Right to die
The right to die is an ethical or institutional entitlement of any individual to commit suicide or to undergo voluntary euthanasia. Possession of this right is often understood to mean that a person with a terminal illness should be allowed to commit suicide or assisted suicide or to decline life-prolonging treatment, where a disease would otherwise prolong their suffering to an identical result. The question of who, if anyone, should be empowered to make these decisions is often central to debate.
Proponents typically associate the right to die with the idea that one's body and one's life are one's own, to dispose of as one sees fit. However, a legitimate state interest in preventing irrational suicides is sometimes argued. Pilpel and Amsel write, "Contemporary proponents of ‘rational suicide’ or the ‘right to die’ usually demand by ‘rationality’ that the decision to kill oneself be both the autonomous choice of the agent (i.e., not due to the physician or the family pressuring them to ‘do the right thing’ and commit suicide) and a ‘best option under the circumstances’ choice desired by the stoics or utilitarians, as well as other natural conditions such as the choice being stable, not an impulsive decision, not due to mental illness, achieved after due deliberation, etc."
Hinduism accepts the right to die for those who are tormented by terminal diseases or those who have no desire, ambition or no responsibilities remaining; and allows death through the non-violent practice of fasting to the point of starvation (Prayopavesa). Jainism has a similar practice named Santhara. Other religious views on suicide vary in their tolerance, and include denial of the right as well as condemnation of the act. In the Catholic faith, suicide is considered a grave sin.
A debate exists within bioethics over whether the right to die is universal, only applies under certain circumstances—such as terminal illness, or if it exists at all. A court in the American state of Montana, for example, has found that the right to die applies to those with life-threatening medical conditions. Suicide advocate Ludwig Minelli, euthanasia expert Sean W. Asher and bioethics professor Jacob J. Appel, in contrast, argue that, all competent people have a right to end their own lives. Appel has suggested that the right to die is a test for the overall freedom of a given society.
The 1991 Patient Self-Determination Act passed by The Congress of the USA at the request of the financial arm of Medicare does permit elderly Medicare/Medicaid patients (and by implication, all "terminal" patients) to prepare an advanced directive in which they elect or choose to refuse life-extending and/or life-saving treatments as a means of shortening their lives to shorten their suffering unto certain death. The treatment refused in an advanced directive under US law, because of the 1991 PSDA, does not have to be proved to be "medically futile" under some existing due-process procedure developed under state laws, such as TADA in Texas.
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Most often, the idea of the right to die is related to a person's wish that caregivers allow death—for example, by not providing life support or vital medication—under certain conditions when recovery is highly unlikely or impossible. It may also refer to issues regarding physician-assisted suicide. It may be called passive euthanasia in cases where the patient is unable to make decisions about treatment. Living wills and Do Not Resuscitate orders are legal instruments that make a patient's treatment decisions known ahead of time; allowing a patient to die based on such decisions is not considered to be euthanasia. Usually these patients have also made explicit their wish to receive only palliative care to reduce pain and suffering.
Although specialized legal instruments differ from place to place, there are two more that are important in this context. The Five Wishes document allows a person to state in advance the priorities and values they wish to have honored at the end of life. And the Medical Durable Power of Attorney (or MDPOA) designates an agent to make decisions in case of incapacity, and can be used to give written guidance regarding end of life decision making. The MDPOA is generally considered to be the most powerful of all such instruments. All others may require interpretation on the part of health care providers or even court-appointed guardians; the MDPOA takes the job of interpretation out of the hands of strangers and gives it to a person selected and trusted by the individual; of course it is a personal decision.
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The Netherlands legalized voluntary euthanasia in 2001 and is one of the few countries in the world to have done so. Under current Dutch law, euthanasia by doctors is only legal in cases of "hopeless and unbearable" suffering. In practice this means that it is limited to those suffering from serious medical conditions (including mental illness) and in considerable pain. Helping somebody to commit suicide without meeting the qualifications of the current Dutch euthanasia law is illegal. These criteria concern the patient's request, the patient's suffering (unbearable and hopeless), the information provided to the patient, the presence of reasonable alternatives, consultation of another physician and the applied method of ending life.
In February 2010 a citizens' initiative called Uit Vrije Wil (Out of Free Will) further demanded that all Dutch people over 70 who feel tired of life should have the right to professional help in ending it. The organization, initiated by Milly van Stiphout and Yvonne van Baarle, started collecting signatures in support of this proposed change in Dutch legislation. A number of prominent Dutch citizens supported the initiative, including former ministers and artists, legal scholars and physicians. Among them were former politicians Frits Bolkestein, Hedy d'Ancona and Jan Terlouw, as well as television personality Mies Bouwman. But in spite of this, nobody can claim a 'right' to get professional help to die, and no professional can be forced to end the life of someone else. Moreover, there is no rationale for this 70 year age limit.
As of August 2011 a B.C. Supreme Court judge had been requested to speed up a right-to die lawsuit so that Gloria Taylor could have a doctor assist her in committing suicide. She suffered from Lou Gehrig's disease. She died of an infection in 2012.
A B.C. Civil Liberties lawsuit is representing six plaintiffs and challenges the laws that make it a criminal offence to assist seriously and incurably ill individuals to die with dignity.
On June 5, 2014 Quebec became the first Canadian province to pass right-to-die legislation. The federal government is expected to challenge this measure.
Euthanasia, where a physician or another third party administers a lethal medication, is illegal in every state. Assisted suicide, where the physician or third party gives the patient the means to end his/her own life, is legal in the states of Oregon, Washington, Montana, and Vermont. It is required in these states that the patient be of sound mind when requesting assisted suicide, as confirmed by a doctor and other witnesses, and that the patient be diagnosed with a terminal illness.
- A Pilpel, L Amsel. "What is Wrong with Rational Suicide"
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- See Washington Initiative 1000, which passed on 4 November 2008.
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- (Dutch) "Uit Vrije Wil — Burgerinitiatief voltooid leven"