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Euthanasia (Greek, "good death") is the practice of killing a person or animal, in a painless or minimally painful way, for merciful reasons, usually to end their suffering. This article discusses euthanasia in humans; a separate article covers animal euthanasia.
Euthanasia in the strict sense involves actively causing death. This is in some cases legal in the Netherlands (see below), but in few other countries. Euthanasia in a wider sense includes assisting someone to commit suicide, in particular physician-assisted suicide (PAS).
Allowing death—e.g. by not providing life support or vital medication—is not considered euthanasia if it is the patient's wish. It is sometimes called passive euthanasia in cases where the patient is unable to make decisions about treatment. Living wills and Do Not Resuscitate orders are legal instruments that make a patient's treatment decisions known ahead of time; allowing a patient to die based on such decisions is never considered euthanasia.
In some cases, a patients' religion must be taken into account, for example Jehovah's Witnesses are not allowed to accept blood transfusions for themselves or their loved ones, and cannot be resuscitated, as both of these are against their beliefs.
Terminal sedation is a combination of medically inducing a deep sleep and stopping other treatment. It is considered to be euthanasia by some, but under current law and medical practice it is considered a form of palliative care.
Advocates of euthanasia generally insist that euthanasia should be voluntary, requiring informed consent, and that it should only be used in cases of terminal illness that cause unbearable suffering. Its opponents challenge it on several ethical grounds, including a slippery slope argument that it is the first step towards compulsory euthanasia.
Types of euthanasia
Apart from the above classifications three types of euthanasia may be identified, depending upon the sentience of the individual.
Voluntary euthanasia
This is the truest and fullest form of euthanasia wherein the individual requests euthanasia - either during illness or before, if complete incapacitation is expected (coma would be an example). Euthanasia in these cases differs from suicide by existing only within the context of the amelioration of suffering in the process of death. Volition must be informed and free (i.e. not under duress from any third party).
Non-voluntary euthanasia
Where an individual lacks sentience (in a coma, for example) and hence cannot decide, or distinguish, between life and death, such a person cannot give consent or cannot give informed consent, and therefore any euthanasia is not voluntary but also not involuntary. Famously notable as "turning off life-support", it is often done when resuscitation is not expected, or after severe brain damage that renders a person incapable of making life decisions.
Involuntary euthanasia
Where an individual may distinguish between life and death - and may fully realise the difference between them, any medical killing is involuntary. If, for example, a man is going to experience severe agony and does not consent to death, euthanasia imposed upon him is ethically and morally, if not legally, forbidden as murder.
In Nazi Germany the term "euthanasia" (Euthanasie) referred to the systematic killing of deformed children and mentally ill adults under the T-4 Euthanasia Program. This has tainted the word in German-speaking countries; the alternate term is "Sterbehilfe", which means "help to die." Any time that medical personnel determine on behalf of a sentient and responsible individual that his or her life is not worth living, the medical killing of such a person as it is considered to be done for the prevention of suffering is involuntary euthanasia. This is not to be confused with medical killing in cases of capital punishment or as part of genocide.
Arguments for and against euthanasia
Proponents of euthanasia argue that only patients can determine when suffering makes life worse than death and that such persons can and should be allowed to make the decision. Some also argue that terminally ill patients are respected more by having their suffering end than by being kept alive against their will. Additionally, a utilitarian argument can be made about the harms to the whole of maintaining the individual beyond viability. Philosopher Peter Singer has been one of the most outspoken proponents of euthanasia, arguing from a utilitarian philosophical point of view.
Arguments from opponents of euthanasia can be divided in two main categories: religious and prudential.
Many religious people, primarily Christians, object that it is not loving to kill someone, and that pain medications are good enough that suffering is preventable if doctors have the will. Many religions also regard one's life as being derived from God and thus that either it is His (not one's own) to take, or that destroying it is an offense to Him. Further, in most Western nations the prohibition on killing is considered a moral absolute that cannot be conditioned by ethical concerns.
The second type of argument against euthanasia is that it is not prudent to advocate it; that is, eventually we all may be suffering, and if we think ahead, we may think it better if the doctors on whom we depend are not tempted to perform euthanasia. If euthanasia were to be allowed, it is feared by some, doctors might press people into euthanasia to reduce medical costs, or because their family wants them to die. (It should be noted that saving the family medical costs would be a coercive factor and therefore would disqualify a person from informed and free consent.) Additionally, however, doctors themselves often argue against euthanasia, as providing death is antithetical to their primary function and training. If, some have argued, a doctor is trained both to cure and kill, then he or she is being told always to judge when to kill and his or her best efforts at saving life will not be expended.
The peaceful and painless death by euthanasia may be a chimera, as euthanasia does not always succeed in its goals, but the ethical and legal debates engendered by the practice proceed from the question of principle, rather than any single practice.
Legislation and national political movements
Australia
Euthanasia was legalised in Australia's Northern Territory, by the Rights of the Terminally Ill Act 1995. However, this law was soon made ineffective by an amendment by the Commonwealth government to the Northern Territory (Self-Government) Act 1978. (The powers of the Northern Territory legislature, unlike those of the State legislatures, are not guaranteed by the Australian Constitution.) Three people had already been legally euthanised, however, before the Commonwealth government made this amendment.
Belgium
After an extensive discussion the Belgian parliament legalised euthanasia in late September 2002. The new legislation, however, institutes a complicated process, which has been criticized as an attempt to establish a bureaucracy of death. Nevertheless, euthanasia is now legal and its proponents in the country hope that it will stop many illegal practises (it is said that several thousand illegal acts of euthanasia have been carried out in Belgium each year). (disputed — see talk page)
The Netherlands
In The Netherlands the Termination of Life on Request and Assisted Suicide (Review Procedures) Act, legalizing euthanasia and PAS in certain circumstances, took effect on April 1, 2002.
The law permits euthanasia and PAS when each of the following conditions is fulfilled:
- the patient has asked repeatedly
- the patient's suffering is unbearable with no prospect of improvement
- the doctor has prior to the act consulted a colleague.
The doctor must also report the cause of death to the municipal coroner in accordance with the relevant provisions of the Burial and Cremation Act. A regional review committee assesses whether a case of termination of life on request or assisted suicide complies with the due care criteria. Depending on its findings, the case will either be closed or brought to the attention of the Public Prosecutor. Finally, the legislation offers an explicit recognition of the validity of a written declaration of will of the patient regarding euthanasia (a "euthanasia directive"). Such declarations can be used when a patient is in coma or otherwise unable to state whether they want euthanasia or not.
Euthanasia remains a criminal offense in cases not meeting the law's specific conditions, with the exception of several situations that are not subject to the restrictions of the law at all, because they are considered normal medical practice:
- stopping or not starting a medically useless treatment
- at the patient's request stopping or not starting a treatment
- speeding up death as side-effect of treatment necessary for alleviating serious suffering
From the time that euthanasia first came to be widely practiced in the Netherlands, it was formally subject to review by boards of doctors in each hospital. The law essentially codified what had already become unofficial law by judgments in the courts.
The legislation has wide support among the socially libertarian Dutch, who have one of the world's highest life expectancies.
Statistics and methods
In 2003, in the Netherlands 1626 cases were reported of euthanasia in the sense of a physician causing death. Usually the sedative sodium thiopental is intravenously administered to induce a coma, and after making sure the patient is in a deep coma, typically after some minutes, a muscle relaxant is administered to stop the breathing and cause death.
There were 148 cases of PAS, usually by drinking a strong barbiturate potion. The doctor has to be present for two reasons:
- to make sure the potion is not taken by a different person, by accident (or, theoretically, for "unauthorized" suicide or perhaps even murder)
- to monitor the process and be available to apply the combined procedure mentioned below, if necessary.
In two cases the doctor was reprimanded for not being present while the patient drank the potion. They did not realize that this is required.
In addition, there were 41 cases of a combination of the two procedures: usually these cases concern the situation that the patient drinks the potion, but that this does not cause death. After a few hours, or earlier in the case of vomiting, the muscle relaxant is administered to cause death.
By far, most cases concerned cancer patients. Also, in most cases the procedure was applied at home.
United States
In the United States, the most common form of euthanasia is withholding tube-feeding to elderly and incapacitated patients. This is generally considered an abuse when the patient might recover. These patients die protracted deaths by dehydration. However, it is so common in some areas that the family must actively prevent it, or it will occur. (disputed — see talk page)
Contrary to the rest of the United States, Oregon has legalized assisted suicide: residents have voted for it at the Oregon Ballot Measure 16 (1994), and voted against repealing it at the Oregon Ballot Measure 51 (1997). As of 2002, it is estimated that nearly 100 terminally ill patients have committed doctor assisted suicide since the law went into effect in 1997. It is difficult to determine accurate figures, since doctors are not required by law to report when they have granted the patient's request. Oregon's law has been attacked by various organizations, and federal government parties that support those organizations, ever since it was first enacted.
See also
External links
de:Sterbehilfe
fr:Euthanasie
nl:Euthanasie
pl:Eutanazja
zh:安乐死
sv:Ddshjlp
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