Euthanasia, also known as assisted suicide, physician-assisted suicide (dying), doctor-assisted dying (suicide), and more loosely termed mercy killing, means to take a deliberate action with the express intention of ending a life to relieve intractable (persistent, unstoppable) suffering.
Some interpret euthanasia as the practice of ending a life in a painless manner. Many disagree with this interpretation, because it needs to include a reference to intractable suffering.
In the majority of countries euthanasia or assisted suicide is against the law. According to the National Health Service (NHS), UK, it is illegal to help somebody kill themselves, regardless of circumstances. Assisted suicide, or voluntary euthanasia carries a maximum sentence of 14 years in prison in the UK. In the USA the law varies in some states (see further down).
There are two main classifications of euthanasia:
- Voluntary euthanasia - this is euthanasia conducted with consent. Since 2009 voluntary euthanasia has been legal in Belgium, Luxembourg, The Netherlands, Switzerland, and the states of Oregon (USA) and Washington (USA).
- Involuntary euthanasia - euthanasia is conducted without consent. The decision is made by another person because the patient is incapable to doing so himself/herself.
There are two procedural classifications of euthanasia:
- Passive euthanasia - this is when life-sustaining treatments are withheld. The definition of passive euthanasia is often not clear cut. For example, if a doctor prescribes increasing doses of opioid analgesia (strong painkilling medications) which may eventually be toxic for the patient, some may argue whether passive euthanasia is taking place - in most cases, the doctor's measure is seen as a passive one. Many claim that the term is wrong, because euthanasia has not taken place, because there is no intention to take life.
- Active euthanasia - lethal substances or forces are used to end the patient's life. Active euthanasia includes life-ending actions conducted by the patient or somebody else.
Active euthanasia is a much more controversial subject than passive euthanasia. Individuals are torn by religious, moral, ethical and compassionate arguments surrounding the issue. Euthanasia has been a very controversial and emotive topic for a long time.
The term assisted suicide has several different interpretations. Perhaps the most widely used and accepted is "the intentional hastening of death by a terminally ill patient with assistance from a doctor, relative, or another person."
Some people will insist that something along the lines of "in order relieve intractable (persistent, unstoppable) suffering" needs to be added to the meaning, while others insist that "terminally ill patient" already includes that meaning.
Medical definitions of euthanasia
According to MediLexicon's medical dictionary:
- "A quiet, painless death." or
- "The intentional putting to death of a person with an incurable or painful disease intended as an act of mercy."
Active euthanasia is:
"A mode of ending life in which the intent is to cause the patient's death in a single act (also called mercy killing)."
Passive euthanasia is:
"A mode of ending life in which a physician is given an option not to prescribe futile treatments for the hopelessly ill patient."
Options for terminal patients or those with intractable suffering and pain
Patients with a terminal or serious and progressive illness in most developed countries have several options, including:
The World Health Organization (WHO) defines palliative care as:
"An approach that improves the quality of life of patients and their families facing the problems 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".
One goal of palliative care is for the patients and families to accept dying as a normal process. It seeks to provide relief from pain and uncomfortable symptoms while integrating psychological and spiritual features of patient care. Palliative care strives to offer a support system to help patients live their remaining time as actively as they can and to help families bereave and deal with the illness of a loved one.
Since pain is the most visible sign of distress among patients receiving palliative care, affecting about 70% of cancer patients and 65% of patients dying from non-malignant diseases, opioids are a very common treatment option.
These medicines form part of well-established treatment plans for managing pain as well as several other symptoms that patients encounter. Often, opioids are chosen during palliative care in spite of the side effects such as drowsiness, nausea, vomiting, and constipation.
Some type of palliative care is given to about 1.2 million Americans and 45,000 new patients each year in England, Wales, and Northern Ireland. About 90% of these patients have cancer, while the remaining patients have heart disease, stroke, motor neuron disease, or multiple sclerosis. The providers of the palliative care include in-patient care, hospital support services, community care, day care and outpatient care.
In the USA, UK and many other countries a patient can refuse treatment that is recommended by a doctor or some other health care professional, as long as they have been properly informed and are of sound mind. In the UK, the Mental Health Act 1983 excludes children and people under the age of 18 years.
According to the Department of Health, UK, nobody can give consent on behalf of an incompetent adult, such as one who is in a coma. Nevertheless, doctors take into account the best interests of the patient when deciding on treatment options. A patient's best interests are based on:
- What the patient wanted when he/she was competent
- The patient's general state of health
- The patient's spiritual and religious welfare.
An example in the UK
The doctor may decide the best option for a patient who is declared as clinically brain dead is to switch of the life-support machines; equipment without which the patient will die. The doctor in charge will talk to the patient's family. However, the final decision is the doctor's, and strict criteria must be met.
A living will (advance directive)
This is a legally binding document which anybody may draw up in advance if they are concerned that perhaps they will be unable to expresses their wishes at a later date. In the advance directive the individual states what they want to happen if they become too ill to be able to refuse or consent to medical treatment.
On the next page, we look at the history of euthanasia and euthanasia law throughout the world. On the final page we discuss arguments for and against voluntary euthanasia.