Voluntary euthanasia
Encyclopedia
Voluntary euthanasia refers to the practice of ending a life in a painless manner. Voluntary euthanasia
Euthanasia
Euthanasia refers to the practice of intentionally ending a life in order to relieve pain and suffering....

 (VE) and physician-assisted suicide (PAS) have been the focus of great controversy in recent years.

As of 2009, some forms of voluntary euthanasia are legal in Belgium
Belgium
Belgium , officially the Kingdom of Belgium, is a federal state in Western Europe. It is a founding member of the European Union and hosts the EU's headquarters, and those of several other major international organisations such as NATO.Belgium is also a member of, or affiliated to, many...

, Luxembourg
Luxembourg
Luxembourg , officially the Grand Duchy of Luxembourg , is a landlocked country in western Europe, bordered by Belgium, France, and Germany. It has two principal regions: the Oesling in the North as part of the Ardennes massif, and the Gutland in the south...

, the Netherlands
Euthanasia in the Netherlands
Euthanasia in the Netherlands is regulated by the "Termination of Life on Request and Assisted Suicide Act" from 2002. It states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care...

, Switzerland
Switzerland
Switzerland name of one of the Swiss cantons. ; ; ; or ), in its full name the Swiss Confederation , is a federal republic consisting of 26 cantons, with Bern as the seat of the federal authorities. The country is situated in Western Europe,Or Central Europe depending on the definition....

, and the U.S. state
U.S. state
A U.S. state is any one of the 50 federated states of the United States of America that share sovereignty with the federal government. Because of this shared sovereignty, an American is a citizen both of the federal entity and of his or her state of domicile. Four states use the official title of...

s 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...

 and Washington.

Assisted suicide

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 where the patient actively takes the last step in their death. The term "assisted suicide" is contrasted with "active euthanasia" when the difference between providing the means and actively administering lethal medicine is considered important, though in practice, the distinction can appear very hard to draw. For example, Swiss law on assisted suicide allows assisted suicide, while all forms of active euthanasia (like lethal injection) remain prohibited.

Some jurisdictions declare that a person dying as a result of physician assisted suicide does not commit suicide. This ensures that terminally ill people choosing assisted suicide options do not have reduced insurance claims compared to people dying in "natural" way. For example, the Oregon Death with Dignity Act defines that "... participation under the Act is not suicide, so should not affect insurance benefits by that definition."

Other terminology

Voluntary refusal of food and fluids (VRFF) or Patient Refusal of Nutrition and Hydration (PRNH) is bordering on euthanasia. Some authors classify it as a form of passive euthanasia, while others treat it separately because it is treated differently from legal point of view and often perceived as a more ethical option. VRFF is sometimes suggested as a legal alternative to euthanasia in jurisdictions disallowing euthanasia.

History

The term euthanasia comes from the Greek words "eu"-meaning good and "thanatos"-meaning death, which combined means “well-death” or "dying well". 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...

 mentions euthanasia in the Hippocratic Oath
Hippocratic Oath
The Hippocratic Oath is an oath historically taken by physicians and other healthcare professionals swearing to practice medicine ethically. It is widely believed to have been written by Hippocrates, often regarded as the father of western medicine, or by one of his students. The oath is written in...

, which was written between 400 and 300 BC The original Oath states: “To please no one will I prescribe a deadly drug nor give advice which may cause his death.” Despite this, the ancient Greeks and Romans generally did not believe that life needed to be preserved at any cost and were, in consequence, tolerant of suicide in cases where no relief could be offered to the dying or, in the case of the Stoics and Epicureans, where a person no longer cared for his life.

English Common Law from the 14th century until the middle of the last century made suicide a criminal act in England and Wales. Assisting others to kill themselves remains illegal in that jurisdiction. However, in the 16th century, 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...

, considered a saint by Roman Catholics, described a utopian community
Utopia (book)
Utopia is a work of fiction by Thomas More published in 1516...

 and 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", see The meaning of the work.

Modern history

Since the 19th Century, euthanasia has sparked intermittent debates and activism in North America and Europe. According to medical historian Ezekiel Emanuel, it was the availability of anesthesia that ushered in the modern era of euthanasia. In 1828, the first known anti-euthanasia law in the United States was passed in the state of New York
New York
New York is a state in the Northeastern region of the United States. It is the nation's third most populous state. New York is bordered by New Jersey and Pennsylvania to the south, and by Connecticut, Massachusetts and Vermont to the east...

, with many other localities and states following suit over a period of several years. After the Civil War, voluntary euthanasia was promoted by advocates, including some doctors. Support peaked around the turn of the century in the US and then grew again in the 1930s.

In an article in the Bulletin of the History of Medicine
Bulletin of the History of Medicine
The Bulletin of the History of Medicine is an academic journal founded in 1939. It is the official publication of the American Association for the History of Medicine. It is also the official publication of the Johns Hopkins Institute of the History of Medicine...

, Brown University historian Jacob M. Appel documented extensive political debate over legislation to legalize physician-assisted suicide in both Iowa and Ohio in 1906. Appel indicates social activist Anna S. Hall was the driving force behind this movement. According to historian 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...

, leading public figures, including Clarence Darrow
Clarence Darrow
Clarence Seward Darrow was an American lawyer and leading member of the American Civil Liberties Union, best known for defending teenage thrill killers Leopold and Loeb in their trial for murdering 14-year-old Robert "Bobby" Franks and defending John T...

 and Jack London
Jack London
John Griffith "Jack" London was an American author, journalist, and social activist. He was a pioneer in the then-burgeoning world of commercial magazine fiction and was one of the first fiction writers to obtain worldwide celebrity and a large fortune from his fiction alone...

, advocated for the legalization of euthanasia.

Euthanasia societies were formed in England in 1935 and in the USA in 1938 to promote euthanasia. Although euthanasia legislation did not pass in the USA or England, in 1937, doctor-assisted euthanasia was declared legal in Switzerland as long as the doctor ending the life had nothing to gain. During this same era, US courts tackled cases involving critically ill people who requested physician assistance in dying as well as “mercy killings”, such as by parents of their severely disabled children.

Post-War history

During the post-war period, prominent proponents of euthanasia included Glanville Williams (The Sanctity of Life and the Criminal Law) and clergyman Joseph Fletcher
Joseph Fletcher
Joseph Fletcher was an American professor who founded the theory of situational ethics in the 1960s, and was a pioneer in the field of bioethics. Fletcher was a leading academic involved in the topics of abortion, infanticide, euthanasia, eugenics, and cloning. Ordained as an Episcopal priest, he...

 ("Morals and medicine"). By the 1960s, advocacy for a right-to-die approach to voluntary euthanasia increased.

Australia

In 1996, the world's first euthanasia legislation, the Rights of the Terminally Ill Act 1996, was passed in the Northern Territory
Northern Territory
The Northern Territory is a federal territory of Australia, occupying much of the centre of the mainland continent, as well as the central northern regions...

 of Australia
Australia
Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...

. Four patients died under the Act, using a euthanasia device
Euthanasia device
A euthanasia device is a machine engineered to allow an individual to die quickly with minimal pain. The most common devices are those designed to help terminally ill people die by voluntary euthanasia or assisted suicide without prolonged pain. They may be operated by a second party, such as a...

 designed by Dr Philip Nitschke
Philip Nitschke
Dr. Philip Nitschke is an Australian medical doctor, humanist, author and founder and director of the pro-euthanasia group Exit International. He campaigned successfully to have a legal euthanasia law passed in Australia's Northern Territory and assisted four people in ending their lives before...

. The legislation was overturned by Australia’s Federal Parliament in 1997. In response to the overturning of the Act, Dr Nitschke founded EXIT International
EXIT (Australia)
Exit International, is a pro-euthanasia group founded by Dr. Philip Nitschke. It was previously known as the Voluntary Euthanasia Research Foundation...

. In 2009, an Australian quadriplegic was granted the right to refuse sustenance and be allowed to die. The Supreme Court of Western Australia ruled that it was up to Christian Rossiter, aged 49, to decide if he was to continue to receive medical care (tube feeding) and that his carers had to abide by his wishes. Chief Justice Wayne Martin also stipulated that his carers, Brightwater Care, would not be held criminally responsible for following his instructions. Rossiter died on September 21, 2009 following a chest infection.

Europe

In 1957 in Britain
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...

, Judge Devlin
Patrick Devlin, Baron Devlin
Patrick Arthur Devlin, Baron Devlin, PC was a British lawyer, judge and jurist. He wrote a report on Britain's involvement in Nyasaland in 1959...

 ruled in the trial of Dr John Bodkin Adams
John Bodkin Adams
John Bodkin Adams was an Irish-born British general practitioner, convicted fraudster and suspected serial killer. Between the years 1946 and 1956, more than 160 of his patients died in suspicious circumstances. Of these, 132 left him money or items in their will. He was tried and acquitted for...

 that causing death through the administration of lethal drugs to a patient, if the intention is solely to alleviate pain, is not considered murder even if death is a potential or even likely outcome. In 1993, the Netherlands decriminalized doctor-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...

, and in 2002, restrictions were loosened. During that year, physician-assisted suicide was approved in Belgium
Belgium
Belgium , officially the Kingdom of Belgium, is a federal state in Western Europe. It is a founding member of the European Union and hosts the EU's headquarters, and those of several other major international organisations such as NATO.Belgium is also a member of, or affiliated to, many...

. Belgium's at the time most famous author Hugo Claus
Hugo Claus
Hugo Maurice Julien Claus was a leading Belgian author who published under his own name as well as various pseudonyms. Claus' literary contributions spanned the genres of drama, the novel, and poetry; he also left a legacy as a painter and film director...

, suffering from Alzheimer's disease
Alzheimer's disease
Alzheimer's disease also known in medical literature as Alzheimer disease is the most common form of dementia. There is no cure for the disease, which worsens as it progresses, and eventually leads to death...

, was among those that asked for euthanasia. He died in March 2008, assisted by an Antwerp doctor.

United States

A key turning point in the debate over voluntary euthanasia (and physician assisted dying), at least in the United States, was the public furor over the case of Karen Ann Quinlan
Karen Ann Quinlan
Karen Ann Quinlan was an important figure in the history of the right to die controversy in the United States....

. The Quinlan case paved the way for legal protection of voluntary passive euthanasia. In 1977, California legalized living wills and other states soon followed suit.

In 1980 the Hemlock Society USA was founded in Santa Monica by Derek Humphry
Derek Humphry
Derek Humphry is a British-born American journalist, author and principal founder in 1980 of the Hemlock Society USA and past president of the World Federation of Right to Die Societies, both of which support the notion of decriminalisation of voluntary euthanasia...

. It was the first group in America to provide information to the terminally ill in case they wanted a hastened death. Hemlock also campaigned and partially financed drives to reform the law. In 2003 Hemlock was merged with End of Life Choices, which changed its name to Compassion and Choices.

In 1990, Dr. Jack Kevorkian
Jack Kevorkian
Jacob "Jack" Kevorkian , commonly known as "Dr. Death", was an American pathologist, euthanasia activist, painter, composer and instrumentalist. He is best known for publicly championing a terminal patient's right to die via physician-assisted suicide; he said he assisted at least 130 patients to...

, a Michigan physician, became infamous for educating and assisting people in committing physician-assisted suicide, which resulted in a Michigan law against the practice in 1992. Kevorkian was tried and convicted in 1999 for a murder displayed on television. Also in 1990, the Supreme Court approved the use of non-active euthanasia.

In 1994, Oregon voters approved the Death with Dignity Act, permitting doctors to assist terminal patients with six months or less to live to end their lives. The U.S. Supreme Court allowed such laws in 1997. The Bush administration failed in its attempt to use drug law to stop Oregon in 2001, in the case Gonzales v. Oregon
Gonzales v. Oregon
Gonzales v. Oregon, 546 U.S. 243 , was a decision by the United States Supreme Court, which ruled that the United States Attorney General could not enforce the federal Controlled Substances Act against physicians who prescribed drugs, in compliance with Oregon state law, for the assisted suicide of...

.

Most recently, amid U.S. government roadblocks and controversy in the 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...

, where a Floridian who was in a vegetative state since 1990, had her feeding tube removed in 2005. Her husband had won the right to take her off life support, which he claimed she would want but was difficult to confirm as she had no living will
Living will
An advance health care directive, also known as living will, personal directive, advance directive, or advance decision, are instructions given by individuals specifying what actions should be taken for their health in the event that they are no longer able to make decisions due to illness or...

 and the rest of her family claimed otherwise.

In November 2008, Washington Initiative 1000 made Washington the second U.S. state to legalize physician-assisted suicide.

China and Hong Kong

While active euthanasia remains illegal in China, it is gaining increasing acceptance among doctors and the general populace.

In Hong Kong, support for euthanasia among the general public is higher among those who put less importance on religious belief, those who are non-Christian, those who have higher family incomes, those who have more experience in taking care of terminally ill family members, and those who are older.

Arguments for and against voluntary euthanasia

Since World War II
World War II
World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...

, the debate over euthanasia in Western countries has centered on voluntary euthanasia within regulated health care systems. In some cases, judicial decisions, legislation, and regulations have made voluntary euthanasia an explicit option for patients and their guardians. Proponents and critics of such voluntary euthanasia policies offer the following reasons for and against official voluntary euthanasia policies:

Reasons given for voluntary euthanasia

  • Choice: Proponents of voluntary euthanasia emphasize that choice is a fundamental principle for liberal democracies and free market systems.
  • Quality of Life: The pain and suffering a person feels during a disease, even with pain relievers, can be incomprehensible to a person who has not gone through it. Even without considering the physical pain, it is often difficult for patients to overcome the emotional pain of losing their independence.
  • Opinion of Witnesses: Those who witness others die are "particularly convinced" that the law should be changed to allow assisted death.
  • Economic costs and human resources: Today in many countries there is a shortage of hospital space. The energy of doctors and hospital beds could be used for people whose lives could be saved instead of continuing the life of those who want to die which increases the general quality of care and shortens hospital waiting lists. It is a burden to keep people alive past the point they can contribute to society, especially if the resources used could be spent on a curable ailment.

Reasons given against voluntary euthanasia

  • Professional role: Critics argue that voluntary euthanasia could unduly compromise the professional roles of health care employees, especially doctors. They point out that European physicians of previous centuries traditionally swore some variation of the Hippocratic Oath
    Hippocratic Oath
    The Hippocratic Oath is an oath historically taken by physicians and other healthcare professionals swearing to practice medicine ethically. It is widely believed to have been written by Hippocrates, often regarded as the father of western medicine, or by one of his students. The oath is written in...

    , which in its ancient form excluded euthanasia: "To please no one will I prescribe a deadly drug nor give advice which may cause his death.." However, since the 1970s, this oath has largely fallen out of use.
  • Moral/Theological: Some people, including many Christians, consider euthanasia of some or all types to be morally unacceptable. This view usually treats euthanasia to be a type of murder
    Murder
    Murder is the unlawful killing, with malice aforethought, of another human being, and generally this state of mind distinguishes murder from other forms of unlawful homicide...

     and voluntary euthanasia as a type of suicide
    Suicide
    Suicide is the act of intentionally causing one's own death. Suicide is often committed out of despair or attributed to some underlying mental disorder, such as depression, bipolar disorder, schizophrenia, alcoholism, or drug abuse...

    , the morality of which is the subject of active debate.
  • Necessity: If there is some reason to believe the cause of a patient's illness or suffering is or will soon be curable, the correct action is sometimes considered to attempt to bring about a cure or engage in palliative care.
  • Feasibility of implementation: Euthanasia can only be considered "voluntary" if a patient is mentally competent to make the decision, i.e., has a rational understanding of options and consequences. Competence
    Competence (law)
    In American law, competence concerns the mental capacity of an individual to participate in legal proceedings. Defendants that do not possess sufficient "competence" are usually excluded from criminal prosecution, while witnesses found not to possess requisite competence cannot testify...

     can be difficult to determine or even define.
  • Consent under pressure: Given the economic grounds for voluntary euthanasia, critics of voluntary euthanasia are concerned that patients may experience psychological pressure to consent to voluntary euthanasia rather than be a financial burden on their families. Even where health costs are mostly covered by public money, as in various European countries, voluntary euthanasia critics are concerned that hospital personnel would have an economic incentive to advise or pressure people toward euthanasia consent.

Slippery Slope

Non-voluntary euthanasia is sometimes cited as one of the possible outcomes of the slippery slope
Slippery slope
In debate or rhetoric, a slippery slope is a classic form of argument, arguably an informal fallacy...

 argument, in which it is claimed that permitting voluntary euthanasia to occur will lead to the support and legalization of non-voluntary and involuntary euthanasia
Involuntary euthanasia
Non-voluntary euthanasia is euthanasia conducted where the explicit consent of the individual concerned is unavailable...

.

Medical Ethics on Euthanasia

Euthanasia brings about many ethical issues regarding a patient’s death. Some physicians say euthanasia is a rational choice for competent patients who wish to die to escape unbearable suffering. Others feel that aiding in the patient’s death goes against a physician’s duty to preserve life.

For voluntary euthanasia In America

Physicians who are in favor of euthanasia state that to keep euthanasia or physician-assisted suicide (PAS) illegal is a violation of patient freedoms. They believe that any competent terminally-ill patient should have the right to choose death or refuse life-saving treatment. The U.S. Constitution does not state that the government can keep a person from committing suicide and if PAS was a right, patients could die with dignity and leave others with a positive memory and not what they had become. Suicide and assistance from their physician is seen as the only option those patients have. By allowing PAS and euthanasia, the patient can say their final goodbyes to their loved ones and leave the world by choice. With the suffering and the knowledge from the doctor, this may also suggest that PAS is a humane answer to the excruciating pain.

Not only will PAS and euthanasia help with psychological suffering and give autonomy to the patient, PAS can help reduce health care costs and free up doctors and nurses. By keeping a terminally-ill patient alive, the patient must pay for any medical necessary procedures. These procedures can include x-rays, prescribed drugs, or any lab tests that needs to be performed. All of these procedures can run up a medical costs. Since the bills will continue to come for the patient, they will lose more of the money they would want to leave behind for their family. If the patient wants to end the suffering, the reason for racking up the bills and keeping the patient alive are lacking (13). Also, the costly treatment to keep the terminally-ill patient alive from medical funding cannot be used for other types of care, like prenatal, where it would save lives and improve long-term quality of life. Along with reduced health care costs, more doctors and nurses could be freed up. A shortage of medical staff is a critical problem hospitals face and studies have found that understaffed hospitals make many mistakes and provide less quality care. Attending to terminally-ill patients, who would rather die, is not the best use of the medical staff. If PAS and euthanasia were legalized, more staff would have time to care for others and there would be an increase in the quality of care administered.

Physician-assisted suicide and euthanasia can lower health care costs, free up doctors and nurses, and give back the right to the patient to practice autonomy. By keeping PAS and euthanasia illegal, each terminally-ill patient is being discriminated against because they are not able put this option into action. Those patients because of their disability do not have the same right as any other person in the United States.

Against voluntary euthanasia

Many physicians and medical staff have numerous reasons for prohibiting the legalization of PAS and euthanasia. A main argument against PAS is the violation of the Hippocratic oath that some doctors take. The Hippocratic oath states “I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan,”. By being a part of PAS and prescribing a lethal dosage of a drug could weaken the doctor-patient relationship
Doctor-patient relationship
The doctor-patient relationship is central to the practice of healthcare and is essential for the delivery of high-quality health care in the diagnosis and treatment of disease. The doctor-patient relationship forms one of the foundations of contemporary medical ethics...

 because of the oath some doctors take (13).

Another reason for prohibiting PAS and euthanasia is the option of abusing PAS if it were to become legal. Poor or uninsured patients may not have the money or no access to proper care will have limited options, and they could be pressured towards assisted death. For emotionally and physiologically disturbed patients, they could abuse the PAS option and those patients could convince their doctor to help end their life. By keeping PAS and euthanasia illegal, doctors have opportunity to right their wrong diagnoses and prevent leaning towards suicide of a redeemable person (13), there are cases where patients who are not terminally ill are mistakenly admitted into hospices and such patients could become subject to euthanasia.
By having more time with the terminally-ill patient, the doctor is giving them constant care and medical attention. Many people believe that the unbearable pain can be controlled to tolerable levels if given proper care from the hospital staff.

Voluntary euthanasia and the Law

During the 20th Century, efforts to change government policies on euthanasia have met limited success in Western countries. Country policies are described here
Euthanasia and the Law
Efforts to change government policies on euthanasia in the 20th century have met limited success in Western countries. Euthanasia policies have also been developed by a variety of NGOs, most notably medical associations and advocacy organizations. As of 2011, active euthanasia is only legal in the...

 in alphabetical order, followed by the exceptional case of the Netherlands
Euthanasia in the Netherlands
Euthanasia in the Netherlands is regulated by the "Termination of Life on Request and Assisted Suicide Act" from 2002. It states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care...

. Euthanasia policies have also been developed by a variety of NGOs, most notably medical associations and advocacy organizations.

Voluntary euthanasia and religion

There are many different religious views among on the issue of voluntary euthanasia, although many moral theologians are critical of the procedure.

Euthanasia protocols

Euthanasia can be accomplished either through an oral, intravenous, or intramuscular administration of drugs, or by oxygen deprivation (anoxia
Hypoxia (medical)
Hypoxia, or hypoxiation, is a pathological condition in which the body as a whole or a region of the body is deprived of adequate oxygen supply. Variations in arterial oxygen concentrations can be part of the normal physiology, for example, during strenuous physical exercise...

), as in some euthanasia machines. In individuals who are incapable of swallowing lethal doses of medication, an intravenous route is preferred. The following is a Dutch protocol for parenteral (intravenous) administration to obtain euthanasia:

Intravenous administration is the most reliable and rapid way to accomplish euthanasia. A coma is first induced by intravenous administration of 20 mg/kg sodium thiopental
Sodium thiopental
Sodium thiopental, better known as Sodium Pentothal , thiopental, thiopentone sodium, or Trapanal , is a rapid-onset short-acting barbiturate general anaesthetic...

 (Nesdonal) in a small volume (10 ml physiological saline). Then a triple intravenous dose of a non-depolarizing neuromuscular muscle relaxant
Muscle relaxant
A muscle relaxant is a drug which affects skeletal muscle function and decreases the muscle tone. It may be used to alleviate symptoms such as muscle spasms, pain, and hyperreflexia. The term "muscle relaxant" is used to refer to two major therapeutic groups: neuromuscular blockers and spasmolytics...

 is given, such as 20 mg pancuronium bromide (Pavulon) or 20 mg vecuronium bromide (Norcuron). The muscle relaxant should preferably be given intravenously, in order to ensure optimal availability. Only for pancuronium bromide (Pavulon) are there substantial indications that the agent may also be given intramuscularly in a dosage of 40 mg.

With regards to voluntary euthanasia, many people argue that 'equal access' should apply to access to suicide as well, so therefore disabled people who cannot kill themselves should have access to voluntary euthanasia.

Literature

Apart from The Old Law
The Old Law
The Old Law, or A New Way to Please You is a seventeenth-century tragicomedy written by Thomas Middleton, William Rowley, and Philip Massinger...

, a 17th century tragicomedy
Tragicomedy
Tragicomedy is fictional work that blends aspects of the genres of tragedy and comedy. In English literature, from Shakespeare's time to the nineteenth century, tragicomedy referred to a serious play with either a happy ending or enough jokes throughout the play to lighten the mood.-Classical...

 written by Thomas Middleton
Thomas Middleton
Thomas Middleton was an English Jacobean playwright and poet. Middleton stands with John Fletcher and Ben Jonson as among the most successful and prolific of playwrights who wrote their best plays during the Jacobean period. He was one of the few Renaissance dramatists to achieve equal success in...

, William Rowley
William Rowley
William Rowley was an English Jacobean dramatist, best known for works written in collaboration with more successful writers. His date of birth is estimated to have been c. 1585; he was buried on 11 February 1626...

, and Philip Massinger
Philip Massinger
Philip Massinger was an English dramatist. His finely plotted plays, including A New Way to Pay Old Debts, The City Madam and The Roman Actor, are noted for their satire and realism, and their political and social themes.-Early life:The son of Arthur Massinger or Messenger, he was baptized at St....

, one of the early books to deal with euthanasia in a fictional context is Anthony Trollope
Anthony Trollope
Anthony Trollope was one of the most successful, prolific and respected English novelists of the Victorian era. Some of his best-loved works, collectively known as the Chronicles of Barsetshire, revolve around the imaginary county of Barsetshire...

's 1882 dystopia
Dystopia
A dystopia is the idea of a society in a repressive and controlled state, often under the guise of being utopian, as characterized in books like Brave New World and Nineteen Eighty-Four...

n novel, The Fixed Period
The Fixed Period
The Fixed Period is a satirical dystopian novel by Anthony Trollope.-Introduction:It was first published in six instalments in Blackwood's Magazine in 1881-82 and in book form in 1882. In the same year there also appeared U.S. and Tauchnitz editions of the novel. There were no further editions...

. Ricarda Huch
Ricarda Huch
Ricarda Huch was a pioneering German intellectual. Trained as a historian, and the author of many works of European history, she also wrote novels, poems, and a play. Asteroid 879 Ricarda is named in her honour.- Life :...

's novel The Deruga Case
The Deruga Case
Der Fall Deruga is a novel by Ricarda Huch first published in German in 1917 about a physician charged with killing his ex-wife...

(1917) is about a physician who is acquitted after performing euthanasia on his dying ex-wife.

'Quality of Mercy' in The Prosecution Rests is a fable exploring the facets of aging, Alzheimer's disease
Alzheimer's disease
Alzheimer's disease also known in medical literature as Alzheimer disease is the most common form of dementia. There is no cure for the disease, which worsens as it progresses, and eventually leads to death...

, and euthanasia. The story line makes no judgment but frees the reader to decide.

In the book The Giver
The Giver
The Giver is a 1993 soft science fiction novel by Lois Lowry. It is set in a society which is at first presented as a utopian society and gradually appears more and more dystopian. The novel follows a boy named Jonas through the twelfth year of his life...

, euthanasia is used as a form of punishment.

Film

The films Children of Men
Children of Men
Children of Men is a 2006 science fiction film loosely adapted from P. D. James's 1992 novel The Children of Men, directed by Alfonso Cuarón. In 2027, two decades of human infertility have left society on the brink of collapse. Illegal immigrants seek sanctuary in England, where the last...

and Soylent Green
Soylent Green
Soylent Green is a 1973 American science fiction film directed by Richard Fleischer. Starring Charlton Heston, the film overlays the police procedural and science fiction genres as it depicts the investigation into the murder of a wealthy businessman in a dystopian future suffering from pollution,...

depict instances of government-sponsored euthanasia in order to strengthen their dystopian themes. The protagonist of the film Johnny Got His Gun
Johnny Got His Gun
Johnny Got His Gun is an anti-war novel written in 1938 by American novelist and screenwriter Dalton Trumboand published by J. B. Lippincott company.-Plot:...

is a brutally mutilated war veteran whose request for euthanasia furthers the work's anti-war message. The recent films Mar Adentro
Mar adentro
The Sea Inside is a 2004 film by the Spanish director Alejandro Amenábar. It is based on the real-life story of Ramón Sampedro , a Spanish ship mechanic left quadriplegic after a diving accident and his 29-year campaign in support of euthanasia and the right to end his life.- Plot summary :This is...

and Million Dollar Baby
Million Dollar Baby
Million Dollar Baby is a 2004 American sports drama film directed, co-produced, and scored by Clint Eastwood and starring Eastwood, Hilary Swank, and Morgan Freeman...

argue more directly in favor of euthanasia by illustrating the suffering of their protagonists. These films have provoked debate and controversy in their home countries of Spain and the United States respectively.

Media

In March 2010, the PBS FRONTLINE TV program in the United States showed a documentary called "The Suicide Tourist" which told the story of Professor Craig Ewert, his family, and the Swiss group Dignitas
Dignitas (euthanasia group)
Dignitas is a Swiss assisted dying group that helps those with terminal illness and severe physical and mental illnesses to die assisted by qualified doctors and nurses...

, and their decision to commit assisted suicide in Switzerland after he was diagnosed and suffering with ALS
Amyotrophic lateral sclerosis
Amyotrophic lateral sclerosis , also referred to as Lou Gehrig's disease, is a form of motor neuron disease caused by the degeneration of upper and lower neurons, located in the ventral horn of the spinal cord and the cortical neurons that provide their efferent input...

 (Lou Gehrig's Disease).

Music

Thrash metal band Megadeth
Megadeth
Megadeth is an American heavy metal band from Los Angeles, California which was formed in 1983 by guitarist/vocalist Dave Mustaine, bassist Dave Ellefson and guitarist Greg Handevidt, following Mustaine's expulsion from Metallica. The band has since released 13 studio albums, three live albums, two...

's 1994 album Youthanasia
Youthanasia
Youthanasia is the sixth studio album by American heavy metal band Megadeth, released on November 1, 1994 through Capitol Records. A remixed and remastered version, featuring several bonus tracks, was released in 2004....

(the title is a pun on euthanasia) implies that society is euthanizing its youth.

See also

  • Arthur Koestler
    Arthur Koestler
    Arthur Koestler CBE was a Hungarian author and journalist. Koestler was born in Budapest and, apart from his early school years, was educated in Austria...

    , author, vice-president of EXIT (now the Voluntary Euthanasia Society).
  • Bertrand Dawson, 1st Viscount Dawson of Penn
    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:...

     - physician to 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....

    , to whom he gave a lethal injection.
  • Chantal Sébire
    Chantal Sébire
    Chantal Sébire was a retired French teacher who suffered from esthesioneuroblastoma, a rare form of cancer, and fought for the right to die through euthanasia.-Background:...

  • George Exoo
    George Exoo
    George Exoo is an Ohio-born former Unitarian Universalist minister and assisted suicide activist. He was originally a Methodist and has a doctorate in music history from University of California, Berkeley...

  • Derek Humphry
    Derek Humphry
    Derek Humphry is a British-born American journalist, author and principal founder in 1980 of the Hemlock Society USA and past president of the World Federation of Right to Die Societies, both of which support the notion of decriminalisation of voluntary euthanasia...

     - Founder of the Hemlock Society
    Hemlock Society
    The Hemlock Society USA was a national right-to-die organization founded in Santa Monica, California by Derek Humphry in 1980. Its primary missions included providing information to dying persons and supporting legislation permitting physician-assisted suicide. In 1992, following the publication of...

    , President of ERGO, past-president of the World Federation of Right to Die Societies
    World Federation of Right to Die Societies
    The World Federation of Right to Die Societies is an international federation of associations that promote access to voluntary euthanasia.It is made up of 46 associations from 27 countries. It holds regular international meetings on dying and death....

     and author of Final Exit
    Final Exit
    Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying is a controversial 1992 book by Derek Humphry, founder of the Hemlock Society in California and past president of the World Federation of Right to Die Societies....

    .
  • Diane Pretty
    Diane Pretty
    Diane Pretty was a British woman from Luton who became notable after being the focus of a debate about the laws of euthanasia in United Kingdom during the early part of the 21st century...

  • Dignitas
    Dignitas (euthanasia group)
    Dignitas is a Swiss assisted dying group that helps those with terminal illness and severe physical and mental illnesses to die assisted by qualified doctors and nurses...

     (euthanasia group in Switzerland)
  • Dr. Death
    Dr. Death
    Dr. Death may refer to:People:*Aribert Heim, Austrian doctor and one of the world's most wanted Nazi war criminals*Josef Mengele, German doctor and also an infamous Nazi war criminal, also known as the "Angel of Death"...

      (book by Jonathon Kellerman)
  • Euthanasia machine, a DIY option for individuals
  • Euthanasia: Opposing Viewpoints (2000)
    Euthanasia: Opposing Viewpoints (2000)
    Euthanasia: Opposing Viewpoints is a book, in the Opposing Viewpoints series.It presents selections of contrasting points of view on four central questions about euthanasia: whether it is ethical; whether it should be legalized; whether legalizing it would lead to involuntary killing; and whether...

    , listing key sources in an anthology
  • Final Exit
    Final Exit
    Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying is a controversial 1992 book by Derek Humphry, founder of the Hemlock Society in California and past president of the World Federation of Right to Die Societies....

     (book)
  • Futile medical care
    Futile medical care
    Futile medical care refers to the belief that in cases where there is no hope for improvement of an incapacitating condition that no course of treatment is called for. It is distinct from the idea of euthanasia because euthanasia involves active intervention to end life, while withholding futile...

  • International Task Force on Euthanasia and Assisted Suicide
    International Task Force on Euthanasia and Assisted Suicide
    The International Task Force on Euthanasia and Assisted Suicide is a 501 non-profit educational organization that concerns itself with the issues of euthanasia, doctor-prescribed suicide, advance directives, assisted suicide proposals, "right-to-die" cases, disability rights, pain control, and...

  • Jack Kevorkian
    Jack Kevorkian
    Jacob "Jack" Kevorkian , commonly known as "Dr. Death", was an American pathologist, euthanasia activist, painter, composer and instrumentalist. He is best known for publicly championing a terminal patient's right to die via physician-assisted suicide; he said he assisted at least 130 patients to...

  • John Bodkin Adams
    John Bodkin Adams
    John Bodkin Adams was an Irish-born British general practitioner, convicted fraudster and suspected serial killer. Between the years 1946 and 1956, more than 160 of his patients died in suspicious circumstances. Of these, 132 left him money or items in their will. He was tried and acquitted for...

    , Eastbourne
    Eastbourne
    Eastbourne is a large town and borough in East Sussex, on the south coast of England between Brighton and Hastings. The town is situated at the eastern end of the chalk South Downs alongside the high cliff at Beachy Head...

    , 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...

     doctor, tried for murder in 1957 but claimed euthanasia. Acquitted.
  • Kaishakunin
    Kaishakunin
    A kaishakunin is an appointed second whose duty is to behead one who has committed seppuku, Japanese ritual suicide, at the moment of agony...

     - Assists in the Japanese ritual seppuku
    Seppuku
    is a form of Japanese ritual suicide by disembowelment. Seppuku was originally reserved only for samurai. Part of the samurai bushido honor code, seppuku was either used voluntarily by samurai to die with honor rather than fall into the hands of their enemies , or as a form of capital punishment...

     (suicide)
  • Karen Ann Quinlan
    Karen Ann Quinlan
    Karen Ann Quinlan was an important figure in the history of the right to die controversy in the United States....

     and 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...

     - Cases of persistent vegetative state
    Persistent vegetative state
    A persistent vegetative state is a disorder of consciousness in which patients with severe brain damage are in a state of partial arousal rather than true awareness. It is a diagnosis of some uncertainty in that it deals with a syndrome. After four weeks in a vegetative state , the patient is...

  • 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:*...

     - Founder of the Voluntary Euthanasia Legalisation Society in Great Britain
  • Peter Singer
    Peter Singer
    Peter Albert David Singer is an Australian philosopher who is the Ira W. DeCamp Professor of Bioethics at Princeton University and Laureate Professor at the Centre for Applied Philosophy and Public Ethics at the University of Melbourne...

     - bioethicist, utilitarian
  • Philip Nitschke
    Philip Nitschke
    Dr. Philip Nitschke is an Australian medical doctor, humanist, author and founder and director of the pro-euthanasia group Exit International. He campaigned successfully to have a legal euthanasia law passed in Australia's Northern Territory and assisted four people in ending their lives before...

  • 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...

  • Senicide
    Senicide
    Senicide or geronticide is the abandonment to death, suicide or killing of the elderly.- History :Societal views and legal repercussions have varied greatly in regards to senicide....

  • Suicide tourism
    Suicide tourism
    Suicide tourism is a form of tourism associated with the pro-euthanasia movement which organizes trips for potential suicide candidates in the few places where euthanasia is tolerated, in the hopes of encouraging the decriminalization of the practice in many parts of the world.-Cambodia:An...

  • Terminal sedation
    Terminal sedation
    In medicine, specifically in end-of-life care, palliative sedation is the palliative practice of relieving distress in a terminally ill person in the last hours or days of a dying patient's life, usually by means of a continuous...

  • Terry Wallis
    Terry Wallis
    Terry Wallis is an American man living in the Ozark Mountains of Arkansas who on June 11, 2003 regained awareness after spending almost 20 years in a minimally conscious state....


External links

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