Euthanasia

For the Megadeth album, see Youthanasia.

A euthanasia machine.

Euthanasia (from Greek: ευθανασία - ευ "good", θανατος "death") refers to assisted dying. The assistance ends the life of a person or an animal in a painless or minimally painful way. Euthanasia is most often performed in a merciful way, in order to end suffering. For non-human mercy killings see animal euthanasia.

The terminology and its implications

Euthanasia as a topic is often highly-charged—emotionally, politically, and morally. Terminology and laws shift over time, geographically and globally, causing a great deal of confusion. In politically and emotionally loaded terms, this is frequently and incorrectly referred to as physician-assisted suicide.

There is some debate as to whether euthanasia refers to "letting die" or "allowing to die." In the United States and the Netherlands, "letting die" or "allowing to die" refer to areas which the state consider ethically and legally acceptable and permissible. This includes the withholding and withdrawing of medical treatment such as dialysis, feeding tubes or hydration and nutrition when they no longer prolong the life of the dying person. Sometimes, as a body's major organ systems shut down, a dying person may feel most comfortable without any fluids or food. To provide fluids and nutrition in this situation is like "force feeding" a body that does not "want" or need to be fed or hydrated, and doing so may actually cause physical discomfort and suffering. This is a different situation than when the person is not dying, and whose body can absorb nutrition and fluids.

In most other countries removing or denying treatment is usually seen as murder. In a growing number of law cases over the last 20 years, the jury has usually sided with the defendant.

Following are several summary statements defining what euthanasia can include. These are followed by expanded definitions of each. Euthanasia (assisted dying) may employ methods that are either indirect or direct. Indirect methods of euthanasia are defined by an individual him or herself taking the final step inducing death. Direct methods are defined by the involvement of others (clinicians) who take the final step inducing death. Direct euthanasia can either be voluntary, nonvoluntary or involuntary. (See Karl Binding and Alfred Hoche for one of the first uses of the three types of euthanasia.)

Indirect euthanasia means the involvement of a clinician (e.g. physician, clinical nurse practitioner, pharmacist) as an agent who participates only by providing treatment for symptoms (for example pain) with a known side effect being an early death. This is different from physician assisted suicide whereas a doctor purposefully provides the means to a patient in the form of drugs and delivery mechanisms to kill him/herself. This could mean writing or filling a prescription for medications in a quantity large enough to cause death when taken by the patient. This kind of assistance is currently legal in the American state of Oregon. It became legal in 1998 as a result of the "Death with Dignity Act" which was passed in the state in 1994.

Direct euthanasia means the involvement of a clinician as agent in inducing a patient’s death. (e.g. administering a lethal drug by injection.) Direct euthanasia is not currently legal anywhere in the US, but both direct and indirect euthanasia are legal in Belgium and the Netherlands. This may be due to the patient being incapable of committing suicide without help, possibly due to their illness.

Voluntary euthanasia occurs with the fully-informed request of a decisionally-competent adult patient or that of their surrogate (proxy). (Example: Thomas Youk, with ALS was assisted by Jack Kevorkian.)

Nonvoluntary euthanasia occurs without the fully-informed consent and fully-informed request of a decisionally-competent adult patient or that of their surrogate (proxy). An example of this might be if a patient has decisional capacity but is not told they will be euthanized; or, if a patient is not conscious or lacks decisional-capacity and their surrogate is not told the patient will be euthanized.

Involuntary euthanasia occurs over the objection of a patient or their surrogate (proxy). An example of this might be if a patient with decisional capacity (or their surrogate) is told what will happen. The patient (or surrogate) refuses yet the patient is euthanized anyway.

Terminal sedation is a combination of medically inducing a deep sleep and stopping other treatment, with the exception of medication for symptom control (such as analgesia). It is considered to be euthanasia by some, but under current law and medical practice it is considered a form of palliative care.

In Nazi Germany the term "euthanasia" (Euthanasie) referred to the systematic killing of disabled children and adults under the T-4 Euthanasia Program. This program was cancelled (at least officially) after public disapproval was expressed. This has tainted the word especially in German-speaking countries; especially as one of the main advocates of euthanasia in Germany after World War II, was Werner Catel, a leading Nazi doctor directly involved in T4. The alternate term is the older Sterbehilfe, which means "help the dying to die smoothly". This meaning of the term "Sterbehilfe" is used within today's discussions in German newspapers and in other public forums like the TV, radio and the Internet.

Oregon (United States)

Oregon Law, passed by voters in 1994 and reaffirmed by voters in 1997, states an individual must meet the following criteria:

1) 18 years of age or older, unless consent is given by a parent for children under the age of 18

2) a resident of Oregon,

3) informed consent must be given; the patient must be mentally capable of making the consent

4) diagnosed with a terminal illness that will lead to death within six months and is not basing his or her decision to die on depression or another mental disorder. Two physicians assist in verification.

Also, it is required by law that this must be verified by two physicians, as well as by two witnesses.

Statistics and methods

In 2003, in Oregon 42 cases of physician assisted dying were reported (0.14% of all deaths), all by drinking a strong barbiturate potion, usually 9g of Pentobarbital. The doctor is not required to be present; in 12 cases he/she was.

Since 1998, 171 Oregonians have relied on the "Death with Dignity" law. There were three cases of regurgitation. In each case at least one third of the potion was retained, which caused death anyway, though in one case only after 48 hours.

The time from ingestion to unconsciousness was 1 to 20 minutes (average 4 minutes), the time from ingestion to death 5 minutes to 48 hours (average 20 minutes).

Attitudes on Euthanasia in the United States

In the last 20 years, some states have faced voter ballot initiatives and legislation bills attempting to legalize euthanasia and assisted suicide. Some examples include: Washington voters saw Ballot Initiative 119 in 1991, California placed Proposition 161 on the ballot in 1992, and Michigan included Proposal B in their ballot in 1998. Public opinion concerning this issue has become an increasingly important because widespread support could very well facilitate the legalization of these policies in other states, such as in Oregon.

While many people are aware of the ongoing debates concerning the issue of euthanasia and assisted suicide, it has been unclear where the public opinion stands in the United States. A recent Gallup Poll survey did show that 75% of Americans supported euthanasia, however further research has shown that there are significant differences in levels of support for euthanasia across distinct social groups. Recently, these attitudes have been receiving more attention since they not only could influence the legislation on this topic, but how patients are cared for in the future.

Religion

Some of the differences in public attitudes towards the right to die debate stem from the diversity of religion in this country. The United States contains a wide array of religious views, and these views seem to correlate with whether euthanasia was supported. Using the results from past General Social Surveys performed, some patterns can be found. Respondents that did not affiliate with a religion were found to support euthanasia more than those who did.

Of the religious groups that were studied, which were mostly Christian in this particular study, conservative Protestants (including Southern Baptists, Pentecostals, and Evangelicals) were more opposed to euthanasia than non-affiliates and the other religious groups.

Moderate Protestants (including Lutherans and Methodists) and Catholics showed mixed views concerning end of life decisions in general. Both of these groups showed less support than non-affiliates, but were less opposed to it than conservative Protestants. Moderate Protestants are less likely to take a literal interpretation to Bible than their conservative counterparts, and some leaderships tend to take a less oppositional view on the issue. Despite the fact that the Catholic Church has come out in firm opposition to physician-assisted suicide, they share the nearly same level of support as moderate Protestants.

The liberal Protestants (including some Presbyterians and Episcopalians) were the most supportive of the groups. In general, they had looser affiliations with religious institutions and their views were similar to those of non-affiliates. Within all these groups, religiosity (identified as being frequency of church attendance and self-evaluation) also affected their level of opposition towards euthanasia. Individuals who attended church regularly and more frequently and considered themselves more religious were found to be more opposed than to those who had a lower level of religiosity ^[1].

Race and Ethnicity

Recent studies have shown a difference in acceptance of euthanasia among different racial and ethnic groups. Compared to African Americans, Caucasians were found to be more accepting of euthanasia as a whole. They are also more likely to have advance directives and to use other end of life measures.^[2] African Americans are 2.8 times more likely to oppose euthanasia than Caucasians. The main reason for this discrepancy is attributed to the lower levels of trust in the medical establishment.^[3] Researchers believe that past history of abuses towards minority in medicine (such as the Tuskegee Syphilis Study) have made minority groups less trustful of the level of care they receive. Studies have also found that there are significant disparities in the treatment and pain management that non-Caucasian groups received in the health care setting.^[4]

Within African Americans, level of education has also contributed to whether an individual would support euthanasia. Without a four-year college degree, African Americans were 2.24 times more likely to oppose euthanasia than those who did attain one. However, level of education does not significantly influence any other group. Some researchers also suggest that African Americans also tend to be more religious, however this is a claim that is difficult to substantiate and define.^[5] However, only these two groups have been studied in extensive detail. Although it has been found that non-Caucasian groups are less supportive of euthanasia than Caucasians, there is still some ambiguity as to what degree this is true.

Gender

The research on differences in attitudes towards euthanasia across gender has shown that overall, gender is not considered a significant factor in predicting opinion. However, some studies have shown that there are differences in views between males and females. A recent Gallup Poll found that 84% of males supported euthanasia compared to 64% of females.^[6] Some cite the prior studies showing that women have a higher level of religiosity and moral conservatism as a reason of explanation. Within both genders, there are differences in attitudes towards euthanasia due to other influences. For example, one study found that African American women are 2.37 times more likely to oppose euthanasia than Caucasian women. African American men are 3.61 times more likely to oppose euthanasia than Caucasian men.^[7]

Economic Education

While the United States has a rather advanced health care system, it also contains a large population of uninsured poor and working class people that are not always able to afford to take advantage of it. In the debate over whether to legalize euthanasia, many academics fear that people lacking the resources to afford alternative options would become over represented in the percentage of those who did chose euthanasia. Several studies have shown that subjects from low-income groups oppose euthanasia more than other income groups. Compared to other factors, income level is not a strong predictor of support for euthanasia. For females, income level is less of predictor than in males.^[8]

Euthanasia by Omission in America: The Texas Futile Care Law

On March 15, 2005, six month old infant Sun Hudson was the first person to die under The Texas Futile Care Law signed by then Governor George W. Bush. [9]

In December 2005, a controversial case under Texas law involved Tirhas Habtegiris, a young woman and legal immigrant from Africa. Under the law, in some situations, Texas hospitals and physicians have the right to withdraw life support on a patient who they declare terminally ill.[10]

See also

• Manslaughter
• Omission
• Suicide Act 1961
• Karl Binding
• Alfred Hoche
• Werner Catel
• Jack Kevorkian
• Diane Pretty
• Texas Futile Care Law

References

1. ^ Burdette, Amy M; Hill, Terrence D; Moulton, Benjamin E. Religion and Attitudes toward Physician-Assisted Suicide and Terminal Palliative Care. Journal for the Scientific Study of Religion, 2005, 44, 1, Mar, 79-93.
2. ^ Jennings, Patricia K.,Talley, Clarence R.. A Good Death?: White Privilege and Public Opinion. Race, Gender, & Class. New Orleans: Jul 31, 2003. Vol. 10, Iss. 3; pg. 42.
3. ^ Moore, D. (2005 May 17). “Three in Four Americans Support Euthanasia.” The Gallup Organization.
4. ^ Werth Jr., James L.; Blevins, Dean; Toussaint, Karine L.; Durham, Martha R. The influence of cultural diversity on end-of-life care and decisions. The American Behavioral Scientist; Oct 2002; 46, 2; pg 204-219.

External links

Neutral

• Euthanasia and Religion - various religious views of euthanasia
• Religion and Ethics - Euthanasia - many views of euthanasia, for, against, and religious

For euthanasia

• Compassion & Choices - provides education, support and advocacy for the choice-in-dying movement
• Dignity in Dying - leading campaigning organisation promoting patient choice at the end of life
• World Federation of Right To Die Societies
• Assisted Suicide
• Voluntary Euthanasia- Atheist Foundation of Australia Inc
• Stanford Encyclopedia of Philosophy entry
• A defense of euthanasia

Against euthanasia

• www.carenotkilling.org.uk - Care NOT Killing: a UK alliance promoting palliative care, opposing euthanasia and assisted suicide
• euthanasia.com
• National Right to Life articles on euthanasia
• International Task Force against Euthanasia- many resources
• Non-religious arguments against euthanasia
• A Papal encyclical dealing with a number of issues of life and death including euthanasia
• A brief presentation of the issue and the Christian Catholic viewpoint on it

By country

Netherlands

• Official:
  • Ministry of Justice brochure on euthanasia and PAS (PDF, in Dutch)
  • Ministry of Health on euthanasia and PAS
  • Joint annual report 2003 of the Regional Euthanasia Review Conmmittees (PDF)
• For:
  • Right to Die-NL - Dutch union for voluntary termination of life NVVE
  • NRC Handelblad April 14, 2001 interview of Els 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. Els 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, citing the existence of cards stating Do Not Euthanize carried by some in the Netherlands.
  • Weekly Standard Article Claiming Unauthorized Euthanasia of Dutch Infants
  • December 18, 2000 National Review Opinion, Wesley Smith- Cites statistics showing frequent involuntary physician-assisted deaths in the Netherlands.

United States

• Oregon's Death with Dignity Act (State Website)
• Texas — The Futile Care Law

Canada

• The Euthanasia Prevention Coalition of Canada