euthanasia

n.
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.]

euthanasia

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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.

n

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

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.

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.

IN BRIEF: Mercy killing.

Sometimes euthanasia is more kind to a pet than letting it suffer.

(yooh-thuh-nay-zhuh)

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

Proposals to make euthanasia legal in the United States have inspired heated debate.

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Euthanasia

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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