Euthanasia
Euthanasia (
Greek, "good
death") is the practice of killing a person or animal, in a painless or minimally painful way, for merciful reasons, usually to end
suffering. This article discusses euthanasia in humans; a separate article covers
animal euthanasia.
Euthanasia in the strict sense involves actively causing death. This is in some cases legal in the Netherlands (see below), but in few other countries.
Euthanasia in a wider sense includes assisting someone to commit
suicide, in particular
physician-assisted suicide (PAS); some also extend it to the practice of not interfering with suicide, such as allowing a patient to decline vital medication or treatment or honoring a patient's
Do Not Resuscitate directive.
The term
terminal sedation (TS) is used for inducing a deep sleep and withholding water and food. This eliminates suffering, but, depending on the condition of the patient, it may or may not speed up death (perhaps not if the patient would die in a few days anyway).
Terminal
sedation is a combination of aggressive
palliative care (sedatives to treat unbearable symptoms) and withdrawal of
life-sustaining therapy (fluids, nutrition, and other treatments), and may thus be considered legal and acceptable, as belonging to normal medical practice, even in jurisdictions and cases where euthanasia and PAS are not. For example, see the
Uniform Rights of the Terminally Ill Act (U.S.); see also
Doctrine of double effect (DDE).
However, it may give rise to concern if it is effectively euthanasia or PAS, but without the regulations and restrictions of those. It is sometimes called "slow euthanasia".
Advocates of euthanasia generally insist that euthanasia should be voluntary, requiring
informed consent, that it should only be used in cases of terminal illness that cause unbearable suffering. Its opponents challenge it on several ethical grounds, including a
slippery slope argument that it is the first step towards compulsory euthanasia.
Types of euthanasia
Apart from the above classifications three types of euthanasia may be identified, depending upon the sentience of the individual.
Voluntary euthanasia
This is the truest and fullest form of euthanasia wherein the individual requests euthanasia - either during illness or before, if complete incapacitation is expected (coma would be an example).
Non-voluntary euthanasia
Where an individual lacks sentience (in a coma, for example) and hence cannot decide, or distinguish, between life and death. Famously notable as "turning off life-support", it is often done when resuscitation is not expected, or after severe brain damage.
Involuntary euthanasia
Where an individual may distinguish between life and death - and may fully realise the difference between them, but who death is imposed upon. If, for example, a man is going to experience severe agony and does not consent to death, euthanasia may be imposed upon him.
In Nazi Germany the term "euthanasia" (Euthanasie) referred to the systematic killing of deformed children and mentally ill adults under the T-4 Euthanasia Program. This has tainted the word in German-speaking countries; the alternate term is "Sterbehilfe", which means "help to die."
Arguments for and against euthanasia
Proponents of euthanasia state that people should be allowed to decide that they do not want to live any more, and that terminally ill patients are respected more by having their suffering end than by being kept alive against their will. Philosopher Peter Singer has been one of the most outspoken proponents of euthanasia, arguing from a utilitarian philosophical point of view.
Arguments from opponents of euthanasia can be divided in two main categories: religious and prudential.
Many religious people, primarily Christians, object that it is not loving to kill someone, and that pain medications are good enough that suffering is preventable if doctors have the will. Many religions also regard one's life as from God and that either it is His (not yours), or throwing it away insults Him.
The second type of argument against euthanasia is that it is not prudent to advocate it; that eventually we all may be suffering, and if we think ahead, we may think it better if the doctors on whom we depend are not tempted to perform euthanasia. If euthanasia were to be allowed, it is feared by some, doctors might press people into euthanasia to reduce medical costs, or because their family wants them to die.
It should be noted that doctors routinely and legally provide medical treatment to the terminally ill involving the use of large quantities of pain-killing drugs, primarily to relieve the patient's pain, but in doses that may suppress bodily functions and thus shorten the life of the patient.
However, as the goal of the treatment is the relief of suffering rather than the shortening of life (even if that is a known consequence) doctors who oppose euthanasia argue vigorously that such treatment is not euthanasia.
It should be noted that in about a quarter even of the medically supervised euthanasias there are 'complications', like respiratory paralysis that make the event of death itself anything but pleasant.
Legislation and national political movements
Australia
\nEuthanasia was legalised in Australia's Northern Territory, by the Rights of the Terminally Ill Act 1995.\nThis law was soon however made ineffective by an amendment by the Commonwealth government to the Northern Territory (Self-Government) Act 1978.\n(The powers of the Northern Territory legislature, unlike those of the State legislatures, are not guaranteed by the Australian Constitution.)\nThree people had already been legally euthanasied, however, before the Commonwealth government made this amendment.
Belgium
\nAfter an extensive discussion the Belgian parliament legalised euthanasia in late September 2002. The new legislation, however, institutes a complicated process, which has been criticized as an attempt to establish a bureaucracy of death. Nevertheless, euthanasia is now legal and its proponents in the country hope that it will stop many illegal practises (it is said that several thousand illegal acts of euthanasia have been carried out in Belgium each year).
The Netherlands
In The Netherlands the Termination of Life on Request and Assisted Suicide (Review Procedures) Act, legalizing euthenasia in certain circumstances, took effect on April 1, 2002.
The law permits euthanasia when the patient has asked repeatedly, when the patient's suffering is unbearable with no prospect of improvement, and when the doctor has prior to the act consulted a colleague. The doctor must also report the cause of death to the municipal coroner in accordance with the relevant provisions of the Burial and Cremation Act. A regional review committee assesses whether a case of termination of life on request or assisted suicide complies with the due care criteria. Depending on its findings, the case will either be closed or brought to the attention of the Public Prosecutor. Finally, the legislation offers an explicit recognition of the validity of a written declaration of will of the patient regarding euthanasia (a "euthanasia directive"). Such declarations can be used when a patient is in coma or otherwise unable to state whether they want euthanasia or not.
Euthenasia remains a criminal offense in cases not meeting the law's specific conditions, with the exception of several situations that are not subject to the restrictions of the law at all, because they are considered normal medical practice:\n*stopping or not starting a medically useless treatment\n*at the patient's request stopping or not starting a treatment\n*speeding up death as side-effect of treatment necessary for alleviating serious suffering
From the time that euthanasia first came to be widely practiced in the Netherlands, it was formally subject to review by boards of doctors in each hospital. The law essentially codified what had already become unofficial law by judgments in the courts.
The legislation has wide support among the traditionally libertarian Dutch, who have one of the world's highest life expectancies.
Statistics and methods
In 2003, in the Netherlands 1626 cases were reported of euthanasia in the sense of a physician causing death. Usually the sedative sodium thiopental is intravenously administered to induce a coma, and after making sure the patient is in a deep coma, typically after some minutes, a muscle relaxant is administered to stop the breathing and cause death.
There were 148 cases of PAS, usually by drinking a strong barbiturate potion. The doctor has to be present for two reasons:\n*to make sure the potion is not taken by a different person, by accident (or, theoretically, for "unauthorized" suicide or perhaps even murder)\n*to monitor the process and be available to apply the combined procedure mentioned below, if necessary.
In two cases the doctor was reprimanded for not being present while the patient drank the potion. They did not realize that this is required.
In addition, there were 41 cases of a combination of the two procedures: usually these cases concern the situation that the patient drinks the potion, but that this does not cause death. After a few hours, or earlier in the case of vomitting, the muscle relaxant is administered to cause death.
By far the most cases concerned cancer patients. In most cases the procedure was applied at home.
United States
\nIn the United States, the most common form of euthanasia is withholding tube-feeding to elderly and incapacitated patients. This is generally considered an abuse when the patient might recover. These patients die protracted deaths by dehydration. However, it is so common in some areas that the family must actively prevent it, or it will occur.
Contrary to the rest of the United States, Oregon has legalized assisted suicide: residents have voted for it at the Oregon Ballot Measure 16 (1994), and voted against repealing it at the Oregon Ballot Measure 51 (1997). As of 2002, it is estimated that nearly 100 terminally ill patients have committed doctor assisted suicide since the law went into effect in 1997. It is difficult to determine accurate figures, since doctors are not required by law to report when they have granted the patient's request. Oregon's law has been attacked by various organizations, and federal government parties that support those organizations, ever since it was first enacted.
See also
\n*Jack Kevorkian, Sue Rodriguez, Edward Brongersma\n*Infanticide\n*Oregon's Death with Dignity Act\n*Lethal injection\n*Medical ethics, Hippocratic Oath
External links
\n*World Federation of Right To Die Societies\n*http://www.assistedsuicide.org/\n*Netherlands:\n** HREF="http://www.justitie.nl/english/Images/23_35490.pdf" class="external">Ministry of Justice brochure on euthanasia and PAS (PDF)\n**Ministry of Health on euthanasia and PAS\n**Joint annual report 2002 of the Regional Euthanasia Review Conmmittees (PDF) (that of 2003 is not yet available in English) \n**Right to Die-NL - Dutch union for voluntary termination of life NVVE
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