Category Archives: Euthanasia

An intensive care unit in Belgium. Labour MP Robert Flello said: 'I think we face a real humanitarian crisis in those countries which have euthanasia or assisted suicide' (Photo: AP)

The case will be examined by Dutch prosecutors to see if a crime has been committed

Dutch prosecutors are being asked to examine the case of an elderly woman who was reportedly drugged and then pinned down while a doctor pumped lethal drugs into her body.

A female doctor has been formally reprimanded for performing the act of euthanasia because the patient was suffering from dementia and could not properly consent.

When the woman was first diagnosed with dementia four years ago she had indicated that she was willing to end her life by euthanasia but not now.

Her nursing home decided the moment had arrived when her condition deteriorated and she began to wander the wards at night and behave aggressively.

The doctor reportedly drugged the womans coffee to calm her down, an act the regional euthanasia assessment committee decided was wrong.

The doctor also allegedly asked the womans family to hold her down when she reacted negatively to the procedure, and ripped out the drip carrying the euthanasia drugs.

The assessment committee said the doctor had crossed a line and has passed the case to prosecutors who will decide if a crime has been committed.

The forcible euthanasia represents the first case involving a doctor to be referred to the Dutch prosecution service.

Dutch law, which dates from 2002, permits euthanasia only in cases of unbearable and untreatable suffering but it is increasingly used on people with dementia and mental health problems.

The latest euthanasia figures from Holland show that the number of mental health patients killed by euthanasia has quadrupled in just four years.

Last year it emerged that an alcoholic and a victim of child sex abuse were killed by euthanasia.

The latest figures also show that the 2015 total of euthanasia deaths some 5,306 cases represents a leap of 50 per cent in the last five years.

The case has emerged as a new study has predicted that Canadas new euthanasia laws, which closely resemble those in the Netherlands, could cut as much as 84 million from its annual health budget.

Researchers from the University of Calgary identified the substantial savings that could be made from reducing end-of-life care.

The study, published in the Canadian Medical Association Journal, said that health care at the end of life was intensive and could go on for months.

Euthanasia, however, would cost the state just 15 per patient.

Robert Flello, the Labour MP for Stoke-on-Trent South and a Catholic, said the implications of the study were absolutely horrific.

It reinforces anecdotal evidence coming out of Holland that doctors are rationing health care by using euthanasia, said Mr Flello, a co-chairman of the All Party Parliamentary Pro-Life Group.

Quite frankly, it terrifies me, he said. We have issues with bed-blocking and if we ever had euthanasia or even so-called assisted dying in this country then we would have a real issue with cuts to our NHS being softened by actually just killing people off.

I find the prospect simply terrifying.

Mr Flello also severely criticised the forcible euthanasia of the elderly dementia sufferer in Holland, adding: I think we face a real humanitarian crisis in those countries which have euthanasia or assisted suicide and quite frankly I dont want that appalling situation here.

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Doctor 'asked family to hold down struggling euthanasia victim' - Catholic Herald Online

This article is about mercy killing of animals. For compassionate death in humans, see Euthanasia.

Animal euthanasia (euthanasia from Greek: ; "good death") is the act of putting an animal to death or allowing it to die by withholding extreme medical measures. Reasons for euthanasia include incurable (and especially painful) conditions or diseases,[1] lack of resources to continue supporting the animal, or laboratory test procedures. Euthanasia methods are designed to cause minimal pain and distress. Euthanasia is distinct from animal slaughter and pest control although in some cases the procedure is the same.

In domesticated animals, this process is commonly referred to by euphemisms such as "put down", "put to sleep", or "put out of his/her/its misery".

The methods of anesthesia can be divided into pharmacological and physical methods. Acceptable pharmacological methods include injected drugs and gases that first depress the central nervous system and then cardiovascular activity. Acceptable physical methods must first cause rapid loss of consciousness by disrupting the central nervous system. The most common methods are discussed here, but there are other acceptable methods used in different situations.[2]

Unconsciousness, respiratory then cardiac arrest follow rapidly, usually within 30seconds.[3] Observers generally describe the method as leading to a quick and peaceful death.

For companion animals euthanized in animal shelters, 14 states in the US now prescribe intravenous injection as the required method. These laws date to 1990, when Georgia's "Humane Euthanasia Act" became the first state law to mandate this method. Before that, gas chambers and other means were commonly employed. The Georgia law was resisted by the Georgia Commissioner of Agriculture, Tommy Irvin, who was charged with enforcing the act. In March 2007, he was sued by former State Representative Chesley V. Morton, who wrote the law, and subsequently ordered by the Court to enforce all provisions of the Act.[4]

Some veterinarians perform a two-stage process: an initial injection that simply renders the pet unconscious and a second shot that causes death.[citation needed] This allows the owner the chance to say goodbye to a live pet without their emotions stressing the pet. It also greatly mitigates any tendency toward spasm and other involuntary movement which tends to increase the emotional upset that the pet's owner experiences.

For large animals, the volumes of barbiturates required are considered by some to be impractical, although this is standard practice in the United States.[5] For horses and cattle, other drugs may be available. Some specially formulated combination products are available, such as Somulose (Secobarbital/Cinchocaine) and Tributame (Embutramide/Chloroquine/Lidocaine), which cause deep unconsciousness and cardiac arrest independently with a lower volume of injection, thus making the process faster, safer, and more effective.

Occasionally, a horse injected with these mixtures may display apparent seizure activity before death. This may be due to premature cardiac arrest. However, if normal precautions (e.g., sedation with detomidine) are taken, this is rarely a problem.[6] Anecdotal reports that long-term use of phenylbutazone increases the risk of this reaction are unverified.

After the animal has expired, it is not uncommon for the body to have posthumous body jerks, or for the animal to have a sudden bladder outburst.

Gas anesthetics such as isoflurane and sevoflurane can be used for euthanasia of very small animals. The animals are placed in sealed chambers where high levels of anesthetic gas are introduced. Death may also be caused using carbon dioxide once unconsciousness has been achieved by inhaled anaesthetic.[7] Carbon dioxide is often used on its own for euthanasia of wild animals.[8] There are mixed opinions on whether it causes distress when used on its own, with human experiments lending support to the evidence that it can cause distress and equivocal results in non-humans.[9] In 2013, the American Veterinary Medical Association (AVMA) issued new guidelines for carbon dioxide induction, stating that a flow rate of 10% to 30% volume/min is optimal for the humane euthanization of small rodents.[10]

Carbon monoxide is often used, but some states in the US have banned its use in animal shelters: although carbon monoxide poisoning is not particularly painful, the conditions in the gas chamber are often not humane.[11]Nitrogen has been shown to be effective, although some young animals are rather resistant[12] and it currently is not widely used.

Cervical dislocation, or displacement (breaking or fracturing) of the neck, is an older yet less common method of killing small animals such as mice. Performed properly it is intended to cause as painless death as possible and has no cost or equipment involved. The handler must know the proper method of executing the movement which will cause the cervical displacement and without proper training and method education there is a risk of not causing death and can cause severe pain and suffering. It is unknown how long an animal remains conscious, or the level of suffering it goes through after a correct snapping of the neck, which is why it has become less common and often substituted with inhalants.

When intravenous injection is not possible, euthanasia drugs such as pentobarbital can be injected directly into a heart chamber or body cavity.

While intraperitoneal injection is fully acceptable (although it may take up to 15 minutes to take effect in dogs and cats[7]), an intracardiac (IC) injection may only be performed on an unconscious or deeply sedated animal. Performing IC injections on a fully conscious animal in places with humane laws for animal handling is often a criminal offense.[13]

This can be an appropriate means of euthanasia for large animals (e.g., horses, cattle, deer) if performed properly. This may be performed by means of:

The reasons for euthanasia of pets and other animals include:

Small animal euthanasia is typically performed in a veterinary clinic or hospital or in an animal shelter and is usually carried out by a veterinarian or a veterinary technician working under the veterinarian's supervision. Often animal shelter workers are trained to perform euthanasia as well. Some veterinarians will perform euthanasia at the pet owner's homethis is virtually mandatory in the case of large animal euthanasia. In the case of large animals which have sustained injuries, this will also occur at the site of the accident, for example, on a racecourse.

Some animal rights organizations support animal euthanasia in certain circumstances and practice euthanasia at shelters that they operate.[16]

Many pet owners choose to have their pets cremated or buried after the pet is euthanized,[17] and there are pet funeral homes that specialize in animal burial or cremation.[18] Otherwise, the animal facility will often freeze the body and subsequently send it to the local landfill.[19]

In some instances, animals euthanized at shelters or animal control agencies have been sent to meat rendering facilities[20][21][22] to be processed for use in cosmetics, fertilizer, gelatin, poultry feed, pharmaceuticals and pet food.[23] It was proposed that the presence of pentobarbital in dog food may have caused dogs to become less responsive to the drug when being euthanized.[24] However, a 2002 FDA study found no dog or cat DNA in the foods they tested, so it was theorized that the drug found in dog food came from euthanized cattle and horses. Furthermore, the level of the drug found in pet food was safe.[25]

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Animal euthanasia - Wikipedia

"Half a Life" is the 22nd episode of the fourth season of the American science fiction television series Star Trek: The Next Generation, the 96th episode overall. It was originally released on May 6, 1991, in broadcast syndication. The episode was the first of the series written by Peter Allan Fields, who later joined the writing staff. Director Les Landau said that "Half a Life" was a morality play about "how society deals with the elderly".[2]

Set in the 24th century, the series follows the adventures of the crew of the Federation starship Enterprise. In this episode, Lwaxana Troi (Majel Barrett) falls in love with Timicin (David Ogden Stiers), a Kaelon scientist who is attempting to test his theories of stellar ignition in the hopes of saving his world's dying star. The experiment fails, and Lwaxana encourages Timicin to continue his research, but as he is about to turn sixty years of age, he prepares instead for a ritual suicide. According to Timicin's cultural tradition, his people voluntarily choose euthanasia to prevent the aged from becoming a burden to the younger generation.

The episode features the first appearance of Michelle Forbes in the Star Trek franchise; she would later appear as Ensign Ro Laren during season five. The cast praised the story and the expansion of the Lwaxana character. The episode received positive reviews, with critics noting the performances of Stiers and Barrett, their character's love story, and the changes to the Lwaxana character.

The U.S.S. Enterprise takes aboard Deanna Troi's (Marina Sirtis) eccentric mother Lwaxana (Majel Barrett) and Dr. Timicin (David Ogden Stiers) of Kaelon II. Timicin is brought aboard to conduct an experiment which he hopes will save his threatened home planet, as its sun is in a state of near-collapse. The Federation enlists the Enterprise to take Timicin to a sun in a similar state of decay to conduct experiments which may yield a method for saving the Kaelon system from destruction.

Upon arrival at their destination, the crew assists Timicin in modifying photon torpedos to launch into the proxy sun with the expectation that it will repair the damaged star and prove that the technique can be safely applied to the Kaelon sun. The torpedos are fired and, although the experiment seems initially to work, the effect is short-lived and the star explodes. The Enterprise returns to Kaelon II. Timicin is crushed, and after some questioning by Lwaxana, he reveals that there are other things troubling him. Timicin tells Lwaxana that he is about to turn 60, and on Kaelon II, everyone who reaches that age performs the "Resolution", a ritual act of voluntary euthanasia. Lwaxana is outraged to learn of this and brings it to the attention of Captain Jean-Luc Picard (Patrick Stewart). Picard makes it clear to Lwaxana that due to the Prime Directive, he will not interfere in the planet's local affairs. Lwaxana tries to beam herself down to the planet to halt the process herself but she is thwarted by Deanna who comforts her.

After Lwaxana and Timicin spend an evening together, he tries to explain the custom of the Resolution. He tells her that a fixed age had to be selected by the Kaelons because just randomly choosing a time to die would be heartless. Lwaxana finds the practice barbaric and refuses to accept the Kaelon tradition. She tells Timicin how a Betazed woman on her planet successfully fought the tradition of wearing ornate wigs that contained live, captive birds. It only took one courageous woman to step forward and end this cruel tradition. Lwaxana also compares Timicin's plans to end his life with his research to save his star. If it is Timicin's time to die, Lwaxana argues, perhaps it is also time for his star to die as well, so why should he continue to try to prevent it? Timicin thinks about what Lwaxana has told him.

Timicin's analysis of the failed test turns up some promising options, but if he follows through with the Resolution, no one will have his experience and knowledge to carry on his work to save his world. Concerned, Timicin requests asylum on the Enterprise so that he can renounce the Resolution and continue his research. B'Tardat (Terrence E. McNally), the Science Minister on Kaelon II, is outraged after learning of Timicin's request for asylum, and he sends up two warships to ensure that the Enterprise does not leave the system with Timicin on board. As Picard orders the bridge crew to analyze the offensive capabilities of the Kaelonian ships, Timicin realizes that his situation is not as simple as he had hoped, for his home planet will not accept any further reports from him, and he is told that even if he does find a solution, they will not accept it.

Dara (Michelle Forbes), Timicin's daughter, beams on board the Enterprise to insist that he return to Kaelon II and undergo the Resolution. She tells him that she cannot bear the thought of him being laid to rest anywhere but next to her mother and, although she loves him, she is ashamed of him. Timicin realizes that he is not the man to forge a cultural revolution, and agrees to return to Kaelon II. Lwaxana, despite her disagreement, realizes that Timicin's decision is his to make. As it is the custom for loved ones to be present at the Resolution, Lwaxana beams down to be with him at his side as he dies.

"Half a Life" was the first Star Trek credit for writer Peter Allan Fields, who would later co-write the "The Inner Light" with Morgan Gendel before becoming a staff writer on Star Trek: The Next Generation during season five.[3][4] Prior to writing the script, Fields reviewed "Haven" and "Manhunt", the two previous Lwaxana Troi episodes, but did not use them as references except to note Lwaxana's level of privilege. "I realized that you give her as much as they'll let her have. She'll take it", he explained.[2]

Marina Sirtis, who played Lwaxana's daughter Deanna Troi on the show, thought that compared to earlier episodes, "Half a Life" showed a different side of her character's mother. Lwaxana's interactions in the episode, argues Sirtis, considerably broadened the character; previous episodes had a tendency to become centered around Deanna and Lwaxana.[2] Sirtis and director Les Landau felt that the plot of "Half a Life" resembled a morality play. Landau noted the similarity between the episode and the morality play-style plots that franchise creator Gene Roddenberry included in Star Trek: The Original Series.[2][5] "It deals with the whole issue of growing old and how society deals with the elderly and, in my mind, it was one of the most pertinent story-lines I have done", Landau recalled.[2]

The episode guest starred David Ogden Stiers, best known for his role as Major Charles Emerson Winchester III on the American television series M*A*S*H. Stiers, a fan of Star Trek: The Next Generation, was enthusiastic when the producers asked him if he would be interested in appearing on the show. On the set during production, Stiers met Gene Roddenberry, the series producer, and was invited to his house to practice scenes with Roddenberry's wife, Majel Barrett.[6] Stiers described Roddenberry as "a grand old man - not in his behaviour but in people's deference to him".[6]

Speaking highly of the story in "Half a Life", Stiers indicated that the mood of the episode accentuated the debate over Timicin's decision to end his life. "It was an emotionally involved piece. The script quite responsibly argued both sides [of the suicide] issue and left the viewer to determine whether such a practice is acceptable or not," Stiers said. "That episode was more powerful than simply a discussion."[6]

Michelle Forbes makes her first The Next Generation appearance in "Half a Life", in a performance which led directly to her later casting in the larger role of Ensign Ro Laren, a recurring character from season five onwards.[3][4]

"Half a Life" was first released within the United States on May 6, 1991, in broadcast syndication.[7]Keith DeCandido, in a review for Tor.com, commended Stiers' acting, saying that he gave "a noble, nuanced performance as Timicin."[3] He also approved of the episode, saying that it was the first time that Lwaxana Troi was treated as a real character without causing him to cringe; at the same time, DeCandido did not forget the problems with her previous appearances on the show.[3] Noting that it was one of the best episodes to feature a Prime Directive debate, DeCandido endorsed the writer's idea not to take sides regarding the suicide. "This is a magnificent, tragic love story, one that takes a thin character and gives her depth, one that gives us a beautifully realized guest character in Timicin (casting Stiers was a masterstroke, as he always brings subtle nuance to his roles), and one that takes its issues seriously," DeCandido wrote.[3] He gave the episode a score of eight out of ten,[3] later concluding that it featured "one of the show's most tragic love stories."[8]

In their book The Unauthorized Trek: The Complete Next Generation, James Van Hise and Hal Schuster observed a significant improvement in Majel Barrett's performance in this episode compared to her previous appearances.[9] They said that Barrett was "capable of depth and feeling",[9] and described the ending of the episode as "touching and disturbing". A society shouldn't naturally evolve to include ritual suicide, Van Hise and Schuster argue, but population control methods such as the one-child policy in China, appear linked to a similar required effect, albeit through different means.[9]

Reviewing the episode for The A.V. Club, Zack Handlen said that Timicin served as an "excellent foil" for Lwaxana and made her "seem less ridiculous".[10] The relationship between Lwaxana and Timicin "has a believable core", even if it is "broad and arguably rushed", writes Handlen.[10] "There are some powerful moments... and it's pleasant for once to see Lwaxana adding, rather than subtracting, from a storyline."[10] Handlen, however, criticizes the setup of Timicin's situation, as it reduced the characterization available to some of the Enterprise crew.[10] In spite of its flaw, Handlen decides that "the episode largely redeems itself by staying true to its main point: No matter how much time you have left, it's never enough."[10]

"Half a Life" was first released on VHS cassette in the United States and Canada on July 23, 1996.[11] The episode was later released in the United States on September 3, 2002, as part of the Star Trek: The Next Generation season four DVD box set.[12] The first Blu Ray release was in the United Kingdom on July 29, 2013,[13] followed by the United States on July 30.[14]

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Half a Life (Star Trek: The Next Generation) - Wikipedia

This article is about euthanasia of humans. For mercy killings performed on other animals, see Animal euthanasia.

Euthanasia (from Greek: ; "good death": , eu; "well" or "good" , thanatos; "death") is the practice of intentionally ending a life in order to relieve pain and suffering.[1]

There are different euthanasia laws in each country. 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".[2] In the Netherlands and Flanders, euthanasia is understood as "termination of life by a doctor at the request of a patient".[3]

Euthanasia is categorized in different ways, which include voluntary, non-voluntary, or involuntary. Voluntary euthanasia is legal in some countries. Non-voluntary euthanasia (patient's consent unavailable) is illegal in all countries. Involuntary euthanasia (without asking consent or against the patient's will) is also illegal in all countries and is usually considered murder.[4] As of 2006, euthanasia is the most active area of research in contemporary bioethics.[5]

In some countries there is a divisive public controversy over the moral, ethical, and legal issues of euthanasia. Those who are against euthanasia may argue for the sanctity of life, while proponents of euthanasia rights emphasize alleviating suffering, and preserving bodily integrity, self-determination, and personal autonomy.[6] Jurisdictions where euthanasia is legal include the Netherlands, Canada,[7]Colombia, Belgium, and Luxembourg.

Like other terms borrowed from history, "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."[8] 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 conceptthe euthanasia "which regards the preparation of the soul."[9]

In current usage, euthanasia has been defined as the "painless inducement of a quick death".[10] However, it is argued that this approach fails to properly define euthanasia, as it leaves open a number of possible actions which 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.[11][12]

Another approach incorporates the notion of suffering into the definition.[11] 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",[13] 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".[14] Counterexamples can be given: such definitions may encompass killing a person suffering from an incurable disease for personal gain (such as to claim an inheritance), and commentators such as Tom Beauchamp and Arnold Davidson have argued that doing so would constitute "murder simpliciter" rather than euthanasia.[11]

The third element incorporated into many definitions is that of intentionality the death must be intended, rather than being accidental, and the intent of the action must be a "merciful death".[11] 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."[15] 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."[12] Definitions such as that 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."[2] Beauchamp and Davidson also highlight Baruch Brody's "an act of euthanasia is one in which one person... (A) kills another person (B) for the benefit of the second person, who actually does benefit from being killed".[16]

Draper argued that any definition of euthanasia must incorporate four elements: an agent and a subject; an intention; a 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."[17] Prior to Draper, Beauchamp and Davidson had also offered a definition that includes these elements. Their definition specifically discounts fetuses in order to distinguish between abortions and euthanasia:[18]

"In summary, we have argued... that the death of a human being, A, is an instance of euthanasia if and only if (1) A's death is intended by at least one other human being, B, where B is either the cause of death or a causally relevant feature of the event resulting in death (whether by action or by omission); (2) there is either sufficient current evidence for B to believe that A is acutely suffering or irreversibly comatose, or there is sufficient current evidence related to A's present condition such that one or more known causal laws supports B's belief that A will be in a condition of acute suffering or irreversible comatoseness; (3) (a) B's primary reason for intending A's death is cessation of A's (actual or predicted future) suffering or irreversible comatoseness, where B does not intend A's death for a different primary reason, though there may be other relevant reasons, and (b) there is sufficient current evidence for either A or B that causal means to A's death will not produce any more suffering than would be produced for A if B were not to intervene; (4) the causal means to the event of A's death are chosen by A or B to be as painless as possible, unless either A or B has an overriding reason for a more painful causal means, where the reason for choosing the latter causal means does not conflict with the evidence in 3b; (5) A is a nonfetal organism."[19]

Wreen, in part responding to Beauchamp and Davidson, offered a six-part definition:

"Person A committed an act of euthanasia if and only if (1) A killed B or let her die; (2) A intended to kill B; (3) the intention specified in (2) was at least partial cause of the action specified in (1); (4) the causal journey from the intention specified in (2) to the action specified in (1) is more or less in accordance with A's plan of action; (5) A's killing of B is a voluntary action; (6) the motive for the action specified in (1), the motive standing behind the intention specified in (2), is the good of the person killed."[20]

Wreen also considered a seventh requirement: "(7) The good specified in (6) 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.[21]

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".[21] 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 (EPAC) Ethics Task Force, the authors offered: "Medicalized killing of a person without the person's consent, whether nonvoluntary (where the person in unable to consent) or involuntary (against the person's will) is not euthanasia: it is murder. Hence, euthanasia can be voluntary only."[22] 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.[21]

Euthanasia may be classified according to whether a person gives informed consent into three types: voluntary, non-voluntary and involuntary.[23][24]

There is a debate within the medical and bioethics literature about whether or not the non-voluntary (and by extension, involuntary) 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 as one of their criteria, although it may have been required to justify euthanasia.[11][25] However, others see consent as essential.

Euthanasia conducted with the consent of the patient is termed voluntary euthanasia. Active voluntary euthanasia is legal in Belgium, Luxembourg and the Netherlands. Passive voluntary euthanasia is legal throughout the U.S. per Cruzan v. Director, Missouri Department of Health. When the patient brings about his or her 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.

Euthanasia conducted when the consent of the patient is unavailable is termed non-voluntary euthanasia. Examples include child euthanasia, which is illegal worldwide but decriminalised under certain specific circumstances in the Netherlands under the Groningen Protocol.

Euthanasia conducted against the will of the patient is termed involuntary euthanasia.

Voluntary, non-voluntary and involuntary euthanasia can all be further divided into passive or active variants.[26] Passive euthanasia entails the withholding of common treatments, such as antibiotics, necessary for the continuance of life.[2] Active euthanasia entails the use of lethal substances or forces, such as administering a lethal injection, to kill and is the most controversial means. While some authors consider these terms to be misleading and unhelpful, they are nonetheless used in the literature, and so should be clarified and understood. Active euthanasia involves taking deliberate steps to end a patient's life. As an example, an administration of a lethal compound that might induce a cardiac arrest, a practice that is illegal in most jurisdictions. Passive euthanasia occur when treatments necessary for the continuance of life are withheld. 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.[2]

According to the historian N. D. A. Kemp, the origin of the contemporary debate on euthanasia started in 1870.[27] Euthanasia is known to have been debated and practiced long before that date. 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 Marseilles. 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" (noting there is some debate in the literature about whether or not this was intended to encompass euthanasia).[28][29][30]

The term "euthanasia" in the earlier sense of supporting someone as they died was used for the first time by Francis Bacon (15611626). 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:

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 between the theological care of the soul of sick people from the physical care and medical treatment by doctors.[32][33]

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,[34] as did Francois Ranchin (15651641), a French physician and professor of medicine, and Michael Boudewijns (16011681), a physician and teacher.[29]:208[35] Other voices argued for euthanasia, such as John Donne in 1624,[36] and euthanasia continued to be practised. In 1678, the publication of Caspar Questel's De pulvinari morientibus non subtrahend, ("On the pillow of which the dying should not be deprived"), initiated debate on the topic. Questel described various customs which were employed at the time to hasten the death of the dying, (including the sudden removal of a pillow, which was believed to accelerate death), and argued against their use, as doing so was "against the laws of God and Nature".[29]:209211 This view was shared by many who followed, including Philipp Jakob Spener, Veit Riedlin and Johann Georg Krnitz.[29]:211 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.[29]:211214

Suicide and euthanasia became more accepted during the Age of Enlightenment.[35]Thomas More wrote of euthanasia in Utopia, although it is not clear if More was intending to endorse the practice.[29]:208209 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.[37]

In the mid-1800s, the use of morphine to treat "the pains of death" emerged, with John Warren recommending its use in 1848. A similar use of chloroform was revealed by Joseph Bullar in 1866. However, in neither case was it recommended that the use should be to hasten death. In 1870 Samuel Williams, a schoolteacher, initiated the contemporary euthanasia debate through a speech given at the Birmingham Speculative Club in England, which was subsequently published in a one-off publication entitled Essays of the Birmingham Speculative Club, the collected works of a number of members of an amateur philosophical society.[38]:794 Williams' proposal was to use chloroform to deliberately hasten the death of terminally ill patients:

That in all cases of hopeless and painful illness, it should be the recognized duty of the medical attendant, whenever so desired by the patient, to administer choloroform or such other anaesthetic as may by-and-bye supersede chloroform so as to destroy consciousness at once, and put the sufferer to a quick and painless death; all needful precautions being adopted to prevent any possible abuse of such duty; and means being taken to establish, beyond the possibility of doubt or question, that the remedy was applied at the express wish of the patient.

The essay was favourably reviewed in The Saturday Review, but an editorial against the essay appeared in The Spectator.[27] From there it proved to be influential, and other writers came out in support of such views: Lionel Tollemache wrote in favour of euthanasia, as did Annie Besant, the essayist and reformer who later became involved with the National Secular Society, considering it a duty to society to "die voluntarily and painlessly" when one reaches the point of becoming a 'burden'.[27][39]Popular Science analyzed the issue in May 1873, assessing both sides of the argument.[40] Kemp notes that at the time, medical doctors did not participate in the discussion; it was "essentially a philosophical enterprise... tied inextricably to a number of objections to the Christian doctrine of the sanctity of human life".[27]

The rise of the euthanasia movement in the United States coincided with the so-called Gilded Age, a time of social and technological change that encompassed an "individualistic conservatism that praised laissez-faire economics, scientific method, and rationalism", along with major depressions, industrialisation and conflict between corporations and labour unions.[38]:794 It was also the period in which the modern hospital system was developed, which has been seen as a factor in the emergence of the euthanasia debate.[41]

Robert Ingersoll argued for euthanasia, stating in 1894 that where someone is suffering from a terminal illness, such as terminal cancer, they should have a right to end their pain through suicide. Felix Adler offered a similar approach, although, unlike Ingersoll, Adler did not reject religion. In fact, he argued from an Ethical Culture framework. In 1891, Alder argued that those suffering from overwhelming pain should have the right to commit suicide, and, furthermore, that it should be permissible for a doctor to assist thus making Adler the first "prominent American" to argue for suicide in cases where people were suffering from chronic illness.[42] Both Ingersoll and Adler argued for voluntary euthanasia of adults suffering from terminal ailments.[42] Dowbiggin argues that by breaking down prior moral objections to euthanasia and suicide, Ingersoll and Adler enabled others to stretch the definition of euthanasia.[43]

The first attempt to legalise euthanasia took place in the United States, when Henry Hunt introduced legislation into the General Assembly of Ohio in 1906.[44]:614 Hunt did so at the behest of Anna Hall, a wealthy heiress who was a major figure in the euthanasia movement during the early 20th century in the United States. Hall had watched her mother die after an extended battle with liver cancer, and had dedicated herself to ensuring that others would not have to endure the same suffering. Towards this end she engaged in an extensive letter writing campaign, recruited Lurana Sheldon and Maud Ballington Booth, and organised a debate on euthanasia at the annual meeting of the American Humane Association in 1905 described by Jacob Appel as the first significant public debate on the topic in the 20th century.[44]:614616

Hunt's bill called for the administration of an anesthetic to bring about a patient's death, so long as the person is of lawful age and sound mind, and was suffering from a fatal injury, an irrevocable illness, or great physical pain. It also required that the case be heard by a physician, required informed consent in front of three witnesses, and required the attendance of three physicians who had to agree that the patient's recovery was impossible. A motion to reject the bill outright was voted down, but the bill failed to pass, 79 to 23.[38]:796[44]:618619

Along with the Ohio euthanasia proposal, in 1906 Assemblyman Ross Gregory introduced a proposal to permit euthanasia to the Iowa legislature. However, the Iowa legislation was broader in scope than that offered in Ohio. It allowed for the death of any person of at least ten years of age who suffered from an ailment that would prove fatal and cause extreme pain, should they be of sound mind and express a desire to artificially hasten their death. In addition, it allowed for infants to be euthanised if they were sufficiently deformed, and permitted guardians to request euthanasia on behalf of their wards. The proposed legislation also imposed penalties on physicians who refused to perform euthanasia when requested: a 612 month prison term and a fine of between $200 and $1000. The proposal proved to be controversial.[44]:619621 It engendered considerable debate and failed to pass, having been withdrawn from consideration after being passed to the Committee on Public Health.[44]:623

After 1906 the euthanasia debate reduced in intensity, resurfacing periodically, but not returning to the same level of debate until the 1930s in the United Kingdom.[38]:796

The Voluntary Euthanasia Legalisation Society was founded in 1935 by Charles Killick Millard (now called Dignity in Dying). The movement campaigned for the legalisation of euthanasia in Great Britain.

In January 1936, King George V was given a fatal dose of morphine and cocaine in order to hasten his death. At the time he was suffering from cardio-respiratory failure, and the decision to end his life was made by his physician, Lord Dawson.[45] Although this event was kept a secret for over 50 years, the death of George V coincided with proposed legislation in the House of Lords to legalise euthanasia. The legislation came through the British Volunteer Euthanasia Legalisation Society.[46]

Euthanasia opponent Ian Dowbiggin argues that the early membership of the Euthanasia Society of America (ESA) reflected how many perceived euthanasia at the time, often seeing it as a eugenics matter rather than an issue concerning individual rights.[42] Dowbiggin argues that not every eugenist joined the ESA "solely for eugenic reasons", but he postulates that there were clear ideological connections between the eugenics and euthanasia movements.[42]

A 24 July 1939 killing of a severely disabled infant in Nazi Germany was described in a BBC "Genocide Under the Nazis Timeline" as the first "state-sponsored euthanasia".[47] Parties that consented to the killing included Hitler's office, the parents, and the Reich Committee for the Scientific Registration of Serious and Congenitally Based Illnesses.[47]The Telegraph noted that the killing of the disabled infantwhose name was Gerhard Kretschmar, born blind, with missing limbs, subject to convulsions, and reportedly "an idiot" provided "the rationale for a secret Nazi decree that led to 'mercy killings' of almost 300,000 mentally and physically handicapped people".[48] While Kretchmar's killing received parental consent, most of the 5,000 to 8,000 children killed afterwards were forcibly taken from their parents.[47][48]

The "euthanasia campaign" of mass murder gathered momentum on 14 January 1940 when the "handicapped" were killed with gas vans and killing centres, eventually leading to the deaths of 70,000 adult Germans.[49] Professor Robert Jay Lifton, author of The Nazi Doctors and a leading authority on the T4 program, contrasts this program with what he considers to be a genuine euthanasia. He explains that the Nazi version of "euthanasia" was based on the work of Adolf Jost, who published The Right to Death (Das Recht auf den Tod) in 1895. Lifton writes: "Jost argued that control over the death of the individual must ultimately belong to the social organism, the state. This concept is in direct opposition to the Anglo-American concept of euthanasia, which emphasizes the individual's 'right to die' or 'right to death' or 'right to his or her own death,' as the ultimate human claim. In contrast, Jost was pointing to the state's right to kill.... Ultimately the argument was biological: 'The rights to death [are] the key to the fitness of life.' The state must own deathmust killin order to keep the social organism alive and healthy."[50]

In modern terms, the use of "euthanasia" in the context of Action T4 is seen to be a euphemism to disguise a program of genocide, in which people were killed on the grounds of "disabilities, religious beliefs, and discordant individual values".[51] Compared to the discussions of euthanasia that emerged post-war, the Nazi program may have been worded in terms that appear similar to the modern use of "euthanasia", but there was no "mercy" and the patients were not necessarily terminally ill.[51] Despite these differences, historian and euthanasia opponent Ian Dowbiggin writes that "the origins of Nazi euthanasia, like those of the American euthanasia movement, predate the Third Reich and were intertwined with the history of eugenics and Social Darwinism, and with efforts to discredit traditional morality and ethics."[42]:65

On January 6, 1949, the Euthanasia Society of America presented to the New York State Legislature a petition to legalize euthanasia, signed by 379 leading Protestant and Jewish ministers, the largest group of religious leaders ever to have taken this stance. A similar petition had been sent to the New York State Legislature in 1947, signed by approximately 1,000 New York physicians. Catholic religious leaders criticized the petition, saying that such a bill would "legalize a suicide-murder pact" and a "rationalization of the fifth commandment of God, 'Though Shalt Not Kill.'"[52] The Right Reverend Robert E. McCormick stated that

"The ultimate object of the Euthanasia Society is based on the Totalitarian principle that the state is supreme and that the individual does not have the right to live if his continuance in life is a burden or hindrance to the state. The Nazis followed this principle and compulsory Euthanasia was practiced as a part of their program during the recent war. We American citizens of New York State must ask ourselves this question: 'Are we going to finish Hitler's job?'"[52]

The petition brought tensions between the American Euthanasia Society and the Catholic Church to a head that contributed to a climate of anti-Catholic sentiment generally regarding issues such as birth control, eugenics, and population control.[42]

The petition did not lead to a law.

Historically, the euthanasia debate has tended to focus on a number of key concerns. According to euthanasia opponent Ezekiel Emanuel, proponents of euthanasia have presented four main arguments: a) that people have a right to self-determination, and thus should be allowed to choose their own fate; b) assisting a subject to die might be a better choice than requiring that they continue to suffer; c) the distinction between passive euthanasia, which is often permitted, and active euthanasia, which is not substantive (or that the underlying principlethe doctrine of double effectis unreasonable or unsound); and d) permitting euthanasia will not necessarily lead to unacceptable consequences. Pro-euthanasia activists often point to countries like the Netherlands and Belgium, and states like Oregon, where euthanasia has been legalized, to argue that it is mostly unproblematic.

Similarly, Emanuel argues that there are four major arguments presented by opponents of euthanasia: a) not all deaths are painful; b) alternatives, such as cessation of active treatment, combined with the use of effective pain relief, are available; c) the distinction between active and passive euthanasia is morally significant; and d) legalising euthanasia will place society on a slippery slope,[53] which will lead to unacceptable consequences.[38]:7978 In fact, in Oregon, in 2013, pain wasn't one of the top five reasons people sought euthanasia. Top reasons were a loss of dignity, and a fear of burdening others.[54]

In the United States in 2013, 47% nationwide supported doctor-assisted suicide. This included 32% of Latinos, 29% of African-Americans, and almost nobody with disabilities.[54]

West's Encyclopedia of American Law states that "a 'mercy killing' or euthanasia is generally considered to be a criminal homicide"[55] and is normally used as a synonym of homicide committed at a request made by the patient.[56]

The judicial sense of the term "homicide" includes any intervention undertaken with the express intention of ending a life, even to relieve intractable suffering.[56][57][58] Not all homicide is unlawful.[59] Two designations of homicide that carry no criminal punishment are justifiable and excusable homicide.[59] In most countries this is not the status of euthanasia. The term "euthanasia" is usually confined to the active variety; the University of Washington website states that "euthanasia generally means that the physician would act directly, for instance by giving a lethal injection, to end the patient's life".[60]Physician-assisted suicide is thus not classified as euthanasia by the US State of Oregon, where it is legal under the Oregon Death with Dignity Act, and despite its name, it is not legally classified as suicide either.[61] Unlike physician-assisted suicide, withholding or withdrawing life-sustaining treatments with patient consent (voluntary) is almost unanimously considered, at least in the United States, to be legal.[62] The use of pain medication in order to relieve suffering, even if it hastens death, has been held as legal in several court decisions.[60]

Some governments around the world have legalized voluntary euthanasia but most commonly it is still considered to be criminal homicide. In the Netherlands and Belgium, where euthanasia has been legalized, it still remains homicide although it is not prosecuted and not punishable if the perpetrator (the doctor) meets certain legal conditions.[63][64][65][66]

A survey in the United States of more than 10,000 physicians came to the result that approximately 16% of physicians would ever consider halting life-sustaining therapy because the family demands it, even if they believed that it was premature. Approximately 55% would not, and for the remaining 29%, it would depend on circumstances.[67]

This study also stated that approximately 46% of physicians agree that physician-assisted suicide should be allowed in some cases; 41% do not, and the remaining 14% think it depends.[67]

In the United Kingdom, the pro-assisted dying group Dignity in Dying cite conflicting research on attitudes by doctors to assisted dying: with a 2009 Palliative Medicine-published survey showing 64% support (to 34% oppose) for assisted dying in cases where a patient has an incurable and painful disease, while 49% of doctors in a study published in BMC Medical Ethics oppose changing the law on assisted dying to 39% in favour.[68]

See more here:

Euthanasia - Wikipedia

Dr. Christina was the first veterinarian in the Phoenix area to dedicate a service to home euthanasia. She started her practice in 2004.

Home euthanasia allows your Phoenix Arizona dog or cat feel more relaxed and at peace when the time comes. You will feel more relaxed and at peace as well. The clinic environment can be sterile and stressful for your pet. It is also difficult to grieve while in a waiting room full of people and other animals.

Veterinarian allows owners to say goodbye to pets at home

Dr. Christina is committed to honoring the human-animal bond and supporting pet owners facing the most difficult decision of their pets life. Her desire is for each euthanasia to end with the feeling of peace and the reassurance that this was the best decision for the pet.

Dr. Christina services the Phoenix metro area, including Buckeye, Gold Canyon, New River and Maricopa. Click here to see our Service Area

If you have any questions please contact Doctor Christina.

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Gentle Journey Phoenix Arizona In Home Pet Euthanasia

In dealing with an objection to the view of abortion presented in Chapter 6, we have already looked beyond abortion to infanticide. In so doing we will have confirmed the suspicion of supporters of the sanctity of human life that once abortion is accepted, euthanasia lurks around the next comer - and for them, euthanasia is an unequivocal evil. It has, they point out, been rejected by doctors since the fifth century B.C., when physicians first took the Oath of Hippocrates and swore 'to give no deadly medicine to anyone if asked, nor suggest any such counsel'. Moreover, they argue, the Nazi extermination programme is a recent and terrible example of what can happen once we give the state the power to MI innocent human beings.

I do not deny that if one accepts abortion on the grounds provided in Chapter 6, the case for killing other human beings, in certain circumstances, is strong. As I shall try to show in this chapter, however, this is not something to be regarded with horror, and the use of the Nazi analogy is utterly misleading. On the contrary, once we abandon those doctrines about the sanctity of human life that - as we saw in Chapter 4 - collapse as soon as they are questioned, it is the refusal to accept killing that, in some cases, is horrific.

'Euthanasia' means, according to the dictionary, 'a gentle and easy death', but it is now used to refer to the killing of those who are incurably ill and in great pain or distress, for the sake of those killed, and in order to spare them further suffering or distress. This is the main topic of this chapter. I shall also consider, however, some cases in which, though killing is not contrary to the wishes of the human who is killed, it is also not carried out specifically for the sake of that being. As we shall see, some cases involving newborn infants fall into this category. Such cases may not be 'euthanasia' within the strict meaning of the term, but they can usefully be included within the same general discussion, as long as we are clear about the relevant differences.

Within the usual definition of euthanasia there are three different types, each of which raises distinctive ethical issues. it will help our discussion if we begin by setting out this threefold distinction and then assess the justifiability of each type.

TYPES OF EUTHANASIA

Most of the groups currently campaigning for changes in the law to allow euthanasia are campaigning for voluntary euthanasia - that is, euthanasia carried out at the request of the person killed.

Sometimes voluntary euthanasia is scarcely distinguishable from assisted suicide. In Jean's Way, Derek Humphry has told how his wife Jean, when dying of cancer, asked him to provide her with the means to end her life swiftly and without pain. They had seen the situation coming and discussed it beforehand. Derek obtained some tablets and gave them to Jean, who took them and died soon afterwards.

Dr Jack Kevorkian, a Michigan pathologist, went one step further when he built a 'suicide machine' to help terminally ill people commit suicide. His machine consisted of a metal pole with three different bottles attached to a tube of the kind used to provide an intravenous drip. The doctor inserts the tube in the patient's vein, but at this stage only a harmless saline solution can pass through it. The patient may then flip a switch, which will allow a coma-inducing drug to come through the tube; this is automatically followed by a lethal drug contained in the third bottle. Dr Kevorkian announced that he was pre- pared to make the machine available to any terminally ill patient who wished to use it. (Assisting suicide is not against the law in Michigan.) In June 1990, Janet Adkins, who was suffering from Alzheimer's disease, but still competent to make the decision to end her life, contacted Dr Kevorkian and told him of her wish to die, rather than go through the slow and progressive deterioration that the disease involves. Dr Kevorkian was in attendance while she made use of his machine, and then re- ported Janet Adkins's death to the police. He was subsequently charged with murder, but the judge refused to allow the charge to proceed to trial, on the grounds that Janet Adkins had caused her own death. The following year Dr Kevorkian made his device available to two other people, who used it in order to end their lives.

In other cases, people wanting to die may be unable to kill themselves. In 1973 George Zygmaniak was injured in a motorcycle accident near his home in New Jersey. He was taken to hospital, where he was found to be totally paralysed from the neck down. He was also in considerable pain. He told his doctor and his brother, Lester, that he did not want to live in this condition. He begged them both to kill him. Lester questioned the doctor and hospital staff about George's prospects of recovery: he was told that they were nil. He then smuggled a gun into the hospital, and said to his brother: 'I am here to end your pain, George. Is it all right with you?' George, who was now unable to speak because of an operation to assist his breathing, nodded affirmatively. Lester shot him through the temple.

The Zygmaniak case appears to be a clear instance of voluntary euthanasia, although without some of the procedural safeguards that advocates of the legalisation of voluntary euthanasia propose. For instance, medical opinions about the patient's prospects of recovery were obtained only in an informal manner. Nor was there a careful attempt to establish, before independent witnesses, that George's desire for death was of a fixed and rational kind, based on the best available information about his situation. The killing was not carried out by a doctor. An injection would have been less distressing to others than shooting. But these choices were not open to Lester Zygrnaniak, for the law in New Jersey, as in most other places, regards mercy killing as murder, and if he had made his plans known, he would not have been able to carry them out.

Euthanasia can be voluntary even if a person is not able, as Jean Humphry, Janet Adkins, and George Zygmaniak were able, to indicate the wish to die right up to the moment the tablets are swallowed, the switch thrown, or the trigger pulled. A person may, while in good health, make a written request for euthanasia if, through accident or illness, she should come to be incapable of making or expressing a decision to die, in pain, or without the use of her mental faculties, and there is no reasonable hope of recovery. In killing a person who has made such a request, who has re-affirmed it from time to time, and who is now in one of the states described, one could truly claim to be acting with her consent.

There is now one country in which doctors can openly help their patients to die in a peaceful and dignified way. In the Netherlands, a series of court cases during the 1980s upheld a doctor's right to assist a patient to die, even if that assistance amounted to giving the patient a lethal injection. Doctors in the Netherlands who comply with certain guidelines (which will be described later in this chapter) can now quite openly carry out euthanasia and can report this on the death certificate with- out fear of prosecution. It has been estimated that about 2,300 deaths each year result from euthanasia carried out in this way.

Involuntary Euthanasia

I shall regard euthanasia as involuntary when the person killed is capable of consenting to her own death, but does not do so, either because she is not asked, or because she is asked and chooses to go on living. Admittedly this definition lumps two different cases under one heading. There is a significant difference between killing someone who chooses to go on living and killing someone who has not consented to being killed, but if asked, would have consented. In practice, though, it is hard to imagine cases in which a person is capable of consenting and would have consented if asked, but was not asked. For why not ask? Only in the most bizarre situations could one conceive of a reason for not obtaining the consent of a person both able and willing to consent.

Killing someone who has not consented to being killed can properly be regarded as euthanasia only when the motive for killing is the desire to prevent unbearable suffering on the part of the person killed. It is, of course, odd that anyone acting from this motive should disregard the wishes of the person for whose sake the action is done. Genuine cases of involuntary euthanasia appear to be very rare.

Non-voluntary Euthanasia

These two definitions leave room for a third kind of euthanasia. If a human being is not capable of understanding the choice between life and death, euthanasia would be neither voluntary nor involuntary, but non-voluntary. Those unable to give con- sent would include incurably ill or severely disabled infants, and people who through accident, illness, or old age have permanently lost the capacity to understand the issue involved, with- out having previously requested or rejected euthanasia in these circumstances.

Several cases of non-voluntary euthanasia have reached the courts and the popular press. Here is one example. Louis Repouille had a son who was described as 'incurably imbecile', had been bed-ridden since infancy and blind for five years. According to Repouille: 'He was just like dead all the time.... He couldn't walk, he couldn't talk, he couldn't do anything.' in the end Repouille killed his son with chloroform.

In 1988 a case arose that well illustrates the way in which modern medical technology forces us to make life and death decisions. Samuel Linares, an infant, swallowed a small object that stuck in his windpipe, causing a loss of oxygen to the brain. He was admitted to a Chicago hospital in a coma and placed on a respirator. Eight months later he was still comatose, still on the respirator, and the hospital was planning to move Samuel to a long-term care unit. Shortly before the move, Samuel's parents visited him in the hospital. His mother left the room, while his father produced a pistol and told the nurse to keep away. He then disconnected Samuel from the respirator, and cradled the baby in his arms until he died. When he was sure Samuel was dead, he gave up his pistol and surrendered to police. He was charged with murder, but the grand jury refused to issue a homicide indictment, and he subsequently received a suspended sentence on a minor charge arising from the use of the pistol. Obviously, such cases raise different issues from those raised by voluntary euthanasia. There is no desire to die on the part of the infant. It may also be questioned whether, in such cases, the death is carried out for the sake of the infant, or for the sake of the family as a whole. If Louis Repouille's son was 'just like dead all the time', then he may have been so profoundly brain- damaged that he was not capable of suffering at all. That is also likely to have been true of the comatose Samuel Linares. In that case, while caring for him would have been a great and no doubt futile burden for the family, and in the Linares case, a drain on the state's limited medical resources as well, the infants were not suffering, and death could not be said to be in, or contrary to, their interests. It is therefore not euthanasia, strictly speaking, as I have defined the term. it might nevertheless be a justifiable ending of a human life.

Since cases of infanticide and non-voluntary euthanasia are the kind of case most nearly akin to our previous discussions of the status of animals and the human fetus, we shall consider them first.

JUSTIFYING INFANTICIDE AND NON-VOLUNTARY EUTHANASIA

As we have seen, euthanasia is non-voluntary when the subject has never had the capacity to choose to live or die. This is the situation of the severely disabled infant or the older human being who has been profoundly intellectually disabled since birth. Euthanasia or other forms of killing are also non- voluntary when the subject is not now but once was capable of making the crucial choice, and did not then express any preference relevant to her present condition.

The case of someone who has never been capable of choosing to live or die is a little more straightforward than that of a person who had, but has now lost, the capacity to make such a decision. We shall, once again, separate the two cases and take the more straightforward one first. For simplicity, I shall concentrate on infants, although everything I say about them would apply to older children or adults whose mental age is and has always been that of an infant.

Life and Death Decisions for Disabled Infants

If we were to approach the issue of life or death for a seriously disabled human infant without any prior discussion of the ethics of killing in general, we might be unable to resolve the conflict between the widely accepted obligation to protect the sanctity of human life, and the goal of reducing suffering. Some say that such decisions are 'subjective', or that life and death questions must be left to God and Nature. Our previous discussions have, however, prepared the ground, and the principles established and applied in the preceding three chapters make the issue much less baffling than most take it to be.

In Chapter 4 we saw that the fact that a being is a human being, in the sense of a member of the species Homo sapiens, is not relevant to the wrongness of killing it; it is, rather, characteristics like rationality, autonomy, and self-consciousness that make a difference. Infants lack these characteristics. Killing them, therefore, cannot be equated with killing normal human beings, or any other self-conscious beings. This conclusion is not limited to infants who, because of irreversible intellectual disabilities, will never be rational, self-conscious beings. We saw in our discussion of abortion that the potential of a fetus to become a rational, self-conscious being cannot count against killing it at a stage when it lacks these characteristics - not, that is, unless we are also prepared to count the value of rational self-conscious life as a reason against contraception and celibacy. No infant - disabled or not - has as strong a claim to life as beings capable of seeing themselves as distinct entities, existing over time.

The difference between killing disabled and normal infants lies not in any supposed right to life that the latter has and the former lacks, but in other considerations about killing. Most obviously there is the difference that often exists in the attitudes of the parents. The birth of a child is usually a happy event for the parents. They have, nowadays, often planned for the child. The mother has carried it for nine months. From birth, a natural affection begins to bind the parents to it. So one important reason why it is normally a terrible thing to kill an infant is the effect the killing will have on its parents.

It is different when the infant is born with a serious disability. Birth abnormalities vary, of course. Some are trivial and have little effect on the child or its parents; but others turn the normally joyful event of birth into a threat to the happiness of the parents, and any other children they may have.

Parents may, with good reason, regret that a disabled child was ever born. In that event the effect that the death of the child will have on its parents can be a reason for, rather than against killing it. Some parents want even the most gravely disabled infant to live as long as possible, and this desire would then be a reason against killing the infant. But what if this is not the case? in the discussion that follows I shall assume that the parents do not want the disabled child to live. I shall also assume that the disability is so serious that - again in contrast to the situation of an unwanted but normal child today - there are no other couples keen to adopt the infant. This is a realistic assumption even in a society in which there is a long waiting- list of couples wishing to adopt normal babies. It is true that from time to time cases of infants who are severely disabled and are being allowed to die have reached the courts in a glare of publicity, and this has led to couples offering to adopt the child. Unfortunately such offers are the product of the highly publicised dramatic life-and-death situation, and do not extend to the less publicised but far more cormnon situations in which parents feel themselves unable to look after a severely disabled child, and the child then languishes in an institution.

Infants are sentient beings who are neither rational nor self- conscious. So if we turn to consider the infants in themselves, independently of the attitudes of their parents, since their species is not relevant to their moral status, the principles that govern the wrongness of killing non-human animals who are sentient but not rational or self-conscious must apply here too. As we saw, the most plausible arguments for attributing a right to life to a being apply only if there is some awareness of oneself as a being existing over time, or as a continuing mental self. Nor can respect for autonomy apply where there is no capacity for autonomy. The remaining principles identified in Chapter 4 are utilitarian. Hence the quality of life that the infant can be expected to have is important.

One relatively common birth disability is a faulty development of the spine known as spina bifida. Its prevalence, varies in different countries, but it can affect as many as one in five hundred live births. In the more severe cases, the child will be permanently paralysed from the waistdown and lack control of bowels or bladder. Often excess fluid accumulates in the brain, a condition known as hydrocephalus, which can result in intellectual disabilities. Though some forms of treatment exist, if the child is badly affected at birth, the paralysis, incontinence, and intellectual disability cannot be overcome.

Some doctors closely connected with children suffering from severe spina bifida believe that the lives of the worst affected children are so miserable that it is wrong to resort to surgery to keep them alive. Published descriptions of the lives of these children support the judgment that these worst affected children will have lives filled with pain and discomfort. They need repeated major surgery to prevent curvature of the spine, due to the paralysis, and to correct other abnormalities. Some children with spina bifida have had forty major operations before they reach their teenage years.

When the life of an infant will be so miserable as not to be worth living, from the internal perspective of the being who will lead that life, both the 'prior existence' and the 'total' version of utilitarianism entail that, if there are no 'extrinsic' reasons for keeping the infant alive - like the feelings of the parents - it is better that the child should be helped to die without further suffering. A more difficult problem arises - and the convergence between the two views ends - when we consider disabilities that make the child's life prospects significantly less promising than those of a normal child, but not so bleak as to make the child's life not worth living. Haemophilia is probably in this category. The haemophiliac lacks the element in normal blood that makes it clot and thus risks prolonged bleeding, especially internal bleeding, from the slightest injury. if allowed to continue, this bleeding leads to permanent crippling and eventually death. The bleeding is very painful and although improved treatments have eliminated the need for constant blood transfusions, haemophiliacs still have to spend a lot of time in hospital. They are unable to play most sports and live constantly on the edge of crisis. Nevertheless, haemophiliacs do not appear to spend their time wondering whether to end it all; most find life definitely worth living, despite the difficulties they face.

Given these facts, suppose that a newborn baby is diagnosed as a haemophiliac. The parents, daunted by the prospect of bringing up a child with this condition, are not anxious for him to live. Could euthanasia be defended here? Our first reaction may well be a firm 'no', for the infant can be expected to have a life that is worth living, even if not quite as good as that of a normal baby. The 'prior existence' version of utilitarianism sup- ports this judgment. The infant exists. His life can be expected to contain a positive balance of happiness over misery. To kill him would deprive him of this positive balance of happiness. Therefore it would be wrong.

On the 'total' version of utilitarianism, however, we cannot reach a decision on the basis of this information alone. The total view makes it necessary to ask whether the death of the haemophiliac infant would lead to the creation of another being who would not otherwise have existed. In other words, if the haemophiliac child is killed, will his parents have another child whom they would not have if the haemophiliac child lives? If they would, is the second child likely to have a better life than the one killed?

Often it will be possible to answer both these questions affinnatively. A woman may plan to have two children. If one dies while she is of child-bearing age, she may conceive another in its place. Suppose a woman planning to have two children has one normal child, and then gives birth to a haemophiliac child. The burden of caring for that child may make it impossible for her to cope with a third child; but if the disabled child were to die, she would have another. It is also plausible to suppose that the prospects of a happy life are better for a normal child than for a haemophiliac.

When the death of a disabled infant will lead to the birth of another infant with better prospects of a happy life, the total amount of happiness will be greater if the disabled infant is killed. The loss of happy life for the first infant is outweighed by the gain of a happier life for the second. Therefore, if killing the haemophiliac infant has no adverse effect on others, it would, according to the total view, be right to kill him.

The total view treats infants as replaceable, in much the same way as it treats non-self-conscious animals (as we saw in Chapter 5). Many will think that the replaceability argument cannot be applied to human infants. The direct killing of even the most hopelessly disabled infant is still officially regarded as murder; how then could the killing of infants with far less serious problems, like haernophilia, be accepted? Yet on further reflection, the implications of the replaceability argument do not seem quite so bizarre. For there are disabled members of our species whom we now deal with exactly as the argument suggests we should. These cases closely resemble the ones we have been discussing. There is only one difference, and that is a difference of timing - the timing of the discovery of the problem, and the consequent killing of the disabled being.

Prenatal diagnosis is now a routine procedure for pregnant women. There are various medical techniques for obtaining information about the fetus during the early months of pregnancy. At one stage in the development of these procedures, it was possible to discover the sex of the fetus, but not whether the fetus would suffer from haemophilia. Haemophilia is a sex- linked genetic defect, from which only males suffer; females can carry the gene and pass it on to their male offspring without themselves being affected. So a woman who knew that she carried the gene for haemophilia could, at that stage, avoid giving birth to a haemophiliac child only by finding out the sex of the fetus, and aborting all males fetuses. Statistically, only half of these male children of women who carried the defective gene would have suffered from haernophilia, but there was then no way to find out to which half a particular fetus belonged. Therefore twice as many fetuses were being killed as necessary, in order to avoid the birth of children with haemophilia. This practice was widespread in many countries, and yet did not cause any great outcry. Now that we have techniques for identifying haemophilia before birth, we can be more selective, but the principle is the same: women are offered, and usually accept, abortions in order to avoid giving birth to children with haemophilia.

The same can be said about some other conditions that can be detected before birth. Down's syndrome, formerly known as mongolism, is one of these. Children with this condition have intellectual disabilities and most will never be able to live in- dependently, but their lives, like those of small children, can be joyful. The risk of having a Down's syndrome child increases sharply with the age of the mother, and for this reason prenatal diagnosis is routinely offered to pregnant women over 35. Again, undergoing the procedure implies that if the test for Down's syndrome is positive, the woman will consider aborting the fetus and, if she still wishes to have another child, will start another pregnancy, which has a good chance of being normal.

Prenatal diagnosis, followed by abortion in selected cases, is common practice in countries with liberal abortion laws and advanced medical techniques. I think this is as it should be. As the arguments of Chapter 6 indicate, I believe that abortion can be justified. Note, however, that neither haemophilia nor Down's syndrome is so crippling as to make life not worth living, from the inner perspective of the person with the condition. To abort a fetus with one of these disabilities, intending to have another child who will not be disabled, is to treat fetuses as interchangeable or replaceable. If the mother has previously decided to have a certain number of children, say two, then what she is doing, in effect, is rejecting one potential child in favour of another. She could, in defence of her actions, say: the loss of life of the aborted fetus is outweighed by the gain of a better life for the normal child who will be conceived only if the disabled one dies.

When death occurs before birth, replaceability does not conflict with generally accepted moral convictions. That a fetus is known to be disabled is widely accepted as a ground for abortion. Yet in discussing abortion, we saw that birth does not mark a morally significant dividing line. I cannot see how one could defend the view that fetuses may be 'replaced' before birth, but newborn infants may not be. Nor is there any other point, such as viability, that does a better job of dividing the fetus from the infant. Self-consciousness, which could provide a basis for holding that it is wrong to kill one being and replace it with another, is not to be found in either the fetus or the newborn infant. Neither the fetus nor the newborn infant is an individual capable of regarding itself as a distinct entity with a life of its own to lead, and it is only for newborn infants, or for still earlier stages of human life, that replaceability should be considered to be an ethically acceptable option.

It may still be objected that to replace either a fetus or a newborn infant is wrong because it suggests to disabled people living today that their lives are less worth living than the lives of people who are not disabled. Yet it is surely flying in the face of reality to deny that, on average, this is so. That is the only way to make sense of actions that we all take for granted. Recall thalidomide: this drug, when taken by pregnant women, caused many children to be born without arms or legs. Once the cause of the abnormal births was discovered, the drug was taken off the market, and the company responsible had to pay compensation. If we really believed that there is no reason to think of the life of a disabled person as likely to be any worse than that of a normal person, we would not have regarded this as a tragedy. No compensation would have been sought, or awarded by the courts. The children would merely have been 'different'. We could even have left the drug on the market, so that women who found it a useful sleeping pill during pregnancy could continue to take it. If this sounds grotesque, that is only because we are all in no doubt at all that it is better to be born with limbs than without them. To believe this involves no disrespect at all for those who are lacking limbs; it simply recognises the reality of the difficulties they face.

In any case, the position taken here does not imply that it would be better that no people born with severe disabilities should survive; it implies only that the parents of such infants should be able to make this decision. Nor does this imply lack of respect or equal consideration for people with disabilities who are now living their own lives in accordance with their own wishes. As we saw at the end of Chapter 2, the principle of equal consideration of interests rejects any discounting of the interests of people on grounds of disability.

Even those who reject abortion and the idea that the fetus is replaceable are likely to regard possible people as replaceable. Recall the second woman in Parfit's case of the two women, described in Chapter 5. She was told by her doctor that if she went ahead with her plan to become pregnant immediately, her child would have a disability (it could have been haemophilia); but if she waited three months her child would not have the disability. If we think she would do wrong not to wait, it can only be because we are comparing the two possible lives and judging one to have better prospects than the other. Of course, at this stage no life has begun; but the question is, when does a life, in the morally significant sense, really begin? in Chapters 4 and 5 we saw several reasons for saying that life only begins in the morally significant sense when there is awareness of one's existence over time. The metaphor of life as a journey also provides a reason for holding that in infancy, life's voyage has scarcely begun.

Regarding newborn infants as replaceable, as we now regard fetuses, would have considerable advantages over prenatal diagnosis followed by abortion. Prenatal diagnosis still cannot detect all major disabilities. Some disabilities, in fact, are not present before birth; they may be the result of extremely pre- mature birth, or of something going wrong in the birth process itself. At present parents can choose to keep or destroy their disabled offspring only if the disability happens to be detected during pregnancy. There is no logical basis for restricting parents' choice to these particular disabilities. If disabled newborn infants were not regarded as having a right to life until, say, a week or a month after birth it would allow parents, in consultation with their doctors, to choose on the basis of far greater knowledge of the infant's condition than is possible before birth. All these remarks have been concerned with the wrongness of ending the life of the infant, considered in itself rather than for its effects on others. When we take effects on others into account, the picture may alter. Obviously, to go through the whole of pregnancy and labour, only to give birth to a child who one decides should not live, would be a difficult, perhaps heartbreaking, experience. For this reason many women would prefer prenatal diagnosis and abortion rather than live birth with the possibility of infanticide; but if the latter is not morally worse than the former, this would seem to be a choice that the woman herself should be allowed to make.

Another factor to take into account is the possibility of adoption. When there are more couples wishing to adopt than nor- mal children available for adoption, a childless couple may be prepared to adopt a haemophiliac. This would relieve the mother of the burden of bringing up a haemophiliac child, and enable her to have another child, if she wished. Then the replaceability argument could not justify infanticide, for bringing the other child into existence would not be dependent on the death of the haemophiliac. The death of the haemophiliac would then be a straightforward loss of a life of positive quality, not outweighed by the creation of another being with a better life.

So the issue of ending life for disabled newborn infants is not without complications, which we do not have the space to discuss adequately. Nevertheless the main point is clear: killing a disabled infant is not morally equivalent to killing a person. Very often it is not wrong at all.

Other Non-voluntary Life and Death Decisions

In the preceding section we discussed justifiable killing for beings who have never been capable of choosing to live or die. Ending a life without consent may also be considered in the case of those who were once persons capable of choosing to live or die, but now, through accident or old age, have permanently lost this capacity, and did not, prior to losing it, express any views about whether they wished to go on living in such circumstances. These cases are not rare. Many hospitals care for motor accident victims whose brains have been damaged beyond all possible recovery. They may survive, in a coma, or perhaps barely conscious, for several years. In 1991, the Lancet reported that Rita Greene, a nurse, had been a patient at D.C. General Hospital in Washington for thirty-nine years without knowing it. Now aged sixty-three, she had been in a vegetative state since undergoing open heart surgery in 1952. The report stated that at any given time, between 5,000 and 10,000 Americans are surviving in a vegetative state. In other developed countries, where life-prolonging technology is not used so aggressively, there are far fewer long-term patients in this condition.

In most respects, these human beings do not differ importantly from disabled infants. They are not self-conscious, rational, or autonomous, and so considerations of a right to life or of respecting autonomy do not apply. If they have no experiences at all, and can never have any again, their lives have no intrinsic value. Their life's journey has come to an end. They are biologically alive, but not biographically. (If this verdict seems harsh, ask yourself whether there is anything to choose between the following options: (a) instant death or (b) instant coma, followed by death, without recovery, in ten years' time. I can see no advantage in survival in a comatose state, if death without recovery is certain.) The lives of those who are not in a coma and are conscious but not self-conscious have value if such beings experience more pleasure than pain, or have preferences that can be satisfied; but it is difficult to see the point of keeping such human beings alive if their life is, on the whole, miserable.

There is one important respect in which these cases differ from disabled infants. In discussing infanticide in the final section of Chapter 6, 1 cited Bentham's comment that infanticide need not 'give the slightest inquietude to the most timid imagination'. This is because those old enough to be aware of the killing of disabled infants are necessarily outside the scope of the policy. This cannot be said of euthanasia applied to those who once were rational and self-conscious. So a possible objection to this form of euthanasia would be that it will lead to insecurity and fear among those who are not now, but might come to be, within its scope. For instance, elderly people, knowing that non-voluntary euthanasia is sometimes applied to senile elderly patients, bedridden, suffering, and lacking the capacity to accept or reject death, might fear that every injection or tablet will be lethal. This fear might be quite irrational, but it would be difficult to convince people of this, particularly if old age really had affected their memory or powers of reasoning.

This objection might be met by a procedure allowing those who do not wish to be subjected to non-voluntary euthanasia under any circumstances to register their refusal. Perhaps this would suffice; but perhaps it would not provide enough reassurance. if not, non-voluntary euthanasia would be justifiable only for those never capable of choosing to live or die.

JUSTIFYING VOLUNTARY EUTHANASIA

Under existing laws in most countries, people suffering unrelievable pain or distress from an incurable illness who beg their doctors to end their lives are asking their doctors to risk a murder charge. Although juries are extremely reluctant to convict in cases of this kind the law is clear that neither the request, nor the degree of suffering, nor the incurable condition of the person killed, is a defence to a charge of murder. Advocates of voluntary euthanasia propose that this law be changed so that a doctor could legally act on a patient's desire to die without further suffering. Doctors have been able to do this quite openly in the Netherlands, as a result of a series of court decisions during the 1980s, as long as they comply with certain conditions. In Ger- many, doctors may provide a patient with the means to end her life, but they may not administer the substance to her.

The case for voluntary euthanasia has some common ground with the case for non-voluntary euthanasia, in that death is a benefit for the one killed. The two kinds of euthanasia differ, however, in that voluntary euthanasia involves the killing of a person, a rational and self-conscious being and not a merely conscious being. (To be strictly accurate it must be said that this is not always so, because although only rational and self-conscious beings can consent to their own deaths, they may not be rational and self-conscious at the time euthanasia is contemplated - the doctor may, for instance, be acting on a prior written request for euthanasia if, through accident or illness, one's rational faculties should be irretrievably lost. For simplicity we shall, henceforth, disregard this complication.)

We have seen that it is possible to justify ending the life of a human being who lacks the capacity to consent. We must now ask in what way the ethical issues are different when the being is capable of consenting, and does in fact consent.

Let us return to the general principles about killing proposed in Chapter 4. 1 argued there that killing a self-conscious being is a more serious matter than killing a merely conscious being. I gave four distinct grounds on which this could be argued:

1. The classical utilitarian claim that since self-conscious beings are capable of fearing their own death, killing them has worse effects on others. 2. The preference utilitarian calculation that counts the thwarting of the victim's desire to go on living as an important reason against killing. 3. A theory of rights according to which to have a right one must have the ability to desire that to which one has a right, so that to have a right to life one must be able to desire one's own continued existence. 4. Respect for the autonomous decisions of rational agents.

Now suppose we have a situation in which a person suffering from a painful and incurable disease wishes to die. if the individual were not a person - not rational or self-conscious - euthanasia would, as I have said, be justifiable. Do any of the four grounds for holding that it is normally worse to kill a person provide reasons against killing when the individual is a person who wants to die?

The classical utilitarian objection does not apply to killing that takes place only with the genuine consent of the person killed. That people are killed under these conditions would have no tendency to spread fear or insecurity, since we have no cause to be fearful of being killed with our own genuine consent. If we do not wish to be killed, we simply do not consent. In fact, the argument from fear points in favour of voluntary euthanasia, for if voluntary euthanasia is not permitted we may, with good cause, be fearful that our deaths will be unnecessarily drawn out and distressing. In the Netherlands, a nationwide study commissioned by the government found that 'Many patients want an assurance that their doctor will assist them to die should suffering become unbearable.' Often, having received this assurance, no persistent request for euthanasia eventuated. The availability of euthanasia brought comfort without euthanasia having to be provided.

Preference utilitarianism also points in favour of, not against, voluntary euthanasia. Just as preference utilitarianism must count a desire to go on living as a reason against killing, so it must count a desire to die as a reason for killing.

Next, according to the theory of rights we have considered, it is an essential feature of a right that one can waive one's rights if one so chooses. I may have a right to privacy; but I can, if I wish, film every detail of my daily life and invite the neighbours to my home movies. Neighbours sufficiently intrigued to accept my invitation could do so without violating my right to privacy, since the right has on this occasion been waived. Similarly, to say that I have a right to life is not to say that it would be wrong for my doctor to end my life, if she does so at my request. In making this request I waive my right to life.

Lastly, the principle of respect for autonomy tells us to allow rational agents to live their own lives according to their own autonomous decisions, free from coercion or interference; but if rational agents should autonomously choose to die, then respect for autonomy will lead us to assist them to do as they choose.

So, although there are reasons for thinking that killing a self-conscious being is normally worse than killing any other kind of being, in the special case of voluntary euthanasia most of these reasons count for euthanasia rather than against. Surprising as this result might at first seem, it really does no more than reflect the fact that what is special about self-conscious beings is that they can know that they exist over time and will, unless they die, continue to exist. Normally this continued existence is fervently desired; when the foreseeable continued existence is dreaded rather than desired however, the desire to die may take the place of the normal desire to live, reversing the reasons against killing based on the desire to live. Thus the case for voluntary euthanasia is arguably much stronger than the case for non-voluntary euthanasia.

Some opponents of the legalisation of voluntary euthanasia might concede that all this follows, if we have a genuinely free and rational decision to die: but, they add, we can never be sure that a request to be killed is the result of a free and rational decision. Will not the sick and elderly be pressured by their relatives to end their lives quickly? Will it not be possible to commit outright murder by pretending that a person has requested euthanasia? And even if there is no pressure of falsification, can anyone who is ill, suffering pain, and very probably in a drugged and confused state of mind, make a rational decision about whether to live or die?

These questions raise technical difficulties for the legalisation of voluntary euthanasia, rather than objections to the under- lying ethical principles; but they are serious difficulties nonetheless. The guidelines developed by the courts in the Netherlands have sought to meet them by proposing that euthanasia is acceptable only if

Euthanasia in these circumstances is strongly supported by the Royal Dutch Medical Association, and by the general public in the Netherlands. The guidelines make murder in the guise of euthanasia rather far-fetched, and there is no evidence of an increase in the murder rate in the Netherlands.

It is often said, in debates about euthanasia, that doctors can be mistaken. In rare instances patients diagnosed by two competent doctors as suffering from an incurable condition have survived and enjoyed years of good health. Possibly the legalisation of voluntary euthanasia would, over the years, mean the deaths of a few people who would otherwise have recovered from their immediate illness and lived for some extra years. This is not, however, the knockdown argument against euthanasia that some imagine it to be. Against a very small number of unnecessary deaths that might occur if euthanasia is legalised we must place the very large amount of pain and distress that will be suffered if euthanasia is not legalised, by patients who really are terminally ill. Longer life is not such a supreme good that it outweighs all other considerations. (if it were, there would be many more effective ways of saving life - such as a ban on smoking, or a reduction of speed limits to 40 kilometres per hour - than prohibiting voluntary euthanasia.) The possibility that two doctors may make a mistake means that the person who opts for euthanasia is deciding on the balance of probabilities and giving up a very slight chance of survival in order to avoid suffering that will almost certainly end in death. This may be a perfectly rational choice. Probability is the guide of life, and of death, too. Against this, some will reply that improved care for the terminally ill has eliminated pain and made voluntary euthanasia unnecessary. Elisabeth Kubler-Ross, whose On Death and Dying is perhaps the best-known book on care for the dying, has claimed that none of her patients request euthanasia. Given personal attention an the right medication, she says, people come to accept their deaths and die peacefully without pain.

Kubler-Ross may be right. It may be possible, now, to eliminate pain. In almost all cases, it may even be possible to do it in a way that leaves patients in possession of their rational faculties and free from vomiting, nausea, or other distressing side-effects. Unfortunately only a minority of dying patients now receive this kind of care. Nor is physical pain the only problem. There can also be other distressing conditions, like bones so fragile they fracture at sudden movements, uncontrollable nausea and vomiting, slow starvation due to a cancerous growth, inability to control one's bowels or bladder, difficulty in breathing, and so on.

Dr Timothy Quill, a doctor from Rochester, New York, has described how he prescribed barbiturate sleeping pills for 'Diane', a patient with a severe form of leukaemia, knowing that she wanted the tablets in order to be able to end her life. Dr Quill had known Diane for many years, and admired her courage in dealing with previous serious illnesses. in an article in the New England Journal of Medicine, Dr Quill wrote:

It was extraordinarily important to Diane to maintain control of herself and her own dignity during the time remaining to her. When this was no longer possible, she clearly wanted to die. As a former director of a hospice program, I know how to use pain medicines to keep patients comfortable and lessen suffering. I explained the philosophy of comfort care, which I strongly believe in. Although Diane understood and appreciated this, she had known of people lingering in what was called relative com- fort, and she wanted no part of it. When the time came, she wanted to take her life in the least painful way possible. Knowing of her desire for independence and her decision to stay in control, I thought this request made perfect sense.... In our discussion it became clear that preoccupation with her fear of a lingering death would interfere with Diane's getting the most out of the time she had left until she found a safe way to ensure her death.

Not all dying patients who wish to die are fortunate enough to have a doctor like Timothy Quill. Betty Rollin has described, in her moving book Last Wish, how her mother developed ovarian cancer that spread to other parts of her body. One morning her mother said to her:

I've had a wonderful life, but now it's over, or it should be. I'm not afraid to die, but I am afraid of this illness, what it's doing to me.... There's never any relief from it now. Nothing but nausea and this pain.... There won't be any more chemotherapy. There's no treatment anymore. So what happens to me now? I know what happens. I'll die slowly .... I don't want that .... Who does it benefit if I die slowly? if it benefits my children I'd be willing. But it's not going to do you any good .... There's no point in a slow death, none. I've never liked doing things with no point. I've got to end this.

Betty Rollin found it very difficult to help her mother to carry out her desire: 'Physician after physician turned down our pleas for help (How many pills? What kind?).' After her book about her mother's death was published, she received hundreds of letters, many from people, or close relatives of people, who had tried to die, failed, and suffered even more. Many of these people were denied help from doctors, because although suicide is legal in most jurisdictions, assisted suicide is not.

Perhaps one day it will be possible to treat all terminally ill and incurable patients in such a way that no one requests euthanasia and the subject becomes a non-issue; but this is now just a utopian ideal, and no reason at all to deny euthanasia to those who must live and die in far less comfortable conditions. It is, in any case, highly paternalistic to tell dying patients that they are now so well looked after that they need not be offered the option of euthanasia. It would be more in keeping with respect for individual freedom and autonomy to legalise euthanasia and let patients decide whether their situation is bearable.

Do these arguments for voluntary euthanasia perhaps give too much weight to individual freedom and autonomy? After all, we do not allow people free choices on matters like, for instance, the taking of heroin. This is a restriction of freedom but, in the view of many, one that can be justified on paternalistic grounds. If preventing people from becoming heroin addicts is justifiable paternalism, why isn't preventing people from having themselves killed?

The question is a reasonable one, because respect for individual freedom can be carded too far. John Stuart Mill thought that the state should never interfere with the individual except to prevent harm to others. The individual's own good, Mill thought, is not a proper reason for state intervention. But Mill may have had too high an opinion of the rationality of a human being. It may occasionally be right to prevent people from making choices that are obviously not rationally based and that we can be sure they will later regret. The prohibition of voluntary euthanasia cannot be justified on paternalistic grounds, how- ever, for voluntary euthanasia is an act for which good reasons exist. Voluntary euthanasia occurs only when, to the best of medical knowledge, a person is suffering from an incurable and painful or extremely distressing condition. In these circumstances one cannot say that to choose to die quickly is obviously irrational. The strength of the case for voluntary euthanasia lies in this combination of respect for the preferences, or autonomy, of those who decide for euthanasia; and the clear rational basis of the decision itself.

NOT JUSTIFYING INVOLUNTARY EUTHANASIA

Involuntary euthanasia resembles voluntary euthanasia in that it involves the killing of those capable of consenting to their own death. It differs in that they do not consent. This difference is crucial, as the argument of the preceding section shows. All the four reasons against killing self-conscious beings apply when the person killed does not choose to die.

Would it ever be possible to justify involuntary euthanasia on paternalistic grounds, to save someone extreme agony? It might be possible to imagine a case in which the agony was so great, and so certain, that the weight of utilitarian considerations favouring euthanasia override all four reasons against killing self-conscious beings. Yet to make this decision one would have to be confident that one can judge when a person's life is so bad as to be not worth living, better than that person can judge herself it is not clear that we are ever justified in having much confidence in our judgments about whether the life of another person is, to that person, worth living. That the other person wishes to go on living is good evidence that her life is worth living. What better evidence could there be?

The only kind of case in which the paternalistic argument is at all plausible is one in which the person to be killed does not realise what agony she will suffer in future, and if she is not killed now she will have to live through to the very end. On these grounds one might kill a person who has - though she does not yet realise it - fallen into the hands of homicidal sadists who will torture her to death. These cases are, fortunately, more commonly encountered in fiction than reality.

If in real life we are unlikely ever to encounter a case of justifiable involuntary euthanasia, then it may be best to dismiss from our minds the fanciful cases in which one might imagine defending it, and treat the rule against involuntary euthanasia as, for all practical purposes, absolute. Here [R. M.] Hare's distinction between critical and intuitive levels of moral reasoning (see Chapter 4), is again relevant. The case described in the preceding paragraph is one in which, if we were reasoning at the critical level, we might consider involuntary euthanasia justifiable; but at the intuitive level, the level of moral reasoning we apply in our daily lives, we can simply say that euthanasia is only justifiable if those killed either

1. lack the ability to consent to death, because they lack the capacity to understand the choice between their own continued existence or non-existence; or 2. have the capacity to choose between their own continued life or death and to make an informed, voluntary, and settled decision to die.

ACTIVE AND PASSIVE EUTHANASIA

The conclusions we have reached in this chapter will shock a large number of readers, for they violate one of the most fundamental tenets of Western ethics - the wrongness of killing innocent human beings. I have already made one attempt to show that my conclusions are, at least in the area of disabled infants, a less radical departure from existing practice than one might suppose. I pointed out that many societies allow a pregnant woman to Ml a fetus at a late stage of pregnancy if there is a significant risk of it being disabled; and since the line between a developed fetus and a newborn infant is not a crucial moral divide, it is difficult to see why it is worse to kill a newborn infant known to be disabled. In this section I shall argue that there is another area of accepted medical practice that is not intrinsically different from the practices that the arguments of this chapter would allow.

I have already referred to the birth defect known as spina bifida, in which the infant is born with an opening in the back, exposing the spinal cord. Until 1957, most of these infants died young, but in that year doctors began using a new kind of valve, to drain off the excess fluid that otherwise accumulates in the head with this condition. In some hospitals it then became standard practice to make vigorous efforts to save every spina bifida infant. The result was that few such infants died - but of those who survived, many were severely disabled, with gross paralysis, multiple deformities of the legs and spine, and no control of bowel or bladder. Intellectual disabilities were also common. in short, the existence of these children caused great difficulty for their families and was often a misery for the children themselves.

After studying the results of this policy of active treatment a British doctor, John Lorber, proposed that instead of treating all cases of spina bifida, only those who have the defect in a mild form should be selected for treatment. (He proposed that the final decision should be up to the parents, but parents nearly always accept the recommendations of the doctors.) This principle of selective treatment has now been widely accepted in many countries and in Britain has been recognised as legitimate by the Department of Health and Social Security. The result is that fewer spina bifida children survive beyond infancy, but those who do survive are, by and large, the ones whose physical and mental disabilities are relatively minor.

The policy of selection, then, appears to be a desirable one:but what happens to those disabled infants not selected for treatment? Lorber does not disguise the fact that in these cases the hope is that the infant will die soon and without suffering. it is to achieve this objective that surgical operations and other forms of active treatment are not undertaken, although pain and discomfort are as far as possible relieved. If the infant happens to get an infection, the kind of infection that in a normal infant would be swiftly cleared up with antibiotics, no antibiotics are given. Since the survival of the infant is not desired, no steps are taken to prevent a condition, easily curable by ordinary medical techniques, proving fatal.

All this is, as I have said, accepted medical practice. in articles in medical journals, doctors have described cases in which they have allowed infants to die. These cases are not limited to spina bifida, but include, for instance, babies born with Down's syndome and other complications. In 1982, the 'Baby Doe' case brought this practice to the attention of the American public. 'Baby Doe' was the legal pseudonym of a baby born in Bloomington, Indiana, with Down's syndrome and some additional problems. The most serious of these was that the passage from the mouth to the stomach - the oesophagus - was not property formed. This meant that Baby Doe could not receive nourishment by mouth. The problem could have been repaired by surgery - but in this case the parents, after discussing the situation with their obstetrician, refused permission for surgery. Without surgery, Baby Doe would soon die. Baby Doe's father later said that as a schoolteacher he had worked closely with Down syndrome children, and that he and his wife had decided that it was in the best interests of Baby Doe, and of their family a whole (they had two other children), to refuse consent f the operation. The hospital authorities, uncertain of their leg position, took the matter to court. Both the local county court and the Indiana State Supreme Court upheld the parents' rig] to refuse consent to surgery. The case attracted national made attention, and an attempt was made to take it to the U.S. Supreme Court, but before this could happen, Baby Doe died.

One result of the Baby Doe case was that the U.S. government headed at the time by President Ronald Reagan, who had come, to power with the backing of the right-wing religious 'Moral Majority', issued a regulation directing that all infants are to be given necessary life-saving treatment, irrespective of disability. But the new regulations were strongly resisted by the American Medical Association and the American Academy of Pediatrics. In court hearings on the regulations, even Dr C. Everett Koop, Reagan's surgeon-general and the driving force behind the attempt to ensure that all infants should be treated, had to admit that there were some cases in which he would not provide life sustaining treatment. Dr Koop mentioned three conditions in which, he said, life-sustaining treatment was not appropriate anencephalic infants (infants born without a brain); infants who had, usually as a result of extreme prematurity, suffered such severe bleeding in the brain that they would never be able to breathe without a respirator and would never be able even to recognise another person; and infants lacking a major part of their digestive tract, who could only be kept alive by means o a drip providing nourishment directly into the bloodstream.

The regulations were eventually accepted only in a watered down form, allowing some flexibility to doctors. Even so, a subsequent survey of American paediatricians specialising in the care of newborn infants showed that 76 percent thought that the regulations were not necessary, 66 percent considered the regulations interfered with parents' right to determine what course of action was in the best interests of their children, and 60 percent believed that the regulations did not allow adequate consideration of infants' suffering.

In a series of British cases, the courts have accepted the view that the quality of a child's life is a relevant consideration in deciding whether life-sustaining treatment should be provided. In a case called In re B, concerning a baby like Baby Doe, with Down's syndrome and an intestinal obstruction, the court said that surgery should be carried out, because the infant's life would not be'demonstrably awful'. in another case, Re C, where the baby had a poorly formed brain combined with severe physical handicaps, the court authorised the paediatric team to refrain from giving life-prolonging treatment. This was also the course taken in the case of Re Baby J: this infant was born extremely prematurely, and was blind and deaf and would probably never have been able to speak.

Thus, though many would disagree with Baby Doe's parents about allowing a Down's syndrome infant to die (because people with Down's syndrome can live enjoyable lives and be warm and loving individuals), virtually everyone recognises that in more severe conditions, allowing an infant to die is the only humane and ethically acceptable course to take. The question is: if it is right to allow infants to die, why is it wrong to kill them?

This question has not escaped the notice of the doctors involved. Frequently they answer it by a pious reference to the nineteenth-century poet, Arthur Clough, who wrote:

Thou shalt not kill; but need'st not strive Officiously to keep alive.

Unfortunately for those who appeal to Clough's immortal lines as an authoritative ethical pronouncement, they come from a biting satire - 'The Latest Decalogue' - the intent of which is to mock the attitudes described. The opening lines, for example, are:

Thou shalt have one god only; who Would be at the expense of two. No graven images may be Worshipped except the currency.

So Clough cannot be numbered on the side of those who think it wrong to kill, but right not to try too hard to keep alive. is there, nonetheless, something to be said for this idea? The view that there is something to be said for it is often termed 'the acts and omissions doctrine'. It holds that there is an important moral distinction between performing an act that has certain consequences - say , the death of a disabled child - and omitting to do something that has the same consequences. if this doctrine is correct, the doctor who gives the child a lethal injection does wrong; the doctor who omits to give the child antibiotics, knowing full well that without antibiotics the child will die, does not.

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Taking Life: Humans, by Peter Singer - Utilitarian

Voluntary euthanasia is the practice of ending a life in a painless manner. Voluntary euthanasia (VE) and physician-assisted suicide (PAS) have been the focus of great controversy in recent years.

As of 2009, some forms of voluntary euthanasia are legal in Belgium,[1]Luxembourg,[2] the Netherlands,[1]Switzerland,[1] and Canada.[3]

Voluntary refusal of food and fluids (VRFF) or Patient Refusal of Nutrition and Hydration (PRNH) is bordering on euthanasia. Some authors classify it as a form of passive euthanasia,[4] while others treat it separately because it is treated differently from legal point of view and often perceived as a more ethical option.[5] VRFF is sometimes suggested as a legal alternative to euthanasia in jurisdictions disallowing euthanasia.[citation needed]

Assisted suicide is a practice in which a person receives assistance in bringing about their death, typically people suffering from a severe physical illness,[6] in which the final step in the process is actively performed by the person concerned. In physician-assisted suicide (also called physician aid-in-dying or PAD) a physician knowingly provides a competent but suffering patient, upon the patient's request, with the means by which the patient intends to end his or her own life.[7] Assisted suicide is contrasted with "active euthanasia" when the difference between providing the means and actively administering lethal medicine is considered important.[8] For example, Swiss law allows assisted suicide while all forms of active euthanasia (like lethal injection) remain prohibited.[9]

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 BC The original Oath states: To please no one will I prescribe a deadly drug nor give advice which may cause his death.[10] 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.[11][12]

English Common Law from the 14th century 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 16th century, Thomas More, considered a saint by Roman Catholics, described a utopian community and 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", see The meaning of the work.[11][13]

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.[14] After the Civil War, voluntary euthanasia was promoted by advocates, including some doctors.[15] Support peaked around the start of the 20th century in the US and then grew again in the 1930s.

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.[16] Appel indicates social activist Anna S. Hall was the driving force behind this movement.[16] According to historian Ian Dowbiggin, leading public figures, including Clarence Darrow and Jack London, advocated for the legalization of euthanasia.[17]

Euthanasia societies[which?] were formed in England in 1935 and in the USA in 1938 to promote euthanasia. Although euthanasia legislation did not pass in the USA or England, in 1937, doctor-assisted euthanasia was declared legal in Switzerland as long as the doctor ending the life had nothing to gain.[10][18] During this same era, US courts 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.[citation needed]

During the post-war 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.

In 1996, the world's first euthanasia legislation, the Rights of the Terminally Ill Act 1996, was passed in the Northern Territory of Australia.[19] Four patients died through assisted suicide under the Act, using a device designed by Dr Philip Nitschke. The legislation was overturned by Australias Federal Parliament in 1997.[10][11][18] In response to the overturning of the Act, Nitschke founded EXIT International. In 2009, an Australian quadriplegic was granted the right to refuse sustenance and be allowed to die.[20] The Supreme Court of Western Australia ruled that it was up to Christian Rossiter, aged 49, to decide if he was to continue to receive medical care (tube feeding) and that his carers had to abide by his wishes. Chief Justice Wayne Martin also stipulated that his carers, Brightwater Care, would not be held criminally responsible for following his instructions. Rossiter died on 21 September 2009 following a chest infection.[21][22]

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.[23] 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.

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 Karen Ann Quinlan case. The Quinlan case paved the way for legal protection of voluntary passive euthanasia.[24] In 1977, California legalized living wills and other states soon followed suit.

In 1980 the Hemlock Society USA was founded in Santa Monica by Derek Humphry. It was the first group in America to provide information to the terminally ill in case they wanted a hastened death. Hemlock also campaigned and partially financed drives to reform the law. In 2003 Hemlock was merged with End of Life Choices, which changed its name to Compassion and Choices.

In 1990, Dr. Jack Kevorkian, a Michigan physician, became famous for educating and assisting people in committing physician-assisted 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.[10][18] Also in 1990, the Supreme Court approved the use of non-active euthanasia.[25]

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.[11] The Bush administration failed in its attempt to use drug law to stop Oregon in 2001, in the case Gonzales v. Oregon.[18]

In 2005, amid U.S. government roadblocks and controversy, Terri Schiavo, a Floridian who had been in a vegetative state since 1990, had her feeding tube removed. 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.[18]

In November 2008, Washington Initiative 1000 made Washington the second U.S. state to legalize physician-assisted suicide.

Euthanasia is a criminal offense in China. For example, in Shanghai a 67-year-old man was sentenced to 5 years in prison when he euthanized his 92-year-old mother when she emerged from a hospital procedure only able to move one finger and one toe. The sentence was considered lenient, because he had displayed filial piety toward his mother.[26]

While active euthanasia remains illegal in China, it is gaining increasing acceptance among doctors and the general populace.[27]

In Hong Kong, support for euthanasia among the general public is higher among those who put less importance on religious belief, those who are non-Christian, those who have higher family incomes, those who have more experience in taking care of terminally ill family members, and those who are older.[28]

Since World War II, the debate over euthanasia in Western countries has centered on voluntary euthanasia within regulated health care systems. In some cases, judicial decisions, legislation, and regulations have made voluntary euthanasia an explicit option for patients and their guardians.[29] Proponents and critics of such voluntary euthanasia policies offer the following reasons for and against official voluntary euthanasia policies:

Proponents of voluntary euthanasia emphasize that choice is a fundamental principle for liberal democracies and free market systems.[11]

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.[11]

Those who witness others die are "particularly convinced" that the law should be changed to allow assisted death.[30]

Today in many countries there is a shortage of hospital space. Medical personnel and hospital beds could be used for people whose lives could be saved instead of continuing the lives of those who want to die, thus increasing the general quality of care and shortening 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.[31]

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.

Some people, including many Christians, consider euthanasia of some or all types to be morally unacceptable.[11] 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.

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.[11]

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.[11]

Consent under pressure: Given the economic grounds for voluntary euthanasia, critics of voluntary euthanasia are concerned that patients may experience psychological pressure to consent to voluntary euthanasia rather than be a financial burden on their families.[32] Even where health costs are mostly covered by public money, as in most developed countries, voluntary euthanasia critics are concerned that hospital personnel would have an economic incentive to advise or pressure people toward euthanasia consent.[33]

Non-voluntary euthanasia is sometimes cited as one of the possible outcomes of the slippery slope argument, in which it is claimed that permitting voluntary euthanasia to occur will lead to the support and legalization of non-voluntary and involuntary euthanasia.[34]

The right to life movement opposes voluntary euthanasia.

Euthanasia brings about many ethical issues regarding a patients death. Some physicians say euthanasia is a rational choice for competent patients who wish to die to escape unbearable suffering.[35]

Physicians who are in favor of euthanasia state that to keep euthanasia or physician-assisted suicide (PAS) illegal is a violation of patient freedoms. They believe that any competent terminally-ill patient should have the right to choose death or refuse life-saving treatment.[35][36] Suicide and assistance from their physician is seen as the only option those patients have.[35] With the suffering and the knowledge from the doctor, this may also suggest that PAS is a humane answer to the excruciating pain.[35]

An argument against PAS is the violation of the Hippocratic oath that some doctors take. The Hippocratic oath states "I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan".[35]

Another reason for prohibiting PAS and euthanasia is the option of abusing PAS if it were to become legal. Poor or uninsured patients may not have the money or no access to proper care will have limited options, and they could be pressured towards assisted death.[35]

During the 20th century, efforts to change government policies on euthanasia have met limited success in Western countries. Euthanasia policies have also been developed by a variety of NGOs, most notably medical associations and advocacy organizations.

There are many different religious views among on the issue of voluntary euthanasia, although many moral theologians are critical of the procedure.

Euthanasia can be accomplished either through an oral, intravenous, or intramuscular administration of drugs, or by oxygen deprivation (anoxia), as in some euthanasia machines. 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. A coma is first induced by intravenous administration of 20mg/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 20mg pancuronium bromide (Pavulon) or 20mg 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 40mg.[37]

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.

Apart from The Old Law, a 17th-century tragicomedy written by Thomas Middleton, William Rowley, and Philip Massinger, one of the early books to deal with euthanasia in a fictional context is Anthony Trollope's 1882 dystopian novel, The Fixed Period. Ricarda Huch's novel The Deruga Case (1917) is about a physician who is acquitted after performing euthanasia on his dying ex-wife.

"Quality of Mercy" in The Prosecution Rests is a fable exploring the facets of aging, Alzheimer's disease, and euthanasia.[38] The story line makes no judgement but frees the reader to decide.

The plot of Christopher Buckley's 2007 novel Boomsday involves the use of 'Voluntary euthanasia' of seniors as a political ploy to stave of the insolvency of social security as more and more of the aging US population reaches retirement age.

The films Children of Men and Soylent Green depict instances of government-sponsored euthanasia in order to strengthen their dystopian themes. The protagonist of the film Johnny Got His Gun is a brutally mutilated war veteran whose request for euthanasia furthers the work's anti-war message. The recent films Mar Adentro and Million Dollar Baby argue more directly in favor of euthanasia by illustrating the suffering of their protagonists. These films have provoked debate and controversy in their home countries of Spain and the United States respectively.

In March 2010, the PBS Frontline TV program in the United States showed a documentary called "The Suicide Tourist" which told the story of Professor Craig Ewert, his family, and the Swiss group Dignitas, and their decision to commit assisted suicide in Switzerland after he was diagnosed and suffering with ALS (Lou Gehrig's Disease).[39]

Thrash metal band Megadeth's 1994 album Youthanasia (the title is a pun on euthanasia) implies that society is euthanizing its youth.

The documentary film How to Die in Oregon follows the lives of select terminally ill individuals who weigh the options of continuing to live and euthanasia. This film employs emotional appeal to the audience on the controversial topic of voluntary euthanasia.[40]

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Voluntary euthanasia - Wikipedia

A Belgian lawmaker told CNN affiliate VTM that the physician-assisted suicide happened within the past week.

The child, who was suffering from an incurable disease, had asked for euthanasia, Sen. Jean-Jacques De Gucht told VTM. The identity of the child and age are unknown.

"I think it's very important that we, as a society, have given the opportunity to those people to decide for themselves in what manner they cope with that situation," said Gucht, a supporter of euthanasia legislation.

Wim Distelmans, who chairs Belgium's Federal Control and Evaluation Committee on Euthanasia, told state broadcaster RTBF that fortunately few children had demanded mercy killing but "that does not mean we should deny them the right to a dignified death."

In 2014, the bill extended the "right to die" to those under the age of 18. But there were additional strict conditions, including that the child was judged to be able to understand what euthanasia means.

Consent of parents or guardians must also be given.

"This can only be in cases of serious and incurable diseases, which is the same thing for adults ... but for minors an additional condition is that the death must be expected in the near future," Jacqueline Herremans told RTBF. Herremans is the president of Belgium's Association for the Right to Die with Dignity and also a member of the federal committee on euthanasia.

Belgium is the only country that allows euthanasia for children of any age.

The Netherlands also allows mercy killings for children, but only for those 12 and over. It became the first country to legalize euthanasia in April 2002.

CNN's Margot Haddad contributed to this report.

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Belgium euthanasia: First child dies - CNN.com

In this Feb. 7, 2014 file photo, Belgian doctor Marc Van Hoey, a general practitioner who is president of the Right to Die Association in the region of Flanders, speaks with the Associated Press at his practice in Antwerp, Belgium.

Yves Logghe, AP

A terminally ill minor has been helped to die in Belgium for the first time since the country did away with age restrictions on euthanasia two years ago, according to the senator who wrote the law.

Liberal Senator Jean-Jacques De Gucht confirmed the death of the sick juvenile to The Associated Press Saturday.

He said the minor was from Belgiums Flemish region, but declined to provide any further details about the patient to protect the privacy of the grieving family.

Belgium is the only country that allows minors of any age assistance in dying, De Gucht said. In Holland, the lower age limit for euthanasia is 12 years.

Its terrible when a youngster suffers, but it gives me some comfort to know that now there is a choice out there for children in the final terminal stages, De Gucht said. Its important that society doesnt neglect people in such pain.

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29-year-old woman with terminal brain cancer tells CBS News' Jan Crawford about the emotional toll her illness has taken and how she's coming to ...

The Belgian law has very strict rules for the euthanasia to be approved. It requires the minor to be in the final stages of a terminal illness, to understand the difference between life and death rationally and to have asked to end his or her life on repeated occasions. It also requires parental consent and finally the approval of two doctors, including a psychiatrist.

The law -one of the most far-reaching in the Western world - had wide public support when it was introduced in 2014, but was opposed by some pediatricians and the countrys Roman Catholic clergy.

Catholic teaching forbids euthanasia and the president of the Italian bishops conference on Saturday described the news of the euthanasia of a child as painful and worrisome.

It pains us as Christians but it also pains us as persons, Genoa Cardinal Angelo Bagnasco told Italian news agency ANSA.

As House of Representative members in Belgium cast their ballots in 2014 and an electronic tally board lit up with enough green lights to indicate the measure would carry, a lone protester in the chamber shouted assassins!

Socialist Hans Bonte at the time said no member of the House hoped the law would ever be used. But he said all Belgians, including minors, deserved the right to bid farewell to life in humane circumstances without having to fear they were breaking the law.

Some have questioned whether children should be allowed to make the choice between life and death. In 2014, a group of doctors - including pediatricians - signed a group letter to voice opposition to the measure.

A lot of people - in whatever profession - still have a problem coping with the idea that people can choose when they end their own life, De Gucht said.

2016 The Associated Press. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed.

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First child dies by legal euthanasia in Belgium - CBS News

Euthanasia is illegal in most of the United States. Physician aid in dying (PAD), or assisted suicide, is legal in the states of Washington, Oregon, California, and Vermont;[1] its status is disputed in Montana. The key difference between euthanasia and PAD is who administers the lethal dose of medication: Euthanasia entails the physician or another third party administering the medication, whereas PAD requires the patient to self-administer the medication and to determine whether and when to do this.[citation needed] Attempts to legalize PAD resulted in ballot initiatives and "legislation bills" within the United States of America in the last 20 years. For example, the state of Washington voters saw Ballot Initiative 119 in 1991, the state of California placed Proposition 161 on the ballot in 1992, Oregon voters passed Measure 16 (Death with Dignity Act) in 1994, the state of Michigan included Proposal B in their ballot in 1998, and Washington's Initiative 1000 passed in 2008. Vermont's state legislature passed a bill making PAD legal in May 2013. However, on May 31, 2013, Maine rejected a similar bill within its state legislature (95-13).[citation needed]

Debates about the ethics of euthanasia and physician-assisted suicide date from ancient Greece and Rome. After the development of ether, physicians began advocating the use of anesthetics to relieve the pain of death. In 1870, Samuel Williams first proposed using anesthetics and morphine to intentionally end a patient's life. Over the next 35 years, debates about euthanasia raged in the United States which resulted in an Ohio bill to legalize euthanasia in 1906, a bill that was ultimately defeated.[2]

Euthanasia advocacy in the U.S. peaked again during the 1930s and diminished significantly during and after World War II. Euthanasia efforts were revived during the 1960s and 1970s, under the right-to-die rubric, physician assisted death in liberal bioethics, and through advance directives and do not resuscitate orders.

Several major court cases advanced the legal rights of patients, or their guardians, to practice at least voluntary passive euthanasia (physician assisted death). These include the Karen Ann Quinlan (1976), Brophy and Nancy Cruzan cases. More recent years have seen policies fine-tuned and re-stated, as with Washington v. Glucksberg (1997) and the Terri Schiavo case. The numerous legislative rulings and legal precedents that were brought about in the wake of the Quinlan case had their ethical foundation in the famous 1983 report completed by the Presidents Commission for the Study of Ethical Problems in Medicine, under the title "Deciding to Forgo Life-Sustaining Treatment" (Angell, Marcia. "How to Die in Massachusetts." The New York Review of Books. 21 February 2013: 60.3. Web. 14 Jul. 2014.). The Commission sustained in its findings that it was morally acceptable to give up a life-supporting therapy and that withholding or withdrawing such a therapy is the same thing from an ethical stand-point, while artificial feeding and other life-supporting therapy are of the same importance for the patients and doctors. Before this report, to withdraw a medical therapy was regarded as much more serious decision than not to start a therapy at all, while artificial feeding was viewed as a special treatment. By 1990, barely a decade and a half after the New Jersey Supreme Courts historic decision, patients were well aware that they could decline any form of medical therapy if they simply choose to do that either directly or by expressing their wish via appointed representative.

In a 2004 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. The driving force behind this movement was social activist Anna S. Hall. Canadian historian Ian Dowbiggen's 2003 book, A Merciful End, revealed the role that leading public figures, including Clarence Darrow and Jack London, played in advocating for the legalization of euthanasia.

In the 1983 case of Barber v. Superior Court, two physicians had honored a family's request to withdraw both respirator and intravenous feeding and hydration tubes from a comatose patient. The physicians were charged with murder, despite the fact that they were doing what the family wanted. The court held that all charges should be dropped because the treatments had all been ineffective and burdensome. Withdrawal of treatment, even if life-ending, is morally and legally permitted. Competent patients or their surrogates can decide to withdraw treatments, usually after the treatments are found ineffective, painful, or burdensome.[3]

The California legislature passed a bill legalizing physician-assisted suicide in September 2015, and the bill was signed into law by Governor Jerry Brown on October 5, 2015. [4] The law went into effect in June 2016.[5]

On May 31, 2013, the Maine state legislature rejected decriminalization of physician assisted suicide and voluntary euthanasia (95-43).

On December 5, 2009, state District Court judge Dorothy McCarter ruled in favor of a terminally ill Billings resident who had filed a lawsuit with the assistance of Compassion & Choices, a patient rights group. The ruling states that competent, terminally ill patients have the right to self-administer lethal doses of medication as prescribed by a physician. Physicians who prescribe such medications will not face legal punishment.[6] On December 31, 2009, the Montana Supreme Court delivered its verdict in the case of Baxter v. Montana. The court held that there was "nothing in Montana Supreme Court precedent or Montana statutes indicating that physician aid in dying is against public policy," although prosecutions under the state's assisted suicide statute are still possible.

In the United States legal and ethical debates about euthanasia became more prominent in the case of Karen Ann Quinlan who went into a coma after allegedly mixing tranquilizers with alcohol, surviving biologically for 9 years in a "persistent vegetative state" even after the New Jersey Supreme Court approval to remove her from a respirator. This case caused a widespread public concern about "lives not worth living" and the possibility of at least voluntary euthanasia if it could be ascertained that the patient would not have wanted to live in this condition.[7]

Measure 16 in 1994 established the Oregon Death with Dignity Act, which legalizes physician-assisted dying with certain restrictions, making Oregon the first U.S. state and one of the first jurisdictions in the world to officially do so. The measure was approved in the 8 November 1994 general election in a tight race with the final tally showing 627,980 votes (51.3%) in favor, and 596,018 votes (48.7%) against.[8] The law survived an attempted repeal in 1997, which was defeated at the ballot by a 60% vote.[9] In 2005, after several attempts by lawmakers at both the state and federal level to overturn the Oregon law, the Supreme Court of the United States ruled 6-3 to uphold the law after hearing arguments in the case of Gonzales v. Oregon.

In 1999, the state of Texas passed the Advance Directives Act. Under the law, in some situations, Texas hospitals and physicians have the right to withdraw life support measures, such as mechanical respiration, from terminally ill patients when such treatment is considered to be both futile and inappropriate. This is sometimes referred to as "passive euthanasia".

In 2005, a six-month-old infant, Sun Hudson, with a uniformly fatal disease thanatophoric dysplasia, was the first patient in which "a United States court has allowed life-sustaining treatment to be withdrawn from a pediatric patient over the objections of the child's parent."[10]

In 2008, the electorate of the state of Washington voted in favor of Initiative 1000 which made assisted suicide legal in the state through the Washington Death with Dignity Act.

On May 20, 2013, Vermont Governor Peter Shumlin signed a legislative bill making PAD legal in Vermont.

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, Oregon passed the Death with Dignity Act in 1994, and Michigan included Proposal B in their ballot in 1998. Despite the earlier failure, in November 2008 physician-assisted dying was approved in Washington by Initiative 1000.

In 2000, Maine voters defeated a referendum to legalize physician-assisted suicide. The proposal was defeated by a 51%-49% margin.

Reflecting the religious and cultural diversity of the United States, there is a wide range of public opinion about euthanasia and the right-to-die movement in the United States. During the past 30 years, public research shows that views on euthanasia tend to correlate with religious affiliation and culture, though not gender.

In one recent study dealing primarily with Christian denominations such as Southern Baptists, Pentecostals, and Evangelicals and Catholics tended to be opposed to euthanasia. Moderate Protestants, (e.g., Lutherans and Methodists) showed mixed views concerning end of life decisions in general. Both of these groups showed less support than non-affiliates, but were less opposed to it than conservative Protestants. Respondents that did not affiliate with a religion were found to support euthanasia more than those who did. The liberal Protestants (including some Presbyterians and Episcopalians) were the most supportive. In general, liberal Protestants affiliate more loosely with religious institutions and their views were not similar to those of non-affiliates. Within all groups, religiosity (i.e., self-evaluation and frequency of church attendance) also correlated to opinions on euthanasia. Individuals who attended church regularly and more frequently and considered themselves more religious were found to be more opposed to euthanasia than to those who had a lower level of religiosity.[11]

Recent studies have shown white Americans to be more accepting of euthanasia than black Americans. They are also more likely to have advance directives and to use other end-of-life measures.[12] Black Americans are almost 3 times more likely to oppose euthanasia than white Americans. Some speculate that this discrepancy is due to the lower levels of trust in the medical establishment.[13] Select researchers believe that historical medical abuses towards minorities (such as the Tuskegee Syphilis Study) have made minority groups less trustful of the level of care they receive. One study also found that there are significant disparities in the medical treatment and pain management that white Americans and other Americans receive.[14]

Among black Americans, education correlates to support for euthanasia. Black Americans without a four-year degree are twice as likely to oppose euthanasia than those with at least that much education. Level of education, however, does not significantly influence other racial groups in the US. Some researchers suggest that black Americans tend to be more religious, a claim that is difficult to substantiate and define.[13] Only black and white Americans have been studied in extensive detail. Although it has been found that minority groups are less supportive of euthanasia than white Americans, there is still some ambiguity as to what degree this is true.

A recent Gallup Poll found that 84% of males supported euthanasia compared to 64% of females.[15] Some cite the prior studies showing that women have a higher level of religiosity and moral conservatism as an explanation. Within both sexes, there are differences in attitudes towards euthanasia due to other influences. For example, one study found that black American women are 2.37 times more likely to oppose euthanasia than white American women. Black American men are 3.61 times more likely to oppose euthanasia than white American men.[16]

In "Gender, Feminism, and Death: Physician-Assisted Suicide and Euthanasia" Susan M. Wolf warns of the gender disparities if euthanasia or physician-assisted suicide were legal. Wolf highlights four possible gender effects: higher incidence of women than men dying by physician-assisted suicide; more women seeking physician-assisted suicide or euthanasia for different reasons than men; physicians granting or refusing requests for assisted suicide or euthanasia because of the gender of the patient; gender affecting the broad public debate by envisioning a woman patient when considering the debate.[17]

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Euthanasia in the United States - Wikipedia, the free ...