Daily Archives: June 25, 2016

Euthanasia Debate

Euthanasia is defined as the practice of ending a life prematurely in order to end pain and suffering. The process is also sometimes called Mercy Killing. Euthanasia can fall into several categories. Voluntary Euthanasia is carried out with the permission of the person whose life is taken. Involuntary euthanasia is carried out without permission, such as in the case of a criminal execution. The moral and social questions surrounding these practices are the most active fields of research in Bioethics today. Many Supreme Court cases, such as Gonzales v. Oregon and Baxter vs. Montana, also surround this issue.

Voluntary euthanasia is typically performed when a person is suffering from a terminal illness and is in great pain. When the patient performs this procedure with the help of a doctor, the term assisted suicide is often used. This practice is legal in Belgium, the Netherlands and Luxemburg. It is also legal in the state of Oregon, Washington and Montana. Passive euthanasia is carried out by terminating a medication that is keeping a patient alive or not performing a life-saving procedure. Active euthanasia involves the administration of a lethal drug or otherwise actively ending the life. These two types of procedures carry different moral and social issues.

There is a lot of controversy surrounding the issue of euthanasia and whether or not it should be legal. From a legal standpoint, the Encyclopedia of American Law categorizes mercy killing as a class of criminal homicide. Judicially, not all homicide is illegal. Killing is seen as excusable when used as a criminal punishment, but inexcusable when carried out for any other reason. In most nations, euthanasia is considered criminal homicide: however, in the jurisdictions mentioned above, it is placed on the other side of the table with criminal punishment.

Arguments regarding the euthanasia debate often depend on the method used to take the life of the patient. The Oregon Death with Dignity Act made it legal for residents to request a lethal injection from a doctor. This is seen in other jurisdictions as being a criminal form of homicide. However, passive euthanasia through denial of drugs or procedures is considered to be legal in almost all jurisdictions. Those who argue for euthanasia feel that there is no difference. Those who are against it disagree.

Many arguments also hinge on religious beliefs. Many Christians believe that taking a life, for any reason, is interfering with God's plan and is comparable to murder. The most conservative of Christians are against even passive euthanasia. Some religious people do take the other side of the argument and believe that the drugs to end suffering early are God-given and should be used.

One of the main groups of people who are involved with the euthanasia debate is physicians. One survey in the United States recorded the opinions of over 10,000 medical doctors and found that sixteen percent would consider stopping a life-maintaining therapy at the recommendation of family or the patient. Fifty five percent would never do such. The study also found that 46 percent of doctors believe that physician assisted suicide should be allowed in some cases.

The controversy surrounding euthanasia involves many aspects of religion, medical and social sciences. As this is one of the most studied fields of bioethics, one can rest assured that more studies will be performed to learn more about this issue and how to best address it.

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Euthanasia Debate | Debate.org

Euthanasia (from Greek: -, eu, "good," , thanatos, "death") is the practice of terminating the life of a human being or animal with an incurable disease, intolerable suffering, or a possibly undignified death in a painless or minimally painful way, for the purpose of limiting suffering. It is a form of homicide; the question is whether it should be considered justifiable or criminal.

Euthanasia refers both to the situation when a substance is administered to a person with intent to kill that person or, with basically the same intent, when removing someone from life support. There may be a legal divide between making someone die and letting someone die. In some instances, the first is (in some societies) defined as murder, the other is simply allowing nature to take its course. Consequently, laws around the world vary greatly with regard to euthanasia and are constantly subject to change as cultural values shift and better palliative care or treatments become available. Thus, while euthanasia is legal in some nations, in others it is criminalized.

Of related note is the fact that suicide, or attempted suicide, is no longer a criminal offense in most states. This demonstrates that there is consent among the states to self determination, however, the majority of the states argue that assisting in suicide is illegal and punishable even when there is written consent from the individual. The problem with written consent is that it is still not sufficient to show self-determination, as it could be coerced; if active euthanasia were to become legal, a process would have to be in place to assure that the patient's consent is fully voluntary.

Euthanasia has been used with several meanings:

The term euthanasia is used only in senses (6) and (7) in this article. When other people debate about euthanasia, they could well be using it in senses (1) through (5), or with some other definition. To make this distinction clearer, two other definitions of euthanasia follow:

There can be passive, non-aggressive, and aggressive euthanasia.

James Rachels has challenged both the use and moral significance of that distinction for several reasons:

To begin with a familiar type of situation, a patient who is dying of incurable cancer of the throat is in terrible pain, which can no longer be satisfactorily alleviated. He is certain to die within a few days, even if present treatment is continued, but he does not want to go on living for those days since the pain is unbearable. So he asks the doctor for an end to it, and his family joins in this request. Suppose the doctor agrees to withhold treatment. The justification for his doing so is that the patient is in terrible agony, and since he is going to die anyway, it would be wrong to prolong his suffering needlessly. But now notice this. If one simply withholds treatment, it may take the patient longer to die, and so he may suffer more than he would if more direct action were taken and a lethal injection given. This fact provides strong reason for thinking that, once the initial decision not to prolong his agony has been made, active euthanasia is actually preferable to passive euthanasia, rather than the reverse (Rachels 1975 and 1986).

There is also involuntary, non-voluntary, and voluntary euthanasia.

Mercy killing refers to killing someone to put them out of their suffering. The killer may or may not have the informed consent of the person killed. We shall use the term mercy killing only when there is no consent. Legally, mercy killing without consent is usually treated as murder.

Murder is intentionally killing someone in an unlawful way. There are two kinds of murder:

In most parts of the world, types (1) and (2) murder are treated identically. In other parts, type (1) murder is excusable under certain special circumstances, in which case it ceases to be considered murder. Murder is, by definition, unlawful. It is a legal term, not a moral one. Whether euthanasia is murder or not is a simple question for lawyers"Will you go to jail for doing it or won't you?"

Whether euthanasia should be considered murder or not is a matter for legislators. Whether euthanasia is good or bad is a deep question for the individual citizen. A right to die and a pro life proponent could both agree "euthanasia is murder," meaning one will go to jail if he were caught doing it, but the right to die proponent would add, "but under certain circumstances, it should not be, just as it is not considered murder now in the Netherlands."

The term "euthanasia" comes from the Greek words eu and thanatos, which combined means good death. Hippocrates mentions euthanasia in the Hippocratic Oath, which was written between 400 and 300 B.C.E. 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.

The English Common Law from the 1300s until today also disapproved of both suicide and assisting suicide. It distinguished a suicide, who was by definition of unsound mind, from a felo-de-se or "evildoer against himself," who had coolly decided to end it all and, thereby, perpetrated an infamous crime. Such a person forfeited his entire estate to the crown. Furthermore his corpse was subjected to public indignities, such as being dragged through the streets and hung from the gallows, and was finally consigned to "ignominious burial," and, as the legal scholars put it, the favored method was beneath a crossroads with a stake driven through the body.

Since the nineteenth 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.

Euthanasia societies were formed in England, in 1935, and in the U.S., 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 (targeting those such as the mentally "defective"). Meanwhile, during this same era, 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 (Kamisar 1977).

Prior to World War II, the Nazis carried out a controversial and now-condemned euthanasia program. In 1939, Nazis, in what was code named Action T4, involuntarily euthanized children under three who exhibited mental retardation, physical deformity, or other debilitating problems whom they considered "unworthy of life. This program was later extended to include older children and adults.

Leo Alexander, a judge at the Nuremberg trials after World War II, employed a "slippery slope" argument to suggest that any act of mercy killing inevitably will lead to the mass killings of unwanted persons:

The beginnings at first were a subtle shifting in the basic attitude of the physicians. It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as life not worthy to be lived. This attitude in its early stages concerned itself merely with the severely and chronically sick. Gradually, the sphere of those to be included in this category was enlarged to encompass the socially unproductive, the ideologically unwanted, the racially unwanted and finally all non-Germans.

Critics of this position point to the fact that there is no relation at all between the Nazi "euthanasia" program and modern debates about euthanasia. The Nazis, after all, used the word "euthanasia" to camouflage mass murder. All victims died involuntarily, and no documented case exists where a terminal patient was voluntarily killed. The program was carried out in the closest of secrecy and under a dictatorship. One of the lessons that we should learn from this experience is that secrecy is not in the public interest.

However, due to outrage over Nazi euthanasia crimes, 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, began speaking against euthanasia as a violation of the sanctity of life.

Nevertheless, owing to its principle of double effect, Catholic moral theology did leave room for shortening life with pain-killers and what would could be characterized as passive euthanasia (Papal statements 1956-1957). On the other hand, judges were often lenient in mercy-killing cases (Humphrey and Wickett, 1991, ch.4).

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. In 1975, Karen Ann Quinlan, for reasons still unknown, ceased breathing for several minutes. Failing to respond to mouth-to mouth resuscitation by friends she was taken by ambulance to a hospital in New Jersey. Physicians who examined her described her as being in "a chronic, persistent, vegetative state," and later it was judged that no form of treatment could restore her to cognitive life. Her father asked to be appointed her legal guardian with the expressed purpose of discontinuing the respirator which kept Karen alive. After some delay, the Supreme Court of New Jersey granted the request. The respirator was turned off. Karen Ann Quinlan remained alive but comatose until June 11, 1985, when she died at the age of 31.

In 1990, 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 later tried and convicted in 1999, for a murder displayed on television. Meanwhile in 1990, the Supreme Court approved the use of non-aggressive euthanasia.

Suicide or attempted suicide, in most states, is no longer a criminal offense. This demonstrates that there is consent among the states to self determination, however, the majority of the states postulate that assisting in suicide is illegal and punishable even when there is written consent from the individual. Let us now see how individual religions regard the complex subject of euthanasia.

In Catholic medical ethics, official pronouncements tend to strongly oppose active euthanasia, whether voluntary or not. Nevertheless, Catholic moral theology does allow dying to proceed without medical interventions that would be considered "extraordinary" or "disproportionate." The most important official Catholic statement is the Declaration on Euthanasia (Sacred Congregation, Vatican 1980).

The Catholic policy rests on several core principles of Catholic medical ethics, including the sanctity of human life, the dignity of the human person, concomitant human rights, and due proportionality in casuistic remedies (Ibid.).

Protestant denominations vary widely on their approach to euthanasia and physician assisted death. Since the 1970s, Evangelical churches have worked with Roman Catholics on a sanctity of life approach, though the Evangelicals may be adopting a more exceptionless opposition. While liberal Protestant denominations have largely eschewed euthanasia, many individual advocates (such as Joseph Fletcher) and euthanasia society activists have been Protestant clergy and laity. As physician assisted dying has obtained greater legal support, some liberal Protestant denominations have offered religious arguments and support for limited forms of euthanasia.

Not unlike the trend among Protestants, Jewish movements have become divided over euthanasia since the 1970s. Generally, Orthodox Jewish thinkers oppose voluntary euthanasia, often vigorously, though there is some backing for voluntary passive euthanasia in limited circumstances (Daniel Sinclair, Moshe Tendler, Shlomo Zalman Auerbach, Moshe Feinstein). Likewise, within the Conservative Judaism movement, there has been increasing support for passive euthanasia. In Reform Judaism responsa, the preponderance of anti-euthanasia sentiment has shifted in recent years to increasing support for certain passive euthanasia.

In Theravada Buddhism, a monk can be expelled for praising the advantages of death, even if they simply describe the miseries of life or the bliss of the afterlife in a way that might inspire a person to commit suicide or pine away to death. In caring for the terminally ill, one is forbidden to treat a patient so as to bring on death faster than would occur if the disease were allowed to run its natural course (Buddhist Monastic Code I: Chapter 4).

In Hinduism, the Law of Karma states that any bad action happening in one lifetime will be reflected in the next. Euthanasia could be seen as murder, and releasing the Atman before its time. However, when a body is in a vegetative state, and with no quality of life, it could be seen that the Atman has already left. When avatars come down to earth they normally do so to help out humankind. Since they have already attained Moksha they choose when they want to leave.

Muslims are against euthanasia. They believe that all human life is sacred because it is given by Allah, and that Allah chooses how long each person will live. Human beings should not interfere in this. Euthanasia and suicide are not included among the reasons allowed for killing in Islam.

"Do not take life, which Allah made sacred, other than in the course of justice" (Qur'an 17:33).

"If anyone kills a personunless it be for murder or spreading mischief in the landit would be as if he killed the whole people" (Qur'an 5:32).

The Prophet said: "Amongst the nations before you there was a man who got a wound, and growing impatient (with its pain), he took a knife and cut his hand with it and the blood did not stop till he died. Allah said, 'My Slave hurried to bring death upon himself so I have forbidden him (to enter) Paradise'" (Sahih Bukhari 4.56.669).

The debate in the ethics literature on euthanasia is just as divided as the debate on physician-assisted suicide, perhaps more so. "Slippery-slope" arguments are often made, supported by claims about abuse of voluntary euthanasia in the Netherlands.

Arguments against it are based on the integrity of medicine as a profession. In response, autonomy and quality-of-life-base arguments are made in support of euthanasia, underscored by claims that when the only way to relieve a dying patient's pain or suffering is terminal sedation with loss of consciousness, death is a preferable alternativean argument also made in support of physician-assisted suicide.

To summarize, there may be some circumstances when euthanasia is the morally correct action, however, one should also understand that there are real concerns about legalizing euthanasia because of fear of misuse and/or overuse and the fear of the slippery slope leading to a loss of respect for the value of life. What is needed are improvements in research, the best palliative care available, and above all, people should, perhaps, at this time begin modifying homicide laws to include motivational factors as a legitimate defense.

Just as homicide is acceptable in cases of self-defense, it could be considered acceptable if the motive is mercy. Obviously, strict parameters would have to be established that would include patients' request and approval, or, in the case of incompetent patients, advance directives in the form of a living will or family and court approval.

Mirroring this attitude, there are countries and/or statessuch as Albania (in 1999), Australia (1995), Belgium (2002), The Netherlands (2002), the U.S. state of Oregon, and Switzerland (1942)that, in one way or other, have legalized euthanasia; in the case of Switzerland, a long time ago.

In others, such as UK and U.S., discussion has moved toward ending its illegality. On November 5, 2006, Britain's Royal College of Obstetricians and Gynecologists submitted a proposal to the Nuffield Council on Bioethics calling for consideration of permitting the euthanasia of disabled newborns. The report did not address the current illegality of euthanasia in the United Kingdom, but rather calls for reconsideration of its viability as a legitimate medical practice.

In the U.S., recent Gallup Poll surveys showed that more than 60 percent of Americans supported euthanasia (Carroll 2006; Moore 2005) and attempts to legalize euthanasia and assisted suicide resulted in ballot initiatives and legislation bills within the United States in the last 20 years. For example, Washington voters saw Ballot Initiative 119 in 1991, California placed Proposition 161 on the ballot in 1992, Michigan included Proposal B in their ballot in 1998, and Oregon passed the Death with Dignity Act. The United States Supreme Court has ruled on the constitutionality of assisted suicide, in 2000, recognizing individual interests and deciding how, rather than whether they will die.

Perhaps a fitting conclusion of the subject could be the Japanese suggestion of the Law governing euthanasia:

All links retrieved May 26, 2015.

Autopsy Brain death Clinical death Euthanasia Persistent vegetative state Terminal illness

Immortality Infant mortality Legal death Maternal death Mortality rate

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A root cause for the desire to commit suicide is often depression. This can often be controlled with medication. If you are depressed, I strongly recommend that you seek medical help to see if your depression can be lifted.

Another cause of suicidal ideation is often intolerable levels of pain associated with a terminal illness, like cancer. Many physicians are reluctant to prescribe high levels of some pain killers out of fear that the person will become addicted to them. If you are suffering from pain in spite of medication, try insisting on better levels or types of pain killers. Recruit friends and family to intercede with your physician if you can.

If you feel overwhelmed and lack an effective support system of friends and family, consider tapping into the services of a crisis hotline. These are called by various names: distress centers, crisis centers, suicide prevention centers, etc. Their telephone numbers can often be found in the first page(s) of your telephone directory. If you cannot find a number for a center in your area, try phoning directory assistance at 4-1-1.

In the United States, you can call 1-800-273-TALK. See: http://www.suicidepreventionlifeline.org/ They will direct you to a crisis center in your area.

U.S. Crisis Center map

Crisis centers/distress centers/ etc are often confidential services that you can phone up at any time of the day or night for support. You can usually remain anonymous.

Wikipedia lists suicide crisis lines for many countries from Australia to the United States at: https://en.wikipedia.org/ Although these lines are often called "suicide prevention lines" or "crisis lines." most of the people calling are not suicidal, not in crisis, but are in distress. So, don't be reluctant to call them because you are not suicidal or in crisis.

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Throughout North America, committing suicide or attempting to commit suicide is no longer a criminal offense. However, helping another person commit suicide is generally considered a criminal act. A few exceptions are:

There were four failed ballot initiatives between 1991 and 2000:

Between 1994 and 2016, there have been in excess of 75 legislative bills to legalize PAS in at least 21 states. Almost all failed to become law. 4

The author of this section is approaching his 80th birthday and is in good health. To him, end of life issues have taken on a personal aspect. Being an Agnostic, he doubts the existence of an afterlife. He does not fear death. He does not fear being dead. However, he has considerable fear about the process of dying, For many people in North America is an agonizingly painful and lengthy process during which time one's enjoyment of life often drops to zero and becomes negative without any hope that it will return to positive territory. Fortunately for him, he lives in Canada which -- like all other developed countries except for the U.S. -- has universal health care. So he will receive competent medical attention. Unfortunately, pain management is often as poorly managed in Canada as it is in the U.S. He regards suicide as a civil right and would prefer that he have access to a means of suicide if life becomes unbearable. He thus strongly supports legalizing physician assisted suicide.

He is critical of PAS laws that have been passed to date because they generally give access to assisted dying only to terminally ill people who are expected to die in the near future of natural causes. They do not do anything for people who experience chronic, overwhelming pain with no hope of relief for years.

He has attempted to remain impartial, objective and fair while writing these essays.

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Euthanasia and Physician Assisted Suicide - All sides

There are arguments both for and against euthanasia and assisted suicide.

Some of the main arguments are outlined below. You should be aware that these arguments do not necessarily represent the opinions or policies of NHS Choices or the Department of Health.

There are twomain types of argument used to support the practices of euthanasia and assisted suicide. They are the:

These arguments are discussed in more detail below.

The ethical argument states thateveryone should beable to choose when and how they want to die, and that they should be able to do so with dignity.

The concept of "quality of life" is an important aspect of this argument. The idea put forward as part of the religious argument against euthanasia and assisted suicide (see below)that life is sacred and is therefore alwaysbetter than deathis rejected. The ethical argumentsuggests that life should only continue as long as a person feels their life is worth living.

For example, someone who supports the use ofeuthanasia or assisted suicide based on the ethical argument may believe that a person should be able to choose to end their life if they are living in intolerable pain and their quality of life is severely diminished.

The pragmatic argument states that many of the practices used inend of life care are a type of euthanasia in all but name.

For example, there is the practice of making a "do not attemptcardiopulmonary resuscitation" (DNACPR)order, where a person requests not to receive treatment if their heart stops beating or they stop breathing.

Critics have argued that DNACPR is a type of passive euthanasia, because a person is denied treatment that could potentially save their life.

Another controversial practice is known as palliative sedation. This is where a person who is experiencing extreme suffering, for which there is no effective treatment, is put to sleep using sedative medication. Palliative sedation is often used to treat burns victims who are expected to die.

While palliative sedation is not directly carried out for the purpose of ending lives, many of the sedatives used carry a risk of speeding up death. Therefore, itcould be argued that palliative sedation is a type of active euthanasia.

The pragmatic argument is that if euthanasia in these forms is being carried outanyway, society might as well legalise it and ensure that it is properly regulated.

It should be stressed, however,that the above interpretations of DNACPR and palliative sedation are very controversial and are not accepted by most doctors, nurses and palliative care specialists.

Read more about thealternatives to euthanasia for responses to these interpretations.

There are four main types of argument used by people who are againsteuthanasia and assisted suicide. They are known as the:

These arguments are described in more detail below.

The most common religious argument is that human beings are the sacred creation of God, so human life is, by extension, sacred.This is known as the "sanctity of life".

Only God should choose when a human life ends, so committing an act of euthanasia or assisting in suicide is acting against the will of God and is sinful.

This beliefor variations of itis shared by many members of the Christian, Jewish and Islamic faiths, although some individuals may personally feel that there are occasions when quality of life becomes more important than sanctity of life.

The issue is more complex in Hinduism and Buddhism.Scholars from both faiths have argued that euthanasia and assisted suicide are ethically acceptable acts in some circumstances, but these views do not have universal support among Hindus and Buddhists.

Some non-religious people may also have similar beliefs based on the view that permitting euthanasia and assisted suicide "devalues" life.

The slippery slope argument is based on the idea that once a healthcare service, and by extension the government, starts killing its own citizens, a line is crossed that should never have been crossed, and a dangerous precedent has been set.

The concern is that a society that allows voluntary euthanasia will gradually change its attitudes to include non-voluntary and then involuntary euthanasia.

Legalised voluntary euthanasia could eventually lead to a wide range of unforeseen consequences, such as the following:

The medical ethics argument,which is similar to the "slippery slope" argument,states that legalising euthanasia would violate one of the most important medical ethics, which, in the words of the International Code of Medical Ethics, is: "A physician shall always bear in mind the obligation to respect human life".

Asking doctors to abandon their obligation to preserve human life could damage the doctor-patient relationship.Hastening death on a regular basis could become a routine administrative task for doctors, leading to a lack of compassion when dealing with elderly, disabled or terminally ill people.

In turn, people with complex health needs or severe disabilities could become distrustful of their doctors efforts and intentions. They may think thattheir doctor would rather "kill them off" than take responsibility for a complex and demanding case.

The alternative argument is that advances in palliative care and mental health treatment mean there is no reason why any person should ever feel that they are suffering intolerably, whether it is physical or mental suffering, or both.

According to this argument,if a person is giventhe right care, in the right environment, there should be no reason why they are unable tohave a dignified and painless natural death.

Page last reviewed: 11/08/2014

Next review due: 11/08/2017

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Euthanasia and assisted suicide - Arguments - NHS Choices