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Euthanasia (from : + ) is the practice of intentionally ending life to eliminate pain and suffering.
Different countries have different euthanasia laws. 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". In the Netherlands and Belgium, euthanasia is understood as "termination of life by a doctor at the request of a patient". Euthanasia and assisted suicide BBC. Last reviewed June 2011. Accessed 25 July 2011. Archived from the original The Dutch law, however, does not use the term 'euthanasia' but includes the concept under the broader definition of "assisted suicide and termination of life on request".
Euthanasia is categorised in different ways, which include voluntary, non-voluntary, and involuntary. Voluntary and involuntary euthanasia BBC Accessed 12 February 2012. Archived from the original Voluntary euthanasia is when a person wishes to have their life ended and is legal in a growing number of countries. Non-voluntary euthanasia occurs when a patient's consent is unavailable, (e.g., or under a Vegetative state,) and is legal in some countries under certain limited conditions, in both active and passive forms. Involuntary euthanasia, which is done without asking for consent or against the patient's will, is illegal in all countries and is usually considered murder.
, euthanasia had become the most active area of research in bioethics.
Another approach incorporated the notion of suffering into the definition. The definition offered by the Oxford English Dictionary incorporates suffering as a necessary condition with "the painless killing of a patient suffering from an Terminal illness and painful disease or in an irreversible coma", 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"., quoted in Beauchamp & Davidson (1979), p 295. 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.
The third element incorporated into many definitions is that of intentionality: the death must be intended rather than accidental, and the intent of the action must be a "merciful death". 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." 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." Definitions such as those 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." 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"., quoted in Beauchamp & Davidson (1979), p 295.
Draper argued that any definition of euthanasia must incorporate four elements: an agent and a subject; an intention; 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." Prior to Draper, Beauchamp and Davidson had also offered a definition that included these elements. Their definition specifically discounts to distinguish between abortions and euthanasia:
Wreen, in part responding to Beauchamp and Davidson, offered a six-part definition:
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.
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". 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 is unable to consent) or involuntary (against the person's will), is not euthanasia: it is murder. Hence, euthanasia can be voluntary only." 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.
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 one of their criteria, although it may have been required to justify euthanasia. However, others see consent as essential.
Euthanasia: a very gentle and quiet death, which happens without painful convulsions. The word comes from ευ, bene, well, and θανατος, mors, death. Zedlers Universallexikon, Vol. 08, p. 1150, published 1732–54.
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 of the theological care of the soul of sick people from the physical care and medical treatment by doctors.Helge Dvorak: Biographisches Lexikon der Deutschen Burschenschaft. Vol. I, Sub-vol. 4, Heidelberg, 2000, pp. 40–41.
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, "Historical Timeline: History of Euthanasia and Physician-Assisted Suicide," Euthanasia – ProCon.org. Last updated on: 23 July 2013. Retrieved 4 May 2014. as did Francois Ranchin (1565–1641), a French physician and professor of medicine, and Michael Boudewijns (1601–1681), a physician and teacher. Other voices argued for euthanasia, such as John Donne in 1624, 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". This view was shared by others who followed, including Philipp Jakob Spener, Veit Riedlin and Johann Georg Krünitz. 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.
Suicide and euthanasia became more accepted during the Age of Enlightenment. Thomas More wrote of euthanasia in Utopia, although it is not clear if More was intending to endorse the practice. 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.
The essay was favourably reviewed in The Saturday Review, but an editorial against the essay appeared in The Spectator. 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'. Popular Science analyzed the issue in May 1873, assessing both sides of the argument. 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".
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 movement framework. In 1891, Adler 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. Both Ingersoll and Adler argued for voluntary euthanasia of adults suffering from terminal ailments. Dowbiggin argues that by breaking down prior moral objections to euthanasia and suicide, Ingersoll and Adler enabled others to stretch the definition of euthanasia.
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. Hunt did so at the behest of Anna Sophina 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.
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.
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 6–12-month prison term and a fine of between $200 and $1,000. The proposal proved to be controversial. It engendered considerable debate and failed to pass, having been withdrawn from consideration after being passed to the Committee on Public Health.
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.
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. 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.
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. 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.
The "euthanasia campaign" of mass murder gathered momentum on 14 January 1940 when the "handicapped" were killed with gas vans and at killing centres, eventually leading to the deaths of 70,000 adult Germans. Genocide Under the Nazis Timeline: 14 January 1940 BBC Accessed 23 July 2011. Quotation: "The 'euthanasia campaign' gathers momentum in Germany, as six special killing centres and gas vans, under an organisation code-named T4, are used in the murder of 'handicapped' adults. Over 70,000 Germans will eventually be killed in this act of mass murder – it is the first time poison bas will be used for such a purpose". was a campaign of mass murder by involuntary euthanasia in Nazi Germany. Its code name Aktion T4 is derived from Tiergartenstraße 4, a street address of the Chancellery department which recruited and paid personnel associated with the program. 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 death—must kill—in order to keep the social organism alive and healthy.Basic Books 1986, 46
In modern terms, the use of "euthanasia" in the context of Aktion T4 is seen to be a to disguise a program of genocide, in which people were killed on the grounds of "disabilities, religious beliefs, and discordant individual values". 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. 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."
The petition brought tensions between the American Euthanasia Society and the Catholic Church to a head that contributed to a climate of Anti-Catholicism sentiment generally, regarding issues such as birth control, eugenics, and population control. However, the petition did not result in any legal changes.
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, which will lead to unacceptable consequences. In fact, in Oregon, in 2013, pain was not among the top five end-of-life concerns of terminally-ill people who sought euthanasia.
In the United States in 2013, 47% nationwide supported doctor-assisted suicide. This included 32% of Latinos and 29% of African-Americans. Some US disability rights organizations have also opposed bills legalizing assisted suicide.
A 2015 Populus Ltd poll in the United Kingdom found broad public support for assisted dying; 82% of people supported the introduction of assisted dying laws, including 86% of people with disabilities.
An alternative approach to the question is seen in the hospice movement which promotes palliative care for the dying and terminally ill. This has pioneered the use of pain-relieving drugs in a holistic atmosphere in which the patient's spiritual care ranks alongside physical care. It 'intends neither to hasten nor postpone death'.
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Eligibility for euthanasia varies across jurisdictions where it is legal. Some countries such as Belgium and the Netherlands allow euthanasia for mental illness.
West's Encyclopedia of American Law states that "a 'mercy killing' or euthanasia is generally considered to be a criminal homicide" and is normally used as a synonym of homicide committed at a request made by the patient. (1998). 9780314201577, West Publishing Company. ISBN 9780314201577
The judicial sense of the term "homicide" includes any intervention undertaken with the express intention of ending a life, even to relieve intractable suffering.Carmen Tomás Y Valiente, La regulación de la eutanasia en Holanda, Anuario de Derecho Penal y Ciencias Penales – Núm. L, Enero 1997 Not all homicide is unlawful. Two designations of homicide that carry no criminal punishment are justifiable and excusable homicide. 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". Assisted suicide is thus not classified as euthanasia by Oregon, where it is legal under the Oregon Death with Dignity Act, and despite its name, it is not legally classified as suicide either. 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. The use of pain medication to relieve suffering, even if it hastens death, has been held as legal in several court decisions.
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.Concluding observations of the Human Rights Committee : Netherlands. 27 August 2001Carmen Tomás Y Valiente, La regulación de la eutanasia en Holanda, Anuario de Derecho Penal y Ciencias Penales – Núm. L, Enero 1997
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. Common Cause (India) was the main petitioner in the case, filed in 2005.
In the United Kingdom, the assisted dying campaign group Dignity in Dying cites research in which 54% of general practitioners support or are neutral towards a law change on assisted dying. Similarly, a 2017 Doctors.net.uk poll reported in the British Medical Journal stated that 55% of doctors believe assisted dying, in defined circumstances, should be legalised in the UK.
In 2019, the World Medical Association issued a statement during its 70th Assembly declaring itself opposed to euthanasia and assisted suicide.
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." Protestant and other non-Catholic churches which oppose euthanasia include:
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