essay on euthanasia

Euthanasia - Essay Samples And Topic Ideas For Free

Euthanasia, also known as assisted dying or mercy killing, remains a deeply contested ethical and legal issue. Essays could delve into the various forms of euthanasia, such as voluntary, non-voluntary, and involuntary euthanasia, discussing the moral and legal implications of each. The discourse might extend to the examination of the cultural, religious, and societal attitudes towards euthanasia, exploring how different societies and religious groups perceive the right to die. Discussions could also focus on the experiences of countries and regions that have legalized euthanasia, examining the impact on healthcare practices, legal frameworks, and societal attitudes. Moreover, the broader implications of euthanasia on medical ethics, patient autonomy, and the sanctity of life could be explored to provide a comprehensive understanding of the complexities surrounding euthanasia and the ongoing debates on its legalization and practice. A substantial compilation of free essay instances related to Euthanasia you can find at Papersowl. You can use our samples for inspiration to write your own essay, research paper, or just to explore a new topic for yourself.

Euthanasia: is it Ethical

While doing research on the topic of Euthanasia and Physician Assisted Suicide, I have come to see that people have a hard time believing that this should be an option for people who have terminal illnesses. Euthanasia is the painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma and Physician Assisted Suicide (PAS) is The voluntary termination of one's own life by administration of a lethal substance with the direct or indirect […]

Arguments for and against Euthanasia

Euthanasia is also known as physician-assisted suicide or good death. It refers to the method where animals that are suffering or in discomfort are helped to rest in death. Many pet owners consider Euthanasia a more compassionate manner of bidding their beloved animals goodbye. In the case of people, many states have not legalized euthanasia for people with dementia or those suffering from incurable diseases. Euthanasia creates an ethical dilemma on three main lines: legal, medical, and philosophical. There are […]

Ethics Behind Physician-Assisted Suicide

Assisted suicide is the act of intentionally killing yourself with the assistance of someone else. In the United States, physician-assisted suicide is when a physician provides a patient, who meets the criteria of having a terminal illness, with medication in order to terminate their life to relieve pain and/or suffering. Physician-assisted suicide is often confused with euthanasia. Euthanasia is illegal in the US. It requires a doctor, or another individual, to administer the medication to the patient. Other terms for […]

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Why Euthanasia should be Legalised

Did you know that the word euthanasia comes from Greek which means good death? However, Only 9 out of the 196 countries in the world have legalised euthanasia or assisted death, including the Netherlands, Belgium, Switzerland and Japan. - posted on Deccan Chronicle. These are all first world countries that value freedom and I strongly believe that Euthanasia should be extended to all other countries. There are 4 different types of euthanasia voluntary, involuntary, active and passive euthanasia. First, I […]

The Ban on Euthanasia

Imagine your girl best friend gets into a car crash. After the incident, you find out she suffered major spinal cord damage and her legs will be paralyzed for the rest of her life. You go to visit her in the hospital the same week but arrive to shocking news. She tells you she has lost the will to live and wants to be euthanized, or painlessly killed. She tells you she is worried about how this accident will affect […]

Assisted Suicide the Rights we have

The right to assisted suicide is one of the most controversial topics ever discussed because of the fact that other people control your life when you are unable to. But some people think that they can stop you from dying even though death is inevitable when one is terminally ill. They think that because of religious and moral reasons they could stop someone from ending their own life. Assisted suicide also known as ""Euthanasia"" is used to make a painless […]

Economic Benefits of Euthanasia

Euthanasia is assisted suicide, it is an action taken by a doctor with consent of the patient in order to relieve immense pain and suffering. However, is the overall process of Euthanasia beneficial for the economy? Based on research, euthanasia is beneficial to the economy, and saves a vast amount of money for families for hospital stays, private insurance companies, taxpayers, and medicare each year. For a hospital stay, the average cost per inpatient day is $2,534.00 for a local […]

Euthanasia Debate

The intention to deliberately help someone accelerate the death of an incurable patient, even to stop his or her suffering has never been an easy task. The ethics of euthanasia is one that has been debated over since the fourth century B.C. Euthanasia is translated from Greek as "good death" or "easy death. At first, the term referred to painless and peaceful natural deaths in old age that occurred in comfortable and familiar surroundings. Today the word is currently understood […]

Physician-assisted Suicide: Right to Die

You may have heard of Physician-assisted suicide before, but what exactly is it? Physician-Assisted suicide is when someone who is terminally ill and completely competent of making choices the right to take their own life, legally with the help of a doctor. Though it seems as if they should be able to do that, in most states the law does get in the way of that. There are ethical and moral issues surrounding this issue. Regardless of those issues, those […]

Religious Perspectives on Euthanasia

Death is one of the most important things that religions deal with. All faiths offer meaning and explanations for death and dying; all faiths try to find a place for death and dying within human experience. Most religions disapprove of euthanasia. Some of them absolutely forbid it. Virtually all religions state that those who become vulnerable through illness or disability deserve special care and protection and that proper end of life care is a much better thing than euthanasia. Religions […]

Active and Passive Euthanasia

Euthanasia is the termination of a terminally ill person's life in order to relieve patients of their severe and untreatable pain. It is further broken down into two types: active and passive. In this paper, I will be focusing on active euthanasia and will argue that it is morally justifiable for a physician to alleviate agony for a patient and their family via direct action. Active euthanasia is morally permissible when a patient explicitly states their consent due to the […]

Physician Assisted Suicide: Medical Practice

Physician assisted suicide is when a physician provides a patient with the necessary means and information to help the patient perform a life ending act. Physician assisted suicide is when is when a person gets prescribed a lethal dose of medication from their physician that they can take when they get ready too. Physician assisted suicide has become an option for those around the world and even legal in certain States in the US. This option is legal in 6 […]

The Controversy over Euthanasia

Euthanasia, as defined by the Merriam-Webster Dictionary, is the act or practice of killing or permitting the death of hopelessly sick or injured individuals (such as persons or domestic animals) in a relatively painless way for reasons of mercy. The growing euthanasia epidemic has raised a profusion of controversy in recent years due to the legal and moral implications. Although described as relatively painless,euthanasia is something that should be methodically and thoroughly thought through because of the permanent effect it […]

Euthanasia and Death Penalty

Euthanasia and death penalty are two controversy topics, that get a lot of attention in today's life. The subject itself has the roots deep in the beginning of the humankind. It is interesting and maybe useful to learn the answer and if there is right or wrong in those actions. The decision if a person should live or die depends on the state laws. There are both opponents and supporters of the subject. However different the opinions are, the state […]

Physician Assisted Suicide: the Growing Issue of Dying with Dignity and Euthanasia

Is someone wanting to die with dignity more important than the conscience of a doctor who provides care for others? The issue of physician-assisted death can be summed up by simply saying it has a snowball effect. What starts as physician-assisted death turns into euthanizing and from there it could end up in the killing of patients without their full comprehension as to what they agreed to. The solution to this issue is accepting there is a problem and figuring […]

Definition of Euthanasia

Euthanasia defined as an intentionally ending of the life of the terminally ill person in order to relieve pain or suffering, done by a physician, legally. This is not to be confused with the similar physician assisted suicide, the suicide of patient suffering from an incurable disease, effected by the taking of lethal drug by a doctor for this purpose. It is legal in only a few places of the world, and the laws vary by the places. That means […]

Physician Assisted Suicide

Healthcare isn't as perfect as we think it should be considering there are so many medications and treatments that can help restore or cure one's illness. When needing the assistance of a healthcare facility, there are many different challenges that can impact patients and their families. Challenges that include life or death decision making, insurance coverage, the need for medications, cost of services, and so on. As these challenges may seem as if they are minor to some, they truly […]

Euthanasia and Physician-Assisted Suicide

In a documentary, Charles Scott was a man who loved to read, sing, and enjoy being outdoors. He was diagnosed with lymphoma. Struggling every day just to breathe after walking 10 steps to the bathroom and dealing with his eyesight deteriorating, He found life to be full of pain instead of joy. He found no want in having to wait through multiple medications, operations, pain, hospice, and finally him dying suffocating trying to catch his breath” he wished to die […]

Physician-Assisted Euthanasia/Suicide

Part 1: Ethical Question Should doctors have a choice to opt out of assisting terminally ill patients with euthanasia/suicide? Part 2: Introduction Some people think being a physician is an exciting job for the most part. However, physicians have the task of making tough decisions that could hurt many people emotionally. The morality of assisted euthanasia and suicide has been questioned by many people. Some may consider euthanasia and suicide immoral any wrong. Unfortunately, euthanasia and suicide may be the […]

Arguments for Legalizing Euthanasia

I once heard euthanasia is a heart-wrenching kindness and i believe that to be true.Although we as vet techs know it is the right thing to do, being apart of ending there pain and suffering,it is hard being the one to end it knowing the bond an animal has with its owner.Everyone has their own thoughts about this topic and how we prefer to handle it.There are different tolerances everyone has on how it should be done and what the […]

Why Active Euthanasia and Physician Assisted Suicide should be Legalized

This reference source gives us an overview of why euthanasia should be legalized. It goes into depth about how patients and doctors are affected by the decision to end a person's life, and moral issues, and whether it is right or wrong to purposely end someone's life. This source highlights that euthanasia should be in the best interest of the patient who is suffering from an illness, such as an incurable disease or a serious health issue. Doctors should be […]

Physician-assisted Suicide is not Federally Mandated

Physician-assisted suicide is not federally mandated due to the lack of bipartisanship in Congress, the principles of federalism, and contributions from conservative organizations and interest groups. The attitudes and moral acceptability about certain behaviors and actions differ significantly among Republicans and Democrats. According to a 2007 survey, 62% of Democrats support doctors assisting a terminally ill patient to commit suicide, while only 49% of Republicans support this notion (Gallup, Inc 2007). 59% of Democrats also find physician-assisted suicide to be […]

Physician-assisted Suicide and Euthanasia

Physician-assisted suicide and euthanasia have become some of the most highly controversial topics discussed in medicine, making those who have medicine as an occupation question the morality behind the act. A common misconception people often times make is confusing the fact that physician-assisted suicide and voluntary active euthanasia as the same thing. The NCI dictionary of cancer terms states euthanasia is accessibility to ""[a]n easy or painless death or the intentional ending of the life of a person suffering from […]

Euthanasia and Physician Assisted Suicide

Sometimes people criticize euthanasia and physician-assisted suicide from what is called "pro-life" perspectives and other times from "pro-death" perspectives; each perspective has a different argument about their position and the side they are on in this debate. This paper will review some of these arguments that have been made to date, as well as some of the more recent developments in this issue (Dieterle 129). To begin with, many people argue that euthanasia and physician-assisted suicide are morally acceptable because […]

Hinduism and Buddhist Perspective of Suicide and Euthanasia

The principle of ahimsa, or no violence, is fervently held in Hinduism and is reflective in followers' everyday lives. This concept extends to oneself as well as others. For one, suicide is condemned in this religion because all life is considered sacred. Humans life is perceived as precious because only through one of the three human realms can liberation be achieved. Other living things, such as insects and animals, do not receive the same opportunity, so it is crucial followers […]

Euthanasia – One of the most Debated Topics Today

The topic of euthanasia is one of the most debated topics today. Elderly patients can be pressured into a decision they don't want to make. Citizens can also be unfairly euthanized as well. Euthanasia should stay illegal due to the obligation to elderly patients, non permitted euthanization, of an individual, and which can open hopefully widen perspective on this issue, as well as many others. Euthanasia is a complex topic that can't be described simply and without depth. Euthanasia can […]

Physician-assisted Suicide Debate

Let's say a patient is in incredible pain or has an incurable illness and the patient can only be kept alive by machines or by enduring their pain. Should any patient who is in these circumstances be allowed to choose death over this life? Many people go against assisted suicide because of religion and or whatever they believe in. Another reason why people may disagree is that the patients who are not in the right mind and or are too […]

Ethics and Challenges of Euthanasia

As there are other patients who have a higher chance of living, euthanizing the patient was the more practical option. Euthanasia advocates argue that futile care may harm others. For instance, a young child with an acute respiratory disease, who has a potentially higher chance of getting cured, could not get a bed and ventilator in the ICU because others were using it even though they are not getting any personal benefit from the treatment (Niederman & Berger, 2010). This […]

Euthanasia: Merciful Death or Playing God

A death by suicide. Just hearing the word suicide can send chills down one's spine. How could someone get to the point of self-termination? Why would anybody ever consider such a terrible way to die? The thing is, suicide does not have to be a terrible or scary way to die if one is faced with insurmountable troubles accompanying an untreatable disease. With assistance from licensed professionals, it can give those suffering a painless option if they so choose to […]

What is Euthanasia?

Euthanasia is a easy death, some may say euthanasia is a undeviating act for taking a life through prescription drugs. A patient that has a short expand of life can address such an issue with their healthcare provider. Counseling can be provided before the final decision is made by doctor and the patient. At anytime the patient reserves the right to with draw from the process. The patient however must have good reason for the process before a doctor will […]

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• Solutions to Gun Violence
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How To Write An Essay On Euthanasia

Introduction to the concept of euthanasia.

When embarking on an essay about euthanasia, it’s crucial to begin with a clear definition of what euthanasia entails. Euthanasia, often referred to as "mercy killing," is the act of intentionally ending a person's life to relieve them of suffering, typically from a terminal illness or an incurable condition. In your introduction, outline the various types of euthanasia, such as voluntary, non-voluntary, and involuntary, and the ethical, legal, and moral questions they raise. This introductory segment sets the stage for an in-depth exploration of the arguments for and against euthanasia and its implications in the realms of medicine, ethics, and law.

Exploring the Arguments For and Against Euthanasia

The body of your essay should delve into the complex arguments surrounding euthanasia. On one hand, proponents argue that euthanasia is a compassionate response to unbearable suffering, respecting an individual's right to choose death over prolonged pain. They may also cite the importance of dignity in death and the reduction of medical costs for terminally ill patients. On the other hand, opponents raise concerns about the sanctity of life, the potential for abuse, and the slippery slope towards non-voluntary or involuntary euthanasia. They may also discuss the moral obligations of medical professionals to preserve life. This section should present a balanced view of the debate, providing a comprehensive understanding of the various perspectives on euthanasia.

Ethical and Legal Considerations

A crucial aspect of your essay should be an examination of the ethical and legal considerations surrounding euthanasia. Discuss the ethical principles involved, such as autonomy, beneficence, non-maleficence, and justice. Explore how different countries and cultures view and legislate euthanasia, noting the variations in legal frameworks and the criteria required for it to be carried out. This analysis should provide insight into the complexities of legalizing and regulating euthanasia, and the ethical dilemmas faced by healthcare providers, patients, and their families.

Concluding with Personal Reflections and Broader Implications

Conclude your essay by summarizing the key points and offering personal reflections on the topic. Reflect on the implications of euthanasia for society and the field of healthcare. Consider how advances in medical technology and changes in societal attitudes might influence the future of euthanasia. Your conclusion should not only provide closure to your essay but also encourage further thought and dialogue on this sensitive and contentious issue, highlighting the ongoing importance of ethical deliberation in decisions about life and death.

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Essay on Euthanasia: 100, 200 and 300 Words Samples

• Updated on  
• Feb 22, 2024

Essay on Euthanasia: Euthanasia refers to the act of killing a person without any emotions or mercy. Euthanasia is an ethnically complex and controversial topic, with different perspectives and legal regulations on different topics. School students and individuals preparing for competitive exams are given assigned topics like essays on euthanasia. The objective of such topics is to check the candidate’s perspectives and what punishment should be morally and legally right according to them. 

If you are assigned an essay on euthanasia, it means your examiner or teacher wants to know your level of understanding of the topic. In this article, we will provide you with some samples of essays on euthanasia. Feel free to take ideas from the essays discussed below.

Master the art of essay writing with our blog on How to Write an Essay in English .

Table of Contents

• 1 Essay on Euthanasia in 150 Words
• 2.1 Euthanasia Vs Physician-Assisted Suicide
• 2.2 Euthanasia Classification
• 3 Is Euthanasia Bad?

Essay on Euthanasia in 150 Words

Euthanasia or mercy killing is the act of deliberately ending a person’s life.  This term was coined by Sir Francis Bacon. Different countries have their perspectives and laws against such harmful acts. The Government of India, 2016, drafted a bill on passive euthanasia and called it ‘The Medical Treatment of Terminally Ill Patient’s Bill (Protection of Patients and Medical Practitioners). 

Euthanasia is divided into different classifications: Voluntary, Involuntary and Non-Voluntary. Voluntary euthanasia is legal in countries like Belgium and the Netherlands, with the patient’s consent. On one side, some supporters argue for an individual’s right to autonomy and a dignified death. On the other hand, the opponents raise concerns about the sanctity of life, the potential for abuse, and the slippery slope towards devaluing human existence. The ethical debate extends to questions of consent, quality of life, and societal implications.

Also Read: Essay on National Science Day for Students in English

Essay on Euthanasia in 350 Words

The term ‘Euthanasia’ was first coined by Sir Francis Bacon, who referred to an easy and painless death, without necessarily implying intentional or assisted actions. In recent years, different countries have come up with different approaches, and legal regulations against euthanasia have been put forward. 

In 2016, the government of India drafted a bill, where euthanasia was categorised as a punishable offence. According to Sections 309 and 306 of the Indian Penal Code, any attempt to commit suicide and abetment of suicide is a punishable offence. However, if a person is brain dead, only then he or she can be taken off life support only with the help of family members.

Euthanasia Vs Physician-Assisted Suicide

Euthanasia is the act of intentionally causing the death of a person to relieve their suffering, typically due to a terminal illness or unbearable pain. 

Physician-assisted suicide involves a medical professional providing the means or information necessary for a person to end their own life, typically by prescribing a lethal dose of medication.

In euthanasia, a third party, often a healthcare professional, administers a lethal substance or performs an action directly causing the person’s death.

It is the final decision of the patient that brings out the decision of their death.

Euthanasia Classification

Voluntary Euthanasia

It refers to the situation when the person who is suffering explicitly requests or consents to euthanasia. A patient with a terminal illness may express his or her clear and informed desire to end their life to a medical professional.

Involuntary

It refers to the situation when euthanasia is performed without the explicit consent of the person, often due to the individual being unable to communicate their wishes.

Non-Voluntary

In this situation, euthanasia is performed without the explicit consent of the person, and the person’s wishes are unknown.

Active euthanasia refers to the deliberate action of causing a person’s death, such as administering a lethal dose of medication.

It means allowing a person to die by withholding or withdrawing treatment or life-sustaining measures.

Euthanasia and assisted suicide are a defeat for all. We are called never to abandon those who are suffering, never giving up but caring and loving to restore hope. — Pope Francis (@Pontifex) June 5, 2019

Also Read: Essay on Cleanliness

Is Euthanasia Bad?

Euthanasia is a subjective term and its perspectives vary from person to person. Different cultures, countries and religions have their own set of values and beliefs. Life is sacred and gifted to us by god or nature. Therefore, intentionally causing death goes against moral and religious beliefs. 

However, some people have raised concerns about the potential for a slippery slope, where the acceptance of euthanasia could lead to the devaluation of human life, involuntary euthanasia, or abuse of the practice. Some even argue that euthanasia conflicts with their traditional medical ethics of preserving life and prioritizing the well-being of the patient.

Today, countries like the Netherlands and Belgium have legalised euthanasia. In India, the USA and the UK, it is a punishable offence with varying sentences and fines. Euthanasia is a complex and controversial topic and creating a law against or for it requires a comprehensive study by experts and the opinions of all sections of society. 

Ans: Euthanasia refers to the act of killing a person without any emotions or mercy. Euthanasia is an ethnically complex and controversial topic, with different perspectives and legal regulations on different topics.

Ans: The term ‘Euthanasia’ was first coined by Sir Francis Bacon, who referred to an easy and painless death, without necessarily implying intentional or assisted actions. In recent years, different countries have come up with different approaches, and legal regulations against euthanasia have been put forward.  In 2016, the government of India drafted a bill, where euthanasia was categorised as a punishable offence. According to Sections 309 and 306 of the Indian Penal Code, any attempt to commit suicide and abetment of suicide is a punishable offence. However, if a person is brain dead, only then he or she can be taken off life support only with the help of family members.

Ans: Belgium and the Netherlands have legalised euthanasia. However, it is banned in India.

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158 Euthanasia Topics & Essay Examples

If you’re writing a euthanasia essay, questions and topics on the subject can be tricky to find. Not with our list!

• 📑 Aspects to Cover in a Euthanasia Essay

🏆 Best Euthanasia Essay Examples & Topics

💡 clever euthanasia titles, 🎓 simple & easy euthanasia essay titles, ✅ most interesting euthanasia topics to write about, ❓ euthanasia essay questions.

Our experts have prepared a variety of ideas for your paper or speech. In the article below, find original euthanasia research questions and essay titles. And good luck with your assignment!

📑 Aspects to Cover in an Euthanasia Essay

Euthanasia is the process of intentional life ending. Its goal is to stop patients’ suffering and pain. In today’s world, euthanasia is a debatable topic, and there are many questions about it.

Euthanasia essays can help students to raise awareness of the process and its aspects. That is why it is crucial to research this issue and write papers on it.

You can discuss various problems in your essay on euthanasia, as there is a broad variety of related issues. You can choose the one you are the most concerned about, search for euthanasia essay questions online or consult your professor.

Here are some examples of euthanasia essay topics and titles we can suggest:

• The benefits and disadvantages of a physician-assisted suicide
• Ethical dilemmas associated with euthanasia
• An individual’s right to die
• Euthanasia as one of the most debatable topics in today’s society
• The ethical dilemma around euthanasia
• The ethics associated with voluntary euthanasia
• Can euthanasia be considered murder?
• Euthanasia debate: Should the government legalize this procedure?
• The legality of physician-assisted suicide in today’s society

Once you have selected one of the euthanasia essay titles, you can start working on your paper. Here are some important aspects to cover:

Start from developing a solid euthanasia essay thesis. You should state the main idea of your paper and your primary argument clearly. A thesis statement can look like this: Euthanasia is beneficial for patients because it prevents them from suffering. Euthanasia can be equal to murder.

• Remember to include a definition of euthanasia and related terms, such as physician-assisted suicide. Your audience should understand what you are talking about in the essay.
• Do not forget to include the existing evidence on the issue. For instance, you can research euthanasia in different countries, the debates around its legalization, and all other aspects related to the problem. Support your claims with facts and cite your sources correctly.
• Legal and ethical questions are some of the most significant aspects you should cover in the essay. Discuss the potential benefits and disadvantages of the procedure, as well as its impact on patients’ families and medical professionals.
• If you are writing an opinion paper, do not forget to state your opinion clearly. Include relevant experience, if possible (for example, if you work at a hospital and patients have asked you about the procedure). Have you met people who could have benefited from euthanasia? Include their stories, if applicable.
• Do not forget to cover the legal aspects of euthanasia in your state. Is it legal to perform some form of euthanasia where you live or work? Do you think it is beneficial for the patients?
• Remember to look at the grading rubric to see what other aspects you should cover in your paper. For example, your professor may want you to state a counter-argument and include a refutation paragraph. Make sure that you follow all of your instructor’s requirements.
• If you are not sure that you have covered all the necessary questions related to your issue, check out related articles and analyze the authors’ arguments. Avoid copying other people’s work and only use it as an inspiration.

Please find our free samples below with the best ideas for your work!

• Euthanasia: Advantages and Disadvantages The most heavily criticized of all such similar actions is involuntary euthanasia which bears the brunt of all severe protests against the issue, with involuntary euthanasia being dubbed as the deprivation of an individual of […]
• Arguments in Favor of Euthanasia Due to the sensitivity of the issue, laws that will protect the rights of both the patient and the physicians who practice euthanasia should be put in place.
• Consequentialism: Euthanasia and Physician-Assisted Suicide People against euthanasia view the consequences of legalization as a gateway to other unethical practices being accepted, which is a slippery slope that could lead to adverse consequences to the fundamental principles and values of […]
• Euthanasia as Self-Termination Velleman believes that a person should not have the right to end their life as it can make other people suffer, but there is an objection to his opinion related to that person’s own pain.
• An Argument Against Euthanasia 5 Generally, it is contrary to the duty of the subject of euthanasia and that of those who intend to perform the mercy killing to take one’s life based on their own assessment of the […]
• Advantages and Disadvantages of Euthanasia in Modern Society In its turn, this points out to the fact that, in the field of health care, the notion of medicinal compassion organically derives out of the notion of scientific progress, and not out of the […]
• Why Active Euthanasia is Morally Wrong The issue of active euthanasia has come to the attention of the public over the past decades as more people demand for the right to be assisted to die.
• The Problem of Euthanasia in Animal Shelters Animal shelters are forced to euthanize animals for a number of reasons which includes: Lack of funds to treat sick animals, overcrowding as a result of the increased number of animals brought in by owners […]
• Euthanasia and Assisted Suicide The final act that results in the death of the person is however usually performed by the person intending to die after the provision of information, advice and even the ways through which he or […]
• Euthanasia: Legalisation of a Mercy Killing The fact that the minority of countries and only several states in the US accept euthanasia proves that today people are still not ready to accept it as a mercy.
• Euthanasia: Fighting for the Right Cause Sommerville is a renowned Samuel Gale Professor of Law at the McGill University in Montreal, the Professor in the Faculty of Medicine, and the Founding Director of the Center for Medicine, Ethics, and Law. The […]
• The Death Definition and the Need for Euthanasia If the concept of the soul is to be believed in, then one’s death is simply a process that detaches the soul from the body.
• Euthanasia as a Polarizing Issue The example of a plethora of countries shows that the inclusion of assisted suicide is not detrimental to the broad society.
• Rachel’s Stance on Euthanasia: Passive and Active Killing Despite the appealing nature of Rachel’s argument, his claims of equity of killing and letting a person die are not ethically right. A major distinction between killing and witnessing death is the level of responsibility […]
• Euthanasia for Terminally Ill People: Pros & Cons Despite the fact that euthanasia causes a lot of controversy, every person should have the right to end suffering. Permission of euthanasia is the realization of a person’s right to dispose of their body.
• Euthanasia: Arguments for and Against If the disease has reduced a person to a vegetative state and deprived them of consciousness, then their life is no longer fully human and therefore is not considered a blessing.
• Analysis of Ethical Dilemma: Euthanasia One of these is the right to live, which includes much more than the ability to simply exist, and suggests an adherence to a minimum of quality and self-determination.
• Euthanasia-Related Ethical and Legal Issues There are no discussions about whether the person has the right to commit suicide or not because most individuals agree that it is the decision of the adult person who can dispose of their life.
• Euthanasia: Legal Prohibitions and Permits In addition, it is necessary to take into account the right of a suffering person to get rid of the suffering of loved ones.
• Euthanasia: Why Is It Such a Big Problem? Thus, according to the utilitarian viewpoint, there is no problem with euthanasia as along as it is better for the patient. Who is it to decide what is better for the patient?
• Euthanasia and Assisted Suicide as a Current Issue in Nursing Nowadays, even in nations where the procedure of euthanasia and assisted suicide has been legal for decades, this topic continues to be controversial due to ethical and policy issues. However, in the light of the […]
• Euthanasia and Its Main Advantages However, after realizing the condition is untreatable and having the consent of both the sick person and the relatives, undertaking assisted suicide will enable the patient to evade extreme suffering.
• Euthanasia: Nurses’ Attitudes Towards Death The weakest part of the article is that most of the participants did not clearly define the concept of euthanasia, which casts doubt on the reliability of the sampled data.
• Right to Die With Euthanasia Methods The possible answer is to develop the functionality of both ordinary public hospitals and hospices that are located in their departments. In addition, it is critical to specify the desirable methods of euthanasia.
• “Active and Passive Euthanasia” by James Rachels The second issue about euthanasia that Rachels raises is the difference between killing and allowing one to die. For Rachels, it is necessary to emphasize that killing is sometimes even more humane than allowing one […]
• Arguments Against Legalization of Euthanasia Although the PAS/E should be offered voluntarily to a patient, in some cases it is offered in secret by physicians to patients who are perceived to be dying.
• Euthanasia: The Terri Schiavo Case Analysis The long-term judicial resolution of the Terri Schiavo case was related to the bioethical problem of the humanity of euthanasia, which had many opponents and supporters.
• Can Euthanasia Be Considered Ethical Consequently, from this perspective, the act of euthanasia would be regarded as violence to someone else’s life. As a result, euthanasia is likely to be considered unethical from the point of view of any of […]
• “Active and Passive Euthanasia” and “Sexual Morality” According to Scruton, morality is a constraint upon reasons for action and a normal consequence of the possession of a first-person perspective. For Scruton, sexual morality includes the condemnation of lust and perversion that is, […]
• Nursing Role in Euthanasia Decision and Procedures The weakest point is the lack of analysis of other factors’ influence on the process of euthanasia. The researchers discovered that the role of nurses in euthanasia is underestimated.
• Aspects of Nursing and Euthanasia The subject of the research by Monteverde was to ask people who work in the medical sphere and face the necessity for euthanasia, whether they are for or against it, and why.
• Pros and Cons of Euthanasia from an Ethical Perspective Primarily, this is apparent on American soil, in which some states decriminalized euthanasia, although the supreme court maintained that there is no law that legalized the practice nor the ban of the mentioned act.
• Euthanasia in the Context of Christianity The questions addressed in the paper include the notions of fall and resurrection as means of interpreting suffering, the Christian stance on the value of human life and euthanasia, and the discussion of possible solutions […]
• Nursing Practice and Euthanasia’s Ethical Issues Effective healthcare management is the involvement of all stakeholders, such as CMS, and the federal government in the decision-making process to improve the sustainable growth in the effectiveness of Medicaid.
• Counseling on Euthanasia and End-of-Life Decision The immediate dynamic killing is a clinical demonstration coordinated to the hardship of life, while a doctor helped self-destruction is a demonstration of the doctor where he gives the patient a medicament for taking life.
• Euthanasia and Physician-Assisted Suicide Articles According to the methods of application, there are two main types of euthanasia: “active”, which consists in performing certain actions to accelerate the death of a hopelessly ill person, and “passive”, the meaning of which […]
• Legal and Ethical Issues of Euthanasia Davis argues that there exists a challenge on how to establish a consensus in the competing views regarding the desire for patients to have the choice to die with dignity while under pain and distress […]
• Debates on Euthanasia – Opposes the Use Therefore, the legal system should work hand in hand with healthcare shareholders in distinguishing the limits between the patients’ rights and the physicians’ accountability based on the possible life-limiting treatment choices.
• Active Euthanasia: Ethical Dilema In case of active euthanasia, it is the patient who requests the medical practitioner to end his or her life and the former abides by the wish.
• Euthanasia: Every For and Against Jane L Givens and Susan L Mitchell “Concerns about End-of-Life Care and Support for Euthanasia” Journal of Pain and Symptom Management Article in Press FOR The authors state socio-demographic characteristics of the people are the […]
• Pro Euthanasia in the United States The discussions of euthanasia implementation in the United States began in the early 19th century after the development of ether, which was applied to pain-relieving.
• Human Euthanasia Should Be Allowed It is stated that there is a shift in a social attitude towards human euthanasia, where people are beginning to realize that people’s lives are their rights.
• The Euthanasia in Humans The moral and ethical aspects of medical practice include not only the features of interaction with patients and other interested parties but also deeper nuances. In particular, one of the controversial and acute topics is euthanasia and its acceptability from different perspectives, including both patients’ and healthcare employees’ positions. In addition, religious issues are involved, […]
• Euthanasia: Philosophical Issues at Stake in Rodriguez I will argue that the prohibition of euthanasia contradicts utilitarianism and the principle of quality of life in particular, and can hardly be supported by paternalism since the ban does not benefit an individual’s life.
• “Euthanasia Reconsidered” by Deagle In more detail, there is a clearly discernible introduction that provides the background to the topic, introduces the thesis statement, and state the opinion of the author of the topic discussed.
• Euthanasia Movement in Modern America Euthanasia movements in modern America perfected the art of rhetoric in their communication and this worked for them in terms of winning the heart of the public.
• Euthanasia: The Issue of Medical Ethics In this respect, the position of a physician under the strain of extreme circumstances should be weighed about the value of compassion.
• The Dilemma of Euthanasia It is at this point, when it becomes a contention of professional ethics and moral considerations on the part of Jack and his wife on the one hand, and personal choice on the part of […]
• David Velleman’s Views on Euthanasia Velleman is correct in his conviction that in this case, the patient’s decision will be the outcome of a federal right to die; the situation with euthanasia is common to that of abortion with the […]
• Euthanasia: Ethical Debates When a patient is in the final stage of life, sometimes, the disease or the conditions of the patient, cause a lot of physical and psychological suffering.
• Euthanasia Moral and Ethical Agitation If grandma were a dog, most all would agree that the only humane option would be to ‘put her to sleep.’ U.S.citizens are guaranteed certain rights but not the right to wouldie with dignity.’ This […]
• Life-Span Development: Terri Schiavo’s Euthanasia Case Euthanasia is the process of stopping the medical maintenance of a patient’s life when the patient/herself does not want to suffer anymore and the doctors are sure that no improvements in the patient’s condition are […]
• Euthanasia and Other Life Termination Options However, there is a strong case for helping terminally ill patients spend the remainder of their lives with care provided by the medical fraternity and with support from the state and insurance companies. And in […]
• The Problem of Euthanasia Nevertheless, we must recognize that the interruption of life, alone or with the help of doctors, is contrary to one of the basic tenets of Christianity: the more people suffer on earth, the easier it […]
• Euthanasia: Allow Them to Be Free From Body Euthanasia, the practice of deliberately bring about an easy, painless, and moderate death to a person who is in the last days of his life and can no more bear the pain of living, has […]
• Palliative Medicine Replacement for Euthanasia Euthanasia is not about helping ill and dying people to end their pain and bring comfort. Euthanasia undermines the core values of life and decreases the motivation to provide care for the dying.
• Euthanasia in Christian Spirituality and Ethics By examining Christian’s views on the fallenness of the world, the hope of resurrection, and the value of a person’s life, one can see that euthanasia is not a morally acceptable option for a Christian […]
• Euthanasia: A Legalized Right to Die Nothing could be further from the intent of those who favor a limited reconsideration of public policy in the areas of assisted suicide and voluntary active euthanasia.
• Euthanasia and Suicide Issues in Christian Ethics Based on the two perceptions of euthanasia, theological and professional, it is valid to say that assisted suicide is probably not the best way out.
• Euthanasia: Morals, Ethics, and the Value of Life James Rachels however disagrees with the position taken by doctors when it comes to active Euthanasia and argues that, given a case where the patient is in intolerable pain and is certain to die in […]
• Euthanasia. Arguments of Opponents The request of the patient to relieve them from Karma and sufferings that is clarification and healing, nobody gives the right to break life of a physical body.
• Attitudes Related to Euthanasia and Physician-Assisted Suicide Among Terminally Ill Patients Consequently, the outlined safeguard becomes the first line of defense in making sure that only the right individuals with chronic and incurable medical conditions benefit from assisted death.
• Active Euthanasia Legalization Controversy While many people present the notions of medical ethics, the right to life, and the availability of palliative care to oppose active euthanasia, there are those who support it since it is evidence-based in nature […]
• Dying With Dignity: Euthanasia Debate On the other hand, the supporters of the law claim that assisted death is not a suicide, and it allows more end-of-life options for terminally ill patients. The majority of people are concerned with control […]
• Euthanasia Legalization as an Unethical Practice The decision to legalize euthanasia is an idea that societies should ignore since it places many global citizens at risk, fails to provide adequate safeguards, diminishes social values, and undermines the teachings of Islam.
• The Ethics of Euthanasia In the analysis of the claims in favor and against euthanasia, the cause and effect relationships between the factors affecting the choice of euthanasia should be established.
• Today’s Moral Issues: Euthanasia To ensure that the right to life is respect, the law was amended to include assisted or aided suicide as a criminal offense.
• Controversial Issues of Euthanasia Decision We now had to make this difficult decision to end his life and relieve him of all the pain that he was undergoing.
• Confronting Physician-Assisted Suicide and Euthanasia It was because of that pain that led my mother and I to bring her to a Chinese holistic healer who treated her with some sort of secret Chinese medical injection.
• Assisted Suicide and Euthanasia Rights in Canada The article asserts that in the year 1993, Rodriquez petitioned in vain to the Supreme Court of Canada to allow her to undertake euthanasia. In the article, the author asserts that, in the year 1993, […]
• Euthanasia: “Being a Burden” by Martin Gunderson As it was implied in the Introduction, in his article, Gunderson argues in favor of the idea that it is utterly inappropriate to even consider the legalization of voluntary euthanasia, due to a number of […]
• Euthanasia as a Way of Painless Termination of Life The introduction of the Hippocratic School led to the abolishment of the practice. According to the approach, taking human life is unethical and violation of the core right to life.
• Euthanasia and Other Life-Destroying Procedures From this perspective, it is unethical to decide in favor of an end-of-life procedure on the condition that there are at least minimal chances for a patient’s survival.
• Ethics of Euthanasia and Pain-Relieving This leads to the historical argument that voluntary euthanasia is often the beginning of a slippery slope that gives rise to unintentional euthanasia and the murder of people who are unwanted in society.
• Euthanasia Legalization: Public Policy Debates The requirements of physicians to perform euthanasia and consideration of the second opinion eliminate the violation of legal and ethical stipulations, and thus, control the performance of euthanasia in health care environment. Opponents of euthanasia […]
• Euthanasia: Moral Rationalist View Human beings rely on the available evidence to generate beliefs about life and goals that should be attained, and thus the use of reason leads to success in these objectives.
• Euthanasia: Is It Worth the Fuss? In order to grasp the gist of the deliberations in this essay, it is important to first apprehend what the term euthanasia means and bring this meaning in the context of this essay.
• Active and Passive Euthanasia Analysis and Its Concept The issue of morality is one of the things that have to be mentioned when discussing the concept of euthanasia. In this instance, both the patient and the doctor know that there is no cure […]
• Euthanasia in Today’s Society Euthanasia is the deliberate termination of life with the intention of relieving a patient from pain and suffering. If the prognosis of a patient is gloomy, medical care providers may find it more compassionate to […]
• When Ethics and Euthanasia Conflict? The main aim is to reduce the lifetime of a patient who is terminally ill. There is a deep mistrust of the motivations that fuel euthanasia.
• Religions Views on Euthanasia This essay highlights religious thoughts with regard to the whole issue of euthanasia, bringing into focus the extent to which our society has been influenced by courtesy of the Dr.
• Euthanasia as the Key Controversy of the XXI Century The fact that in the present-day society, human life is put at the top of the entire list of values is a major achievement of the civilization and the fact that the current society is […]
• Euthanasia: Is It the Best Solution? In twentieth century, various agencies erupted to address the practice of euthanasia such as Voluntary Euthanasia Legislation Society in 1935, which was advocating for its legalization in London and the National Society for the Legalization […]
• Legalizing Euthanasia The are supporters of the idea that only God has the right to take human’s life, on the other hand, the sufferings of the person may be unbearable and they may ask for euthanasia to […]
• Euthanasia: Right to Live or Right to Die Euthanasia or mercy killing as it is informally referred is the act of ending a person life if it is deemed to be the only way to help a person get out of their suffering.
• A New Fight to Legalize Euthanasia Before settling down on the conclusion of the need to adopt the practice of euthanasia in our state, it is important to visit some basic aspects that are very key in the issue of euthanasia.
• The Morality of Euthanasia In the meantime the medication and the doctors are not trivial anymore in stopping the pain and the victim despite all the sufferings, he or she is in a vegetative state and there is nothing […]
• The Ethics of Active Euthanasia In support of the euthanasia action, the argument is that there are circumstances when the rule of natural life can be violated.
• Is Euthanasia a Morally Wrong Choice for Terminal Patients? It is imperative to note that for both the opponents and proponents of euthanasia, the quality of life is usually the focal point, even though there is no agreement on the criteria of defining quality […]
• The Right to Life and Active Euthanasia The god of every individual should be the only one to bring death to a person and no person should have the authority to accept dying no matter the situation he/she is in.
• Singer’s Views on Voluntary Euthanasia, Non-voluntary Euthanasia, and Involuntary Euthanasia Hence, if a person consciously consents to die, there are no chances for recovery, and killing is the only way to deprive a patient from pain and suffering, euthanasia can be regarded as voluntary.
• Euthanasia Authorization Debate Euthanasia, which is equivalent to the termination of life, can be equated to a total breach of the principle of the sacredness of life, as well as the breach of the legal right of human […]
• Moral and Ethical Concerns of Euthanasia in Healthcare In the matter of euthanasia, professionals ought to decide between the overall good of the dying patient and that of other stakeholders.
• Good and Harm to Humanity of the Use a Euthanasia An Overview of Euthanasia The meaning of euthanasia has changed over the years from how it was originally construed to what it means to the contemporary world.
• Euthanasia and Meaning of Life The meaning of life is the most general aspect of judging about the requirements that must be set out by laws and people’s morals in regarding to the voluntary or involuntary taking of that life.
• Euthanasia: Your Right to Die? Although both positions can be supported with a lot of arguments, people should change their absolutely negative vision of euthanasia because the right to die with the help of physicians can be considered as one […]
• Euthanasia and Human’s Right to Die Trying to support human life with the help of modern equipment is a good idea, however, not in case there are no chances for a person to live without that equipment.
• Euthanasia Moral Permissibility Secondly, the application of voluntary euthanasia should not be regarded as the only way of reducing the pain that a patient can experience.
• Euthanasia (Mercy Killing) In some circumstances, the family and friends of the patient might request the hospital to terminate the life of the patient without necessarily informing the patient.
• Euthanasian Issues in Modern Society Is it possible to find the relief in the life which is full of pain and agony for those people who suffer from serious diseases and have only a little chance to get rid of […]
• Euthanasia From a Disciple of Jesus Christ in Today’s World Another form of euthanasia is that of Assisted Suicide where the person intending to end his/her life is provided with the necessary guidance, means as well as information as to how to go about the […]
• Euthanasia and Modern Society Towards this end Battin asserts that “the relief of pain of a patient is the least disputed and of the highest priority to the physician” in direct reference to sole and major reason of carrying […]
• Euthanasia: Moral Issues and Clinical Challenges Therefore, any law that rejects euthanasia is a bad one because it denies the patients the right and the liberty to die peacefully.
• Ethical Issues Surrounding the Choice of Euthanasia in the United States
• The Advantages and Disadvantages of the Legalization of Euthanasia
• Confronting Physician-Assisted Suicide and Euthanasia
• The Difference Between Active and Passive Euthanasia
• Euthanasia: Current Policy, Problems, and Solution
• The Permit and Legalization of Euthanasia for the Terminally Ill Patients
• Moral and Religious Differences Between Euthanasia and Suicide
• The Criticisms and Opposition of Euthanasia in Australia
• Assisted Suicide and Euthanasia It Is Not Murder, It Is Mercy
• The Factors That Influence the Legalization of Active and Passive Euthanasia in the United States
• Roman Catholic Church’s Teachings on Abortion and Euthanasia
• The Different Reasons Why People Are Against Euthanasia
• Religious and Ethical Arguments in Favour of Euthanasia
• The Moral and Ethical Views on the Goal of Euthanasia
• Euthanasia and the Role of Politics and Religion
• The Philosophical, Legal, and Medical Issues on Euthanasia
• General Information About Euthanasia and the Legality of Suicide in Australia
• The Nazi Euthanasia Programme Based on Racial Purity Theories
• Dr. Jack Kevorkian’s Role in Physician-Assisted Suicide and Euthanasia
• Utilitarian and Libertarian Views on Euthanasia
• The Moral and Religious Differences, if Any, Between Euthanasia and Suicide
• Biblical World View About the Euthanasia, Suicide, and Capital Punishment
• The Truth About Euthanasia and Assisted Suicide
• Tracing Back the Origins of the Practice of Euthanasia During the Greeks and Roman Times
• The Causes and Effects of Euthanasia and the Moral Right To Die
• The Arguments Against Euthanasia From a Standpoint of a Catholic Christian in the United States of America?
• Why Should Active Euthanasia and Physician-Assisted Suicide Be Legalized?
• What Are the Good and Bad Sides of Euthanasia?
• Do People Have To Commit Suicide by Euthanasia (Suicide by a Doctor)?
• What Is the Difference Between Passive and Active Euthanasia?
• What Are the Social Issues and Ethical Values of Euthanasia?
• What Is the Current Legal Situation Regarding Euthanasia?
• How Does Prohibition of Euthanasia Limit Our Rights?
• What Is the American Medical Association’s Attitude to Euthanasia?
• Can Hegelian Dialectics Justify Euthanasia?
• What Are the Viewpoints and Studies of the Legalization of Euthanasia in the United States?
• Why Does Parenting Make Euthanasia More Acceptable?
• What Are the Negative Arguments Against Euthanasia?
• Voluntary Euthanasia: What’s Right and Wrong?
• Why Can Christians not Accept Euthanasia?
• Can Euthanasia Help the Terminally Ill?
• What Are the Top Ten Reasons for Legalizing Euthanasia?
• Should Non Voluntary Euthanasia Be Legal?
• What Is the Difference Between Doctor-Assisted Suicide and Euthanasia?
• Why Should Euthanasia and Assisted Suicide Be Legalized?
• What’s Wrong With Involuntary Euthanasia?
• Why Are There So Different Views on Abortion and Euthanasia?
• How Would Christians Respond to the Issue of Abortion and Euthanasia?
• What Are the Objections To Legalizing Euthanasia in Hong Kong?
• How Does Euthanasia Devalue Human Life?
• What Are the Views and Arguments About Euthanasia?
• How May the Christian Faith Inform the Debate Over Euthanasia?
• What Does Euthanasia Mean to Society Today?
• What Are the Religious and Ethical Considerations to the Issue of Euthanasia?
• Euthanasia and Assisted Suicide – Who Wants It?
• Chicago (A-D)
• Chicago (N-B)

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The Ethics of Euthanasia

Malleeka Suy | SQ Blogger | SQ Online (2021-2022)

Picture t his: It is the year 3020, and the Martian soil you have been drilling into has finally worked out. Colonizing Mars is taking shape, and soon your family can permanently live on this rusty, rocky planet. However, the effects of progress don’t go unnoticed; every time you move, your skin screams in pain. Everything you once loved doing has lost its appeal. Would you take death in your own hands or live until a painful end?

This moral dilemma seems straight out of a science-fiction novel for most, but euthanasia is a legitimate deliberation for patients with terminal and mental illnesses who deem their lives too painful to live on. It is a practice that is still heavily debated in modern bioethics. Among many definitions, the American Medical Association defines euthanasia as the administration of a lethal agent by a medical professional to a patient to relieve their intolerable or incurable suffering.

Although euthanasia is not a new scientific process, as it has been practiced since the time of the ancient Greeks more than three thousand years ago, it wasn’t generally accepted by Western medicine until recently. The Netherlands was the first country to allow legal euthanasia and assisted suicide in 2002, totaling 1.7-2.8% of total deaths. Euthanasia is generally illegal in the United States, but in a nationwide 2017 American poll , 73% of the public were in favor of euthanasia, and 57% said euthanasia is morally acceptable. These numbers are nearly double the initial poll in 1947. If I had to guess why, it may be partly because of progressive exposure to mental health and its effects. This may have allowed people to understand and empathize with the circumstances and support what euthanasia stands for: a release from an unbearable life.

Euthanasia is especially controversial among general society and the bioethical community. One main argument for the support of euthanasia is grounded in personal autonomy–our ability to act independently– since living life is about minimizing physical pain and maximizing dignity and control . This idea is rooted in ancient times when physicians considered dying with peace and dignity a human right. An article from Stanford’s Encyclopedia of Philosophy regards autonomy as self-determination, so choices about how and when people die is them taking responsibility for their lives. Terminally ill patients in Oregon mentioned how they chose euthanasia because their condition stripped them of their independence and ability to engage in activities that gave their life meaning. After all, what is the meaning of life if we cannot live it?

Another article by the Linacre Quarterly highlights how the ethics of compassion justify the use of euthanasia. From a humanitarian standpoint, we can show compassion by suffering and sympathizing with patients and respecting their wishes of euthanasia as their “remedy.” Kenneth L. Vaux, a consultant in medical ethics, notes in his article that physicians would give a lethal dose to their loved ones out of love if they were dying and suffering, so he finds it “strange and hypocritical” that doctors cannot legally do so for their patients. He claims that “we have lost empathy, sympathy, and the covenant of care with those who have entrusted their lives to us because they believe we embody those very qualities.” Vaux also asks: “Having barred the door to Death, are we not then obliged at some point to open it?” He suggests that since doctors bring life into the world every day, consensually ending a patient’s life for their benefit should be no different.

Despite popular social support, there are many arguments against euthanasia as well–the most popular being religion. Several faiths, such as Christianity, see euthanasia as a form of murder and find it to be morally unacceptable because it may weaken society’s respect for the sanctity of life. Religious groups actively argue against euthanasia, and for this reason, euthanasia became a debate of preservation and purity of life.

Even though medicine is rooted in science, some physicians also use religion as justification against practicing euthanasia. Contrary to public British opinion, studies show that most UK doctors do not support legislation permitting euthanasia due to their religiosity or faith, and less than a quarter of doctors would be willing to practice euthanasia if it became legal.

Physicians also have a professional obligation to fulfill that becomes morally blurred with euthanasia. For more than 2,500 years, doctors have taken the Hippocratic Oath to do no harm and treat those under their care. Does bringing death by euthanasia violate the Hippocratic Oath, or is it in line with a doctor’s mission? Would acting under Hippocrates then make a doctor a hypocrite?

Because of this subjectivity, doctors sometimes feel uncertain about administering euthanasia. Even if a patient is under a lot of pain and medication, how can doctors be sure that their decision was made rationally? In a Dutch article , an experienced psychiatrist dealing with a patient’s invisible suffering made him uncertain about assessing how deeply rooted their suffering really was, and therefore how moral it would be to allow euthanasia to happen. The fickle nature of the human mind makes many physicians and ethicists question whether or not euthanasia should be a normal practice.

Physicians often have their own reservations about euthanasia and how they cope with patients who wish for it. They frequently feel pressured by the patient or the patient’s relatives to perform euthanasia. A 2011 survey among Dutch physicians also found that 86% of physicians dread the emotional burden of performing euthanasia. One physician recounts how a patient told them, “If you won’t perform euthanasia, I might go to a railway line or climb a high building.” This form of blackmail can lead to dangerous expectations, where future normativity of the practice is anticipated or even praised.

Instead of placing the burden on doctors, what if the government or even robots could control euthanasia? Although this faceless jurisdiction seems like a good solution, critics argue that euthanasia would be normalized and twisted for eugenic purposes, adding to the nightmare of AI domination and impeding the sanctity and preciousness of life. These speculations seem inconceivable, but history has unfortunately seen it happen, such as in Hitler’s Germany, where Aktion T4, a Euthanasia Program systematically murdered patients with disabilities to restore the “integrity” of the German nation, thrived. Perhaps then a grimmer alternative to the use of euthanasia is the elimination of incurable, disabled, or elderly patients. Mechanization of euthanasia would also impact the patient and the medical profession, both in what it means to be human and obeying the Hippocratic Oath. Routinization of the practice could also increase the desires of people’s wishes to end their lives, whether individually justified or not.

References:

https://jamanetwork.com/journals/jama/article-abstract/2532018

https://plato.stanford.edu/entries/euthanasia-voluntary/#MoraCaseForVoluEuth

http://www.cirugiaycirujanos.com/frame_esp.php?id=308

https://www.sciencedirect.com/science/article/pii/S0885392414003066?via%3Dihub

https://www.healthline.com/health/what-is-euthanasia#making-a-decision

https://livinganddyingwell.org.uk/wp-content/uploads/2020/02/Redefining-Physicians-Role-in-Assisted-Dying.pdf

https://shibbolethsp.jstor.org/start?entityID=urn%3Amace%3Aincommon%3Aucsd.edu&dest=

https://www.jstor.org/stable/3561966&site=jstor

https://doi.org/10.1177%2F0269216310397688

https://www.medicalnewstoday.com/articles/182951#some-statistics

https://journals.sagepub.com/doi/10.1177/0269216310397688

https://www.nejm.org/doi/10.1056/NEJMclde1310667

https://medicine.missouri.edu/centers-institutes-labs/health-ethics/faq/euthanasia

https://news.gallup.com/poll/211928/majority-americans-remain-supportive-euthanasia.aspx

https://www.ama-assn.org/delivering-care/ethics/euthanasia

https://pubmed.ncbi.nlm.nih.gov/21145197/

https://doi.org/10.1016/j.jpainsymman.2014.04.016

https://www.ccsenet.org/journal/index.php/gjhs/article/view/19405/13366

https://encyclopedia.ushmm.org/content/en/article/euthanasia-program

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Ethics guide

Ethics of euthanasia - introduction

This article introduces the debate around euthanasia. Should human beings have the right to decide on issues of life and death?

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What is euthanasia, page options.

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Euthanasia is the termination of a very sick person's life in order to relieve them of their suffering.

A person who undergoes euthanasia usually has an incurable condition. But there are other instances where some people want their life to be ended.

In many cases, it is carried out at the person's request but there are times when they may be too ill and the decision is made by relatives, medics or, in some instances, the courts.

The term is derived from the Greek word euthanatos which means easy death.

Euthanasia is against the law in the UK where it is illegal to help anyone kill themselves. Voluntary euthanasia or assisted suicide can lead to imprisonment of up to 14 years.

The issue has been at the centre of very heated debates for many years and is surrounded by religious, ethical and practical considerations.

The ethics of euthanasia

Euthanasia raises a number of agonising moral dilemmas:

• is it ever right to end the life of a terminally ill patient who is undergoing severe pain and suffering?
• under what circumstances can euthanasia be justifiable, if at all?
• is there a moral difference between killing someone and letting them die?

At the heart of these arguments are the different ideas that people have about the meaning and value of human existence.

Should human beings have the right to decide on issues of life and death?

There are also a number of arguments based on practical issues.

Some people think that euthanasia shouldn't be allowed, even if it was morally right, because it could be abused and used as a cover for murder.

Killing or letting die

Euthanasia can be carried out either by taking actions , including giving a lethal injection, or by not doing what is necessary to keep a person alive (such as failing to keep their feeding tube going).

'Extraordinary' medical care

It is not euthanasia if a patient dies as a result of refusing extraordinary or burdensome medical treatment .

Euthanasia and pain relief

It's not euthanasia to give a drug in order to reduce pain, even though the drug causes the patient to die sooner. This is because the doctor's intention was to relieve the pain, not to kill the patient. This argument is sometimes known as the Doctrine of Double Effect .

Mercy killing

Very often people call euthanasia 'mercy killing', perhaps thinking of it for someone who is terminally ill and suffering prolonged, unbearable pain.

Why people want euthanasia

Most people think unbearable pain is the main reason people seek euthanasia, but some surveys in the USA and the Netherlands showed that less than a third of requests for euthanasia were because of severe pain.

Terminally ill people can have their quality of life severely damaged by physical conditions such as incontinence, nausea and vomiting, breathlessness, paralysis and difficulty in swallowing.

Psychological factors that cause people to think of euthanasia include depression, fearing loss of control or dignity, feeling a burden, or dislike of being dependent.

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Voluntary Euthanasia

The entry sets out five conditions often said to be necessary for anyone to be a candidate for legalized voluntary euthanasia (and, with appropriate qualifications, physician-assisted suicide), outlines the moral case advanced by those in favor of legalizing voluntary euthanasia, and discusses the five most important objections made by those who deny that voluntary euthanasia is morally permissible and who are, in consequence, opposed to its being legalized.

1. Introduction

2. five conditions often proposed as necessary for candidacy for voluntary euthanasia, 3. a moral case for voluntary euthanasia, 4. five objections to the moral permissibility of voluntary euthanasia, other internet resources, related entries.

When a person performs an act of euthanasia, she brings about the death of another person because she believes the latter’s present existence is so bad that he would be better off dead, or believes that unless she intervenes and ends his life, his life will very soon become so bad that he would be better off dead. Accordingly, the motive of the person who performs an act of euthanasia is to benefit the one whose death is brought about. (This also holds for many instances of physician-assisted suicide, but use of the latter term is usually restricted to forms of assistance which stop short of the physician ‘bringing about the death’ of the patient, for example, those involving means that have to be activated by the patient.)

It is important to emphasize the motive of benefiting the person who is assisted to die because well-being is a key value in relation to the morality of euthanasia (see Section 3 below). Nonetheless, the defensibility of the contention that someone can be better off dead has been the subject of extensive philosophical deliberation. Those who claim that a person can be better off dead believe this to be true when the life that remains in prospect for that person has no positive value for her (a possibility which is discussed by e.g., Foot, 1977; McMahan 2002; Bradley 2009), whereas some of those who hold that a person’s life is inviolable deny that a person can ever be better off dead (e.g., Keown in Jackson and Keown 2012). A Kant-inspired variant on this latter position has been advanced by Velleman (1999). He considers that a person’s well-being can only matter if she is of intrinsic value and so that it is impermissible to violate a person’s rational nature (the source of her intrinsic value) for the sake of her well-being. Accordingly, he holds that it is impermissible to assist someone to die who judges that she would be better off dead and competently requests assistance with dying. The only exception is when a person’s life is so degraded as to call into question her rational nature, albeit he thinks it unlikely that anyone in that position will remain competent to request assistance with dying. This position appears to be at odds with the well-established right of a competent patient to refuse life-prolonging medical treatment, at least when further treatment is refused because she considers that her life no longer has value for her and further treatment will not restore its value to her. (For further reasons to reject arguments for the inviolability of the life of a person, including Velleman’s, see e.g., McMahan 2002; Young 2007; Sumner 2011, 2017.)

Because our concern will be with voluntary euthanasia – that is, with those instances of euthanasia in which a clearly competent person makes a voluntary and enduring request to be helped to die (or, by extension, when an authorised proxy makes a substituted judgment by choosing in the manner the no-longer-competent person would have chosen had he remained competent) – a second key value is the competence of the person requesting assistance with dying. There will be occasion to mention non-voluntary euthanasia – instances of euthanasia where a person lacks the competence at the time when a decision is to be made to request euthanasia and has not previously competently declared a preference for it via an advance directive (see the entry on advance directives ) – only when consideration is given to the claim that permitting voluntary euthanasia will lead via a slippery slope to permitting non-voluntary euthanasia. Nothing will be said here about involuntary euthanasia , where a competent person’s life is brought to an end despite an explicit expression of opposition to euthanasia, beyond saying that, no matter how honorable the perpetrator’s motive, such a death is, and ought to be, unlawful.

Debate about the morality and legality of voluntary euthanasia has been, for the most part, a phenomenon of the second half of the twentieth century and the beginning of the twenty first century. Certainly, the ancient Greeks and Romans did not believe that life needed to be preserved at any cost and were, in consequence, tolerant of suicide when no relief could be offered to a dying person or, in the case of the Stoics and Epicureans, when a person no longer cared for his life. In the sixteenth century, Thomas More, in describing a utopian community, envisaged such a community as one that would facilitate the death of those whose lives had become burdensome as a result of ‘torturing and lingering pain’. But it has only been in the last hundred years that there have been concerted efforts to make legal provision for voluntary euthanasia. Until quite recently there had been no success in obtaining such legal provision (though assisted suicide, including, but not limited to, physician-assisted suicide, has been legally tolerated in Switzerland for a number of decades). However, the outlook changed dramatically in the 1970s and 80s because of a series of court cases in the Netherlands which culminated in an agreement between the legal and medical authorities to ensure that no physician would be prosecuted for assisting a patient to die as long as certain guidelines were strictly adhered to (see Griffiths, et al., 1998). In brief, the guidelines were established to permit physicians to practise voluntary euthanasia in those instances in which a competent patient had made a voluntary and informed request to be helped to die, the patient’s suffering was unbearable, there was no way of making that suffering bearable that was acceptable to the patient, and the physician’s judgements as to diagnosis and prognosis were confirmed after consultation with another physician.

The first legislative approval for voluntary euthanasia was achieved with the passage in the parliament of Australia’s Northern Territory of a bill enabling physicians to practise voluntary euthanasia. Subsequent to the Act’s proclamation in 1996, it faced a series of legal challenges from opponents of voluntary euthanasia. In 1997 the challenges culminated in the Australian National Parliament overturning the legislation when it prohibited Australian territories from enacting legislation to permit voluntary euthanasia on constitutional grounds. Australia is a federation consisting of six states and two territories. Unlike the territories, the states do have the constitutional right to enact such legislation and in 2017 the state of Victoria did just that. The legislation came into effect in 2019. In 2019, a second state, Western Australia, enacted legislation to enable voluntary medically assisted death. The legislation became effective in 2021. In 2021 three further states, Tasmania, South Australia and Queensland enacted legislation to enable voluntary medically assisted death which came into force in 2022 for the first two, and 2023 for the third. Finally, in 2022 NSW enacted legislation which came into force in 2023 resulting in voluntary medically assisted death being available in each of the states. Attempts are currently being made in both the Australian Capital Territory and the Northern Territory to introduce legislation in favor of voluntary medically assisted death that will avoid being vetoed by the federal parliament.

In November 2000, the Netherlands passed legislation to legalize the practice of voluntary euthanasia. The legislation passed through all the parliamentary stages early in 2001. The Belgian parliament passed similar legislation in 2002 and Luxembourg followed suit in 2009. (For a very helpful comparative study of relevant legislation see Lewis 2007. See also Griffiths, et al. 2008.)

In Oregon in the United States, legislation was introduced in 1997 to permit physician-assisted suicide after a referendum strongly endorsed the proposed legislation. Later in 1997 the Supreme Court of the United States ruled that there is no constitutional right to physician-assisted suicide; however, the Court did not preclude individual states from legislating in favor of physician-assisted suicide (so the Oregon legislation was unaffected). Since that time the Oregon legislation has been successfully utilised by a significant number of people and similar legislation has been passed in the state of Washington in 2009, in Vermont in 2013, and more recently still in California, Colorado, Florida, Hawaii, Iowa, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New Mexico and the District of Columbia. A series of judicial decisions in the state of Montana in 2008 and 2009 established that the state could not prohibit physician-assisted suicide but legislation has not yet been introduced to codify the legal situation. A number of the remaining states are currently considering physician-assisted suicide bills.

A similar legal position to that in Montana obtained in the nation of Colombia from the late 1990s as a result of a majority ruling by its Constitutional Court in favor of the legality of physician-assisted suicide but legislative provision was finally made only quite recently. In 2021, Spain legalized voluntary euthanasia. In Austria and Germany courts have authorised physician-assisted suicide but no legislative backing for the practice has been introduced, while in Italy legislation for voluntary medically assisted death has been passed in one house of the bicameral parliament. In Portugal legislation for physician-assisted suicide was passed but was subsequently rejected by the Constitutional Court.

In Canada, the province of Quebec introduced legislation permitting medical aid in dying in 2014. The legislation came into effect in 2016 at around the same time that the Canadian National Parliament passed legislation permitting both physician-assisted suicide and voluntary euthanasia throughout all of the Canadian federation. (For a brief account of events leading up to the enactment of the various pieces of legislation in Canada see Downie and Schuklenk 2021.)

New Zealand held a referendum in 2019 which resulted in approval for the introduction of legislation for voluntary medically assisted death. The legislation came into effect late in 2021.

In the following countries legislative proposals for voluntary medically assisted death are presently under review: the Czech Republic, France, Ireland, the Isle of Man, Japan, Jersey, South Korea, the Philippines, Slovenia and the United Kingdom.

With that brief sketch of the historical background in place, we will proceed first to consider the conditions that those who have advocated making voluntary medically assisted death legally permissible have typically insisted should be satisfied. Consideration of the proposed conditions will establish a framework for the moral interrogation that will follow in Sections 3 and 4. Section 3 will outline the positive moral case put forward by those who want voluntary euthanasia and physician-assisted suicide to be legally permissible. Section 4 will be devoted to scrutinising the most important of the objections that have been levelled against that case by those opposed to the legalization of voluntary euthanasia and physician-assisted suicide.

Advocates of voluntary euthanasia typically contend that if a person

• is suffering from a terminal illness;
• is unlikely to benefit from the discovery of a cure for that illness during what remains of her life expectancy;
• is, as a direct result of the illness, either suffering intolerable pain, or only has available a life that is unacceptably burdensome (e.g., because the illness has to be treated in ways that lead to her being unacceptably dependent on others or on technological means of life support);
• has an enduring, voluntary and competent wish to die (or has, prior to losing the competence to do so, expressed a wish to be assisted to die in the event that conditions (a)-(c) are satisfied); and
• is unable without assistance to end her life,

there should be legal and medical provision to facilitate her being allowed to die or assisted to die.

It should be acknowledged that these conditions are quite restrictive, indeed more restrictive than many think appropriate. In particular, the first condition restricts access to voluntary euthanasia to those who are terminally ill . While that expression is not free of all ambiguity, for present purposes it can be agreed that it does not include those who are rendered quadriplegic as a result of accidents, or sufferers from chronic diseases, or individuals who succumb to forms of dementia like Alzheimer’s Disease, to say nothing of those afflicted by ‘existential suffering’. Those who consider that cases like these show the first condition to be too restrictive (e.g., Varelius 2014, Braun, 2023) may, nonetheless, agree that including them as candidates for legalized voluntary euthanasia is likely to make it far harder in many jurisdictions to gain sufficient support for legalization (and so to make it harder to help those terminally ill persons who wish to die). Even so, they believe that voluntary euthanasia should be permitted for those who consider their lives no longer worth living, not just for for the terminally ill. Whether those who judge that their lives are no longer worth living, and so believe their lives are in that sense ‘complete’, should be afforded medical assistance with dying, has recently become a pressing concern in Belgium and the Netherlands. Several court cases have affirmed that such assistance may sometimes be provided for individuals in the former category even though the question remains as to whether it is properly a medical responsibility to render assistance with dying to someone who believes her life is complete despite her not suffering from a terminal medical condition (see, e.g., Young 2017). Relatedly, the issues of whether those suffering from a disability which will not reasonably foreseeably lead to death and those suffering because of a mental illness should be able to access medical assistance with dying have recently been the subject of intense debate in Canada. The debate culminated in disabled individuals, whose conditions are the cause of enduring, intolerable and irremediable suffering, being given access to medical assistance with dying as long as they are capable of making a competent request for that assistance. An intention to make a similar arrangement for those whose sole underlying condition is a mental illness was flagged for introduction in 2024, but has been temporarily shelved until further research has been conducted on the issue. It seems likely that the changes that have been made, or mooted, in these jurisdictions to the eligibility conditions for medical assistance with dying will lead to an expansion of the eligibility conditions for voluntary medically assisted death in other jurisdictions.

The fifth condition further restricts access to voluntary euthanasia by excluding those capable of ending their own lives, and so may be thought unduly restrictive by those who would wish to discourage terminally ill patients from attempting suicide. There will be yet others who consider this condition to be too restrictive because competent patients can always refuse nutrition and hydration (see, e.g., Bernat, et al. 1993; Savulescu 2014). Though this is true, many competent dying persons still wish to have access to legalized medically assisted death, rather than having to rely on refusing nutrition and hydration, so that they may retain control over the timing of their deaths and avoid needlessly prolonging the process of dying.

The second condition is intended simply to reflect the fact that it is normally possible to say when someone’s health status is incurable. So-called ‘miracle’ cures may be proclaimed by sensationalist journalists, but progress toward medical breakthroughs is typically painstaking. If there are miracles wrought by God that will be quite another matter entirely, but it is at least clear that not everyone’s death is thus to be staved off.

The third condition recognises what many who oppose the legalization of voluntary euthanasia do not, namely, that it is not only a desire to be released from pain that leads people to request help with dying. In the Netherlands, for example, pain has been found to be a less significant reason for requesting assistance with dying than other forms of suffering like frustration over loss of independence (see e.g., Marquet, et al. 2003; Onwuteaka-Philipsen, et al. 2012; Emanuel, et al. 2016). Sufferers from some terminal conditions may have their pain relieved but have to endure side effects that, for them, make life unbearable. Others may not have to cope with pain but, instead, with having to rely on forms of life support that simultaneously rob their lives of quality (as with, e.g., motor neurone disease). Yet others struggle with psychological distress and various psychiatric conditions and believe these conditions ought to be counted among the forms of suffering that qualify competent individuals to access medical assistance with dying. There has been greater recognition of, and support for, this position in those jurisdictions that make the role of unbearable suffering central to the determination of the eligibility of competent individuals for medical assistance with dying (see the discussion above of the first condition). Even so, inclusion of these forms of suffering highlights legitimate issues to do with the competence of at least some of those who suffer from them. (For a helpful recent study of the handling of requests for assistance with dying by psychiatric patients in the Netherlands see Kim, et al. 2016.)

A final preliminary point is that the fourth condition requires that the choice to die not only be uncoerced and competent but that it be enduring. The choice is one that will require time for reflection, and, almost certainly, discussion with others, so should not be settled in a moment. Nonetheless, as with other decisions affecting matters of importance, adults are presumed to choose voluntarily and to be competent unless the presence of defeating considerations can be established. (See the entry on decision-making capacity .) The burden of proof of establishing lack of voluntariness, or lack of competence, is on those who refuse to accept an adult person’s choice. There is no need to deny that this burden can sometimes be met (e.g., by pointing to the person’s being in a state of clinical depression). The claim is only that the onus falls on those who assert that an adult’s choice is not competent. (There are different issues to be faced when the competence of at least some older children and adolescents is at issue. In the Netherlands, for example, those aged twelve and older have sometimes been found to be competent to make end-of-life decisions for themselves. However, the topic will not be pursued further here because the focus of the entry is on competent adults.)

Clearly the five conditions set out above are likely to require some refinement if complete agreement is to be reached but there is sufficient agreement for us to proceed without further ado to consideration of the cases for and against legalization of voluntary euthanasia. (However, for a fuller discussion of issues concerning the definition of ‘euthanasia’ see, e.g., Beauchamp and Davidson 1979.)

One central ethical contention in support of voluntary euthanasia is that respect for persons demands respect for their autonomous choices as long as those choices do not result in harm to others. Respect for people’s autonomous choices is directly connected with the requirement for competence because autonomy presupposes competence (cf., Brock 1992). People have an interest in making important decisions about their lives in accordance with their own conception of how they want to live. In exercising autonomy, or self-determination, individuals take responsibility for their lives; since dying is a part of life, choices about the manner of their dying and the timing of their death are, for many people, part of what is involved in taking responsibility for their lives. Many are concerned about what the last phase of their lives will be like, not merely because of fears that their dying might involve them in great suffering, but also because of the desire to retain their dignity, and as much control over their lives as possible, during this phase. A second contention in support of voluntary euthanasia was mentioned at the beginning of this entry, namely the importance of promoting the well-being of persons. When someone is suffering intolerable pain or only has available a life that is unacceptably burdensome (see the third condition above), and he competently requests medical assistance with dying, his well-being may best be promoted by affording him that assistance. When harnessed together, the value to individuals of making autonomous choices, and the value to those individuals who make such choices of promoting their own well-being, provide the moral foundation for requests for voluntary euthanasia. Each consideration is necessary for moral justification of the practice, but taken in isolation neither suffices (see, e.g., Young 2007, 2017; Sumner 2011, 2017).

The technological interventions of modern medicine have had the effect of stretching out the time it takes for many people to die. Sometimes the added life this brings is an occasion for rejoicing; sometimes it drags out the period of significant physical and intellectual decline that a person undergoes with the result that life becomes no longer worth living. Many believe there is no single, objectively correct answer as to when, if at all, a person’s life becomes a burden and hence unwanted. If they are right, that simply points up the importance of individuals being able to decide autonomously for themselves whether their own lives retain sufficient quality and dignity to make life worth living. Others maintain that individuals can be in error about whether their lives continue to be worth living (cf., Foot 1977). The conditions outlined above in Section 2 are intended by those who propose them to serve, among other purposes, to safeguard against such error. But it is worth adding that in the event that a person who considers that she satisfies those conditions is judged by her medical attendants to be in error about whether it would be worth her continuing to live, the likely outcome is that those attendants will refuse to provide medical assistance with dying. (Evidence that will be mentioned below shows that this happens more frequently than might be predicted in jurisdictions in which medically assisted dying has been legalized. (There are discussions of the principles at stake in such matters in Young 2007; Wicclair 2011; Sumner 2020.) Unless a patient is able to be transferred to the care of other medical professionals who accept her assessment, she will have to rely on her own resources (e.g., by refusing nutrition and hydration). Even so, other things being equal, as long as a critically ill person is competent, her own judgement of whether continued life is a benefit to her ought to carry the greatest weight in any end-of-life decision making regardless of whether she is in a severely compromised and debilitated state. The idea that a competent individual’s autonomous judgment of the value to her of continued life should trump an assessment by others of her well-being should not be thought surprising because precisely the same happens when a competent patient refuses life-prolonging treatment.

Suppose, for the sake of argument, that it is agreed that we should respect a person’s competent request for medical assistance with dying (e.g., so as to enable her to achieve her autonomously chosen goal of an easeful death). It might be thought that in such an eventuality different moral concerns will be introduced from those that arise in connection with competent refusals. After all, while competent patients are entitled to refuse any form of medical treatment, they are not entitled to insist on the administration of forms of medical treatment that have no prospect of conferring a medical benefit or are not being provided because of a scarcity of medical resources or their affordability. While each of these points is sound, it remains the case that medical personnel have a duty to relieve suffering when that is within their capacity. Accordingly, doctors who regard medical assistance with dying as an element of appropriate medical care will consider it morally permissible to agree to a request for assistance with dying by a competent dying patient who wishes to avoid unbearable suffering. The reason for claiming only that this is morally permissible rather than morally obligatory will be explained in a subsequent paragraph. (For further reflections on the issue of responses to requests for medical assistance see, for instance, Dworkin 1998; Sumner 2011, 2017, 2020; Young 2007, 2017.)

Notwithstanding this response, as was seen earlier, at least some proponents of voluntary medically assisted dying wish to question why medical assistance with dying should be restricted to those covered by, in particular, the first three conditions set out above in Section 2. If people’s competent requests for medically assisted death should be respected why impose any restrictions at all on who may have access to medically assisted death? Why, for example, should those suffering from depression, or forms of dementia, not be eligible for medically assisted dying? Most proponents of voluntary medically assisted dying hold that there are at least two reasons for restricting access to it to those who satisfy the conditions set out earlier (or, a modified set that takes account of the concerns canvassed in the discussion of those proposed conditions). First, they contend that there are political grounds for doing so, namely, that because legalizing medically assisted dying for competent individuals is politically contested, the best hope for its legalization lies in focusing on those forms of suffering most likely to effect law reform. That is why some proponents deny the eligibility even of sufferers from conditions like ‘locked-in’ syndrome, motor neurone disease, and multiple sclerosis for voluntary medically assisted dying since, strictly, they are not terminally ill, and reliance has to be placed in consequence on their claim to be suffering unbearably. Second, and relatedly, most proponents of the legalization of medical assistance with dying have been cautious about supporting medically assisted death for those suffering from, for example, depression and dementia, because not only are they not terminally ill, but their competence to request assistance with dying is apt to be called into question, particularly in instances where they have given no prior indication of their preference for such assistance. Restricting access to medical assistance with dying to those whose suffering is less likely to be disputed avoids becoming embroiled in controversy. As was noted earlier, some critics of the restrictive approach (e.g., Varelius 2014) take a harder line and claim that it should not even be necessary for a person to be suffering from a medical condition to be eligible for medical assistance with dying; it should be enough to be ‘tired of life’. Only in a few jurisdictions, viz., Switzerland, the Netherlands and Belgium, has this issue been seriously broached. Regardless of what may happen in those jurisdictions, those seeking the legal provision of medical assistance with dying in other jurisdictions seem likely to maintain that if such assistance is to be seen as a legitimate form of medical care it has to be provided in response to a medical condition (rather than because someone is ‘tired of life’), and, indeed, restricted to those who satisfy the conditions outlined earlier in Section 2 (or some similar set of conditions). In short, these latter hold that making an autonomous request for assistance with dying is necessary, but should not be sufficient, for triggering such assistance.

There is one final matter of relevance to the moral case for voluntary medically assisted death on which comment must be made. The comment concerns a point foreshadowed in a previous paragraph, but it is also linked with the remark just made about the insufficiency of an autonomous request for assistance with dying to trigger that assistance. It is important to make the point that respect has to be shown not only for the dying person’s autonomy but also for the professional autonomy of any medical personnel asked to lend assistance with dying. The value (or, as some would prefer, the right) of self-determination does not entitle a patient to try to compel medical professionals to act contrary to their own moral or professional values. Hence, if voluntary euthanasia is to be legally permitted, it must be against a backdrop of respect for professional autonomy. Similarly, if a doctor’s view of her moral or professional responsibilities is at odds with her patient’s competent request for euthanasia, she should make provision, where it is feasible to do so, for the transfer of the patient to the care of a doctor who faces no such conflict. Given that, to date, those who contend that no scope should be permitted for conscientious objection within medical practice have garnered very little support for that view, making use of referrals and transfers remains the most effective means of resolving such disagreements.

Opponents of voluntary euthanasia have endeavored in a variety of ways to counter the very straightforward moral case that has been laid out above for its legalization (see, for example, Keown 2002; Foley, et al. 2002; Biggar 2004; Gorsuch 2006). Some of the counter-arguments are concerned only with whether the moral case warrants making the practice of voluntary euthanasia legal, whereas others are concerned with trying to undermine the moral case itself. In what follows, consideration will be given to the five most important counter-arguments. (For more comprehensive discussions of the morality and legality of medically assisted death see Biggar 2004; Gorsuch 2006; Young 2007; Sumner 2011, 2017; Keown 2018).

4.1 Objection 1

It is sometimes said (e.g., Emanuel 1999; Keown in Jackson and Keown 2012) that it is not necessary nowadays for people to die while suffering from intolerable or overwhelming pain because the provision of effective palliative care has improved steadily, and hospice care is more widely available. Some have urged, in consequence, that voluntary euthanasia is unnecessary.

There are several flaws in this contention. First, while both good palliative care and hospice care make important contributions to the care of the dying, neither is a panacea. To get the best palliative care for an individual involves trial and error, with some consequent suffering in the process; moreover, even the best care fails to relieve all pain and suffering. Perhaps even more importantly, high quality palliative care commonly exacts a price in the form of side-effects such as nausea, incontinence, loss of awareness because of semi-permanent drowsiness, and so on. A rosy picture is often painted as to how palliative care can transform the plight of the dying. Such a picture is misleading according to those who have closely observed the effect of extended courses of treatment with drugs like morphine. For these reasons many skilled palliative care specialists acknowledge that palliative care does not enable an easeful death for every patient. Second, even though the sort of care provided through hospices is to be applauded, it is care that is available to only a small proportion of the terminally ill and then usually only in the very last stages of the illness (typically a matter of a few weeks). Notwithstanding that only relatively few of the dying have access to hospice care it is worth drawing attention to the fact that in, Oregon, to cite one example, a high proportion of those who have sought physician-assisted suicide were in hospice care. Third, and of greatest significance for present purposes, not everyone wishes to avail themselves of palliative or hospice care. For those who prefer to die on their own terms and in their own time, neither option may be attractive. As previously mentioned, a major source of distress for many dying patients is the frustration that comes with being unable to satisfy their autonomous wishes. Fourth, as also indicated earlier, the suffering that occasions a desire to end life is not always traceable to pain caused by illness. For some, what is intolerable is their forced dependence on others or on life-supporting machinery; for these patients, the availability of effective pain control is not the primary concern. (In relation to the preceding matters see Rietjens, et al. 2009 and Onwuteaka-Philipsen et al. 2012 for findings for the Netherlands; and, for Oregon, Ganzini, et al. 2009.)

4.2 Objection 2

A second, related objection to the moral and legal permissibility of voluntary euthanasia turns on the claim that we can never have sufficient evidence to be justified in believing that a dying person’s request to be helped to die is competent, enduring and genuinely voluntary.

It is certainly true that a request to die may not reflect an enduring desire to die (just as some attempts to commit suicide may reflect only temporary despair). That is why advocates of the legalization of voluntary euthanasia have argued that a cooling off period should normally be required before euthanasia is permitted to ensure that the request is enduring. That having been said, to claim that we can never be justified in believing that someone’s request to die reflects a settled preference for death is to go too far. If a competent person discusses the issue with others on different occasions over time, and remains steady in her resolve, or privately reflects on the issue for an extended period and does not waver in her conviction, her wish to die surely must be counted as enduring.

But, it might be asked, what if a person is racked with pain, or mentally confused because of the measures taken to relieve her pain, and is, in consequence, unable to think clearly and rationally about the alternatives? It has to be agreed that a person in those circumstances who wants to die should not be assumed to have a truly voluntary and enduring desire to die. However, there are at least two important points to make about those in such circumstances. First, they do not account for all of the terminally ill, so even if it is acknowledged that such people are incapable of agreeing to voluntary euthanasia that does not show that no one can ever voluntarily request help to die. Second, it is possible in at least some jurisdictions for a person to indicate, in advance of losing the capacity to give competent consent, how she would wish to be treated should she become terminally ill and suffer either intolerable pain or an unacceptable loss of control over her life (cf., for instance, Dworkin 1993). ‘Living wills’ or ‘advance directives’ are legal instruments for giving voice to people’s wishes while they are capable of giving competent, enduring and voluntary consent, including to their wanting help to die. As long as they are easily revocable in the event of a change of mind (just as civil wills are), they should be respected as evidence of a well thought-out conviction. (For more detailed consideration of these instruments see the entry on advance directives .)

Perhaps, though, what is really at issue in this objection is whether anyone can ever form a competent, enduring and voluntary judgement about being better off dead, rather than continuing to suffer from an illness, prior to suffering such an illness (cf., Keown in Jackson and Keown 2012). If this is what underlies the objection it is surely too paternalistic to be acceptable. Why is it not possible for a person to have sufficient inductive evidence (e.g., based on the experience of the deaths of friends or family) to know her own mind, and act accordingly, without having had direct experience of such suffering?

4.3 Objection 3

According to the traditional interpretation of the ‘doctrine of double effect’ it is permissible to act in a way which it is foreseen will have a bad effect, provided only that

• the bad effect occurs as a side-effect (i.e., indirectly) to the achievement of the act that is directly aimed at;
• the act directly aimed at is itself morally good or, at least, morally neutral;
• the good effect is not achieved by way of the bad, that is, the bad must not be a means to the good; and
• the bad effect must not be so serious as to outweigh the good effect.

Hence, it is permissible, according to the doctrine of double effect, to, for example, alleviate pain (a good effect) by administering a drug such as morphine, knowing that doing so will shorten life, but impermissible to administer the same drug with the direct intention of terminating a patient’s life (a bad effect). This latter claim is said to apply regardless of whether the drug is given at the person’s request.

This is not the appropriate forum for a full consideration of the doctrine, for which see the entry on the doctrine of double effect . However, there is one very important criticism to be made of the application of the doctrine that has direct relevance to the issue of voluntary euthanasia.

On the most plausible reading, the doctrine of double effect can be relevant to the permissibility of voluntary euthanasia only when a person’s death is bad for her or, to put it another way, a harm to her. Sometimes the notion of ‘harm’ is understood simply as damage to a person’s interests whether consented to or not. At other times, it is understood, more strictly, as damage that has been wrongfully inflicted. On either understanding of harm, there can be instances in which death for a person does not constitute a harm for her because it will either render her better off, or, as some would insist, no worse off, when compared with remaining alive. Accordingly, in those instances, the doctrine of double effect can have no relevance to the debate about the permissibility of voluntary euthanasia. (For extended discussions of the doctrine of double effect and its bearing on the moral permissibility of voluntary euthanasia see, e.g., McIntyre 2001; Woodward 2001; Cavanaugh 2006; Young 2007; Sumner 2011, 2017.)

4.4 Objection 4

As was noted earlier in Section 3, there is a widespread belief that so-called passive (voluntary) euthanasia, wherein life-sustaining or life-prolonging measures are withdrawn or withheld in response to a competent patient’s request, is morally permissible. The reason why passive (voluntary) euthanasia is said to be morally permissible is that the patient is simply allowed to die because steps are not taken to preserve or prolong life. This happens, for example, when a dying patient requests the withdrawal or the withholding of measures whose administration would be medically futile, or unacceptably burdensome. By contrast, active (voluntary) euthanasia is said to be morally impermissible because it is claimed to require an unjustifiable intentional act of killing to satisfy the patient’s request (cf., for example, Finnis, 1995; Keown in Jackson and Keown 2012; Keown 2018).

Despite its popularity and widespread use, the distinction between passive and active euthanasia is neither particularly clear nor morally helpful. (For a fuller discussion, see McMahan 2002.) Whether behavior is described in terms of acts or omissions (a distinction which underpins the alleged difference between active and passive voluntary euthanasia and that between killing a person and letting her die), is often a matter of pragmatics rather than anything of deeper moral importance. Consider, for instance, the practice (once common in hospitals) of deliberately proceeding slowly to a ward in response to a request to provide assistance for a patient who has been assigned a ‘not for resuscitation’ code. Or, consider ‘pulling the plug’ on a respirator keeping an otherwise dying patient alive, as against not replacing the oxygen supply when it runs out. Are these acts or omissions? If the answers turn on merely pragmatic considerations the supposed distinction between passive euthanasia and active euthanasia will be hard to sustain.

Even supposing that the distinction between acts and omissions, and the associated distinction between killing and letting die, can be satisfactorily clarified (on which see the entry doing v. allowing harm ), there remains the issue of whether these distinctions have moral significance in every circumstance. Consider a case of a patient suffering from motor neurone disease who is completely respirator dependent, finds her condition intolerable, and competently and persistently requests to be removed from the respirator so that she may die. Even the Catholic Church in recent times has been prepared to agree that it is permissible, in a case like this, to turn off the respirator. No doubt this has been because the Catholic Church considers such a patient is only being allowed to die. Even were it to be agreed, for the sake of argument, that such a death should be regarded as an instance of letting die, this concession would not show that it would have been morally worse had the patient been killed at her request (active voluntary euthanasia) rather than being allowed to die (passive voluntary euthanasia). Indeed, supporters of voluntary medically assisted death maintain that since death is beneficial in such an instance (or, at the very least, leaves the dying person no worse off), actively bringing about the death is morally to be preferred to just allowing it to happen because the desired benefit is achieved sooner and thus with less suffering.

Opponents of voluntary euthanasia claim, however, that the difference between active and passive euthanasia is to be found in the agent’s intention: if someone’s life is intentionally terminated she has been killed, whereas if she is just no longer being aggressively treated, her death should be attributed to the underlying disease. Many physicians would say that their intention in withholding or withdrawing life-sustaining medical treatment in such circumstances is simply to respect the patient’s wishes. This is plausible in those instances where the patient competently requests that aggressive treatment no longer be given (or, the patient’s proxy makes such a request). But it will often be implausible. In many cases the most plausible interpretation of a physician’s intention in withholding or withdrawing life-sustaining measures is that it is to end the patient’s life. Consider the palliative care practice of ‘terminally sedating’ a patient after a decision has been made to cease aggressive treatment. Suppose (as sometimes happens) that this is then followed by withholding artificially supplied nutrition. In these latter instances the best explanation of the physician’s behavior is that the physician intends thereby to end the life of the patient. What could be the point of the action, the goal aimed at, the intended outcome, if not to end the patient’s life? (Cf. Winkler 1995.) No sense can be made of the action as being intended to palliate the patient’s diseased condition, or to keep the patient comfortable. Nor is it appropriate to claim that what kills the patient is the underlying disease. What kills the patient is the act of depriving her of nutrition (i.e., of starving her to death). The point can be generalized to cover many more instances involving either the withdrawal or the withholding of life-sustaining medical treatment. In short, there is no good reason to think that whereas so-called passive voluntary euthanasia is morally acceptable active voluntary euthanasia never can be.

But we can go further. Giving titrated doses of morphine that reach levels beyond those needed to control pain, or removing a respirator from a sufferer from motor neurone disease, seem to many of us to amount to intentionally bringing about the death of the person being cared for. To be sure, as was acknowledged above, there are circumstances in which doctors can truthfully say that the actions they perform, or omissions they make, will bring about the deaths of their patients even though it was not their intention that those patients would die. So, for instance, if a patient refuses life-prolonging medical treatment because she considers it futile, it can be reasonable to say that her doctor’s intention in complying with the request was simply to respect her wishes. Nevertheless, as we have seen, there are other circumstances in which it is highly stilted to claim, as some doctors continue to do, that they had no intention of bringing about death.

These considerations should settle matters but do not do so for those who maintain that killing, in medical contexts, is always morally unjustified – a premise that underwrites much of the debate surrounding this fourth objection. But this underlying assumption is open to challenge and has been challenged by, for instance, Rachels 1986 and McMahan 2002. One of the reasons the challengers have given is that there are cases in which killing a competent dying person when she requests assistance with dying, is morally preferable to allowing her to die, namely, when taking the latter option would serve only to prolong her suffering against her wishes. Further, despite the longstanding legal doctrine that no one can justifiably consent to be killed (on which more later), it surely is relevant to the justification of an act of killing that the person killed has autonomously decided that she would be better off dead and so asks to be helped to die.

4.5 Objection 5

It is sometimes said that if society allows voluntary euthanasia to be legalized, we will then have set foot on a slippery slope that will lead us eventually to support other forms of euthanasia, including, in particular, non-voluntary euthanasia. Whereas it was once the common refrain that that was precisely what happened in Hitler’s Germany, in recent decades the tendency has been to claim that experience with legalized euthanasia in the Netherlands and Belgium, in particular, has confirmed the reality of the slippery slope.

Slippery slope arguments come in various versions. One (but not the only) way of classifying them has been to refer to logical, psychological and arbitrary line versions. The common feature of the different forms is the contention that once the first step is taken on a slippery slope the subsequent steps follow inexorably, whether for logical reasons, psychological reasons, or to avoid arbitrariness in ‘drawing a line’ between a person’s actions. (For further discussion see, e.g., Rachels 1986; Brock 1992; Walton 1992.)

We need first to consider whether, at the theoretical level, any of these forms of argument is powerful enough to refute the case for the legalization of voluntary euthanasia. We will then be in a position to comment on the alleged empirical support from the experiences of Hitler’s Germany and, more recently, of legalized euthanasia in the Netherlands and elsewhere, for the existence of a slippery slope that supposedly comes into being with the legalization of voluntary euthanasia.

To begin with, there is nothing logically inconsistent in supporting voluntary euthanasia while maintaining the moral inappropriateness of non-voluntary euthanasia. (However, for an attempt to press the charge that there is such an inconsistency see, e.g., Keown 2022.) Undoubtedly, some advocates of voluntary euthanasia wish also to lend their support to some acts of non-voluntary euthanasia, for example, for those in persistent vegetative states who have never indicated their wishes about being helped to die, or for certain severely disabled infants for whom the outlook is hopeless. (See, e.g., Kuhse and Singer 1985; Singer 1994; Stingl 2010; Sumner 2017.) Others believe that the consent of the patient is strictly required if euthanasia is appropriately to be legalized. The difference is not a matter of logical acumen; it is to be explained by reference to the importance placed on key values by the respective supporters. Thus, for example, those who insist on the necessity for a competent request by a patient for medical assistance with dying typically believe that such a request is the paramount consideration in end-of-life decision making (even when it is harnessed to the value of individual well-being), whereas those who consider a person’s best interests to be the paramount consideration are more likely to believe in the justifiability of instances of non-voluntary euthanasia like those mentioned above.

Next, it is hard to see why moving from voluntary to non-voluntary euthanasia is supposed to be psychologically inevitable. Why should those who support the legalization of voluntary euthanasia, because they value the autonomy of the individual, find it psychologically easier, in consequence, to endorse the killing of those who are not able competently to request assistance with dying? What reason is there to believe that they will, as a result of their support for voluntary euthanasia, be psychologically driven to endorse a practice of non-voluntary euthanasia?

Finally, since there is nothing arbitrary about distinguishing voluntary euthanasia from non-voluntary euthanasia (because the line between them is based on clear principles), there can be no substance to the charge that only by arbitrarily drawing a line between them could non-voluntary euthanasia be avoided were voluntary euthanasia to be legalized.

What, though, of Hitler’s Germany and the recent experience of legalized voluntary euthanasia in the Netherlands and elsewhere? The former is easily dismissed as an indication of an inevitable descent from voluntary euthanasia to non-voluntary. There never was a policy in favor of, or a legal practice of, voluntary euthanasia in Germany in the 1920s to the 1940s (see, for example, Burleigh 1994). There was, prior to Hitler coming to power, a clear practice of killing some disabled persons. But it was never suggested that their being killed was justified by reference to their best interests; rather, it was said that society would be benefited. Hitler’s later revival of the practice and its widening to take in other groups such as Jews and gypsies was part of a program of eugenics , not euthanasia.

Since the publication of the Remmelink Report in 1991 into the medical practice of euthanasia in the Netherlands, it has frequently been said that the Dutch experience shows that legally protecting voluntary euthanasia is impossible without also affording shelter to the non-voluntary euthanasia that will follow in its train (see, e.g., Keown 2018). In the period since that report there have been regular national studies of the practice of euthanasia in the Netherlands (see, e.g., Rietjens, et al. 2009; Onwuteaka-Philipsen, et al. 2012; van der Heide, et al. 2017). The findings from these national studies have consistently shown that there is no evidence for the existence of such a slippery slope. Among the specific findings the following are worth mentioning: of those terminally ill persons who have been assisted to die about sixty per cent have clearly been cases of voluntary euthanasia as it has been characterised in this entry; of the remainder, the vast majority of cases were of patients who at the time of their medically assisted deaths were no longer competent. It might be thought that these deaths ought to be regarded as instances of non-voluntary euthanasia. But, in fact, it would be inappropriate to regard them as such. Here is why. For the overwhelming majority of these cases, the decisions to end life were taken only after consultation between the attending doctor(s) and close family members, and so can legitimately be thought of as involving substituted judgements. Moreover, according to the researchers, the overwhelming majority of these cases fit within either of two common practices that occur in countries where voluntary euthanasia has not been legalized, namely, that of terminal sedation of dying patients, and that of giving large doses of opioids to relieve pain while foreseeing that this will also end life. In a very few cases, there was no consultation with relatives, though in those cases there were consultations with other medical personnel. The researchers contend that these instances are best explained by the fact that families in the Netherlands strictly have no final legal authority to act as surrogate decision-makers for incompetent persons. For these reasons the researchers maintain that non-voluntary euthanasia is not widely practised in the Netherlands.

That there have only been a handful of prosecutions of Dutch doctors for failing to follow agreed procedures (Griffiths, et al. 1998; Asscher and van de Vathorst 2020), that none of the doctors prosecuted has had a significant penalty imposed, that a significant proportion of requests for medical assistance with dying are rejected as unjustifiable, and that the Dutch public have regularly reaffirmed their support for the agreed procedures suggests that, contrary to the claims of some critics, the legalization of voluntary euthanasia has not increased the incidence of non-voluntary euthanasia. A similar picture to the one in the Netherlands has emerged from studies of the operation of the law concerning physician-assisted suicide in Oregon. Indeed, in a recent wide-ranging study of attitudes and practices of voluntary euthanasia and physician-assisted suicide covering two continents, a prominent critic of these practices has concluded (in agreement with his co-authors) that little evidence exists of abuse, particularly of the vulnerable (see Emanuel, et al., 2016). Unfortunately, insufficient time has elapsed for appropriate studies to be conducted in the other jurisdictions that have legalized either voluntary euthanasia or physician-assisted suicide (but for some relevant evidence see e.g., White, et al. 2022). Finally, some commentators have pointed out that there may, in reality, be more danger of the line between voluntary and non-voluntary euthanasia being blurred if euthanasia is practised in the absence of legal recognition, since there will, in those circumstances, be neither transparency nor monitoring (which cannot be said of the Netherlands, Belgium, Oregon and so on).

None of this is to suggest that it is not necessary to ensure the presence of safeguards against potential abuse of legally protected voluntary euthanasia. This is particularly important for the protection of those who have become incompetent by the time decisions need to be taken about whether to assist them to die. Furthermore, it is, of course, possible that the reform of any law may have unintended effects. However, if the arguments outlined above are sound (and the experience in the Netherlands, Belgium and Luxembourg, along with the more limited experience in several states in the United States and in Canada, is, for the present, not only the best evidence we have that they are sound, but the only relevant evidence), that does not seem very likely.

It is now well-established in many jurisdictions that competent patients are entitled to make their own decisions about life-sustaining medical treatment. That is why they can refuse such treatment even when doing so is tantamount to deciding to end their life. It is plausible to think that the fundamental basis of the right to decide about life-sustaining treatment – respect for a person’s autonomy and her assessment of what will best serve her well-being – has direct relevance to the legalization of voluntary euthanasia (see, e.g., Dworkin 1998; Young 2007, 2017; Sumner 2011, 2017). In consequence, extending the right of self-determination to cover cases of voluntary euthanasia does not require a dramatic shift in legal policy. Nor do any novel legal values or principles need to be invoked. Indeed, the fact that suicide and attempted suicide are no longer criminal offences in many jurisdictions indicates that the central importance of individual self-determination in a closely analogous context has been accepted. The fact that voluntary euthanasia and physician-assisted suicide have not been more widely decriminalized is perhaps best explained along a similar line to the one that has frequently been offered for excluding the consent of the victim as a justification for an act of killing, namely the difficulties thought to exist in establishing the genuineness of the consent. But, the establishment of suitable procedures for giving consent to voluntary euthanasia and physician-assisted suicide is surely no harder than establishing procedures for competently refusing burdensome or otherwise unwanted medical treatment. The latter has already been accomplished in many jurisdictions, so the former should be achievable as well.

Suppose that the moral case for legalizing voluntary euthanasia and physician-assisted suicide does come to be judged more widely as stronger than the case against legalization, and they are made legally permissible in more jurisdictions than at present. Should doctors take part in the practice? Should only doctors perform voluntary euthanasia? These questions ought to be answered in light of the best understanding of what it is to provide medical care. The proper administration of medical care should promote the welfare of patients while respecting their individual self-determination. It is these twin values that should guide medical care, not the preservation of life at all costs, or the preservation of life without regard to whether patients want their lives prolonged should they judge that life is no longer of benefit or value to them. Many doctors in those jurisdictions where medically assisted death has been legalized and, to judge from available survey evidence, in other liberal democracies as well, see the practice of voluntary euthanasia and physician-assisted suicide as not only compatible with their professional commitments but also with their conception of the best medical care for the dying. That being so, doctors of the same conviction in jurisdictions in which voluntary medically assisted death is currently illegal should no longer be prohibited by law from lending their professional assistance to competent terminally ill persons who request assistance with dying because of irremediable suffering or because their lives no longer have value for them.

• Asscher, E. and S. van de Vathorst, 2020, “First Prosecution of a Dutch Doctor Since the Euthanasia Act of 2002: What Does It Mean?”, Journal of Medical Ethics , 46: 71–75.
• Beauchamp, T. and A. Davidson, 1979, “The Definition of Euthanasia”, The Journal of Medicine and Philosophy , 4: 294–312.
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• Finnis, J., 1995, “A Philosophical Case Against Euthanasia” in J. Keown (ed.), Euthanasia Examined: Ethical, Clinical and Legal Perspectives , Cambridge: Cambridge University Press.
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• Griffiths, J., H. Weyers and M. Adams, 2008, Euthanasia and Law in Europe , Oxford: Hart Publishing.
• Jackson, E. and J. Keown, 2012, Debating Euthanasia , Oxford: Hart Publishing.
• Keown, J., 2018, Euthanasia, Ethics and Public Policy: an argument against legalization , 2nd edition, New York: Cambridge University Press.
• –––, 2022, “The Logical Link Between Voluntary and Non-Voluntary Euthanasia”, Cambridge Law Journal , 81: 84–108.
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• Kuhse, H. and P. Singer, 1985, Should the Baby Live?: The Problem of Handicapped Infants , Oxford: Oxford University Press.
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• McMahan, J., 2002, The Ethics of Killing: Problems at the Margins of Life , New York: Oxford University Press.
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• Rietjens, J., P. van der Maas, B. Onwuteaka-Philipsen, J. van Delden and A. van der Heide, 2009, “Two Decades of Research on Euthanasia from the Netherlands: What Have We Learnt and What Questions Remain?”, Journal of Bioethical Inquiry , 6: 271–283.
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• Singer, P. 1994, Rethinking Life and Death: The Collapse of Our Traditional Ethics , Melbourne: Text Publishing.
• Stingl, M., (ed.), 2010, The Price of Compassion: Assisted Suicide and Euthanasia , Peterborough, Ontario: Broadview Press.
• Sumner, L., 2011, Assisted Death: A Study in Ethics and Law , Oxford: Oxford University Press.
• –––, 2017, Physician-Assisted Death: What Everyone Needs to Know , New York: Oxford University Press.
• –––, 2020, “Conscientious Refusal to Provide Medically Assisted Dying”, University of Toronto Law Journal , 71: 1–31.
• van der Heide, A., J.van Delden and B. Onwuteaka-Philipsen, 2017, “End-of-Life Decisions in the Netherlands over 25 Years”, New England Journal of Medicine , 377: 492–494.
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• Velleman, J., 1999, “A Right of Self-Termination?”, Ethics , 109: 606–628.
• White, B., L. Willmott, K. Del Villar, J. Hewitt, E. Close, L. Greaves, J. Cameron, R. Meehan and J. Downie, 2022, “Who is Eligible for Voluntary Assisted Death?: Nine Medical Conditions Assessed Against Five Legal Frameworks”, University of New South Wales Law Journal , 45: 401–444.
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• Woodward, P., (ed.), 2001, The Doctrine of Double Effect: Philosophers Debate a Controversial Moral Principle , Notre Dame, Indiana: University of Notre Dame Press.
• Young, R., 2007, Medically Assisted Death , Cambridge: Cambridge University Press.
• –––, 2017, “An Argument in Favor of the Morality of Voluntary Medically Assisted Death”, in M. Cholbi (ed.), Euthanasia and Assisted Suicide: Global Views on Choosing to End Life , Santa Barbara: Praeger.

How to cite this entry . Preview the PDF version of this entry at the Friends of the SEP Society . Look up topics and thinkers related to this entry at the Internet Philosophy Ontology Project (InPhO). Enhanced bibliography for this entry at PhilPapers , with links to its database.

• Medically Assisted Dying , an annotated bibliography authored by Robert Young (La Trobe University)
• Eight Reasons Not to Legalize Physician Assisted Suicide , by David Albert Jones, online resource at the Anscombe Bioethics Centre website.

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Voluntary euthanasia: A utilitarian perspective

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Belgium legalised voluntary euthanasia in 2002, thus ending the long isolation of the Netherlands as the only country in which doctors could openly give lethal injections to patients who have requested help in dying. Meanwhile in Oregon, in the United States, doctors may prescribe drugs for terminally ill patients, who can use them to end their life - if they are able to swallow and digest them. But despite President Bush's oft-repeated statements that his philosophy is to 'trust individuals to make the right decisions' and his opposition to 'distant bureaucracies', his administration is doing its best to prevent Oregonians acting in accordance with a law that its voters have twice ratified. The situation regarding voluntary euthanasia around the world is therefore very much in flux. This essay reviews ethical arguments regarding voluntary euthanasia and physician-assisted suicide from a utilitarian perspective. I shall begin by asking why it is normally wrong to kill an innocent person, and whether these reasons apply to aiding a person who, when rational and competent, asks to be killed or given the means to commit suicide. Then I shall consider more specific utilitarian arguments for and against permitting voluntary euthanasia.

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• Euthanasia, Active, Voluntary Medicine & Life Sciences 100%
• Euthanasia Arts & Humanities 90%
• euthanasia Social Sciences 66%
• Doctors Arts & Humanities 26%
• Capital Punishment Medicine & Life Sciences 22%
• Ethical Review Medicine & Life Sciences 20%
• Assisted Suicide Medicine & Life Sciences 19%
• George W. Bush Arts & Humanities 18%

T1 - Voluntary euthanasia

T2 - A utilitarian perspective

AU - Singer, Peter

PY - 2003/10

Y1 - 2003/10

N2 - Belgium legalised voluntary euthanasia in 2002, thus ending the long isolation of the Netherlands as the only country in which doctors could openly give lethal injections to patients who have requested help in dying. Meanwhile in Oregon, in the United States, doctors may prescribe drugs for terminally ill patients, who can use them to end their life - if they are able to swallow and digest them. But despite President Bush's oft-repeated statements that his philosophy is to 'trust individuals to make the right decisions' and his opposition to 'distant bureaucracies', his administration is doing its best to prevent Oregonians acting in accordance with a law that its voters have twice ratified. The situation regarding voluntary euthanasia around the world is therefore very much in flux. This essay reviews ethical arguments regarding voluntary euthanasia and physician-assisted suicide from a utilitarian perspective. I shall begin by asking why it is normally wrong to kill an innocent person, and whether these reasons apply to aiding a person who, when rational and competent, asks to be killed or given the means to commit suicide. Then I shall consider more specific utilitarian arguments for and against permitting voluntary euthanasia.

AB - Belgium legalised voluntary euthanasia in 2002, thus ending the long isolation of the Netherlands as the only country in which doctors could openly give lethal injections to patients who have requested help in dying. Meanwhile in Oregon, in the United States, doctors may prescribe drugs for terminally ill patients, who can use them to end their life - if they are able to swallow and digest them. But despite President Bush's oft-repeated statements that his philosophy is to 'trust individuals to make the right decisions' and his opposition to 'distant bureaucracies', his administration is doing its best to prevent Oregonians acting in accordance with a law that its voters have twice ratified. The situation regarding voluntary euthanasia around the world is therefore very much in flux. This essay reviews ethical arguments regarding voluntary euthanasia and physician-assisted suicide from a utilitarian perspective. I shall begin by asking why it is normally wrong to kill an innocent person, and whether these reasons apply to aiding a person who, when rational and competent, asks to be killed or given the means to commit suicide. Then I shall consider more specific utilitarian arguments for and against permitting voluntary euthanasia.

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• P Peretti-Watel , researcher ( peretti{at}marseille.inserm.fr ) 1 ,
• M K Bendiane , researcher 2 ,
• H Pegliasco , chairman 3 ,
• J M Lapiana , director of palliative care centre 4 ,
• R Favre , professor 5 ,
• A Galinier , consultant 6 ,
• J P Moatti , professor 7
• 1 Regional Center for Disease Control of South-Eastern France, 13006 Marseille, France
• 2 Health and Medical Research National Institute, Research Unit 379, Social Sciences Applied to Medical Innovation, Institut Paoli Calmettes, Marseille,
• 3 Departmental Center of Private Health Professionals, Marseille
• 4 La Maison, Gardanne, France
• 5 Assistance Publique Hôpitaux de Marseille, Service of Medical Oncology, Marseille
• 6 Assistance Publique-Hôpitaux de Marseille, Department of Penitentiary Care, Marseille, France
• 7 Department of Economics, University of Aix-Marseille II, France
• Correspondence to: P Peretti-Watel
• Accepted 28 July 2003

Introduction

During the past decade, the debate about legalising euthanasia has grown in many developed countries, including France. Medical journals have reflected this: surveys have assessed doctors' attitudes toward euthanasia and bioethics articles have discussed the pros and cons. Supporters of legalisation argue that euthanasia is a continuation of palliative care and that doctors must respect patients' autonomy, including a wish to die. 1 The latter argument suggests that cultural differences shape opinions about euthanasia, because the emphasis on autonomy is greater in English speaking countries than in other developed countries. 2 3

We assessed French doctors' opinions toward euthanasia and collected data about their attitudes and practices. We compared medical specialties which demand different amounts of palliative care and different amounts of empathy toward and communication with terminally ill patients.

Participants, methods, and results

In 2002, the Regional Center for Disease Control of South-Eastern France and the Health and Medical Research National Institute did a telephone survey of a sample of doctors, stratified by specialty. We selected general practitioners, oncologists, and neurologists randomly from all French doctors, kept on file by the National Health Insurance Fund.

We investigated respondents' involvement in end of life care and palliative care, their attitude toward terminally ill patients, and whether “euthanasia should be legalised, as in the Netherlands.” We compared medical specialties with Pearson's χ 2 .

We contacted 1552 doctors, and 917 (59%) agreed to participate. Response rate was greater for oncologists (217/261; 83%) and neurologists (198/287; 69%) than for general practitioners (502/1004; 50%). Doctors who did not respond were generally too busy; they did not differ in sex, age, or size of town from respondents.

Only a minority of respondents were trained in palliative care, especially neurologists (24/198; 12.1%). Oncologists treated more terminally ill patients during the past year (mean 26.3 patients v 9.4 for neurologists and 7.0 for general practitioners; P < 0.05), and general practitioners practised less often in palliative care units ( table ). Oncologists were less likely to feel uncomfortable with terminally ill patients (7.8% v 16.7% among general practitioners and 27.8% among neurologists; P < 0.001) and more prone to systematically communicate the objectives of treatment (65.9% v 57.2% among general practitioners and 47.0% among neurologists; P < 0.01) and the diagnosis to competent terminally ill patients. Oncologists were also less in favour of legalising euthanasia (35.5% v 44.8% of general practitioners and 46.5% of neurologists; P < 0.05).

French doctors' involvement in end of life care and palliative care, their attitude to and communication with patients, and their opinion on legalising euthanasia, 2002. Values are numbers (percentages) unless otherwise stated

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Many French doctors want euthanasia to be legalised. This opinion is more common among general practitioners and neurologists than among oncologists, who are more experienced in end of life care, more frequently trained in palliative care, and show greater comfort and better communication with terminally ill patients. Because most proponents of legalisation argue that euthanasia is a continuation of end of life care and that doctors should respect patients' autonomy, including a wish to die, we expected to find the reverse.

Our study has several limitations. Answering questions about a sensitive topic on the telephone can be difficult, a questionnaire with a fixed choice of answers prevented doctors from qualifying or justifying their responses, and we lacked detailed information about doctors who did not respond.

Previous studies found similar patterns, but the French counterparts to Italian general practitioners and US oncologists were more in favour of legalising euthanasia. 3 4 Our findings contradict the argument that opinions on euthanasia are related to cultural differences in English speaking countries; comparative studies are needed. 2 In France, the support shown for euthanasia may be due to a lack of professional knowledge on palliative care. 5 Improving such knowledge would improve end of life care and may also clarify the debate over euthanasia.

Acknowledgments

We thank H Granier, Y Obadia, B Planchet-Barraud, F Ravallec, M Rotily, and O Priolo.

Contributors MKB, HP, JML, RF, and AG designed the survey and reviewed and improved the paper. JPM and PP-W did the statistical analysis and wrote the paper. PP-W is guarantor.

Funding Departmental Centre of Private Health Professionals (grant from the fund for improving ambulatory care), Assistance Publique-Hôpitaux de Marseilles (within the hospital programme for clinical research), and Cancer Research Foundation (ARC).

Competing interests None declared.

Ethical approval Not needed.

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• Penley WC ,
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Informative essay on euthanasia

Table of Contents

Different groups and individuals have diverse viewpoints with regard to euthanasia, a view that is largely shaped on the ethical, religious, moral or professional standpoints. Over the past decades, euthanasia has grown to become an issue that has generated debates in medical, legal and ethical studies. The pertinence of the euthanasia issue is manifested in the discourse of human rights with regards to the relationship between the healthcare providers and the patients.

This paper explores a consortium of secondary sources in discussing the diverse issues and opinions in its bid to find answers of the questions surrounding the euthanasia debate. With more specificity, the paper will review literature that attempts to discuss the ethical and legal debates of either type of euthanasia. Through the rational focus on the arguments brought forth by the supporters and the opponents of euthanasia, the paper will prove that the diverse opinions about euthanasia are significant pointers to the need for more regulatory and legislative responses with the aim of safeguarding the professional and ethical obligations that govern the relationship between healthcare providers and their patient populations.

Introduction

Euthanasia is an old concept used in medical field to insinuate gentle or peaceful death. In other quarters, euthanasia has been referred to as assisted suicide, as it is considered a deliberate act of ending the life of a person in order to relieve that person of the suffering accruing from pain. In the modern day, many patients struggle with different illnesses, with some such as terminal cancer exposing them to overwhelming muscle and body tissue pains. The decision by a doctor to give such patient an overdose of muscle relaxants is referred to as euthanasia, as this ends the patient’s life.

As Levy, Azar, Huberfeld, Siegel and Strous (2012) explain, euthanasia exhibits all characteristics of an activity that speeds up the death of an individual. However, these deliberations have to be based on the existence of a terminal medical condition, as will be explained in this paper. The growing number of studies aimed at demystifying the pros and cons of euthanasia categorize euthanasia as among the current debatable issues that present many glaring questions. The stakeholders involved in this debate have further heightened the contention as the frequent encounter of ethical issues against the human approach to enjoying life present more courses for debate. In exploring the constructs of the debate surrounding euthanasia, it is important to consider the diverse viewpoints from which the supporters and opponents develop their opinions.

Literature review

In a study conducted by Strinic (2015) to ascertain the prevalence of euthanasia around the world, it was established that the concept of euthanasia remains largely dependent on the social, cultural and religious values that define a community. On a similar note, Pereira (2011) observed that across the world, glaring ambiguities and controversies cloud the regulations and laws surrounding the handling of human health, further referring to the scientific progress and technological innovation infiltrated in the healthcare provision industries.

In a bid to explain how euthanasia is administered, Quaghebeur, Dierckx de Casterle and Gastmans (2011) identified two main types of euthanasia. Active euthanasia refers to the deliberate intervention of ending an individual’s life. Active euthanasia can be conducted through injecting a person with a dose of fatal substance. On the other hand, passive euthanasia refers to the withdrawal of treatment, hence leading to the death of a person. Such treatment should be aimed at maintaining the life of a person. By withholding this form of treatment, passive euthanasia is demonstrated in the event that the person dies. For instance, a person suffering from HIV may be a victim of passive euthanasia if antiretroviral medications are withheld.

The classifications of euthanasia, however, vary depending on the decisions of the stakeholders involved, as Sulmasy, Travaline, Mitchell and Ely (2016) write. In circumstances where a person makes a conscious decision that leads him or her to ask for death, voluntary euthanasia is exercised. The individual’s consent is significant in facilitating voluntary euthanasia, unlike is the case when it concerns non-voluntary euthanasia.

Under this euthanasia classification, a person’s decision-making incapacitation is taken over by another person, who makes the decision on their behalf. Therefore, as Strinic (2015) narrates, non-voluntary euthanasia refers to an assisted decision to end the life of a person who is unable to give consent. On the other hand, other people are killed contrary to their expressed wishes, devoid of their consent. This is classified as involuntary euthanasia.

In as much as studies have established the types and categories of euthanasia, the debates surrounding the application of euthanasia in medical care continue to generate controversy. While looking at some of the arguments in favor of euthanasia, Naga and Maryyan (2013) observed that the compassion argument is the main reason why certain groups and individuals support euthanasia. As for the compassion argument, supporters hold the belief that euthanasia gives people the chance to end their lives with dignity. According to this argument, continued suffering exposes people to undignified death, which to the supporters of euthanasia is not only unkind but also inhumane.

The right to choice is among the leading arguments in support of euthanasia. Supporters of euthanasia believe that that a person’s right to make decisions and choices should be respected regardless of their condition. This standpoint, which Levy, Azar, Huberfeld, Siegel and Strous (2012) referred to as the autonomy argument, gives every patient the liberty to decide whether to continue living. Similarly, having considered the sufferings of many people that have ended up in painful deaths, supporters of euthanasia argue that the process is safeguarded by the legislative and regulatory constructs of the government.

On the other hand, Naga and Maryyan (2013) elucidate, technological and scientific advancements have made it easier for people to access advanced treatments. Along with this argument, the opponents of euthanasia claim that there are alternative types of care that can be explored rather than killing the patients. Besides, opponents argue that the there are several care options to administer in order to minimize the pain endured by a patient.

Scholars, such as Napier (2014), likened euthanasia to giving medical professionals the powers to terminate life. In his argument, the author vividly explains how doctors can misuse this power by killing without the request of the patient, with reference to the 1990s trends in Netherlands where over 1,000 patients were killed without their consent or request. Despite the fact that governments have laid bare the stipulations for euthanasia, Strinic (2015) warned that it is virtually impossible to control euthanasia, since minimal clinical reports have been made to document physician-assisted suicide, despite their legality in several jurisdictions.

The ethical arguments of euthanasia are based mainly on the constructs of practicality, human rights, ethicality and philosophy. According to the libertarian argument, euthanasia is an ethical practice that circles around the privacy of an individual. In this argument, death is considered a private matter. Basing their argument on privacy, Sulmasy, Travaline, Mitchell and Ely (2016) explained that the libertarian argument considers euthanasia as a practice that is not harmful to others. In addition, this ethical standpoint sees no need and rights for external interference.

The utilitarian argument for euthanasia considers the happiness and benefit that the society stands to gain from a decision. According to McCarthy and Gastmans (2014), utilitarianism considers an act ethical only if it provides extra human happiness. Along with this argument, the happiness of the patient is weighed against that of the society, which constitutes the friends, family and medical staff. The continued stay of a patient in hospital drains finances from the family and friends. Similarly, the pain subjected to the patient causes psychological strain to the family and friends. Euthanasia is considered ethical as it ends the mystery of the patient, just as much as it relieves the family and friends of the financial, emotional and psychological burdens.

On the other hand, euthanasia is considered unethical based on the constructs of human rights. According to Łagosz (2014), a society is deemed ethical if it exercises respect for the sanctity of life, which is protected by religion and medical profession. Therefore, euthanasia delinks the respect that the society accords to the sanctity of life.

Equality is one of the leading factors that generate harmony within societies, as Napier (2014) writes. In the face of an ethical society, each person should be treated with equality in order to uphold harmony. However, euthanasia casts aspersions on the worthlessness of other lives, such as those of the sick or disabled. Therefore, this argument claims that euthanasia is an agent of discrimination, which goes against the ethicality of an act.

There have been several developments surrounding the regulations and legislations of euthanasia. The Netherlands was the first country to legalize euthanasia in 2002, thereby imposing strict conditions that stipulate its application in situations that the patient is proven to be in unbearable pain accruing from incurable disease (Pereira, 2011). In the US, five states followed the Oregon initiative by allowing doctors to terminate the lives of terminally ill patients. Despite this, euthanasia is still illegal in the US, as it remains widely controversial.

In this discussion, euthanasia has been cast as an emotional, practical and ethical debate. Along this study, the broad history of euthanasia has been used to paint a picture of the significance of the topic. In conclusion, the diverse opinions surrounding euthanasia have been highlighted using the social, financial, emotional and ethical considerations.

• Łagosz, M. (2014). Philosophy of Life. Few Arguments against Euthanasia. Dialogue And Universalism, 24(2), 105-113. http://dx.doi.org/10.5840/du201424231
• Levy, T., Azar, S., Huberfeld, R., Siegel, A., & Strous, R. (2012). ATTITUDES TOWARDS EUTHANASIA AND ASSISTED SUICIDE: A COMPARISON BETWEEN PSYCHIATRISTS AND OTHER PHYSICIANS. Bioethics, 27(7), 402-408. http://dx.doi.org/10.1111/j.1467-8519.2012.01968.x
• McCarthy, J. & Gastmans, C. (2014). Moral distress: A review of the argument-based nursing ethics literature. Nursing Ethics, 22(1), 131-152. http://dx.doi.org/10.1177/0969733014557139
• Naga, B. & Maryyan, M. (2013). Legal and Ethical Issues of Euthanasia : Argumentative Essay. Middle East Journal Of Nursing, 7(5), 31-39. http://dx.doi.org/10.5742/mejn.2013.75330
• Napier, S. (2014). St. Ambrose, Euthanasia, and Antisenescence Arguments: Death as a Good?. Logos: A Journal Of Catholic Thought And Culture, 17(2), 39-57. http://dx.doi.org/10.1353/log.2014.0019
• Pereira, J. (2011). Legalizing euthanasia or assisted suicide: the illusion of safeguards and controls.Current Oncology, 18(2). http://dx.doi.org/10.3747/co.v18i2.883
• Quaghebeur, T., Dierckx de Casterle, B., & Gastmans, C. (2011). Nursing and Euthanasia: a Review of Argument-Based Ethics Literature. Nursing Ethics, 16(4), 466-486. http://dx.doi.org/10.1177/0969733009104610
• Strinic, V. (2015). Arguments in Support and Against Euthanasia. British Journal Of Medicine And Medical Research, 9(7), 1-12. http://dx.doi.org/10.9734/bjmmr/2015/19151
• Sulmasy, D., Travaline, J., Mitchell, L., & Ely, E. (2016). Non-faith-based arguments against physician-assisted suicide and euthanasia. The Linacre Quarterly, 83(3), 246-257. http://dx.doi.org/10.1080/00243639.2016.1201375
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Euthanasia – Arguments in Favour and Against

Last updated on April 7, 2024 by ClearIAS Team

Euthanasia is the deliberate act of ending a person’s life to relieve them of suffering. It is a complex and ethically sensitive topic that has sparked debates and discussions worldwide. There are different forms of euthanasia, and it is regulated differently in various countries.

Euthanasia (“good death”) is the practice of intentionally ending a life to relieve pain and suffering. It is also known as ‘mercy killing’.

In many countries, there is a divisive public controversy over the moral, ethical, and legal issues of euthanasia. Euthanasia is categorized in different ways, which include voluntary, non-voluntary, or involuntary. Euthanasia is also classified into active and passive Euthanasia.

Table of Contents

Voluntary, Non-Voluntary, and Involuntary Euthanasia

• Voluntary euthanasia: It is conducted with the consent of the patient and is termed voluntary euthanasia. Voluntary euthanasia is legal in some countries. Jurisdictions, where euthanasia is legal, include the Netherlands, Colombia, Belgium, and Luxembourg.
• Non-Voluntary euthanasia: It is conducted where the consent of the patient is unavailable and is termed non-voluntary euthanasia. Non-voluntary euthanasia is illegal in all countries. Examples include child euthanasia, which is illegal worldwide but decriminalized under certain specific circumstances in the Netherlands under the Groningen Protocol.
• Involuntary euthanasia: It is conducted against the will of the patient and is termed involuntary euthanasia. Involuntary euthanasia is usually considered murder.

Passive vs Active euthanasia

Voluntary, non-voluntary, and involuntary euthanasia can all be further divided into passive or active variants.

• Passive euthanasia entails the withholding of common treatments, such as antibiotics, necessary for the continuance of life.
• Active euthanasia entails the use of lethal substances or forces, such as administering a lethal injection, to kill and is the most controversial means.

Euthanasia debate

Euthanasia raises profound ethical and moral questions. Supporters argue that it can be a compassionate and dignified way to end suffering, particularly in cases of terminal illness.

Opponents argue that it raises significant ethical concerns, including the potential for abuse, coercion, and mistakes in diagnosing terminal conditions.

Arguments in Favor

Historically, the euthanasia debate has tended to focus on several key concerns. According to euthanasia opponent Ezekiel Emanuel, proponents of euthanasia have presented four main arguments:

• that people have a right to self-determination, and thus should be allowed to choose their fate
• assisting a subject to die might be a better choice than requiring that they continue to suffer
• the distinction between passive euthanasia, which is often permitted, and active euthanasia, which is not substantive (or that the underlying principle–the doctrine of double effect–is unreasonable or unsound);
• 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.
• Constitution of India: ‘Right to life’ is a natural right embodied in Article 21 but euthanasia/suicide is an unnatural termination or extinction of life and, therefore, incompatible and inconsistent with the concept of ‘right to life’. The State must protect life and the physician’s duty to provide care and not to harm patients. Supreme Court in Gian Kaur Case 1996 has held that the right to life under Article 21 does not include the right to die.
• Caregiver’s burden: Right-to-die supporters argue that people who have an incurable, degenerative, disabling, or debilitating condition should be allowed to die in dignity. This argument is further defended by those, who have chronic debilitating illness even though it is not terminal such as severe mental illness. The majority of such petitions are filed by the sufferers or family members or their caretakers. The caregiver’s burden is huge and cuts across various financial, emotional, time, physical, mental, and social domains.
• Refusing care: The right to refuse medical treatment is well recognized in law, including medical treatment that sustains or prolongs life. For example, a patient suffering from blood cancer can refuse treatment or deny feeds through a nasogastric tube. Recognition of the right to refuse treatment gives way to passive euthanasia.
• Encouraging organ transplantation: Mercy killing in terminally ill patients provides an opportunity to advocate for organ donation. This, in turn, will help many patients with organ failure waiting for transplantation. Not only does euthanasia give the ‘Right to die‘ for the terminally ill, but also the ‘Right to life‘ for the organ needy patients.

Arguments against

Emanuel argues that there are four major arguments presented by opponents of euthanasia:

• not all deaths are painful;
• alternatives, such as cessation of active treatment, combined with the use of effective pain relief, are available;
• the distinction between active and passive euthanasia is morally significant; and
• legalizing euthanasia will place society on a slippery slope, which will lead to unacceptable consequences
• Euthanasia weakens society’s respect for the sanctity of life.
• Euthanasia might not be in a person’s best interests, for example, getting old-aged parents killed for property will.
• Belief in God’s miracle of curing the terminally ill.
• The prospect of a discovery of a possible cure for the disease shortly.
• Proper palliative care makes euthanasia unnecessary.
• There is no way of properly regulating euthanasia.
• Allowing euthanasia will lead to less good care for the terminally ill.
• Allowing euthanasia undermines the commitment of doctors and nurses to save lives.
• Euthanasia may become a cost-effective way to treat the terminally ill.
• Allowing euthanasia will discourage the search for new cures and treatments for the terminally ill.
• Euthanasia gives too much power to doctors.

Euthanasia in India

Passive euthanasia is legal in India. On 7 March 2011, the Supreme Court of India legalized passive euthanasia using the withdrawal of life support to patients in a permanent vegetative state. The decision was made as part of the verdict in a case involving Aruna Shanbaug, who had been in a Persistent Vegetative State (PVS) for 42 years until she died in 2015.

The Aruna Shanbaug Case

In March 2011, the Supreme Court of India passed a historic judgment permitting Passive Euthanasia in the country. This judgment was passed after Pinki Virani’s plea to the highest court in December 2009 under the Constitutional provision of “Next Friend”. It’s a landmark law which places the power of choice in the hands of the individual, over government, medical or religious control which sees all suffering as “destiny”. The Supreme Court specified two irreversible conditions to permit Passive Euthanasia Law in its 2011 Law:

• The brain-dead for whom the ventilator can be switched off.
• Those in a Persistent Vegetative State (PVS) for whom the feed can be tapered out and pain-managing palliatives be added, according to laid-down international specifications.

The same judgment law also asked for the scrapping of 309 , the code that penalizes those who survive suicide attempts. In December 2014, the Government of India declared its intention.

PIL filed by Common Cause

However, on 25 February 2014, a three-judge bench of the Supreme Court of India termed the judgment in the Aruna Shanbaug case to be ‘inconsistent in itself’ and referred the issue of euthanasia to its five-judge Constitution bench on a PIL filed by Common Cause , which case is the basis of the current debate.

Then, the CJI referred to an earlier Constitution Bench judgment which, in the Gian Kaur case , “did not express any binding view on the subject of euthanasia; rather it reiterated that the legislature would be the appropriate authority to bring change.” Though that judgment said the right to live with dignity under Article 21 was inclusive of the right to die with dignity, it did not conclude the validity of euthanasia, be it active or passive.

“So, the only judgment that holds the field about euthanasia in India is the ruling in the Aruna Shanbaug case, which upholds the validity of passive euthanasia and lays down an elaborate procedure for executing the same on the wrong premise that the Constitution Bench in Gian Kaur had upheld the same,” the CJI said.

Common Cause Case: In 2018, the Supreme Court issued a significant judgment in the Common Cause case. The court recognized the right to die with dignity as a fundamental right and permitted passive euthanasia. It provided guidelines for the process and conditions under which passive euthanasia could be allowed.

Government’s endorsement of Passive Euthanasia

On December 23, 2014, the Government of India endorsed and re-validated the Passive Euthanasia judgment law in a Press Release, after stating in the Rajya Sabha as follows: The Hon’ble Supreme Court of India, while dismissing the plea for mercy killing in a particular case, laid down comprehensive guidelines to process cases relating to passive euthanasia.

Thereafter, the matter of mercy killing was examined in consultation with the Ministry of Law and Justice and it has been decided that since the Hon’ble Supreme Court has already laid down the guidelines, these should be followed and treated as law in such cases. At present, there is no legislation on this subject and the judgment of the Hon’ble Supreme Court is binding on all.

The court rejected active euthanasia using lethal injection. In the absence of a law regulating euthanasia in India, the court stated that its decision becomes the law of the land until the Indian parliament enacts a suitable law. Active euthanasia, including the administration of lethal compounds to end life, is still illegal in India, and in most countries.

As India had no law about euthanasia, the Supreme Court’s guidelines are law until and unless Parliament passes legislation. The following guidelines were laid down:

• A decision has to be taken to discontinue life support either by the parents the spouse or other close relatives, or in the absence of any of them, such a decision can be taken even by a person or a body of persons acting as a next friend. It can also be taken by the doctors attending the patient. However, the decision should be taken bona fide in the best interest of the patient.
• Even if a decision is taken by the near relatives or doctors or next friend to withdraw life support, such a decision requires approval from the High Court concerned.
• When such an application is filled, the Chief Justice of the High Court should forthwith constitute a Bench of at least two Judges who should decide whether to approve or not. A committee of three reputed doctors to be nominated by the Bench, will report the condition of the patient. Before giving the verdict, a notice regarding the report should be given to the close relatives and the State. After hearing the parties, the High Court can give its verdict.

A law commission had proposed legislation on “passive euthanasia”, it said. According to the Centre, the decision to come out with a bill was taken after considering the directives of the apex court, the law commission’s 241st report, and a private member bill introduced in Parliament in 2014.

The Centre said that initially, a meeting was held under the chairmanship of B.P. Sharma, secretary in the Health and Family Welfare Ministry, on May 22, 2015, to examine the draft of The Medical Treatment of Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill and the draft of The Euthanasia (Regulation) Bill.

This move to introduce a bill is a welcome step to clear the grey areas in the Euthanasia debate. Students can also link to this issue while answering questions on:

• Judicial activism: SC framing laws when the parliament hasn’t. Just like the Visaka case.
• Ethical dilemma in Paper 4 .

In India,  euthanasia has no legal aspect , and there is no penal law yet introduced in the IPC that specifically deals with euthanasia.

• However, the Supreme Court of India legalized passive euthanasia in 2018 with some conditions, allowing patients to withdraw medical support if they go into an irreversible coma.
• Passive euthanasia is a matter of ‘living will’, and an adult in their conscious mind is permitted to refuse medical treatment or voluntarily decide not to take medical treatment to embrace death naturally, under certain conditions.
• Individuals are only allowed to draft a living will while in a normal state of health and mind.
• Active euthanasia remains illegal in India.

Read:  Living wills

Article by: Jishnu J Raju

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Reader Interactions

February 11, 2016 at 3:48 pm

excellent one..

February 24, 2016 at 8:34 pm

Giving passive euthanasia to a patient who is already dead (not literally) is a right choice.Its better than making them as well as others to suffer.

July 20, 2017 at 4:28 pm

so very true.

July 1, 2016 at 10:58 pm

If the patient does not wants to suffer and himself asking for euthanasia then voluntary euthanasia should be made legal because it will be difficult for him to live than to die. But in case of involuntary euthanasia, there should be some specific time limit upto which the patient’s relatives must wait for him to recover but if there is no improvement like in case of coma , after 7-10 years , there is less chances of the patient to recover. In such cases , involuntary euthanasia should be made legal.

March 16, 2017 at 12:37 pm

no it is not possible If the patient tends to recover over a period of time or suddenly he becomes normal then the involuntary euthanasia will become very dangerous

March 16, 2017 at 12:35 pm

Very Very Useful

June 26, 2018 at 8:12 am

Helpful source I can use to rely on research. Thank you so much, clear IAS.

May 17, 2019 at 9:58 pm

Thanku for quality content

May 23, 2020 at 10:27 pm

“Mercy Killing ” is a responsible debate . It mainly depends on persons will on his /her life.

July 2, 2020 at 2:26 pm

Euthanasia should not be accepted as there is always some hope for better.

May 24, 2021 at 11:57 am

If under Article 21 of the constitution, right to live with dignity is inclusive of right to die with dignity, then why should the provisions under the Euthanasia act be restricted to the old and dying patients. There are a lot of people in their 60s and 70s with limited financial resources, who feel neglected / unwanted by the family who would like to die with dignity rather than be dependent on their children or the other members of family. They may be in good health but would still like to self determine to end their life with dignity. In such cases the law should allow for such people to adopt active Euthanasia. Such people could be persuaded to donate their organs which will help save other lives.

August 25, 2021 at 9:40 am

euthanasia cannot be legalised because of its higher probability of misuse. whether it is for property, money or because of any family problem

August 4, 2022 at 12:11 pm

A thought for all: If you do not have a choice to life, i.e. choose to be born then how can choosing your own means of death, be fair or valid? Something you cannot create or re-created is not yours to manage. My say: God is the giver of life and He alone should take it. Our sufferings are a means of learning, loving, understanding and above all our closeness to Almighty God.

June 28, 2023 at 6:36 pm

ur death is already written whether you take it or god does so doesnt matter

September 19, 2022 at 12:47 pm

I can’t put my dog to sleep for I am as old as he; and despite our handicaps he also wants to live like me.

Boghos L. Artinian

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Choosing Death over Suffering

Informing patients about physician aid-in-dying .

For the first time, many physicians, regardless of specialty, are being forced to consider what the standard of care will be for informing patients about “assisted suicide” or "physician aid-in-dying ” (PAD). The American Medical Association (AMA) Code of Medical Ethics does not condone physician participation, calling the practice “fundamentally incompatible with the physician’s role as healer.”  [1]  As an alternative to PAD, the AMA advocates aggressive multidisciplinary interventions including emotional support and adequate pain control.  [2]

Although the AMA is opposed to the practice of PAD, a 2010 survey of more than 21,000 medical professionals found that the majority of the doctors surveyed (54 percent) favored a patient’s right to physician aid-in-dying.  [3]  As of this writing, PAD has been legalized or available through court ruling in seven states (California, Colorado, Hawaii, Oregon, Montana, Vermont, Washington) and the District of Columbia; New Jersey is passing legislation following suit in August, followed by Maine in September. As more states legalize PAD and the AMA continues to affirm it to be unethical, many physicians will have to decide whether to follow the ethical cannon of their profession or allow patients to exercise their rights under the law. In light of the rapid expansion of PAD as an end-of-life option, the medical community needs to determine an ethical standard for informing patients about the choices available to them.

Diagnosed with amyotrophic lateral sclerosis (ALS),  Craig Ewert  made the decision to choose how he would spend his final days, and ultimately end his life. Mr. Ewert and his wife traveled to Switzerland where, with the legal assistance of a physician, he died at age fifty-nine by consuming a lethal dose of pentobarbital. Prior to his death, Mr. Ewert stated, “At this point, I’ve got two choices . . . if I go through with it, I die, as I must at some point. If I do not go through with it, my choice is essentially to suffer and to inflict suffering on my family and then die—possibly in a way that is considerably more stressful and painful than this way (physician aid-in dying). So, I’ve got death, and I’ve got suffering and death. You know, this makes a whole lot of sense to me.”  [4]

Mr. Ewert’s story is not unique. Since 1997, over 2,000 Americans have made the decision to end their lives with the help of a physician, rather than to suffer during the end stages of terminal illnesses.  [5]  Twenty years ago, PAD was illegal in all fifty states. In 1997, Oregon became the first state to legally allow terminally ill patients the option to hasten death by taking a prescription medication.  [6]  Many more states have attempted to pass legislation legalizing PAD, including a Ballot initiative in Massachusetts.  [6]  However, no standard of care yet exists to guide physicians and patients during the medical decision-making process about the option of physician aid in dying at the end of life. This poses an ethical quandary for providers.

Enshrined in the principle of informed consent are two ideas. First is the patient’s legal right to make the decisions that affect his or her medical care. [6] , [7] , [8]  Second, the patient has a right to know about the options available from which to choose. Because most patients are not experts in medical matters, the physician is obligated to disclose relevant information so the patient can make an “informed” decision about his or her treatment. [6] , [7] , [8]  Traditionally, the information that a physician has a duty to disclose has been based on the customs and traditions of the community. [6] , [7] , [8]  Essentially, physicians are responsible to disclose only information about care and treatment options that are customarily disclosed within the physicians’ and patients’ community. In the case of PAD, in places where it is not legal, physicians have not customarily informed patients of this option. As more states legalize PAD and the practice becomes more ethically accepted, it is important to determine a standard of care to guide physicians.

When determining an ethical standard of discussing physician aid in dying during medical decision-making, it is important to begin with the caveat that physicians are not ethically obligated to assist a patient in ending his or her life, even if the physician informs the patient of the right to do so. Physicians have the right to conscientious objection, that is, the right to recuse him or herself from treating a patient when he or she religiously or ethically opposes the treatment option, and when the physician’s recusal will not compromise the quality, efficiency, or equitable delivery of the patient’s care.  [9]  Thus, the question of whether a physician ought to inform a patient about the possibility of PAD is separate from whether the physician is obligated to help assist a patient who wants to exercise this medical decision.

Since the AMA does not condone PAD, but more than half of physicians surveyed support this option, a disconnect exists between the ethical values put forth in the AMA Code of Medical Ethics and the values of practicing physicians. While physicians are not legally or ethically bound to provide PAD, in places where the practice is legal, the AMA’s position against this practice presents physicians with the dilemma of choosing between the doctrine of informed consent what is ethical and what is legal when advising patients on end-of-life medical options. Although PAD may be a legally accepted option in many states, it is not universally condoned as an ethical practice within the medical profession. The question of whether physicians ought to inform patients of a controversial medical intervention is not new. Several years ago, when Plan B, an emergency contraceptive pill, was released as a secondary form of birth control, pharmacists and physicians around the country were forced to determine whether they would provide Plan B to their patients.  [9]  Although it was uniformly legal to provide Plan B, the medical community determined that physicians could decline to prescribe it and pharmacists could decline to provide it to patients. However, providers who refused were ethically required to direct patients to a provider who would provide Plan B.  [9]

In the case of PAD, if the patient approaches their doctor about this option, physicians who contentiously object to providing it should direct patients to providers who are willing to discuss this option. The question of whether physicians are ethically obligated to bring this option to the patient’s attention in the first place as part of the informed consent process during medical decision-making is more complex. The AMA has issued an official opinion that "[p]atients have the right to receive information and ask questions about well-considered decisions about care.”  [10]  Thus, a physician’s right to conscientious objection does not trump the patient’s right to informed consent in medical decision-making.

In order to support physicians in these difficult end-of-life decisions, one approach may be to have palliative care physicians discuss this option with patients. Palliative care providers have special training in how to talk about the dying process and may be the best physician to have this discussion with dying patients. Although, asking palliative care physicians—given their specialized training and ability to handle dying patients—to have these difficult conversations may be the best practical idea, this approach as a matter of policy has the potential to create a stigma about palliative care and the role these physicians play in the death and dying process. Palliative care physicians work to help improve quality of life and alleviate suffering during the end of life without intentionally hastening death.  [10]  Aiding patients in dying is in direct contention with the goals of palliative care as aid in dying intrinsically hastens death. If palliative care becomes associated with the act of hastening death, the specialty may face the unintended consequence of patients fearing palliative care.

Another option for ensuring patients are appropriately informed of their end-of-life options is to have a non-physician approach patients, similar to the role the  Organ Procurement and Transplantation Network  plays during organ procurement. Yet another would be to create a national registry of physicians willing and able to assist patients who indicate an interest in learning more about assisted death options. This could be accomplished by creating a centralized mechanism for patients to inquire about PAD, as suggested by Prokopetz and Lehmann.  [11]

Establishing a standard of care for the informed consent process is important in ensuring that all patients are informed about available, appropriate, and ethical end-of-life care options. Although the AMA denounces aid in dying as an unethical practice, physicians may argue that if PAD is legal in their state of practice and presenting end-of-life care is appropriate for the patient, then physicians should be allowed to present this choice without condemnation from his or her accrediting body. Allowing each physician to individually determine whether he or she is comfortable having the conversation about PAD options may be seen as protecting physician’s individual conscience. However, such a policy may result in an unjust provision of care in that all patients will not be uniformly informed about the end-of-life care possibilities. And although providing information about PAD may make some physicians uncomfortable, this standard does not deviate from established ethical norms of informed consent, such as the responsibility of physicians to inform patients that abortion is an option (even if the physician contentiously objects to performing abortions).

Providing patients with all end-of-life care options, including PAD as a routine part of the informed consent process will allow the greatest number of patients to consider this option. In states where PAD is legal, standing informed consent doctrines justify requiring physicians to give patients this information as part of the informed consent process; it is harder to justify this practice in states where PAD is not legal. In states where PAD is not legal, physicians should at least have the discretion to inform patients who would benefit from this information about options in states where PAD is legally available. In allowing physicians the option to discuss physician aid in dying, more patients will have the ability to consider this option when making end-of-life decisions.

Amber R. Comer, PhD, JD , can be reached at comer(at)iu.edu.

[1]  American Medical Association. Principles of Medical Ethics. Physician-Assisted Suicide, Code of Medical Ethics Opinion 5.7.  American Medical Association (Chicago, IL: 2017) https://www.ama-assn.org/delivering-care/ethics/physician-assisted-suicide .

[2]  American Medical Association. P rinciples of Medical Ethics. Code of Medical Ethics: Caring for Patients at the End of Life, Chapter 5.  American Medical Association (Chicago, IL: 2017) https://www.ama-assn.org/delivering-care/ethics/code-medical-ethics-caring-patients-end-life .

[3]  Span, Paula. "Physician Aid in Dying Gains Acceptance in the U.S."  New York Times . (New York City, NY) Jan. 16, 2017.

[4]  Zaritsky, John, dir.  The Suicide Tourist 2010, 11  " The Suicide Tourist." Aired on March 2, 2010 on Frontline PBS.  https://www.pbs.org/wgbh/pages/frontline/suicidetourist/ . 

[5]  Oregon Health Authority. Oregon Death with Dignity Act: 2015 Data Summary.  Oregon Health Authority (OR: 2016)  https://www.oregon.gov/oha/ph/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year18.pdf . 

[6]  Beauchamp, Tom L., James F. Childress.  Principles of Biomedical Ethics  (New York: Oxford University Press, 1979) 56-96.

[7]  Faden, Ruth and Tom L. Beauchamp.  A History and Theory of Informed Consent  (New York: Oxford University Press, 1986)

[8]  Lidz, Charles W., Paul S. Appelbaum, and Alan Meisel. "Two Models of Implementing Informed Consent."  JAMA Internal Medicine  148, no. 6 (1988): 1385-1389. https://doi.org/10.1001/archinte.1988.00380060149027 .

[9]  Wicclaid, Mark R..  Conscientious Objection in Health Care: An Ethical Analysis  (New York: Cambridge University Press, 2011).

[10]  American Academy of Hospice and Palliative Medicine. Statement on Physician-Assisted Dying.  American Academy of Hospice and Palliative Medicine (Chicago, IL: 2016)  http://aahpm.org/positions/pad . 

[11]  Prokopetz, Julian and Lisa Soleymani Lehmann. "Redefining Physicians’ Role in Assisted Dying."  New England Journal of Medicine  367, no. 5 (2012): 97-99. https://doi.org/10.1056/NEJMp1205283 .

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Euthanasia Essay

Euthanasia Essay : Euthanasia And Euthanasia

This is why Euthanasia is important and summarizing the research that I found on Euthanasia. Euthanasia is important because there is a lot of arguments about Euthanasia. Some people support it and some people do not support Euthanasia (Euthanasia and assisted suicide- Arguments). Euthanasia allows people to be free from physical pain. It is the hastening of death of a patient to prevent further sufferings (Euthanasia Revisited). The religious argument states God chooses when human life ends. Euthanasia

The Debate Of Euthanasia And Euthanasia

INTRODUCTION: The debate of euthanasia is an ongoing one that’s shrouded with much controversy and ambiguity regarding the ethics of it in contemporary Australian society. However, the frequency of this topic being debated by physicians, influential figures and the media has become more prominent now than ever. In particular, in association with its impending legislation within Australian states. (The Royal Australian and New Zealand College of Psychiatrists,2012) Various types of euthanasia are recognised,

The Issue Of Euthanasia And Euthanasia

life is beyond toleration or they feel as though there is no point to living, the issue of euthanasia often arises. Euthanasia is technically defined as “the act or practice of killing someone who is very sick or injured in order to prevent any more suffering”. In america people have the right to end their life. The topic of euthanasia is one that is highly disputed among people over the world.” Euthanasia means killing someone who is very sick to prevent more suffering” (Weaver 1). An example of

Euthanasia Essay : The Euthanasia

the euthanasia process and what to expect. The euthanasia can take place in the privacy of your own home or you may choose to have it done at your veterinarian’s office. Your veterinarian may offer at home euthanasia or you may be able to locate a veterinary service that does at home euthanasia such as Home To Heaven. This is a personal choice and should be made with you and your pet’s comfort in mind. Additionally, you may want to decide if you wish to be present during the euthanasia. Some

Euthanasi Euthanasia And Euthanasia

etymology of the word ‘euthanasia’ originates from the Greek language which has a literal meaning of “good death”. Other names for euthanasia are ‘assisted suicide’ and ‘mercy killing’. Euthanasia is done when the person is suffering from a terminal illness such as cancer, and then steps are taken to end the person’s life so that they no longer have to suffer. [Helga Kuhse. July 1992. Bioethics News. The World Federation of Right to Die Societies. http://www.worldrtd.net/euthanasia-fact-sheet. Accessed

Euthanasia And The Death Of Euthanasia

for the dying who request euthanasia to be able to end their suffering. Euthanasia is considered a “gentle and easy death” because it comes from the Greek words, Eu meaning good and Thanatosis meaning death. Euthanasia is illegal in most of the United States. However, assisted suicide, is legal in six different states. The states that assisted suicide is legal in are California, Oregon, Colorado, Washington DC, Vermont and Washington. The key difference between euthanasia and assisted suicide is who

The Death Of Euthanasia And Euthanasia

ostensibly to relieve him/her from severely unrelenting pain and suffering is called Euthanasia. The word Euthanasia is derived from a combination Greek prefix, ‘Eu’ and ‘thanatos’ meaning good and death respectively (Humphry 1-A). According to Webster’s Dictionary, Euthanasia is the practice or an act of ending the life of a hopelessly sick or injured person and will eventually lead to his/her death. Euthanasia—commonly referred to as mercy killing draws and a lot of unending debates and unparallel

or even a friend, so generally they try to steer clear of that particular subject. However if euthanasia is brought up into the conversation views change and people want to make their voices and opinions heard, especially when it is in regards to their religious beliefs about the matter, sometimes it just sparks a flame deep down inside of an individual that they did not even realize they had. Euthanasia is, “the act or practice of killing hopelessly sick or injured individuals (as persons or domestic

Euthanasia, the practice of medically terminating life in order to relieve pain and suffering of a patient, has been a complex and controversial topic since its conception. In ancient Greece and Rome attitudes toward active euthanasia, and suicide had tended to be tolerant. However, the rise of the Christian faith reinforced the views of the Hippocratic Oath, a swearing of ethical conduct historically taken by physicians. This shift concluded a medical consensus in opposition of euthanasia. Issues

consider. The word Euthanasia means “Good Death” and is also the name of one of the greatest controversities alongside abortion. Over the years people have been swayed between the ideas of what Euthanasia entails, yet in the end we are all going to die. When arguing for Euthanasia people would bring up such points as to the benefits of saving a loved one from future suffering or allowing the patient to decide how they die on their own. The opposing argument would argue that once Euthanasia is wrong because

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• Published: 15 January 2014

Should assisted dying be legalised?

• Thomas D G Frost 1 ,
• Devan Sinha 2 &
• Barnabas J Gilbert 3  

Philosophy, Ethics, and Humanities in Medicine volume  9 , Article number:  3 ( 2014 ) Cite this article

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When an individual facing intractable pain is given an estimate of a few months to live, does hastening death become a viable and legitimate alternative for willing patients? Has the time come for physicians to do away with the traditional notion of healthcare as maintaining or improving physical and mental health, and instead accept their own limitations by facilitating death when requested? The Universities of Oxford and Cambridge held the 2013 Varsity Medical Debate on the motion “This House Would Legalise Assisted Dying”. This article summarises the key arguments developed over the course of the debate. We will explore how assisted dying can affect both the patient and doctor; the nature of consent and limits of autonomy; the effects on society; the viability of a proposed model; and, perhaps most importantly, the potential need for the practice within our current medico-legal framework.

Introduction

Over the past two centuries, the United Kingdom has experienced rapid population growth associated with a substantial decline in mortality from acute infectious diseases and poor nutrition [ 1 ]. As the average life expectancy has increased, so too have the rates of debilitating chronic illness – particularly coronary artery disease and cancers [ 2 ]. These diseases require years of treatment instead of the mere days to weeks that medicine once operated within [ 2 ]. Although healthcare systems have sought to adapt to such changes, aiming to prevent and treat such disease wherever possible, debate has arisen regarding those patients in the latter stages of chronic, incurable, terminal conditions [ 3 , 4 ]. Moreover, there is increasing recognition that the patient must be at the centre of health care decision-making, such that outcomes must be tailored to their individual needs and views. By extension, assisted dying might seem a logical step to help achieve these goals within the realm of end-of-life decision making [ 5 ]. Several jurisdictions, notably Oregon (1997) and the Netherlands (2001) have already legalised assisted dying in some form. These factors have contributed to ongoing legislative discussions within Parliaments for almost a decade, with current opinion polling suggesting a majority of medical practitioners and the public in favour of physician-assisted suicide [ 6 ].

Viability of assisted dying in practice

In the UK, a model for assisted dying has been developed from the legal structure found within the Assisted Dying Bill introduced by Lord Falconer in the House of Lords in 2013 [ 7 ]. Assisted dying could only be considered under circumstances in which a patient of legal age is diagnosed with a progressive disease that is irreversible by treatment and is “reasonably expected to die within six months” [ 7 ]. Registered medical practitioners would make such decisions for patients with terminal illnesses. Addressing the technicalities of ‘assisted dying’ requires distinction between ‘physician-assisted suicide’ (offering patients medical actions or cessation of actions by which they can end their own life) and ‘euthanasia’ (whereby the medical practitioner actively induces death). In light of the strong hostility of the medical profession towards active euthanasia, this proposed model, as with previous attempts to legalise assisted dying, permitted only the former [ 8 – 10 ].

However, there is concern that such distinction may be unrealistic in practice because medical practitioners could find themselves with a patient who had failed to successfully end their own life and was subsequently left in a state of greater suffering. Were such a patient no longer able to give consent, a heavy burden would then be placed on the physician regarding how to proceed. Moreover, the practice of physician-assisted suicide might be deemed discriminatory, for example by giving only patients with good mobility control over their own method of death.

The Assisted Dying Bill 2013 included the provision that any terminal prognosis must be confirmed and attested by a second registered practitioner. The strictness of such criteria has parallels to a similar double-physician requirement when procuring a legal abortion under the 1967 Abortion Act. The stated aims of the provision in both cases are as follows: first, to check the accuracy of the prognosis upon which the decision was being made; second, to ensure that the situation meets the required criteria; and third, to check that such a decision was taken by the patient after full consideration of all available options [ 11 , 12 ]. By having a second independent doctor, the legislation ensures that all three checks are met without prejudice or mistake.

Problematic for any protocol for assisted dying is the fact that estimates of life expectancy in terminal prognoses are erroneous in 80.3% of cases [ 13 ]. Furthermore, the accuracy of such prognoses deteriorates with increased length of clinical predicted survival. Forecasts of survival times are based largely on past clinical experience, and the inherent variability between patients makes this more of an art than a science. This brings to concern both the accuracy of any prognosis meeting the six-month threshold and the validity of requests for assisted dying based partly or wholly on predicted survival times. Whilst the majority of errors in life expectancy forecasts are a matter of over-optimism and hence would not affect either of those two concerns, many cases remain unaccounted for. Overly pessimistic forecasts occur in 17.3% of prognoses; hence we must decide whether the one in six patients making a decision based on an inaccurate prognosis is too high a cost to justify the use of this system. Patients requesting an assisted death often cite future expectations of dependency, loss of dignity, or pain [ 14 ]. If the hypothetical point at which the progression of their illness means they would consider life to be not worth living is not, as informed, mere weeks away but in fact many more months, then this information would have resulted in a different decision outcome and potentiated unnecessary loss of life.

Whilst the presence of a second doctor would be expected to mitigate such forecasting errors, the anchoring bias of the initial prediction may be enough to similarly reduce the accuracy of the second estimate. It is prudent to question the true independence of a second medical practitioner, and whether this second consultation could become more of a formality, as has now become the case with abortion [ 15 ].

Another challenge for an assisted dying system would be to recognise whether patients requesting death were legally competent to make that decision. Consider that any request for suicide from a patient with clinical depression is generally categorised as a manifestation of that mental disorder, thereby lacking capacity. It is arguably impossible to separate out the natural reactions to terminal illness and clinical depression. Indeed, there is evidence that major depressive disorders afflict between 25% and 77% of patients with terminal illness [ 16 , 17 ]. Any protocol for assisted dying must first determine what qualifies as a ‘fit mental state’ for a terminal patient.

The need for assisted dying

It could be argued that a doctor’s fundamental duty is to alleviate forms of suffering in the best interests of the patient. The avoidance of physical pain, as an obvious manifestation of suffering, might explain why assisted dying would be both necessary and within the duties of a doctor to provide. The evolving principle in common law known as the ‘Doctrine of Double Effect’ offers a solution to this problem [ 18 ]. This legal judgement stated that “[a doctor] is entitled to do all that is proper and necessary to relieve pain even if the measures he takes may incidentally shorten life”. This entails that a protocol already exists for patients searching for an escape from chronic pain. Furthermore, numerous retrospective studies have revealed very little correlation between opioid dose and mean survival times: one study of over 700 opioid-treated patients found that the variation in survival time from high-dose opioid treatment is less than 10% [ 19 – 21 ]. It can therefore be said that pain alone, if appropriately managed, should never be cause for considering assisted dying as an alternative.

By contrast, the ‘Doctrine of Double Effect’ might be seen as a subjective interpretation that has been applied unequally due to a lack of specialist training or knowledge [ 22 ]. Despite this, the principle can be easily understood and poor awareness can be remedied by improvements in medical education and standardisation of protocols. Moreover, should we choose to accept arguments for assisted dying that are based upon inadequate administration of pain medication, we set a precedent for conceding shortcomings in palliative care and other end-of-life treatments. Offering hastened death could become an alternative to actively seeking to improve such failings.

Whilst much has been made of the ‘pain argument’ here, the call for assisted dying is rarely this simple. Many patients also suffer a loss of dignity, often due to their lack of mobility – the inability to relieve oneself without help is a potent example. Beyond this are additional fears of further debilitation and the emotional costs of dealing with chronic illness, both for the patient and for their relatives and friends. A study of terminal patients in Oregon showed that these were the most significant reasons behind requests for assisted suicide, the next commonest reason being the perception of themselves as a ‘burden’ [ 14 ]. Clearly, we could seek to provide balanced, compassionate medical care for these patients, and still fail to address these points.

Developments in healthcare and technology may reduce this emotional burden, but remain an imperfect solution.

Rights of patients and limitations of their autonomy

J.S. Mill’s pithy dictum describes autonomy as follows: “over himself, over his own body and mind, the individual is sovereign” [ 23 ]. Not only has the sanctity of bodily autonomy profoundly influenced the development of liberal democracies, it has also provoked a holistic shift in making our healthcare systems more patient-centred – “care that meets and responds to patients’ wants, needs and preferences and where patients are autonomous and able to decide for themselves” [ 5 ]. The ethical principle of controlling the fate of one’s own body is inherently relevant to the debate on assisted dying. It is difficult to reconcile that citizens may have the right to do almost anything to and with their own bodies– from participating in extreme sports to having elective plastic surgery – yet a terminal patient cannot choose to avoid experiencing additional months of discomfort or loss of dignity in their final months of life.

Expectation of individual liberty has been codified in law. The right to bodily autonomy has been interpreted to be included under Article 8 - the right to privacy - of the European Convention on Human Rights (ECHR) and subsequently the Human Rights Act (HRA) [ 24 , 25 ]. Moreover, the ECHR underpins the right of individuals to ‘inherent dignity’ [ 26 ]. Hence, if an individual feels that dignity is unattainable due to the progression of a terminal illness, then taking recourse though assisted dying ought to be a legitimate option.

Conversely, there are two notable oversights in this interpretation of a right to assisted dying as an extension of the principles of bodily autonomy:

First, it would be wrong to view individual liberty as absolute. The HRA allows for exceptions to Article 8 on grounds of ‘health or morals’ [ 25 ]. The principle of autonomy is not inviolable. Governments have limited such privileges for the protection of individuals and society, for example by criminalizing the use of recreational drugs or the selling of one’s own organs. The preservation of life by denying assisted dying could fall within this category.

Second, the right of autonomy is not necessarily intrinsic to human beings but, as Kant argued, is dependent on our ‘rational nature’ [ 27 ]. This concept sees autonomy as an exercise of ‘evaluative choice’ [ 27 ], requiring rationality on the part of individuals to appreciate the nature of options and their consequences. To achieve true autonomy, there must be sufficient information to make those rational decisions; this is the basis of informed consent and why it is a fundamental duty of a doctor to offer a patient an informed series of treatment options [ 28 ]. The logistical issue is that doctors are unable to advise patients regarding the point at which their situation becomes less preferable to being dead. No doctor (or individual) has any knowledge or experience of what ‘death’ may be like. Hence, in this case, the idea of exercising true autonomy through informed consent might be considered meaningless.

Legalising assisted dying by attempting to establish an absolute right to bodily autonomy may undermine other individual and group rights. Vulnerable patients may feel pressured into assisted dying because of social, emotional, or financial strains placed on family and/or friends. This is exemplified by the trend showing that the proportion of patients stating ‘relief of burden’ on others as the reason for requesting assisted dying has risen from 17% to 25% in Oregon since legalisation [ 29 ]. One could even consider the risk of assisted dying becoming an expected choice rather than a free one. Thus, assisted dying may erode the elemental right to life of terminal patients as the value of their life becomes tied to relative costs to society and to those around them.

Moreover, by creating one class of individuals for whom life is expendable, that particular view may be extended by society to all groups possessing such attributes (e.g. the permanently disabled). There would be a definite risk to the rights of these vulnerable groups in the form of society being less willing to provide for their health and social care.

It is often raised that the limited legalisation of assisted dying would inevitably become extended in scope, but this is not necessarily a flaw. Even if the right to determine the manner of death were later extended to a wider group of people, posterity may reflect positively on such a change, just as extending the franchise to women ultimately led to legislation demanding equal pay.

Effect on health professionals and their role

‘To act in the best interest of the patient’ is often cited as a central duty of the doctor [ 28 ]. This concept of ‘best interest’ guiding the doctor’s action has seen the development of two important ethical principles: beneficence and non-maleficence. Beneficence mandates that the actions of the doctor must be aimed to bring about benefit (clinical improvement) for the patient, usually measured in terms of reduced morbidity or mortality; non-maleficence requires that the doctor not carry out treatment that is likely to cause overall harm the patient [ 30 ]. These traditional ethical imperatives on a doctor both conflict with intentionally hastening the death of a patient, and a resolution of this tension would require redefining what constitutes ‘acting in the best interest’.

A further dimension is the potential reluctance of health professionals to engage in a practice that contravenes their own ethical beliefs, particularly as this would affect doctors who never entered training in the knowledge that assisting patients to die would be an expected duty. This is certainly no argument against the introduction of assisted dying; indeed, a recent survey of a cohort of NHS doctors found that 46% would seriously consider requests from patients to undertake steps to hasten death [ 31 ]. It merely expresses the point that any early model would have to account for the fact that an initial 54% of the doctors in the NHS would be required to advise qualifying patients of assisted dying as a legitimate option, despite disagreeing with it in principle.

Furthermore, doctors who agree ethically with this practice may find themselves facing conflicts of interest. It is expensive to treat chronically ill patients, particularly in the final months of life [ 32 ]. Moreover, it would be difficult for commissioners to ignore the fact that the sustained treatment of one individual could deprive many others from access to surgery or access to novel drugs. Such an argument does not suggest that doctors or any other hospital staff would treat this practice without appropriate respect or care; rather it acknowledges the need for appropriate rationing of care and questions the intentions of service providers. The perception of an ulterior motive could negatively impact patient trust. One survey showed that a reasonable minority of patients (27%) – and particularly particularly the elderly – believe that legalising assisted dying would lessen their trust in their personal physician [ 33 ]. The costs of weakened trust in the doctor-patient relationship could far outweigh the benefits of assisted dying, particularly given the importance of trust when treating a chronic patient for an extended period of time.

There is no doubt that assisted dying would empower some patients to maximise control over the timing and manner of their own death. Such expression of autonomy would surely solidify moves towards a patient-centred approach to healthcare. However, the capacity for such consensual requests remains in doubt. Clinically, the patient’s state of mind and the reliability of diagnostic predictions are of issue; philosophically, the idea of informed consent for death is contradictory. The implications for patients, physicians and society have been weighed extensively within this article. The central tenet throughout has been the balancing of an individual’s right to escape a circumstance that they find intolerable, alongside the consequential changes to their other rights, and the rights and responsibilities of third parties. Ultimately, the challenge is for us as a society to decide where this balance lies.

About the debate

The Varsity Medical Debate was started in 2008 with the aim of allowing students, professors and members of the polis, to engage in discussion about ethics and policy within healthcare. Utilising the age-old rivalry between the two Universities, the debate encourages medical students from both Oxford and Cambridge to consider and articulate the arguments behind topics that will feature heavily in their future careers.

The debate was judged on the logic, coherence, and evidence in arguments, as well as flair in presentation. Although the debaters may not have necessarily agreed with their allocated side, the debate format required them to acknowledge a particular school of thought and present the key arguments behind it. Oxford, who opposed the motion, was awarded the victory in the debate; however, this does not mean that the judges believe that position ought to become public policy.

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Acknowledgements

For Cambridge University: Hilmi Bayri (Trinity), Alistair Bolger (Jesus), Casey Swerner (St Johns).

For Oxford University: Devan Sinha (Brasenose), Thomas Frost (Lincoln), Collis Tahzib (Lincoln).

Martin Farrell (Cambridge).

Baroness Finlay: Professor of Palliative Care Medicine and former President of the Royal Society of Medicine.

Dr. Roger Armour: Vascular Surgeon and Inventor of the Lens Free Ophthalmoscope.

Mr. Robert Preston: Director of Living and Dying Well.

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Frost, T.D.G., Sinha, D. & Gilbert, B.J. Should assisted dying be legalised?. Philos Ethics Humanit Med 9 , 3 (2014). https://doi.org/10.1186/1747-5341-9-3

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Psychologist becomes first person in Peru to die by euthanasia after fighting in court for years

LIMA, Peru (AP) — A Peruvian psychologist who had an incurable disease that weakened her muscles and left her bedridden for several years died by euthanasia, her lawyer said Monday, becoming the first person in the country to obtain the right to die with medical assistance.

Ana Estrada fought for years in Peruvian courts for the right to die with dignity, and became a celebrity in the conservative country where euthanasia and assisted suicide are illegal.

In 2022, Estrada was granted an exception by the nation’s Supreme Court, which upheld a ruling by a lower court that gave Estrada the right to decide when to end her life, and said that those who helped her would not be punished. Estrada became the first person to obtain the right to die with medical assistance in Peru.

“Ana’s struggle for her right to die with dignity has helped to educate thousands of Peruvians about this right and the importance of defending it,” her lawyer, Josefina Miró Quesada, said in a statement. “Her struggle transcended our nation’s borders.”

Estrada, 47, had an incurable disease called polymyositis that wastes away muscles. She began to present the first symptoms as a teenager and started to use a wheelchair at the age of 20 because she had lost the strength to walk.

Estrada obtained a psychology degree and became a therapist. She earned enough money to buy her own apartment and became independent from her parents.

By 2017, however, Estrada’s condition worsened and she could no longer get up from her bed. She had difficulty breathing and survived pneumonia. And even though she could not type, Estrada used transcription software to produce a blog called “Ana for a death with dignity,” where she discussed her struggles and her decision to seek euthanasia.

“I am no longer free,” she said in an interview with the Associated Press in 2018. “I am not the same person I was before.”

With the help of Peru’s Human Rights Ombudsman, Estrada won a lawsuit that gave her the right to die with euthanasia. From her bed, she participated in court sessions through video conferences.

Estrada told judges in 2022 that she valued life, and did not want to die immediately, but wanted to have the freedom to decide when to end her life.

“I want to accede to euthanasia when I can no longer sustain suffering in life,” she said. “And when I decide to bid farewell to my loved ones in peace and with tranquility.”

Only a handful of countries have legalized euthanasia, including Canada, Belgium and Spain. Some U.S. states, including Maine and Oregon, allow physician-assisted suicide , where a doctor provides a terminally ill patient with the means to end their life.

Euthanasia is illegal in most Latin American countries except for Colombia, which legalized it in 2015, and Ecuador, which decriminalized the practice in February .

Follow AP’s coverage of Latin America and the Caribbean at https://apnews.com/hub/latin-america

Copyright 2024 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed without permission.

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Euthanasia: agreeing to disagree?

Søren holm.

1 Centre for Social Ethics and Policy, School of Law, Williamson Building, University of Manchester, Manchester, M13 9PL UK

2 Section for Medical Ethics, University of Oslo, Oslo, Norway

In discussions about the legalisation of active, voluntary euthanasia it is sometimes claimed that what should happen in a liberal society is that the two sides in the debate “agree to disagree”. This paper explores what is entailed by agreeing to disagree and shows that this is considerably more complicated than what is usually believed to be the case. Agreeing to disagree is philosophically problematic and will often lead to an unstable compromise.

In discussions about the legalisation of active, voluntary euthanasia performed by medical doctors 1 it is sometimes claimed that what should happen in a liberal society is (merely?) that the two sides in the debate “agree to disagree” or “split the difference” (Huxtable 2007 ); and the Netherlands is taken as an example of this kind of accommodation. Agreeing to disagree will allow persons to pursue their own idea of the good life and the good death both as patients and as health care professionals, it will calm the often vociferous and unnecessarily antagonistic public debate, it will exhibit state impartiality and it will lead to a resolution that is the right one in an area where significant liberty interests of patients are at stake.

The underlying idea is that even if we cannot agree on whether euthanasia is ethically acceptable we can reach a societal accommodation that allows those who can find a willing doctor to end their life by euthanasia without fear of criminal prosecution.

The present paper will problematise this account of the virtues and effects of “agreeing to disagree” through an analysis of what that type of societal accommodation actually entails in the context of euthanasia.

The first part of the paper will briefly rehearse some philosophical arguments against compromise or accommodation as a viable option in a context of deep value conflict about an important ethical issue.

The second part will then more concretely analyse (1) what the pro-euthanasia side wants to achieve by the legalisation of euthanasia and (2) what the anti-euthanasia side is worried about in relation to legalisation.

The third part will then show that “agreeing to disagree” is significantly more complicated and fraught with problems than is sometimes assumed.

Throughout the paper no position will be taken as to whether euthanasia is in general, or in specific instances ethically justifiable. The analysis will primarily be drawing on resources from political philosophy and political science and not from moral philosophy.

The paper will also not try to provide a final answer to the question of whether “agreeing to disagree” is a philosophically coherent position to advocate given the strong underlying views on both sides of the debate. But it is worth noting that for someone, such as Dame Mary Warnock believes that doctors who refuse euthanasia requests are ‘Genuinely wicked’ it would be strange to agree to disagree and difficult to see what the agreement could be about (News Letter 2009 ).

Agreeing to disagree and deep value conflict

Within a modern liberal society it is arguable that the best way of resolving policy differences is through some form of deliberative democracy. The parties sit down, trash out their differences and try to argue their way to an outcome that is either accepted or at least acceptable to all participants in the process (Guttman and Thompson 1990 ; Guttman 1993 ; Habermas 1992 ; Habermas 1995 ; Rawls 1996 ; Holm 2006 ).

At both the theoretical and the practical level this kind of process is likely to work best when the different views of the parties stem only from the fact that they have different interests. Such differences can be mediated through reflection and/or compromise.

If, however the differences are differences in values it may be more difficult to achieve a resolution or a compromise. Values are often more intimately connected with the participant’s ultimate world view than interests are and they more often involve metaphysical commitments (McCarthy 1996 ). 2 This is, for instance quite obvious in the abortion debate where one of the issues at stake is the metaphysics of persons and of personal identity.

There are circumstances where disagreements about values are likely to generate irresolvable standoffs. This is especially likely to happen if one or both of the positions involve what John Woods calls:

“Philosophy’s Most Difficult Problem . Let A  = <{ P 1,…., Pn }, C > be a valid argument, a sequence in which C is a logical consequence of proceeding steps. Philosophy’s Most Difficult Problem is that of adjudicating in a principled way the conflict between supposing that A is a sound demonstration of a counterintuitive truth, as opposed to seeing it as a counterexample of its premises.” (Woods 2000 , p. 205).

Discussions about euthanasia often involve exactly this kind of problem. It is, for instance well known that the personhood approaches to moral status involved in many pro-euthanasia arguments generate highly counterintuitive results in relation to beginning of life and end of life issues and that these very results are often seen as a reductio of such approaches by their opponents.

If, furthermore the values on both sides are firmly entrenched we may reach a standoff that excludes negotiability, where the mere suggestion that there is a possible compromise is seen as grotesque and improper.

What is the legalisation of euthanasia supposed to achieve?

Let us, despite the philosophical problems raised above move on and ask what proponents of euthanasia want to achieve through the legalisation of the activity.

The most minimal legalisation of euthanasia would simply involve the decriminalisation of the activity, but supporters of euthanasia understandably want more, because mere decriminalisation will not in itself entail that euthanasia is available.

Decriminalisation is, for instance, compatible with strong professional condemnation and disciplinary action and even with expulsion from the profession of those who perform the acts. The UK regulator of medical doctors the General Medical Council (GMC) does, for instance, oblige doctors to observe duties that they are not legally obliged to observe (e.g. acting as good Samaritans) and it requires them to abstain from acts that are not illegal (e.g. looking at legal internet pornography on work computers). Doctors who breach GMC guidance in these areas may lose their license to practice, even if they have done nothing that could remotely be construed as illegal or criminal. Supporters of euthanasia will therefore not only require that euthanasia is decriminalised but also that it is deemed to be acceptable professional practice and are furthermore likely to require that those who choose to practise euthanasia within the agreed boundaries are not discriminated against in employment decisions.

This is part of a more general feature of the pro-euthanasia position. Those who hold this position view euthanasia as morally justified and therefore also want it to become socially normalised. For them euthanasia is just a normal medical service; and in public health care systems or systems with a large component of third party payment supporters of euthanasia will also want euthanasia to be conceived of as a normal health care service in relation to payment. For instance, if a General Practitioner (GP) attends a patient at home to perform euthanasia the GP should be reimbursed as for any other home visit of similar complexity.

The requirement of normalisation of euthanasia also reaches beyond the health care setting to issues such as death certification, burial and insurance law. For the proponent of euthanasia, death following euthanasia should be treated as a ‘normal death’ and not for instance as a kind of suicide or a potentially illegal killing. 3

What worries does legalisation of euthanasia raise?

Opponents of euthanasia share the concern about the effect of legalisation on the status of health care professionals, but they are likely to focus on the other side of the coin, i.e. the effects in relation to those who do not want to perform euthanasia. Any euthanasia legislation is likely to contain a conscientious objection provision, but this may not be enough to protect doctors and other health care professionals in the long run. After the legalisation of abortion it has become difficult for doctors who do not want to perform abortions to specialise in gynaecology and obstetrics and similar difficulties might occur in some specialties in relation to euthanasia. There has also been a tendency in some jurisdictions to interpret conscientious objection clauses quite narrowly both with regard to the type of health care personnel that is covered and with regard to the kind of involvement that a person can object to participate in. Opponents of euthanasia are therefore likely to require stronger protections than mere conscientious objection.

A related issue is that a right to conscientious objection is often combined with a professional duty to refer the patient to another practitioner willing to perform the act in question. But for someone who thinks that euthanasia is closely akin to murder such a duty is highly problematic.

More generally those who are opposed to euthanasia will also be opposed to the general normalisation of euthanasia as a medical service. They are likely to want it to be kept separate and special, and may be unlikely to be willing to have it included in normal reimbursement mechanisms. This may be combined with an unwillingness to contribute financially through insurance premiums or taxation to a practice seen as morally abhorrent.

In relation to resources in the health care system there may also be a worry about whether introducing euthanasia as an option undermines or weakens claims to have expensive life prolonging treatment provided, or whether in the long run a presumption would be established that choosing euthanasia was the morally right choice in some circumstances of severe resource constraints.

Opponents of euthanasia are also likely to have a distinct worry in relation to whether both sides involved in the societal bargain are willing to let it stand. Is “agreeing to disagree” about active, voluntary euthanasia performed by a medical doctor a stable accommodation or just a staging post to the legalisation of other forms of euthanasia. This is, paradoxically a concern that is at least partially fuelled by the writings of academic bioethicists and legal scholars in relation to end of life decisions and abortion. A typical type of argument in these writings is a consistency argument of the form “society already allows X, therefore it is inconsistent not to allow Y which is currently prohibited”. There are many problems with consistency arguments of this type, but they are never the less often rhetorically powerful (Holm 2003 ). It is obvious that the legalisation of euthanasia will enable a variety of new consistency arguments to be brought forward. What is going to be legalised is, for instance not initially “euthanasia on demand” but euthanasia in cases of terminal disease with significant, irremediable suffering. But the underlying justification for allowing euthanasia only in this specific class of circumstances is inherently unstable because it relies on elements of both respect for autonomy and the relief of suffering.

Why is agreeing to disagree difficult?

From the analysis so far it has become clear that there are several problems with implementing “agreeing to disagree” as a societal accommodation or compromise in relation to euthanasia, even if we believed it made philosophical sense to advocate such a position.

The first problem is that whereas it might be possible to agree to disagree about the very narrow issue of decriminalisation of euthanasia, it is much more difficult to agree to disagree about the normalisation of euthanasia as a type of medical/health care intervention. It is practically difficult to confine the legalisation of euthanasia to mere permission. There will almost always also be an element of acceptance in any legalisation. 4

The second problem is that the situation established by agreeing to disagree is unstable. It satisfies neither side in the debate and there is therefore always a temptation to try to disturb the equilibrium and get a little more; and a possible lingering suspicion that that is exactly what the other side will try to do.

The third problem is that any move from the now prevailing status quo in most countries, i.e. that euthanasia is illegal will be a move that only involves loss seen from the point of view of a strict opponent of euthanasia. For such and opponent there is nothing to be gained in the move itself and the only incentive to agree to disagree is if it is believed that the legal position after agreeing to disagree will be more restrictive than any position that would be reached without agreeing to this form of accommodation.

If the position in the Netherlands can rightly be described as “agreeing to disagree”, and I do not want to claim that this is an accurate or adequate description, then it is a position that has been reached through a long historical development. It has been reached in a specific societal context and there is evidence that what the Dutch have agreed to disagree about has changed over time. It is not obvious that other societies can reach the same kind of accommodation in one single step.

For the philosopher the main problem with “agreeing to disagree” as a policy solution is that it requires both sides to suspend judgement on whether the counterintuitive consequences of accepting, for instance a personhood based justification of the permissibility of voluntary, active euthanasia should count as a reductio or should instead be seen as pointing to future goals for policy development. It furthermore requires the philosophical proponents of euthanasia to acquiesce in what they see as illiberal legislation prohibiting euthanasia in circumstances where it should be allowed; and it requires the philosophical opponents of euthanasia to accept that a kind of killing they think is profoundly unethical should be allowed in law. We can see how philosophers on both sides might “agree to disagree” as citizens, but if they continue to believe, as they almost inevitably must do that they have the correct argument on their side, agreeing to disagree will create significant cognitive dissonance and unease.

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1 In the following all unqualified uses of the term “euthanasia” refer to active, voluntary euthanasia performed by a doctor.

2 Let us in passing note that any call for the exclusion of metaphysical commitments from ethical debates about human life and death is potentially highly problematic. First because every participant in the debate has metaphysical commitments that influences their position and second because the exclusion of metaphysical commitments from the debate is likely to be a bigger burden for some participants than for others.

3 This is exactly why the “Dutch solution”, leaving euthanasia as technically illegal but not prosecuted if the criteria are fulfilled is often criticised by proponents of euthanasia.

4 Even mere decriminalisation of euthanasia by medical doctors could be seen as conveying some form of social acceptance by classifying the act as a medical act and thereby lending it some of the lustre (if such lustre exists) of medicine and the medical profession.

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