Euthanasia

Euthanasia is the practice of assisting the death of an animal or patient, often to alleviate suffering or because the patient is in a persistent vegetative state. It is ethically controversial, and human euthanasia is outlawed in most places (Switzerland, Belgium, Albania and the Netherlands are exceptions). Opponents of euthanasia say that it is murder, although most definitions of murder note that it is unlawful killing, and if euthanasia were legal, it would not be unlawful. Pain management specialists also believe that suffering usually can be relieved without euthanasia.

The term euthanasia covers a variety of different situations, which have different moral issues attached to them. Proponents believe euthanasia is the ultimate expression of free will, allowing patients to determine their fate and put an end to their suffering.

Consensuality

The term euthanasia covers both voluntary and involuntary death. In the former, a person elects or specifies conditions for medically-assisted death, often in the form of a living will. The moral issues that accompany voluntary euthanasia are whether or not assisting suicide compromises the professional ethics of doctors and other health providers. Critics will often point out that euthanasia violates the Hippocratic Oath and suggest that patients may be subjected to coercion in order to obtain consent - that people may be pressured, or at least feel pressured, into giving consent in order to save the costs of healthcare, or to free up hospital beds and resources for others.

Even more complexity comes into play when a surrogate makes the decision, not a member of the treatment team. As mentioned, there are moral issues even when there is prior consent. If the patient is an adult that has not prepared conditions, or has never been competent to do so (including children), laws may allow a next of kin to make such a decision, typically under considerable control.

Veterinary euthanasia, of course, involves a surrogate decision. Where a strong human-animal bond exists, the surrogate may have a sense if the animal is experiencing a poor quality of life. In other cases, the owner may want to rely on the decision of the veterinarian. The American Veterinary Medical Society also recognizes needs for euthanasia in wildlife control, zoo animals, mass euthanasia for epidemic control, the laboratory, and situations where an animal is in public view and where meaningful veterinary care is impossible.

Perhaps the greatest concern is that a state agency will enforce involuntary euthanasia. The Nazi Action T4 program was called a euthanasia program, but that essentially was propaganda: all deaths were involuntary, and the methods of inducing death frequently caused suffering.

Passivity

Euthanasia describes both passive and active euthanasia - that is, euthanasia through not providing medical care and euthanasia through an active intervention - for instance, an injection of a drug that would end a persons life. A lot of the moral discussion around the different circumstances tend to focus around the idea of double effect - that is the morality of an action that is done with a particular purpose, but which has a side-effect which, if it were performed directly would be considered immoral. In the case of euthanasia, often strong sedatives are prescribed to people close to the end of their life, with the principle effect being reduction of pain, but the side-effect being speeding up death.

Legal and political status

Switzerland

In Switzerland, voluntary assisted euthanasia is legal if done by a party that is not motivated by self-interest. Two groups, EXIT Switzerland and Dignitas, provide voluntary euthanasia services – the former to members in Switzerland, and the latter to both Swiss and foreign residents. Around 60% of the assisted suicides performed through Dignitas have been German 'suicide tourists', and over 100 have been from the United Kingdom.

United Kingdom

The United Kingdom forbids euthanasia under the Suicide Act 1961. In recent years, a number of challenges have been made to the law on euthanasia. Motor neurone disease sufferer Diane Pretty challenged the prohibition under the Human Rights Act 1998 but failed.

Many patients seeking euthanasia have traveled to Switzerland to use the services of the Dignitas clinic. Legal challenges have been brought by families of Dignitas patients to ensure that if they accompany their relatives to Switzerland that they will not be prosecuted upon their return. Politically, change is resisted here - many seem comfortable with keeping the laws as they are in the full knowledge that will not be used, but are available for use in extreme or unpredicted circumstances. Some family members of assisted suicide seekers have challenged and succeeded in getting the Director of Public Prosecutions to reveal the policy used to determine whether or not family members who assist with suicide either in Britain or abroad are to be criminally prosecuted.

In the 2005/06 session, Lord Joffe introduced the Assisted Dying for the Terminal Ill Bill. It proposed to make it legal for doctors to prescribe drugs that would allow a terminally ill patient in the last six months of their life to end their life, so long as that person was of sound mind, not depressed, and signed their consent in advance. The bill was campaigned against heavily by the religious lobby, including the Catholic Cardinal Cormac Murphy O'Connor, Archbishop of Canterbury Rowan Williams, Bishop of Southwark Tom Butler, the ProLife Alliance and campaign group Care Not Killing, as well as by disability activists. The Bill was not passed by the House of Lords. Joffe-style assisted dying amendments have been proposed to the 2009 Coroners and Justice Bill.

U.S.: Oregon

In 1997, the State of Oregon passed the Death with Dignity Act which "allows terminally-ill Oregonians to end their lives through the voluntary self-administration of lethal medications, expressly prescribed by a physician for that purpose". Compassion in Dying of Oregon, the campaign group which supported Oregon's law, states that the law's use has been "modest", and that in 2000, they received approximately 1,000 calls from Oregon patients seeking information about assisted dying, of whom 68 requested access to the provisions of the law. In 2000, only 27 Oregonians took the medication to end their own life.

In November of 2001, George W. Bush's U.S. Attorney General John Ashcroft started an action against the State of Oregon over the Death with Dignity Act. He sought to enforce the Controlled Substances Act, interpreting it as to prevent assisted suicide by the meaning of the terms "legitimate medical purpose". Ashcroft was defeated at the U.S. District Court level, but the State of Oregon won in April 2002. This was appealed in September to the 9th Circuit Court which ruled in May of 2004. Following Ashcroft's resignation, the new Attorney General, Alberto Gonzales appealed the 9th Circuit decision to the Supreme Court of the United States - Gonzales v. Oregon 546 U.S. 243 (2006) - which followed the 9th Circuit's decisions, but not it's reasoning.

The Death With Dignity National Center advocate for the use of the Oregon model nationally and are currently lobbying for the passage of legislation in the State of Washington to implement Oregon-style euthanasia laws.

Religious and theological concerns

Non-religious people are fairly consistently in support of access to doctor-assisted suicide, while many religious people and organizations oppose euthanasia, seeing it as against God's will or as an affront to the sanctity of human life.

Catholicism rejects active euthanasia, while allowing, under the 1980 Declaration on Euthanasia, some instances of passive euthanasia if done in extraordinary circumstances. Islam has similar policies. Protestant and Jewish denominations are split on euthanasia, with more liberal adherents, clergy and denominations supporting euthanasia, with conservatives in opposition.

Methods

The most common means of euthanasia, in humans and animals, is a lethal dose of barbiturates, usually pentobarbital. These can be taken orally if the subject is conscious and cooperative, or administered intravenously.

Humans

While some protocols follow an anesthetic dose of barbiturate with agents that paralyze the muscles and then stop the heart, these are generally not considered necessary, but an artifact of using the triple-agent sequence for cardioplegia, or elective stopping of the heart for surgery. Triple-agent sequences also are used in lethal injection.

Jack Kevorkian used a carbon monoxide inhaler as well as injected barbiturates.

Veterinary medicine

The triple-agent method, however, is not recommended by the American Veterinary Medicine Association in its guidelines for animal euthanasia. While injected barbiturates are preferred, inhaled agents may be used with specific species and under controlled conditions. The latter include carbon dioxide and carbon monoxide.

Other methods are acceptable, with considerations of the species, skills required, and practical considerations. For example, a penetrating captive bolt physical strike to the brain is considered a humane means of slaughtering meat animals, and can be used for euthanasia in appropriate animals. In some circumstances, such as wildlife in the field, gunshot may be the only practical means.

Famous euthanasia incidents

Perhaps the most famous doctor performing assisted suicide is Jack Kevorkian - often referred to as Dr. Death, who, until his conviction and imprisonment in 1999, assisted over 130 people in their death. He created a device, called the Thanatron, to help patients administer drugs intravenously, later replacing it with the Mercitron, which administered carbon monoxide. He was convicted after sending a video of him assisting in the death of Thomas Hyde, which prompted prosecution and imprisonment - he was paroled in June 2007. Conservative critics allege that he was addicted to killing so he could further his own research, and that a number of those he killed were not ill.

Diane Pretty suffered from motor neurone disease and sued the British government under the Human Rights Act, but her appeals failed after the courts decided that the European Convention on Human Rights and Fundamental Freedoms does not provide for a right to die. She died in 2001.

The English opera conductor Sir Edward Downes and his wife Lady Joan Downes committed suicide together at the Dignitas clinic in Switzerland in 2009. Lady Downes was 74 years old and had been diagnosed with terminal pancreatic cancer. Her husband had no terminal illness, but was both blind and quite deaf and was strongly reliant on his wife.