EUTHANASIA

[Greek, good death.] The term normally implies an intentional termination of life by another at the explicit request of the person who wishes to die. Euthanasia is generally defined as the act of killing an incurably ill person out of concern and compassion for that person's suffering. It is sometimes called mercy killing, but many advocates of euthanasia define mercy killing more precisely as the ending of another person's life without his or her request. Euthanasia, on the other hand, is usually separated into two categories: passive euthanasia and active euthanasia. In many jurisdictions, active euthanasia can be considered murder ormanslaughter, whereas passive euthanasia is accepted by professional medical societies, and by the law under certain circumstances.

Passive Euthanasia

Hastening the death of a person by altering some form of support and letting nature take its course is known as passive euthanasia. Examples include such things as turning off respirators, halting medications, discontinuing food and water so as to allowing a person to dehydrate or starve to death, or failure to resuscitate.

Passive euthanasia also includes giving a patient large doses of morphine to control pain, in spite of the likelihood that the painkiller will suppress respiration and cause death earlier than it otherwise would have happened. Such doses of painkillers have a dual effect of relieving pain and hastening death. Administering such medication is regarded as ethical in most political jurisdictions and by most medical societies.

These procedures are performed on terminally ill, suffering persons so that natural death will occur sooner. They are also commonly performed on persons in a persistent vegetative state; for example, individuals with massive brain damage or in a coma from which they likely will not regain consciousness.

Active Euthanasia

Far more controversial, active euthanasia involves causing the death of a person through a direct action, in response to a request from that person. A well-known example of active euthanasia was the death of a terminally ill Michigan patient on September 17, 1998. On that date, Dr. jack kevorkian videotaped himself administering a lethal medication to Thomas Youk, a 52-year-old Michigan man with amyotrophic lateral sclerosis. CBS broadcast the videotape on 60 Minutes less than a week later. Authorities subsequently charged Kevorkian with first-degree premeditated murder, criminal assistance of a suicide, and delivery of a controlled substance for administering lethal medication to a terminally ill man. There was no dispute that the dose was administered at the request of Mr. Youk, nor any dispute that Mr. Youk was terminally ill. A jury found Kevorkian guilty of second-degree murder in 1999. He was sent to prison.

Physician-Assisted Suicide

Somewhat of a hybrid between passive and active euthanasia is physician-assisted suicide (PAS), also known as voluntary passive euthanasia. In this situation, a physician supplies information and/or the means of committing suicide (e.g., a prescription for lethal dose of sleeping pills, or a supply of carbon monoxide gas) to a person, so that that individual can successfully terminate his or her own life.

Physician-assisted suicide received greater public attention after Dr. Kevorkian, a retired pathologist from Michigan, participated in his first such procedure in 1990. Kevorkian set up a machine that allowed a 54-year-old woman suffering from Alzheimer's disease (a degenerative neurological condition) to press a button that delivered a lethal poison into her veins. Kevorkian went on to assist in the suicides of dozens of individuals suffering from terminal, debilitating, or chronic illnesses. In 1992, Michigan passed an assisted-suicide bill (Mich. Comp. Laws § 752.1021) that was specifically designed to stop Kevorkian's activities, but technicalities and questions as to its constitutionality delayed its implementation, thus allowing Kevorkian to continue assisting suicides—often in direct opposition to court injunctions.

Kevorkian was charged with murder several times but was not initially found guilty. When murder charges were brought against him for his first three assisted suicides, for example, they were dismissed because Michigan, at that time, had no law against assisted suicide. In 1994, Kevorkian was tried and found not guilty of assisting in the August 1993 suicide of Thomas W. Hyde Jr. In December 1994, however, Michigan's supreme court ruled in People v. Kevorkian, 447 Mich. 436, 527 N.W. 2d 714, that there is no constitutional right to commit suicide, with or without assistance, and upheld the Michigan statute that made assisted suicide a crime. The following year, the U.S. Supreme Court refused to hear Kevorkian's appeal from the state supreme court's ruling.

Observers disagree about the humanity of Kevorkian's activities. Some see him as a hero who sought to give suffering people greater choice and dignity in dying. Others point to his lack of procedural precautions and fear that the widespread practice of assisted suicide will lead to the unnecessary death of people who could have been helped by other means, including treatment for depression. Many opponents of assisted suicide find the same faults in the practice that they see in other forms of euthanasia. They envision its leading to a devaluation of human life and even to a genocidal killing of vulnerable or so-called undesirable individuals.

The U.S. Supreme Court has made two important rulings on assisted suicide. In washington v. glucksberg, 521 U.S. 702, 117 S.Ct. 2258, 138 L.Ed.2d 772, 65 (1997), three terminally ill patients, four physicians, and a non-profit organization had brought action against the state of Washington for declaratory judgment, that a statute banning assisted suicide violated due process clause. On June 26, 1997, the Supreme Court unanimously upheld the right of states to prohibit assisted suicide, holding that: (1) asserted right to assistance in committing suicide was not a fundamental liberty interest protected by due process clause, and (2) Washington's ban on assisted suicide was rationally related to legitimate government interests. In Vacco v. Quill, 521 U.S. 793, 117 S.Ct. 2293, 138 L.Ed.2d 834 (1997), physicians challenged the constitutionality of New York statutes making it a crime to aid a person in committing suicide or attempting to commit suicide. The Supreme Court held that New York's prohibition on assisting suicide did not violate the equal protection clause of the fourteenth amendment.

Involuntary Euthanasia

The term involuntary euthanasia is used to describe the killing of a person who has not explicitly requested aid in dying. This term is most often used with respect to patients who are in a persistent vegetative state and who probably will never recover consciousness.

Euthanasia Considerations

Euthanasia is a divisive topic, and different interpretations of its meaning, practice, and morality abound. Those who favor active euthanasia and a patient's right to die, do not acknowledge a distinction between active and passive euthanasia. They assert that the withdrawal of life-sustaining treatment cannot be distinguished in principle from affirmative steps to hasten a patient's death. In both situations, they argue, a person intends to cause the patient's death, acts out of compassionate motives, and causes the same outcome. In their view, turning off a life-sustaining respirator switch and giving a lethal injection are morally equivalent actions.

Opponents of active euthanasia argue that it undermines the value of, and respect for, all human life; erodes trust in physicians; desensitizes society to killing; and contradicts many people's religious beliefs. Moreover, they maintain that the intentions and natures of active and passive euthanasia are not essentially the same. In active euthanasia, a person directly intends to cause death and uses available means to achieve this end. In passive euthanasia, a person decides against using a certain form of treatment and then directs that such treatment be withdrawn or withheld, accepting but not intending the patient's death, which is caused by the underlying illness.

While people cite differing reasons for choosing to end their own lives, those suffering from a terminal illness typically state that a serious disorder or disease has adversely affected their quality of life to the point where they no longer wish to continue living. Under such circumstances, patients may have been diagnosed with a degenerative, progressive illness such as ALS, Huntington's disease, multiple sclerosis, AIDS, or Alzheimer's disease. Patients with such illnesses often fear, with good reason, a gradual loss of the quality of life in the future as the disease or disorder progresses, or they might already have lost a good deal of their independence and thus might require continuous care. Some feel that this loss of autonomy causes an unacceptable loss of personal dignity. Others realize that they will be dying in the near future and simply want to have total control over the process. Some point out that in addition to physical considerations, they do not want to diminish their assets by incurring large medical costs as their death approaches. They feel that they ought to have the option to die sooner and to pass on their assets to their beneficiaries.

Euthanasia and Physician-Assisted Suicide

Imagine that you are suffering from a disease that is terminal, debilitating, and very painful. Should you have the right to die when you wish rather than live in continued agony? Should your doctor be legally free to help you take your own life, perhaps by prescribing some pills and telling you their fatal dosage? Or should the law forbid anyone—including doctors—to assist in the suicide of another human being? These are just some of the questions that surround the issue of physician-assisted suicide, a widely debated ethical issue in modern medicine.

Physician-assisted suicide is a form of voluntary euthanasia. In other words, it involves a patient voluntarily acting to end his or her life. Physician-assisted suicide differs from conventional suicide in that it is facilitated by a physician who confirms the patient's diagnosis, rules out conditions such as depression that may be clouding the patient's judgment, and finally provides the means for committing suicide. Such action usually consists of taking a lethal overdose of prescription medication. However, the over 130 patients who were assisted by Dr. jack kevorkian between 1990 and 1998 chose to press a button which delivered a lethal poison into their veins, or to put on a mask that emitted carbon monoxide into their lungs. Assisted suicide is a felony offense in most states and is also expressly forbidden in the American Medical Association's (AMA's) Code of Medical Ethics. In 1999, Kevorkian was found guilty of second-degree murder in an assisted suicide case. He was sentenced to serve 10 to 25 years.

The debate surrounding physician-assisted suicide in the United States has been influenced by medical practices in other countries, particularly the Netherlands, which legalized both active euthanasia and physician-assisted suicide, in April 2001 (effective 2002). Physician-assisted suicide in the Netherlands is conducted within strict guidelines that include the following requirements: the patient's request for assisted suicide must be voluntary, the patient must be experiencing intolerable suffering, all other alternatives for treatment must have been explored, and the physician must consult another independent physician before proceeding. A study commissioned by the Dutch government indicated that, in 2001, about 3,500 deaths, or 2.5 percent of the 140,000 death cases that were reported in the Netherlands that year, occurred by active euthanasia. The study, known as the Remmelink Report, defined euthanasia as the termination of life at the patient's request. Figures also indicated that 300 deaths, or 0.2 percent, were caused by physician-assisted suicide.

In the United States, the debate on legalizing assisted suicide began in earnest in the 1970s. On one side of the debate have been patients' rights groups who have lobbied for what they call the right to die—or the right to choose to die, as some have clarified it— of terminally ill patients. The strongest opposition to the legalization of physician-assisted suicide has come from physicians' groups such as the AMA and from religious groups that are morally opposed to the practice.

One person who has done much to make the case for physician-assisted suicide is Derek Humphry, a former journalist who founded the Hemlock Society, in 1980, after seeing the pain and suffering his first wife experienced when she died from cancer. In 2003, the organization changed its name to End-of-Life Choices, which encompasses more clearly the issues supported by its members. With a new name and a new motto, "Dignity Compassion Control," the organization continues to advocate for the right of terminally ill people to choose voluntary euthanasia, or what Humphry has termed self-deliverance.

Humphry has written several books on the subject of voluntary euthanasia, including Jean's Way (1978), which recounts his struggle to assist his wife's death in 1975; Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying (1991), a controversial book that gives detailed advice on how terminally ill people may take their own life; and Lawful Exit: The Limits of Freedom for Help in Dying (1993), which contains Humphry's own recommendations for legislation that would legalize physician-assisted suicide and active voluntary euthanasia. In Humphry's words, the "right to choose to die" is "the ultimate civil liberty."

Humphry presents physician-assisted suicide as a merciful, dignified option for people whose illness has eroded their quality of life beyond the limits of tolerance. He also points out that what he calls beneficent euthanasia occurs every day in medical facilities as physicians make decisions regarding the end of life. Others, including some medical ethicists, go so far as to claim that a decision to withhold antibiotics, oxygen, or nutrition from a terminally ill patient is no less "active" a form of euthanasia than is administering a fatal dose of morphine. Indeed, they see the common practice of withholding life support as more open to potential abuse than the practice of physician-assisted suicide. The former, they argue, is a less visible, less easily regulated decision. Proponents of physician-assisted suicide also claim that diseases kill people in far more cruel ways than would any means of death that a physician might provide for an irreversibly ill patient. As a result, they see the action of assisting in suicide as entirely compatible with the physician's duty to the patient.

However, Humphry has been an open critic of Kevorkian's work. He has described Kevorkian's theory and practice of assisted suicide as open-ended euthanasia. Noting Kevorkian's lack of precautionary measures such as the use of waiting periods and second opinions, Humphry sees any wider application of Kevorkian's methods as potentially leading to abuse and tragedy. "The thinking people in our movement are appalled by it," Humphry said. "If you have Kevorkian's type of euthanasia, it will be a slippery slope. Kevorkian's is a recipe for skiing down a glacier."

Detractors of physician-assisted suicide also use the familiar "slippery slope" argument, proposing that once physician-assisted suicide is legalized, other forms of euthanasia will more likely be practiced as well. They see assisted suicide as potentially leading to situations in which elderly, chronically ill, and handicapped people, along with others, are killed through active, nonvoluntary euthanasia. Related to this idea is the view that widespread practice of physician-assisted suicide might claim the lives of those whose intolerable suffering is caused by treatable depression. They point out that terminally ill people or others in pain are often also suffering from depression, and that despite their illness, their feelings of hopelessness can often be addressed through means such as counseling and antidepressant medication.

The Catholic Church is one of many religious organizations that opposes euthanasia and assisted suicide. In Pope John Paul II's words, medical killings such as those caused by assisted suicide are "crimes which no human law can claim to legitimize." Basing its arguments on passages from the Bible, Catholic theology has for many centuries opposed all forms of suicide. Catholicism argues that innocent human life may not be destroyed for any reason whatsoever.

The debate over physician-assisted suicide eventually reached the Supreme Court. In 1994, an advocacy group known as Compassion in Dying filed two lawsuits (Compassion in Dying et al v. Washington and Quill et al v. Vacco) challenging the constitutionality of state laws banning assisted dying in Washington and New York. Compassion in Dying won in the District Court in Washington. Chief Judge Barbara Rothstein wrote, "There is no more profoundly personal decision, nor one which is closer to the heart of personal liberty, than the choice which a terminally ill person makes to end his or her suffering and hasten an inevitable death." In New York, Compassion in Dying lost and filed an appeal in the Second Circuit.

In 1995, Washington's Compassion ruling was overturned by the Ninth Circuit Court of Appeals, reinstating the anti-suicide law. In 1996, however, after reconsideration, the Ninth Circuit Court of Appeals issued a reversal decision in Compassion v. Washington. That decision held that assisted dying was protected by liberty and privacy provisions of the U.S. Constitution. The majority wrote that, "Those who believe strongly that death must come without physician assistance are free to follow that creed, be they doctors or patients. They are not free, however, to force their views, their religious convictions, or their philosophies on all the other members of a democratic society, and to compel those whose values differ with theirs to die painful, protracted, and agonizing deaths."

In April 1996, the Second Circuit joined the Ninth in recognizing constitutional protection for assisted dying in the Quill case, holding that the New York statutes criminalizing assisted suicide violate the equal protection clause of the fourteenth amendment. However, on June 26, 1997, the U.S. Supreme Court reversed both the Ninth and Second Circuit Court in washington v. glucksberg, 521 U.S. 702, 117 S.Ct. 2258, 138 L.Ed.2d 772 (1997) and Vacco v. Quill, 521 U.S. 743, 117 S.Ct. 2293, 138 L.Ed.2d 834 (1997). The Court ruled that state laws against assisting a suicide are not unconstitutional, but also stated that patients have a right to aggressive treatment of pain and other symptoms, even if the treatment hastens death. The Court wrote, "Throughout the Nation, Americans are engaged in an earnest and profound debate about the morality, legality and practicality of physician assisted suicide. Our holding permits this debate to continue, as it should in a democratic society."

Ultimately then, the voters and representatives of the states and the legal system itself will have to decide whether or not physician-assisted suicide will be legalized. Regardless of what side prevails in the debate, the exchange of ideas that it creates may lead to a greater understanding of the difficult choices surrounding death in our time.

further readings

Cohen-Almagor, Raphael. 2001. The Right to Die With Dignity: An Argument in Ethics, Medicine, and Law. New Brunswick, N.J.: Rutgers Univ. Press.

End of Life Choices. Available online at <www.endoflifechoices.org> (accessed August 25, 2003).

Hendin, Herbert. 2002. "The Dutch Experience." Issues in Law & Medicine (spring).

cross-references

Death and Dying; Physicians and Surgeons.

Some patients who decide that they wish to commit suicide are unable or unwilling to accomplish the act without assistance from their physician. Physician-assisted suicide helps them to die under conditions, and at the time, that they wish. PAS is currently legal in the U.S., only in the state of Oregon, under severe restrictions. In other states, a terminally ill patient who wishes to die must continue living until their body eventually collapses, or until a family member or friend commits a criminal act by helping them to commit suicide.

Historical Considerations

Traditional Christian beliefs concerning all forms of suicide were well documented by Thomas Aquinas during the thirteenth century. He condemned all suicide (whether assisted or not) on the theory that it violated one's natural desire to live. Among European writers, Michel de Montaigne was the first major dissenter on this issue. During the sixteenth century, he wrote a series of essays arguing that suicide should be a matter of personal choice, a human right. He concluded it to be a rational option under certain circumstances.

Attempting to commit suicide was once a criminal act. It has been decriminalized for many decades in most jurisdictions. However, assisted suicide remains a criminal act throughout the United States, with the exception of the state of Oregon. In that state, it is permitted under tightly controlled conditions.

Oregon's Euthanasia Law

In 1994, voters in the state of Oregon approved a ballot measure that would have legalized euthanasia under limited conditions. Under the Death With Dignity law, a person who sought physician-assisted suicide would have to meet certain criteria:

• The person must be terminally ill.
• The person must have six months or less to live.
• The person must make two oral requests for assistance in dying.
• The person must make one written request for assistance in dying.
• The person must convince two physicians that he or she is sincere and not acting on a whim, and that the decision is voluntary.
• The person must not have been influenced by depression.
• The person must be informed of "the feasible alternatives," including, but not limited to, comfort care, hospice care, and pain control.
• The person must wait for 15 days.

Under the proposed law, a person who met all requirements could receive a prescription of a barbiturate that would be sufficient to cause death. Physicians would be prohibited from inducing death by injection or carbon monoxide.

The national right to life committee, supported by the Roman Catholic Church, obtained a court injunction to delay implementation of the measure. The law stalled in the appeals process. In the meantime, the measure was not enacted. In 1997, there was a second public referendum, and the law was enacted. Within 24 hours of the announcement of the results, state officials had forms for physicians to record instances of assisted suicide. These were later distributed to physicians in the state. The form is entitled "Request for Medication to End My Life in a Humane and Dignified Manner."

Immediately after the law was affirmed, Thomas Constantine, the administrator of the federal drug enforcement administration (DEA), wrote a policy statement which said that prescribing drugs to help terminally ill patients kill themselves would be a violation of the Controlled Substances Act. Nevertheless, on March 26, 1998, a woman in her mid-eighties died from a lethal dose of barbiturates, which had been prescribed by her doctor under the Oregon law. She was the first person to publicly use the law to commit suicide. She had been fighting breast cancer for 20 years and recently had been told by her doctor that she had less than two months to live. She had been experiencing increased difficulty breathing. She made a tape recording in which she stated, "I'm looking forward to it. I will be relieved of all the stress I have." Her personal doctor would not help her end her life, so she turned to an advocacy group, Compassion in Dying. That group located a doctor to assist her. She fell into a deep sleep about five minutes after taking the lethal dose of pills, and she died peacefully about 25 minutes later. Attorney General janet reno officially reversed Constantine's ruling a few weeks later, stating that doctors who use the law to prescribe lethal drugs to terminally ill patients will not be prosecuted and that drug laws were intended to block illegal trafficking in drugs, not to cover situations like the Oregon suicide law.

Despite significant controversy, by the end of 1998, one prediction of the anti-choice forces had not materialized: there was no rush of people to Oregon to seek an easy end to life. While it was predicted that many would take advantage of the law, of the 23 terminally ill individuals who applied to end their own lives in 1998, 15 committed suicide, usually within a day of receiving the prescription. Six died from their illnesses without using the medication. Two remained alive at the end of 1998. From 1998 to 2002, 129 people have opted for physician assisted suicide.

In early 2001, Oregon state senator Ron Wyden wrote Attorney General john ashcroft asking that the george w. bush administration not mount an attack on the state law permitting assistance in suicide. Ashcroft wrote a letter to Asa Hutchinson, chief of the Drug Enforcement Administration. He declared that assisting a terminally ill patient to commit suicide is not a "legitimate medical purpose" for federally controlled drugs. He said that physicians who use drugs to help patients die face suspension or revocation of their licenses to prescribe federally controlled drugs. This was contrary to the position taken by Janet Reno, his predecessor. The attorney general of Oregon, Hardy Myers, quickly initiated a lawsuit to have the Ashcroft's directive declared unconstitutional. The federal district court in Oregon issued a temporary injunction, which prevents the federal government from enforcing Ashcroft's interpretation of the Controlled Substances Act (CSA). The state of Oregon requested that the court block the federal department of justice from taking legal action against Oregon doctors who prescribe medication to help their patients commit suicide. A federal judge ruled in favor of the state law in 2002, and the Department of Justice appealed the decision to the U.S. Court of Appeals for the Ninth Circuit. Both sides have stated that they will appeal the decision if they lose.

Other States

According to the online website, Euthanasia.com, 35 states have legislated against assisted suicide, while nine other states have cited it as a crime under common law. Still more states have introduced or passed statutes criminalizing assisted suicide. These statutes forbid a person to knowingly assist or aid another in committing suicide. Some also prohibit soliciting, advising, or encouraging another to commit suicide. Some statutes penalize assisted suicide under guidelines established for murder or manslaughter, whereas others make it a unique offense with separate penalties. Few courts have interpreted the assisted-suicide statutes, because prosecutions for assisted suicide are rare. In cases of assisted suicide, a state usually prosecutes individuals for murder or manslaughter. The Ohio state supreme court, however, ruled in 1996 that assisted suicide is not a crime.

further readings

Behuniak, Susan M. 2003. Physician-Assisted Suicide: The Anatomy of a Constitutional Law Issue. Lanham, Md.: Rowman & Littlefield.

Dyck, Arthur J. 2001. When Killing Is Wrong: Physician-Assisted Suicide and the Courts. Cleveland, Ohio: Pilgrim Press.

Euthanasia.com. Available online at <www.euthanasia.com> (accessed November 10, 2003).

Palmer, Larry I. 2000. Endings and Beginnings: Law, Medicine, and Society in Assisted Life and Death. Westport, Conn.: Praeger.

cross-references

Death and Dying.

Euthanasia

The passage from life to death should be serene and dignified, not an agonizing ordeal. This conception of eu (good) thanasia (death) is expressed in the term itself as it comes from Greek antiquity. A serene death might be achieved through skilled and compassionate care, as well as by the dying person's own sense of having lived a righteous life. There were circumstances, however, in which hastening the end of a life seemed the only apparent way to relieve suffering. A fatally injured or wounded individual might implore another person to put an end to the suffering. Mercy killing, as it became known, occurred on battlefields throughout the world. Animals with painful and fatal injuries would also be released from their suffering.

The root conception of euthanasia has divided itself into two branches. Prevention and reduction of suffering is the primary mission of the hospice or palliative care movement (Saunders 1997). State of the art medication, skilled nursing care, and family support enhance the possibilities of maintaining a meaningful quality of life until the end. The other branch advocates the principle and practice of avoiding suffering by foreshortening life. Health care professionals, ethicists, clergy, and the general public are all faced with the question of what guidelines should be used in attempting to help people to end their lives without pain and other distressing symptoms. Should people rely upon palliative care—and only palliative care—in every instance? Or is it acceptable—even obligatory—to terminate a life to prevent further suffering?

Euthanasia: History, Controversy, Facts

Objective discussion of euthanasia has become increasingly difficult since this term became associated with state-sponsored mass murder in Nazi Germany. Robert J. Lifton (1986) documents in The Nazi Doctors how these doctors took the lives of thousands of their fellow citizens on orders from the government. These unfortunates were institutional residents who required shelter and care but were neither terminally ill nor in pain. They were "useless eaters" whose murder was thinly disguised as euthanasia. The fact that this program could be carried out without effective protest became a stepping stone for the subsequent slaughter of Jews and Romi (Gypsies) in the Holocaust.

This cynical abuse of the euthanasia concept was itself encouraged by two previous movements (Pernick 1996). Eugenics had as its mission the weeding out of "inferior" genetic stock from the population in order to upgrade society with the finest human specimen. Sterilization of people deemed to have undesirable characteristics was to be the major tool, but other possibilities were also being considered. In the United States one of these other possibilities gained some influential advocacy: infants born with impairments should be allowed to perish or perhaps be "mercifully" put to death immediately. The Black Stork movement did not succeed in its aims, but raised enough clamor to attract the attention of people who would later become active in the Nazi movement.

Awareness of the Nazi mass murders has made many people wary of any movement that speaks favorably of euthanasia. It has generated the slippery slope argument: Permitting any action to end a person's life in any situation might lead to many more deaths. People who give high priority to the slippery slope argument often are sympathetic to the plight of a particular person who is suffering greatly. They might assent to some form of euthanasia in this instance, but fear that such a precedent would make it easier to end the life of somebody whose condition is less serious, and so on until one has slipped way down the slope. Proponents believe that adequate safeguards through legislation, regulation, and due process can limit euthanasia to the situations in which it is most appropriate.

One of the most controversial issues centers on the use of active versus passive euthanasia. Active euthanasia occurs when something is done with the specific intention of ending a person's life, such as injecting a lethal medication. Passive euthanasia occurs when interventions that might prolong life are withheld, such as deciding against connecting a dying person to a life support. This distinction, though, is not always so straightforward. Is "pulling the plug" a form of active or passive euthanasia? It might be considered active because it requires an intentional action to turn off life support services. However, the weight of opinion now considers withdrawal of interventions to be a passive form of euthanasia: one stops doing something.

The distinction is consequential because some people who reject active euthanasia do accept passive euthanasia as a practice that provides benefits to the dying person without violating ethical standards and religious values. Legislation and court decisions also tend to treat active and passive euthanasia differently. The situation is even more complicated. It can also be argued that it is an evasion to regard passive euthanasia as acceptable while condemning active interventions because both approaches result in an earlier death. Perhaps passive euthanasia is also sometimes unintentionally cruel because the person continues to suffer while life runs out (Rachels 1989). Whether or not we should continue to focus on the active versus passive distinction is a controversy that does not seem close to resolution.

Support has not come easily for even the more limited forms of euthanasia: withholding or withdrawing life support interventions. The living will was introduced in 1968 as a document expressing an individual's wish to avoid "artificial means and heroic measures" at the end of life (Scofield 1989). This document did not have the force of law, depending instead on the willingness of physicians to accept the patient's request. The landmark case of Karen Ann Quinlan in 1975 aroused enormous public and professional controversy in addition to the personal distress experienced by her parents (Kastenbaum 2001). The young woman lapsed into a coma after a party and never recovered consciousness. Physicians believed she would die if taken off the ventilator. Courts first ruled against and then in favor of the request to withdraw this intervention. To the astonishment of many, Quinlan lived another ten years, though without showing any signs of mental life. Courts have since made a variety of rulings with the overall effect of accepting withdrawing of treatment under specified circumstances. The significant principle of informed consent has also received support: a mentally competent person has the right to reject proposed treatments. Advance directives—more flexible and refined versions of the living will—now provide individuals with an improved opportunity to state their preferences for end-of-life care, thereby reducing the burden of decision making on the part of others (King 1996). Furthermore, most state legislatures have passed natural death acts that affirm a person's right to avoid the prolongation of suffering or a persistent vegetative state.

Very much still gripped by controversy is the proposition that society should honor "death on demand" (Baird and Rosenbaum 1989; Cohen 1988; Gomez 1991; Kevorkian 1991; Scherer and Simon 1999; Singer 1996). Should physicians be permitted—or even required—to end a terminally ill and suffering person's life by lethal injection or similar means? Proponents argue that the individual has the right to die as well as the right to live. Society fails dying people, consigning them to agony and despair. It is time to shake off outmoded tradition and provide a quick and merciful ending for those in terminal torment.

Opponents muster arguments from a variety of perspectives. "Thou shalt not kill" and "Man should not play God" are objections that are based on religious faith. "Doctors should not kill" expresses the view that the physician's reputation and role would be compromised by also becoming an agent of death. The prohibition against doctors providing lethal medicines is traced back to the Hippocratic Oath (fifth century b.c.e.), but in reality physicians have been divided on this subject since antiquity, and the Oath itself does not command as much power in the medical community as one might suppose (Edelstein 1943; Kevorkian 1991). Another objection has already been noted: the slippery slope is sure to become even more treacherous if physician-assisted death is countenanced. For every death that occurs after due process, many others will take place on whim and impulse.

Perhaps the most formidable criticism comes from people who are familiar with hospice care. Jack Kevorkian, M.D., the most conspicuous advocate and practitioner of physician-assisted death in the United States, has been charged with ignorance both of palliative care measures, depression, and family dynamics (Kaplan 2000). According to these criticisms, Kevorkian has performed and encouraged medical homicides on people who (1) could have found relief through competent management of their symptoms, (2) needed treatment for depression, and (3) were not terminally ill in the first place. Studies reported by Kalman J. Kaplan and his colleagues provide some support for these charges. After being associated with more than a hundred deaths, Kevorkian was found guilty and jailed on charges of second degree murder.

The world continues to observe, wonder, and dispute about the legalization of euthanasia in the Netherlands. The issue became salient in 1973 when a doctor obeyed her dying mother's request to end her life. Eventually the Dutch Supreme Court made a ruling that has remained confusing to those not familiar with that nation's justice system. Euthanasia was illegal, but it was also acceptable—if it involves a competent person who has had full access to information and an adequate time to decide, and is in a situation of intolerable and hopeless suffering without any acceptable alternative remaining. The physician must also consult another independent doctor with experience in end-of-life care. Over the years doctors practicing euthanasia in the Netherlands have either followed these guidelines conscientiously, or found ways around the guidelines whenever it suited the physician's interests—depending on whose version of the events and which study one cares to believe. The legal side of the issue was clarified when the Dutch parliament passed and the Senate confirmed a pro-euthanasia legislative act (April 11, 2001).

Other nations are also struggling with the euthanasia decision. Australia's Northern Territory, for example, approved physician-assisted suicide for the terminally ill, but it proved difficult to find doctors willing to perform this act, and the measure itself was subsequently overturned at the national level. A voter-approved bill is on the books in Oregon, but the future of legalized physician-assisted death in the United States, as in most other nations, remains an open question.

See also:Death and Dying; Grief, Loss, and Bereavement; Hospice; Infanticide; Suicide

Bibliography

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edelstein, l. (1943). the hippocratic oath: text, translation, and interpretation. baltimore: johns hopkins university press.

gomez, c. (1991). regulating death. new york: free press.

greenberg, s. i. (1997). euthanasia and assisted suicide.springfield, il: charles c. thomas.

kaplan, k. j., ed. (2000). right to die versus sacredness oflife. amityville, ny: baywood.

kastenbaum, r. (2001). death, society, and human experience, 7th edition. boston: allyn & bacon.

kevorkian, j. (1991). prescription: medicide. buffalo, ny:prometheus press.

king, n. m. p. (1996). making sense of advance directives. rev. edition. washington, dc: georgetown university press.

lifton, r. j. (1986). the nazi doctors. new york: basicbooks.

pernick, m. s. (1996). the black stork. new york: oxforduniversity press.

saunders, c. (1997). "hospices worldwide: a missionstatement." in hospice care on the international scene, ed. c. saunders and r. kastenbaum. new york: springer.

scherer, j. m., and simon, r. j. (1999). euthanasia and the right to die. lanham, md: rowman & littlefield.

scofield, g. (1989). "the living will." in encyclopedia of death, ed. r. kastenbaum and b. kastenbaum. phoenix, az: oryx press.

singer, p. (1996). rethinking life and death. new york:st. martin's griffith.

robert kastenbaum

EUTHANASIA

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

See alsoAssisted Suicide ; Death and Dying ; "Right to Die" Cases ; Washington v. Glucksberg .

euthanasia 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, and 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.

euthanasia. 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 The act of ending the life of a person or animal in order to prevent further suffering, e.g. from an incurable and painful disease. This can be achieved by administering a lethal drug or by withholding vital treatment. In human medicine euthanasia is fraught with ethical and legal problems, and is illegal in most countries. Where it is practised, strict safeguards are enforced to ensure that the patient's wishes are determined and adhered to. Euthanasia is widely performed in veterinary medicine.

euthanasia the painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma. The practice is illegal in most countries, although euthanasia in cases where the patient has given active consent is accepted in practice in the Netherlands.

The word is recorded from the early 17th century (in the sense ‘easy death’), and comes from Greek, from eu ‘well’ + thanatos ‘death’.

euthanasia (yooth-ăn-ay-ziă) n. the act of taking life to relieve suffering. compulsory e. termination of the life of a person (e.g. an infant) who cannot express his or her own wishes, which is universally illegal. voluntary e. euthanasia produced at the request of the patient, achieved by active steps, usually administration of a drug, or more passively, for example by deliberately withholding treatment. See also (assisted) suicide.

eu·tha·na·sia / ˌyoō[unvoicedth]əˈnāzhə/ • n. the painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma. The practice is illegal in most countries. ORIGIN: early 17th cent. (in the sense ‘easy death’): from Greek, from eu ‘well’ + thanatos ‘death.’

euthanasia (Gk. ‘good death’) Inducing the painless death of a person (usually with a terminal illness), often by a drug. It is illegal in most countries. Voluntary euthanasia, the taking of life with the consent of the patient, is legal in the Netherlands. Passive euthanasia, the withholding of life-supporting treatment, is a form of voluntary euthanasia.

euthanasia easy death XVII; means of bringing this about XVIII. — Gr. euthanasíā, f. EU- + thánatos death.

euthanasia. See DYING, CARE OF THE.

euthanasia •astrantia • Bastia •Dei gratia, hamartia •poinsettia •in absentia, Parmentier •Izvestia •meteor, wheatear •Whittier • cottier • Ostia •consortia, courtier •protea • Yakutia • frontier • Althea •Anthea • Parthia •Pythia, stichomythia •Carinthia, Cynthia •forsythia • Scythia • clothier • salvia •Latvia • Yugoslavia • envier •Flavia, Moldavia, Moravia, Octavia, paviour (US pavior), Scandinavia, Xavier •Bolivia, Livia, Olivia, trivia •Sylvia • Guinevere • Elzevir •Monrovia, Segovia •Retrovir • effluvia • colloquia •Goodyear • yesteryear • brassiere •Abkhazia •Anastasia, aphasia, brazier, dysphasia, dysplasia, euthanasia, fantasia, Frazier, glazier, grazier, gymnasia, Malaysia •amnesia, anaesthesia (US anesthesia), analgesia, freesia, Indonesia, Silesia, synaesthesia •artemisia, Kirghizia, Tunisia •ambrosia, crozier, hosier, osier, symposia