable to Socrates, Plato, and the Stoics. It is rejected in traditional Christian belief, chiefly because it is thought to contravene the prohibition of murder in the Ten Commandments. The organized movement for legalization of euthanasia commenced in England in 1935, when C. Killick Millard founded the Voluntary Euthanasia Legalisation Society (later called the Euthanasia Society). The societys bill was defeated in the House of Lords in 1936, as was a motion on the same subject in the House of Lords in 1950. In the United States the Euthanasia Society of America was founded in 1938.

The first countries to legalize euthanasia were the Netherlands in 2001 and Belgium in 2002. In 1997 Oregon became the first state in the United States to decriminalize physician-assisted suicide; opponents of the controversial law, however, attempted to have it overturned. In 2009 the Supreme Court of South Korea recognized a right to die with dignity in its decision to approve a request by the family of a brain-dead woman that she be removed from life-support systems.

The potential of modern medical practice to prolong life through technological means has provoked the question of what courses of action should be available to the physician and the family in cases of extreme physical or emotional suffering, especially if the patient is incapable of choice. Passively doing nothing to prolong life or withdrawing life-support measures has resulted in criminal charges being brought against physicians; on the other hand, the families of comatose and apparently terminal patients have instituted legal action against the medical establishment to make them stop the use of extraordinary life support.

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Euthanasia | law | Britannica.com

Euthanasia in the United States – Wikipedia

Euthanasia is illegal in most of the United States. Physician aid in dying (PAD), or assisted suicide, is legal in the states of Washington DC,[1] Pennsylvania,[2] California, Colorado, Oregon, Vermont, Hawaii, and Washington;[3][4] its status is disputed in Montana. The key difference between euthanasia and assisted suicide is who administers the lethal dose of medication: Euthanasia entails the physician or another third party administering the medication, whereas in assisted suicide it is the patient’s prerogative to self-administer the medication in order to end their life.[5]

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Debates about the ethics of euthanasia and physician-assisted suicide date from ancient Greece and Rome. After the development of ether, physicians began advocating the use of anesthetics to relieve the pain of death. In 1870, Samuel Williams first proposed using anesthetics and morphine to intentionally end a patient’s life. Over the next 35 years, debates about euthanasia raged in the United States which resulted in an Ohio bill to legalize euthanasia in 1906, a bill that was ultimately defeated.[6]

Euthanasia advocacy in the U.S. peaked again during the 1930s and diminished significantly during and after World War II. Euthanasia efforts were revived during the 1960s and 1970s, under the right-to-die rubric, physician assisted death in liberal bioethics, and through advance directives and do not resuscitate orders.

Several major court cases advanced the legal rights of patients, or their guardians, to practice at least voluntary passive euthanasia (physician assisted death). These include the Karen Ann Quinlan case (1976), Brophy and Nancy Cruzan cases. More recent years have seen policies fine-tuned and re-stated, as with Washington v. Glucksberg (1997) and the Terri Schiavo case. The numerous legislative rulings and legal precedents that were brought about in the wake of the Quinlan case had their ethical foundation in the famous 1983 report completed by the Presidents Commission for the Study of Ethical Problems in Medicine, under the title “Deciding to Forgo Life-Sustaining Treatment” (Angell, Marcia. “How to Die in Massachusetts.” The New York Review of Books. 21 February 2013: 60.3. Web. 14 Jul. 2014.). The Commission sustained in its findings that it was morally acceptable to give up a life-supporting therapy and that withholding or withdrawing such a therapy is the same thing from an ethical stand-point, while artificial feeding and other life-supporting therapy are of the same importance for the patients and doctors. Before this report, to withdraw a medical therapy was regarded as much more serious decision than not to start a therapy at all, while artificial feeding was viewed as a special treatment. By 1990, barely a decade and a half after the New Jersey Supreme Courts historic decision, patients were well aware that they could decline any form of medical therapy if they simply choose to do that either directly or by expressing their wish via appointed representative.

In a 2004 article in the Bulletin of the History of Medicine, Brown University historian Jacob M. Appel documented extensive political debate over legislation to legalize physician-assisted suicide in both Iowa and Ohio in 1906. The driving force behind this movement was social activist Anna S. Hall. Canadian historian Ian Dowbiggen’s 2003 book, A Merciful End, revealed the role that leading public figures, including Clarence Darrow and Jack London, played in advocating for the legalization of euthanasia.

In the 1983 case of Barber v. Superior Court, two physicians had honored a family’s request to withdraw both respirator and intravenous feeding and hydration tubes from a comatose patient. The physicians were charged with murder, despite the fact that they were doing what the family wanted. The court held that all charges should be dropped because the treatments had all been ineffective and burdensome. Withdrawal of treatment, even if life-ending, is morally and legally permitted. Competent patients or their surrogates can decide to withdraw treatments, usually after the treatments are found ineffective, painful, or burdensome.[7]

On May 31, 2013, the Maine state legislature rejected decriminalization of physician assisted suicide and voluntary euthanasia (95-43).

In the United States legal and ethical debates about euthanasia became more prominent in the Karen Ann Quinlan case who went into a coma after allegedly mixing tranquilizers with alcohol, surviving biologically for 9 years in a “persistent vegetative state” even after the New Jersey Supreme Court approval to remove her from a respirator. This case caused a widespread public concern about “lives not worth living” and the possibility of at least voluntary euthanasia if it could be ascertained that the patient would not have wanted to live in this condition.[8]

In 1999, the state of Texas passed the Advance Directives Act. Under the law, in some situations, Texas hospitals and physicians have the right to withdraw life support measures, such as mechanical respiration, from terminally ill patients when such treatment is considered to be both futile and inappropriate. This is sometimes referred to as “passive euthanasia”.

In 2005, a six-month-old infant, Sun Hudson, with a uniformly fatal disease thanatophoric dysplasia, was the first patient in which “a United States court has allowed life-sustaining treatment to be withdrawn from a pediatric patient over the objections of the child’s parent”.[9]

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, Oregon passed the Death with Dignity Act in 1994, and Michigan included Proposal B in their ballot in 1998.

Reflecting the religious and cultural diversity of the United States, there is a wide range of public opinion about euthanasia and the right-to-die movement in the United States. During the past 30 years, public research shows that views on euthanasia tend to correlate with religious affiliation and culture, though not gender.

In one recent study dealing primarily with Christian denominations such as Southern Baptists, Pentecostals, and Evangelicals and Catholics tended to be opposed to euthanasia. Moderate Protestants, (e.g., 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. Respondents that did not affiliate with a religion were found to support euthanasia more than those who did. The liberal Protestants (including some Presbyterians and Episcopalians) were the most supportive. In general, liberal Protestants affiliate more loosely with religious institutions and their views were not similar to those of non-affiliates. Within all groups, religiosity (i.e., self-evaluation and frequency of church attendance) also correlated to opinions on euthanasia. Individuals who attended church regularly and more frequently and considered themselves more religious were found to be more opposed to euthanasia than to those who had a lower level of religiosity.[10]

Recent studies have shown white Americans to be more accepting of euthanasia than black Americans. They are also more likely to have advance directives and to use other end-of-life measures.[11] African Americans are almost 3 times more likely to oppose euthanasia than white Americans. Some speculate that this discrepancy is due to the lower levels of trust in the medical establishment.[12] Select researchers believe that historical medical abuses towards minorities (such as the Tuskegee Syphilis Study) have made minority groups less trustful of the level of care they receive. One study also found that there are significant disparities in the medical treatment and pain management that white Americans and other Americans receive.[13]

Among African Americans, education correlates to support for euthanasia. Black 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.[12] Only black and white Americans have been studied in extensive detail. Although it has been found that minority groups are less supportive of euthanasia than white Americans, there is still some ambiguity as to what degree this is true.

A recent Gallup Poll found that 84% of males supported euthanasia compared to 64% of females.[14] 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 black American women are 2.37 times more likely to oppose euthanasia than white American women. African American men are 3.61 times more likely to oppose euthanasia than white American men.[15]

In “Gender, Feminism, and Death: Physician-Assisted Suicide and Euthanasia” Susan M. Wolf warns of the gender disparities if euthanasia or physician-assisted suicide were legal. Wolf highlights four possible gender effects: higher incidence of women than men dying by physician-assisted suicide; more women seeking physician-assisted suicide or euthanasia for different reasons than men; physicians granting or refusing requests for assisted suicide or euthanasia because of the gender of the patient; gender affecting the broad public debate by envisioning a woman patient when considering the debate.[16]

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Euthanasia in the United States – Wikipedia

Euthanasia – Wikipedia

Euthanasia (from Greek: ; “good death”: , eu; “well” or “good” , thanatos; “death”) is the practice of intentionally ending a life to relieve pain and suffering.[1][2]

There are different euthanasia laws in each country. 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 it under the broader definition of “assisted suicide and termination of life on request”.[5]

Euthanasia is categorized in different ways, which include voluntary, non-voluntary, or involuntary. Voluntary euthanasia is legal in some countries. Non-voluntary euthanasia (patient’s consent unavailable) is illegal in all countries. Involuntary euthanasia (without asking consent or against the patient’s will) is also illegal in all countries and is usually considered murder.[6] As of 2006, euthanasia is the most active area of research in contemporary bioethics.[7] In some countries there is a divisive public controversy over the moral, ethical, and legal issues of 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 (ex. Belgium, Canada, Switzerland) and is limited to specific circumstances and the approval of councilors and doctors or other specialists. In some countries such as Nigeria, Saudi Arabia and Pakistan, support for active euthanasia is almost non-existent.

Like other terms borrowed from history, “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.”[8] 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 conceptthe euthanasia “which regards the preparation of the soul.”[9]

In current usage, euthanasia has been 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 which 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 incorporates 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 being 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 that 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; a 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 includes 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 in 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]

Euthanasia may be classified into three types, according to whether a person gives informed consent: voluntary, non-voluntary and involuntary.[23][24]

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 as one of their criteria, although it may have been required to justify euthanasia.[11][25] However, others see consent as essential.

Voluntary euthanasia is conducted with the consent of the patient. 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 his or her 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 is conducted when the consent of the patient is unavailable. Examples include child euthanasia, which is illegal worldwide but decriminalised under certain specific circumstances in the Netherlands under the Groningen Protocol.

Involuntary euthanasia is conducted against the will of the patient.

Voluntary, non-voluntary and involuntary types can be further divided into passive or active variants.[26] 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 the 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]

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 Marseilles. 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).[27][28][29]

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 , bene, well, and , mors, death.[30]

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 between the theological care of the soul of sick people from the physical care and medical treatment by doctors.[31][32]

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,[33] as did Francois Ranchin (15651641), a French physician and professor of medicine, and Michael Boudewijns (16011681), a physician and teacher.[28]:208[34] Other voices argued for euthanasia, such as John Donne in 1624,[35] 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”.[28]:209211 This view was shared by others who followed, including Philipp Jakob Spener, Veit Riedlin and Johann Georg Krnitz.[28]: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.[28]:211214

Suicide and euthanasia became more accepted during the Age of Enlightenment.[34] Thomas More wrote of euthanasia in Utopia, although it is not clear if More was intending to endorse the practice.[28]:208209 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.[36]

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.[37]: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.

The essay was favourably reviewed in The Saturday Review, but an editorial against the essay appeared in The Spectator.[38] 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’.[38][39] Popular Science analyzed the issue in May 1873, assessing both sides of the argument.[40] 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”.[38]

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.[37]: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.[41]

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, Alder 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.[42] Both Ingersoll and Adler argued for voluntary euthanasia of adults suffering from terminal ailments.[42] Dowbiggin argues that by breaking down prior moral objections to euthanasia and suicide, Ingersoll and Adler enabled others to stretch the definition of euthanasia.[43]

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.[44]:614 Hunt did so at the behest of Anna S. 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.[44]:614616

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.[37]:796[44]:618619

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 612 month prison term and a fine of between $200 and $1,000. The proposal proved to be controversial.[44]:619621 It engendered considerable debate and failed to pass, having been withdrawn from consideration after being passed to the Committee on Public Health.[44]: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.[37]: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.[42] 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.[42]

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.[45] 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.[46]

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”.[47] 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.[47] The Telegraph noted that the killing of the disabled infantwhose 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”.[48] While Kretchmar’s killing received parental consent, most of the 5,000 to 8,000 children killed afterwards were forcibly taken from their parents.[47][48]

The “euthanasia campaign” of mass murder gathered momentum on 14 January 1940 when the “handicapped” were killed with gas vans and killing centres, eventually leading to the deaths of 70,000 adult Germans.[49] 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 deathmust killin order to keep the social organism alive and healthy.[50]

In modern terms, the use of “euthanasia” in the context of Action 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”.[51] 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.[51] 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.”[42]:65

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. 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.'”[52] 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?'”[52]

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.[42]

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 principlethe doctrine of double effectis 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,[53] which will lead to unacceptable consequences.[37]:797-8 In fact, in Oregon, in 2013, pain wasn’t one of the top five reasons people sought euthanasia. Top reasons were a loss of dignity, and a fear of burdening others.[54]

In the United States in 2013, 47% nationwide supported doctor-assisted suicide. This included 32% of Latinos, 29% of African-Americans, and almost nobody with disabilities.[54]

West’s Encyclopedia of American Law states that “a ‘mercy killing’ or euthanasia is generally considered to be a criminal homicide”[55] and is normally used as a synonym of homicide committed at a request made by the patient.[56]

The judicial sense of the term “homicide” includes any intervention undertaken with the express intention of ending a life, even to relieve intractable suffering.[56][57][58] Not all homicide is unlawful.[59] Two designations of homicide that carry no criminal punishment are justifiable and excusable homicide.[59] 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”.[60] 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.[61] 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.[62] The use of pain medication to relieve suffering, even if it hastens death, has been held as legal in several court decisions.[60]

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.[63][64][65][66]

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.[67]

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”.[68] 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.[68]

In the United Kingdom, the pro-assisted dying group Dignity in Dying cite conflicting research on attitudes by doctors to assisted dying: with a 2009 Palliative Medicine-published survey showing 64% support (to 34% oppose) for assisted dying in cases where a patient has an incurable and painful disease, while 49% of doctors in a study published in BMC Medical Ethics oppose changing the law on assisted dying to 39% in favour.[69]

The Roman Catholic Church strongly opposes and condemns euthanasia and assisted suicide as morally wrong. The Catholic Church states that, “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, the practice is unacceptable within the Church.[70] The Orthodox Church in America, along with other Eastern Orthodox Churches, also opposes euthanasia stating that it must be condemned as murder stating that, “Euthanasia is the deliberate cessation to end human life.”[71]

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 is “morally wrong and unacceptable to take a human life to relieve the suffering caused by incurable illnesses.” [71] Other Protestant churches which oppose euthanasia include:

The Church of England accepts passive euthanasia under some circumstances, but is strongly against active euthanasia, and has led opposition against recent attempt to legalise it.[81] 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.[82].

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 Koran 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.[83]

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.[84]

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Euthanasia – Wikipedia

Euthanasia | law | Britannica.com

Euthanasia, also called mercy killing, act or practice of painlessly putting to death persons suffering from painful and incurable disease or incapacitating physical disorder or allowing them to die by withholding treatment or withdrawing artificial life-support measures. Because there is no specific provision for it in most legal systems, it is usually regarded as either suicide (if performed by the patient himself) or murder (if performed by another). A physician may, however, lawfully decide not to prolong life in cases of extreme suffering, and he may administer drugs to relieve pain even if this shortens the patients life. In the late 20th century, several European countries had special provisions in their criminal codes for lenient sentencing and the consideration of extenuating circumstances in prosecutions for euthanasia.

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ethics: Abortion, euthanasia, and the value of human life

A number of ethical questions are concerned with the endpoints of the human life span. The question of whether abortion or the use of human embryos as sources of stem cells can be morally justified was exhaustively discussed

The opinion that euthanasia is morally permissible is traceable to Socrates, Plato, and the Stoics. It is rejected in traditional Christian belief, chiefly because it is thought to contravene the prohibition of murder in the Ten Commandments. The organized movement for legalization of euthanasia commenced in England in 1935, when C. Killick Millard founded the Voluntary Euthanasia Legalisation Society (later called the Euthanasia Society). The societys bill was defeated in the House of Lords in 1936, as was a motion on the same subject in the House of Lords in 1950. In the United States the Euthanasia Society of America was founded in 1938.

The first countries to legalize euthanasia were the Netherlands in 2001 and Belgium in 2002. In 1997 Oregon became the first state in the United States to decriminalize physician-assisted suicide; opponents of the controversial law, however, attempted to have it overturned. In 2009 the Supreme Court of South Korea recognized a right to die with dignity in its decision to approve a request by the family of a brain-dead woman that she be removed from life-support systems.

The potential of modern medical practice to prolong life through technological means has provoked the question of what courses of action should be available to the physician and the family in cases of extreme physical or emotional suffering, especially if the patient is incapable of choice. Passively doing nothing to prolong life or withdrawing life-support measures has resulted in criminal charges being brought against physicians; on the other hand, the families of comatose and apparently terminal patients have instituted legal action against the medical establishment to make them stop the use of extraordinary life support.

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Euthanasia | law | Britannica.com

Euthanasia | definition of euthanasia by Medical dictionary

euthanasia[uthah-nazhah]

1. an easy or painless death.

1. A quiet, painless death.

2. The intentional putting to death of a person with an incurable or painful disease intended as an act of mercy.

[eu- + G. thanatos, death]

1. an easy or painless death.

2. mercy killing; the deliberate ending of life of a person suffering from an incurable disease.

The act or practice of ending the life of a person or animal having a terminal illness or a medical condition that causes suffering perceived as incompatible with an acceptable quality of life, as by lethal injection or the suspension of certain medical treatments.

Etymology: Gk, eu, good; thanatos, death

2 an easy, quiet, painless death.

1. The intentional putting to death of a person with an incurable or painful disease, intended as an act of mercy.

[eu- + G. thanatos, death]

The act of putting a person or animal to death painlessly or allowing them to die by withholding medical services, usually because of a painful and incurable disease. Mercy killing is another term for euthanasia.

n the act of facilitating death in a terminally ill patient, whether by deliberate activity, such as the administration of drugs that hasten death (known as active euthanasia), or passive, as in the withholding of life-extending treatment (passive euthanasia).

1. A quiet, painless death.

2. The intentional putting to death of a person with an incurable or painful disease intended as an act of mercy.

[eu- + G. thanatos, death]

(thnzh), n an act of deliberately bringing about the death of a person who is suffering from an incurable disease or condition; also called mercy killing. Active euthanasia is illegal in most jurisdictions; passive euthanasia, or the withholding of some life support systems, has legal standing in some jurisdictions.

1. an easy or painless death.

2. the deliberate ending of life of an animal suffering from an incurable disease; called also mercy killing, to put down, to put to sleep.

For the individual animal intravenous injection of a massive dose of barbiturate is best. Any narcotizing drug creates difficulties if the carcass is to be disposed of for pet meat. In those cases shooting with a bullet or captive bolt pistol is recommended because of the speed of the despatch. For large numbers of animals at a pound or shelter, injection procedures are still superior to the bulk methods which all have the fallibility of poorly managed and supervised machinery. Carbon monoxide is very fast but dangerous to the operators of the cabinet. Electrocution cannot be performed en masse and gassing with carbon monoxide or lowering of the atmospheric pressure are not really quick enough. Small laboratory animals are still despatched by a sharp blow to the head and birds by guillotine or separation of the cervical vertebrae.

uses mains electrical current passed through the subject’s body via clips applied to the skin of the ear and the tail. Not much employed because of danger to human operators, likelihood of equipment failure and need for close contact with device.

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Euthanasia | definition of euthanasia by Medical dictionary

Euthanasia – ProCon.org

Proponents of euthanasia and physician-assisted suicide (PAS) contend that terminally ill people should have the right to end their suffering with a quick, dignified, and compassionate death. They argue that the right to die is protected by the same constitutional safeguards that guarantee such rights as marriage, procreation, and the refusal or termination of life-saving medical treatment.

Opponents of euthanasia and physician-assisted suicide contend that doctors have a moral responsibility to keep their patients alive as reflected by the Hippocratic Oath. They argue there may be a “slippery slope” from euthanasia to murder, and that legalizing euthanasia will unfairly target the poor and disabled and create incentives for insurance companies to terminate lives in order to save money.

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Definitions

Law and Public Policy

Euthanasia in Practice

Physician Involvement in Euthanasia and PAS

American Healthcare System

Religious Concerns

Moral Differences in Forms of Assisted Dying

End-of-Life Legal Documents

Palliative Care

“Slippery Slope” Argument

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Last updated on 5/16/2018 9:07:37 AM PST

Opponents of euthanasia and physician-assisted suicide contend that doctors have a moral responsibility to keep their patients alive as reflected by the Hippocratic Oath. They argue there may be a “slippery slope” from euthanasia to murder, and that legalizing euthanasia will unfairly target the poor and disabled and create incentives for insurance companies to terminate lives in order to save money.

PROS & CONS BY CATEGORY

CORE QUESTION

Definitions

Law and Public Policy

Euthanasia in Practice

Physician Involvement in Euthanasia and PAS

American Healthcare System

Religious Concerns

Moral Differences in Forms of Assisted Dying

End-of-Life Legal Documents

Palliative Care

“Slippery Slope” Argument

Special Groups

Historical Issues

Archived Notices

Last updated on 5/16/2018 9:07:37 AM PST

Continued here:

Euthanasia – ProCon.org

Euthanasia – Wikipedia

Euthanasia (from Greek: ; “good death”: , eu; “well” or “good” , thanatos; “death”) is the practice of intentionally ending a life to relieve pain and suffering.[1][2]

There are different euthanasia laws in each country. 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 it under the broader definition of “assisted suicide and termination of life on request”.[5]

Euthanasia is categorized in different ways, which include voluntary, non-voluntary, or involuntary. Voluntary euthanasia is legal in some countries. Non-voluntary euthanasia (patient’s consent unavailable) is illegal in all countries. Involuntary euthanasia (without asking consent or against the patient’s will) is also illegal in all countries and is usually considered murder.[6] As of 2006, euthanasia is the most active area of research in contemporary bioethics.[7] In some countries there is a divisive public controversy over the moral, ethical, and legal issues of 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 (ex. Belgium, Canada, Switzerland) and is limited to specific circumstances and the approval of councilors and doctors or other specialists. In some countries such as Nigeria, Saudi Arabia and Pakistan, support for active euthanasia is almost non-existent.

Like other terms borrowed from history, “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.”[8] 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 conceptthe euthanasia “which regards the preparation of the soul.”[9]

In current usage, euthanasia has been 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 which 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 incorporates 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 being 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 that 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; a 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 includes 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 in 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]

Euthanasia may be classified into three types, according to whether a person gives informed consent: voluntary, non-voluntary and involuntary.[23][24]

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 as one of their criteria, although it may have been required to justify euthanasia.[11][25] However, others see consent as essential.

Voluntary euthanasia is conducted with the consent of the patient. 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 his or her 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 is conducted when the consent of the patient is unavailable. Examples include child euthanasia, which is illegal worldwide but decriminalised under certain specific circumstances in the Netherlands under the Groningen Protocol.

Involuntary euthanasia is conducted against the will of the patient.

Voluntary, non-voluntary and involuntary types can be further divided into passive or active variants.[26] 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 the 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]

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 Marseilles. 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).[27][28][29]

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 , bene, well, and , mors, death.[30]

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 between the theological care of the soul of sick people from the physical care and medical treatment by doctors.[31][32]

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,[33] as did Francois Ranchin (15651641), a French physician and professor of medicine, and Michael Boudewijns (16011681), a physician and teacher.[28]:208[34] Other voices argued for euthanasia, such as John Donne in 1624,[35] 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”.[28]:209211 This view was shared by others who followed, including Philipp Jakob Spener, Veit Riedlin and Johann Georg Krnitz.[28]: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.[28]:211214

Suicide and euthanasia became more accepted during the Age of Enlightenment.[34] Thomas More wrote of euthanasia in Utopia, although it is not clear if More was intending to endorse the practice.[28]:208209 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.[36]

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.[37]: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.

The essay was favourably reviewed in The Saturday Review, but an editorial against the essay appeared in The Spectator.[38] 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’.[38][39] Popular Science analyzed the issue in May 1873, assessing both sides of the argument.[40] 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”.[38]

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.[37]: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.[41]

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, Alder 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.[42] Both Ingersoll and Adler argued for voluntary euthanasia of adults suffering from terminal ailments.[42] Dowbiggin argues that by breaking down prior moral objections to euthanasia and suicide, Ingersoll and Adler enabled others to stretch the definition of euthanasia.[43]

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.[44]:614 Hunt did so at the behest of Anna S. 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.[44]:614616

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.[37]:796[44]:618619

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 612 month prison term and a fine of between $200 and $1,000. The proposal proved to be controversial.[44]:619621 It engendered considerable debate and failed to pass, having been withdrawn from consideration after being passed to the Committee on Public Health.[44]: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.[37]: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.[42] 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.[42]

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.[45] 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.[46]

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”.[47] 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.[47] The Telegraph noted that the killing of the disabled infantwhose 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”.[48] While Kretchmar’s killing received parental consent, most of the 5,000 to 8,000 children killed afterwards were forcibly taken from their parents.[47][48]

The “euthanasia campaign” of mass murder gathered momentum on 14 January 1940 when the “handicapped” were killed with gas vans and killing centres, eventually leading to the deaths of 70,000 adult Germans.[49] 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 deathmust killin order to keep the social organism alive and healthy.[50]

In modern terms, the use of “euthanasia” in the context of Action 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”.[51] 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.[51] 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.”[42]:65

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. 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.'”[52] 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?'”[52]

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.[42]

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 principlethe doctrine of double effectis 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,[53] which will lead to unacceptable consequences.[37]:797-8 In fact, in Oregon, in 2013, pain wasn’t one of the top five reasons people sought euthanasia. Top reasons were a loss of dignity, and a fear of burdening others.[54]

In the United States in 2013, 47% nationwide supported doctor-assisted suicide. This included 32% of Latinos, 29% of African-Americans, and almost nobody with disabilities.[54]

West’s Encyclopedia of American Law states that “a ‘mercy killing’ or euthanasia is generally considered to be a criminal homicide”[55] and is normally used as a synonym of homicide committed at a request made by the patient.[56]

The judicial sense of the term “homicide” includes any intervention undertaken with the express intention of ending a life, even to relieve intractable suffering.[56][57][58] Not all homicide is unlawful.[59] Two designations of homicide that carry no criminal punishment are justifiable and excusable homicide.[59] 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”.[60] 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.[61] 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.[62] The use of pain medication to relieve suffering, even if it hastens death, has been held as legal in several court decisions.[60]

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.[63][64][65][66]

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.[67]

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”.[68] 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.[68]

In the United Kingdom, the pro-assisted dying group Dignity in Dying cite conflicting research on attitudes by doctors to assisted dying: with a 2009 Palliative Medicine-published survey showing 64% support (to 34% oppose) for assisted dying in cases where a patient has an incurable and painful disease, while 49% of doctors in a study published in BMC Medical Ethics oppose changing the law on assisted dying to 39% in favour.[69]

The Roman Catholic Church strongly opposes and condemns euthanasia and assisted suicide as morally wrong. The Catholic Church states that, “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, the practice is unacceptable within the Church.[70] The Orthodox Church in America, along with other Eastern Orthodox Churches, also opposes euthanasia stating that it must be condemned as murder stating that, “Euthanasia is the deliberate cessation to end human life.”[71]

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 is “morally wrong and unacceptable to take a human life to relieve the suffering caused by incurable illnesses.” [71] Other Protestant churches which oppose euthanasia include:

The Church of England accepts passive euthanasia under some circumstances, but is strongly against active euthanasia, and has led opposition against recent attempt to legalise it.[81] 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.[82].

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 Koran 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.[83]

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.[84]

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Euthanasia – Wikipedia

Euthanasia – Wikipedia

Euthanasia (from Greek: ; “good death”: , eu; “well” or “good” , thanatos; “death”) is the practice of intentionally ending a life to relieve pain and suffering.[1][2]

There are different euthanasia laws in each country. 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 it under the broader definition of “assisted suicide and termination of life on request”.[5]

Euthanasia is categorized in different ways, which include voluntary, non-voluntary, or involuntary. Voluntary euthanasia is legal in some countries. Non-voluntary euthanasia (patient’s consent unavailable) is illegal in all countries. Involuntary euthanasia (without asking consent or against the patient’s will) is also illegal in all countries and is usually considered murder.[6] As of 2006, euthanasia is the most active area of research in contemporary bioethics.[7] In some countries there is a divisive public controversy over the moral, ethical, and legal issues of 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 (ex. Belgium, Canada, Switzerland) and is limited to specific circumstances and the approval of councilors and doctors or other specialists. In some countries such as Nigeria, Saudi Arabia and Pakistan, support for active euthanasia is almost non-existent.

Like other terms borrowed from history, “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.”[8] 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 conceptthe euthanasia “which regards the preparation of the soul.”[9]

In current usage, euthanasia has been 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 which 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 incorporates 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 being 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 that 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; a 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 includes 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 in 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]

Euthanasia may be classified into three types, according to whether a person gives informed consent: voluntary, non-voluntary and involuntary.[23][24]

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 as one of their criteria, although it may have been required to justify euthanasia.[11][25] However, others see consent as essential.

Voluntary euthanasia is conducted with the consent of the patient. 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 his or her 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 is conducted when the consent of the patient is unavailable. Examples include child euthanasia, which is illegal worldwide but decriminalised under certain specific circumstances in the Netherlands under the Groningen Protocol.

Involuntary euthanasia is conducted against the will of the patient.

Voluntary, non-voluntary and involuntary types can be further divided into passive or active variants.[26] 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 the 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]

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 Marseilles. 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).[27][28][29]

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 , bene, well, and , mors, death.[30]

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 between the theological care of the soul of sick people from the physical care and medical treatment by doctors.[31][32]

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,[33] as did Francois Ranchin (15651641), a French physician and professor of medicine, and Michael Boudewijns (16011681), a physician and teacher.[28]:208[34] Other voices argued for euthanasia, such as John Donne in 1624,[35] 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”.[28]:209211 This view was shared by others who followed, including Philipp Jakob Spener, Veit Riedlin and Johann Georg Krnitz.[28]: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.[28]:211214

Suicide and euthanasia became more accepted during the Age of Enlightenment.[34] Thomas More wrote of euthanasia in Utopia, although it is not clear if More was intending to endorse the practice.[28]:208209 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.[36]

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.[37]: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.

The essay was favourably reviewed in The Saturday Review, but an editorial against the essay appeared in The Spectator.[38] 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’.[38][39] Popular Science analyzed the issue in May 1873, assessing both sides of the argument.[40] 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”.[38]

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.[37]: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.[41]

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, Alder 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.[42] Both Ingersoll and Adler argued for voluntary euthanasia of adults suffering from terminal ailments.[42] Dowbiggin argues that by breaking down prior moral objections to euthanasia and suicide, Ingersoll and Adler enabled others to stretch the definition of euthanasia.[43]

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.[44]:614 Hunt did so at the behest of Anna S. 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.[44]:614616

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.[37]:796[44]:618619

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 612 month prison term and a fine of between $200 and $1,000. The proposal proved to be controversial.[44]:619621 It engendered considerable debate and failed to pass, having been withdrawn from consideration after being passed to the Committee on Public Health.[44]: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.[37]: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.[42] 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.[42]

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.[45] 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.[46]

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”.[47] 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.[47] The Telegraph noted that the killing of the disabled infantwhose 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”.[48] While Kretchmar’s killing received parental consent, most of the 5,000 to 8,000 children killed afterwards were forcibly taken from their parents.[47][48]

The “euthanasia campaign” of mass murder gathered momentum on 14 January 1940 when the “handicapped” were killed with gas vans and killing centres, eventually leading to the deaths of 70,000 adult Germans.[49] 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 deathmust killin order to keep the social organism alive and healthy.[50]

In modern terms, the use of “euthanasia” in the context of Action 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”.[51] 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.[51] 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.”[42]:65

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. 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.'”[52] 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?'”[52]

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.[42]

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 principlethe doctrine of double effectis 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,[53] which will lead to unacceptable consequences.[37]:797-8 In fact, in Oregon, in 2013, pain wasn’t one of the top five reasons people sought euthanasia. Top reasons were a loss of dignity, and a fear of burdening others.[54]

In the United States in 2013, 47% nationwide supported doctor-assisted suicide. This included 32% of Latinos, 29% of African-Americans, and almost nobody with disabilities.[54]

West’s Encyclopedia of American Law states that “a ‘mercy killing’ or euthanasia is generally considered to be a criminal homicide”[55] and is normally used as a synonym of homicide committed at a request made by the patient.[56]

The judicial sense of the term “homicide” includes any intervention undertaken with the express intention of ending a life, even to relieve intractable suffering.[56][57][58] Not all homicide is unlawful.[59] Two designations of homicide that carry no criminal punishment are justifiable and excusable homicide.[59] 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”.[60] 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.[61] 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.[62] The use of pain medication to relieve suffering, even if it hastens death, has been held as legal in several court decisions.[60]

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.[63][64][65][66]

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.[67]

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”.[68] 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.[68]

In the United Kingdom, the pro-assisted dying group Dignity in Dying cite conflicting research on attitudes by doctors to assisted dying: with a 2009 Palliative Medicine-published survey showing 64% support (to 34% oppose) for assisted dying in cases where a patient has an incurable and painful disease, while 49% of doctors in a study published in BMC Medical Ethics oppose changing the law on assisted dying to 39% in favour.[69]

The Roman Catholic Church strongly opposes and condemns euthanasia and assisted suicide as morally wrong. The Catholic Church states that, “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, the practice is unacceptable within the Church.[70] The Orthodox Church in America, along with other Eastern Orthodox Churches, also opposes euthanasia stating that it must be condemned as murder stating that, “Euthanasia is the deliberate cessation to end human life.”[71]

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 is “morally wrong and unacceptable to take a human life to relieve the suffering caused by incurable illnesses.” [71] Other Protestant churches which oppose euthanasia include:

The Church of England accepts passive euthanasia under some circumstances, but is strongly against active euthanasia, and has led opposition against recent attempt to legalise it.[81] 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.[82].

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 Koran 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.[83]

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.[84]

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Euthanasia – Wikipedia


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