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Euthanasia

Euthanasia

Overview
Euthanasia refers to the practice of intentionally ending a life in order to relieve pain
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...

 and suffering
Suffering
Suffering, or pain in a broad sense, is an individual's basic affective experience of unpleasantness and aversion associated with harm or threat of harm. Suffering may be qualified as physical or mental. It may come in all degrees of intensity, from mild to intolerable. Factors of duration and...

.

There are different euthanasia laws in each country. The House of Lords
House of Lords
The House of Lords is the upper house of the Parliament of the United Kingdom. Like the House of Commons, it meets in the Palace of Westminster....

 Select Committee on Medical Ethics
Medical ethics
Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.-History:Historically,...

 of England
England
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...

 defines euthanasia as "a deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering". In the Netherlands
Netherlands
The Netherlands is a constituent country of the Kingdom of the Netherlands, located mainly in North-West Europe and with several islands in the Caribbean. Mainland Netherlands borders the North Sea to the north and west, Belgium to the south, and Germany to the east, and shares maritime borders...

, euthanasia is understood as "termination of life by a doctor at the request of a patient".

Euthanasia is categorized in different ways, which include voluntary, non-voluntary, or involuntary.
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Encyclopedia
Euthanasia refers to the practice of intentionally ending a life in order to relieve pain
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...

 and suffering
Suffering
Suffering, or pain in a broad sense, is an individual's basic affective experience of unpleasantness and aversion associated with harm or threat of harm. Suffering may be qualified as physical or mental. It may come in all degrees of intensity, from mild to intolerable. Factors of duration and...

.

There are different euthanasia laws in each country. The House of Lords
House of Lords
The House of Lords is the upper house of the Parliament of the United Kingdom. Like the House of Commons, it meets in the Palace of Westminster....

 Select Committee on Medical Ethics
Medical ethics
Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.-History:Historically,...

 of England
England
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...

 defines euthanasia as "a deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering". In the Netherlands
Netherlands
The Netherlands is a constituent country of the Kingdom of the Netherlands, located mainly in North-West Europe and with several islands in the Caribbean. Mainland Netherlands borders the North Sea to the north and west, Belgium to the south, and Germany to the east, and shares maritime borders...

, euthanasia is understood as "termination of life by a doctor at the request of a patient".

Euthanasia is categorized in different ways, which include voluntary, non-voluntary, or involuntary. Voluntary euthanasia
Voluntary euthanasia
Voluntary euthanasia refers to the practice of ending a life in a painless manner...

 is legal in some countries and U.S. states. Non-voluntary euthanasia is illegal in all countries. However, in the Netherlands
Netherlands
The Netherlands is a constituent country of the Kingdom of the Netherlands, located mainly in North-West Europe and with several islands in the Caribbean. Mainland Netherlands borders the North Sea to the north and west, Belgium to the south, and Germany to the east, and shares maritime borders...

, physicians can avoid prosecution by following well described and strict conditions. Involuntary euthanasia
Involuntary euthanasia
Non-voluntary euthanasia is euthanasia conducted where the explicit consent of the individual concerned is unavailable...

 is usually considered murder.

Euthanasia is the most active area of research in contemporary bioethics
Bioethics
Bioethics is the study of controversial ethics brought about by advances in biology and medicine. Bioethicists are concerned with the ethical questions that arise in the relationships among life sciences, biotechnology, medicine, politics, law, and philosophy....

.

Definition


Like other terms borrowed from history, the "euthanasia" has had different meanings depending on usage. The first apparent usage of the term "euthanasia" belongs to the historian Suetonius
Suetonius
Gaius Suetonius Tranquillus, commonly known as Suetonius , was a Roman historian belonging to the equestrian order in the early Imperial era....

 who described how the Emperor Augustus
Augustus
Augustus ;23 September 63 BC – 19 August AD 14) is considered the first emperor of the Roman Empire, which he ruled alone from 27 BC until his death in 14 AD.The dates of his rule are contemporary dates; Augustus lived under two calendars, the Roman Republican until 45 BC, and the Julian...

, "dying quickly and without suffering in the arms of his wife, Livia, experienced the 'euthanasia' he had wished for." The word "euthanasia" was first used in a medical context by Francis Bacon
Francis Bacon
Francis Bacon, 1st Viscount St Albans, KC was an English philosopher, statesman, scientist, lawyer, jurist, author and pioneer of the scientific method. He served both as Attorney General and Lord Chancellor of England...

 in the 17th century, to refer to an easy, painless, happy death, during which it was a "physician's responsibility to alleviate the 'physical sufferings' of the body." Bacon referred to an "outward euthanasia"—the term "outward" he used to distinguish from a spiritual concept—the euthanasia "which regards the preparation of the soul."

In current usage, one approach to defining euthanasia has been to mirror Suetonius, regarding it as the "painless inducement of a quick death". However, it is argued that this approach fails to properly define euthanasia, as it leaves open a number of possible actions which would meet the requirements of the definition, but would not be seen as euthanasia. In particular, these include situations where a person kills another, painlessly, but for no reason beyond that of personal gain; or accidental deaths which are quick and painless, but not intentional.

Thus another approach is to incorporate the notion of suffering
Suffering
Suffering, or pain in a broad sense, is an individual's basic affective experience of unpleasantness and aversion associated with harm or threat of harm. Suffering may be qualified as physical or mental. It may come in all degrees of intensity, from mild to intolerable. Factors of duration and...

 into the definition. The definition offered by the Oxford English Dictionary
Oxford English Dictionary
The Oxford English Dictionary , published by the Oxford University Press, is the self-styled premier dictionary of the English language. Two fully bound print editions of the OED have been published under its current name, in 1928 and 1989. The first edition was published in twelve volumes , and...

 incorporates suffering as a necessary condition, with "the painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma", and this approach can be seen as a part of other works, such as Marvin Khol and Paul Kurtz's "a mode or act of inducing or permitting death painlessly as a relief from suffering". However, focusing on this approach to defining euthanasia may also lead to counterexamples: such definitions may encompass killing a person suffering from an incurable disease for personal gain (such as to claim an inheritance), and commentators such as Tom Beauchamp
Tom Beauchamp
Tom L. Beauchamp is an American philosopher and bioethicist. He currently serves as Professor of Philosophy and Senior Research Scholar at the Kennedy Institute of Ethics at Georgetown University. He earned his B.A. from Southern Methodist University in 1963, a B.D. from Yale Divinity School, and...

 & Arnold Davidson
Arnold Davidson
Arnold I. Davidson Ph.D. is Robert O. Anderson Distinguished Service Professor in Philosophy, Comparative Literature, History of Science, and Philosophy of Religion at the University of Chicago. He is also a member of the Committee on the Conceptual Foundations of Science at Chicago and a...

 have argued that doing such would constitute "murder simpliciter" rather than euthanasia.

The third element incorporated into many definitions is that of intentionality – the death must be intended, rather than being accidental, and the intent of the action must be a "merciful death". Michael Wreen argued that “the principal thing that distinguishes euthanasia from intentional killing simpliciter is the agent's motive: it must be a good motive insofar as the good of the person killed is concerned”, a view mirrored by Heather Draper, who also spoke to the importance of motive, arguing that "the motive forms a crucial part of arguments for euthanasia, because it must be in the best interests of the person on the receiving end." Definitions such as that offered by the House of Lords
House of Lords
The House of Lords is the upper house of the Parliament of the United Kingdom. Like the House of Commons, it meets in the Palace of Westminster....

 Select Committee on Medical Ethics
Medical ethics
Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.-History:Historically,...

 take this path, where euthanasia is defined as "a deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering." Beauchamp & Davidson also highlight Baruch Brody's
Baruch Brody
Baruch Brody is an American bioethicist who was among the first scholars in the field of applied ethics to write about abortion in the era following Roe v. Wade...

 "an act of euthanasia is one in which one person ... (A) kills another person (B) for the benefit of the second person, who actually does benefit from being killed".

Draper argued that any definition of euthanasia must incorporate four elements: an agent and a subject; an intention; a causal proximity, such that the actions of the agent lead to the outcome; and an outcome. Based on this, she offered a definition incorporating those elements, stating that euthanasia "must be defined as death that results from the intention of one person to kill another person, using the most gentle and painless means possible, that is motivated solely by the best interests of the person who dies." Prior to Draper, Beauchamp & Davidson had also offered a definition which includes these elements, although they offered a somewhat longer account, and one that specifically discounts fetus
Fetus
A fetus is a developing mammal or other viviparous vertebrate after the embryonic stage and before birth.In humans, the fetal stage of prenatal development starts at the beginning of the 11th week in gestational age, which is the 9th week after fertilization.-Etymology and spelling variations:The...

es in order to distinguish between abortion
Abortion
Abortion is defined as the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to viability. An abortion can occur spontaneously, in which case it is usually called a miscarriage, or it can be purposely induced...

s and euthanasia:
Wreen, in part responding to Beauchamp & Davidson, offered a six part definition:
Wreen also considered a seventh requirement: "(7) The good specified in (6) is, or at least includes, the avoidance of evil", although as Wreen noted in the paper, he was not convinced that the restriction was required.

In discussing his definition, Wreen noted the difficulty of justifying euthanasia when faced with the notion of the subject's "right to life
Right to life
Right to life is a phrase that describes the belief that a human being has an essential right to live, particularly that a human being has the right not to be killed by another human being...

". In response, Wreen argued that euthanasia has to be voluntary, and that "involuntary euthanasia is, as such, a great wrong". Other commentators incorporate consent more directly into their definitions. For example, in a discussion of euthanasia presented in 2003 by the European Association of Palliative Care (EPAC) Ethics Task Force, the authors offered: "Medicalized killing of a person without the person's consent, whether nonvoluntary (where the person in unable to consent) or involuntary (against the person's will) is not euthanasia: it is murder. Hence, euthanasia can be voluntary only." Although the EPAC Ethics Task Force argued that both non-voluntary and involuntary euthanasia
Involuntary euthanasia
Non-voluntary euthanasia is euthanasia conducted where the explicit consent of the individual concerned is unavailable...

 could not be included in the definition of euthanasia, there is discussion in the literature about excluding one but not the other.

Classification of euthanasia


Euthanasia may be classified according to whether a person gives informed consent
Informed consent
Informed consent is a phrase often used in law to indicate that the consent a person gives meets certain minimum standards. As a literal matter, in the absence of fraud, it is redundant. An informed consent can be said to have been given based upon a clear appreciation and understanding of the...

 into three types: voluntary, non-voluntary and involuntary.

There is a debate within the medical and bioethics literature about whether or not the non-voluntary (and by extension, involuntary) killing of patients can be regarded as euthanasia, irrespective of intent or the patient's circumstances. In the definitions offered by Beauchamp & Davidson and, later, by Wreen, consent on the part of the patient was not considered to be one of their criteria, although it may have been required to justify euthanasia. However, others see consent as essential.

Voluntary euthanasia


Euthanasia conducted with the consent of the patient is termed voluntary euthanasia
Voluntary euthanasia
Voluntary euthanasia refers to the practice of ending a life in a painless manner...

. Active voluntary euthanasia is legal in Belgium, Luxembourg and the Netherlands. Passive voluntary euthanasia is legal throughout the U.S. per Cruzan v. Director, Missouri Department of Health
Cruzan v. Director, Missouri Department of Health
Cruzan v. Director, Missouri Department of Health, 497 U.S. 261 , was a United States Supreme Court case argued on December 6, 1989 and decided on June 25, 1990...

. When the patient brings about his or her own death with the assistance of a physician, the term assisted suicide
Assisted suicide
Assisted suicide is the common term for actions by which an individual helps another person voluntarily bring about his or her own death. "Assistance" may mean providing one with the means to end one's own life, but may extend to other actions. It differs to euthanasia where another person ends...

 is often used instead. Assisted suicide is legal in Switzerland and the U.S. states of Oregon, Washington and Montana.

Non-voluntary euthanasia



Euthanasia conducted where the consent of the patient is unavailable is termed non-voluntary euthanasia. Examples include child euthanasia
Child euthanasia
Child euthanasia is a controversial form of non-voluntary euthanasia that is applied to children who are gravely ill or suffer from significant birth defects....

, which is illegal worldwide but decriminalised under certain specific circumstances in the Netherlands under the Groningen Protocol
Groningen Protocol
The Groningen Protocol is a text created in September 2004 by Eduard Verhagen, the medical director of the department of pediatrics at the University Medical Center Groningen in Groningen, The Netherlands...

.

Involuntary euthanasia



Euthanasia conducted against the will of the patient is termed involuntary euthanasia
Involuntary euthanasia
Non-voluntary euthanasia is euthanasia conducted where the explicit consent of the individual concerned is unavailable...

.

Procedural decision


Voluntary, non-voluntary and involuntary euthanasia can all be further divided into passive or active variants. A number of authors consider these terms to be misleading and unhelpful.

Passive euthanasia


Passive euthanasia entails the withholding of common treatments, such as antibiotics, necessary for the continuance of life.

Active euthanasia


Active euthanasia entails the use of lethal substances or forces to kill and is the most controversial means.

History


According to the historian N. D. A. Kemp, the origin of the contemporary debate on euthanasia started in 1870. Nevertheless, euthanasia was debated and practiced long before that date. Euthanasia was practised in Ancient Greece
Ancient Greece
Ancient Greece is a civilization belonging to a period of Greek history that lasted from the Archaic period of the 8th to 6th centuries BC to the end of antiquity. Immediately following this period was the beginning of the Early Middle Ages and the Byzantine era. Included in Ancient Greece is the...

 and Rome
Rome
Rome is the capital of Italy and the country's largest and most populated city and comune, with over 2.7 million residents in . The city is located in the central-western portion of the Italian Peninsula, on the Tiber River within the Lazio region of Italy.Rome's history spans two and a half...

: for example, hemlock
Conium
Conium is a genus of two species of highly poisonous perennial herbaceous flowering plants in the family Apiaceae, native to Europe and the Mediterranean region as Conium maculatum, and to southern Africa as Conium chaerophylloides....

 was employed as a means of hastening death on the island of Kea
Kea (island)
Kea , also known as Gia or Tzia , Zea, and, in Antiquity, Keos , is an island of the Cyclades archipelago, in the Aegean Sea, in Greece. Kea is part of the Kea-Kythnos peripheral unit. Its capital, Ioulis, is inland at a high altitude and is considered quite picturesque...

, a technique also employed in Marseilles and by Socrates
Socrates
Socrates was a classical Greek Athenian philosopher. Credited as one of the founders of Western philosophy, he is an enigmatic figure known chiefly through the accounts of later classical writers, especially the writings of his students Plato and Xenophon, and the plays of his contemporary ...

 in Athens
Athens
Athens , is the capital and largest city of Greece. Athens dominates the Attica region and is one of the world's oldest cities, as its recorded history spans around 3,400 years. Classical Athens was a powerful city-state...

. Euthanasia, in the sense of the deliberate hastening of a person's death, was supported by Socrates, Plato
Plato
Plato , was a Classical Greek philosopher, mathematician, student of Socrates, writer of philosophical dialogues, and founder of the Academy in Athens, the first institution of higher learning in the Western world. Along with his mentor, Socrates, and his student, Aristotle, Plato helped to lay the...

 and Seneca the Elder
Seneca the Elder
Lucius or Marcus Annaeus Seneca, known as Seneca the Elder and Seneca the Rhetorician , was a Roman rhetorician and writer, born of a wealthy equestrian family of Cordoba, Hispania...

 in the ancient world, although Hippocrates
Hippocrates
Hippocrates of Cos or Hippokrates of Kos was an ancient Greek physician of the Age of Pericles , and is considered one of the most outstanding figures in the history of medicine...

 appears to have spoken against the practice, writing "I will not prescribe a deadly drug to please someone, nor give advice that may cause his death" (noting there is some debate in the literature about whether or not this was intended to encompass euthanasia).

Euthanasia was strongly opposed in the Judeo-Christian
Judeo-Christian
Judeo-Christian is a term used in the United States since the 1940s to refer to standards of ethics said to be held in common by Judaism and Christianity, for example the Ten Commandments...

 tradition. Thomas Aquinas
Thomas Aquinas
Thomas Aquinas, O.P. , also Thomas of Aquin or Aquino, was an Italian Dominican priest of the Catholic Church, and an immensely influential philosopher and theologian in the tradition of scholasticism, known as Doctor Angelicus, Doctor Communis, or Doctor Universalis...

 opposed both, as did Francois Ranchin (1565–1641), a French physician and professor of medicine, and Michael Boudewijns (1601–1681), a physician and teacher. Nevertheless, there were voices arguing for euthanasia, such as John Donne
John Donne
John Donne 31 March 1631), English poet, satirist, lawyer, and priest, is now considered the preeminent representative of the metaphysical poets. His works are notable for their strong and sensual style and include sonnets, love poetry, religious poems, Latin translations, epigrams, elegies, songs,...

 in 1624, and euthanasia continued to be practised. Thus in 1678, the publication of Caspar Questel's De pulvinari morientibus non subtrahend, ("On the pillow of which the dying should not be deprived"), initiated debate on the topic. Questel described various customs which were employed at the time to hasten the death of the dying, (including the sudden removal of a pillow, which was believed to accelerate death), and argued against their use, as doing so was "against the laws of God and Nature". This view was shared by many who followed, including Philipp Jakob Spener, Veit Riedlin and Johann Georg Krünitz
Johann Georg Krünitz
Johann Georg Krünitz was a German encyclopedist who started the 242-volume Oekonomische Encyklopädie and during his lifetime managed to complete its first 72 volumes.-Life:...

. In spite of opposition, euthanasia continued to be practised, involving techniques such as bleeding, suffocation and removing people from their beds to be placed on the cold ground.

Suicide and euthanasia were more acceptable under Protestantism and during the Age of Enlightenment
Age of Enlightenment
The Age of Enlightenment was an elite cultural movement of intellectuals in 18th century Europe that sought to mobilize the power of reason in order to reform society and advance knowledge. It promoted intellectual interchange and opposed intolerance and abuses in church and state...

, and Thomas More
Thomas More
Sir Thomas More , also known by Catholics as Saint Thomas More, was an English lawyer, social philosopher, author, statesman and noted Renaissance humanist. He was an important councillor to Henry VIII of England and, for three years toward the end of his life, Lord Chancellor...

 wrote of euthanasia in Utopia
Utopia (book)
Utopia is a work of fiction by Thomas More published in 1516...

, although it is not clear if More was intending to endorse the practise. Other cultures have taken different approaches: for example, in Japan suicide has not traditionally been viewed as a sin, and accordingly the perceptions of euthanasia are different from those in other parts of the world.

Beginnings of the contemporary euthanasia debate


In the mid-1800s, the use of morphine
Morphine
Morphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...

 to treat "the pains of death" emerged, with John Warren
John Collins Warren
John Collins Warren , of Boston, was one of the most renowned American surgeons of the 19th century. In 1846 he gave permission to William T.G. Morton to provide ether anesthesia while Warren performed a minor surgical procedure...

 recommending its use in 1848. A similar use of chloroform
Chloroform
Chloroform is an organic compound with formula CHCl3. It is one of the four chloromethanes. The colorless, sweet-smelling, dense liquid is a trihalomethane, and is considered somewhat hazardous...

 was revealed by Joseph Bullar in 1866. However, in neither case was it recommended that the use should be to hasten death. In 1870 Samuel Williams, a schoolteacher, initiated the contemporary euthanasia debate through a speech given at the Birmingham Speculative Club, which was subsequently published in a one-off publication entitled Essays of the Birmingham Speculative Club, the collected works of a number of members of an amateur philosophical society. Williams' proposal was to use chloroform to deliberately hasten the death of terminally ill patients:
The essay was favourably reviewed in The Saturday Review
Saturday Review (London)
The Saturday Review of politics, literature, science, and art was a London weekly newspaper established by A. J. B. Beresford Hope in 1855....

, and an editorial speaking against the essay appeared in The Spectator
The Spectator
The Spectator is a weekly British magazine first published on 6 July 1828. It is currently owned by David and Frederick Barclay, who also owns The Daily Telegraph. Its principal subject areas are politics and culture...

. From there it proved to be influential, and other writers came out in support of such views: Lionel Tollemache wrote in favour of euthanasia, as did Annie Besant
Annie Besant
Annie Besant was a prominent British Theosophist, women's rights activist, writer and orator and supporter of Irish and Indian self rule.She was married at 19 to Frank Besant but separated from him over religious differences. She then became a prominent speaker for the National Secular Society ...

, the essayist and reformer who later became involved with the National Secular Society
National Secular Society
The National Secular Society is a British campaigning organisation that promotes secularism and the separation of church and state. It holds that no-one should gain advantage or disadvantage because of their religion or lack of religion. It was founded by Charles Bradlaugh in 1866...

, considering it a duty to society to "die voluntarily and painlessly" when one reaches the point of becoming a 'burden'. Popular Science also analyzed the issue in May 1873, assessing both sides of the argument. Nevertheless, Kemp notes that at the time, medical doctors did not participate in the discussion; it was "essentially a philosophical enterprise... tied inextricably to a number of objections to the Christian doctrine of the sanctity of human life".

The early euthanasia movement in the United States



The rise of the euthanasia movement in the United States coincided with the so-called Gilded Age
Gilded Age
In United States history, the Gilded Age refers to the era of rapid economic and population growth in the United States during the post–Civil War and post-Reconstruction eras of the late 19th century. The term "Gilded Age" was coined by Mark Twain and Charles Dudley Warner in their book The Gilded...

 – a time of social and technological change that encompassed an "individualistic conservatism
Conservatism
Conservatism is a political and social philosophy that promotes the maintenance of traditional institutions and supports, at the most, minimal and gradual change in society. Some conservatives seek to preserve things as they are, emphasizing stability and continuity, while others oppose modernism...

 that praised laissez faire economics, scientific method
Scientific method
Scientific method refers to a body of techniques for investigating phenomena, acquiring new knowledge, or correcting and integrating previous knowledge. To be termed scientific, a method of inquiry must be based on gathering empirical and measurable evidence subject to specific principles of...

, and rationalism
Rationalism
In epistemology and in its modern sense, rationalism is "any view appealing to reason as a source of knowledge or justification" . In more technical terms, it is a method or a theory "in which the criterion of the truth is not sensory but intellectual and deductive"...

", along with major depression
Depression (economics)
In economics, a depression is a sustained, long-term downturn in economic activity in one or more economies. It is a more severe downturn than a recession, which is seen by some economists as part of the modern business cycle....

s, industrialisation
Industrialisation
Industrialization is the process of social and economic change that transforms a human group from an agrarian society into an industrial one...

 and conflict between corporations and labor unions. It was also a time that saw the development of the modern hospital system, seen as a factor in the emergence of the euthanasia debate.

Robert Ingersoll
Robert G. Ingersoll
Robert Green "Bob" Ingersoll was a Civil War veteran, American political leader, and orator during the Golden Age of Freethought, noted for his broad range of culture and his defense of agnosticism. He was nicknamed "The Great Agnostic."-Life and career:Robert Ingersoll was born in Dresden, New York...

 argued for euthanasia, stating in 1894 that where someone is suffering from a terminal illness, such as terminal cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...

, they should have a right to end their pain through suicide. Felix Adler offered a similar approach, although, unlike Ingersoll, Adler did not reject religion, instead arguing from an Ethical Culture framework. In 1891, Alder argued that those suffering from overwhelming pain should have the right to commit suicide, and, furthermore, that it should be permissible for a doctor to assist – thus making Adler the first "prominent American" to argue for suicide in cases where people were suffering from chronic illness. Both Ingersoll and Adler argued for voluntary euthanasia of adults suffering from terminal ailments.

America also saw the first attempt to legalise euthanasia, when Henry Hunt
Henry Thomas Hunt
Henry Thomas Hunt was the reform-minded mayor of Cincinnati, Ohio from 1912 to 1913. Hunt, 33 years old when he took office, quickly became known as the Boy Mayor...

 introduced legislation into the General Assembly
Ohio General Assembly
The Ohio General Assembly is the state legislature of the U.S. state of Ohio. It consists of the 99-member Ohio House of Representatives and the 33-member Ohio Senate...

 of Ohio
Ohio
Ohio is a Midwestern state in the United States. The 34th largest state by area in the U.S.,it is the 7th‑most populous with over 11.5 million residents, containing several major American cities and seven metropolitan areas with populations of 500,000 or more.The state's capital is Columbus...

 in 1906. Hunt did so at the behest of Anna Hall
Anna Hall
Anna S. Hall was a leading figure in the movement to legalize euthanasia in the United States during the first decade of the twentieth century. Miss Hall was the daughter and heir of noted Arctic explorer Charles Francis Hall...

, a wealthy heiress who was a major figure in the euthanasia movement during the early 20th century in the United States. Hall had watched her mother die after an extended battle with liver cancer
Liver cancer
Liver tumors or hepatic tumors are tumors or growths on or in the liver . Several distinct types of tumors can develop in the liver because the liver is made up of various cell types. These growths can be benign or malignant...

, and had dedicated herself to ensuring that others would not have to endure the same suffering. Towards this end she engaged in an extensive letter writing campaign, recruited Lurana Sheldon and Maud Ballington Booth
Maud Ballington Booth
Maud Elizabeth Charlesworth later changed her name to Maud Ballington Booth, was an Salvation Army leader and co-founder of the Volunteers of America....

, and organised a debate on euthanasia at the annual meeting of the American Humane Association
American Humane Association
The American Humane Association is an organization founded in 1877 dedicated to the welfare of animals and children.The AHA's Film and Television Unit has monitored the welfare of animals during the production of films and television programs since 1940. They are the source of the familiar...

 in 1905 – described by Jacob Appel
Jacob M. Appel
Jacob M. Appel is an American author, bioethicist and social critic. He is best known for his short stories, his work as a playwright, and his writing in the fields of reproductive ethics, organ donation, neuroethics and euthanasia....

 as the first significant public debate on the topic in the 20th century. Hunt's bill called for the administration of an anesthetic to bring about a patient's death, so long as the person is of lawful age and sound mind, and was suffering from a fatal injury, an irrecoverable illness or great physical pain. It also required that the case be heard by a physician, required informed consent in front of three witnesses, and then required the attendance of three physicians who had to agree that the patient's recovery was impossible. A motion to reject the bill outright was voted down, but the bill itself failed to pass, 79 to 23.

Along with the Ohio euthanasia proposal, 1906 also witnessed the creation of a second bill: Assemblyman Ross Gregory introduced a proposal to permit euthanasia to the Iowa
Iowa
Iowa is a state located in the Midwestern United States, an area often referred to as the "American Heartland". It derives its name from the Ioway people, one of the many American Indian tribes that occupied the state at the time of European exploration. Iowa was a part of the French colony of New...

 legislature. However, the Iowa legislation was far broader in scope than that offered in Ohio. It allowed for the death of any person of at least ten years of age who suffered from an ailment that would prove fatal and cause extreme pain, should they be of sound mind and express a desire to artificially hasten their death. In addition, it allowed for infants to be euthanised if they were sufficiently deformed, and permitted guardians to request euthanasia on behalf of their wards. The proposed legislation also imposed penalties on physicians who refused to perform euthanasia when requested: a 6-12 month prison term and a fine of between $200 and $1000 dollars. Unsurprisingly, the proposal proved to be controversial. It engendered considerable debate but failed to pass, having been withdrawn from consideration after being passed to the Committee on Public Health.

After 1906 the euthanasia debate reduced in intensity, resurfacing periodically but not returning to the same level of debate until the 1930s in the United Kingdom.

1930s


In January 1936, King George V
George V of the United Kingdom
George V was King of the United Kingdom and the British Dominions, and Emperor of India, from 6 May 1910 through the First World War until his death in 1936....

 was given a fatal dose of morphine and cocaine
Cocaine
Cocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...

 in order to hasten his death. At the time he was suffering from cardiorespiratory failure, and the decision to end his life was made by his physician, Lord Dawson
Bertrand Dawson, 1st Viscount Dawson of Penn
Bertrand Edward Dawson, 1st Viscount Dawson of Penn, GCVO, KCB, KCMG, PC, FRCP was a physician to the British Royal Family and President of the Royal College of Physicians‎.-Early life and education:...

. Although this remained a secret for over 50 years, the death of George V coincided with proposed legislation in the House of Lords
House of Lords
The House of Lords is the upper house of the Parliament of the United Kingdom. Like the House of Commons, it meets in the Palace of Westminster....

 to legalise euthanasia. The legislation came through the British Volunteer Euthanasia Legalisation Society (now known as Dignity in Dying
Dignity in Dying
Dignity in Dying is a United Kingdom nationwide campaigning organisation. It is funded by voluntary contributions from members of the public, and as of December 2010, it claimed to have 25,000 actively subscribing supporters...

), which was formed in 1935, although its formation can be traced back to a 1931 speech by Dr Charles Killick Millard
Killick Millard
Charles Killick Millard was a British doctor who in 1935 founded the Voluntary Euthanasia Legalisation Society, a movement that campaigned for the legalisation of euthanasia in Great Britain.- External links:*...

.

Euthanasia opponent Ian Dowbiggin argues that the early membership of the Euthanasia Society of America (ESA) reflected how many perceived euthanasia at the time, often seeing it as a eugenics matter rather than an issue concerning individual rights. Dowbiggin argues that not every eugenist joined the ESA "solely for eugenic reasons", but he postulates that there were clear ideological connections between the eugenics and euthanasia movements.

A July 24, 1939 killing of a severely disabled infant in Nazi Germany
Nazi Germany
Nazi Germany , also known as the Third Reich , but officially called German Reich from 1933 to 1943 and Greater German Reich from 26 June 1943 onward, is the name commonly used to refer to the state of Germany from 1933 to 1945, when it was a totalitarian dictatorship ruled by...

 was described in a BBC
BBC
The British Broadcasting Corporation is a British public service broadcaster. Its headquarters is at Broadcasting House in the City of Westminster, London. It is the largest broadcaster in the world, with about 23,000 staff...

 "Genocide Under the Nazis Timeline" as the first "state-sponsored euthanasia". Parties that consented to the killing included Hitler's office, the parents, and the Reich Committee for the Scientific Registration of Serious and Congenitally Based Illnesses. The Telegraph
The Daily Telegraph
The Daily Telegraph is a daily morning broadsheet newspaper distributed throughout the United Kingdom and internationally. The newspaper was founded by Arthur B...

noted that the killing of the disabled infant—whose name was Gerhard Kretschmar
Gerhard Kretschmar
Gerhard Herbert Kretschmar , was a German child born with severe disabilities. After receiving a petition from the child's parents, the German chancellor Adolf Hitler authorized one of his personal physicians, Dr Karl Brandt, to have the child killed...

, born blind, with missing limbs, subject to convulsions, and reportedly "an idiot"— provided "the rationale for a secret Nazi decree that led to 'mercy killings' of almost 300,000 mentally and physically handicapped people". While Kretchmar's killing received parental consent, afterwards, most of the 5,000 to 8,000 killed children were forcibly taken from their parents.

Nazi Euthanasia Program (Action T4)




The "euthanasia campaign" of mass murder gathered momentum on 14 January 1940 when the "handicapped" were killed with gas vans and killing centres, eventually leading to the deaths of 70,000 adult Germans. Professor Robert Jay Lifton
Robert Jay Lifton
Robert Jay Lifton is an American psychiatrist and author, chiefly known for his studies of the psychological causes and effects of war and political violence and for his theory of thought reform...

, author of The Nazi Doctors and a leading authority on the T4 program, contrasts this program with what he considers to be a genuine euthanasia. He explains that the Nazi version of "euthanasia" was based on the work of Adolf Jost, who published The Right to Death (Das Recht auf den Tod) in 1895. Lifton writes: "Jost argued that control over the death of the individual must ultimately belong to the social organism, the state. This concept is in direct opposition to the Anglo-American concept of euthanasia, which emphasizes the individual's 'right to die' or 'right to death' or 'right to his or her own death,' as the ultimate human claim. In contrast, Jost was pointing to the state's right to kill. [...] Ultimately the argument was biological: 'The rights to death [are] the key to the fitness of life.' The state must own death—must kill—in order to keep the social organism alive and healthy."

In modern terms, the use of "euthanasia" in the context of Action T4 is seen to be a euphemism to disguise a program of genocide
Genocide
Genocide is defined as "the deliberate and systematic destruction, in whole or in part, of an ethnic, racial, religious, or national group", though what constitutes enough of a "part" to qualify as genocide has been subject to much debate by legal scholars...

, in which people were killed on the grounds "disabilities, religious beliefs, and discordant individual values". Compared to the discussions of euthanasia that emerged post-war, the Nazi program may have been worded in terms that appear similar to the modern use of the euthanasia, but there was no "mercy" and the patients were not necessarily terminally ill. Despite these differences, historian and euthanasia opponent Ian Dowbiggin
Ian Dowbiggin
Ian Robert Dowbiggin is an academic historian, a historian of medicine, a prominent commentator on Catholicism, and an opponent of euthanasia and physician-assisted suicide. He is a professor in the History department at the University of Prince Edward Island...

 writes that "the origins of Nazi euthanasia, like those of the American euthanasia movement, predate the Third Reich and were intertwined with the history of eugenics and social Darwinism, and with efforts to discredit traditional morality and ethics."

Euthanasia debate


Historically, the euthanasia debate has tended to focus on a number of key concerns. According to euthanasia opponent Ezekiel Emanuel, proponents of euthanasia have presented four main arguments: a) that people have a right to self-determination
Self-determination
Self-determination is the principle in international law that nations have the right to freely choose their sovereignty and international political status with no external compulsion or external interference...

, and thus should be allowed to choose their own fate; b) assisting a subject to die might be a better choice than requiring that they continue to suffer; c) the distinction between passive euthanasia, which is often permitted, and active euthanasia, which is not, is not substantive (or that the underlying principle–the doctrine of double effect–is unreasonable or unsound); and d) permitting euthanasia will not necessarily lead to unacceptable consequences.

Similarly, Emanuel argues that there are four major arguments presented by opponents of euthanasia: a) not all deaths are painful; b) alternatives, such as cessation of active treatment, combined with the use of effective pain relief, are available; c) the distinction between active and passive euthanasia is morally significant; and d) legalising euthanasia will place society on a slippery slope
Euthanasia and the slippery slope
Critics of euthanasia sometimes claim that legalizing any form of the practice will lead to a slippery slope effect, resulting eventually in non-voluntary or even involuntary euthanasia...

, which will lead to unacceptable consequences.

Legal status


West's Encyclopedia of American Law states that "a 'mercy killing' or euthanasia is generally considered to be a criminal homicide" and is normally used as a synonym of homicide committed at a request made by the patient.

The judicial sense of the term "homicide
Homicide
Homicide refers to the act of a human killing another human. Murder, for example, is a type of homicide. It can also describe a person who has committed such an act, though this use is rare in modern English...

" includes any intervention undertaken with the express intention of ending a life, even to relieve intractable suffering. Not all homicide is unlawful. Two designations of homicide that carry no criminal punishment are justifiable and excusable homicide. In most countries this is not the status of euthanasia. The term "euthanasia" is usually confined to the active variety; the University of Washington website states that "euthanasia generally means that the physician would act directly, for instance by giving a lethal injection, to end the patient's life". Physician-assisted suicide
Assisted suicide
Assisted suicide is the common term for actions by which an individual helps another person voluntarily bring about his or her own death. "Assistance" may mean providing one with the means to end one's own life, but may extend to other actions. It differs to euthanasia where another person ends...

 is thus not classified as euthanasia by the US State of Oregon
Oregon
Oregon is a state in the Pacific Northwest region of the United States. It is located on the Pacific coast, with Washington to the north, California to the south, Nevada on the southeast and Idaho to the east. The Columbia and Snake rivers delineate much of Oregon's northern and eastern...

, where it is legal under the Oregon Death with Dignity Act, and despite its name, it is not legally classified as suicide either. Unlike physician-assisted suicide, withholding or withdrawing life-sustaining treatments with patient consent (voluntary) is almost unanimously considered, at least in the United States, to be legal. The use of pain medication in order to relieve suffering, even if it hastens death, has been held as legal in several court decisions.

Some governments around the world have legalized voluntary euthanasia but generally it remains as a criminal homicide. In the Netherlands and Belgium, where euthanasia has been legalized, it still remains homicide although it is not prosecuted and not punishable if the perpetrator (the doctor) meets certain legal exceptions.

Physician sentiment


A survey in the United States of more than 10,000 physicians came to the result that approximately 16% of physicians would ever consider halting life-sustaining therapy because the family demands it, even if believed that it was premature. Approximately 55% would not, and for the remaining 29%, it would depend on circumstances.

This study also stated that approximately 46% of physicians agree that physician-assisted suicide should be allowed in some cases; 41% do not, and the remaining 14% think it depends.

In the United Kingdom, the pro-assisted dying group Dignity in Dying
Dignity in Dying
Dignity in Dying is a United Kingdom nationwide campaigning organisation. It is funded by voluntary contributions from members of the public, and as of December 2010, it claimed to have 25,000 actively subscribing supporters...

 cite conflicting research on attitudes by doctors to assisted dying: with a 2009 Palliative Medicine-published survey showing 64% support (to 34% oppose) for assisted dying in cases where a patient has an incurable and painful disease, while 49% of doctors in a study published in BMC Medical Ethics oppose changing the law on assisted dying to 39% in favour.

See also

  • Animal euthanasia
    Animal euthanasia
    Animal euthanasia is the act of putting to death painlessly or allowing to die, as by withholding extreme medical measures, an animal suffering from an incurable, especially a painful, disease or condition. Euthanasia methods are designed to cause minimal pain and distress...

  • Coup de grâce
    Coup de grâce
    The expression coup de grâce means a death blow intended to end the suffering of a wounded creature. The phrase can refer to the killing of civilians or soldiers, friends or enemies, with or without the consent of the sufferer...

  • Dysthanasia
    Dysthanasia
    In medicine, dysthanasia means "bad death" and is considered a common fault of modern medicine:Technologies such as an implantable cardioverter defibrillator, artificial ventilation, ventricular assist devices, and extracorporeal membrane oxygenation can extend the dying process.Dysthanasia is a...

  • Euthanasia and the slippery slope
    Euthanasia and the slippery slope
    Critics of euthanasia sometimes claim that legalizing any form of the practice will lead to a slippery slope effect, resulting eventually in non-voluntary or even involuntary euthanasia...

  • Medical law
    Medical law
    Medical law is the branch of law which concerns the prerogatives and responsibilities of medical professionals and the rights of the patient. It should not be confused with medical jurisprudence, which is a branch of medicine, rather than a branch of law....

  • Palliative sedation
  • Principle of double effect
    Principle of double effect
    The principle of double effect; also known as the rule of double effect; the doctrine of double effect, often abbreviated as DDE or PDE; double-effect reasoning; or simply double effect, is a set of ethical criteria for evaluating the permissibility of acting when one's otherwise legitimate act...

  • Terri Schiavo case
    Terri Schiavo case
    The Terri Schiavo case was a legal battle in the United States between the legal guardians and the parents of Teresa Marie "Terri" Schiavo that lasted from 1998 to 2005...


External links