What is Euthanasia?
The Merriam Webster Dictionary defines Euthanasia as The act or practice of killing or permitting the death of hopelessly sick or injured individuals (as persons or domestic animals) in a relatively painless way for reasons of mercy. The Oxford Dictionaries says Euthanasia is the painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma.
Euthanasia continues to be the subject matter of much debate and controversy the world over. While the issue is inexorably linked to ethics, legality, social order, religion, philosophy, and even metaphysics, individual instances have come up that have swayed sentiments. The context of death, the processes of administration of euthanasia, and the extent to which it may be monitored still remains murky.
Voluntary, Non Voluntary And Passive Euthanasia
The many forms of Euthanasia have been debated across the world. While active euthanasia, or directly causing the death of a patient has been condemned by many, the morality of active euthanasia or simply allowing a patient to die has also been questioned. Passive euthanasia may include withdrawing life supporting treatment or withholding surgery or medication.
One of the most debated cases of passive euthanasia was the case of Dr Harry J Haiselden who withheld the surgery of a blue baby in 1915 amidst a national controversy. The incident made news across America and woke the country up to the debate centered on mercy killing.
Euthanasia, in this case was involuntary, as the baby was too young to seek death but in many cases it is sought out by terminally sick patients or long term sufferers.
Physician assisted suicide or physician aided dying has been the most controversial of all forms of Euthanasia. It raises many questions about the morality of assisted dying and about medical ethics itself.
A physician providing medications or other means to a patient with the understanding that the patient intends to use them to commit suicide Michael Manning, MD, in his book Euthanasia and Physician-Assisted Suicide: Killing or Caring?
Till 1st century BC The ancient Greeks and Romans widely supported Euthanasia. Physicians supported voluntary death to end terminal suffering and assisted death was considered legal.
1st century BC through Middle Ages The rise of Christianity brought a staunch opposition to Euthanasia and assisted death. Thomas Aquinas severely condemned suicide. Judaism also condemns Euthanasia.
17th and 18th centuries Though the Common Law prohibited suicide, euthanasia and assisted death in any form, renaissance writers rose to challenge the law.
1828 The first US statute outlawing euthanasia was passed in New York State. Most other states soon followed suit. In July 1868, by the time the Fourteenth Amendment to the US constitution was adopted, euthanasia or assisted suicide was a crime in most states.
Late 19th century the isolation of Morphine from Opium in 1803 by Frederich Wilhelm Adam Serturner was a great achievement. By the end of the century the use of morphine as an analgesic had become widespread. Samuel Williams became one of the earliest advocates of euthanasia and the use of lethal doses of morphine by the end of the 19th century.
Early 20th century The start of the century saw a bill supporting euthanasia being defeated in Ohio in 1906. Barring sporadic incidents such Dr Haiselden's stand for euthanasia in Chicago and the feature film, The Black Stork, there was not much support for assisted death.
1930 - 1949 The advent of the Great Depression again brought up the subject of euthanasia and assisted dying. The Voluntary Euthanasia Legislation Society was founded in 1935 in the US but the same year a bill legalizing Euthanasia was defeated in the House of Commons (UK).
National Society for the Legalization of Euthanasia (NSLE), later called the Euthanasia Society of America (ESA) was established in 1938. But with the outbreak of World War II and with the uninhibited use of the involuntary euthanasia by the Nazis, popular sentiments in the US and other countries were in for a change.
1950 - 1969 In the early 1950s the euthanasia societies of US and UK petitioned the United Nations to include euthanasia in the Declaration of Human Rights. The movement took a new direction when a Harvard Medical School Committee redefined 'death' by certifying irreversible coma as a key criterion. Many started to take a keen interest in bioethics.
1970 - 1989 Even as the US Senate held the earliest national hearing on assisted dying (1972), the American Hospital Association (AHA) acknowledged the patient's right to refuse treatment (1973). On March 31, 1976 in a historic ruling, the New Jersey Supreme court authorized the removal of respirator from Karen Quinlan, a coma patient. In October 1976, California became the first US state to pass a law granting terminally ill patients the right to authorize withdrawal of life support. By the next year, Arkansas, California, Idaho, Nevada, New Mexico, North Carolina, Oregon, and Texas became the first states to have their Right to Die Bills signed into laws. Even as Pope John Paul II's opposition was considered a setback by euthanasia crusaders the American Medical Association pledged support. In 1987the California State Bar became the first public body to pass a resolution supporting assisted dying.
1990 - 2009 In 1990 the US Congress passed the Patient Self Determination Act. After much effort on the part of the activists, Oregon State passed the Death with Dignity Act in 1994 legalizing physician assisted dying.
In 2001 the Netherlands legalized euthanasia and in 2008 Luxembourg gave assisted suicide its assent. In 2008, Washington also legalized its Death with Dignity Act. The same year in a judicial ruling Montana also legalized physician assisted suicide.
In 2005, the Terri Schiavo case made national news. Terri aged 26 (1990), a resident of Florida, had suffered from a cardiac arrest which cut off oxygen supply to the brain. Having been declared vegetative Terri was fed by a nasogastric tube. In 1998, Michael Schiavo, Terri husband filed a petition to remove the feeding tube. After seven years of appeals, motions and five suits at the federal district court, Terri died in March 2005, 13 days after her feeding tube was removed.
Law Of The Land
While most countries of the world have clear policies on suicide, euthanasia is still the subject matter of gray areas.
|Colombia||Constitutionally Valid; Not ratified by Congress||Illegal|
|Japan||Constitutionally Illegal but validated by court rulings||Illegal|
Legal Status Of Euthanasia In the US
In the US, physician assisted suicide is constitutionally legal in Oregon and Washington and has been upheld by the courts of Montana. In states where there are no specific laws prohibiting physician assisted suicide it is possible to prosecute under the common law, if the state recognizes common law crimes.
|Alabama||Illegal||No Prohibiting Laws|
|District of Columbia||Illegal||No Prohibiting Laws|
|Idaho||Illegal||No Prohibiting Laws|
|Massachusetts||Illegal||No Prohibiting Laws|
|Montana||Illegal||Legal (Court Ruling)|
|North Carolina||Illegal||No Prohibiting Laws|
|Ohio||Illegal||No Prohibiting Laws|
|Utah||Illegal||No Prohibiting Laws|
|Vermont||Illegal||No Prohibiting Laws|
|West Virginia||Illegal||No Prohibiting Laws|
|Wyoming||Illegal||No Prohibiting Laws|
Pro Euthanasia Arguments
Right to Die is seen by activists as an intrinsic human right to choose death, the time of death and the means. So long as a patient is clear about the intent and lucid in reasoning, the right needs to be upheld.
Human Rights activists supporting euthanasia believe that the choice of death is inherent in the choice of death because the process of dying is a part of life itself.
No Harm Caused to state and other people by the decision to voluntarily ask for assistance in dying is a major argument extended by the libertarians. The activists believe that sometimes euthanasia may act in the best interests of the state, family and the patient thereby providing much needed relief and is thereby morally endorsed.
Regulation of Euthanasia is a key argument that legal and social activists extend in favor of assisted dying. Euthanasia or assisted dying need not necessarily be uncontrolled or lack a framework for administration. When approached in a suitably regulated manner it could be for the greater good, they argue.
Scarcity of Medical Aid is another argument that supports euthanasia. With terminally ill patients, the consumption of scarce medical resources and facilities is high often for prolonged periods thereby depriving those who may live healthy lives if provided the same opportunities.
Dignity in Dying is an argument extended by those who believe that just as human beings strive to lead progressive and dignified lives, death is a matter of dignity too. The very fiber of life is centered on achieving a glorious existence and a peaceful end.
Death is the Natural End and hence may be chosen at anytime is another argument extended by those who support euthanasia. Death is neither unnatural and hence need not be left to accidental or natural causes, especially in cases of terminally ill patients.
Needless to say these arguments have evoked strong criticism by many. These are also the basis of pro-euthanasia legislations passed by many countries.
Euthanasia Pros and Cons
Anti Euthanasia Arguments
The Sanctity of Life argument extended by critics, reasons that by agreeing to administer euthanasia, we implicitly agree that some lives are worth less than others. What was sacred when endowed by Nature, and what has been meticulously preserved and nourished may not be taken away at will.
Scientific Arguments opposing euthanasia are extended by those who believe that proper palliative care makes assisted dying unnecessary. Besides, with the advancement of medical science remedies and cures for ailments are being discovered at a very fast pace. By administering euthanasia we may be depriving the patient a chance at recovery. Besides taking away the physician's motivation to work towards a recovery, there is no adequate framework to regulate euthanasia, critics say.
Slippery Slope and Medical Decline of practitioners is another concern. That euthanasia may be misused especially in cases of child and involuntary euthanasia is an issue to be grappled with. The morality of the medical practice or bio ethics would soon be a matter of definition. Who decides and defines the criteria for administering euthanasia? Who decides on the framework or the procedures to be followed? These are difficult questions to answer, the critics argue.
Religious arguments against euthanasia are perhaps the most forceful. The Roman Catholic Church is staunchly opposed to euthanasia. While most of the opposing religious views hold that only God has the right to give or take a life, other religious orders including the Anglican, Methodist, and Unitarian movements take a more liberal view of euthanasia. Buddhism, Sikhism, and Hinduism prohibit the voluntary murder but are less distinct about euthanasia. Jainism glorifies voluntary suicide by fasting but Islam and Judaism are staunchly opposed to any form of euthanasia, assisted dying, or suicide. A number of religious cults, however, endorse the practice of writing a living will.
Dr Jack Kevorkian, a Michigan pathologist, came to be known as Dr Death for his active advocacy of euthanasia. The doctor claimed to have medically assisted over 130 patients in choosing death. He served eight years in prison for second degree murder. Dr Jack Kevorkian famous statement "Dying is not a crime" became synonymous with the cause of euthanasia.
Australian doctor, Philip Nitschke founded the pro euthanasia group Exit International. After having successfully campaigned for a euthanasia law to be passed in Northern Territory, Dr Nitschke claimed to be the first doctor to have administered the lethal dose of injection and complied with the law.
In more recent news, 92 year old Sharlotte Hydorn from California made headlines by selling suicide kits. Hydorn sold her kits under the brand name GLADD (Glorious Life And Dignified Death) for over twenty years. When 29 year old Nicholas Klonoski from Oregon used one of her kits, Oregon passed a legislation banning the sale of such kits. In May 2012, Hydorn was sentenced to supervised probation for a tax-related offense and agreed to discontinuing her business as part of her plea deal.
Art Imitates Life
Being at the heart of a heated debate, Euthanasia has been the subject of many expansive movies across the years - Dark Victory (1939), An Act of Murder (1948), They Shoot Horses, Don't They? (1969), Sunshine (1973), Murder or Mercy? (1974), One Flew Over the Cuckoo's Nest (1975), The End (1978), Act of Love (1980), Whose Life Is It Anyway? (1981), When The Time Comes (1987), Murder or Mercy? (1987), The Right To Die (1987), Last Wish (1992), The Last Supper (1994), The English Patient (1996), The Sea Inside (2004), Million Dollar Baby (2004). In 2010, Al Pacino won an Emmy for his portrayal of Jack Kevorkian in the movie You Don't Know Jack (2010). In India the movie Guzaarish, released in 2010, made an emphatic statement in favor of euthanasia. The Spanish film Mar Adentro, based on the real life campaign of Ramon Sampedro immortalized the words "Quiero morir, para vivir en tu memoria" I want to die, so that I can live in your memory.
A terminally ill patient may request euthanasia by active interference or by withdrawal of support. The lucidity of the patient's judgment is weighed against the family's sentiments and the physician's objectivity. The case becomes more complex in case of involuntary euthanasia. Does a child born with debilitating physical or mental disability lose the right to live? Are we subjecting such a child and its parents to a lifetime of suffering and possible abuse? Is there dignity in choosing death? Or does exercising the choice amount to squandering away a precious life? Does the individual's choice extend to emotional trauma? Does physical pain leave a person's ability to make a rational choice impaired?
Should the Right to Euthanasia and Physician-assisted Death Be Recognized?