thesis against euthanasia

Tips on How to Write a Euthanasia Argumentative Essay

Abortion, birth control, death sentencing, legalization of medical marijuana, and gender reassignment surgery remain the most controversial medical issues in contemporary society.  Euthanasia is also among the controversial topics in the medical field. It draws arguments from philosophy, ethics, and religious points of view.

By definition derives from a Greek term that means good death, and it is the practice where an experienced medical practitioner or a physician intentionally ends an individual's life to end pain and suffering. The names mercy killing or physician-assisted suicide also knows it.

Different countries have different laws as regards euthanasia. In the UK, physician-assisted suicide is illegal and can earn a medical practitioner 14 years imprisonment. All over the world, there is a fierce debate as regards mercy killing.

Like any other controversial topic, there are arguments for and against euthanasia. Thus, there are two sides to the debate. The proponents or those for euthanasia believe it is a personal choice issue, even when death is involved.

On the other hand, those against euthanasia or the opponents believe that physicians must only assist patients when the patients are sound to make such a decision. That is where the debate centers.

This article explores some of the important basics to follow when writing an exposition, argumentative, persuasive, or informative essay on euthanasia.

Steps in Writing a Paper on Euthanasia

When assigned homework on writing a research paper or essay on euthanasia, follow these steps to make it perfect.

1. Read the Prompt

The essay or research paper prompt always have instructions to follow when writing any academic work. Students, therefore, should read it to pick up the mind of the professor or teaching assistant on the assigned academic task. When reading the prompt, be keen to understand what approach the professor prefers. Besides, it should also tell you the type of essay you are required to write and the scope.

2. Choose a Captivating Topic

After reading the prompt, you are required to frame your euthanasia essay title. Make sure that the title you choose is captivating enough as it invites the audience to read your essay. The title of your essay must not divert from the topic, but make it catchy enough to lure and keep readers. An original and well-structured essay title on euthanasia should give an idea of what to expect in the body paragraphs. It simply gives them a reason to read your essay.

3. Decide on the Best Thesis Statement for your Euthanasia Essay

Creating a thesis statement for a euthanasia essay does not deviate from the conventions of essay writing. The same is consistent when writing a thesis statement for a euthanasia research paper. The thesis statement can be a sentence or two at the end of the introduction that sums up your stance on the topic of euthanasia. It should be brief, well crafted, straight to the point, and outstanding. Right from the start, it should flow with the rest of the essay and each preceding paragraph should support the thesis statement.

4. Write an Outline

An outline gives you a roadmap of what to write in each part of the essay, including the essay hook, introduction, thesis statement, body paragraphs, and the conclusion. We have provided a sample euthanasia essay outline in this article, be sure to look at it.

5. Write the First Draft

With all ingredients in place, it is now time to write your euthanasia essay by piecing up all the different parts. Begin with an essay hook, then the background information on the topic, then the thesis statement in the introduction. The body paragraphs should each contain an idea that is well supported with facts from books, journals, articles, and other scholarly sources. Be sure to follow the MLA, APA, Harvard, or Chicago formatting conventions when writing the paper as advised in the essay prompt.

6. Proofread and Edit the Essay

You have succeeded in skinning the elephant, and it is now time to cut the pieces and consume. Failure to proofread and edit an essay can be dangerous for your grade. There is always an illusion that you wrote it well after all. However, if you take some time off and come to it later, you will notice some mistakes. If you want somebody to proofread your euthanasia essay, you can use our essay editing service . All the same, proofreading an essay is necessary before turning the essay in.

Creating a Euthanasia Essay or Research Paper Outline

Like any other academic paper, having a blueprint of the entire essay on euthanasia makes it easy to write. Writing an outline is preceded by choosing a great topic. In your outline or structure of argumentative essay on euthanasia, you should highlight the main ideas such as the thesis statement, essay hook, introduction, topic sentences for the body paragraphs and supporting facts, and the concluding remarks. Here is a sample outline for a euthanasia argumentative essay.

This is a skeleton for your euthanasia essay:

Introduction

• Hook sentence/ attention grabber
• Thesis statement
• Background statement (history of euthanasia and definition)
• Transition to Main Body
• The legal landscape of euthanasia globally
• How euthanasia affects physician-patient relationships
• Biblical stance on euthanasia
• Consequences of illegal euthanasia
• Ethical and moral issues of euthanasia
• Philosophical stance on euthanasia
• Transition to Conclusion
• Restated thesis statement
• Unexpected twist or a final argument
• Food for thought

Sample Euthanasia Essay Outline

Title: Euthanasia is not justified

Essay hook - It is there on TV, but did you know that a situation could prompt a doctor to bring to an end suffering and pain to a terminally ill patient? There is more than meets the eye on euthanasia.

Thesis statement : despite the arguments for and against euthanasia, it is legally and morally wrong to kill any person, as it is disregard of the right to life of an individual and the value of human life.

Paragraph 1: Euthanasia should be condemned as it ends the sacred lives of human beings.

• Only God gives life and has the authority to take it and not humans.
• The bible says, Thou shalt not kill.
• The Quran states, "Whoever killed a Mujahid (a person who is granted the pledge of protection by the Muslims) shall not smell the fragrance of Paradise though its fragrance can be smelt at a distance of forty years (of traveling).

Paragraph 2: Euthanasia gives physicians the power to determine who lives and who dies.

• Doctors end up playing the role of God.
• It could be worse when doctors make mistakes or advance their self-interests to make money. They can liaise with family members to kill for the execution of a will.

Paragraph 3: it destroys the patient-physician relationship

• Patients trust the doctors for healing
• When performed on other patients, the remaining patients lose trust in the same doctor of the facility.
• Under the Hippocratic Oath, doctors are supposed to alleviate pain, end suffering, and protect life, not eliminate it.

Paragraph 4: euthanasia is a form of murder

• Life is lost in the end.
• There are chances that when tried with other therapeutic and non-therapeutic approaches, terminally ill patients can always get better.
• It is selfish to kill a patient based on a medical report, which in itself could be erratic.
• Patients respond well to advanced care approaches.

Paragraph 5: ( Counterargument) euthanasia proponents argue based on relieving suffering and pain as well as reducing the escalating cost of healthcare.

• Euthanasia helps families avoid spending much on treating a patient who might not get well.
• It is the wish of the patients who have made peace with the fact that they might not recover.

  Conclusion

In sum, advancement in technology in the medical field and the existence of palliative care are evidence enough that there is no need for mercy killing. Even though there are claims that it ends pain and suffering, it involves killing a patient who maybe could respond to novel approaches to treatment.

Abohaimed, S., Matar, B., Al-Shimali, H., Al-Thalji, K., Al-Othman, O., Zurba, Y., & Shah, N. (2019). Attitudes of Physicians towards Different Types of Euthanasia in Kuwait.  Medical Principles and Practice ,  28 (3), 199-207.

Attell, B. K. (2017). Changing attitudes toward euthanasia and suicide for terminally ill persons, 1977 to 2016: an age-period-cohort analysis.  OMEGA-Journal of Death and Dying , 0030222817729612.

Barone, S., & Unguru, Y. (2017). Should Euthanasia Be Considered Iatrogenic? AMA journal of ethics, 19(8), 802-814.

Emanuel, E. (2017). Euthanasia and physician-assisted suicide: focus on the data.  The Medical Journal of Australia ,  206 (8), 1-2e1.

Inbadas, H., Zaman, S., Whitelaw, S., & Clark, D. (2017). Declarations on euthanasia and assisted dying.  Death Studies, 41 (9), 574-584.

Jacobs, R. K., & Hendricks, M. (2018). Medical students' perspectives on euthanasia and physician-assisted suicide and their views on legalising these practices in South Africa.  South African Medical Journal ,  108 (6), 484-489.

Math, S. B., & Chaturvedi, S. K. (2012). Euthanasia: the right to life vs right to die.  The Indian journal of medical research, 136 (6), 899.

Reichlin, M. (2001). Euthanasia in the Netherlands.  KOS , (193), 22-29.

Saul, H. (2014, November 5). The Vatican Condemns Brittany Maynard's Decision to end her Life as �Absurd'.

Sulmasy, D. P., Travaline, J. M., & Louise, M. A. (2016). Non-faith-based arguments against physician-assisted suicide and euthanasia.  The Linacre Quarterly, 83 (3), 246-257.

Euthanasia Essay Introduction Ideas

An introduction is a gate into the compound of your well-reasoned thoughts, ideas, and opinions in an essay. As such, the introduction should be well structured in a manner that catches the attention of the readers from the onset.

While it seems the hardest thing to do, writing an introduction should never give you the fear of stress, blank page, or induce a writer's block. Instead, it should flow right from the essay hook to the thesis statement.

Given that you can access statistics, legal variations, and individual stories based on personal experiences with euthanasia online, writing a euthanasia essay introduction should be a walk in the park.

Ensure that the introduction to the essay is catchy, appealing, and informative. Here are some ideas to use:

• Rights of humans to life
• How euthanasia is carried out
• When euthanasia is legally allowed
• Stories from those with experience in euthanasia
• The stance of doctors on euthanasia
• Definition of euthanasia
• Countries that allow euthanasia
• Statistics of physicians assisted suicide in a given state, locality, or continent.
• Perception of the public given the diversity of culture

There are tons of ideas on how to start an essay on euthanasia.  You need to research, immerse yourself in the topic, and scoop the best evidence. Presenting facts in an argumentative essay on euthanasia will help convince the readers to argue for or against euthanasia. Based on your stance, make statements in favor of euthanasia or statements against euthanasia known from the onset through the strong thesis statement.

Essay Topics and Ideas on Euthanasia

• Should Euthanasia be legal?
• What are the different types of euthanasia?
• Is euthanasia morally justified?
• Cross-cultural comparison of attitudes and beliefs on euthanasia
• The history of euthanasia
• Euthanasia from a Patient's Point of View
• Should euthanasia be considered Iatrogenic?
• Does euthanasia epitomize failed medical approaches?
• How does euthanasia work?
• Should Physician-Assisted Suicide be legal?
• Sociology of Death and Dying
• Arguments for and against euthanasia and assisted suicide
• Euthanasia is a moral dilemma
• The euthanasia debate
• It Is Much Better to Die with Dignity Than to Live with Pain Essay
• Euthanasia Is a Moral, Ethical, and Proper
• Euthanasia Law of Euthanasia in California and New York
• Effect of Euthanasia on Special Population
• Euthanasia is inhuman
• Role of nurses in Euthanasia
• Are family and relative decisions considered during the euthanasia
• The biblical stance on euthanasia

Related Articles:

• Argumentative essay topics and Ideas
• Topics and ideas for informative essays

Get Help with Writing Euthanasia Argumentative Essay for School

We have covered the tips of writing an argumentative essay on euthanasia. Besides, we have also presented a sample euthanasia essay outline, which can help you write your essay. However, sometimes you might lack the motivation to write an essay on euthanasia, even when you have access to argumentative essay examples on euthanasia. 

It is the right time to pay someone to write your argumentative essay . We have the best essay writers who have expertise in creating the best argumentative essays on any topic.  They understand the entire process of argumentative writing and can create a top-grade euthanasia essay within the shortest turnaround time.

Do not wait until it is too late; let our nerds help you ace your homework. Order an essay today and forget your academic writing woes.

Order Essay on Euthanasia!

Gradecrest is a professional writing service that provides original model papers. We offer personalized services along with research materials for assistance purposes only. All the materials from our website should be used with proper references. See our Terms of Use Page for proper details.

• - Google Chrome

Intended for healthcare professionals

• Access provided by Google Indexer
• My email alerts
• BMA member login
• Username * Password * Forgot your log in details? Need to activate BMA Member Log In Log in via OpenAthens Log in via your institution

Search form

• Advanced search
• Search responses
• Search blogs
• News & Views
• Euthanasia and...

Euthanasia and assisted dying: the illusion of autonomy—an essay by Ole Hartling

Read our coverage of the assisted dying debate.

• Related content
• Peer review
• Ole Hartling , former chairman
• Danish Council of Ethics, Denmark
• hartling{at}dadlnet.dk

As a medical doctor I have, with some worry, followed the assisted dying debate that regularly hits headlines in many parts of the world. The main arguments for legalisation are respecting self-determination and alleviating suffering. Since those arguments appear self-evident, my book Euthanasia and the Ethics of a Doctor’s Decisions—An Argument Against Assisted Dying 1 aimed to contribute to the international debate on this matter.

I found it worthwhile to look into the arguments for legalisation more closely, with the hope of sowing a little doubt in the minds of those who exhibit absolute certainty in the matter. This essay focuses on one point: the concept of “autonomy.”

(While there are several definitions of voluntary, involuntary, and non-voluntary euthanasia as well as assisted dying, assisted suicide, and physician assisted suicide, for the purposes of brevity in this essay, I use “assisted dying” throughout.)

Currently, in richer countries, arguments for legalising assisted dying frequently refer to the right to self-determination—or autonomy and free will. Our ability to self-determine seems to be unlimited and our right to it inviolable. The public’s response to opinion poll questions on voluntary euthanasia show that people can scarcely imagine not being able to make up their own minds, nor can they imagine not having the choice. Moreover, a healthy person answering a poll may have difficulty imagining being in a predicament where they simply would not wish to be given the choice.

I question whether self-determination is genuinely possible when choosing your own death. In my book, I explain that the choice will always be made in the context of a non-autonomous assessment of your quality of life—that is, an assessment outside your control. 1

All essential decisions that we make are made in relation to other people. Our decisions are affected by other people, and they affect other people. Although healthy people find it difficult to imagine themselves in situations where they do not decide freely, it is also true that all of us are vulnerable and dependent on others.

Yet autonomy in relation to assisted dying is often viewed in the same way as our fundamental right to choose our own course in life. If we are able to control our lives, then surely we can also control our death. Autonomy with respect to your own death, however, is already halved: you can choose to die if you don’t want to live, but you cannot choose to live if you are about to die.

Decisions about your own death are not made in normal day-to-day contexts. The wish to die arises against a backdrop: of desperation, a feeling of hopelessness, possibly a feeling of being superfluous. Otherwise, the wish would not be there. Thus, it is under these circumstances that the right to self-determination is exercised and the decision is made. Such a situation is a fragile basis for autonomy and an even more fragile basis for decision making. The choice regarding your own death is therefore completely different from most other choices usually associated with the concept of autonomy.

Here are just some of the critical matters that would arise if assisted dying were legalised.

A duty to die

The possibility of choosing to die would inhabit everyone’s consciousness—the patient, the doctor, the relatives, and the care staff—even if not formulated as an out-and-out offer. But if a law on assisted dying gives the patient a right to die, that right may turn into a duty to die. How autonomously can the weakest people act when the world around them deems their ill, dependent, and pained quality of life as beyond recovery?

Patients can find themselves directly or indirectly under duress to choose that option if they consider themselves sufficiently pained and their quality of life sufficiently low. Patients must be at liberty to choose assisted dying freely, of course—that is how it is presented—but the point is that the patient cannot get out of having to choose. It has been called the “prison of freedom.”

Internalised external pressure

Pressure on the patient does not have to be direct or articulated. As pointed out by the US professor of biomedical ethics Daniel Sulmasy it may exist as an “internalised external pressure.” 2 Likewise, the French bioethicist Emmanuel Hirsch states that individual autonomy can be an illusion. The theologian Nigel Biggar quotes Hirsch saying that a patient “may truly want to die, but this desire is not the fruit of his freedom alone, it may be—and most often is—the translation of the attitude of those around him, if not of society as a whole which no longer believes in the value of his life and signals this to him in all sorts of ways. Here we have a supreme paradox: someone is cast out of the land of the living and then thinks that he, personally, wants to die.” 3

The end of autonomy

An inherent problem of autonomy in connection with assisted dying is that a person who uses his or her presumed right to self-determination to choose death definitively precludes himself or herself from deciding or choosing anything. Where death is concerned, your right to self- determination can be exerted only by disposing of it for good. By your autonomy, in other words, you opt to no longer have autonomy. And those around must respect the right to self-determination. The respect refers to a person who is respected, but this is precisely the person who disappears.

Danish philosopher Johannes Sløk, who supported legalisation, said, “The actual concept of death has no content, for death is the same as nothing, and one cannot choose between life and nothing. Rather, therefore, one must speak of opting out; one opts out of life, without thereby choosing anything else. Death is not ‘something other’ than life; it is the cessation or annihilation of life.”

Autonomy is a consistent principle running through the care and management of patients and is enshrined in law. However, a patient’s autonomy means that he or she has the right to decline any treatment. It does not entail a right to have any treatment the patient might wish for. Patients do not have the right to demand treatment that signifies another’s duty to fulfil that right. If that were so, autonomy would be the same as “autocracy”—rule of the self over others. Even though patients have the right to reject any intervention, they do not have the right to demand any intervention. Rejecting any claim that the person might make is not a violation of a patient’s self- determination—for example, there may be sound medical reasons for not complying with a demand. The doctor also has autonomy, allowing him or her to say no. Refusing to kill a person or assist in killing cannot be a violation of that person’s autonomy.

The killing ban

Assisted dying requires the doctor’s moral and physical help. It is a binding agreement between two people: the one who is to be killed and the one who is to kill or assist in killing. But our society does not condone killing as a relationship between two legally competent, consenting people. Exemptions from the killing ban involve war or self-defence and are not justified on the grounds that the killing is done for the “benefit” of someone else.

Valuation of a life

If the action is to be decriminalised, as some people wish, it means the doctor will have to enter into deliberations and arguments for and against a request for assisted dying each time. That is, whether he or she is willing to grant it. The alternative would be to refer the patient to another doctor who might be willing to help—that doctor would still have to assess whether the patient’s life was worth preserving.

Thus, autonomy is not the only factor or even always the key factor when deciding whether assisted dying can be granted. It is not only the patient’s own evaluation that is crucial. The value of the patient’s life must also be assessed as sufficiently low. This demonstrates the limitation of the patient’s self-determination.

Relieving suffering

If a competent and legally capable person must have the option of voluntarily choosing assisted dying in the event of unbearable suffering, why does suffering have to be a requirement? The answer is straightforward: our concepts of assisted dying imply that compassion must form a crucial aspect of the decision—mercy killing and compassionate killing are synonyms. But this leads instantly to the question of why we should not also perform assisted dying on people who are not in a position to ask for it themselves but are also suffering.

Some people find the reasoning unproblematic. It stands to reason that relieving suffering is a duty after all. But in this context it is not unproblematic, because it effectively shifts the focus from the autonomy claimed. According to prevailing ideas about autonomy, patients initially evaluate their quality of life themselves, but ultimately it is those around them who end up gauging that quality and the value of their life. That is to say, the justification for assisted dying is borne on the premise that certain lives are not worth living rather than the presence of a request. The whole point is that in the process, respect for the right to self-determination becomes relative.

Autonomy is largely an illusion in the case of assisted dying. 1 A patient overwhelmed by suffering may be more in need of compassion, care, and love than of a kind offer to help end his or her life. It is not a question of whether people have a right to say that they are unworthy. It is a question of whether they have a right to be believed when saying it.

Ole Hartling is a physician of over 30 years standing, doctor of medical sciences at the University of Copenhagen, professor of health promotion at the University of Roskilde, and an author and co-author of several books and scientific articles published mainly in Scandinavia. Between 2000 and 2007 he was a member of the Danish Council of Ethics and its chair for five years. During this time, the council extensively debated the ethics of euthanasia and assisted dying.

Competing interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

• Gastmans C ,
• MacKellar C

To Die or Not to Die: A Kantian Perspective on Euthanasia

• Published: 07 November 2021
• Volume 39 , pages 13–24, ( 2022 )

Cite this article

• Navin Sinha   ORCID: orcid.org/0000-0003-3086-3504 1  

1072 Accesses

Explore all metrics

The paper attempts to explore the implications of Kant's moral criticism of suicide in the case of euthanasia. The paper argues that since Kant's criticism of suicide is essentially directed towards rational beings who are in full control of their rational faculty. It would hence not be applicable in case of individuals who are suffering from dementia and who have expressed a prior desire to be euthanized in such a scenario.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price includes VAT (Russian Federation)

Instant access to the full article PDF.

Rent this article via DeepDyve

Institutional subscriptions

Similar content being viewed by others

“You Got Me Into This …”: Procreative Responsibility and Its Implications for Suicide and Euthanasia

“You Got Me Into This…”: Procreative Responsibility and Its Implications for Suicide and Euthanasia

Suicide and Homicide: Symmetries and Asymmetries in Kant’s Ethics

Suzanne E. Dowie

https://www.ama-assn.org/delivering-care/ethics/euthanasia visited on 08/04/20.

Marina Budic, ‘Suicide Euthanasia and the Duty to Die: A Kantian Approach to Euthanasia’, ( 2017 ) Philosophy and Society 29, 89. Also see generally, Hazel Biggs, Death with Dignity and the Law, (Hart Publishing 2001 ), Michael Cholbi (ed), Euthanasia and Assisted Suicide: Global Views on Choosing to End Life (Praeger, 2017 ), Helga Kushe, Udo Schuklenk and others (ed), Bioethics an Anthology (3rd ed, Wiley Blackwell, 2016 ); Ora O’Neil, Autonomy and Trust in Bioethics, (CUP, 2002 ).

Robert Young, Voluntary Euthanasia, Stanford Encyclopaedia of Philosophy (Spring 2020 Edition) Edward N Zalta (ed) at https://plato.stanford.edu/archives/spr2020/entries/voluntary/ visited on 08/04/20.

cf Budic (note 2) 90.

For example, in India, there were two forms of altruistic suicide- Jauhar and Sati. Jauhar or mass suicide, was practiced by women when their male counterparts were defeated in battle. Suicide in such situation was undertaken to avoid rape, enslavement and other retributions against them. In Sati, the wife would immolate herself on the funeral pyre of her husband. While sati is often justified on religious grounds, there is a possible economic angle to it as well. See generally, Lakshmi Vijay Kumar, “Altruistic Suicide in India’, 2010 Arch Suicide Res 8, 73–80.

The ‘sanctity of life” theory as a prohibition against suicide can be found in the works of classical thinkers like Plato and Socrates. For Plato, the act of suicide represented the act of releasing our soul from our bodies. Suicide under religious heads were regarded as sins. For example, early and medieval Christianity also used religious precepts to prohibit suicide. For, example the often-quoted command from the Old Testament, “Thou shall not kill’, was taken to be forbidding self-destruction. Similar views can be found in Islam, Hinduism and Buddhism. See generally, Michael Cholbi, Suicide, The Stanford Encyclopaedia of Philosophy (Fall 2017 Edition) Edward N Zalta (ed) at https://plato.stanford.edu/artchives/fall2017/entries/suicide/ visited on 08/04/2020.

The Greek philosopher Seneca believed that it was better to kill oneself than to live with failing capacities. For example in one of his works he observed “I will not abandon old age, if old age preserves me intact as regards the better part of myself; but if old age begins to shatter my mind, and to pull its various faculties to pieces, if it leaves me not life, but only the breath of life”. Seneca, “58th Letter to Lucilius,” trans. R. M. Gummere, in T. E. Page et al. (eds.).

Mark Timmons, Moral Theory an Introduction (2nd edn, Rowman and Littlefield Publishers, 2004 ) 2010.

Young (note 5).

Andrews Reath, Kant’s Conception of the Autonomy of the Will, in Oliver Sensen (eds), Kant on Moral Autonomy (Cambridge 2013) 33.

Timmons (n 10) 207.

The idea that dignity consist of the inherent worth of an individual is also commonly associated with the idea of human rights. All international human rights instruments endorse directly or indirectly the “inherent dignity’ of an individual as the source of human rights. However, for a contrary opinion see Oliver Sensen, who argues that Kantian dignity is based on the concept of dignity by which he means that it is not a distinct metaphysical property, that itself dignity is not a source of rights, and dignity is primarily about duties to oneself. Oliver Sensen, Kant on Human Dignity ( 2011 Deutsche Nationalbibliothek) 161.

Christopher McCrudden, ‘Human Dignity and Judicial Interpretation of Human Rights’( 2008 ) 19 EJIL 655, 659.

See generally, Rachel Bayefsky, Dignity, Honour, and Human Rights: Kant's Perspective , ( 2013 ) 41 Political Theory 809, 816.

Jeniffer. E. Bulcock, ‘How Kant would Chose to Die’ (Master’s Thesis, University of New Hampshire Durham, 2006 ).

By hypothetical imperative Kant refers to all those external forces of causality that derives its validity as an object of desire, and therefore is of a conditional nature.

Immanuel Kant, Lectures on Ethics, ed. Peter Heath and J.B. Schneewind. (New York: Cambridge University Press, 1997), 148.

Kerstein Samuel, Treating Persons as Means’, The Stanford Encyclopedia of Philosophy (Summer 2019 Edition), Edward N. Zalta (ed.), URL =  <  https://plato.stanford.edu/archives/sum2019/entries/persons-means/  > . Accessed on 22/09/20.

For example, Kant observes “There is thus lodged in man an unlimited capacity that can be determined to operate in his nature through himself alone, and not through anything else in nature. This is freedom, and through it we may recognize the duty of self-preservation” Lectures (note 24) 144.

Rachel (note 21) 814.

Rachel (note 21) 816–819.

Lectures (n 24) 147.

Yost, Benjamin S. “Kant’s Justification of the Death Penalty Reconsidered”, 2020 Kantian Review 15.

Sharp, Robert, “The Dangers of Euthanasia and Dementia: How Kantian Thinking Might be used to Support non-voluntary euthanasia in cases of extreme dementia”, 2012 Bioethics 26, 231–235.

Questions regarding capacity and consent and also those for determining at a what particular stage a person lose the capacity to make decisions for himself are mostly empirical enquiries. Existing laws on mental capacity presumes that a patient has the capacity to make decisions and that decisions taken by him with regard to his treatment (stopping) are taken in full understanding of the consequences. However, existing literature suggests this might not always be the case. See, Colin Gavaghan, Capacity and Assisted Dying in Michael Cholbi (ed), Euthanasia and Assisted Suicide: Global Views on Choosing to End Life ( 2017 Praeger); S Natalie Banner, “Can Procedural and Substantive Elements of Decision- Making be Reconciled in Assessments of Mental Capacity?”( 2013 ) International Journal of Law in Context 9, 71–86.

Brassington Iain “Killing people: what Kant could have said about suicide and euthanasia but did not”, 2006 Journal of Medical Ethics 32, 571–574.; Dennis Cooley, “A Kantian Moral Duty for the Soon-to-be Demented to Commit Suicide”, ( 2007 ) AJOB 7, 37–44; Sharp, Robert, “The dangers of euthanasia and dementia: how Kantian thinking might be used to support non-voluntary euthanasia in cases of extreme dementia”, (Sharp 2012 ) Bioethics 26, 231– 235.

Dennis Cooley, “A Kantian Moral Duty for the Soon-to-be Demented to Commit Suicide”, ( 2007 ) AJOB 7, 37–44.

Sharp (note 50) 232.

Cooley (note 54) 37–44.

Sharp (note 50) 234. For similar claims see Joshua Beckler, ‘Kantian Ethics: A Support for Euthanasia with Extreme Dementia’, 2012 CedarEthics Online 16.

Sharp (note 50) 234. Kant’s duty of beneficence flows from his duty to others regarding their happiness. Kant regards such duties as imperfect duties or duties of commission. It includes the duty to cultivate the virtues of beneficence, gratitude and sympathy.

Ibid 235–245.

Cholbi, Michael ( 2014 ), “Kant on Euthanasia and the Duty to Die: Clearing the Air”, Journal of Medical Ethics, 2014 Bioethics 41, 607–610.

Sharp (note 50) 234.

See Cholbi’s criticism against this line of thought. Cholbi (note 62) 609.

Ibid 607. Cholbi claims (in a footnote) that Cooley’s assumption of Kantian duty to die is also based on an erroneous reading of Kant. He argues that while Kant considers it heroic for someone to sacrifice herself to save her honor, the act still violates her humanity. Thus, disallowing the possibility of a duty to die.

Rachel (note 27) 824, 25.

Bayefsky, R. (2013). Dignity, honour, and human rights: Kant’s perspective. Political Theory, 41 , 809–816.

Article   Google Scholar  

Beckler, J. (2012). Kantian ethics: A support for euthanasia with extreme dementia. Cedar Ethics , 16 , 1–7.

Google Scholar  

Brassington, I. (2006). Killing people: What Kant could have said about suicide and euthanasia but did not. Journal of Medical Ethics, 32 , 571–574.

Budic, M. (2017). Suicide euthanasia and the duty to die: A Kantian approach to Euthanasia. Philosophy and Society, 29 , 88–114.

Bulcock, J. E. (2006). How Kant would chose to die . Master’s Thesis, University of New Hampshire Durham.

Cholbi, M. (2014). Kant on Euthanasia and the duty to die: Clearing the air. Journal of Medical Ethics, Bioethics, 41 , 607–610.

Cholbi, M. (Ed.). (2017). Euthanasia and Assisted Suicide: Global Views on Choosing to End Life . Praeger.

Cholbi, M. Suicide, The Stanford Encyclopaedia of Philosophy (Fall 2017 Edition) E. N Zalta (Ed.). Visited on 08/04/2020. https://plato.stanford.edu/artchives/fall2017/entries/suicide/

Christopher, M. (2008). Human dignity and judicial interpretation of human rights. EJIL, 19 , 655–659.

Colin, G. (2017). Capacity and assisted dying. In M. Cholbi (Ed.), Euthanasia and assisted suicide: Global views on choosing to end life. Praeger.

Dennis, C. (2007). A Kantian moral duty for the soon-to-be demented to commit suicide. AJOB, 7 , 37–44.

Hazel, B. (2001). Death with dignity and the law . Hart Publishing.

Helga, K., Schuklenk, U., et al. (ed). (2016). Bioethics an anthology (3rd ed.). Wiley Blackwell.

Natalie Banner, S. (2013). Can procedural and substantive elements of decision-making be reconciled in assessments of mental capacity? International Journal of Law in Context, 9 , 71–86.

O’Neil, O. (2002). Autonomy and trust in bioethics . CUP.

Book   Google Scholar  

Sensen, O. (2011). Kant on human dignity . Deutsche Nationalbibliothek.

Sharp, R. (2012). The dangers of euthanasia and dementia: How Kantian thinking might be used to support non-voluntary euthanasia in cases of extreme dementia. Bioethics, 26 , 231–235.

Timmons, M. (2013). Moral Theory an Introduction (2nd ed.). Rowman and Littlefield Publishers.

Vijay Kumar, L. (2004). Altruistic suicide in India. Archives of Suicide Research, 8 , 73–80.

Yost, B. S. (2010). Kant’s justification of the death penalty reconsidered. Kantian Review, 15 , 1–27.

Young, R. Voluntary Euthanasia, Stanford Encyclopaedia of Philosophy (Spring 2020 Edition). In E. N. Zalta (Ed). Visited on 08/04/20. https://plato.stanford.edu/archives/spr2020/entries/voluntary/ 〹

Download references

The article was not funded.

Author information

Authors and affiliations.

School of Business and Law, Navrachana University, Vadodara, 391410, India

Navin Sinha

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Navin Sinha .

Ethics declarations

Conflict of interest.

I hereby declare that I have not received any grant whatsoever in writing this research article. I declare that I have no conflict of interest of any kind.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher's note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Sinha, N. To Die or Not to Die: A Kantian Perspective on Euthanasia. J. Indian Counc. Philos. Res. 39 , 13–24 (2022). https://doi.org/10.1007/s40961-021-00265-3

Download citation

Received : 10 November 2020

Accepted : 13 October 2021

Published : 07 November 2021

Issue Date : January 2022

DOI : https://doi.org/10.1007/s40961-021-00265-3

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Find a journal
• Publish with us
• Track your research

• Harvard Division of Continuing Education
• DCE Theses and Dissertations
• Communities & Collections
• By Issue Date
• FAS Department
• Quick submit
• Waiver Generator
• DASH Stories
• Accessibility
• COVID-related Research

Terms of Use

• Privacy Policy
• By Collections
• By Departments

Euthanasia and the Law: The Rise of Euthanasia and Relationship With Palliative Healthcare

Citable link to this page

Collections.

• DCE Theses and Dissertations [1188]

Contact administrator regarding this item (to report mistakes or request changes)

The Ethical and Legal Implications of Euthanasia

Generally, the topic of euthanasia has resulted in hot debates among all stakeholders, including healthcare professionals and legal experts, due to the ethical and legal issues associated with the topic. It affects both patients and their healthcare providers. Over the years, the debate on euthanasia has focused on suffering patients with terminal illnesses. However, the topic has extended to include even patients with mental illnesses like depression. Therefore, it is appropriate to look at the controversy surrounding euthanasia in a recent case study. Euthanasia is a controversial topic that requires further inquiry to fully understand different opinions offered by the opposing sides and the ethical implications associated with it.

Recent Case Study

The case published in the Catholic Herald involves a 29-year-old woman who underwent euthanasia following a series of mental illnesses. According to the author, despite being physically fit, the woman was given a lethal injection, having been granted her wish to die by the court after eight years of legal battles. In her argument, the woman claimed she had experienced extreme bouts of depression that had made her life intolerable. The case raised concerns among various stakeholders, including politicians who lamented how dangerous euthanasia could be.

Ethical Issues Involved in the Case Study

Generally, the case study raises various ethical dilemmas related to euthanasia, including when it is justifiable to end one’s life. In addition, the topic also opens up a whole discussion on the limitations of patients’ autonomy and the ethical responsibilities of healthcare professionals, as highlighted in the bioethical principles of beneficence and maleficence. Concerning autonomy, questions are raised regarding the patient’s capability to understand the decision that she was making. With superior knowledge and training, the physician is best positioned to help make an ethical decision that is in the patient’s best interest to protect patients from irresponsible choices. For patients to make an autonomous decision, they should be mentally capable of comprehending the information of the decision. In the case study, the patient has a mental health condition. Hence, her ability to make rational decisions is in question.

The Context of Euthanasia

The case study highlights euthanasia, particularly among patients with mental conditions such as depression. Historically, numerous attempts have been made to legalize euthanasia, but minimal success has occurred. The euthanasia discussion in psychiatry was awakened after the Nazi Holocaust when thousands of psychiatric patients were gassed or poisoned to death under the ‘euthanasia program’. According to Felder, the Nazi euthanasia program was used by scientists, mainly physicians, to conduct medical experiments. It is out of the scientific experiments of the Nazi physicians that ‘The Nuremberg Code’ was established to guide future experiments on human subjects.

Additionally, politicians have had their hand in the matter by sponsoring bills to legalize the act, with some opposing such attempts and publicly making their views known. From a social perspective, euthanasia has continued to be controversial, with many societies coming up to air their opinion. In the traditional Christian context and culture, euthanasia is viewed as morally unacceptable due to human life’s sacred nature. However, other social groups support euthanasia with the thought of extending dignity to death, such as the Voluntary Euthanasia Society. As such, there is no single available societal perspective regarding the issue of euthanasia. Hence, it is important to society as it touches on the critical matters of life and death.

The Differing Perspectives on Euthanasia

The individuals and societies in support of euthanasia have always centered their opinion on patient suffering. They argue that patients in the terminal stages of illness experience excruciating pain and have poor wound healing, poor social interactions, and many other aspects of physical suffering. According to the proponents, euthanasia is a more merciful response to relieve this suffering, especially where the quality of life is jeopardized. Among the patients with mental illnesses, the proponents argue that some mental conditions, including severe depression, induce intense suffering and are unresponsive to treatment. Additionally, the proponents note that since the patients request most cases of euthanasia, it is a way for physicians to show respect for personal autonomy. Thus, to the proponents, euthanasia relieves undue suffering and is in harmony with respect for autonomy and the individual’s right to a dignified death.

Contrary to the proponents’ arguments, the opponents base their argument on the intrinsic wrongness of killing, professional integrity, and the possibility of potential abuse. According to Naga and Mrayyan, willingly ending one’s life is inconsistent with human rights, and alternatives should be sought to relieve the patient’s suffering and improve their quality of life. Furthermore, Naga and Mrayyan note that administering lethal substances by physicians to end life is unethical according to guiding medical ethical practices, especially the Hippocratic Oath that restricts physicians from administering such substances to their patients or aiding their patients to die. They also note that legalizing euthanasia could lead to its potential abuse and a slippery slope where individuals will use it to escape chronic but manageable medical conditions.

Evaluation of the Arguments and Their Ethical Implications

The arguments presented by both the proponents and the opponents seem to be entirely influenced by one’s culture, moral philosophy, and personal experiences. Those opposed to euthanasia seem to be influenced by their religious cultures. Specifically, Christian teachings view life as sacred and state it should not be terminated prematurely at any cost. On the other hand, the proponents seem to subscribe to the Stoic philosophy that has always defended suicide as a reasonable departure from life, especially when intense suffering is involved. Anecdotal evidence also suggests that personal life experiences with suffering may make one choose to end one’s life. For example, seeing a cancer patient suffer may make individuals consider euthanasia if diagnosed with a similar terminal disease, as they will not want to experience the same ordeal.

While both the proponents and those opposed to euthanasia have valid arguments, myriads of ethical issues surround each side’s perspective. It is indeed true that certain illnesses, including mental conditions, lead to severe suffering and reduced quality of life. However, ethical issues arise regarding the ability of the patients requesting euthanasia to make autonomous decisions. For example, Appelbaum notes that it is common for depressed patients to reject treatment and even request death, yet change their decision once the depression is resolved. Accordingly, this raises the ethical question concerning the impact of the mental illness itself on the patient’s decision-making. It has also been observed that most patients are only resistant to one form of treatment and that other options should be tried to relieve their suffering.

Furthermore, it is noted that the right to autonomy is not always absolute and that physicians have the legal and ethical responsibility to override the patient’s decisions and continue pursuing alternative treatment in response to the patient’s symptoms and request a dignified death. Thus, the argument regarding patients’ autonomy to end their lives is weak. On the other hand, the opponents’ unethical medical practice mainly touches on physicians’ ethical responsibilities to act in good faith and protect their patients from harm. In line with non-maleficence and beneficence principles, physicians cannot administer lethal dosages to their patients as it causes more harm than good. Additionally, the claim of potential abuse if euthanasia is legalized, holds grounds owing to several reported cases, including ones with mental illnesses, where euthanasia has been performed without following due process in countries where it is legalized. Thus, the ethical questions raised by those opposed to euthanasia regarding non-maleficence, benevolence, and potential abuse are strongly supported by evidence.

Personal Perspective on Euthanasia

The issue of euthanasia among depressed patients will continue to dominate medical discussions. Subjectively, the opponents of euthanasia seem to offer a strong argument. Notably, depression can be treated just like other mental conditions, and symptoms can be controlled where treatment is impossible. Patient autonomy among psychiatric patients is in question. Mental illnesses tend to affect one’s way of thinking, and suicidal ideations are common phenomena among depressed patients. I have dealt with patients who have changed their stance on ‘mercy killing’ after a series of professional counseling sessions and continued treatment. Thinking about these experiences concerning my patients and the ethical dilemmas related to euthanasia makes me view it as an undesirable event in medical practice that I will not want to engage in.

The topic of euthanasia is controversial based on the numerous arguments aired by those in its support and those who are against it. The case study published in the Catholic Herald offers a good scenario through which the effects of euthanasia can be accessed and its ethical implications reviewed. While the Pro-euthanasia argument is based on the need to relieve undue suffering, respect autonomy, and grant the right to a dignified death, the opponents have emphasized the intrinsic wrongness of killing, professional integrity, and the possibility of a “slippery slope”. Overall, the ethical issues addressed autonomy, beneficence, and non-maleficence. Subjectively, the ethical questions touching upon professional integrity, especially the need to observe non-maleficence and doing good, are strong enough to make me offer my support against euthanasia.

📎 References:

1. Appelbaum, P. S. (2017). Should mental disorders be a basis for physician-assisted death? Law & Psychiatry, 68(4), 315-317. https://doi.org/10.1176/appi.ps.201700013 2. Beauchamp, T. L. (2016) Principlism in bioethics. In P. Serna & J. A. Seoane (Eds.), Bioethical decision making and argumentation (pp. 1-16). New York, NY: Springer. 3. Caldwell, S. (2018, February 1). Dutch doctors euthanize a 29-year old woman with depression. Catholic Herald. 4. Felder, B. M. (2013). “Euthanasia,” human experiments, and psychiatry in Nazi-occupied Lithuania, 1941-1944. Holocaust and Genocide Studies, 27(2), 242-275. https://doi.org/10.1093/hgs/dct025 5. Kim, S. Y., De Vries, R. G., & Peteet, J. R. (2016). Euthanasia and assisted suicide of patients with psychiatric disorders in the Netherlands 2011 to 2014. JAMA Psychiatry, 73(4), 362-368. https://doi.org/10.1001/jamapsychiatry.2015.2887 6. Naga, B. S. B., & Mrayyan, M. T. (2013). Legal and ethical issues of euthanasia: Argumentative essay. Middle East Journal of Nursing, 7(5), 31-39. https://doi.org/10.5742/MEJN.2013.75330 7. Nunes R., & Rego, G. (2016.) Euthanasia: A challenge to medical ethics. Journal of Clinical Research & Bioethics, 7(4), 1-5. https://doi.org/10.4172/2155-9627.1000282 8. Tomasini, F. (2014). Stoic defence of physician-assisted suicide. Acta Bioethica, 20(1), 99-108. Retrieved from https://scielo.conicyt.cl/pdf/abioeth/v20n1/art11.pdf

Table of content

Crafted with Care:

Nursing Essays!

Precision, Passion, & Professionalism in Every Page.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Ann Med Surg (Lond)
• v.75; 2022 Mar

Euthanasia and assisted suicide: An in-depth review of relevant historical aspects

Yelson alejandro picón-jaimes.

a Medical and Surgical Research Center, Future Surgeons Chapter, Colombian Surgery Association, Bogotá, Colombia

Ivan David Lozada-Martinez

b Grupo Prometheus y Biomedicina Aplicada a las Ciencias Clínicas, School of Medicine, Universidad de Cartagena, Cartagena, Colombia

Javier Esteban Orozco-Chinome

c Department of Medicine, RedSalud, Santiago de Chile, Chile

Lina María Montaña-Gómez

d Department of Medicine, Keralty Salud, Bogotá, Colombia

María Paz Bolaño-Romero

Luis rafael moscote-salazar.

e Colombian Clinical Research Group in Neurocritical Care, Latin American Council of Neurocritical Care, Bogotá, Colombia

Tariq Janjua

f Department of Intensive Care, Regions Hospital, Minnesota, USA

Sabrina Rahman

g Independent University, Dhaka, Bangladesh

End-of-life care is an increasingly relevant topic due to advances in biomedical research and the establishment of new disciplines in evidence-based medicine and bioethics. Euthanasia and assisted suicide are two terms widely discussed in medicine, which cause displeasure on many occasions and cause relief on others. The evolution of these terms and the events associated with their study have allowed the evaluation of cases that have established useful definitions for the legal regulation of palliative care and public policies in the different health systems. However, there are still many aspects to be elucidated and defined. Based on the above, this review aimed to compile relevant historical aspects on the evolution of euthanasia and assisted suicide, which will allow understanding the use and research of these terms.

• • The history of euthanasia and assisted suicide has been traumatic.
• • The church and research have been decisive in the definition of euthanasia.
• • The legal framework on the use of euthanasia and assisted suicide has been strengthened.

1. Introduction

Euthanasia and assisted suicide are two topics discussed throughout history, mainly because they fall within the scope of life as a human right, which has been universally defended for many years [ 1 ]. However, the mean of the word euthanasia as good death generates conflicts at social, moral, and ethical levels. Mainly because death is a loss, it is difficult to understand it as something positive and; additionally, several historical events such as the Nazi experiments related the term euthanasia more to murder than to a kind and compassionate act [ 1 ]. More current texts mention that euthanasia is the process in which, through the use or abstention of clinical measures, the death of a patient in an incurable or terminal condition can be hastened to avoid excessive suffering [ 2 ].

The difference between euthanasia and assisted suicide is that in the latter, the patient takes the final action; however, both practices can be combined in the term assisted death [ 2 ]. At present, several countries authorize assisted death, including Holland, Luxembourg, and Canada [ 3 ]. Belgium and Colombia have regulations that decriminalize only euthanasia; other places where assisted suicide is legal are Switzerland and five states of the United America states, specifically Oregon, Vermont, Washington, California, and Montana [ 2 , 3 ]. Spain recently joined the list of countries that have legislated on euthanasia through the organic law March 2021 of March 24 that regulates euthanasia in that state in both public and private institutions [ 4 ]. The fact that more and more countries were joining the legislation on euthanasia and assisted suicide has brought to light the opinion of thinkers, politicians, philosophers, and physicians. Several nations have initiated discussions on the matter in their governmental systems. Latin America is trying to advance powerfully in this medical-philosophical field. Currently, in Chile, the “Muerte digna y cuidados paliativos” law, which seeks to regulate the issue of euthanasia and assisted suicide in the country, is being debated in Congress [ 5 ].

It is essential to know the point of view of physicians on euthanasia and assisted suicide, especially taking into account that these professionals who provide care and accompany patients during this moment, which, if approved, would involve the medical community in both public and private health systems. Although it seems easy to think that physicians have a position in favor of the act of euthanasia because they are in direct and continuous contact with end-of-life situations, such as palliative care, terminally ill, and critically ill patients. It is important to remember that the Hippocratic medical oaths taken at the time of graduation of professionals are mostly categorical in mentioning the rejection of euthanasia and assisted suicide [ 6 ]. Furthermore, it is also important to note that many of the oldest universities in the Western world originated through the Catholic Church; and just this creed condemns the practice of euthanasia and continues to condemn it to this day. This situation generates that many medical students in these schools have behaviors based on humanist principles under the protection of faith and religion and therefore reject the possibility of euthanasia [ 7 , 8 ].

The relevance of the topic and the extensive discussion that it has had in recent months due to the COVID-19 pandemic added to the particular interest of bioethics in this topic and the need to know the point of view of doctors and other health professionals on euthanasia and assisted suicide.

2. Origin and meaning of the term euthanasia

The word euthanasia derives from the Greek word “eu” which means good, and the word “thanatos” which means death; therefore, the etymological meaning of this word is “good death”. Over time the evolution of the meaning has varied; even as we will see below was considered a form of eradication of people categorized under the designation of leading a less dignified life. Assisted suicide is a condition in which the patient is the one who carries out the action that ends his life through the ingestion of a lethal drug but has been dispensed in the context of health care and therefore called assisted. This care is provided by a physician trained in the area. However, it requires the prior coordination of a multidisciplinary team and even the assessment by an ethics committee to determine that the patient is exercising full autonomy, free from coercion by the situation he/she is living and free from the fatalistic desires of a psychiatric illness [ 9 ]. In a more literary sense, the word euthanasia meaning of “giving death to a person who freely requests it in order to free himself from suffering that is irreversible and that the person himself considers intolerable” [ 9 ].

Some authors go deeper into the definition and consider that for the meaning of euthanasia, are necessary to consider elements that are essential in the word itself; such as the fact that it is an act that seeks to provoke death and that carried out to eliminate the suffering in the person who is dying. Other elements with a secondary character in the definition are the patient's consent (which must be granted respecting autonomy and freedom in the positive and negative sense; that means the fact must be not be coerced in any way). Another element is the terminal nature of the disease, with an irreversible outcome that generates precariousness and a loss of dignity. The third secondary element is the absence of pain of the death through the use of drugs such as high-potency analgesics, including opioids, high-potency muscle relaxants, and even anesthetic drugs. Finally, the last element is the health context in which the action is performed (essential in some legislations to be considered euthanasia) [ 10 ]. According to the World Health Organization, the union of these two components is the current definition of euthanasia, which describes as “the action performed by a person to cause the painless death of another subject, or not preventing death in case of terminal illness or irreversible coma. Furthermore, with the explicit condition that the patient must be suffering physical, emotional, or spiritual and that affliction is uncontrollable with conventional measures such as medical treatments, analgesics, among others; then the objective of euthanasia is to alleviate this suffering” [ 11 ]. Unfortunately, the term euthanasia has been misused over the years, and other practices have been named with this word. An example of this situation occurred during the Nazi tyranny when the word euthanasia concerned the murder of people with disabilities, mental disorders, low social status, or gay people. At that time, euthanasia was even a simultaneous practice to the Jewish genocide [ 11 ].

Not only has the term been misused; also exists an enormous variability of terms to refer to euthanasia. For example, the laws created to regulate euthanasia have different names around the world; in the Netherlands (Holland), the law that regulates this practice is known as the law of termination of life; in Belgium, it is called euthanasia law, in France, it is called euthanasia law too. In Oregon (USA), it is called the death with dignity act; in California, it is the end of life option act. In Canada is called the medical assistance in dying act. Victoria (Australia) is the voluntary assisted dying bill, but all these denominations refer to the already well-known term euthanasia [ 11 ].

3. Evolution of euthanasia and assisted suicide: digging into historical events

To understand the evolution and relevance of these concepts should analyze the history of euthanasia and assisted suicide; from the emergence of the term, going through its first manifestations in antiquity; mentioning the conceptions of great thinkers such as Plato and Hippocrates; going through the role of the Catholic Church; mainly in the Middle Age, where following the thought of St. Thomas Aquinas, self-induced death or death contemplated by own will, was condemned. Later, with the renaissance age and the resurgence of science, technology, and the arts, the term euthanasia made a transition to a form similar to what we know today from thinkers such as Thomas More and Francis Bacon. Finally, the first signs of eugenics were known in London, Sweden, Germany, and the United States in the twentieth century. There was a relationship with the term euthanasia that was later used interchangeably, especially in the Nazi regime, to denote a form of systemic murder that sought to eradicate those who were not worthy of living a life.

Since the sixties, with emblematic cases, the path towards the decriminalization of euthanasia began in some countries, especially concerning the cessation of extreme support measures in cases of irreversible illness or a terminal condition. The practice has progressed to the appearance of laws on euthanasia in several countries.

4. Euthanasia and assisted suicide in ancient times

In book III of Plato's “The Republic”, the author stated that those who live their lives amidst illnesses and medicines or who were not physically healthy should be left to die; implying that it was thought that people in these conditions suffered so much that their quality of life diminished, which seemed understandable to these thinkers. However, other authors such as Hippocrates and his famous Hippocratic oath sought the protection of the patient's life through medicine, especially in vulnerable health conditions prone to fatal outcomes. This Hippocratic oath is the same oath that permeates our times and constitutes an argument among those who mark their position against euthanasia and assisted suicide [ 12 , 13 ].

Other texts that collect thoughts of Socrates and his disciple Plato point out that it was possible and well understood to think of ceasing to live in the face of a severe illness; to consider death to avoid a long and torturous agony. This fact is compatible with the conception of current euthanasia since this is the end of this health care procedure [ 13 ].

In The Republic, the text by Plato, the physician Heroditus is also condemned for inventing a way to prolong death and over manage the symptoms of serious illnesses, which is currently known as distanasia or excessive treatment prolongs life. This kind of excessive treatment prolongs the sick person's suffering, even leading him to maintain biological signs present but in a state of alienation and absolute dependence on medical equipment such as ventilators and artificial feeding [ 13 ]. However, the strongest indication that Euthanasic suicide was encouraged in Greece lies in other thinkers such as the Pythagoreans, Aristotelians, and Epicureans who strongly condemned this practice, which suggests that it was carried out repeatedly as a method and was therefore condemned by these thinkers [ 12 , 13 ]. According to stoicism, the pain that exceeded the limits of what was humanly bearable was one of the causes for which the wise man separates himself from life. Referring to one of the nuances that euthanasia touches today, that is, at a point of elevated suffering, the dignity and essence of the person are lost, persisting only the biological part but in the absence of the person's well-being as a being. In this sense, Lucius Seneca said that a person should not love life too much or hate it; but that person should have a middle ground and end their life when they ceased to perceive life as a good, worthy, and longed-for event [ 1 , 12 ].

During the Roman Empire and in the territories under its rule, it was believed that the terminally ill who commit suicide had sufficient reasons to do so; so since suicide caused by impatience and lack of resolution to pain or illness was accepted, when there was no access to medicines. In addition, there was little development in medicine during that time, and many of the sick died without treatment [ 12 ]. This situation changed later with the emergence of the Catholic church; in this age, who attempted against own life, was deprived of burial in the ground. Saint Augustine said that the suicide was an abominable and detestable act; from 693 AD, anyone who attempted against his physical integrity was excommunicated. Rejecting to the individuals and their lineage, depriving them of the possibility of attending the funeral and even expelled from cities and stripped of the properties they owned [ 12 , 13 ].

4.1. Euthanasia and assisted suicide in the Middle Age

During the Middle Age, Catholicism governed the sciences, arts, and medicine; the sciences fell asleep. Due to this solid religious tendency and the persistence of Augustinian thought, suicide was not well seen. It was not allowed to administer a lethal substance to a person to end the suffering of a severe or terminal illness [ 9 , 12 ]. People who took their own lives at this time could not be buried “Christianly”; therefore, they did not have access to a funeral, nor to the accompaniment of their family in a religious rite. Physical suffering and pain were then seen as a path to glorification. Suffering was extolled as the form that god purified the sin, similar to the suffering that Jesus endured during his Calvary days. However, a contrary situation was experienced in battles; a sort of short dagger-like weapon was often used to finish off badly wounded enemies and thus reduce their suffering, thus depriving them of the possibility of healing and was called “mercy killing” [ 12 ].

5. Euthanasia in renaissance

With the awakening of science and philosophy, ancient philosophers' thoughts took up again, giving priority to man, the world, and nature, thus promoting medical and scientific development. In their discourse, Thomas More and Francis Bacon refer to euthanasia; however, they give a eugenic sense to the concept of euthanasia, similar to that professed in the book of Plato's Republic. It is precise with these phylosophers that the term euthanasia got its current focus, referring to the acceleration of the death of a seriously ill person who has no possibility of recovery [ 12 ]. In other words, it was during this period that euthanasia acquired its current meaning, and death began to be considered the last act of life. Therefore, it was necessary to help the dying person with all available resources to achieve a dignified death without suffering, closing the cycle of life that ends with death [ 13 , 14 ].

In his work titled “Utopia”, Thomas More affirmed that in the ideal nation should be given the necessary and supportive care to the dying. Furthermore, in case of extraordinary suffering, it can be recommended to end the suffering, but only if the patient agrees, through deprivation of food or with the administration of a lethal drug; this procedure must be known to the affected person and with the due permission of authorities and priests [ 12 , 13 ]. Later, in the 17th century, the theologian Johann Andreae, in his utopia “Christianopolis”, contradicts the arguments of Bacon and Moro, defending the right of the seriously ill and incurably ill to continue living, even if they are disturbed and alienated, advocating for the care based on support and indulgence [ 15 , 16 ]. Similarly, many physicians rejected the concepts of Plato, Moro, and Bacon. Instead, they focused on opposing euthanasia, most notably in the nineteenth century. For example, the physician Christoph Hufeland mentioned that the doctor's job was only to preserve life, whether it was a fate or a misfortune, or whether it was worth living [ 16 ].

5.1. Euthanasia in the 20th century

Before considering the relevant aspects of euthanasia in the 20th century, it is vital to highlight the manuscript by Licata et al. [ 17 ], which narrates two episodes of euthanasia in the 19th century. The first one happened in Sicily (Italy) in 1860, during the battle of Calatafimi, where two soldiers were in constant suffering, one because he had a serious leg fracture with gangrene, and the other with a gunshot wound. The two soldiers begged to be allowed to die, and how they were in a precarious place without medical supplies, they gave them an opium pill, which calmed them until they died [ 17 ]. The second episode reported by Licata et al. [ 17 ] was witnessed by a Swedish doctor named Alex Munthe; who evidenced the pain of many patients in a Parisian hospital. So he decided to start administering morphine to help people who had been seriously injured by wolves and had a poor prognosis; therefore, the purpose of opioid use was analgesia while death was occurring.

It is also important to highlight the manuscript entitled “Euthanasia” by S. Williams published in 1873 in “Popular Science Monthly”, a journal that published texts by Darwin, Edison, Pasteur, and Beecher. This text included the report for the active euthanasia of seriously ill patients without a cure, in which the physicians were advised to administer chloroform to these patients or another anesthetic agent to reduce the level of consciousness of the subject and speed up their death in a painless manner [ 16 ].

Understanding that euthanasia was already reported in the nineteenth century, years after, specifically in 1900, the influence of eugenics, utilitarianism, social Darwinism, and the new currents of thought in England and Germany; it began in various parts around the world, projects that considered the active termination of life, thus giving rise to euthanasia societies in which there were discussions between philosophers, theologians, lawyers, and medical doctors. Those societies discussed diverse cases, such as the tuberculous patient Roland Gerkan, who was considered unfit and therefore a candidate to be released from the world [ 16 ]. The scarcity of resources, famine, and wars were reasons to promote euthanasia as a form of elimination of subjects considered weak or unfit, as argued in texts such as Ernst Haeckel's. However, opponents to the practice, such as Binding and Hoche, defended the principle of free will in 1920 [ 16 ].

5.2. Euthanasia in the time of the Nazis

As mentioned above, the term euthanasia was misused during this period; approximately 275,000 subjects (as reported at the Nuremberg International Military Tribunal 1945–1946), who had some degree of physical or mental disability, were killed during Adolf Hitler's Euthanasia program [ 13 ]. However, the Nazis were not the first to practice a form of eugenics under the name of euthanasia, since the early 1900s in London had already begun the sterilization of the rejected, such as the blind, deaf, mentally retarded, people with epilepsy, criminals, and rapists. This practice spread to different countries like Sweden and the United States [ 13 , 16 ].

For the Nazis, euthanasia represented the systematic murder of those whose lives were unworthy of living [ 13 ]. The name given to this doctrine was “Aktion T4”. At first and by law, from 1939, the hospitals were obliged to account for all disabled newborns, which led to the execution of more than 5000 newborns utilizing food deprivation or lethal injection [ 12 , 18 ].

A year before that law, in 1938, one of the first known cases of euthanasia in children arose in Germany. That history called the story of child K, in which it was the father of the minor who asked Hitler in writing for euthanasia for his son because the child had a severe mental disability and critical morphic disorders. Hitler gave his consent to carry out the procedure on child K, and thus the program began to spread throughout the Aleman territory. Since then, physicians and nurses had been in charge of reporting the newborns with alterations, arising the “Kinderfachabteilugen” for the internment of children who would be sentenced to death after a committee's decision [ 12 , 18 , 19 ]. A list of diseases and conditions that were considered undesirable to be transmitted to Hitler's superior Aryan race was determined; thus, any child with idiocy, mongolism, blindness, deafness, hydrocephalus, paralysis, and spinal, head, and hip malformations were eligible for euthanasia [ 19 ].

Subsequently, the program was extended to adults with chronic illness, so those people were selected and transported by T4 personnel to psychiatric sanatoriums strategically located far away. There, the ill patients received the injection of barbiturate overdoses, and carbon monoxide poisoning was tested as a method of elimination, surging the widely known gas chamber of the concentration camp extermination; this situation occurred before 1940 [ 12 , 19 ]. Again, physicians and nurses were the ones who designated to the patients to receive those procedures; in this case, these health professionals supported Nazi exterminations. They took the patients to the sanatoriums, where psychiatrists evaluated them and designated with red color if they should die and with a blue color if they were allowed to live (this form of selection was similar in children) [ 12 , 13 , 19 ]. In this case, the pathologies considered as criteria for death were those generating disability such as schizophrenia, paralysis, syphilis with sequelae, epilepsy, chorea, patients with chronic diseases with many recent treatments, subjects of non-German origin and individuals of mixed blood [ 19 ]. Once in the sanatoriums, they were informed that they would undergo a physical evaluation and take a shower to disinfect themselves; instead, they were killed in gas chambers [ 12 , 13 ]. Despite the church's action in 1941 against Nazis and after achieving suspension of the Aktion T4 project; the Nazi supporters kept the practices secretly, resuming them in 1942, with the difference that the victims were killed by lethal injection, by an overdose of drugs, or left to starve to death, instead of the use of gas chambers. This new modified form of euthanasia, which did not include gas chambers, became known as “savage euthanasia” [ 12 , 13 , 19 ].

5.3. Euthanasia since the 1960s

In September 1945, trials began for crimes perpetrated by Nazi supporters; the victorious Allied forces conducted these trials at the end of the war. During these tribunals, cases of human experimentation were identified and the public exposure of the Nazi euthanasia program. After the Nuremberg trials and the abolition of Nazi experiments, a series of seven documents emerged, among which the Nuremberg code containing the ten basic principles for human research stood out [ 20 , 21 ].

After these judgments, biotechnology was accelerated, with the apparition of new techniques to intervene in the health-disease process. Additionally, the increase in life expectancy and the appearance of diseases that chronically compromise the state of health of people generated a change in the conception of the critically ill patient and the terminal state of life [ 20 , 21 ]. Cases such as Karen Ann Quinlan brought to the forefront the issue of euthanasia and precisely the control of extreme treatment measures. Karen, a young American woman, was left in a vegetative state due to severe neurological damage following alcohol and barbiturate intoxication. After six months in that state and under the guardianship of a Catholic priest, Karen's parents requested the removal of the artificial respirator, arguing that in her state of consciousness prior to the incident, she had stated that she disagreed with artificially maintaining life in comatose patients. The hospital refused to remove the ventilator, arguing the legal issues for the date, and the parents went to court, which in the first instance granted the hospital the right. Nevertheless, the New Jersey Supreme Court granted Karen Ann's right to die in peace and dignity. Despite the withdrawal of the artificial respirator, he continued to live until 1985, when he finally died [ [21] , [22] , [23] ].

Another important case was Paul Brophy, which also occurred in the United States. Paul was a firefighter in Massachusetts and went into a deep coma due to the rupture of a basilar artery aneurysm; initially, his family advocated for support measures but later requested the hospital to disconnect these means to allow death, as Paul had indicated when he was still conscious. The hospital refused to carry out this procedure, so the family went to court, where the removal of the support measures (gastrostomy) was initially denied. Hence, the family went to the state supreme court, achieving the transfer of Paul to another medical center where the gastrostomy was removed, leading to his death within a few days [ 23 ].

The case of Arthur Koestler, an influential English writer and activist diagnosed with Parkinson's disease and later with leukemia, who served as vice-president of the voluntary euthanasia society (Exit) and wrote a manual book with practical advice for euthanasia called “Guide to Self-Liberation”. He stood out because he applied one of his advice and ingested an overdose of barbiturates, causing his self-death. According to his writings, Koestler was not afraid of death but of the painful process of dying [ 23 ]. In this sense, it was a relevant case because it involved someone who held an important position in an association that advocated euthanasia, in addition to being the author of several works, which made him a recognized public figure [ 23 ].

Baby Doe was a case that also occurred in the United States; it was a small child with Down syndrome who had a tracheoesophageal fistula and esophageal atresia; in this case, surgery was necessary. On the advice of the obstetrician, the parents did not allow surgery, so the hospital managers took the case before a judge who ruled that parents could decide to perform or not the surgery. The case was appealed before a county judge who upheld the parents' power to make the decision, in the course of which the case became public and many families offered to take care of the child; however, before the case reached the supreme court, the child died at six days of age [ 23 ].

In the case of Ingrid Frank, a German woman who was in a quadriplegic state by a traffic accident, who initially sought rehabilitation but later insisted on being allowed to die; it was provided with a drink containing a cyanide solution that she drank. At the same time, she was filmed, which shows a kind of assisted suicide. For that reason, this is another case that deals with this issue and is important to know as background in the development of euthanasia and assisted suicide [ 22 , 23 ].

6. Current and future perspectives

The definition of brain death, the rational use of the concept of euthanasia and assisted suicide, and scientific literacy are the objectives of global bioethics to regulate euthanasia and assisted suicide, which can be accessible in all health systems [ [24] , [25] , [26] , [27] , [28] , [29] , [30] ]. End-of-life care will continue to be a subject of debate due to the struggle between biomedical principles, the different existing legal frameworks, and the general population's beliefs. Medical education and preparation in the perception of death, especially of a dignified death, seems to be the pillar of the understanding of the need to develop medical-legal tools that guarantee the integrity of humans until the end of their existence [ 31 , 32 ]. This is the reason why the new generations of physicians must be trained in bioethics to face these ethical conflicts during the development of their professional careers.

In addition, although the conception of bioethics belongs to the Western world, it is crucial to take into account the point of view of other cultures and creeds, for example, a study carried out in Turkey, where nursing students were questioned, found that many of them understood the reasons for performing euthanasia; however, they know that Islam prohibits it, as well as its legislation, and therefore they would not participate in this type of procedure [ 33 ]. Furthermore, Christianism and Islam prohibit euthanasia, but Judaism also prohibits it; in general, the so-called Abrahamic religions are contrary to any form of assisted death, whether it is active euthanasia, passive, or assisted suicide [ 34 ].

7. Conclusiones

The history and evolution of euthanasia and assisted suicide have been traumatic throughout human history. The church, politics, and biomedical research have been decisive in defining these concepts. Over the years, the legal framework and bioethical concepts on euthanasia have been strengthened. However, there is still much work to educate the general population and health professionals about end-of-life care and dignified death.

It is also important to remember that life is a concept that goes beyond biology. Currently, bioethics seeks to prioritize the concept of dignity, which must be linked to the very definition of life. Although the phrase is often heard that it is not necessary to move to be alive, what is important is that person feels worthy even if they have limited movement. The person's treatment must be individualized in bioethics since each individual is a unique unit. Therefore, medical paternalism must be abandoned. Instead, the subject must be more involved to understand their context and perception of life and dignity.

Ethical approval

It is not necessary.

Sources of funding for your research

Author contribution.

All authors equally contributed to the analysis and writing of the manuscript.

Provenance and peer review

Not commissioned, externally peer reviewed.

Research registration Unique Identifying number (UIN)

• 1. Name of the registry: Not applicable.
• 2. Unique Identifying number or registration ID: Not applicable.
• 3. Hyperlink to your specific registration (must be publicly accessible and will be checked): Not applicable.

Sabrina Rahman. Independent University, Dhaka, Bangladesh. [email protected] .

Declaration of interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

• Share full article

Advertisement

Supported by

Vatican Document Casts Gender Change and Fluidity as Threat to Human Dignity

The statement is likely to be embraced by conservatives and stir consternation among L.G.B.T.Q. advocates who fear it will be used as a cudgel against transgender people.

By Jason Horowitz and Elisabetta Povoledo

Reporting from Rome

The Vatican on Monday issued a new document approved by Pope Francis stating that the church believes that gender fluidity and transition surgery, as well as surrogacy, amount to affronts to human dignity.

The sex a person is assigned at birth, the document argued, was an “irrevocable gift” from God and “any sex-change intervention, as a rule, risks threatening the unique dignity the person has received from the moment of conception.” People who desire “a personal self-determination, as gender theory prescribes,” risk succumbing “to the age-old temptation to make oneself God.”

Regarding surrogacy, the document unequivocally stated the Roman Catholic Church’s opposition, whether the woman carrying a baby “is coerced into it or chooses to subject herself to it freely.” Surrogacy makes the child “a mere means subservient to the arbitrary gain or desire of others,” the Vatican said in the document, which also opposed in vitro fertilization.

The document was intended as a broad statement of the church’s view on human dignity, including the exploitation of the poor, migrants, women and vulnerable people. The Vatican acknowledged that it was touching on difficult issues, but said that in a time of great tumult, it was essential, and it hoped beneficial, for the church to restate its teachings on the centrality of human dignity.

Even if the church’s teachings on culture war issues that Francis has largely avoided are not necessarily new, their consolidation now was likely to be embraced by conservatives for their hard line against liberal ideas on gender and surrogacy.

The document, five years in the making, immediately generated deep consternation among advocates for L.G.B.T.Q. rights in the church, who fear it will be used against transgender people. That was so, they said, even as the document warned of “unjust discrimination” in countries where transgender people are imprisoned or face aggression, violence and sometimes death.

“The Vatican is again supporting and propagating ideas that lead to real physical harm to transgender, nonbinary and other L.G.B.T.Q.+ people,” said Francis DeBernardo, the executive director of New Ways Ministry, a Maryland-based group that advocates for gay Catholics, adding that the Vatican’s defense of human dignity excluded “the segment of the human population who are transgender, nonbinary or gender nonconforming.”

He said it presented an outdated theology based on physical appearance alone and was blind to “the growing reality that a person’s gender includes the psychological, social and spiritual aspects naturally present in their lives.”

The document, he said, showed a “stunning lack of awareness of the actual lives of transgender and nonbinary people.” Its authors ignored the transgender people who shared their experiences with the church, Mr. DeBernardo said, “cavalierly,” and incorrectly, dismissing them as a purely Western phenomenon.

Though the document is a clear setback for L.G.B.T.Q. people and their supporters, the Vatican took pains to strike a balance between protecting personal human dignity and clearly stating church teaching, a tightrope Francis has tried to walk in his more than 11 years as pope.

Francis has made it a hallmark of his papacy to meet with gay and transgender Catholics and has made it his mission to broadcast a message for a more open, and less judgmental, church. Just months ago, Francis upset more conservative corners of his church by explicitly allowing L.G.B.T.Q. Catholics to receive blessings from priests and by allowing transgender people to be baptized and act as godparents .

But he has refused to budge on the church rules and doctrine that many gay and transgender Catholics feel have alienated them, revealing the limits of his push for inclusivity.

“In terms of pastoral consequences,” Cardinal Víctor Manuel Fernández, who leads the Vatican’s office on doctrine, said in a news conference Monday, “the principle of welcoming all is clear in the words of Pope Francis.”

Francis, he said, has repeatedly said that “all, all, all” must be welcomed. “Even those who don’t agree with what the church teaches and who make different choices from those that the church says in its doctrine, must be welcomed,” he said, including “those who think differently on these themes of sexuality.”

But Francis’ words were one thing, and church doctrine another, Cardinal Fernández made clear, drawing a distinction between the document, which he said was of high doctrinal importance, as opposed to the recent statement allowing blessings for same-sex Catholics. The church teaches that “homosexual acts are intrinsically disordered.”

In an echo of the tension between the substance of church law and Francis’ style of a papal inclusivity, Cardinal Fernández said on Monday that perhaps the “intrinsically disordered” language should be modified to better reflect that the church’s message that homosexual acts could not produce life.

“It’s a very strong expression and it requires explanation,” he said. “Maybe we could find an expression that is even clearer to understand what we want to say.”

Though receptive to gay and transgender followers, the pope has also consistently expressed concern about what he calls “ideological colonization,” the notion that wealthy nations arrogantly impose views — whether on gender or surrogacy — on people and religious traditions that do not necessarily agree with them. The document said “gender theory plays a central role” in that vision and that its “scientific coherence is the subject of considerable debate among experts.”

Using “on the one hand” and “on the other hand,” language, the Vatican’s office on teaching and doctrine wrote that “it should be denounced as contrary to human dignity the fact that, in some places, not a few people are imprisoned, tortured, and even deprived of the good of life solely because of their sexual orientation.”

“At the same time,” it continued, “the church highlights the definite critical issues present in gender theory.”

On Monday, Cardinal Fernández also struggled to reconcile the two seemingly dissonant views.

“I am shocked having read a text from some Catholics who said, ‘Bless this military government of our country that created these laws against homosexuals,’” Cardinal Fernández said on Monday. “I wanted to die reading that.”

But he went on to say that the Vatican document was itself not a call for decriminalization, but an affirmation of what the church believed. “We shall see the consequences,” he said, adding that the church would then see how to respond.

In his presentation, Cardinal Fernández described the long process of the drafting of a document on human dignity, “Infinite Dignity,” which began in March 2019, to take into account the “latest developments on the subject in academia and the ambivalent ways in which the concept is understood today.”

In 2023, Francis sent the document back with instructions to “highlight topics closely connected to the theme of dignity, such as poverty, the situation of migrants, violence against women, human trafficking, war, and other themes.” Francis signed off on the document on March 25.

The long road, Cardinal Fernández wrote, “reflects the gravity” of the process.

In the document, the Vatican embraced the “clear progress in understanding human dignity,” pointing to the “desire to eradicate racism, slavery, and the marginalization of women, children, the sick, and people with disabilities.”

But it said the church also sees “grave violations of that dignity,” including abortion, euthanasia, the death penalty, polygamy, torture, the exploitation of the poor and migrants, human trafficking and sex abuse, violence against women, capitalism’s inequality and terrorism.

The document expressed concern that eliminating sexual differences would undercut the family, and that a response “to what are at times understandable aspirations,” will become an absolute truth and ideology, and change how children are raised.

The document argued that changing sex put individualism before nature and that human dignity as a subject was often hijacked to “justify an arbitrary proliferation of new rights,” as if “the ability to express and realize every individual preference or subjective desire should be guaranteed.”

Cardinal Fernández on Monday said that a couple desperate to have a child should turn to adoption, rather than surrogacy or in vitro fertilization because those practices, he said, eroded human dignity writ large.

Individualistic thinking, the document argues, subjugates the universality of dignity to individual standards, concerned with “psycho-physical well-being” or “individual arbitrariness or social recognition.” By making dignity subjective, the Vatican argues, it becomes subject to “arbitrariness and power interests.”

Jason Horowitz is the Rome bureau chief for The Times, covering Italy, the Vatican, Greece and other parts of Southern Europe. More about Jason Horowitz

Elisabetta Povoledo is a reporter based in Rome, covering Italy, the Vatican and the culture of the region. She has been a journalist for 35 years. More about Elisabetta Povoledo