Difference between revisions of "Euthanasia" - New World Encyclopedia

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'''Euthanasia''' (from [[Ancient Greek|Greek]]: ''ευθανασία -ευ'', eu, "[[good]]," ''θάνατος'', thanatos, "[[death]]") is the practice of terminating the [[life]] of a [[person]] or [[animal]] in a presumably [[Pain and nociception|painless]] or minimally painful way, usually by lethal injection.
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'''Euthanasia''' (from [[Ancient Greek|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 [[Pain and nociception|painless]] or minimally painful way, for the purpose of limiting suffering.
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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, religions, and laws change over time, geographically and globally, causing a great deal of confusion.
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We should also note that euthanasia is when a substance is administered to a person with intent to kill them. Euthanasia is not removing someone from life support. There is an enormous moral divide between making someone die and letting someone die. One is murder, the other is simply allowing nature to take its course ( though even this moral divide is not acknowledged by various pro-life groups). Consequently, 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.  
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Here, we should also point out that suicide or attempted suicide, in most states, is no longer a criminal offence. This demonstrates that there is consent among the states to self determination, however, the majority of the states postulate that assisting in suicide is illegal and punishable even when there is written consent from the individual. A problem with the written consent is that it could be coerced; if active euthanasia were to become legal, process would have to be in place to assure that the patient's consent is fully voluntary. Now, back to euthanasia :
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==Terminology ==
  
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== Terminology ==
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===Euthanasia generally===
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It is often difficult to discuss euthanasia due to many different views:
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Euthanasia has several meanings:
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*1.Literally "good death", any peaceful death.
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*2.Using an injection of seconal to kill a pet when it becomes homeless, old, sick or feeble.
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*3.Hitler decided to remove certain groups from the gene pool by killing homosexuals, Jews, gypsies and mentally retarded people. Euthanasia was the Nazi euphemism.
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*4.Killing a patient at the request of the family. The patient is brain dead, comatose or otherwise incapable of letting it be known if he or she would prefer to live or die.
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*5.Mercy killing.
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*6.Physician-assisted suicide. 
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*7.Killing a terminally ill person at their reques.
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We use the term euthanasia only in senses (6) and (7) in this article. When other people debate about euthanasia they could well be using it in senses (1) through (5), or with some other definition. Unfortunately, in English, we use the same word for seven different things.  To make this distinction clearer, two other definitions of euthanasia follow:
  
 
===Euthanasia by means===
 
===Euthanasia by means===
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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.<ref name="bartleby"/><ref name="plato"/>
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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.
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To this point James Rachels challenges both the use and moral significance of that distinction for several reasons. He writes: "…..To begin with a familiar type of situation, a patient who is dying of incurable cancer of the throat is in terrible pain, which can no longer be satisfactorily alleviated. He is certain to die within a few days, even if present treatment is continued, but he does not want to go on living for those days since the pain is unbearable. So he asks the doctor for an end to it, and his family joins in this request…..  Suppose the doctor agrees to withhold treatment...The justification for his doing so is that the patient is in terrible agony, and since he is going to die anyway, it would be wrong to prolong his suffering needlessly. But now notice this. If one simply withholds treatment, it may take the patient longer to die, and so he may suffer more than he would if more direct action were taken and a lethal injection given. This fact provides strong reason for thinking that, once the initial decision not to prolong his agony has been made, active euthanasia is actually preferable to passive euthanasia, rather than the reverse……." ( Rachels  1975 and 1986  ) 
  
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===Euthanasia by consent===
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===Euthanasia by consent===  
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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 above.<ref name="plato"/>
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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. 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 .
  
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===Other designations===
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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.
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There are also the biggest areas of designations of [[Coup de grâce|mercy killing]], [[animal euthanasia]], and physician-assisted suicide which is a term for aggressive voluntary euthanasia.<ref name="bartleby"> http://www.bartleby.com/65/eu/euthanas.html </ref>
 
  
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==History==
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===Mercy killing===
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Killing someone to put them out of their suffering. The killer may or may not have the informed consent of the person killed. We shall  use the term mercy killing only when there is no consent. Legally, mercy killing is usually treated as murder.
  
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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.E. The original Oath states: “To please no one will I prescribe a deadly drug nor give advice which may cause his death.”<ref name="history"> http://www.euthanasia.com/historyeuthanasia.html </ref> 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.<ref name="plato"/><ref>See [[Senicide in antiquity]]</ref>
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===Murder===
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Intentionally killing someone in an unlawful way. There are two kinds of murder.
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1. The murderer has the informed consent of the person killed.
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2. The murderer does not have the informed consent of the person killed.  
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In most parts of the world, types (1) and (2) murder are treated identically. In other parts, type (1) murder is excusable under certain special circumstances, in which case it ceases to be considered murder. Murder is by definition unlawful. It is a legal term not a moral one. Whether euthanasia is murder or not is a simple question for lawyers — "Will you go to jail for doing it or won't you?" Whether euthanasia should be considered murder or not is a matter for legislators. Whether euthansia is good or bad is a deep question for the individual citizen. A right to die and a pro life proponent could both agree "euthanasia is murder", meaning you will go to jail if you are caught doing it, but the right to die person would add, "but under certain circumstances, it should not be, just as it is not considered murder now in the Netherlands."
  
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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".<ref name="plato"/><ref>See Humphry and Wickett (1986:8-10) on More, Montaigne, Donne, and Bacon.</ref> 
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==History==
  
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===Modern history===
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===Ancient history===
  
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Since the 19th Century, euthanasia has sparked intermittent debates and activism in North America and Europe. According to medical historial Ezekiel Emanuel, it was the availability of anesthesia that ushered in the modern era of euthanasia. In 1828, euthanasia was explicitly outlawed in the U.S.{{Fact|date=May 2007}} After the civil war, voluntary euthanasia was promoted by advocates, including some doctors.<ref>Humphry and Wickett 1986:11-12, Emanuel 2004.</ref> Support peaked around the turn of the century in the U.S. and then grew again in the 1930’s.
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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.
  
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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.<ref name="bartleby"/><ref name="history"/> During this period, euthanasia proposals were sometimes mixed with [[eugenics]].<ref>''Merciful Release'' and other sources...</ref> 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").<ref>http://www.eugenicsarchive.org/eugenics/</ref> 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.<ref>Kamisar 1977</ref>
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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.
  
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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.<ref name="history"/>
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The [[English Common Law]] from the 1300’s until today also disapproved of both suicide and assisting suicide. It distinguished a suicide, who was by definition of unsound mind, from a felo-de-se or "evildoer against himself," who had coolly decided to end it all and thereby perpetrated an “infamous crime”. Such a person forfeited his entire estate to the crown. Furthermore his corpse was subjected to public indignities, such as being dragged through the streets and hung from the gallows, and was finally consigned to "ignominious burial," and ,as the legal scholars put it, the favoured method was beneath a crossroads with a stake driven through the body.
  
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===Post-War history===
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===Modern history===
  
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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.<ref>Papal statements 1956-1957 and Gerald Kelly</ref>) On the other hand, judges were often lenient in mercy-killing cases. <ref>Humphrey and Wickett, ch.4. See also, Kamisar and [[John Bodkin Adams]] case.</ref> 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.
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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.  
  
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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.<ref>For the U.K. see the Bland case.</ref> In 1977, California legalized living wills and other states soon followed suit.  
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The earliest American statute explicitly to outlaw assisting suicide was enacted in New York in 1828 (Act of Dec. 10, 1828, ch. 20, §4, 1828 N. Y. Laws 19; codified at 2 N. Y. Rev. Stat. pt. 4, ch. 1, tit. 2, art. 1, §7, p. 661,1829), and many of the new States and Territories followed New York's example.  
  
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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.<ref name="bartleby"/><ref name="history"/> In 1990, the Supreme Court approved the use of non-aggressive euthanasia.<ref> [[Cruzan v. Director, Missouri Department of Health]] </ref>
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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]].
  
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In 1994, Oregon voters approved doctor-assisted suicide and the Supreme Court allowed such laws in 1997.<ref name="plato"/> The Bush administration failed in its attempt to use drug law to stop Oregon in 2001.<ref name="bartleby"/> In 1999, non-aggressive euthanasia was permitted in Texas.  
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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"). Meanwhile, during this same era, 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 ( Kamisar 1977 ).
  
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In 1993, the Netherlands decriminalized doctor-assisted suicide, and in 2002, restrictions were loosened.  During that year, physician-assisted suicide was approved in Belgium. An Australian province approved a euthanasia bill in 1995, but that was overturned by Australia’s legislative branch in 1997.<ref name="bartleby"/><ref name="plato"/><ref name="history"/> 
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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.
  
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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.<ref name="bartleby"/>
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===Post-War history===
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==Euthanasia protocol==
 
  
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[[Image:Euthanasia machine (Australia).JPG|thumb|240px|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.<ref>http://www.smh.com.au/articles/2003/01/10/1041990085855.html</ref>]]
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Leo Alexander,  a judge at the Nuremberg trials after World War II,  employed a ( slippery slope ) argument to suggest that any act of mercy killing inevitably will lead to the mass killings of unwanted persons. He wrote: "…..The beginnings at first were a subtle shifting in the basic attitude of the physicians. It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as life not worthy to be lived. This attitude in its early stages concerned itself merely with the severely and chronically sick. Gradually, the sphere of those to be included in this category was enlarged to encompass the socially unproductive, the ideologically unwanted, the racially unwanted and finally all non-Germans….."
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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:
 
  
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<blockquote>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.<ref>http://www.wweek.com/html/euthanasics.html</ref></blockquote>
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Critics of this position point to the fact that there is no relation at all between the Nazi "euthanasia" program and modern debates about euthanasia. The Nazis, after all, used the word "euthanasia" to camouflage mass murder. All victims died involuntarily, and no documented case exists where a terminal patient was voluntarily killed. The program was carried out in the closest of secrecy and under a dictatorship. One of the lessons that we should learn from this experience is that secrecy is not in the public interest.
  
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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.
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However, 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]].
  
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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 [[Robert Latimer|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 black person wanting to die because they have internalized negative stereotypes about being black.  Another example of this is Keith McCormick, a New Zealander Paralympian who was "mercy-killed" by his caregiver <ref>http://www.nzherald.co.nz/search/story.cfm?storyid=0002EB73-8358-1464-B02B83027AF1010E</ref>, and Matthew Sutton<ref>http://www.abc.net.au/news/newsitems/200704/s1889400.htm</ref>.
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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 ( Papal statements 1956-1957). On the other hand, judges were often lenient in mercy-killing cases( Humphrey and Wickett, ch.4.).  
  
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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.
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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.
  
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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.'''
 
  
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==Arguments for and against Voluntary Euthanasia==
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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]]. In 1975 Karen Ann Quinlan, for reasons still unknown, ceased breathing for several minutes. Failing to respond to mouth-to mouth resuscitation by friends she was taken by ambulance to a hospital in New Jersey. Physicians who examined her described her as being in "a chronic, persistent, vegetative state," and later it was judged that no form of treatment could restore her to cognitive life. Her father asked to be appointed her legal guardian with the expressed purpose of discontinuing the respirator which kept Karen alive. After some delay the Supreme Court of New Jersey granted the request. The respirator was turned off. Karen Ann Quinlan remained alive but comatose until June 11, 1985, when she died at the age of 31.
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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 later tried and convicted in 1999 for a murder displayed on television. Meanwhile in 1990, the Supreme Court approved the use of non-aggressive euthanasia.
  
  
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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 [[Euthanasia#Country examples|Government policies]]) below for specific examples). Proponents and critics of such VE policies offer the following reasons for and against official voluntary euthanasia policies:
 
  
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===Reasons given for Voluntary Euthanasia:===
 
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* Choice: Proponents of VE emphasize that choice is a fundamental principle for liberal democracies and free market systems.<ref name="plato"/>
 
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* 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. <ref name="plato"/>
 
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* 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.{{Fact|date=May 2007}}
 
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* 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.<ref>See also [[Utilitarianism]]</ref>
 
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* 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.
 
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* [[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. {{Fact|date=May 2007}}
 
  
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===Reasons given against Voluntary Euthanasia:===
 
  
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* 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.<ref>[[Hippocratic Oath]]</ref>{{Fact|date=May 2007}}
 
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* Moral: Some people consider euthanasia of some or all types to be morally unacceptable.<ref name="plato">http://plato.stanford.edu/entries/euthanasia-voluntary/ An overview of voluntary euthanasia</ref>  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.
 
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* Theological: Voluntary euthanasia often has been rejected as a violation of the sanctity of human life. Specifically, some Christians and Jews argue that human life ultimately belongs to God, so that humans ought not make the choice to end life. Accordingly, some theologians and other religious thinkers consider VE (and [[suicide]] generally) as sinful acts, i.e. unjustified killings.<ref>See [[Religious views of suicide]]</ref>{{Fact|date=May 2007}}
 
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* 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.<ref name="plato"/>
 
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* 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.<ref name="plato"/>
 
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* Wishes of Family: Family members often desire to spend as much time with their loved ones as possible before they die.
 
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* 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. <ref>"Terminally ill patients often fear being a burden to others and may feel they ought to request euthanasia to relieve their relatives from distress." letter to the editor of the ''Financial Times'' by Dr David Jeffrey, published 11 Jan 2003.</ref> 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.<ref> "If euthanasia became socially acceptable, the sick would no longer be able to trust either doctors or their relatives: many of those earnestly counselling a painless, 'dignified' death would be doing so mainly on financial grounds. Euthanasia would become a euphemism for assisted murder." ''FT WEEKEND - THE FRONT LINE: Don't take liberties with the right to die'' by Michael Prowse, Financial Times, 4th Jan 2003 </ref> 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.{{Fact|date=May 2007}}
 
  
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==Influence of various factors on opinion regarding euthanasia==
 
  
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===Religion===
 
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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.
 
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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.
 
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Moderate Protestants (including [[Lutheranism|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.
 
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The liberal Protestants (including some [[Presbyterians]] and [[Episocopal Church in the United States of America|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.<ref>Burdette, Amy M; Hill, Terrence D; Moulton, Benjamin E. Religion and Attitudes toward Physician-Assisted Suicide and Terminal Palliative Care. Journal for the Scientific Study of Religion, 2005, 44, 1, Mar, 79-93.</ref>
 
  
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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.<ref>[[Thanissaro Bhikkhu]], [http://www.accesstoinsight.org/lib/authors/thanissaro/bmc1/ch04.html "Buddhist Monastic Code I: Chapter 4"]</ref>
 
  
−
[[Jainism]] is worth of  mention when it comes to this topic, as  [[Mahavira|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.
 
  
−
=== Ethnicity ===
+
==Influence of religious policies on opinion regarding euthanasia==
−
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.<ref>Werth Jr., James L.; Blevins, Dean; Toussaint, Karine L.; Durham, Martha R. The influence of cultural diversity on end-of-life care and decisions. The American Behavioral Scientist; Oct 2002; 46, 2; pg 204-219.</ref> 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.<ref>Jennings, Patricia K.,Talley, Clarence R.. A Good Death?: White Privilege and Public Opinion. Race, Gender, & Class. New Orleans: Jul 31, 2003. Vol. 10, Iss. 3; pg. 42.</ref> 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.<ref>Werth Jr., James L.; Blevins, Dean; Toussaint, Karine L.; Durham, Martha R. The influence of cultural diversity on end-of-life care and decisions. The American Behavioral Scientist; Oct 2002; 46, 2; pg 204-219</ref>
+
Suicide or attempted suicide, in most states, is no longer a criminal offence. This demonstrates that there is consent among the states to self determination, however, the majority of the states postulate that assisting in suicide is illegal and punishable even when there is written consent from the individual. A problem with the written consent is that it could be coerced; if active euthanasia were to become legal, process would have to be in place to assure that the patient's consent is fully voluntary. Let us now see how individual religions regard the complex subject of euthanasia.  
 +
===Christian religions===
  
−
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.<ref>Jennings, Patricia K.,Talley, Clarence R.. A Good Death?: White Privilege and Public Opinion. Race, Gender, & Class. New Orleans: Jul 31, 2003. Vol. 10, Iss. 3; pg. 42.</ref> 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.
+
====Roman Catholic policy====
  
−
=== Gender ===
+
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 Declaration on Euthanasia ( Sacred Congregation…, Vatican 1980).  
−
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.<ref>Moore, D. (2005 May 17). “Three in Four Americans Support Euthanasia.” The Gallup Organization.</ref> 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.<ref>Jennings, Patricia K.,Talley, Clarence R.. A Good Death?: White Privilege and Public Opinion. Race, Gender, & Class. New Orleans: Jul 31, 2003. Vol. 10, Iss. 3; pg. 42. the public opinion
 
−
</ref>
 
  
−
==Religious policies==
+
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 ( ibid. ).
−
===Roman Catholic policy===
 
  
−
In [[Catholic medical ethics]], official pronouncements tend to strongly oppose ''active euthanasia,'' whether voluntary or not.<ref>"...no one is permitted to ask for this act of killing, either for himself or herself or for another person entrusted to his or her care, nor can he or she consent to it, either explicitly or implicitly. nor can any authority legitimately recommend or permit such an action."</ref> 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]].<ref>http://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19800505_euthanasia_en.html Sacred Congregation for the Doctrine of the Faith. "Declaration on Euthanasia," May 5, 1980.</ref> Though the Church tends not to use the term, this policy equates to a limited form of passive euthanasia.
+
====Protestant policies====
  
−
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.<ref>http://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19800505_euthanasia_en.html Sacred Congregation for the Doctrine of the Faith. "Declaration on Euthanasia," May 5, 1980.</ref>
+
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.  
  
−
===Protestant policies===
+
====Jewish 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.{{Fact|date=May 2007}}
+
Not unlike the trend among Protestants, Jewish movements have become divided over euthanasia since the 1970s. Generally, [[Orthodox Judaism|Orthodox Jewish]] thinkers oppose voluntary euthanasia, often vigorously, though there is some backing for voluntary passive euthanasia in limited circumstances ( see writings of [[Daniel Sinclair]], [[Moshe Tendler]], [[Shlomo Zalman Auerbach]], [[Moshe Feinstein]]. Likewise, within the [[Conservative Judaism]] movement, there has been increasing support for passive euthanasia. In [[Reform Judaism]] [[responsa]], the preponderance of anti-euthanasia sentiment has shifted in recent years to increasing support for certain passive euthanasia.  
−
 
 
−
===Jewish policies===
 
−
 
 
−
Not unlike the trend among Protestants, Jewish movements have become divided over euthanasia since the 1970s. Generally, [[Orthodox Judaism|Orthodox Jewish]] thinkers oppose voluntary euthanasia, often vigorously,<ref>E.g., [[J. David Bleich]], [[Eliezer Waldenberg]]</ref> though there is some backing for voluntary passive euthanasia in limited circumstances.<ref>E.g., see writings of [[Daniel Sinclair]], [[Moshe Tendler]], [[Shlomo Zalman Auerbach]], [[Moshe Feinstein]].</ref> Likewise, within the [[Conservative Judaism]] movement, there has been increasing support for passive euthanasia (PAD)<ref>See [[Elliot Dorff]] and, for earlier speculation, [[Byron Sherwin]].</ref> In [[Reform Judaism]] [[responsa]], the preponderance of anti-euthanasia sentiment has shifted in recent years to increasing support for certain passive euthanasia (PAD) options.{{Fact|date=May 2007}}
 
  
 
===Non-Abrahamic religions===
 
===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.<ref>[[Thanissaro Bhikkhu]], [http://www.accesstoinsight.org/lib/authors/thanissaro/bmc1/ch04.html "Buddhist Monastic Code I: Chapter 4"]</ref>
+
====Buddhism and Hinduism====
−
 
 
−
[[Jainism]] is worth of  mention when it comes to this topic, as  [[Mahavira|Mahavira Varadhman]], it's founder, is unique in ''explicitly allowing suicide''.{{Fact|date=May 2007}} 
 
−
 
−
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.{{Fact|date=May 2007}}
 
−
 
 
−
 
 
−
 
 
−
== 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.
 
−
 
 
−
=== Australia ===
 
−
Euthanasia was legalised in [[Australia]]'s [[Northern Territory]], by the [[Rights of the Terminally Ill Act (Australia)|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.<ref>http://www.nt.gov.au/lant/parliament/committees/rotti/parldebate.shtml</ref> 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 decriminalising euthanasia.
 
−
 
 
−
=== Belgium ===
 
−
The [[Belgium|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 [[Japan]]ese 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 {{Nihongo|"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 {{Nihongo|"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.<ref>{{cite encyclopedia
 
−
  | title = 安楽死
 
−
  | encyclopedia = 現代用語の基礎知識
 
−
  | pages = 951,953
 
−
  | publisher = 自由国民社
 
−
  | date = 2007}}</ref>
 
−
 
 
−
In the case of passive euthanasia, three conditions must be met:
 
−
# 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;
 
−
# 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;
 
−
# 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:
 
−
# the patient must be suffering from unbearable physical pain;
 
−
# death must be inevitable and drawing near;
 
−
# the patient must give consent.  (Unlike passive euthanasia, living wills and family consent will not suffice.)
 
−
# the physician must have (ineffectively) exhausted all other measures of pain relief.
 
−
 
 
−
===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.
 
−
 
 
−
=== 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]] [[newborn]]s.<ref>{{cite news
 
−
|last=Templeton
 
−
|first=Sarah-Kate
 
−
|title=Doctors: let us kill disabled babies
 
−
|url=http://www.timesonline.co.uk/article/0,,2087-2437921.html
 
−
|accessdate=2007-02-05}}
 
−
</ref> 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:<br />
 
−
* UK doctors are particularly cautious about decisions to shorten life.<ref name="Seale 653-9">Seale C. Characteristics of end-of-life decisions: survey of UK medical practitioners. Palliative Medicine 2006; 20(7): 653-9.</ref>
 
−
*  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.<ref name="Seale 653-9"/>
 
−
* 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.<ref name="Seale 653-9"/>
 
−
* 94% of UK specialist doctors in palliative care are against a change in the law.<ref>Survey. Association of Palliative Medicine, 2006.</ref>
 
−
* 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.{{Fact|date=April 2007}}
 
−
 
 
−
===United Nations===
 
−
 
 
−
The United Nations has reviewed and commented on the Netherlands euthanasia law.[[http://www.unhchr.ch/tbs/doc.nsf/385c2add1632f4a8c12565a9004dc311/dbab71d01e02db11c1256a950041d732?OpenDocument&Highlight=0,euthanasia  Observations of the UN human rights committee]]
 
−
 
 
−
===United States===
 
  
−
Euthanasia is illegal in most of the [[United States of America|United States]]. A recent Gallup Poll survey showed that 60% of Americans supported euthanasia.<ref>Carroll, Joseph (2006, June 19). Public Continues to Support Right-to-Die for Terminally Ill Patients. Retrieved on January 16, 2007, from The Gallup Poll Web site: Please note this was a push poll in where the questions were much broader than just the support of euthansia and to conclude overall support is a mischaracterization. The poll is not a good indicator of the support for euthanasia but instead an indicator for an agenda driven result to show support for euthanasia http://www.galluppoll.com/content/?ci=23356&pg=1</ref> 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 [[List of Washington initiatives to the legislature#1990|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 [[Oregon Ballot Measure 16 (1994)|Death with Dignity Act]].
+
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 ( Buddhist Monastic Code I: Chapter 4 ).
  
−
=== The Netherlands ===
+
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.
  
−
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."<ref>[http://www.minvws.nl/en/themes/euthanasia/default.asp discussion of euthanasia] on the [http://www.minvws.nl site] of the [[Ministry of Public Health, Wellbeing and Sports|Dutch ministry of Health, Welfare and Sports]]</ref>
+
====Islam====
 +
Muslims are against euthanasia. They believe that all human life is sacred because it is given by Allah, and that Allah chooses how long each person will live. Human beings should not interfere in this. Euthanasia and suicide are not included among the reasons allowed for killing in Islam.
  
 +
“……Do not take life, which Allah made sacred, other than in the course of justice….” (Qur'an 17:33).
  
 +
“……If anyone kills a person - unless it be for murder or spreading mischief in the land - it would be as if he killed the whole people…...” (Qur'an 5:32).
  
−
==Non-governmental organizations==
+
The Prophet said: "……Amongst the nations before you there was a man who got a wound, and growing impatient (with its pain), he took a knife and cut his hand with it and the blood did not stop till he died. Allah said, 'My Slave hurried to bring death upon himself so I have forbidden him (to enter) Paradise.'….. " (Sahih Bukhari 4.56.669).
−
Euthanasia policies have also been developed by a variety of NGOs, most notably medical associations and advocacy 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).<ref>Brody, Baruch, McCullough, Rothstein and Bobinski. '''Medical Ethics: Analysis of the issues raised by the Codes, Opinions and Statements'''</ref> 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.<ref>[http://www.doctorsfed.org.uk/content/view/165/39/ On the BMA controversy.]</ref><ref>For professional policies in the English-speaking world, see [http://www.euthanasia.com/page17.html this selection by an advocacy NGO.]</ref>
 
  
−
On euthanasia (narrowly-defined here as directly causing death), Brody sums up the U.S. medical NGO arena:
+
==General Conclusions==
  
−
<blockquote>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.<ref>Brody et al., p.283</ref></blockquote>
+
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, etc.  
  
−
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.<ref>[http://www.dignityindying.org.uk Dignity in Dying.] In an unsympathetic account, the International Task Force on Euthanasia and Assisted Suicide has detailed the ebb and flow of euthanasia proponents. http://www.internationaltaskforce.org/rpt2005_I.htm#204</ref> In addition to professional and religious groups, there are NGOs opposed to euthanasia<ref>http://www.euthanasia.com/page10.html</ref> found in various countries.
+
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.
 +
To summarize, we believe that there are some circumstances when euthanasia is the morally correct action, however, we should also understand that there are real concerns about legalizing euthanasia because of fear of misuse and/or overuse and the fear of the slippery slope leading to a loss of respect for the value of life. What is needed is improvements in research, the best palliative care available, and above all, we should, perhaps, at this time begin modifying homicide laws to include motivational factors as a legitimate defense. Just as homicide is acceptable in cases of self-defense, it could be considered acceptable if the motive is mercy.  
 +
Obviously, strict parameters would have to be established that would include patients' request and approval, or, in the case of incompetent patients, advance directives in the form of a living will or family and court approval. And always remember: Euthanasia is homicide. Some homicides are justified.
 +
And finally, there are countries and/or states ---- such as : Albania ( in 1999 ),  Australia ( 1995 ) , Belgium ( 2002),  Japan ( which is, just recently, strongly leaning towards legalizing it ) , The Netherlands (2002),  the US state of  Oregon, and  Switzerland ( 1942 ), ---- that in one way or other legalized euthanasia; in case of Switzerland, a long time ago.
  
−
==Euthanasia in the arts, film and literature==
+
Others, such as U.K. and USA, are  trying to cease making it illegal. 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]] [[newborn]]s. 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.
−
*[[Alexander (film)]]
 
−
*''[[Children of Men]]''
 
−
* '''Dr. Kiriko''', who specializes in euthanasia, from [[Black Jack (manga)]]
 
−
*''[[The English Patient]]''
 
−
*''[[John Bodkin Adams|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]]
 
−
*''[[Johnny Got His Gun]]'' Book and film
 
−
*''[[Lawrence of Arabia (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 (2004 film)|Simon]]''
 
−
*''[[Soylent Green]]''
 
−
*''[[They Shoot Horses Don't They|They Shoot Horses, Don't They?]]''
 
−
*''[[Whose Life is it Anyway?]]''
 
  
 +
And in the US , recent Gallup Poll surveys showed that more than 60% of Americans supported euthanasia ( Carroll 2006; Moore 2005 ) and 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 [[List of Washington initiatives to the legislature #1990|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 [[Oregon Ballot Measure 16 (1994)|Death with Dignity Act]]. The U.S. Supreme Court has ruled on the constitutionality of assisted suicide, in 2000, recognizing individual interests and deciding how, rather than whether they will die.
  
 +
Perhaps a fitting conclusion of the subject could be the Japanese suggestion of the Law governing euthanasia :
  
−
==Notes==
+
In the case of  '''passive euthanasia''', three conditions must be met:
−
{{reflist}}
 
  
 +
*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.
  
−
==Selected bibliography==
+
*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.
−
=== Neutral (approx.) ===
 
  
−
* Battin, Margaret P., Rhodes, Rosamond, and Silvers, Anita, eds. ''Physician assisted suicide: expanding the debate''. NY: Routledge, 1998.
+
*The patient may be passively euthanized by stopping medical treatment, chemotherapy, dialysis, artificial respiration, blood transfusion, IV drip, etc.
  
−
* 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.
+
For '''active euthanasia''', four conditions must be met:
  
−
{{cite book |author=Dennis J. Horan, David Mall, eds. |title=Death, dying, and euthanasia |publisher=University Publications of America |location=Frederick, MD |year=1977 |pages= |isbn=0-89093-139-9 |oclc= |doi=}}
+
*The patient must be suffering from unbearable physical pain.
  
−
* 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)
+
*Death must be inevitable and drawing near.
  
−
* 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.
+
*The patient must give consent. (Unlike passive euthanasia, living wills and family consent will not suffice.)
  
−
* Palmer, “Dr. Adams’ Trial for Murder” in The Criminal Law Review. (Reporting on R. v. Adams with  Devlin J. at 375f.) 365-377, 1957.
+
*The physician must have (ineffectively) exhausted all other measures of pain relief.
  
−
* 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 ===
 
  
−
{{cite book |author=Giorgio Agamben; translated by Daniel Heller-Roazen |title=Homo sacer: sovereign power and bare life |publisher=Stanford University Press |location=Stanford, Calif |year=1998 |pages= |isbn=0-8047-3218-3 |oclc= |doi=}}
 
  
−
{{cite book |author=Raphael Cohen-Almagor |title=The right to die with dignity: an argument in ethics, medicine, and law |publisher=Rutgers University Press |location=New Brunswick, N.J |year=2001 |pages= |isbn=0-8135-2986-7 |oclc= |doi=}}
 
  
−
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.
 
  
−
{{cite book |author=Derek Humphry, Ann Wickett |title=The right to die: understanding euthanasia |publisher=Harper & Row |location=San Francisco |year=1986 |pages= |isbn=0-06-015578-7 |oclc= |doi=}}
 
  
−
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.
+
==References & Selected bibliography==
  
−
Sacred congregation for the doctrine of the faith. 1980. The declaration on euthanasia. Vatican City: The Vatican.
+
*Battin, Margaret P., Rhodes, Rosamond, and Silvers, Anita, eds. ''Physician assisted suicide: expanding the debate''. NY: Routledge, 1998
 +
*Dworkin, R. M. Life's Dominion: An Argument About Abortion, Euthanasia, and Individual Freedom. New York: Knopf, 1993
 +
*Fletcher, Joseph F.. Morals and medicine; the moral problems of: the patient's right to know the truth, contraception, artificial insemination, sterilization, euthanasia, Princeton University Press, Princeton, N.J, 1954
 +
*Humphry, D., and Ann Wickett, The right to die: understanding euthanasia, Harper & Row, San Francisco 1986
 +
*Kamisar, Yale, “Some non-religious views against proposed 'mercy-killing'  legislation”;  in: Death, dying, and euthanasia, edited by D. J. Horan and D. Mall. University Publications of America, Washington, 1977; Original edition, Minnesota Law Review 42:6 (May 1958)
 +
*Kopelman, Loretta M., deVille, Kenneth A., eds. ''Physician-assisted suicide: What are the issues?'' Kluwer Academic Publishers, Dordrecht 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
 +
*Moore, D.,  “Three in Four Americans Support Euthanasia.” The Gallup Organization. May 17, 2005
 +
*Panicola, Michael,  . Catholic teaching on prolonging life: setting the record straight. In Death and dying: a reader, edited by T. A. Shannon. Lanham, Rowman & Littlefield Publishers. MD, 2004
 +
*PCSEPMBBR, President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Washington, DC, United States 1983; Deciding to forego life-sustaining treatment: a report on the ethical, medical, and legal issues in treatment decisions,: President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Supt. of Docs. U.S. G.P.O., 1983
 +
*Rachels, James, The End of Life: Euthanasia and Morality, Oxford University Press, New York, 1986; orig. in: New England Journal of Medicine, 1975
 +
*Robertson, John, “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. 1977Original 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.
 +
*Sacred congregation for the doctrine of the faith: “The declaration on euthanasia”, The Vatican, Vatican City 1980
  
 
==External links==
 
==External links==

Revision as of 22:54, 6 July 2007



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. We should also note that euthanasia is when a substance is administered to a person with intent to kill them. Euthanasia is not removing someone from life support. There is an enormous moral divide between making someone die and letting someone die. One is murder, the other is simply allowing nature to take its course ( though even this moral divide is not acknowledged by various pro-life groups). Consequently, 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. Here, we should also point out that suicide or attempted suicide, in most states, is no longer a criminal offence. This demonstrates that there is consent among the states to self determination, however, the majority of the states postulate that assisting in suicide is illegal and punishable even when there is written consent from the individual. A problem with the written consent is that it could be coerced; if active euthanasia were to become legal, process would have to be in place to assure that the patient's consent is fully voluntary. Now, back to euthanasia :

Terminology

Euthanasia generally

Euthanasia has several meanings:

  • 1.Literally "good death", any peaceful death.
  • 2.Using an injection of seconal to kill a pet when it becomes homeless, old, sick or feeble.
  • 3.Hitler decided to remove certain groups from the gene pool by killing homosexuals, Jews, gypsies and mentally retarded people. Euthanasia was the Nazi euphemism.
  • 4.Killing a patient at the request of the family. The patient is brain dead, comatose or otherwise incapable of letting it be known if he or she would prefer to live or die.
  • 5.Mercy killing.
  • 6.Physician-assisted suicide.
  • 7.Killing a terminally ill person at their reques.

We use the term euthanasia only in senses (6) and (7) in this article. When other people debate about euthanasia they could well be using it in senses (1) through (5), or with some other definition. Unfortunately, in English, we use the same word for seven different things. To make this distinction clearer, two other definitions of euthanasia follow:

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. To this point James Rachels challenges both the use and moral significance of that distinction for several reasons. He writes: "…..To begin with a familiar type of situation, a patient who is dying of incurable cancer of the throat is in terrible pain, which can no longer be satisfactorily alleviated. He is certain to die within a few days, even if present treatment is continued, but he does not want to go on living for those days since the pain is unbearable. So he asks the doctor for an end to it, and his family joins in this request….. Suppose the doctor agrees to withhold treatment...The justification for his doing so is that the patient is in terrible agony, and since he is going to die anyway, it would be wrong to prolong his suffering needlessly. But now notice this. If one simply withholds treatment, it may take the patient longer to die, and so he may suffer more than he would if more direct action were taken and a lethal injection given. This fact provides strong reason for thinking that, once the initial decision not to prolong his agony has been made, active euthanasia is actually preferable to passive euthanasia, rather than the reverse……." ( Rachels 1975 and 1986 )

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. 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 .

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.

Mercy killing

Killing someone to put them out of their suffering. The killer may or may not have the informed consent of the person killed. We shall use the term mercy killing only when there is no consent. Legally, mercy killing is usually treated as murder.

Murder

Intentionally killing someone in an unlawful way. There are two kinds of murder. 1. The murderer has the informed consent of the person killed. 2. The murderer does not have the informed consent of the person killed. In most parts of the world, types (1) and (2) murder are treated identically. In other parts, type (1) murder is excusable under certain special circumstances, in which case it ceases to be considered murder. Murder is by definition unlawful. It is a legal term not a moral one. Whether euthanasia is murder or not is a simple question for lawyers — "Will you go to jail for doing it or won't you?" Whether euthanasia should be considered murder or not is a matter for legislators. Whether euthansia is good or bad is a deep question for the individual citizen. A right to die and a pro life proponent could both agree "euthanasia is murder", meaning you will go to jail if you are caught doing it, but the right to die person would add, "but under certain circumstances, it should not be, just as it is not considered murder now in the Netherlands."

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.E. 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. It distinguished a suicide, who was by definition of unsound mind, from a felo-de-se or "evildoer against himself," who had coolly decided to end it all and thereby perpetrated an “infamous crime”. Such a person forfeited his entire estate to the crown. Furthermore his corpse was subjected to public indignities, such as being dragged through the streets and hung from the gallows, and was finally consigned to "ignominious burial," and ,as the legal scholars put it, the favoured method was beneath a crossroads with a stake driven through the body.

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.

The earliest American statute explicitly to outlaw assisting suicide was enacted in New York in 1828 (Act of Dec. 10, 1828, ch. 20, §4, 1828 N. Y. Laws 19; codified at 2 N. Y. Rev. Stat. pt. 4, ch. 1, tit. 2, art. 1, §7, p. 661,1829), and many of the new States and Territories followed New York's example.

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"). Meanwhile, during this same era, 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 ( Kamisar 1977 ).

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

Leo Alexander, a judge at the Nuremberg trials after World War II, employed a ( slippery slope ) argument to suggest that any act of mercy killing inevitably will lead to the mass killings of unwanted persons. He wrote: "…..The beginnings at first were a subtle shifting in the basic attitude of the physicians. It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as life not worthy to be lived. This attitude in its early stages concerned itself merely with the severely and chronically sick. Gradually, the sphere of those to be included in this category was enlarged to encompass the socially unproductive, the ideologically unwanted, the racially unwanted and finally all non-Germans….."

Critics of this position point to the fact that there is no relation at all between the Nazi "euthanasia" program and modern debates about euthanasia. The Nazis, after all, used the word "euthanasia" to camouflage mass murder. All victims died involuntarily, and no documented case exists where a terminal patient was voluntarily killed. The program was carried out in the closest of secrecy and under a dictatorship. One of the lessons that we should learn from this experience is that secrecy is not in the public interest.

However, 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 ( Papal statements 1956-1957). On the other hand, judges were often lenient in mercy-killing cases( Humphrey and Wickett, ch.4.).

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. In 1975 Karen Ann Quinlan, for reasons still unknown, ceased breathing for several minutes. Failing to respond to mouth-to mouth resuscitation by friends she was taken by ambulance to a hospital in New Jersey. Physicians who examined her described her as being in "a chronic, persistent, vegetative state," and later it was judged that no form of treatment could restore her to cognitive life. Her father asked to be appointed her legal guardian with the expressed purpose of discontinuing the respirator which kept Karen alive. After some delay the Supreme Court of New Jersey granted the request. The respirator was turned off. Karen Ann Quinlan remained alive but comatose until June 11, 1985, when she died at the age of 31. 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 later tried and convicted in 1999 for a murder displayed on television. Meanwhile in 1990, the Supreme Court approved the use of non-aggressive euthanasia.


Influence of religious policies on opinion regarding euthanasia

Suicide or attempted suicide, in most states, is no longer a criminal offence. This demonstrates that there is consent among the states to self determination, however, the majority of the states postulate that assisting in suicide is illegal and punishable even when there is written consent from the individual. A problem with the written consent is that it could be coerced; if active euthanasia were to become legal, process would have to be in place to assure that the patient's consent is fully voluntary. Let us now see how individual religions regard the complex subject of euthanasia.

Christian religions

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 Declaration on Euthanasia ( Sacred Congregation…, Vatican 1980).

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 ( ibid. ).

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 ( see writings of Daniel Sinclair, Moshe Tendler, Shlomo Zalman Auerbach, Moshe Feinstein. Likewise, within the Conservative Judaism movement, there has been increasing support for passive euthanasia. In Reform Judaism responsa, the preponderance of anti-euthanasia sentiment has shifted in recent years to increasing support for certain passive euthanasia.

Non-Abrahamic religions

Buddhism and Hinduism

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 ( Buddhist Monastic Code I: Chapter 4 ).

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.

Islam

Muslims are against euthanasia. They believe that all human life is sacred because it is given by Allah, and that Allah chooses how long each person will live. Human beings should not interfere in this. Euthanasia and suicide are not included among the reasons allowed for killing in Islam.

“……Do not take life, which Allah made sacred, other than in the course of justice….” (Qur'an 17:33).

“……If anyone kills a person - unless it be for murder or spreading mischief in the land - it would be as if he killed the whole people…...” (Qur'an 5:32).

The Prophet said: "……Amongst the nations before you there was a man who got a wound, and growing impatient (with its pain), he took a knife and cut his hand with it and the blood did not stop till he died. Allah said, 'My Slave hurried to bring death upon himself so I have forbidden him (to enter) Paradise.'….. " (Sahih Bukhari 4.56.669).

General Conclusions

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, etc.

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. To summarize, we believe that there are some circumstances when euthanasia is the morally correct action, however, we should also understand that there are real concerns about legalizing euthanasia because of fear of misuse and/or overuse and the fear of the slippery slope leading to a loss of respect for the value of life. What is needed is improvements in research, the best palliative care available, and above all, we should, perhaps, at this time begin modifying homicide laws to include motivational factors as a legitimate defense. Just as homicide is acceptable in cases of self-defense, it could be considered acceptable if the motive is mercy. Obviously, strict parameters would have to be established that would include patients' request and approval, or, in the case of incompetent patients, advance directives in the form of a living will or family and court approval. And always remember: Euthanasia is homicide. Some homicides are justified. And finally, there are countries and/or states ---- such as : Albania ( in 1999 ), Australia ( 1995 ) , Belgium ( 2002), Japan ( which is, just recently, strongly leaning towards legalizing it ) , The Netherlands (2002), the US state of Oregon, and Switzerland ( 1942 ), ---- that in one way or other legalized euthanasia; in case of Switzerland, a long time ago.

Others, such as U.K. and USA, are trying to cease making it illegal. 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.

And in the US , recent Gallup Poll surveys showed that more than 60% of Americans supported euthanasia ( Carroll 2006; Moore 2005 ) and 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. The U.S. Supreme Court has ruled on the constitutionality of assisted suicide, in 2000, recognizing individual interests and deciding how, rather than whether they will die.

Perhaps a fitting conclusion of the subject could be the Japanese suggestion of the Law governing euthanasia :

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

  • 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.
  • 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.
  • 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:

  • The patient must be suffering from unbearable physical pain.
  • Death must be inevitable and drawing near.
  • The patient must give consent. (Unlike passive euthanasia, living wills and family consent will not suffice.)
  • The physician must have (ineffectively) exhausted all other measures of pain relief.


References & Selected bibliography

  • Battin, Margaret P., Rhodes, Rosamond, and Silvers, Anita, eds. Physician assisted suicide: expanding the debate. NY: Routledge, 1998
  • Dworkin, R. M. Life's Dominion: An Argument About Abortion, Euthanasia, and Individual Freedom. New York: Knopf, 1993
  • Fletcher, Joseph F.. Morals and medicine; the moral problems of: the patient's right to know the truth, contraception, artificial insemination, sterilization, euthanasia, Princeton University Press, Princeton, N.J, 1954
  • Humphry, D., and Ann Wickett, The right to die: understanding euthanasia, Harper & Row, San Francisco 1986
  • Kamisar, Yale, “Some non-religious views against proposed 'mercy-killing' legislation”; in: Death, dying, and euthanasia, edited by D. J. Horan and D. Mall. University Publications of America, Washington, 1977; Original edition, Minnesota Law Review 42:6 (May 1958)
  • Kopelman, Loretta M., deVille, Kenneth A., eds. Physician-assisted suicide: What are the issues? Kluwer Academic Publishers, Dordrecht 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
  • Moore, D., “Three in Four Americans Support Euthanasia.” The Gallup Organization. May 17, 2005
  • Panicola, Michael, . Catholic teaching on prolonging life: setting the record straight. In Death and dying: a reader, edited by T. A. Shannon. Lanham, Rowman & Littlefield Publishers. MD, 2004
  • PCSEPMBBR, President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Washington, DC, United States 1983; Deciding to forego life-sustaining treatment: a report on the ethical, medical, and legal issues in treatment decisions,: President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Supt. of Docs. U.S. G.P.O., 1983
  • Rachels, James, The End of Life: Euthanasia and Morality, Oxford University Press, New York, 1986; orig. in: New England Journal of Medicine, 1975
  • Robertson, John, “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. 1977Original 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.
  • Sacred congregation for the doctrine of the faith: “The declaration on euthanasia”, The Vatican, Vatican City 1980

External links

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Opposition


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