Euthanasia: What, Where and Why?

In short, euthanasia refers to the intentional ending of life in order to end suffering. The topic is highly controversial and its checkered legal status across the world reflects the differences in opinion.

Euthanasia has a long history, having been used in ancient Greek and Roman civilisations. Even in the early days, euthanasia was a hot topic that called upon moral, religious and medical arguments. It is a little known fact that, in January 1936, King George V was given a fatal dose of morphine and cocaine by his physician – Lord Dawson – in order to hasten his death.

In this article, we will discuss what euthanasia is, and some of the arguments for and against.

Euthanasia definitions

Euthanasia has many, subtly different, definitions, all of which overlap to a certain degree. The crux of most of them is that a life is ended at their request, in order to end suffering that is likely to be ongoing; a merciful death, if you will.

The Oxford English Dictionary refers to it as:

“The painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma.”

Marvin Khol and Paul Kurtz’s define it as:

“a mode or act of inducing or permitting death painlessly as a relief from suffering.”

Similarly, the House of Lords Select Committee on Medical Ethics, gives precise definition of euthanasia as:

“A deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering.”

Baruch A. Brody, an American bioethicist defines euthanasia as:

“An act of euthanasia is one in which one person […] (A) kills another person (B) for the benefit of the second person, who actually does benefit from being killed”

Euthanasia is broken down into different categories. Two commonly used brackets are the following:

• Passive: withholding medical care or essential medication to bring about the end of the patient’s life; this is considered legal in most jurisdictions.
• Active: actively administering, for instance, a lethal injection to kill the individual. Active euthanasia is the most controversial of the two.

Because of the nature of euthanasia, even the definitions above are considered controversial and unhelpful by some. There is a certain blurring between the two, for instance, if a doctor administers increasing quantities of necessary, but eventually lethal opioid pain relief, which category would it fall into?

Euthanasia is further split into three categories:

• Voluntary euthanasia: conducted with the consent of the patient. active voluntary euthanasia is legal in Belgium, Luxembourg and the Netherlands and passive voluntary euthanasia is legal in the US. This category also includes “assisted suicide.”
• Non-voluntary euthanasia: when consent from the patient is not available, if they are in a coma, or in the case of children. Non-voluntary euthanasia is illegal worldwide, except the Netherlands where child euthanasia can be carried out if the following four criteria are all met:
  • The presence of unbearable and hopeless suffering
  • The parent’s consent to termination of life
  • Medical consultation has taken place
  • Careful execution of the termination.
• Involuntary euthanasia: euthanasia carried out against the will of the patient. This is generally classed as murder and the fear of this type of euthanasia, in part, fuels the debate surrounding the topic.

The euthanasia debate

As the categories above elucidate, euthanasia is a multifaceted issue with no simple, clear answers. A Gallup poll asked Americans the following question:

“When a person has a disease that cannot be cured and is living in severe pain, do you think doctors should or should not be allowed by law to assist the patient to commit suicide if the patient requests it?”

In 2015, 68% of responders thought it should be legal and 28% though it should not. In 2014 the split was 58%/39%, so the mood has substantially changed, but, over the past two decades, the percentage of those who agree with assisted suicide has fluctuated between 52% and 68%, no one has their mind made up.

Although there are many aspects to the euthanasia debate, some of the arguments that appear most commonly fit into the following categories:

Arguments for euthanasia

• People have the right to self-determination and should be able to choose what happens to them. Humans should be allowed to act autonomously.
• Assisting someone’s death might be a better choice than allowing suffering to continue. It is kinder to allow them to “die with dignity” than prolong their pain.
• The distinction between passive euthanasia (which is often allowed) and active euthanasia is not a meaningful distinction.
• With proper regulation, permitting euthanasia will not necessarily lead to unacceptable consequences as the opponents fear.

Arguments against euthanasia

• Not all deaths are painful, pain relief is very effective and palliative care and hospices provide excellent care.
• Alternatives such as the cessation of treatment in combination with pain relief is a better option.
• The difference between active and passive euthanasia is morally significant. Much of the debate hinges upon this argument.
• Legalizing euthanasia might put society on a slippery slope, leading to unacceptable consequences. Opponents fear that by legalizing voluntary euthanasia it might open the floodgates to non-voluntary and involuntary euthanasia.
• Religious aspects. For instance, many Christians feel that it is interfering with god’s plans
• A right to choose death would put an obligation on doctors to kill. Alternatively, a patient’s right to decide might easily become a decision made by a physician.

In a society where youth and vigor is prized and the elderly are increasingly marginalized, a patient who felt they were becoming a burden to relatives might feel pressurized to be euthanized.

Medscape completed a survey of 10,000 American physicians in 2010. When asked “Would you ever consider halting life-sustaining therapy because the family demands it, even if you believed that it was premature?” 16.3% said they would and 54.5% said they would not.

When they were asked “Should physician-assisted suicide be allowed in some cases?” Almost 46% said it should and nearly 41% said it should not, the rest responded that “it depends.”

A survey of UK doctors asked whether a person with an incurable and painful disease, from which they will die, should be allowed by law to end their life. Roughly one third agreed that they should be allowed to choose, almost two thirds disagreed. They also found that doctors working in palliative care were more likely to be against assisted dying.

Legal status of euthanasia

Because of the complexity of the euthanasia issue, it comes as no surprise that there are legal differences between countries.

Currently, euthanasia is legal in:

• Netherlands: since 2002
• Belgium: since 2002
• Ireland: passive euthanasia only
• Colombia: since 2015
• Luxembourg: since 2008.

Assisted suicide is legal in:

• Switzerland: assisting suicide is only a crime if the motive is selfish
• Germany
• Japan: an official law has not been passed but a legal framework has been designed
• Albania
• Canada: currently being debated and awaiting a finalized law
• America: varies by state:
  • Washington since 2008
  • Oregon since 1994
  • Vermont since 2013
  • New Mexico (disputed)
  • Montana (disputed)
  • California since January 2016.

Who opts for euthanasia?

A review conducted in 2013 investigated euthanasia and assisted suicide in countries where it is currently legal. The following are some of their findings:

• In most places men more commonly opted for assisted suicide than women (except Switzerland).
• The group most commonly choosing euthanasia was 60 – 85-year-olds, followed by 40 – 59-year-olds.
• Most people who had an assisted death were married, followed by widowed, then divorced
• The disease most commonly found in euthanasia cases was cancer. Others included ALS, multiple sclerosis and cardiovascular disease.
• The Netherlands had the highest number of assisted deaths: 3,695 in 2011 (2.5% of all deaths).
• In regions where euthanasia was legal, between 0.1% and 2.9% of all deaths were assisted.