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- Main article: The psychological considerations in assisted suicide
Euthanasia (literally "good death" in Ancient Greek) refers to the practice of ending a life in a painless manner. As of 2008, some forms of euthanasia are legal in Belgium, Luxembourg, The Netherlands, Switzerland, the [U.S. states of Oregon and Washington the Autonomous Community of Andalusia (Spain), and Thailand. Stances on euthanasia vary greatly; it is called murderous by some and merciful by others. Such controversy arises in part from the serious moral issues attached to the subject and in part from the fact that "euthanasia" is an umbrella term that describes a number of different methods.
- 1 Classification of euthanasia
- 2 History
- 3 Arguments for and against voluntary euthanasia
- 4 Euthanasia and the Law
- 5 Euthanasia and religion
- 6 Euthanasia protocol
- 7 Notes and references
- 8 See also
- 9 External links
Classification of euthanasia
Euthanasia by consent
Euthanasia may be conducted with consent (voluntary euthanasia) or without consent (involuntary euthanasia). Involuntary euthanasia is conducted where an individual makes a decision for another person incapable of doing so. The decision can be made based on what the incapacitated individual would have wanted, or it could be made on substituted judgment of what the decision maker would want were he or she in the incapacitated person's place, or finally, the decision could be made by assessing objectively whether euthanasia is the most beneficial course of treatment. In any case, euthanasia by proxy consent is highly controversial, especially because multiple proxies may claim the authority to decide for the patient and may or may not have explicit consent from the patient to make that decision.
Euthanasia may be conducted passively, non-actively, and actively. Passive euthanasia entails the withholding of common treatments (such as antibiotics, pain medications, or surgery) or the distribution of a medication (such as morphine) to relieve pain, knowing that it may also result in death (principle of double effect). Passive euthanasia is the most accepted form, and it is a common practice in most hospitals. Non-active euthanasia entails the withdrawing of life support and is more controversial. Active euthanasia entails the use of lethal substances or forces to kill and is the most controversial means.
- Main article: Assisted suicide
Assisted suicide is active, voluntary euthanasia.
The term euthanasia comes from the Greek words "eu"-meaning good and "thanatos"-meaning death, which combined means “well-death” or "dying well". Hippocrates mentions euthanasia in the Hippocratic Oath, which was written between 400 and 300 B.C. The original Oath states: “To please no one will I prescribe a deadly drug nor give advice which may cause his death.” Despite this, the ancient Greeks and Romans generally did not believe that life needed to be preserved at any cost and were, in consequence, tolerant of suicide in cases where no relief could be offered to the dying or, in the case of the Stoics and Epicureans, where a person no longer cared for his life.
English Common Law from the 1300s until the middle of the last century made suicide a criminal act in England and Wales. Assisting others to kill themselves remains illegal in that jurisdiction. However, in the 1500s, Thomas More, in describing a utopian community, envisaged such a community as one that would facilitate the death of those whose lives had become burdensome as a result of "torturing and lingering pain".
Since the 19th Century, euthanasia has sparked intermittent debates and activism in North America and Europe. According to medical historian Ezekiel Emanuel, it was the availability of anesthesia that ushered in the modern era of euthanasia. In 1828, the first known anti-euthanasia law in the United States was passed in the state of New York, with many other localities and states following suit over a period of several years. After the Civil War, voluntary euthanasia was promoted by advocates, including some doctors. Support peaked around the turn of the century in the U.S. and then grew again in the 1930s.
The first major effort to legalize euthanasia in the United States arose as part of the eugenics movement in the early years of the twentieth century. In an article in the Bulletin of the History of Medicine, Brown University historian Jacob M. Appel documented extensive political debate over legislation to legalize physician-assisted suicide in both Iowa and Ohio in 1906. Appel indicates social activist Anna S. Hall was the driving force behind this movement. In his book A Merciful End, Ian Dowbiggen has revealed the role that leading public figures, including Clarence Darrow and Jack London, played in advocating for the legalization of euthanasia.
Euthanasia societies were formed in England in 1935 and in the U.S.A. in 1938 to promote aggressive euthanasia. Although euthanasia legislation did not pass in the U.S. or England, in 1937, doctor-assisted euthanasia was declared legal in Switzerland as long as the person ending the life has nothing to gain. During this period, euthanasia proposals were sometimes mixed with eugenics. While some proponents focused on voluntary euthanasia for the terminally ill, others expressed interest in involuntary euthanasia for certain eugenic motivations (e.g., mentally "defective"). During this same era, meanwhile, U.S. court trials tackled cases involving critically ill people who requested physician assistance in dying as well as “mercy killings”, such as by parents of their severely disabled children.
Prior to and during World War II, the Nazis carried out an involuntary euthanasia program, largely in secret. In 1939, Nazis, in what was code-named Action T4, killed children under three who exhibited mental retardation, physical deformity or other debilitating problems which they considered gave the disabled child "life unworthy of life”. This program was later extended to include older children and adults.. Inmates of mental asylums in Germany and Austria would be transported to an intermediate facility, from where they would be retransported to one of six killing centres at Brandenburg near Berlin (January 1940 - September 1940), Grafeneck near Stuttgart (January 1940 - December 1940), Hartheim near Linz in Austria (January 1940 - December 1944), Sonnenstein/Pirna near Dresden (April 1940 - August 1943), Bernburg near Magdeburg (September 1940 - April 1943), Hadamar near Koblenz (January 1941 - August 1941). Religious protest especially but not limited to Catholic prelates caused Hitler to order the official cancellation of T4 but postwar investigation made it clear that the practice continued in institutes where personnel were sympathetic to eugenic policies.
The T4 program of the Nazis was extended to killing of concentration camp inmates when Philipp Bouhler,the head of the T4 program, allowed Heinrich Himmler to utilize T4 doctors, staff and facilities to kill concentration camp prisoners who were "most seriously ill" in a program designated "14f13". 
Due to outrage over Nazi euthanasia, in the 1940s and 1950s there was very little public support for euthanasia, especially for any involuntary, eugenics-based proposals. Catholic church leaders, among others, continued speaking against euthanasia as a violation of the sanctity of life. (Nevertheless, owing to its principle of double effect, Roman Catholic moral theology did leave room for shortening life with pain-killers and what could be characterized as passive euthanasia.) On the other hand, judges were often lenient in mercy-killing cases. In 1957 in Britain, Judge Devlin ruled in the trial of Dr John Bodkin Adams that causing death through the administration of lethal drugs to a patient, if the intention is solely to alleviate pain, is not considered murder even if death is a potential or even likely outcome. During this period, prominent proponents of euthanasia included Glanville Williams (The Sanctity of Life and the Criminal Law) and clergyman Joseph Fletcher ("Morals and medicine"). By the 1960s, advocacy for a right-to-die approach to voluntary euthanasia increased.
A key turning point in the debate over voluntary euthanasia (and physician assisted dying), at least in the United States, was the public furor over the case of Karen Ann Quinlan. The Quinlan case paved the way for legal protection of voluntary passive euthanasia. In 1977, California legalized living wills and other states soon followed suit.
In 1990, Dr. Jack Kevorkian, a Michigan physician, became infamous for encouraging and assisting people in committing suicide which resulted in a Michigan law against the practice in 1992. Kevorkian was tried and convicted in 1999 for a murder displayed on television. Also in 1990, the Supreme Court approved the use of non-aggressive euthanasia.
In 1994, Oregon voters approved the Death with Dignity Act, permitting doctors to assist terminal patients with six months or less to live to end their lives. The U.S. Supreme Court allowed such laws in 1997. The Bush administration failed in its attempt to use drug law to stop Oregon in 2001, in the case Gonzales v. Oregon. In 1999, non-aggressive euthanasia was permitted in Texas.
In 1993, the Netherlands decriminalized doctor-assisted suicide, and in 2002, restrictions were loosened. During that year, physician-assisted suicide was approved in Belgium. Belgium's at the time most famous author Hugo Claus, suffering from Alzheimer's disease, was among those that asked for euthanasia. He died in March 2008, assisted by an Antwerp doctor. Australia's Northern Territory approved a euthanasia bill in 1995, but that was overturned by Australia’s Federal Parliament in 1997.
Most recently, amid U.S. government roadblocks and controversy in the Terri Schiavo case, where a Floridian who was in a vegetative state since 1990, had her feeding tube removed in 2005. Her husband had won the right to take her off life support, which he claimed she would want but was difficult to confirm as she had no living will and the rest of her family claimed otherwise.
In November 2008, Washington Initiative 1000 made Washington the second U.S. state to legalize physician-assisted suicide.
Arguments for and against voluntary euthanasia
Since World War II, the debate over euthanasia in Western countries has centered on voluntary euthanasia (VE) within regulated health care systems. In some cases, judicial decisions, legislation, and regulations have made VE an explicit option for patients and their guardians. Proponents and critics of such VE policies offer the following reasons for and against official voluntary euthanasia policies:
Reasons given for voluntary euthanasia:
- Choice: Proponents of VE emphasize that choice is a fundamental principle for liberal democracies and free market systems.
- Quality of Life: The pain and suffering a person feels during a disease, even with pain relievers, can be incomprehensible to a person who has not gone through it. Even without considering the physical pain, it is often difficult for patients to overcome the emotional pain of losing their independence. 
- Economic costs and human resources: Today in many countries there is a shortage of hospital space. The energy of doctors and hospital beds could be used for people whose lives could be saved instead of continuing the life of those who want to die which increases the general quality of care and shortens hospital waiting lists. It is a burden to keep people alive past the point they can contribute to society, especially if the resources used could be spent on a curable ailment.
Reasons given against voluntary euthanasia:
- Professional role: Critics argue that voluntary euthanasia could unduly compromise the professional roles of health care employees, especially doctors. They point out that European physicians of previous centuries traditionally swore some variation of the Hippocratic Oath, which in its ancient form excluded euthanasia: "To please no one will I prescribe a deadly drug nor give advice which may cause his death.." However, since the 1970s, this oath has largely fallen out of use.
- Moral: Some people consider euthanasia of some or all types to be morally unacceptable. This view usually treats euthanasia to be a type of murder and voluntary euthanasia as a type of suicide, the morality of which is the subject of active debate.
- Theological: Voluntary euthanasia has often been rejected as a violation of the sanctity of human life. Specifically, some Christians argue that human life ultimately belongs to God, so that humans should not be the ones to make the choice to end life. Orthodox Judaism takes basically the same approach, however, it is more open minded, and does, given certain circumstances, allow for euthanasia to be exercised under passive or non-aggressive means. Accordingly, some theologians and other religious thinkers consider voluntary euthanasia (and suicide generally) as sinful acts, i.e. unjustified killings.
- Feasibility of implementation: Euthanasia can only be considered "voluntary" if a patient is mentally competent to make the decision, i.e., has a rational understanding of options and consequences. Competence can be difficult to determine or even define.
- Necessity: If there is some reason to believe the cause of a patient's illness or suffering is or will soon be curable, the correct action is sometimes considered to attempt to bring about a cure or engage in palliative care.
- Wishes of Family: Family members often desire to spend as much time with their loved ones as possible before they die.
- Consent under pressure: Given the economic grounds for voluntary euthanasia (VE), critics of VE are concerned that patients may experience psychological pressure to consent to voluntary euthanasia rather than be a financial burden on their families.  Even where health costs are mostly covered by public money, as in various European countries, VE critics are concerned that hospital personnel would have an economic incentive to advise or pressure people toward euthanasia consent.
Euthanasia and the Law
- Main article: Euthanasia and the law
During the 20th Century, efforts to change government policies on euthanasia have met limited success in Western countries. Country policies are described here in alphabetical order, followed by the exceptional case of The Netherlands. Euthanasia policies have also been developed by a variety of NGOs, most notably medical associations and advocacy organizations.
Euthanasia and religion
- Main article: Euthanasia and religion
- See also: Lethal injection#Euthanasia protocol
Euthanasia can be accomplished either through an oral, intravenous, or intramuscular administration of drugs. In individuals who are incapable of swallowing lethal doses of medication, an intravenous route is preferred. The following is a Dutch protocol for parenteral (intravenous) administration to obtain euthanasia:
Intravenous administration is the most reliable and rapid way to accomplish euthanasia and therefore can be safely recommended. A coma is first induced by intravenous administration of 20 mg/kg sodium thiopental (Nesdonal) in a small volume (10 ml physiological saline). Then a triple intravenous dose of a non-depolarizing neuromuscular muscle relaxant is given, such as 20 mg pancuronium bromide (Pavulon) or 20 mg vecuronium bromide (Norcuron). The muscle relaxant should preferably be given intravenously, in order to ensure optimal availability. Only for pancuronium bromide (Pavulon) are there substantial indications that the agent may also be given intramuscularly in a dosage of 40 mg.
With regards to nonvoluntary euthanasia, the cases where the person could consent but was not asked are often viewed differently from those where the person could not consent. Some people raise issues regarding stereotypes of disability that can lead to non-disabled or less disabled people overestimating the person's suffering, or assuming it to be unchangeable when it could be changed. For example, many disability rights advocates responded to Tracy Latimer's murder by pointing out that her parents had refused a hip surgery that could have greatly reduced or eliminated the physical pain Tracy experienced. Also, they point out that a severely disabled person need not be in emotional pain at their situation, and claim that the emotional pain, if present, is due to societal prejudice rather than the disability, analogous to a person of a particular ethnicity wanting to die because they have internalized negative stereotypes about their ethnic background. Another example of this is Keith McCormick, a New Zealander Paralympian who was "mercy-killed" by his caregiver, and Matthew Sutton.
With regards to voluntary euthanasia, many people argue that 'equal access' should apply to access to suicide as well, so therefore disabled people who cannot kill themselves should have access to voluntary euthanasia.
Notes and references
- Advance directives
- Assisted suicide
- Death attitudes
- Manslaughter/manslaughter in English law
- Oregon "Death With Dignity" Act
- Professional ethics
- Suicide Act 1961
- Terminal dehydration
- Texas Futile Care Law
- Treatment witholding
- Euthanasia and the law
- Luxembourg says 'yes' to euthanasia
- Oregon’s Death with Dignity law and Euthanasia in the Netherlands: Factual Disputes
- See Washington Initiative 1000, which passed on 4 Nov 2008.
- "Andalucía permitirá por ley la eutanasia pasiva para enfermos incurables", 20 Minutos. 31 May 2008
- "Andalusia euthanasia law unnecessary, expert warns", Catholic News Agency. 26 Jun 2008
- พระราชบัญญัติสุขภาพแห่งชาติ พ.ศ. 2550. (2550, 19 มีนาคม). ราชกิจจานุเบกษา, (เล่ม 124, ตอนที่ 16 ก).
- http://plato.stanford.edu/entries/euthanasia-voluntary/ An overview of voluntary euthanasia
- "Glossary." CCAC Programs. 2005. Canadian Council on Animal Care. 13 July 2007 (http://www.ccac.ca/en/CCAC_Programs/ETCC/GlossaryEng.htm).
- History of Euthanasia
- See Senicide
- See Humphry and Wickett (1986:8-10) on More, Montaigne, Donne, and Bacon.
- History of Euthanasia ([PowerPoint presentation), Euthanasia.com. "The earliest American statute explicitly to outlaw assisting suicide was enacted in New York in 1828, Act of Dec. 10, 1828, ch. 20, §4, 1828 N. Y. Laws 19 (codified at 2 N. Y. Rev. Stat. pt. 4, ch. 1, tit. 2, art. 1, §7, p. 661 (1829)), and many of the new States and Territories followed New York's example. Marzen 73-74." Retrieved June 16, 2007.
- Humphry and Wickett 1986:11-12, Emanuel 2004.
- Appel, Jacob M. "A Duty to Kill? A Duty to Die." Bulletin of the History of Medicine. 78.3 (October 2004): 610-634.
- A Merciful End: The Euthanasia Movement in Modern America (Hardcover) by Ian Dowbiggin
- euthanasia. The Columbia Encyclopedia, Sixth Edition. 2001-07
- Merciful Release and other sources...
- Kamisar 1977
- Lifton, Robert JayThe Nazi Doctors: Medical Killing and the Psychology of Genocide, p. 135 1986 Basic Books
- Papal statements 1956-1957 and Gerald Kelly
- Humphrey and Wickett, ch.4. See also Kamisar.
- Margaret Otlowski, Voluntary Euthanasia and the Common Law, Oxford University Press, 1997, pp. 175-177
- For the UK see the Bland case.
- Cruzan v. Director, Missouri Department of Health
- Australia passes first euthanasia law
- See Government policies below for specific examples
- See also Utilitarianism
- See Religious views of suicide
- "Terminally ill patients often fear being a burden to others and may feel they ought to request euthanasia to relieve their relatives from distress." letter to the editor of the Financial Times by Dr David Jeffrey, published 11 Jan 2003.
- "If euthanasia became socially acceptable, the sick would no longer be able to trust either doctors or their relatives: many of those earnestly counselling a painless, 'dignified' death would be doing so mainly on financial grounds. Euthanasia would become a euphemism for assisted murder." FT WEEKEND - THE FRONT LINE: Don't take liberties with the right to die by Michael Prowse, Financial Times, 4th Jan 2003
- Administration and Compounding Of Euthanasic Agents.
- NZ Herald Story.
- Parents walk free after killing son. ABC News Online.
- http://www.deathcamps.org/euthanasia/t4intro.html Nazi Euthanasia
- Euthanasia and Religion - various religious views of euthanasia
- Religion and Ethics - Euthanasia - many views of euthanasia, for, against, and religious
- - Euthanasia World Directory international information on voluntary euthanasia, assisted suicide, and self-deliverance
-  provides guides to self-deliverance for the terminally and hopelessly ill to end their suffering
- Compassion & Choices - provides education, support and advocacy for the choice-in-dying movement
- Dignity in Dying - leading campaigning organisation promoting patient choice at the end of life
- World Federation of Right To Die Societies
- Assisted Suicide
- Suicide & Euthanasia- Presents pro-choice arguments from a Biblical perspective.
- Voluntary Euthanasia- Atheist Foundation of Australia Inc
- Stanford Encyclopedia of Philosophy entry
- A defense of euthanasia
-  Phillip Nitzschke's euthanasia law reform advocacy website, currently based in New Zealand.
- Fish Euthanasia A guide to fish Euthanasia
- www.carenotkilling.org.uk - Care, NOT Killing: a UK alliance promoting palliative care, opposing euthanasia and assisted suicide
- National Right to Life articles on euthanasia
- International Task Force against Euthanasia- many resources
- Non-religious arguments against euthanasia
- A Papal encyclical dealing with a number of issues of life and death including euthanasia
- A brief presentation of the issue and the Christian Catholic viewpoint on it
- Right to Die-NL - Dutch union for voluntary termination of life NVVE
- NRC Handelblad April 14, 2001 interview of Els Borst: Transparency in Euthanasia- Note that this is from an anti-euthanasia web site, but claims to be merely a translation of a Dutch article. Els Borst is a former Dutch minister of Health.
- Clinical Problems with the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands, NEJM, February 24, 2000
- Consultants or Facilitators? Medical Journal of Australia, 1999 Editorial- Cites original research, including that on alternative palliative care
- Wall Street Journal Opinion Article on Dutch Euthanasia The article claims that unofficial Euthanasia is performed on many people, often without patient consultation, according to Dutch statistics, and that many old Dutch people are afraid to go to the hospital, citing the existence of cards stating Do Not Euthanize carried by some in the Netherlands.
- United States
- Oregon's Death with Dignity Act (State Website)
- Texas — The Futile Care Law
- New Zealand
- http://www.ves.org.nz/ Voluntary Euthanasia Society (pro-mercy)
- http://www.right-to-life.org/ Right to Life New Zealand (pro-care)
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