Euthanasia and physician-assisted suicide refer to deliberate action taken with the intention of ending a life, in order to relieve persistent suffering.
In most countries, euthanasia is against the law and it may carry a jail sentence. In the United States, the law varies between states.
Euthanasia has long been a controversial and emotive topic.
Euthanasia and assisted suicide
Assisted suicide: Is it an act of compassion?
The definitions of euthanasia and assisted suicide vary.
One useful distinction is:
Euthanasia: A doctor is allowed by law to end a person’s life by a painless means, as long as the patient and their family agree.
Assisted suicide: A doctor assists a patient to commit suicide if they request it.
Voluntary and involuntary euthanasia
Euthanasia can also be classed as voluntary or involuntary.
Voluntary: When euthanasia is conducted with consent. Voluntary euthanasia is currently legal in Belgium, Luxembourg, The Netherlands, Switzerland, and the states of Oregon and Washington in the U.S.
Non-voluntary: When euthanasia is conducted on a person who is unable to consent due to their current health condition. In this scenario the decision is made by another appropriate person, on behalf of the patient, based on their quality of life and suffering.
Involuntary: When euthanasia is performed on a person who would be able to provide informed consent, but does not, either because they do not want to die, or because they were not asked. This is called murder, as it’s often against the patients will.
Passive and active euthanasia
There are two procedural classifications of euthanasia:
Passive euthanasia is when life-sustaining treatments are withheld. The definitions are not precise. If a doctor prescribes increasing doses of strong painkilling medications, such as opioids, this may eventually be toxic for the patient. Some may argue that this is passive euthanasia.
Others, however, would say this is not euthanasia, because there is no intention to take life.
Active euthanasia is when someone uses lethal substances or forces to end a patient’s life, whether by the patient or somebody else.
Active euthanasia is more controversial, and it is more likely to involve religious, moral, ethical, and compassionate arguments.
What is assisted suicide?
Assisted suicide has several different interpretations and definitions.
“Intentionally helping a person commit suicide by providing drugs for self-administration, at that person’s voluntary and competent request.”
Some definitions include the words, “in order to relieve intractable (persistent, unstoppable) suffering.”
The role of palliative care
Since pain is the most visible sign of distress of persistent suffering, people with cancer and other life-threatening, chronic conditions will often receive palliative care. Opioids are commonly used to manage pain and other symptoms.
The adverse effects of opioids include drowsiness, nausea, vomiting, and constipation. They can also be addictive. An overdose can be life-threatening.
In many countries, including the U.S., a patient can refuse treatment that is recommended by a health professional, as long as they have been properly informed and are “of sound mind.”
One argument against euthanasia or physician-assisted suicide is the Hippocratic Oath, dating back some 2,500 years. All doctors take this oath.
The Hippocratic Oath
The original oath included, among other things, the following words:
“I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.”
There are variations of the modern oath.
“If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty.”
As the world has changed since the time of Hippocrates, some feel that the original oath is outdated. In some countries, an updated version is used, while in others, for example, Pakistan, doctors still adhere to the original.
As more treatments become available, for example, the possibility of extending life, whatever its quality, is an increasingly complex issue.
Euthanasia in the United States
In the U.S. and other countries, euthanasia has been a topic of debate since the early 1800s.