euthanasia

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The act or practice of ending the life of an individual suffering from a terminal illness or an incurable condition, as by lethal injection or the suspension of extraordinary medical treatment.

[Greek euthanasiā, a good death : eu-, eu- + thanatos, death.]

The ideals of bodily incorruptibility and immortality have been envisaged in many cultures and religions: Christianity, for instance, holds that, had man not sinned and been expelled from Paradise, there would have been no disease and death. In truth, mortality has been the great, omnipresent mystery — beyond man's powers and in the hands of the gods or fate. Hence man has tried to tame death.

On the one hand, there have been efforts to prolong life with a view to creating quasi-eternal existence on earth. With the alchemy of the Middle Ages, partly borrowed from the Arabs, an ambitious quest for the prolongation of life entered Western culture. The thirteenth-century cleric Roger Bacon claimed that Christian medicine would surpass pagan science by the conquest of senescence. Francis Bacon and the later philosophers of the Enlightenment expressed confidence that the advancement of science would produce the indefinite prolongation of life.

On the other hand, there has been the ambition of mastering death, not by preventing it, but by controlling its timing, means, and manner. Within traditional Christian culture, a good death (as prescribed by the ars moriendi — the art of dying well) was a Christian death; departing in a state of grace, denouncing Satan, praying to God, repenting one's sins, and (for Roman Catholics) receiving the sacraments.

Increasingly, from the eighteenth century, the good death became a rather more secularized concept, and within that framework euthanasia assumed relevance. In its original meaning, however, ‘euthanasia’ referred to any means for securing an ‘easy’ death; for example, by leading a temperate life or by cultivating an acceptance of mortality. The Discorsi della vita sobria (Discourses on the Temperate Life) of Luigi Cornaro (c.1463-1566!), written in his eighties and frequently consulted into the eighteenth century, featured both an easy (or holy) terminus in advanced years and the prospect of longer life — up to 120 years — through the pursuit of moderation in food, drink, and lifestyle.

Francis Bacon praised prolongevity as the ‘most noble’ purpose of medicine. He also argued that relief of suffering was a desideratum in terminal care, and that the physician may sometimes hasten death. The Enlightenment brought intense interest in prolongevity. Benjamin Franklin boldly declared senescence to be not a natural process but a ‘disease’ to be cured, and he predicted that longevity might stretch to a thousand years or more. The Marquis Condorcet and William Godwin speculated about virtually immortal life.

But ‘euthanasia’ increasingly came to connote measures taken by the physician, including the possibility of hastening death to prevent pain or suffering. At the same time, the idea of dying well was secularized. The traditional good death scenario — calling upon God and renouncing Satan — gave way to an emphasis upon a quiet and peaceful death. Tranquil death, it was argued, should be like sleep. A peaceful death betokened a serene conscience, a life well lived. It squared with Romantic notions of the beauty of death, particularly in those who died young. Thus, in the new idea of euthanasia emerging in the nineteenth century, it was the duty of the doctor to ensure a peaceful death, by careful management, and judicious application of opiates to dull pain and induce coma. At the wishes of family or patient, the family doctor was doubtless the frequent agent of informal (and illegal) euthanasia in the nineteenth and twentieth century.

Any trend there had been towards the informal acceptance of euthanasia was rendered more problematic in recent times. The Nazis introduced legal euthanasia, approved by doctors, for selected people such as the severely mentally disabled, on the grounds that they had a life which was not worth living. The later extension to persons considered simply undesirable — Jews, Gypsies, and homosexuals — perverted euthanasia to supremely evil purposes. The Nazi ‘final solution’ has created suspicion that any broader acceptance, practice, or legalization of euthanasia would be the thin end of the wedge that in due course would lead to (possibly compulsory) public euthanasia programmes for problematic or costly people, especially the very old, the poor, and the demented.

In addition, death now increasingly occurs in public institutions, notably hospitals and hospices. This may make humane euthanasia more difficult, as physicians and nursing staff involved in such practices may be justifiably afraid that they thereby risk exposure and legal prosecution. Those liable to promote such exposure are established religious groups, including Roman Catholics, Orthodox Jews and pressure groups such as ‘Life’. They fundamentally disapprove of mercy killing on religious grounds, and may believe that suffering is God's will and that God alone should determine when life ends.

Yet the conditions of modern death and recent developments in medicine are also increasing advocacy and desire for euthanasia. Life-saving and life-supporting technologies now make it possible to interrupt and extend the natural dying process. Resuscitation or antibiotics may defer death, and life may be sustained by ventilators or tube feeding when there is no prospect of recovery. It has become widely accepted that withholding or withdrawing treatment in such circumstances — for example for those with advanced cancer or paralysis, or in a permanent vegetative state — is good medical practice and also legal. At the same time developments in palliative care aim to ease the pain and distress of the conscious dying person by the judicious use of drugs. Such drugs may hasten death, but provided the intention is to control symptoms this is accepted morally and legally by the doctrine of double effect. Whilst these humane approaches — non-treatment decisions, and drugs for symptom control — are generally accepted, there remains acute controversy about the deliberate administration of lethal doses of drugs or other measures to ensure death, whether as active euthanasia, or ‘physician-assisted suicide’.

Euthanasia may be squared with the professional ethics of the physician and with normal morality through the argument that, while it is the doctor's duty to save life, that duty does not run so far as to prolong life through artificial means in all circumstances.

Changes in opinion, public policy, and medical practice have been most marked in the Netherlands, where since 1984 the national medical association has accepted medical euthanasia, under strictly controlled circumstances. Although this remained unlawful until 2001, there were no prosecutions provided that doctors abided by strict guidelines based on a patient's valid request. By 1995 a survey suggested that active euthanasia (a physician humanely intervening to end a terminally-ill patient's life at the request of that patient) was taking place in around 1.8% of all deaths. (In some 87% of such cases, the patient was expected to be able to live, or to be kept alive, only for a further month.) Public acceptance of this practice had been facilitated by the development of ‘living wills’. Since 1994 in the Netherlands, physicians have been legally obliged to honour ‘living wills’ — a measure welcomed by the medical profession as it absolves them of legal problems. Acceptance of euthanasia seems equally widespread amongst religious and non-religious Dutch people, though members of the Dutch Reformed (Calvinist) Church still tend to be distrustful of the practice. Such practices have met with a much more divided reception elsewhere. In Britain, where euthanasia remains illegal, the pressure group Exit has been subject to prosecution, as has the controversial American pathologist, Dr Jack Kevorkian, who has advocated and participated in doctor-assisted suicide at the patient's request.

The advance of modern medicine presents deep dilemmas. If a patient is in a permanent coma, should life support measures be employed? And should a patient near death from both painful cancer and debilitating heart disease be resuscitated? No easy answers are available to any such questions, which set the sanctity of human life against the question of personal autonomy, and raise fundamental legal and moral questions as to the ownership of the body.

— Roy Porter, Bryan Jennett

Bibliography

• Baruch, A. B. (ed.) (1989). Suicide and euthanasia: historical and contemporary themes. Kluwer, Dordrecht.
• British Medical Association (2001). Withholding and withdrawing life-prolonging medical treatment: guidance for decision making. 2nd ed BMJ Books, London

See also death; eugenics; suicide; vegetative state.

Deliberately bringing about the death of a person who is suffering from an incurable disease or condition; also called mercy killing. Active euthanasia is illegal in most jurisdictions; passive euthanasia, or the withholding of some life support systems, has legal standing in some jurisdictions.

Life‐and‐death medical decisions—and, in particular, decisions that lead inexorably to death—have been at issue in three Supreme Court cases since 1990. Washington v. Glucksberg (1997) and Vacco v. Quill (1997) rejected claims that terminally ill, competent patients had a constitutional right to the assistance of a physician in ending their lives. The plaintiffs were challenging state laws that barred doctors from prescribing lethal doses of medication for such patients. In the third case, Cruzan v. Director, Missouri Department of Health (1990), a patient was maintained on life support machinery in a persistent vegetative state and was incompetent to make decisions about her own treatment. The Court held that the state could prohibit the withdrawal of life support, absent “clear and convincing” evidence that this patient, if competent, would have decided to terminate treatment.

For some justices, constitutional liberty protects a person's right to make life's most important, intimate decisions free from state interference. Decisions about the timing of one's death, like decisions about contraception and abortion, would qualify. For other justices, liberty does not extend that far. These justices tend to identify liberty with traditional American legal practice—and the right to die hardly qualifies as a traditional legal right.

The Court does recognize a constitutional right of patients to refuse life‐prolonging treatment, under some circumstances at least. A majority of the justices, however, regard this right as an aspect of the traditional prerogative of persons to refuse unwanted bodily intrusions, including unwanted medical treatments—and not as part of an independent constitutional “right to die” or as a justifiable constitutional inference from the importance and intimacy of life‐and‐death decisions. Justices who take this position may hold nonetheless that a state cannot bar doctors from prescribing high doses of pain medication—even lethal doses, if necessary—to patients enduring severe and otherwise unmanageable pain.

Bibliography

• Ronald Dworkin, Life's Dominion: An Argument About Abortion, Euthanasia, and Individual Freedom (1993).
• Albert R. Jonsen, The Birth of Bioethics (1998).
• Leon R. Kass, Life, Liberty and the Defense of Dignity: The Challenge for Bioethics (2002).
• Cass R. Sunstein, One Case At a Time: Judicial Minimalism on the Supreme Court (1999)

— Sheldon Gelman

For more information on euthanasia, visit Britannica.com.

As a practice that involves the intentional taking of life, euthanasia is contrary to basic Buddhist ethical teachings because it violates the first of the Five Precepts (pañca-śīla). It is also contrary to the more general moral principle of ahiṃsā. This conclusion applies to both the active and passive forms of the practice, even when accompanied by a compassionate motivation with the end of avoiding suffering. The term ‘euthanasia’ has no direct equivalent in canonical Buddhist languages. Euthanasia as an ethical issue is not explicitly discussed in canonical or commentarial sources, and no clear cases of euthanasia are reported. However, there are canonical cases of suicide and attempted suicide which have a bearing on the issue. One concerns the monastic precept against taking life, the third of the four pārājika-dharmas, which was introduced by the Buddha when a group of monks became disenchanted with life and began to kill themselves, some dying by their own hand and others with the aid of an intermediary. The Buddha intervened to prevent this, thus apparently introducing a prohibition on voluntary euthanasia. In other situations where monks in great pain contemplated suicide they are encouraged to turn their thoughts away from this and to use their experience as a means to developing insight into the nature of suffering and impermanence (anitya).

Euthanasia, Greek for "good death," refers to the termination of the life of a person suffering from a painful and incurable medical condition. Also known as "mercy killing," euthanasia is distinguished from suicide by the necessary participation of a third party, typically either a physician or family member.

Twenty-first-century disputes over euthanasia are often seen as a by product of advances in biomedical technology capable of prolonging a person's life indefinitely. Indeed, the moral and legal aspects of euthanasia are extremely complicated, as experts distinguish between active and passive euthanasia as well as voluntary and involuntary euthanasia. Additional issues include the definition of a "terminal" illness and whether pain, an intractable disease, or both, are required to make the practice morally acceptable.

Such complexity has led to a variety of legal positions worldwide. The United States officially forbids euthanasia, while some European countries, such as Switzerland, Germany, Poland, and Norway, are more lenient, allowing for a variety of mitigating circumstances and reduced criminal penalties. In 1993 the Netherlands passed a law prescribing guidelines for medically assisted suicide; Uruguay has exempted mercy killing from criminal prosecution since 1933. To help untangle these issues and better understand euthanasia, this article will consider the history of euthanasia, the "right to die" movement, and physician-assisted suicide within an American social and legal context.

Mercy Killing

Mercy killing, practiced since antiquity, has been debated throughout history. Ancient Greek, Indian, and Asian texts describe infanticide as an acceptable solution for children physically unsuited for or incapable of living. In Plato's Phaedo, when Socrates drinks hemlock, a poison, he maintains his dignity in death, an action immortalized in the modern pro-euthanasia organization, the Hemlock Society.

While many other Greeks, including Aristotle and the Stoics, sanctioned euthanasia, most early Christian thinkers condemned the practice. Both Saint Augustine and Saint Thomas Aquinas prohibited active euthanasia and suicide on the grounds that it was an affront to the sanctity of life and usurped the divine right of life and death. They did, however, permit passive euthanasia—the discontinuation of life-saving treatments—even though death would then be imminent. In the seventeenth and eighteenth centuries European thinkers went even farther, as Francis Bacon, David Hume, and Immanuel Kant considered both active and passive euthanasia morally acceptable.

However, early American laws specifically forbade assisted suicide; New York enacted statutes against the practice in 1828, and both the Field Penal Code (1877) for the Dakota Territory and later the Model Penal Code followed suit. Yet the polio epidemics of the 1920s and 1930s tested these legal codes, as many protested the potential for dependence on the new Drinker tanks or "iron lungs." By the end of the decade proponents of mercy killing sought legal protection, establishing the Euthanasia Society of America in 1938 to promote the practice as well as legislation. Similar organizations formed in Great Britain and Germany, although revelations of indiscriminate and inhumane Nazi practices ultimately led to the condemnation of the movement by the Roman Catholic Church following World War II and helped defeat legislation in Connecticut (1959), Idaho (1969), Oregon (1973), and Montana (1973).

"right to Die"

Debate over euthanasia resurfaced in the 1970s amid growing concern over individual rights, the Karen Ann Quinlan case, and the "right to die" movement. In 1975 Quinlan, a twenty-one-year-old who had accidentally overdosed on barbiturates, alcohol, and valium, slipped into a coma, and was kept alive by a respirator and other medical apparatus. The "sleeping beauty" case captivated the nation, as the public debated who was responsible for the decision to maintain or disconnect the machines and the indignity of being kept alive by medical technology.

Ultimately, Quinlan's case helped redefine "brain death" and the legal framework for voluntary and involuntary decision making. The New Jersey Supreme Court ruled in 1976 that, given her "irreversible condition" and the right to privacy guaranteed by the Constitution, her family, the appropriate surrogates, could remove her from life support. The court's approval of passive euthanasia fueled the "right to die" movement; by 1977 thirty-eight legislatures had submitted over fifty bills to enact legislation expanding the power of attorney and sanctioning living wills, precursors to "do not resuscitate" orders. At the same time, the American Medical Association renewed its opposition to euthanasia, arguing that passive euthanasia—the removal of life support—is ethically acceptable only in "terminal" cases where "extraordinary procedures" are required to maintain life in a manner inconvenient and inefficient for the patient. Remarkably, Quinlan lived in a vegetative state unassisted until 1985, by which time a "right of refusal" was generally accepted, supported by the due process clause of the Constitution giving individuals the right to make decisions free from unreasonable governmental interference.

By the 1990s, advocates of euthanasia such as the Hemlock Society (established 1980) campaigned for physician-assisted suicide or active euthanasia, reviving the debate over the limits of an individual's "right to die." Proponents argued that a painless injection or combination of drugs was far more humane than disconnecting a feeding tube and allowing the person to starve. Physicians, however, were caught in an ethical dilemma, given the Hippocratic Oath to do no harm, relieve suffering, and prolong life. For patients with intractable disease and consistent pain, the goals of relieving suffering and prolonging life are inherently contradictory. If the physician acts to end the suffering through assisted suicide, he or she violates the creed to do no harm and prolong life; if the physician refuses to act, suffering is prolonged rather than assuaged.

Physician-Assisted Suicide

Physicians, like the public, were divided over the morality of assisted suicide. The state of Washington failed to pass a "right to die" voter initiative in 1991, as did California the following year. However, in 1994, Oregon passed Measure 16, a"Death with Dignity Act" drafted by attorney Cheryl K. Smith, former legal counsel for the Hemlock Society. The act allowed physicians to prescribe and dispense, but not administer, the necessary lethal drugs. Remarkably, the bold new legislation was soon overshadowed by the figure of Dr. Jack Kevorkian, who quickly became a political lightning-rod for the "right to die" movement.

A retired pathologist, Dr. Kevorkian, or "Dr. Death" to his detractors, made headlines in the 1990s by assisting over 130 people to commit suicide. The author of Prescription: Medicide, Dr. Kevorkian made his reputation challenging a 1993 Michigan law prohibiting physician-assisted suicide. Backed by the American Civil Liberties Union, Kevorkian argued that the law, which had been expressly written to outlaw his practice of active euthanasia, denied individuals the right to choose how and when they died. However, Kevorkian's legal stance suffered when it was revealed that many of his patients' diseases were not terminal and were unverified. Unrepentant, the seventy-year-old physician continued his practice until a Michigan court sentenced him in 1999 to ten to twenty-five years in prison for the second-degree murder of Thomas Youk, a patient with Lou Gehrig's disease. Ultimately, Kevorkian's arrogance proved to be his downfall; the airing of Youk's suicide on the television program 60 Minutes infuriated the court, as did his participation in another assisted suicide while released on bail.

Proponents of active euthanasia received another series of setbacks in the late 1990s as the courts, supported by a broad coalition inflamed by rumors of pressure and a lack of consent in assisted suicides in Oregon, moved to derail the movement. Although the details of Oregon's euthanasia practice remain private, fears that assisted suicide was used to reduce health care costs and that patients were pressured to accept lethal drugs rather than treatment solidified an anti-euthanasia coalition of hospice organizations, medical associations, religious organizations, and pro-life groups. In 1997 the United States Supreme Court unanimously refused to issue an assisted-suicide Roe v. Wade decision in the case of Washington v. Glucksberg. Chief Justice William Rehnquist stated that assisted suicide posed substantial harm for individuals already at risk because of their age, poverty, or lack of access to quality medical care. Months later, the Florida Supreme Court refused to consider assisted suicide a right under the privacy statute of the Florida Constitution, and a bill legalizing the practice foundered in the Maine legislature the following year.

In the early 2000s the debate over physician-assisted suicide remained contested at the state level. The Supreme Court's decision in Washington v. Glucksberg remanded the decision on active euthanasia to the state courts because the justices argued that each state had the right to protect its residents and thus a federal decision was inappropriate. Indeed, the Court's position in Washington is similar to one taken in an earlier ruling on passive euthanasia. In Cruzan v. Director, Missouri Department of Health (1990), the Supreme Court held that a state could forbid termination of treatment in the absence of "clear and convincing evidence" of the patient's own wishes. While this gave individual states the freedom to determine appropriate standards for involuntary passive euthanasia, a majority of states adhered to the precedents set by the Quinlan case in making their determination. Advocates of physician-assisted suicide hoped that responsible practices in Oregon and the Netherlands would persuade their opponents, and they downplayed the economic arguments for active euthanasia amid a social climate decrying HMO (health maintenance organization) cost-cutting operations.

Bibliography

Doudera, A. Edward, and J. Douglas Peters, eds. Legal and Ethical Aspects of Treating Critically and Terminally Ill Patients. Ann Arbor, Mich.: AUPHA, 1982.

Humphry, Derek. Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying. Eugene, Ore.: Hemlock Society, 1991.

President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Deciding to Forego Life-Sustaining Treatment: A Report on the Ethical, Medical, and Legal Issues in Treatment Decisions. Washington, D.C.: U.S. Government Printing Office, 1983.

Schneiderman, Lawrence J., and Nancy S. Jecker. Wrong Medicine: Doctors, Patients, and Futile Treatment. Baltimore: Johns Hopkins University Press, 1995.

Weir, Robert F. Abating Treatment with Critically Ill Patients: Ethical and Legal Limits to the Medical Prolongation of Life. New York: Oxford University Press, 1989.

—J. G. Whitesides

-Greek: easy death. The act or practice of painlessly terminating the life of a person or animal. As applied to animals, it is sometimes referred to as "humane disposal." N.J.S.A. 45: 16-14. As applied to persons, it is accepted in some cultures but in the United States it may be treated as criminal, subjecting those responsible to prosecution under the homicide statutes. Two types of euthanasia exist.

active euthanasia refers to the act of putting to death. Also known as "mercy killing," it involves the termination of life as painlessly as possible such as by an injection of lethal medications. Courts are struggling with this area of law which is also known as "assisted suicide." For the rights of the terminally ill, see 95 Uniform Laws Annotated 609 (1987).

passive euthanasia involves withholding artificial life support, such as breathing or feeding tubes. It is often called the "right to die."

An exception to prosecution has been developed in some jurisdictions in which the termination of the life of an incurably ill patient is no longer treated as criminal if done by a guardian or immediate family member after consultation with an ethics committee of a hospital, and if accomplished by the negative means of withdrawing life-support systems or extraordinary medical care rather than by some affirmative act. 355 A. 2d 647. See also brain death.

Painlessly putting someone to death — usually someone with an incurable and painful disease; mercy killing.

1. an easy or painless death.
2. the deliberate ending of life of an animal suffering from an incurable disease; called also mercy killing, to put down, to put to sleep.
For the individual animal intravenous injection of a massive dose of barbiturate is best. Any narcotizing drug creates difficulties if the carcass is to be disposed of for pet meat. In those cases shooting with a bullet or captive bolt pistol is recommended because of the speed of the despatch. For large numbers of animals at a pound or shelter, injection procedures are still superior to the bulk methods which all have the fallibility of poorly managed and supervised machinery. Carbon monoxide is very fast but dangerous to the operators of the cabinet. Electrocution cannot be performed en masse and gassing with carbon monoxide or lowering of the atmospheric pressure are not really quick enough. Small laboratory animals are still despatched by a sharp blow to the head and birds by guillotine or separation of the cervical vertebrae.

• electrical e. — uses mains electrical current passed through the subject's body via clips applied to the skin of the ear and the tail. Not much employed because of danger to human operators, likelihood of equipment failure and need for close contact with device.

For mercy killings performed on animals, see Animal euthanasia.

Suicide

History

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Views

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Related phenomena

Ideation · Self-harm · Suicide note

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Euthanasia (from the Greek ευθανασία meaning "good death": ευ-, eu- (well or good) + θάνατος, thanatos (death)) refers to the practice of ending a life in a painless manner. Many different forms of euthanasia can be distinguished, including animal euthanasia and human euthanasia, and within the latter, voluntary and involuntary euthanasia. Voluntary euthanasia and physician-assisted suicide have been the focus of great controversy in recent years.

As of 2009, some forms of active euthanasia are legal in Belgium,^[1] Luxembourg,^[2] The Netherlands,^[1] Switzerland,^[1] Thailand,^[3] and the U.S. states of Oregon^[4] and Washington.^[5]

Contents 1 Classification of euthanasia 1.1 Euthanasia by consent 1.2 Euthanasia by means 1.3 Assisted suicide 1.4 Other terminology 2 History 2.1 Modern history 2.1.1 Nazi Germany 2.2 Post-War history 2.2.1 Australia 2.2.2 Europe 2.2.3 United States 2.2.4 China and Hong Kong 3 Arguments for and against voluntary euthanasia 3.1 Reasons given for voluntary euthanasia 3.2 Reasons given against voluntary euthanasia 4 Euthanasia and the Law 5 Euthanasia and religion 5.1 Buddhism 5.2 Christianity 5.2.1 Catholicism 5.2.2 Protestantism 5.3 Hinduism 5.4 Islam 5.5 Jainism 5.6 Judaism 5.7 The Samurai tradition 5.8 Shinto 6 Euthanasia protocol 7 Euthanasia in the arts 8 See also 9 References 9.1 Bibliography 9.1.1 Neutral 9.1.2 Viewpoints 9.2 Notes 10 External links

Classification of euthanasia

Euthanasia by consent

Euthanasia may be conducted with consent (voluntary euthanasia) or without consent (involuntary euthanasia). Involuntary euthanasia is conducted where an individual makes a decision for another person incapable of doing so. The decision can be made based on what the incapacitated individual would have wanted, or it could be made on substituted judgment of what the decision maker would want were he or she in the incapacitated person's place, or finally, the decision could be made by assessing objectively whether euthanasia is the most beneficial course of treatment. In any case, euthanasia by proxy consent is highly controversial, especially because multiple proxies may claim the authority to decide for the patient and may or may not have explicit consent from the patient to make that decision.^[6]

Euthanasia by means

Euthanasia may be conducted passively, non-actively, and actively. Passive euthanasia entails the withholding of common treatments (such as antibiotics, chemotherapy in cancer, or surgery) or the distribution of a medication (such as morphine) to relieve pain, knowing that it may also result in death (principle of double effect). Passive euthanasia is the most accepted form, and it is a common practice in most hospitals. Non-active euthanasia entails the withdrawing of life support and is more controversial. Active euthanasia entails the use of lethal substances or forces to kill and is the most controversial means. An individual may use a euthanasia machine to perform euthanasia on himself / herself.

Assisted suicide

Main article: Assisted suicide

Assisted suicide is a form of euthanasia where the patient actively takes the last step in their death. The term "assisted suicide" is contrasted with "active euthanasia" when the difference between providing the means and actively administering lethal medicine is considered important^[7]. For example, Swiss law on assisted suicide allows assisted suicide, while all forms of active euthanasia (like lethal injection) remain prohibited.

Some jurisdictions declare that a person dying as a result of physician assisted suicide does not commit suicide. This ensures that terminally ill people choosing assisted suicide options do not have reduced insurance claims compared to people dying in "natural" way. For example, the Oregon Death with Dignity Act defines that "... participation under the Act is not suicide, so should not affect insurance benefits by that definition."^[8]

Other terminology

A coup de grâce is a "death blow" given to end the misery of a dying enemy or friend, or that precipitates the final destruction of an entity such as a ship or business.

Voluntary refusal of food and fluids (VRFF) or Patient Refusal of Nutrition and Hydration (PRNH) is bordering on euthanasia. Some authors classify it as a form of passive euthanasia,^[9] while others treat it separately because it is treated differently from legal point of view and often perceived as a more ethical option^[10]. VRFF is sometimes suggested as a legal alternative to euthanasia in jurisdictions disallowing euthanasia.^{[citation needed]}

Animal euthanasia is to kill an animal without pain or distress."^[11] Techniques to accomplish this include cervical dislocation (breaking the spine) and exsanguination (fatal blood loss).^[11]

History

The term euthanasia comes from the Greek words "eu"-meaning good and "thanatos"-meaning death, which combined means “well-death” or "dying well". Hippocrates mentions euthanasia in the Hippocratic Oath, which was written between 400 and 300 B.C. The original Oath states: “To please no one will I prescribe a deadly drug nor give advice which may cause his death.”^[12] Despite this, the ancient Greeks and Romans generally did not believe that life needed to be preserved at any cost and were, in consequence, tolerant of suicide in cases where no relief could be offered to the dying or, in the case of the Stoics and Epicureans, where a person no longer cared for his life.^[6][13]

English Common Law from the 1300s until the middle of the last century made suicide a criminal act in England and Wales. Assisting others to kill themselves remains illegal in that jurisdiction. However, in the 1500s, Thomas More, in describing a utopian community, envisaged such a community as one that would facilitate the death of those whose lives had become burdensome as a result of "torturing and lingering pain".^[6][14]

Modern history

Since the 19th Century, euthanasia has sparked intermittent debates and activism in North America and Europe. According to medical historian Ezekiel Emanuel, it was the availability of anesthesia that ushered in the modern era of euthanasia. In 1828, the first known anti-euthanasia law in the United States was passed in the state of New York, with many other localities and states following suit over a period of several years.^[15] After the Civil War, voluntary euthanasia was promoted by advocates, including some doctors.^[16] Support peaked around the turn of the century in the US and then grew again in the 1930s.

In an article in the Bulletin of the History of Medicine, Brown University historian Jacob M. Appel documented extensive political debate over legislation to legalize physician-assisted suicide in both Iowa and Ohio in 1906.^[17] Appel indicates social activist Anna S. Hall was the driving force behind this movement.^[17] Leading public figures, including Clarence Darrow and Jack London, advocated for the legalization of euthanasia.^[18]

Euthanasia societies^[which?] were formed in England in 1935 and in the USA in 1938 to promote euthanasia. Although euthanasia legislation did not pass in the USA or England, in 1937, doctor-assisted euthanasia was declared legal in Switzerland as long as the doctor ending the life had nothing to gain.^[12][19] During this same era, US courts tackled cases involving critically ill people who requested physician assistance in dying as well as “mercy killings”, such as by parents of their severely disabled children.^{[citation needed]}

Nazi Germany

"Of course, I had always known that the use of the term 'euthanasia' by the Nazi killers was a euphemism to camouflage their murder of human beings they had designated as 'life unworthy of life'; that their aim was not to shorten the lives of persons with painful terminal diseases but to kill human beings they considered inferior, who could otherwise have lived for many years."

— The Origins of Nazi Genocide: From Euthanasia to the Final Solution, Henry Friedlander, UNC Press, 1997

Prior to and during World War II, Nazi Germany conducted a euphemistically^[20] named "euthanasia program",^[21] code-named Action T4. This program was based on eugenics and grounded in the view that the state is responsible for providing racial hygiene.^[22][23][24] Even though this program was referred to as an "euthanasia program", the Nazi German use of the term euthanasia differs from the common current view and use of the term.^[24][25]

Further information: Action T4 and euthanasia

Post-War history

In the Western sphere, judges were often lenient in mercy-killing cases despite continuing religious opposition.^[26] During the post-war period, prominent proponents of euthanasia included Glanville Williams (The Sanctity of Life and the Criminal Law) and clergyman Joseph Fletcher ("Morals and medicine"). By the 1960s, advocacy for a right-to-die approach to voluntary euthanasia increased.

Australia

In 1995, the world's first euthanasia legislation, the Rights of the Terminally Ill Act 1995, was passed in the Northern Territory of Australia.^[27] Four patients died under the Act, using a euthanasia device designed by Dr Philip Nitschke. The legislation was overturned in 1997 by Australia’s Federal Parliament in 1997.^[6][12][19] In response to the overturning of the Act, Dr Nitschke founded EXIT International.

Europe

In 1957 in Britain, Judge Devlin ruled in the trial of Dr John Bodkin Adams that causing death through the administration of lethal drugs to a patient, if the intention is solely to alleviate pain, is not considered murder even if death is a potential or even likely outcome.^[28] In 1993, the Netherlands decriminalized doctor-assisted suicide, and in 2002, restrictions were loosened. During that year, physician-assisted suicide was approved in Belgium. Belgium's at the time most famous author Hugo Claus, suffering from Alzheimer's disease, was among those that asked for euthanasia. He died in March 2008, assisted by an Antwerp doctor.

United States

A key turning point in the debate over voluntary euthanasia (and physician assisted dying), at least in the United States, was the public furor over the case of Karen Ann Quinlan. The Quinlan case paved the way for legal protection of voluntary passive euthanasia.^[29] In 1977, California legalized living wills and other states soon followed suit.

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

In 1990, Dr. Jack Kevorkian, a Michigan physician, became infamous for encouraging and assisting people in committing suicide which resulted in a Michigan law against the practice in 1992. Kevorkian was tried and convicted in 1999 for a murder displayed on television.^[12][19] Also in 1990, the Supreme Court approved the use of non-active euthanasia.^[30]

In 1994, Oregon voters approved the Death with Dignity Act, permitting doctors to assist terminal patients with six months or less to live to end their lives. The U.S. Supreme Court allowed such laws in 1997.^[6] The Bush administration failed in its attempt to use drug law to stop Oregon in 2001, in the case Gonzales v. Oregon.^[19] In 1999, non-active euthanasia was permitted in Texas.^{[citation needed]}

Most recently, amid U.S. government roadblocks and controversy in the Terri Schiavo case, where a Floridian who was in a vegetative state since 1990, had her feeding tube removed in 2005. Her husband had won the right to take her off life support, which he claimed she would want but was difficult to confirm as she had no living will and the rest of her family claimed otherwise.^[19]

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

China and Hong Kong

While active euthanasia remains illegal in China, it is gaining increasing acceptance among doctors and the general populace.^[31]

In Hong Kong, support for euthanasia among the general public is higher among those who put less importance on religious belief, those who are non-Christian, those who have higher family incomes, those who have more experience in taking care of terminally ill family members, and those who are older.^[32]

Arguments for and against voluntary euthanasia

Since World War II, the debate over euthanasia in Western countries has centered on voluntary euthanasia (VE) within regulated health care systems. In some cases, judicial decisions, legislation, and regulations have made VE an explicit option for patients and their guardians.^[33] Proponents and critics of such VE policies offer the following reasons for and against official voluntary euthanasia policies:

Reasons given for voluntary euthanasia

• Choice: Proponents of VE emphasize that choice is a fundamental principle for liberal democracies and free market systems.^[6]
• Quality of Life: The pain and suffering a person feels during a disease, even with pain relievers, can be incomprehensible to a person who has not gone through it. Even without considering the physical pain, it is often difficult for patients to overcome the emotional pain of losing their independence. ^[6]
• Economic costs and human resources: Today in many countries there is a shortage of hospital space. The energy of doctors and hospital beds could be used for people whose lives could be saved instead of continuing the life of those who want to die which increases the general quality of care and shortens hospital waiting lists. It is a burden to keep people alive past the point they can contribute to society, especially if the resources used could be spent on a curable ailment.^[34]

Reasons given against voluntary euthanasia

• Professional role: Critics argue that voluntary euthanasia could unduly compromise the professional roles of health care employees, especially doctors. They point out that European physicians of previous centuries traditionally swore some variation of the Hippocratic Oath, which in its ancient form excluded euthanasia: "To please no one will I prescribe a deadly drug nor give advice which may cause his death.." However, since the 1970s, this oath has largely fallen out of use.
• Moral/Theological: Some people, incluidng many Christians, consider euthanasia of some or all types to be morally unacceptable.^[6] This view usually treats euthanasia to be a type of murder and voluntary euthanasia as a type of suicide, the morality of which is the subject of active debate.
• Necessity: If there is some reason to believe the cause of a patient's illness or suffering is or will soon be curable, the correct action is sometimes considered to attempt to bring about a cure or engage in palliative care.^[6]
• Feasibility of implementation: Euthanasia can only be considered "voluntary" if a patient is mentally competent to make the decision, i.e., has a rational understanding of options and consequences. Competence can be difficult to determine or even define.^[6]
• Consent under pressure: Given the economic grounds for voluntary euthanasia (VE), critics of VE are concerned that patients may experience psychological pressure to consent to voluntary euthanasia rather than be a financial burden on their families. ^[35] Even where health costs are mostly covered by public money, as in various European countries, VE critics are concerned that hospital personnel would have an economic incentive to advise or pressure people toward euthanasia consent.^[36]

Euthanasia and the Law

Main article: Euthanasia and the law

During the 20th Century, efforts to change government policies on euthanasia have met limited success in Western countries. Country policies are described here in alphabetical order, followed by the exceptional case of The Netherlands. Euthanasia policies have also been developed by a variety of NGOs, most notably medical associations and advocacy organizations.

Euthanasia and religion

Buddhism

There are many different views among Buddhists on the issue of euthanasia. Here are a few:

In Theravada Buddhism a lay person daily recites the simple formula: "I undertake the precept to abstain from destroying living beings."^[37] For Buddhist monastics (bhikkhu) however the rules are more explicitly spelled out. For example, in the monastic code (Patimokkha), it states:

"Should any bhikkhu intentionally deprive a human being of life, or search for an assassin for him, or praise the advantages of death, or incite him to die (thus): 'My good man, what use is this wretched, miserable life to you? Death would be better for you than life,' or with such an idea in mind, such a purpose in mind, should in various ways praise the advantages of death or incite him to die, he also is defeated and no longer in communion."^[38]

In other words, such a monk or nun would be expelled irrevocably from the Buddhist monastic community (sangha).^[39] The prohibition against assisting another in their death includes circumstances when a monastic is caring for the terminally ill and extends to a prohibition against a monastic's purposively hastening another's death through word, action or treatment.^[38]

American Buddhist monk Thanissaro Bhikkhu wrote:

Thus, from the Buddha's perspective, encouraging a sick person to relax her grip on life or to give up the will to live would not count as an act of compassion. Instead of trying to ease the patient's transition to death, the Buddha focused on easing his or her insight into suffering and its end.^[40]

The Dalai Lama was cited by the Agence-France Presse in a 18 September 1996 article entitled "Dalai Lama Backs Euthanasia in Exceptional Circumstances" regarding his position on legal euthanasia:

Asked his view on euthanasia, the Dalai Lama said Buddhists believed every life was precious and none more so than human life, adding: 'I think it's better to avoid it.'

'But at the same time I think with abortion, (which) Buddhism considers an act of killing ... the Buddhist way is to judge the right and wrong or the pros and cons.'

He cited the case of a person in a coma with no possibility of recovery or a woman whose pregnancy threatened her life or that of the child or both where the harm caused by not taking action might be greater.

"These are, I think from the Buddhist viewpoint, exceptional cases," he said. "So it's best to be judged on a case by case basis."

Christianity

Catholicism

Catholic teaching condemns euthanasia as a "crime against life".^[41] The teaching of the Catholic Church on euthanasia rests on several core principles of Catholic ethics, including the sanctity of human life, the dignity of the human person, concomitant human rights, due proportionality in casuistic remedies, the unavoidability of death, and the importance of charity.^[42] The Church's official position is the 1980 Declaration on Euthanasia issued by the Sacred Congregation for the Doctrine of the Faith.^[42]

In Catholic medical ethics official pronouncements strongly oppose active euthanasia, whether voluntary or not^[43], while allowing dying to proceed without medical interventions that would be considered "extraordinary" or "disproportionate." The Declaration on Euthanasia states that:

"When inevitable death is imminent... it is permitted in conscience to take the decision to refuse forms of treatment that would only secure a precarious and burdensome prolongation of life, so long as the normal care due to a sick person in similar cases is not interrupted."

The Declaration concludes that doctors, beyond providing medical skill, must above all provide patients "with the comfort of boundless kindness and heartfelt charity".

Although the Declaration allows people to decline heroic medical treatment when death is imminently inevitable, it unequivocably prohibits the hastening of death and restates Vatican II's condemnation of "crimes against life 'such as any type of murder, genocide, abortion, euthanasia, or willful suicide'". ^[41]

So due to its principle of double effect, Roman Catholic moral theology does leave room for shortening life with pain-killers and what could be characterized as passive euthanasia.^{[citation needed][44]}

Protestantism

Protestant denominations vary widely on their approach to euthanasia and physician assisted death. Since the 1970s, Evangelical churches have worked with Roman Catholics on a sanctity of life approach, though some Evangelicals may be adopting a more exceptionless opposition. While liberal Protestant denominations have largely eschewed euthanasia, many individual advocates (e.g., Joseph Fletcher) and euthanasia society activists have been Protestant clergy and laity. As physician assisted dying has obtained greater legal support, some liberal Protestant denominations have offered religious arguments and support for limited forms of euthanasia.

Hinduism

There are two Hindu points of view on euthanasia. By helping to end a painful life a person is performing a good deed and so fulfilling their moral obligations. On the other hand, by helping to end a life, even one filled with suffering, a person is disturbing the timing of the cycle of death and rebirth. This is a bad thing to do, and those involved in the euthanasia will take on the remaining karma of the patient. However, the same argument suggests that keeping a person artificially alive on a life-support machines would also be a bad thing to do.^[45]

Islam

Islam categorically forbids all forms of suicide and any action that may help another to kill themselves.^{[46] [47]} It is forbidden for a Muslim to plan, or come to know through self-will, the time of his own death in advance^[48]. The precedent for this comes from the Islamic prophet Muhammad having refused to bless the body of a person who had committed suicide. If an individual is suffering from a terminal illness, it is permissible for the individual to refuse medication and/or resuscitation. Other examples include individuals suffering from kidney failure who refuse dialysis treatments and cancer patients who refuse chemotherapy.

Jainism

Mavavira Varadhmana explicitly allows a sharavak (follower of Jainism) full consent to put an end to his or her life if the sharavak feels that such a stage is near that moksha can be achieved this way. Liberation from the cycles of lives being the primary objective in the religion.^{[citation needed]}

Judaism

Like the trend among Protestants, Jewish medical ethics have become divided, partly on denominational lines, over euthanasia and end of life treatment since the 1970s. Generally, Jewish thinkers oppose voluntary euthanasia, often vigorously,^[49] though there is some backing for voluntary passive euthanasia in limited circumstances.^[50] Likewise, within the Conservative Judaism movement, there has been increasing support for passive euthanasia (PAD)^[51] In Reform Judaism responsa, the preponderance of anti-euthanasia sentiment has shifted in recent years to increasing support for certain passive euthanasia (PAD) options.^{[citation needed]}

The Samurai tradition

The samurai ritual of seppuku is analogous to euthanasia, in that an assistant would behead the suicide after the suicide had fatally stabbed themselves in order to bring death swiftly and reduce the time the suicide was in pain. It was thus a form of voluntary euthanasia, or mercy killing. In line with Buddhist thinking, the seppuku ritual laid great emphasis on the suicide having a peaceful mind during the action.^[52]

Shinto

In Japan, where the dominant religion is Shinto, 69% of the religious organisations agree with the act of voluntary passive euthanasia.^[53] The corresponding figure was 75% when the family asked for it. In Shinto, the prolongation of life using artificial means is a disgraceful act against life.^[53] Views on active euthanasia are mixed, with 25% Shinto and Buddhist organisations in Japan supporting voluntary active euthanasia.

Euthanasia protocol

See also: Lethal injection#Euthanasia protocol

A euthanasia device invented by Dr Philip Nitschke that facilitated euthanasia through heavy doses of drugs. The laptop screen led the user through a series of steps and questions to ensure he or she was fully prepared. The machine in a museum.

Euthanasia can be accomplished either through an oral, intravenous, or intramuscular administration of drugs, or by oxygen deprivation (anoxia), as in some euthanasia machines. In individuals who are incapable of swallowing lethal doses of medication, an intravenous route is preferred. The following is a Dutch protocol for parenteral (intravenous) administration to obtain euthanasia:

Intravenous administration is the most reliable and rapid way to accomplish euthanasia. A coma is first induced by intravenous administration of 20 mg/kg sodium thiopental (Nesdonal) in a small volume (10 ml physiological saline). Then a triple intravenous dose of a non-depolarizing neuromuscular muscle relaxant is given, such as 20 mg pancuronium bromide (Pavulon) or 20 mg vecuronium bromide (Norcuron). The muscle relaxant should preferably be given intravenously, in order to ensure optimal availability. Only for pancuronium bromide (Pavulon) are there substantial indications that the agent may also be given intramuscularly in a dosage of 40 mg.^[54]

With regards to nonvoluntary euthanasia, the cases where the person could consent but was not asked are often viewed differently from those where the person could not consent. Some people raise issues regarding stereotypes of disability that can lead to non-disabled or less disabled people overestimating the person's suffering, or assuming it to be unchangeable when it could be changed. For example, many disability rights advocates responded to Tracy Latimer's murder by pointing out that her parents had refused a hip surgery that could have greatly reduced or eliminated the physical pain Tracy experienced. Also, they point out that a severely disabled person need not be in emotional pain at their situation, and claim that the emotional pain, if present, is due to societal prejudice rather than the disability, analogous to a person of a particular ethnicity wanting to die because they have internalized negative stereotypes about their ethnic background. Another example of this is Keith McCormick, a New Zealander Paralympian who was "mercy-killed" by his caregiver, and Matthew Sutton.^[55][56]

With regards to voluntary euthanasia, many people argue that 'equal access' should apply to access to suicide as well, so therefore disabled people who cannot kill themselves should have access to voluntary euthanasia.

Euthanasia in the arts

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

The films Children of Men and Soylent Green, as well as the book The Giver, depict instances of government-sponsored euthanasia in order to strengthen their dystopian themes. The protagonist of Johnny Got His Gun is a brutally mutilated war veteran whose request for euthanasia furthers the work's anti-war message.

The recent films Mar Adentro and Million Dollar Baby argue more directly in favor of euthanasia by illustrating the suffering of their protagonists. These films have provoked debate and controversy in their home countries of Spain and the United States respectively.

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

See also

• Action T4 - Nazi Germany's program to kill disabled people, euphemistically called "euthanasia"
• Arthur Koestler, author, vice-president of EXIT (now the Voluntary Euthanasia Society).
• Bertrand Dawson, 1st Viscount Dawson of Penn - physician to George V, to whom he gave a lethal injection.
• Chantal Sébire
• George Exoo
• Derek Humphry - President of the World Federation of Right to Die Societies.
• Diane Pretty
• Dignitas (euthanasia group in Switzerland)
• Dr. Death (book by Jonathon Kellerman)
• Euthanasia machine, a DIY option for individuals
• Euthanasia: Opposing Viewpoints (2000), listing key sources in an anthology
• Final Exit (book)
• Futile medical care
• International Task Force on Euthanasia and Assisted Suicide
• Jack Kevorkian
• John Bodkin Adams, Eastbourne, England doctor, tried for murder in 1957 but claimed euthanasia. Acquitted.
• Kaishakunin - Assists in the Japanese ritual seppuku (suicide)
• Karen Ann Quinlan and Terri Schiavo case - Cases of persistent vegetative state
• Killick Millard - Founder of the Voluntary Euthanasia Legalisation Society in Great Britain
• Peter Singer - bioethicist, utilitarian
• Philip Nitschke
• Principle of double effect
• Senicide
• Terminal sedation
• Terry Wallis
• Voluntary Active Euthanasia

References

Bibliography

Neutral

• Battin, Margaret P., Rhodes, Rosamond, and Silvers, Anita, eds. Physician assisted suicide: expanding the debate. NY: Routledge, 1998.

• Emanuel, Ezekiel J. 2004. "The history of euthanasia debates in the United States and Britain" in Death and dying: a reader, edited by T. A. Shannon. Lanham, MD: Rowman & Littlefield Publishers.

• Dennis J. Horan, David Mall, eds. (1977). Death, dying, and euthanasia. Frederick, MD: University Publications of America. ISBN 0-89093-139-9. 

• Kopelman, Loretta M., deVille, Kenneth A., eds. Physician-assisted suicide: What are the issues? Dordrecht: Kluwer Academic Publishers, 2001. (E.g., Engelhardt on secular bioethics)

• Magnusson, Roger S. “The sanctity of life and the right to die: social and jurisprudential aspects of the euthanasia debate in Australia and the United States” in Pacific Rim Law & Policy Journal (6:1), January 1997.

• Palmer, “Dr. Adams’ Trial for Murder” in The Criminal Law Review. (Reporting on R. v. Adams with Devlin J. at 375f.) 365-377, 1957.

• Paterson, Craig, "A History of Ideas Concerning Suicide, Assisted Suicide and Euthanasia" (2005). Available at SSRN: http://ssrn.com/abstract=1029229

• PCSEPMBBR, United States. President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. 1983. Deciding to forego life-sustaining treatment: a report on the ethical, medical, and legal issues in treatment decisions. Washington, DC: President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research: For sale by the Supt. of Docs. U.S. G.P.O.

• Robertson, John. 1977. Involuntary euthanasia of defective newborns: a legal analysis. In Death, dying, and euthanasia, edited by D. J. Horan and D. Mall. Washington: University Publications of America. Original edition, Stanford Law Review 27 (1975) 213-269.

• Stone, T. Howard, and Winslade, William J. “Physician-assisted suicide and euthanasia in the United States” in Journal of Legal Medicine (16:481-507), December 1995.

Viewpoints

• Giorgio Agamben; translated by Daniel Heller-Roazen (1998). Homo sacer: sovereign power and bare life. Stanford, Calif: Stanford University Press. ISBN 0-8047-3218-3. 

• Raphael Cohen-Almagor (2001). The right to die with dignity: an argument in ethics, medicine, and law. New Brunswick, N.J: Rutgers University Press. ISBN 0-8135-2986-7. 

• Appel, Jacob. 2007. A Suicide Right for the Mentally Ill? A Swiss Case Opens a New Debate. Hastings Center Report, Vol. 37, No. 3.

• Dworkin, R. M. Life's Dominion: An Argument About Abortion, Euthanasia, and Individual Freedom. New York: Knopf, 1993.

• Fletcher, Joseph F. 1954. Morals and medicine; the moral problems of: the patient's right to know the truth, contraception, artificial insemination, sterilization, euthanasia. Princeton, N.J.K.: Princeton University Press.

• Derek Humphry, Ann Wickett (1986). The right to die: understanding euthanasia. San Francisco: Harper & Row. ISBN 0-06-015578-7. 

• Kamisar, Yale. 1977. Some non-religious views against proposed 'mercy-killing' legislation. In Death, dying, and euthanasia, edited by D. J. Horan and D. Mall. Washington: University Publications of America. Original edition, Minnesota Law Review 42:6 (May 1958).

• Kelly, Gerald. “The duty of using artificial means of preserving life” in Theological Studies (11:203-220), 1950.

• Panicola, Michael. 2004. Catholic teaching on prolonging life: setting the record straight. In Death and dying: a reader, edited by T. A. Shannon. Lanham, MD: Rowman & Littlefield Publishers.

• Paterson, Craig. Assisted Suicide and Euthanasia: An Natural Law Ethics Approach. Aldershot, Hampshire: Ashgate, 2008.

• Rachels, James. The End of Life: Euthanasia and Morality. New York: Oxford University Press, 1986.

• Sacred congregation for the doctrine of the faith. 1980. The declaration on euthanasia. Vatican City: The Vatican.

• Tassano, Fabian. The Power of Life or Death: Medical Coercion and the Euthanasia Debate. Foreword by Thomas Szasz, MD. London: Duckworth, 1995. Oxford: Oxford Forum, 1999.

Notes

1. ^ ^{a b c} Euthanasia and the law
2. ^ Luxembourg says 'yes' to euthanasia
3. ^ พระราชบัญญัติสุขภาพแห่งชาติ พ.ศ. 2550. (2550, 19 มีนาคม). ราชกิจจานุเบกษา, (เล่ม 124, ตอนที่ 16 ก).
4. ^ Oregon’s Death with Dignity law and Euthanasia in the Netherlands: Factual Disputes
5. ^ See Washington Initiative 1000, which passed on 4 November 2008.
6. ^ ^{a b c d e f g h i j} http://plato.stanford.edu/entries/euthanasia-voluntary/ An overview of voluntary euthanasia
7. ^ http://www.springerlink.com/content/n0a66j00l1mnnlju/ Assisted suicide bordering on active euthanasia, International Journal of Legal Medicine, Volume 117, Number 2 / April, 2003
8. ^ "FAQs about Death with Dignity". www.oregon.gov. http://www.oregon.gov/DHS/ph/pas/faqs.shtml#insurance. Retrieved on 2009-03-10. 
9. ^ http://www.amsa.org/dd/prnh.cfm Patient Refusal of Nutrition and Hydration: Walking the Ever-Finer Line
10. ^ Harvath TA. Voluntary refusal of food and fluids: attitudes of Oregon hospice nurses and social workers. Int J Palliat Nurs. 2004 May;10(5):236-41
11. ^ ^{a b} "Glossary." CCAC Programs. 2005. Canadian Council on Animal Care. 13 July 2007 (http://www.ccac.ca/en/CCAC_Programs/ETCC/GlossaryEng.htm).
12. ^ ^{a b c d} History of Euthanasia
13. ^ See Senicide
14. ^ See Humphry and Wickett (1986:8-10) on More, Montaigne, Donne, and Bacon.
15. ^ History of Euthanasia (PowerPoint presentation), Euthanasia.com. "The earliest American statute explicitly to outlaw assisting suicide was enacted in New York in 1828, Act of December 10, 1828, ch. 20, §4, 1828 N. Y. Laws 19 (codified at 2 N. Y. Rev. Stat. pt. 4, ch. 1, tit. 2, art. 1, §7, p. 661 (1829)), and many of the new States and Territories followed New York's example. Marzen 73-74." Retrieved June 16, 2007.
16. ^ Humphry and Wickett 1986:11-12, Emanuel 2004.
17. ^ ^{a b} Appel, Jacob M. "A Duty to Kill? A Duty to Die." Bulletin of the History of Medicine. 78.3 (October 2004): 610-634.
18. ^ Dowbiggin, Ian. A Merciful End: The Euthanasia Movement in Modern America. OUP. ISBN 0195154436. 
19. ^ ^{a b c d e} euthanasia. The Columbia Encyclopedia, Sixth Edition. 2001-07
20. ^ Friedlander, Henry (1997). The Origins of Nazi Genocide: From Euthanasia to the Final Solution. UNC Press. pp. xi. ISBN 0807846759. http://books.google.com/books?id=gqLDEKVk2nMC&printsec=frontcover&source=gbs_summary_r&cad=0#PPR11,M1. 
21. ^ "Transcription". United States Holocaust Museum. http://www.ushmm.org/research/doctors/three.htm. 
22. ^ Hitler, Mein Kampf, 447 (cited by Peter Padfield, Himmler, Macmillan 1990, 260).
23. ^ Kershaw, II, 252
24. ^ ^{a b} Basic Books 1986, 46
25. ^ Stein, Stuart D. ""Life Unworthy of Life" and other Medical Killing Programmes". http://www.ess.uwe.ac.uk/genocide/mord.htm. 
26. ^ Humphrey and Wickett, ch.4. See also Kamisar.
27. ^ Australia passes first euthanasia law
28. ^ Margaret Otlowski, Voluntary Euthanasia and the Common Law, Oxford University Press, 1997, pp. 175-177
29. ^ For the UK see the Bland case.
30. ^ Cruzan v. Director, Missouri Department of Health
31. ^ Pu SD (April 1991). "Euthanasia in China: a report". J Med Philos 16 (2): 131–8. PMID 2061698. 
32. ^ Chong AM, Fok SY (December 2004). "Attitudes toward Euthanasia in Hong Kong - A Comparison Between Physicians and the General Public". Death Studies 29 (1): 29–54. http://www.informaworld.com/smpp/content~content=a725279585.  Chong AM, Fok SY (2009). "Attitudes toward euthanasia: implications for social work practice". Soc Work Health Care 48 (2): 119–33. doi:10.1080/00981380802533298. PMID 19197770. 
33. ^ See Government policies below for specific examples
34. ^ See also Utilitarianism
35. ^ "Terminally ill patients often fear being a burden to others and may feel they ought to request euthanasia to relieve their relatives from distress." letter to the editor of the Financial Times by Dr David Jeffrey, published 11 January 2003.
36. ^ "If euthanasia became socially acceptable, the sick would no longer be able to trust either doctors or their relatives: many of those earnestly counselling a painless, 'dignified' death would be doing so mainly on financial grounds. Euthanasia would become a euphemism for assisted murder." FT WEEKEND - THE FRONT LINE: Don't take liberties with the right to die by Michael Prowse, Financial Times, 4th January 2003
37. ^ This is the first of the Five Precepts. It has various interpretations.
38. ^ ^{a b} Thanissaro Bhikkhu (1994). Buddhist Monastic Code I: Chapter 4, Parajika. Retrieved 2007-11-11 from "Access to Insight" at http://www.accesstoinsight.org/lib/authors/thanissaro/bmc1/ch04.html.
39. ^ There are only four offenses (parajika) that could lead to such an expulsion for a monk; eight such offenses for a nun (bhikkhuni). The other three parajika for monks are: engaging in a sexual act; stealing; and, falsely claiming to have achieved advanced spiritual states (such as jhanic absorptions or nibbana) (Thanissaro 1994).
40. ^ Thanissaro Bhikkhu “Educating Compassion” Article link at Access to Insight
41. ^ ^{a b} SACRED CONGREGATION FOR THE DOCTRINE OF THE FAITH: DECLARATION ON EUTHANASIA quoting GAUDIUM ET SPES
42. ^ ^{a b} "Sacred Congregation for the Doctrine of the Faith. "Declaration on Euthanasia," May 5, 1980". http://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19800505_euthanasia_en.html. 
43. ^ "...no one is permitted to ask for this act of killing, either for himself or herself or for another person entrusted to his or her care, nor can he or she consent to it, either explicitly or implicitly. nor can any authority legitimately recommend or permit such an action."
44. ^ Papal statements 1956-1957 and Gerald Kelly
45. ^ "BBC - Religion & Ethics - Euthanasia". www.bbc.co.uk. http://www.bbc.co.uk/religion/religions/hinduism/hinduethics/euthanasia.shtml. Retrieved on 2009-02-14. 
46. ^ Translation of Sahih Bukhari, Book 71. University of Southern California. Hadith 7.71.670. http://www.usc.edu/dept/MSA/fundamentals/hadithsunnah/bukhari/071.sbt.html#007.071.670. 
47. ^ Translation of Sahih Muslim, Book 35. University of Southern California. Hadith 35.6485. http://www.usc.edu/dept/MSA/fundamentals/hadithsunnah/muslim/035.smt.html#035.6485. 
48. ^ Translation of Sahih Muslim, Book 35. University of Southern California. Hadith 35.6480. http://www.usc.edu/dept/MSA/fundamentals/hadithsunnah/muslim/035.smt.html#035.6480. 
49. ^ E.g., J. David Bleich, Eliezer Waldenberg
50. ^ E.g., see writings of Daniel Sinclair, Moshe Tendler, Shlomo Zalman Auerbach, Moshe Feinstein.
51. ^ See Elliot Dorff and, for earlier speculation, Byron Sherwin.
52. ^ "BBC - Religion & Ethics - Buddhism, euthanasia and suicide". www.bbc.co.uk. http://www.bbc.co.uk/religion/religions/buddhism/buddhistethics/euthanasiasuicide.shtml. Retrieved on 2009-02-14. 
53. ^ ^{a b} "9.3. Implications of Japanese religious views toward life and death in medicine". www.eubios.info. http://www.eubios.info/ABC4/abc4288.htm. Retrieved on 2009-02-14. 
54. ^ "Administration and Compounding Of Euthanasic Agents". http://www.wweek.com/html/euthanasics.html. 
55. ^ "NZ Herald Story". http://www.nzherald.co.nz/search/story.cfm?storyid=0002EB73-8358-1464-B02B83027AF1010E. 
56. ^ "Parents walk free after killing son". ABC News Online. 2007-04-04. http://www.abc.net.au/news/newsitems/200704/s1889400.htm. 

External links

Look up Euthanasia in Wiktionary, the free dictionary.

• Religion and Ethics - Euthanasia - many views of euthanasia, for, against, and religious, from the BBC
• Stanford Encyclopedia of Philosophy entry

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Dansk (Danish)
n. - medlidenhedsdrab, dødshjælp

Nederlands (Dutch)
euthanasie

Français (French)
n. - euthanasie

Deutsch (German)
n. - Euthanasie, Sterbehilfe

Ελληνική (Greek)
n. - ευθανασία

Italiano (Italian)
eutanasia

Português (Portuguese)
n. - eutanásia (f)

Русский (Russian)
эвтаназия

Español (Spanish)
n. - eutanasia

Svenska (Swedish)
n. - eutanasi, dödshjälp, fridfull död

中文（简体）(Chinese (Simplified))
安乐死

中文（繁體）(Chinese (Traditional))
n. - 安樂死

한국어 (Korean)
n. - 안락사

日本語 (Japanese)
n. - 安楽死

العربيه (Arabic)
‏(الاسم) القتل الرحيم‏

עברית (Hebrew)
n. - ‮המתת חסד, מיתת חסד‬

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