2 Arguments for and against euthanasia

Proponents of euthanasia argue that only patients can determine when suffering makes life worse than death and that such persons can and should be allowed to make the decision. Some also argue that terminally ill patients are respected more by having their suffering end than by being kept alive against their will. Additionally, a utilitarian argument can be made about the harms to the whole of maintaining the individual beyond viability. Philosopher Peter Singer has been one of the most outspoken proponents of euthanasia, arguing from a utilitarian philosophical point of view.

Arguments from opponents of euthanasia can be divided in two main categories: religious and prudential.

Many religious people, primarily Christians, object that it is not loving to kill someone, and that pain medications are good enough that suffering is preventable if doctors have the will. Many religions also regard one's life as being derived from God and thus that either it is His (not one's own) to take, or that destroying it is an offense to Him. Further, in most Western nations the prohibition on killing is considered a moral absolute that cannot be conditioned by ethical concerns.

The second type of argument against euthanasia is that it is not prudent to advocate it; that is, eventually we all may be suffering, and if we think ahead, we may think it better if the doctors on whom we depend are not tempted to perform euthanasia. Euthanasia is inherently less complex than palliative care, and training for euthanasia does not qualify a physician to estimate a patient's response to palliation. Like all medical procedures, euthanasia can fail, or bring additional suffering. Some claim that if euthanasia were allowed, doctors might press people into euthanasia to reduce medical costs, or because their family wants them to die. (Many people believe that saving medical costs is a coercive argument that should disqualify a person from giving free consent.) Many doctors argue against euthanasia, as providing death is antithetical to their primary function and training. If, some have argued, a doctor is trained both to cure and kill, then he or she is being told always to judge when to kill and his or her best efforts at saving life will not be expended.

3 Legislation and national political movements

3.1 Australia

Euthanasia was legalised in Australia's Northern Territory, by the Rights of the Terminally Ill Act 1995. However, this law was soon made ineffective by an amendment by the Commonwealth government to the Northern Territory (Self-Government) Act 1978. (The powers of the Northern Territory legislature, unlike those of the State legislatures, are not guaranteed by the Australian Constitution.) Three people had already been legally euthanised, however, before the Commonwealth government made this amendment. ...

3.2 Belgium

After an extensive discussion the Belgian parliament legalised euthanasia in late September 2002. The new legislation, however, institutes a complicated process, which has been criticized as an attempt to establish a bureaucracy of death. Nevertheless, euthanasia is now legal and its proponents in the country hope that it will stop many illegal practises (it is said that several thousand illegal acts of euthanasia have been carried out in Belgium each year). ( disputed — see talk page)

3.3 The Netherlands

In The Netherlands the Termination of Life on Request and Assisted Suicide (Review Procedures) Act, legalizing euthanasia and PAS in certain circumstances, took effect on April 1, 2002.

The law permits euthanasia and PAS when each of the following conditions is fulfilled:

• the patient has asked repeatedly
• the patient's suffering is unbearable with no prospect of improvement
• the doctor has prior to the act consulted a colleague.

The doctor must also report the cause of death to the municipal coroner in accordance with the relevant provisions of the Burial and Cremation Act. A regional review committee assesses whether a case of termination of life on request or assisted suicide complies with the due care criteria. Depending on its findings, the case will either be closed or brought to the attention of the Public Prosecutor. Finally, the legislation offers an explicit recognition of the validity of a written declaration of will of the patient regarding euthanasia (a "euthanasia directive"). Such declarations can be used when a patient is in coma or otherwise unable to state whether they want euthanasia or not.

Euthanasia remains a criminal offense in cases not meeting the law's specific conditions, with the exception of several situations that are not subject to the restrictions of the law at all, because they are considered normal medical practice:

• stopping or not starting a medically useless treatment
• at the patient's request stopping or not starting a treatment
• speeding up death as side-effect of treatment necessary for alleviating serious suffering

From the time that euthanasia first came to be widely practiced in the Netherlands, it was formally subject to review by boards of doctors in each hospital. The law essentially codified what had already become unofficial law by judgments in the courts.

The legislation has wide support among the socially libertarian Dutch, who have one of the world's highest life expectancies.

3.3.1 Statistics and methods

In 2003, in the Netherlands 1626 cases were reported of euthanasia in the sense of a physician causing death. Usually the sedative sodium thiopental is intravenously administered to induce a coma, and after making sure the patient is in a deep coma, typically after some minutes, a muscle relaxant is administered to stop the breathing and cause death.

Officials report 148 cases of PAS, usually by drinking a strong barbiturate potion. The doctor is required to be present for two reasons:

• to make sure the potion is not taken by a different person, by accident (or, theoretically, for "unauthorized" suicide or perhaps even murder)
• to monitor the process and be available to apply the combined procedure mentioned below, if necessary.

In two cases the doctor was reprimanded for not being present while the patient drank the potion. They did not realize that this is required.

Forty-one cases were reported to combine the two procedures: usually in these cases the patient drinks the potion, but this does not cause death. After a few hours, or earlier in the case of vomiting, the muscle relaxant is administered to cause death.

By far, most reported cases concerned cancer patients. Also, in most cases the procedure was applied at home.

Note that some medical authorities and investigative reporters claim there are substantial numbers of euthanasias in the Netherlands performed without consultation or official notice. (See links below)

3.4 United States

In the United States, the most common form of euthanasia is withholding tube-feeding to elderly and incapacitated patients. This is generally considered an abuse when the patient might recover. These patients die protracted deaths by dehydration. However, it is so common in some areas that the family must actively prevent it, or it will occur. ( disputed — see talk page)

Contrary to the rest of the United States, Oregon has legalized assisted suicide: residents have voted for it at the Oregon Ballot Measure 16 (1994), and voted against repealing it at the Oregon Ballot Measure 51 (1997). As of 2002, it is estimated that nearly 100 terminally ill patients have committed doctor assisted suicide since the law went into effect in 1997. It is difficult to determine accurate figures, since doctors are not required by law to report when they have granted the patient's request. Oregon's law has been attacked by various organizations, and federal government parties that support those organizations, ever since it was first enacted.

4 See also

• Jack Kevorkian, Sue Rodriguez, Edward Brongersma
• Infanticide
• Oregon's Death with Dignity Act
• Lethal injection
• Medical ethics, Hippocratic Oath
• T-4 Euthanasia Program

5 External links

• For:
• http://www.euthanasia.com/
• World Federation of Right To Die Societies
• Assisted Suicide
• Against:
• National Right to Life articles on euthanasia
• International Task Force against Euthanasia- many resources

• Netherlands:
  • Official:
  • Ministry of Justice brochure on euthanasia and PAS (PDF)
  • Ministry of Health on euthanasia and PAS
  • Joint annual report 2002 of the Regional Euthanasia Review Conmmittees (PDF) (that of 2003 is not yet available in English)
  • For:
  • Right to Die-NL - Dutch union for voluntary termination of life NVVE
  • NRC Handelblad April 14, 2001 interview of Eli Borst: Transparency in Euthanasia- Note that this is from an anti-euthanasia web site, but claims to be merely a translation of a Dutch article. Eli Borst is a prominent Dutch advocate of Euthanasia.
  • Against:
  • Clinical Problems with the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands, NEJM, February 24, 2000
  • Consultants or Facilitators? Medical Journal of Australia, 1999 Editorial- Cites original research, including that on alternative palliative care
  • Wall Street Journal Article on Dutch Euthanasia The article claims that unofficial Euthanasia is performed on as many as sixteen adults per day (90% of adult physician-assisted deaths), and 8% of all infants, often without patient consultation, according to Dutch statistics. This source claims that many old Dutch people are afraid to go to the hospital.
  • Weekly Standard Article Claiming Unauthorized Euthanasia of Dutch Infants
  • December 18, 2000 National Review Opinion, Wesley Smith- Cites statistics showing frquent involuntary phsyician-assisted deaths in the Netherlands.
• Oregon:
  • Oregon's Death with Dignity Act (State Website)

Medicine Death Core issues in ethics

<Hide>