euthanasia should not be legalized essay

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Why active euthanasia...

Why euthanasia should not be legalised

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Why active euthanasia and physician assisted suicide should be legalised

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In response to the editorial regarding the legalisation of active euthanasia and physician-assisted suicide,1 I present the following arguments against the legalisation of active euthanasia.

Active euthanasia is unnecessary because alternative treatments exist

It is widely believed that there are only two options for patients with terminal illness: either they die suffering or receive euthanasia. Recent research in palliative medicine has shown that virtually all unpleasant symptoms experienced in terminal illness can be relieved or alleviated by existing techniques.

Requests for active euthanasia are rarely free and active.

A person with terminal illness is vulnerable, lacking the skills and knowledge to alleviate their symptoms. It is very difficult for him to be entirely objective about his own situation. Their capacity for decision-making may equally be affected by confusion, dementia or symptoms, which could be relieved with appropriate treatment. Patients who on admission say "let me die" usually after effective treatment are grateful that their request was not acceded to.

Active euthanasia gives too much power to doctors

Ironically, active euthanasia legislation makes doctors less accountable and gives them more power. Patients generally decide in favour of euthanasia on the basis of information given to them by doctors. If a doctor confidently suggests a certain course of action, it can be difficult for a patient to resist. However, diagnoses may be mistaken and prognoses may be widely misjudged. Active euthanasia gives the medical practitioner power, which in turn can be abused.

Active euthanasia leads inevitably to involuntary euthanasia

When active euthanasia has been previously accepted and legalised, it has led inevitably to inactive euthanasia.

Holland is moving rapidly down the slippery slope with the public conscience changing quickly to accept such action as acceptable. The Royal Dutch Medical Association has recommended that the termination of the lives of patients suffering from dementia is acceptable under certain conditions. Case reports include a woman killed at her own request for reasons of "mental suffering".[2]

Such a progression requires only four accelerating factors: favourable public opinion, willing doctors, economic pressure and a law allowing it. In most Western countries the first three ingredients are present already. When legislation comes into effect and political and economic interests are brought to bear, the generated momentum inevitably follows.

Dr Liz Croton SHO A&E City Hospital NHS Trust, Dudley Rd,Birmingham B18 7QH [email protected]

1. Doyle L, Doyle L. Why active euthanasia and physician assisted suicide should be legalised. BMJ 2001:323;1079-80.

Competing interests: No competing interests

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Why We Should Not Legalize Euthanasia

The Foundational Ethical Principle Obliging Us To Protect Life Must Be Translated Into a Concrete Norm

Fr. Place is research theologian for the Curia and counsel for policy development, Archdiocese of Chicago. This article is based on his talk at the 1992 Frank M. Norfleet Forum for the Advancement of Health, Memphis.

The euthanasia debate is really the backdrop for a discussion within our society about the very nature of human life and meaning. Because the origin of life is in God, human beings do not have dominion over life but are stewards of life.

The powerful combination of sanctity and stewardship is expressed in the foundational ethical principle. This principle says that no person has the right to directly take innocent human life and in fact there is a positive obligation to nurture and protect life.

In our secular society there is a need to develop a "natural" metaphysic of sacredness. Such a metaphysic can serve as bedrock from which a foundational principle can be developed and then applied in concrete moral norms. It can show that life contributes to the full dignity of the human person. For this perspective to be effective in countering the movement to legalize euthanasia, this sense of integral wholeness of human personhood must be demonstrated in a convincing manner. It can be because a dualistic philosophical bias has been found wanting by Western culture.

We must arrive at what ethicists would call concrete norms that guide individual choices. At issue is how we translate our foundational principle—Do not directly attack innocent human life—into a concrete norm when confronted with the possibility of death.

Some persons question whether the concrete norm opposing euthanasia should be a matter of public morality. To answer this question, we must turn to our foundational principle. As a society, we must ask ourselves, How "sacred" is life? Will that natural sense of awe about life, that natural desire not to be vulnerable, be enhanced or threatened by making euthanasia legal?

Euthanasia has become the ethical issue of the 1990s and the focus of some of our most controversial public policy questions. I oppose the legalization of euthanasia. But we must do more than simply disagree with its proponents. It is possible, using the belief structures of the Judeo-Christian tradition and other reflections, to develop a persuasive understanding of human life that can serve as the foundation for an ethic that would oppose the legalization of euthanasia.

Although voters in California and Washington State have rejected assisted-suicide initiatives, the euthanasia debate will continue. Religion serves a vital role in this public policy discussion. But I see the euthanasia debate as symptomatic of a much more profound cultural discussion on the nature and meaning of human life. Certain foundational principles, which can be formulated in both religious and secular terms, can guide the opposition to euthanasia.

Religion and Public Policy Persons involved in the euthanasia debate are often concerned about the role of religion. Many people are concerned that participation by religious leaders is an inappropriate attempt to impose a particular religion's morality on society. But the constitution protects our nation's religious pluralism and ensures that a person who practices a religion or a person who practices no religion will not be excluded from participating in public policy development. Such participation, however, is based on two distinctions:

The distinction between civil law and morality. Although our legal tradition is rooted in moral principles, "the scope of law is more limited and its purpose is not the moralization of society." 1 Everything that people of good will consider to be morally wrong need not be made illegal. This should only happen when the mutually agreed-on demands of the public good or the public order require it.
The distinction between public moral questions and private moral questions. Something is a matter of public morality if it affects the public order of society. Catholic thinker John Courtney Murray defined public order as encompassing three goods: public peace, essential protection of human rights, and commonly accepted standards of moral behavior in a community. As a general principle, the domain of law and public policy is public morality, not private morality.

Thus religious leaders must be circumspect when they speak outside their congregations. Some areas of religious belief and practice are not appropriate matter for legislation. Religious leaders should speak out, however, on matters pertaining to public morality. In a pluralistic society religious leaders are as free as other citizens to participate in the public discussion that seeks to build consensus on what constitutes public morality. Card. Joseph Bernardin of Chicago has suggested that when religious leaders do participate in such public dialogue, they must translate their religious beliefs or philosophical assumptions "into commonly agreed upon language, arguments and categories before they can become the moral or ethical foundations for key public policy choices." 2 He adds:

A rationally persuasive case must be made that an action violates the rights of another or that the consequences of actions on a given issue are so important to society that the authority of the state ought to be invoked through public policy or civil statute, to govern personal and group behavior. Obviously, in a pluralistic society, arriving at a consensus on what pertains to public policy is never easy. But we have been able to achieve such consensus in the past by a process of dialogue, decision making and review of our decisions.

In accepting Card. Bernardin's challenge, I will explain why the legalization of euthanasia would violate the public order of our society and therefore should not be allowed. Persons who propose the legalization of euthanasia must be held to the same standard: They must demonstrate how such a change of public policy would not adversely affect public order.

The Cultural Context Although euthanasia is not new in Western culture, it is evident that euthanasia has not been acceptable practice within U.S. culture or our civil laws. Only in the past few years has euthanasia become a matter of public discussion and concern. The reasons for this growing openness to euthanasia are many, including the advancements of medical technology that have made it possible to maintain and extend human life as never before. Clearly, the sense of powerlessness and the fear of needless pain often associated with such advanced forms of treatment have been practical reasons for the advancement of the euthanasia movement. However, deeper reasons exist for this euthanasia phenomenon—reasons that are cultural or philosophical.

Underlying Assumptions Harvard's Arthur J. Dyck has identified what he considers to be the underlying presuppositions of an ethic of euthanasia. They are as follows:

That an individual's life belongs to the individual to dispose of entirely as he or she wishes;
That the dignity that attaches to personhood by reason of the freedom to make moral choices demands also the freedom to take one's life;
That there is such a thing as a life not worth living, whether by reason of distress, illness, physical or mental handicaps, or even sheer despair for whatever reason;
That what is sacred or supreme in value is the "human dignity" that resides in man's own rational capacity to choose and control life and death. 3

Obviously, one might disagree with some of Dyck's characterizations, but I suggest that he has captured, in a general sense , the presuppositions of the euthanasia movement. And there is much to be said for these presuppositions. For example, they make us aware that values exist beyond those of physical survival. Similarly, they force us to realize that death is not the greatest harm which can befall a person.

Assumptions' Weaknesses Nevertheless, weaknesses are inherent in these assumptions. Rev. Richard M. Gula, SS, identifies three:

They are arbitrary in that they identify a few values to define the significance of human life and fail to put them in the context of a full spectrum of human values and their consequences.
Taken as a freestanding composite, they are too risky. It is not self-evident why their application could not be extended to the most vulnerable members of society such as the elderly and the handicapped.
They erode the "character of a helping community of trust and care." 4

Disagreements regarding the end of life choices open to dying persons reflect non-moral assumptions about the source of meaning and good in human life; the significance of suffering and death in human experience; the relation between dependency, dignity and control; the moral character of caring relationships; and the nature of the human self. 5

The euthanasia debate is really the backdrop for a discussion within American society about the very nature of human life and meaning. Although societies seldom choose to engage such fundamental questions in their abstract form, we must not lose sight of the fact that we are discussing more than whether euthanasia should be legalized.

Argument Against Euthanasia For Catholics (indeed for many Christians), at the center of such a discussion on the nature of human life and meaning is the question of the sanctity of human life. For the believer, God is the origin of all life and the sustainer of all life. For that reason human life has a dignity greater than the sum of life's parts. In a sense this dignity is not intrinsic to the human person. Human dignity is not conferred by one's actions, by the judgments of others, or by the fiat of law. Rather, it is conferred by God. Intimately associated with the concept of sanctity is an awareness that, because the origin of life is in God, human beings do not have dominion over life but are the stewards of life, which is a gift from another.

The Foundational Ethical Principle The powerful combination of sanctity and stewardship is expressed in the foundational ethical principle. This principle says that no person has the right to directly take innocent human life and, in fact, we have a positive obligation to nurture and protect life. This same ethical principle inspired religious leaders and the faithful to participate in the civil rights movement of the 1950s and 1960s, raised citizens' concern about the morality of nuclear warfare, enlightened the discussions on the manner in which the war against Iraq was conducted, and now motivates the drive against the legalization of euthanasia. This foundational ethical principle is the keystone, if you will, of a consistent ethic of life.

Many persons might suggest that this perspective on the sacredness of life is no longer valid for a large number of Americans. They argue that traditional Judeo-Christian symbols and values are no longer adequate to serve as a substratum for the development of a consensus or vision to guide the evaluation of the needs of public order. Some Americans believe we should replace that substratum with one similar to Dyck's presuppositions. If this were to happen, the legalization of euthanasia would be easily justified.

As a committed Christian, I disagree with such a contention. But it is not enough to simply disagree. As Card. Bernardin has proposed, we must offer a positive vision that opposes euthanasia, one secular America will heed.

A Positive Vision Several persons have attempted to develop such a vision. One of the more persuasive contributions is that of Edward Shils. Shils proposes a natural metaphysic that supports the sacredness of life. Sacredness for him is not rooted in a transcendent creator but "in the primordial experience of being alive, in the fear of extinction, in the spontaneous revulsion to contrived interventions and unnatural destruction of human life, and in the sense of awe one feels before one's own vitality and that of the species." 6

For Shils, sanctity of life does not come from outside life but from the experience of life itself. On a pragmatic level, Shils and others argue that unless sacredness of life is acknowledged, the entire structure of human values and rights will collapse. This natural metaphysic of sacredness, much as the Christian understanding, serves as bedrock from which a foundational principle must be developed and then applied in concrete moral norms. The process of developing such a principle is complex, and there is room for disagreement. For example, one could hold to a natural understanding of the sacredness of life and still support euthanasia.

Developing a Foundational Principle Instrumental Good To develop a foundational principle, it is necessary to discuss the question, Is human life and its natural sacredness only an instrumental good necessary for personal fulfillment? Or is it something more? Many euthanasia supporters view life as an instrumental good. In other words, the living body is a means to achieve the true end or purpose of being, which is personal activity. Bodily life provides the wherewithal for personal fulfillment. And when the personal component (the ability to control life through rational choice) is missing, the person has no obligation to continue living. Bodily living has lost its purpose.

The Body-Person Distinction In response to this dualistic distinction between body and person, Fr. Gula proposes an anthropology that "regards the human being as one. . . . Bodily life participates in the integrity of the human person as a substantive good of human life, and human life is the life of a personal being." 7 In other words, life is not only a condition necessary for a person to achieve other values, it is intrinsic to being human, and it contributes to the full dignity of the human person. This sense of an integral wholeness to personhood must be demonstrated in a convincing manner. And I believe it can be, because a dualistic philosophical bias has been found wanting by Western culture.

A Community of Trust and Care Another area that must be addressed is the nature of the community in which human life is situated. As Fr. Gula notes, "If we focused our attention solely on the dying patient and extended our vision no further, then perhaps we might be able to make a case for euthanasia. But if we are socially conscious so that our vision encompasses the caring community as well, then we can make a better case against euthanasia." 8

In this context Stanley Hauerwas has argued that an essential aspect of human experience is the need and the desire to trust the community in which one lives. If life is sacred, then that community of necessity will be a community of trust and care. Euthanasia would be unacceptable because it means the community has abandoned its responsibility to care and comfort. Euthanasia fails to show to dying persons what Hauerwas calls "the continuing trustworthiness of their existence." 9

In a similar fashion one must evaluate euthanasia's effect on the life of the community. Because we are social by nature, we are connected to others. Our individual choices have an impact on others. We must keep in mind that:

Actions reflect and give expression to certain values and beliefs. The more people perform a certain action and the more frequently they perform it, the more those values and beliefs are expressed. The effect is cumulative and eventually influences the moral tone and character of a society. . . . [And] as a result, we need to be concerned not only with individual welfare but also with societal welfare. 10

Clearly, as Robert Bellah and others have demonstrated, the relationship between individual and community is an issue of fundamental importance to our society. 11 An increased sense of isolation and alienation affects many in our midst because we have allowed the individual to be separated from community. In a sense euthanasia can be seen as the logical conclusion of the existential angst of the person alienated from self and community.

Setting Concrete Ethical Norms If we are able as human beings and as a society to agree on this foundational principle, it is then necessary to apply it to concrete ethical issues. We must arrive at what ethicists would call concrete, or material, norms that guide individual choices.

Historically, we have done this. For example, we believe it is wrong to take the life of another person except in self-defense. In simple, straightforward terms we say it is wrong to murder. As a society, we accept this concrete norm as true whether its source is the decalogue or a secular ethic of human sacredness. And we affirm this concrete norm with such conviction that we teach it to our young and expect them to make it part of their code of personal or private morality. We are offended or frightened when we see it violated, especially in senseless or wanton killing.

We also have come to the conclusion that the consequences of the violation of this concrete norm are so great that they threaten the well-being of society. In other words, murder threatens the good of the public order. The public peace is shattered, and the protection of human rights compromised. For these reasons the concrete norm "Do not murder" has been translated into public law. It is understood to be part of the public morality.

At issue, then, is how we translate our foundational principle—Do not directly attack innocent human life—into a concrete norm when confronted with the possibility of death. I could argue that the earlier discussion about the natural "sacredness" of life, the integrity of personhood, and the trustworthiness necessary to sustain human community can be drawn together to support a concrete moral norm saying that it would be wrong to directly take or assist in the taking of human life to relieve pain or suffering. Although originally grounded in a Christian foundational principle, this concrete norm opposing euthanasia now has a nonsectarian basis, like the concrete norm regarding murder. It can, if you will, be called a human or a natural norm.

Although many persons might agree this is a worthy concrete norm to guide the development of personal morality, they would question whether it is so exceptionless, or the consequences of its violation so significant, as to also make it a matter of public morality. For this reason, some are questioning the validity of the existing societal presumption—namely, they question whether the concrete norm opposing euthanasia should be a matter of public morality.

To answer this question, we must return to the grounding for our foundational principle. As a society, we must ask ourselves, How "sacred" is life? Will that natural sense of awe about life, that natural desire not to be vulnerable or at risk, be enhanced or threatened by making euthanasia legal? Are enough protections available in the human community, in light of human foibles and limitations, to ensure that this practice will not make individuals more vulnerable to outside attack? In other words, will the "safe harbor" that laws against murder and euthanasia have created for human existence be enhanced or diminished? We must consider whether, as a society, we want to say that human life is but another "thing" to be used and discarded at will, like a broken toy. Is this the understanding of life we wish to celebrate as a civil society? We must ask whether we are happy living as lone rangers on the frontier of life or whether community is essential to our well-being. And if it is, what are the mutual commitments of trust necessary to support and sustain such community? Will the legalization of euthanasia enhance these commitments or detract?

Meeting the Challenge All too often the euthanasia discussion has not addressed these more fundamental issues. The image of persons dying needlessly painful deaths controlled by insensitive medical technology dominates the discussion. And I suspect many persons who might vote to legalize euthanasia are doing so out of desperation. Ironically, they view their votes as the only way to preserve the sacredness of life and community. What they fail to see is how in fact euthanasia compromises what they most deeply believe.

Card. Bernardin addressed this reality in the following terms:

It is important for us to address the sense of powerlessness which many people experience in regard to the contemporary practice of medicine. While the catch phrase "patient as person" is a helpful guide in this matter, we have to extend this concept more aggressively into the world of critical and terminal illness where the patient is the frailest and most vulnerable. We must also face our own fear of death and learn to provide for those who are dying or critically ill in a way that preserves their dignity and ennobles them. . . . In this way we can eliminate many of the legitimate concerns that may motivate people to consider euthanasia—which otherwise would be unacceptable to them and to society. 12

I agree with the cardinal. The reasoned and sophisticated arguments against the legalization of euthanasia will never be heard and the real discussion will not take place unless, as individuals and providers of healthcare, we first meet this critical challenge.

Joseph Bernardin, "Address: Consistent Ethic of Life Conference," Consistent Ethic of Life , Sheed & Ward, Kansas City, MO, 1988, pp. 86-95.
Joseph Bernardin, "Euthanasia: Ethical and Legal Challenges," Origins , June 9, 1988, p. 52.
Arthur J. Dyck, "An Alternative to the Ethics of Euthanasia," as cited in Richard M. Gula, What Are They Saying about Euthanasia? Paulist Press, Mahwah, NJ, 1986, p. 169. These reflections are deeply indebted to Fr. Gula's masterful analysis of this important subject.
Gula, p. 70.
Courtney S. Campbell, "Religious Ethics and Active Euthanasia in a Pluralistic Society," Kennedy Institute of Ethics Journal , vol. 2, 1992, pp. 253-284.
Edward Shils, "The Sanctity of Life," in Daniel H. Labby, ed., Life or Death: Ethics and Options , University of Washington Press, Seattle, 1968, p. 12.
Gula, p. 97.
Gula, p. 71.
Ron Hamel and Edwin DuBose, "Views of Major Faith Traditions," in Ron Hamel, ed., Active Euthanasia, Religion and the Public Debate , Park Ridge Center, Chicago, 1991.
Robert N. Bellah, Habits of the Heart: Individualism and Commitment in American Life , HarperCollins, New York City, 1986.
Bernardin, "Euthanasia," p. 56.

HOW THE CATHOLIC TRADITION VIEWS EUTHANASIA

In the Catholic tradition euthanasia is understood "as an action or omission which of itself or by intention causes death in order that all suffering may in this way be eliminated" (Congregation for the Doctrine of the Faith, "Declaration on Euthanasia," Origins , vol. 10, 1980, pp. 154-157). Euthanasia may be voluntary or involuntary. The difference is found in the patient's intention. Voluntary euthanasia is when a patient ends his or her own life with the assistance of a care giver, or when a care giver does it at a patient's request. Involuntary euthanasia occurs when a care giver ends a patient's life without the patient's consent.

Also, euthanasia may be either active or passive. Active euthanasia occurs when death is induced through an external method, such as Dr. Jack Kevorkian's machine. Passive euthanasia occurs "if the cause of death is present within one's body, but is not resisted when there is a moral obligation to do so" (Kevin O'Rourke, "Assisted Suicide: An Evaluation," Journal of Pain and Symptom Management , vol. 6, 1991, p. 2).

Within the Catholic theological tradition, no moral distinction is made between active and passive euthanasia. Both are described as causing the death of a person who is ill when there is a moral obligation to prolong that person's life.

Key to this ethical analysis is the assumption that there is a moral obligation to preserve and protect human life. The existence of such an obligation is relevant because, according to the Catholic theological tradition, there are times when no moral obligation exists to prolong life—namely, when the care or treatment would be futile or disproportionately burdensome. Consequently, when there is no such obligation and a person is allowed to die from a fatal pathological condition, "then the act by which one is allowed to die is not euthanasia" (O'Rourke).

This is an important point. Catholic tradition does not require that persons who are dying be kept alive needlessly. Rather, it opposes reversing a centuries-old tradition enshrined in our civil law saying that no one should directly take the life of another innocent person or assist in the taking of that life even if that person is dying or is seriously ill.

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Home — Essay Samples — Social Issues — Euthanasia — Why Euthanasia Should Be Legal: Analysis of Arguments and Counterarguments

Why Euthanasia Should Be Legal: Analysis of Arguments and Counterarguments

Categories: Assisted Suicide Euthanasia Right to Die

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Published: Aug 14, 2023

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Introduction, why euthanasia should be legal, works cited, counterarguments.

Corder, Mike. “Dutch Euthanasia Center Sees 22% Rise in Requests in 2019.” WAVY.com, 7 Feb. 2020, www.wavy.com/news/health/dutch-euthanasia-center-sees-22-rise-in-requests-in-2019/. Accessed 10 March 2020.
Davis, Jacky. “Kevin Davis Deserved Choice.” Dignity in Dying, www.dignityindying.org.uk/story/kevin-davis/. Accessed 13 March 2020.
De La Torre, Esther B. The Right to Assisted Suicide, www.lonestar.edu/rightto-assist-suicide.htm. Accessed 19 March 2020.
“Euthanasia Laws - Information on the Law about Euthanasia.” Information on the Law about Euthanasia - Suicide, Life, Act, and Mercy - JRank Articles, law.jrank.org/pages/11858/Euthanasia.html. Accessed 10 March 2020.

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Why Euthanasia Should not be Legalized

A Reflection on the Dutch Experiment

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Henk Jochemsen 8

Part of the book series: International Library of Ethics, Law, and the New Medicine ((LIME,volume 12))

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The experience of the Netherlands continues to be cited as illustrative of the euthanasia debate that is going on in many countries. The parliamentary debates on the legalization of euthanasia (November 2000 in the Second Chamber and April 2001 First Chamber) have drawn a lot of international attention. But, before this legalization in the Penal Code this country had adopted a legal regulation of euthanasia and, before and after that, extensive surveys into the practice of euthanasia had been carried out. The fact that the Dutch example is cited both by those who favor the legislation of euthanasia and those who reject it demonstrates that empirical data in themselves do not settle an ethical or juridical issue.

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Jochemsen, H. (2001). Why Euthanasia Should not be Legalized. In: Weisstub, D.N., Thomasma, D.C., Gauthier, S., Tomossy, G.F. (eds) Aging: Decisions at the End of Life. International Library of Ethics, Law, and the New Medicine, vol 12. Springer, Dordrecht. https://doi.org/10.1007/978-94-015-9682-4_5

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Mercy killing debate: should euthanasia be legalized?

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Many new cases of physician-assisted suicide or mercy killing are emerging in Western countries. Some of them have regulated it. Do you think euthanasia should be legalized? Under what circumstances? Do we have the right to die as we choose?

Mercy Killing Debate

Euthanasia or physician- assisted suicide , also know as mercy killing , is becoming a prominent public debate . The implications of legalizing assisted suicide are wide-ranging from a medical , legal, political and ethical point of view.

The term euthanasia means "good death" in Greek. With the progress of medicine in multiple domains (e.g. anesthesiology, pain medicine) came the problem of the decision of death. Some countries, like for instance Belgium, The Netherlands, and some states in the USA, including New Mexico, Montana, Oregon and Vermont, have passed laws allowing voluntary euthanasia. But the legality of choosing the moment of death is an extremely controversial subject because it appeals to personal views on ethics and morality and is highly emotional and linked to religious beliefs. Most countries still consider euthanasia a crime . Some people consider allowing euthanasia to risk opening a slippery slope where killing may become more common, and risk the killing of people misinformed or against their will. These people also worry about the risk of killing any person with some sort of suffering (e.g. mental disability, physical handicap). Supporters of euthanasia claim it is an individual right to decide when to die, to keep control of their fate when it is still possible.

Types of euthanasia

There are different types of euthanasia according to whether the will of the patient has been expressed.

Voluntary euthanasia : to intentionally end the life of someone who asked for it to relieve physical pain and psychological suffering. It can be considered as assisted suicide. Patient gives informed consent. An official signed document in which one declares one wants to be euthanized.
Non-voluntary euthanasia : consent of the patient is unavailable. Usually family members are asked about the possible will of the patient as well as their own wish.
Involuntary euthanasia is against the patient’s will and is illegal, considered as murder, in most countries.

Euthanasia can also be divided into:

Passive euthanasia: when the family or medical staff withhold life support (e.g. medication, respiratory machine, feeding or liquids) from the patient.
Active euthanasia: when the patient is administered (e.g. injected) a lethal dose of any chemical substance to end her/life.

And you? Do you support mercy killing ? Should euthanasia be legalized? Before voting and commenting you may want to consider the pros and cons of legalizing physician-assisted suicide (see below).

Watch this video on the mercy killing debate

Euthanasia pros and cons

Dying with dignity: some people are deeply sick, postrated and unable to do even the most basic human actions, such as eating, changing clothes, washing themselves or using the toilets. They often find their state degrading and humilliating and may prefer to die with dignity and stop being a burden to those around them.
End to human suffering: people with terminal illness and no chance of recovery often suffer great physical pain and emotional distress. Ending their lives, if they wish so, can spare them from an unnecessary suffering.
Legal certainty: according to research conducted in the Netherlands, regulating euthanasia has improved legal certainty and has contributed to the carefulness of assisted suicide.
Healthcare spending: keeping alive terminal patients who are suffering and not able to recover is also very expensive and detracts medical resources from other patients who could heal or need treatments. Families of the patients who want to end their lives may also face bills which can very negatively affect their finances.
Autonomy and self-determination: opposing to someone's will of ending her/his life goes against that person freedom and right of deciding on their future.
Moral and ethical problems: physician assisted death clashes with religious beliefs. Many religions state that human life end should not be decided by people but by God.
Misunderstandings and errors: there are cases in which doctors have wrongfully diagnosed a terminal disease or have thought that a patient is without hope of recovery. However, medicine evolves and cures may be found. Some new treatments may become effective were others failed. So terminating someone's life even with her/his consent may be a mistake.
Legalizing murder: regulating euthanasia for some extreme cases may mean crossing a line. It has been argued that this could be a slippery slope which could end up with the legalization of an increasing number of cases for ending a life for utilitarian reasons.
Abuse: if euthanasia is legal, there may be an incentive to exaggerate the negative condition of patients so that the family decides to "disconnect" them so that the hospital or insurance company saves money.
Complexity: even if countries decide to legalize euthanasia, there may be great difficulties in agreeing with the cases and situations in which these mercy killings are acceptable and with the legal procedures that should be respected.

Taking all these pros and cons into consideration and the experience in the territories where it has been legalized, what would you recommend doing?

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Meeting report
Open access
Published: 15 January 2014

Should assisted dying be legalised?

Thomas D G Frost 1 ,
Devan Sinha 2 &
Barnabas J Gilbert 3

Philosophy, Ethics, and Humanities in Medicine volume 9 , Article number: 3 ( 2014 ) Cite this article

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When an individual facing intractable pain is given an estimate of a few months to live, does hastening death become a viable and legitimate alternative for willing patients? Has the time come for physicians to do away with the traditional notion of healthcare as maintaining or improving physical and mental health, and instead accept their own limitations by facilitating death when requested? The Universities of Oxford and Cambridge held the 2013 Varsity Medical Debate on the motion “This House Would Legalise Assisted Dying”. This article summarises the key arguments developed over the course of the debate. We will explore how assisted dying can affect both the patient and doctor; the nature of consent and limits of autonomy; the effects on society; the viability of a proposed model; and, perhaps most importantly, the potential need for the practice within our current medico-legal framework.

Introduction

Over the past two centuries, the United Kingdom has experienced rapid population growth associated with a substantial decline in mortality from acute infectious diseases and poor nutrition [ 1 ]. As the average life expectancy has increased, so too have the rates of debilitating chronic illness – particularly coronary artery disease and cancers [ 2 ]. These diseases require years of treatment instead of the mere days to weeks that medicine once operated within [ 2 ]. Although healthcare systems have sought to adapt to such changes, aiming to prevent and treat such disease wherever possible, debate has arisen regarding those patients in the latter stages of chronic, incurable, terminal conditions [ 3 , 4 ]. Moreover, there is increasing recognition that the patient must be at the centre of health care decision-making, such that outcomes must be tailored to their individual needs and views. By extension, assisted dying might seem a logical step to help achieve these goals within the realm of end-of-life decision making [ 5 ]. Several jurisdictions, notably Oregon (1997) and the Netherlands (2001) have already legalised assisted dying in some form. These factors have contributed to ongoing legislative discussions within Parliaments for almost a decade, with current opinion polling suggesting a majority of medical practitioners and the public in favour of physician-assisted suicide [ 6 ].

Viability of assisted dying in practice

In the UK, a model for assisted dying has been developed from the legal structure found within the Assisted Dying Bill introduced by Lord Falconer in the House of Lords in 2013 [ 7 ]. Assisted dying could only be considered under circumstances in which a patient of legal age is diagnosed with a progressive disease that is irreversible by treatment and is “reasonably expected to die within six months” [ 7 ]. Registered medical practitioners would make such decisions for patients with terminal illnesses. Addressing the technicalities of ‘assisted dying’ requires distinction between ‘physician-assisted suicide’ (offering patients medical actions or cessation of actions by which they can end their own life) and ‘euthanasia’ (whereby the medical practitioner actively induces death). In light of the strong hostility of the medical profession towards active euthanasia, this proposed model, as with previous attempts to legalise assisted dying, permitted only the former [ 8 – 10 ].

However, there is concern that such distinction may be unrealistic in practice because medical practitioners could find themselves with a patient who had failed to successfully end their own life and was subsequently left in a state of greater suffering. Were such a patient no longer able to give consent, a heavy burden would then be placed on the physician regarding how to proceed. Moreover, the practice of physician-assisted suicide might be deemed discriminatory, for example by giving only patients with good mobility control over their own method of death.

The Assisted Dying Bill 2013 included the provision that any terminal prognosis must be confirmed and attested by a second registered practitioner. The strictness of such criteria has parallels to a similar double-physician requirement when procuring a legal abortion under the 1967 Abortion Act. The stated aims of the provision in both cases are as follows: first, to check the accuracy of the prognosis upon which the decision was being made; second, to ensure that the situation meets the required criteria; and third, to check that such a decision was taken by the patient after full consideration of all available options [ 11 , 12 ]. By having a second independent doctor, the legislation ensures that all three checks are met without prejudice or mistake.

Problematic for any protocol for assisted dying is the fact that estimates of life expectancy in terminal prognoses are erroneous in 80.3% of cases [ 13 ]. Furthermore, the accuracy of such prognoses deteriorates with increased length of clinical predicted survival. Forecasts of survival times are based largely on past clinical experience, and the inherent variability between patients makes this more of an art than a science. This brings to concern both the accuracy of any prognosis meeting the six-month threshold and the validity of requests for assisted dying based partly or wholly on predicted survival times. Whilst the majority of errors in life expectancy forecasts are a matter of over-optimism and hence would not affect either of those two concerns, many cases remain unaccounted for. Overly pessimistic forecasts occur in 17.3% of prognoses; hence we must decide whether the one in six patients making a decision based on an inaccurate prognosis is too high a cost to justify the use of this system. Patients requesting an assisted death often cite future expectations of dependency, loss of dignity, or pain [ 14 ]. If the hypothetical point at which the progression of their illness means they would consider life to be not worth living is not, as informed, mere weeks away but in fact many more months, then this information would have resulted in a different decision outcome and potentiated unnecessary loss of life.

Whilst the presence of a second doctor would be expected to mitigate such forecasting errors, the anchoring bias of the initial prediction may be enough to similarly reduce the accuracy of the second estimate. It is prudent to question the true independence of a second medical practitioner, and whether this second consultation could become more of a formality, as has now become the case with abortion [ 15 ].

Another challenge for an assisted dying system would be to recognise whether patients requesting death were legally competent to make that decision. Consider that any request for suicide from a patient with clinical depression is generally categorised as a manifestation of that mental disorder, thereby lacking capacity. It is arguably impossible to separate out the natural reactions to terminal illness and clinical depression. Indeed, there is evidence that major depressive disorders afflict between 25% and 77% of patients with terminal illness [ 16 , 17 ]. Any protocol for assisted dying must first determine what qualifies as a ‘fit mental state’ for a terminal patient.

The need for assisted dying

It could be argued that a doctor’s fundamental duty is to alleviate forms of suffering in the best interests of the patient. The avoidance of physical pain, as an obvious manifestation of suffering, might explain why assisted dying would be both necessary and within the duties of a doctor to provide. The evolving principle in common law known as the ‘Doctrine of Double Effect’ offers a solution to this problem [ 18 ]. This legal judgement stated that “[a doctor] is entitled to do all that is proper and necessary to relieve pain even if the measures he takes may incidentally shorten life”. This entails that a protocol already exists for patients searching for an escape from chronic pain. Furthermore, numerous retrospective studies have revealed very little correlation between opioid dose and mean survival times: one study of over 700 opioid-treated patients found that the variation in survival time from high-dose opioid treatment is less than 10% [ 19 – 21 ]. It can therefore be said that pain alone, if appropriately managed, should never be cause for considering assisted dying as an alternative.

By contrast, the ‘Doctrine of Double Effect’ might be seen as a subjective interpretation that has been applied unequally due to a lack of specialist training or knowledge [ 22 ]. Despite this, the principle can be easily understood and poor awareness can be remedied by improvements in medical education and standardisation of protocols. Moreover, should we choose to accept arguments for assisted dying that are based upon inadequate administration of pain medication, we set a precedent for conceding shortcomings in palliative care and other end-of-life treatments. Offering hastened death could become an alternative to actively seeking to improve such failings.

Whilst much has been made of the ‘pain argument’ here, the call for assisted dying is rarely this simple. Many patients also suffer a loss of dignity, often due to their lack of mobility – the inability to relieve oneself without help is a potent example. Beyond this are additional fears of further debilitation and the emotional costs of dealing with chronic illness, both for the patient and for their relatives and friends. A study of terminal patients in Oregon showed that these were the most significant reasons behind requests for assisted suicide, the next commonest reason being the perception of themselves as a ‘burden’ [ 14 ]. Clearly, we could seek to provide balanced, compassionate medical care for these patients, and still fail to address these points.

Developments in healthcare and technology may reduce this emotional burden, but remain an imperfect solution.

Rights of patients and limitations of their autonomy

J.S. Mill’s pithy dictum describes autonomy as follows: “over himself, over his own body and mind, the individual is sovereign” [ 23 ]. Not only has the sanctity of bodily autonomy profoundly influenced the development of liberal democracies, it has also provoked a holistic shift in making our healthcare systems more patient-centred – “care that meets and responds to patients’ wants, needs and preferences and where patients are autonomous and able to decide for themselves” [ 5 ]. The ethical principle of controlling the fate of one’s own body is inherently relevant to the debate on assisted dying. It is difficult to reconcile that citizens may have the right to do almost anything to and with their own bodies– from participating in extreme sports to having elective plastic surgery – yet a terminal patient cannot choose to avoid experiencing additional months of discomfort or loss of dignity in their final months of life.

Expectation of individual liberty has been codified in law. The right to bodily autonomy has been interpreted to be included under Article 8 - the right to privacy - of the European Convention on Human Rights (ECHR) and subsequently the Human Rights Act (HRA) [ 24 , 25 ]. Moreover, the ECHR underpins the right of individuals to ‘inherent dignity’ [ 26 ]. Hence, if an individual feels that dignity is unattainable due to the progression of a terminal illness, then taking recourse though assisted dying ought to be a legitimate option.

Conversely, there are two notable oversights in this interpretation of a right to assisted dying as an extension of the principles of bodily autonomy:

First, it would be wrong to view individual liberty as absolute. The HRA allows for exceptions to Article 8 on grounds of ‘health or morals’ [ 25 ]. The principle of autonomy is not inviolable. Governments have limited such privileges for the protection of individuals and society, for example by criminalizing the use of recreational drugs or the selling of one’s own organs. The preservation of life by denying assisted dying could fall within this category.

Second, the right of autonomy is not necessarily intrinsic to human beings but, as Kant argued, is dependent on our ‘rational nature’ [ 27 ]. This concept sees autonomy as an exercise of ‘evaluative choice’ [ 27 ], requiring rationality on the part of individuals to appreciate the nature of options and their consequences. To achieve true autonomy, there must be sufficient information to make those rational decisions; this is the basis of informed consent and why it is a fundamental duty of a doctor to offer a patient an informed series of treatment options [ 28 ]. The logistical issue is that doctors are unable to advise patients regarding the point at which their situation becomes less preferable to being dead. No doctor (or individual) has any knowledge or experience of what ‘death’ may be like. Hence, in this case, the idea of exercising true autonomy through informed consent might be considered meaningless.

Legalising assisted dying by attempting to establish an absolute right to bodily autonomy may undermine other individual and group rights. Vulnerable patients may feel pressured into assisted dying because of social, emotional, or financial strains placed on family and/or friends. This is exemplified by the trend showing that the proportion of patients stating ‘relief of burden’ on others as the reason for requesting assisted dying has risen from 17% to 25% in Oregon since legalisation [ 29 ]. One could even consider the risk of assisted dying becoming an expected choice rather than a free one. Thus, assisted dying may erode the elemental right to life of terminal patients as the value of their life becomes tied to relative costs to society and to those around them.

Moreover, by creating one class of individuals for whom life is expendable, that particular view may be extended by society to all groups possessing such attributes (e.g. the permanently disabled). There would be a definite risk to the rights of these vulnerable groups in the form of society being less willing to provide for their health and social care.

It is often raised that the limited legalisation of assisted dying would inevitably become extended in scope, but this is not necessarily a flaw. Even if the right to determine the manner of death were later extended to a wider group of people, posterity may reflect positively on such a change, just as extending the franchise to women ultimately led to legislation demanding equal pay.

Effect on health professionals and their role

‘To act in the best interest of the patient’ is often cited as a central duty of the doctor [ 28 ]. This concept of ‘best interest’ guiding the doctor’s action has seen the development of two important ethical principles: beneficence and non-maleficence. Beneficence mandates that the actions of the doctor must be aimed to bring about benefit (clinical improvement) for the patient, usually measured in terms of reduced morbidity or mortality; non-maleficence requires that the doctor not carry out treatment that is likely to cause overall harm the patient [ 30 ]. These traditional ethical imperatives on a doctor both conflict with intentionally hastening the death of a patient, and a resolution of this tension would require redefining what constitutes ‘acting in the best interest’.

A further dimension is the potential reluctance of health professionals to engage in a practice that contravenes their own ethical beliefs, particularly as this would affect doctors who never entered training in the knowledge that assisting patients to die would be an expected duty. This is certainly no argument against the introduction of assisted dying; indeed, a recent survey of a cohort of NHS doctors found that 46% would seriously consider requests from patients to undertake steps to hasten death [ 31 ]. It merely expresses the point that any early model would have to account for the fact that an initial 54% of the doctors in the NHS would be required to advise qualifying patients of assisted dying as a legitimate option, despite disagreeing with it in principle.

Furthermore, doctors who agree ethically with this practice may find themselves facing conflicts of interest. It is expensive to treat chronically ill patients, particularly in the final months of life [ 32 ]. Moreover, it would be difficult for commissioners to ignore the fact that the sustained treatment of one individual could deprive many others from access to surgery or access to novel drugs. Such an argument does not suggest that doctors or any other hospital staff would treat this practice without appropriate respect or care; rather it acknowledges the need for appropriate rationing of care and questions the intentions of service providers. The perception of an ulterior motive could negatively impact patient trust. One survey showed that a reasonable minority of patients (27%) – and particularly particularly the elderly – believe that legalising assisted dying would lessen their trust in their personal physician [ 33 ]. The costs of weakened trust in the doctor-patient relationship could far outweigh the benefits of assisted dying, particularly given the importance of trust when treating a chronic patient for an extended period of time.

There is no doubt that assisted dying would empower some patients to maximise control over the timing and manner of their own death. Such expression of autonomy would surely solidify moves towards a patient-centred approach to healthcare. However, the capacity for such consensual requests remains in doubt. Clinically, the patient’s state of mind and the reliability of diagnostic predictions are of issue; philosophically, the idea of informed consent for death is contradictory. The implications for patients, physicians and society have been weighed extensively within this article. The central tenet throughout has been the balancing of an individual’s right to escape a circumstance that they find intolerable, alongside the consequential changes to their other rights, and the rights and responsibilities of third parties. Ultimately, the challenge is for us as a society to decide where this balance lies.

About the debate

The Varsity Medical Debate was started in 2008 with the aim of allowing students, professors and members of the polis, to engage in discussion about ethics and policy within healthcare. Utilising the age-old rivalry between the two Universities, the debate encourages medical students from both Oxford and Cambridge to consider and articulate the arguments behind topics that will feature heavily in their future careers.

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Acknowledgements

For Cambridge University: Hilmi Bayri (Trinity), Alistair Bolger (Jesus), Casey Swerner (St Johns).

For Oxford University: Devan Sinha (Brasenose), Thomas Frost (Lincoln), Collis Tahzib (Lincoln).

Martin Farrell (Cambridge).

Baroness Finlay: Professor of Palliative Care Medicine and former President of the Royal Society of Medicine.

Dr. Roger Armour: Vascular Surgeon and Inventor of the Lens Free Ophthalmoscope.

Mr. Robert Preston: Director of Living and Dying Well.

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Frost, T.D.G., Sinha, D. & Gilbert, B.J. Should assisted dying be legalised?. Philos Ethics Humanit Med 9 , 3 (2014). https://doi.org/10.1186/1747-5341-9-3

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Conceptual illustration of a nurse pushing a patient into light symbolising assisted dying.

Why assisted dying should remain illegal

Michael Wenham was grateful that the option of assisted dying wasn’t available to him when he had a frightening diagnosis. Plus letters from Charles Harris and Alison Watson

Dame Esther Rantzen has done the country yet another service in raising the issue of assisted dying again ( Esther Rantzen ‘considering assisted dying’ if cancer treatment fails, 19 December ). As someone who experiences the “intolerable suffering” of a prolonged incurable disease, I believe we should be far less scared of talking about the taboo subject of dying.

I well remember the day when, after a year of tests, the consultant confirmed that I had “a motor neurone disorder”. I knew what that meant, as it was the year that Diane Pretty’s case to allow her husband to help her take her own life, because she had motor neurone disease, was hitting the headlines. I asked the doctor how long he thought I had left. “Everyone’s different. Let’s wait and see.” The prospects seemed bleak. I anticipated one last Christmas with my family.

In the event, my worst fears weren’t realised; my diagnosis was refined to primary lateral sclerosis, a slowly developing form of MND. Twenty-two years later, I’m still alive and able to find hope and fulfilment in my very restricted life. Day to day, I’m totally dependent on my wife and carer from dressing to bedtime. I occasionally have falls, choke when swallowing, and my speech is barely intelligible. However, my quality of life is enhanced by a team of health professionals who are excellent in this area.

Looking ahead, I don’t wish to hasten my death, and I am grateful that, thanks to the law, I couldn’t be tempted to choose an early death on my first frightening diagnosis. As it should, the law provides a vital safeguarding function. So I have real reservations about any proposals that seek to legalise assisted suicide in the future. Michael Wenham Wantage, Oxfordshire

It’s certainly true that there is a danger of abuse with assisted dying, as Katia Lom says ( ‘When life becomes intolerable, I want out’: Britons’ views on assisted dying. 22 December ), as well as putting pressure on already overworked doctors, but there are potential solutions.

One strong contender is to add a new division to the Office of the Public Guardian, which oversees power of attorney. My wife and I have taken out lasting power of attorney in case of future need, to cover both finance and health.

It would not be difficult to devise a similar legal document, to be drawn up in advance, to cover assisted dying: a “lasting power of extinction”. If enacted, it would need the approval of a third party, perhaps delegated by the Office of the Public Guardian, whose job would be to ensure that no pressure was being put on the subject for financial or other reasons. Charles Harris London

Assisted dying
Death and dying

Article Contents

The implication of a medicalized dying process, the historical case against physicians assisting suicide, the medical cloak, collaborators in euthanasia, healing and euthanasia, recent developments, is euthanasia medical treatment, acknowledgements.

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Euthanasia is not medical treatment

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J. Donald Boudreau, Margaret A. Somerville, Euthanasia is not medical treatment, British Medical Bulletin , Volume 106, Issue 1, June 2013, Pages 45–66, https://doi.org/10.1093/bmb/ldt010

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The public assumes that if euthanasia and assisted suicide were to be legalized they would be carried out by physicians.

In furthering critical analysis, we supplement the discourse in the ethics and palliative care literature with that from medical education and evolving jurisprudence.

Both proponents and opponents agree that the values of respect for human life and for individuals' autonomy are relevant to the debate.

Advocates of euthanasia and assisted suicide give priority to the right to personal autonomy and avoid discussions of harmful impacts of these practices on medicine, law and society. Opponents give priority to respect for life and identify such harmful effects. These both require euthanasia to remain legally prohibited.

Proposals are emerging that if society legalizes euthanasia it should not be mandated to physicians.

The impact of characterizing euthanasia as ‘medical treatment’ on physicians' professional identity and on the institutions of medicine and law should be examined in jurisdictions where assisted suicide and euthanasia have been de-criminalized.

….tha'll nivver feel it, tha'll be out of existence i' two minutes

James Billington

Physician-assisted suicide (PAS) and euthanasia are among the most contentious issues faced by the medical profession. Numerous scholars have argued in favor of 1 or against 2 ‘assisted death’, as these interventions are euphemistically called. These debates generally take it for granted that the person carrying out euthanasia will be a physician. That assumption has been questioned, most recently, by two ethicists from the Harvard Medical School who propose a limited role for physicians in assisted dying. 3 We discuss their proposal shortly. The possibility of deleting the physician from the equation has certainly not been salient in professional discourse.

In this article we will examine factors, highlighting historical contexts and the influence of language, which have helped campaigners who aim to sanitize ‘assisted dying’ by associating it with medicine. We broach the issue of whether euthanasia can be considered medical treatment by focusing on the irreconcilability of euthanasia with medicine's mandate to heal.

In the remainder of this text, we use the word euthanasia to include PAS, unless the contrary is indicated. We do so in accordance with the fact that both procedures raise the same ethical and legal considerations with respect to many of the issues discussed in this article. In PAS and euthanasia, physicians and society are complicit in helping persons to commit suicide or giving them a lethal injection, respectively. Moreover, whether or not a society will alter its laws to allow ‘medically induced death’ is a binary decision.

Are medical doctors, by being responsible for the prolongation of the dying process, blameworthy for the existence of conditions that elicit a desire for hastened death? The profession has indeed created circumstances, through overly aggressive technical interventions, whereby persons' illness narratives have included chapters with alienating, depersonalizing and dehumanizing plots and characters. The following trajectory of a hypothetical patient with amyotrophic lateral sclerosis is all too common: first, non-invasive nocturnal ventilation enters the scenario; next, a wheelchair; then a Dobhof feeding tube, promptly replaced by a jejunostomy; innumerable venous punctures and catheterizations; intervening urinary tract infections; recurrent aspiration pneumonias, followed by invasive ventilation, eventually necessitating a tracheostomy; accompanied by unremitting despondency; and finally, progressive somnolence and terminal sepsis. Too many patients find themselves in a sickroom in such a state, one of spent physical resources and suspended hope or even total despair. Some would add that this metaphoric dwelling is also inhabited by a crushed spirituality.

Pro-euthanasia advocates sometimes present such scenarios to support their views that the profession is, in some measure, responsible for the condition in which a patient may conceive of no escape or redress other than self-willed death. A comment such as, ‘I'd rather die than slog on with deformity, disfigurement and disability', is not infrequently heard and, when expressed, often denounces a sequence of medical interventions rather than the original illness. In dire situations, one of the few avenues that can seem to offer a sense of comfort is that of personal control. Control, usually packaged in a discursive frame of politico-judicial personal autonomy, can be manifest as a desire to manage the ultimate mode of exit from life, that is, for patients to select the method, place and hour of their death. Moreover, some may want this stance to be legitimized by societal approval and even see it as a heroic act and as furthering a common cause, by promoting shared values and ideologies. 4

It would, however, be an overstatement to attribute all changes in the nature of death to the health professions. Improvements in general socioeconomic conditions have decreased the incidence of death from catastrophic accidents, trauma and obstetrical mishaps and have lessened the impact of previously deadly infectious diseases. Undeniably, the shift in prevalence from acute and preventable conditions to chronic degenerative diseases, as well as many cancers, is a consequence of a prolongation of life resulting from improvements in public health, universal literacy and preventive interventions. Nonetheless, there is a kernel of truth in the notion, expressed in commentaries dating from Hellenistic to modern times, that physicians have invented ‘lingering’ death. 5 We believe that some of the profession's approaches in responding to illness in modern society may have fueled the clamour for radical solutions such as euthanasia.

The process has been abetted by those who espouse so-called ‘progressive values’, in what are often referred to as the ‘culture wars’, and who often manifest a pervasive questioning of authority. 6 A desire for unfettered individual decision-making powers—seeing ‘radical autonomy’ as always being the overriding value—and the demotion of established religions as influential voices in the public square are also important factors in the rise in demands to legalize euthanasia. We consider euthanasia a misguided solution to a complex socio-cultural transformation. It is reasonable that the medical profession not deny its contributions to the situation; but, it would be perverse if it allows itself to be co-opted by a perceived need for atonement. It must be vigilant to avoid over-compensating by endorsing society-sanctioned euthanasia.

The profession must not disown its ethical tradition or abandon its basic precepts. The potential harm is not only to individuals, but also to the institutions of medicine and law and the roles they play in society, especially in secular societies, where they are the primary carriers of the value of respect for human life, at the level of both the individual person and society. Ironically, they are more important in this regard now than when religion was the main carrier of the value of respect for life. 4 Therefore, the degrees of freedom, in terms of legitimate actions and behaviours available to physicians confronted with a dying patient are, and must remain, clearly and strictly limited.

The injunction against physician involvement in hastening death has recurred throughout recorded history, the Hippocratic Oath providing the following emblematic statement: ‘I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect’. 7 This unambiguous prohibition has oriented medical practice towards specific ends and means and away from certain others for over 2400 years. Its enduring impact was apparent in early-modern Western society. Euthanasia was discussed by the lawyer Casper Questel in a book entitled ‘De pulvinari morientibus non subtrahendo’. 8 Translated as ‘On the pillow of which the dying should not be deprived’, it described common practices that were thought to hasten death. These popular practices included removing pillows from dying persons so that, with their bodies completely supine, ventilatory capacity would be constricted and death accelerated. Another strategy was to transfer dying persons from their beds to the ground. Perhaps the latter operated through a tacit understanding that the bodily cold thereby induced would bring dying persons closer to their natural demise. Regardless of the underlying pathophysiologic mechanism, it is highly probable that symbolism (for example, facilitating passage of the soul from the shell of the dying body to life eternal) was at play. We note that it was natural death that was sought, not terminating the life of the person.

An intriguing and noteworthy feature of this ancient text is that such practices were popular amongst the general public. They were not acts delegated by society to a particular group and certainly not restricted to medical doctors. Questel was aware of undesirable ramifications if they were practiced by physicians. Physicians risked losing trust should they be discovered to have intentionally shortened the lives of dying patients. Trust is of paramount importance to a successful doctor–patient encounter and is indispensable to the implicit moral contract between the profession and society. 9 Maintaining the trust of individual patients and of society is a sine qua non for the maintenance of professional status. Participating in euthanasia carries the risk of vitiating trustworthiness.

Constraints on physician complicity in euthanasia are to be found throughout history. An 1826 Latin manuscript by a physician, Carl Friedrich Marx, referred to medical euthanasia as the skillful alleviation of suffering. 10 He absolutely forbade physicians from engaging in any attempt at accelerating death, stating : ‘ … and least of all should he be permitted, prompted either by other people's request or his own sense of mercy, to end the patient's pitiful condition by purposefully and deliberately hastening death’. Examples of more recent statements of such prohibitions include the defeat in the House of Lords in 1932 of the ‘Voluntary Euthanasia Bill’ 11 and the Canadian parliament's clear rejection in 2010, by a vote of 228 to 59, of Bill C-384, a private member's bill that would have permitted PAS and euthanasia. 12

Certain jurisdictions, notably the Netherlands and Belgium, have legalized euthanasia. In America, Oregon's ‘Death with Dignity Act’, which permits PAS, came into force in 1997 and Washington state followed suit in 2008. However, on 6 November 2012, Massachusetts voters defeated a ballot that would have allowed assisted suicide, 51–49%. There have been discussions, debates and proposed legislation in many other American states and other countries in the recent past. Generally, these have reaffirmed the ban on medical assistance in killing (whether in the context of end-of-life or, in the USA, physicians' involvement in carrying out capital punishment through lethal injections). The Benelux and a few American states represent the exception to the rule. ‘Do not kill’ has been considered a moral absolute for most physicians for millennia, and remains so for physicians even in jurisdictions where the public has looked favorably on legislative change. That medicine has all to do with healing, and nothing to do with the purposeful ending of life, has been a reverberating imperative throughout history.

The pro-euthanasia lobby derives advantages by aligning itself tightly with medicine and physicians. The history of physician involvement in capital punishment is illustrative of this strategy. Juries in the USA, who had seen horrific footage of convicted murderers being executed in the ‘electric chair’, became reluctant to convict persons accused of capital offences or to vote for a death sentence for felons convicted of a capital offence. Most physicians and the American Medical Association adamantly opposed medicine's involvement in administering capital punishment by lethal injections. Nevertheless, some physicians participated. By virtue of their involvement and in concocting a method of execution that makes a convicted criminal appear serene during final moments, enhanced acceptability was conferred on the procedure. It has been suggested that ‘the law turned to medicine to rescue the death penalty’. 13

It is germane to point out that the word ‘doctor’ is linked etymologically to ‘teacher’. The Oxford English dictionary's definition is: ‘one who gives instruction in some branch of knowledge, or inculcates opinions or principles’. 14 Medical doctors can influence public opinion, much as teachers contribute to the socialization of their pupils. The recruitment of doctors, both as a collectivity and as individuals, to undertake a procedure, can greatly modify the public's view of that procedure.

Language is critically important in not only reflecting, but also creating reality. For example, the field testing conducted prior to the passage of the Oregon Death with Dignity Act demonstrated that when the intervention was described as ‘suicide’ or ‘euthanasia’, popular support declined by 10–12%. 15 The phrase ‘death with dignity’, by avoiding the negative connotations of suicide, was perceived as less alarming. It was able to create a halo of benignity and to generate greater support for and muted opposition to the proposed law. For similar reasons, the euphemism ‘physician assistance in a dignified death’ is reassuring. It would be rare indeed for an individual to wish explicitly for a gruesome death or want to banish a benevolent healer from the sickroom. Research shows that emotions, 16 which we would qualify as ‘examined emotions’, and we would add, moral intuition, are important in making good ethical decisions. Choice of language affects both these human ways of knowing what is morally right and morally wrong. 17

Jill Dierterle, a member of the Department of History and Philosophy at Eastern Michigan University, denigrates the validity and power of words in order to claim that none of the anti-PAS arguments hold merit and concludes that ‘we have no reason not to legalize it’. 18 She turns a blind eye to any potential harm and conveniently overlooks the lacuna in current data-gathering procedures or impact assessments. This stance flies in the face of the golden rule of medicine: primum non nocere. Hence, it is anathema to the vast majority of practicing physicians. Few of us, presented with a new and relatively untested therapeutic instrument, would conclude, ‘we have no reason to doubt its safety; let's forge ahead’. Her nonchalant dismissal borders on the offensive. Note how she handles an important deontological argument against PAS: ‘ … if PAS is wrong, its wrongness cannot be constituted by its conflict with the Hippocratic Oath. After all, the Hippocratic Oath itself is just a bunch of words’. 18 With the phrase ‘just a bunch of words’ Diertele implies that the oath is hollow and meaningless. But ethical precepts and laws are also just a ‘bunch of words’, yet they establish our metaphysical reality—what can be called our metaphysical ecosystem—which, depending on its nature, determines whether or not we have a society in which reasonable people would want to live.

It is critical to the euthanasia debate to consider what role, if any, physicians may, should or must not play. It is not a ‘given’ that, were euthanasia to be legalized, it would be inextricable from the medical mandate. We propose that it is in the best interests of individuals and society to remove the medical cloak from euthanasia in order to lay bare fundamental arguments against it. The stakes are too high to have the veneer of doctoring obscure the essential core of what is involved and its potential harms and risks.

The commentary previously mentioned, ‘Redefining Physicians’ Role in Assisted Dying’, suggests that a non-physician group could be made responsible for the ‘active’ role in euthanasia. 3 The label ‘thanatologist’ has been suggested for such a group. 11 The possibility that a new discipline might emerge raises a set of intriguing questions: What would be the scope of practice of thanatologists? Where would one draw the line between ‘active’ and ‘passive’ roles? Of what might their education consist? We want to make it clear that we believe euthanasia is inherently wrong and, therefore, should never be undertaken, but, it is important to consider what such a proposal could involve if it were put into practice.

It is reasonable to speculate that the training could be offered in a program at a technical level and that the duration of training period would be modest. The act of terminating someone's life is thought to be fairly straightforward—at least, the execution of it is not overly complicated. The experience in the UK of recruiting and training hangmen can provide useful clues. 19 Executioners were trained in the late 19th to mid-20th century with a 5-day course that included lectures, a practical component—‘applicants to pass pinioning in the presence of the Governor’—and ended with a written examination that included simple algebra—the applicant was required to calculate the length of drop (i.e. stretch of the rope) for men of varying weights. Given the complexity of drug-based protocols used in euthanasia, 5 days of instruction would likely be insufficient. A program in the order of 24 weeks, as is the case for cadet training in many police academies, might allow for core objectives to be adequately covered and relevant abilities to be tested and credentialed.

A provocative essay on the topic suggests that lawyers could be trained in euthanasia, practicing a new specialty called legistrothanatry. 20 Although admittedly implausible, the proposal serves to foreground pragmatic issues relevant to the debate. It rests on two fundamental assumptions: (i) that lawyers are trained to interpret laws and regulations accurately, to apply them strictly and to act on the basis of implementing patients' values and (ii) that carrying out the required tasks does not require sophisticated technical expertise. The authors state, ‘Attorneys who wish to provide this service would require only a small amount of additional training’. 20 An appropriate educational blueprint could include the following cognitive base: the physiology of dying, basic pharmacology and an overview of the historical, ethical and legal aspects of natural and requested/assisted death. The toolkit of required skills would likely include: communication, verification of decision-making capacity and informed consent, securing of intravenous access, supplying and/or administering of lethal drugs, management of complications, accurate recognition of death and completion of death certificates. The desired attitudinal substrate would include: personal resolve (that is, stick-with-it-ness), respect for individuals' rights to autonomy and self-determination, and, ideally, a calm demeanour.

Although the tone of the previous discussion may be—and should be—rather ‘chilling’, the substance it addresses has clearly gained a foothold in the current medical literature. A description of procedures for successful euthanasia has been published; one is entitled ‘Euthanasia: medications and medical procedures’. 21 It includes protocols for dealing with terminal dyspnea or agitation in the terminal phase, euthanasia, and the induction of ‘controlled sedation’. Controlled sedation is placed in inverted commas by the author, presumably because he feels that it needs qualification; in his opinion, it represent a hypocritical response to suffering and is undertaken with the aim of muzzling the patient while he dies. We note, but will not discuss here, the ethical issues raised by ‘palliative sedation’, sometimes called ‘terminal sedation’, in which the dying patient is sedated in order to relieve otherwise unrelievable suffering. We suggest that the former term should be used when sedation is the only reasonable, medically indicated, way to relieve the patient's suffering (when it is not euthanasia); the latter term is appropriate when those conditions are not fulfilled and the doctor's intention is to hasten the patient's death (when it is euthanasia).

The epigram to the euthanasia guidelines cited above is fascinating. It states: ‘One summer evening, Mr J-M L, suffering from Charcot's Disease, passed away peacefully after having asked for and obtained the assistance of a physician. Upon leaving the home, the latter did not ponder: ‘What did I do?’ but rather, ‘Did I do it well?’ (Translation by author JDB) 21 This formulation reveals a unique mindset. The affective and moral stance expressed in that quote is closely aligned to a technical perspective, one where the emphasis is on accomplishing tasks with self-efficacy as opposed to one embellished with critical reflection. Meta-reflection is an important aspect of doctoring. What we do and the conversations we routinely engage in forge who we become; they become a habitus. Even the clothing we wear can influence our thought processes. For example, a recent article documents the impacts on cognition of donning a lab coat. 22 If the simple habitual act of wearing a white lab coat can affect thinking and action, one can easily imagine the harmful impacts of regular discussions of euthanasia as they insinuate themselves into the ethos of medical care.

‘The Executioner's Bible’, a story of England's executioners in the 20th century, describes the work of the hangman as a ‘cold, clinical operation’. 19 The epigram we have chosen for our essay, extracted from that textbook, is a quote from James Billington, the UK's Chief Executioner from 1891 to 1901. It is intended to evoke calculated efficiency. The author of ‘Euthanasia: medications and medical procedures’ is similarly categorical, prescriptive and unrestrained by self-doubt. For example, he advises the physician not to propose suicide without medical assistance; to do so is considered incompatible with the role of the physician. He warns the physician against using ‘violent options’ (such as injecting potassium chloride) as this is considered contrary to medical ethics. Leaving aside a disregard for the value of respect for life, the punctilious euthanizer can be seen as behaving with professional dignity and serenity, within a priori defined limits. As the Home Office stated in 1926, when describing the work of hangman William Willis, ‘ … .even an executioner can remain humane and decorous’. 19 Our purpose in making this historical link is not to denigrate advocates of euthanasia. Rather, through this analogy we are endeavoring to focus on the act itself and not just the actor. The latter is often well meaning.

Thanatologists, given the narrow focus of their field of expertise would, over time, almost certainly develop clinical practice guidelines; these might be tailored to different illness categories, for instance, neurodegenerative diseases and the various cancers with poor prognosis. This process seems to be well underway. For example, a recent paper explores euthanasia requests and practices in a highly particularized context, namely, patients in Belgium dying of lung cancer. 23 If euthanasia is accepted as integral to ‘medical care’, this sort of disease-specific focus will surely expand. One can envisage the emergence of guidelines delineating the complementary roles of physicians and thanatologists. Most physicians (we hope) would eschew any involvement in euthanasia and confine themselves to traditional roles such as diagnosing, estimating prognosis and providing supportive care and symptom control, that is, excellent palliative care—which does not include euthanasia, as some advocates argue it should.

The extent to which principled opponents of euthanasia would be legally ‘excused’ from participating in the steps leading up to fulfilling a patient's request for assisted death is a contentious aspect of the debate. How would the profession balance the requirement for individual physicians to fulfill specific social roles and the need to respect the freedom of conscience of those who, on moral grounds, reject certain options? Physician–philosopher Edmund Pellegrino argues that physicians can refrain from entering into professional relationships that have the potential to erode their moral integrity; he offers strategies to assist the physician in navigating potential conflicts. 24

Psychiatrists and medical ethicists who do not reject euthanasia would be expected to focus on soliciting patient perspectives, exploring options and assessing comprehension, competence and voluntariness—that in making her decision, the patient is free from coercion, duress or undue influence, assuming this is possible. The profession has begun to equip itself with tools to deal with this incipient new clinical reality in jurisdictions which allow euthanasia. Physicians in the USA have been provided with an eight-step algorithm to assist them in discussing assisted suicide with patients who request it. 25 These guidelines were developed immediately after the legalization of PAS in Oregon. It is reasonable to expect that additional decision-making tools will emerge should the practice gain wider societal acceptance. Also, the possible consequences on undergraduate medical education, should it have to include protocols for ending patients' lives, have been explored. 26

Again, we note that the above discussion is included for the sake of comprehensive coverage of the issue of physicians' involvement in euthanasia, were it to be legalized, and whether it could be ethically acceptable ‘medical treatment’ or even ‘therapy’. It is not meant to signal that we see euthanasia as ethically acceptable.

It has been repeatedly found that of all separately identified groups in Western societies, physicians are among the most opposed to involvement in euthanasia. There is substantial indirect evidence to support this claim, even in jurisdictions in which doctor-assisted death is legal. For example, in Oregon, there is a suggestion that some patients have to resort to ‘doctor shopping’ to obtain their lethal medications. The Oregon Public Health Division's annual report for 2011 shows that one physician was responsible for 14 of the requisite prescriptions out of a total of 114 that year. 27 Also, the Netherlands recently approved the launching of mobile euthanasia clinics. A stated reason for this development was that patients' goals in self-determination were being thwarted by physician resistance to providing euthanasia. Not all physicians, including many Dutch colleagues, are on-side with having euthanasia become a medical act.

A questionnaire-based study comparing the opinions of the Dutch general public with that of physicians revealed some marked differences. With respect to the active ending of life for patients with dementia, the level of acceptance was 63% for the public and 6% for physicians. 28 With respect to terminally ill cancer patients, the figures were much higher and less divergent; this may be a consequence of the prolonged experience of euthanasia in cases of terminal illness in the Netherlands. Or, it might be that often survey questions are phrased as, ‘If a person is in terrible pain, should they be given access to euthanasia?’ The respondent must choose between leaving the person in pain and euthanizing them. But this choice is wrongly constructed. The person should be able to choose fully adequate pain management—that is, the ‘death’ of the pain—without having to endorse the intentional infliction of death on the patient. 29 Despite high levels of acceptance by physicians of euthanasia for cancer patients in the Netherlands, recent reports reveal persistent ethical concerns. 30 It is also noteworthy that physicians involved in palliative care, including in Britain, appear to be particularly concerned about legalizing euthanasia. 31

What underlies the medical profession's reluctance to accept euthanasia? There are multiple explanations. Aside from ethical, moral and religious beliefs, one of the most salient and compelling has to do with one's conception of the medical mandate, especially as it relates to healing. Healing is a challenging term to define. Many in our institution (the Faculty of Medicine, McGill University) consider it to be ‘a relational process involving movement towards an experience of integrity and wholeness’. 32 It has been operationally defined as ‘the personal experience of the transcendence of suffering’. 33 A feature of healing important to our thesis is the notion that healing does not require biological integrity. Although it may seem counter intuitive at first glance, it has been pointed out that if a sick person is able to construct new meaning and is able to achieve a greater sense of wholeness, that individual may ‘die healed’. 32 It is undeniably a vastly different concept than curing, although they are not in opposition one to the other. Most physicians accept the healer role as a fundamental and enduring characteristic of the profession. 34 In our undergraduate medical program, this concept is taught using the term ‘physicianship’; it refers to the dual and complementary roles of the physician—the physician as healer and professional. 35 It could be argued that one can remain ‘professional’ even while serving as a collaborator in requested death. On the contrary, many commentators—the American Medical Association is a prime example 36 —believe that it is impossible to do so as a ‘healer’, one who is focused on accompanying the patient on a transformational journey towards personal integrity that transcends the embodied self.

The process of healing in the doctor–patient relationship is poorly understood. We do not have a complete picture of how it is initiated or which clinical skills or abilities are essential in fostering a healing relationship. The literature suggests that healing resides in the quality of interpersonal connections and that it requires a deep respect for the agency of the physician in the therapeutic process. 37 An appreciation of the placebo effect, or in more poetic terms, the ‘doctor as the medicine’, is required. 38 , 39 It is almost certainly linked to the phenomena of transference and counter-transference and it may utilize the power differential for salutary purposes, even if these phenomena operate largely at a covert level.

The patient–doctor relationship is marked by intense ambivalence. Any physician who has initiated a discussion with a patient on the issue of resuscitation or desired level of technical intervention will realize how easily it can be misinterpreted, how quickly it can catalyze existential angst and how thoroughly it can overwhelm hopeful sentiments. Affective turmoil and cognitive dissonance can rapidly ensue. These sorts of cross-purpose exchanges would surely be magnified in the context of discussions regarding euthanasia. Although there may be a productive ‘meeting of the minds’ in any specific doctor–patient dyad, the risks of emotional derailment, self-effacing dependency and irremediable miscommunication should not be minimized. It is inconceivable to us that deep layers of existential suffering would not be activated and exposed by such a discussion. A healing space that can support patients would be unnecessarily deflated. Admittedly, this belief is based on incomplete understandings of the clinical encounter, yet the axiomatic foundation of that encounter is anchored in a 2400-year old tradition. We must consider why we have so jealously guarded that tradition. We could always have abandoned it by accepting euthanasia. Unlike many other current medical–ethical dilemmas, neither death nor euthanasia is a novel issue presented by new technoscience.

Many proponents of euthanasia like to claim that opponents rely on two types of unsound arguments: one based on empirical data and the other anchored in axiology. In the first instance, they allege that the outcomes data available from jurisdictions where euthanasia or assisted suicide has been legalized, suggest that our fears of potential abuse are groundless. They deny that there is a ‘logical’ slippery slope—that the situations in which euthanasia will be available will expand over time—or a ‘practical’ slippery slope—that euthanasia will be used abusively. Pro-euthanasia advocates claim that evolving legislation does not pose a threat to persons with a disability, does not lead to euthanasia without consent, does not invite extension of the practice to vulnerable populations—in short, that it has not become a ‘run-away train’. They usually express satisfaction with individual clinicians' professional restraint and integrity as well as with administrative safe guards. Some suggest that the acceptance of euthanasia results in improvements in traditional palliative care. This belief that it represents a positive force for changing prevailing clinical practices is not based on robust evidence. Moreover, the evidence for the existence of a practical slippery slope is very convincing. This was very recently affirmed by the High Court of Ireland, in a judgment we discuss shortly, in deciding whether prohibiting assisted suicide contravened the Irish Constitution, which it held it did not. 40

A recent dramatic example of the logical slope's gravitational pull is the euthanizing, in December 2012, of 45-year-old twins in Belgium. Deaf since childhood, Marc and Eddy Verbessem were facing the additional disability of blindness. Accepting that they were irremediably suffering, their physician euthanized them. 41 Euthanizing patients with non-terminal conditions, even though it can be legal in Belgium, will surely meet with the disapproval of most physicians. Even within the pro-euthanasia movement, this development may be considered an aberration. Nonetheless, there are increasing numbers of commentators who subscribe to the following philosophy: ‘If a patient is mentally competent and wants to die, his body itself constitutes unwarranted life-support unfairly prolonging his or her mental life’. 42

There are two arguments, both warranting careful scrutiny, frequently advanced in support of physician involvement in euthanasia. The first is that physicians have privileged access to information about their patients' unique perspectives and circumstances, including personal resources and frailties, as well as complex family dynamics. That argument has been undermined by evolving practices. The ‘Oregon Public Health Divisions’ report for 2011 reveals that the median length of the doctor–patient relationship for those who died by PAS was merely 12 weeks (with a range of 1–1379 weeks). 27 It is highly unlikely that a physician would have acquired a sophisticated understanding of a person's values, hopes and fears in the matter of a few weeks. It is even less plausible in the case of the mobile euthanasia units currently being deployed in the Netherlands. The second argument is that physicians are inclined, by temperament and experience, to accompany their patients throughout the illness trajectory, including death. That too is not defensible on the known facts. For example, in Oregon, in the first 3 years of the administration of Oregon's ‘Death with Dignity Act’, physicians were present at approximately half of assisted deaths. By 2005, it was 23%. In 2011, it was a mere 9%. 27 The behaviour of these prescribing physicians is not congruent with the image of physicians represented in that iconic painting by Sir Luke Fildes, bearing the title ‘The Doctor’, and often used to portray empathic witnessing. Pro-euthanasia advocates can come across as rather intrepid in their defense of personal autonomy. Autonomy is the overriding principle that is used to buttress arguments in favor of euthanasia; indeed, it generally runs roughshod over all other considerations. Many pro-euthanasia commentators are disposed to brush off concerns about the impact of accepting ‘radical autonomy’ as always being the overriding value—especially concerns about the risks and harms to vulnerable people and to important shared values, in particular, respect for life at the societal level. A 2012 case in British Columbia manifests all these issues; it involved vulnerable persons, values conflicts and shows the preferencing by the court of the value of individual autonomy in relation to euthanasia. The case originates in a challenge to the Canadian Criminal Code's current prohibition of assisted suicide. 43

Gloria Taylor, a plaintiff in the case, Carter v Canada (Attorney General) 44 , was a person with ALS who requested assisted suicide arguing that as her illness progressed she would be incapable of committing suicide, unaided, due to her physical disability. The judge, Justice Lynn Smith, ruled in the plaintiff's favour on the basis that the prohibition was unconstitutional on the grounds that it contravened both Ms Taylor's constitutional ‘right to life, liberty and security of the person’ (under section 7 of the Canadian Charter of Rights and Freedoms) 45 and her right not to be discriminated against as a physically disabled person (under section 15 of the Charter ); and that the prohibition could not be saved (under section 1 of the Charter ), as a reasonable limit on constitutionally protected rights. Consequently, the judge held that the law prohibiting assistance in suicide was not applicable with respect to preventing Ms Taylor and other people in similar circumstances from having such assistance. The judgment is very long and legally complex and is now on appeal. Read as a whole, it strongly supports legalizing PAS and euthanasia.

In that case, the Canadian court reviewed the available evidence from other jurisdictions with liberalised legislation and concluded that there was no evidence of abuse. This Court also reviewed the same evidence and has drawn exactly the opposite conclusions. The medical literature documents specific examples of abuse which, even if exceptional, are nonetheless deeply disturbing. Moreover, contrary to the views of the Canadian court, there is evidence from this literature that certain groups (such as disabled neonates and disabled or demented elderly persons) are vulnerable to abuse. Above all, the fact that the number of LAWER (‘life-ending acts without explicit request’) cases remains strikingly high in jurisdictions which have liberalised their law on assisted suicide (Switzerland, Netherlands and Belgium) – ranging from 0.4% to over 1% of all deaths in these jurisdictions according to the latest figures – without any obvious official response speaks for itself as to the risks involved’. 40

One can also question Justice Smith's conclusions that PAS is not inherently unethical; that individuals' right to autonomy takes priority over the value of respect for life; that sanctity of life is only a religious value; that there is no relevant ethical or moral difference between refusals of life-support treatment that result in the death of the patient and euthanasia; and, that the availability of legalized PAS is necessary ‘medical treatment’ for some.

Justice Smith's justification for allowing euthanasia is largely based on a selective application of Canadian Charter of Rights and Freedoms jurisprudence 45 and depends upon her being able to distinguish the binding precedent set by the Supreme Court of Canada in the Rodriguez case. 46 The latter held, in a four to three split among the judges, that the Canadian Criminal Code's prohibition on assisted suicide 43 was constitutionally valid.

Invoking the Canadian Charter of Rights and Freedoms , Justice Smith ruled that Ms Taylor's right to life was infringed by the prohibition of assisted suicide because she might conclude that ‘she needs to take her own life while physically able to do so, at an earlier date than she would find necessary if she could be assisted’. 44 We believe that this would strike many as a straw man argument. It is to convert a right to life to a right to assisted suicide, by accepting as a breach of a right to life that a person will commit suicide sooner, if not given access to assisted suicide. But validating assistance in committing suicide hardly upholds a right to life.

Like everybody else, Ms Taylor has a right to refuse treatment even if that means she will die sooner than she otherwise would. Justice Smith accepts the plaintiffs' argument that there is no ethical or moral difference between euthanasia and refusals of life-support treatment that result in death and, therefore, both should be legal. But a right to refuse treatment is based in a right to inviolability—a right not to be touched, including by treatment, without one's informed consent. It is not a right to die or a right to be killed. At most, people have a negative content right to be allowed to die, not any right to positive assistance to achieve that outcome. A person with Ms Taylor's illness trajectory will surely die—even more precipitously if they decline many of the interventions described in the hypothetical patient with ALS we introduced earlier on. (Subsequent to the judgment, Ms Taylor died a natural death from an infection). It is also important to underline that current medical practices enable physicians to attenuate much of the suffering that may accompany the progressive loss of function and well-being in advanced ALS.

The judge appears also to accept the argument that legalizing euthanasia enhances palliative care. This goes some way towards treating euthanasia, as some have termed it, ‘the last act of good palliative care’. 47 It is also consistent with the ‘no-difference-between-them approach’ to a spectrum of end-of-life medical interventions. Euthanasia is confused with interventions, such as pain management and rights to refuse treatment, which are ethically and legally acceptable, and an argument is thus set up that, if we are to act consistently, euthanasia must also be ethically and legally acceptable. It is tantamount to legalizing euthanasia through confusion. 48

In the policy, ‘palliative care’ is defined as ‘a qualified medical practitioner, or a person acting under the general supervision of a qualified medical practitioner, administering medication or other treatment to a terminally ill patient with the intention of relieving pain or suffering, even though this may hasten death’. The policy states that that conduct, ‘when provided or administered according to accepted ethical medical standards, is not subject to criminal prosecution’. 44

In other words, the policy's definition of palliative care can be expansively interpreted to place euthanasia in same category as other end-of-life interventions which may hasten death.

For the sake of exploration of the issue, let us assume momentarily that euthanasia is medical treatment. What might flow from this?

Classifying euthanasia as medical treatment would affect the scope of disclosure of information necessary to obtain informed consent. A physician must disclose to the patient all reasonably indicated medical treatments as well as their risks and benefits. It would now have to include euthanasia. Even most pro-euthanasia advocates regard it as unethical for a physician to introduce the possibility of euthanasia. Currently, it is generally accepted that any discussion of it must be initiated by the patient.

It would also mean that to obtain informed consent to euthanasia, all reasonably indicated treatments would need to be offered and they would certainly include all necessary palliative care, in particular, fully adequate pain management. Many of those advocating for euthanasia posit euthanasia and palliative care as alternatives, but informed consent to euthanasia could not be obtained unless good palliative care was available. This is not available to a majority of people who die in Canada; it has been estimated that less than 30% have access to even the most minimal form of palliative care. 49

As well, Canadian psychiatrist Dr Harvey Max Chochinov, who specializes in psychiatric treatment for dying people, has shown that there are significant fluctuations in the will to live, even as death is imminent. 50 The impact of these findings, as well as conditions such as depression, on the possibility of obtaining valid informed consent to euthanasia would need to be fully addressed.

Another crucially important issue is that, if PAS and euthanasia are ‘medical treatment’, then surrogate decision-makers have the authority to consent to them for the patient. Their decisions must be based on either their knowledge of what the patient would have wanted or, if those wishes are unknown, their belief that these interventions are in the ‘best interests’ of the patient. Would mentally incompetent people and those with dementia or disabled newborn babies, as is now the case in the Netherlands under the Groningen protocol, be eligible for ‘therapeutic homicide’? 51

Yet another issue is what would be the indications for euthanasia as medical treatment and who could access it if were legalized? Justice Smith, citing an expert witness for the plaintiffs, refers to ‘the end-of-life population’. 44 This is a term used in the Royal Society of Canada Expert Panel Report on End of Life Decision - Making. 52 In the report, this population is defined as those persons on a continuum beginning with any serious diagnosis or injury. This represents an expansion of a term, ‘end-of-life’, traditionally used for those inevitably in the last days of life, to all people with serious chronic conditions, resulting from illness or injury, that may be fatal in the course of time. And, of course, it is notoriously difficult to predict with any certainty the timing of even obviously terminal illnesses. It is precisely the type of ‘slippery slope’ that we fear emerging from the ‘limited’ exception, as defined by Justice Smith. It will likely culminate in more decisions similar to that taken in the case of the Verbessem brothers in Belgium.

It is also pertinent to point out that Canada continues to fund and promote programs that aim to prevent suicide. If suicide is conferred the status of a right or is held to be acceptable medical treatment it would be difficult to reconcile this situation with the presence of programs that aim to actively thwart it. Some resolve this dilemma by trying to banish the word ‘suicide’ from the debate, in favor of the phrase ‘assisted dying’. Marcia Angell, erstwhile editor of the NEJM and a fervent proponent of PAS, endorses the notion that ‘assisted dying’ can be distinguished from ‘typical suicide’. The latter is described as being undertaken by someone with a normal life expectancy, whereas the former is carried out in someone ‘who is near death from natural causes anyway’. 53 They are going to die anyway, so what does it matter?! We believe that this reasoning is rather disingenuous and that it can result in a dishonouring of that segment remaining in someone's life, whether this is measured in minutes or months, and could deprive them of something as ephemeral as dreams and hopes. It certainly negates the idea of dying as our last great act of living. 54

Finally, a decision classifying euthanasia as medical treatment could have impact far outside the context of issues directly related to death and dying. For example, in Canada, the federal and provincial governments' respective powers are allocated under the Canadian Constitution. The criminal law power belongs to the federal parliament and the power to govern health and social services to the provincial legislatures. If euthanasia was defined as medical treatment, the federal parliament's prohibition of it in the Criminal Code could be invalid by reason of its trespassing on the provincial jurisdiction to govern health and social services. That is one reason that the Quebec College of Physicians and Surgeons, which supports legalizing euthanasia, argues that it is medical treatment. Likewise, the Quebec Legislative Assembly committee, which issued a report, ‘Dying with Dignity’, 55 adopts the same argument. From past experience, we expect that Quebec might challenge the constitutional validity of the Criminal Code prohibition on this basis. However, a legal committee, set up by the Quebec government, has proposed another approach. It has just reported on how Quebec could operationalize giving doctors legal immunity for carrying out euthanasia, including by the Attorney General of Quebec instructing Crown Prosecutors not to prosecute them under the Criminal Code for doing so, provided they comply with certain guidelines. 56 In either case we could see Quebec becoming ‘separate’ from the rest of Canada on this critically important issue.

In pondering medicine's possible involvement in euthanasia, we must foreground those aspects of the medical mandate that are immutable and eternally relevant. We believe these to be the constant nature of ‘illness’, changeless across time, place and culture, and the resultant obligations of the healer. It is important to appreciate how illness affects persons in all spheres of their lives. Patients become intensely vulnerable, impressionable and open to abuse. Pellegrino has summarized the nature of the clinical encounter eloquently as ‘a peculiar constellation of urgency, intimacy, unavoidability, unpredictability and extraordinary vulnerability within which trust must be given’. 57 This vulnerability sets up an intense and enduring obligation of physicians; they must respond to the wounded person with authenticity, compassion and moral agency. The latter demands that physicians harness and deploy their unique influences and persuasive powers in a particular manner. The essential nature of physicianship has evolved over time in a direction that recognizes the extraordinary vulnerability of patients and guards ferociously against their exploitation. In part, this has been achieved by imposing inviolable limits on the physician's terrain of action. Moreover, we believe that, even if one accepted that euthanasia was ethically acceptable—which we do not—it opens up too many doors for abuse.

The medical profession has arrived at a crossroad; it must choose whether to embrace euthanasia as medical treatment, as a logical extension of end-of-life care, or it can reject the redefinition of its healing mandate that this would entail. We believe, that looking back in the future, the euthanasia events of the present time will be seen as a turning point, not only for the profession of medicine, but also for societies. Crossing the line in the sand articulated by Hippocrates, that as a physician ‘I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect’, would result in the ‘doctor as healer’ becoming the ‘doctor as executioner’. In short, healing and euthanizing are simply not miscible and euthanasia can never be considered ‘medical treatment’.

Donald Boudreau was an Arnold P. Gold Foundation Associate Professor of Medicine when this manuscript was written and submitted. He is grateful for the financial support the foundation has provided in the past and requests that readers appreciate the opinions expressed herein are his personal views and not necessarily reflective of the perspectives of the Foundation, its staff, affiliates or benefactors.

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Euthanasia & Assisted Suicide Should Not Be Legal

Introduction, arguments pro euthanasia, arguments against euthanasia, works cited.

Euthanasia is a Greek word made up of two words. “ Eu meaning good and thanatos meaning death” (“Definition of Euthanasia” 1). It is can therefore be translated loosely as good death. In the modern context, it is the practice of terminating an individual’s life whose life is considered intolerable. To ensure the reduction of pain, this process is carried out in a way that subjects the patients to the minimum possible pain. This involves means like lethal injections, removing the patient from life support, or overdosing the patient. Euthanasia may also be described as mercy killing or the assisted suicide of the patient by the medical staff or the patient’s family. Many understand euthanasia as an act of a doctor who injects a patient with lethal concoction to kill to stop immense pain. For years, Euthanasia has been a controversial subject in most countries and homes. It is for this reason that this paper will focus on the pros and cons of carrying out mercy killing.

There are four types of euthanasia, they include direct and voluntary. In this case the patient chooses how they wish to die and proceed to carry it out by themselves without any assistance or if there is assistance, the person usually helping them are usually unaware of this fact. Under voluntary but indirect, the method used to kill the patient is often chosen in advance. “Direct and involuntary euthanasia is done for the patient without them agreeing to it” (Fletcher 223). Finally, we have indirect and involuntary, this normally done by the hospital when they decide that nothing further can be done for the patient and as such they remove the life support system (Fletcher 223-4).

Euthanasia is a classic case of freedom of choice. The patient has the right to choose how he or she wishes to die in regards to their terminal illnesses that they are unable to live with the condition anymore. The patient decides on whether he or she wants to continue living with their condition. This will give the patient an opportunity to die in dignity as well as avoid the excruciating pain and embrace a timely death. The extent to this right is however central to the individuals autonomy and his integrity.

The making of Euthanasia legal will assist in the alleviation of pain of most terminally ill patients who have no hope of recovering and wish that they had the option of ending their lives in the most humane and painless way possible. For those who have conditions that the pain medications do nothing to alleviate, it is only fair that they be given the option of ending their misery in this way. This will not only help in ending the suffering of their family members who are tortured by the fact that their loved ones are in unbearable pain and that there is nothing they can do about it. This should however, only apply to those patients who are agreeable to Euthanasia, because it would be morally wrong to use euthanasia on a patient who is against it for whatever reason.

Euthanasia should be legalized, in that the cost of taking care of these terminally ill patients can become quite expensive and will eventually become too much for the family to pay the hospital expenses. In most cases, the patients usually require very specialized equipment to keep them going and to keep their organs functioning properly. The cost of maintaining them in this conditions or supported by these machines are very high and at some point it becomes too much for the family to handle. Legalizing euthanasia will help the family to at least, not incur exorbitant medical costs. It is for this reason that euthanasia should be made legal.

Keeping a patient on life support when the family members know that there is nothing that can be done for them to make them better and that all that is being done is only to make them comfortable is at most cruel to the family. This drains them emotionally and as such, they cannot function well on their other daily activities. Their lives now revolve on the patient who is not getting any better and as such, no one can move on with their lives. This can become quite draining emotionally for the relatives and may in turn lead to medical health conditions for the family members as they are constantly worrying about the patient, and that is not good for the members.

Legalizing euthanasia will help prevent the rising rates of people who decide to end their own lives after they have come to the decision that they cannot take the physical pain their condition puts them. This will ensure that a professional does euthanasia, and that the patient will experience minimal pain having opted for this method of ending their lives. This will have resulted when the patient’s quality of life has become difficult and uncomfortable as a result of too much physical or emotional pain (Pellegrino 3118).

More and more people are getting sick currently, it is for this reason that some people would argue that the hospitals are becoming over crowded since there are just too many patients. For this reason alone, some argue that euthanasia be legalized, since when a patient has no hope of recovering from a terminal illness, it is pointless to have them occupy hospital space when there is a different patient whose ailments are not terminal who could be using that space. The argument here is that there could be more bed space for those patients whose diseases curable. This also helps to free up funds that may be used to help other people (Darren 1).

There are those who are however opposed to the use of Euthanasia. They argue that it undermines the value and respect for all human rights. They fear that the set guidelines will not be able to avoid sliding down the “slippery slope”, which will eventually lead to the use of involuntary euthanasia and as a result in the selective devaluation of the lives of those dearest to us. The legalization of the use of euthanasia will put pressure on the terminally ill patients to conform in order to relieve their family and friends from the burden, both economical and emotional, of having to take care of them and worry about them as well (McCarrick 2).

Taking the life of another person should not be rationalized no matter the situation. Taking the life of another person should not be rationalized no matter the situation. The human life has to be protected under any circumstance or situation. Medicine has advanced since years of past to help prolong the life span of man, the same medicine cannot be used to take the same lives that it is supposed to be protecting and healing. It would be a conflict of ideas and purpose if euthanasia were to be legalized and offered in our hospitals, the same ones that are supposed t be providing health care services to the population (Maisie 1).

One can never be sure the motives of those pushing a patient to undergo Euthanasia. Man is known to be unscrupulous when he or she is after something that may benefit him or her. In order to benefit from it relatives of the patient may try to persuade him to make a decision that favors them. The relatives may be eyeing the patient’s wealth in that they want to inherit it when they die. It is therefore going to be difficult to determine whose motives are genuine when they propose euthanasia for their loved ones (Maisie 1).

There is no doctor who can give a definite timeline as to when an individual or patient is to die. If euthanasia is made legal, it will lead to very many unlawful deaths that with advanced treatments could have been survived by the patient. In addition to this, legalizing euthanasia would empower the law abusers and as such increase the distrust of the public towards the medical practitioners (Maisie 1).

Apart from these factors, euthanasia would also lead to a decline in the medical care offered in our hospitals. This will result because the research companies will no longer find it essential to research on better modes of treatments as they will have become lax in their work. They will argue that there is an alternative way to end the suffering of the patients, which is euthanasia, and as such, no research will be done to help find the cures to these diseases.

Doctors on the hand have a problem with euthanasia as it goes against the Hippocratic Oath that they took before they were given the powers to practice medicine. The role of all medical practitioners is to protect life and as a result, this does not allow them to take part in the killing of the patients for whatever reason (Darren 1).

It is never clear that a patient really wants to die. Everyone fears death and as such, one cannot say that death is the better option to the physical suffering and pain that they are experiencing. An individual should only take euthanasia as an option if and only if they really want it and that they understand their condition in that nothing can be done for them and that the pain is too much for them to bear or that the pain cannot be managed (Darren 1).

Perhaps the biggest con is that euthanasia is immoral. To take one’s life regardless of the circumstances is considered to be morally wrong by most major religions in the world. For instance, the Roman Catholics consider this murder and is not to be condoned by the church or the society. Although the Hindus think it might be best to help in killing an individual so as to bring an end to their misery, they also believe this will affect the balance of life and rebirth. The Islam also forbids all forms of euthanasia or mercy killing. There are however some religions that are not totally against mercy killing. The protestant for instance have a more liberal opinion on the use of euthanasia. The Shintoists also believe that should a person ask for assistance to end their lives, then you are obliged to do so (Darren 1).

In conclusion, euthanasia should not be legalized, as it will help to create many social problems. Human life is sacred to many cultural societies in the world. Therefore, it should be treated as such. The legalization of the use of euthanasia will only serve to devalue the human life and make it worthless. It could also lead to the development of people feigning illnesses in order to have euthanasia administered to them. The church is against this because only God has the right to take one’s life away as well as give it. euthanasia if legalized will give man the power to usurp God’s duties and this is considered unacceptable in many religions. As pointed out in the arguments above, it is important that euthanasia remains illegal by all means.

Darren, Sweeper. Euthanasia- Pros and Cons of Mercy Killing . (n.d.). 2010. Web.

Definition of Euthanasia . 1998. Web.

Fletcher, Joseph. “The Courts and Euthanasia.” Law, Medicine & Health Care 15.4 (1987/1988): 223-230.

Maisie, Moo. Pros and Cons of Euthanasia . 2007. Web.

McCarrick, Pat. Active Euthanasia and Assisted Suicide. (n.d.). 2010. Web.

Pellegrino, Edmund. “Ethics.” Journal of the American Medical Association 265.23 (1991): 3118-3119.

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Euthanasia – Arguments in Favour and Against

Last updated on April 7, 2024 by ClearIAS Team

Euthanasia is the deliberate act of ending a person’s life to relieve them of suffering. It is a complex and ethically sensitive topic that has sparked debates and discussions worldwide. There are different forms of euthanasia, and it is regulated differently in various countries.

Euthanasia (“good death”) is the practice of intentionally ending a life to relieve pain and suffering. It is also known as ‘mercy killing’.

In many countries, there is a divisive public controversy over the moral, ethical, and legal issues of euthanasia. Euthanasia is categorized in different ways, which include voluntary, non-voluntary, or involuntary. Euthanasia is also classified into active and passive Euthanasia.

Table of Contents

Voluntary, Non-Voluntary, and Involuntary Euthanasia

Voluntary euthanasia: It is conducted with the consent of the patient and is termed voluntary euthanasia. Voluntary euthanasia is legal in some countries. Jurisdictions, where euthanasia is legal, include the Netherlands, Colombia, Belgium, and Luxembourg.
Non-Voluntary euthanasia: It is conducted where the consent of the patient is unavailable and is termed non-voluntary euthanasia. Non-voluntary euthanasia is illegal in all countries. Examples include child euthanasia, which is illegal worldwide but decriminalized under certain specific circumstances in the Netherlands under the Groningen Protocol.
Involuntary euthanasia: It is conducted against the will of the patient and is termed involuntary euthanasia. Involuntary euthanasia is usually considered murder.

Passive vs Active euthanasia

Voluntary, non-voluntary, and involuntary euthanasia can all be further divided into passive or active variants.

Passive euthanasia entails the withholding of common treatments, such as antibiotics, necessary for the continuance of life.
Active euthanasia entails the use of lethal substances or forces, such as administering a lethal injection, to kill and is the most controversial means.

Euthanasia debate

Euthanasia raises profound ethical and moral questions. Supporters argue that it can be a compassionate and dignified way to end suffering, particularly in cases of terminal illness.

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Opponents argue that it raises significant ethical concerns, including the potential for abuse, coercion, and mistakes in diagnosing terminal conditions.

Arguments in Favor

Historically, the euthanasia debate has tended to focus on several key concerns. According to euthanasia opponent Ezekiel Emanuel, proponents of euthanasia have presented four main arguments:

that people have a right to self-determination, and thus should be allowed to choose their fate
assisting a subject to die might be a better choice than requiring that they continue to suffer
the distinction between passive euthanasia, which is often permitted, and active euthanasia, which is not substantive (or that the underlying principle–the doctrine of double effect–is unreasonable or unsound);
permitting euthanasia will not necessarily lead to unacceptable consequences. Pro-euthanasia activists often point to countries like the Netherlands and Belgium, and states like Oregon, where euthanasia has been legalized, to argue that it is mostly unproblematic.
Constitution of India: ‘Right to life’ is a natural right embodied in Article 21 but euthanasia/suicide is an unnatural termination or extinction of life and, therefore, incompatible and inconsistent with the concept of ‘right to life’. The State must protect life and the physician’s duty to provide care and not to harm patients. Supreme Court in Gian Kaur Case 1996 has held that the right to life under Article 21 does not include the right to die.
Caregiver’s burden: Right-to-die supporters argue that people who have an incurable, degenerative, disabling, or debilitating condition should be allowed to die in dignity. This argument is further defended by those, who have chronic debilitating illness even though it is not terminal such as severe mental illness. The majority of such petitions are filed by the sufferers or family members or their caretakers. The caregiver’s burden is huge and cuts across various financial, emotional, time, physical, mental, and social domains.
Refusing care: The right to refuse medical treatment is well recognized in law, including medical treatment that sustains or prolongs life. For example, a patient suffering from blood cancer can refuse treatment or deny feeds through a nasogastric tube. Recognition of the right to refuse treatment gives way to passive euthanasia.
Encouraging organ transplantation: Mercy killing in terminally ill patients provides an opportunity to advocate for organ donation. This, in turn, will help many patients with organ failure waiting for transplantation. Not only does euthanasia give the ‘Right to die‘ for the terminally ill, but also the ‘Right to life‘ for the organ needy patients.

Arguments against

Emanuel argues that there are four major arguments presented by opponents of euthanasia:

not all deaths are painful;
alternatives, such as cessation of active treatment, combined with the use of effective pain relief, are available;
the distinction between active and passive euthanasia is morally significant; and
legalizing euthanasia will place society on a slippery slope, which will lead to unacceptable consequences
Euthanasia weakens society’s respect for the sanctity of life.
Euthanasia might not be in a person’s best interests, for example, getting old-aged parents killed for property will.
Belief in God’s miracle of curing the terminally ill.
The prospect of a discovery of a possible cure for the disease shortly.
Proper palliative care makes euthanasia unnecessary.
There is no way of properly regulating euthanasia.
Allowing euthanasia will lead to less good care for the terminally ill.
Allowing euthanasia undermines the commitment of doctors and nurses to save lives.
Euthanasia may become a cost-effective way to treat the terminally ill.
Allowing euthanasia will discourage the search for new cures and treatments for the terminally ill.
Euthanasia gives too much power to doctors.

Euthanasia in India

Passive euthanasia is legal in India. On 7 March 2011, the Supreme Court of India legalized passive euthanasia using the withdrawal of life support to patients in a permanent vegetative state. The decision was made as part of the verdict in a case involving Aruna Shanbaug, who had been in a Persistent Vegetative State (PVS) for 42 years until she died in 2015.

The Aruna Shanbaug Case

In March 2011, the Supreme Court of India passed a historic judgment permitting Passive Euthanasia in the country. This judgment was passed after Pinki Virani’s plea to the highest court in December 2009 under the Constitutional provision of “Next Friend”. It’s a landmark law which places the power of choice in the hands of the individual, over government, medical or religious control which sees all suffering as “destiny”. The Supreme Court specified two irreversible conditions to permit Passive Euthanasia Law in its 2011 Law:

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The brain-dead for whom the ventilator can be switched off.
Those in a Persistent Vegetative State (PVS) for whom the feed can be tapered out and pain-managing palliatives be added, according to laid-down international specifications.

The same judgment law also asked for the scrapping of 309 , the code that penalizes those who survive suicide attempts. In December 2014, the Government of India declared its intention.

PIL filed by Common Cause

However, on 25 February 2014, a three-judge bench of the Supreme Court of India termed the judgment in the Aruna Shanbaug case to be ‘inconsistent in itself’ and referred the issue of euthanasia to its five-judge Constitution bench on a PIL filed by Common Cause , which case is the basis of the current debate.

Then, the CJI referred to an earlier Constitution Bench judgment which, in the Gian Kaur case , “did not express any binding view on the subject of euthanasia; rather it reiterated that the legislature would be the appropriate authority to bring change.” Though that judgment said the right to live with dignity under Article 21 was inclusive of the right to die with dignity, it did not conclude the validity of euthanasia, be it active or passive.

“So, the only judgment that holds the field about euthanasia in India is the ruling in the Aruna Shanbaug case, which upholds the validity of passive euthanasia and lays down an elaborate procedure for executing the same on the wrong premise that the Constitution Bench in Gian Kaur had upheld the same,” the CJI said.

Common Cause Case: In 2018, the Supreme Court issued a significant judgment in the Common Cause case. The court recognized the right to die with dignity as a fundamental right and permitted passive euthanasia. It provided guidelines for the process and conditions under which passive euthanasia could be allowed.

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Government’s endorsement of Passive Euthanasia

On December 23, 2014, the Government of India endorsed and re-validated the Passive Euthanasia judgment law in a Press Release, after stating in the Rajya Sabha as follows: The Hon’ble Supreme Court of India, while dismissing the plea for mercy killing in a particular case, laid down comprehensive guidelines to process cases relating to passive euthanasia.

Thereafter, the matter of mercy killing was examined in consultation with the Ministry of Law and Justice and it has been decided that since the Hon’ble Supreme Court has already laid down the guidelines, these should be followed and treated as law in such cases. At present, there is no legislation on this subject and the judgment of the Hon’ble Supreme Court is binding on all.

The court rejected active euthanasia using lethal injection. In the absence of a law regulating euthanasia in India, the court stated that its decision becomes the law of the land until the Indian parliament enacts a suitable law. Active euthanasia, including the administration of lethal compounds to end life, is still illegal in India, and in most countries.

As India had no law about euthanasia, the Supreme Court’s guidelines are law until and unless Parliament passes legislation. The following guidelines were laid down:

A decision has to be taken to discontinue life support either by the parents the spouse or other close relatives, or in the absence of any of them, such a decision can be taken even by a person or a body of persons acting as a next friend. It can also be taken by the doctors attending the patient. However, the decision should be taken bona fide in the best interest of the patient.
Even if a decision is taken by the near relatives or doctors or next friend to withdraw life support, such a decision requires approval from the High Court concerned.
When such an application is filled, the Chief Justice of the High Court should forthwith constitute a Bench of at least two Judges who should decide whether to approve or not. A committee of three reputed doctors to be nominated by the Bench, will report the condition of the patient. Before giving the verdict, a notice regarding the report should be given to the close relatives and the State. After hearing the parties, the High Court can give its verdict.

A law commission had proposed legislation on “passive euthanasia”, it said. According to the Centre, the decision to come out with a bill was taken after considering the directives of the apex court, the law commission’s 241st report, and a private member bill introduced in Parliament in 2014.

The Centre said that initially, a meeting was held under the chairmanship of B.P. Sharma, secretary in the Health and Family Welfare Ministry, on May 22, 2015, to examine the draft of The Medical Treatment of Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill and the draft of The Euthanasia (Regulation) Bill.

This move to introduce a bill is a welcome step to clear the grey areas in the Euthanasia debate. Students can also link to this issue while answering questions on:

Judicial activism: SC framing laws when the parliament hasn’t. Just like the Visaka case.
Ethical dilemma in Paper 4 .

In India, euthanasia has no legal aspect , and there is no penal law yet introduced in the IPC that specifically deals with euthanasia.

However, the Supreme Court of India legalized passive euthanasia in 2018 with some conditions, allowing patients to withdraw medical support if they go into an irreversible coma.
Passive euthanasia is a matter of ‘living will’, and an adult in their conscious mind is permitted to refuse medical treatment or voluntarily decide not to take medical treatment to embrace death naturally, under certain conditions.
Individuals are only allowed to draft a living will while in a normal state of health and mind.
Active euthanasia remains illegal in India.

Read: Living wills

Article by: Jishnu J Raju

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Reader Interactions

February 11, 2016 at 3:48 pm

excellent one..

February 24, 2016 at 8:34 pm

Giving passive euthanasia to a patient who is already dead (not literally) is a right choice.Its better than making them as well as others to suffer.

July 20, 2017 at 4:28 pm

so very true.

July 1, 2016 at 10:58 pm

If the patient does not wants to suffer and himself asking for euthanasia then voluntary euthanasia should be made legal because it will be difficult for him to live than to die. But in case of involuntary euthanasia, there should be some specific time limit upto which the patient’s relatives must wait for him to recover but if there is no improvement like in case of coma , after 7-10 years , there is less chances of the patient to recover. In such cases , involuntary euthanasia should be made legal.

March 16, 2017 at 12:37 pm

no it is not possible If the patient tends to recover over a period of time or suddenly he becomes normal then the involuntary euthanasia will become very dangerous

March 16, 2017 at 12:35 pm

Very Very Useful

June 26, 2018 at 8:12 am

Helpful source I can use to rely on research. Thank you so much, clear IAS.

May 17, 2019 at 9:58 pm

Thanku for quality content

May 23, 2020 at 10:27 pm

“Mercy Killing ” is a responsible debate . It mainly depends on persons will on his /her life.

July 2, 2020 at 2:26 pm

Euthanasia should not be accepted as there is always some hope for better.

May 24, 2021 at 11:57 am

If under Article 21 of the constitution, right to live with dignity is inclusive of right to die with dignity, then why should the provisions under the Euthanasia act be restricted to the old and dying patients. There are a lot of people in their 60s and 70s with limited financial resources, who feel neglected / unwanted by the family who would like to die with dignity rather than be dependent on their children or the other members of family. They may be in good health but would still like to self determine to end their life with dignity. In such cases the law should allow for such people to adopt active Euthanasia. Such people could be persuaded to donate their organs which will help save other lives.

August 25, 2021 at 9:40 am

euthanasia cannot be legalised because of its higher probability of misuse. whether it is for property, money or because of any family problem

August 4, 2022 at 12:11 pm

A thought for all: If you do not have a choice to life, i.e. choose to be born then how can choosing your own means of death, be fair or valid? Something you cannot create or re-created is not yours to manage. My say: God is the giver of life and He alone should take it. Our sufferings are a means of learning, loving, understanding and above all our closeness to Almighty God.

June 28, 2023 at 6:36 pm

ur death is already written whether you take it or god does so doesnt matter

September 19, 2022 at 12:47 pm

I can’t put my dog to sleep for I am as old as he; and despite our handicaps he also wants to live like me.

Boghos L. Artinian

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Legalizing euthanasia or assisted suicide: the illusion of safeguards and controls

Euthanasia or assisted suicide—and sometimes both—have been legalized in a small number of countries and states. In all jurisdictions, laws and safeguards were put in place to prevent abuse and misuse of these practices. Prevention measures have included, among others, explicit consent by the person requesting euthanasia, mandatory reporting of all cases, administration only by physicians (with the exception of Switzerland), and consultation by a second physician.

The present paper provides evidence that these laws and safeguards are regularly ignored and transgressed in all the jurisdictions and that transgressions are not prosecuted. For example, about 900 people annually are administered lethal substances without having given explicit consent, and in one jurisdiction, almost 50% of cases of euthanasia are not reported. Increased tolerance of transgressions in societies with such laws represents a social “slippery slope,” as do changes to the laws and criteria that followed legalization. Although the initial intent was to limit euthanasia and assisted suicide to a last-resort option for a very small number of terminally ill people, some jurisdictions now extend the practice to newborns, children, and people with dementia. A terminal illness is no longer a prerequisite. In the Netherlands, euthanasia for anyone over the age of 70 who is “tired of living” is now being considered. Legalizing euthanasia and assisted suicide therefore places many people at risk, affects the values of society over time, and does not provide controls and safeguards.

1. INTRODUCTION

Euthanasia is generally defined as the act, undertaken only by a physician, that intentionally ends the life of a person at his or her request 1 , 2 . The physician therefore administers the lethal substance. In physician-assisted suicide ( pas ) on the other hand, a person self-administers a lethal substance prescribed by a physician.

To date, the Netherlands, Belgium, and Luxembourg have legalized euthanasia 1 , 2 . The laws in the Netherlands and Luxembourg also allow pas . In the United States, the states of Oregon and Washington legalized pas in 1997 and 1999 respectively, but euthanasia remains illegal 3 . The situation in the state of Montana is currently unclear; a bill legalizing pas was passed by the state legislature in 2010, but was recently defeated by the state’s Senate Judiciary Committee.

In the Netherlands, euthanasia and pas were formally legalized in 2001 after about 30 years of public debate 1 . Since the 1980s, guidelines and procedures for performing and controlling euthanasia have been developed and adapted several times by the Royal Dutch Medical Association in collaboration with that country’s judicial system. Despite opposition, including that from the Belgian Medical Association, Belgium legalized euthanasia in 2002 after about 3 years of public discourse that included government commissions. The law was guided by the Netherlands and Oregon experiences, and the public was assured that any defects in the Dutch law would be addressed in the Belgian law. Luxembourg legalized euthanasia and pas in 2009. Switzerland is an exception, in that assisted suicide, although not formally legalized, is tolerated as a result of a loophole in a law dating back to the early 1900s that decriminalizes suicide. Euthanasia, however, is illegal 4 . A person committing suicide may do so with assistance as long as the assistant has no selfish motives and does not stand to gain personally from the death. Unlike other jurisdictions that require euthanasia or assisted suicide to be performed only by physicians, Switzerland allows non-physicians to assist suicide.

In all these jurisdictions, safeguards, criteria, and procedures were put in place to control the practices, to ensure societal oversight, and to prevent euthanasia and pas from being abused or misused 5 . Some criteria and procedures are common across the jurisdictions; others vary from country to country 5 , 6 . The extent to which these controls and safeguards have been able to control the practices and to avoid abuse merits closer inspection, particularly by jurisdictions contemplating the legalization of euthanasia and pas . The present paper explores the effectiveness of the safeguards and the “slippery slope” phenomenon.

2. SAFEGUARDS AND THEIR EFFECTIVENESS

2.1. voluntary, written consent.

In all jurisdictions, the request for euthanasia or pas has to be voluntary, well-considered, informed, and persistent over time. The requesting person must provide explicit written consent and must be competent at the time the request is made. Despite those safeguards, more than 500 people in the Netherlands are euthanized involuntarily every year. In 2005, a total of 2410 deaths by euthanasia or pas were reported, representing 1.7% of all deaths in the Netherlands. More than 560 people (0.4% of all deaths) were administered lethal substances without having given explicit consent 7 . For every 5 people euthanized, 1 is euthanized without having given explicit consent. Attempts at bringing those cases to trial have failed, providing evidence that the judicial system has become more tolerant over time of such transgressions 5 .

In Belgium, the rate of involuntary and non-voluntary euthanasia deaths (that is, without explicit consent) is 3 times higher than it is in the Netherlands 8 , 9 . (“Involuntary euthanasia” refers to a situation in which a person possesses the capacity but has not provided consent, and “non-voluntary euthanasia,” to a situation in which a person is unable to provide consent for reasons such as severe dementia or coma). A recent study found that in the Flemish part of Belgium, 66 of 208 cases of “euthanasia” (32%) occurred in the absence of request or consent 10 . The reasons for not discussing the decision to end the person’s life and not obtaining consent were that patients were comatose (70% of cases) or had dementia (21% of cases). In 17% of cases, the physicians proceeded without consent because they felt that euthanasia was “clearly in the patient’s best interest” and, in 8% of cases, that discussing it with the patient would have been harmful to that patient. Those findings accord with the results of a previous study in which 25 of 1644 non-sudden deaths had been the result of euthanasia without explicit consent 8 .

Some proponents of euthanasia contend that the foregoing figures are misrepresentative, because many people may have at some time in their lives expressed a wish for or support of euthanasia, albeit not formally. The counterargument is that the legal requirement of explicit written consent is important if abuse and misuse are to be avoided. After all, written consent has become essential in medical research when participants are to be subjected to an intervention, many of which pose far lesser mortality risks. Recent history is replete with examples of abuse of medical research in the absence of explicit informed consent.

2.2. Mandatory Reporting

Reporting is mandatory in all the jurisdictions, but this requirement is often ignored 11 , 12 . In Belgium, nearly half of all cases of euthanasia are not reported to the Federal Control and Evaluation Committee 13 . Legal requirements were more frequently not met in unreported cases than in reported cases: a written request for euthanasia was more often absent (88% vs. 18%), physicians specialized in palliative care were consulted less often (55% vs. 98%), and the drugs were more often administered by a nurse (41% vs. 0%). Most of the unreported cases (92%) involved acts of euthanasia, but were not perceived to be “euthanasia” by the physician. In the Netherlands, at least 20% of cases of euthanasia go unreported 7 . That number is probably conservative because it represents only cases that can be traced; the actual number may be as high as 40% 14 . Although reporting rates have increased from pre-legalization in 2001, 20% represents several hundred people annually.

2.3. Only by Physicians

The involvement of nurses gives cause for concern because all the jurisdictions, with the exception of Switzerland, require that the acts be performed only by physicians. In a recent study in Flanders, 120 nurses reported having cared for a patient who received life-ending drugs without explicit request 15 . Nurses performed the euthanasia in 12% of the cases and in 45% of the cases without explicit consent. In many instances, the physicians were absent. Factors significantly associated with a nurse administering the life-ending drugs included the nurse being a male working in a hospital and the patient being over 80 years of age.

2.4. Second Opinion and Consultation

All jurisdictions except for Switzerland require a consultation by a second physician to ensure that all criteria have been met before proceeding with euthanasia or pas . In Belgium, a third physician has to review the case if the person’s condition is deemed to be non-terminal. The consultant must be independent (not connected with the care of the patient or with the care provider) and must provide an objective assessment. However, there is evidence from Belgium, the Netherlands, and Oregon that this process is not universally applied 10 , 13 . In the Netherlands, for example, a consultation was not sought in 35% of cases of involuntary euthanasia 7 . In 1998 in the Netherlands, 25% of patients requesting euthanasia received psychiatric consultation; in 2010 none did 16 . Moreover, non-reporting seems to be associated with a lack of consultation by a second doctor 14 .

In Oregon, a physician member of a pro-assisted-suicide lobby group provided the consultation in 58 of 61 consecutive cases of patients receiving pas in Oregon 17 . This raises concerns about the objectivity of the process and the safety of the patients, and raises questions about the influence of bias on the part of these physicians on the process.

Networks of physicians trained to provide the consultation role when euthanasia is sought have been established in the Netherlands (Support and Consultation on Euthanasia in the Netherlands) and Belgium [Life End Information Forum ( leif )] 18 . Their role includes ensuring that the person is informed of all options, including palliative care. However, most leif physicians have simply followed a 24-hour theoretical course, of which only 3 hours are related to palliative care, hardly sufficient to enable a leif member to provide adequate advice on complex palliative care needs 19 . The development of expertise in palliative care, as in any other specialty, requires a considerable amount of time. In the United Kingdom, it involves a 4-year residency program, and in Australia and the United States, 3 years.

Oregon requires that a patient be referred to a psychiatrist or psychologist for treatment if the prescribing or consulting physician is concerned that the patient’s judgment is impaired by a mental disorder such as depression. In 2007, none of the people who died by lethal ingestion in Oregon had been evaluated by a psychiatrist or a psychologist 20 , despite considerable evidence that, compared with non-depressed patients, patients who are depressed are more likely to request euthanasia and that treatment for depression will often result in the patient rescinding the request 21 – 23 . In a study of 200 terminally ill cancer patients, for example, the prevalence of depressive syndromes was 59% among patients with a pervasive desire to die, but only 8% among patients without such a desire 21 . Despite that finding, many health professionals and family members of patients in Oregon who pursue pas generally do not believe that depression influences the choice for hastened death 24 .

A recent Oregon-based study demonstrated that some depressed patients are slipping through the cracks 25 . Among terminally ill patients who received a prescription for a lethal drug, 1 in 6 had clinical depression. Of the 18 patients in the study who received a prescription for the lethal drug, 3 had major depression, and all of them went on to die by lethal ingestion, but had been assessed by a mental health specialist.

There is evidence, therefore, that safeguards are ineffective and that many people who should not be euthanized or receive pas are dying by those means. Of concern, too, is the fact that transgressions of the laws are not prosecuted and that the tolerance level for transgressions of the laws has increased. Moreover, as the next section will explore, the boundaries of what constitutes “good” practices with respect to euthanasia and pas continue to change, and some of the current practices would just a few decades ago have been considered unacceptable in those jurisdictions that have legalized the practices.

3. THE “SLIPPERY SLOPE” ARGUMENT

The “slippery slope” argument, a complex legal and philosophical concept, generally asserts that one exception to a law is followed by more exceptions until a point is reached that would initially have been unacceptable. The “slippery slope” argument has, however, several interpretations 26 , some of which are not germane to the euthanasia discussion. The interpretations proposed by Keown in 2002 27 appear very relevant, however. He refers to these collectively as a “practical slippery slope,” although the term “social slippery slope” may be more applicable. The first interpretation postulates that acceptance of one sort of euthanasia will lead to other, even less acceptable, forms of euthanasia. The second contends that euthanasia and pas , which originally would be regulated as a last-resort option in only very select situations, could, over time, become less of a last resort and be sought more quickly, even becoming a first choice in some cases.

The circumvention of safeguards and laws, with little if any prosecution, provides some evidence of the social slippery slope phenomenon described by Keown 5 , 28 . Till now, no cases of euthanasia have been sent to the judicial authorities for further investigation in Belgium. In the Netherlands, 16 cases (0.21% of all notified cases) were sent to the judicial authorities in the first 4 years after the euthanasia law came into effect; few were investigated, and none were prosecuted 5 . In one case, a counsellor who provided advice to a non-terminally ill person on how to commit suicide was acquitted 29 . There has therefore been an increasing tolerance toward transgressions of the law, indicating a change in societal values after legalization of euthanasia and assisted suicide.

In the 1987 preamble to its guidelines for euthanasia, the Royal Dutch Medical Association had written “If there is no request from the patient, then proceeding with the termination of his life is [juristically] a matter of murder or killing, and not of euthanasia.” By 2001, the association was supportive of the new law in which a written wish in an advance directive for euthanasia would be acceptable, and it is tolerant of non-voluntary and involuntary euthanasia 7 , 30 , 31 . However, basing a request on an advance directive or living will may be ethically problematic because the request is not contemporaneous with the act and may not be evidence of the will of the patient at the time euthanasia is carried out.

Initially, in the 1970s and 1980s, euthanasia and pas advocates in the Netherlands made the case that these acts would be limited to a small number of terminally ill patients experiencing intolerable suffering and that the practices would be considered last-resort options only. By 2002, euthanasia laws in neither Belgium nor the Netherlands limited euthanasia to persons with a terminal disease (recognizing that the concept of “terminal” is in itself open to interpretation and errors). The Dutch law requires only that a person be “suffering hopelessly and unbearably.” “Suffering” is defined as both physical and psychological, which includes people with depression. In Belgium, the law ambiguously states that the person “must be in a hopeless medical situation and be constantly suffering physically or psychologically.” By 2006, the Royal Dutch Medical Association had declared that “being over the age of 70 and tired of living” should be an acceptable reason for requesting euthanasia 32 . That change is most concerning in light of evidence of elder abuse in many societies, including Canada 33 , and evidence that a large number of frail elderly people and terminally ill patients already feel a sense of being burden on their families and society, and a sense of isolation. The concern that these people may feel obliged to access euthanasia or pas if it were to become available is therefore not unreasonable, although evidence to verify that concern is not currently available.

In Oregon, although a terminal illness with a prognosis of less than 6 months to live has to be present, intolerable suffering that cannot be relieved is not a basic requirement (again recognizing that the concept of “intolerable suffering” is in itself ambiguous). This definition enables physicians to assist in suicide without inquiring into the source of the medical, psychological, social, and existential concerns that usually underlie requests for assisted suicide. Physicians are required to indicate that palliative care is a feasible alternative, but are not required to be knowledgeable about how to relieve physical or emotional suffering.

Until 2001, the Netherlands allowed only adults access to euthanasia or pas . However, the 2001 law allowed for children aged 12–16 years to be euthanized if consent is provided by their parents, even though this age group is generally not considered capable of making such decisions 5 . The law even allows physicians to proceed with euthanasia if there is disagreement between the parents. By 2005, the Groningen Protocol, which allows euthanasia of newborns and younger children who are expected to have “no hope of a good quality of life,” was implemented 34 , 35 . In 2006, legislators in Belgium announced their intention to change the euthanasia law to include infants, teenagers, and people with dementia or Alzheimer disease 36 .

In Belgium, some critical care specialists have opted to ignore the requirement that, in the case of non-terminally-ill patients, an interval of 1 month is required from the time of a first request until the time that euthanasia is performed. One specialist reported that, in his unit, the average time from admission until euthanasia was performed for patients that seemed to be in a “hopeless” situation was about 3.5 days 37 . Beneficence, this specialist argued, was the overriding principle.

Initially, euthanasia in the Netherlands was to be a last-resort option in the absence of other treatment options. Surprisingly, however, palliative care consultations are not mandatory in the jurisdictions that allow euthanasia or assisted suicide, even though uncontrolled pain and symptoms remain among the reasons for requesting euthanasia or pas 38 . Requests by the Belgian palliative care community to include an obligatory palliative care consultation (“palliative filter”) were denied 19 . From 2002 to 2007 in Belgium, a palliative care physician was consulted (second opinion) in only 12% of all cases of euthanasia 31 . Palliative care physicians and teams were not involved in the care of more than 65% of cases receiving euthanasia. Moreover, the rates of palliative care involvement have been decreasing. In 2002, palliative care teams were consulted in 19% of euthanasia cases, but by 2007 such involvement had declined to 9% of cases. That finding contradicts claims that in Belgium, legalization has been accompanied by significant improvements in palliative care in the country 39 . Other studies have reported even lower palliative care involvement 8 , 13 . It must be noted that legalization of euthanasia or pas has not been required in other countries such as the United Kingdom, Australia, Ireland, France, and Spain, in which palliative care has developed more than it has in Belgium and the Netherlands.

The usefulness of a single palliative care assessment has been challenged—even when it is an obligatory requirement, as is the case at the University Hospital of the Canton of Vaud, Lausanne, Switzerland (the first hospital to allow, in 2005, assisted suicide in Switzerland 40 ) 41 . Among U.K. palliative care physicians, 63% feel that a single assessment is insufficient to fully evaluate and address the needs of a person requesting euthanasia or pas 42 . A similar number of U.K. psychiatrists have expressed similar concerns 43 , 44 , and only 6% of Oregon psychiatrists are comfortable providing consultations for patients requesting pas 45 .

Originally, it was the view of the Supreme Court of the Netherlands, the Royal Dutch Medical Association, and the ministers of Justice and Health that euthanasia would not be an option in situations in which alternative treatments were available but the patient had refused them. When this view conflicted with the accepted ethical principle that patients are allowed to refuse a treatment option, the law was altered to allow access to euthanasia even if the person refused another available option such as palliative or psychiatric care. One consequence of the change is that, the appropriateness of suicide prevention programs may begin to be questioned, because people wanting to commit suicide should, on the basis of autonomy and choice, have the same rights as those requesting euthanasia.

There are other examples that a “social slippery slope” phenomenon does indeed exist. In Switzerland in 2006, the university hospital in Geneva reduced its already limited palliative care staff (to 1.5 from 2 full-time physicians) after a hospital decision to allow assisted suicide; the community-based palliative care service was also closed (JP. Unpublished data). Of physicians in the Netherlands, 15% have expressed concern that economic pressures may prompt them to consider euthanasia for some of their patients; a case has already been cited of a dying patient who was euthanized to free a hospital bed 46 . There is evidence that attracting doctors to train in and provide palliative care was made more difficult because of access to euthanasia and pas , perceived by some to present easier solutions, because providing palliative care requires competencies and emotional and time commitments on the part of the clinician 47 , 48 . At the United Kingdom’s parliamentary hearings on euthanasia a few years ago, one Dutch physician asserted that “We don’t need palliative medicine, we practice euthanasia” 49 . Compared with euthanasia cases, cases without an explicit request were more likely to have a shorter length of treatment of the terminal illness 10 .

Advocates of euthanasia have largely ignored these concerns about the “social slippery slope” and have opted to refute the “slippery slope” argument on the basis that legalizing euthanasia and pas has not led to exponential increases in cases of euthanasia or pas or in a disproportionate number of vulnerable persons being euthanized 7 , 26 , 30 . However, there is evidence that challenges those assertion.

The number of deaths by euthanasia in Flanders has doubled since 1998 30 . Of the total deaths in this Flemish-speaking part of Belgium (population 6 million), 1.1%, 0.3%, and 1.9% occurred by euthanasia in 1998, 2001, and 2007 respectively 30 (about 620, 500, and 1040 people respectively in those years). The requirement of the law to report euthanasia cases (aided by laxity in prosecuting cases that fall outside the requirement) may explain some, but not all, of the increase 31 . Chambaere et al. 10 reported in the Canadian Medical Association Journal that in Belgium, euthanasia without consent had decreased from 3.2% in 1998 to 1.8% in 2007. But a closer review of the original study shows that the rate had declined to 1.5% in 2001 and then increased again to 1.8% in 2007 30 .

In Holland, the overall rate of euthanasia was 1.7% of all deaths in 2005, down from 2.4% and 2.6% in 2001 and 1995 respectively, but no different from 1990 when the rate was 1.7% 7 . However, the Dutch government’s official statistics indicate a rise of 13% in 2009 compared with 2008; euthanasia now accounts for 2% of all deaths. Given the increasing numbers, interest in developing facilities that provide euthanasia (similar to those of the Swiss pro–assisted suicide group Dignitas) has recently been increasing. In Oregon, although the number of cases of pas remain very small relative to the population, the rate has been increasing: 24 prescriptions were written in 1998 (16 of which led to deaths by pas ), 67 prescriptions in 2003 (43 of which led to deaths by pas ), and 89 in 2007 50 .

In Belgium, the rates of involuntary and non-voluntary euthanasia have decreased; together they accounted for 3.2%, 1.5%, and 1.8% of all deaths in 1998, 2001, and 2007 respectively (1800, 840, and, 990 people respectively in those years) 30 . In the Netherlands, the rate decreased from 0.7% in 2001 to 0.4% in 2005 7 . The actual rate is probably higher, given the large number of unreported cases. Notwithstanding the decrease, the rates are perturbing.

Battin et al. 51 examined data from Oregon and the Netherlands and concluded, as have others 30 , that there was no evidence that vulnerable people, except for people with aids , are euthanized disproportionately more. “Vulnerable” was defined in that study as individuals who are elderly, female, uninsured, of low educational status, poor, physically disabled or chronically ill, younger than the age of majority, affected with psychiatric illnesses including depression, or of a racial or ethnic minority. Finlay and George challenged the study on the basis that vulnerability to pas or euthanasia cannot be categorized simply by reference to race, sex, or other socioeconomic status. Other characteristics, such as emotional state, reaction to loss, personality type, and the sense of being a burden are also important 52 . Patients are also vulnerable to the level of training and experience that their physicians have in palliative care and to the personal views of their physicians about the topic. For example, one study showed that the more physicians know about palliative care, the less they favour euthanasia and pas 53 .

Two recent studies further contradict the findings by Battin and colleagues. Chambaere et al. found that voluntary and involuntary euthanasia occurred predominantly among patients 80 years of age or older who were in a coma or who had dementia 10 . According to them, these patients “fit the description of vulnerable patient groups at risk of life-ending without request.” They concluded that “attention should therefore be paid to protecting these patient groups from such practices.” In another study, two of the factors significantly associated with a nurse administering life-ending drugs were the absence of an explicit request from the patient and the patient being 80 years of age or older 15 .

4. THE RESPONSE

What can be done, then, when the best of palliative care is unable to address suffering?

Zylicz, a palliative care specialist who has worked extensively in the Netherlands with people requesting euthanasia and pas , provides a taxonomy to understand the reasons underlying the requests and provides stepping stones for addressing the requests. The requests can be classified into five categories (summarized by the abbreviation abcde ) 54 :

Being afraid of what the future may hold
Experiencing burnout from unrelenting disease
Having the wish and need for control
Experiencing depression
Experiencing extremes of suffering, including refractory pain and other symptoms

Strategies are available to begin to address severe refractory symptoms, to treat depression, and to deal with the fear that some people have of what the future with a terminal disease may hold. Approximately 10%–15% of pain and other physical symptoms (such as dyspnea and agitated delirium) cannot be controlled with first- and second-line approaches and become refractory. For these symptoms, there is the option of palliative sedation. Palliative sedation is defined as “the monitored use of medications intended to induce a state of decreased or absent awareness (unconsciousness) in order to relieve the burden of otherwise intractable suffering in a manner that is ethically acceptable to the patient, family and health-care providers in patients that are imminently dying” 55 . Its intent is not to hasten death, which differentiates it from euthanasia. The goal is to achieve comfort at the lowest dose of sedative possible (usually with midazolam infusion, not with opioids) and at the lightest level of sedation. Some patients therefore achieve comfort at light levels of sedation, allowing them to continue interacting with family; in others, comfort is achieved only at deep levels of sedation.

Studies have shown that losing a sense of dignity and hope and taking on a sense of burden prompt some people to seek euthanasia and pas 21 – 23 , 56 . Strategies to improve the sense of dignity, based on empirical studies that have explored the concept of dignity within palliative care, have been shown to work 57 . Similar strategies need to be developed in the areas of hope and burden.

Given effective palliation, including palliative sedation for patients with refractory symptoms, the only remaining issue is that of legalizing “on-demand” euthanasia and pas when there is no terminal disease or when the person is tired of living or has a mental illness. Legalizing euthanasia and assisted suicide in these circumstances is most concerning and would have major implications over time, including changing a society’s values and making suicide prevention programs redundant because people wishing to commit suicide would then be entitled to do so.

In 30 years, the Netherlands has moved from euthanasia of people who are terminally ill, to euthanasia of those who are chronically ill; from euthanasia for physical illness, to euthanasia for mental illness; from euthanasia for mental illness, to euthanasia for psychological distress or mental suffering—and now to euthanasia simply if a person is over the age of 70 and “tired of living.” Dutch euthanasia protocols have also moved from conscious patients providing explicit consent, to unconscious patients unable to provide consent. Denying euthanasia or pas in the Netherlands is now considered a form of discrimination against people with chronic illness, whether the illness be physical or psychological, because those people will be forced to “suffer” longer than those who are terminally ill. Non-voluntary euthanasia is now being justified by appealing to the social duty of citizens and the ethical pillar of beneficence. In the Netherlands, euthanasia has moved from being a measure of last resort to being one of early intervention. Belgium has followed suit 37 , and troubling evidence is emerging from Oregon specifically with respect to the protection of people with depression and the objectivity of the process.

The United Nations has found that the euthanasia law in the Netherlands is in violation of its Universal Declaration of Human Rights because of the risk it poses to the rights of safety and integrity for every person’s life. The UN has also expressed concern that the system may fail to detect and to prevent situations in which people could be subjected to undue pressure to access or to provide euthanasia and could circumvent the safeguards that are in place.

Autonomy and choice are important values in any society, but they are not without limits. Our democratic societies have many laws that limit individual autonomy and choice so as to protect the larger community. These include, among many others, limits on excessive driving speeds and the obligation to contribute by way of personal and corporate income taxes. Why then should different standards on autonomy and choice apply in the case of euthanasia and pas ?

Legislators in several countries and jurisdictions have, in just the last year, voted against legalizing euthanasia and pas in part because of the concerns and evidence described in this paper. Those jurisdictions include France, Scotland, England, South Australia, and New Hampshire. They have opted to improve palliative care services and to educate health professionals and the public.

6. CONFLICT OF INTEREST DISCLOSURES

The author has no financial conflict of interest to declare.

7. REFERENCES

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Euthanasia Should Not Be Legalized Philosophy Essay

Published Date: 23 Mar 2015

Disclaimer: This essay has been written and submitted by students and is not an example of our work. Please click this link to view samples of our professional work witten by our professional essay writers . Any opinions, findings, conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of EssayCompany.

Should a dying patient have the right to require doctors to end his life? Should a doctor be protected from lawsuits if he assistes his patients to kill themselves as required? Those pro-euthanasia supporters will give a definite answer "Yes", but they overlook the potential threat behind this "assisted suicide".

Euthanasia, also called "mercy killing", is one of the most controversial issues in nowaday society. Many people approve such a quiet and easy way of death and argue that euthanasia should be legalized. But in fact, euthanasia is in conflict with most religions and will bring tremendous negative influences to the whole society. Therefore it should never be legalized. The main reasons can be listed as follows.

Point 1: euthanasia violates the religious beliefs of many nations and the legitimation of euthanasia will probably provoke opposition of those devout religious people. The matter of death constitutes one of the most important things that religions deal with. Almost every faith pays special attention to death. According to most religions, all human life is sacred, and is worth protecting. In Qur'an, the holy book of Islam, it is clearly stated that "when their time comes they cannot delay it for a single hour nor can they bring it forward by a single hour", that is to say the length of one's life is destined, we can never do anything to interfere with it. Only Allah has the right to end it. Similarly, life is a gift from God, according to Christianity. It is wrong to meddle in the process of dying, whether in form of murder, suicide or euthanasia, since the right to decide death belongs to God alone. In addition, the Jewish tradition also regards human life with supreme moral values and forbids doing anything that might shorten life.

Almost all religions object to euthanasia, so the legitimation of euthanasia will undoutedly pose challenges to religions. What would that lead to then? The rules of religions are destroyed and people will be puzzled and then lose their belief in religions. The devout religious people may feel offended and try to get rid of those pro-euthanasia ones who originally were part of them. The religious schools gradually break down and without the restriction of religion in a society, there is sure to be a sharp increase in the crime rate. The social stability will be under threat.

We must die some day, but our religions tell us that we are not allowed to arrange our death. The legitimation of euthanasia replaces the role of God with some earthly human beings. Considering the great shock it will cause to religions, "the power to play with people's lives should not be handed out under a legal or medical disguise." (Hassan, 2008, p. 25)

Point 2: the legitimation of euthanasia can easily be abused, by the doctors, relatives of the patient, even the government. If someone is going to inherit one million dollars when his aunty dies, and when he is offered an opportunity to give her a lethal injection, might the heir not find it alluring? In another case, a doctor makes a mistake in an operation which results in the death of the patient. Might he ascribe the medical accident to the patient's will of euthanasia? If euthanasia is made legal, we have to face the fact that someone with evil intention will be glad to take advantage of this legal loophole, especially those persons around the patient. For the family members, when it comes to financial considerations, it is quite possible for the family to resort to euthanasia, in order to get rid of the big burden--the patient. For the relevant doctors, they are provided with a reasonable excuse to cover up their potential medical mistakes. And as Pidd (2009) stated, those who could have died well in excellent nursing and care will die unwillingly because they are forced to do so.

Additionally, a government usually needs to allocate funds to look after the dying patients. And medical welfare cost always takes up a high percentage in a country"s payout. Once euthanasia becomes legal, the government can reduce the paying for treatment and care simply by replacing them with euthanasia. Is it likely to happen? No one can tell but such risk does exist and will weaken many other public services which are aimed at caring for the dying patient, or others like services offered in homes for the aged (the government can also replace the services for old people with euthanasia).

For one thing, it is sure that legalizing euthanasia will make it appearl to all citizens and imply an irresponsible way to deal with the dying patients. People becomes indifferent to the elderly and " the right to death " will probably become "the duty to death". (Frey, 1998, p. 107)

Point 3: the legitimation of euthanasia will weaken a patient's will to fight with diseases. It is a fact but seldom known by the public that euthanasia is unnecessary in many cases. According to David (1992),

"the failure to adequately treat the pain and other symptoms experienced by the terminally ill patient is confused with a lack of choice and dignity in the dying process. And the poor education and training in pain and symptom management received by health-care professionals often results in uncontrolled symptoms, during which time a patient may request euthanasia. Despite this situation, however, terminal patients rarely ask for euthanasia or assisted suicide." (p.69-70)

When patients lack necessary knowledge about the pain or disease, they tend to exaggerate their illness and relate them to death. As a result, they require euthanasia because of they can not bear the pain rather than they are not strong enough to beat the disease. It is a tragedy for someone who takes euthanasia as they could have lived a longer time as long as they sick with it.

"where there is life, there is hope". Euthanasia is totally against this saying. It denies the willpower of human nature, denies hopes in life, and even denies the worthwhile existence of human being. Life is more valuable because of hardship. After one's struggle with death, he becomes tougher and tougher. But euthanasia takes this opportunity away. Instead, it offers those mentally impotent persons an escape from physical discomfort, from the potential power of their will, from a truly meaningful life. It deprives many people of the opportunity to rise from the ashes, like the phoenix, and should therefore be forbiddened.

Objection: some pro-euthanasia people hold that euthanasia represents the freedom of one's will and saves his dignity when he dies. Euthanasia is the symbol of democracy. It is not true. Euthanasia seems to guarantee a dignified death, but it in fact exposes the impotence of man's character: he is unable to confront himself with the fact and lacks strong confidence to change his fate. Besides, euthanasia gives someone the right to kill another and others the excuse to free them from the dying patients. Because of it, the patients "were sufferers, they were helpless, they were hopeless, they were burdens." (Ervin, 2002, para. 5) In some degree, it questions the values of humanity. From the human angle, euthanasia should apply only to people who are so valueless that they don't deserve a life, but how can there be someone like this? Since the legalization of euthanasia will raise serious moral and social issues, the legitimation of it will surely result in tremendous catastrophic consequences in society.

In conclusion, euthanasia is virtually an act helping people die. It promotes abuse, gives doctors the right to murder and is contradictory to religious beliefs. Besides, like Rayfield (2010) said, there are much more better choices except euthanasia if we want to create a society focusing on compassion and care and helping dying people. The legalization of euthanasia hinder the development of truly sympathy to the care of the dying and can arise many social problems. Therefore, it should never be legalized.

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Palliative Care. Physician Obligation. Financial Motivations. 1. Legalization. "The right to die should be a matter of personal choice. We are able to choose all kinds of things in life from who we marry to what kind of work we do and I think when one comes to the end of one's life, whether you have a terminal illness or whether you're ...
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Active euthanasia gives the medical. practitioner power, which in turn can be abused. Active euthanasia leads inevitably to involuntary euthanasia. When active euthanasia has been previously accepted and. legalised, it has led inevitably to inactive euthanasia. Holland is moving rapidly down the slippery slope with the.
Euthanasia Should Not Be Legalized Philosophy Essay
Euthanasia, also called "mercy killing", is one of the most controversial issues in nowaday society. Many people approve such a quiet and easy way of death and argue that euthanasia should be legalized. But in fact, euthanasia is in conflict with most religions and will bring tremendous negative influences to the whole society.
Why We Should Not Legalize Euthanasia
The euthanasia debate is really the backdrop for a discussion within our society about the very nature of human life and meaning. Because the origin of life is in God, human beings do not have dominion over life but are stewards of life. The powerful combination of sanctity and stewardship is expressed in the foundational ethical principle.
Focus: Death: Pros and Cons of Physician Aid in Dying
Euthanasia, also called mercy killing, refers to the administration of a lethal medication to an incurably suffering patient. It may be voluntary (the patient requests it) or involuntary. Euthanasia is illegal in the United States, but voluntary euthanasia is legal in Belgium, Colombia, Luxembourg, and Canada.
Why Euthanasia Should not Be Legal: Ethical and Practical Reasons
Ethical Concerns and Sanctity of Life. One of the fundamental ethical concerns regarding euthanasia revolves around the sanctity of life. The sanctity of life principle asserts that all human life is inherently valuable and should be preserved and protected.
Why Euthanasia Should Be Legal: Analysis of Arguments and
This highlights the importance of considering why euthanasia should be legal in this essay. Granting patients the autonomy to make this decision would honor their right to choose how they wish to approach their final moments and put an end to their unbearable suffering. Moreover, legalizing euthanasia could ease the burden on families by ...
Why Euthanasia Should not be Legalized
But, before this legalization in the Penal Code this country had adopted a legal regulation of euthanasia and, before and after that, extensive surveys into the practice of euthanasia had been carried out. ... Juridical and ethical essays on life, the body and death],469-574. Reeks: Het recht in de samenleving, van het Centrum Grondslagen van ...
Mercy killing debate: should euthanasia be legalized?
Mercy Killing Debate. Euthanasia or physician- assisted suicide, also know as mercy killing, is becoming a prominent public debate. The implications of legalizing assisted suicide are wide-ranging from a medical, legal, political and ethical point of view. The term euthanasia means "good death" in Greek.
Should assisted dying be legalised?
Conversely, there are two notable oversights in this interpretation of a right to assisted dying as an extension of the principles of bodily autonomy: First, it would be wrong to view individual liberty as absolute. The HRA allows for exceptions to Article 8 on grounds of 'health or morals' [ 25 ].
Euthanasia and assisted dying: what is the current position and what
Definition and current legal framework. Assisted dying is a general term that incorporates both physician-assisted dying and voluntary active euthanasia.Voluntary active euthanasia includes a physician (or third person) intentionally ending a person's life normally through the administration of drugs, at that person's voluntary and competent request. 2, 3 Facilitating a person's death ...
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If euthanasia is legalised, then there is a grave apprehension that the State may refuse to invest in health (working towards Right to life). Legalised euthanasia has led to a severe decline in the quality of care for terminally-ill patients in Holland 7. Hence, in a welfare state there should not be any role of euthanasia in any form.
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Why assisted dying should remain illegal. Michael Wenham was grateful that the option of assisted dying wasn't available to him when he had a frightening diagnosis. Plus letters from Charles ...
Existential Suffering as a Legitimization of Euthanasia
Existential Suffering as a Legitimization of Euthanasia - Volume 32 Issue 1. Introduction. The controversial nature of the issue of whether it should be legal to perform euthanasia or assist in another's suicide has waned, and several countries have legalized these options, but it would not be realistic to expect a universally accepted perspective to be forthcoming.
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The impact of characterizing euthanasia as 'medical treatment' on physicians' professional identity and on the institutions of medicine and law should be examined in jurisdictions where assisted suicide and euthanasia have been de-criminalized. euthanasia, assisted suicide, palliative care, suffering, healing, medical legislation. Topic:
Should Euthanasia be Legal?
In such a circumstance the most appropriate answer will be a big no. this again may pave a way for euthanasia to be legalized as keeping a person who wishes to die alive may be inhuman and cruel (Global Politician, web). Euthanasia in political arena has created both agreements and rivalries.
Why Euthanasia Should Not Be Legal: Pros and Cons
Therefore, Euthanasia is not to be legalised as it goes against one of the commandments of the bible, "Thou shalt not kill". In all, it is believed that death should come naturally, and euthanasia should not be legal. For the purposes of allowing people to die with dignity, euthanasia should be legalised to prevent cruelty, protecting human ...
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Conclusion. In conclusion, euthanasia should not be legalized, as it will help to create many social problems. Human life is sacred to many cultural societies in the world. Therefore, it should be treated as such. The legalization of the use of euthanasia will only serve to devalue the human life and make it worthless.
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Euthanasia ("good death") is the practice of intentionally ending a life to relieve pain and suffering. It is also known as 'mercy killing'. In many countries, there is a divisive public controversy over the moral, ethical, and legal issues of euthanasia. Euthanasia is categorized in different ways, which include voluntary, non ...
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Luxembourg legalized euthanasia and pas in 2009. Switzerland is an exception, in that assisted suicide, although not formally legalized, is tolerated as a result of a loophole in a law dating back to the early 1900s that decriminalizes suicide. Euthanasia, however, is illegal 4. A person committing suicide may do so with assistance as long as ...
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I firmly believe that euthanasia should not be implemented or legalized for the following reasons: First of all, in the concept of life and death, wherein Buka (2008) commented that "the definitions of 'life' and 'death' are subject of debate throughout healthcare professional frameworks.". There are both ends of the spectrum ...
Euthenasia essay (pdf)
Euthanasia should be legal in california because many people with terminal illnesses can't handle the process of a painful death. Dying from a terminal illness can not only be physically painful but emotionally as well. For some, passing away before the pain gets to them is a better option. Suicide rates are much higher in those with serious ...
Why Euthanasia Should Be Legal Essay
Introduction. Euthanasia is defined as "the act of deliberately ending a person's life to relieve suffering". People seek euthanasia as it provides a solution to problems that many views as insurmountable; more specifically to deal with "unbearable" suffering that may arise in life, and or death.
Euthanasia Should Not Be Legalized Philosophy Essay
Therefore it should never be legalized. The main reasons can be listed as follows. Point 1: euthanasia violates the religious beliefs of many nations and the legitimation of euthanasia will probably provoke opposition of those devout religious people. The matter of death constitutes one of the most important things that religions deal with.

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Why active euthanasia and physician assisted suicide should be legalised

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Why Euthanasia Should Be Legal: Analysis of Arguments and Counterarguments

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Should assisted dying be legalised?

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Euthanasia is not medical treatment

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Euthanasia & Assisted Suicide Should Not Be Legal

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Legalizing euthanasia or assisted suicide: the illusion of safeguards and controls

1. INTRODUCTION

2. SAFEGUARDS AND THEIR EFFECTIVENESS

2.2. Mandatory Reporting