euthanasia background essay

The History of the Euthanasia Movement

The idea that death should be merciful is not new. Around 1800, pioneers of euthanasia pulled on the legs of those who’d been hanged to hasten their deaths.

Jack Kevorkian attending an HBO premiere

The idea that death should be merciful is not new. When a person is gravely wounded or terminally ill, when death is inevitable, and the suffering is so great that living no longer brings any joy to the person, it is understandable that he or she may wish to die. In “Two Pioneers of Euthanasia Around 1800,” Michael Stolberg cites accounts of people pulling on the legs of those who had been hanged, but had not yet died, to hasten their deaths. He mentions also Apologie , the autobiography of a French surgeon named Ambroise Paré who happened upon three gravely wounded soldiers. An uninjured soldier asked the surgeon if they would live, to which he responded they would not. The uninjured soldier proceeded to slit their throats.

The invention and widespread use of morphine in the 19th century to treat, and then to kill, pain led to the belief that a less painful dying process was possible, Giza Lopes writes in her book Dying With Dignity: A Legal Approach to Assisted Death . In the mid-19th century, surgeons began using chloroform, which had fewer negative side effects than morphine, and which knocked people unconscious. In 1885, the American Medical Association officially opposed voluntary euthanasia. Though some doctors believed in the redemptive nature of suffering, the opposition was not overwhelming enough to stop the movement. The ability to relieve pain experienced as the result of surgical procedures, childbirth, or mere living, logically led to conversations about death and dying. Medications could alleviate end-of-life suffering and expedite death.

As time and technology progressed, everyday people came to see physicians as godlike figures, and, Lopes writes, doctors claimed a role in the process of dying. Through the early 20th century, opiates were still widely available, but physicians had begun to take control of prescribing and administering other medications.

On January 23, 1906, the Ohio legislature introduced a euthanasia bill. A Cincinnati woman named Anna Hall had lobbied hard to legalize euthanasia, hoping to hasten the death of her mother, who was suffering from a terminal and painful illness. That same year, Dr. R. H. Gregory introduced a similar bill to the Iowa state legislature. These two have been dubbed the “chloroform bills.”

Doctors and ethicists from both the United States and England hashed out their thoughts on euthanasia in medical journals, and the movements in both countries evolved in tandem. When Dr. Gregory proposed the Iowa euthanasia bill, the British Medical Journal responded , tearing into him:

That the man is either a crank of a particularly noxious type or a mere-notoriety hunter, is clear enough from the statement attributed to him that he simply wishes to make lawful that which is already daily practised by the greatest physicians and surgeons in every large hospital in the United States. If Dr. Gregory really believes this, he is more credulous than the simplest gobe-mouche who swallows without straining the ‘platform facts’ of antivivisection and antivaccination; if he does not believe it, he is a liar of the basest kind.

A few years later, in 1911, a woman named Sadie Marchant, who was living in a Shaker colony and struggling to breathe with a single functioning lung for years, asked for help dying. The Shakers with whom she’d been living prayed and decided finally that helping her die would be the right thing to do. Two of the Shakers were arrested. Their case was ultimately dismissed in January 1912, Lopes writes in Dying With Dignity . The case was well covered by newspapers across the country including the Washington Times and the New York Times . The dismissal of charges helped cement the idea of “euthanasia” as merciful in the case of terminal illness and grave suffering.

In 1935, the euthanasia movement got going in earnest in England when the Voluntary Euthanasia Legalization Society was founded. It held its inaugural meeting that year, and the society’s founder, C. Killick Millard, wrote to the British Medical Journal that he hoped the British Medical Association, which had not offered an opinion one way or another, would not offer an opinion. The decision to die, the author continued, was not a medical one.

A bill was introduced to Britain’s House of Lords in 1936 that would allow anyone over 21 years old who was mentally competent and fatally ill, or sick with an incurable disease, and suffering from immense pain to request voluntary euthanasia. The person would have to have two witnesses and be seen by several doctors, and then apply to the Minister of Health, who would then have to interview the dying person. That bill’s requirements are nearly identical to the ones that are now law today in several U.S. states. With 35 to 14 votes, the bill was defeated.

In 1957, the Vatican proclaimed that passive euthanasia was acceptable , according to Thomas R. Cole’s review of A Merciful End . Passive euthanasia is the deliberate decision to withhold lifesaving measures, like a ventilator, knowing that death will result. Hoping to take advantage of the change in public opinion after the Pope’s declaration, assisted-suicide advocates pivoted to focus on legalizing passive euthanasia.

Fast-forward four decades to 1994, when Oregon became the first state to legalize aid in dying. The law was immediately challenged, Lee v. State of Oregon . The case made its way through the court system for the next three years, and in February 1997, the Ninth Circuit Court of Appeals dismissed the lower court’s ruling against the Oregon Death with Dignity Act. The law went into effect in 1997.

Around the same time, Dr. Jack Kevorkian was traveling across the country with his “death machine,” making the cover of Time and stirring up conversation about end-of-life choices. District attorneys brought criminal charges against Kevorkian for ending people’s lives several times, but he was convicted only once. Kevorkian had filmed himself giving a man with amyotrophic lateral sclerosis (ALS) life-ending medication. He then gave the tape to Mike Wallace, host of 60 Minutes. Wallace aired the tape on TV alongside an interview with Kevorkian. In the tape, after the man dies, Kevorkian challenges the district attorney to take him to court. Reluctantly, the DA did, and this time Dr. Death lost. Kevorkian was sentenced to between 10 and 25 years in prison, the New York Times reported in his obituary . He was released in June 2007, after promising he’d never help in another suicide. He died in 2011.

* * * Today, anyone choosing to die under the law in states where physician aid is legal, like Oregon, Washington, Vermont, Montana, and California, must be able to self-administer the life-ending medication. If the patient cannot, then he or she is ineligible, which means that most people suffering from neuromuscular diseases like ALS and Parkinson’s will not be able to ease their pain legally. By the time people with these diseases are within six months of death, more often than not, they cannot self-administer.

That said, some doctors are still willing to help patients die, whether legally or illegally. In non-Catholic hospices, as in those associated with the Church, palliative sedation—like the so-called passive euthanasia of yore—is one way doctors help their patients hasten death. The “ doctrine of double effect ” safeguards doctors whose good-faith actions result in the death of their patients. If the doctor can make the case that he or she administered medicine without knowing or not believing it would result in a patient’s death, the doctrine protects them.

As medical technology gets better and better, death can become more prolonged and more difficult. A heart attack that once might have killed a person can now serve as a “wakeup call.” Ventilators keep people breathing far beyond when their bodies would have died naturally. Death does not come as it used to. While some people might welcome more days, regardless of their pain or diminished physical state, others do not. Policy and medical ethics have not kept up with technology.

Editor’s Note: The penultimate paragraph of this story was edited to clarify that Catholic hospices have Vatican approval to use palliative sedation.

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Home — Essay Samples — Social Issues — Euthanasia — The Arguments for Euthanasia: A Critical Analysis

The Arguments for Euthanasia: a Critical Analysis

Categories: Assisted Suicide Euthanasia

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Published: Sep 7, 2023

Words: 769 | Pages: 2 | 4 min read

Introduction, autonomy and self-determination: a fundamental right, relief of suffering: a compassionate response, protection of personal choice: preserving individual freedom.

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Voluntary Euthanasia

The entry sets out five conditions often said to be necessary for anyone to be a candidate for legalized voluntary euthanasia (and, with appropriate qualifications, physician-assisted suicide), outlines the moral case advanced by those in favor of legalizing voluntary euthanasia, and discusses the five most important objections made by those who deny that voluntary euthanasia is morally permissible and who are, in consequence, opposed to its being legalized.

1. Introduction

2. five conditions often proposed as necessary for candidacy for voluntary euthanasia, 3. a moral case for voluntary euthanasia, 4. five objections to the moral permissibility of voluntary euthanasia, other internet resources, related entries.

When a person performs an act of euthanasia, she brings about the death of another person because she believes the latter’s present existence is so bad that he would be better off dead, or believes that unless she intervenes and ends his life, his life will very soon become so bad that he would be better off dead. Accordingly, the motive of the person who performs an act of euthanasia is to benefit the one whose death is brought about. (This also holds for many instances of physician-assisted suicide, but use of the latter term is usually restricted to forms of assistance which stop short of the physician ‘bringing about the death’ of the patient, for example, those involving means that have to be activated by the patient.)

It is important to emphasize the motive of benefiting the person who is assisted to die because well-being is a key value in relation to the morality of euthanasia (see Section 3 below). Nonetheless, the defensibility of the contention that someone can be better off dead has been the subject of extensive philosophical deliberation. Those who claim that a person can be better off dead believe this to be true when the life that remains in prospect for that person has no positive value for her (a possibility which is discussed by e.g., Foot, 1977; McMahan 2002; Bradley 2009), whereas some of those who hold that a person’s life is inviolable deny that a person can ever be better off dead (e.g., Keown in Jackson and Keown 2012). A Kant-inspired variant on this latter position has been advanced by Velleman (1999). He considers that a person’s well-being can only matter if she is of intrinsic value and so that it is impermissible to violate a person’s rational nature (the source of her intrinsic value) for the sake of her well-being. Accordingly, he holds that it is impermissible to assist someone to die who judges that she would be better off dead and competently requests assistance with dying. The only exception is when a person’s life is so degraded as to call into question her rational nature, albeit he thinks it unlikely that anyone in that position will remain competent to request assistance with dying. This position appears to be at odds with the well-established right of a competent patient to refuse life-prolonging medical treatment, at least when further treatment is refused because she considers that her life no longer has value for her and further treatment will not restore its value to her. (For further reasons to reject arguments for the inviolability of the life of a person, including Velleman’s, see e.g., McMahan 2002; Young 2007; Sumner 2011, 2017.)

Because our concern will be with voluntary euthanasia – that is, with those instances of euthanasia in which a clearly competent person makes a voluntary and enduring request to be helped to die (or, by extension, when an authorised proxy makes a substituted judgment by choosing in the manner the no-longer-competent person would have chosen had he remained competent) – a second key value is the competence of the person requesting assistance with dying. There will be occasion to mention non-voluntary euthanasia – instances of euthanasia where a person lacks the competence at the time when a decision is to be made to request euthanasia and has not previously competently declared a preference for it via an advance directive (see the entry on advance directives ) – only when consideration is given to the claim that permitting voluntary euthanasia will lead via a slippery slope to permitting non-voluntary euthanasia. Nothing will be said here about involuntary euthanasia , where a competent person’s life is brought to an end despite an explicit expression of opposition to euthanasia, beyond saying that, no matter how honorable the perpetrator’s motive, such a death is, and ought to be, unlawful.

Debate about the morality and legality of voluntary euthanasia has been, for the most part, a phenomenon of the second half of the twentieth century and the beginning of the twenty first century. Certainly, the ancient Greeks and Romans did not believe that life needed to be preserved at any cost and were, in consequence, tolerant of suicide when no relief could be offered to a dying person or, in the case of the Stoics and Epicureans, when a person no longer cared for his life. In the sixteenth century, Thomas More, in describing a utopian community, envisaged such a community as one that would facilitate the death of those whose lives had become burdensome as a result of ‘torturing and lingering pain’. But it has only been in the last hundred years that there have been concerted efforts to make legal provision for voluntary euthanasia. Until quite recently there had been no success in obtaining such legal provision (though assisted suicide, including, but not limited to, physician-assisted suicide, has been legally tolerated in Switzerland for a number of decades). However, the outlook changed dramatically in the 1970s and 80s because of a series of court cases in the Netherlands which culminated in an agreement between the legal and medical authorities to ensure that no physician would be prosecuted for assisting a patient to die as long as certain guidelines were strictly adhered to (see Griffiths, et al., 1998). In brief, the guidelines were established to permit physicians to practise voluntary euthanasia in those instances in which a competent patient had made a voluntary and informed request to be helped to die, the patient’s suffering was unbearable, there was no way of making that suffering bearable that was acceptable to the patient, and the physician’s judgements as to diagnosis and prognosis were confirmed after consultation with another physician.

The first legislative approval for voluntary euthanasia was achieved with the passage in the parliament of Australia’s Northern Territory of a bill enabling physicians to practise voluntary euthanasia. Subsequent to the Act’s proclamation in 1996, it faced a series of legal challenges from opponents of voluntary euthanasia. In 1997 the challenges culminated in the Australian National Parliament overturning the legislation when it prohibited Australian territories from enacting legislation to permit voluntary euthanasia on constitutional grounds. Australia is a federation consisting of six states and two territories. Unlike the territories, the states do have the constitutional right to enact such legislation and in 2017 the state of Victoria did just that. The legislation came into effect in 2019. In 2019, a second state, Western Australia, enacted legislation to enable voluntary medically assisted death. The legislation became effective in 2021. In 2021 three further states, Tasmania, South Australia and Queensland enacted legislation to enable voluntary medically assisted death which came into force in 2022 for the first two, and 2023 for the third. Finally, in 2022 NSW enacted legislation which came into force in 2023 resulting in voluntary medically assisted death being available in each of the states. Attempts are currently being made in both the Australian Capital Territory and the Northern Territory to introduce legislation in favor of voluntary medically assisted death that will avoid being vetoed by the federal parliament.

In November 2000, the Netherlands passed legislation to legalize the practice of voluntary euthanasia. The legislation passed through all the parliamentary stages early in 2001. The Belgian parliament passed similar legislation in 2002 and Luxembourg followed suit in 2009. (For a very helpful comparative study of relevant legislation see Lewis 2007. See also Griffiths, et al. 2008.)

In Oregon in the United States, legislation was introduced in 1997 to permit physician-assisted suicide after a referendum strongly endorsed the proposed legislation. Later in 1997 the Supreme Court of the United States ruled that there is no constitutional right to physician-assisted suicide; however, the Court did not preclude individual states from legislating in favor of physician-assisted suicide (so the Oregon legislation was unaffected). Since that time the Oregon legislation has been successfully utilised by a significant number of people and similar legislation has been passed in the state of Washington in 2009, in Vermont in 2013, and more recently still in California, Colorado, Florida, Hawaii, Iowa, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New Mexico and the District of Columbia. A series of judicial decisions in the state of Montana in 2008 and 2009 established that the state could not prohibit physician-assisted suicide but legislation has not yet been introduced to codify the legal situation. A number of the remaining states are currently considering physician-assisted suicide bills.

A similar legal position to that in Montana obtained in the nation of Colombia from the late 1990s as a result of a majority ruling by its Constitutional Court in favor of the legality of physician-assisted suicide but legislative provision was finally made only quite recently. In 2021, Spain legalized voluntary euthanasia. In Austria and Germany courts have authorised physician-assisted suicide but no legislative backing for the practice has been introduced, while in Italy legislation for voluntary medically assisted death has been passed in one house of the bicameral parliament. In Portugal legislation for physician-assisted suicide was passed but was subsequently rejected by the Constitutional Court.

In Canada, the province of Quebec introduced legislation permitting medical aid in dying in 2014. The legislation came into effect in 2016 at around the same time that the Canadian National Parliament passed legislation permitting both physician-assisted suicide and voluntary euthanasia throughout all of the Canadian federation. (For a brief account of events leading up to the enactment of the various pieces of legislation in Canada see Downie and Schuklenk 2021.)

New Zealand held a referendum in 2019 which resulted in approval for the introduction of legislation for voluntary medically assisted death. The legislation came into effect late in 2021.

In the following countries legislative proposals for voluntary medically assisted death are presently under review: the Czech Republic, France, Ireland, the Isle of Man, Japan, Jersey, South Korea, the Philippines, Slovenia and the United Kingdom.

With that brief sketch of the historical background in place, we will proceed first to consider the conditions that those who have advocated making voluntary medically assisted death legally permissible have typically insisted should be satisfied. Consideration of the proposed conditions will establish a framework for the moral interrogation that will follow in Sections 3 and 4. Section 3 will outline the positive moral case put forward by those who want voluntary euthanasia and physician-assisted suicide to be legally permissible. Section 4 will be devoted to scrutinising the most important of the objections that have been levelled against that case by those opposed to the legalization of voluntary euthanasia and physician-assisted suicide.

Advocates of voluntary euthanasia typically contend that if a person

is suffering from a terminal illness;
is unlikely to benefit from the discovery of a cure for that illness during what remains of her life expectancy;
is, as a direct result of the illness, either suffering intolerable pain, or only has available a life that is unacceptably burdensome (e.g., because the illness has to be treated in ways that lead to her being unacceptably dependent on others or on technological means of life support);
has an enduring, voluntary and competent wish to die (or has, prior to losing the competence to do so, expressed a wish to be assisted to die in the event that conditions (a)-(c) are satisfied); and
is unable without assistance to end her life,

there should be legal and medical provision to facilitate her being allowed to die or assisted to die.

It should be acknowledged that these conditions are quite restrictive, indeed more restrictive than many think appropriate. In particular, the first condition restricts access to voluntary euthanasia to those who are terminally ill . While that expression is not free of all ambiguity, for present purposes it can be agreed that it does not include those who are rendered quadriplegic as a result of accidents, or sufferers from chronic diseases, or individuals who succumb to forms of dementia like Alzheimer’s Disease, to say nothing of those afflicted by ‘existential suffering’. Those who consider that cases like these show the first condition to be too restrictive (e.g., Varelius 2014, Braun, 2023) may, nonetheless, agree that including them as candidates for legalized voluntary euthanasia is likely to make it far harder in many jurisdictions to gain sufficient support for legalization (and so to make it harder to help those terminally ill persons who wish to die). Even so, they believe that voluntary euthanasia should be permitted for those who consider their lives no longer worth living, not just for for the terminally ill. Whether those who judge that their lives are no longer worth living, and so believe their lives are in that sense ‘complete’, should be afforded medical assistance with dying, has recently become a pressing concern in Belgium and the Netherlands. Several court cases have affirmed that such assistance may sometimes be provided for individuals in the former category even though the question remains as to whether it is properly a medical responsibility to render assistance with dying to someone who believes her life is complete despite her not suffering from a terminal medical condition (see, e.g., Young 2017). Relatedly, the issues of whether those suffering from a disability which will not reasonably foreseeably lead to death and those suffering because of a mental illness should be able to access medical assistance with dying have recently been the subject of intense debate in Canada. The debate culminated in disabled individuals, whose conditions are the cause of enduring, intolerable and irremediable suffering, being given access to medical assistance with dying as long as they are capable of making a competent request for that assistance. An intention to make a similar arrangement for those whose sole underlying condition is a mental illness was flagged for introduction in 2024, but has been temporarily shelved until further research has been conducted on the issue. It seems likely that the changes that have been made, or mooted, in these jurisdictions to the eligibility conditions for medical assistance with dying will lead to an expansion of the eligibility conditions for voluntary medically assisted death in other jurisdictions.

The fifth condition further restricts access to voluntary euthanasia by excluding those capable of ending their own lives, and so may be thought unduly restrictive by those who would wish to discourage terminally ill patients from attempting suicide. There will be yet others who consider this condition to be too restrictive because competent patients can always refuse nutrition and hydration (see, e.g., Bernat, et al. 1993; Savulescu 2014). Though this is true, many competent dying persons still wish to have access to legalized medically assisted death, rather than having to rely on refusing nutrition and hydration, so that they may retain control over the timing of their deaths and avoid needlessly prolonging the process of dying.

The second condition is intended simply to reflect the fact that it is normally possible to say when someone’s health status is incurable. So-called ‘miracle’ cures may be proclaimed by sensationalist journalists, but progress toward medical breakthroughs is typically painstaking. If there are miracles wrought by God that will be quite another matter entirely, but it is at least clear that not everyone’s death is thus to be staved off.

The third condition recognises what many who oppose the legalization of voluntary euthanasia do not, namely, that it is not only a desire to be released from pain that leads people to request help with dying. In the Netherlands, for example, pain has been found to be a less significant reason for requesting assistance with dying than other forms of suffering like frustration over loss of independence (see e.g., Marquet, et al. 2003; Onwuteaka-Philipsen, et al. 2012; Emanuel, et al. 2016). Sufferers from some terminal conditions may have their pain relieved but have to endure side effects that, for them, make life unbearable. Others may not have to cope with pain but, instead, with having to rely on forms of life support that simultaneously rob their lives of quality (as with, e.g., motor neurone disease). Yet others struggle with psychological distress and various psychiatric conditions and believe these conditions ought to be counted among the forms of suffering that qualify competent individuals to access medical assistance with dying. There has been greater recognition of, and support for, this position in those jurisdictions that make the role of unbearable suffering central to the determination of the eligibility of competent individuals for medical assistance with dying (see the discussion above of the first condition). Even so, inclusion of these forms of suffering highlights legitimate issues to do with the competence of at least some of those who suffer from them. (For a helpful recent study of the handling of requests for assistance with dying by psychiatric patients in the Netherlands see Kim, et al. 2016.)

A final preliminary point is that the fourth condition requires that the choice to die not only be uncoerced and competent but that it be enduring. The choice is one that will require time for reflection, and, almost certainly, discussion with others, so should not be settled in a moment. Nonetheless, as with other decisions affecting matters of importance, adults are presumed to choose voluntarily and to be competent unless the presence of defeating considerations can be established. (See the entry on decision-making capacity .) The burden of proof of establishing lack of voluntariness, or lack of competence, is on those who refuse to accept an adult person’s choice. There is no need to deny that this burden can sometimes be met (e.g., by pointing to the person’s being in a state of clinical depression). The claim is only that the onus falls on those who assert that an adult’s choice is not competent. (There are different issues to be faced when the competence of at least some older children and adolescents is at issue. In the Netherlands, for example, those aged twelve and older have sometimes been found to be competent to make end-of-life decisions for themselves. However, the topic will not be pursued further here because the focus of the entry is on competent adults.)

Clearly the five conditions set out above are likely to require some refinement if complete agreement is to be reached but there is sufficient agreement for us to proceed without further ado to consideration of the cases for and against legalization of voluntary euthanasia. (However, for a fuller discussion of issues concerning the definition of ‘euthanasia’ see, e.g., Beauchamp and Davidson 1979.)

One central ethical contention in support of voluntary euthanasia is that respect for persons demands respect for their autonomous choices as long as those choices do not result in harm to others. Respect for people’s autonomous choices is directly connected with the requirement for competence because autonomy presupposes competence (cf., Brock 1992). People have an interest in making important decisions about their lives in accordance with their own conception of how they want to live. In exercising autonomy, or self-determination, individuals take responsibility for their lives; since dying is a part of life, choices about the manner of their dying and the timing of their death are, for many people, part of what is involved in taking responsibility for their lives. Many are concerned about what the last phase of their lives will be like, not merely because of fears that their dying might involve them in great suffering, but also because of the desire to retain their dignity, and as much control over their lives as possible, during this phase. A second contention in support of voluntary euthanasia was mentioned at the beginning of this entry, namely the importance of promoting the well-being of persons. When someone is suffering intolerable pain or only has available a life that is unacceptably burdensome (see the third condition above), and he competently requests medical assistance with dying, his well-being may best be promoted by affording him that assistance. When harnessed together, the value to individuals of making autonomous choices, and the value to those individuals who make such choices of promoting their own well-being, provide the moral foundation for requests for voluntary euthanasia. Each consideration is necessary for moral justification of the practice, but taken in isolation neither suffices (see, e.g., Young 2007, 2017; Sumner 2011, 2017).

The technological interventions of modern medicine have had the effect of stretching out the time it takes for many people to die. Sometimes the added life this brings is an occasion for rejoicing; sometimes it drags out the period of significant physical and intellectual decline that a person undergoes with the result that life becomes no longer worth living. Many believe there is no single, objectively correct answer as to when, if at all, a person’s life becomes a burden and hence unwanted. If they are right, that simply points up the importance of individuals being able to decide autonomously for themselves whether their own lives retain sufficient quality and dignity to make life worth living. Others maintain that individuals can be in error about whether their lives continue to be worth living (cf., Foot 1977). The conditions outlined above in Section 2 are intended by those who propose them to serve, among other purposes, to safeguard against such error. But it is worth adding that in the event that a person who considers that she satisfies those conditions is judged by her medical attendants to be in error about whether it would be worth her continuing to live, the likely outcome is that those attendants will refuse to provide medical assistance with dying. (Evidence that will be mentioned below shows that this happens more frequently than might be predicted in jurisdictions in which medically assisted dying has been legalized. (There are discussions of the principles at stake in such matters in Young 2007; Wicclair 2011; Sumner 2020.) Unless a patient is able to be transferred to the care of other medical professionals who accept her assessment, she will have to rely on her own resources (e.g., by refusing nutrition and hydration). Even so, other things being equal, as long as a critically ill person is competent, her own judgement of whether continued life is a benefit to her ought to carry the greatest weight in any end-of-life decision making regardless of whether she is in a severely compromised and debilitated state. The idea that a competent individual’s autonomous judgment of the value to her of continued life should trump an assessment by others of her well-being should not be thought surprising because precisely the same happens when a competent patient refuses life-prolonging treatment.

Suppose, for the sake of argument, that it is agreed that we should respect a person’s competent request for medical assistance with dying (e.g., so as to enable her to achieve her autonomously chosen goal of an easeful death). It might be thought that in such an eventuality different moral concerns will be introduced from those that arise in connection with competent refusals. After all, while competent patients are entitled to refuse any form of medical treatment, they are not entitled to insist on the administration of forms of medical treatment that have no prospect of conferring a medical benefit or are not being provided because of a scarcity of medical resources or their affordability. While each of these points is sound, it remains the case that medical personnel have a duty to relieve suffering when that is within their capacity. Accordingly, doctors who regard medical assistance with dying as an element of appropriate medical care will consider it morally permissible to agree to a request for assistance with dying by a competent dying patient who wishes to avoid unbearable suffering. The reason for claiming only that this is morally permissible rather than morally obligatory will be explained in a subsequent paragraph. (For further reflections on the issue of responses to requests for medical assistance see, for instance, Dworkin 1998; Sumner 2011, 2017, 2020; Young 2007, 2017.)

Notwithstanding this response, as was seen earlier, at least some proponents of voluntary medically assisted dying wish to question why medical assistance with dying should be restricted to those covered by, in particular, the first three conditions set out above in Section 2. If people’s competent requests for medically assisted death should be respected why impose any restrictions at all on who may have access to medically assisted death? Why, for example, should those suffering from depression, or forms of dementia, not be eligible for medically assisted dying? Most proponents of voluntary medically assisted dying hold that there are at least two reasons for restricting access to it to those who satisfy the conditions set out earlier (or, a modified set that takes account of the concerns canvassed in the discussion of those proposed conditions). First, they contend that there are political grounds for doing so, namely, that because legalizing medically assisted dying for competent individuals is politically contested, the best hope for its legalization lies in focusing on those forms of suffering most likely to effect law reform. That is why some proponents deny the eligibility even of sufferers from conditions like ‘locked-in’ syndrome, motor neurone disease, and multiple sclerosis for voluntary medically assisted dying since, strictly, they are not terminally ill, and reliance has to be placed in consequence on their claim to be suffering unbearably. Second, and relatedly, most proponents of the legalization of medical assistance with dying have been cautious about supporting medically assisted death for those suffering from, for example, depression and dementia, because not only are they not terminally ill, but their competence to request assistance with dying is apt to be called into question, particularly in instances where they have given no prior indication of their preference for such assistance. Restricting access to medical assistance with dying to those whose suffering is less likely to be disputed avoids becoming embroiled in controversy. As was noted earlier, some critics of the restrictive approach (e.g., Varelius 2014) take a harder line and claim that it should not even be necessary for a person to be suffering from a medical condition to be eligible for medical assistance with dying; it should be enough to be ‘tired of life’. Only in a few jurisdictions, viz., Switzerland, the Netherlands and Belgium, has this issue been seriously broached. Regardless of what may happen in those jurisdictions, those seeking the legal provision of medical assistance with dying in other jurisdictions seem likely to maintain that if such assistance is to be seen as a legitimate form of medical care it has to be provided in response to a medical condition (rather than because someone is ‘tired of life’), and, indeed, restricted to those who satisfy the conditions outlined earlier in Section 2 (or some similar set of conditions). In short, these latter hold that making an autonomous request for assistance with dying is necessary, but should not be sufficient, for triggering such assistance.

There is one final matter of relevance to the moral case for voluntary medically assisted death on which comment must be made. The comment concerns a point foreshadowed in a previous paragraph, but it is also linked with the remark just made about the insufficiency of an autonomous request for assistance with dying to trigger that assistance. It is important to make the point that respect has to be shown not only for the dying person’s autonomy but also for the professional autonomy of any medical personnel asked to lend assistance with dying. The value (or, as some would prefer, the right) of self-determination does not entitle a patient to try to compel medical professionals to act contrary to their own moral or professional values. Hence, if voluntary euthanasia is to be legally permitted, it must be against a backdrop of respect for professional autonomy. Similarly, if a doctor’s view of her moral or professional responsibilities is at odds with her patient’s competent request for euthanasia, she should make provision, where it is feasible to do so, for the transfer of the patient to the care of a doctor who faces no such conflict. Given that, to date, those who contend that no scope should be permitted for conscientious objection within medical practice have garnered very little support for that view, making use of referrals and transfers remains the most effective means of resolving such disagreements.

Opponents of voluntary euthanasia have endeavored in a variety of ways to counter the very straightforward moral case that has been laid out above for its legalization (see, for example, Keown 2002; Foley, et al. 2002; Biggar 2004; Gorsuch 2006). Some of the counter-arguments are concerned only with whether the moral case warrants making the practice of voluntary euthanasia legal, whereas others are concerned with trying to undermine the moral case itself. In what follows, consideration will be given to the five most important counter-arguments. (For more comprehensive discussions of the morality and legality of medically assisted death see Biggar 2004; Gorsuch 2006; Young 2007; Sumner 2011, 2017; Keown 2018).

4.1 Objection 1

It is sometimes said (e.g., Emanuel 1999; Keown in Jackson and Keown 2012) that it is not necessary nowadays for people to die while suffering from intolerable or overwhelming pain because the provision of effective palliative care has improved steadily, and hospice care is more widely available. Some have urged, in consequence, that voluntary euthanasia is unnecessary.

There are several flaws in this contention. First, while both good palliative care and hospice care make important contributions to the care of the dying, neither is a panacea. To get the best palliative care for an individual involves trial and error, with some consequent suffering in the process; moreover, even the best care fails to relieve all pain and suffering. Perhaps even more importantly, high quality palliative care commonly exacts a price in the form of side-effects such as nausea, incontinence, loss of awareness because of semi-permanent drowsiness, and so on. A rosy picture is often painted as to how palliative care can transform the plight of the dying. Such a picture is misleading according to those who have closely observed the effect of extended courses of treatment with drugs like morphine. For these reasons many skilled palliative care specialists acknowledge that palliative care does not enable an easeful death for every patient. Second, even though the sort of care provided through hospices is to be applauded, it is care that is available to only a small proportion of the terminally ill and then usually only in the very last stages of the illness (typically a matter of a few weeks). Notwithstanding that only relatively few of the dying have access to hospice care it is worth drawing attention to the fact that in, Oregon, to cite one example, a high proportion of those who have sought physician-assisted suicide were in hospice care. Third, and of greatest significance for present purposes, not everyone wishes to avail themselves of palliative or hospice care. For those who prefer to die on their own terms and in their own time, neither option may be attractive. As previously mentioned, a major source of distress for many dying patients is the frustration that comes with being unable to satisfy their autonomous wishes. Fourth, as also indicated earlier, the suffering that occasions a desire to end life is not always traceable to pain caused by illness. For some, what is intolerable is their forced dependence on others or on life-supporting machinery; for these patients, the availability of effective pain control is not the primary concern. (In relation to the preceding matters see Rietjens, et al. 2009 and Onwuteaka-Philipsen et al. 2012 for findings for the Netherlands; and, for Oregon, Ganzini, et al. 2009.)

4.2 Objection 2

A second, related objection to the moral and legal permissibility of voluntary euthanasia turns on the claim that we can never have sufficient evidence to be justified in believing that a dying person’s request to be helped to die is competent, enduring and genuinely voluntary.

It is certainly true that a request to die may not reflect an enduring desire to die (just as some attempts to commit suicide may reflect only temporary despair). That is why advocates of the legalization of voluntary euthanasia have argued that a cooling off period should normally be required before euthanasia is permitted to ensure that the request is enduring. That having been said, to claim that we can never be justified in believing that someone’s request to die reflects a settled preference for death is to go too far. If a competent person discusses the issue with others on different occasions over time, and remains steady in her resolve, or privately reflects on the issue for an extended period and does not waver in her conviction, her wish to die surely must be counted as enduring.

But, it might be asked, what if a person is racked with pain, or mentally confused because of the measures taken to relieve her pain, and is, in consequence, unable to think clearly and rationally about the alternatives? It has to be agreed that a person in those circumstances who wants to die should not be assumed to have a truly voluntary and enduring desire to die. However, there are at least two important points to make about those in such circumstances. First, they do not account for all of the terminally ill, so even if it is acknowledged that such people are incapable of agreeing to voluntary euthanasia that does not show that no one can ever voluntarily request help to die. Second, it is possible in at least some jurisdictions for a person to indicate, in advance of losing the capacity to give competent consent, how she would wish to be treated should she become terminally ill and suffer either intolerable pain or an unacceptable loss of control over her life (cf., for instance, Dworkin 1993). ‘Living wills’ or ‘advance directives’ are legal instruments for giving voice to people’s wishes while they are capable of giving competent, enduring and voluntary consent, including to their wanting help to die. As long as they are easily revocable in the event of a change of mind (just as civil wills are), they should be respected as evidence of a well thought-out conviction. (For more detailed consideration of these instruments see the entry on advance directives .)

Perhaps, though, what is really at issue in this objection is whether anyone can ever form a competent, enduring and voluntary judgement about being better off dead, rather than continuing to suffer from an illness, prior to suffering such an illness (cf., Keown in Jackson and Keown 2012). If this is what underlies the objection it is surely too paternalistic to be acceptable. Why is it not possible for a person to have sufficient inductive evidence (e.g., based on the experience of the deaths of friends or family) to know her own mind, and act accordingly, without having had direct experience of such suffering?

4.3 Objection 3

According to the traditional interpretation of the ‘doctrine of double effect’ it is permissible to act in a way which it is foreseen will have a bad effect, provided only that

the bad effect occurs as a side-effect (i.e., indirectly) to the achievement of the act that is directly aimed at;
the act directly aimed at is itself morally good or, at least, morally neutral;
the good effect is not achieved by way of the bad, that is, the bad must not be a means to the good; and
the bad effect must not be so serious as to outweigh the good effect.

Hence, it is permissible, according to the doctrine of double effect, to, for example, alleviate pain (a good effect) by administering a drug, knowing that doing so will shorten life, but impermissible to administer the same drug with the direct intention of terminating a patient’s life (a bad effect). This latter claim is said to apply regardless of whether the drug is given at the person’s request.

This is not the appropriate forum for a full consideration of the doctrine, for which see the entry on the doctrine of double effect . However, there is one very important criticism to be made of the application of the doctrine that has direct relevance to the issue of voluntary euthanasia.

On the most plausible reading, the doctrine of double effect can be relevant to the permissibility of voluntary euthanasia only when a person’s death is bad for her or, to put it another way, a harm to her. Sometimes the notion of ‘harm’ is understood simply as damage to a person’s interests whether consented to or not. At other times, it is understood, more strictly, as damage that has been wrongfully inflicted. On either understanding of harm, there can be instances in which death for a person does not constitute a harm for her because it will either render her better off, or, as some would insist, no worse off, when compared with remaining alive. Accordingly, in those instances, the doctrine of double effect can have no relevance to the debate about the permissibility of voluntary euthanasia. (For extended discussions of the doctrine of double effect and its bearing on the moral permissibility of voluntary euthanasia see, e.g., McIntyre 2001; Woodward 2001; Cavanaugh 2006; Young 2007; Sumner 2011, 2017.)

4.4 Objection 4

As was noted earlier in Section 3, there is a widespread belief that so-called passive (voluntary) euthanasia, wherein life-sustaining or life-prolonging measures are withdrawn or withheld in response to a competent patient’s request, is morally permissible. The reason why passive (voluntary) euthanasia is said to be morally permissible is that the patient is simply allowed to die because steps are not taken to preserve or prolong life. This happens, for example, when a dying patient requests the withdrawal or the withholding of measures whose administration would be medically futile, or unacceptably burdensome. By contrast, active (voluntary) euthanasia is said to be morally impermissible because it is claimed to require an unjustifiable intentional act of killing to satisfy the patient’s request (cf., for example, Finnis, 1995; Keown in Jackson and Keown 2012; Keown 2018).

Despite its popularity and widespread use, the distinction between passive and active euthanasia is neither particularly clear nor morally helpful. (For a fuller discussion, see McMahan 2002.) Whether behavior is described in terms of acts or omissions (a distinction which underpins the alleged difference between active and passive voluntary euthanasia and that between killing a person and letting her die), is often a matter of pragmatics rather than anything of deeper moral importance. Consider, for instance, the practice (once common in hospitals) of deliberately proceeding slowly to a ward in response to a request to provide assistance for a patient who has been assigned a ‘not for resuscitation’ code. Or, consider ‘pulling the plug’ on a respirator keeping an otherwise dying patient alive, as against not replacing the oxygen supply when it runs out. Are these acts or omissions? If the answers turn on merely pragmatic considerations the supposed distinction between passive euthanasia and active euthanasia will be hard to sustain.

Even supposing that the distinction between acts and omissions, and the associated distinction between killing and letting die, can be satisfactorily clarified (on which see the entry doing v. allowing harm ), there remains the issue of whether these distinctions have moral significance in every circumstance. Consider a case of a patient suffering from motor neurone disease who is completely respirator dependent, finds her condition intolerable, and competently and persistently requests to be removed from the respirator so that she may die. Even the Catholic Church in recent times has been prepared to agree that it is permissible, in a case like this, to turn off the respirator. No doubt this has been because the Catholic Church considers such a patient is only being allowed to die. Even were it to be agreed, for the sake of argument, that such a death should be regarded as an instance of letting die, this concession would not show that it would have been morally worse had the patient been killed at her request (active voluntary euthanasia) rather than being allowed to die (passive voluntary euthanasia). Indeed, supporters of voluntary medically assisted death maintain that since death is beneficial in such an instance (or, at the very least, leaves the dying person no worse off), actively bringing about the death is morally to be preferred to just allowing it to happen because the desired benefit is achieved sooner and thus with less suffering.

Opponents of voluntary euthanasia claim, however, that the difference between active and passive euthanasia is to be found in the agent’s intention: if someone’s life is intentionally terminated she has been killed, whereas if she is just no longer being aggressively treated, her death should be attributed to the underlying disease. Many physicians would say that their intention in withholding or withdrawing life-sustaining medical treatment in such circumstances is simply to respect the patient’s wishes. This is plausible in those instances where the patient competently requests that aggressive treatment no longer be given (or, the patient’s proxy makes such a request). But it will often be implausible. In many cases the most plausible interpretation of a physician’s intention in withholding or withdrawing life-sustaining measures is that it is to end the patient’s life. Consider the palliative care practice of ‘terminally sedating’ a patient after a decision has been made to cease aggressive treatment. Suppose (as sometimes happens) that this is then followed by withholding artificially supplied nutrition. In these latter instances the best explanation of the physician’s behavior is that the physician intends thereby to end the life of the patient. What could be the point of the action, the goal aimed at, the intended outcome, if not to end the patient’s life? (Cf. Winkler 1995.) No sense can be made of the action as being intended to palliate the patient’s diseased condition, or to keep the patient comfortable. Nor is it appropriate to claim that what kills the patient is the underlying disease. What kills the patient is the act of depriving her of nutrition (i.e., of starving her to death). The point can be generalized to cover many more instances involving either the withdrawal or the withholding of life-sustaining medical treatment. In short, there is no good reason to think that whereas so-called passive voluntary euthanasia is morally acceptable active voluntary euthanasia never can be.

But we can go further. Giving titrated doses of morphine that reach levels beyond those needed to control pain, or removing a respirator from a sufferer from motor neurone disease, seem to many of us to amount to intentionally bringing about the death of the person being cared for. To be sure, as was acknowledged above, there are circumstances in which doctors can truthfully say that the actions they perform, or omissions they make, will bring about the deaths of their patients even though it was not their intention that those patients would die. So, for instance, if a patient refuses life-prolonging medical treatment because she considers it futile, it can be reasonable to say that her doctor’s intention in complying with the request was simply to respect her wishes. Nevertheless, as we have seen, there are other circumstances in which it is highly stilted to claim, as some doctors continue to do, that they had no intention of bringing about death.

These considerations should settle matters but do not do so for those who maintain that killing, in medical contexts, is always morally unjustified – a premise that underwrites much of the debate surrounding this fourth objection. But this underlying assumption is open to challenge and has been challenged by, for instance, Rachels 1986 and McMahan 2002. One of the reasons the challengers have given is that there are cases in which killing a competent dying person when she requests assistance with dying, is morally preferable to allowing her to die, namely, when taking the latter option would serve only to prolong her suffering against her wishes. Further, despite the longstanding legal doctrine that no one can justifiably consent to be killed (on which more later), it surely is relevant to the justification of an act of killing that the person killed has autonomously decided that she would be better off dead and so asks to be helped to die.

4.5 Objection 5

It is sometimes said that if society allows voluntary euthanasia to be legalized, we will then have set foot on a slippery slope that will lead us eventually to support other forms of euthanasia, including, in particular, non-voluntary euthanasia. Whereas it was once the common refrain that that was precisely what happened in Hitler’s Germany, in recent decades the tendency has been to claim that experience with legalized euthanasia in the Netherlands and Belgium, in particular, has confirmed the reality of the slippery slope.

Slippery slope arguments come in various versions. One (but not the only) way of classifying them has been to refer to logical, psychological and arbitrary line versions. The common feature of the different forms is the contention that once the first step is taken on a slippery slope the subsequent steps follow inexorably, whether for logical reasons, psychological reasons, or to avoid arbitrariness in ‘drawing a line’ between a person’s actions. (For further discussion see, e.g., Rachels 1986; Brock 1992; Walton 1992.)

We need first to consider whether, at the theoretical level, any of these forms of argument is powerful enough to refute the case for the legalization of voluntary euthanasia. We will then be in a position to comment on the alleged empirical support from the experiences of Hitler’s Germany and, more recently, of legalized euthanasia in the Netherlands and elsewhere, for the existence of a slippery slope that supposedly comes into being with the legalization of voluntary euthanasia.

To begin with, there is nothing logically inconsistent in supporting voluntary euthanasia while maintaining the moral inappropriateness of non-voluntary euthanasia. (However, for an attempt to press the charge that there is such an inconsistency see, e.g., Keown 2022.) Undoubtedly, some advocates of voluntary euthanasia wish also to lend their support to some acts of non-voluntary euthanasia, for example, for those in persistent vegetative states who have never indicated their wishes about being helped to die, or for certain severely disabled infants for whom the outlook is hopeless. (See, e.g., Kuhse and Singer 1985; Singer 1994; Stingl 2010; Sumner 2017.) Others believe that the consent of the patient is strictly required if euthanasia is appropriately to be legalized. The difference is not a matter of logical acumen; it is to be explained by reference to the importance placed on key values by the respective supporters. Thus, for example, those who insist on the necessity for a competent request by a patient for medical assistance with dying typically believe that such a request is the paramount consideration in end-of-life decision making (even when it is harnessed to the value of individual well-being), whereas those who consider a person’s best interests to be the paramount consideration are more likely to believe in the justifiability of instances of non-voluntary euthanasia like those mentioned above.

Next, it is hard to see why moving from voluntary to non-voluntary euthanasia is supposed to be psychologically inevitable. Why should those who support the legalization of voluntary euthanasia, because they value the autonomy of the individual, find it psychologically easier, in consequence, to endorse the killing of those who are not able competently to request assistance with dying? What reason is there to believe that they will, as a result of their support for voluntary euthanasia, be psychologically driven to endorse a practice of non-voluntary euthanasia?

Finally, since there is nothing arbitrary about distinguishing voluntary euthanasia from non-voluntary euthanasia (because the line between them is based on clear principles), there can be no substance to the charge that only by arbitrarily drawing a line between them could non-voluntary euthanasia be avoided were voluntary euthanasia to be legalized.

What, though, of Hitler’s Germany and the recent experience of legalized voluntary euthanasia in the Netherlands and elsewhere? The former is easily dismissed as an indication of an inevitable descent from voluntary euthanasia to non-voluntary. There never was a policy in favor of, or a legal practice of, voluntary euthanasia in Germany in the 1920s to the 1940s (see, for example, Burleigh 1994). There was, prior to Hitler coming to power, a clear practice of killing some disabled persons. But it was never suggested that their being killed was justified by reference to their best interests; rather, it was said that society would be benefited. Hitler’s later revival of the practice and its widening to take in other groups such as Jews and gypsies was part of a program of eugenics , not euthanasia.

Since the publication of the Remmelink Report in 1991 into the medical practice of euthanasia in the Netherlands, it has frequently been said that the Dutch experience shows that legally protecting voluntary euthanasia is impossible without also affording shelter to the non-voluntary euthanasia that will follow in its train (see, e.g., Keown 2018). In the period since that report there have been regular national studies of the practice of euthanasia in the Netherlands (see, e.g., Rietjens, et al. 2009; Onwuteaka-Philipsen, et al. 2012; van der Heide, et al. 2017). The findings from these national studies have consistently shown that there is no evidence for the existence of such a slippery slope. Among the specific findings the following are worth mentioning: of those terminally ill persons who have been assisted to die about sixty per cent have clearly been cases of voluntary euthanasia as it has been characterised in this entry; of the remainder, the vast majority of cases were of patients who at the time of their medically assisted deaths were no longer competent. It might be thought that these deaths ought to be regarded as instances of non-voluntary euthanasia. But, in fact, it would be inappropriate to regard them as such. Here is why. For the overwhelming majority of these cases, the decisions to end life were taken only after consultation between the attending doctor(s) and close family members, and so can legitimately be thought of as involving substituted judgements. Moreover, according to the researchers, the overwhelming majority of these cases fit within either of two common practices that occur in countries where voluntary euthanasia has not been legalized, namely, that of terminal sedation of dying patients, and that of giving large doses of opioids to relieve pain while foreseeing that this will also end life. In a very few cases, there was no consultation with relatives, though in those cases there were consultations with other medical personnel. The researchers contend that these instances are best explained by the fact that families in the Netherlands strictly have no final legal authority to act as surrogate decision-makers for incompetent persons. For these reasons the researchers maintain that non-voluntary euthanasia is not widely practised in the Netherlands.

That there have only been a handful of prosecutions of Dutch doctors for failing to follow agreed procedures (Griffiths, et al. 1998; Asscher and van de Vathorst 2020), that none of the doctors prosecuted has had a significant penalty imposed, that a significant proportion of requests for medical assistance with dying are rejected as unjustifiable, and that the Dutch public have regularly reaffirmed their support for the agreed procedures suggests that, contrary to the claims of some critics, the legalization of voluntary euthanasia has not increased the incidence of non-voluntary euthanasia. A similar picture to the one in the Netherlands has emerged from studies of the operation of the law concerning physician-assisted suicide in Oregon. Indeed, in a recent wide-ranging study of attitudes and practices of voluntary euthanasia and physician-assisted suicide covering two continents, a prominent critic of these practices has concluded (in agreement with his co-authors) that little evidence exists of abuse, particularly of the vulnerable (see Emanuel, et al., 2016). Unfortunately, insufficient time has elapsed for appropriate studies to be conducted in the other jurisdictions that have legalized either voluntary euthanasia or physician-assisted suicide (but for some relevant evidence see e.g., White, et al. 2022). Finally, some commentators have pointed out that there may, in reality, be more danger of the line between voluntary and non-voluntary euthanasia being blurred if euthanasia is practised in the absence of legal recognition, since there will, in those circumstances, be neither transparency nor monitoring (which cannot be said of the Netherlands, Belgium, Oregon and so on).

None of this is to suggest that it is not necessary to ensure the presence of safeguards against potential abuse of legally protected voluntary euthanasia. This is particularly important for the protection of those who have become incompetent by the time decisions need to be taken about whether to assist them to die. Furthermore, it is, of course, possible that the reform of any law may have unintended effects. However, if the arguments outlined above are sound (and the experience in the Netherlands, Belgium and Luxembourg, along with the more limited experience in several states in the United States and in Canada, is, for the present, not only the best evidence we have that they are sound, but the only relevant evidence), that does not seem very likely.

It is now well-established in many jurisdictions that competent patients are entitled to make their own decisions about life-sustaining medical treatment. That is why they can refuse such treatment even when doing so is tantamount to deciding to end their life. It is plausible to think that the fundamental basis of the right to decide about life-sustaining treatment – respect for a person’s autonomy and her assessment of what will best serve her well-being – has direct relevance to the legalization of voluntary euthanasia (see, e.g., Dworkin 1998; Young 2007, 2017; Sumner 2011, 2017). In consequence, extending the right of self-determination to cover cases of voluntary euthanasia does not require a dramatic shift in legal policy. Nor do any novel legal values or principles need to be invoked. Indeed, the fact that suicide and attempted suicide are no longer criminal offences in many jurisdictions indicates that the central importance of individual self-determination in a closely analogous context has been accepted. The fact that voluntary euthanasia and physician-assisted suicide have not been more widely decriminalized is perhaps best explained along a similar line to the one that has frequently been offered for excluding the consent of the victim as a justification for an act of killing, namely the difficulties thought to exist in establishing the genuineness of the consent. But, the establishment of suitable procedures for giving consent to voluntary euthanasia and physician-assisted suicide is surely no harder than establishing procedures for competently refusing burdensome or otherwise unwanted medical treatment. The latter has already been accomplished in many jurisdictions, so the former should be achievable as well.

Suppose that the moral case for legalizing voluntary euthanasia and physician-assisted suicide does come to be judged more widely as stronger than the case against legalization, and they are made legally permissible in more jurisdictions than at present. Should doctors take part in the practice? Should only doctors perform voluntary euthanasia? These questions ought to be answered in light of the best understanding of what it is to provide medical care. The proper administration of medical care should promote the welfare of patients while respecting their individual self-determination. It is these twin values that should guide medical care, not the preservation of life at all costs, or the preservation of life without regard to whether patients want their lives prolonged should they judge that life is no longer of benefit or value to them. Many doctors in those jurisdictions where medically assisted death has been legalized and, to judge from available survey evidence, in other liberal democracies as well, see the practice of voluntary euthanasia and physician-assisted suicide as not only compatible with their professional commitments but also with their conception of the best medical care for the dying. That being so, doctors of the same conviction in jurisdictions in which voluntary medically assisted death is currently illegal should no longer be prohibited by law from lending their professional assistance to competent terminally ill persons who request assistance with dying because of irremediable suffering or because their lives no longer have value for them.

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Ganzini, L., E. Goy and S. Dobscha, 2009, “Oregonians’ Reasons for Requesting Physician Aid in Dying”, Archives of Internal Medicine , 169: 489–492.
Gorsuch, N., 2006, The Future of Assisted Suicide and Euthanasia , Princeton, New Jersey: Princeton University Press.
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Keown, J., 2018, Euthanasia, Ethics and Public Policy: an argument against legalization , 2nd edition, New York: Cambridge University Press.
–––, 2022, “The Logical Link Between Voluntary and Non-Voluntary Euthanasia”, Cambridge Law Journal , 81: 84–108.
Kim, S., R. De Vries and J. Peteet, 2016, “Euthanasia and Assisted Suicide of Patients with Psychiatric Disorders in the Netherlands 2011 to 2014”, Journal of the American Medical Association Psychiatry , 73: 362–368.
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Lewis, P., 2007, Assisted Dying and Legal Change , Oxford: Oxford University Press.
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McIntyre, A., 2001, “Doing Away With Double Effect”, Ethics , 111: 219–255.
McMahan, J., 2002, The Ethics of Killing: Problems at the Margins of Life , New York: Oxford University Press.
Onwuteaka-Philipsen, B., A. Brinkman-Stoppelenburg, C. Penning, G. Jong-Krul, J. van Delden and A. van der Heide, 2012, “Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990–2010: A repeated cross-sectional survey”, The Lancet , 380: 908–915.
Rachels, J., 1986, The End of Life: Euthanasia and Morality , Oxford: Oxford University Press.
Rietjens, J., P. van der Maas, B. Onwuteaka-Philipsen, J. van Delden and A. van der Heide, 2009, “Two Decades of Research on Euthanasia from the Netherlands: What Have We Learnt and What Questions Remain?”, Journal of Bioethical Inquiry , 6: 271–283.
Savulescu, J., 2014, “A Simple Solution to the Puzzles of End of Life? Voluntary Palliated Starvation”, Journal of Medical Ethics , 40: 110–113.
Singer, P. 1994, Rethinking Life and Death: The Collapse of Our Traditional Ethics , Melbourne: Text Publishing.
Stingl, M., (ed.), 2010, The Price of Compassion: Assisted Suicide and Euthanasia , Peterborough, Ontario: Broadview Press.
Sumner, L., 2011, Assisted Death: A Study in Ethics and Law , Oxford: Oxford University Press.
–––, 2017, Physician-Assisted Death: What Everyone Needs to Know , New York: Oxford University Press.
–––, 2020, “Conscientious Refusal to Provide Medically Assisted Dying”, University of Toronto Law Journal , 71: 1–31.
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How to cite this entry . Preview the PDF version of this entry at the Friends of the SEP Society . Look up topics and thinkers related to this entry at the Internet Philosophy Ontology Project (InPhO). Enhanced bibliography for this entry at PhilPapers , with links to its database.

Medically Assisted Dying , an annotated bibliography authored by Robert Young (La Trobe University)
Eight Reasons Not to Legalize Physician Assisted Suicide , by David Albert Jones, online resource at the Anscombe Bioethics Centre website.

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J R Soc Med
v.111(11); 2018 Nov

Euthanasia and assisted dying: what is the current position and what are the key arguments informing the debate?

Andreas fontalis.

1 St George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK

Efthymia Prousali

2 Aristotle University of Thessaloniki, 54124 Thessaloniki Greece

Kunal Kulkarni

3 University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, LE1 5WW, UK

Assisted dying is a highly controversial moral issue incorporating both physician-assisted dying (PAD) and voluntary active euthanasia. End-of-life practices are debated in many countries, with assisted dying receiving different consideration across various jurisdictions. In this paper, we provide an analytic framework of the current position and the main arguments related to the rights and moral principles concerning assisted dying. Assisted dying proponents focus on the respect of autonomy, self-determination and forestalling suffering. On the other hand, concerns are raised regarding the interpretation of the constitutional right to life and balancing this with the premise of assisted dying, alongside the impacts of assisted dying on the doctor–patient relationship, which is fundamentally based on trust, mutual respect and the premise of ‘first do no harm’. Our review is underpinning the interpretation of constitutional rights and the Hippocratic Oath with the premise of assisted dying, alongside the impacts of assisted dying on the doctor–patient relationship. Most clinicians remain untrained in such decision making, with fears against crossing key ethical divides. Due to the increasing number of cases of assisted dying and lack of consensus, our review enables the integration of ethical and legal aspects and facilitates decision making.

Introduction

Assisted dying remains a highly controversial moral issue, with clinical, legal, political, religious and ethical considerations playing an important role. Lack of consensus and ongoing debate are features of modern life, while the law generally sustains a broader, pluralist outlook. Advances in both life-prolonging treatments and palliative care in recent years are inextricably intertwined with this complex topic, resulting in the continuing demand for amendments on current legislations. 1 This review presents an overview of the current status of this topical debate.

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 without their prior consent incorporates both non-voluntary euthanasia (when the patient is not capable of providing informed consent, e.g. vegetative state, young child) and involuntary euthanasia (against patient’s will). Physician-assisted dying is defined as follows: a physician intentionally helping a person to terminate their life by providing drugs for self-administration, at that person’s voluntary and competent request. 2 , 3 Consequently, in the first case a third person acts resulting in patient’s death, whereas in physician-assisted dying the action is undertaken by the patient who is given lethal medication by a physician. 2

Discussion regarding withholding or withdrawing treatment and requesting assisted death has emerged in association with the simultaneous expansion of palliative care across the world. The World Health Organization defines palliative care is an approach that

improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. 4

It intends to neither hasten nor postpone death. Nonetheless, in practice, terminally ill patients – often with full mental capacity – may develop a loss of self-determination as their condition deteriorates and express a desire for assisted dying to alleviate intractable physical symptoms.

Assisted dying is an emotionally and ethically challenging subject, which understandably receives varying degrees of acceptance among different global jurisdictions. Currently, there is legal provision for assisted dying (or variants) in only four European countries (the Netherlands, Belgium, Switzerland and Luxemburg), Canada, Colombia and the United States of America (USA) states of Oregon, Washington, Montana, Vermont, California, Colorado and Washington, DC, representing nearly 18% of the US population. 5 , 6 Switzerland is the only country which permits the act of assisted dying performed by a non-physician. Moreover, non-Swiss citizens can exploit the Swiss law by visiting Switzerland in order to access assisted dying. 7 In these more tolerant jurisdictions, palliative care is seen as an important link in the same chain as assisted dying in caring for terminally ill individuals, rather than an alternative. Elsewhere in the world, an assisted death remains a criminal offence, prosecutable through various legal routes. For example, in the UK, all forms of assisted dying remain illegal and can be considered under criminal laws of manslaughter or murder, or under the Suicide Act (1961), depending on the circumstances. 6 Prosecution guidelines were first issued by the Director of Public Prosecutions in 2009 following House of Lords ruling in the case of Debbie Purdy, which stated that there was ambiguous guidance regarding when people would be prosecuted for encouraging or assisting suicide. The guidelines suggest that while each case will be assessed on its relative merits, individuals acting in the capacity of a healthcare professional are more likely to be prosecuted for assisting or encouraging suicide, although to date no report-providing doctor or accompanying individual has been prosecuted for helping patients to travel abroad from the UK to end their life. 8 In England and Scotland, three assisted dying bills have been proposed and debated, largely based on the Oregon Death with Dignity Act (1997) from the USA, which permits assisted dying; none were passed.

We performed a systematic search of MEDLINE and EMBASE databases from conception to January 2018. The search terms used were ‘euthanasia’, ‘assisted dying OR death’, ‘assisted suicide’, ‘medical ethics’, ‘autonomy’, ‘end of life’ and ‘sanctity of life’. We also combined free text searching with Medical Subject Headings (MeSH) terms and no restrictions were set in publication date, study design and publication status.

Principles of bioethics

Autonomy and right to life.

Beauchamp and Childress developed a standard approach to bioethics and advocated for four principles that lie at the heart of healthcare ethics and underpin decision-making. 9 , 10 Respect for autonomy is one of the fundamental concepts, in combination with justice , beneficence and non-maleficence .

In medical practice, autonomy describes the right of competent adults to make informed decisions about their own medical care, prior to any investigation or treatment taking place. For a physician, respect for autonomy includes acknowledging and preserving a patient’s right to self-determination and providing the necessary guidance, which would allow for an informed and independent choice, free of coercion.

However, autonomy is far from a straightforward consideration. Onora O'Neill, in an attempt to scrutinise the context of autonomy in her Gifford lectures, makes a clear and compelling distinction between the approach of John Stuart Mill and Kant regarding the subject of autonomy. 11 As O’Neill vividly describes, Mill stretches the bound of choice and ‘sees individuals not merely as choosing to implement whatever desires they happen to have at a given moment, but as taking charge of those desires, as reflecting on and selecting among them in distinctive ways’. 11 The Kantian version of autonomy is guided by a ‘practical reason’. Kant views autonomy as ‘a matter of acting on certain sorts of principles, and specifically on principles of obligation’ rather than a form of self-expression and supports that ‘there can be no possibility of freedom for any one individual if that person acts without reference to all other moral agents’. 12 O’Neill embraces the Kantian view and contextualises it as ‘principled autonomy’ compared to ‘individualistic autonomy’. O’Neill’s work vigorously illustrates the fragility of the concept of autonomy and its contingency on a number of other considerations, particularly the network of human relationships within which it features.

The greatest expression of autonomous self-determination is the right of ‘capacitous’ adults to refuse any proposed intervention (irrespective of rationality), even if this decision could result in harm or death, provided they are capable of freely reaching a decision in the above manner. For this reason, obtaining informed consent from a patient after they have been offered all the relevant information regarding their situation is of paramount importance. During the past decades, the development of liberal democracies has highlighted the significance of self-determination, with healthcare systems increasingly adopting more patient-centred approaches to care decisions. The right to bodily autonomy has also been enshrined under Article 8 ( Table 1 ) of the European Convention on Human Rights (ECHR).

Article 8: Right to respect for private and family life.

Taking the above into consideration, Article 8 encompasses inter alia the right to personal development. In a technical legal sense within the jurisdiction of Swiss law, it includes a patient’s choice to avoid what they consider an undignified and severe end to their life. 14 Proponents of this highly contentious argument claim that seriously ill patients should have a choice in whether or not they wish to continue living with a condition that undermines their inherent dignity and personal identity, 15 without violating the principle of sanctity of life. Therefore, it can be argued that respecting autonomy inherently involves the prima facie right of a patient to control the circumstances and time of death by requesting help in dying. This could minimise the suffering of an individual or their family and improve the quality of the end of the patient’s life, as their wishes would be respected and dignity would be preserved. 16 , 17

A further dimension that can be considered is the treating clinician’s ethical beliefs and values. During their training, most practising clinicians have not experienced the concept of assisted dying as an expected duty in the context of patients’ autonomy. 18 Nevertheless, it is important to consider the magnitude of patients’ autonomy within modern society. Individual liberty ought not to be viewed as absolute and exceptions to Article 8 should be provided in favour of preservation and reverence to life. 17 , 18

The right to life is guaranteed by Article 2 ( Table 2 ) of the European Convention on Human Rights. Under Article 2, the State is enjoined to abstain from the deliberate and illicit taking of life, as well as to protect vulnerable people against actions by which they could jeopardise their lives. The principle of sanctity of life emerges frequently in modern discussion, particularly in Anglo-American bioethics, surrounding public controversy about end of life and abortion issues. Yet, its moral foundation is rarely unriddled and understood. The sanctity of life position asserts that life has sanctity and its value prevails all other values. No individual’s life deserves priority, and sanctity is attributed to life regardless of the physiological status, imminence of death, suffering or individual’s wishes to live or die. 19

Article 2: Right to life.

This argument is often associated, but not fully equated, with religious and cultural traditions that generally object to assisted death, because human life is viewed as God’s sovereign creation. From a religious perspective, God is considered the only one who can determine the beginning and end of human life. The sanctity of life is a value also clearly mirrored under Article 9 of the European Convention on Human Rights, which refers to freedom of thought, conscience and religion. 13 It is notable, though, that Article 2 does not encompass assisted dying, i.e. in situations where a person’s decision to end their life has been taken independently and with absolute perception of what it implied.

The crucial issue is therefore one of balance . Patient autonomy has to be balanced against the principle of sanctity of life. It should be acknowledged though that the autonomy argument is secondary in its applicability on whether assisted dying is ethically permissible and cannot solely guide decisions on what is morally impermissible, as it constitutes only a piece of the puzzle. The right to end a life that an individual finds intolerable has to be considered in association with its resulting impact on other rights, regulations and the responsibilities of healthcare professionals in facilitating assisted dying. 18

As discussed, justice constitutes one of the main four fundamental principles of medical ethics. All individuals in a society should be treated equally and impartially. One of the arguments that has monopolised the debate concerning assisted dying is the ‘slippery slope’. According to this, should assisted suicide be established, then it might be applied in circumstances that fall outside the scope of morally permissible cases, such as in patients who may not be fully competent. 17 Furthermore, if a person is motivated by means other than his own will, for example through external coercion, then patient autonomy is infringed.

In this regard, concerns are raised about vulnerable populations, such as the terminally ill, the mentally incapacitated and the elderly. There remains the understandable fear that assisted dying could potentially lead society toward an attitude that suffering should not be a part of life, interdependency is a burden and the lives of disabled of terminally ill individuals are not worth living. 20 The implications of such an attitude on vulnerable populations is clear, with individuals potentially forced or coerced into assisted dying for reasons other than their own free will.

The slippery slope argument is inordinately complex and controversial evidence exists in the literature in favour of both sides. Cases of assisted dying in the Netherlands grew from 1882 in 2002 to 5306 in 2014. 21 Eight-one cases were concerned with dementia and 41 with mental health-related reasons only in 2014. 6 In the light of data from Holland, the slippery slope argument is supported in a number of respects, e.g. concerns about legislation ‘creep’, lack of availability of good palliative care and fears in the vulnerable and elderly. Early data published from Oregon were also concordant. The number of physician-assisted deaths progressively rose from 16 in 1998 to 71 during 2011; loss of autonomy (88.7%) and ability to participate in enjoyable activities (90.1%) were the two most commonly reported end-of life concerns. 22 In increasingly financially constrained health and social care systems, fears have also been raised regarding the impact of budget-cutting trends and their potential impact on terminally ill individuals for whom the alternatives are only high-cost life-prolonging or quality-enhancing (rather than curative) treatments.

However, recent data summarising the 20 years’ experience in Oregon suggest the opposite. According to the authors, patients requesting an assisted death allegedly belong to a higher than average socioeconomic class and have a higher than average education level. 23 Oregon, the first state in the US to allow assisted dying, employed strict criteria that had an influential role in other jurisdictions. 5 The criteria comprised the agreement of another doctor, the assessment of the patient’s mental capacity and the presence of a terminal illness with less than six months to live. 24 Additional measures to ensure an informed and unforced decision involved adequate pain relief and access to end-of-life care. 25 Assisted dying proponents support that safeguards and regulations in place are very powerful since only one in 50 terminally ill patients have a discussion about the process with their doctor and even fewer complete it. 26

Rhetoric from opponents has raised concerns of whether such safeguards could ever be adequate, which appears to be a key argument in the debate in some jurisdictions as well. Consequently, any future legal permissibility of assisted dying should be developed in conjunction with clear regulatory safeguards to ensure the abuse of assisted dying and protect vulnerable individuals from coercion. 3 . Such safeguards must also preserve societal justice and ensure equitability and availability of healthcare is not a deciding factor in assisted dying decision-making.

The Hippocratic Oath and the principles of beneficence and non-maleficence

The principles of beneficence and non-maleficence , plainly described in the Hippocratic Oath, have been the foundation of medical ethics for many centuries. Beneficence states that a doctor should act in the best interest of the patient. Non-maleficence states ‘first, do no harm’ – ‘ primum non nocere ’. 27 Conformation to these fundamental principles is enshrined within Hippocratic Oath, which involve aiming to benefit, or perhaps most importantly, not doing any harm to a patient. Moreover, modern medical education in most countries follows legal and cultural opposition to an assisted death. Healthcare professionals are therefore currently not adequately trained to participate in assisted dying. Professional opinion also remains divided on whether further involvement would benefit or damage public perception of the profession, given the potential conflict between these two ethical principles. The UK’s medical representative body, the British Medical Association (BMA), has acknowledged this lack of consensus, but clearly concludes with their view that assisted dying should not be made legal in the UK. 28

However, the evolution of decision-making processes in modern medicine, particularly regarding end-of-life decisions, and with patients increasingly at the heart of shared decision-making (e.g. the UK NHS’ ‘no decision about me, without me’ policy), have applied pressure on clinicians to reconsider their collective professional stance on assisted dying. Indeed, an increasing number of legal challenges from patients and assisted dying representative organisations are taking place worldwide to challenge local legislation against an assisted death.

Assisted dying therefore challenges the conflict faced between the ultimate purpose of modern medical and social care and its founding ethical principles. Relief of suffering through an assisted death can be argued as a distinct entity to palliative care, with the former – if safely and carefully considered – potentially an important way of fulfilling a clinician’s duty to preserve autonomy and do good for a patient – for example, in cases where alternatives are treatments which provide no benefit or do not prolong or improve the quality of life of a terminally ill patient. 27 , 29 A further consideration is that of an individual doctor’s ethical and moral beliefs, which are also an important factor should a patient request an assisted death; indeed, the British Medical Association has proposed that should assisted dying legislation be derived, then there should be a clear demarcation between those physicians who do and do not offer this option. 30

Freedom of thought, conscience and religion

A further controversial issue is raised by Article 9 of the European Convention on Human Rights, which protects the rights of freedom of thought, conscience and religion. Its impact on the assisted dying debate centres on whether requesting an assisted, dignified death constitutes a manifestation of belief, therefore falling within the remit of Article 9. Several European Court decisions have determined that individual views are entitled to protection only if they ‘attain a certain level of cogency, seriousness, cohesion and importance’. 31

Seriousness and importance are undoubtedly justified when considering an individual’s decision to end their life. On the other hand, an informed desire to die with dignity may well constitute a coherent and cogent view. For instance, it remains debatable whether approaching death through a solely palliative care lens constitutes a less dignified way to die than assisted dying. 31 Article 9 may therefore provide a preferable framework for decisions relating to the right to die with dignity than Article 8, which focuses on a patients’ autonomy; while the former aims to protect truly coherent and cogent decisions, it may be argued that the latter in isolation could potentially open a bigger door to a broader attitude towards assisted dying. 13

Furthermore, Article 3 should also be considered as a safeguard, as this prohibits torture and degrading treatment. 17 Ultimately, each potential assisted dying case is unique and its various facets should therefore be approached carefully under the scope of relevant legislation (e.g. European Convention on Human Rights Articles 2, 3, 8 and 9), and individual/societal ethical and moral perspectives ( Tables 1 1 to to4 4 ).

Article 3: Prohibition of torture.

Article 9: Freedom of thought, conscience and religion.

Implications of assisted dying in the doctor–patient relationship

As discussed, a key concern of the medical profession remains the impact of legalisation of assisted dying on the doctor–patient relationship. This relationship is fundamentally based on trust. Although aspects of assisted dying may be considered in conflict with certain underlying ethical obligations placed upon doctors, considering a patient’s autonomous wishes, alongside the moral perspectives of the doctor, is also an important aspect of this relationship. 32 , 33 This quandary is recognised by the Swiss Academy of Medical Sciences in their ethical guidelines, which acknowledges that ‘in certain special cases a doctor’s personal decision to assist a dying patient to commit suicide is in accordance with his or her conscience and has to be respected’. 18

The delicate balance between the views of patients, doctors and society can pose an ethical dilemma, with the potential to serve a disruptive influence on the sanctity of the doctor–patient relationship and negatively distorting how society perceives the role and motives of healthcare professionals. For example, as previously considered, particularly in healthcare systems where doctors play the role of gatekeeper to healthcare, a doctor’s support for an assisted death for a terminally ill individual might be negatively interpreted as a conflict of interest, with a desire to help relieve the social and economic burden of a patient’s illness upon society overriding the patient’s individual interests. Ultimately, should appropriate safeguarding measures be deployed alongside relevant legislation, assisted dying may risk eroding doctors’ professional integrity. 34

Current position of doctors’ professional groups in the UK and the USA

As expected, the discussion around adopting assisted dying has caused much controversy among the doctors’ professional groups and bodies. Several professional organisations in the UK have clearly expressed their opposing views to assisted dying such as the British Medical Association, the Royal College of General Practitioners and the Royal College of Surgeons of England, whereas others maintain a neutral position including the Royal College of Nursing, the Royal College of Psychiatrists and the Royal Pharmaceutical Society. 5 The Royal Society of Medicine has no policy on the issue since ‘its remit is the education of doctors and health professionals and the promotion of debate, not the making of policy’. 35

In the US, the American Medical Association, representing nearly 250,000 members, vehemently opposes legalisation of assisted dying as does the American College of Physicians with more than 150,000 members. 6

Conclusions

The debate surrounding assisted dying is never far from the headlines, particularly while its legal status in most jurisdictions remains inadequate and discursive. However, alongside the evolution of palliative care, there appears to be an increasingly vocal desire for legislation to support assisted dying in selected cases. 21 Developing a sensitive balance between established cultural norms and a progressive, well-balanced, transparent and safe attitude towards assisted dying is key. 24 More patient-centred attitudes towards health and social care increasingly place patients – quite rightly – at the heart of everything health professionals do. Patients’ needs, attitudes and beliefs must be therefore at the forefront of decision-making. However, when considering these alongside the fundamental principles of bioethics as well as legislation and doctors’ own beliefs, conflict can arise, thereby leaving the assisted dying debate in a state of limbo. Whether assisted dying should be legalised (albeit with stringent controls) remains controversial; as considered in this essay, even the basic moral principles can conflict when considering the arguments for and against supporting an assisted death, making consensus building far from straightforward.

Ultimately, individual patients’ autonomy should be balanced with a fundamental right to life, impacts on the individual doctor–patient relationship and wider society and the safeguards required to prevent misuse of any assisted dying regulations. The challenge remains for society to decide where this balance lies, guided by regional religious, cultural and legislative perspectives.

Developing the required ethical competencies among medical professionals is also key; given the current absence of legal support for assisted dying in most jurisdictions, most clinicians remain untrained in such decision-making. Indeed with understandable fears against crossing key ethical divides, physician support for an assisted death tends to be lower than that of patients. 36 Dying is a natural part of human life. With growing demand worldwide, the assisted dying debate will increasingly come to the fore – something healthcare professionals, politicians and legislators cannot ignore.

Declarations

Competing interests.

None declared.

Ethics approval

Ethics approval was not required for this review.

Contributorship

AF and EP conceived, designed the study and performed the literature search. All authors analysed the data and drafted the manuscript. All authors contributed to and approved the final version of the manuscript.

Acknowledgements

Not commissioned; peer-reviewed by David Misselbrook.

The Ethical and Legal Implications of Euthanasia

Generally, the topic of euthanasia has resulted in hot debates among all stakeholders, including healthcare professionals and legal experts, due to the ethical and legal issues associated with the topic. It affects both patients and their healthcare providers. Over the years, the debate on euthanasia has focused on suffering patients with terminal illnesses. However, the topic has extended to include even patients with mental illnesses like depression. Therefore, it is appropriate to look at the controversy surrounding euthanasia in a recent case study. Euthanasia is a controversial topic that requires further inquiry to fully understand different opinions offered by the opposing sides and the ethical implications associated with it.

Recent Case Study

The case published in the Catholic Herald involves a 29-year-old woman who underwent euthanasia following a series of mental illnesses. According to the author, despite being physically fit, the woman was given a lethal injection, having been granted her wish to die by the court after eight years of legal battles. In her argument, the woman claimed she had experienced extreme bouts of depression that had made her life intolerable. The case raised concerns among various stakeholders, including politicians who lamented how dangerous euthanasia could be.

Ethical Issues Involved in the Case Study

Generally, the case study raises various ethical dilemmas related to euthanasia, including when it is justifiable to end one’s life. In addition, the topic also opens up a whole discussion on the limitations of patients’ autonomy and the ethical responsibilities of healthcare professionals, as highlighted in the bioethical principles of beneficence and maleficence. Concerning autonomy, questions are raised regarding the patient’s capability to understand the decision that she was making. With superior knowledge and training, the physician is best positioned to help make an ethical decision that is in the patient’s best interest to protect patients from irresponsible choices. For patients to make an autonomous decision, they should be mentally capable of comprehending the information of the decision. In the case study, the patient has a mental health condition. Hence, her ability to make rational decisions is in question.

The Context of Euthanasia

The case study highlights euthanasia, particularly among patients with mental conditions such as depression. Historically, numerous attempts have been made to legalize euthanasia, but minimal success has occurred. The euthanasia discussion in psychiatry was awakened after the Nazi Holocaust when thousands of psychiatric patients were gassed or poisoned to death under the ‘euthanasia program’. According to Felder, the Nazi euthanasia program was used by scientists, mainly physicians, to conduct medical experiments. It is out of the scientific experiments of the Nazi physicians that ‘The Nuremberg Code’ was established to guide future experiments on human subjects.

Additionally, politicians have had their hand in the matter by sponsoring bills to legalize the act, with some opposing such attempts and publicly making their views known. From a social perspective, euthanasia has continued to be controversial, with many societies coming up to air their opinion. In the traditional Christian context and culture, euthanasia is viewed as morally unacceptable due to human life’s sacred nature. However, other social groups support euthanasia with the thought of extending dignity to death, such as the Voluntary Euthanasia Society. As such, there is no single available societal perspective regarding the issue of euthanasia. Hence, it is important to society as it touches on the critical matters of life and death.

The Differing Perspectives on Euthanasia

The individuals and societies in support of euthanasia have always centered their opinion on patient suffering. They argue that patients in the terminal stages of illness experience excruciating pain and have poor wound healing, poor social interactions, and many other aspects of physical suffering. According to the proponents, euthanasia is a more merciful response to relieve this suffering, especially where the quality of life is jeopardized. Among the patients with mental illnesses, the proponents argue that some mental conditions, including severe depression, induce intense suffering and are unresponsive to treatment. Additionally, the proponents note that since the patients request most cases of euthanasia, it is a way for physicians to show respect for personal autonomy. Thus, to the proponents, euthanasia relieves undue suffering and is in harmony with respect for autonomy and the individual’s right to a dignified death.

Contrary to the proponents’ arguments, the opponents base their argument on the intrinsic wrongness of killing, professional integrity, and the possibility of potential abuse. According to Naga and Mrayyan, willingly ending one’s life is inconsistent with human rights, and alternatives should be sought to relieve the patient’s suffering and improve their quality of life. Furthermore, Naga and Mrayyan note that administering lethal substances by physicians to end life is unethical according to guiding medical ethical practices, especially the Hippocratic Oath that restricts physicians from administering such substances to their patients or aiding their patients to die. They also note that legalizing euthanasia could lead to its potential abuse and a slippery slope where individuals will use it to escape chronic but manageable medical conditions.

Evaluation of the Arguments and Their Ethical Implications

The arguments presented by both the proponents and the opponents seem to be entirely influenced by one’s culture, moral philosophy, and personal experiences. Those opposed to euthanasia seem to be influenced by their religious cultures. Specifically, Christian teachings view life as sacred and state it should not be terminated prematurely at any cost. On the other hand, the proponents seem to subscribe to the Stoic philosophy that has always defended suicide as a reasonable departure from life, especially when intense suffering is involved. Anecdotal evidence also suggests that personal life experiences with suffering may make one choose to end one’s life. For example, seeing a cancer patient suffer may make individuals consider euthanasia if diagnosed with a similar terminal disease, as they will not want to experience the same ordeal.

While both the proponents and those opposed to euthanasia have valid arguments, myriads of ethical issues surround each side’s perspective. It is indeed true that certain illnesses, including mental conditions, lead to severe suffering and reduced quality of life. However, ethical issues arise regarding the ability of the patients requesting euthanasia to make autonomous decisions. For example, Appelbaum notes that it is common for depressed patients to reject treatment and even request death, yet change their decision once the depression is resolved. Accordingly, this raises the ethical question concerning the impact of the mental illness itself on the patient’s decision-making. It has also been observed that most patients are only resistant to one form of treatment and that other options should be tried to relieve their suffering.

Furthermore, it is noted that the right to autonomy is not always absolute and that physicians have the legal and ethical responsibility to override the patient’s decisions and continue pursuing alternative treatment in response to the patient’s symptoms and request a dignified death. Thus, the argument regarding patients’ autonomy to end their lives is weak. On the other hand, the opponents’ unethical medical practice mainly touches on physicians’ ethical responsibilities to act in good faith and protect their patients from harm. In line with non-maleficence and beneficence principles, physicians cannot administer lethal dosages to their patients as it causes more harm than good. Additionally, the claim of potential abuse if euthanasia is legalized, holds grounds owing to several reported cases, including ones with mental illnesses, where euthanasia has been performed without following due process in countries where it is legalized. Thus, the ethical questions raised by those opposed to euthanasia regarding non-maleficence, benevolence, and potential abuse are strongly supported by evidence.

Personal Perspective on Euthanasia

The issue of euthanasia among depressed patients will continue to dominate medical discussions. Subjectively, the opponents of euthanasia seem to offer a strong argument. Notably, depression can be treated just like other mental conditions, and symptoms can be controlled where treatment is impossible. Patient autonomy among psychiatric patients is in question. Mental illnesses tend to affect one’s way of thinking, and suicidal ideations are common phenomena among depressed patients. I have dealt with patients who have changed their stance on ‘mercy killing’ after a series of professional counseling sessions and continued treatment. Thinking about these experiences concerning my patients and the ethical dilemmas related to euthanasia makes me view it as an undesirable event in medical practice that I will not want to engage in.

The topic of euthanasia is controversial based on the numerous arguments aired by those in its support and those who are against it. The case study published in the Catholic Herald offers a good scenario through which the effects of euthanasia can be accessed and its ethical implications reviewed. While the Pro-euthanasia argument is based on the need to relieve undue suffering, respect autonomy, and grant the right to a dignified death, the opponents have emphasized the intrinsic wrongness of killing, professional integrity, and the possibility of a “slippery slope”. Overall, the ethical issues addressed autonomy, beneficence, and non-maleficence. Subjectively, the ethical questions touching upon professional integrity, especially the need to observe non-maleficence and doing good, are strong enough to make me offer my support against euthanasia.

📎 References:

1. Appelbaum, P. S. (2017). Should mental disorders be a basis for physician-assisted death? Law & Psychiatry, 68(4), 315-317. https://doi.org/10.1176/appi.ps.201700013 2. Beauchamp, T. L. (2016) Principlism in bioethics. In P. Serna & J. A. Seoane (Eds.), Bioethical decision making and argumentation (pp. 1-16). New York, NY: Springer. 3. Caldwell, S. (2018, February 1). Dutch doctors euthanize a 29-year old woman with depression. Catholic Herald. 4. Felder, B. M. (2013). “Euthanasia,” human experiments, and psychiatry in Nazi-occupied Lithuania, 1941-1944. Holocaust and Genocide Studies, 27(2), 242-275. https://doi.org/10.1093/hgs/dct025 5. Kim, S. Y., De Vries, R. G., & Peteet, J. R. (2016). Euthanasia and assisted suicide of patients with psychiatric disorders in the Netherlands 2011 to 2014. JAMA Psychiatry, 73(4), 362-368. https://doi.org/10.1001/jamapsychiatry.2015.2887 6. Naga, B. S. B., & Mrayyan, M. T. (2013). Legal and ethical issues of euthanasia: Argumentative essay. Middle East Journal of Nursing, 7(5), 31-39. https://doi.org/10.5742/MEJN.2013.75330 7. Nunes R., & Rego, G. (2016.) Euthanasia: A challenge to medical ethics. Journal of Clinical Research & Bioethics, 7(4), 1-5. https://doi.org/10.4172/2155-9627.1000282 8. Tomasini, F. (2014). Stoic defence of physician-assisted suicide. Acta Bioethica, 20(1), 99-108. Retrieved from https://scielo.conicyt.cl/pdf/abioeth/v20n1/art11.pdf

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Euthanasia and Modern Society Argumentative Essay

Historical background, arguments for and against.

Euthanasia is Greek word that when directly translated refers to the “good death”; more specifically euthanasia is a term that is used to describe death conditions that has been undertaken deliberately for purposes of alleviating suffering of an individual usually from a terminal illness for which no recovery is expected.

Hence, for euthanasia to be defined to have occurred three conditions must be met i.e. it should be deliberate, must involve taking life and should be with intention of relieving “intractable” suffering (Rawls, 1971). There are various forms of euthanasia, but which are generally categorized into two types; passive euthanasia and active euthanasia. In this paper I wish to argue that euthanasia is not a moral issue and should be legalized globally since it is justified and should therefore not be regulated.

The debate surrounding the morality and legality of euthanasia is one that has been ongoing since the 17 th century when the word euthanasia was first invented and used in the medical field (Pateman and Rawls, 1987). In modern day society the actual meaning of euthanasia has taken different forms and is usually interpreted differently in medical and legal context.

However it was not until the late 1980s when scholarly articles that advocated and argued against the morality of euthanasia were first published. In her article written in 1987 titled “Euthanasia”, Battin advocated for euthanasia by expounding on the moral virtues of euthanasia and why it should be used in the medical context (Pateman and Rawls, 1987).

The case of euthanasia as advocated by Battin is based on the noble idea behind euthanasia which is basically to alleviate pain. Towards this end Battin asserts that “the relief of pain of a patient is the least disputed and of the highest priority to the physician” in direct reference to sole and major reason of carrying out euthanasia, a fact that is not even contested by the proponents of the euthanasia practice (Pateman and Rawls, 1971).

In the following section of the paper we shall analyze the various ideologies that have been advanced in defense and against the practice of euthanasia. Generally the positions of euthanasia proponents and opponents have to do with morality, religion and legal issues.

For instance, the argument advanced by proponents regarding the need to undertake euthanasia in order to relieve such patients from their physical and emotional pains assumes a moral point of view all other factors being constant. From a religion perspective the debate on euthanasia continues to be a contentious issue because of their different viewpoints. However it is in medical perspective that the practice of euthanasia is most polarized, radical and a never ending issue of contention.

On one hand for example, euthanasia practice radically contradicts the principles of medicine as well as on the very tenets that the practice of medicine was found. Indeed, the fundamental principle of medical practitioner’s demands that they undertake anything possible to save life and ensure it preservation; this is the cardinal oath that doctors must take prior to being allowed to practice.

But on the other hand, and equally important responsibilities of the doctor involves alleviating pain and suffering by bringing about cure, it is when this cure becomes elusive that the idea of euthanasia does not seem so much outrageous or in that case in conflict with the fundamental principles of medicine.

Besides in contemporary society, the practice of medicine has assumed new levels altogether which are very different from the nature of medicine as it was practiced in ancient times, and which these principles of medicine were actually based. In fact, the reasons why the issue of euthanasia has become so polarized has everything to do with advances that has been made in medicine and due to the emerging type of diseases, which are both a product of modern society.

Advance in technology for instance has meant that machines that can sustain life in near death circumstances have been invented. But this technological introduction has only complicated the issue of euthanasia in two major ways; one of which regards the cost and the other has to do with this leap of technology per se.

Regarding cost, it is basically impossible to continuously maintain a person in a life saving machine for several years due to the prohibitive cost alone. Strictly speaking even on a cost benefit analysis such action is not logical unless there are major improvements on the side of the patient.

Another reason why lives saving machines have complicated the issue of euthanasia is because this technological leap has necessitated the redefinition of death, death in the sense of when it should be presumed to occur and for very good reasons.

Indeed, the fact that this life supporting machines have the capability to continue sustaining life in patients that are in vegetative state requires us to redefine when death should be presumed to occur especially given their ability to sustain life even when massive organ failure occurs, usually what would have resulted to death were it not for the ability of this machines.

Due to this eventuality brought about by this technological advent, modern day definition of death has also taken several meanings. The definition of death as it is currently described includes three forms; whole brain death, higher brain death and traditional death which is usually through cardiovascular arrest (Hassan, 2006).

These various definitions of death are for the purpose of providing leeway of undertaking or preventing euthanasia based on the perspective that one get to look at it. For instance when death is defined as having occurred due to higher brain death, then life support machine is not necessary and can be removed since death in this case is not subject to cardiovascular arrest but rather to higher brain activity (Hassan, 2006); I say this is just being hypocritical.

However in traditional terms life support machines cannot be withdrawn from patients since their death is subject to their cardiovascular arrest which is incidentally enabled through the life supporting machines (Hassan, 2006); (this is even more ironical).

Finally the reason why modernity complicates the issue of euthanasia is because of the increase and emerging of new diseases that are increasingly becoming not only terminal but very painful and humiliating as well. Most of these diseases are a product of modernity and are usually the one at the centre of euthanasia debate mainly because they are terminal and painful diseases.

However, the debate on euthanasia is hardly limited to the various perspectives of legal, medical, moral and religion as we have so far discussed, but also involve philosophical perspectives as well.

The Social Contract Theory is an ideology that is largely attributed to Thomas Hobbes although its concepts have been around for quite some time (Celeste, 2004). In Social Theory Contract, Hobbes argues that human are rational beings but which only reason and act with their best interests at heart in what he refers as “coomodious living” which entail various aspects of life such as morality, society and politics (Celeste, 2004).

The relevance of this theory therefore in the context of euthanasia is that people’s moral standings are usually tied together with the political factors of the society. Perhaps, what Hobbes is advocating concerning euthanasia, is to let the moral and political factors of a society be the framework of determining the justification of euthanasia.

An even more unusual theory regarding euthanasia has been advanced by Susan Wolf in a critique of the Physician Assisted Suicide (PAS) concept in which the influence of culture, socialization and sexism as determinant factors of euthanasia are adequately tackled (Dieterle, 2007). The underlying argument that Wolf attempts to portray in that paper claims that euthanasia is largely a gender issue which should not be legalized under the existing legal laws and cultural practices of the society.

In this paper, the practice of euthanasia is described to be gender based in that women are affected differently by the practice compared to men and are more predisposed to the practice than men, mainly because the culture in America tends to devalue women who are terminally ill, disabled or considerably aged more than is the case for their male counterparts (Dieterle, 2007).

In this critique by wolf two major points are raised to support her claim of gender based euthanasia, one of which she claims that majority of persons that are likely to seek PAS would be females rather than males, which in itself is an injustice.

However, data analysis of the various countries and states in America that have so far legalized euthanasia turns out not to support this assertion. The trend is the same even for other countries that have allowed euthanasia such as Netherlands where males constitutes the larger percentage than females.

As we can see from the facts discussed it is clear that the modern society has evolved to a point that justifies euthanasia because of the strides in technology and lifestyle changes that necessitates that people be mercifully relieved of life should the situation demand so.

As it is, governments have circumvented the legalization of euthanasia by giving it different definitions as we have seen to fit its intentions. But at the end of the day it is euthanasia, and it is not right to discriminate against citizens based on the nature of death and in the process deny those who also need it as much.

Celeste, F. (2004). Social Contract Theory: Internet Encyclopedia of Philosophy . Web.

Dieterle, J. (2007). Physician Assisted Suicide: A New Look at the Arguments. Bioethics , 21 (3): 127-139.

Hassan, O. (2006). Euthanasia: Ethic-Legal Issues . Web.

Pateman, C & Rawls, J. (1987). Euthanasia in Health Care Ethics: An Introduction . Carlifornia, CA: Temple University Press.

Rawls, J. (1971). A Theory of Justice . Washington, DC: Harvard University Press.

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An Argument Against Euthanasia
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What is euthanasia.

Euthanasia is the practice of ending the life of a patient to limit the patient’s suffering. The patient in question would typically be terminally ill or experiencing great pain and suffering.

The word “euthanasia” itself comes from the Greek words “ eu ” (good) and “ thanatos ” (death). The idea is that instead of condemning someone to a slow, painful, or undignified death, euthanasia would allow the patient to experience a relatively “good death.”

Types of euthanasia

Different practices fall under the label “euthanasia.” Here are some distinctions demarcating different versions.

Active euthanasia : killing a patient by active means, for example, injecting a patient with a lethal dose of a drug. Sometimes called “aggressive” euthanasia. Passive euthanasia : intentionally letting a patient die by withholding artificial life support such as a ventilator or feeding tube. Some ethicists distinguish between withholding life support and withdrawing life support (the patient is on life support but then removed from it). Voluntary euthanasia : with the consent of the patient. Involuntary euthanasia : without the consent of the patient, for example, if the patient is unconscious and his or her wishes are unknown.. Some ethicists distinguish between “involuntary” (against the patient’s wishes) and “nonvoluntary” (without the patient’s consent but wishes are unknown) forms. Self-administered euthanasia : the patient administers the means of death. Other-administered euthanasia : a person other than the patient administers the means of death. Assisted : the patient administers the means of death but with the assistance of another person, such as a physician.

There are many possible combinations of the above types, and many types of euthanasia are morally controversial. Some types of euthanasia, such as assisted voluntary forms, are legal in some countries.

Mercy-killing: The term “mercy-killing” usually refers to active, involuntary or nonvoluntary, other-administered euthanasia. In other words, someone kills a patient without their explicit consent to end the patient’s suffering. Some ethicists think that

Physician-assisted suicide: The phrase “physician-assisted suicide” refers to active, voluntary, assisted euthanasia where a physician assists the patient. A physician provides the patient with a means, such as sufficient medication, for the patient to kill him or herself.

Some instances of euthanasia are relatively uncontroversial. Killing a patient against their will (involuntary, aggressive/active, other-administered), for instance, is almost universally condemned. During the late 1930’s and early 1940’s, in Germany, Adolf Hitler carried out a program to exterminate children with disabilities (with or without their parent’s permission) under the guise of improving the Aryan “race” and reducing costs to society. Everyone now thinks this kind of euthanasia in the service of a eugenics program was clearly morally wrong.

What are key disputes in the controversy over euthanasia?

Advocates of active euthanasia typically argue that killing the patients in question is not worse than letting them die. Advocates of voluntary euthanasia often claim that patients should have the right to do what they want with their own lives. Advocates of mercy killing argue that for patients who are in vegetative states with no prospect of recovery, letting them die prevents future needless and futile treatment efforts. If they are suffering then killing them prevents further suffering. Advocates of physician-assisted suicide argue that a physician assisting a terminally ill or suffering patient is merely helping the patient who wishes to die with dignity.

Critics of the euthanasia typically argue that killing is always wrong, that nonvoluntary or involuntary euthanasia violates patient rights, or that physician-assisted suicide violates an obligation to do no harm.

Killing vs. letting die : There is dispute over whether killing a patient is really any worse than letting the patient die if both result in the same outcome.

Commonsense morality usually thinks that letting a person die is not as bad as killing a person. We sometimes condemn letting an innocent person die and sometimes not, but we always condemn killing an innocent person.

Consider different instances of “letting die.” One might claim that it is wrong to let our neighbor die of an accident if we could easily have saved his or her life by calling an ambulance. On the other hand, we let starving people in poor countries die without condemning ourselves for failing to save them, because we think they have no right to demand we prevent their deaths. But if someone killed a neighbor or starving people we would think that wrong.

Likewise, we would condemn a healthcare professional who kills a patient. But we might accept the healthcare professional who at patient and family request withholds artificial life support to allow a suffering, terminally ill patient to die.

The distinction between killing and letting die is controversial in healthcare because critics charge there is no proper moral basis for the distinction. They say that killing the above patient brings about the same end as letting the patient die. Others object to this and claim that the nature of the act of killing is different than letting die in ways that make it morally wrong.

Ordinary vs. extraordinary treatment : Ordinary medical treatment includes stopping bleeding, administering pain killers and antibiotics, and setting fractures. But using a mechanical ventilator to keep a patient breathing is sometimes considered extraordinary treatment or care. Some ethicists believe letting a patient die by withholding or withdrawing artificial treatment or care is acceptable but withholding or withdrawing ordinary treatment or care is not. This view is controversial. Some claim the distinction between ordinary and extraordinary treatment is artificial, contrived, vague, or constantly changing as technology progresses

Death intended vs. anticipated : Some ethicists believe that if a suffering, terminally-ill patient dies because of intentionally receiving pain-relieving medications, it makes a difference whether the death itself was intended or merely anticipated. If the death was intended it is wrong but if the death was anticipated it might be morally acceptable. This reasoning relies on the moral principle called the principle of double effect.

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Gnostic Beliefs: a Deep Dive into the Spiritual Mystique and Ancient Wisdom

This essay about Gnosticism outlines its core beliefs and historical significance. It describes Gnosticism as a spiritual philosophy that emphasizes personal enlightenment through “gnosis,” or divine knowledge, which is seen as a path to liberation from the material world. Central to Gnostic belief is the concept of the demiurge, a lesser deity who created the physical universe, which is viewed as flawed. The essay discusses the Gnostic perspective on scripture, highlighting their appreciation for apocryphal texts as important tools for spiritual understanding. It also traces Gnosticism’s influence throughout history, particularly its tension with early Christian doctrine and its resurgence in modern spiritual and psychological contexts. The essay concludes by reflecting on Gnosticism’s enduring appeal to those seeking a personal connection with the divine, outside of traditional religious structures.

How it works

Gnosticism is a mysterious term with a complex historical background. It describes a broad range of spiritual practices that existed before Christianity and permeated many other religions, providing a distinctive viewpoint on the divine, people, and the cosmos. Gnosticism is a philosophical and theological blend that has captivated academics and spiritual seekers for millennia, in contrast to the more regimented teachings of mainstream religious movements.

At the heart of Gnostic belief is the conviction that divine knowledge, or “gnosis,” is the key to spiritual enlightenment.

This knowledge is not readily accessible through traditional religious scriptures or rituals; instead, it requires an introspective journey into the self. Gnostics believe that this profound knowledge can liberate the spirit from the material world, which they often view as flawed or even malevolent.

The concept of a demiurge, a lesser god who is thought to have created the physical world, is central to many Gnostic traditions. This being is considered ignorant of the spiritual world or even antagonistic towards it. Consequently, the physical universe is seen as a flawed, imperfect creation, a distant echo of a more perfect, spiritual reality that is hidden from human perception. The demiurge is often contrasted with a higher, unknowable divine force that embodies true goodness and the ultimate source of spiritual truth.

Human beings, according to Gnostic thought, contain a spark of this divine essence. This spark is trapped within the physical body and the material world, obscured by ignorance and the deceptive influence of the demiurge. Salvation, therefore, involves awakening this inner divine spark and reconnecting with the higher, spiritual reality. This salvation is intensely personal and experiential, requiring individual revelation rather than communal worship or the intercession of religious authorities.

Gnosticism’s view of scripture and religious texts also sets it apart from other religious traditions. For Gnostics, texts are not infallible revelations but are instead tools to aid in the quest for spiritual understanding. They value apocryphal texts—those writings that were left out of the standard religious canons—as much as, if not more than, the canonical scriptures. These texts often contain alternative narratives and deeper insights into the nature of divinity, cosmology, and salvation.

Throughout history, Gnosticism has influenced numerous religious and philosophical movements, sometimes merging seamlessly with them and at other times existing on the fringes or even in opposition. In the early Christian era, Gnosticism presented a significant alternative to what would become mainstream Christian doctrine. The Church Fathers, such as Irenaeus and Tertullian, wrote extensively against Gnosticism, viewing it as a heresy that threatened the orthodoxy of their communities.

Despite such opposition, or perhaps because of it, Gnosticism has persisted as an undercurrent in spiritual and philosophical thought. In the modern era, it has experienced a resurgence, finding new expressions in literature, psychology, and new age spirituality. The works of Carl Jung, for example, reintroduced Gnostic themes by emphasizing the importance of personal discovery and the integration of hidden parts of the self.

Gnosticism’s appeal lies in its promise of deeper knowledge and an intimate connection with the divine. It speaks to those who feel alienated from traditional religious institutions and who seek a more personal, transformative spiritual experience. As we continue to explore the vast landscapes of human belief and spirituality, Gnosticism remains a compelling and profound path for those drawn to its mystical allure.

In conclusion, Gnosticism offers a unique lens through which to view the world—a perspective that challenges conventional religious doctrines and invites a deeper, more personal exploration of spirituality. Whether one sees it as a historical curiosity or a living tradition, it undeniably contributes to the rich tapestry of global religious thought and continues to fascinate scholars and spiritual seekers alike.

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Photo essay: A collection of our favorite Houston Landing photos for April 2024

Last week, I started typing up a list in the Notes app on my iPhone entitled “Compelling Visual Storytelling Scenes.”

Photos have always given me perspective, and I wanted to compile a list of scenes that stirred a strong sense of emotion in me. Some of the pictures on this list are from moments we photographed at the Landing; others are photos made by other colleagues.

I created the list to inspire both you, the reader, and our newsroom – reporters, editors and photographers alike – as we continue to brainstorm and dissect which elements make for a captivating photo.

The list includes examples of real moments:

A father fighting back tears at his daughter’s high school graduation while facing an imminent deportation order
A truck driver taking a break from their route to play the guitar in a field
A man training his dog without a care in the world with a refinery literally on fire in the background

This month, Houston Landing’s best photography captured several scenes I know will be engraved in my memory:

Iqra Ali and Ali Aamar trying a football toss at an arcade during an Eid al-Fitr celebration in Houston, photographed by independent photojournalist Mark Felix
Beautifully silhouetted actresses playing the roles of Jesus Christ’s followers before the Stations of the Cross on Good Friday at Queen of Peace Catholic Church, by staff photojournalist Antranik Tavitian
Houston Mayor John Whitmire, who, instead of standing behind a podium, stakes a sign into the ground while announcing that the controversial Freed-Montrose Neighborhood Library will remain open, a moment-based image taken by independent photojournalist Meridith Kohut

Moments ground us, and April’s selection of Landing photojournalism memorializes those moments — whether it’s independent photographer Annie Mulligan’s picture of third graders at Anderson Elementary School gasping in awe at the solar eclipse, or a snapshot from independent photographer Meridith Kohut of 10-year-old William Lee launching a dragon kite into the air during the Hermann Park Conservancy’s Kite Festival.

I urge you, as a Landing reader, to spend some time with this month’s compilation of photos and to challenge yourself to consider how a picture turns a story from a string of words into a moment encapsulated in color and shape.

The list in my iPhone’s Notes app came from my desire to encourage our staff to reconsider how journalists incorporate and prioritize visual storytelling in our overall work. Photos comprise individual moments of time, yes, but they also complete — not just enhance — the overall story we publish.

The post Photo essay: A collection of our favorite Houston Landing photos for April 2024 appeared first on Houston Landing .

Our Director of Photography picks the best images of the month, from a truck driver’s break to a man training his dog with a blazing refinery in the background.

COMMENTS

Euthanasia and assisted suicide: An in-depth review of relevant
3. Evolution of euthanasia and assisted suicide: digging into historical events. To understand the evolution and relevance of these concepts should analyze the history of euthanasia and assisted suicide; from the emergence of the term, going through its first manifestations in antiquity; mentioning the conceptions of great thinkers such as Plato and Hippocrates; going through the role of the ...
Euthanasia
euthanasia, act or practice of painlessly putting to death persons suffering from painful and incurable disease or incapacitating physical disorder or allowing them to die by withholding treatment or withdrawing artificial life-support measures. Because there is no specific provision for it in most legal systems, it is usually regarded as either suicide (if performed by the patient himself) or ...
Euthanasia and assisted dying: what is the current position and what
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 without their prior consent incorporates ...
Why Euthanasia Should Be Legal: Analysis of Arguments and
Background. While euthanasia has recently received media coverage, euthanasia has been going on back to the early times. In reality, the ancient Greeks believed that there should be no reason for someone to keep on living when they do not want to be alive in the first place.
The History of the Euthanasia Movement
The History of the Euthanasia Movement. The idea that death should be merciful is not new. Around 1800, pioneers of euthanasia pulled on the legs of those who'd been hanged to hasten their deaths. Dr. Jack Kevorkian attends the premiere of "You Don't Know Jack," a film about his life, 2010. The icon indicates free access to the linked ...
158 Euthanasia Topics & Essay Examples
Here are some examples of euthanasia essay topics and titles we can suggest: The benefits and disadvantages of a physician-assisted suicide. Ethical dilemmas associated with euthanasia. An individual's right to die. Euthanasia as one of the most debatable topics in today's society.
Existential Suffering as a Legitimization of Euthanasia
"Euthanasia"—as a working definition—here refers to both euthanasia in the strict sense (i.e., a person's voluntary death by means of little or no pain, brought about by another than that person) and assisted suicide (i.e., a person's suicide that is brought about with the aid of another than that person), unless otherwise indicated.
Euthanasia and the Law: The Rise of Euthanasia and Relationship With
Abstract. Acting as the conductor on the train of impending death, a divisive turn to the left will hasten human pain and end life; while a swerve to the right will prolong human life, but also, extend unbearable human pain and suffering. One could make sound arguments that both of these grim decisions are equally acts of compassion or malice.
Euthanasia: Right to life vs right to die
The word euthanasia, originated in Greece means a good death 1.Euthanasia encompasses various dimensions, from active (introducing something to cause death) to passive (withholding treatment or supportive measures); voluntary (consent) to involuntary (consent from guardian) and physician assisted (where physician's prescribe the medicine and patient or the third party administers the ...
PDF A good death: is euthanasia the answer?
Involuntary euthanasia is considered unacceptable by most individuals and is not a significant part of the current euthanasia debate and proposals. This paper focuses on active, direct, voluntary euthanasia, and on assisted suicide. Our discussion also addresses the role of health care professionals in acts of euthanasia and assisted suicide.
The Arguments for Euthanasia: a Critical Analysis
Protection of Personal Choice: Preserving Individual Freedom. The argument for euthanasia also revolves around the protection of personal choice, particularly in matters as profound as life and death. Advocates assert that individuals should have the right to decide when and how they want to die, especially when facing a terminal illness or ...
Voluntary Euthanasia
4.4 Objection 4. As was noted earlier in Section 3, there is a widespread belief that so-called passive (voluntary) euthanasia, wherein life-sustaining or life-prolonging measures are withdrawn or withheld in response to a competent patient's request, is morally permissible.
Arguments in Support and Against Euthanasia
The aim of this article is to present and confront the arguments in support of euthanasia and physician assisted suicide, and the arguments against. The arguments for and against euthanasia are listed and discussed to literature cited. Euthanasia is an act of mercy, and, basically means to take a deliberate action with the express intention of ...
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 ...
Assisted dying: The motivations, benefits and pitfalls of hastening death
That evidence suggests that the desire to hasten death often comes from wanting to maintain some power over one's own life, Goy says. "In our research, the main reason people voiced for wanting the option was that they really wanted to have control over the circumstances of dying."
Essay Example: The Ethical and Legal Implications of Euthanasia
However, ethical issues arise regarding the ability of the patients requesting euthanasia to make autonomous decisions. For example, Appelbaum notes that it is common for depressed patients to reject treatment and even request death, yet change their decision once the depression is resolved.
Euthanasia and Modern Society
Historical Background. The debate surrounding the morality and legality of euthanasia is one that has been ongoing since the 17 th century when the word euthanasia was first invented and used in the medical field (Pateman and Rawls, 1987). In modern day society the actual meaning of euthanasia has taken different forms and is usually ...
Essay on Euthanasia: 100, 200 and 300 Words Samples
Essay on Euthanasia in 150 Words. Euthanasia or mercy killing is the act of deliberately ending a person's life. This term was coined by Sir Francis Bacon. Different countries have their perspectives and laws against such harmful acts. The Government of India, 2016, drafted a bill on passive euthanasia and called it 'The Medical Treatment ...
Euthanasia
Euthanasia (from Greek: εὐθανασία, lit. 'good death': εὖ, eu, 'well, good' + θάνατος, thanatos, 'death') is the practice of intentionally ending life to eliminate pain and suffering. [1] [2] Different countries have different euthanasia laws. The British House of Lords select committee on medical ethics defines euthanasia as ...
Euthanasia and assisted suicide: An in-depth review of relevant
Euthanasia and assisted suicide are two topics discussed throughout history, mainly because they fall within the scope of life as a human right, which has been universally defended for many years [ 1 ]. However, the mean of the word euthanasia as good death generates conflicts at social, moral, and ethical levels.
Euthanasia
Euthanasia is the practice of ending the life of a patient to limit the patient's suffering. The patient in question would typically be terminally ill or experiencing great pain and suffering. The word "euthanasia" itself comes from the Greek words " eu " (good) and " thanatos " (death). The idea is that instead of condemning ...
Essay on Euthanasia for Students and Children in English
1. Euthanasia is the voluntary act of a patient suffering a terminal disease, of terminating their life. 2. Euthanasia is essentially divided into two types — Active and Passive Euthanasia. 3. In active Euthanasia, a person directly and deliberately causes the patient's death with lethal drug dosage.
Gnostic Beliefs: A Deep Dive into the Spiritual Mystique and Ancient
Essay Example: Gnosticism is a mysterious term with a complex historical background. It describes a broad range of spiritual practices that existed before Christianity and permeated many other religions, providing a distinctive viewpoint on the divine, people, and the cosmos. Gnosticism is a
Photo essay: A collection of our favorite Houston Landing photos ...
Photos have always given me perspective, and I wanted to compile a list of scenes that stirred a strong sense of emotion in me. Some of the pictures on this list are from moments we photographed ...

The History of the Euthanasia Movement

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Voluntary Euthanasia

1. Introduction

4.1 Objection 1

4.2 Objection 2

4.3 Objection 3

4.4 Objection 4

4.5 Objection 5

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Euthanasia and assisted dying: what is the current position and what are the key arguments informing the debate?

Efthymia Prousali

Kunal Kulkarni

Introduction

Definition and current legal framework

Principles of bioethics

The Hippocratic Oath and the principles of beneficence and non-maleficence

Freedom of thought, conscience and religion

Implications of assisted dying in the doctor–patient relationship

Current position of doctors’ professional groups in the UK and the USA

Conclusions

Declarations

Ethics approval

Contributorship

Acknowledgements

The Ethical and Legal Implications of Euthanasia

Recent Case Study

Ethical Issues Involved in the Case Study

The Context of Euthanasia

The Differing Perspectives on Euthanasia

Evaluation of the Arguments and Their Ethical Implications

Personal Perspective on Euthanasia

Euthanasia and Modern Society Argumentative Essay

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