Euthanasia
Euthanasia is the practice of intentionally ending life to eliminate pain and suffering.
Different countries have different euthanasia laws. The British House of Lords select committee on medical ethics defines euthanasia as "a deliberate intervention undertaken with the express intention of ending a life to relieve intractable suffering". In the Netherlands and Belgium, euthanasia is understood as "termination of life by a doctor at the request of a patient". The Dutch law, however, does not use the term 'euthanasia' but includes the concept under the broader definition of "assisted suicide and termination of life on request".
Euthanasia is categorised in different ways, which include voluntary, non-voluntary, and involuntary. Voluntary euthanasia is when a person wishes to have their life ended and is legal in a growing number of countries. Non-voluntary euthanasia occurs when a patient's consent is unavailable, and is legal in some countries under certain limited conditions, in both active and passive forms. Involuntary euthanasia, which is done without asking for consent or against the patient's will, is illegal in all countries and is usually considered murder.
, euthanasia had become the most active area of research in bioethics.
In some countries, divisive public controversy occurs over the moral, ethical, and legal issues associated with euthanasia. Passive euthanasia is legal under some circumstances in many countries. Active euthanasia, however, is legal or de facto legal in only a handful of countries, which limit it to specific circumstances and require the approval of counsellors, doctors, or other specialists. In some countries—such as Nigeria, Saudi Arabia, and Pakistan—support for active euthanasia is almost nonexistent.
Definition
Current usage
As of 2024, dictionary definitions focus on euthanasia as the act of killing someone to prevent further suffering. There is no sense of whether the person agrees or is proactive in the situation.Past discussions on key elements
In 1974 euthanasia was defined as the "painless inducement of a quick death". However, it is argued that this approach fails to properly define euthanasia, as it leaves open a number of possible actions that would meet the requirements of the definition but would not be seen as euthanasia. In particular, these include situations where a person kills another, painlessly, but for no reason beyond that of personal gain, or accidental deaths that are quick and painless but not intentional.Another approach incorporated the notion of suffering into the definition. The definition offered by the Oxford English Dictionary incorporates suffering as a necessary condition with "the painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma", This approach is included in Marvin Khol and Paul Kurtz's definition of it as "a mode or act of inducing or permitting death painlessly as a relief from suffering". Counterexamples can be given: such definitions may encompass killing a person suffering from an incurable disease for personal gain, and commentators such as Tom Beauchamp and Arnold Davidson have argued that doing so would constitute "murder simpliciter" rather than euthanasia.
The third element incorporated into many definitions is that of intentionality: the death must be intended rather than accidental, and the intent of the action must be a "merciful death". Michael Wreen argued that "the principal thing that distinguishes euthanasia from intentional killing simpliciter is the agent's motive: it must be a good motive insofar as the good of the person killed is concerned." Similarly, Heather Draper speaks to the importance of motive, arguing that "the motive forms a crucial part of arguments for euthanasia, because it must be in the best interests of the person on the receiving end." Definitions such as those offered by the House of Lords Select committee on Medical Ethics take this path, where euthanasia is defined as "a deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering." Beauchamp and Davidson also highlight Baruch Brody's "an act of euthanasia is one in which one person ... kills another person for the benefit of the second person, who actually does benefit from being killed".
Draper argued that any definition of euthanasia must incorporate four elements: an agent and a subject; an intention; causal proximity, such that the actions of the agent lead to the outcome; and an outcome. Based on this, she offered a definition incorporating those elements, stating that euthanasia "must be defined as death that results from the intention of one person to kill another person, using the most gentle and painless means possible, that is motivated solely by the best interests of the person who dies." Prior to Draper, Beauchamp and Davidson had also offered a definition that included these elements. Their definition specifically discounts fetuses to distinguish between abortions and euthanasia:
Wreen, in part responding to Beauchamp and Davidson, offered a six-part definition:
Wreen also considered a seventh requirement: " The good specified in is, or at least includes, the avoidance of evil", although, as Wreen noted in the paper, he was not convinced that the restriction was required.
In discussing his definition, Wreen noted the difficulty of justifying euthanasia when faced with the notion of the subject's "right to life". In response, Wreen argued that euthanasia has to be voluntary and that "involuntary euthanasia is, as such, a great wrong". Other commentators incorporate consent more directly into their definitions. For example, in a discussion of euthanasia presented in 2003 by the European Association of Palliative Care Ethics Task Force, the authors offered: "Medicalized killing of a person without the person's consent, whether nonvoluntary or involuntary, is not euthanasia: it is murder. Hence, euthanasia can be voluntary only." Although the EPAC Ethics Task Force argued that both non-voluntary and involuntary euthanasia could not be included in the definition of euthanasia, there is discussion in the literature about excluding one but not the other.
Historical use
"Euthanasia" has had different meanings depending on usage. The first apparent usage of the term "euthanasia" belongs to the historian Suetonius, who described how the Emperor Augustus, "dying quickly and without suffering in the arms of his wife, Livia, experienced the 'euthanasia' he had wished for." The word "euthanasia" was first used in a medical context by Francis Bacon in the 17th century to refer to an easy, painless, happy death, during which it was a "physician's responsibility to alleviate the 'physical sufferings' of the body." Bacon referred to an "outward euthanasia"—the term "outward" he used to distinguish from a spiritual concept—the euthanasia "which regards the preparation of the soul."Classification
Euthanasia may be classified into three types, according to whether a person gives informed consent: voluntary, non-voluntary and involuntary.There is a debate within the medical and bioethics literature about whether or not the non-voluntary killing of patients can be regarded as euthanasia, irrespective of intent or the patient's circumstances. In the definitions offered by Beauchamp and Davidson and, later, by Wreen, consent on the part of the patient was not considered one of their criteria, although it may have been required to justify euthanasia. However, others see consent as essential.
Voluntary euthanasia
is conducted with the consent of the patient. Active voluntary euthanasia is legal in Belgium, Luxembourg and the Netherlands. Passive voluntary euthanasia is legal throughout the US per Cruzan v. Director, Missouri Department of Health. When the patient brings about their own death with the assistance of a physician, the term assisted suicide is often used instead. Assisted suicide is legal in Switzerland and the U.S. states of California, Oregon, Washington, Montana and Vermont.Non-voluntary euthanasia
is conducted when the consent of the patient is unavailable. Examples include child euthanasia, which is illegal worldwide but decriminalised under certain specific circumstances in the Netherlands under the Groningen Protocol. Passive forms of non-voluntary euthanasia are legal in a number of countries under specified conditions.Involuntary euthanasia
is done without asking for consent or against the patient's will. It is considered murder and is illegal in all countries.Passive and active euthanasia
Voluntary, non-voluntary and involuntary types can be further divided into passive or active variants. Passive euthanasia entails the withholding treatment necessary for the continuance of life. Active euthanasia entails the use of lethal substances or forces, and is more controversial. While some authors consider these terms to be misleading and unhelpful, they are nonetheless commonly used. In some cases, such as the administration of increasingly necessary, but toxic doses of painkillers, there is a debate whether or not to regard the practice as active or passive.History
Euthanasia was practiced in Ancient Greece and Rome: for example, hemlock was employed as a means of hastening death on the island of Kea, a technique also employed in Massalia. Euthanasia, in the sense of the deliberate hastening of a person's death, was supported by Socrates, Plato and Seneca the Elder in the ancient world, although Hippocrates appears to have spoken against the practice, writing "I will not prescribe a deadly drug to please someone, nor give advice that may cause his death".Early modern period
The term euthanasia, in the earlier sense of supporting someone as they died, was used for the first time by Francis Bacon. In his work, Euthanasia medica, he chose this ancient Greek word and, in doing so, distinguished between euthanasia interior, the preparation of the soul for death, and euthanasia exterior, which was intended to make the end of life easier and painless, in exceptional circumstances by shortening life. That the ancient meaning of an easy death came to the fore again in the early modern period can be seen from its definition in the 18th century Zedlers Universallexikon:Euthanasia: a very gentle and quiet death, which happens without painful convulsions. The word comes from ευ, bene, well, and θανατος, mors, death.
The concept of euthanasia in the sense of alleviating the process of death goes back to the medical historian Karl Friedrich Heinrich Marx, who drew on Bacon's philosophical ideas. According to Marx, a doctor had a moral duty to ease the suffering of death through encouragement, support and mitigation using medication. Such an "alleviation of death" reflected the contemporary zeitgeist, but was brought into the medical canon of responsibility for the first time by Marx. Marx also stressed the distinction of the theological care of the soul of sick people from the physical care and medical treatment by doctors.
Euthanasia in its modern sense has always been strongly opposed in the Judeo-Christian tradition. Thomas Aquinas opposed both and argued that the practice of euthanasia contradicted our natural human instincts of survival, as did Francois Ranchin, a French physician and professor of medicine, and Michael Boudewijns, a physician and teacher. Other voices argued for euthanasia, such as John Donne in 1624, and euthanasia continued to be practised. In 1678, the publication of Caspar Questel's De pulvinari morientibus non-subtrahend,, initiated debate on the topic. Questel described various customs which were employed at the time to hasten the death of the dying,, and argued against their use, as doing so was "against the laws of God and Nature". This view was shared by others who followed, including Philipp Jakob Spener, Veit Riedlin and Johann Georg Krünitz. Despite opposition, euthanasia continued to be practised, involving techniques such as bleeding, suffocation, and removing people from their beds to be placed on the cold ground.
Suicide and euthanasia became more accepted during the Age of Enlightenment. Thomas More wrote of euthanasia in Utopia, although it is not clear if More was intending to endorse the practice. Other cultures have taken different approaches: for example, in Japan suicide has not traditionally been viewed as a sin, as it is used in cases of honor, and accordingly, the perceptions of euthanasia are different from those in other parts of the world.