euthanasia

Definition

Euthanasia (Greek, "good death") is the practice of killing a person or animal, in a painless or minimally painful way, for merciful reasons, usually to end their suffering. This article discusses euthanasia in humans; a separate article covers animal euthanasia.

Euthanasia in the strict sense involves actively causing death. This is in some cases legal in the Netherlands (see below), but in few other countries. Euthanasia in a wider sense includes assisting someone to commit suicide, in particular physician-assisted suicide (PAS).

Allowing death—e.g. by not providing life support or vital medication—is not considered euthanasia if it is the patient's wish. It is sometimes called passive euthanasia in cases where the patient is unable to make decisions about treatment. Living wills and Do Not Resuscitate orders are legal instruments that make a patient's treatment decisions known ahead of time; allowing a patient to die based on such decisions is never considered euthanasia. In some cases, a patients' religion must be taken into account, for example Jehovah's Witnesses are not allowed to accept blood transfusions for themselves or their loved ones, and cannot be resuscitated, as both of these are against their beliefs.

Terminal sedation is a combination of medically inducing a deep sleep and stopping other treatment. It is considered to be euthanasia by some, but under current law and medical practice it is considered a form of palliative care.

Advocates of euthanasia generally insist that euthanasia should be voluntary, requiring informed consent, and that it should only be used in cases of terminal illness that cause unbearable suffering. Its opponents challenge it on several ethical grounds, including a slippery slope argument that it is the first step towards compulsory euthanasia.

Types of euthanasia

Apart from the above classifications three types of euthanasia may be identified, depending upon the sentience of the individual.

Voluntary euthanasia
This is the truest and fullest form of euthanasia wherein the individual requests euthanasia - either during illness or before, if complete incapacitation is expected (coma would be an example). Euthanasia in these cases differs from suicide by existing only within the context of the amelioration of suffering in the process of death. Volition must be informed and free (i.e. not under duress from any third party).

Non-voluntary euthanasia
Where an individual lacks sentience (in a coma, for example) and hence cannot decide, or distinguish, between life and death, such a person cannot give consent or cannot give informed consent, and therefore any euthanasia is not voluntary but also not involuntary. Famously notable as "turning off life-support", it is often done when resuscitation is not expected, or after severe brain damage that renders a person incapable of making life decisions.

Involuntary euthanasia
Where an individual may distinguish between life and death - and may fully realise the difference between them, any medical killing is involuntary. If, for example, a man is going to experience severe agony and does not consent to death, euthanasia imposed upon him is ethically and morally, if not legally, forbidden as murder.

In Nazi Germany the term "euthanasia" (Euthanasie) referred to the systematic killing of deformed children and mentally ill adults under the T-4 Euthanasia Program. This has tainted the word in German-speaking countries; the alternate term is "Sterbehilfe", which means "help to die." Any time that medical personnel determine on behalf of a sentient and responsible individual that his or her life is not worth living, the medical killing of such a person as it is considered to be done for the prevention of suffering is involuntary euthanasia. This is not to be confused with medical killing in cases of capital punishment or as part of genocide.