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Euthanasia (from the Greek meaning of "good death": (well or good), thanatos (death)) refers to the practice of ending a life in a manner which relieves pain and suffering. According to the House of Lords Select Committee on Medical Ethics, the precise definition of euthanasia is "a deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering."[1]
Euthanasia is categorized in different ways, which include voluntary, non-voluntary, or involuntary and active or passive. Euthanasia is usually used to refer to active euthanasia, and in this sense, euthanasia is usually considered to be criminal homicide, but voluntary, passive euthanasia is widely non-criminal.
The controversy surrounding euthanasia centers around a two-pronged argument by opponents which characterizes euthanasia as either voluntary "suicides", or as involuntary murders. (Hence, opponents argue that a broad policy of "euthanasia" is tantamount to eugenics). Much hinges on whether a particular death was considered an "easy", "painless", or "happy" one, or whether it was a "wrongful death". Proponents typically consider a death that increased suffering to be "wrongful", while opponents typically consider any deliberate death as "wrongful". "Euthanasia's" original meaning introduced the idea of a "rightful death" beyond that only found in natural deaths.
Euthanasia is the most active area of research in contemporary bioethics.
Classification of euthanasia
Euthanasia may be classified according to whether a person gives informed consent into three types: voluntary, non-voluntary and involuntary.[5][6]
There is a debate within the medical and bioethics literature about whether or not the non-voluntary (and by extension, involuntary) killing of patients can be regarded as euthanasia, irrespective of intent or the patient's circumstances. In the definitions offered by Beauchamp & Davidson and, later, by Wreen, consent on the part of the patient was not considered to be one of their criteria.[7][8] However, others see consent as essential. For example, in a discussion of euthanasia presented in 2003 by the European Association of Palliative Care (EPAC) Ethics Task Force, the authors offered the unambiguous statement:
| Medicalized killing of a person without the person's consent, whether nonvoluntary (where the person in unable to consent) or involuntary (against the person's will) is not euthanasia: it is murder. Hence, euthanasia can be voluntary only.[9] | |
Voluntary euthanasia
Euthanasia conducted with the consent of the patient is termed voluntary euthanasia. Voluntary euthanasia is legal in Belgium, Luxembourg, the Netherlands, Switzerland, and the U.S. states of Oregon and Washington. When the patient brings about his or her own death with the assistance of a physician, the term assisted suicide is often used instead.
Non-voluntary euthanasia
Euthanasia conducted where the consent of the patient is unavailable is termed non-voluntary euthanasia. Examples include child euthanasia, which is illegal worldwide but decriminalised under certain specific circumstances in the Netherlands under the Groningen Protocol.
Involuntary euthanasia
Main article: Involuntary euthanasia
Euthanasia conducted against the will of the patient is termed involuntary euthanasia.
Procedural decision
Voluntary, non-voluntary and involuntary euthanasia can all be further divided into passive or active variants. A number of authors consider these terms to be misleading and unhelpful.
Passive euthanasia
Passive euthanasia entails the withholding of common treatments, such as antibiotics, necessary for the continuance of life. Whether the administration of increasingly necessary, albeit toxic doses of opioid analgesia is regarded as active or passive euthanasia is a matter of moral interpretation, but in order to pacify doctors' consciences, it is usually regarded as a passive measure.[1]
Active euthanasia
Active euthanasia entails the use of lethal substances or forces to kill and is the most controversial means. An individual may use a euthanasia device to perform active voluntary euthanasia on himself / herself.
Legal status
West's Encyclopedia of American Law states that "a 'mercy killing' or euthanasia is generally considered to be a criminal homicide"[11] and is normally used as a synonym of homicide committed at a request made by the patient.[12]
The judicial sense of the term "homicide" includes any intervention undertaken with the express intention of ending a life, even to relieve intractable suffering.[12][13][14] Not all homicide is unlawful.[15] Two designations of homicide that carry no criminal punishment are justifiable and excusable homicide.[15] In most countries this is not the status of euthanasia. The term "euthanasia" is usually confined to the active variety; the University of Washington website states that "euthanasia generally means that the physician would act directly, for instance by giving a lethal injection, to end the patient's life". Physician-assisted suicide is thus not classified as euthanasia by the US State of Oregon, where it is legal under the Oregon Death with Dignity Act, and despite its name, it is not legally classified as suicide either.[17] Unlike physician-assisted suicide, withholding or withdrawing life-sustaining treatments with patient consent (voluntary) is almost unanimously considered, at least in the United States, to be legal.[16] The use of pain medication in order to relieve suffering, even if it hastens death, has been held as legal in several court decisions.
Some governments around the world have legalized voluntary euthanasia but generally it remains as a criminal homicide. In the Netherlands and Belgium, where euthanasia has been legalized, it still remains homicide although it is not prosecuted and not punishable if the perpetrator (the doctor) meets certain legal exceptions.
The Church of Euthanasia was inspired by a dream, in which Rev. Chris Korda confronted an alien intelligence known as The Being who speaks for the inhabitants of Earth in other dimensions. The Being warned that our planet's ecosystem is failing, and that our leaders deny this. The Being asked why our leaders lie to us, and why so many of us believe these lies. Rev. Korda awoke from the dream moaning the Church's infamous slogan, Save the Planet - Kill Yourself.
Every aspect of the deepening global environmental crisis, including climate change, poisoning of the water and atmosphere, reduction of biodiversity, and topsoil erosion, directly results from the over-abundance of a single species: homo sapiens. The human population is increasing by one million every four days, according the Washington-based Population Reference Bureau. This is a net increase of 95 million per year, the current population of Mexico.
Even a major war or epidemic hardly dents the rate of growth, and modern wars have tremendous environmental consequences. It is for these practical reasons, as well as moral ones, that Euthanasians support only voluntary forms of population reduction, including suicide, free abortion, and sodomy, which they define as any sexual act not intended for procreation. They are also fiercely vegetarian, and support cannibalism for those who insist on eating flesh.
The planet is a living, breathing organism, and is capable of defending itself if necessary. The Church hopes to avoid the suffering this would entail by achieving a massive leap of consciousness in which human beings begin to think of themselves, not as individuals belonging to races or nation-states, but as a species. This species awareness would be the first step towards what Biodiversity author and population expert Paul Erlich calls "our absolute responsibility to protect what are our only known living companions in the universe."
Arguments in Favor of Euthanasia
Arguments in favor of euthanasia are generally based upon beliefs concerning individual liberty, what constitutes a "good" or "appropriate" death, and certain life situations that are considered unacceptable. These arguments are generally based upon moral or religious values as well as certain beliefs concerning the value and quality of human life. They also often suppose that people are capable of making rational decisions, even when they are suffering and terminally ill.
The good death. According to this view, certain ways of dying are better than others. Usually a good death is described ideally as drifting into death in a pleasing environment as one falls asleep. The ancient Roman orator and statesman Cicero said that a good death is the ideal way of respecting natural law and public order by departing from the earth with dignity and tranquility. Euthanasia can be seen as a way to assure that a person dies in a dignified and appropriate manner.
Individual liberty. In his Essay on Suicide, the eighteenth-century Scottish philosopher David Hume stated that all individuals in a free society should be able to choose the manner of their death. Some people, for example, feel that this right must be tempered by the obligation to not cause harm to others.
Right to maintain human dignity. This argument is similar to the concept of the good death, except that the objective is to avoid a poor quality of life during the dying process rather than seek out a particular idealized way of dying the good death. There are great individual differences in what constitutes a dignified way to live and die. Commonly mentioned indignities to justify premature death include: being a burden to others, living a deteriorated state incapable of normal daily activities, having to be placed in a hospital or a nursing home, and being dependent upon intrusive medical apparatus to continue living or engaging in everyday tasks. The general public often assumes that certain chronic and terminal illnesses inevitably result in a poor quality of life. However, research suggests that the psychosocial environment determines quality of life as much or more than the nature of the illness, per se.
Reduction of suffering. In 1516 the English statesman and author Sir Thomas More described euthanasia to end suffering in his book Utopia as "those that are ill from incurable diseases they comfort by sitting and talking with them, and with all means available. But if the disease is not only incurable but also full of continuous pain and anguish, then the priests and magistrates exhort the patient saying that he has become . . . irksome to others and grievous to himself; that he ought to . . . dispatch himself out of that painful life as out of a prison or torture rack or else allow his life to be ended by others" (More 1964, pp. 186187). In 1994 the philosophy professor Margaret Battin wrote that euthanasia to reduce suffering has two components: to avoid future pain and suffering and to end current pain and suffering. This definition generally assumes that the pain is not only intolerable but interminable.
Justice. Gerald Gruman described euthanasia in order to achieve "justice" in society as "thrift euthanasia," where decisions are made to end lives of certain patients in situations where there is competition for limited resources in medical care. When there is a scarcity of certain medical resources in a society, not all people who are ill can continue to live. In such situations, one can suggest that "less valuable" individuals should give up their places to persons who contribute more to society; if they are unwilling, others should decide who should live and who should die. An extreme example is the eugenics programs based upon Darwinian concepts, such as those proposed by the German biologist Ernst Haeckel in 1904. Haeckel proposed that in order to reduce welfare and medical costs "hundreds of thousands of incurable lunatics, lepers, people with cancer" be killed by means of morphine or some other "painless and rapid poison" (1904). This approach inspired the National Socialists led by Adolf Hitler in their eugenics program.
Even if one disagrees with any form of eugenics program for economic reasons, one may still consider the fact that social pressure often exists in situations where medical resources are limited. The concept of "distributive justice"involves looking at the collective good or general welfare as something to be shared among the total membership of society. When resources are limited, society may question, for example, if it is worth expending tremendous resources to maintain the life of one incurably ill individual in a vegetative unconscious state rather than using those resources to help cure those who have promising prognoses for recovery.
Avoiding botched suicides. Molloy states that if euthanasia remains illegal, some people will be forced to attempt suicide or try to kill loved ones without any help. He contends that in some instances unsuccessful suicide attempts and botched euthanasia by others may result in a life situation that is worse than before. It can be argued that legalization of euthanasia will avoid suffering from botched attempts and the prosecution of loved ones who are acting sincerely at the request of a family member.
Control of existing practices. In countries where euthanasia is illegal there are clandestine practices by physicians and family members regardless of the laws. Proponents of euthanasia in the Netherlands often state that as long as euthanasia remains illegal in a country, physicians and other citizens will camouflage those activities and there will be no monitoring or control of what occurs. An advantage to legalizing euthanasia would be to control existing practices and ensure that there are fewer abuses.
Arguments against Euthanasia
The arguments against euthanasia include religious and ethical beliefs about the sancitity of life as well as a number of arguments allowing for euthanasia that will inevitably lead to a situation where some individuals will risk having their deaths hastened against their will.
Sanctity of human life. This belief, based upon religious values, considers human life sacred and inviolable. No person may take the life of another. For example, St. Augustine interpreted the biblical prescript against killing as being absolute, even including the taking of one's own life. Another argument for the sanctity of human life is that this constitutes one of the pillars of social order that must be maintained to avoid social breakdown. For example, St. Thomas Aquinas condemned suicide because it goes against one's obligation to oneself, the community, and God.
Wrong diagnoses and new treatments. According to this point of view, where there is life there is hope. It is possible that a terminal diagnosis is in error; some people thought to be dying from an incurable disease are victims of a mistaken diagnosis or may miraculously continue to live. Also, because of the rapid pace of advances in medical science, there may soon be a cure for diseases that are at the time of the euthanasia considered to be incurable. Thus, euthanasia may be a mistake if there is a possibility, however slight, that the person is not really going to die. For example, it can be said that many persons with AIDS (acquired immunodeficiency syndrome) who ended their life prematurely because of impending death may have continued to live for a long time because of the development of new treatments for the disease.
The Wedge or Slippery Slope. This argument maintains that when one accepts killing upon demand in certain situations, despite the best controls and regulations, there is a risk of abuses. Furthermore, there is concern that once the door is opened to justify murder under some intolerable circumstances, there is the possibility of developing broader criteria and making euthanasia more widespread. For example, in the Netherlands euthanasia and assisted suicide was first only available to those who were terminally ill. Since 1998 the regulations for euthanasia have been used to permit access to euthanasia and assisted suicide to persons who are not terminally ill but who suffer hopelessly from chronic physical or even psychological illnesses.
Protection of the weak, incompetent, and disadvantaged. This argument is similar to the Wedge or Slippery Slope argument. The concerns with the Protection of the Weak argument are that people who may be unable to make informed choices concerning euthanasia may be forced to opt for a premature death or may become victims of non-voluntary or involuntary euthanasia.
The value of suffering. Suffering may be seen as good for the soul, a heroic act, or the price to pay for one's sins in order to guarantee a better life in the hereafter. Jesus' suffering on the cross may be considered an example of an appropriate way to die. If suffering is admirable, then seeking to end suffering by euthanasia cannot be condoned.
The option of suicide is always available. Because suicide is always available and not illegal in most countries, one can argue that legalization of euthanasia is not necessary because a person can always find some means of committing suicide. Because of the dangers in legalizing euthanasia, one might instead encourage people to commit suicide rather than involving others in their deaths. One may further argue that those who "do not have the courage" to end their own lives may be too ambivalent and should not be put to death by others.
The impossibility of competent and rational decision making. The seventeenth-century philosopher Spinoza felt that the desire to survive is such an essential part of human nature that humans may not rationally prefer not to survive and kill themselves. According to this view, anyone who wants to die may not be acting rationally. Furthermore, one may question if it is possible when experiencing pain and suffering to make a rational decision before the pain and suffering is controlled. Finally, one may question whether or not most important human decision making is rational and why one should expect a person to be more rational when terminally ill. Major decisions such as choice of career, marriage partners, where to live, and whether or not to have children may be more emotional than rational. Also, there are no generally accepted criteria of what constitutes a rational argument in favor of euthanasia: What is logical and rational for one person may constitute reasons for continuing to fight against death in another person in a similar situation.
Choosing death for the wrong reasons. Many people consider euthanasia because they are experiencing pain and suffering. Ignorance of the availability of interventions to reduce pain and suffering may lead to a choice to end life. People involved in palliative care programs that focus upon reducing the suffering of terminally ill patients contend that better pain control and improvement of the psychosocial situation can alleviate a large proportion of the suffering and reduce the desire for euthanasia.
Undiagnosed clinical depression. It may be considered appropriate for people who are dying to feel sad and unhappy. However, some terminally ill persons may suffer from a more severe and potentially treatable psychiatric syndrome of clinical depression. In some instances, the depression may be a side effect of treatment of the illness or may be related to the psychosocial environment of an institution. According to this view, accurate diagnosis and treatment with antidepressant medication and/or psychotherapy is a preferable option to euthanasia.
Erosion of confidence in physicians. According to this argument, if physicians are allowed to kill some terminally ill patients then confidence in physicians may be diminished. Medical practictioners and proponents of this argument have suggested that only "specialists" should practice euthanasia if it is legalized so that physicians can maintain their reputation as advocates in the fight against death and the reduction of pain and suffering.
Compromising the right to choose by involving others in one's death. Brian Mishara has argued that humans generally experience tremendous ambivalence about ending their lives by suicide, so much so that most highly suicidal people change their minds before an attempt and the vast majority of persons who initiate a suicide attempt do not die from their attempt. He questions whether the involvement of a physician in ending a person's life may create a social situation where there is tremendous pressure to complete the suicidal act and die rather than exercising the choice to continue to live. Once a physician has been convinced that euthanasia is acceptable and appropriate, it is not easy for a person to admit to the doctor that he or she is feeling ambivalent or scared and would like to put off the decision for a while. This analysis suggests that involving others in death can compromise people's rights to change their minds because of the social pressures to complete the act.