Euthanasia

I

Introduction

Euthanasia (literally “good death”), practice of ending a life so as to release an individual from an incurable disease or intolerable suffering, also called “mercy killing”. The term is sometimes used generally to refer to an easy or painless death. Voluntary euthanasia involves a request by the dying patient or that person’s legal representative. Passive or negative euthanasia involves not doing something to prevent death—that is, allowing someone to die; active or positive euthanasia involves taking deliberate action to cause a death.

II

History

Euthanasia has been accepted both legally and morally in various forms in many societies. In ancient Greece and Rome it was permissible in some situations to help others die. For example, the Greek writer Plutarch mentioned that in Sparta infanticide was practised on children who lacked “health and vigour”. Both Socrates and Plato sanctioned forms of euthanasia in certain cases. Voluntary euthanasia for the elderly was an approved custom in several ancient societies.

With the rise of organized religion, euthanasia became morally and ethically abhorrent. Christianity, Judaism, and Islam all hold human life sacred and condemn euthanasia in any form.

Following traditional religious principles, Western laws have generally considered the act of helping someone to die a form of homicide subject to legal sanctions. Even a passive withholding of help to prevent death has frequently been severely punished. Euthanasia, however, is thought to occur secretly in all societies, including those in which it is held to be immoral and illegal.

III

Legal Aspects

Organizations supporting the legalization of voluntary euthanasia were established in Britain in 1935 and in the United States in 1938. They have gained some public support, but have so far been unable to achieve their goal in either nation. In the past few decades, Western laws against passive and voluntary euthanasia have slowly been eased, although serious moral and legal questions still exist.

Critics point to the so-called euthanasia committees in Nazi Germany that were empowered to condemn and execute anyone found to be a burden to the state. This instance of abuse of the power of life and death has long served as a warning to some against allowing the practice of euthanasia. Proponents, on the other hand, point out that almost any individual freedom involves some risk of abuse, and argue that such risks can be kept to a minimum by ensuring proper legal safeguards.

In April 2005 the Mental Capacity Act was given royal assent in the United Kingdom and was expected to come into force in 2007. The act gives legal power to “living wills”, in which people can say whether they want medical treatment withheld if they become severely incapacitated. It establishes a legal presumption that everybody is able to make decisions about their own treatment unless they are proved to be mentally incapable of doing so. It also allows people to give somebody the power of attorney to make decisions on their behalf, which could be challenged by doctors.

IV

Medical Considerations

The medical profession has generally been caught in the middle of the social controversies that rage over euthanasia. Government and religious groups as well as the medical profession itself agree that doctors are not required to use “extraordinary means” to prolong the life of terminally ill people. What constitutes extraordinary means is usually left to the discretion of the patient’s family. Modern technological advances, such as the use of respirators and artificial kidney machines, have made it possible to keep people alive for long periods of time even when they are permanently unconscious or irrevocably brain damaged. Proponents of euthanasia, however, believe that prolonging life in this way may cause great suffering to the patient and family. In addition, certain life-support systems are so expensive that the financial implications have to be considered. Conversely, some opponents of euthanasia argue that the increasing success that doctors have had in transplanting human organs might lead to abuse of the practice of euthanasia. That is, they fear that doctors may violate the rights of the dying donor in order to help preserve the life of an organ recipient. This is one area where proper legal safeguards are clearly required.

New professional and legal definitions of death and medical responsibilities are slowly being developed to fit these complex new realities. Brain death, the point when the higher centres of the brain cease to function and no electrical activity is registered in the brain, making death the inevitable outcome, is widely accepted as the time when it is legal to turn off a patient’s life-support system, with the permission of the family.

Today, patients in many countries are entitled to opt for passive euthanasia; that is, to make free and informed choices to refuse life support. With regard to active euthanasia, in the Netherlands, long known for one of the most liberal euthanasia policies of all industrialized nations, the Royal Dutch Medical Association (RDMA) issued revised guidelines on the practice in 1995. It has emphasized greater patient responsibility, whereby patients themselves carry out the final act, usually by taking an overdose of drugs that have been prescribed by a doctor, in what is termed “medically assisted suicide”. This is aimed at relieving in part the emotional stress and moral burden experienced by doctors who assist in such cases. Although consensual killing is still technically illegal, doctors are virtually guaranteed immunity from prosecution if they follow RDMA guidelines.

In Australia in 1996, after long debate, the Northern Territory passed pioneering legislation that permitted medically assisted suicide—using a computer program, which enabled the terminally ill patient to tap his or her command into a laptop computer and administer a lethal dose of drugs if appropriate—the first place in the world to make this form of euthanasia legal. However, in early 1997 the Australian government repealed the legislation. It had been condemned by Church, political, and Aboriginal leaders. In the state of Oregon, United States, the Supreme Court upheld a law in 2006 allowing doctors to assist in suicide in cases where the patient has less than six months to live and is of sound mind.

See also Death and Dying; Suicide; Thanatology.