The word euthanasia is formed from the Greek eu (good) and thanatos (death) and is commonly used to refer to the act of deliberately causing the death of a person in severe pain as a result of a terminal or incurable illness. Euthanasia may be defined as “active,” where there is a deliberate act to end a terminally ill person’s life, or “passive,” where life-prolonging medical treatment is deliberately withheld or withdrawn, with the latter practice relatively uncontroversial.
Voluntary euthanasia (VE) occurs when a third party intentionally takes another’s life to relieve that person’s suffering and does so in response to that person’s request. Nonvoluntary euthanasia occurs when the patient’s explicit consent is unavailable, for example, due to being in a persistent vegetative state; while involuntary euthanasia arises where the patient is killed against their will. In assisted suicide (AS), a third party helps the patient to end his or her life, but does not administer any fatal treatment; when the third party is a medical practitioner, this is referred to as physician-assisted suicide (PAS). VE and AS raise a number of ethical, legal, and practical issues.
Arguments for VE and AS
The key arguments in favor of VE and AS are primarily rooted in the basic rights of individuals. Patient autonomy and self-determination mean that individuals have the right to control their own bodies, including how and when they die. Further, as long as euthanasia remains illegal, its administration will be inconsistent and potentially discriminatory as it will not be equally available to all who seek it. Advocates argue that where there is no reasonable prospect of meaningful recovery, compassion demands that patients’ suffering not be prolonged against their will.
Prohibitions are ineffective and may bring the law into disrepute; the fact that breaches of the law are routinely ignored or go unpunished may undermine public confidence in the law. According to critics, the law is incoherent, and there is no moral justification for permitting passive euthanasia while denying active euthanasia. Similarly, since it is not generally an offence to commit suicide, it is illogical that assisting someone to do so is illegal.
Opinion polls generally show strong and increasing public support for VE. Some proponents contend that regulation and the development of appropriate guidelines and reporting practices may promote patient rights.
Arguments Against VE and AS
The key arguments against VE and AS are generally philosophical or metaphysical. Religious opponents hold that life is sacred and that deliberately ending someone’s life can never be justified. Many believe that suffering is part of life and find value even in this aspect of existence. Physical suffering has traditionally been viewed as a means of promoting spiritual growth.
The medical profession is particularly affected by end-of-life decisions by their patients. PAS undermines the role of medical professionals as healers, many of whom feel compelled to extend a patient’s life as far as their abilities will allow. Active euthanasia, however, is a much greater challenge to the medical professional’s call to “do no harm.” Physicians may feel pressured by patients or their patients’ families into assisting with a suicide against their principles. Dread, some argue, is the driving motivation for most terminally ill patients to seek an early death. Improvements in palliative care, however, may allow patients to live out their lives without enduring physical pain while dying.
Finally, there exists the potential for abuse. Vulnerable patients may feel pressured into consenting to end their lives. Others may opt for euthanasia in order to relieve their families of the burden of caring for them. The terminally ill frequently suffer from depression and may look to VE rather than treatment as a source of relief.
VE, AS, and the Law
Although VE is illegal in Switzerland, AS has been legal since 1941, provided the person assisting in another’s suicide is acting altruistically and not out of self-interest. There is no requirement that the patient be a resident of Switzerland or for a physician to be involved. Between 1998 and 2011, the Dignitas organization reportedly assisted in the deaths of 1,298 people; official figures indicated that 97 foreigners traveled to Switzerland to die in 2010, down from 199 in 2006.
In the Netherlands, a court decision in 1984 provided a defense of necessity for doctors who assisted in a patient’s death if this was the only way of ending their suffering. Between 1994 and 2002, prosecutorial guidelines indicated when a doctor would be charged in relation to such cases. The Termination of Life on Request and Assisted Suicide (Review Procedures) Act went into effect in 2002, making VE and PAS legal in the Netherlands. National surveys in 1990, 1995, 2001, 2005, and 2010 revealed that VE accounted for 1.7 to 2.8 percent of deaths, while AS accounted for 0.1 to 0.2 percent of deaths. The proportion of deaths attributable to VE and AS does not appear to have increased since the law was changed in2002, while the incidence of life-terminating acts without explicit request of the patient decreased from 0.8 to 0.7 percent from 1990 to 2001 to 0.4 percent in 2005 and 0.2 percent in 2010.
PAS is available in three jurisdictions in the United States. Oregon passed the Death With Dignity Act in 1994, and the legislation went into effect in December 1997. Between 1998 and 2011, there were 596 PAS deaths, increasing steadily from 16 in 1998 to 71 in 2011; however, the rate of such deaths remains low, at approximately 2 per 1,000 deaths.
In 1996, the Northern Territory (NT) in Australia legislated to permit VE and AS. The legislation was upheld by the NT Supreme Court, but was repealed in 1997 by the Commonwealth Euthanasia Laws Act (1997), which denied the NT and two other jurisdictions the power to make laws permitting euthanasia or AS. At the time the act was repealed, four people were reported to have received assistance in dying under the act.
In 1997, Colombia’s highest court decriminalized euthanasia in circumstances in which a patient suffered from a terminal illness, had requested death, and no medical treatments existed. In 2010, the same court ruled that “no person can be held criminally responsible for taking the life of a terminally ill patient who has given clear authorization to do so.” In August 2012, the Colombian Senate approved the regulation of euthanasia.
Belgium passed the Act on Euthanasia in 2002, making VE available to adults and emancipated minors. It is also available to unconscious patients (non-voluntary euthanasia), provided the person signed a declaration in advance requesting euthanasia. In 1997, VE accounted for 1.1 percent of deaths; by 2005, this had risen to 1.9 percent. However, the incidence of AS fell from 0.12 percent to 0.07 percent, while life-terminating acts without the explicit request of the patient fell from 3.2 percent to 1.8 percent. There were reportedly 1,133 euthanasia deaths in 2011, compared with 393 in 2005.
A 2009 decision by the Supreme Court of Montana determined that there was “nothing in Montana [law] … indicating that physician aid in dying is against public policy.” Also in 2009, the Death With Dignity Act passed in Washington State. By the end of 2011, there had been 157 PAS deaths, increasing from 36 in 2009 to 70 in 2011.
Euthanasia and AS were legalized in Luxembourg by the Law of 16 March 2009 on Euthanasia and Assisted Suicide. There were reportedly five cases in 2009–10. In England and Wales, the consent of the director of public prosecutions (DPP) is required to prosecute suspected AS cases. In 2010, the DPP released its Policy for Prosecutors in Respect of Cases of Encouraging or Assisting Suicide, which sets out 16 public interest factors in favor of prosecution (e.g., the victim was under 18) and six factors against prosecution (e.g., the victim had reached a voluntary, clear, settled, and informed decision to commit suicide). In the 18 months following the policy’s release, police reportedly provided details of 44 cases of suspected AS to the DPP (up from 4 to 13 reported cases per year in the preceding decade), but none of these resulted in prosecution. The Policy on Prosecuting the Offence of Assisted Suicide in Northern Ireland in 2010 essentially mirrors the policy in England and Wales.
In June 2012, the Supreme Court of British Columbia in Canada handed down its decision in Carter v. Canada (Attorney-General). The plaintiffs had challenged provisions of the Canadian Criminal Code that prohibited AS. The court concluded that the law was an unjustified infringement on the plaintiffs’ right to equality, life, liberty, and security of the person. The court declared the law invalid, but granted Parliament 12 months to enact new laws. In August 2012, by consent, the court of appeal granted a stay on the declaration of invalidity, pending an appeal by the minister of justice and attorney general.
- Bartels, Lorana and Margaret Otlowski. “A Right to Die? Euthanasia and the Law in Australia.” Journal of Law and Medicine, v.17 (2010).
- Crown Prosecution Service. “Policy for Prosecutors in Respect of Cases of Encouraging or Assisting Suicide.” http://www.cps.gov.uk/publications/prosecution/assisted_suicide_policy.html (Accessed October 2013).
- Onwuteaka-Philipsen, Bregje, et al. “Trends in End-of-Life Practices Before and After the Enactment of the Euthanasia Law in the Netherlands From 1990 to 2010: A Repeated Cross-Sectional Survey.” Lancet, v.380 (2012).
- Pereira, José. “Legalizing Euthanasia or Assisted Suicide: The Illusion of Safeguards and Controls.” Current Oncology, v.18 (2011).
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