Euthanasia, Aid in Dying, and their Ethics

Sarah Timbie for Health Empowerment Coalition

What is euthanasia?

The term “euthanasia” refers to the deliberate action of ending the life of a patient who is suffering from an incurable disease. Within the term euthanasia, there are a few different categories. Voluntary euthanasia refers to the practice of ending another person’s life after being given clear and free consent from that person. Voluntary euthanasia is different from medically assisted death, in which someone assists an individual with their desire to die by providing them with medication or a medical instrument that leads to death. It is important to note that in the case of medically assisted death, the individual is the one to make the final decision to end their life.¹ For example, a physician injecting a terminally ill patient with a lethal drug would be euthanasia; if the physician supplied the drug to a patient who would then administer it themselves, then this would be medically assisted death. There is also a distinction between active and passive euthanasia. Active euthanasia requires a physician to end a patient’s life actively by doing something, such as injecting them with a lethal drug. Passive euthanasia refers to the withholding of necessary medicine or life support, ultimately resulting in the death of the patient. ²

For the most part, medically assisted death is what people are referring to in the discussion of laws and legislation that involve aiding patients in their deaths. This is most commonly known as physician-assisted suicide, but can also be called physician-assisted death, right to die, Death with Dignity, etc.³ Advocates for aid in dying prefer different terms for multiple reasons, but in this article, I will be using the phrases “medically assisted death” and “medical assistance in dying,” specifically in relation to physician and patient interactions.

What is the history of euthanasia?

The first country to officially legalize both euthanasia and medical aid in dying was the Netherlands in 2001.⁴ However, euthanasia has been practiced throughout time, whether it has been legal or not. The word itself is Greek in origin, meaning “good death,” and there are many references to it by philosophers and authors of antiquity.⁵ Examples from ancient texts show that even in antiquity, the opinions on euthanasia varied greatly. For the most part, the philosophers and dramatists of ancient society – including Hippocrates, the father of medicine and creator of the Hippocratic Oath – were opposed to active euthanasia, but may have accepted the act of passive euthanasia to end a patient’s suffering.⁶

The concept of using medication to assist in death was first proposed in 1870 by Samuel D. Williams when he proposed mercy killing to leaders of Victorian England. This was only made possible because of the recent discovery of analgesic medications’ use in pain treatment, such as morphine. Samuel D. Williams was not a physician, yet he advocated for the use of such drugs in the practice of euthanasia.⁷ The American Medical Association condemned Williams’ ideas.

The first ever bill proposing the legalization of euthanasia in the United States was introduced by Democratic Representative Henry Hunt in the Columbus, Ohio General Assembly in 1906, but it was subsequently rejected.⁸ This bill was on the behalf of the wealthy heiress Annah S. Hall, whose mother suffered greatly during an 18-month long battle with liver cancer. Miss Hall was the first person in the US to start the effort to legalize euthanasia.

Where is euthanasia legal?

The legality of euthanasia is complicated in certain areas. While the Netherlands was the first country to create extensive guidelines and laws for euthanasia, doctors in the country were known to offer euthanasia to terminally ill patients decades before, and authorities did not prosecute them.⁴ Euthanasia is currently legal in Belgium, Luxembourg, Canada, New Zealand, Spain, the Netherlands, and Colombia.⁹ Active euthanasia is illegal in every state of the US, but physician-assisted death is allowed in California, Colorado, the District of Columbia, Hawaii, Maine, New Jersey, New Mexico, Oregon, Vermont, and Washington.¹⁰ Passive euthanasia is legal in all US states.

Who qualifies for medical aid in dying?

The qualification process varies depending on where in the world someone is considering euthanasia. To qualify for a prescription in the US for medically assisted death, people must first reside in a state that allows physician-assisted death, be eighteen years of age or older, be mentally competent and capable of making decisions pertaining to health, and be diagnosed with a terminal illness leading to death estimated to occur within six months.⁶

In the Netherlands, the patient must request the treatment themselves from a physician and be considered to face extreme suffering. Additionally, at least one other physician must have also examined the patient and decided that there are no other treatment options.⁴ Only when both physicians agree that there is no hope for saving the patient’s life, an assisted death be pursued as an option.

Arguments for/against euthanasia

There are arguments for and against euthanasia, and public opinion is constantly fluctuating. A Gallup poll social survey from May 2020 reported that 74% of US adults support some form of medically assisted death. Individual states have also polled their residents, but the percentages of people for and against medical aid in dying vary depending on the state. Factors such as religion, level of education, race, and social background may also influence opinions on the matter.¹¹

Some examples of common arguments in favor of the legalization of medical aid in dying are:

• No matter how ill someone is, they still have the right to freedom and self-determination; these rights should allow people to make their own decisions, including the decision of dying.¹²

• The process of dying can cause patients immense pain, and medical aid in dying can relieve that pain.⁶

• Medical aid in dying is a medical practice, and therefore doctors can ensure a death for their patient that is better than other death alternatives.³

Some examples of common arguments in opposition to medical aid in dying are:

• Even though patients have autonomy and freedom, this does not mean they can do anything they want.¹²

• A lot of terminally ill patients suffer from pain and symptoms that are not treated properly. Instead of assistance in dying, they should first be treated properly.⁶

• Terminally ill patients, as well as the elderly, have higher depression rates but are not referred to mental health professionals enough, which might alleviate symptoms causing the patient to choose a medically-assisted death.³

Major religions’ views on aid in dying

Most major religions include concepts opposing medical aid in dying. In Abrahamic religions, there is a common belief that “only God should be able to end life,” and based on this, no one should take the life of another or themselves.¹³ Hinduism and Buddhism also oppose medical aid in dying because of the belief in karma and reincarnation, where behavior has consequences that can affect the soul’s process of liberation in reincarnation.⁶ The Roman Catholic Church has the strictest position on the topic of medically aided death, saying that no type of assistance in any situation is acceptable. It is even opposed to passive euthanasia, which is legal in all of the US.¹⁰

There are, however, many members of these faiths who believe differently. Some religious groups also make exceptions if patients are near death and suffering, and others have debated the ethics for years without coming up with a firm statement on the topic.

References:

1. Terry, P., M.D. “Euthanasia and Assisted Suicide,” Mayo Clinic Proceedings, https://www.mayoclinicproceedings.org/article/S0025-6196(11)64289-4/fulltext. (1995).

2. University of Missouri School of Medicine, “Euthanasia,” https://medicine.missouri.edu/centers-institutes-labs/health-ethics/faq/euthanasia.

3. Dugdale, Lydia S et al. “Pros and Cons of Physician Aid in Dying.” The Yale journal of biology and medicine vol. 92,4 747-750. 20 Dec. 2019

4. Wise, J, “Netherlands, first country to legalize euthanasia,” Bulletin of the World Health Organization vol. 79(6) (2001): 580.

5. Papadimitriou, John D et al. “Euthanasia and suicide in antiquity: viewpoint of the dramatists and philosophers.” Journal of the Royal Society of Medicine vol. 100,1 (2007): 25-8. doi:10.1177/014107680710000111

6. Ibid.

7. Michael Manning, MD Euthanasia and Physician-Assisted Suicide: Killing or Caring?, 1998 from ProCon.org “History of Euthanasia and Physician-Assisted Suicide,” https://euthanasia.procon.org/historical-timeline/.

8. Appel, Jacob M. “A Duty to Kill? A Duty to Die? Rethinking the Euthanasia Controversy of 1906.” Bulletin of the History of Medicine, vol. 78, no. 3, The Johns Hopkins University Press, 2004, pp. 610–34, http://www.jstor.org/stable/44448062.

9. Linares, A. “These people want to die. Will their countries allow euthanasia?” Noticias Telemundo, https://www.nbcnews.com/news/latino/people-want-die-will-countries-allow-euthanasia-rcna3307. (2021).

10. Death with Dignity, “Current Death with Dignity Laws,” https://deathwithdignity.org/learn/death-with-dignity-acts/

11. Compassion & Choices, “Polling on Medical Aid in Dying,” https://compassionandchoices.org/resource/polling-medical-aid-dying/

12. Emanuel EJ, Joffe S. Assisted Suicide and Euthanasia. In: Kufe DW, Pollock RE, Weichselbaum RR, et al., editors. Holland-Frei Cancer Medicine. 6th edition. Hamilton (ON): BC Decker; 2003. Available from: https://www.ncbi.nlm.nih.gov/books/NBK13381/

13. Aguilera, E. “Major religions oppose assisted suicide,” KPCC, https://archive.kpcc.org/news/2015/05/14/51609/major-religions-oppose-assisted-suicide/. (2015).

Author: Sarah Timbie

Edited by: Mateya Rettig, Maggie Sell, and Darshana Banka

The Health Empowerment Coalition is a student-led organization that aims to empower individuals across the United States to improve their health literacy and take charge of their health. The views expressed in this article are the authors’ own and do not reflect the official opinions of the institutions at which they work and study. Additionally, the content in this article is not intended to provide medical advice.