Euthanasia

The "Sarco device," which will painlessly asphyxiate someone who enters it.

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Euthanasia (Greek for 'good death') is the act of ending, or aiding in ending, life due to some compelling circumstances. While these "circumstances" have connotations of "disposing of the useless," in modern discussions, it usually refers to helping end the suffering of the terminally ill. Euthanasia can be a form of homicide when another person carries it out. Theorists usually distinguish between voluntary (with the person's consent), involuntary (without their consent) and non-voluntary (when the person is unable to consent, such as a comatose patient) forms of euthanasia. Generally only voluntary and non-voluntary forms of euthanasia are legal. When the act is done by the individual who is going to die, with another's help, it is referred to as assisted suicide or, more euphemistically, as "aid in dying" or "death with dignity".

Weasel words

Like with the issue of abortion, there are for and against arguments, each often guilty of using weasel words to show themselves in a good light. Those in favor of euthanasia concentrate on the "dignity" of the process when compared to more painful deaths at the hands of crippling diseases. Those against euthanasia prefer to talk about the "sanctity of life" and the spirit of fighting through "bad times." At the same time, they in turn invoke "dignity" to argue that euthanasia diminishes this. Sufferers of chronic conditions often resent the implication that they cannot live meaningful lives with dignity, while people speaking of how "sacred" life is aren't in general bedridden or permanently drugged up with pain-killers, so they're also not in the best position to speak on the subject. Answers in opinion polls depend significantly on how questions are phrased.

Methods

There are two main methods for euthanasia.

• Active euthanasia is the act of directly terminating the patient's life, often with a series of drugs that are designed or are known to be immediately fatal. As well as being performed professionally, this can be done deliberately by the individual and perhaps a friend helping them. Numerous websites and books contain the recipes and methods needed to invoke a painless and more dignified death than more "conventional" suicide mechanisms.

• Passive euthanasia is deliberately leaving a patient without medical care so that they will die due to their condition at an earlier stage. This is common with terminal illnesses, such as cancer, where the quality of life is reduced throughout treatment. Sometimes it is the express wish of the individual not to be treated or not to be revived in the case of cardiac arrest.

The "passive" option can further be divided into what is known as "non-active" euthanasia. In this case, although death is intentional and undoubtedly caused by the action, it is indirect or technically a side effect of the action. End-of-life hospice care often involves such acts as administering pain killers at a level that will relieve intense pain and may also hasten death – a process sometimes referred to as the "principle of double effect" where the patient's death is not the desired outcome of the action, but is recognised as a side effect of the treatment.

Non-active euthanasia can also include switching off life support machines or removing feeding tubes, such as in the case of Terri Schiavo. There is much debate in the moral philosophy community over whether there is any real philosophical difference between "active" and "passive" forms of euthanasia. For example, the utilitarian position holds that the two are equivalent, or that "active" euthanasia is often better in order to save pain.

Legalities

Legality of euthanasia in different countries

While euthanasia has not found legal support in most of the United States (see Dr. Jack Kevorkian), it is possible to circumvent laws by other means. Montana, New Mexico, Oregon, Washington and Vermont allow assisted suicide to people with terminal illnesses, but not to people with other incurable conditions like quadriplegia.

Passive euthanasia is legal in most, if not all, countries, and includes things such as withdrawing life support machines or just not giving medicine to the patient. Non-active is also legal in most countries. Patients (or next of kin when they are unable to consent) allowed to reject any medical care, even when doing so is fatal, so long as they are competent. Some people have "do not resuscitate" orders or similar on file ahead of time stating when they reject life-saving care that doctors must follow. Debate regarding laws therefore is usually concentrated upon active euthanasia, since few argue against people being allowed to do this. Usually this is not called "euthanasia" however, with that term served for active forms.

Active euthanasia is only legal in a few countries, such as Belgium, the Netherlands and Canton of Zürich in Switzerland where Dignitas' assisted suicide clinic operates. As a result of this, many people from Europe often travel to these places so that they can be euthanized.

Trends

Soldiers injured beyond recovery in combat have been known to ask for death, and have received it, from enemy and fellow soldiers alike.

A study in the Netherlands looking at data from 2003 to 2016 found about a threefold increase in euthanasia, with cancer patients being the largest number of cases.

Arguments for

Supporters of euthanasia claim it is the humane and caring thing to do, as long as the patient is clearly competent and explicit in their wishes. Forcing someone to continue living and suffering against their will could be considered cruel.

There is a certain disparity when in an "advanced" society, one can end the pain of a beloved pet (such as a dog or cat) but cannot do the same thing for a beloved relative who asks for it. Likewise, it is legal for healthy convicted murderers to be executed, against their will, by overdoses of barbiturates (described by The Peaceful Pill Handbook as the most reliable means of bringing about a peaceful death), but not for seriously ill, law-abiding citizens to be consensually administered the same.

Practically speaking, people who desperately want euthanasia may be able to die whether it is legal or not. Controlled and regulated euthanasia could be better than leaving people to try their hand at DIY euthanasia or suicide. Under controlled euthanasia, the patient may choose to spend their last minutes doing something of their choice (like listening to favorite music or spending time with loved ones) before peacefully ending their lives. The planned and supervised nature could also protect loved ones from the trauma of discovering a dead body.

Many proponents of euthanasia believe that coercion is unlikely and/or can easily be prevented. A 2009 study in the Netherlands claimed that "[t]he frequency of ending of life without explicit patient request did not increase over the studied years." Further, "there is no evidence for a higher frequency of euthanasia among the elderly, people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations." The study found that the rate of euthanasia had actually begun to decrease since 2005.

Supports also stress that making euthanasia legal does not mean it can't be thoroughly regulated. A well written law could leave in processes for consoling prior to euthanasia and/or a requirement that a psychiatrist speak with a patient and confirm they are mentally sound, understand their request, and are not being coerced before signing off on the procedure.

Arguments against

There is a religious critique that argues that only Gawd should be the one to take (an innocent) human life. Religious people may also argue that it is an affront to the sanctity of life and that suffering has value. (Though saying "God approves of your suffering" to someone in unbearable pain sounds awfully callous.)

Some opponents argue that euthanasia is too painful for family members; euthanasia gets rid of one person's suffering by giving it to the family instead. While family members' feelings are certainly meaningful, whether this should be allowed to determine if someone else lives or dies is up for debate. It's also true that not all family members oppose their loved ones' decisions; euthanasia may be more painful for family members who were not consulted or who voiced disagreement. It can further be argued that forcing family members to watch a loved one slowly and painfully dying due to a lack of a euthanasia option can also cause suffering to families. In addition, philosophers such as David Velleman have argued against euthanasia on broadly Kantian grounds.

Furthermore, there is the concern that making euthanasia be common practice might result in worse care for people with terminal illnesses.

Some people worry about a "slippery slope" leading to widespread euthanasia.

There are also concerns of the possibility of coercion with regards to euthanasia. Some opponents of euthanasia worry that members of vulnerable minority groups may be encouraged to seek euthanasia instead of being given adequate support, and believe that current euthanasia laws do not offer good enough protection.

Some of the "arguments against euthanasia" are really not arguments against consensual euthanasia, just arguments against reckless legislation that lacks adequate protections.

Defining consent

Gas chamber where the Nazis forcibly euthanized disabled people.

People have raised concerns over disabled people, poor people, and the elderly potentially being pressured into euthanasia without being given options to improve their quality of life. Some of these people believe euthanasia should be banned in order to protect these people, while others believe that euthanasia should be legalized with protections against coercion.

Various controversies also exist on whether people who have been euthanized did give informed consent to the procedure, or were perhaps forced or coerced into the process. Any decent person on either side of the debate can agree that no one should be euthanized against their will.^{[citation NOT needed]} The question of how this should be prevented is still being discussed.

Capacity to consent

Capacity to consent can become unclear in cases of mental illness and intellectual disability. Serious mental illness or disability could prevent someone from thinking clearly. Figuring out who is able to consent, and who is not, can pose a difficult challenge.

It is also notable that mental illnesses can cloud judgment and are not always lifelong. Someone who is in "unbearable suffering" one year may be doing just fine the next year after receiving appropriate treatment.

One controversial instance involves the euthanasia of a woman with a history of mental health issues. In Belgium, three doctors faced criminal charges for allegedly falsifying an autism diagnosis as an excuse for euthanasia. The woman's sisters claimed that the woman was not autistic, but was seeking assisted suicide after a bad breakup. Counseling, rather than death, may have been more appropriate in her case.

Social and financial pressures

Disability

“”Negative attitudes about disability often promote the idea that it is better to die than to need help with daily living. People with disabilities are vulnerable to isolation in institutional settings and abuse by caregivers, which can also lead to feelings of depression and hopelessness.... Instead of improving the lives of people with disabilities and illnesses, physician-assisted suicide laws "solve" these problems by ending people's lives.

—The Autistic Self Advocacy Network

The disability rights movement has voiced concerns over people with disabilities potentially being pressured into euthanasia. Disabled people may feel like burdens when they lack appropriate support. "If the only alternative to death offered to those who require assistance is poverty and segregation, we are not providing people with meaningful choices," wrote the Autistic Self Advocacy Network in 2013. The United States National Council on Disability warned in 2019 that vulnerable people may be put at risk by euthanasia laws, and that some people (especially minorities) who express suicidal ideation may be given euthanasia instead of mental health treatment. In one UK poll, 70% of disabled people were concerned that allowing assisted dying could lead to pressure on disabled people to end their lives.

Assisted suicide has been made an option for autistic people in some countries, even if the autistic person does not suffer from any serious illnesses. This has raised concerns that autistic people (who often face needless discrimination, unemployment, abuse, and neglect) may feel that death is their best option when society fails to provide them appropriate support. A 2016 study warned that the Dutch criteria for euthanasia and assisted suicide likely did not include adequate safeguards for autistic people and those with intellectual disabilities.

Offering death to people with disabilities, without valuing their lives or giving them adequate opportunities to participate in normal society, could veer into eugenics territory.

Financial pressure

Socrates was made to drink poison by the Athenian government.

In US states where euthanasia is legal, some insurance companies have refused to cover life-extending treatments and offered to cover euthanasia costs instead. Dr. Brian Callister reports that these decisions have even been made in cases in which the patient has a 50% or more chance of being cured with the right treatment. The Death with Dignity movement has disputed whether insurance companies have acted unfairly.

Elder care and dementia

There have also been concerns about elderly people being pressured into unwanted euthanasia. Hypothetically, selfish family members could push for an elderly person to be euthanized, and the elderly person may struggle to advocate for themselves. Harm could likely be prevented if the doctors take time to listen to the patient and make sure they are choosing euthanasia freely.

There is also the issue of consent in dementia: what if someone says they want to be euthanized, but then becomes uncertain or changes their mind as the dementia progresses? Should their original or current wishes be respected?

One Dutch case involved the euthanasia of an elderly woman with dementia who had previously expressed a desire for euthanasia. But she resisted when the doctor attempted to give her a lethal injection, so the doctor asked her family to hold her down. The woman died and the doctor was cleared of wrongdoing.

Potential safeguards

“”There's a need to be stricter because now we see that sometimes euthanasia is granted too quickly, too easily, without enough checks and balances.

—Dr. Joris Vandenberghe, psychiatrist

Banning euthanasia outright is one potential safeguard, but it also risks depriving people of choices and causing them to resort to other methods of suicide (which may be painful or result in someone being traumatized when discovering a body). Proponents of euthanasia rights believe that there are other ways to prevent coercion.

One method involves signing a DNR or "Do Not Resuscitate" order in case medical intervention fails. However, these are rarely legally binding, as they may not been seen as necessarily expressing the patient's wishes at the time when resuscitation is needed.

Independent evaluations could help reduce the risk of someone mistakenly being labeled as consenting. The patient could be interviewed to make sure that they are clear-minded and confident in their decision. (A patient who seems conflicted or uncertain could be refused and advised to wait and take more time to think.)

The Flemish Psychiatric Association has recommended that patients first undergo all proven treatments before resorting to euthanasia. This could reduce the risk of euthanizing patients whose suffering could be ended through nonlethal medical intervention. Although this may invite a "gate-keeping" opportunity, when no available treatment actually works, but the patient is still refused and left to their problems.

Ending discrimination and providing adequate resources for people with illnesses or disabilities would be one way to ensure that they have a meaningful choice between life and death. While this is a good idea for many reasons, it's not going to be easy to accomplish.

See also

• Aktion T4 - Godwin's Law, baby!
• Eugenics - what we should avoid
• Pro life
• Pro choice

External links

• The Euthanasia Debate on Riyarchy (Collaborative argument map for outlining and ending the euthanasia debate)