Euthanasia is a practice of mercifully ending a person’s life

Euthanasia

I

INTRODUCTION

Euthanasia is a practice of mercifully ending a person’s life in order to release the person from an incurable disease, intolerable suffering, or undignified death. The word euthanasia derives from the Greek for “good death” and originally referred to intentional mercy killing. When medical advances made prolonging the lives of dying or comatose patients possible, the term euthanasia was also applied to a lack of action to prevent death.

Active euthanasia involves painlessly putting individuals to death for merciful reasons, as when a doctor administers a lethal dose of medication to a patient. Passive euthanasia involves not doing something to prevent death, as when doctors refrain from using an artificial respirator to keep alive a terminally ill patient.

In voluntary euthanasia, a person asks to die (by either active or passive euthanasia). Nonvoluntary euthanasia refers to ending the life of a person who is not mentally competent to make an informed request to die, such as a comatose patient.

Euthanasia differs from assisted suicide, in which a patient voluntarily brings about his or her own death with the assistance of another person, typically a physician. In this case, the act is a suicide (intentional self-inflicted death), because the patient actually causes his or her own death.

II

BACKGROUND

Euthanasia has been accepted in some forms by various groups or societies throughout history. In ancient Greece and Rome helping others die or putting them to death was considered permissible in some situations. For example, in the Greek city of Sparta newborns with severe birth defects were put to death. Voluntary euthanasia for the elderly was an approved custom in several ancient societies. However, as Christianity developed and grew powerful in the West, euthanasia became morally and ethically abhorrent and was viewed as a violation of God’s gift of life. Today most branches of Christianity, Judaism, and Islam condemn active euthanasia, although some permit restricted forms of passive euthanasia.

Following traditional religious principles, Western laws have generally treated the act of assisting someone in dying as a form of punishable homicide (unlawful killing). However, in modern times laws have become more secular. Those who wish to legalize euthanasia have argued that, under principles of individual liberty (such as those expressed in the Constitution of the United States), individuals have a legal right to die as they choose. Most countries (including the United States), however, have not fully adopted this position and retain restrictions on euthanasia.

The first organizations to promote the legalization of voluntary euthanasia in the United States and Great Britain formed in the 1930s. For several decades these organizations remained small and had little impact. However, in the late 1970s the pro-euthanasia movement gained significant momentum after a highly publicized incident in the United States. In 1975 a 21-year-old woman named Karen Ann Quinlan suffered a respiratory arrest that resulted in severe and irreversible brain damage and left her in a coma. Several months later, after doctors informed them that their daughter’s recovery was extremely unlikely, Quinlan’s parents requested that artificial means of life support be removed. The hospital refused this request.

After a lengthy legal battle, in 1976 the Quinlans obtained a court order allowing them to remove the artificial respirator that was thought to be keeping their daughter alive. The New Jersey Supreme Court ruled that the Quinlans could disconnect the device so that the patient could “die with dignity.” This decision spawned increased discussion of the scope of patients’ rights to control their death. (Although the respirator was removed in 1976, Quinlan began to breathe on her own. She lived until 1985 without ever regaining consciousness.)

In the early 1990s the decision of Nancy B. v. Hotel-Dieu de Quebec in Canada played a similar role in promoting public awareness of the issues surrounding euthanasia. In this case, a young woman paralyzed as a result of the rare disease known as Guillain-Barré syndrome wished to have the artificial breathing mechanism that kept her alive disconnected. Concluding that such refusal of treatment was permissible, in January 1992 a Québec superior court judge authorized the woman’s physician to remove the respirator.

III

LAWS

As laws have evolved from their traditional religious underpinnings, certain forms of euthanasia have been legally accepted. In general, laws attempt to draw a line between passive euthanasia (generally associated with allowing a person to die) and active euthanasia (generally associated with killing a person). While laws commonly permit passive euthanasia, active euthanasia is typically prohibited.

A

In the United States and Canada

Laws in the United States and Canada maintain the distinction between passive and active euthanasia. While active euthanasia is prohibited, courts in both countries have ruled that physicians should not be legally punished if they withhold or withdraw a life-sustaining treatment at the request of a patient or the patient’s authorized representative. These decisions are based on increasing acceptance of the doctrine that patients possess a right to refuse treatment.

Until the late 1970s, whether or not patients possessed a legal right of refusal was highly disputed. One factor that may have contributed to growing acceptance of this right is the ability to keep individuals alive for long periods of time—even when they are permanently unconscious or severely brain-damaged. Proponents of legalized euthanasia believe that prolonging life through the use of modern technological advances, such as respirators and kidney machines, may cause unwarranted suffering to the patient and the family. As technology has advanced, the legal rights of the patient to forgo such technological intervention have expanded.

Every U.S. state has adopted laws that authorize legally competent individuals to make advanced directives, often referred to as living wills. Such documents allow individuals to control some features of the time and manner of their deaths. In particular, these directives empower and instruct doctors to withhold life-support systems if the individuals become terminally ill. Furthermore, the federal Patient Self-Determination Act, which became effective in 1991, requires federally certified health-care facilities to notify competent adult patients of their right to accept or refuse medical treatment. The facilities must also inform such patients of their rights under the applicable state law to formulate an advanced directive. Patients in Canada have similar rights to refuse life-sustaining treatments and formulate advanced directives.

Only one U.S. state, Oregon, has enacted a law allowing physicians to actively assist patients who wish to end their lives. However, Oregon’s law concerns assisted suicide rather than active euthanasia. It authorizes physicians to prescribe lethal amounts of medication that patients then administer themselves.

In response to modern medical technology, physicians and lawmakers are slowly developing new professional and legal definitions of death. Additionally, experts are formulating rules to implement these definitions in clinical situations—for example, when procuring organs for transplantation. The majority of states have accepted a definition of brain death—the point when certain parts of the brain cease to function—as the time when it is legal to turn off a patient’s life-support system, with permission from the family.

B

In Other Countries

In 1995 the Northern Territory of Australia became the first jurisdiction to explicitly legalize voluntary active euthanasia. However, the federal parliament of Australia overturned the law in 1997. In 2001 The Netherlands became the first country to legalize active euthanasia and assisted suicide, formalizing medical practices that the government had tolerated for years. Under the Dutch law, euthanasia is justified (not legally punishable) if the physician follows strict guidelines. Justified euthanasia occurs if (1) the patient makes a voluntary, informed, and stable request; (2) the patient is suffering unbearably with no prospect of improvement; (3) the physician consults with another physician, who in turn concurs with the decision to help the patient die; and (4) the physician performing the euthanasia procedure carefully reviews the patient’s condition. Officials estimate that about 2 percent of all deaths in The Netherlands each year occur as a result of euthanasia.

In 2002 the parliament of Belgium legalized active euthanasia under limited conditions. Like the Dutch law, the Belgian law allows physicians to perform euthanasia only for patients who are suffering unbearably with no hope of improvement. The patient must make a voluntary, well-considered, and repeated request to die, and the request must be put in writing. Other physicians must be consulted to confirm the patient’s condition. Additionally, each act of euthanasia must be reported to a government commission for review.

IV

PREVALENCE

Although establishing the actual prevalence of active euthanasia is difficult, studies suggest that the practice is not common in the United States. In a study published in 1998 in the New England Journal of Medicine, only about 6 percent of physicians surveyed reported that they had helped a patient hasten his or her own death by administering a lethal injection or prescribing a fatal dose of medication. (Eighteen percent of the responding physicians indicated that they had received requests for such assistance.) However, one-fifth of the physicians surveyed indicated that they would be willing to assist patients if it were legal to do so. No comparable data are available for Canada. However, in 1998 the Canadian Medical Association (CMA) proposed that a study of euthanasia and physician-assisted suicide be undertaken due to poor information on the subject.

V

ETHICAL CONCERNS

The issue of euthanasia raises ethical questions for physicians and other health-care providers. The ethical code of physicians in the United States has long been based in part on the Hippocratic Oath, which requires physicians to do no harm. However, medical ethics are refined over time as definitions of harm change. Prior to the 1970s, the right of patients to refuse life-sustaining treatment (passive euthanasia) was controversial. As a result of various court cases, this right is nearly universally acknowledged today, even among conservative bioethicists (see Medical Ethics).

The controversy over active euthanasia remains intense, in part because of opposition from religious groups and many members of the legal and medical professions. Opponents of voluntary active euthanasia emphasize that health-care providers have professional obligations that prohibit killing. These opponents maintain that active euthanasia is inconsistent with the roles of nursing, caregiving, and healing. Opponents also argue that permitting physicians to engage in active euthanasia creates intolerable risks of abuse and misuse of the power over life and death. They acknowledge that particular instances of active euthanasia may sometimes be morally justified. However, opponents argue that sanctioning the practice of killing would, on balance, cause more harm than benefit.

Supporters of voluntary active euthanasia maintain that, in certain cases, relief from suffering (rather than preserving life) should be the primary objective of health-care providers. They argue that society is obligated to acknowledge the rights of patients and to respect the decisions of those who elect euthanasia. Supporters of active euthanasia contend that since society has acknowledged a patient’s right to passive euthanasia (for example, by legally recognizing refusal of life-sustaining treatment), active euthanasia should similarly be permitted. When arguing on behalf of legalizing active euthanasia, proponents emphasize circumstances in which a condition has become overwhelmingly burdensome for a patient, pain management for the patient is inadequate, and only a physician seems capable of bringing relief. They also point out that almost any individual freedom involves some risk of abuse and argue that such risks can be kept to a minimum by using proper legal safeguards.