Involuntary euthanasia

Involuntary euthanasia occurs when euthanasia is performed on a person who is able to provide informed consent, but does not, either because they do not choose to die, or because they were not asked.

Involuntary euthanasia is contrasted with voluntary euthanasia (euthanasia performed with the patient's consent) and non-voluntary euthanasia (where the patient is unable to give their informed consent, for example when a patient is comatose or a child). Involuntary euthanasia is widely opposed and is regarded as a crime in legal jurisdictions, and is sometimes used as a reason for not changing laws relating to other forms of euthanasia.

Definitions of involuntary euthanasia

Euthanasia raises many difficult questions about the differences between homicide and suicide. The Oxford English Dictionary defines euthanasia as “a gentle and easy death,” and in recent use it is associated with inducing such a death. Literature on the subject of euthanasia has expanded upon this basic definition, but there is little consensus about what situations actually constitute euthanasia. The concept of a mercy killing is commonly associated with euthanasia because the person administering the euthanasia is understood as being altruistically motivated to relieve the suffering of the patient. Many definitions of euthanasia account for voluntary and non consensual, whether non-voluntary, involuntary or both, forms of euthanasia. Definitions of involuntary euthanasia are controversial, particularly due to the history of eugenics programs enacted by killing people of perceived hereditary inferiority under the pretense that they were suffering and labeling these acts as euthanasia.

History of involuntary euthanasia

United States

Euthanasia became a subject of public discussion in the United States at the turn of the 20th century. Felix Adler, a prominent educator and scholar, issued the first authoritative call in 1891 for the provision of lethal drugs to terminally ill patients who requested to die. In 1906, Ohio considered a law to legalize such a form of euthanasia, but it did not make it out of committee. While much of the debate focused on voluntary euthanasia, other calls for involuntary euthanasia were vocalized as well. In 1900, W. Duncan McKim, a New York physician and author published a book titled “Heredity and Human Progress.” This book suggested that people with severe inherited defects, including retarded people, epileptics, habitual drunks and criminals, should be given a quick and painless death by carbonic gas.

In January 1938, the National Society for the Legalization of Euthanasia was formed, and was renamed the Euthanasia Society of America (ESA) later that year. It advocated for the legalization of euthanasia in the United States, primarily by lobbying state legislators. Many prominent ESA members advocated for involuntary euthanasia of people with mental disabilities, including Ann Mitchell, a former asylum patient and main financial supporter of the ESA until her suicide in 1942. Ann Mitchell is also credited with structuring the ESA as a eugenics project. ESA’s first president was Charles Potter, an ex-Unitarian minister who advocated for coercive eugenic sterilization and involuntary euthanasia to eliminate undesirable defective people from society.

The ESA initially advocated for both voluntary and involuntary euthanasia of people with severe disabilities. The organization soon realized that involuntary euthanasia had negative connotations, particularly its association with the Nazi’s euthanasia program, and began advocating for voluntary euthanasia exclusively. The ESA continues to exist today.

World War II Germany

Main article: Action T4

Olga Benário Prestes in 1928, later murdered at Bernburg Euthanasia Centre

Gas chamber in Hadamar killing center

American war crimes investigators question Irmgard Huber at the Hadamar killing center, May 1945

Adolf Hitler enacted the Aktion T4 program in October of 1939 to euthanize “incurably ill, physically or mentally disabled, emotionally distraught, and elderly people.” The Aktion T4 program was also designed to euthanize those whom were deemed "inferior and threatening to the well being of the Aryan race." This program was also designed as part of a larger, “Final Solution” eugenics program. Within months of enactment, the Nazi’s expanded its definition of whom could be euthanized to include those who were of a certain ethnicity as well as economic level. Many people who did not want to be euthanized by this enacted program were murdered anyway against their will. Six killing centers were constructed after T4’s enactment, with one of the most notable being the Hadamar killing center. At these centers, people deemed handicapped or “unfit” by “medical experts” were put to death in gruesome ways. For example, gas chambers were disguised to look like showers, and some were starved to death. Often at these centers, mass euthanasia via gas chambers took place. The meticulous research undertaken by the Nazi's after the deceased was euthanized ultimately was used as a prototype for much larger euthanasia institutions for larger death camps such as Auschwitz and Treblinka, implemented later on in the war.

Approximately 200,000 people were killed over a six year span due to the T4 program. The T4 euthanasia institutions were shut down by Allied troops in 1945.

Euthanasia in the Netherlands

Main article: Euthanasia in the Netherlands

The practice and regulation of euthanasia and assisted suicide in the Netherlands has been described as a stepping stone by Dillmann and Van Der Wal. Although euthanasia and assisted suicide can be seen as morally similar because it results in death, the important difference is the choice given to the patient in question. Of the 5000 requests in the Netherlands, the most important reasons for requests were futile suffering, avoidance of humiliation, and unbearable suffering. Despite the free decisions of patients, in about 1000 of the cases, doctors prescribed drugs with the explicit goal of shortening the patient's life without the explicit request of the patient. Although there are legal avenues for assisted suicide, patients are still faced with the decisions of care givers.

The Dutch practice is not a result of scarce resources because the whole Dutch population is insured. Instead, this is an attempt by the government to end the needless suffering of its citizens. Although there is good intention behind the law, there are still problems such as obtaining explicit requests from the patients and the grey area of influencing the decision making process by doctors. Despite these problems, new research by Katrina Hedberg et al. show no evidence to justify the grave and important concern often expressed about the potential for abuse — namely, the fear that legalised physician‐assisted dying will target the vulnerable or pose the greatest risk to people in vulnerable groups.

Although there is no fear for abuse by some, research by John Koewn shows otherwise. In a new report, he shows that about 1000 deaths were hastened without the explicit request of the patient. Doctors do not always tell the truth in reporting their euthanasia patients. As a result, doctors and nurses tend to break the law in certain circumstances.