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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 it 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 and Physician Assisted Suicide: All sides to …

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A root cause for the desire to commit suicide is often depression. This can often be controlled with medication. If you are depressed, I strongly recommend that you seek medical help to see if your depression can be lifted.

Another cause of suicidal ideation is often intolerable levels of pain associated with a terminal illness, like cancer. Many physicians are reluctant to prescribe high levels of some pain killers out of fear that the person will become addicted to them. If you are suffering from pain in spite of medication, try insisting on better levels or types of pain killers. Recruit friends and family to intercede with your physician if you can.

If you feel overwhelmed and lack an effective support system of friends and family, consider tapping into the services of a crisis hotline. These are called by various names: distress centers, crisis centers, suicide prevention centers, etc. Their telephone numbers can often be found in the first page(s) of your telephone directory. If you cannot find a number for a center in your area, try phoning directory assistance at 4-1-1.

In the United States, you can call 1-800-273-TALK. See: http://www.suicidepreventionlifeline.org/ They will direct you to a crisis center in your area.

U.S. Crisis Center map

Crisis centers/distress centers/ etc are often confidential services that you can phone up at any time of the day or night for support. You can usually remain anonymous.

Wikipedia lists suicide crisis lines for many countries from Australia to the United States at: https://en.wikipedia.org/ Although these lines are often called “suicide prevention lines” or “crisis lines.” most of the people calling are not suicidal, not in crisis, but are in distress. So, don’t be reluctant to call them because you are not suicidal or in crisis.

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Throughout North America, committing suicide or attempting to commit suicide is no longer a criminal offense. However, helping another person commit suicide is generally considered a criminal act. A few exceptions are:

There were four failed ballot initiatives between 1991 and 2000:

Between 1994 and 2016, there have been in excess of 75 legislative bills to legalize PAS in at least 21 states. Almost all failed to become law. 4

The author of this section is approaching his 80th birthday and is in good health. To him, end of life issues have taken on a personal aspect. Being an Agnostic, he doubts the existence of an afterlife. He does not fear death. He does not fear being dead. However, he has considerable fear about the process of dying, For many people in North America is an agonizingly painful and lengthy process during which time one’s enjoyment of life often drops to zero and becomes negative without any hope that it will return to positive territory. Fortunately for him, he lives in Canada which — like all other developed countries except for the U.S. — has universal health care. So he will receive competent medical attention. Unfortunately, pain management is often as poorly managed in Canada as it is in the U.S. He regards suicide as a civil right and would prefer that he have access to a means of suicide if life becomes unbearable. He thus strongly supports legalizing physician assisted suicide.

He is critical of PAS laws that have been passed to date because they generally give access to assisted dying only to terminally ill people who are expected to die in the near future of natural causes. They do not do anything for people who experience chronic, overwhelming pain with no hope of relief for years.

He has attempted to remain impartial, objective and fair while writing these essays.

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Euthanasia – Simple English Wikipedia, the free encyclopedia

Euthanasia is when a person’s life is ended because of disease or pain, which has made them suffer. This is different from assisted suicide, where a person helps someone kill themselves. It is also different to murder, where the reason is not to suffering, but to kill for the killer’s own ends. Euthanasia can be voluntary, where the person who dies asks for help in ending their life. Where the person is unable to make their decision known, it is usually called non-voluntary euthanasia. Where someone is killed against their will, is usually called murder.

Euthanasia is illegal in most countries. It is permitted in a small number of countries, such as the Netherlands, Belgium and Victoria, Australia.[1] Where it is permitted there are many rules, and only in cases where the patient is terminally ill. Though euthanasia is not legal in the United States, doctors can assist people to kill themselves. This is legal in Washington, Oregon, and Montana. Physician Assisted Suicide (PAD) is different to euthanasia; it is about who gives the medication to end a patients life. The The World Federation of Right to Die Societies says physician-assisted suicide means “making lethal means available to the patient to be used at a time of the patients own choosing. In these cases the patient takes the legal dose of poison themselves, it is not given by the doctor. It is euthanasia when the doctor has the main role in ending the patients life by giving the poison.

Euthanasia can be active or passive, and voluntary, non-voluntary and involuntary. Many people see important differences and they can accept some types but not others.

Passive euthanasia means letting a person die. A terminally ill person is allowed to die, even if treatment could help them to live longer. This includes removing life support, such as a ventilator which is being used to keep the person alive, or not giving them food or water. Active euthanasia means doing something to end a person’s life. This could be giving them an injection or pills that will cause their death.[2]

Some people see passive euthanasia as a more acceptable choice, because it is not a deliberate act to kill. However, others argue that once someone has decided to allow another person to die, they should make it as fast and as painless as possible, and act to bring about their death. Also known as mercy killing.[3]

Voluntary euthanasia is when someone asks to be allowed to die or to be killed. This is often seen as the best by people who believe in euthanasia, because it is clear that the person wants to die. If the person can not say that they want to die, but people think that they would ask to die if they could, then it is non-voluntary euthanasia. Non-voluntary euthanasia is a choice for people who are in a coma or who are very young, as they can not say what they want. Involuntary euthansia is when someone is killed even though they asked not to die, or when they could have asked to die but did not.[4] Many people think that this is murder not euthanasia.[5]

These types of can be mixed. If someone asks to die, and another person gives them an injection that will kill them, then it is active voluntary euthanasia. Someone in a coma who is kept alive with a ventilator, and the doctors turn it off and they die, would be passive non-voluntary euthanasia.[6]

Some people believe that euthanasia should be allowed, and some people think that it should not.

Some people believe that allowing euthanasia will result in bad things happening. If it is allowed for people asking to die, then it might be allowed for people who are very sick but are not able to ask to die. If that happens, then maybe it would be allowed for people who are very sick and will not recover, but do not want to die. This is called the “slippery slope” argument.[7]

People who believe in the slippery slope argument point to times when this happened. In Germany, Adolf Hitler allowed disabled children to be killed, and called it euthanasia. People now agree that this was wrong, but if euthanasia was allowed it could happen again. They think it is too big a risk to allow euthanasia at all.[7]

Other people say there is a big difference between killing a very sick person who asks to die, and killing a child with a disability. They do not think euthanasia will lead to bad things. They say that Hitler’s actions were not euthanasia.[7]

The American Medical Association (AMA) and other doctors believe it is a doctor’s role to help, not kill people.[source?] In one study 76% of doctors said they would not carry out euthanasia, even if it was legal.[source?] They feel patients would not trust them. In the Netherlands where euthanasia is legal, 60% of older people in one study were scared that their their doctors would kill them.[source?]

Palliative care is when people who are ill and going to die are given special care to make them more comfortable. It may include hospice care, when the patient is sent to a special hospital for people who are dying. Palliative care can involve pain relief and help for the patient and family to come to terms with death. In some cases, doctors will give patient drugs which make them stay asleep, so that they will not feel pain.[8][9]

Palliative care is not perfect, and so it is not always seen as a replacement for euthanasia. There is still some pain, and there can be other side-effects, where the patient can still feel very sick. Palliative care is not available for all people, and not all people who wish to die through euthanasia are so sick that they will die soon. Some people have healthy bodies, but they are suffering in other ways, and palliative care will not always help them.[7]

The principle of double effect was first described by Thomas Aquinas over 700 years ago. It says that it is sometimes alright to do a bad thing something good happens, and it was the good thing that they wanted.[10] Aquinas used the example of self defense: sometimes a person will kill someone who attacks them, but death was not what the person was trying to do. They only wanted to protect themselves. So even though killing someone is bad, wanting to protect themselves was not.[11]

Some people say that doctors may treat a person to reduce the their pain, and as a result the person will die sooner. If the doctor gives the treatment in order to help the patient die, then it is euthanasia. But if the doctor gives the treatment in order to stop the pain, and does not intend for the patient to die, then it may not be euthanasia, even if the doctor knew that the treatment would kill the patient.[11]

Suicide is when a person kills themselves. Sometimes when a person is very sick they need help to die, and this is called assisted suicide.[12] In some countries people are allowed to help as long as they do not kill the person,[13] and it can be seen as a more acceptable option because it must be the person’s own decision.[12] Because the assisting person did not kill, it is not always considered to be euthanasia. [7]

[1]

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Euthanasia – Simple English Wikipedia, the free encyclopedia

Euthanasia and Physician Assisted Suicide: All sides to …

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A root cause for the desire to commit suicide is often depression. This can often be controlled with medication. If you are depressed, I strongly recommend that you seek medical help to see if your depression can be lifted.

Another cause of suicidal ideation is often intolerable levels of pain associated with a terminal illness, like cancer. Many physicians are reluctant to prescribe high levels of some pain killers out of fear that the person will become addicted to them. If you are suffering from pain in spite of medication, try insisting on better levels or types of pain killers. Recruit friends and family to intercede with your physician if you can.

If you feel overwhelmed and lack an effective support system of friends and family, consider tapping into the services of a crisis hotline. These are called by various names: distress centers, crisis centers, suicide prevention centers, etc. Their telephone numbers can often be found in the first page(s) of your telephone directory. If you cannot find a number for a center in your area, try phoning directory assistance at 4-1-1.

In the United States, you can call 1-800-273-TALK. See: http://www.suicidepreventionlifeline.org/ They will direct you to a crisis center in your area.

U.S. Crisis Center map

Crisis centers/distress centers/ etc are often confidential services that you can phone up at any time of the day or night for support. You can usually remain anonymous.

Wikipedia lists suicide crisis lines for many countries from Australia to the United States at: https://en.wikipedia.org/ Although these lines are often called “suicide prevention lines” or “crisis lines.” most of the people calling are not suicidal, not in crisis, but are in distress. So, don’t be reluctant to call them because you are not suicidal or in crisis.

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Throughout North America, committing suicide or attempting to commit suicide is no longer a criminal offense. However, helping another person commit suicide is generally considered a criminal act. A few exceptions are:

There were four failed ballot initiatives between 1991 and 2000:

Between 1994 and 2016, there have been in excess of 75 legislative bills to legalize PAS in at least 21 states. Almost all failed to become law. 4

The author of this section is approaching his 80th birthday and is in good health. To him, end of life issues have taken on a personal aspect. Being an Agnostic, he doubts the existence of an afterlife. He does not fear death. He does not fear being dead. However, he has considerable fear about the process of dying, For many people in North America is an agonizingly painful and lengthy process during which time one’s enjoyment of life often drops to zero and becomes negative without any hope that it will return to positive territory. Fortunately for him, he lives in Canada which — like all other developed countries except for the U.S. — has universal health care. So he will receive competent medical attention. Unfortunately, pain management is often as poorly managed in Canada as it is in the U.S. He regards suicide as a civil right and would prefer that he have access to a means of suicide if life becomes unbearable. He thus strongly supports legalizing physician assisted suicide.

He is critical of PAS laws that have been passed to date because they generally give access to assisted dying only to terminally ill people who are expected to die in the near future of natural causes. They do not do anything for people who experience chronic, overwhelming pain with no hope of relief for years.

He has attempted to remain impartial, objective and fair while writing these essays.

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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 it 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 – Simple English Wikipedia, the free encyclopedia

Euthanasia is when a person’s life is ended because of disease or pain, which has made them suffer. This is different from assisted suicide, where a person helps someone kill themselves. It is also different to murder, where the reason is not to suffering, but to kill for the killer’s own ends. Euthanasia can be voluntary, where the person who dies asks for help in ending their life. Where the person is unable to make their decision known, it is usually called non-voluntary euthanasia. Where someone is killed against their will, is usually called murder.

Euthanasia is illegal in most countries. It is permitted in a small number of countries, such as the Netherlands, Belgium and Victoria, Australia.[1] Where it is permitted there are many rules, and only in cases where the patient is terminally ill. Though euthanasia is not legal in the United States, doctors can assist people to kill themselves. This is legal in Washington, Oregon, and Montana. Physician Assisted Suicide (PAD) is different to euthanasia; it is about who gives the medication to end a patients life. The The World Federation of Right to Die Societies says physician-assisted suicide means “making lethal means available to the patient to be used at a time of the patients own choosing. In these cases the patient takes the legal dose of poison themselves, it is not given by the doctor. It is euthanasia when the doctor has the main role in ending the patients life by giving the poison.

Euthanasia can be active or passive, and voluntary, non-voluntary and involuntary. Many people see important differences and they can accept some types but not others.

Passive euthanasia means letting a person die. A terminally ill person is allowed to die, even if treatment could help them to live longer. This includes removing life support, such as a ventilator which is being used to keep the person alive, or not giving them food or water. Active euthanasia means doing something to end a person’s life. This could be giving them an injection or pills that will cause their death.[2]

Some people see passive euthanasia as a more acceptable choice, because it is not a deliberate act to kill. However, others argue that once someone has decided to allow another person to die, they should make it as fast and as painless as possible, and act to bring about their death. Also known as mercy killing.[3]

Voluntary euthanasia is when someone asks to be allowed to die or to be killed. This is often seen as the best by people who believe in euthanasia, because it is clear that the person wants to die. If the person can not say that they want to die, but people think that they would ask to die if they could, then it is non-voluntary euthanasia. Non-voluntary euthanasia is a choice for people who are in a coma or who are very young, as they can not say what they want. Involuntary euthansia is when someone is killed even though they asked not to die, or when they could have asked to die but did not.[4] Many people think that this is murder not euthanasia.[5]

These types of can be mixed. If someone asks to die, and another person gives them an injection that will kill them, then it is active voluntary euthanasia. Someone in a coma who is kept alive with a ventilator, and the doctors turn it off and they die, would be passive non-voluntary euthanasia.[6]

Some people believe that euthanasia should be allowed, and some people think that it should not.

Some people believe that allowing euthanasia will result in bad things happening. If it is allowed for people asking to die, then it might be allowed for people who are very sick but are not able to ask to die. If that happens, then maybe it would be allowed for people who are very sick and will not recover, but do not want to die. This is called the “slippery slope” argument.[7]

People who believe in the slippery slope argument point to times when this happened. In Germany, Adolf Hitler allowed disabled children to be killed, and called it euthanasia. People now agree that this was wrong, but if euthanasia was allowed it could happen again. They think it is too big a risk to allow euthanasia at all.[7]

Other people say there is a big difference between killing a very sick person who asks to die, and killing a child with a disability. They do not think euthanasia will lead to bad things. They say that Hitler’s actions were not euthanasia.[7]

The American Medical Association (AMA) and other doctors believe it is a doctor’s role to help, not kill people.[source?] In one study 76% of doctors said they would not carry out euthanasia, even if it was legal.[source?] They feel patients would not trust them. In the Netherlands where euthanasia is legal, 60% of older people in one study were scared that their their doctors would kill them.[source?]

Palliative care is when people who are ill and going to die are given special care to make them more comfortable. It may include hospice care, when the patient is sent to a special hospital for people who are dying. Palliative care can involve pain relief and help for the patient and family to come to terms with death. In some cases, doctors will give patient drugs which make them stay asleep, so that they will not feel pain.[8][9]

Palliative care is not perfect, and so it is not always seen as a replacement for euthanasia. There is still some pain, and there can be other side-effects, where the patient can still feel very sick. Palliative care is not available for all people, and not all people who wish to die through euthanasia are so sick that they will die soon. Some people have healthy bodies, but they are suffering in other ways, and palliative care will not always help them.[7]

The principle of double effect was first described by Thomas Aquinas over 700 years ago. It says that it is sometimes alright to do a bad thing something good happens, and it was the good thing that they wanted.[10] Aquinas used the example of self defense: sometimes a person will kill someone who attacks them, but death was not what the person was trying to do. They only wanted to protect themselves. So even though killing someone is bad, wanting to protect themselves was not.[11]

Some people say that doctors may treat a person to reduce the their pain, and as a result the person will die sooner. If the doctor gives the treatment in order to help the patient die, then it is euthanasia. But if the doctor gives the treatment in order to stop the pain, and does not intend for the patient to die, then it may not be euthanasia, even if the doctor knew that the treatment would kill the patient.[11]

Suicide is when a person kills themselves. Sometimes when a person is very sick they need help to die, and this is called assisted suicide.[12] In some countries people are allowed to help as long as they do not kill the person,[13] and it can be seen as a more acceptable option because it must be the person’s own decision.[12] Because the assisting person did not kill, it is not always considered to be euthanasia. [7]

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Euthanasia – Simple English Wikipedia, the free encyclopedia

Aktion T4 – Wikipedia

Aktion T4 (German, pronounced [aktsion te fi]) was a postwar name for mass murder through involuntary euthanasia in Nazi Germany.[4][b] The name T4 is an abbreviation of Tiergartenstrae 4, a street address of the Chancellery department set up in the spring of 1940, in the Berlin borough of Tiergarten, which recruited and paid personnel associated withT4.[c] Certain German physicians were authorized to select patients “deemed incurably sick, after most critical medical examination” and then administer to them a “mercy death” (Gnadentod). In October 1939 Adolf Hitler signed a “euthanasia note” backdated to 1 September 1939, that authorized his physician Karl Brandt and Reichsleiter Philipp Bouhler to implement the programme.

The killings took place from September 1939 until the end of the war in 1945, during which 275,000 to 300,000[a] people were killed at various extermination centres at psychiatric hospitals in Germany and Austria, along with those in occupied Poland and the Protectorate of Bohemia and Moravia (now the Czech Republic). The number of victims was originally recorded as 70,273 people but this number has been increased by the discovery of victims listed in the archives of former East Germany.[1][12][d] About half of those killed were taken from church-run asylums, often with the approval of the Protestant or Catholic authorities of the institutions. Despite the Holy See announcing on 2 December 1940 that the policy was contrary to the natural and positive Divine law and that “The direct killing of an innocent person because of mental or physical defects is not allowed”, the declaration was not upheld by some Catholic authorities in Germany. In the summer of 1941, protests were led in Germany by Bishop von Galen, whose intervention, according to Richard J. Evans, led to “the strongest, most explicit and most widespread protest movement against any policy since the beginning of the Third Reich”.

Several reasons for the programme have been offered, including eugenics, compassion, reducing suffering, racial hygiene, economy and pressure on the welfare budget. After the nominal end of the programme, physicians in German and Austrian facilities continued many of the practices of Aktion T4, until the defeat of Germany in 1945. The unofficial continuation of the policy led to additional deaths by medicine and similar means, resulting in 93,521 beds “emptied” by the end of 1941.[e][f] Technology that was developed under Aktion T4, particularly the use of lethal gas to kill large numbers of people, was taken over by the medical division of the Reich Interior Ministry, along with personnel who had participated in the development of the technology and later participated in Operation Reinhard.

The technology, personnel and techniques developed were instrumental in the implementation of Nazi genocides. Although the programme was authorized by Hitler, the killings have since come to be viewed as murders in Germany. The number killed was about 200,000 in Germany and Austria, while in other European countries about 100,000 persons were also victims.[d][12][24][25]

The term “Aktion T4” came into use after the war; before that German terminology included Euthanasie (euthanasia) and Gnadentod (merciful death). The T4 programme stemmed from the Nazi Party policy of “racial hygiene”, a belief that the German people needed to be cleansed of racial enemies, which included people with disabilities as well as anyone who was confined to a mental health facility. The euthanasia programme was part of the evolution of the policy of administrative killings that culminated in the extermination of Jews of Europe during the Nazi genocides. In his book Mein Kampf (1924), Hitler wrote that one day racial hygiene, “will appear as a deed greater than the most victorious wars of our present bourgeois era”.[citation needed]

The idea of sterilising those carrying hereditary defects or exhibiting what was thought to be hereditary “antisocial” behaviour was widely accepted. Canada, Denmark, Switzerland and the US had passed laws for the coerced sterilisation of people before Germany. Studies conducted in the 1920s ranked Germany as a country that was unusually reluctant to introduce sterilisation legislation.

The policy and research agenda of racial hygiene and eugenics were promoted by Emil Kraepelin. The eugenic sterilization of persons diagnosed with (and viewed as predisposed to) schizophrenia was advocated by Eugen Bleuler, who presumed racial deterioration because of mental and physical cripples in his Textbook of Psychiatry:

The more severely burdened should not propagate themselves If we do nothing but make mental and physical cripples capable of propagating themselves, and the healthy stocks have to limit the number of their children because so much has to be done for the maintenance of others, if natural selection is generally suppressed, then unless we will get new measures our race must rapidly deteriorate.

In July 1933 “Law for the Prevention of Hereditarily Diseased Offspring” prescribed compulsory sterilisation for people with conditions thought to be hereditary, such as schizophrenia, epilepsy, Huntington’s chorea and “imbecility”. Sterilisation was also legalised for chronic alcoholism and other forms of social deviance. The law was administered by the Interior Ministry under Wilhelm Frick through special Hereditary Health Courts (Erbgesundheitsgerichte), which examined the inmates of nursing homes, asylums, prisons, aged-care homes and special schools, to select those to be sterilised.

It is estimated that 360,000 people were sterilised under this law between 1933 and 1939.[36] Within the Nazi administration, some suggested that the programme should be extended to people with physical disabilities but such ideas had to be expressed carefully, given that one of the most powerful figures of the regime, Joseph Goebbels, had a deformed right leg.[g] After 1937 the acute shortage of labour in Germany, arising from rearmament, meant that anyone capable of work was deemed to be “useful” and thus exempted from the law and the rate of sterilisation declined.

Karl Brandt, personal doctor to Hitler and Hans Lammers, the head of the Reich Chancellery, testified after the war that Hitler had told them as early as 1933when the sterilisation law was passedthat he favoured the killing of the incurably ill but recognised that public opinion would not accept this. In 1935, Hitler told the Leader of Reich Doctors, Gerhard Wagner, that the question could not be taken up in peacetime, “Such a problem could be more smoothly and easily carried out in war”. He wrote that he intended to “radically solve” the problem of the mental asylums in such an event. Aktion T4 began with a “trial” case in late 1938. Hitler instructed Brandt to evaluate a family’s petition for the “mercy killing” of their son who was blind, had physical and developmental disabilities.[h] The child, born near Leipzig and eventually identified as Gerhard Kretschmar, was killed in July 1939. Hitler instructed Brandt to proceed in the same manner in all similar cases.

On 18 August 1939, three weeks after the killing of the boy, the Reich Committee for the Scientific Registering of Hereditary and Congenital Illnesses was established. It was to prepare and proceed with the registration of sick children or newborns identified as defective. Secret killing of infants began in 1939 and increased after the war started. By 1941 more than 5,000 children had been killed. Hitler was in favour of killing those whom he judged to be lebensunwertes Leben (Life unworthy of life). In a 1939 conference with Leonardo Conti, Reich Health Leader and state secretary for health in the Interior Ministry and Hans Lammers, Chief of the Reich Chancellerya few months before the “euthanasia” decreeHitler gave as examples the mentally ill who he said could only be “bedded on sawdust or sand” because they “perpetually dirtied themselves” and “put their own excrement into their mouths”. This issue, according to the Nazi regime, assumed new urgency in wartime.

After the invasion of Poland, Hermann Pfannmller said

Fr mich ist die Vorstellung untragbar, dass beste, blhende Jugend an der Front ihr Leben lassen muss, damit verblichene Asoziale und unverantwortliche Antisoziale ein gesichertes Dasein haben. (It is unbearable to me that the flower of our youth must lose their lives at the front, while that feeble-minded and asocial element can have a secure existence in the asylum.)

Pfannmller advocated killing by a gradual decrease of food, which he believed was more merciful than poison injections.

The German eugenics movement had an extreme wing even before the Nazis came to power. As early as 1920, Alfred Hoche and Karl Binding advocated killing people whose lives were “unworthy of life” (lebensunwertes Leben). Darwinism was interpreted by them as justification of the demand for “beneficial” genes and eradication of the “harmful” ones. Robert Lifton wrote, “The argument went that the best young men died in war, causing a loss to the Volk of the best available genes. The genes of those who did not fight (the worst genes) then proliferated freely, accelerating biological and cultural degeneration”. The advocacy of eugenics in Germany gained ground after 1930, when the Depression was used to excuse cuts in funding to state mental hospitals, creating squalor and overcrowding.

Many German eugenicists were nationalists and antisemites, who embraced the Nazi regime with enthusiasm. Many were appointed to positions in the Health Ministry and German research institutes. Their ideas were gradually adopted by the majority of the German medical profession, from which Jewish and communist doctors were soon purged. During the 1930s the Nazi Party had carried out a campaign of propaganda in favour of euthanasia. The National Socialist Racial and Political Office (NSRPA) produced leaflets, posters and short films to be shown in cinemas, pointing out to Germans the cost of maintaining asylums for the incurably ill and insane. These films included The Inheritance (Das Erbe, 1935), The Victim of the Past (Opfer der Vergangenheit, 1937), which was given a major premire in Berlin and was shown in all German cinemas, and I Accuse (Ich klage an, 1941), which was based on a novel by Hellmuth Unger, a consultant for “child euthanasia”.

In mid-1939 Hitler authorized the creation of the Reich Committee for the Scientific Registering of Serious Hereditary and Congenital Illnesses (Reichsausschuss zur wissenschaftlichen Erfassung erb- und anlagebedingter schwerer Leiden), headed by Dr. Karl Brandt, his physician, and administered by Herbert Linden of the Interior Ministry as well as SS-Oberfhrer Viktor Brack. Brandt and Bouhler were authorized to approve applications to kill children in relevant circumstances, though Bouhler left the details to subordinates such as Brack and SA-Oberfhrer Werner Blankenburg.

Extermination centres were established at six existing psychiatric hospitals: Bernburg, Brandenburg, Grafeneck, Hadamar, Hartheim, and Sonnenstein. One thousand children under the age of 17 were killed at the institutions Am Spiegelgrund and Gugging in Austria. They played a crucial role in developments leading to the Holocaust. As a related aspect of the “medical” and scientific basis of this programme, the Nazi doctors took thousands of brains from ‘euthanasia’ victims for research.

From August 1939, the Interior Ministry registered children with disabilities, requiring doctors and midwives to report all cases of newborns with severe disabilities; the ‘guardian’ consent element soon disappeared. Those to be killed were identified as “all children under three years of age in whom any of the following ‘serious hereditary diseases’ were ‘suspected’: idiocy and Down syndrome (especially when associated with blindness and deafness); microcephaly; hydrocephaly; malformations of all kinds, especially of limbs, head, and spinal column; and paralysis, including spastic conditions”. The reports were assessed by a panel of medical experts, of whom three were required to give their approval before a child could be killed.[i]

The Ministry used deceit when dealing with parents or guardians, particularly in Catholic areas, where parents were generally uncooperative. Parents were told that their children were being sent to “Special Sections”, where they would receive improved treatment. The children sent to these centres were kept for “assessment” for a few weeks and then killed by injection of toxic chemicals, typically phenol; their deaths were recorded as “pneumonia”. Autopsies were usually performed and brain samples were taken to be used for “medical research”. Post mortem examinations apparently helped to ease the consciences of many of those involved, giving them the feeling that there was a genuine medical purpose to the killings. The most notorious of these institutions in Austria was Am Spiegelgrund, where from 1940 to 1945, 789 children were killed by lethal injection, gas poisoning and physical abuse.[64] Childrens’ brains were preserved in jars of formaldehyde and stored in the basement of the clinic and in the private collection of Heinrich Gross, one of the institution’s directors, until 2001.

When the Second World War began in September 1939, less rigorous standards of assessment and a quicker approval process were adopted. Older children and adolescents were included and the conditions covered came to include

…various borderline or limited impairments in children of different ages, culminating in the killing of those designated as juvenile delinquents. Jewish children could be placed in the net primarily because they were Jewish; and at one of the institutions, a special department was set up for ‘minor Jewish-Aryan half-breeds’.

More pressure was placed on parents to agree to their children being sent away. Many parents suspected what was happening, especially when it became apparent that institutions for children with disabilities were being systematically cleared of their charges and refused consent. The parents were warned that they could lose custody of all their children and if that did not suffice, the parents could be threatened with call-up for ‘labour duty’. By 1941, more than 5,000 children had been killed.[j] The last child to be killed under Aktion T4 was Richard Jenne on 29 May 1945 in the children’s ward of the Kaufbeuren-Irsee state hospital in Bavaria, Germany, more than three weeks after U.S. Army troops had occupied the town.[67]

Brandt and Bouhler developed plans to expand the programme of euthanasia to adults. In July 1939 they held a meeting attended by Conti and Professor Werner Heyde, head of the SS medical department. This meeting agreed to arrange a national register of all institutionalised people with mental illnesses or physical disabilities. The first adults with disabilities to be killed en masse by the Nazi regime were Poles. After the invasion on 1 September 1939, adults with disabilities were shot by the SS men of Einsatzkommando 16, Selbstschutz and EK-Einmann under the command of SS-Sturmbannfhrer Rudolf Trger, with overall command by Reinhard Heydrich, during the genocidal Operation Tannenberg[k] All hospitals and mental asylums of the Wartheland were emptied. The region was incorporated into Germany and earmarked for resettlement by Volksdeutsche following the German conquest of Poland.[71] In the Danzig (now Gdask) area, some 7,000 Polish patients of various institutions were shot and 10,000 were killed in the Gdynia area. Similar measures were taken in other areas of Poland destined for incorporation into Germany. The first experiments with the gassing of patients were conducted in October 1939 at Fort VII in Posen (occupied Pozna), where hundreds of prisoners were killed by means of carbon monoxide poisoning, in an improvised gas chamber developed by Dr Albert Widmann, chief chemist of the German Criminal Police (Kripo). In December 1939, Reichsfhrer-SS Heinrich Himmler witnessed one of these gassings, ensuring that this invention would later be put to much wider uses.

The idea of killing adult mental patients soon spread from occupied Poland to adjoining areas of Germany, probably because Nazi Party and SS officers in these areas were most familiar with what was happening in Poland. These were also the areas where Germans wounded from the Polish campaign were expected to be accommodated, which created a demand for hospital space. The Gauleiter of Pomerania, Franz Schwede-Coburg, sent 1,400 patients from five Pomeranian hospitals to undisclosed locations in occupied Poland, where they were shot. The Gauleiter of East Prussia, Erich Koch, had 1,600 patients killed out of sight. More than 8,000 Germans were killed in this initial wave of killings carried out on the orders of local officials, although Himmler certainly knew and approved of them.

The legal basis for the programme was a 1939 letter from Hitler, not a formal “Fhrer’s decree” with the force of law. Hitler bypassed Conti, the Health Minister and his department, who might have raised questions about the legality of the programme and entrusted it to Bouhler and Brandt.[l]

Reich Leader Bouhler and Dr. Brandt are entrusted with the responsibility of extending the authority of physicians, to be designated by name, so that patients who, after a most critical diagnosis, on the basis of human judgment [menschlichem Ermessen], are considered incurable, can be granted mercy death [Gnadentod].

The killings were administered by Viktor Brack and his staff from Tiergartenstrae 4, disguised as the “Charitable Foundation for Cure and Institutional Care” offices which served as the front and was supervised by Bouhler and Brandt. The officials in charge included Dr Herbert Linden, who had been involved in the child killing programme; Dr Ernst-Robert Grawitz, chief physician of the SS; and August Becker, an SS chemist. The officials selected the doctors who were to carry out the operational part of the programme; based on political reliability as long-term Nazis, professional reputation and sympathy for radical eugenics. The list included physicians who had proved their worth in the child-killing programme, such as Unger, Heinze and Hermann Pfannmller. The recruits were mostly psychiatrists, notably Professor Carl Schneider of Heidelberg, Professor Max de Crinis of Berlin and Professor Paul Nitsche from the Sonnenstein state institution. Heyde became the operational leader of the programme, succeeded later by Nitsche.

In early October, all hospitals, nursing homes, old-age homes and sanatoria were required to report all patients who had been institutionalised for five years or more, who had been committed as “criminally insane”, who were of “non-Aryan race” or who had been diagnosed with any on a list of conditions. The conditions included schizophrenia, epilepsy, Huntington’s chorea, advanced syphilis, senile dementia, paralysis, encephalitis and “terminal neurological conditions generally”. Many doctors and administrators assumed that the reports were to identify inmates who were capable of being drafted for “labour service” and tended to overstate the degree of incapacity of their patients, to protect them from labour conscription. When some institutions refused to co-operate, teams of T4 doctors (or Nazi medical students) visited and compiled the lists, sometimes in a haphazard and ideologically motivated way. During 1940, all Jewish patients were removed from institutions and killed.[m]

As with child inmates, adults were assessed by a panel of experts, working at the Tiergartenstrae offices. The experts were required to make their judgements on the reports, not medical histories or examinations. Sometimes they dealt with hundreds of reports at a time. On each they marked a + (death), a – (life), or occasionally a ? meaning that they were unable to decide. Three “death” verdicts condemned the person and as with reviews of children, the process became less rigorous, the range of conditions considered “unsustainable” grew broader and zealous Nazis further down the chain of command increasingly made decisions on their own initiative.

The first gassings in Germany proper took place in January 1940 at the Brandenburg Euthanasia Centre. The operation was headed by Brack, who said “the needle belongs in the hand of the doctor.” Bottled pure carbon monoxide gas was used. At trials, Brandt described the process as a “major advance in medical history”. Once the efficacy of the method was confirmed, it became standardised, and instituted at a number of centres across Germany under the supervision of Widmann, Becker, and Christian Wirth a Kripo officer who later played a prominent role in the extermination of the Jews as commandant of newly built death camps in occupied Poland. In addition to Brandenburg, the killing centres included Grafeneck Castle in Baden-Wrttemberg (10,824 dead), Schloss Hartheim near Linz in Austria (over 18,000 dead), Sonnenstein Euthanasia Centre in Saxony (15,000 dead), Bernburg Euthanasia Centre in Saxony-Anhalt and Hadamar Euthanasia Centre in Hesse (14,494 dead). The same facilities were also used to kill mentally sound prisoners transferred from concentration camps in Germany, Austria and occupied parts of Poland.

Condemned patients were transferred from their institutions to newly built centres in the T4 Charitable Ambulance buses, called the Community Patients Transports Service. They were run by teams of SS men wearing white coats, to give it an air of medical care. To prevent the families and doctors of the patients from tracing them, the patients were often first sent to transit centres in major hospitals, where they were supposedly assessed. They were moved again to special treatment (Sonderbehandlung) centres. Families were sent letters explaining that owing to wartime regulations, it was not possible for them to visit relatives in these centres. Most of these patients were killed within 24 hours of arriving at the centres, and their bodies cremated. For every person killed, a death certificate was prepared, giving a false but plausible cause of death. This was sent to the family along with an urn of ashes (random ashes, since the victims were cremated en masse). The preparation of thousands of falsified death certificates took up most of the working day of the doctors who operated the centres.

During 1940, the centres at Brandenburg, Grafeneck and Hartheim killed nearly 10,000 people each, while another 6,000 were killed at Sonnenstein. In all, about 35,000 people were killed in T4 operations that year. Operations at Brandenburg and Grafeneck were wound up at the end of the year, partly because the areas they served had been cleared and partly because of public opposition. In 1941, however, the centres at Bernburg and Sonnenstein increased their operations, while Hartheim (where Wirth and Franz Stangl were successively commandants) continued as before. As a result, another 35,000 people were killed before August 1941, when the T4 programme was officially shut down by Hitler. Even after that date, however, the centres continued to be used to kill concentration camp inmates: eventually some 20,000 people in this category were killed.[n]

In 1971, Gitta Sereny conducted a series of interviews with Stangl, who was in prison in Dsseldorf after having been convicted of co-responsibility for killing 900,000 people as commandant of the Sobibor and Treblinka extermination camps in Poland. Stangl gave Sereny a detailed account of the operations of the T4 programme based on his time as commandant of the killing facility at the Hartheim institute. He described how the inmates of various asylums were removed and transported by bus to Hartheim. Some were in no mental state to know what was happening to them, but many were perfectly sane, and for them various forms of deception were used. They were told they were at a special clinic where they would receive improved treatment, and were given a brief medical examination on arrival. They were induced to enter what appeared to be a shower block, where they were gassed with carbon monoxide (the ruse was also used at extermination camps).

The SS functionaries and hospital staff associated with Action T4 in the German Reich were paid from the central office at Tiergartenstrasse 4 in Berlin from the spring of 1940. The SS and police from SS-Sonderkommando Lange responsible for murdering the majority of patients in the annexed territories of Poland since October 1939, took their salaries from the normal police fund, supervised by the administration of the newly formed Wartheland district; the programme in Germany and occupied Poland was overseen by Heinrich Himmler. Before 2013, it was believed that 70,000 persons were murdered in the euthanasia programme but the German Federal Archives reported that research in the archives of former East Germany, indicated that the number of victims in Germany and Austria from 1939 to 1945, was about 200,000 persons and that another 100,000 persons were victims in other European countries.[12][24][92] In the German T4 centres there was at least the semblance of legality in keeping records and writing letters. In Polish psychiatric hospitals no one was left behind. killings were inflicted using gas-vans, sealed army bunkers and machine guns; families were not informed about the murdered relatives and the empty wards were handed over to the SS.

After the official end of the euthanasia programme in 1941, most of the personnel and high-ranking officials, as well as gassing technology and the techniques used to deceive victims, were transferred under the jurisdiction of the national medical division of the Reich Interior Ministry. Further gassing experiments with the use of mobile gas chambers (Einsatzwagen) were conducted at Soldau concentration camp by Herbert Lange following Operation Barbarossa. Lange was appointed commander of the Chemno extermination camp in December 1941. He was given three gas vans by the RSHA, converted by the Gaubschat GmbH in Berlin and before February 1942, killed 3,830 Polish Jews and around 4,000 Romani, under the guise of “resettlement”. After the Wannsee conference, implementation of gassing technology was accelerated by Heydrich. Beginning in the spring of 1942, three killing factories were built secretly in east-central Poland. The SS officers responsible for the earlier Aktion T4, including Wirth, Stangl and Irmfried Eberl, had important roles in the implementation of the “Final Solution” for the next two years.[o] The first killing centre equipped with stationary gas chambers modelled on technology developed under Aktion T4 was established at Beec in the General Government territory of occupied Poland; the decision preceded the Wannsee Conference of January 1942 by three months.

In January 1939, Brack commissioned a paper from Professor of Moral Theology at the University of Paderborn, Joseph Mayer, on the likely reactions of the churches in the event of a state euthanasia programme being instituted. Mayer a longstanding euthanasia advocate reported that the churches would not oppose such a programme if it was seen to be in the national interest. Brack showed this paper to Hitler in July, and it may have increased his confidence that the “euthanasia” programme would be acceptable to German public opinion. Notably, when Sereny interviewed Mayer shortly before his death in 1967, he denied that he formally condoned the killing of people with disabilities but no copies of this paper are known to survive.

There were those who opposed the T4 programme within the bureaucracy. Lothar Kreyssig, a district judge and member of the Confessing Church, wrote to Grtner protesting that the action was illegal since no law or formal decree from Hitler had authorised it. Grtner replied, “If you cannot recognise the will of the Fhrer as a source of law, then you cannot remain a judge”, and had Kreyssig dismissed. Hitler had a fixed policy of not issuing written instructions for policies relating to what could later be condemned by international community, but made an exception when he provided Bouhler and Brack with written authority for the T4 programme in his confidential letter of October 1939 in order to overcome opposition within the German state bureaucracy. Hitler told Bouhler that, “the Fhrer’s Chancellery must under no circumstances be seen to be active in this matter.” The Justice Minister, Franz Grtner, had to be shown Hitler’s letter in August 1940 to gain his cooperation.

In the towns where the killing centres were located, many people saw the inmates arrive in buses, saw the smoke from the crematoria chimneys and noticed that the buses were returning empty. In Hadamar, ashes containing human hair rained down on the town. The T4 programme was no secret. Despite the strictest orders, some of the staff at the killing centres talked about what was going on. In some cases families could tell that the causes of death in certificates were false, e.g. when a patient was claimed to have died of appendicitis, even though his appendix had been surgically removed some years earlier. In other cases, several families in the same town would receive death certificates on the same day. In May 1941, the Frankfurt County Court wrote to Grtner describing scenes in Hadamar where children shouted in the streets that people were being taken away in buses to be gassed.

During 1940, rumours of what was taking place spread and many Germans withdrew their relatives from asylums and sanatoria to care for them at home, often with great expense and difficulty. In some places doctors and psychiatrists co-operated with families to have patients discharged or if the families could afford it, transferred them to private clinics beyond the reach of T4. Other doctors “re-diagnosed” patients so that they no longer met the T4 criteria, which risked exposure when Nazi zealots from Berlin conducted inspections. In Kiel, Professor Hans Gerhard Creutzfeldt managed to save nearly all of his patients. Lifton listed a handful of psychiatrists and administrators who opposed the killings; many doctors collaborated, either through ignorance, agreement with Nazi eugenicist policies or fear of the regime.

Protest letters were sent to the Reich Chancellery and the Ministry of Justice, some from Nazi Party members. The first open protest against the removal of people from asylums took place at Absberg in Franconia in February 1941 and others followed. The SD report on the incident at Absberg noted that “the removal of residents from the Ottilien Home has caused a great deal of unpleasantness” and described large crowds of Catholic townspeople, among them Party members, protesting against the action. Similar petitions and protests occurred throughout Austria as rumors spread of mass killings at the Hartheim Euthanasia Centre and of mysterious deaths at the children’s clinic, Am Spiegelgrund in Vienna. Anna Wdl, a nurse and mother of child with a disability, vehemently petitioned to Hermann Linden at the Reich Ministry of the Interior in Berlin to prevent her son, Alfred, from being transferred from Gugging, where he lived and which also became a euthanasia center. Wdl failed and Alfred was sent to Am Spiegelgrund, where he was killed on February 22, 1941. His brain was preserved in formaldehyde for “research” and stored in the clinic for sixty years.

The Lutheran theologian Friedrich von Bodelschwingh (director of the Bethel Institution for Epilepsy at Bielefeld) and Pastor Paul-Gerhard Braune (director of the Hoffnungstal Institution near Berlin) protested. Bodelschwingh negotiated directly with Brandt and indirectly with Hermann Gring, whose cousin was a prominent psychiatrist. Braune had meetings with Justice Minister Grtner, who was always dubious about the legality of the programme. Grtner later wrote a strongly worded letter to Hitler protesting against it; Hitler did not read it but was told about it by Lammers. Bishop Theophil Wurm, presiding the Evangelical-Lutheran Church in Wrttemberg, wrote to Interior Minister Frick in March 1940 and the same month a confidential report from the Sicherheitsdienst (SD) in Austria, warned that the killing programme must be implemented with stealth “in order to avoid a probable backlash of public opinion during the war”. On 4 December 1940, Reinhold Sautter, the Supreme Church Councillor of the Wrttemberg State Church, complained to the Nazi Ministerial Councillor Eugen Sthle for the murders in Grafeneck Castle. Stahle said “The fifth commandment Thou shalt not kill, is no commandment of God but a Jewish invention”.

Bishop Heinrich Wienken of Berlin, a leading member of the Caritas Association, was selected by the Fulda episcopal synod to represent the views of the Catholic Church in meetings with T4 operatives. In 2008, Michael Burleigh wrote

Wienken seems to have gone partially native in the sense that he gradually abandoned an absolute stance based on the Fifth Commandment in favour of winning limited concessions regarding the restriction of killing to ‘complete idiots’, access to the sacraments and the exclusion of ill Roman Catholic priests from these policies.

Despite a decree issued by the Vatican on 2 December 1940 stating that the T4 policy was “against natural and positive Divine law” and that “The direct killing of an innocent person because of mental or physical defects is not allowed”, the Catholic Church hierarchy in Germany decided to take no further action. Incensed by the Nazi appropriation of Church property in Mnster to accommodate people made homeless by an air raid, in July and August 1941 the Bishop of Mnster, August von Galen, gave four sermons criticizing the Nazis for arresting Jesuits, confiscating church property and for the euthanasia program. Galen sent the text to Hitler by telegram, calling on

…. the Fhrer to defend the people against the Gestapo. It is a terrible, unjust and catastrophic thing when man opposes his will to the will of God…. We are talking about men and women, our compatriots, our brothers and sisters. Poor unproductive people if you wish, but does this mean that they have lost their right to live?

Galen’s sermons were not reported in the German press but were circulated illegally as leaflets. The text was dropped by the Royal Air Force over German troops. In 2009, Richard J. Evans wrote that “This was the strongest, most explicit and most widespread protest movement against any policy since the beginning of the Third Reich”. Local Nazis asked for Galen to be arrested but Goebbels told Hitler that such action would provoke a revolt in Westphalia and Hitler decided to wait until after the war to take revenge.

In 1986, Lifton wrote, “Nazi leaders faced the prospect of either having to imprison prominent, highly admired clergymen and other protesters a course with consequences in terms of adverse public reaction they greatly feared or else end the programme”. Evans considered it “at least possible, even indeed probable” that the T4 programme would have continued beyond Hitler’s initial quota of 70,000 deaths but for the public reaction to Galen’s sermon. Burleigh called assumptions that the sermon affected Hitler’s decision to suspend the T4 program “wishful thinking” and noted that the various Church hierarchies did not complain after the transfer of T4 personnel to Aktion Reinhard. Henry Friedlander wrote that it was not the criticism from the Church but rather the loss of secrecy and “general popular disquiet about the way euthanasia was implemented” that caused the killing to be suspended.[117]

Galen had detailed knowledge of the euthanasia program by July 1940 but did not speak out until almost a year after Protestants had begun to protest. In 2002, Beth A. Griech-Polelle wrote that,

Worried lest they be classified as outsiders or internal enemies, they waited for Protestants, that is the “true Germans”, to risk a confrontation with the government first. If the Protestants were able to be critical of a Nazi policy, then Catholics could function as “good” Germans and yet be critical too.

On 29 June 1943, Pope Pius XII issued the encyclical Mystici corporis Christi, in which he condemned the fact that “physically deformed people, mentally disturbed people and hereditarily ill people have at times been robbed of their lives” in Germany. Following this, in September 1943, a bold but ineffectual condemnation was read by bishops from pulpits across Germany, denouncing the killing of “the innocent and defenceless mentally handicapped and mentally ill, the incurably infirm and fatally wounded, innocent hostages and disarmed prisoners of war and criminal offenders, people of a foreign race or descent”.

On 24 August 1941, Hitler ordered the suspension of the T4 killings. After the invasion of the Soviet Union in June, many T4 personnel were transferred to the east to begin work on the final solution to the Jewish question. The projected death total for the T4 program of 70,000 deaths had been reached by August 1941. The termination of the T4 programme did not end the killing of people with disabilities; from the end of 1941, the killing of adults and children continued less systematically to the end of the war on the local initiative of institute directors and party leaders. After the bombing of Hamburg in July 1943, occupants of old age homes were killed. In the post-war trial of Dr. Hilda Wernicke, Berlin, August, 1946, testimony was given that “500 old, broken women” who had survived the bombing of Stettin in June 1944 were euthanized at the Meseritz-Oberwalde Asylum. The Hartheim, Bernberg, Sonnenstein and Hardamar centres continued in use as “wild euthanasia” centres to kill people sent from all over Germany, until 1945. The methods were lethal injection or starvation, those employed before use of gas chambers. By the end of 1941, about 100,000 people had been killed in the T4 programme. From mid-1941, concentration camp prisoners too feeble or too much trouble to keep alive were murdered after a cursory psychiatric examination under Action 14f13.

After the war a series of trials was held in connection with the Nazi euthanasia programme at various places including: Dresden, Frankfurt, Graz, Nuremberg and Tbingen. In December 1946 an American military tribunal (commonly called the Doctors’ trial) prosecuted 23 doctors and administrators for their roles in war crimes and crimes against humanity. These crimes included the systematic killing of those deemed “unworthy of life”, including people with mental disabilities, the people who were institutionalized mentally ill, and people with physical impairments. After 140 days of proceedings, including the testimony of 85 witnesses and the submission of 1,500 documents, in August 1947 the court pronounced 16 of the defendants guilty. Seven were sentenced to death and executed on 2 June 1948, including Brandt and Brack.

The indictment read in part:

14. Between September 1939 and April 1945 the defendants Karl Brandt, Blome, Brack, and Hoven unlawfully, wilfully, and knowingly committed crimes against humanity, as defined by Article II of Control Council Law No. 10, in that they were principals in, accessories to, ordered, abetted, took a consenting part in, and were connected with plans and enterprises involving the execution of the so called “euthanasia” program of the German Reich, in the course of which the defendants herein murdered hundreds of thousands of human beings, including German civilians, as well as civilians of other nations. The particulars concerning such murders are set forth in paragraph 9 of count two of this indictment and are incorporated herein by reference.

Earlier, in 1945, American forces tried seven staff members of the Hadamar killing centre for the killing of Soviet and Polish nationals, which was within their jurisdiction under international law, as these were the citizens of wartime allies. (Hadamar was within the American Zone of Occupation in Germany. This was before the Allied resolution of December 1945, to prosecute individuals for “crimes against humanity” for such mass atrocities.) Alfons Klein, Karl Ruoff and Wilhelm Willig were sentenced to death and executed; the other four were given long prison sentences. In 1946, newly reconstructed German courts tried members of the Hadamar staff for the murders of nearly 15,000 German citizens at the facility. Adolf Wahlmann and Irmgard Huber, the chief physician and the head nurse, were convicted.

The Ministry for State Security of East Germany stored around 30,000 files of Aktion T4 in their archives. Those files became available to the public only after the German Reunification in 1990, leading to a new wave of research on these wartime crimes.

The German national memorial to the people with disabilities murdered by the Nazis was dedicated in 2014 in Berlin.[135][136] It is located in the pavement of a site next to the Tiergarten park, the location of the former villa at Tiergartenstrasse 4 in Berlin, where more than 60 Nazi bureaucrats and doctors worked in secret under the “T4” program to organize the mass murder of sanatorium and psychiatric hospital patients deemed unworthy to live.[136]

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Aktion T4 – 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 it 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 – Simple English Wikipedia, the free encyclopedia

Euthanasia is when a person’s life is ended because of disease or pain, which has made them suffer. This is different from assisted suicide, where a person helps someone kill themselves. It is also different to murder, where the reason is not to suffering, but to kill for the killer’s own ends. Euthanasia can be voluntary, where the person who dies asks for help in ending their life. Where the person is unable to make their decision known, it is usually called non-voluntary euthanasia. Where someone is killed against their will, is usually called murder.

Euthanasia is illegal in most countries. It is permitted in a small number of countries, such as the Netherlands, Belgium and Victoria, Australia.[1] Where it is permitted there are many rules, and only in cases where the patient is terminally ill. Though euthanasia is not legal in the United States, doctors can assist people to kill themselves. This is legal in Washington, Oregon, and Montana. Physician Assisted Suicide (PAD) is different to euthanasia; it is about who gives the medication to end a patients life. The The World Federation of Right to Die Societies says physician-assisted suicide means “making lethal means available to the patient to be used at a time of the patients own choosing. In these cases the patient takes the legal dose of poison themselves, it is not given by the doctor. It is euthanasia when the doctor has the main role in ending the patients life by giving the poison.

Euthanasia can be active or passive, and voluntary, non-voluntary and involuntary. Many people see important differences and they can accept some types but not others.

Passive euthanasia means letting a person die. A terminally ill person is allowed to die, even if treatment could help them to live longer. This includes removing life support, such as a ventilator which is being used to keep the person alive, or not giving them food or water. Active euthanasia means doing something to end a person’s life. This could be giving them an injection or pills that will cause their death.[2]

Some people see passive euthanasia as a more acceptable choice, because it is not a deliberate act to kill. However, others argue that once someone has decided to allow another person to die, they should make it as fast and as painless as possible, and act to bring about their death. Also known as mercy killing.[3]

Voluntary euthanasia is when someone asks to be allowed to die or to be killed. This is often seen as the best by people who believe in euthanasia, because it is clear that the person wants to die. If the person can not say that they want to die, but people think that they would ask to die if they could, then it is non-voluntary euthanasia. Non-voluntary euthanasia is a choice for people who are in a coma or who are very young, as they can not say what they want. Involuntary euthansia is when someone is killed even though they asked not to die, or when they could have asked to die but did not.[4] Many people think that this is murder not euthanasia.[5]

These types of can be mixed. If someone asks to die, and another person gives them an injection that will kill them, then it is active voluntary euthanasia. Someone in a coma who is kept alive with a ventilator, and the doctors turn it off and they die, would be passive non-voluntary euthanasia.[6]

Some people believe that euthanasia should be allowed, and some people think that it should not.

Some people believe that allowing euthanasia will result in bad things happening. If it is allowed for people asking to die, then it might be allowed for people who are very sick but are not able to ask to die. If that happens, then maybe it would be allowed for people who are very sick and will not recover, but do not want to die. This is called the “slippery slope” argument.[7]

People who believe in the slippery slope argument point to times when this happened. In Germany, Adolf Hitler allowed disabled children to be killed, and called it euthanasia. People now agree that this was wrong, but if euthanasia was allowed it could happen again. They think it is too big a risk to allow euthanasia at all.[7]

Other people say there is a big difference between killing a very sick person who asks to die, and killing a child with a disability. They do not think euthanasia will lead to bad things. They say that Hitler’s actions were not euthanasia.[7]

The American Medical Association (AMA) and other doctors believe it is a doctor’s role to help, not kill people.[source?] In one study 76% of doctors said they would not carry out euthanasia, even if it was legal.[source?] They feel patients would not trust them. In the Netherlands where euthanasia is legal, 60% of older people in one study were scared that their their doctors would kill them.[source?]

Palliative care is when people who are ill and going to die are given special care to make them more comfortable. It may include hospice care, when the patient is sent to a special hospital for people who are dying. Palliative care can involve pain relief and help for the patient and family to come to terms with death. In some cases, doctors will give patient drugs which make them stay asleep, so that they will not feel pain.[8][9]

Palliative care is not perfect, and so it is not always seen as a replacement for euthanasia. There is still some pain, and there can be other side-effects, where the patient can still feel very sick. Palliative care is not available for all people, and not all people who wish to die through euthanasia are so sick that they will die soon. Some people have healthy bodies, but they are suffering in other ways, and palliative care will not always help them.[7]

The principle of double effect was first described by Thomas Aquinas over 700 years ago. It says that it is sometimes alright to do a bad thing something good happens, and it was the good thing that they wanted.[10] Aquinas used the example of self defense: sometimes a person will kill someone who attacks them, but death was not what the person was trying to do. They only wanted to protect themselves. So even though killing someone is bad, wanting to protect themselves was not.[11]

Some people say that doctors may treat a person to reduce the their pain, and as a result the person will die sooner. If the doctor gives the treatment in order to help the patient die, then it is euthanasia. But if the doctor gives the treatment in order to stop the pain, and does not intend for the patient to die, then it may not be euthanasia, even if the doctor knew that the treatment would kill the patient.[11]

Suicide is when a person kills themselves. Sometimes when a person is very sick they need help to die, and this is called assisted suicide.[12] In some countries people are allowed to help as long as they do not kill the person,[13] and it can be seen as a more acceptable option because it must be the person’s own decision.[12] Because the assisting person did not kill, it is not always considered to be euthanasia. [7]

[1]

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Euthanasia – Simple English Wikipedia, the free encyclopedia

Aktion T4 – Wikipedia

Aktion T4 (German, pronounced [aktsion te fi]) was a postwar name for mass murder through involuntary euthanasia in Nazi Germany.[4][b] The name T4 is an abbreviation of Tiergartenstrae 4, a street address of the Chancellery department set up in the spring of 1940, in the Berlin borough of Tiergarten, which recruited and paid personnel associated withT4.[c] Certain German physicians were authorized to select patients “deemed incurably sick, after most critical medical examination” and then administer to them a “mercy death” (Gnadentod). In October 1939 Adolf Hitler signed a “euthanasia note” backdated to 1 September 1939, that authorized his physician Karl Brandt and Reichsleiter Philipp Bouhler to implement the programme.

The killings took place from September 1939 until the end of the war in 1945, during which 275,000 to 300,000[a] people were killed at various extermination centres at psychiatric hospitals in Germany and Austria, along with those in occupied Poland and the Protectorate of Bohemia and Moravia (now the Czech Republic). The number of victims was originally recorded as 70,273 people but this number has been increased by the discovery of victims listed in the archives of former East Germany.[1][12][d] About half of those killed were taken from church-run asylums, often with the approval of the Protestant or Catholic authorities of the institutions. Despite the Holy See announcing on 2 December 1940 that the policy was contrary to the natural and positive Divine law and that “The direct killing of an innocent person because of mental or physical defects is not allowed”, the declaration was not upheld by some Catholic authorities in Germany. In the summer of 1941, protests were led in Germany by Bishop von Galen, whose intervention, according to Richard J. Evans, led to “the strongest, most explicit and most widespread protest movement against any policy since the beginning of the Third Reich”.

Several reasons for the programme have been offered, including eugenics, compassion, reducing suffering, racial hygiene, economy and pressure on the welfare budget. After the nominal end of the programme, physicians in German and Austrian facilities continued many of the practices of Aktion T4, until the defeat of Germany in 1945. The unofficial continuation of the policy led to additional deaths by medicine and similar means, resulting in 93,521 beds “emptied” by the end of 1941.[e][f] Technology that was developed under Aktion T4, particularly the use of lethal gas to kill large numbers of people, was taken over by the medical division of the Reich Interior Ministry, along with personnel who had participated in the development of the technology and later participated in Operation Reinhard.

The technology, personnel and techniques developed were instrumental in the implementation of Nazi genocides. Although the programme was authorized by Hitler, the killings have since come to be viewed as murders in Germany. The number killed was about 200,000 in Germany and Austria, while in other European countries about 100,000 persons were also victims.[d][12][24][25]

The term “Aktion T4” came into use after the war; before that German terminology included Euthanasie (euthanasia) and Gnadentod (merciful death). The T4 programme stemmed from the Nazi Party policy of “racial hygiene”, a belief that the German people needed to be cleansed of racial enemies, which included people with disabilities as well as anyone who was confined to a mental health facility. The euthanasia programme was part of the evolution of the policy of administrative killings that culminated in the extermination of Jews of Europe during the Nazi genocides. In his book Mein Kampf (1924), Hitler wrote that one day racial hygiene, “will appear as a deed greater than the most victorious wars of our present bourgeois era”.[citation needed]

The idea of sterilising those carrying hereditary defects or exhibiting what was thought to be hereditary “antisocial” behaviour was widely accepted. Canada, Denmark, Switzerland and the US had passed laws for the coerced sterilisation of people before Germany. Studies conducted in the 1920s ranked Germany as a country that was unusually reluctant to introduce sterilisation legislation.

The policy and research agenda of racial hygiene and eugenics were promoted by Emil Kraepelin. The eugenic sterilization of persons diagnosed with (and viewed as predisposed to) schizophrenia was advocated by Eugen Bleuler, who presumed racial deterioration because of mental and physical cripples in his Textbook of Psychiatry:

The more severely burdened should not propagate themselves If we do nothing but make mental and physical cripples capable of propagating themselves, and the healthy stocks have to limit the number of their children because so much has to be done for the maintenance of others, if natural selection is generally suppressed, then unless we will get new measures our race must rapidly deteriorate.

In July 1933 “Law for the Prevention of Hereditarily Diseased Offspring” prescribed compulsory sterilisation for people with conditions thought to be hereditary, such as schizophrenia, epilepsy, Huntington’s chorea and “imbecility”. Sterilisation was also legalised for chronic alcoholism and other forms of social deviance. The law was administered by the Interior Ministry under Wilhelm Frick through special Hereditary Health Courts (Erbgesundheitsgerichte), which examined the inmates of nursing homes, asylums, prisons, aged-care homes and special schools, to select those to be sterilised.

It is estimated that 360,000 people were sterilised under this law between 1933 and 1939.[36] Within the Nazi administration, some suggested that the programme should be extended to people with physical disabilities but such ideas had to be expressed carefully, given that one of the most powerful figures of the regime, Joseph Goebbels, had a deformed right leg.[g] After 1937 the acute shortage of labour in Germany, arising from rearmament, meant that anyone capable of work was deemed to be “useful” and thus exempted from the law and the rate of sterilisation declined.

Karl Brandt, personal doctor to Hitler and Hans Lammers, the head of the Reich Chancellery, testified after the war that Hitler had told them as early as 1933when the sterilisation law was passedthat he favoured the killing of the incurably ill but recognised that public opinion would not accept this. In 1935, Hitler told the Leader of Reich Doctors, Gerhard Wagner, that the question could not be taken up in peacetime, “Such a problem could be more smoothly and easily carried out in war”. He wrote that he intended to “radically solve” the problem of the mental asylums in such an event. Aktion T4 began with a “trial” case in late 1938. Hitler instructed Brandt to evaluate a family’s petition for the “mercy killing” of their son who was blind, had physical and developmental disabilities.[h] The child, born near Leipzig and eventually identified as Gerhard Kretschmar, was killed in July 1939. Hitler instructed Brandt to proceed in the same manner in all similar cases.

On 18 August 1939, three weeks after the killing of the boy, the Reich Committee for the Scientific Registering of Hereditary and Congenital Illnesses was established. It was to prepare and proceed with the registration of sick children or newborns identified as defective. Secret killing of infants began in 1939 and increased after the war started. By 1941 more than 5,000 children had been killed. Hitler was in favour of killing those whom he judged to be lebensunwertes Leben (Life unworthy of life). In a 1939 conference with Leonardo Conti, Reich Health Leader and state secretary for health in the Interior Ministry and Hans Lammers, Chief of the Reich Chancellerya few months before the “euthanasia” decreeHitler gave as examples the mentally ill who he said could only be “bedded on sawdust or sand” because they “perpetually dirtied themselves” and “put their own excrement into their mouths”. This issue, according to the Nazi regime, assumed new urgency in wartime.

After the invasion of Poland, Hermann Pfannmller said

Fr mich ist die Vorstellung untragbar, dass beste, blhende Jugend an der Front ihr Leben lassen muss, damit verblichene Asoziale und unverantwortliche Antisoziale ein gesichertes Dasein haben. (It is unbearable to me that the flower of our youth must lose their lives at the front, while that feeble-minded and asocial element can have a secure existence in the asylum.)

Pfannmller advocated killing by a gradual decrease of food, which he believed was more merciful than poison injections.

The German eugenics movement had an extreme wing even before the Nazis came to power. As early as 1920, Alfred Hoche and Karl Binding advocated killing people whose lives were “unworthy of life” (lebensunwertes Leben). Darwinism was interpreted by them as justification of the demand for “beneficial” genes and eradication of the “harmful” ones. Robert Lifton wrote, “The argument went that the best young men died in war, causing a loss to the Volk of the best available genes. The genes of those who did not fight (the worst genes) then proliferated freely, accelerating biological and cultural degeneration”. The advocacy of eugenics in Germany gained ground after 1930, when the Depression was used to excuse cuts in funding to state mental hospitals, creating squalor and overcrowding.

Many German eugenicists were nationalists and antisemites, who embraced the Nazi regime with enthusiasm. Many were appointed to positions in the Health Ministry and German research institutes. Their ideas were gradually adopted by the majority of the German medical profession, from which Jewish and communist doctors were soon purged. During the 1930s the Nazi Party had carried out a campaign of propaganda in favour of euthanasia. The National Socialist Racial and Political Office (NSRPA) produced leaflets, posters and short films to be shown in cinemas, pointing out to Germans the cost of maintaining asylums for the incurably ill and insane. These films included The Inheritance (Das Erbe, 1935), The Victim of the Past (Opfer der Vergangenheit, 1937), which was given a major premire in Berlin and was shown in all German cinemas, and I Accuse (Ich klage an, 1941), which was based on a novel by Hellmuth Unger, a consultant for “child euthanasia”.

In mid-1939 Hitler authorized the creation of the Reich Committee for the Scientific Registering of Serious Hereditary and Congenital Illnesses (Reichsausschuss zur wissenschaftlichen Erfassung erb- und anlagebedingter schwerer Leiden), headed by Dr. Karl Brandt, his physician, and administered by Herbert Linden of the Interior Ministry as well as SS-Oberfhrer Viktor Brack. Brandt and Bouhler were authorized to approve applications to kill children in relevant circumstances, though Bouhler left the details to subordinates such as Brack and SA-Oberfhrer Werner Blankenburg.

Extermination centres were established at six existing psychiatric hospitals: Bernburg, Brandenburg, Grafeneck, Hadamar, Hartheim, and Sonnenstein. One thousand children under the age of 17 were killed at the institutions Am Spiegelgrund and Gugging in Austria. They played a crucial role in developments leading to the Holocaust. As a related aspect of the “medical” and scientific basis of this programme, the Nazi doctors took thousands of brains from ‘euthanasia’ victims for research.

From August 1939, the Interior Ministry registered children with disabilities, requiring doctors and midwives to report all cases of newborns with severe disabilities; the ‘guardian’ consent element soon disappeared. Those to be killed were identified as “all children under three years of age in whom any of the following ‘serious hereditary diseases’ were ‘suspected’: idiocy and Down syndrome (especially when associated with blindness and deafness); microcephaly; hydrocephaly; malformations of all kinds, especially of limbs, head, and spinal column; and paralysis, including spastic conditions”. The reports were assessed by a panel of medical experts, of whom three were required to give their approval before a child could be killed.[i]

The Ministry used deceit when dealing with parents or guardians, particularly in Catholic areas, where parents were generally uncooperative. Parents were told that their children were being sent to “Special Sections”, where they would receive improved treatment. The children sent to these centres were kept for “assessment” for a few weeks and then killed by injection of toxic chemicals, typically phenol; their deaths were recorded as “pneumonia”. Autopsies were usually performed and brain samples were taken to be used for “medical research”. Post mortem examinations apparently helped to ease the consciences of many of those involved, giving them the feeling that there was a genuine medical purpose to the killings. The most notorious of these institutions in Austria was Am Spiegelgrund, where from 1940 to 1945, 789 children were killed by lethal injection, gas poisoning and physical abuse.[64] Childrens’ brains were preserved in jars of formaldehyde and stored in the basement of the clinic and in the private collection of Heinrich Gross, one of the institution’s directors, until 2001.

When the Second World War began in September 1939, less rigorous standards of assessment and a quicker approval process were adopted. Older children and adolescents were included and the conditions covered came to include

…various borderline or limited impairments in children of different ages, culminating in the killing of those designated as juvenile delinquents. Jewish children could be placed in the net primarily because they were Jewish; and at one of the institutions, a special department was set up for ‘minor Jewish-Aryan half-breeds’.

More pressure was placed on parents to agree to their children being sent away. Many parents suspected what was happening, especially when it became apparent that institutions for children with disabilities were being systematically cleared of their charges and refused consent. The parents were warned that they could lose custody of all their children and if that did not suffice, the parents could be threatened with call-up for ‘labour duty’. By 1941, more than 5,000 children had been killed.[j] The last child to be killed under Aktion T4 was Richard Jenne on 29 May 1945 in the children’s ward of the Kaufbeuren-Irsee state hospital in Bavaria, Germany, more than three weeks after U.S. Army troops had occupied the town.[67]

Brandt and Bouhler developed plans to expand the programme of euthanasia to adults. In July 1939 they held a meeting attended by Conti and Professor Werner Heyde, head of the SS medical department. This meeting agreed to arrange a national register of all institutionalised people with mental illnesses or physical disabilities. The first adults with disabilities to be killed en masse by the Nazi regime were Poles. After the invasion on 1 September 1939, adults with disabilities were shot by the SS men of Einsatzkommando 16, Selbstschutz and EK-Einmann under the command of SS-Sturmbannfhrer Rudolf Trger, with overall command by Reinhard Heydrich, during the genocidal Operation Tannenberg[k] All hospitals and mental asylums of the Wartheland were emptied. The region was incorporated into Germany and earmarked for resettlement by Volksdeutsche following the German conquest of Poland.[71] In the Danzig (now Gdask) area, some 7,000 Polish patients of various institutions were shot and 10,000 were killed in the Gdynia area. Similar measures were taken in other areas of Poland destined for incorporation into Germany. The first experiments with the gassing of patients were conducted in October 1939 at Fort VII in Posen (occupied Pozna), where hundreds of prisoners were killed by means of carbon monoxide poisoning, in an improvised gas chamber developed by Dr Albert Widmann, chief chemist of the German Criminal Police (Kripo). In December 1939, Reichsfhrer-SS Heinrich Himmler witnessed one of these gassings, ensuring that this invention would later be put to much wider uses.

The idea of killing adult mental patients soon spread from occupied Poland to adjoining areas of Germany, probably because Nazi Party and SS officers in these areas were most familiar with what was happening in Poland. These were also the areas where Germans wounded from the Polish campaign were expected to be accommodated, which created a demand for hospital space. The Gauleiter of Pomerania, Franz Schwede-Coburg, sent 1,400 patients from five Pomeranian hospitals to undisclosed locations in occupied Poland, where they were shot. The Gauleiter of East Prussia, Erich Koch, had 1,600 patients killed out of sight. More than 8,000 Germans were killed in this initial wave of killings carried out on the orders of local officials, although Himmler certainly knew and approved of them.

The legal basis for the programme was a 1939 letter from Hitler, not a formal “Fhrer’s decree” with the force of law. Hitler bypassed Conti, the Health Minister and his department, who might have raised questions about the legality of the programme and entrusted it to Bouhler and Brandt.[l]

Reich Leader Bouhler and Dr. Brandt are entrusted with the responsibility of extending the authority of physicians, to be designated by name, so that patients who, after a most critical diagnosis, on the basis of human judgment [menschlichem Ermessen], are considered incurable, can be granted mercy death [Gnadentod].

The killings were administered by Viktor Brack and his staff from Tiergartenstrae 4, disguised as the “Charitable Foundation for Cure and Institutional Care” offices which served as the front and was supervised by Bouhler and Brandt. The officials in charge included Dr Herbert Linden, who had been involved in the child killing programme; Dr Ernst-Robert Grawitz, chief physician of the SS; and August Becker, an SS chemist. The officials selected the doctors who were to carry out the operational part of the programme; based on political reliability as long-term Nazis, professional reputation and sympathy for radical eugenics. The list included physicians who had proved their worth in the child-killing programme, such as Unger, Heinze and Hermann Pfannmller. The recruits were mostly psychiatrists, notably Professor Carl Schneider of Heidelberg, Professor Max de Crinis of Berlin and Professor Paul Nitsche from the Sonnenstein state institution. Heyde became the operational leader of the programme, succeeded later by Nitsche.

In early October, all hospitals, nursing homes, old-age homes and sanatoria were required to report all patients who had been institutionalised for five years or more, who had been committed as “criminally insane”, who were of “non-Aryan race” or who had been diagnosed with any on a list of conditions. The conditions included schizophrenia, epilepsy, Huntington’s chorea, advanced syphilis, senile dementia, paralysis, encephalitis and “terminal neurological conditions generally”. Many doctors and administrators assumed that the reports were to identify inmates who were capable of being drafted for “labour service” and tended to overstate the degree of incapacity of their patients, to protect them from labour conscription. When some institutions refused to co-operate, teams of T4 doctors (or Nazi medical students) visited and compiled the lists, sometimes in a haphazard and ideologically motivated way. During 1940, all Jewish patients were removed from institutions and killed.[m]

As with child inmates, adults were assessed by a panel of experts, working at the Tiergartenstrae offices. The experts were required to make their judgements on the reports, not medical histories or examinations. Sometimes they dealt with hundreds of reports at a time. On each they marked a + (death), a – (life), or occasionally a ? meaning that they were unable to decide. Three “death” verdicts condemned the person and as with reviews of children, the process became less rigorous, the range of conditions considered “unsustainable” grew broader and zealous Nazis further down the chain of command increasingly made decisions on their own initiative.

The first gassings in Germany proper took place in January 1940 at the Brandenburg Euthanasia Centre. The operation was headed by Brack, who said “the needle belongs in the hand of the doctor.” Bottled pure carbon monoxide gas was used. At trials, Brandt described the process as a “major advance in medical history”. Once the efficacy of the method was confirmed, it became standardised, and instituted at a number of centres across Germany under the supervision of Widmann, Becker, and Christian Wirth a Kripo officer who later played a prominent role in the extermination of the Jews as commandant of newly built death camps in occupied Poland. In addition to Brandenburg, the killing centres included Grafeneck Castle in Baden-Wrttemberg (10,824 dead), Schloss Hartheim near Linz in Austria (over 18,000 dead), Sonnenstein Euthanasia Centre in Saxony (15,000 dead), Bernburg Euthanasia Centre in Saxony-Anhalt and Hadamar Euthanasia Centre in Hesse (14,494 dead). The same facilities were also used to kill mentally sound prisoners transferred from concentration camps in Germany, Austria and occupied parts of Poland.

Condemned patients were transferred from their institutions to newly built centres in the T4 Charitable Ambulance buses, called the Community Patients Transports Service. They were run by teams of SS men wearing white coats, to give it an air of medical care. To prevent the families and doctors of the patients from tracing them, the patients were often first sent to transit centres in major hospitals, where they were supposedly assessed. They were moved again to special treatment (Sonderbehandlung) centres. Families were sent letters explaining that owing to wartime regulations, it was not possible for them to visit relatives in these centres. Most of these patients were killed within 24 hours of arriving at the centres, and their bodies cremated. For every person killed, a death certificate was prepared, giving a false but plausible cause of death. This was sent to the family along with an urn of ashes (random ashes, since the victims were cremated en masse). The preparation of thousands of falsified death certificates took up most of the working day of the doctors who operated the centres.

During 1940, the centres at Brandenburg, Grafeneck and Hartheim killed nearly 10,000 people each, while another 6,000 were killed at Sonnenstein. In all, about 35,000 people were killed in T4 operations that year. Operations at Brandenburg and Grafeneck were wound up at the end of the year, partly because the areas they served had been cleared and partly because of public opposition. In 1941, however, the centres at Bernburg and Sonnenstein increased their operations, while Hartheim (where Wirth and Franz Stangl were successively commandants) continued as before. As a result, another 35,000 people were killed before August 1941, when the T4 programme was officially shut down by Hitler. Even after that date, however, the centres continued to be used to kill concentration camp inmates: eventually some 20,000 people in this category were killed.[n]

In 1971, Gitta Sereny conducted a series of interviews with Stangl, who was in prison in Dsseldorf after having been convicted of co-responsibility for killing 900,000 people as commandant of the Sobibor and Treblinka extermination camps in Poland. Stangl gave Sereny a detailed account of the operations of the T4 programme based on his time as commandant of the killing facility at the Hartheim institute. He described how the inmates of various asylums were removed and transported by bus to Hartheim. Some were in no mental state to know what was happening to them, but many were perfectly sane, and for them various forms of deception were used. They were told they were at a special clinic where they would receive improved treatment, and were given a brief medical examination on arrival. They were induced to enter what appeared to be a shower block, where they were gassed with carbon monoxide (the ruse was also used at extermination camps).

The SS functionaries and hospital staff associated with Action T4 in the German Reich were paid from the central office at Tiergartenstrasse 4 in Berlin from the spring of 1940. The SS and police from SS-Sonderkommando Lange responsible for murdering the majority of patients in the annexed territories of Poland since October 1939, took their salaries from the normal police fund, supervised by the administration of the newly formed Wartheland district; the programme in Germany and occupied Poland was overseen by Heinrich Himmler. Before 2013, it was believed that 70,000 persons were murdered in the euthanasia programme but the German Federal Archives reported that research in the archives of former East Germany, indicated that the number of victims in Germany and Austria from 1939 to 1945, was about 200,000 persons and that another 100,000 persons were victims in other European countries.[12][24][92] In the German T4 centres there was at least the semblance of legality in keeping records and writing letters. In Polish psychiatric hospitals no one was left behind. killings were inflicted using gas-vans, sealed army bunkers and machine guns; families were not informed about the murdered relatives and the empty wards were handed over to the SS.

After the official end of the euthanasia programme in 1941, most of the personnel and high-ranking officials, as well as gassing technology and the techniques used to deceive victims, were transferred under the jurisdiction of the national medical division of the Reich Interior Ministry. Further gassing experiments with the use of mobile gas chambers (Einsatzwagen) were conducted at Soldau concentration camp by Herbert Lange following Operation Barbarossa. Lange was appointed commander of the Chemno extermination camp in December 1941. He was given three gas vans by the RSHA, converted by the Gaubschat GmbH in Berlin and before February 1942, killed 3,830 Polish Jews and around 4,000 Romani, under the guise of “resettlement”. After the Wannsee conference, implementation of gassing technology was accelerated by Heydrich. Beginning in the spring of 1942, three killing factories were built secretly in east-central Poland. The SS officers responsible for the earlier Aktion T4, including Wirth, Stangl and Irmfried Eberl, had important roles in the implementation of the “Final Solution” for the next two years.[o] The first killing centre equipped with stationary gas chambers modelled on technology developed under Aktion T4 was established at Beec in the General Government territory of occupied Poland; the decision preceded the Wannsee Conference of January 1942 by three months.

In January 1939, Brack commissioned a paper from Professor of Moral Theology at the University of Paderborn, Joseph Mayer, on the likely reactions of the churches in the event of a state euthanasia programme being instituted. Mayer a longstanding euthanasia advocate reported that the churches would not oppose such a programme if it was seen to be in the national interest. Brack showed this paper to Hitler in July, and it may have increased his confidence that the “euthanasia” programme would be acceptable to German public opinion. Notably, when Sereny interviewed Mayer shortly before his death in 1967, he denied that he formally condoned the killing of people with disabilities but no copies of this paper are known to survive.

There were those who opposed the T4 programme within the bureaucracy. Lothar Kreyssig, a district judge and member of the Confessing Church, wrote to Grtner protesting that the action was illegal since no law or formal decree from Hitler had authorised it. Grtner replied, “If you cannot recognise the will of the Fhrer as a source of law, then you cannot remain a judge”, and had Kreyssig dismissed. Hitler had a fixed policy of not issuing written instructions for policies relating to what could later be condemned by international community, but made an exception when he provided Bouhler and Brack with written authority for the T4 programme in his confidential letter of October 1939 in order to overcome opposition within the German state bureaucracy. Hitler told Bouhler that, “the Fhrer’s Chancellery must under no circumstances be seen to be active in this matter.” The Justice Minister, Franz Grtner, had to be shown Hitler’s letter in August 1940 to gain his cooperation.

In the towns where the killing centres were located, many people saw the inmates arrive in buses, saw the smoke from the crematoria chimneys and noticed that the buses were returning empty. In Hadamar, ashes containing human hair rained down on the town. The T4 programme was no secret. Despite the strictest orders, some of the staff at the killing centres talked about what was going on. In some cases families could tell that the causes of death in certificates were false, e.g. when a patient was claimed to have died of appendicitis, even though his appendix had been surgically removed some years earlier. In other cases, several families in the same town would receive death certificates on the same day. In May 1941, the Frankfurt County Court wrote to Grtner describing scenes in Hadamar where children shouted in the streets that people were being taken away in buses to be gassed.

During 1940, rumours of what was taking place spread and many Germans withdrew their relatives from asylums and sanatoria to care for them at home, often with great expense and difficulty. In some places doctors and psychiatrists co-operated with families to have patients discharged or if the families could afford it, transferred them to private clinics beyond the reach of T4. Other doctors “re-diagnosed” patients so that they no longer met the T4 criteria, which risked exposure when Nazi zealots from Berlin conducted inspections. In Kiel, Professor Hans Gerhard Creutzfeldt managed to save nearly all of his patients. Lifton listed a handful of psychiatrists and administrators who opposed the killings; many doctors collaborated, either through ignorance, agreement with Nazi eugenicist policies or fear of the regime.

Protest letters were sent to the Reich Chancellery and the Ministry of Justice, some from Nazi Party members. The first open protest against the removal of people from asylums took place at Absberg in Franconia in February 1941 and others followed. The SD report on the incident at Absberg noted that “the removal of residents from the Ottilien Home has caused a great deal of unpleasantness” and described large crowds of Catholic townspeople, among them Party members, protesting against the action. Similar petitions and protests occurred throughout Austria as rumors spread of mass killings at the Hartheim Euthanasia Centre and of mysterious deaths at the children’s clinic, Am Spiegelgrund in Vienna. Anna Wdl, a nurse and mother of child with a disability, vehemently petitioned to Hermann Linden at the Reich Ministry of the Interior in Berlin to prevent her son, Alfred, from being transferred from Gugging, where he lived and which also became a euthanasia center. Wdl failed and Alfred was sent to Am Spiegelgrund, where he was killed on February 22, 1941. His brain was preserved in formaldehyde for “research” and stored in the clinic for sixty years.

The Lutheran theologian Friedrich von Bodelschwingh (director of the Bethel Institution for Epilepsy at Bielefeld) and Pastor Paul-Gerhard Braune (director of the Hoffnungstal Institution near Berlin) protested. Bodelschwingh negotiated directly with Brandt and indirectly with Hermann Gring, whose cousin was a prominent psychiatrist. Braune had meetings with Justice Minister Grtner, who was always dubious about the legality of the programme. Grtner later wrote a strongly worded letter to Hitler protesting against it; Hitler did not read it but was told about it by Lammers. Bishop Theophil Wurm, presiding the Evangelical-Lutheran Church in Wrttemberg, wrote to Interior Minister Frick in March 1940 and the same month a confidential report from the Sicherheitsdienst (SD) in Austria, warned that the killing programme must be implemented with stealth “in order to avoid a probable backlash of public opinion during the war”. On 4 December 1940, Reinhold Sautter, the Supreme Church Councillor of the Wrttemberg State Church, complained to the Nazi Ministerial Councillor Eugen Sthle for the murders in Grafeneck Castle. Stahle said “The fifth commandment Thou shalt not kill, is no commandment of God but a Jewish invention”.

Bishop Heinrich Wienken of Berlin, a leading member of the Caritas Association, was selected by the Fulda episcopal synod to represent the views of the Catholic Church in meetings with T4 operatives. In 2008, Michael Burleigh wrote

Wienken seems to have gone partially native in the sense that he gradually abandoned an absolute stance based on the Fifth Commandment in favour of winning limited concessions regarding the restriction of killing to ‘complete idiots’, access to the sacraments and the exclusion of ill Roman Catholic priests from these policies.

Despite a decree issued by the Vatican on 2 December 1940 stating that the T4 policy was “against natural and positive Divine law” and that “The direct killing of an innocent person because of mental or physical defects is not allowed”, the Catholic Church hierarchy in Germany decided to take no further action. Incensed by the Nazi appropriation of Church property in Mnster to accommodate people made homeless by an air raid, in July and August 1941 the Bishop of Mnster, August von Galen, gave four sermons criticizing the Nazis for arresting Jesuits, confiscating church property and for the euthanasia program. Galen sent the text to Hitler by telegram, calling on

…. the Fhrer to defend the people against the Gestapo. It is a terrible, unjust and catastrophic thing when man opposes his will to the will of God…. We are talking about men and women, our compatriots, our brothers and sisters. Poor unproductive people if you wish, but does this mean that they have lost their right to live?

Galen’s sermons were not reported in the German press but were circulated illegally as leaflets. The text was dropped by the Royal Air Force over German troops. In 2009, Richard J. Evans wrote that “This was the strongest, most explicit and most widespread protest movement against any policy since the beginning of the Third Reich”. Local Nazis asked for Galen to be arrested but Goebbels told Hitler that such action would provoke a revolt in Westphalia and Hitler decided to wait until after the war to take revenge.

In 1986, Lifton wrote, “Nazi leaders faced the prospect of either having to imprison prominent, highly admired clergymen and other protesters a course with consequences in terms of adverse public reaction they greatly feared or else end the programme”. Evans considered it “at least possible, even indeed probable” that the T4 programme would have continued beyond Hitler’s initial quota of 70,000 deaths but for the public reaction to Galen’s sermon. Burleigh called assumptions that the sermon affected Hitler’s decision to suspend the T4 program “wishful thinking” and noted that the various Church hierarchies did not complain after the transfer of T4 personnel to Aktion Reinhard. Henry Friedlander wrote that it was not the criticism from the Church but rather the loss of secrecy and “general popular disquiet about the way euthanasia was implemented” that caused the killing to be suspended.[117]

Galen had detailed knowledge of the euthanasia program by July 1940 but did not speak out until almost a year after Protestants had begun to protest. In 2002, Beth A. Griech-Polelle wrote that,

Worried lest they be classified as outsiders or internal enemies, they waited for Protestants, that is the “true Germans”, to risk a confrontation with the government first. If the Protestants were able to be critical of a Nazi policy, then Catholics could function as “good” Germans and yet be critical too.

On 29 June 1943, Pope Pius XII issued the encyclical Mystici corporis Christi, in which he condemned the fact that “physically deformed people, mentally disturbed people and hereditarily ill people have at times been robbed of their lives” in Germany. Following this, in September 1943, a bold but ineffectual condemnation was read by bishops from pulpits across Germany, denouncing the killing of “the innocent and defenceless mentally handicapped and mentally ill, the incurably infirm and fatally wounded, innocent hostages and disarmed prisoners of war and criminal offenders, people of a foreign race or descent”.

On 24 August 1941, Hitler ordered the suspension of the T4 killings. After the invasion of the Soviet Union in June, many T4 personnel were transferred to the east to begin work on the final solution to the Jewish question. The projected death total for the T4 program of 70,000 deaths had been reached by August 1941. The termination of the T4 programme did not end the killing of people with disabilities; from the end of 1941, the killing of adults and children continued less systematically to the end of the war on the local initiative of institute directors and party leaders. After the bombing of Hamburg in July 1943, occupants of old age homes were killed. In the post-war trial of Dr. Hilda Wernicke, Berlin, August, 1946, testimony was given that “500 old, broken women” who had survived the bombing of Stettin in June 1944 were euthanized at the Meseritz-Oberwalde Asylum. The Hartheim, Bernberg, Sonnenstein and Hardamar centres continued in use as “wild euthanasia” centres to kill people sent from all over Germany, until 1945. The methods were lethal injection or starvation, those employed before use of gas chambers. By the end of 1941, about 100,000 people had been killed in the T4 programme. From mid-1941, concentration camp prisoners too feeble or too much trouble to keep alive were murdered after a cursory psychiatric examination under Action 14f13.

After the war a series of trials was held in connection with the Nazi euthanasia programme at various places including: Dresden, Frankfurt, Graz, Nuremberg and Tbingen. In December 1946 an American military tribunal (commonly called the Doctors’ trial) prosecuted 23 doctors and administrators for their roles in war crimes and crimes against humanity. These crimes included the systematic killing of those deemed “unworthy of life”, including people with mental disabilities, the people who were institutionalized mentally ill, and people with physical impairments. After 140 days of proceedings, including the testimony of 85 witnesses and the submission of 1,500 documents, in August 1947 the court pronounced 16 of the defendants guilty. Seven were sentenced to death and executed on 2 June 1948, including Brandt and Brack.

The indictment read in part:

14. Between September 1939 and April 1945 the defendants Karl Brandt, Blome, Brack, and Hoven unlawfully, wilfully, and knowingly committed crimes against humanity, as defined by Article II of Control Council Law No. 10, in that they were principals in, accessories to, ordered, abetted, took a consenting part in, and were connected with plans and enterprises involving the execution of the so called “euthanasia” program of the German Reich, in the course of which the defendants herein murdered hundreds of thousands of human beings, including German civilians, as well as civilians of other nations. The particulars concerning such murders are set forth in paragraph 9 of count two of this indictment and are incorporated herein by reference.

Earlier, in 1945, American forces tried seven staff members of the Hadamar killing centre for the killing of Soviet and Polish nationals, which was within their jurisdiction under international law, as these were the citizens of wartime allies. (Hadamar was within the American Zone of Occupation in Germany. This was before the Allied resolution of December 1945, to prosecute individuals for “crimes against humanity” for such mass atrocities.) Alfons Klein, Karl Ruoff and Wilhelm Willig were sentenced to death and executed; the other four were given long prison sentences. In 1946, newly reconstructed German courts tried members of the Hadamar staff for the murders of nearly 15,000 German citizens at the facility. Adolf Wahlmann and Irmgard Huber, the chief physician and the head nurse, were convicted.

The Ministry for State Security of East Germany stored around 30,000 files of Aktion T4 in their archives. Those files became available to the public only after the German Reunification in 1990, leading to a new wave of research on these wartime crimes.

The German national memorial to the people with disabilities murdered by the Nazis was dedicated in 2014 in Berlin.[135][136] It is located in the pavement of a site next to the Tiergarten park, the location of the former villa at Tiergartenstrasse 4 in Berlin, where more than 60 Nazi bureaucrats and doctors worked in secret under the “T4” program to organize the mass murder of sanatorium and psychiatric hospital patients deemed unworthy to live.[136]

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Aktion T4 – 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 it 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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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

End-of-Life Legal Documents

Palliative Care

“Slippery Slope” Argument

Special Groups

Historical Issues

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Euthanasia – ProCon.org

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]

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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.

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

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

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Euthanasia – ProCon.org

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 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 – 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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