Euthanasia

For mercy killings not performed on humans, see animal euthanasia.

Euthanasia (from Greek: ευθανασία -ευ, eu, "good", θάνατος, thanatos, "death") is the practice of terminating the life of a person or animal with an incurable disease, intolerable suffering, or a possibly undignified death in a painless or minimally painful way, for the purpose of limiting suffering.

Laws around the world vary greatly with regard to euthanasia and are constantly subject to change as cultural values shift and better palliative care or treatments become available. It is legal in some nations, while in others it may be criminalized. Due to the gravity of the issue, strict restrictions and proceedings are enforced regardless of legal status.

Terminology

It is often difficult to discuss euthanasia due to many different views:

Euthanasia by means

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

Euthanasia by consent

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

Other designations

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

History

Ancient history

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

The English Common Law from the 1300’s until today also disapproved of both suicide and assisting suicide. However, in the 1500s, Thomas More, in describing a utopian community, envisaged such a community as one that would facilitate the death of those whose lives had become burdensome as a result of "torturing and lingering pain".

Modern history

Since the 19th Century, euthanasia has sparked intermittent debates and activism in North America and Europe. According to medical historian Ezekiel Emanuel, it was the availability of anesthesia that ushered in the modern era of euthanasia. In 1828, the first known anti-euthanasia law in the United States was passed in the state of New York, with many other localities and states following suit over a period of several years. After the civil war, voluntary euthanasia was promoted by advocates, including some doctors. Support peaked around the turn of the century in the U.S. and then grew again in the 1930’s.

Euthanasia societies were formed in England in 1935 and in the U.S.A. in 1938 to promote aggressive euthanasia. Although euthanasia legislation did not pass in the U.S. or England, in 1937, doctor-assisted euthanasia was declared legal in Switzerland as long as the person ending the life has nothing to gain. During this period, euthanasia proposals were sometimes mixed with eugenics. While some proponents focused on voluntary euthanasia for the terminally ill, others expressed interest in involuntary euthanasia for certain eugenic motivations (e.g., mentally "defective"). During this same era, meanwhile, U.S. court trials tackled cases involving critically ill people who requested physician assistance in dying as well as “mercy killings”, such as by parents of their severely disabled children.

Prior to World War II, the Nazis carried out a controversial and now-condemned euthanasia program. In 1939, Nazis, in what was code named Action T4, involuntarily euthanized children under three who exhibited mental retardation, physical deformity, or other debilitating problems whom they considered "life unworthy of life”. This program was later extended to include older children and adults.

Post-War history

Due to outrage over Nazi euthanasia crimes, in the 1940s and 1950s there was very little public support for euthanasia, especially for any involuntary, eugenics-based proposals. Catholic church leaders, among others, began speaking against euthanasia as a violation of the sanctity of life. (Nevertheless, owing to its principle of double effect, Catholic moral theology did leave room for shortening life with pain-killers and what would could be characterized as passive euthanasia.) On the other hand, judges were often lenient in mercy-killing cases. During this period, prominent proponents of euthanasia included Glanville Williams (The Sanctity of Life and the Criminal Law) and clergyman Joseph Fletcher ("Morals and medicine"). By the 1960s, advocacy for a right-to-die approach to voluntary euthanasia increased.

A key turning point in the debate over voluntary euthanasia (and physician assisted dying), at least in the United States, was the public furor over the case of Karen Ann Quinlan. The Quinlan case paved the way for legal protection of voluntary passive euthanasia. In 1977, California legalized living wills and other states soon followed suit.

In 1990, Dr. Jack Kevorkian, a Michigan physician, became infamous for encouraging and assisting people in committing suicide which resulted in a Michigan law against the practice in 1992. Kevorkian was tried and convicted in 1999 for a murder displayed on television. In 1990, the Supreme Court approved the use of non-aggressive euthanasia.

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

In 1993, the Netherlands decriminalized doctor-assisted suicide, and in 2002, restrictions were loosened. During that year, physician-assisted suicide was approved in Belgium. Australia's Northern Territory approved a euthanasia bill in 1995, but that was overturned by Australia’s Federal Parliament in 1997.

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

Arguments for and against Voluntary Euthanasia

Since World War II, the debate over euthanasia in Western countries has centered on voluntary euthanasia (VE) within regulated health care systems. In some cases, judicial decisions, legislation, and regulations have made VE an explicit option for patients and their guardians(See Government policies) below for specific examples). Proponents and critics of such VE policies offer the following reasons for and against official voluntary euthanasia policies:

Reasons given for Voluntary Euthanasia:

• Choice: Proponents of VE emphasize that choice is a fundamental principle for liberal democracies and free market systems.
• Quality of Life: The pain and suffering a person feels during a disease can be incomprehensible, even with pain relievers, to a person who has not gone through it. Even without considering the physical pain, it is often difficult for patients to overcome the emotional pain of losing their independence.
• Economic costs and human resources: Today in many countries there is a shortage of hospital space. The energy of doctors and hospital beds could be used for people whose lives could be saved instead of continuing the life of those who want to die which increases the general quality of care and shortens hospital waiting lists.
• Moral: Some people consider euthanasia to be just another choice a person makes, and for moral reasons against it to be undue influence by others.
• Pressure: All the arguments against voluntary euthanasia can be used by society to form a terrible and continuing psychological pressure on people to continue living for years against their better judgement. One example of this pressure is the risky and painful methods that those who genuinely wish to die would otherwise need to use, such as hanging.
• Sociobiology: Currently many if not most euthanasia proponents and laws tend to favor the dying or very unhealthy for access to euthanasia. However some highly controversial proponents claim that access should be even more widely available. For example, from a sociobiological viewpoint, genetic relatives may seek to keep an individual alive (Kin Selection), even against the individual's will. This would be especially so for individuals who are not actually dying anyway. More liberal voluntary euthanasia policies would empower the individual to counteract any such biased interest on the part of relatives.

Reasons given against Voluntary Euthanasia:

• Professional role: Critics argue that VE could unduly compromise the professional roles of health care employees, especially doctors. They point out that every doctor must swear upon some variation of the Hippocratic Oath, which they interpret as explicitly excluding euthanasia.
• Moral: Some people consider euthanasia of some or all types to be morally unacceptable. This view usually treats euthanasia to be a type of murder and voluntary euthanasia as a type of suicide, the morality of which is the subject of active debate.
• Theological: Voluntary euthanasia often has been rejected as a violation of the sanctity of human life. Specifically, some Christians argue that human life ultimately belongs to God, so that humans ought not make the choice to end life. Orthodox Judaism takes basically the same approach, however, it is more open minded, and does given certain circumstances allow for euthanasia to be exercised under passive or non-aggressive means. Accordingly, some theologians and other religious thinkers consider VE (and suicide generally) as sinful acts, i.e. unjustified killings.
• Feasibility of implementation: Euthanasia can only be considered "voluntary" if a patient is mentally competent to make the decision, i.e., has a rational understanding of options and consequences. Competence can be difficult to determine or even define.
• Necessity: If there is some reason to believe the cause of a patient's illness or suffering is or will soon be curable, the correct action is sometimes considered to be attempting to bring about a cure or engage in palliative care.
• Wishes of Family: Family members often desire to spend as much time with their loved ones as possible before they die.
• Consent under pressure: Given the economic grounds for voluntary euthanasia (VE), critics of VE are concerned that patients may experience psychological pressure to consent to voluntary euthanasia rather than be a financial burden on their families. Even where health costs are mostly covered by public monies, as in various European counties, VE critics are concerned that hospital personnel would have an economic incentive to advise or pressure people toward euthanasia consent. While VE proponents concede that personal and even socialized economic costs may add to the motivations for consent, they point out that health systems offer sufficient exceptions so as to relieve the pressure on hospital personnel.

Influence of various factors on opinion regarding euthanasia

United States

Religion

Some of the differences in public attitudes towards the right to die debate stem from the diversity of religion in the United States. The United States contains a wide array of religious views, and these views seem to correlate with whether euthanasia was supported. Using the results from past General Social Surveys performed, some patterns can be found. Respondents that did not affiliate with a religion were found to support euthanasia more than those who did.

Of the religious groups that were studied (which were mostly Christian in this particular study), Southern Baptists, Pentecostals, and Evangelicals and Catholics were more opposed to euthanasia than non-affiliates and the other religious groups.

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

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

In Theravada Buddhism, a monk can be expelled for praising the advantages of death, even if they simply describe the miseries of life or the bliss of the after-life in a way that might inspire a person to commit suicide or pine away to death. In caring for the terminally ill, one is forbidden to treat a patient so as to bring on death faster than would occur if the disease were allowed to run its natural course.

Mahavira Varadhman, the founder of Jainism, explicitly allows suicide.

In Hinduism, the Law of Karma states that any bad action happening in one lifetime will be reflected in the next. Euthanasia could be seen as murder, and releasing the Atman before its time. However, when a body is in a vegetative state, and with no quality of life, it could be seen that the Atman has already left. When avatars come down to earth they normally do so to help out mankind. Since they have already attained Moksha they choose when they want to leave.

Ethnicity

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

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

Gender

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

Governmental, religious, and other non-governmental policymaking

During the 20th Century, efforts to change government policies on euthanasia have met limited success in Western countries. Country policies are described below in alphabetical order, followed by the exceptional case of The Netherlands. Euthanasia policies have also been developed by a variety of NGOs, most notably medical associations and advocacy organizations.

Albania

Euthanasia was legalized in Albania in 1999, it was stated that any form of voluntary euthanasia was legal under the rights of the terminally ill act of 1995. Passive euthanasia is considered legal should three or more family members consent to the decision. Albanias euthanasia policy has been controversial among life groups and the Catholic Church, but due to other more prominant countries also legalizing forms of euthanasia, it has meant a more relaxed world attitude to the matter.

Australia

Euthanasia was legalised in Australia's Northern Territory, by the Rights of the Terminally Ill Act 1995. Soon after, the law was voided by an amendment by the Commonwealth to the Northern Territory (Self-Government) Act 1978. The powers of the Northern Territory legislature, unlike those of the State legislatures, are not guaranteed by the Australian constitution. However, before the Commonwealth government made this amendment, three people had already been practiced legal voluntary euthanasia (PAS), aided by Dr Philip Nitschke. The first person was a taxi driver, Bob Dent, who died on 22 September, 1996.

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

Belgium

The Belgian parliament legalized euthanasia in late September 2002. Proponents of euthanasia state that prior to the law, several thousand illegal acts of euthanasia were carried out in Belgium each year. According to proponents, the legislation incorporated a complicated process, which has been criticized as an attempt to establish a "bureaucracy of death".

Japan

The Japanese government has no official laws on the status of euthanasia and the Supreme Court of Japan has never ruled on the matter. Rather, to date, Japan's euthanasia policy has been decided by two local court cases, one in Nagoya in 1962, and another after an incident at Tokai University in 1995. The first case involved "passive euthanasia" (消極的安楽死, shōkyokuteki anrakushi) (i.e., allowing a patient to die by turning off life support) and the latter case involved "active euthanasia" (積極的安楽死, sekkyokuteki anrakushi) (e.g., through injection). The judgments in these cases set forth a legal framework and a set of conditions within which both passive and active euthanasia could be legal. Nevertheless, in both of these particular cases the doctors were found guilty of violating these conditions when taking the lives of their patients. Further, because the findings of these courts have yet to be upheld at the federal level, these precedents are not necessarily binding. Nevertheless, at present, there is a tentative legal framework for implementing euthanasia in Japan.

In the case of passive euthanasia, three conditions must be met:

1. the patient must be suffering from an incurable disease, and in the final stages of the disease from which he/she/ is unlikely to make a recovery;
2. the patient must give express consent to stopping treatment, and this consent must be obtained and preserved prior to death. If the patient is not able to give clear consent, their consent may be determined from a pre-written document such as a living will or the testimony of the family;
3. the patient may be passively euthanized by stopping medical treatment, chemotherapy, dialysis, artificial respiration, blood transfusion, IV drip, etc.

For active euthanasia, four conditions must be met:

1. the patient must be suffering from unbearable physical pain;
2. death must be inevitable and drawing near;
3. the patient must give consent. (Unlike passive euthanasia, living wills and family consent will not suffice.)
4. the physician must have (ineffectively) exhausted all other measures of pain relief.

The Netherlands

Main article: Euthanasia in the Netherlands

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

Switzerland

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

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

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

Recent debate in Switzerland has focused on assisted suicide rights for the mentally ill. A decision by the Swiss Federal Supreme Court on November 3, 2006, laid out standards under which psychiatric patients might terminate their lives: “It cannot be denied that an incurable, long-lasting, severe mental impairment similar to a somatic one can create a suffering out of which a patient would find his/her life in the long run not worth living anymore. Based on more recent ethical, juridical and medical statements, a possible prescription of Sodium-Pentobarbital is not necessarily contra-indicated and thus no longer generally a violation of medical duty of care. However, utmost restraint needs to be exercised: It has to be distinguished between the wish to die that is expression of a curable psychic distortion and which calls for treatment, and the wish to die that bases on a self-determined, carefully considered and lasting decision of a lucid person ("balance suicide") which possibly needs to be respected. If the wish to die bases on an autonomous, the general situation comprising decision, under certain circumstances even mentally ill may be prescribed Sodium-Pentobarbital and thus be granted help to commit suicide." "Whether the prerequisites for this are given cannot be judged on separated from medical – especially psychiatric – special knowledge and proves to be difficult in practice; therefore, the appropriate assessment requires the presentation of a special in-depth psychiatric opinion." A controversial article in the Hastings Center Report by Brown University Professor Jacob M. Appel advocated adopting similar rules in the United States.

The United Kingdom

On November 5, 2006, Britain's Royal College of Obstetricians and Gynaecologists submitted a proposal to the Nuffield Council on Bioethics calling for consideration of permitting the euthanasia of disabled newborns. The report does not address the current illegality of euthanasia in the United Kingdom, but rather calls for reconsideration of its viability as a legitimate medical practice.

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

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

Currently in the UK, any person found to be assisting suicide is breaking the law and can be convicted of assisting suicide or attempting to do so (i.e. if a doctor gives a patient in great pain a bottle of morphine to take (to commit suicide) when the pain gets too great). Although two-thirds of Britons think it should be legal, a recent 'Assisted Dying for the Terminally-Ill' Bill was turned down in the lower political chamber, the House of Commons, by a 4-1 margin. As such, many terminally-ill Britons wishing to kill themselves go to Switzerland or Holland (where euthanasia is legal), a Hospice, or just wait at home.

United Nations

The United Nations has reviewed and commented on the Netherlands euthanasia law.

United States

Main article: Euthanasia in the United States

Aggressive euthanasia is illegal in most of the United States. Patients retain the rights to refuse medical treatment and to receive appropriate management of pain at their request (passive euthanasia), even if the patients' choices hasten their deaths. Additionally, futile or disproportionately burdensome treatments, such as life-support machines, may be withdrawn under specified circumstances. U.S. residents may also choose to commit suicide without the assistance of medical professionals or oversight from any legal authority.

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

Religious policies

Roman Catholic policy

In Catholic medical ethics, official pronouncements tend to strongly oppose active euthanasia, whether voluntary or not. Nevertheless, Catholic moral theology does allow dying to proceed without medical interventions that would be considered "extraordinary" or "disproportionate." The most important official Catholic statement is the 1980 Declaration on Euthanasia issued by the Sacred Congregation for the Doctrine of the Faith. Though the Church tends not to use the term, this policy equates to a limited form of passive euthanasia.

The Catholic policy rests on several core principles of Catholic medical ethics, including the sanctity of human life, the dignity of the human person, concomitant human rights, and due proportionality in casuistic remedies.

Protestant policies

Protestant denominations vary widely on their approach to euthanasia and physician assisted death. Since the 1970s, Evangelical churches have worked with Roman Catholics on a sanctity of life approach, though the Evangelicals may be adopting a more exceptionless opposition. While liberal Protestant denominations have largely eschewed euthanasia, many individual advocates (e.g., Joseph Fletcher) and euthanasia society activists have been Protestant clergy and laity. As physician assisted dying has obtained greater legal support, some liberal Protestant denominations have offered religious arguments and support for limited forms of euthanasia.

Jewish policies

Not unlike the trend among Protestants, Jewish movements have become divided over euthanasia since the 1970s. Generally, Orthodox Jewish thinkers oppose voluntary euthanasia, often vigorously, though there is some backing for voluntary passive euthanasia in limited circumstances. Likewise, within the Conservative Judaism movement, there has been increasing support for passive euthanasia (PAD) In Reform Judaism responsa, the preponderance of anti-euthanasia sentiment has shifted in recent years to increasing support for certain passive euthanasia (PAD) options.

Non-Abrahamic religions

In Theravada Buddhism, a monk can be expelled for praising the advantages of death, even if they simply describe the miseries of life or the bliss of the after-life in a way that might inspire a person to commit suicide or pine away to death. In caring for the terminally ill, one is forbidden to treat a patient so as to bring on death faster than would occur if the disease were allowed to run its natural course.

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

In Hinduism, the Law of Karma states that any bad action happening in one lifetime will be reflected in the next. Euthanasia could be seen as murder, and releasing the Atman before its time. However, when a body is in a vegetative state, and with no quality of life, it could be seen that the Atman has already left. When avatars come down to earth they normally do so to help out mankind. Since they have already attained Moksha they choose when they want to leave.

Non-governmental organizations

There are a number of historical studies about the thorough euthanasia-related policies of professional associations. In a chapter entitled "End-of-life Decisions," for instance, Brody et al. present Codes of Ethics and other policies developed by: the American Medical Association, the American Academy of Physical Medicine and Rehabilitation, the American College of Emergency Physicians (ACEP), the American College of Physicians - American Society of Internal Medicine (ACP-ASIM), the American Geriatrics Society (AGS), the American Academy of Hospice and Palliative Care (AAHPM), and the American Academy of Neurology (AAN). In their analysis, Brody et al. found it necessary to distinguish such topics as euthanasia, physician-assisted suicide, informed consent and refusal, advance directives, pregnant patients, surrogate decision-making (including neonates), DNR orders, irreversible loss of consciousness, quality of life (as a criterion for limiting end-of-life care), withholding and withdrawing intervention, and futility. Similar distinctions presumably are found outside the U.S., as with the highly contested statements of the British Medical Association.

On euthanasia (narrowly-defined here as directly causing death), Brody sums up the U.S. medical NGO arena:

The debate in the ethics literature on euthanasia is just as divided as the debate on physician-assisted suicide, perhaps more so. Slippery-slope arguments are often made, supported by claims about abuse of voluntary euthanasia in the Netherlands.... Arguments against it are based on the integrity of medicine as a profession. In response, autonomy and quality-of-life-base arguments are made in support of euthanasia, underscored by claims that when the only way to relieve a dying patient's pain or suffering is terminal sedation with loss of consciousness, death is a preferable alternative -- an argument also made in support of physician-assisted suicide.

Other NGOs that advocate for and against various euthanasia-related policies are found throughout the world. Among proponents, perhaps the leading NGO is the UK's Dignity in Dying, the successor to the (Voluntary) Euthanasia Society. In addition to professional and religious groups, there are NGOs opposed to euthanasia found in various countries.

Euthanasia protocol

See Lethal Injection for more information.

A machine that can facilitate euthanasia through heavy doses of drugs. The laptop screen leads the user through a series of steps and questions to ensure they are fully prepared. The final injection is then done by motors controlled by the computer.

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

Intravenous administration is the most reliable and rapid way to accomplish euthanasia and therefore can be safely recommended. A coma is first induced by intravenous administration of 20 mg/kg thiopental sodium (Nesdonal) in a small volume (10 ml physiological saline). Then a triple intravenous dose of a non-depolarizing neuromuscular muscle relaxant is given, such as 20 mg pancuronium dibromide (Pavulon) or 20 mg vecuronium bromide (Norcuron). The muscle relaxant should preferably be given intravenously, in order to ensure optimal availability. Only for pancuronium dibromide (Pavulon) are there substantial indications that the agent may also be given intramuscularly in a dosage of 40 mg.

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

With regards to nonvoluntary euthanasia, the cases where the person could consent but was not asked are often viewed differently from those where the person could not consent. Some people raise issues regarding stereotypes of disability that can lead to non-disabled or less disabled people overestimating the person's suffering, or assuming it to be unchangeable when it could be changed. For example, many disability rights advocates responded to Tracy Latimer's murder by pointing out that her parents had refused a hip surgery that could have greatly reduced or eliminated the physical pain Tracy experienced. Also, they point out that a severely disabled person need not be in emotional pain at their situation, and claim that the emotional pain, if present, is due to societal prejudice rather than the disability, analogous to a person of a particular ethnicity wanting to die because they have internalized negative stereotypes about their ethnic background. Another example of this is Keith McCormick, a New Zealander Paralympian who was "mercy-killed" by his caregiver , and Matthew Sutton.

With regards to voluntary euthanasia, many people argue that 'equal access' should apply to access to suicide as well, so therefore disabled people who cannot kill themselves should have access to voluntary euthanasia.

Others respond to this argument by pointing out that if a nondisabled person attempts suicide, all measures possible are taken to save their lives. Suicidal people are often given involuntary medical treatment so that they will not die. This argument states that it is due to societal prejudice, namely that disabled people are of lower worth and that any unhappiness must be due to the disability, which results in greater support of voluntary euthanasia by disabled people than suicide by nondisabled people.

Euthanasia in the arts, film and literature

• Alexander (film)
• Children of Men
• Dead Man Walking [film]
• Dr. Kiriko, who specializes in euthanasia, from Black Jack (manga)
• The English Patient
• The Good Doctor Bodkin Adams TV docudrama based on: Cullen, Pamela

V., "A Stranger in Blood: The Case Files on Dr John Bodkin Adams", London, Elliott & Thompson, 2006, ISBN 1-904027-19-9

• EastEnders, BBC television soap opera
• The Greatest Show on Earth
• Harsh Times
• Love Among the Ruins by Evelyn Waugh
• Ik omhels je met 1000 armen (in English, I embrace you with 1000 arms)
• Il est plus tard que tu ne penses ("It is Later than You Think") by Gilbert Cesbron
• [Igby Goes Down]]
• Johnny Got His Gun Book and film
• Lawrence of Arabia
• The Life of David Gale
• Logan's Run
• Mar adentro (in English, The Sea Inside)
• Million Dollar Baby
• Million Dollar Abie, The Simpsons episode
• Of Mice and Men Book and film
• One Flew Over the Cuckoo's Nest Book and film
• One True Thing Film
• Pan's Labyrinth
• Pebble in the Sky (1950) by Isaac Asimov
• Saw III
• Simon
• Soylent Green
• They Shoot Horses, Don't They?
• Whose Life is it Anyway?
• The Promise Documentary by Leanne Pooley
• The Giver by Lois Lowry

See also

• Euthanasia: Opposing Viewpoints (2000), listing key sources in an anthology
• Voluntary Active Euthanasia
• International Task Force on Euthanasia and Assisted Suicide
• Terminal sedation
• Senicide in antiquity
• Dr John Bodkin Adams, Eastbourne, England doctor, tried for murder in 1957 but claimed euthanasia. Acquitted.
• Derek Humphry - President of the World Federation of Right to Die Societies.
• Diane Pretty
• Jack Kevorkian
• Arthur Koestler, author, vice-president of EXIT (now the Voluntary Euthanasia Society).
• Final Exit (book)
• Kaishakunin - Assists in the Japanese ritual seppuku (suicide)
• Karen Ann Quinlan and Terri Schiavo - Cases of persistent vegetative state
• Killick Millard - Founder of the Voluntary Euthanasia Legalisation Society in Great Britain
• Peter Singer" - bioethicist, utilitarian
• Principle of double effect
• Terry Wallis
• Action T4 - Nazi Germany's program to kill disabled people, justified as "euthanasia"
• Bertrand Dawson, 1st Viscount Dawson of Penn - physician to George V, to whom he gave a lethal injection.

Selected bibliography

Neutral (approx.)

• Battin, Margaret P., Rhodes, Rosamond, and Silvers, Anita, eds. Physician assisted suicide: expanding the debate. NY: Routledge, 1998.

• Emanuel, Ezekiel J. 2004. "The history of euthanasia debates in the United States and Britain" in Death and dying: a reader, edited by T. A. Shannon. Lanham, MD: Rowman & Littlefield Publishers.

Dennis J. Horan, David Mall, eds. (1977). Death, dying, and euthanasia. Frederick, MD: University Publications of America. ISBN 0-89093-139-9. {{cite book}}: |author= has generic name (help)CS1 maint: multiple names: authors list (link)

• Kopelman, Loretta M., deVille, Kenneth A., eds. Physician-assisted suicide: What are the issues? Dordrecht: Kluwer Academic Publishers, 2001. (E.g., Engelhardt on secular bioethics)

• Magnusson, Roger S. “The sanctity of life and the right to die: social and jurisprudential aspects of the euthanasia debate in Australia and the United States” in Pacific Rim Law & Policy Journal (6:1), January 1997.

• Palmer, “Dr. Adams’ Trial for Murder” in The Criminal Law Review. (Reporting on R. v. Adams with Devlin J. at 375f.) 365-377, 1957.

• PCSEPMBBR, United States. President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. 1983. Deciding to forego life-sustaining treatment: a report on the ethical, medical, and legal issues in treatment decisions. Washington, DC: President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research: For sale by the Supt. of Docs. U.S. G.P.O.

• Robertson, John. 1977. Involuntary euthanasia of defective newborns: a legal analysis. In Death, dying, and euthanasia, edited by D. J. Horan and D. Mall. Washington: University Publications of America. Original edition, Stanford Law Review 27 (1975) 213-269.

• Stone, T. Howard, and Winslade, William J. “Physician-assisted suicide and euthanasia in the United States” in Journal of Legal Medicine (16:481-507), December 1995.

Viewpoints

Giorgio Agamben; translated by Daniel Heller-Roazen (1998). Homo sacer: sovereign power and bare life. Stanford, Calif: Stanford University Press. ISBN 0-8047-3218-3.{{cite book}}: CS1 maint: multiple names: authors list (link)

Raphael Cohen-Almagor (2001). The right to die with dignity: an argument in ethics, medicine, and law. New Brunswick, N.J: Rutgers University Press. ISBN 0-8135-2986-7.

Dworkin, R. M. Life's Dominion: An Argument About Abortion, Euthanasia, and Individual Freedom. New York: Knopf, 1993.

Fletcher, Joseph F. 1954. Morals and medicine; the moral problems of: the patient's right to know the truth, contraception, artificial insemination, sterilization, euthanasia. Princeton, N.J.: Princeton University Press.

Derek Humphry, Ann Wickett (1986). The right to die: understanding euthanasia. San Francisco: Harper & Row. ISBN 0-06-015578-7.

Kamisar, Yale. 1977. Some non-religious views against proposed 'mercy-killing' legislation. In Death, dying, and euthanasia, edited by D. J. Horan and D. Mall. Washington: University Publications of America. Original edition, Minnesota Law Review 42:6 (May 1958).

Kelly, Gerald. “The duty of using artificial means of preserving life” in Theological Studies (11:203-220), 1950.

Panicola, Michael. 2004. Catholic teaching on prolonging life: setting the record straight. In Death and dying: a reader, edited by T. A. Shannon. Lanham, MD: Rowman & Littlefield Publishers.

Rachels, James. The End of Life: Euthanasia and Morality. New York: Oxford University Press, 1986.

Sacred congregation for the doctrine of the faith. 1980. The declaration on euthanasia. Vatican City: The Vatican.

External links

Neutral

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

Support

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

Opposition

• Not Dead Yet (the disability rights group opposing Assisted Suicide)
• Is Killing Kind?
• Christian Study on euthanasia
• www.carenotkilling.org.uk - Care, NOT Killing: a UK alliance promoting palliative care, opposing euthanasia and assisted suicide
• euthanasia.com
• National Right to Life articles on euthanasia
• International Task Force against Euthanasia- many resources
• Non-religious arguments against euthanasia
• A Papal encyclical dealing with a number of issues of life and death including euthanasia
• A brief presentation of the issue and the Christian Catholic viewpoint on it
• The Rosicrucian Fellowship's viewpoint: Suicide and Euthanasia
• Scholarly articles on Euthanasia from the Wisconsin Lutheran Seminary Library