Euthanasia is the act of causing or permitting the death of someone who may be suffering from an incurable or terminal illness, often as a way to end the suffering of that individual. In its oldest and most general sense, the word euthanasia simply means “good, or gentle, death.” The term is sometimes synonymous with suicide, mercy killing, death with dignity, physician-assisted suicide (PAS), and physician-aided dying (PAD).
The act of mercy killing has been practiced in human cultures throughout history. The issue is discussed in the writings of several early Greek philosophers, who considered it to be morally acceptable. Soon after the fall of Rome, however, the rise of the Christian church and its sway over civil law rendered mercy killing immoral and illegal. The practice is known to have been carried out in secret, right up to modern times.
The term euthanasia made its first appearance in the writings of seventeenth- and eighteenth-century English scholars. It was not until 1935, however, when the Voluntary Euthanasia Society was formed in Britain, that anyone thought to challenge laws forbidding euthanasia. Although as many as half the population at the time supported some form of PAS, attempts to legalize the practice invariably failed.
During World War II (1939–1945), Nazi dictator Adolf Hitler (1889–1945) signed a decree authorizing physicians throughout Germany to “euthanize” tens of thousands of mentally and physically disabled children and adults. As part of his program to racially cleanse the German population, it was the first step that would ultimately lead to the death of millions of Jews, Romani (Gypsies), Catholics, and gay people. Following the war, revelations about the scope and devastation of the program would have a profound impact on public opinion regarding euthanasia.
As medical technology advanced in the 1940s, so did the means by which the sick and dying could be kept alive. Instead of dying at home, more people were being treated—and dying—in hospitals. A strict interpretation of the Hippocratic Oath often meant that doctors would attempt to maintain a person’s life for as long as physically possible, even if it went against the wishes of their patients or their patients’ families.
In 1975, a New Jersey woman named Karen Ann Quinlan was admitted to a hospital for a drug and alcohol overdose. She had slipped into a coma, a persistent vegetative state in which the woman’s brain had been damaged beyond repair. Knowing that she might never regain consciousness, Quinlan’s parents asked the hospital to remove her from life support, but the hospital refused. A year and several court hearings later, the parents finally won their battle to have her removed from life support, although Quinlan continued to live in a vegetative state for another ten years before dying of pneumonia in 1986.
Also in 1975, British journalist Derek Humphry (1930–) agreed to help his own wife, who endured terrible pain from an incurable form of cancer, end her suffering by giving her a fatal dose of medication obtained from an unnamed physician. After publishing a book about the affair, authorities investigated but chose not to prosecute Humphry. He later moved to the United States where he formed the Hemlock Society to promote public tolerance for the right to die by terminally ill patients.
By the 1980s, and with the beginning of the AIDS epidemic, public opinion began to shift, and the discussion soon included not only the right to die by removal of life support or other life-sustaining treatments, but also the right of physicians to actively assist in a person’s death. In 1986, the American Medical Association withdrew its opposition to the removal of life support for patients in a persistent vegetative state. In 1990, Janet Adkins, an Oregon woman diagnosed with Alzheimer’s disease, took her own life with the assistance of a retired Michigan pathologist named Jack Kevorkian (1928–2011). Kevorkian later claimed to have helped as many as 150 others take their own lives. It was, in his words, a doctor’s duty to help the terminally ill carry out their own wish to die.
In 2014, the issue over the right to die garnered media attention in the United States when a young woman named Brittany Maynard began a campaign to legalize PAS in the United States. The woman, who was suffering from incurable brain cancer, had to move to Oregon to fulfill her wish to die. At the time, Oregon was one of the only states that legalized PAS. Maynard wanted to see PAS as an option for all Americans. Maynard died on November 1, 2014, after taking drugs prescribed from her doctor. After her death, her family partnered with organizations to continue Maynard’s fight to legalize PAS in all fifty US states.
Types of Euthanasia
As it pertains to patients with incurable diseases, or who are terminally ill, euthanasia can be voluntary, non-voluntary, or involuntary. Voluntary euthanasia is performed at the explicit request of the patient or by advance directive, such as a “Do Not Resuscitate” (DNR) order or a living will. Non-voluntary euthanasia is performed when patients cannot make their wishes known such as a patient in a coma. Involuntary euthanasia is performed without a patient’s consent or directive. This is sometimes performed in cases where the person asks to live, but it is known that he or she will die anyway. An example of involuntary euthanasia is when a soldier who has had been severely injured in combat is shot by another solider because he or she knows the injured soldier will not survive the injury. The debate over euthanasia is mostly about the ethics of allowing an individual to voluntarily choose death and the legal status of those who choose to assist in the process.
Euthanasia also can be categorized as passive or active. Passive euthanasia involves the removal of life-support systems used to sustain a patient’s life or the withholding of a treatment that might prolong the life of a patient. Active euthanasia requires that a doctor or other third party, at the request of the patient, directly administer a lethal dose of a drug to the patient. Alternatively, the doctor may simply provide the drugs and/or apparatus to the patient, allowing the patient to self-administer the lethal dose. This was the method used by Kevorkian, who named his device the Mercitron, in the 1990s.
Although many oppose euthanasia in any form, the debate over passive euthanasia has become less heated since several court rulings have recognized the rights of patients to refuse medical treatment. However, debate still exits over whether other active forms of euthanasia, such as PAS, should be made legal.
For many, the question of whether it is right to take the life of another person, no matter what the circumstances, is unambiguous. The Christian moral tradition, as well as that of other religions, expressly prohibits killing another human being. The sixth commandment, “Thou shalt not kill,” trumps all other considerations. Opposed to this view is the notion that individuals should have the right to choose for themselves the treatment they receive toward the end of life. This idea was part of a larger shift in attitudes during the 1960s and 1970s as the civil rights movement gathered steam. People were growing wary of the medical establishment; suspicions about the motives of doctors and the institutions they served undermined the public trust.
For many, the end to suffering is the most important consideration. Advocates for PAS argue that a life of pain and suffering is no life at all, and the only compassionate course of action is to give those patients the chance to end their suffering and choose when and where to spend their final days.
However, since euthanasia is about making the choice of whether, and when, to die, opponents argue that it is a choice too easily abused or misused. Patients who may be suffering from temporary depression, are mentally unstable, or are simply unable to cope with the conditions of their illness may not be in the best position to make a life or death decision. Further, they argue that active, voluntary euthanasia opens the door to abuse when, for example, a doctor sidesteps the normal safeguards or readily accedes to a patient’s wishes before all the facts about his or her condition or prognosis are known. PAS, in which the patient is required to administer the lethal dose of drugs themselves, is more widely accepted, although opponents of euthanasia find it just as morally reprehensible as the direct, active form. Also it is unclear if PAS is less prone to the same sorts of abuse.
In the United States, Oregon became the first US state to legalize PAS in 1997 by enacting its Death with Dignity Act. Right-to-die advocates have attempted to overturn state bans on assisted suicide on constitutional grounds. In 1997, the US Supreme Court ruled that the constitution does not guarantee an individual’s right to euthanasia and that states are free to enact their own laws governing the issue. Other states, including Washington, Vermont, and California followed suit. In Montana, physicians can prescribe lethal drugs to terminally ill patients. As of 2019, eight states and Washington DC had legalized PAS.
Around the world, voluntary euthanasia is legal in Colombia, the Netherlands, Belgium, Luxembourg, and Canada, as of 2016. PAS is legal in Canada, the Netherlands, Luxembourg, and Switzerland. However, there are many laws and regulations surrounding the right to die in these countries and the debate continues about euthanasia and whether it should be legal.