euthanasia essay starters

158 Euthanasia Topics & Essay Examples

If you’re writing a euthanasia essay, questions and topics on the subject can be tricky to find. Not with our list!

• 📑 Aspects to Cover in a Euthanasia Essay

🏆 Best Euthanasia Essay Examples & Topics

💡 clever euthanasia titles, 🎓 simple & easy euthanasia essay titles, ✅ most interesting euthanasia topics to write about, ❓ euthanasia essay questions.

Our experts have prepared a variety of ideas for your paper or speech. In the article below, find original euthanasia research questions and essay titles. And good luck with your assignment!

📑 Aspects to Cover in an Euthanasia Essay

Euthanasia is the process of intentional life ending. Its goal is to stop patients’ suffering and pain. In today’s world, euthanasia is a debatable topic, and there are many questions about it.

Euthanasia essays can help students to raise awareness of the process and its aspects. That is why it is crucial to research this issue and write papers on it.

You can discuss various problems in your essay on euthanasia, as there is a broad variety of related issues. You can choose the one you are the most concerned about, search for euthanasia essay questions online or consult your professor.

Here are some examples of euthanasia essay topics and titles we can suggest:

• The benefits and disadvantages of a physician-assisted suicide
• Ethical dilemmas associated with euthanasia
• An individual’s right to die
• Euthanasia as one of the most debatable topics in today’s society
• The ethical dilemma around euthanasia
• The ethics associated with voluntary euthanasia
• Can euthanasia be considered murder?
• Euthanasia debate: Should the government legalize this procedure?
• The legality of physician-assisted suicide in today’s society

Once you have selected one of the euthanasia essay titles, you can start working on your paper. Here are some important aspects to cover:

Start from developing a solid euthanasia essay thesis. You should state the main idea of your paper and your primary argument clearly. A thesis statement can look like this: Euthanasia is beneficial for patients because it prevents them from suffering. Euthanasia can be equal to murder.

• Remember to include a definition of euthanasia and related terms, such as physician-assisted suicide. Your audience should understand what you are talking about in the essay.
• Do not forget to include the existing evidence on the issue. For instance, you can research euthanasia in different countries, the debates around its legalization, and all other aspects related to the problem. Support your claims with facts and cite your sources correctly.
• Legal and ethical questions are some of the most significant aspects you should cover in the essay. Discuss the potential benefits and disadvantages of the procedure, as well as its impact on patients’ families and medical professionals.
• If you are writing an opinion paper, do not forget to state your opinion clearly. Include relevant experience, if possible (for example, if you work at a hospital and patients have asked you about the procedure). Have you met people who could have benefited from euthanasia? Include their stories, if applicable.
• Do not forget to cover the legal aspects of euthanasia in your state. Is it legal to perform some form of euthanasia where you live or work? Do you think it is beneficial for the patients?
• Remember to look at the grading rubric to see what other aspects you should cover in your paper. For example, your professor may want you to state a counter-argument and include a refutation paragraph. Make sure that you follow all of your instructor’s requirements.
• If you are not sure that you have covered all the necessary questions related to your issue, check out related articles and analyze the authors’ arguments. Avoid copying other people’s work and only use it as an inspiration.

Please find our free samples below with the best ideas for your work!

• Euthanasia: Advantages and Disadvantages The most heavily criticized of all such similar actions is involuntary euthanasia which bears the brunt of all severe protests against the issue, with involuntary euthanasia being dubbed as the deprivation of an individual of […]
• Arguments in Favor of Euthanasia Due to the sensitivity of the issue, laws that will protect the rights of both the patient and the physicians who practice euthanasia should be put in place.
• Consequentialism: Euthanasia and Physician-Assisted Suicide People against euthanasia view the consequences of legalization as a gateway to other unethical practices being accepted, which is a slippery slope that could lead to adverse consequences to the fundamental principles and values of […]
• The Morality of Euthanasia In the meantime the medication and the doctors are not trivial anymore in stopping the pain and the victim despite all the sufferings, he or she is in a vegetative state and there is nothing […]
• Euthanasia as Self-Termination Velleman believes that a person should not have the right to end their life as it can make other people suffer, but there is an objection to his opinion related to that person’s own pain.
• An Argument Against Euthanasia 5 Generally, it is contrary to the duty of the subject of euthanasia and that of those who intend to perform the mercy killing to take one’s life based on their own assessment of the […]
• David Velleman’s Views on Euthanasia Velleman is correct in his conviction that in this case, the patient’s decision will be the outcome of a federal right to die; the situation with euthanasia is common to that of abortion with the […]
• Why Active Euthanasia is Morally Wrong The issue of active euthanasia has come to the attention of the public over the past decades as more people demand for the right to be assisted to die.
• Euthanasia for Terminally Ill People: Pros & Cons Despite the fact that euthanasia causes a lot of controversy, every person should have the right to end suffering. Permission of euthanasia is the realization of a person’s right to dispose of their body.
• Euthanasia in Christian Spirituality and Ethics By examining Christian’s views on the fallenness of the world, the hope of resurrection, and the value of a person’s life, one can see that euthanasia is not a morally acceptable option for a Christian […]
• Euthanasia: Right to Live or Right to Die Euthanasia or mercy killing as it is informally referred is the act of ending a person life if it is deemed to be the only way to help a person get out of their suffering.
• The Problem of Euthanasia in Animal Shelters Animal shelters are forced to euthanize animals for a number of reasons which includes: Lack of funds to treat sick animals, overcrowding as a result of the increased number of animals brought in by owners […]
• Euthanasia and Assisted Suicide The final act that results in the death of the person is however usually performed by the person intending to die after the provision of information, advice and even the ways through which he or […]
• The Death Definition and the Need for Euthanasia If the concept of the soul is to be believed in, then one’s death is simply a process that detaches the soul from the body.
• Euthanasia as a Polarizing Issue The example of a plethora of countries shows that the inclusion of assisted suicide is not detrimental to the broad society.
• Rachel’s Stance on Euthanasia: Passive and Active Killing Despite the appealing nature of Rachel’s argument, his claims of equity of killing and letting a person die are not ethically right. A major distinction between killing and witnessing death is the level of responsibility […]
• Analysis of Ethical Dilemma: Euthanasia One of these is the right to live, which includes much more than the ability to simply exist, and suggests an adherence to a minimum of quality and self-determination.
• Euthanasia-Related Ethical and Legal Issues There are no discussions about whether the person has the right to commit suicide or not because most individuals agree that it is the decision of the adult person who can dispose of their life.
• Euthanasia: Legal Prohibitions and Permits In addition, it is necessary to take into account the right of a suffering person to get rid of the suffering of loved ones.
• Euthanasia: Why Is It Such a Big Problem? Thus, according to the utilitarian viewpoint, there is no problem with euthanasia as along as it is better for the patient. Who is it to decide what is better for the patient?
• Euthanasia and Assisted Suicide as a Current Issue in Nursing Nowadays, even in nations where the procedure of euthanasia and assisted suicide has been legal for decades, this topic continues to be controversial due to ethical and policy issues. However, in the light of the […]
• Euthanasia and Its Main Advantages However, after realizing the condition is untreatable and having the consent of both the sick person and the relatives, undertaking assisted suicide will enable the patient to evade extreme suffering.
• Euthanasia: Nurses’ Attitudes Towards Death The weakest part of the article is that most of the participants did not clearly define the concept of euthanasia, which casts doubt on the reliability of the sampled data.
• Right to Die With Euthanasia Methods The possible answer is to develop the functionality of both ordinary public hospitals and hospices that are located in their departments. In addition, it is critical to specify the desirable methods of euthanasia.
• “Active and Passive Euthanasia” by James Rachels The second issue about euthanasia that Rachels raises is the difference between killing and allowing one to die. For Rachels, it is necessary to emphasize that killing is sometimes even more humane than allowing one […]
• Arguments Against Legalization of Euthanasia Although the PAS/E should be offered voluntarily to a patient, in some cases it is offered in secret by physicians to patients who are perceived to be dying.
• Euthanasia: The Terri Schiavo Case Analysis The long-term judicial resolution of the Terri Schiavo case was related to the bioethical problem of the humanity of euthanasia, which had many opponents and supporters.
• Can Euthanasia Be Considered Ethical Consequently, from this perspective, the act of euthanasia would be regarded as violence to someone else’s life. As a result, euthanasia is likely to be considered unethical from the point of view of any of […]
• “Active and Passive Euthanasia” and “Sexual Morality” According to Scruton, morality is a constraint upon reasons for action and a normal consequence of the possession of a first-person perspective. For Scruton, sexual morality includes the condemnation of lust and perversion that is, […]
• Nursing Role in Euthanasia Decision and Procedures The weakest point is the lack of analysis of other factors’ influence on the process of euthanasia. The researchers discovered that the role of nurses in euthanasia is underestimated.
• Aspects of Nursing and Euthanasia The subject of the research by Monteverde was to ask people who work in the medical sphere and face the necessity for euthanasia, whether they are for or against it, and why.
• Pros and Cons of Euthanasia from an Ethical Perspective Primarily, this is apparent on American soil, in which some states decriminalized euthanasia, although the supreme court maintained that there is no law that legalized the practice nor the ban of the mentioned act.
• Euthanasia in the Context of Christianity The questions addressed in the paper include the notions of fall and resurrection as means of interpreting suffering, the Christian stance on the value of human life and euthanasia, and the discussion of possible solutions […]
• Nursing Practice and Euthanasia’s Ethical Issues Effective healthcare management is the involvement of all stakeholders, such as CMS, and the federal government in the decision-making process to improve the sustainable growth in the effectiveness of Medicaid.
• Counseling on Euthanasia and End-of-Life Decision The immediate dynamic killing is a clinical demonstration coordinated to the hardship of life, while a doctor helped self-destruction is a demonstration of the doctor where he gives the patient a medicament for taking life.
• Euthanasia and Physician-Assisted Suicide Articles According to the methods of application, there are two main types of euthanasia: “active”, which consists in performing certain actions to accelerate the death of a hopelessly ill person, and “passive”, the meaning of which […]
• Legal and Ethical Issues of Euthanasia Davis argues that there exists a challenge on how to establish a consensus in the competing views regarding the desire for patients to have the choice to die with dignity while under pain and distress […]
• Debates on Euthanasia – Opposes the Use Therefore, the legal system should work hand in hand with healthcare shareholders in distinguishing the limits between the patients’ rights and the physicians’ accountability based on the possible life-limiting treatment choices.
• Active Euthanasia: Ethical Dilema In case of active euthanasia, it is the patient who requests the medical practitioner to end his or her life and the former abides by the wish.
• Euthanasia: Every For and Against Jane L Givens and Susan L Mitchell “Concerns about End-of-Life Care and Support for Euthanasia” Journal of Pain and Symptom Management Article in Press FOR The authors state socio-demographic characteristics of the people are the […]
• Pro Euthanasia in the United States The discussions of euthanasia implementation in the United States began in the early 19th century after the development of ether, which was applied to pain-relieving.
• The Euthanasia in Humans The moral and ethical aspects of medical practice include not only the features of interaction with patients and other interested parties but also deeper nuances. In particular, one of the controversial and acute topics is euthanasia and its acceptability from different perspectives, including both patients’ and healthcare employees’ positions. In addition, religious issues are involved, […]
• Euthanasia: Philosophical Issues at Stake in Rodriguez I will argue that the prohibition of euthanasia contradicts utilitarianism and the principle of quality of life in particular, and can hardly be supported by paternalism since the ban does not benefit an individual’s life.
• “Euthanasia Reconsidered” by Deagle In more detail, there is a clearly discernible introduction that provides the background to the topic, introduces the thesis statement, and state the opinion of the author of the topic discussed.
• Euthanasia Movement in Modern America Euthanasia movements in modern America perfected the art of rhetoric in their communication and this worked for them in terms of winning the heart of the public.
• Euthanasia: The Issue of Medical Ethics In this respect, the position of a physician under the strain of extreme circumstances should be weighed about the value of compassion.
• The Dilemma of Euthanasia It is at this point, when it becomes a contention of professional ethics and moral considerations on the part of Jack and his wife on the one hand, and personal choice on the part of […]
• Euthanasia: Ethical Debates When a patient is in the final stage of life, sometimes, the disease or the conditions of the patient, cause a lot of physical and psychological suffering.
• Euthanasia Moral and Ethical Agitation If grandma were a dog, most all would agree that the only humane option would be to ‘put her to sleep.’ U.S.citizens are guaranteed certain rights but not the right to wouldie with dignity.’ This […]
• Life-Span Development: Terri Schiavo’s Euthanasia Case Euthanasia is the process of stopping the medical maintenance of a patient’s life when the patient/herself does not want to suffer anymore and the doctors are sure that no improvements in the patient’s condition are […]
• Euthanasia and Other Life Termination Options However, there is a strong case for helping terminally ill patients spend the remainder of their lives with care provided by the medical fraternity and with support from the state and insurance companies. And in […]
• The Problem of Euthanasia Nevertheless, we must recognize that the interruption of life, alone or with the help of doctors, is contrary to one of the basic tenets of Christianity: the more people suffer on earth, the easier it […]
• Euthanasia: Allow Them to Be Free From Body Euthanasia, the practice of deliberately bring about an easy, painless, and moderate death to a person who is in the last days of his life and can no more bear the pain of living, has […]
• Palliative Medicine Replacement for Euthanasia Euthanasia is not about helping ill and dying people to end their pain and bring comfort. Euthanasia undermines the core values of life and decreases the motivation to provide care for the dying.
• Euthanasia: A Legalized Right to Die Nothing could be further from the intent of those who favor a limited reconsideration of public policy in the areas of assisted suicide and voluntary active euthanasia.
• Euthanasia and Suicide Issues in Christian Ethics Based on the two perceptions of euthanasia, theological and professional, it is valid to say that assisted suicide is probably not the best way out.
• Euthanasia: Morals, Ethics, and the Value of Life James Rachels however disagrees with the position taken by doctors when it comes to active Euthanasia and argues that, given a case where the patient is in intolerable pain and is certain to die in […]
• Euthanasia. Arguments of Opponents The request of the patient to relieve them from Karma and sufferings that is clarification and healing, nobody gives the right to break life of a physical body.
• Attitudes Related to Euthanasia and Physician-Assisted Suicide Among Terminally Ill Patients Consequently, the outlined safeguard becomes the first line of defense in making sure that only the right individuals with chronic and incurable medical conditions benefit from assisted death.
• Active Euthanasia Legalization Controversy While many people present the notions of medical ethics, the right to life, and the availability of palliative care to oppose active euthanasia, there are those who support it since it is evidence-based in nature […]
• Dying With Dignity: Euthanasia Debate On the other hand, the supporters of the law claim that assisted death is not a suicide, and it allows more end-of-life options for terminally ill patients. The majority of people are concerned with control […]
• Euthanasia Legalization as an Unethical Practice The decision to legalize euthanasia is an idea that societies should ignore since it places many global citizens at risk, fails to provide adequate safeguards, diminishes social values, and undermines the teachings of Islam.
• The Ethics of Euthanasia In the analysis of the claims in favor and against euthanasia, the cause and effect relationships between the factors affecting the choice of euthanasia should be established.
• Today’s Moral Issues: Euthanasia To ensure that the right to life is respect, the law was amended to include assisted or aided suicide as a criminal offense.
• Controversial Issues of Euthanasia Decision We now had to make this difficult decision to end his life and relieve him of all the pain that he was undergoing.
• Confronting Physician-Assisted Suicide and Euthanasia It was because of that pain that led my mother and I to bring her to a Chinese holistic healer who treated her with some sort of secret Chinese medical injection.
• Assisted Suicide and Euthanasia Rights in Canada The article asserts that in the year 1993, Rodriquez petitioned in vain to the Supreme Court of Canada to allow her to undertake euthanasia. In the article, the author asserts that, in the year 1993, […]
• Euthanasia: “Being a Burden” by Martin Gunderson As it was implied in the Introduction, in his article, Gunderson argues in favor of the idea that it is utterly inappropriate to even consider the legalization of voluntary euthanasia, due to a number of […]
• Euthanasia: Fighting for the Right Cause Sommerville is a renowned Samuel Gale Professor of Law at the McGill University in Montreal, the Professor in the Faculty of Medicine, and the Founding Director of the Center for Medicine, Ethics, and Law. The […]
• Euthanasia as a Way of Painless Termination of Life The introduction of the Hippocratic School led to the abolishment of the practice. According to the approach, taking human life is unethical and violation of the core right to life.
• Euthanasia and Other Life-Destroying Procedures From this perspective, it is unethical to decide in favor of an end-of-life procedure on the condition that there are at least minimal chances for a patient’s survival.
• Ethics of Euthanasia and Pain-Relieving This leads to the historical argument that voluntary euthanasia is often the beginning of a slippery slope that gives rise to unintentional euthanasia and the murder of people who are unwanted in society.
• Euthanasia Legalization: Public Policy Debates The requirements of physicians to perform euthanasia and consideration of the second opinion eliminate the violation of legal and ethical stipulations, and thus, control the performance of euthanasia in health care environment. Opponents of euthanasia […]
• Euthanasia: Moral Rationalist View Human beings rely on the available evidence to generate beliefs about life and goals that should be attained, and thus the use of reason leads to success in these objectives.
• Euthanasia: Is It Worth the Fuss? In order to grasp the gist of the deliberations in this essay, it is important to first apprehend what the term euthanasia means and bring this meaning in the context of this essay.
• Active and Passive Euthanasia Analysis and Its Concept The issue of morality is one of the things that have to be mentioned when discussing the concept of euthanasia. In this instance, both the patient and the doctor know that there is no cure […]
• Euthanasia: Legalisation of a Mercy Killing The fact that the minority of countries and only several states in the US accept euthanasia proves that today people are still not ready to accept it as a mercy.
• Euthanasia in Today’s Society Euthanasia is the deliberate termination of life with the intention of relieving a patient from pain and suffering. If the prognosis of a patient is gloomy, medical care providers may find it more compassionate to […]
• When Ethics and Euthanasia Conflict? The main aim is to reduce the lifetime of a patient who is terminally ill. There is a deep mistrust of the motivations that fuel euthanasia.
• Religions Views on Euthanasia This essay highlights religious thoughts with regard to the whole issue of euthanasia, bringing into focus the extent to which our society has been influenced by courtesy of the Dr.
• Euthanasia as the Key Controversy of the XXI Century The fact that in the present-day society, human life is put at the top of the entire list of values is a major achievement of the civilization and the fact that the current society is […]
• Euthanasia: Is It the Best Solution? In twentieth century, various agencies erupted to address the practice of euthanasia such as Voluntary Euthanasia Legislation Society in 1935, which was advocating for its legalization in London and the National Society for the Legalization […]
• Legalizing Euthanasia The are supporters of the idea that only God has the right to take human’s life, on the other hand, the sufferings of the person may be unbearable and they may ask for euthanasia to […]
• A New Fight to Legalize Euthanasia Before settling down on the conclusion of the need to adopt the practice of euthanasia in our state, it is important to visit some basic aspects that are very key in the issue of euthanasia.
• The Ethics of Active Euthanasia In support of the euthanasia action, the argument is that there are circumstances when the rule of natural life can be violated.
• Advantages and Disadvantages of Euthanasia in Modern Society In its turn, this points out to the fact that, in the field of health care, the notion of medicinal compassion organically derives out of the notion of scientific progress, and not out of the […]
• Is Euthanasia a Morally Wrong Choice for Terminal Patients? It is imperative to note that for both the opponents and proponents of euthanasia, the quality of life is usually the focal point, even though there is no agreement on the criteria of defining quality […]
• The Right to Life and Active Euthanasia The god of every individual should be the only one to bring death to a person and no person should have the authority to accept dying no matter the situation he/she is in.
• Singer’s Views on Voluntary Euthanasia, Non-voluntary Euthanasia, and Involuntary Euthanasia Hence, if a person consciously consents to die, there are no chances for recovery, and killing is the only way to deprive a patient from pain and suffering, euthanasia can be regarded as voluntary.
• Euthanasia Authorization Debate Euthanasia, which is equivalent to the termination of life, can be equated to a total breach of the principle of the sacredness of life, as well as the breach of the legal right of human […]
• Moral and Ethical Concerns of Euthanasia in Healthcare In the matter of euthanasia, professionals ought to decide between the overall good of the dying patient and that of other stakeholders.
• Good and Harm to Humanity of the Use a Euthanasia An Overview of Euthanasia The meaning of euthanasia has changed over the years from how it was originally construed to what it means to the contemporary world.
• Euthanasia and Meaning of Life The meaning of life is the most general aspect of judging about the requirements that must be set out by laws and people’s morals in regarding to the voluntary or involuntary taking of that life.
• Euthanasia: Your Right to Die? Although both positions can be supported with a lot of arguments, people should change their absolutely negative vision of euthanasia because the right to die with the help of physicians can be considered as one […]
• Euthanasia and Human’s Right to Die Trying to support human life with the help of modern equipment is a good idea, however, not in case there are no chances for a person to live without that equipment.
• Euthanasia Moral Permissibility Secondly, the application of voluntary euthanasia should not be regarded as the only way of reducing the pain that a patient can experience.
• Euthanasia (Mercy Killing) In some circumstances, the family and friends of the patient might request the hospital to terminate the life of the patient without necessarily informing the patient.
• Euthanasian Issues in Modern Society Is it possible to find the relief in the life which is full of pain and agony for those people who suffer from serious diseases and have only a little chance to get rid of […]
• Euthanasia From a Disciple of Jesus Christ in Today’s World Another form of euthanasia is that of Assisted Suicide where the person intending to end his/her life is provided with the necessary guidance, means as well as information as to how to go about the […]
• Euthanasia and Modern Society Towards this end Battin asserts that “the relief of pain of a patient is the least disputed and of the highest priority to the physician” in direct reference to sole and major reason of carrying […]
• Euthanasia: Moral Issues and Clinical Challenges Therefore, any law that rejects euthanasia is a bad one because it denies the patients the right and the liberty to die peacefully.
• Ethical Issues Surrounding the Choice of Euthanasia in the United States
• The Advantages and Disadvantages of the Legalization of Euthanasia
• Confronting Physician-Assisted Suicide and Euthanasia
• The Difference Between Active and Passive Euthanasia
• Euthanasia: Current Policy, Problems, and Solution
• The Permit and Legalization of Euthanasia for the Terminally Ill Patients
• Moral and Religious Differences Between Euthanasia and Suicide
• The Criticisms and Opposition of Euthanasia in Australia
• Assisted Suicide and Euthanasia It Is Not Murder, It Is Mercy
• The Factors That Influence the Legalization of Active and Passive Euthanasia in the United States
• Roman Catholic Church’s Teachings on Abortion and Euthanasia
• The Different Reasons Why People Are Against Euthanasia
• Religious and Ethical Arguments in Favour of Euthanasia
• The Moral and Ethical Views on the Goal of Euthanasia
• Euthanasia and the Role of Politics and Religion
• The Philosophical, Legal, and Medical Issues on Euthanasia
• General Information About Euthanasia and the Legality of Suicide in Australia
• The Nazi Euthanasia Programme Based on Racial Purity Theories
• Dr. Jack Kevorkian’s Role in Physician-Assisted Suicide and Euthanasia
• Utilitarian and Libertarian Views on Euthanasia
• The Moral and Religious Differences, if Any, Between Euthanasia and Suicide
• Biblical World View About the Euthanasia, Suicide, and Capital Punishment
• The Truth About Euthanasia and Assisted Suicide
• Tracing Back the Origins of the Practice of Euthanasia During the Greeks and Roman Times
• The Causes and Effects of Euthanasia and the Moral Right To Die
• The Arguments Against Euthanasia From a Standpoint of a Catholic Christian in the United States of America?
• Why Should Active Euthanasia and Physician-Assisted Suicide Be Legalized?
• What Are the Good and Bad Sides of Euthanasia?
• Do People Have To Commit Suicide by Euthanasia (Suicide by a Doctor)?
• What Is the Difference Between Passive and Active Euthanasia?
• What Are the Social Issues and Ethical Values of Euthanasia?
• What Is the Current Legal Situation Regarding Euthanasia?
• How Does Prohibition of Euthanasia Limit Our Rights?
• What Is the American Medical Association’s Attitude to Euthanasia?
• Can Hegelian Dialectics Justify Euthanasia?
• What Are the Viewpoints and Studies of the Legalization of Euthanasia in the United States?
• Why Does Parenting Make Euthanasia More Acceptable?
• What Are the Negative Arguments Against Euthanasia?
• Voluntary Euthanasia: What’s Right and Wrong?
• Why Can Christians not Accept Euthanasia?
• Can Euthanasia Help the Terminally Ill?
• What Are the Top Ten Reasons for Legalizing Euthanasia?
• Should Non Voluntary Euthanasia Be Legal?
• What Is the Difference Between Doctor-Assisted Suicide and Euthanasia?
• Why Should Euthanasia and Assisted Suicide Be Legalized?
• What’s Wrong With Involuntary Euthanasia?
• Why Are There So Different Views on Abortion and Euthanasia?
• How Would Christians Respond to the Issue of Abortion and Euthanasia?
• What Are the Objections To Legalizing Euthanasia in Hong Kong?
• How Does Euthanasia Devalue Human Life?
• What Are the Views and Arguments About Euthanasia?
• How May the Christian Faith Inform the Debate Over Euthanasia?
• What Does Euthanasia Mean to Society Today?
• What Are the Religious and Ethical Considerations to the Issue of Euthanasia?
• Euthanasia and Assisted Suicide – Who Wants It?
• Human Rights Essay Ideas
• Suffering Essay Topics
• Morality Research Ideas
• Death Penalty Questions
• Healthcare Questions
• Suicide Topics
• Constitution Research Ideas
• Social Justice Essay Ideas
• Chicago (A-D)
• Chicago (N-B)

IvyPanda. (2024, February 28). 158 Euthanasia Topics & Essay Examples. https://ivypanda.com/essays/topic/euthanasia-essay-examples/

"158 Euthanasia Topics & Essay Examples." IvyPanda , 28 Feb. 2024, ivypanda.com/essays/topic/euthanasia-essay-examples/.

IvyPanda . (2024) '158 Euthanasia Topics & Essay Examples'. 28 February.

IvyPanda . 2024. "158 Euthanasia Topics & Essay Examples." February 28, 2024. https://ivypanda.com/essays/topic/euthanasia-essay-examples/.

1. IvyPanda . "158 Euthanasia Topics & Essay Examples." February 28, 2024. https://ivypanda.com/essays/topic/euthanasia-essay-examples/.

Bibliography

IvyPanda . "158 Euthanasia Topics & Essay Examples." February 28, 2024. https://ivypanda.com/essays/topic/euthanasia-essay-examples/.

Home — Essay Samples — Social Issues — Human Rights — Euthanasia

Essays About Euthanasia

Euthanasia essay: examples, types of euthanasia essays:.

• Euthanasia Argumentative Essay: This type of essay presents arguments for and against euthanasia and requires the writer to take a position on the issue.
• Euthanasia Persuasive Essay: The purpose of this essay is to persuade the reader to support or reject the idea of euthanasia. The writer needs to use convincing arguments and evidence to support their position.
• Euthanasia Controversy Essay: This type of essay explores the controversies surrounding euthanasia, including ethical, moral, legal, and religious issues. The writer needs to analyze and present different perspectives on the issue.

Euthanasia: Argumentative Essay

• Choose a clear position: Before you start writing, it's important to decide where you stand on the issue of euthanasia. Do you believe that euthanasia should be legalized, or do you think it should remain illegal? Your position will guide your research and the evidence you present.
• Conduct thorough research: Euthanasia is a complex and controversial issue, so it's essential to do your research before starting to write. Look for reliable sources of information, such as academic articles, government reports, and medical journals.
• Develop a strong thesis statement: Your thesis statement should clearly state your position on euthanasia and provide a roadmap for the rest of your essay. It should be clear, concise, and easy to understand.
• Provide evidence to support your arguments: Use evidence to support your arguments, such as statistics, expert opinions, and case studies. Make sure that your evidence is credible and comes from reputable sources.
• Address counterarguments: It's important to address counterarguments to your position to demonstrate that you have considered all perspectives on the issue. Addressing counterarguments will also make your essay more persuasive.
• Use persuasive language: Use persuasive language to make your argument more convincing. Use strong, clear language that emphasizes your point of view.

Euthanasia: Persuasive Essay

• Conduct research: The writer should conduct thorough research on the topic to gather as much information as possible to support their argument.
• Develop a clear thesis statement: The writer should clearly state their position on euthanasia in the thesis statement.
• Present convincing evidence: The writer should use credible and convincing evidence to support their argument, such as statistics, case studies, and expert opinions.
• Address counterarguments: The writer should acknowledge and address counterarguments to their position, and provide strong rebuttals.
• Use persuasive language: The writer should use persuasive language and techniques, such as emotional appeals and rhetorical questions, to convince the reader of their position.

Euthanasia Controversy Essay

• Start with a clear and concise introduction that presents the topic and the main arguments.
• Conduct thorough research on the topic, using credible sources, such as academic journals, government reports, and expert opinions.
• Present a balanced view of the issue by providing arguments for and against euthanasia.
• Use clear and concise language, avoiding emotional language that may detract from the argument.
• Consider the ethical and moral implications of euthanasia, and the different perspectives of stakeholders involved.
• Conclude the essay with a summary of the main arguments and a final thought on the topic.

Tips for Choosing a Topic for Euthanasia Essays:

• Identify your stance: Before choosing a topic, decide on your position on euthanasia. This will help you select a suitable topic for your essay.
• Conduct research: Thoroughly research the topic of euthanasia to gain a better understanding of the subject matter. Use reliable sources such as books, journals, and academic articles.
• Brainstorm: Create a list of potential topics related to euthanasia and narrow down your choices based on your research and personal interest.
• Focus on a specific aspect: Instead of trying to cover the entire topic of euthanasia in your essay, focus on a specific aspect such as the ethical or legal implications.

Hook Examples for Euthanasia Essays

Anecdotal hook.

Meet John, a terminally ill patient who faces excruciating pain every day. His decision to seek euthanasia sparks a controversial debate over the right to die with dignity.

Question Hook

Is it ethical for physicians to assist patients in ending their lives to relieve unbearable suffering? Explore the moral dilemmas surrounding the topic of euthanasia.

Quotation Hook

"Dying is not a crime." — Jack Kevorkian. Investigate the legacy of Dr. Kevorkian, who championed the cause of physician-assisted suicide, and its impact on the euthanasia debate.

Statistical or Factual Hook

Did you know that euthanasia is legal in several countries, while it remains illegal in others? Examine the global landscape of euthanasia laws and the factors that influence these decisions.

Definition Hook

What exactly is euthanasia, and how does it differ from other end-of-life choices? Delve into the definitions, types, and terminology associated with this complex issue.

Rhetorical Question Hook

Should individuals have the autonomy to decide when and how they will end their lives, especially in cases of terminal illness? Analyze the arguments for and against euthanasia's role in preserving personal freedom.

Historical Hook

Travel through history to explore the evolution of euthanasia practices and laws. Discover how societies have grappled with the idea of mercy killing across centuries.

Contrast Hook

Contrast the perspectives of medical professionals who advocate for euthanasia as a compassionate choice with those who argue for preserving the sanctity of life at all costs. Explore the ethical dilemmas inherent in these differing viewpoints.

Narrative Hook

Step into the shoes of a family member faced with the agonizing decision of whether to support a loved one's request for euthanasia. Their personal story sheds light on the emotional complexities involved.

Shocking Statement Hook

Prepare to be shocked by the cases of covert euthanasia that occur outside the boundaries of the law. These stories expose the gray areas and ethical challenges surrounding end-of-life decisions.

The Dangers of Legalizing Euthanasia

Persuasive essay pro euthanasia, made-to-order essay as fast as you need it.

Each essay is customized to cater to your unique preferences

+ experts online

Advantages and Disadvantages of Euthanasia

Euthanasia, assisted dying and the right to die, human euthanasia as an assisted suicide, the issues why physician-assisted suicide should not be legalized, let us write you an essay from scratch.

• 450+ experts on 30 subjects ready to help
• Custom essay delivered in as few as 3 hours

Physician-assisted Suicide (pas)

A controversy over the issue of physician assisted suicide, right to die: euthanasia issues, my views on the issue of assisted suicide, get a personalized essay in under 3 hours.

Expert-written essays crafted with your exact needs in mind

Physician-assisted Death: Advantages and Moral Matters of Right to Die

Medical and ethical dilemma: euthanasia or right to die, range of moral, ethical and legal perspectives of right to die or euthanasia, discussion on whether human euthanasia should be made illegal, natural death and euthanasia: the catholic church’s historical response, the popularity of euthanasia among the american population, a moral interpretation of euthanasia and murder, analysis of physician-assisted suicide (pas) in terms of bioethics, a debate over allowing physician assisted suicide, arguments expressed by proponents of the legalization of physician-assisted suicide (pas), why physician-assisted suicide for terminally ill patients should be legalized, the arguments for euthanasia: a critical analysis, death with dignity act: ethical dilemma regarding euthanasia, the right to die: debating euthanasia in modern society, advocating for legalizing euthanasia, an assisted suicide: roller coasters as tools for euthanasia, euthanasia: examining arguments, ethics, and legalities, voluntary euthanasia persuasive speech, the struggle with physician assisted suicide in the united states, why euthanasia should not be allowed.

Euthanasia is the practice of intentionally ending life to relieve pain and suffering.

Euthanasia is categorized in different ways, which include voluntary (when a person wills to have their life ended), non-voluntary (when a patient's consent is unavailable), or involuntary (.done without asking for consent or against the patient's will)

Jack Kevorkian, Philip Nitschke, Barbara Coombs Lee.

The United States (Washington, Oregon, California, Colorado, Montana, Vermont, Hawaii), Switzerland, Germany, Japan, the Netherlands, Belgium, Luxembourg, Colombia, Canada.

Though euthanasia is still illegal in England, King George V was euthanized. Euthanasia is mostly administered by giving lethal doses of painkiller or other drugs. Despite Euthanasia being generally illegal in India, there is a tradition of forced euthanasia in South India.

Relevant topics

• Death Penalty
• Freedom of Speech
• Gun Control
• Police Brutality
• Human Trafficking
• Child Labour
• Same Sex Marriage
• Gay Marriage
• Pro Life (Abortion)

By clicking “Check Writers’ Offers”, you agree to our terms of service and privacy policy . We’ll occasionally send you promo and account related email

No need to pay just yet!

Bibliography

We use cookies to personalyze your web-site experience. By continuing we’ll assume you board with our cookie policy .

• Instructions Followed To The Letter
• Deadlines Met At Every Stage
• Unique And Plagiarism Free

45,000+ students realised their study abroad dream with us. Take the first step today

Meet top uk universities from the comfort of your home, here’s your new year gift, one app for all your, study abroad needs, start your journey, track your progress, grow with the community and so much more.

Verification Code

An OTP has been sent to your registered mobile no. Please verify

Thanks for your comment !

Our team will review it before it's shown to our readers.

• School Education /

Essay on Euthanasia: 100, 200 and 300 Words Samples

• Updated on  
• Feb 22, 2024

Essay on Euthanasia: Euthanasia refers to the act of killing a person without any emotions or mercy. Euthanasia is an ethnically complex and controversial topic, with different perspectives and legal regulations on different topics. School students and individuals preparing for competitive exams are given assigned topics like essays on euthanasia. The objective of such topics is to check the candidate’s perspectives and what punishment should be morally and legally right according to them. 

If you are assigned an essay on euthanasia, it means your examiner or teacher wants to know your level of understanding of the topic. In this article, we will provide you with some samples of essays on euthanasia. Feel free to take ideas from the essays discussed below.

Master the art of essay writing with our blog on How to Write an Essay in English .

Table of Contents

• 1 Essay on Euthanasia in 150 Words
• 2.1 Euthanasia Vs Physician-Assisted Suicide
• 2.2 Euthanasia Classification
• 3 Is Euthanasia Bad?

Essay on Euthanasia in 150 Words

Euthanasia or mercy killing is the act of deliberately ending a person’s life.  This term was coined by Sir Francis Bacon. Different countries have their perspectives and laws against such harmful acts. The Government of India, 2016, drafted a bill on passive euthanasia and called it ‘The Medical Treatment of Terminally Ill Patient’s Bill (Protection of Patients and Medical Practitioners). 

Euthanasia is divided into different classifications: Voluntary, Involuntary and Non-Voluntary. Voluntary euthanasia is legal in countries like Belgium and the Netherlands, with the patient’s consent. On one side, some supporters argue for an individual’s right to autonomy and a dignified death. On the other hand, the opponents raise concerns about the sanctity of life, the potential for abuse, and the slippery slope towards devaluing human existence. The ethical debate extends to questions of consent, quality of life, and societal implications.

Also Read: Essay on National Science Day for Students in English

Essay on Euthanasia in 350 Words

The term ‘Euthanasia’ was first coined by Sir Francis Bacon, who referred to an easy and painless death, without necessarily implying intentional or assisted actions. In recent years, different countries have come up with different approaches, and legal regulations against euthanasia have been put forward. 

In 2016, the government of India drafted a bill, where euthanasia was categorised as a punishable offence. According to Sections 309 and 306 of the Indian Penal Code, any attempt to commit suicide and abetment of suicide is a punishable offence. However, if a person is brain dead, only then he or she can be taken off life support only with the help of family members.

Euthanasia Vs Physician-Assisted Suicide

Euthanasia is the act of intentionally causing the death of a person to relieve their suffering, typically due to a terminal illness or unbearable pain. 

Physician-assisted suicide involves a medical professional providing the means or information necessary for a person to end their own life, typically by prescribing a lethal dose of medication.

In euthanasia, a third party, often a healthcare professional, administers a lethal substance or performs an action directly causing the person’s death.

It is the final decision of the patient that brings out the decision of their death.

Euthanasia Classification

Voluntary Euthanasia

It refers to the situation when the person who is suffering explicitly requests or consents to euthanasia. A patient with a terminal illness may express his or her clear and informed desire to end their life to a medical professional.

Involuntary

It refers to the situation when euthanasia is performed without the explicit consent of the person, often due to the individual being unable to communicate their wishes.

Non-Voluntary

In this situation, euthanasia is performed without the explicit consent of the person, and the person’s wishes are unknown.

Active euthanasia refers to the deliberate action of causing a person’s death, such as administering a lethal dose of medication.

It means allowing a person to die by withholding or withdrawing treatment or life-sustaining measures.

Euthanasia and assisted suicide are a defeat for all. We are called never to abandon those who are suffering, never giving up but caring and loving to restore hope. — Pope Francis (@Pontifex) June 5, 2019

Also Read: Essay on Cleanliness

Is Euthanasia Bad?

Euthanasia is a subjective term and its perspectives vary from person to person. Different cultures, countries and religions have their own set of values and beliefs. Life is sacred and gifted to us by god or nature. Therefore, intentionally causing death goes against moral and religious beliefs. 

However, some people have raised concerns about the potential for a slippery slope, where the acceptance of euthanasia could lead to the devaluation of human life, involuntary euthanasia, or abuse of the practice. Some even argue that euthanasia conflicts with their traditional medical ethics of preserving life and prioritizing the well-being of the patient.

Today, countries like the Netherlands and Belgium have legalised euthanasia. In India, the USA and the UK, it is a punishable offence with varying sentences and fines. Euthanasia is a complex and controversial topic and creating a law against or for it requires a comprehensive study by experts and the opinions of all sections of society. 

Ans: Euthanasia refers to the act of killing a person without any emotions or mercy. Euthanasia is an ethnically complex and controversial topic, with different perspectives and legal regulations on different topics.

Ans: The term ‘Euthanasia’ was first coined by Sir Francis Bacon, who referred to an easy and painless death, without necessarily implying intentional or assisted actions. In recent years, different countries have come up with different approaches, and legal regulations against euthanasia have been put forward.  In 2016, the government of India drafted a bill, where euthanasia was categorised as a punishable offence. According to Sections 309 and 306 of the Indian Penal Code, any attempt to commit suicide and abetment of suicide is a punishable offence. However, if a person is brain dead, only then he or she can be taken off life support only with the help of family members.

Ans: Belgium and the Netherlands have legalised euthanasia. However, it is banned in India.

Related Articles

For more information on such interesting topics, visit our essay writing page and follow Leverage Edu.

Shiva Tyagi

With an experience of over a year, I've developed a passion for writing blogs on wide range of topics. I am mostly inspired from topics related to social and environmental fields, where you come up with a positive outcome.

Leave a Reply Cancel reply

Save my name, email, and website in this browser for the next time I comment.

Contact no. *

Connect With Us

45,000+ students realised their study abroad dream with us. take the first step today..

Resend OTP in

Need help with?

Study abroad.

UK, Canada, US & More

IELTS, GRE, GMAT & More

Scholarship, Loans & Forex

Country Preference

New Zealand

Which English test are you planning to take?

Which academic test are you planning to take.

Not Sure yet

When are you planning to take the exam?

Already booked my exam slot

Within 2 Months

Want to learn about the test

Which Degree do you wish to pursue?

When do you want to start studying abroad.

January 2024

September 2024

What is your budget to study abroad?

How would you describe this article ?

Please rate this article

We would like to hear more.

Have something on your mind?

Make your study abroad dream a reality in January 2022 with

India's Biggest Virtual University Fair

Essex Direct Admission Day

Why attend .

Don't Miss Out

Euthanasia - Essay Samples And Topic Ideas For Free

Euthanasia, also known as assisted dying or mercy killing, remains a deeply contested ethical and legal issue. Essays could delve into the various forms of euthanasia, such as voluntary, non-voluntary, and involuntary euthanasia, discussing the moral and legal implications of each. The discourse might extend to the examination of the cultural, religious, and societal attitudes towards euthanasia, exploring how different societies and religious groups perceive the right to die. Discussions could also focus on the experiences of countries and regions that have legalized euthanasia, examining the impact on healthcare practices, legal frameworks, and societal attitudes. Moreover, the broader implications of euthanasia on medical ethics, patient autonomy, and the sanctity of life could be explored to provide a comprehensive understanding of the complexities surrounding euthanasia and the ongoing debates on its legalization and practice. A substantial compilation of free essay instances related to Euthanasia you can find at Papersowl. You can use our samples for inspiration to write your own essay, research paper, or just to explore a new topic for yourself.

Euthanasia: is it Ethical

While doing research on the topic of Euthanasia and Physician Assisted Suicide, I have come to see that people have a hard time believing that this should be an option for people who have terminal illnesses. Euthanasia is the painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma and Physician Assisted Suicide (PAS) is The voluntary termination of one's own life by administration of a lethal substance with the direct or indirect […]

Arguments for and against Euthanasia

Euthanasia is also known as physician-assisted suicide or good death. It refers to the method where animals that are suffering or in discomfort are helped to rest in death. Many pet owners consider Euthanasia a more compassionate manner of bidding their beloved animals goodbye. In the case of people, many states have not legalized euthanasia for people with dementia or those suffering from incurable diseases. Euthanasia creates an ethical dilemma on three main lines: legal, medical, and philosophical. There are […]

Ethics Behind Physician-Assisted Suicide

Assisted suicide is the act of intentionally killing yourself with the assistance of someone else. In the United States, physician-assisted suicide is when a physician provides a patient, who meets the criteria of having a terminal illness, with medication in order to terminate their life to relieve pain and/or suffering. Physician-assisted suicide is often confused with euthanasia. Euthanasia is illegal in the US. It requires a doctor, or another individual, to administer the medication to the patient. Other terms for […]

We will write an essay sample crafted to your needs.

Why Euthanasia should be Legalised

Did you know that the word euthanasia comes from Greek which means good death? However, Only 9 out of the 196 countries in the world have legalised euthanasia or assisted death, including the Netherlands, Belgium, Switzerland and Japan. - posted on Deccan Chronicle. These are all first world countries that value freedom and I strongly believe that Euthanasia should be extended to all other countries. There are 4 different types of euthanasia voluntary, involuntary, active and passive euthanasia. First, I […]

The Ban on Euthanasia

Imagine your girl best friend gets into a car crash. After the incident, you find out she suffered major spinal cord damage and her legs will be paralyzed for the rest of her life. You go to visit her in the hospital the same week but arrive to shocking news. She tells you she has lost the will to live and wants to be euthanized, or painlessly killed. She tells you she is worried about how this accident will affect […]

Assisted Suicide the Rights we have

The right to assisted suicide is one of the most controversial topics ever discussed because of the fact that other people control your life when you are unable to. But some people think that they can stop you from dying even though death is inevitable when one is terminally ill. They think that because of religious and moral reasons they could stop someone from ending their own life. Assisted suicide also known as ""Euthanasia"" is used to make a painless […]

Economic Benefits of Euthanasia

Euthanasia is assisted suicide, it is an action taken by a doctor with consent of the patient in order to relieve immense pain and suffering. However, is the overall process of Euthanasia beneficial for the economy? Based on research, euthanasia is beneficial to the economy, and saves a vast amount of money for families for hospital stays, private insurance companies, taxpayers, and medicare each year. For a hospital stay, the average cost per inpatient day is $2,534.00 for a local […]

Euthanasia Debate

The intention to deliberately help someone accelerate the death of an incurable patient, even to stop his or her suffering has never been an easy task. The ethics of euthanasia is one that has been debated over since the fourth century B.C. Euthanasia is translated from Greek as "good death" or "easy death. At first, the term referred to painless and peaceful natural deaths in old age that occurred in comfortable and familiar surroundings. Today the word is currently understood […]

Physician-assisted Suicide: Right to Die

You may have heard of Physician-assisted suicide before, but what exactly is it? Physician-Assisted suicide is when someone who is terminally ill and completely competent of making choices the right to take their own life, legally with the help of a doctor. Though it seems as if they should be able to do that, in most states the law does get in the way of that. There are ethical and moral issues surrounding this issue. Regardless of those issues, those […]

Religious Perspectives on Euthanasia

Death is one of the most important things that religions deal with. All faiths offer meaning and explanations for death and dying; all faiths try to find a place for death and dying within human experience. Most religions disapprove of euthanasia. Some of them absolutely forbid it. Virtually all religions state that those who become vulnerable through illness or disability deserve special care and protection and that proper end of life care is a much better thing than euthanasia. Religions […]

Active and Passive Euthanasia

Euthanasia is the termination of a terminally ill person's life in order to relieve patients of their severe and untreatable pain. It is further broken down into two types: active and passive. In this paper, I will be focusing on active euthanasia and will argue that it is morally justifiable for a physician to alleviate agony for a patient and their family via direct action. Active euthanasia is morally permissible when a patient explicitly states their consent due to the […]

Physician Assisted Suicide: Medical Practice

Physician assisted suicide is when a physician provides a patient with the necessary means and information to help the patient perform a life ending act. Physician assisted suicide is when is when a person gets prescribed a lethal dose of medication from their physician that they can take when they get ready too. Physician assisted suicide has become an option for those around the world and even legal in certain States in the US. This option is legal in 6 […]

The Controversy over Euthanasia

Euthanasia, as defined by the Merriam-Webster Dictionary, is the act or practice of killing or permitting the death of hopelessly sick or injured individuals (such as persons or domestic animals) in a relatively painless way for reasons of mercy. The growing euthanasia epidemic has raised a profusion of controversy in recent years due to the legal and moral implications. Although described as relatively painless,euthanasia is something that should be methodically and thoroughly thought through because of the permanent effect it […]

Euthanasia and Death Penalty

Euthanasia and death penalty are two controversy topics, that get a lot of attention in today's life. The subject itself has the roots deep in the beginning of the humankind. It is interesting and maybe useful to learn the answer and if there is right or wrong in those actions. The decision if a person should live or die depends on the state laws. There are both opponents and supporters of the subject. However different the opinions are, the state […]

Physician Assisted Suicide: the Growing Issue of Dying with Dignity and Euthanasia

Is someone wanting to die with dignity more important than the conscience of a doctor who provides care for others? The issue of physician-assisted death can be summed up by simply saying it has a snowball effect. What starts as physician-assisted death turns into euthanizing and from there it could end up in the killing of patients without their full comprehension as to what they agreed to. The solution to this issue is accepting there is a problem and figuring […]

Definition of Euthanasia

Euthanasia defined as an intentionally ending of the life of the terminally ill person in order to relieve pain or suffering, done by a physician, legally. This is not to be confused with the similar physician assisted suicide, the suicide of patient suffering from an incurable disease, effected by the taking of lethal drug by a doctor for this purpose. It is legal in only a few places of the world, and the laws vary by the places. That means […]

Physician Assisted Suicide

Healthcare isn't as perfect as we think it should be considering there are so many medications and treatments that can help restore or cure one's illness. When needing the assistance of a healthcare facility, there are many different challenges that can impact patients and their families. Challenges that include life or death decision making, insurance coverage, the need for medications, cost of services, and so on. As these challenges may seem as if they are minor to some, they truly […]

Euthanasia and Physician-Assisted Suicide

In a documentary, Charles Scott was a man who loved to read, sing, and enjoy being outdoors. He was diagnosed with lymphoma. Struggling every day just to breathe after walking 10 steps to the bathroom and dealing with his eyesight deteriorating, He found life to be full of pain instead of joy. He found no want in having to wait through multiple medications, operations, pain, hospice, and finally him dying suffocating trying to catch his breath” he wished to die […]

Physician-Assisted Euthanasia/Suicide

Part 1: Ethical Question Should doctors have a choice to opt out of assisting terminally ill patients with euthanasia/suicide? Part 2: Introduction Some people think being a physician is an exciting job for the most part. However, physicians have the task of making tough decisions that could hurt many people emotionally. The morality of assisted euthanasia and suicide has been questioned by many people. Some may consider euthanasia and suicide immoral any wrong. Unfortunately, euthanasia and suicide may be the […]

Arguments for Legalizing Euthanasia

I once heard euthanasia is a heart-wrenching kindness and i believe that to be true.Although we as vet techs know it is the right thing to do, being apart of ending there pain and suffering,it is hard being the one to end it knowing the bond an animal has with its owner.Everyone has their own thoughts about this topic and how we prefer to handle it.There are different tolerances everyone has on how it should be done and what the […]

Why Active Euthanasia and Physician Assisted Suicide should be Legalized

This reference source gives us an overview of why euthanasia should be legalized. It goes into depth about how patients and doctors are affected by the decision to end a person's life, and moral issues, and whether it is right or wrong to purposely end someone's life. This source highlights that euthanasia should be in the best interest of the patient who is suffering from an illness, such as an incurable disease or a serious health issue. Doctors should be […]

Physician-assisted Suicide is not Federally Mandated

Physician-assisted suicide is not federally mandated due to the lack of bipartisanship in Congress, the principles of federalism, and contributions from conservative organizations and interest groups. The attitudes and moral acceptability about certain behaviors and actions differ significantly among Republicans and Democrats. According to a 2007 survey, 62% of Democrats support doctors assisting a terminally ill patient to commit suicide, while only 49% of Republicans support this notion (Gallup, Inc 2007). 59% of Democrats also find physician-assisted suicide to be […]

Physician-assisted Suicide and Euthanasia

Physician-assisted suicide and euthanasia have become some of the most highly controversial topics discussed in medicine, making those who have medicine as an occupation question the morality behind the act. A common misconception people often times make is confusing the fact that physician-assisted suicide and voluntary active euthanasia as the same thing. The NCI dictionary of cancer terms states euthanasia is accessibility to ""[a]n easy or painless death or the intentional ending of the life of a person suffering from […]

Euthanasia and Physician Assisted Suicide

Sometimes people criticize euthanasia and physician-assisted suicide from what is called "pro-life" perspectives and other times from "pro-death" perspectives; each perspective has a different argument about their position and the side they are on in this debate. This paper will review some of these arguments that have been made to date, as well as some of the more recent developments in this issue (Dieterle 129). To begin with, many people argue that euthanasia and physician-assisted suicide are morally acceptable because […]

Hinduism and Buddhist Perspective of Suicide and Euthanasia

The principle of ahimsa, or no violence, is fervently held in Hinduism and is reflective in followers' everyday lives. This concept extends to oneself as well as others. For one, suicide is condemned in this religion because all life is considered sacred. Humans life is perceived as precious because only through one of the three human realms can liberation be achieved. Other living things, such as insects and animals, do not receive the same opportunity, so it is crucial followers […]

Euthanasia – One of the most Debated Topics Today

The topic of euthanasia is one of the most debated topics today. Elderly patients can be pressured into a decision they don't want to make. Citizens can also be unfairly euthanized as well. Euthanasia should stay illegal due to the obligation to elderly patients, non permitted euthanization, of an individual, and which can open hopefully widen perspective on this issue, as well as many others. Euthanasia is a complex topic that can't be described simply and without depth. Euthanasia can […]

Physician-assisted Suicide Debate

Let's say a patient is in incredible pain or has an incurable illness and the patient can only be kept alive by machines or by enduring their pain. Should any patient who is in these circumstances be allowed to choose death over this life? Many people go against assisted suicide because of religion and or whatever they believe in. Another reason why people may disagree is that the patients who are not in the right mind and or are too […]

Ethics and Challenges of Euthanasia

As there are other patients who have a higher chance of living, euthanizing the patient was the more practical option. Euthanasia advocates argue that futile care may harm others. For instance, a young child with an acute respiratory disease, who has a potentially higher chance of getting cured, could not get a bed and ventilator in the ICU because others were using it even though they are not getting any personal benefit from the treatment (Niederman & Berger, 2010). This […]

Euthanasia: Merciful Death or Playing God

A death by suicide. Just hearing the word suicide can send chills down one's spine. How could someone get to the point of self-termination? Why would anybody ever consider such a terrible way to die? The thing is, suicide does not have to be a terrible or scary way to die if one is faced with insurmountable troubles accompanying an untreatable disease. With assistance from licensed professionals, it can give those suffering a painless option if they so choose to […]

What is Euthanasia?

Euthanasia is a easy death, some may say euthanasia is a undeviating act for taking a life through prescription drugs. A patient that has a short expand of life can address such an issue with their healthcare provider. Counseling can be provided before the final decision is made by doctor and the patient. At anytime the patient reserves the right to with draw from the process. The patient however must have good reason for the process before a doctor will […]

Additional Example Essays

• End Of Life Ethical Issues
• Socioautobiography Choices and Experiences Growing up
• A Class Divided
• Gender Inequality in Education
• Does Arrest Reduce Domestic Violence
• Homelessness in America
• New Imperialism
• Solutions to Gun Violence
• Catherine Roerva: A Complex Figure in the Narrative of Child Abuse
• The Mental Health Stigma
• Psychiatric Nurse Practitioner
• Substance Abuse and Mental Illnesses

How To Write An Essay On Euthanasia

Introduction to the concept of euthanasia.

When embarking on an essay about euthanasia, it’s crucial to begin with a clear definition of what euthanasia entails. Euthanasia, often referred to as "mercy killing," is the act of intentionally ending a person's life to relieve them of suffering, typically from a terminal illness or an incurable condition. In your introduction, outline the various types of euthanasia, such as voluntary, non-voluntary, and involuntary, and the ethical, legal, and moral questions they raise. This introductory segment sets the stage for an in-depth exploration of the arguments for and against euthanasia and its implications in the realms of medicine, ethics, and law.

Exploring the Arguments For and Against Euthanasia

The body of your essay should delve into the complex arguments surrounding euthanasia. On one hand, proponents argue that euthanasia is a compassionate response to unbearable suffering, respecting an individual's right to choose death over prolonged pain. They may also cite the importance of dignity in death and the reduction of medical costs for terminally ill patients. On the other hand, opponents raise concerns about the sanctity of life, the potential for abuse, and the slippery slope towards non-voluntary or involuntary euthanasia. They may also discuss the moral obligations of medical professionals to preserve life. This section should present a balanced view of the debate, providing a comprehensive understanding of the various perspectives on euthanasia.

Ethical and Legal Considerations

A crucial aspect of your essay should be an examination of the ethical and legal considerations surrounding euthanasia. Discuss the ethical principles involved, such as autonomy, beneficence, non-maleficence, and justice. Explore how different countries and cultures view and legislate euthanasia, noting the variations in legal frameworks and the criteria required for it to be carried out. This analysis should provide insight into the complexities of legalizing and regulating euthanasia, and the ethical dilemmas faced by healthcare providers, patients, and their families.

Concluding with Personal Reflections and Broader Implications

Conclude your essay by summarizing the key points and offering personal reflections on the topic. Reflect on the implications of euthanasia for society and the field of healthcare. Consider how advances in medical technology and changes in societal attitudes might influence the future of euthanasia. Your conclusion should not only provide closure to your essay but also encourage further thought and dialogue on this sensitive and contentious issue, highlighting the ongoing importance of ethical deliberation in decisions about life and death.

1. Tell Us Your Requirements

2. Pick your perfect writer

3. Get Your Paper and Pay

Hi! I'm Amy, your personal assistant!

Don't know where to start? Give me your paper requirements and I connect you to an academic expert.

short deadlines

100% Plagiarism-Free

Certified writers

• Table of Contents
• Random Entry
• Chronological
• Editorial Information
• About the SEP
• Editorial Board
• How to Cite the SEP
• Special Characters
• Advanced Tools
• Support the SEP
• PDFs for SEP Friends
• Make a Donation
• SEPIA for Libraries
• Entry Contents

Bibliography

Academic tools.

• Friends PDF Preview
• Author and Citation Info
• Back to Top

Voluntary Euthanasia

The entry sets out five conditions often said to be necessary for anyone to be a candidate for legalized voluntary euthanasia (and, with appropriate qualifications, physician-assisted suicide), outlines the moral case advanced by those in favor of legalizing voluntary euthanasia, and discusses the five most important objections made by those who deny that voluntary euthanasia is morally permissible and who are, in consequence, opposed to its being legalized.

1. Introduction

2. five conditions often proposed as necessary for candidacy for voluntary euthanasia, 3. a moral case for voluntary euthanasia, 4. five objections to the moral permissibility of voluntary euthanasia, other internet resources, related entries.

When a person performs an act of euthanasia, she brings about the death of another person because she believes the latter’s present existence is so bad that he would be better off dead, or believes that unless she intervenes and ends his life, his life will very soon become so bad that he would be better off dead. Accordingly, the motive of the person who performs an act of euthanasia is to benefit the one whose death is brought about. (This also holds for many instances of physician-assisted suicide, but use of the latter term is usually restricted to forms of assistance which stop short of the physician ‘bringing about the death’ of the patient, for example, those involving means that have to be activated by the patient.)

It is important to emphasize the motive of benefiting the person who is assisted to die because well-being is a key value in relation to the morality of euthanasia (see Section 3 below). Nonetheless, the defensibility of the contention that someone can be better off dead has been the subject of extensive philosophical deliberation. Those who claim that a person can be better off dead believe this to be true when the life that remains in prospect for that person has no positive value for her (a possibility which is discussed by e.g., Foot, 1977; McMahan 2002; Bradley 2009), whereas some of those who hold that a person’s life is inviolable deny that a person can ever be better off dead (e.g., Keown in Jackson and Keown 2012). A Kant-inspired variant on this latter position has been advanced by Velleman (1999). He considers that a person’s well-being can only matter if she is of intrinsic value and so that it is impermissible to violate a person’s rational nature (the source of her intrinsic value) for the sake of her well-being. Accordingly, he holds that it is impermissible to assist someone to die who judges that she would be better off dead and competently requests assistance with dying. The only exception is when a person’s life is so degraded as to call into question her rational nature, albeit he thinks it unlikely that anyone in that position will remain competent to request assistance with dying. This position appears to be at odds with the well-established right of a competent patient to refuse life-prolonging medical treatment, at least when further treatment is refused because she considers that her life no longer has value for her and further treatment will not restore its value to her. (For further reasons to reject arguments for the inviolability of the life of a person, including Velleman’s, see e.g., McMahan 2002; Young 2007; Sumner 2011, 2017.)

Because our concern will be with voluntary euthanasia – that is, with those instances of euthanasia in which a clearly competent person makes a voluntary and enduring request to be helped to die (or, by extension, when an authorised proxy makes a substituted judgment by choosing in the manner the no-longer-competent person would have chosen had he remained competent) – a second key value is the competence of the person requesting assistance with dying. There will be occasion to mention non-voluntary euthanasia – instances of euthanasia where a person lacks the competence at the time when a decision is to be made to request euthanasia and has not previously competently declared a preference for it via an advance directive (see the entry on advance directives ) – only when consideration is given to the claim that permitting voluntary euthanasia will lead via a slippery slope to permitting non-voluntary euthanasia. Nothing will be said here about involuntary euthanasia , where a competent person’s life is brought to an end despite an explicit expression of opposition to euthanasia, beyond saying that, no matter how honorable the perpetrator’s motive, such a death is, and ought to be, unlawful.

Debate about the morality and legality of voluntary euthanasia has been, for the most part, a phenomenon of the second half of the twentieth century and the beginning of the twenty first century. Certainly, the ancient Greeks and Romans did not believe that life needed to be preserved at any cost and were, in consequence, tolerant of suicide when no relief could be offered to a dying person or, in the case of the Stoics and Epicureans, when a person no longer cared for his life. In the sixteenth century, Thomas More, in describing a utopian community, 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’. But it has only been in the last hundred years that there have been concerted efforts to make legal provision for voluntary euthanasia. Until quite recently there had been no success in obtaining such legal provision (though assisted suicide, including, but not limited to, physician-assisted suicide, has been legally tolerated in Switzerland for a number of decades). However, the outlook changed dramatically in the 1970s and 80s because of a series of court cases in the Netherlands which culminated in an agreement between the legal and medical authorities to ensure that no physician would be prosecuted for assisting a patient to die as long as certain guidelines were strictly adhered to (see Griffiths, et al., 1998). In brief, the guidelines were established to permit physicians to practise voluntary euthanasia in those instances in which a competent patient had made a voluntary and informed request to be helped to die, the patient’s suffering was unbearable, there was no way of making that suffering bearable that was acceptable to the patient, and the physician’s judgements as to diagnosis and prognosis were confirmed after consultation with another physician.

The first legislative approval for voluntary euthanasia was achieved with the passage in the parliament of Australia’s Northern Territory of a bill enabling physicians to practise voluntary euthanasia. Subsequent to the Act’s proclamation in 1996, it faced a series of legal challenges from opponents of voluntary euthanasia. In 1997 the challenges culminated in the Australian National Parliament overturning the legislation when it prohibited Australian territories from enacting legislation to permit voluntary euthanasia on constitutional grounds. Australia is a federation consisting of six states and two territories. Unlike the territories, the states do have the constitutional right to enact such legislation and in 2017 the state of Victoria did just that. The legislation came into effect in 2019. In 2019, a second state, Western Australia, enacted legislation to enable voluntary medically assisted death. The legislation became effective in 2021. In 2021 three further states, Tasmania, South Australia and Queensland enacted legislation to enable voluntary medically assisted death which came into force in 2022 for the first two, and 2023 for the third. Finally, in 2022 NSW enacted legislation which came into force in 2023 resulting in voluntary medically assisted death being available in each of the states. Attempts are currently being made in both the Australian Capital Territory and the Northern Territory to introduce legislation in favor of voluntary medically assisted death that will avoid being vetoed by the federal parliament.

In November 2000, the Netherlands passed legislation to legalize the practice of voluntary euthanasia. The legislation passed through all the parliamentary stages early in 2001. The Belgian parliament passed similar legislation in 2002 and Luxembourg followed suit in 2009. (For a very helpful comparative study of relevant legislation see Lewis 2007. See also Griffiths, et al. 2008.)

In Oregon in the United States, legislation was introduced in 1997 to permit physician-assisted suicide after a referendum strongly endorsed the proposed legislation. Later in 1997 the Supreme Court of the United States ruled that there is no constitutional right to physician-assisted suicide; however, the Court did not preclude individual states from legislating in favor of physician-assisted suicide (so the Oregon legislation was unaffected). Since that time the Oregon legislation has been successfully utilised by a significant number of people and similar legislation has been passed in the state of Washington in 2009, in Vermont in 2013, and more recently still in California, Colorado, Florida, Hawaii, Iowa, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New Mexico and the District of Columbia. A series of judicial decisions in the state of Montana in 2008 and 2009 established that the state could not prohibit physician-assisted suicide but legislation has not yet been introduced to codify the legal situation. A number of the remaining states are currently considering physician-assisted suicide bills.

A similar legal position to that in Montana obtained in the nation of Colombia from the late 1990s as a result of a majority ruling by its Constitutional Court in favor of the legality of physician-assisted suicide but legislative provision was finally made only quite recently. In 2021, Spain legalized voluntary euthanasia. In Austria and Germany courts have authorised physician-assisted suicide but no legislative backing for the practice has been introduced, while in Italy legislation for voluntary medically assisted death has been passed in one house of the bicameral parliament. In Portugal legislation for physician-assisted suicide was passed but was subsequently rejected by the Constitutional Court.

In Canada, the province of Quebec introduced legislation permitting medical aid in dying in 2014. The legislation came into effect in 2016 at around the same time that the Canadian National Parliament passed legislation permitting both physician-assisted suicide and voluntary euthanasia throughout all of the Canadian federation. (For a brief account of events leading up to the enactment of the various pieces of legislation in Canada see Downie and Schuklenk 2021.)

New Zealand held a referendum in 2019 which resulted in approval for the introduction of legislation for voluntary medically assisted death. The legislation came into effect late in 2021.

In the following countries legislative proposals for voluntary medically assisted death are presently under review: the Czech Republic, France, Ireland, the Isle of Man, Japan, Jersey, South Korea, the Philippines, Slovenia and the United Kingdom.

With that brief sketch of the historical background in place, we will proceed first to consider the conditions that those who have advocated making voluntary medically assisted death legally permissible have typically insisted should be satisfied. Consideration of the proposed conditions will establish a framework for the moral interrogation that will follow in Sections 3 and 4. Section 3 will outline the positive moral case put forward by those who want voluntary euthanasia and physician-assisted suicide to be legally permissible. Section 4 will be devoted to scrutinising the most important of the objections that have been levelled against that case by those opposed to the legalization of voluntary euthanasia and physician-assisted suicide.

Advocates of voluntary euthanasia typically contend that if a person

• is suffering from a terminal illness;
• is unlikely to benefit from the discovery of a cure for that illness during what remains of her life expectancy;
• is, as a direct result of the illness, either suffering intolerable pain, or only has available a life that is unacceptably burdensome (e.g., because the illness has to be treated in ways that lead to her being unacceptably dependent on others or on technological means of life support);
• has an enduring, voluntary and competent wish to die (or has, prior to losing the competence to do so, expressed a wish to be assisted to die in the event that conditions (a)-(c) are satisfied); and
• is unable without assistance to end her life,

there should be legal and medical provision to facilitate her being allowed to die or assisted to die.

It should be acknowledged that these conditions are quite restrictive, indeed more restrictive than many think appropriate. In particular, the first condition restricts access to voluntary euthanasia to those who are terminally ill . While that expression is not free of all ambiguity, for present purposes it can be agreed that it does not include those who are rendered quadriplegic as a result of accidents, or sufferers from chronic diseases, or individuals who succumb to forms of dementia like Alzheimer’s Disease, to say nothing of those afflicted by ‘existential suffering’. Those who consider that cases like these show the first condition to be too restrictive (e.g., Varelius 2014, Braun, 2023) may, nonetheless, agree that including them as candidates for legalized voluntary euthanasia is likely to make it far harder in many jurisdictions to gain sufficient support for legalization (and so to make it harder to help those terminally ill persons who wish to die). Even so, they believe that voluntary euthanasia should be permitted for those who consider their lives no longer worth living, not just for for the terminally ill. Whether those who judge that their lives are no longer worth living, and so believe their lives are in that sense ‘complete’, should be afforded medical assistance with dying, has recently become a pressing concern in Belgium and the Netherlands. Several court cases have affirmed that such assistance may sometimes be provided for individuals in the former category even though the question remains as to whether it is properly a medical responsibility to render assistance with dying to someone who believes her life is complete despite her not suffering from a terminal medical condition (see, e.g., Young 2017). Relatedly, the issues of whether those suffering from a disability which will not reasonably foreseeably lead to death and those suffering because of a mental illness should be able to access medical assistance with dying have recently been the subject of intense debate in Canada. The debate culminated in disabled individuals, whose conditions are the cause of enduring, intolerable and irremediable suffering, being given access to medical assistance with dying as long as they are capable of making a competent request for that assistance. An intention to make a similar arrangement for those whose sole underlying condition is a mental illness was flagged for introduction in 2024, but has been temporarily shelved until further research has been conducted on the issue. It seems likely that the changes that have been made, or mooted, in these jurisdictions to the eligibility conditions for medical assistance with dying will lead to an expansion of the eligibility conditions for voluntary medically assisted death in other jurisdictions.

The fifth condition further restricts access to voluntary euthanasia by excluding those capable of ending their own lives, and so may be thought unduly restrictive by those who would wish to discourage terminally ill patients from attempting suicide. There will be yet others who consider this condition to be too restrictive because competent patients can always refuse nutrition and hydration (see, e.g., Bernat, et al. 1993; Savulescu 2014). Though this is true, many competent dying persons still wish to have access to legalized medically assisted death, rather than having to rely on refusing nutrition and hydration, so that they may retain control over the timing of their deaths and avoid needlessly prolonging the process of dying.

The second condition is intended simply to reflect the fact that it is normally possible to say when someone’s health status is incurable. So-called ‘miracle’ cures may be proclaimed by sensationalist journalists, but progress toward medical breakthroughs is typically painstaking. If there are miracles wrought by God that will be quite another matter entirely, but it is at least clear that not everyone’s death is thus to be staved off.

The third condition recognises what many who oppose the legalization of voluntary euthanasia do not, namely, that it is not only a desire to be released from pain that leads people to request help with dying. In the Netherlands, for example, pain has been found to be a less significant reason for requesting assistance with dying than other forms of suffering like frustration over loss of independence (see e.g., Marquet, et al. 2003; Onwuteaka-Philipsen, et al. 2012; Emanuel, et al. 2016). Sufferers from some terminal conditions may have their pain relieved but have to endure side effects that, for them, make life unbearable. Others may not have to cope with pain but, instead, with having to rely on forms of life support that simultaneously rob their lives of quality (as with, e.g., motor neurone disease). Yet others struggle with psychological distress and various psychiatric conditions and believe these conditions ought to be counted among the forms of suffering that qualify competent individuals to access medical assistance with dying. There has been greater recognition of, and support for, this position in those jurisdictions that make the role of unbearable suffering central to the determination of the eligibility of competent individuals for medical assistance with dying (see the discussion above of the first condition). Even so, inclusion of these forms of suffering highlights legitimate issues to do with the competence of at least some of those who suffer from them. (For a helpful recent study of the handling of requests for assistance with dying by psychiatric patients in the Netherlands see Kim, et al. 2016.)

A final preliminary point is that the fourth condition requires that the choice to die not only be uncoerced and competent but that it be enduring. The choice is one that will require time for reflection, and, almost certainly, discussion with others, so should not be settled in a moment. Nonetheless, as with other decisions affecting matters of importance, adults are presumed to choose voluntarily and to be competent unless the presence of defeating considerations can be established. (See the entry on decision-making capacity .) The burden of proof of establishing lack of voluntariness, or lack of competence, is on those who refuse to accept an adult person’s choice. There is no need to deny that this burden can sometimes be met (e.g., by pointing to the person’s being in a state of clinical depression). The claim is only that the onus falls on those who assert that an adult’s choice is not competent. (There are different issues to be faced when the competence of at least some older children and adolescents is at issue. In the Netherlands, for example, those aged twelve and older have sometimes been found to be competent to make end-of-life decisions for themselves. However, the topic will not be pursued further here because the focus of the entry is on competent adults.)

Clearly the five conditions set out above are likely to require some refinement if complete agreement is to be reached but there is sufficient agreement for us to proceed without further ado to consideration of the cases for and against legalization of voluntary euthanasia. (However, for a fuller discussion of issues concerning the definition of ‘euthanasia’ see, e.g., Beauchamp and Davidson 1979.)

One central ethical contention in support of voluntary euthanasia is that respect for persons demands respect for their autonomous choices as long as those choices do not result in harm to others. Respect for people’s autonomous choices is directly connected with the requirement for competence because autonomy presupposes competence (cf., Brock 1992). People have an interest in making important decisions about their lives in accordance with their own conception of how they want to live. In exercising autonomy, or self-determination, individuals take responsibility for their lives; since dying is a part of life, choices about the manner of their dying and the timing of their death are, for many people, part of what is involved in taking responsibility for their lives. Many are concerned about what the last phase of their lives will be like, not merely because of fears that their dying might involve them in great suffering, but also because of the desire to retain their dignity, and as much control over their lives as possible, during this phase. A second contention in support of voluntary euthanasia was mentioned at the beginning of this entry, namely the importance of promoting the well-being of persons. When someone is suffering intolerable pain or only has available a life that is unacceptably burdensome (see the third condition above), and he competently requests medical assistance with dying, his well-being may best be promoted by affording him that assistance. When harnessed together, the value to individuals of making autonomous choices, and the value to those individuals who make such choices of promoting their own well-being, provide the moral foundation for requests for voluntary euthanasia. Each consideration is necessary for moral justification of the practice, but taken in isolation neither suffices (see, e.g., Young 2007, 2017; Sumner 2011, 2017).

The technological interventions of modern medicine have had the effect of stretching out the time it takes for many people to die. Sometimes the added life this brings is an occasion for rejoicing; sometimes it drags out the period of significant physical and intellectual decline that a person undergoes with the result that life becomes no longer worth living. Many believe there is no single, objectively correct answer as to when, if at all, a person’s life becomes a burden and hence unwanted. If they are right, that simply points up the importance of individuals being able to decide autonomously for themselves whether their own lives retain sufficient quality and dignity to make life worth living. Others maintain that individuals can be in error about whether their lives continue to be worth living (cf., Foot 1977). The conditions outlined above in Section 2 are intended by those who propose them to serve, among other purposes, to safeguard against such error. But it is worth adding that in the event that a person who considers that she satisfies those conditions is judged by her medical attendants to be in error about whether it would be worth her continuing to live, the likely outcome is that those attendants will refuse to provide medical assistance with dying. (Evidence that will be mentioned below shows that this happens more frequently than might be predicted in jurisdictions in which medically assisted dying has been legalized. (There are discussions of the principles at stake in such matters in Young 2007; Wicclair 2011; Sumner 2020.) Unless a patient is able to be transferred to the care of other medical professionals who accept her assessment, she will have to rely on her own resources (e.g., by refusing nutrition and hydration). Even so, other things being equal, as long as a critically ill person is competent, her own judgement of whether continued life is a benefit to her ought to carry the greatest weight in any end-of-life decision making regardless of whether she is in a severely compromised and debilitated state. The idea that a competent individual’s autonomous judgment of the value to her of continued life should trump an assessment by others of her well-being should not be thought surprising because precisely the same happens when a competent patient refuses life-prolonging treatment.

Suppose, for the sake of argument, that it is agreed that we should respect a person’s competent request for medical assistance with dying (e.g., so as to enable her to achieve her autonomously chosen goal of an easeful death). It might be thought that in such an eventuality different moral concerns will be introduced from those that arise in connection with competent refusals. After all, while competent patients are entitled to refuse any form of medical treatment, they are not entitled to insist on the administration of forms of medical treatment that have no prospect of conferring a medical benefit or are not being provided because of a scarcity of medical resources or their affordability. While each of these points is sound, it remains the case that medical personnel have a duty to relieve suffering when that is within their capacity. Accordingly, doctors who regard medical assistance with dying as an element of appropriate medical care will consider it morally permissible to agree to a request for assistance with dying by a competent dying patient who wishes to avoid unbearable suffering. The reason for claiming only that this is morally permissible rather than morally obligatory will be explained in a subsequent paragraph. (For further reflections on the issue of responses to requests for medical assistance see, for instance, Dworkin 1998; Sumner 2011, 2017, 2020; Young 2007, 2017.)

Notwithstanding this response, as was seen earlier, at least some proponents of voluntary medically assisted dying wish to question why medical assistance with dying should be restricted to those covered by, in particular, the first three conditions set out above in Section 2. If people’s competent requests for medically assisted death should be respected why impose any restrictions at all on who may have access to medically assisted death? Why, for example, should those suffering from depression, or forms of dementia, not be eligible for medically assisted dying? Most proponents of voluntary medically assisted dying hold that there are at least two reasons for restricting access to it to those who satisfy the conditions set out earlier (or, a modified set that takes account of the concerns canvassed in the discussion of those proposed conditions). First, they contend that there are political grounds for doing so, namely, that because legalizing medically assisted dying for competent individuals is politically contested, the best hope for its legalization lies in focusing on those forms of suffering most likely to effect law reform. That is why some proponents deny the eligibility even of sufferers from conditions like ‘locked-in’ syndrome, motor neurone disease, and multiple sclerosis for voluntary medically assisted dying since, strictly, they are not terminally ill, and reliance has to be placed in consequence on their claim to be suffering unbearably. Second, and relatedly, most proponents of the legalization of medical assistance with dying have been cautious about supporting medically assisted death for those suffering from, for example, depression and dementia, because not only are they not terminally ill, but their competence to request assistance with dying is apt to be called into question, particularly in instances where they have given no prior indication of their preference for such assistance. Restricting access to medical assistance with dying to those whose suffering is less likely to be disputed avoids becoming embroiled in controversy. As was noted earlier, some critics of the restrictive approach (e.g., Varelius 2014) take a harder line and claim that it should not even be necessary for a person to be suffering from a medical condition to be eligible for medical assistance with dying; it should be enough to be ‘tired of life’. Only in a few jurisdictions, viz., Switzerland, the Netherlands and Belgium, has this issue been seriously broached. Regardless of what may happen in those jurisdictions, those seeking the legal provision of medical assistance with dying in other jurisdictions seem likely to maintain that if such assistance is to be seen as a legitimate form of medical care it has to be provided in response to a medical condition (rather than because someone is ‘tired of life’), and, indeed, restricted to those who satisfy the conditions outlined earlier in Section 2 (or some similar set of conditions). In short, these latter hold that making an autonomous request for assistance with dying is necessary, but should not be sufficient, for triggering such assistance.

There is one final matter of relevance to the moral case for voluntary medically assisted death on which comment must be made. The comment concerns a point foreshadowed in a previous paragraph, but it is also linked with the remark just made about the insufficiency of an autonomous request for assistance with dying to trigger that assistance. It is important to make the point that respect has to be shown not only for the dying person’s autonomy but also for the professional autonomy of any medical personnel asked to lend assistance with dying. The value (or, as some would prefer, the right) of self-determination does not entitle a patient to try to compel medical professionals to act contrary to their own moral or professional values. Hence, if voluntary euthanasia is to be legally permitted, it must be against a backdrop of respect for professional autonomy. Similarly, if a doctor’s view of her moral or professional responsibilities is at odds with her patient’s competent request for euthanasia, she should make provision, where it is feasible to do so, for the transfer of the patient to the care of a doctor who faces no such conflict. Given that, to date, those who contend that no scope should be permitted for conscientious objection within medical practice have garnered very little support for that view, making use of referrals and transfers remains the most effective means of resolving such disagreements.

Opponents of voluntary euthanasia have endeavored in a variety of ways to counter the very straightforward moral case that has been laid out above for its legalization (see, for example, Keown 2002; Foley, et al. 2002; Biggar 2004; Gorsuch 2006). Some of the counter-arguments are concerned only with whether the moral case warrants making the practice of voluntary euthanasia legal, whereas others are concerned with trying to undermine the moral case itself. In what follows, consideration will be given to the five most important counter-arguments. (For more comprehensive discussions of the morality and legality of medically assisted death see Biggar 2004; Gorsuch 2006; Young 2007; Sumner 2011, 2017; Keown 2018).

4.1 Objection 1

It is sometimes said (e.g., Emanuel 1999; Keown in Jackson and Keown 2012) that it is not necessary nowadays for people to die while suffering from intolerable or overwhelming pain because the provision of effective palliative care has improved steadily, and hospice care is more widely available. Some have urged, in consequence, that voluntary euthanasia is unnecessary.

There are several flaws in this contention. First, while both good palliative care and hospice care make important contributions to the care of the dying, neither is a panacea. To get the best palliative care for an individual involves trial and error, with some consequent suffering in the process; moreover, even the best care fails to relieve all pain and suffering. Perhaps even more importantly, high quality palliative care commonly exacts a price in the form of side-effects such as nausea, incontinence, loss of awareness because of semi-permanent drowsiness, and so on. A rosy picture is often painted as to how palliative care can transform the plight of the dying. Such a picture is misleading according to those who have closely observed the effect of extended courses of treatment with drugs like morphine. For these reasons many skilled palliative care specialists acknowledge that palliative care does not enable an easeful death for every patient. Second, even though the sort of care provided through hospices is to be applauded, it is care that is available to only a small proportion of the terminally ill and then usually only in the very last stages of the illness (typically a matter of a few weeks). Notwithstanding that only relatively few of the dying have access to hospice care it is worth drawing attention to the fact that in, Oregon, to cite one example, a high proportion of those who have sought physician-assisted suicide were in hospice care. Third, and of greatest significance for present purposes, not everyone wishes to avail themselves of palliative or hospice care. For those who prefer to die on their own terms and in their own time, neither option may be attractive. As previously mentioned, a major source of distress for many dying patients is the frustration that comes with being unable to satisfy their autonomous wishes. Fourth, as also indicated earlier, the suffering that occasions a desire to end life is not always traceable to pain caused by illness. For some, what is intolerable is their forced dependence on others or on life-supporting machinery; for these patients, the availability of effective pain control is not the primary concern. (In relation to the preceding matters see Rietjens, et al. 2009 and Onwuteaka-Philipsen et al. 2012 for findings for the Netherlands; and, for Oregon, Ganzini, et al. 2009.)

4.2 Objection 2

A second, related objection to the moral and legal permissibility of voluntary euthanasia turns on the claim that we can never have sufficient evidence to be justified in believing that a dying person’s request to be helped to die is competent, enduring and genuinely voluntary.

It is certainly true that a request to die may not reflect an enduring desire to die (just as some attempts to commit suicide may reflect only temporary despair). That is why advocates of the legalization of voluntary euthanasia have argued that a cooling off period should normally be required before euthanasia is permitted to ensure that the request is enduring. That having been said, to claim that we can never be justified in believing that someone’s request to die reflects a settled preference for death is to go too far. If a competent person discusses the issue with others on different occasions over time, and remains steady in her resolve, or privately reflects on the issue for an extended period and does not waver in her conviction, her wish to die surely must be counted as enduring.

But, it might be asked, what if a person is racked with pain, or mentally confused because of the measures taken to relieve her pain, and is, in consequence, unable to think clearly and rationally about the alternatives? It has to be agreed that a person in those circumstances who wants to die should not be assumed to have a truly voluntary and enduring desire to die. However, there are at least two important points to make about those in such circumstances. First, they do not account for all of the terminally ill, so even if it is acknowledged that such people are incapable of agreeing to voluntary euthanasia that does not show that no one can ever voluntarily request help to die. Second, it is possible in at least some jurisdictions for a person to indicate, in advance of losing the capacity to give competent consent, how she would wish to be treated should she become terminally ill and suffer either intolerable pain or an unacceptable loss of control over her life (cf., for instance, Dworkin 1993). ‘Living wills’ or ‘advance directives’ are legal instruments for giving voice to people’s wishes while they are capable of giving competent, enduring and voluntary consent, including to their wanting help to die. As long as they are easily revocable in the event of a change of mind (just as civil wills are), they should be respected as evidence of a well thought-out conviction. (For more detailed consideration of these instruments see the entry on advance directives .)

Perhaps, though, what is really at issue in this objection is whether anyone can ever form a competent, enduring and voluntary judgement about being better off dead, rather than continuing to suffer from an illness, prior to suffering such an illness (cf., Keown in Jackson and Keown 2012). If this is what underlies the objection it is surely too paternalistic to be acceptable. Why is it not possible for a person to have sufficient inductive evidence (e.g., based on the experience of the deaths of friends or family) to know her own mind, and act accordingly, without having had direct experience of such suffering?

4.3 Objection 3

According to the traditional interpretation of the ‘doctrine of double effect’ it is permissible to act in a way which it is foreseen will have a bad effect, provided only that

• the bad effect occurs as a side-effect (i.e., indirectly) to the achievement of the act that is directly aimed at;
• the act directly aimed at is itself morally good or, at least, morally neutral;
• the good effect is not achieved by way of the bad, that is, the bad must not be a means to the good; and
• the bad effect must not be so serious as to outweigh the good effect.

Hence, it is permissible, according to the doctrine of double effect, to, for example, alleviate pain (a good effect) by administering a drug, knowing that doing so will shorten life, but impermissible to administer the same drug with the direct intention of terminating a patient’s life (a bad effect). This latter claim is said to apply regardless of whether the drug is given at the person’s request.

This is not the appropriate forum for a full consideration of the doctrine, for which see the entry on the doctrine of double effect . However, there is one very important criticism to be made of the application of the doctrine that has direct relevance to the issue of voluntary euthanasia.

On the most plausible reading, the doctrine of double effect can be relevant to the permissibility of voluntary euthanasia only when a person’s death is bad for her or, to put it another way, a harm to her. Sometimes the notion of ‘harm’ is understood simply as damage to a person’s interests whether consented to or not. At other times, it is understood, more strictly, as damage that has been wrongfully inflicted. On either understanding of harm, there can be instances in which death for a person does not constitute a harm for her because it will either render her better off, or, as some would insist, no worse off, when compared with remaining alive. Accordingly, in those instances, the doctrine of double effect can have no relevance to the debate about the permissibility of voluntary euthanasia. (For extended discussions of the doctrine of double effect and its bearing on the moral permissibility of voluntary euthanasia see, e.g., McIntyre 2001; Woodward 2001; Cavanaugh 2006; Young 2007; Sumner 2011, 2017.)

4.4 Objection 4

As was noted earlier in Section 3, there is a widespread belief that so-called passive (voluntary) euthanasia, wherein life-sustaining or life-prolonging measures are withdrawn or withheld in response to a competent patient’s request, is morally permissible. The reason why passive (voluntary) euthanasia is said to be morally permissible is that the patient is simply allowed to die because steps are not taken to preserve or prolong life. This happens, for example, when a dying patient requests the withdrawal or the withholding of measures whose administration would be medically futile, or unacceptably burdensome. By contrast, active (voluntary) euthanasia is said to be morally impermissible because it is claimed to require an unjustifiable intentional act of killing to satisfy the patient’s request (cf., for example, Finnis, 1995; Keown in Jackson and Keown 2012; Keown 2018).

Despite its popularity and widespread use, the distinction between passive and active euthanasia is neither particularly clear nor morally helpful. (For a fuller discussion, see McMahan 2002.) Whether behavior is described in terms of acts or omissions (a distinction which underpins the alleged difference between active and passive voluntary euthanasia and that between killing a person and letting her die), is often a matter of pragmatics rather than anything of deeper moral importance. Consider, for instance, the practice (once common in hospitals) of deliberately proceeding slowly to a ward in response to a request to provide assistance for a patient who has been assigned a ‘not for resuscitation’ code. Or, consider ‘pulling the plug’ on a respirator keeping an otherwise dying patient alive, as against not replacing the oxygen supply when it runs out. Are these acts or omissions? If the answers turn on merely pragmatic considerations the supposed distinction between passive euthanasia and active euthanasia will be hard to sustain.

Even supposing that the distinction between acts and omissions, and the associated distinction between killing and letting die, can be satisfactorily clarified (on which see the entry doing v. allowing harm ), there remains the issue of whether these distinctions have moral significance in every circumstance. Consider a case of a patient suffering from motor neurone disease who is completely respirator dependent, finds her condition intolerable, and competently and persistently requests to be removed from the respirator so that she may die. Even the Catholic Church in recent times has been prepared to agree that it is permissible, in a case like this, to turn off the respirator. No doubt this has been because the Catholic Church considers such a patient is only being allowed to die. Even were it to be agreed, for the sake of argument, that such a death should be regarded as an instance of letting die, this concession would not show that it would have been morally worse had the patient been killed at her request (active voluntary euthanasia) rather than being allowed to die (passive voluntary euthanasia). Indeed, supporters of voluntary medically assisted death maintain that since death is beneficial in such an instance (or, at the very least, leaves the dying person no worse off), actively bringing about the death is morally to be preferred to just allowing it to happen because the desired benefit is achieved sooner and thus with less suffering.

Opponents of voluntary euthanasia claim, however, that the difference between active and passive euthanasia is to be found in the agent’s intention: if someone’s life is intentionally terminated she has been killed, whereas if she is just no longer being aggressively treated, her death should be attributed to the underlying disease. Many physicians would say that their intention in withholding or withdrawing life-sustaining medical treatment in such circumstances is simply to respect the patient’s wishes. This is plausible in those instances where the patient competently requests that aggressive treatment no longer be given (or, the patient’s proxy makes such a request). But it will often be implausible. In many cases the most plausible interpretation of a physician’s intention in withholding or withdrawing life-sustaining measures is that it is to end the patient’s life. Consider the palliative care practice of ‘terminally sedating’ a patient after a decision has been made to cease aggressive treatment. Suppose (as sometimes happens) that this is then followed by withholding artificially supplied nutrition. In these latter instances the best explanation of the physician’s behavior is that the physician intends thereby to end the life of the patient. What could be the point of the action, the goal aimed at, the intended outcome, if not to end the patient’s life? (Cf. Winkler 1995.) No sense can be made of the action as being intended to palliate the patient’s diseased condition, or to keep the patient comfortable. Nor is it appropriate to claim that what kills the patient is the underlying disease. What kills the patient is the act of depriving her of nutrition (i.e., of starving her to death). The point can be generalized to cover many more instances involving either the withdrawal or the withholding of life-sustaining medical treatment. In short, there is no good reason to think that whereas so-called passive voluntary euthanasia is morally acceptable active voluntary euthanasia never can be.

But we can go further. Giving titrated doses of morphine that reach levels beyond those needed to control pain, or removing a respirator from a sufferer from motor neurone disease, seem to many of us to amount to intentionally bringing about the death of the person being cared for. To be sure, as was acknowledged above, there are circumstances in which doctors can truthfully say that the actions they perform, or omissions they make, will bring about the deaths of their patients even though it was not their intention that those patients would die. So, for instance, if a patient refuses life-prolonging medical treatment because she considers it futile, it can be reasonable to say that her doctor’s intention in complying with the request was simply to respect her wishes. Nevertheless, as we have seen, there are other circumstances in which it is highly stilted to claim, as some doctors continue to do, that they had no intention of bringing about death.

These considerations should settle matters but do not do so for those who maintain that killing, in medical contexts, is always morally unjustified – a premise that underwrites much of the debate surrounding this fourth objection. But this underlying assumption is open to challenge and has been challenged by, for instance, Rachels 1986 and McMahan 2002. One of the reasons the challengers have given is that there are cases in which killing a competent dying person when she requests assistance with dying, is morally preferable to allowing her to die, namely, when taking the latter option would serve only to prolong her suffering against her wishes. Further, despite the longstanding legal doctrine that no one can justifiably consent to be killed (on which more later), it surely is relevant to the justification of an act of killing that the person killed has autonomously decided that she would be better off dead and so asks to be helped to die.

4.5 Objection 5

It is sometimes said that if society allows voluntary euthanasia to be legalized, we will then have set foot on a slippery slope that will lead us eventually to support other forms of euthanasia, including, in particular, non-voluntary euthanasia. Whereas it was once the common refrain that that was precisely what happened in Hitler’s Germany, in recent decades the tendency has been to claim that experience with legalized euthanasia in the Netherlands and Belgium, in particular, has confirmed the reality of the slippery slope.

Slippery slope arguments come in various versions. One (but not the only) way of classifying them has been to refer to logical, psychological and arbitrary line versions. The common feature of the different forms is the contention that once the first step is taken on a slippery slope the subsequent steps follow inexorably, whether for logical reasons, psychological reasons, or to avoid arbitrariness in ‘drawing a line’ between a person’s actions. (For further discussion see, e.g., Rachels 1986; Brock 1992; Walton 1992.)

We need first to consider whether, at the theoretical level, any of these forms of argument is powerful enough to refute the case for the legalization of voluntary euthanasia. We will then be in a position to comment on the alleged empirical support from the experiences of Hitler’s Germany and, more recently, of legalized euthanasia in the Netherlands and elsewhere, for the existence of a slippery slope that supposedly comes into being with the legalization of voluntary euthanasia.

To begin with, there is nothing logically inconsistent in supporting voluntary euthanasia while maintaining the moral inappropriateness of non-voluntary euthanasia. (However, for an attempt to press the charge that there is such an inconsistency see, e.g., Keown 2022.) Undoubtedly, some advocates of voluntary euthanasia wish also to lend their support to some acts of non-voluntary euthanasia, for example, for those in persistent vegetative states who have never indicated their wishes about being helped to die, or for certain severely disabled infants for whom the outlook is hopeless. (See, e.g., Kuhse and Singer 1985; Singer 1994; Stingl 2010; Sumner 2017.) Others believe that the consent of the patient is strictly required if euthanasia is appropriately to be legalized. The difference is not a matter of logical acumen; it is to be explained by reference to the importance placed on key values by the respective supporters. Thus, for example, those who insist on the necessity for a competent request by a patient for medical assistance with dying typically believe that such a request is the paramount consideration in end-of-life decision making (even when it is harnessed to the value of individual well-being), whereas those who consider a person’s best interests to be the paramount consideration are more likely to believe in the justifiability of instances of non-voluntary euthanasia like those mentioned above.

Next, it is hard to see why moving from voluntary to non-voluntary euthanasia is supposed to be psychologically inevitable. Why should those who support the legalization of voluntary euthanasia, because they value the autonomy of the individual, find it psychologically easier, in consequence, to endorse the killing of those who are not able competently to request assistance with dying? What reason is there to believe that they will, as a result of their support for voluntary euthanasia, be psychologically driven to endorse a practice of non-voluntary euthanasia?

Finally, since there is nothing arbitrary about distinguishing voluntary euthanasia from non-voluntary euthanasia (because the line between them is based on clear principles), there can be no substance to the charge that only by arbitrarily drawing a line between them could non-voluntary euthanasia be avoided were voluntary euthanasia to be legalized.

What, though, of Hitler’s Germany and the recent experience of legalized voluntary euthanasia in the Netherlands and elsewhere? The former is easily dismissed as an indication of an inevitable descent from voluntary euthanasia to non-voluntary. There never was a policy in favor of, or a legal practice of, voluntary euthanasia in Germany in the 1920s to the 1940s (see, for example, Burleigh 1994). There was, prior to Hitler coming to power, a clear practice of killing some disabled persons. But it was never suggested that their being killed was justified by reference to their best interests; rather, it was said that society would be benefited. Hitler’s later revival of the practice and its widening to take in other groups such as Jews and gypsies was part of a program of eugenics , not euthanasia.

Since the publication of the Remmelink Report in 1991 into the medical practice of euthanasia in the Netherlands, it has frequently been said that the Dutch experience shows that legally protecting voluntary euthanasia is impossible without also affording shelter to the non-voluntary euthanasia that will follow in its train (see, e.g., Keown 2018). In the period since that report there have been regular national studies of the practice of euthanasia in the Netherlands (see, e.g., Rietjens, et al. 2009; Onwuteaka-Philipsen, et al. 2012; van der Heide, et al. 2017). The findings from these national studies have consistently shown that there is no evidence for the existence of such a slippery slope. Among the specific findings the following are worth mentioning: of those terminally ill persons who have been assisted to die about sixty per cent have clearly been cases of voluntary euthanasia as it has been characterised in this entry; of the remainder, the vast majority of cases were of patients who at the time of their medically assisted deaths were no longer competent. It might be thought that these deaths ought to be regarded as instances of non-voluntary euthanasia. But, in fact, it would be inappropriate to regard them as such. Here is why. For the overwhelming majority of these cases, the decisions to end life were taken only after consultation between the attending doctor(s) and close family members, and so can legitimately be thought of as involving substituted judgements. Moreover, according to the researchers, the overwhelming majority of these cases fit within either of two common practices that occur in countries where voluntary euthanasia has not been legalized, namely, that of terminal sedation of dying patients, and that of giving large doses of opioids to relieve pain while foreseeing that this will also end life. In a very few cases, there was no consultation with relatives, though in those cases there were consultations with other medical personnel. The researchers contend that these instances are best explained by the fact that families in the Netherlands strictly have no final legal authority to act as surrogate decision-makers for incompetent persons. For these reasons the researchers maintain that non-voluntary euthanasia is not widely practised in the Netherlands.

That there have only been a handful of prosecutions of Dutch doctors for failing to follow agreed procedures (Griffiths, et al. 1998; Asscher and van de Vathorst 2020), that none of the doctors prosecuted has had a significant penalty imposed, that a significant proportion of requests for medical assistance with dying are rejected as unjustifiable, and that the Dutch public have regularly reaffirmed their support for the agreed procedures suggests that, contrary to the claims of some critics, the legalization of voluntary euthanasia has not increased the incidence of non-voluntary euthanasia. A similar picture to the one in the Netherlands has emerged from studies of the operation of the law concerning physician-assisted suicide in Oregon. Indeed, in a recent wide-ranging study of attitudes and practices of voluntary euthanasia and physician-assisted suicide covering two continents, a prominent critic of these practices has concluded (in agreement with his co-authors) that little evidence exists of abuse, particularly of the vulnerable (see Emanuel, et al., 2016). Unfortunately, insufficient time has elapsed for appropriate studies to be conducted in the other jurisdictions that have legalized either voluntary euthanasia or physician-assisted suicide (but for some relevant evidence see e.g., White, et al. 2022). Finally, some commentators have pointed out that there may, in reality, be more danger of the line between voluntary and non-voluntary euthanasia being blurred if euthanasia is practised in the absence of legal recognition, since there will, in those circumstances, be neither transparency nor monitoring (which cannot be said of the Netherlands, Belgium, Oregon and so on).

None of this is to suggest that it is not necessary to ensure the presence of safeguards against potential abuse of legally protected voluntary euthanasia. This is particularly important for the protection of those who have become incompetent by the time decisions need to be taken about whether to assist them to die. Furthermore, it is, of course, possible that the reform of any law may have unintended effects. However, if the arguments outlined above are sound (and the experience in the Netherlands, Belgium and Luxembourg, along with the more limited experience in several states in the United States and in Canada, is, for the present, not only the best evidence we have that they are sound, but the only relevant evidence), that does not seem very likely.

It is now well-established in many jurisdictions that competent patients are entitled to make their own decisions about life-sustaining medical treatment. That is why they can refuse such treatment even when doing so is tantamount to deciding to end their life. It is plausible to think that the fundamental basis of the right to decide about life-sustaining treatment – respect for a person’s autonomy and her assessment of what will best serve her well-being – has direct relevance to the legalization of voluntary euthanasia (see, e.g., Dworkin 1998; Young 2007, 2017; Sumner 2011, 2017). In consequence, extending the right of self-determination to cover cases of voluntary euthanasia does not require a dramatic shift in legal policy. Nor do any novel legal values or principles need to be invoked. Indeed, the fact that suicide and attempted suicide are no longer criminal offences in many jurisdictions indicates that the central importance of individual self-determination in a closely analogous context has been accepted. The fact that voluntary euthanasia and physician-assisted suicide have not been more widely decriminalized is perhaps best explained along a similar line to the one that has frequently been offered for excluding the consent of the victim as a justification for an act of killing, namely the difficulties thought to exist in establishing the genuineness of the consent. But, the establishment of suitable procedures for giving consent to voluntary euthanasia and physician-assisted suicide is surely no harder than establishing procedures for competently refusing burdensome or otherwise unwanted medical treatment. The latter has already been accomplished in many jurisdictions, so the former should be achievable as well.

Suppose that the moral case for legalizing voluntary euthanasia and physician-assisted suicide does come to be judged more widely as stronger than the case against legalization, and they are made legally permissible in more jurisdictions than at present. Should doctors take part in the practice? Should only doctors perform voluntary euthanasia? These questions ought to be answered in light of the best understanding of what it is to provide medical care. The proper administration of medical care should promote the welfare of patients while respecting their individual self-determination. It is these twin values that should guide medical care, not the preservation of life at all costs, or the preservation of life without regard to whether patients want their lives prolonged should they judge that life is no longer of benefit or value to them. Many doctors in those jurisdictions where medically assisted death has been legalized and, to judge from available survey evidence, in other liberal democracies as well, see the practice of voluntary euthanasia and physician-assisted suicide as not only compatible with their professional commitments but also with their conception of the best medical care for the dying. That being so, doctors of the same conviction in jurisdictions in which voluntary medically assisted death is currently illegal should no longer be prohibited by law from lending their professional assistance to competent terminally ill persons who request assistance with dying because of irremediable suffering or because their lives no longer have value for them.

• Asscher, E. and S. van de Vathorst, 2020, “First Prosecution of a Dutch Doctor Since the Euthanasia Act of 2002: What Does It Mean?”, Journal of Medical Ethics , 46: 71–75.
• Beauchamp, T. and A. Davidson, 1979, “The Definition of Euthanasia”, The Journal of Medicine and Philosophy , 4: 294–312.
• Bernat, J., B. Gert, and R. Mognielnicki, 1993, “Patient Refusal of Hydration and Nutrition: An Alternative to Physician Assisted Suicide or Voluntary Euthanasia”, Archives of Internal Medicine , 153: 2723–2728.
• Biggar, N., 2004, Aiming to Kill: The Ethics of Suicide and Euthanasia , London: Darton, Longman and Todd.
• Bradley, B., 2009, Well-Being and Death , Oxford: Clarendon Press.
• Braun, E., 2023, “An autonomy-based approach to assisted suicide: a way to avoid the expressivist objection against assisted dying laws”, Journal of Medical Ethics , 49: 497–501.
• Brock, D., 1993, “Voluntary Active Euthanasia”, Hastings Center Report , 22(2): 10–22.
• Burleigh, M., 1994, Death and Deliverance: Euthanasia in Germany c. 1900–1945 , Cambridge: Cambridge University Press.
• Cavanaugh, T., 2006, Double-Effect Reasoning: Doing Good and Avoiding Evil , Oxford: Clarendon Press.
• Commission on the Study of Medical Practice Concerning Euthanasia: Medical Decisions Concerning the End of Life , The Hague: SdU, 1991. (This is known as ‘The Remmelink Report’.)
• Downie, J. and U. Schuklenk, 2021, “Social determinants of health and slippery slopes in assisted dying debates: lessons from Canada”, Journal of Medical Ethics , 47: 662–669.
• Dworkin, R., 1993, Life’s Dominion: An Argument About Abortion, Euthanasia, and Individual Freedom , New York: Random House.
• Dworkin, G., 1998, “Public Policy and Physician-Assisted Suicide”, in Dworkin, Frey, & Bok 1998, pp. 64–80.
• Dworkin, G., R. Frey, and S. Bok, 1998, Euthanasia and Physician-Assisted Suicide: For and Against , Cambridge: Cambridge University Press.
• Emanuel, E., 1999, “What Is the Great Benefit of Legalizing Euthanasia or Physician-Assisted Suicide?”, Ethics , 109: 629–642.
• Emanuel, E., B. Onwuteaka-Philipsen, J. Urwin and J. Cohen, 2016, “Attitudes and Practices of Euthanasia and Physician-Assisted Suicide in the United States, Canada and Europe”, Journal of the American Medical Association , 316: 79–90.
• Finnis, J., 1995, “A Philosophical Case Against Euthanasia” in J. Keown (ed.), Euthanasia Examined: Ethical, Clinical and Legal Perspectives , Cambridge: Cambridge University Press.
• Foley, K. and H. Hendin (eds.), 2002, The Case Against Assisted Suicide: For the Right to End-of-Life Care , Baltimore: The Johns Hopkins University Press.
• Foot, P., 1977, “Euthanasia”, Philosophy and Public Affairs , 6: 85–112.
• Ganzini, L., E. Goy and S. Dobscha, 2009, “Oregonians’ Reasons for Requesting Physician Aid in Dying”, Archives of Internal Medicine , 169: 489–492.
• Gorsuch, N., 2006, The Future of Assisted Suicide and Euthanasia , Princeton, New Jersey: Princeton University Press.
• Griffiths, J., A. Bood, and H. Weyers, 1998, Euthanasia and Law in the Netherlands , Amsterdam: Amsterdam University Press.
• Griffiths, J., H. Weyers and M. Adams, 2008, Euthanasia and Law in Europe , Oxford: Hart Publishing.
• Jackson, E. and J. Keown, 2012, Debating Euthanasia , Oxford: Hart Publishing.
• Keown, J., 2018, Euthanasia, Ethics and Public Policy: an argument against legalization , 2nd edition, New York: Cambridge University Press.
• –––, 2022, “The Logical Link Between Voluntary and Non-Voluntary Euthanasia”, Cambridge Law Journal , 81: 84–108.
• Kim, S., R. De Vries and J. Peteet, 2016, “Euthanasia and Assisted Suicide of Patients with Psychiatric Disorders in the Netherlands 2011 to 2014”, Journal of the American Medical Association Psychiatry , 73: 362–368.
• Kuhse, H. and P. Singer, 1985, Should the Baby Live?: The Problem of Handicapped Infants , Oxford: Oxford University Press.
• Lewis, P., 2007, Assisted Dying and Legal Change , Oxford: Oxford University Press.
• Marquet, R., A. Bartelds, G. Visser, P. Spreeuwenberg and L. Peters, 2003, “Twenty Five Years of Requests for Euthanasia and Physician Assisted Suicide in Dutch General Practice: Trend Analysis”, British Medical Journal , 327: 201–202.
• McIntyre, A., 2001, “Doing Away With Double Effect”, Ethics , 111: 219–255.
• McMahan, J., 2002, The Ethics of Killing: Problems at the Margins of Life , New York: Oxford University Press.
• Onwuteaka-Philipsen, B., A. Brinkman-Stoppelenburg, C. Penning, G. Jong-Krul, J. van Delden and A. van der Heide, 2012, “Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990–2010: A repeated cross-sectional survey”, The Lancet , 380: 908–915.
• Rachels, J., 1986, The End of Life: Euthanasia and Morality , Oxford: Oxford University Press.
• Rietjens, J., P. van der Maas, B. Onwuteaka-Philipsen, J. van Delden and A. van der Heide, 2009, “Two Decades of Research on Euthanasia from the Netherlands: What Have We Learnt and What Questions Remain?”, Journal of Bioethical Inquiry , 6: 271–283.
• Savulescu, J., 2014, “A Simple Solution to the Puzzles of End of Life? Voluntary Palliated Starvation”, Journal of Medical Ethics , 40: 110–113.
• Singer, P. 1994, Rethinking Life and Death: The Collapse of Our Traditional Ethics , Melbourne: Text Publishing.
• Stingl, M., (ed.), 2010, The Price of Compassion: Assisted Suicide and Euthanasia , Peterborough, Ontario: Broadview Press.
• Sumner, L., 2011, Assisted Death: A Study in Ethics and Law , Oxford: Oxford University Press.
• –––, 2017, Physician-Assisted Death: What Everyone Needs to Know , New York: Oxford University Press.
• –––, 2020, “Conscientious Refusal to Provide Medically Assisted Dying”, University of Toronto Law Journal , 71: 1–31.
• van der Heide, A., J.van Delden and B. Onwuteaka-Philipsen, 2017, “End-of-Life Decisions in the Netherlands over 25 Years”, New England Journal of Medicine , 377: 492–494.
• Varelius, J., 2014, “Medical Expertise, Existential Suffering and Ending Life”, Journal of Medical Ethics , 40: 104–107.
• Velleman, J., 1999, “A Right of Self-Termination?”, Ethics , 109: 606–628.
• White, B., L. Willmott, K. Del Villar, J. Hewitt, E. Close, L. Greaves, J. Cameron, R. Meehan and J. Downie, 2022, “Who is Eligible for Voluntary Assisted Death?: Nine Medical Conditions Assessed Against Five Legal Frameworks”, University of New South Wales Law Journal , 45: 401–444.
• Wicclair, M., 2011, Conscientious Objection in Health Care: An Ethical Analysis , Cambridge: Cambridge University Press.
• Winkler, E., 1995, “Reflections on the State of Current Debate Over Physician-Assisted Suicide and Euthanasia”, Bioethics , 9: 313–326.
• Woodward, P., (ed.), 2001, The Doctrine of Double Effect: Philosophers Debate a Controversial Moral Principle , Notre Dame, Indiana: University of Notre Dame Press.
• Young, R., 2007, Medically Assisted Death , Cambridge: Cambridge University Press.
• –––, 2017, “An Argument in Favor of the Morality of Voluntary Medically Assisted Death”, in M. Cholbi (ed.), Euthanasia and Assisted Suicide: Global Views on Choosing to End Life , Santa Barbara: Praeger.

How to cite this entry . Preview the PDF version of this entry at the Friends of the SEP Society . Look up topics and thinkers related to this entry at the Internet Philosophy Ontology Project (InPhO). Enhanced bibliography for this entry at PhilPapers , with links to its database.

• Medically Assisted Dying , an annotated bibliography authored by Robert Young (La Trobe University)
• Eight Reasons Not to Legalize Physician Assisted Suicide , by David Albert Jones, online resource at the Anscombe Bioethics Centre website.

advance directives | decision-making capacity | doing vs. allowing harm | double effect, doctrine of

Copyright © 2024 by Robert Young < robert . young @ iinet . net . au >

• Accessibility

Support SEP

Mirror sites.

View this site from another server:

• Info about mirror sites

The Stanford Encyclopedia of Philosophy is copyright © 2024 by The Metaphysics Research Lab , Department of Philosophy, Stanford University

Library of Congress Catalog Data: ISSN 1095-5054

Euthanasia Essays

Kantianism and utilitarianism.

Euthanasia is one of the issues that different philosophers have discussed in length. Euthanasia denotes any action that terminates the life of an individual in…

Dignified death as assisted by physician

Introduction Physician-assisted death is not a new invention. In ancient Rome and Greece, Strouse (2017) writes, physician-assisted suicide and voluntary euthanasia were a common practice…

Physician-assisted suicide

Should physician-assisted suicide be allowed in certain cases, such as on patients with advanced terminal diseases, but not in other cases? Introduction: Hippocratic Oath requires…

Physician-assisted suicide and theory application

Should physician-assisted suicide be allowed in certain cases, such as on patients with advanced terminal diseases, but not in other cases? Physician-assisted suicide is the…

Informative essay on euthanasia

Abstract Different groups and individuals have diverse viewpoints with regard to euthanasia, a view that is largely shaped on the ethical, religious, moral or professional…

Euthanasia should be legal

Euthanasia is among the issues that have aroused intense debates over time such that it is recognized as a pertinent issue in the human rights…

Where to find quality euthanasia paper examples?

There are many essays on euthanasia available at GradeMiners.

How do you use the euthanasia essay examples?

You can write your essays using our euthanasia essay examples.

Can I download a sample?

You can, indeed. But it is strictly forbidden to claim them as your own.

Are all the presented essay examples free to use?

Yes, all the essay examples in our database are free.

The subject of euthanasia has always been contentious and sensitive. Physician-assisted suicide and euthanasia relate to intentional actions to end a life to relieve severe suffering. Euthanasia is prohibited by legislation and is often punishable by imprisonment. The law differs from state to state in the United States.

Euthanasia Essay Examples: Historical Background

Since the early 1800s, euthanasia has been a contentious issue in the United States. and other nations. The first anti-euthanasia statute in the United States was enacted in New York state in 1828. Other states eventually did the same. The availability of anesthetic, according to bioethicist Ezekiel Emmanual of the American National Institutes of Health (NIH), ushered in the contemporary era of euthanasia in the 20th century.

A euthanasia society was founded in the United States in 1938 to promote assisted suicides. In Switzerland, physician-assisted suicide has been permitted since 1937, provided the physician has nothing to gain from the patient’s death. The right-to-die movement gained support for euthanasia in the 1960s.

In 2002, the Netherlands decriminalized physician-assisted suicide and eased some regulations. In 2002, Belgium legalized physician-aided suicide.

In 1977, California legalized them, and soon after that, other states did so. In the living will, the person specifies their preferences for medical treatment if they cannot do so for themselves.

You can use our service to learn more about the history of euthanasia, its moral sides, and ethics.

Search Our Essays on Euthanasia

We are all aware of the challenges posed by essay writing. Issues like euthanasia are frequently discussed, especially in sociology or biology classes. We are all aware that writing essays can be challenging. It gets more complicated when you require assistance with writing about pertinent topics. We created a website with more than 100,000 free academic essays produced by qualified authors.

For more information on this issue, read our essays

Our writers can produce original academic works that satisfy the needs of each student. You may rely on GradeMiners since we have a team of professional writers available to assist you whenever you need it with your essay about death, medicine, or the pain of people deciding on euthanasia.

Browse through our collection of essays on euthanasia

Thanks to our robust search options, finding what you need is simple. You can search for papers by topic or author, for instance, to see whether there are any publications about your work.

We offer information and sample essays

Our specialists can give a historical background of assisted suicide. The necessary samples will be found by simply searching. Furthermore, there will be countless essays about euthanasia. Pick the one that interests you most.

Numerous papers on euthanasia

The world’s top writers have joined to create outstanding articles. Please, remember how many sleepless nights our writers endured so that everyone may more fully comprehend this issue.

A Collection of Eutanasia Papers

To get top grades and wow your lecturer, order a top-notch paper from GradeMiners. We know how essential it is for students to collaborate with professionals when writing their academic papers so they may focus on other areas of their lives. To better understand what we do and be motivated to write your piece or order a special one for yourself, look at our examples of essays on the care and sufferings of patients.

• ☠️ Assisted Suicide
• Affordable Care Act
• Breast Cancer
• Genetic Engineering

• Help & FAQ

Voluntary euthanasia: A utilitarian perspective

• Center for Human Values

Research output : Contribution to journal › Article › peer-review

Belgium legalised voluntary euthanasia in 2002, thus ending the long isolation of the Netherlands as the only country in which doctors could openly give lethal injections to patients who have requested help in dying. Meanwhile in Oregon, in the United States, doctors may prescribe drugs for terminally ill patients, who can use them to end their life - if they are able to swallow and digest them. But despite President Bush's oft-repeated statements that his philosophy is to 'trust individuals to make the right decisions' and his opposition to 'distant bureaucracies', his administration is doing its best to prevent Oregonians acting in accordance with a law that its voters have twice ratified. The situation regarding voluntary euthanasia around the world is therefore very much in flux. This essay reviews ethical arguments regarding voluntary euthanasia and physician-assisted suicide from a utilitarian perspective. I shall begin by asking why it is normally wrong to kill an innocent person, and whether these reasons apply to aiding a person who, when rational and competent, asks to be killed or given the means to commit suicide. Then I shall consider more specific utilitarian arguments for and against permitting voluntary euthanasia.

All Science Journal Classification (ASJC) codes

• Health(social science)
• Health Policy

Access to Document

• 10.1111/1467-8519.00366

Other files and links

• Link to publication in Scopus
• Link to the citations in Scopus

Fingerprint

• Euthanasia, Active, Voluntary Medicine & Life Sciences 100%
• Euthanasia Arts & Humanities 90%
• euthanasia Social Sciences 66%
• Doctors Arts & Humanities 26%
• Capital Punishment Medicine & Life Sciences 22%
• Ethical Review Medicine & Life Sciences 20%
• Assisted Suicide Medicine & Life Sciences 19%
• George W. Bush Arts & Humanities 18%

T1 - Voluntary euthanasia

T2 - A utilitarian perspective

AU - Singer, Peter

PY - 2003/10

Y1 - 2003/10

N2 - Belgium legalised voluntary euthanasia in 2002, thus ending the long isolation of the Netherlands as the only country in which doctors could openly give lethal injections to patients who have requested help in dying. Meanwhile in Oregon, in the United States, doctors may prescribe drugs for terminally ill patients, who can use them to end their life - if they are able to swallow and digest them. But despite President Bush's oft-repeated statements that his philosophy is to 'trust individuals to make the right decisions' and his opposition to 'distant bureaucracies', his administration is doing its best to prevent Oregonians acting in accordance with a law that its voters have twice ratified. The situation regarding voluntary euthanasia around the world is therefore very much in flux. This essay reviews ethical arguments regarding voluntary euthanasia and physician-assisted suicide from a utilitarian perspective. I shall begin by asking why it is normally wrong to kill an innocent person, and whether these reasons apply to aiding a person who, when rational and competent, asks to be killed or given the means to commit suicide. Then I shall consider more specific utilitarian arguments for and against permitting voluntary euthanasia.

AB - Belgium legalised voluntary euthanasia in 2002, thus ending the long isolation of the Netherlands as the only country in which doctors could openly give lethal injections to patients who have requested help in dying. Meanwhile in Oregon, in the United States, doctors may prescribe drugs for terminally ill patients, who can use them to end their life - if they are able to swallow and digest them. But despite President Bush's oft-repeated statements that his philosophy is to 'trust individuals to make the right decisions' and his opposition to 'distant bureaucracies', his administration is doing its best to prevent Oregonians acting in accordance with a law that its voters have twice ratified. The situation regarding voluntary euthanasia around the world is therefore very much in flux. This essay reviews ethical arguments regarding voluntary euthanasia and physician-assisted suicide from a utilitarian perspective. I shall begin by asking why it is normally wrong to kill an innocent person, and whether these reasons apply to aiding a person who, when rational and competent, asks to be killed or given the means to commit suicide. Then I shall consider more specific utilitarian arguments for and against permitting voluntary euthanasia.

UR - http://www.scopus.com/inward/record.url?scp=0142147067&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0142147067&partnerID=8YFLogxK

U2 - 10.1111/1467-8519.00366

DO - 10.1111/1467-8519.00366

M3 - Article

C2 - 14959723

AN - SCOPUS:0142147067

SN - 0269-9702

JO - Bioethics

JF - Bioethics

• Meeting report
• Open access
• Published: 15 January 2014

Should assisted dying be legalised?

• Thomas D G Frost 1 ,
• Devan Sinha 2 &
• Barnabas J Gilbert 3  

Philosophy, Ethics, and Humanities in Medicine volume  9 , Article number:  3 ( 2014 ) Cite this article

69k Accesses

8 Citations

7 Altmetric

Metrics details

When an individual facing intractable pain is given an estimate of a few months to live, does hastening death become a viable and legitimate alternative for willing patients? Has the time come for physicians to do away with the traditional notion of healthcare as maintaining or improving physical and mental health, and instead accept their own limitations by facilitating death when requested? The Universities of Oxford and Cambridge held the 2013 Varsity Medical Debate on the motion “This House Would Legalise Assisted Dying”. This article summarises the key arguments developed over the course of the debate. We will explore how assisted dying can affect both the patient and doctor; the nature of consent and limits of autonomy; the effects on society; the viability of a proposed model; and, perhaps most importantly, the potential need for the practice within our current medico-legal framework.

Introduction

Over the past two centuries, the United Kingdom has experienced rapid population growth associated with a substantial decline in mortality from acute infectious diseases and poor nutrition [ 1 ]. As the average life expectancy has increased, so too have the rates of debilitating chronic illness – particularly coronary artery disease and cancers [ 2 ]. These diseases require years of treatment instead of the mere days to weeks that medicine once operated within [ 2 ]. Although healthcare systems have sought to adapt to such changes, aiming to prevent and treat such disease wherever possible, debate has arisen regarding those patients in the latter stages of chronic, incurable, terminal conditions [ 3 , 4 ]. Moreover, there is increasing recognition that the patient must be at the centre of health care decision-making, such that outcomes must be tailored to their individual needs and views. By extension, assisted dying might seem a logical step to help achieve these goals within the realm of end-of-life decision making [ 5 ]. Several jurisdictions, notably Oregon (1997) and the Netherlands (2001) have already legalised assisted dying in some form. These factors have contributed to ongoing legislative discussions within Parliaments for almost a decade, with current opinion polling suggesting a majority of medical practitioners and the public in favour of physician-assisted suicide [ 6 ].

Viability of assisted dying in practice

In the UK, a model for assisted dying has been developed from the legal structure found within the Assisted Dying Bill introduced by Lord Falconer in the House of Lords in 2013 [ 7 ]. Assisted dying could only be considered under circumstances in which a patient of legal age is diagnosed with a progressive disease that is irreversible by treatment and is “reasonably expected to die within six months” [ 7 ]. Registered medical practitioners would make such decisions for patients with terminal illnesses. Addressing the technicalities of ‘assisted dying’ requires distinction between ‘physician-assisted suicide’ (offering patients medical actions or cessation of actions by which they can end their own life) and ‘euthanasia’ (whereby the medical practitioner actively induces death). In light of the strong hostility of the medical profession towards active euthanasia, this proposed model, as with previous attempts to legalise assisted dying, permitted only the former [ 8 – 10 ].

However, there is concern that such distinction may be unrealistic in practice because medical practitioners could find themselves with a patient who had failed to successfully end their own life and was subsequently left in a state of greater suffering. Were such a patient no longer able to give consent, a heavy burden would then be placed on the physician regarding how to proceed. Moreover, the practice of physician-assisted suicide might be deemed discriminatory, for example by giving only patients with good mobility control over their own method of death.

The Assisted Dying Bill 2013 included the provision that any terminal prognosis must be confirmed and attested by a second registered practitioner. The strictness of such criteria has parallels to a similar double-physician requirement when procuring a legal abortion under the 1967 Abortion Act. The stated aims of the provision in both cases are as follows: first, to check the accuracy of the prognosis upon which the decision was being made; second, to ensure that the situation meets the required criteria; and third, to check that such a decision was taken by the patient after full consideration of all available options [ 11 , 12 ]. By having a second independent doctor, the legislation ensures that all three checks are met without prejudice or mistake.

Problematic for any protocol for assisted dying is the fact that estimates of life expectancy in terminal prognoses are erroneous in 80.3% of cases [ 13 ]. Furthermore, the accuracy of such prognoses deteriorates with increased length of clinical predicted survival. Forecasts of survival times are based largely on past clinical experience, and the inherent variability between patients makes this more of an art than a science. This brings to concern both the accuracy of any prognosis meeting the six-month threshold and the validity of requests for assisted dying based partly or wholly on predicted survival times. Whilst the majority of errors in life expectancy forecasts are a matter of over-optimism and hence would not affect either of those two concerns, many cases remain unaccounted for. Overly pessimistic forecasts occur in 17.3% of prognoses; hence we must decide whether the one in six patients making a decision based on an inaccurate prognosis is too high a cost to justify the use of this system. Patients requesting an assisted death often cite future expectations of dependency, loss of dignity, or pain [ 14 ]. If the hypothetical point at which the progression of their illness means they would consider life to be not worth living is not, as informed, mere weeks away but in fact many more months, then this information would have resulted in a different decision outcome and potentiated unnecessary loss of life.

Whilst the presence of a second doctor would be expected to mitigate such forecasting errors, the anchoring bias of the initial prediction may be enough to similarly reduce the accuracy of the second estimate. It is prudent to question the true independence of a second medical practitioner, and whether this second consultation could become more of a formality, as has now become the case with abortion [ 15 ].

Another challenge for an assisted dying system would be to recognise whether patients requesting death were legally competent to make that decision. Consider that any request for suicide from a patient with clinical depression is generally categorised as a manifestation of that mental disorder, thereby lacking capacity. It is arguably impossible to separate out the natural reactions to terminal illness and clinical depression. Indeed, there is evidence that major depressive disorders afflict between 25% and 77% of patients with terminal illness [ 16 , 17 ]. Any protocol for assisted dying must first determine what qualifies as a ‘fit mental state’ for a terminal patient.

The need for assisted dying

It could be argued that a doctor’s fundamental duty is to alleviate forms of suffering in the best interests of the patient. The avoidance of physical pain, as an obvious manifestation of suffering, might explain why assisted dying would be both necessary and within the duties of a doctor to provide. The evolving principle in common law known as the ‘Doctrine of Double Effect’ offers a solution to this problem [ 18 ]. This legal judgement stated that “[a doctor] is entitled to do all that is proper and necessary to relieve pain even if the measures he takes may incidentally shorten life”. This entails that a protocol already exists for patients searching for an escape from chronic pain. Furthermore, numerous retrospective studies have revealed very little correlation between opioid dose and mean survival times: one study of over 700 opioid-treated patients found that the variation in survival time from high-dose opioid treatment is less than 10% [ 19 – 21 ]. It can therefore be said that pain alone, if appropriately managed, should never be cause for considering assisted dying as an alternative.

By contrast, the ‘Doctrine of Double Effect’ might be seen as a subjective interpretation that has been applied unequally due to a lack of specialist training or knowledge [ 22 ]. Despite this, the principle can be easily understood and poor awareness can be remedied by improvements in medical education and standardisation of protocols. Moreover, should we choose to accept arguments for assisted dying that are based upon inadequate administration of pain medication, we set a precedent for conceding shortcomings in palliative care and other end-of-life treatments. Offering hastened death could become an alternative to actively seeking to improve such failings.

Whilst much has been made of the ‘pain argument’ here, the call for assisted dying is rarely this simple. Many patients also suffer a loss of dignity, often due to their lack of mobility – the inability to relieve oneself without help is a potent example. Beyond this are additional fears of further debilitation and the emotional costs of dealing with chronic illness, both for the patient and for their relatives and friends. A study of terminal patients in Oregon showed that these were the most significant reasons behind requests for assisted suicide, the next commonest reason being the perception of themselves as a ‘burden’ [ 14 ]. Clearly, we could seek to provide balanced, compassionate medical care for these patients, and still fail to address these points.

Developments in healthcare and technology may reduce this emotional burden, but remain an imperfect solution.

Rights of patients and limitations of their autonomy

J.S. Mill’s pithy dictum describes autonomy as follows: “over himself, over his own body and mind, the individual is sovereign” [ 23 ]. Not only has the sanctity of bodily autonomy profoundly influenced the development of liberal democracies, it has also provoked a holistic shift in making our healthcare systems more patient-centred – “care that meets and responds to patients’ wants, needs and preferences and where patients are autonomous and able to decide for themselves” [ 5 ]. The ethical principle of controlling the fate of one’s own body is inherently relevant to the debate on assisted dying. It is difficult to reconcile that citizens may have the right to do almost anything to and with their own bodies– from participating in extreme sports to having elective plastic surgery – yet a terminal patient cannot choose to avoid experiencing additional months of discomfort or loss of dignity in their final months of life.

Expectation of individual liberty has been codified in law. The right to bodily autonomy has been interpreted to be included under Article 8 - the right to privacy - of the European Convention on Human Rights (ECHR) and subsequently the Human Rights Act (HRA) [ 24 , 25 ]. Moreover, the ECHR underpins the right of individuals to ‘inherent dignity’ [ 26 ]. Hence, if an individual feels that dignity is unattainable due to the progression of a terminal illness, then taking recourse though assisted dying ought to be a legitimate option.

Conversely, there are two notable oversights in this interpretation of a right to assisted dying as an extension of the principles of bodily autonomy:

First, it would be wrong to view individual liberty as absolute. The HRA allows for exceptions to Article 8 on grounds of ‘health or morals’ [ 25 ]. The principle of autonomy is not inviolable. Governments have limited such privileges for the protection of individuals and society, for example by criminalizing the use of recreational drugs or the selling of one’s own organs. The preservation of life by denying assisted dying could fall within this category.

Second, the right of autonomy is not necessarily intrinsic to human beings but, as Kant argued, is dependent on our ‘rational nature’ [ 27 ]. This concept sees autonomy as an exercise of ‘evaluative choice’ [ 27 ], requiring rationality on the part of individuals to appreciate the nature of options and their consequences. To achieve true autonomy, there must be sufficient information to make those rational decisions; this is the basis of informed consent and why it is a fundamental duty of a doctor to offer a patient an informed series of treatment options [ 28 ]. The logistical issue is that doctors are unable to advise patients regarding the point at which their situation becomes less preferable to being dead. No doctor (or individual) has any knowledge or experience of what ‘death’ may be like. Hence, in this case, the idea of exercising true autonomy through informed consent might be considered meaningless.

Legalising assisted dying by attempting to establish an absolute right to bodily autonomy may undermine other individual and group rights. Vulnerable patients may feel pressured into assisted dying because of social, emotional, or financial strains placed on family and/or friends. This is exemplified by the trend showing that the proportion of patients stating ‘relief of burden’ on others as the reason for requesting assisted dying has risen from 17% to 25% in Oregon since legalisation [ 29 ]. One could even consider the risk of assisted dying becoming an expected choice rather than a free one. Thus, assisted dying may erode the elemental right to life of terminal patients as the value of their life becomes tied to relative costs to society and to those around them.

Moreover, by creating one class of individuals for whom life is expendable, that particular view may be extended by society to all groups possessing such attributes (e.g. the permanently disabled). There would be a definite risk to the rights of these vulnerable groups in the form of society being less willing to provide for their health and social care.

It is often raised that the limited legalisation of assisted dying would inevitably become extended in scope, but this is not necessarily a flaw. Even if the right to determine the manner of death were later extended to a wider group of people, posterity may reflect positively on such a change, just as extending the franchise to women ultimately led to legislation demanding equal pay.

Effect on health professionals and their role

‘To act in the best interest of the patient’ is often cited as a central duty of the doctor [ 28 ]. This concept of ‘best interest’ guiding the doctor’s action has seen the development of two important ethical principles: beneficence and non-maleficence. Beneficence mandates that the actions of the doctor must be aimed to bring about benefit (clinical improvement) for the patient, usually measured in terms of reduced morbidity or mortality; non-maleficence requires that the doctor not carry out treatment that is likely to cause overall harm the patient [ 30 ]. These traditional ethical imperatives on a doctor both conflict with intentionally hastening the death of a patient, and a resolution of this tension would require redefining what constitutes ‘acting in the best interest’.

A further dimension is the potential reluctance of health professionals to engage in a practice that contravenes their own ethical beliefs, particularly as this would affect doctors who never entered training in the knowledge that assisting patients to die would be an expected duty. This is certainly no argument against the introduction of assisted dying; indeed, a recent survey of a cohort of NHS doctors found that 46% would seriously consider requests from patients to undertake steps to hasten death [ 31 ]. It merely expresses the point that any early model would have to account for the fact that an initial 54% of the doctors in the NHS would be required to advise qualifying patients of assisted dying as a legitimate option, despite disagreeing with it in principle.

Furthermore, doctors who agree ethically with this practice may find themselves facing conflicts of interest. It is expensive to treat chronically ill patients, particularly in the final months of life [ 32 ]. Moreover, it would be difficult for commissioners to ignore the fact that the sustained treatment of one individual could deprive many others from access to surgery or access to novel drugs. Such an argument does not suggest that doctors or any other hospital staff would treat this practice without appropriate respect or care; rather it acknowledges the need for appropriate rationing of care and questions the intentions of service providers. The perception of an ulterior motive could negatively impact patient trust. One survey showed that a reasonable minority of patients (27%) – and particularly particularly the elderly – believe that legalising assisted dying would lessen their trust in their personal physician [ 33 ]. The costs of weakened trust in the doctor-patient relationship could far outweigh the benefits of assisted dying, particularly given the importance of trust when treating a chronic patient for an extended period of time.

There is no doubt that assisted dying would empower some patients to maximise control over the timing and manner of their own death. Such expression of autonomy would surely solidify moves towards a patient-centred approach to healthcare. However, the capacity for such consensual requests remains in doubt. Clinically, the patient’s state of mind and the reliability of diagnostic predictions are of issue; philosophically, the idea of informed consent for death is contradictory. The implications for patients, physicians and society have been weighed extensively within this article. The central tenet throughout has been the balancing of an individual’s right to escape a circumstance that they find intolerable, alongside the consequential changes to their other rights, and the rights and responsibilities of third parties. Ultimately, the challenge is for us as a society to decide where this balance lies.

About the debate

The Varsity Medical Debate was started in 2008 with the aim of allowing students, professors and members of the polis, to engage in discussion about ethics and policy within healthcare. Utilising the age-old rivalry between the two Universities, the debate encourages medical students from both Oxford and Cambridge to consider and articulate the arguments behind topics that will feature heavily in their future careers.

The debate was judged on the logic, coherence, and evidence in arguments, as well as flair in presentation. Although the debaters may not have necessarily agreed with their allocated side, the debate format required them to acknowledge a particular school of thought and present the key arguments behind it. Oxford, who opposed the motion, was awarded the victory in the debate; however, this does not mean that the judges believe that position ought to become public policy.

Colgrove J: The McKeown thesis: a historical controversy and its enduring influence. Am J Public Health. 2002, 92: 725-729. 10.2105/AJPH.92.5.725

Article   Google Scholar  

Yach D, Hawkes C, Linn Gould C, Hofman K: The global burden of chronic diseases: overcoming impediments to prevention and control. J Am Med Assoc. 2004, 291 (21): 2616-2622. 10.1001/jama.291.21.2616. doi:10.1001/jama.291.21.2616

Lankhorst EK, Spreeuwenberg C: Managing Chronic Conditions. Experience in Eight Countries. European Observatory on Health Systems and Policies. Edited by: Nolte E, Cécile K, Martin MK. 2008, The Netherlands: WHO Regional Office Europe

Google Scholar  

Hudson PL, Kristjanson LJ, Ashby M: Desire for hastened death in patients with advanced disease and the evidence base of clinical guidelines: a systematic review. Palliat Med. 2006, 20: 693-701. 10.1177/0269216306071799

Hogg C: Patient-Centred Care - Tomorrow’s Doctors. 2004, GMC

Harris D, Richard B, Khanna P: Assisted dying: the ongoing debate. Postgrad Med J. 2006, 82 (970): 479-482. doi:10.1136/pgmj.2006.047530

House of Lords assisted Dying Bill: House of Lords. 2013, http://www.publications.parliament.uk/pa/bills/lbill/2013-2014/0024/2014024.pdf (accessed 23 October 2013)

House of Lords Assisted Dying for the Terminally Ill Bill: House of Lords. 2005, http://www.publications.parliament.uk/pa/ld200506/ldbills/036/2006036.pdf (accessed 15 Feb 2006)

Sanders K, Chaloner C: Voluntary euthanasia: ethical concepts and definitions. Nurs Stand. 2007, 21 (35): 41-44. 10.7748/ns2007.05.21.35.41.c4554. 10.7748/ns2007.05.21.35.41.c4554

Lee W, Price A, Rayner L, Hotopf M: Survey of doctors’ opinions of the legalisation of physician assisted suicide. BMC Med Ethics. 2009, 10: 2- 10.1186/1472-6939-10-2

House of Commons: Science and Technology Committee, Scientific Developments Relating to the Abortion Act 1967. 2007, London: tso, Volume 1

Royal College of Obstetricians and Gynecologists, Campaigns and Opinions. http://www.rcog.org.uk/what-we-do/campaigning-and-opinions/briefings-and-qas-/human-fertilisation-and-embryology-bill/brie-1

Christakis NA, Lamont EB: Extent and determinants of error in physicians’ prognoses in terminally ill patients. BMJ. 2000, 320: 469-473. 10.1136/bmj.320.7233.469

Ganzini L, Goy E, Dobscha S: Oregonians’ reasons for requesting physician aid in dying. J Am Med Assoc Int Med. 2009, 169 (5): 489-492. doi:10.1001/archinternmed.2008.579

Care Quality Commision. Findings of Termination of Pregnancy Inspections Published. 2012, http://www.cqc.org.uk/media/findings-termination-pregnancy-inspections-published , July

Watson M, Lucas C, Hoy A: Oxford Handbook of Palliative Care. 2005, Oxford: Oxford University Medical Press

Fine R: Depression, anxiety, and delirium in the terminally ill patient. Proc (Bayl Univ Med Cent). 2001, 14 (2): 130-133.

R v Adams [1957] Crim LR 773.

Morita T, Tsunoda J, Inoue S, Chihara S: Effects of high dose opioids and sedatives on survival in terminally ill cancer patients. J Pain Symptom Manage. 2001, 21 (4): 282-289. doi:10.1016/S0885-3924(01)00258-5

Bengoechea I, Gutiérrez S, Vrotsou K, Onaindia M, Lopez J: Opioid use at the end of life and survival in a hospital at home unit. J Palliat Med. 2010, 100828074323069: doi:10.1089/jpm.2010.0031

Thorns A, Sykes N: Opioid use in last week of life and implications for end-of-life decision-making. Lancet. 2000, 356 (9227): 398-399. doi:10.1016/S0140-6736(00)02534-4

Preston T, Patterson J: The rule of double effect. N Engl J Med. 1998, 338: 1389-1391.

Mill JS: “On Liberty” in On Liberty and Other Essays. 14-15.

Human Rights Act. 1998, HMSO

Judgment on the Merits Delivered by a Chamber. Y.F. v. TURKEY, no. 24209, /94, ECHR 2003-IV

McCrudden C: Human dignity and judicial interpretation of human rights. Eur J Int Law. 2008, 19 (4): 655-724. 10.1093/ejil/chn043. doi:10.1093/ejil/chn043

Savulescu J: Autonomy, the Good Life and Controversial Choices. 2006

General Medical Council: Good Medical Practice. 2013, GMC

Oregon Department of Human Services. Fifth Annual Report on Oregon’s Death with Dignity act. http://egov.oregon.gov/DHS/ph/pas/docs/year5.pdf

Campbell : Medical Ethics. 1997, Oxford: Oxford University Press

Ward B, Tate P: Attitudes among NHS doctors to requests for euthanasia. BMJ. 1994, 308: 1332- 10.1136/bmj.308.6940.1332

National Audit Office. End of Life Care : Report by the Comptroller and Auditor General. HC 1043 Session 2007-2008. 2008, NAO

Hall M, Trachtenberg M, Duggan E: The impact on patient trust of legalising physician aid in dying. J Med Ethics. 2005, 31 (12): 693-697. doi:10.1136/jme.2004.011452

Download references

Acknowledgements

For Cambridge University: Hilmi Bayri (Trinity), Alistair Bolger (Jesus), Casey Swerner (St Johns).

For Oxford University: Devan Sinha (Brasenose), Thomas Frost (Lincoln), Collis Tahzib (Lincoln).

Martin Farrell (Cambridge).

Baroness Finlay: Professor of Palliative Care Medicine and former President of the Royal Society of Medicine.

Dr. Roger Armour: Vascular Surgeon and Inventor of the Lens Free Ophthalmoscope.

Mr. Robert Preston: Director of Living and Dying Well.

Author information

Authors and affiliations.

Lincoln College, Turl Street, Oxford, OX1 3DR, UK

Thomas D G Frost

Brasenose College, Oxford, OX1 4AJ, UK

Devan Sinha

Green Templeton College, Woodstock Road, Oxford, OX2 6HG, UK

Barnabas J Gilbert

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Barnabas J Gilbert .

Additional information

Competing interests.

The authors declare that they have no competing interests.

Authors’ contributions

All authors planned and elucidated the layout. TDGF and DS drafted the manuscript which was critically edited and added to by BJG. All authors have read and approved the final draft.

Rights and permissions

Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( https://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated.

Reprints and permissions

About this article

Cite this article.

Frost, T.D.G., Sinha, D. & Gilbert, B.J. Should assisted dying be legalised?. Philos Ethics Humanit Med 9 , 3 (2014). https://doi.org/10.1186/1747-5341-9-3

Download citation

Received : 12 November 2013

Accepted : 11 January 2014

Published : 15 January 2014

DOI : https://doi.org/10.1186/1747-5341-9-3

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Assisted dying
• Legalisation
• Physician-assisted suicide

Philosophy, Ethics, and Humanities in Medicine

ISSN: 1747-5341

• Submission enquiries: Access here and click Contact Us
• General enquiries: [email protected]

Online ordering is currently unavailable due to technical issues. We apologise for any delays responding to customers while we resolve this. For further updates please visit our website: https://www.cambridge.org/news-and-insights/technical-incident

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings .

Login Alert

• > Journals
• > Cambridge Quarterly of Healthcare Ethics
• > Volume 32 Issue 1
• > Existential Suffering as a Legitimization of Euthanasia

Article contents

Introduction, the right to euthanasia, the meaning of life and the meaning of “life”, the individual suffering, existential suffering as a legitimization of euthanasia.

Published online by Cambridge University Press:  04 November 2022

Several countries have legalized euthanasia on the basis of medically diagnosable suffering over the last decennial; the criteria to which they adhere differ. The topic of this article is euthanasia on the basis of existential suffering. This article presents a recent proposal to legalize euthanasia for people who experience such suffering and then discusses the issue of what the value of life may be, and whether the standard that life is normally something positive should be accepted. This provides the foundation to answer the question of whether euthanasia on the basis of existential suffering should be allowed.

The controversial nature of the issue of whether it should be legal to perform euthanasia or assist in another’s suicide has waned, and several countries have legalized these options, but it would not be realistic to expect a universally accepted perspective to be forthcoming. While this observation may be made with respect to the issue in general (i.e., whether euthanasia or assisted suicide should be accepted at all ), I will focus on a specific aspect and presume that euthanasia Footnote 1 as such is acceptable in certain cases of suffering whose cause may be medically diagnosed. I say “certain cases” since those who accept that euthanasia should in principle be allowed in cases of medically diagnosable suffering may differ amongst themselves with respect to the criteria that should be in place, and the countries referred to above do not adhere to (precisely) the same criteria. This is not the topic of the present inquiry, which is rather focused on answering the question of whether it should be allowed to perform euthanasia in cases where medically diagnosable suffering is absent.

A recent proposal in the Netherlands to allow euthanasia in such cases is presented in section “The Right to Euthanasia.” The basis for euthanasia in terms of a natural right is examined in order to determine whether a right to euthanasia may be defended on such a basis. I do not start from the premise that an inalienable right to euthanasia exists and should be acknowledged, nor would I base such a right on moral considerations, on account of the fact that no compelling reasons exist to conclude that either of such foundations must be acknowledged to exist and it is not clear, even if this were the case, that such a right must cogently be derived from one of them or both.

I will rather limit myself to considering the interests that are at stake and inquiring how they may best be served. The word “best” is problematic, however, especially in light of what has just been said. I will not, however, attribute a special meaning to this word and hold that no absolute standard is to be adhered to. It is not clear what this standard should be (or which of the existing candidates that are presented, from different perspectives, should be opted, in favor of its alternatives, foregoing the issue here of whether it might exist , waiting to be discovered, in the first place). An additional problem is that the freedom of someone who would not accept that standard would be curtailed, since the standard would be forced on such an individual.

What I present as an answer to the main question presented above is, accordingly, simply a reflection of what policy is most desirable , at least according to me, for which I present arguments in the hopes of convincing those who read this article. Before presenting that position in the section “The Individual Suffering,” I will analyze what the value of life might be and how this may be determined. This is what is undertaken in the section “The Meaning of Life and the Meaning of ‘Life.’” The question of whether life is worth living is one of the most challenging ones with which may be confronted. I have tried to do justice to the complexity of this question without losing sight of the practical, concrete issues those who are confronted with it in the darkest moments of their existence face.

When addressing the issue of whether it is desirable to legalize euthanasia and, if so, under what conditions, it is important to acknowledge that different interests are at stake and that the issue may be approached from different perspectives. Important considerations will be addressed in the following sections. The present section is focused on representative legislation, so as to provide a relevant context. The Netherlands is a pioneering country in legalizing euthanasia and if a recent bill is passed, a new category—to which specific criteria apply—in which euthanasia is allowed will be introduced; Dutch legislation and jurisprudence will, accordingly, feature prominently here.

In order to perform euthanasia legally in the Netherlands, a number of criteria must be met. Those that are relevant for the purposes of this article are that it must be performed by a physician, who must hold the conviction that the patient’s suffering is unbearable, with no prospect of improvement. Footnote 2 (“With no prospect of improvement” is the translation of the Dutch word “uitzichtloos,” which may alternatively, more dramatically but arguably also more accurately, be rendered as “prospectlessness.”) The suffering may be physical or have a psychiatric disorder as its cause. Footnote 3 From a practical point of view, the limits of what medicine can accomplish, in some cases, must be acknowledged, Footnote 4 while principally it is justified to say that “If there are no logical differences between mental and physical disorders, there is a strong prima facie case for the possibility and acceptability of psychiatric active voluntary euthanasia (AVE) and physician-assisted suicide (PAS).” Footnote 5 The assessment of a request made by someone with a psychiatric disorder does bring with it specific difficulties for physicians. Footnote 6

Importantly—irrespective of the cause of the suffering—it must be determined what “with no prospect of improvement” and “unbearable” mean. Insofar as the absence of a prospect of improvement is concerned, the possibility of improvement is decisive: “The medical judgment is decisive in ascertaining the absence of a prospect of improvement of the suffering. It must be certain, according to medical expertise, that the patient’s situation will deteriorate and cannot be relieved. The absence of a prospect of improvement is thus objectified.” Footnote 7 A medical standard is thus decisive in determining whether the suffering must be deemed to be without a prospect of improvement or not. The same standard is used for the criterion “unbearable,” but the patient’s perspective is decisive here: “The unbearableness of the suffering must also be determined in order to decide the issue whether euthanasia may be performed, but it is, in contradistinction to the absence of a prospect of improvement of the suffering, a factor that is highly subjective and difficult to objectify.” Footnote 8

It is justified to point to the subjective nature of unbearableness (and the modifier “highly” might have been omitted), but that means that the very justification of the necessity of the criterion becomes debatable. After all, if “unbearableness” is qualified as the point at which the patient’s suffering is such that he feels the need to request euthanasia, no one who requests euthanasia may be said to fail to meet the criterion. (A—secondary—point to consider is that the suffering cannot truly be unbearable, for if it were, the patient would not be able to endure the suffering and—presumably—die as a result, rendering the issue moot.)

Being tired of life is not a sufficient condition for euthanasia, Footnote 9 nor is the conviction that one’s life is completed. Footnote 10 A bill proposed by Pia Dijkstra, a member of the House of Representatives for political party Democrats 66, aims to address this issue by legalizing assisted suicide (but not euthanasia in the strict sense) for those who consider their lives completed and are at least 75 years old. Footnote 11 The suffering the bill addresses is “suffering from life,” resulting from the experience of a completed life. Footnote 12 So-called “end-of-life supporters” (who must have completed special training) rather than (as in the case of euthanasia in the strict sense) physicians are to provide the means to make the suicide possible; the general practitioner of the person who has made the request will be consulted, provided that person consents. Procedures will be in place to prevent requests being made based on “outside pressure.” Footnote 13

The age limit of 75 years is defended in the bill on account of the consideration that young persons will usually have a long life before them, in the course of which problematic circumstances may take a turn for the better, for example, by means of medical treatments yet to be developed. Footnote 14 Is legalizing euthanasia (or assisted suicide) in such cases desirable? One may hold that such legislation is too radical, but it may, conversely, be argued that it is not radical enough. I will present my perspective in the final section, in the wake of the present section and the section “The Meaning of Life and the Meaning of ‘Life.’”

One may argue that (some cases of) euthanasia should be allowed by appealing to a human right, where “human rights” may be defined as follows: “At their most fundamental, core human rights are considered as the transcendental moral principles on which positive law is founded.” Footnote 15 Specifically, one may, insofar as the jurisdiction of a member state of the Council of Europe is concerned, appeal to articles 2 and 8 of the European Convention on Human Rights (ECHR). In Pretty v. United Kingdom , Footnote 16 the European Court of Human Rights (ECtHR) rightly ruled that the rights guaranteed in those articles (namely, the right to life and the right to respect for private and family life) do not confer the right to die. The rights in question are negative rights and thus require the absence of government interference; an interpretation of the articles according to which they would confer a right to die is incompatible with the nature of these rights.

A yet more relevant case for the present discussion is Haas v. Switzerland , Footnote 17 in which the ECtHR, while holding that the right to decide by what means and when one ends one’s life is an aspect of article 8 ECHR, this must be distinguished from a right to obtain the means to end one’s life. Footnote 18 Specifically, it might have been possible, under Swiss law, to obtain such means, but the applicant in this case would have to undergo a psychiatric assessment so that it could be ruled out that his desire to commit suicide was a symptom of mental illness; the ECtHR ruled that the restrictions were legitimate and necessary. Footnote 19

Alternatively, one may appeal to substantive due process, invoking fundamental rights that may not be restricted. This was the central issue, with respect to the right to assisted suicide, in Washington v. Glucksberg. Footnote 20 The Supreme Court ruled that the right could not be invoked on that basis, referring to the rejection in the past of the legalization of assisted suicide. Footnote 21 What is problematic here is that the possibility to invoke the right depends on a—presumably—contingent tradition, which means that it is not truly a fundamental right. Should one, by contrast, hold that a natural right, in isolation from the circumstances as they have developed in a specific country, be at issue, another difficulty presents itself, namely, what, if anything, a natural right might mean. This is a general issue in philosophy; with respect to the topic at hand, I remark that even if one should accept the existence of natural rights, it would need to be made clear whether or not a right to euthanasia, in particular, would exist, so that those defending such a right would be confronted with a twofold burden of proof.

Chemerinsky raises the question: “[…] is the right to physician-assisted suicide so fundamental to autonomy that it should be deemed a fundamental right? Put another way, is it sufficiently analogous in its importance to the privacy rights which the Court has previously protected that the right should be worthy of being deemed a fundamental right?” Footnote 22 He argues against an originalist interpretation of the Constitution, pointing out that other rights than the right to PAS have been acknowledged by the Supreme Court to be fundamental without appealing to the original text of the Constitution. Yet that does not mean that those rights are indeed fundamental rights, but only that the Supreme Court considers certain rights to be fundamental. So the crucial question still remains to be answered, namely, what, if anything, are “fundamental rights”?

Chemerinsky approaches the issue by focusing on autonomy, thus presupposing autonomy to be a guiding principle, not indicating why it should be respected. He may be correct in saying “If any aspect of autonomy is to be deemed fundamental, surely it is the right to choose to die,” Footnote 23 but even apart from the fact that autonomy is not the only relevant factor to consider, an appeal to its importance takes away nothing from the burden of proof if such an appeal is made in the context of “fundamental rights.”

This view is not to be equated with the idea that it is simply desirable that the right to PAS should exist; such an alternative has the benefit of being relieved from the burden of proof just mentioned, but admittedly faces the issue of relativism, since it raises the question of whose perspective should be decisive in determining what is “desirable.” This should in a democratic state presumably be that of the majority of the people, whose preferences and convictions may gradually change; an appeal to tradition is possible, such as in Washington v. Glucksberg , but this raises the question—if the perspective thus found differs from the present perspective—why ideas that prevailed in the past should dictate how one should act or think in the present.

Incidentally, when Chemerinsky appeals to the majority position when he argues that the issue should be left to “the political process,” he also points to the importance of interpreting the Constitution as including a fundamental right to PAS, Footnote 24 apparently expressing a belief that the majority view will (continue to) correspond with such an interpretation.

An appeal to “(human) dignity” is no less problematic. Even if this is presumed to have a meaning, it is clear that defenders of “dignity” do not agree on what this is, which results in different positions: one may associate “dignity” with the protection of life, with the corollary that one’s life should not end prematurely—leaving the issue here what “prematurely” means, since this depends on what is understood by a “natural” life (which depends, inter alia, on whether one considers the accomplishments of modern medicine that lead to a prolonging of the lives of some individuals something natural, or not)—or, conversely, with respect for the freedom to decide for oneself when the time has come to die, Footnote 25 if necessary or desirable by means of euthanasia. Footnote 26 In addition, one may defend the idea of a person as no mere means to advance society’s ends Footnote 27 ; in this case, the difficulty presents itself at another point in the argumentation, namely, at the point it must become clear why this directive should be accepted. Footnote 28

Biggs concedes that “dignity” is not easy to grasp, but maintains: “[…] in spite of its susceptibility to misinterpretation and sophistry, dignity clearly does play a valuable role in contextualizing people’s perceptions of death and dying, especially as it appears to embody a spirit of self-determination that advocates of voluntary euthanasia crave.” Footnote 29 Incorporating an idea into one’s perceptions must be distinguished, though, from justifying an appeal to that idea. As Singer remarks, “‘Death with dignity’ can mean almost anything, depending on what one considers a dignified way to die.” Footnote 30

There is, then, no fundamental right to euthanasia or it is at least not clear what the basis of such a right would be. This state of affairs must not be confused with the issue of the desirability of realizing such a right. It is ultimately the legislature that decides on the matter of legalizing euthanasia. In a democratic state, the majority of the people supposedly—indirectly—support the law. A people is composed of individuals whose votes (should) be decided individually, and I have a particular view I deem most desirable; as I said above, this will be expounded in the final section. That does not mean, though, that I consider my view to be an expression of a natural right, and by saying “most desirable” rather than “right” or “just,” I express a relativistic stance. It is difficult for me to say on what basis I have come to accept this particular viewpoint rather than another, since I cannot go back in time and create an alternative reality in which I would exchange one or more factors that may or may not have decided my viewpoint for one or more other factors and I accept, accordingly, what I hold as tentative. It is always wise to analyze legal matters carefully, but a radical skeptical stance, on the basis of which suspension of judgment is accomplished, is not possible lest no legislation be realized at all.

The question of why it is a problem if a life is terminated prematurely is rarely raised in euthanasia debates, which is surprising, given the existential perspective that is at issue, besides the medical perspective.

Aristotle considers death the most fearful thing, since nothing can be good or bad for someone who is dead. Footnote 31 “Bad” is mentioned here as well as “good,” but this may be explained by the fact that Aristotle defines an active life in accordance with virtue as the function of man and a necessary condition for his happiness. Footnote 32 By contrast, Lucretius, following Epicurus, maintains that death does not concern human beings Footnote 33 since one’s soul, given that it does not remain as a separate substance after death, is mortal. Footnote 34 Which of these views (if any) one is willing to accept depends on one’s metaphysical bent and it seems too hopeful to expect a definitive answer to the question which of these views may be true to be forthcoming anytime soon.

A similar metaphysical perspective may be said to support the idea of an “intrinsically valuable” life that is often presented: “[…] while life is instrumentally valuable to us as we pursue other goods, it is also intrinsically valuable. Something X has intrinsic value to the extent that the value of X is due to what X fundamentally is, apart from X’s relations to other things.” Footnote 35 In accordance with such a viewpoint, one may hold that “[…] life demands from us levels of commitment directed toward its maintenance and furtherance that are in broad accord with a reasonable life narrative and ground projects […].” Footnote 36 One may, accordingly, maintain: “We believe that it is intrinsically regrettable when human life, once begun, ends prematurely. We believe, in other words, that a premature death is bad in itself, even when it is not bad for any particular person.” Footnote 37

Still, does it make sense to speak of something being intrinsic? An evaluator always seems necessary in order to determine whether something is valuable, and to what degree. It is conceivable that something is valuable according to every or even every possible evaluator, that is, everyone now existing and everyone who will exist and anyone that might have existed, but that would (merely) mean that it has an objective value. An objective value differs from an intrinsic value: if all evaluators would cease to exist (and thus cease to value anything), no objective value would remain, while what had an intrinsic value (whatever this might mean) before would—supposedly—not lose this. This is difficult to grasp.

A more promising approach might consist in listing the values that are actually at issue. This is what Bullock does. Given that one may question whether self-determination provides a proper basis for the patient’s well-being, Bullock presents a list of purportedly objective interests, Footnote 38 so as to identify “[…] the substantive goods that contribute to the well-being of an individual and holds that they are good for the individual independently of that individual’s preferences.” Footnote 39

Bullock rightly observes: “[…] the concept of ‘autonomy’ is vague and has various meanings in different contexts.” Footnote 40 Autonomy may be used in two senses: first, the fundamental—and literal—sense of imposing a law (and specifically a putative “moral” law) on oneself, associated with the notion of “free will,” and, second, the sense of legal autonomy, that is, the liberty of citizens, at least those “of sound mind,” to perform legal acts.

Autonomy in the second sense, notwithstanding the objections raised by Bullock, may be defended (if one refrains from also appealing to autonomy in the first sense); suspension of judgment or even denial with respect to the existence (or even meaning) of the former is compatible with acceptance of the latter, an issue to will I return below. For completeness, it must be added that Bullock’s stance on autonomy is nuanced: she promotes “autonomy as a side-constraint on action,” which serves as a type of failsafe: even if one acts in accordance with the individual’s objective interests, his withholding consent must be respected. Footnote 41

Among the objective interests are listed (inter alia): “life, consciousness, and activity,” “pleasures and satisfactions of all or certain kinds,” “happiness, beatitude, contentment, etc.,” “morally good dispositions or virtues,” “just distribution of goods and evils,” and “freedom.” Footnote 42 It is not clear, however, why (all of) these would be objective. Life is, after all, only an interest for those who want to (continue to) live. “Pleasures” will presumably be desired by everyone, but which pleasures are desired depends on the individual, so that speaking of generic pleasures is little illuminating; the same applies to “happiness.” As for “morally good dispositions or virtues,” this may be specified in various ways, presuming that it has a meaning at all; the same applies to “just distribution of goods and evils.”

As for “freedom”: this is precisely what is under discussion, and whether autonomy as a side-constraint suffices may be doubted. Notwithstanding the empirical analyses to which the author, arguably justifiably, refers, Footnote 43 if the absence of self-determination—in accordance with the second sense of “autonomy” outlined above, suspending judgment, incidentally, with respect to what “self” might mean—is a reason to substitute “objective interests” for individual preferences, there is no principled reason to distinguish between end-of-life decisions and certain other types of decisions. End-of-life decisions have a far-reaching effect, but so does buying a house or marrying someone, with respect to which people are normally allowed to act in accordance with their preferences.

It may be objected that what has been said is unjustifiably flippant, if only because carrying out an end-of-life decision is irrevocable. One may imagine someone who requests euthanasia but reverses his decision before the euthanasia is performed; if the euthanasia had been performed, he would have died. Similarly, euthanasia may have been performed on people who, likewise, would have reversed their decision if the period between the request and the act had been longer. It is of course not possible to determine whether this is the case since any relevant response would have to be provided by people who have already died. How much weight does the fact that a hypothetical person would in time—in hindsight—come to reconsider his request, given the irrevocability of the act, carry?

First of all, euthanasia is only possible if strict procedures are adhered to, ensuring that a lasting desire to die exists, and the individual’s request is voluntary and well-considered. Footnote 44 That does not exclude the possibility that euthanasia is performed on people who would have revoked their decision but merely reduces the likelihood that such cases occur, and presumably no procedure is foolproof, but the alternative is that no one should be granted euthanasia, Footnote 45 which would come at the expense of all those who suffer without ever wishing to revoke their decision, who would either have to keep suffering until they die of natural causes or resort to alternative, possibly gruesome, means to end their lives without assistance. The prolonged suffering such people experience—before ultimately dying from another cause than euthanasia—is no less irrevocable than the pleasures of which those who might have come to regret their decision are deprived.

What is important to consider here is that—however harsh this formulation may come across—all euthanasia means, as far as can be assessed without taking a conception of the afterlife into consideration, is that life is shortened by a certain amount of time. One may object that the possibility of an afterlife does have to be taken into consideration, but there is no consensus with respect to whether an afterlife exists and, if so, what this might look like, nor do I have anything to contribute here myself to provide clarity on the matter.

Still, one may hold that an entity (specifically, a deity) may exist that judges and punishes those who commit suicide or invoke the aid of others to let their life end. It is difficult to ascertain what the basis of such a deity’s judgment would be, apart from the preliminary issue of the difficulty of ascertaining that it exists in the first place. Barring the ability to determine that the tenets of a specific religion are true, the individual is left to his own devices. One may resort to Pascal’s wager: by wagering that He exists, one presumably either has nothing to lose (or gain)—namely, if He does not exist—or everything (an eternity of life and happiness) to win —namely, if He does exist—whereas wagering that He does not exist will either—if He indeed does not exist—result in the first situation (so that one will neither gain nor lose anything) or in the outcome that one has everything to lose. Footnote 46 Several objections have—rightly—been levelled against this line of thought, which do not have to be discussed here. I add to them the following consideration, which is relevant for the present theme.

If faith is decisive, nothing can be said of God by means of reason. This is in line with what Pascal observes: “If there is a God, He is infinitely incomprehensible, because, having neither parts nor limits, He does not stand in any relationship to us; consequently, we are incapable to know either what He is or whether He exists.” Footnote 47 Taking seriously the meaning of faith means that nothing can be said of God’s ideas of what is right and wrong without appealing to faith, and there is no reason to presuppose that God (in this sense) would consider suicide or euthanasia something “wrong.” Indeed, He may be of such a nature as to think ending one’s life or having it ended something “right,” rewarding those who let their lives end prematurely with an eternity of life and happiness.

This consideration is of course only relevant if the individual contemplating euthanasia believes in such an entity, unless it would be deemed acceptable to resort to paternalistically forcing a view on individuals. Those who do not subscribe to a religious worldview would merely consider the pains and pleasures that are to be expected if they continue to live; since they opt for euthanasia, they apparently expect to experience more pain than pleasure if they continue to live. (I admit that this is a simplistic analysis compared to what is actually at stake, if only because “pleasure” and “pain” may be defined in various ways and, related to that issue, it may be difficult to balance them. I have not explored these issues since it is not relevant to present a general account here: in line with what will be argued in the final paragraph, the individual’s judgment is decisive in this respect.)

The positive and purposive nature of life, with the corollary that it should in principle be preserved is not proven, and is perhaps unprovable. It may be a heritage of a mix of Christian Footnote 48 and Aristotelian tenets. By contrast, a negative appreciation of life is promulgated in Hinduism, Buddhism, and Jainism, where the goal to be achieved is extinction (ceasing to exist), so that one does not reincarnate. Suicide or euthanasia would express a desire (namely, the desire to end one’s suffering), on the basis of which reincarnation would follow, so that this goal would not be reached.

One may oppose legalizing euthanasia without appealing to religious ideas, but such a position does mean that one has adopted—explicitly or implicitly—a positive outlook on life. Importantly, such an outlook is nonneutral. All that may be said of life in a neutral sense is that it exists , manifested by someone’s beating heart and breathing (forgoing here cases in which someone is kept alive by means of life support). Footnote 49

The question that presents itself is who should decide whether life is something positive or negative. There is no compelling reason for the state (or society) to decide this for the individual, so that the individual’s judgment is decisive. Footnote 50 One may hold that defining life in terms of pain and pleasure is (too) reductionist, or that pain itself has a certain meaning, and even attempt to persuade someone of the positive nature of life, but forcing a worldview on someone would be unacceptable. Having a worldview does not, of course, in and of itself result in anything. Once a request for euthanasia is made, however, the issue is no longer theoretical. If physicians decline such a request on the basis of other considerations than procedural ones (legitimate concerns existing when, e.g., there is doubt whether the individual making the request is competent), they evidence nonneutrality (or even paternalism). Incidentally, it may be defended that physicians whose worldview is incompatible with performing euthanasia should have the right to decline a request on that basis; whether a physician may invoke his worldview in such a case depends on whether the tasks a physician may normally be expected to perform include euthanasia.

Should one hold that “Physicians should help patients at the end of their lives find the ‘why’ they have lost to enable them to endure their abhorrent ‘how’ if they so desire and not resort to physician-assisted suicide and euthanasia,” Footnote 51 a “why” (i.e., a meaning of life) is presupposed to begin with, in accordance with which something worthwhile for which to keep living supposedly exists. Relieving the individual’s suffering without resorting to euthanasia may be an alternative, Footnote 52 but if this option is available, the issue may be moot and, besides, it should not be used as a means to dodge the main question who is to decide whether the individual’s suffering is truly relieved.

The foregoing is not sufficient, however, to determine whether performing euthanasia should be allowed in cases where no medically diagnosable suffering is involved (irrespective of whether one accepts “unbearableness” and “absence of a prospect of improvement” as qualifiers), for some important matters are still to be considered. These will be addressed in the next section.

I have argued that the perspective of the individual should be decisive in assessing the value of life rather than a prevailing worldview (implicit or explicit). The theoretical question of what view on life an individual may have immediately leads to the practical question whether and, if so, in which cases individuals should have the right to euthanasia. Now that the necessary background has been presented, the present section can focus on the remaining issues.

If euthanasia is legal in (certain) cases where the individual suffers from a medically diagnosable cause, it seems difficult not to allow it in (certain) cases where the suffering has another cause. After all, the individual seems to be the proper judge to decide whether the suffering is so grave that ending one’s life is the most desirable outcome. It is unclear why the cause of the suffering should be a relevant issue. If there is a reason to think it may more easily be relieved without resorting to euthanasia in one type of case than in the other, Footnote 53 there is a reason to ensure that the individual requesting euthanasia is informed about possible alternatives (which should, incidentally, be—and presumably already is—part and parcel of any procedure following a request, so irrespective of the cause of suffering), but even if it is supposed that the suffering could in similar cases (disregarding, arguendo , the difficulty of comparing different cases of existential suffering) be relieved, it is still the individual who is to decide whether such information is relevant, and whether he would thus (nonetheless) resort to euthanasia.

Schmidt speaks, in this respect, of the “Argument from Arbitrary Difference”: “The central argument for CLE [completed life euthanasia] is what I call the Argument from Arbitrary Difference : if a concern for people’s autonomy and well-being justifies medical euthanasia, it also justifies CLE. Drawing a distinction between the two is morally arbitrary.” Footnote 54 In addition to that principal argument, one may point to the pragmatic considerations that medical cases may be difficult to demarcate from nonmedical ones Footnote 55 and that the domain of “medicine” is not clearly demarcated. Footnote 56

One may argue, then, that since physicians may face their patients’ existential suffering, which does not significantly differ from the suffering they are trained to address, if euthanasia is allowed on the basis of medically diagnosable suffering, it would be inconsistent not to allow euthanasia on the basis of existential suffering. Footnote 57 This position is defensible, but physicians do not have specific expertise to address this issue. It is for this reason that the Dutch Supreme Court ruled that a physician should not try to help people who experience such suffering, and should instead seek others who could assist in finding a meaning in one’s existence. Footnote 58

The Court fails to indicate, however, whom those others might be; this will presumably depend on the circumstances, and a priest, rabbi, imam, or humanistic therapist, amongst others, are conceivable options. More importantly, though, should none of such counselors—for whatever reason—be able to provide a solution for the individual’s suffering, no (further) recourse appears available. The introduction of end-of-life supporters has, as was mentioned in the section “The Right to Euthanasia,” been proposed in the Netherlands; they may, for individuals who are resolved that no means exist to end their suffering save those an end-of-life supporter may provide, provide those means. Footnote 59

Importantly, though, if what was argued in the section “The Meaning of Life and the Meaning of ‘Life’” is accepted, there is no reason to use the proposed age limit. If individuals’ own judgments in assessing whether they suffer existentially or whether their life has value are decisive, the age limit could instead be 18 years, 21 years, or somewhere in between; this might be a difficult delimitation issue. The idea of a “completed life” is thus fully individualized by separating it from the notion that there is normally (whatever that may be taken to mean) something to complete, which an age limit of 75 years suggests.

The reader is reminded here that end-of-life supporters will not be allowed to perform euthanasia in the strict sense, which will remain a task reserved for physicians, and will only be involved in assisted suicide. If suicide itself is not illegal (so that the corpse of a self-murderer is not treated irreverently as a form of punishment, presumably in the guise of some sort of [vicarious] atonement, and someone who attempts to commit suicide and fails is not punished), then assisted suicide should not be illegal, either. After all, the individual who ends his life is the same in the first case as in the second, the only variable being the means that are provided by the person who assists. Footnote 60 The suicide of someone who acquires a rope and hangs himself is assisted, in a sense, by the storekeeper who sells it, which is not thereby punishable. The phrase “in a sense” is apt, for there is no assisted suicide if the storekeeper does not know what it is intended to be used for (or if he is lied to, and is told it is to be used for something legal), while his action is punishable if he knows the rope’s purpose and sells it nonetheless, thus willingly facilitating the suicide.

A final issue to consider is the danger of a “slippery slope”: if euthanasia (and in the case under discussion assisted suicide) is not just allowed in cases of medically diagnosable suffering and the only criterion is the individual’s assessment of his own life (i.e., whether he experiences suffering sufficient—by his own standards—to request euthanasia or considers his life completed, based on a subjective definition of “suffering” or “completed life”), some people may feel pressured to make a request they do not truly want to make.

This concern should not be dismissed, but, first, it may also be expressed in the case of medically diagnosable suffering, so that it could be used as an argument not to legalize euthanasia for any situation, an outcome that seems too severe, unless one already thinks that euthanasia (and specifically assisted suicide) should not just not be extended to cases where nonmedically diagnosable suffering is involved but should not be allowed under any circumstances, and, second, I remind the reader here that precautions are in place to ensure that the request expresses a genuine desire to die.

This does not mean, though, that a critical stance is unacceptable, and one may legitimately question whether implementing a procedure that seems sound might have unforeseen effects. It is difficult to assess whether and, if so, to what extent such effects have already manifested themselves. On the one hand, one may point to historical examples of accepted killings in exceptional contexts and circumstances that have not resulted in a general devaluation of human life, Footnote 61 and maintain that the Nazi euthanasia program is an irrelevant example since nonvoluntary euthanasia was allowed from the start, Footnote 62 while, on the other hand, data appear to suggest that the permissibility of voluntary euthanasia has led to nonvoluntary euthanasia. Footnote 63

In any event, given the (dire) position of those whose suffering can only be relieved by the radical means discussed here, the best course of action would be to focus on improving the procedures, if necessary. Only then may the interests of everyone involved be said to be taken seriously.

Whether being alive is something positive or negative must be determined by the living. If “the living” is interpreted collectively and life is deemed something positive, with the outcome that euthanasia is forbidden or only allowed in cases of medically diagnosable suffering, an individual whose assessment of (his own) life differs from the assessment of the majority has no right to euthanasia, unless this assessment has a medically diagnosable cause. I have argued that existential suffering should also be acknowledged as a reason to perform euthanasia (or, specifically, to assist in another’s suicide). Only thus may the imposition of the idea that life is something positive, with the corollary that one should in principle (continue to) live, on individuals be forestalled.

The issue is not whether there is a right to die, but whether there is a duty (to continue) to live. The onus is not, then, on the individual who wants to die to prove that he has such a right, but, conversely, on those who keep him from dying by means of euthanasia to prove that he has a duty to live. This given does not preclude the justification of using a procedure to ensure that the individual’s request to have his life ended or receive aid to do so himself is voluntary and well-considered, and that there is a lasting desire to die.

The foregoing is not taken to mean that an absolute right (a “natural” right) to die exists and that legislation that conflicts with the acknowledgement of such a right is therefore invalidated. I have not argued that such a right exists, if only because I would not even know where to begin if it were my intention to do so. I have rather expressed what situation I deem most desirable, having no recourse to a superior standard to make my case. This does not take away anything from the importance of the issue of taking existential suffering seriously.

1. “Euthanasia”—as a working definition—here refers to both euthanasia in the strict sense (i.e., a person’s voluntary death by means of little or no pain, brought about by another than that person) and assisted suicide (i.e., a person’s suicide that is brought about with the aid of another than that person), unless otherwise indicated. Incidentally, “euthanasia” is thus equated with “voluntary euthanasia,” not because “nonvoluntary euthanasia” would not qualify as euthanasia but because nonvoluntary euthanasia is not an issue in the present inquiry; for the same reason, “euthanasia” is equated with “active euthanasia.” “Euthanasia” in the literal sense has a very broad sense, but this will not explored here in order not to needlessly complicate matters; as I just indicated, I will use a working definition here.

2. The relevant legislation where these and the other criteria are listed is the Termination of Life on Request and Assisted Suicide Act. Euthanasia is illegal on the basis of articles 293 and 294 of the Dutch Criminal Code, but euthanasia performed by physicians is not punishable as long as they adhere to the criteria specified in said Act.

3. Dutch Supreme Court , June 6, 1994, at 5.2.

4. Berghmans , R , Widdershoven , G , Widdershoven-Heerding , I. Physician-assisted suicide in psychiatry and loss of hope . International Journal of Law and Psychiatry 2013 ; 36 ( 5/6 ): 436 –43 CrossRef Google Scholar PubMed , at 442.

5. Parker , M. Defending the indefensible? Psychiatry, assisted suicide and human freedom . International Journal of Law and Psychiatry 2013 ; 36 ( 5/6 ): 485 –97 CrossRef Google Scholar PubMed , at 487.

6. For example, Hatherley , JJ . Is the exclusion of psychiatric patients from access to physician-assisted suicide discriminatory? Journal of Medical Ethics 2019 ; 45 ( 12 ): 817 –20 CrossRef Google Scholar PubMed , at 818.

7. Parliamentary Documents: House of Representatives, 1993/1994:23877, no. 1, at 4. The original text reads: “Voor de uitzichtloosheid van het lijden is het medisch oordeel bepalend. Naar medisch vakkundig oordeel moet vaststaan dat de situatie van de patiënt verergert en niet te verbeteren is. Aldus wordt de uitzichtloosheid geobjectiveerd.”

8. Parliamentary Documents: House of Representatives, 1993/1994:23877, no. 1, at 5. The original text reads: “De ondraaglijkheid van het lijden dient voor de vraag of euthanasie mag worden toegepast evenzeer te worden vastgesteld, maar is, in tegenstelling tot de uitzichtloosheid van het lijden, een in hoge mate subjectieve, en moeilijk te objectiveren factor.”

9. Parliamentary Documents: House of Representatives, 1999/2000:26691, no. 6, at 30; 1999/2000:26691, no. 6, at 70; and 2007/2008:31036, no. 3, at 5, 6.

10. Parliamentary Documents: House of Representatives, 2007/2008:31036, no. 8, at 3.

11. Parliamentary Documents: House of Representatives, 2019/2020:35534, no. 2, at 1–10.

12. Parliamentary Documents: House of Representatives, 2019/2020:35534, no. 3, at 2.

13. Parliamentary Documents: House of Representatives, 2019/2020:35534, no. 3, at 23, 36.

14. Parliamentary Documents: House of Representatives, 2019/2020:35534, no. 3, at 20.

15. Tiensuu , P. Whose right to what life? Assisted suicide and the right to life as a fundamental right . Human Rights Law Review 2015 ; 15 ( 2 ): 251 –81 CrossRef Google Scholar , at 252.

16. ECtHR, Pretty v. United Kingdom (Apr. 29, 2002), Application No. 2346/02.

17. ECtHR, Haas v. Switzerland (Jan. 29, 2011), Application No. 31322/07.

18. ECtHR, Haas v. Switzerland (Jan. 29, 2011), at 51, 52.

19. ECtHR, Haas v. Switzerland (Jan. 29, 2011), at 56–8.

20. Washington v. Glucksberg , 521 U.S. 702 (1997), at 720, 721.

21. Washington v. Glucksberg , 521 U.S. 702 (1997), at 728.

22. , Chemerinsky E. Washington v. Glucksberg was tragically wrong . Michigan Law Review 2008 ; 106 ( 8 ): 1501 –16 Google Scholar , at 1506.

23. See note 22 , Chemerinsky 2008, at 1507.

24. See note 22 , Chemerinsky 2008, at 1515.

25. For example, Euthanasia , Biggs H. , Death with Dignity and the Law . Oxford : Hart ; 2001 Google Scholar , at 15, 29; Neeley , GS . The constitutional right to suicide, the quality of life, and the “slippery-slope”: An explicit reply to lingering concerns . Akron Law Review 1994 ; 28 ( 1 ): 53 – 77 Google Scholar PubMed , at 76.

26. See Doomen J. Dignity in life and death. In: Doomen J, Van Schaik M, eds. Religious Ideas in Liberal Democratic States. Lanham, MD: Lexington Books (Rowman & Littlefield); 2021:85–104, at 90–2 for an overview.

27. See note 25 , Neeley 1994, at 65–7.

28. The author does not refer to Kant, but his perspective does come to mind. A discussion of Kant’s ideas would unwarrantably diverge from the discussion at hand; I refer the reader to Doomen J. Beyond dignity. Archiv für Begriffsgeschichte 2016;57:57–72, at 59–61.

29. See note 25 , Biggs 2001, at 157.

30. Singer P. Practical Ethics. Cambridge: Cambridge University Press; 2011, at 156.

31. Aristotle, Ethica Nicomachea. Opera, Vol. 2. Darmstadt: Wissenschaftliche Buchgesellschaft; 1831[±350BC], at 1115a.

32. See note 31 , Aristotle 1831, at 1098a, 1098b.

33. Lucretius. De Rerum Natura. Berlin: Georg Reimer; 1871[±60BC], Book 3, 830, 831, at 105.

34. See note 33 , Lucretius 1871, Book 3, 798, 799, at 105; and 830, 831, at 105.

35. Paterson C. Assisted Suicide and Euthanasia. A Natural Law Ethics Approach. Aldershot: Ashgate; 2008, at 51. Similarly, Dworkin states: “Something is intrinsically valuable […] if its value is independent of what people happen to enjoy or want or need or what is good for them.” Dworkin R. Life’s Dominion. New York, NY: Alfred Knopf; 1993, at 71. The idea of “(human) dignity,” discussed in the previous section, is associated with the idea of an intrinsic value (see note 25 , Biggs 2001, at 145) and with the inherent value of one’s own life (Dworkin 1993, at 238).

36. See note 35 , Paterson 2008, at 78.

37. See note 35 , Dworkin 1993, at 68, 69.

38. Bullock , E. Assisted dying and the proper role of patient autonomy . In: Cholbi , M , Varelius , J , eds. New Directions in the Ethics of Assisted Suicide and Euthanasia . New York, NY : Springer ; 2015 : 11 – 25 CrossRef Google Scholar , at 17, 18.

39. See note 38 , Bullock 2015, at 17.

40. See note 38 , Bullock 2015, at 13.

41. See note 38 , Bullock 2015, at 20–2.

42. See note 38 , Bullock 2015, at 17, 18.

43. See note 38 , Bullock 2015, at 14–6.

44. “Lasting” (the translation of the term “duurzaam,” which is used in the bill) (Parliamentary Documents: House of Representatives, 2019/2020:35534, no. 2, at 2) must be differentiated from “absence of a prospect of improvement” of medically diagnosable suffering (see note 2 ). In the case of medically diagnosable suffering, the suffering is expected to be such that no prospect of improvement exists as a result of a lack of medical means to alleviate it, while “lasting” in the present sense refers to the fact that the person making the request has a lasting desire to die.

45. In line with what Sudarshan argues ( Sudarshan , S. The irrevocability of capital punishment and active voluntary euthanasia . Journal of Applied Philosophy 2021 ; 18 ( 3 ): 431 –43 CrossRef Google Scholar , at 436, 437).

46. Pascal B. Pensées. Œuvres Complètes, Vol. 1. Paris: Librairie de L. Hachette et Cie; 1869 [1669], Article X, at 303–5.

47. See note 46 , Pascal 1869, Article X, at 303. The original text (with the original spelling) reads: “S’il y a un Dieu, il est infiniment incompréhensible, puisque, n’ayant ni parties ni bornes, il n’a nul rapport à nous: nous sommes donc incapables de connoître ni ce qu’il est, ni s’il est.”

48. Compare Simmons , K. Suicide and death with dignity . Journal of Law and the Biosciences 2018 ; 5 ( 2 ): 436 –9, at 439 CrossRef Google Scholar PubMed .

49. It is in this sense that Marcus Aurelius speaks of life. Seeking to consider things as they are in themselves (Marcus Aurelius Antonius. Ta Eis Heauton. Leipzig: B.G. Teubner; 1903 [180AD], Book Δ, ιά, at 34), he indeed identifies life with such physical elements (Book Ζ, ιέ, at 67).

50. Compare Schramme T. Rational suicide, assisted suicide, and indirect legal paternalism. International Journal of Law and Psychiatry 2013;36(5/6):477–84, at 480, 482, and the dissenting opinion of Justice Brennan in Cruzan v. Director, Missouri Department of Health, 497U.S. 261 (1990): “[…] the State has no legitimate general interest in someone’s life, completely abstracted from the interest of the person living that life, that could outweigh the person’s choice to avoid medical treatment.”

51. Sprung , C , Somerville , M , Radbruch , L , Collet , NS , Duttge , G , Piva , J , et al. Physician-assisted suicide and euthanasia: Emerging issues from a global perspective . Journal of Palliative Care 2018 ; 33 ( 4 ): 197 – 203 CrossRef Google Scholar PubMed , at 199.

52. See note 51 , Sprung et al. 2018, at 200.

53. In addition, “[…] what is diagnosed is the condition and not the suffering; physical conditions are objectively diagnosable while physical suffering is not or less so.” Raus , K , Sterckx , S. Euthanasia for mental suffering . In: Cholbi , M , Varelius , J , eds. New Directions in the Ethics of Assisted Suicide and Euthanasia . New York, NY : Springer ; 2015 : 79 – 96 CrossRef Google Scholar , at 89.

54. Schmidt , A. Should we extend voluntary euthanasia to non-medical cases? Solidarity and the social context of elderly suffering . Journal of Moral Philosophy 2020 ; 17 ( 2 ): 129 –62 CrossRef Google Scholar , at 132.

55. See note 54 , Schmidt 2020, at 134, and see note 53 , Raus, Sterckx 2015, at 89.

56. See note 53 , Raus, Sterckx 2015, at 89.

57. Varelius , J. Medical expertise, existential suffering and ending life . Journal of Medical Ethics 2014 ; 40 ( 2 ): 104 –7 CrossRef Google Scholar PubMed , at 106.

58. Dutch Supreme Court , Dec. 24, 2002, at 5.

59. Complementing what he argues, Varelius points to such an alternative: persons with a special expertise on existential questions may, provided that they meet the same standards as physicians insofar as the procedural requirements are concerned, be preferable to physicians (see note 57 , Varelius 2014, at 107).

60. Compare note 50 , Schramme 2013, at 484.

61. See note 25 , Neeley 1994, at 60, 61.

62. Lesser , H. Should it be legal to assist suicide? Journal of Evaluation in Clinical Practice 2010 ; 16 ( 2 ): 330 –4 CrossRef Google Scholar PubMed , at 332.

63. See note 51 , Sprung et al. 2018, at 198.

No CrossRef data available.

View all Google Scholar citations for this article.

Save article to Kindle

To save this article to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle .

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

• Volume 32, Issue 1
• Jasper Doomen (a1)
• DOI: https://doi.org/10.1017/S0963180122000020

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox .

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive .

Reply to: Submit a response

- No HTML tags allowed - Web page URLs will display as text only - Lines and paragraphs break automatically - Attachments, images or tables are not permitted

Your details

Your email address will be used in order to notify you when your comment has been reviewed by the moderator and in case the author(s) of the article or the moderator need to contact you directly.

You have entered the maximum number of contributors

Conflicting interests.

Please list any fees and grants from, employment by, consultancy for, shared ownership in or any close relationship with, at any time over the preceding 36 months, any organisation whose interests may be affected by the publication of the response. Please also list any non-financial associations or interests (personal, professional, political, institutional, religious or other) that a reasonable reader would want to know about in relation to the submitted work. This pertains to all the authors of the piece, their spouses or partners.

• - Google Chrome

Intended for healthcare professionals

• My email alerts
• BMA member login
• Username * Password * Forgot your log in details? Need to activate BMA Member Log In Log in via OpenAthens Log in via your institution

Search form

• Advanced search
• Search responses
• Search blogs
• News & Views
• Euthanasia and...

Euthanasia and assisted dying: the illusion of autonomy—an essay by Ole Hartling

Read our coverage of the assisted dying debate.

• Related content
• Peer review
• Ole Hartling , former chairman
• Danish Council of Ethics, Denmark
• hartling{at}dadlnet.dk

As a medical doctor I have, with some worry, followed the assisted dying debate that regularly hits headlines in many parts of the world. The main arguments for legalisation are respecting self-determination and alleviating suffering. Since those arguments appear self-evident, my book Euthanasia and the Ethics of a Doctor’s Decisions—An Argument Against Assisted Dying 1 aimed to contribute to the international debate on this matter.

I found it worthwhile to look into the arguments for legalisation more closely, with the hope of sowing a little doubt in the minds of those who exhibit absolute certainty in the matter. This essay focuses on one point: the concept of “autonomy.”

(While there are several definitions of voluntary, involuntary, and non-voluntary euthanasia as well as assisted dying, assisted suicide, and physician assisted suicide, for the purposes of brevity in this essay, I use “assisted dying” throughout.)

Currently, in richer countries, arguments for legalising assisted dying frequently refer to the right to self-determination—or autonomy and free will. Our ability to self-determine seems to be unlimited and our right to it inviolable. The public’s response to opinion poll questions on voluntary euthanasia show that people can scarcely imagine not being able to make up their own minds, nor can they imagine not having the choice. Moreover, a healthy person answering a poll may have difficulty imagining being in a predicament where they simply would not wish to be given the choice.

I question whether self-determination is genuinely possible when choosing your own death. In my book, I explain that the choice will always be made in the context of a non-autonomous assessment of your quality of life—that is, an assessment outside your control. 1

All essential decisions that we make are made in relation to other people. Our decisions are affected by other people, and …

Log in using your username and password

BMA Member Log In

If you have a subscription to The BMJ, log in:

• Need to activate
• Log in via institution
• Log in via OpenAthens

Log in through your institution

Subscribe from £184 *.

Subscribe and get access to all BMJ articles, and much more.

* For online subscription

Access this article for 1 day for: £33 / $40 / €36 ( excludes VAT )

You can download a PDF version for your personal record.

Buy this article

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Indian J Med Res
• v.136(6); 2012 Dec

Euthanasia: Right to life vs right to die

Suresh bada math.

Department of Psychiatry National Institute of Mental Health & Neuro Sciences (Deemed University) Bangalore 560 029, India

Santosh K. Chaturvedi

The word euthanasia, originated in Greece means a good death 1 . Euthanasia encompasses various dimensions, from active (introducing something to cause death) to passive (withholding treatment or supportive measures); voluntary (consent) to involuntary (consent from guardian) and physician assisted (where physician's prescribe the medicine and patient or the third party administers the medication to cause death) 2 , 3 . Request for premature ending of life has contributed to the debate about the role of such practices in contemporary health care. This debate cuts across complex and dynamic aspects such as, legal, ethical, human rights, health, religious, economic, spiritual, social and cultural aspects of the civilised society. Here we argue this complex issue from both the supporters and opponents’ perspectives, and also attempts to present the plight of the sufferers and their caregivers. The objective is to discuss the subject of euthanasia from the medical and human rights perspective given the background of the recent Supreme Court judgement 3 in this context.

In India abetment of suicide and attempt to suicide are both criminal offences. In 1994, constitutional validity of Indian Penal Code Section (IPC Sec) 309 was challenged in the Supreme Court 4 . The Supreme Court declared that IPC Sec 309 is unconstitutional, under Article 21 (Right to Life) of the constitution in a landmark judgement 4 . In 1996, an interesting case of abetment of commission of suicide (IPC Sec 306) came to Supreme Court 5 . The accused were convicted in the trial court and later the conviction was upheld by the High Court. They appealed to the Supreme Court and contended that ‘right to die’ be included in Article 21 of the Constitution and any person abetting the commission of suicide by anyone is merely assisting in the enforcement of the fundamental right under Article 21; hence their punishment is violation of Article 21. This made the Supreme Court to rethink and to reconsider the decision of right to die. Immediately the matter was referred to a Constitution Bench of the Indian Supreme Court. The Court held that the right to life under Article 21 of the Constitution does not include the right to die 5 .

Regarding suicide, the Supreme Court reconsidered its decision on suicide. Abetment of suicide (IPC Sec 306) and attempt to suicide (IPC Sec 309) are two distinct offences, hence Section 306 can survive independent of Section 309. It has also clearly stated that a person attempts suicide in a depression, and hence he needs help, rather than punishment. Therefore, the Supreme Court has recommended to Parliament to consider the feasibility of deleting Section 309 from the Indian Penal Code 3 .

Arguments against euthanasia

Eliminating the invalid : Euthanasia opposers argue that if we embrace ‘the right to death with dignity’, people with incurable and debilitating illnesses will be disposed from our civilised society. The practice of palliative care counters this view, as palliative care would provide relief from distressing symptoms and pain, and support to the patient as well as the care giver. Palliative care is an active, compassionate and creative care for the dying 6 .

Constitution of India : ‘Right to life’ is a natural right embodied in Article 21 but suicide is an unnatural termination or extinction of life and, therefore, incompatible and inconsistent with the concept of ‘right to life’. It is the duty of the State to protect life and the physician's duty to provide care and not to harm patients. If euthanasia is legalised, then there is a grave apprehension that the State may refuse to invest in health (working towards Right to life). Legalised euthanasia has led to a severe decline in the quality of care for terminally-ill patients in Holland 7 . Hence, in a welfare state there should not be any role of euthanasia in any form.

Symptom of mental illness : Attempts to suicide or completed suicide are commonly seen in patients suffering from depression 8 , schizophrenia 9 and substance users 10 . It is also documented in patients suffering from obsessive compulsive disorder 11 . Hence, it is essential to assess the mental status of the individual seeking for euthanasia. In classical teaching, attempt to suicide is a psychiatric emergency and it is considered as a desperate call for help or assistance. Several guidelines have been formulated for management of suicidal patients in psychiatry 12 . Hence, attempted suicide is considered as a sign of mental illness 13 .

Malafide intention : In the era of declining morality and justice, there is a possibility of misusing euthanasia by family members or relatives for inheriting the property of the patient. The Supreme Court has also raised this issue in the recent judgement 3 . ‘Mercy killing’ should not lead to ‘killing mercy’ in the hands of the noble medical professionals. Hence, to keep control over the medical professionals, the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 discusses euthanasia briefly in Chapter 6, Section 6.7 and it is in accordance with the provisions of the Transplantation of Human Organ Act, 1994 14 . There is an urgent need to protect patients and also medical practitioners caring the terminally ill patients from unnecessary lawsuit. Law commission had submitted a report (no-196) to the government on this issue 15 .

Emphasis on care : Earlier majority of them died before they reached the hospital but now it is converse. Now sciences had advanced to the extent, life can be prolonged but not to that extent of bringing back the dead one. This phenomenon has raised a complex situation. Earlier diseases outcome was discussed in terms of ‘CURE’ but in the contemporary world of diseases such as cancer, Aids, diabetes, hypertension and mental illness are debated in terms best ‘CARE’, since cure is distant. The principle is to add life to years rather than years to life with a good quality palliative care. The intention is to provide care when cure is not possible by low cost methods. The expectation of society is, ‘cure’ from the health professionals, but the role of medical professionals is to provide ‘care’. Hence, euthanasia for no cure illness does not have a logical argument. Whenever, there is no cure, the society and medical professionals become frustrated and the fellow citizen take extreme measures such as suicide, euthanasia or substance use. In such situations, palliative and rehabilitative care comes to the rescue of the patient and the family. At times, doctors do suggest to the family members to have the patient discharged from the hospital wait for death to come, if the family or patient so desires. Various reasons are quoted for such decisions, such as poverty, non-availability of bed, futile intervention, resources can be utilised for other patients where cure is possible and unfortunately majority of our patient's family do accordingly. Many of the terminally ill patients prefer to die at home, with or without any proper terminal health care. The societal perception needs to be altered and also the medical professionals need to focus on care rather in addition to just cure. The motive for many euthanasia requests is unawareness of alternatives. Patients hear from their doctors that ‘nothing can be done anymore’. However, when patients hear that a lot can be done through palliative care, that the symptoms can be controlled, now and in the future, many do not want euthanasia anymore 16 .

Commercialisation of health care : Passive euthanasia occurs in majority of the hospitals across the county, where poor patients and their family members refuse or withdraw treatment because of the huge cost involved in keeping them alive. If euthanasia is legalised, then commercial health sector will serve death sentence to many disabled and elderly citizens of India for meagre amount of money. This has been highlighted in the Supreme Court Judgement 3 , 17 .

Research has revealed that many terminally ill patients requesting euthanasia, have major depression, and that the desire for death in terminal patients is correlated with the depression 18 . In Indian setting also, strong desire for death was reported by 3 of the 191 advanced cancer patients, and these had severe depression 19 . They need palliative and rehabilitative care. They want to be looked after by enthusiastic, compassionate and humanistic team of health professionals and the complete expenses need to be borne by the State so that ‘Right to life’ becomes a reality and succeeds before ‘Right to death with dignity’. Palliative care actually provides death with dignity and a death considered good by the patient and the care givers.

Counterargument of euthanasia supporters

Caregivers burden : ‘Right-to-die’ supporters argue that people who have an incurable, degenerative, disabling or debilitating condition should be allowed to die in dignity. This argument is further defended for those, who have chronic debilitating illness even though it is not terminal such as severe mental illness. Majority of such petitions are filed by the sufferers or family members or their caretakers. The caregiver's burden is huge and cuts across various domains such as financial, emotional, time, physical, mental and social. Hence, it is uncommon to hear requests from the family members of the person with psychiatric illness to give some poison either to patient or else to them. Coupled with the States inefficiency, apathy and no investment on health is mockery of the ‘Right to life’.

Refusing care : Right to refuse medical treatment is well recognised in law, including medical treatment that sustains or prolongs life. For example, a patient suffering from blood cancer can refuse treatment or deny feeds through nasogastric tube. Recognition of right to refuse treatment gives a way for passive euthanasia. Many do argue that allowing medical termination of pregnancy before 16 wk is also a form of active involuntary euthanasia. This issue of mercy killing of deformed babies has already been in discussion in Holland 20 .

Right to die : Many patients in a persistent vegetative state or else in chronic illness, do not want to be a burden on their family members. Euthanasia can be considered as a way to upheld the ‘Right to life’ by honouring ‘Right to die’ with dignity.

Encouraging the organ transplantation : Euthanasia in terminally ill patients provides an opportunity to advocate for organ donation. This in turn will help many patients with organ failure waiting for transplantation. Not only euthanasia gives ‘Right to die’ for the terminally ill, but also ‘Right to life’ for the organ needy patients.

Constitution of India reads ‘right to life’ is in positive direction of protecting life. Hence, there is an urgent need to fulfil this obligation of ‘Right to life’ by providing ‘food, safe drinking water and health care’. On the contrary, the state does not own the responsibility of promoting, protecting and fulfilling the socio-economic rights such as right to food, right to water, right to education and right to health care, which are basic essential ingredients of right to life. Till date, most of the States has not done anything to support the terminally ill people by providing for hospice care.

If the State takes the responsibility of providing reasonable degree of health care, then majority of the euthanasia supporters will definitely reconsider their argument. We do endorse the Supreme Court Judgement that our contemporary society and public health system is not matured enough to handle this sensitive issue, hence it needs to be withheld. However, this issue needs to be re-examined again after few years depending upon the evolution of the society with regard to providing health care to the disabled and public health sector with regard to providing health care to poor people.

The Supreme Court judgement to withhold decision on this sensitive issue is a first step towards a new era of health care in terminally ill patients. The Judgment laid down is to preserve harmony within a society, when faced with a complex medical, social and legal dilemma. There is a need to enact a legislation to protect terminally ill patients and also medical practitioners caring for them as per the recommendation of Law Commission Report-196 15 . There is also an urgent need to invest in our health care system, so that poor people suffering from ill health can access free health care. Investment in health care is not a charity; ‘Right to Health’ is bestowed under ‘Right to Life’ of our constitution.

• Harvard Division of Continuing Education
• DCE Theses and Dissertations
• Communities & Collections
• By Issue Date
• FAS Department
• Quick submit
• Waiver Generator
• DASH Stories
• Accessibility
• COVID-related Research

Terms of Use

• Privacy Policy
• By Collections
• By Departments

Euthanasia and the Law: The Rise of Euthanasia and Relationship With Palliative Healthcare

Citable link to this page

Collections.

• DCE Theses and Dissertations [1331]

Contact administrator regarding this item (to report mistakes or request changes)

Show Statistical Information

Advertisement

Overcoming Conflicting Definitions of “Euthanasia,” and of “Assisted Suicide,” Through a Value-Neutral Taxonomy of “End-Of-Life Practices”

• Original Research
• Open access
• Published: 02 February 2023
• Volume 20 , pages 51–70, ( 2023 )

Cite this article

You have full access to this open access article

• Thomas D. Riisfeldt   ORCID: orcid.org/0000-0001-5949-5915 1  

4855 Accesses

1 Altmetric

Explore all metrics

This article has been updated

The term “euthanasia” is used in conflicting ways in the bioethical literature, as is the term “assisted suicide,” resulting in definitional confusion, ambiguities, and biases which are counterproductive to ethical and legal discourse. I aim to rectify this problem in two parts. Firstly, I explore a range of conflicting definitions and identify six disputed definitional factors, based on distinctions between (1) killing versus letting die, (2) fully intended versus partially intended versus merely foreseen deaths, (3) voluntary versus nonvoluntary versus involuntary decisions, (4) terminally ill versus non-terminally ill patients, (5) patients who are fully conscious versus those in permanent comas or persistent vegetative states, and (6) patients who are suffering versus those who are not. Secondly, I distil these factors into six “building blocks” and combine them to develop an unambiguous, value-neutral taxonomy of “end-of-life practices.” I hope that this taxonomy provides much-needed clarification and a solid foundation for future ethical and legal discourse.

Similar content being viewed by others

Euthanasia: Passive

Assisted Dying and the Proper Role of Patient Autonomy

Avoid common mistakes on your manuscript.

Euthanasia and assisted suicide are of the utmost practical significance for many patients considering their options at the end of life, as well as for their families and health professionals involved in their care. The ongoing ethical and legal evaluation of these practices is therefore paramount. However, definitional confusion, ambiguities, and biases plague the literature and are counterproductive to this important discourse. Establishing unambiguous and agreed-upon definitions for the central terms of the euthanasia debate is essential for further fruitful ethical and legal discussion. In this essay I aim to rectify this problem. To achieve this, in section 1 I explore six aspects of the definitions of “euthanasia” and “assisted suicide” which are often disputed. In section 2 I break these down into six “building blocks” upon which I develop an inclusive, precise, and value-neutral taxonomy of what I call the “end-of-life practices.” I hope that this taxonomy leads to a greater appreciation of the range of different practices at the end of life and that it reveals some of the hidden metaphysical challenges underlying many of these distinctions. Although the taxonomy is strictly and deliberately value-neutral, I believe that it provides much-needed clarification and a solid foundation for future ethical and legal discourse. In particular, I envisage that readers may utilize it as a platform for their ethical arguments—particularly by way of comparing the ethical significance of the similarities and differences between the various delineated practices—and that it may also aid policymaking and the design of empirical studies. It should also be noted that “euthanasia” may apply to non-human animals (in the veterinary context) as well as to humans, although this article focuses exclusively on humans.

Section 1. There Are No Consensual Definitions of “Euthanasia” or “Assisted Suicide” Owing to Six Disputed Definitional Factors

Paradigm cases.

“Euthanasia” is etymologically derived from the Greek for “good death,” and there is widespread agreement amongst interlocutors that certain paradigm cases constitute euthanasia or assisted suicide respectively; this forms a good starting point for discussion. Suppose that a man named “X” has end-stage metastatic bowel cancer and is slowly dying. Footnote 1 He is fully conscious and does not have dementia or any other form of cognitive impairment. He is suffering from the physical symptoms of pain, shortness of breath, nausea, and vomiting. He is largely bedbound and has lost most of his independence, including the capacity to toilet independently. He has become weary of life; he no longer enjoys many activities or has meaningful life pursuits. He does not want to continue being an emotional and financial burden on his family. Despite this, he is not clinically depressed and does not feel in any way coerced by his family. X decides that he wants to control the manner and timing of his death. For all of these reasons he asks you, his physician (“doctor”), to kill him by administering a lethal injection of a sedative/anaesthetic drug called pentobarbital. You comply, with the full intention of killing him, as a means to relieve his suffering. This is a paradigm case of euthanasia. Suppose that X instead asks you to provide him with a lethal combination of oral drugs which he can take himself at home. Again you comply, with the full intention of those drugs killing him, as a means to relieve his suffering. This is now a paradigm case of assisted suicide. The term “assisted dying” will be discussed later.

Methodology for Identifying Disputed Definitional Factors

Although there is widespread agreement amongst interlocutors that certain paradigm cases like the ones offered above constitute euthanasia or assisted suicide, there is rampant disagreement as to what the correct definitions of the terms actually are and whether or not particular non-paradigm cases constitute euthanasia or assisted suicide. Definitions can be sought from various medical and ethical organizations, from parliamentary legislature and common law, from empirical studies, and from independent bioethicists and other authors writing in the field. These medical and ethical organizations and laws exist at global, continental, national, and state/territory/provincial levels, and medical bodies exist as national medical associations and also as subspecialty associations (particularly adult internal medicine and palliative care subspecialities). This results in quite literally hundreds of definitions of euthanasia and assisted suicide, if not more. To complicate matters further, these definitions have been dynamic over time; they have existed for centuries and have been rapidly evolving, particularly in the last few decades, and it must be acknowledged that there has been a degree of convergence amongst certain interlocutors in recent years. A methodological approach of analysing hundreds of individual definitions is unfeasible, and selecting a representative sample of these definitions without being ad hoc and introducing a selection bias is a challenging task. In the first part of this essay I approach this challenge by selecting a range of definitions spanning the aforementioned types of sources, across multiple continents, and spanning parties who are proponents and opponents of euthanasia and assisted suicide, in an attempt to minimize any such bias. In any case, all that is required for the thesis that follows is to review a sufficient number and type of definitions, in order to identify the various disputed definitional factors that then warrant further evaluation. In the meantime I will focus on definitions of euthanasia and will turn to assisted suicide thereafter.

Global and National Definitions of Euthanasia

To begin at a global level, the World Health Organization has recently retracted its definition and any official position on euthanasia. The next largest global medical body, the World Medical Association (WMA 2015 , 59), most recently defines euthanasia as:

[…] knowingly and intentionally performing an act that is clearly intended to end another person’s life and that includes the following elements: the subject is a competent, informed person with an incurable illness who has voluntarily asked for his or her life to be ended; the agent knows about the person’s condition and desire to die, and commits the act with the primary intention of ending the life of that person; and the act is undertaken with compassion and without personal gain. […] Euthanasia and assisted suicide, according to these definitions, are to be distinguished from the withholding or withdrawal of inappropriate, futile or unwanted medical treatment or the provision of compassionate palliative care, even when these practices shorten life.

Now turning to national medical organizations, the British Medical Association (BMA 2021 , ¶8, 10) defines “voluntary euthanasia” as being where “doctors would administer lethal drugs at the voluntary request of an adult patient with capacity, who meets defined eligibility criteria, with the intention of ending that patient’s life,” and it is restricted to patients that “have either a terminal illness or serious physical illness causing intolerable suffering that cannot be relieved.” The American Medical Association ( 2016 , 10) most recently defines euthanasia as “the administration of a lethal agent by another person to a patient for the purpose of relieving the patient’s intolerable and incurable suffering.” The Australian Medical Association ( 2016 , 1–2) most recently defines euthanasia as “the act of deliberately ending the life of a patient for the purpose of ending intolerable pain and/or suffering,” and specifically excludes from their definition any instance of “not [initiating] or continuing life-prolonging measures, or the administration of treatment or other actions intended to relieve symptoms which may have a secondary consequence of hastening death.”

Now let us turn to definitions arising from empirical studies from the Netherlands and the legislature resulting from these. Van der Maas, van Delden, and Pijnenborg ( 1992 , 23), in the English-version account of the “Commission of Inquiry into the medical practice concerning euthanasia” (aka the “first Remmelink Report”), define euthanasia as “the purposeful acting to terminate life by a person other than the person concerned upon request of the latter.” Related literature in this field, notably van der Maas et al. ( 1991 ), van der Wal and Dillmann ( 1994 ), van der Maas et al. ( 1996 ), Onwuteaka-Philipsen et al. ( 2003 ), and van der Heide et al. ( 2007 ) all define euthanasia in similar ways. Legemaate ( 2004 ), which constitutes the closest to an “official” English translation of the Netherlands’s “Termination of Life on Request and Assisted Suicide (Review Procedures) Act 2002,” also uses the term similarly; this is testament to the considerable efforts to maintain definitional consistency amongst this group of Dutch authors. Legal literature from other European countries such as Belgium, Luxembourg, Switzerland, and Germany could equally have been reviewed here. I will now utilize the definitions just stated as a starting point to explore the disputed definitional factors found across the literature as a whole, again focusing on euthanasia for the time being.

It should first be noted that there are six challenges mentioned herein for which any detailed examination lies beyond the scope of this essay. Three of these challenges are epistemological, regarding the practical difficulties in determining the provider’s true intentions, in determining whether informed consent has truly been provided by the patient, and in determining whether an illness is actually terminal, all on an individual/case-by-case basis. Two of these challenges are metaphysical, regarding the definition of death and regarding theories of causation in the context of two simultaneous causally relevant factors (i.e., simultaneous actions and omissions). The last challenge is empirical, pertaining to whether or not palliative opioid and sedative use hasten or bring about death (along with how this relates to Aquinas’s doctrine of double effect). These are highlighted again in the relevant sections below.

Is Euthanasia Necessarily a Killing or Can It Also Be a Letting Die?

Firstly, I need to distinguish “killing” from “letting die.” Most interlocutors agree that killing is an action or commission, as opposed to letting die which is an omission. Killing in the medical context is usually achieved through injecting a lethal bolus (a large single dose) of a drug. This drug may have analgesic and/or sedative properties (e.g., morphine, an opioid; or pentobarbital, a barbiturate), or it may not (e.g., potassium chloride, an ionic compound which in high doses stops the heart from beating). A combination of drugs may be used. Letting die in the medical context occurs through “withholding or withdrawing inappropriate or futile life-sustaining treatments” (WWIFLSTs). I have chosen this rather cumbersome phrase because it precisely encapsulates the terminology used in the literature.

“Medical futility” is a complex and often controversial concept (Emanuel 2018 ; Fins, McCarthy, and Limehouse 2017 ; Materstvedt and Bosshard 2009 ). For the purpose of this essay it should suffice that a “futile treatment” is one that strives for a medical benefit despite that benefit being impossible to achieve. A “life-sustaining treatment” is any treatment that prolongs life without reversing the underlying medical condition. The prototypical example of withholding life-sustaining treatment is the Do Not Resuscitate (DNR) order (Fins, McCarthy, and Limehouse 2017 ). More than 98 per cent of patients in intensive care units die without cardiopulmonary resuscitation being attempted (Emanuel 2018 ), many of whom would have had DNR orders in place. Another example of withholding life-sustaining treatment is electing not to treat bacterial chest infections with antibiotics. Examples of withdrawing life-sustaining treatments are turning off mechanical ventilators or dialysis machines. Turning off implanted cardiac devices (e.g., permanent pacemakers) constitutes withholding life-sustaining treatment if the device only has a stand-by function or withdrawing life-sustaining treatment if the device has a continuous function (Fins, McCarthy, and Limehouse 2017 ). On average, 3.8 life-sustaining treatments are withheld or withdrawn per dying intensive care unit patient (Emanuel 2018 ). Artificial nutrition and hydration are usually considered to be life-sustaining treatments which can be withheld or withdrawn like any other, although this is controversial (American Academy of Hospice and Palliative Medicine AAHPM 2011 , 2013 ; Jonsen, Siegler, and Winslade 2010 ). Footnote 2

The distinction of killing versus letting die is important because it reflects the dichotomy between “active” and “passive” euthanasia used by some interlocutors; this is synonymous with “direct” and “indirect” euthanasia, respectively. On this account, “active euthanasia” is where the person being euthanized (the patient) is killed by the person providing the euthanasia (usually a doctor). Conversely, “passive euthanasia” is where the doctor lets the patient die by WWIFLSTs, thereby failing to prevent or delay death “from natural causes” (the underlying disease) where the means for doing so was available. This dichotomy is central in Rachels ( 1975 ) and is also recognized by Kerridge, Lowe, and Stewart ( 2013 ), whereas it is rejected by the WMA, BMA, American Medical Association, Australian Medical Association, and the authors from the Netherlands, all of whom state that euthanasia is necessarily an “act.” This position is also shared by the AAHPM (201), Australian and New Zealand Society of Palliative Medicine (ANZSPM 2013 ), Karlawish and James ( 2009 ), Materstvedt and Bosshard ( 2009 ), and Singer ( 2011 ). On this definition the qualifier “active” is superfluous and “active euthanasia” is tautological; conversely, “passive euthanasia” is a contradiction in terms. The distinction is confused further by virtue of some interlocutors stating that “killing through omission” exists or that the metaphysical distinction between killing and letting die rests on an untenable theory of causation altogether. For example, Warnock ( 1998 , 32) claims that “I can kill my pet by neglect as well as by running her over,” and Harris ( 1975 , 83) claims that “if a doctor refuses to treat a patient [when the means for treating that patient were readily available], he has killed that patient as sure as shooting.” Furthermore, some authors use the terms just discussed inconsistently, such as by defining “active euthanasia” as a form of killing and “passive euthanasia” as a form of WWIFLSTs but then claiming that WWIFLSTs is separate from and does not constitute euthanasia (Emanuel 2018 ).

Is Euthanasia Necessarily Fully Intended (On Behalf of the Provider) Or Can It Also Be Partially Intended?

The WMA, BMA, American Medical Association, Australian Medical Association, and the authors from the Netherlands all agree that euthanasia necessarily intends to hasten or bring about death, as opposed to merely foreseeing (but not intending) the hastening or bringing about of death. This is important in the context of two palliative care practices: the appropriately titrated administration of opioids and continuous deep palliative sedation, which—controversially—may hasten or bring about death. Supposing that they do, these two practices are distinct from euthanasia on this orthodox definition provided that they merely foresee (but do not intend) that death will be hastened or brought about. Arguments as to whether or not either of these practices actually do hasten or bring about death, along with arguments regarding their applicability to Aquinas’s doctrine of double effect and arguments regarding the validity of the doctrine itself (McIntyre 2019 ), all lie beyond the scope of this essay.

This distinction is complicated further because the intention for death to be hastened or brought about is not always simply present or absent; a person can have simultaneous intentions, and those intentions can be weighted differently. The contentious question remains as to whether the intention to hasten or bring about death needs to be the only intention present or even the main intention present, for a practice to constitute euthanasia. The WMA and the authors from the Netherlands qualify that the intention has to be “primary” or “explicit” (which can also be considered synonymous with a “full,” “main,” or “principal” intention); however, the other definitions referenced thus far do not use this qualification. Furthermore, hastening or bringing about death can also be “partially” or “secondarily” intended, or at least “not unwelcomed” (these terms are all synonymous), as opposed to being absent altogether (and the death therefore being completely “unintended” or “merely foreseen”; these terms are also synonymous). According to the definitions from the WMA and the Dutch literature, partially intended killing does not constitute euthanasia because it is not fully intended. Conversely, most of the other aforementioned sources disagree, claiming that euthanasia extends to killing with any intention of bringing about or hastening death, irrespective of whether that intention is full or partial. The epistemological challenge of ever actually knowing what another person’s true intentions are in this context is a valid concern which falls beyond the scope of this essay; however, it does not undermine the metaphysical importance that intention has in this context. Any exploration of the definition of euthanasia without reference to the intention of the provider would be incomplete.

Is Euthanasia Necessarily Voluntary (On Behalf of the Patient) Or Can It Also Be Nonvoluntary or Involuntary?

The definitions from the WMA and the Dutch literature all state that euthanasia is necessarily voluntary. The American Medical Association and Australian Medical Association do not explicitly state this, although it could be considered implied through their discussions being in the context of patient requests for euthanasia. The ANZSPM ( 2013 ) and Materstvedt and Bosshard ( 2009 ) also share this view, upon which the qualifier “voluntary” is superfluous, “voluntary euthanasia” is tautological, and “nonvoluntary euthanasia” and “involuntary euthanasia” are contradictions in terms. Note that the BMA defines “voluntary euthanasia” as being necessarily voluntary, although I wonder whether this tautological statement is deliberate so as to emphasize the importance of voluntariness. Conversely, some other authors reject the claim that euthanasia is necessarily voluntary (e.g., Emanuel 2018 ).

The terms “voluntary,” “nonvoluntary,” and “involuntary” refer to the “informed consent” provided or not provided by the patient. The bioethical and legal understandings of informed consent are closely intertwined; most interlocutors agree that at the most basic level there are three necessary and sufficient criteria for informed consent: sufficient provision of information, sufficient decision-making capacity (aka “medical competency”), and freedom from coercion (see Eyal 2019 , ¶2 under “The requirement of informed consent”; Hawkins and Charland 2020 ). Some authors may subdivide these same features into more than three parts, although the way that I have stated them here is sufficient to define the concept of informed consent. If a patient provides informed consent to a practice then it is voluntary and if he expressly does not consent to a practice then it is involuntary; whereas if he neither consents to nor expressly does not consent to a practice then it is nonvoluntary. Footnote 3 An example of this outside of the context of euthanasia would be a patient presenting with fevers and neck stiffness who, from the doctor’s perspective, requires a lumbar puncture (spinal tap) to evaluate for possible meningitis. If the doctor offers this procedure to the patient and the patient consents to it, then the procedure is done voluntarily; if the patient says that he does not want the procedure and the doctor goes ahead and performs it regardless, then the procedure is done involuntarily; and if the patient is unconscious because they are critically unwell with meningitis and they are therefore unable to say either yes or no to the procedure, and the doctor then goes ahead with the procedure, then it is done nonvoluntarily. In the context of euthanasia this trichotomy may be adopted (e.g., Young 2021 ), or it may be rejected such as by adopting a dichotomy instead; Karlawish and James ( 2009 ) do this by distinguishing “competent” from “noncompetent” euthanasia. The epistemological challenge of distinguishing voluntary, nonvoluntary, and involuntary practices on a case-by-case basis in the context of euthanasia is also a valid concern which falls beyond the scope of this essay; although again it does not undermine the metaphysical importance of voluntariness in this context, and any exploration of the definition euthanasia without reference to voluntariness would be incomplete.

Is Euthanasia Necessarily Provided to Patients Who Are Terminally Ill or Can It Also Be Provided to Patients Who Are Not Terminally Ill?

The WMA’s definition states that euthanasia is necessarily provided to patients who are terminally ill, whilst the BMA’s definition states that it necessarily applies to terminally ill patients or those who have a “serious physical illness causing intolerable suffering that cannot be relieved.” Definitions from the American Medical Association, Australian Medical Association, and the Dutch literature do not explicitly state that euthanasia is necessarily provided to terminally ill patients, although they are all discussed in this context. Karlawish and James ( 2009 ) state that euthanasia is necessarily provided to terminally ill patients or those in permanent comas (more on this shortly). Conversely, some interlocutors argue that euthanasia can also include patients who are not terminally ill (see the Royal Dutch Medical Association KNMG 2011 and Young 2021 for further discussions on this point).

A “terminal illness” is an incurable illness which will inevitably result in death unless something else—e.g., an acute traumatic injury—does first. End-stage metastatic bowel cancer is prototypical of a terminal illness, whilst an isolated chest infection (“pneumonia”) which is acutely treatable and fully reversible in a particular patient is prototypical of a non-terminal illness. However, it is important to recognize that there is a significant grey area here. Firstly, an illness which will inevitably result in death might be incurable because a cure is just not available, e.g., end-stage kidney disease is sometimes curable with a kidney transplant but transplants are often unavailable. Secondly, an illness which is curable might not have an acceptable cure, e.g., a difficult course of surgery, chemotherapy, and radiotherapy for a cancer may be unacceptable for some patients. Thirdly, an illness might have been curable at some point in the past but is no longer curable, e.g., cancer which has spread throughout the body after electing not to treat it earlier on when it was more anatomically localized. Fourthly, a collection of illnesses might together be incurable, e.g., although chronic conditions such as obesity, hypertension, diabetes, and some forms of heart and lung disease; acute conditions such as broken hips and chest infections; and complications such as being immobile and bed-bound, are not terminal illnesses on their own, a patient with all of these conditions and complications simultaneously might not be curable in any practical sense. Fifthly, terminal illnesses form a heterogeneous group; someone might live for up to twenty-five years with a very slowly-progressing variant of Alzheimer’s disease, whereas another person might only live for a few months with a very aggressive cancer. However, it is worth noting that some interlocutors reject this orthodox claim and define a terminal illness with some form of time constraint, e.g., Battin et al. ( 2007 ) use a “prognosis less than six months” criterion. Finally, an illness which is currently incurable might become curable in the future, e.g., if a cure for Alzheimer’s disease is achieved. It might even be pessimistically and cynically claimed that, in lieu of a means to immortality, life itself fits the definition of a terminal illness. Distinguishing between terminal and non-terminal illnesses on a case-by-case basis in practice is another epistemological problem altogether which falls beyond the scope of this essay; although again it does not undermine the metaphysical importance of terminal illness in this context, and any exploration of the definition of euthanasia without reference to terminal illness would be incomplete.

Is Euthanasia Necessarily Provided to Patients Who Are Fully Conscious or Can It Also Be Provided to Patients Who Are in Permanent Comas or Persistent Vegetative States?

Another disputed factor is whether or not euthanasia applies to patients in permanent comas or persistent vegetative states (PVSs). In permanent comas, patients are completely unconscious. They lack sleep-wake cycles and cannot be woken, fail to respond normally to painful stimuli along with light and sound, and cannot initiate voluntary movements. The qualifier “permanent” is contentious since it implies diagnostic certainty which is inconsistent with a few rare but well-documented cases of patients “waking up” after being thought to be in permanent comas (Jonsen, Siegler, and Winslade 2010 ). Given that the vast majority of patients thought to be in permanent comas really are in permanent comas, and that diagnostic uncertainty features in the diagnosis of almost every medical condition, I will abstract from this uncertainty and accept the qualifier “permanent” for the purpose of this essay. PVSs are similar, although patients do have sleep-wake cycles and are partially rousable by painful stimuli, light, and sound. However, they completely lack awareness of themselves and their external environments and cannot interact with their environments in any way or initiate voluntary movements (Jonsen, Siegler, and Winslade 2010 ). Permanent comas and PVSs may arise from acute events, e.g., traumatic head injuries or going five minutes without oxygen in a near-drowning, or may result from the end stages of a progressive neurological decline, e.g., in Alzheimer’s disease.

None of the definitions from the WMA, BMA, American Medical Association, Australian Medical Association, or the Dutch literature specifically state whether or not euthanasia applies to patients in permanent comas or PVSs, although they do all state that an expressed autonomous decision for euthanasia is necessary. Therefore, euthanasia would have to be provided to a patient who is fully conscious if that decision were to be made contemporaneously, although euthanasia could possibly also apply to a patient in a permanent coma or PVS if this autonomous decision was expressed pre-emptively via an advanced care directive (ACD). Note that Singer ( 2011 ) and van der Wal and Dillmann ( 1994 ) explicitly exclude comatose patients from the definitions of euthanasia; Singer argues that this is because euthanasia is by definition for the purpose of relieving suffering, whereas patients in permanent comas are incapable of experiencing pain or suffering.

Definitions of death are also critical here. According to the “whole brain” (or “brainstem”) definition of death which is almost unanimously accepted in legal jurisdictions and in clinical medicine globally, patients in permanent comas or PVSs are living persons. On this definition, “death” is “the irreversible cessation of functioning of the entire brain, including the brainstem” (DeGrazia 2021 , ¶1 under “The Current Mainstream View”), and patients in permanent comas or PVSs do have brainstem function. However, there is a competing “higher brain” definition of death, whereby death is “the irreversible cessation of the capacity for consciousness” (DeGrazia 2021 , ¶1 under “A Progressive Alternative”). On this definition, patients in permanent comas or PVSs are not living persons because they lack consciousness or the capacity for future consciousness, despite the fact that the part of their brain which controls respiration and cardiac function (the brainstem) is still functioning. Consequently, if this “higher brain” definition is correct and patients in permanent comas or PVSs are not actually living persons, then euthanasia cannot apply to them. Arguments for and against these competing definitions of death fall beyond the scope of this essay, although I will adopt the more orthodox whole brain definition here for the purpose of taxonomic inclusiveness.

Is Euthanasia Necessarily Provided to Patients Who Are Suffering or Can It Also Be Provided to Patients Who Are Not Suffering?

Stemming from its etymological roots, euthanasia is usually viewed as necessarily being provided to patients who are suffering, in a compassionate way, since this is the very purpose of euthanasia in the first place. It is usually argued that without suffering there should be no reason for a patient to consider euthanasia in the first place, so any conceptualization of euthanasia in this context would be misplaced. The BMA, American Medical Association, and Australian Medical Association all define euthanasia as necessarily being provided to patients who are suffering, using the qualifier “intolerable” on each occasion. The WMA does not explicitly state this, although it could possibly be implied from the necessity that euthanasia is “performed with compassion.”

It should be noted that the presence or absence of suffering in the context of euthanasia is also significant because the bioethical principles of beneficence and non-maleficence are largely dependent upon mitigating or not causing suffering, respectively. These principles may in turn be based upon concepts of natural law, derived from either secular or theistic origins. Bioethical arguments may then appeal to these principles and to concepts of natural law to argue for euthanasia or to argue against euthanasia (e.g., Pellegrino 2005 ). However, further discussion of these arguments would involve value judgements which do not fall within the value-neutral task of this essay.

Furthermore, the presence or absence of suffering is intricately related to the fourth question just discussed concerning terminal illness. Firstly, let us consider patients who are terminally ill. Most of these patients will have some form of physical suffering, e.g., symptoms of pain, shortness of breath, or nausea or vomiting, such as in the settings of advanced cancers or the end stages of chronic heart, lung, kidney, or liver failure. Most will also experience at least some form of non-physical suffering, e.g., emotional/psychological or existential suffering. One possible caveat to this is the case of dementia (of which Alzheimer’s disease is a subtype). In this disease—which is essentially the end-stage of chronic brain failure to continue the above analogy—there may conceivably be instances in which the patient does not have physical symptoms and also does not experience any non-physical suffering (owing to complete oblivion regarding themselves, their diagnosis, and their environment).

The question of just how much suffering, or just how unrelievable that suffering has to be, is also problematic. Suffering clearly exists on a spectrum from mild to intolerable, and the extent to which suffering can be relieved also falls on a spectrum from complete relief (e.g., an antiemetic for mild nausea) to minimal relief (e.g., analgesia for a treatment-refractory severe headache or chronic pain syndrome). Drawing a concrete line somewhere along each of these spectrums is likely to be arbitrary, which is metaphysically troublesome. However, it would seem that a line does need to be drawn at some point, because the trivial suffering at one end of the spectrum (e.g., a sore finger caught in a car door) clearly does not meet the suffering criterion stipulated by most authors as being necessary for euthanasia. Furthermore, the extent of suffering needs to be determined by the person enduring it (as opposed to the outsider observing it), which can pose an additional challenge in the unconscious patient who is unable to communicate; however, there are often objective signs, such as groaning or wincing, that are evidence of suffering in these patients. There is also the further question as to whether non-physical suffering in the absence of physical suffering can ever be sufficient to meet the “intolerable suffering” threshold posited by many interlocutors.

Focusing now on patients who are not terminally ill, there will nonetheless usually be suffering present as the cause for the request for euthanasia in the first place. This is particularly the case if at least some degree of suffering, rather than intolerable and unrelievable suffering, is being considered. The main caveat to this is the case of non-terminally ill people who are simply “done with life,” otherwise stated as “having completed life” or possibly “being tired of life.” The terminology here is challenging; to me, it intuitively refers to someone who does not have any further uncompleted life goals and is ready to not be alive anymore. Existential beliefs are crucially important here; religious or spiritual beliefs in an afterlife may circumvent existential angst and ultimately lead to a mindset of feeling ready to “pass on to the next life,” whilst at the same time atheists might not experience existential angst and instead feel at peace with, and be ready to confront, this great “finality.” Furthermore, if a person is truly not suffering, then calling them a “patient” may be inappropriate and should perhaps be replaced with “recipient,” although I will continue to use “patient” in this essay.

However, contrary to my own intuitions, most interlocutors referring to people who have “completed” or “are done with” life are actually referring to a state of suffering in non-terminally ill patients. The Royal Dutch Medical Association (KNMG 2011 , 14) certainly does not advocate for the term “euthanasia” applying in this context, although it does offer a description of the theory, explaining that:

According to Right to Die-NL (NVVE) the concept of a “completed life” is used for “people who suffer from a complex constellation of factors connected with old age. These are non-life-threatening conditions and physical deterioration (poor eyesight, deafness, difficulty walking, fatigue, apathy, incontinence), resulting in a loss of independence and personal dignity, dependence on care, loss of status and control, a shrinking social network, loss of a sense of purpose and meaning, disengagement from society, fear of the future and the absence of future prospects”

The presence or absence of suffering is also intricately related to our third question discussed earlier. I think that it is contentious as to whether a desire for euthanasia in the absence of significant suffering can ever be truly voluntary, or whether this is only possible in the context of depression or another mental illness, thereby undermining decision-making capacity and hence voluntariness to some extent. The concept of euthanasia provided to people who are not suffering (or at least not suffering from intolerable and unrelievable suffering in the context of a terminal illness) is almost invariably posited in the context of elderly patients. A reason for this is likely because of an assumption that these thoughts in a young person would necessarily be in the context of mental illness. This introduces yet another metaphysical challenge in drawing a non-arbitrary line upon another spectrum: how old is old enough? In the absence of suffering, is a ninety-year-old allowed to be “done with life” without necessarily suffering from a mental illness, whereas a forty-year-old would necessarily be depressed if he shared this belief? What about a sixty- or an eighty-year-old?

The presence or absence of suffering is also intricately related to our fifth question discussed earlier. As previously highlighted, it is contentious as to whether or not patients in permanent comas and PVSs can experience suffering. Given that patients in permanent comas and PVSs are, by definition, not consciously aware of themselves or their surrounding environments, it could be argued that they are physically incapable of suffering because suffering is a conscious, lived experience. However, it could also be argued that an outside observer cannot ever really know what the first-hand experience of being in a permanent coma or PVS would be like, à la Nagel’s “What is it like to be a bat?” ( 1974 ); hence, we may never know if these patients are capable of experiencing suffering, and this may even be a non-falsifiable claim. The distinction between permanent comas and PVSs is also potentially relevant here, given that only the latter respond to painful stimuli; this might be claimed as evidence of suffering, or conversely it might just be considered to be an unconscious, reflexive motor response to a noxious stimulus. As a separate notion altogether, it might be argued that patients in permanent comas and PVSs must be suffering, based on an evaluation of their quality of life, although this is a value judgement from the perspective of an outsider which may cast doubt on the tenability of this position. To complicate matters further, if the patient in the permanent coma or PVS is not really a “person” at all on the higher brain definition of death, then any discussion on the presence or absence of suffering experienced by a person becomes moot in this setting. Although I will not take a position on any of these arguments within the scope of this essay, they do importantly demonstrate that if persons in permanent comas or PVSs are incapable of suffering, and if euthanasia extends to persons in permanent comas and PVSs, then it follows that suffering is not a necessary criterion for a practice to constitute euthanasia. Singer’s ( 2011 ) focus on suffering as a necessary feature of euthanasia, and his excluding patients in permanent comas from the definition of euthanasia, may be partly or entirely owing to this.

Definitions of “Assisted Suicide” and “Assisted Dying”

When sources define “euthanasia” as being necessarily an act, they define “assisted suicide” in the same way, except that in assisted suicide the second party provides the information and/or means for the patient to commit suicide, rather than killing the patient himself. Because assisted suicide requires the (active) provision of information or means, there cannot be “passive” assisted suicide. A possible exception to this would be if a suicidal person was actively seeking out the information or means to commit suicide and the second party had the opportunity to prevent this process but decided not to, which would therefore be “passive” in a sense, although I consider this too farfetched—at least in the context of end-of-life decision-making—to warrant further discussion. The vast majority of interlocutors define euthanasia and assisted suicide as being mutually exclusive, although this is not universal; Jonsen, Siegler and Winslade ( 2010 ) and Singer ( 2011 ) suggest that assisted suicide is a subset of euthanasia, and Cholbi ( 2021 ) suggests that euthanasia is a subset of assisted suicide. The term “assisted dying” is problematic in that it is sometimes used as being synonymous with assisted suicide and is sometimes used as denoting the set containing both euthanasia and assisted suicide. It is occasionally also used in a third way as an attempt to move away from the word “suicide,” which may be considered value-tainted in a similar way to how “killing” may be considered value-tainted. This third usage aims to distinguish the practice of “assisted dying” (in the context of end-of-life decision-making) from assisted suicide outside of this context (e.g., assisting a physically healthy but depressed twenty-year-old to commit suicide).

Previous Work Analysing the Definitional Components of “Euthanasia”

The main previous work analysing the definitional components of euthanasia that I am aware of is that of Beauchamp and Davidson ( 1979 ). This needs to be evaluated in its historical context and the landscape of the ethical and legal literature on euthanasia at that time, and represents a comprehensive and substantial effort to clearly define euthanasia and assisted suicide in a value-neutral way, in doing so recognizing the practical significance of this for both ethical and legal discussions. To summarize, Beauchamp and Davidson argue that there are five criteria which are necessary and sufficient for the definition of euthanasia: (1) the provider intends for the recipient to die and the provider causes or is causally relevant in the recipient’s death, whether it be via active or passive means, (2) the provider believes that the recipient is suffering or in a permanent coma and this belief is grounded on sufficient evidence, (3) the provider’s primary intention is to relieve the recipient’s present or predicted future suffering or irreversible comatoseness and the means by which this is achieved involves less suffering than would otherwise be present, (4) the means by which the recipient’s death is achieved is as painless as possible, unless there is an overwhelming reason to the contrary, and (5) the recipient is not a fetus (so as to separate euthanasia from abortion). Footnote 4

There is some overlap between this definition and our own preceding discussion of the various disputed definitional factors. Regarding our first and third identified questions, Beauchamp and Davidson acknowledge that interlocutors at the time spoke in terms of the dichotomies of active and passive euthanasia, and voluntary and involuntary euthanasia, and argue that any definition of euthanasia must therefore accommodate both of these dichotomies; any other approach would be inadequate. Regarding our second question, they argue that euthanasia must be primarily intended by the provider, although that need not be the only intention. Regarding our fourth question, they argue that patients being euthanized do not necessarily have to be terminally ill. They also argue that euthanasia and “murder” are not mutually exclusive sets (some events may constitute both euthanasia and murder), which also reflects the backdrop wherein under all existing laws at the time, all instances of euthanasia constituted homicide. They then acknowledge that the term “murder” is value-loaded, whilst at the same time acknowledging that at least some instances of euthanasia may be unethical, so this attributed negative value might not always be misplaced. Regarding our fifth question, they state that euthanasia extends to patients in permanent comas.

Beachamp and Davison’s argument pertaining to our sixth question is particularly insightful. They argue that any definition of euthanasia does need to be consistent with its etymological roots of being a “good death.” To qualify as a “good death,” the patient’s death must be a better outcome (or state of affairs) than the patient still being alive. Death could be a better outcome than being alive for two reasons: either the relief of suffering or by virtue of respecting the patient’s autonomously expressed desire to die, although the relief of suffering itself is an independently necessary criterion for euthanasia. However, this can be current suffering or anticipated future suffering, e.g. , the symptoms of Huntington’s disease being expected to manifest twenty years after the time that the genetic diagnosis is originally made (via blood tests in an asymptomatic patient with a family history of the condition). Whilst this “anticipated future suffering” condition appears counterintuitive to me, Beachamp and Davidson then borrow an example from Hare ( 1975 ), wherein someone is trapped under a petrol lorry in a motor vehicle accident and is not currently suffering but will certainly be roasted to death in ten minutes; they argue that killing that person prior to the roasting event occurring would still constitute euthanasia. This also seems intuitive and is thus paradoxical. It suggests yet another spectrum spanning from the patient currently suffering (at time zero) to the patient suffering at some future time point (perhaps minutes or decades from now); drawing a non-arbitrary line upon this spectrum is again metaphysically troublesome.

Beauchamp and Davidson’s ( 1979 ) argument also relates to some further terminological issues. They classify assisted suicide as a subtype of euthanasia, distinguishing it from “unassisted suicide” which is not a form of euthanasia. They also argue that the word “kill” is irrecoverably value-tainted and therefore unsuitable for the definition of euthanasia, so they avoid the word altogether and replace it with “causing death.” Finally, they argue that whilst euthanasia is sometimes used synonymously with “good death” (reflecting its etymological roots), “good death” here is being used as a value-neutral placeholder only, and it does not imply that euthanasia is necessarily “good” in the sense of being necessarily ethical. Therefore, statements such as “euthanasia is bad” (which could be translated as “good death is bad”) are not contradictory, so “euthanasia” can still be used as a value-neutral (rather than a value-loaded) term.

This Rampant Definitional Disagreement Is Problematic

The definitional disagreement evidenced in this essay thus far is problematic in a number of ways. It is confusing in clinical communication, e.g., when doctors are explaining end-of-life options to patients and their families (Materstvedt and Bosshard 2009 ). It is confusing when attempting to interpret and compare evidence from empirical studies investigating attitudes towards, and practices of, euthanasia in countries where it is legal or illegal (Materstvedt and Bosshard 2009 ). It is counterproductive to bioethical discourse; interlocutors may unwittingly be talking past each other and arguing about different practices, and linguistic disputes often distract from, or are conflated with, substantive ethical debate. It may reflect underlying ethical biases; proponents of euthanasia (e.g., Rachels 1975 ) may define “euthanasia” liberally, which suggests that currently accepted medical practices in palliative care already constitute forms of euthanasia, whereas opponents of euthanasia (particularly from medical and subspecialty palliative care bodies) typically do the opposite and define “euthanasia” narrowly, which stresses the differences between euthanasia and the end-of-life practices which currently fall within the scope of mainstream palliative care services. Finally, the most serious danger of all is that different practices which happen to fall under one name might erroneously be assigned the same ethical or legal statuses.

Section 2. The Six Disputed Definitional Factors Can Be Combined to Develop a Value-Neutral Taxonomy of “End-Of-Life Practices”

Previous work in delineating the range of end-of-life practices.

Having established that the terms “euthanasia” and “assisted suicide” are widely disputed and even value-tainted, the prospect of salvaging them for completely consensual, value-neutral use may be bleak. However, a much more promising enterprise may be to consider and categorize the different types of end-of-life practices, as this may better reflect the intricacy and complexity of end-of-life decision-making. The main previous work in this area that I am aware of is the “medical decisions concerning the end of life” (MDEL) system devised in the first Remmelink Report (van der Maas, van Delden, and Pijnenborg 1992 ), which was principally designed for conducting questionnaire-based empirical research into the end-of-life practices which were already happening in the Netherlands at the time, to inform subsequent policymaking.

The Remmelink investigators correctly acknowledge that “defining what is and is not euthanasia was not sufficient.” They also attempt, where possible, to use descriptive terms and avoid any value-loaded terms, although recognize that “it was nevertheless not possible to completely exclude morally charged terms in an investigation of this nature” (19). They approach their categorization system from the perspective of physicians, given that physicians were the ones answering most of the survey questions, whilst recognizing that “differences that are relevant for physicians may be of little relevance to legal experts and vice versa”; although this was balanced against the need to keep the categorization system suitable for drafting subsequent legislation (19). They also acknowledge that, irrespective of what approach is taken to categorization, “there will always remain problems of delineation, of borderline cases or situations” (19).

The Remmelink authors base their discussion around four questions (20):

What does the physician do?

What is the physician’s intention in doing this?

Did the patient request this intervention?

Was the patient able (or not) to decide upon this intervention?

Regarding their first question, the Remmelink authors state that the physician can either “administer drugs that (possibly) hasten the end of life, withhold or withdraw a (possibly) life prolonging treatment” (21). Regarding their second question, they state that the physician either (A) acts with the explicit intention of hastening the end of life, or (B) partly with the purpose of hastening the end of life, or (C) acting whilst taking into account the probability that the end of life will be hastened. Regarding scenario B above, they state that “sometimes an intervention is performed to achieve one particular effect (e.g. pain relief) but the side-effect (e.g. death) is not unwelcome. Strictly speaking, this situation should be categorized as intentional intervention” (21). This middle B category of acting “partly with the purpose” of hastening the end of life was included to reflect the “situation in which death of the patient was not foremost in the physician’s mind but neither was death unwelcome” (21). Regarding scenario C above, they state that “in order to be considered unintentional, this side-effect should in fact not have been desired” (21). Note that this sets potential grounds for ethical and legal evaluation appealing to Aquinas’s doctrine of double effect (see McIntyre 2019 ).

Regarding their third question, the Remmelink authors (1992) state that “the (explicit) request of the patient even forms part of the definition of euthanasia”; however, they distinguish the “explicit” and “permanent” request that is “adhered to voluntarily and after consideration,” from the less concrete request such as when “on hearing an ominous diagnosis, a patient can ask his physician if he would be prepared to terminate life if, in due course, suffering would become unbearable” (22). In this latter case, they explain that “the patient absolutely does not intend that any action should be undertaken at that moment and in a number of cases there will never be a request for direct intervention” (22); this was expressed in their questionnaire as a “request to perform euthanasia or assist with suicide in due course” (22). Regarding such requests in the “foreseeable future” (as opposed to in the present or at a specified future time point), they further separate “spontaneous” from “explicit and repeated” requests. They also specifically state that DNR orders constitute an MDEL (24).

Regarding their fourth question, the Remmelink authors distinguish patients who are able to make a decision for euthanasia from those who cannot, although they recognize difficulties in defining and determining decision-making ability. They state that the usual understanding of decision-making capacity is “being able to appreciate the nature of (assess) the situation so as to reach a decision adequately” (23), and this is importantly irrespective of the outcome of the actual decision; it refers only to the process of making said decision. They also allow for a middle situation for someone with “partial” decision-making capacity, thereby committing to a spectrum of decision-making capacity (rather than it being quantally present or absent).

In defining their MDELs, the Remmelink authors appreciate the vagueness of the concept of the “terminal phase” of an illness and instead avoid this terminology altogether and phrase their questionnaire according to a quantitative estimated prognosis. This was worded as how long “the life of the patient was in fact shortened by the action taken” (23), or in the case of withholding or withdrawing life-sustaining treatment, the decision to “not prolong life by a certain period of time rather than to shorten life by the same period of time” (23). Note that these are both counterfactual claims, comparing the difference between time X (when death occurs with the MDEL being carried out in this actual universe) and time Y (when death would otherwise have occurred “naturally” in another parallel universe if no MDEL was carried out). They acknowledge that many physicians were reluctant to answer these questions owing to significant epistemological challenges in prognostication, although they reason that “if, however, in a large number of cases the physicians indicated that life was shortened by a maximum of hours or days, the cautious assumption can be made that the patient was dying” (24). In contrast, they also reason that if “physicians indicated that life was shortened by weeks or months, one can assume that seriously ill patients were involved who were not yet dying” (24). Note that the Remmelink authors are using the phrase “terminal phase” as synonymous with the “dying phase” of an illness, i.e., the last hours to days of life, in which the body gradually and irreversibly shuts down, including neurological (level of alertness/arousal) and cardiopulmonary functions (breathing rate and pattern, oxygen levels, heart rate, blood pressure). This is separate from the concept of a “terminal illness” as used in this essay, which refers to the diagnosis itself (e.g., widely metastatic bowel cancer) without any reference made to the specific prognosis measured in hours to days.

Tabulating the Logical Space of “End-Of-Life Practices”

Turning now to the second half of my thesis, I argue that the six disputed definitional questions identified in section 1 can be broken down into six “building blocks” and combined to map the logical space of end-of-life practices in this context, which I will call the taxonomy of “end-of-life practices” so as not to conflate them with the MDELs just discussed. Whilst covering some of the same ground as the MDEL system, the taxonomy is designed to exhaustively delineate each possible end-of-life practice including the categorization of borderline cases, for the purpose of aiding ethical arguments and policy making, as opposed to the MDEL’s primary purpose of optimizing the design of questionnaires used for large scale empirical studies which were subsequently translated into policy.

The six building blocks are as follows:

The type of practice (type-status): (i) killing, (ii) assisting suicide, or (iii) letting die (by WWIFLSTs).

The provider’s intention of hastening or bringing about death (intention-status): (i) fully/primarily intended, (ii) partially/secondarily intended (or not unwelcomed), or (iii) merely foreseen (but unintended).

The nature of patient’s request (voluntariness-status): (i) voluntary, (ii) nonvoluntary, or (iii) involuntary.

The patient’s medical condition-status: (i) terminally ill, or (ii) not terminally ill.

The patient’s consciousness-status: (i) fully conscious, (ii) in a permanent coma or PVS but has once been fully conscious, or (iii) has never been and never will be fully conscious (i.e., in newborns).

The patient’s suffering-status: (i) suffering, or (ii) not suffering.

For clarification, regarding the first building block, I have chosen to commit to the word “kill” (as a point of difference from Beauchamp and Davidson) because the alternative phrase “causing the death of” is ambiguous as to whether this denotes killing or the set containing both killing and letting die, dependent upon one’s theory of causation. I use the term “hastening or bringing about death” to denote this set and emphasize that “kill” is being used as a value-neutral placeholder, which could theoretically be substituted for another word or phrase if desired. Regarding the fifth building block, I am using the term “fully conscious” to mean “not in a permanent coma or PVS,” despite the fact that these “fully conscious” patients will of course be unconscious when they are asleep. By “has never been and never will be fully conscious” I am referring to newborns with severe congenital neurological defects resulting in them never being fully conscious, e.g., owing to anencephaly (being born without a major portion of the brain, skull, and scalp). The importance of this distinction from adults in permanent comas or PVSs will become clear shortly.

With a view to being as inclusive as possible, these six building blocks could be combined to delineate 3 × 3 × 3 × 2 × 3 × 2 = 324 different practices; however, many of them turn out to be nonsensical or impossible upon deeper consideration. Tabulating these combinations to determine which ones do and don’t plausibly exist is a lengthy but worthwhile task. To do this, the medical condition-status and consciousness-status are used to create four tables: table 1 pertains to fully conscious, terminally ill patients; table 2 to fully conscious, non-terminally ill patients; table 3 to patients in permanent comas or PVSs who were once fully conscious; and table 4 to patients who have never been and never will be fully conscious. The terminally ill/not terminally ill dichotomy loses most of its importance in patients in permanent comas or PVSs; hence, the medical condition-status does not apply to Tables 3 or 4 , so we can get away with having four tables in total instead of six. In each table, the type-status forms the rows, the intention-status forms the columns, and the voluntariness-status is listed three times as sub-rows in each cell of the table. These tables therefore incorporate combinations of the first five criteria. This will be followed by a discussion of how the sixth building block relates to this schema; for the interim, every patient in each of the following four tables is considered to be suffering unless otherwise stated. To identify a specific end-of-life practice, choose the relevant table using the medical condition- and consciousness-statuses, and then triangulate it within that table using the type-, intention-, and voluntariness-statuses.

To explain how to read this first table, consider the practice with the (^) next to it. This practice is in table 1 so this means that the patient is fully conscious and terminally ill, e.g., with end-stage metastatic bowel cancer. It is in the “killing” row so the practice is a killing, e.g., the doctor administers the patient a lethal injection of pentobarbital. It is in the “fully intended” column so the doctor fully intends to kill the patient with the injection. Finally, it is in the “voluntary” sub-row so the patient provides informed consent to the lethal injection; he voluntarily requests it. This practice is the paradigm case of euthanasia offered initially. The practice with the (^^) next to it is the same except for that it is in the “assisting suicide” row, so rather than injecting the patient with pentobarbital, the doctor has given the patient a combination of lethal oral drugs for him to take himself at home. This practice is the paradigm case of assisted suicide offered initially.

Consider the practice with the (*) next to it. This practice is also in the “assisting suicide” row so it is an assisted suicide. It is in the “partially intended” column so the doctor only partially intends for his involvement to result in the patient’s death. This is only possible if the doctor’s involvement has another, primary intention. In this context that primary intention is probably pain relief. The doctor may have given the patient lots of analgesia, e.g., morphine, with the primary intention of providing sufficient analgesia to relieve the patient’s pain, although with the partial/secondary intention (or at least the not unwelcomed outcome) of either hurrying along the dying process, or alternatively, empowering the patient to commit suicide if he so chooses. The doctor carefully explains to the patient how much of the morphine he would need to take to commit suicide and then leaves the decision of how much to take up to him. Finally, the practice is in the “voluntary” sub-row so the patient has voluntarily requested to be assisted to suicide. Notice that there are no “nonvoluntary” or “involuntary” sub-rows in the “assisting suicide” row. These practices could only be possible if the patient is placed in a situation where he could “accidentally” commit suicide or is forced to commit suicide, respectively. These are too farfetched to warrant serious consideration, and on most accounts suicide cannot be accidental or involuntary by definition (Cholbi 2021 ).

Consider the practice with the (**) next to it. Unlike before, this practice is in the “letting die” row so the patient is allowed to die; in the medical context this is achieved by WWIFLSTs, e.g., through DNR orders. It is in the “merely foreseen” column so bringing about or hastening death is not intended; instead, the WWIFLSTs is intended as a direct means to relieving suffering (independent of death coming about) or as an end in itself. Footnote 5 Finally, it is in the “nonvoluntary” sub-row so the patient does not provide informed consent to, or expressly not consent to, the letting die, e.g., because his decision-making capacity has been undermined by late-stage Alzheimer’s disease. Hence, the DNR order must have been implemented by a surrogate decision-maker, e.g., the patient’s family or medical team. Conversely, if this patient had instead written an ACD himself stating that he would not want resuscitation in the future (and provided that this ACD was written in the past at a time in the early stages of his disease when he still had adequate decision-making capacity), then this end-of-life practice would instead constitute the “voluntary” end-of-life practice immediately above the one marked (**). Interestingly, 80 per cent of DNR orders are implemented by surrogate decision-makers (Fins, McCarthy, and Limehouse 2017 , 8).

Consider the practice with the (***) next to it. This is identical to the last practice except that it is in the “involuntary” sub-row: the patient has expressly not consented to being allowed to die. This would be the case if a medically competent, dying patient requests artificial nutrition and hydration but his medical team make a unilateral decision not to provide it to him on the grounds that it is inappropriate or futile.

It is also interesting to note that—in one study across six countries—45 per cent of letting die occurred with the full intention of hastening or bringing about death (Bosshard et al. 2006 ), unlike cases (**) and (***) just described.

Now, consider the second table:

This table is less populated than the first; some additional practices have been ruled out, not because they are impossible but because they are too farfetched to merit serious consideration. Firstly, consider partially intended or merely foreseen killing or assisting suicide. A patient who is not terminally ill can, by definition, possibly be cured. He might nonetheless be suffering owing to pain or other symptoms. Opioids or sedatives can be administered or provided to him in non-lethal doses. To administer or provide those drugs in lethal doses would suggest that hastening or bringing about death was intended to an extent that it could reasonably be considered the primary intention . Consider a patient with severe, debilitating arthritis. His pain can be substantially relieved through a non-lethal dose of opioids (or other analgesics). If a lethal dose is used, it would seem strange for the doctor to claim that he was primarily intending to relieve pain and that hastening or bringing about his patient’s death was only partially intended or merely foreseen. Given that death could have been avoided, and that death is usually a more significant outcome than relieving pain in patients who are not already dying, it can reasonably be claimed that the doctor’s actual primary intention was bringing about death.

However, consider merely foreseen letting die. When a patient is not terminally ill, cure is by definition possible, so medical intervention aimed at achieving a cure cannot be “futile” in the way that we have defined medical futility. Nonetheless, intervention in these patients can be considered “inappropriate” in three ways. Firstly, sometimes curative treatment is inappropriate because it is unwanted: consider a Jehovah’s Witness refusing a life-saving blood transfusion on religious grounds. In this case the doctor respects the Jehovah’s Witness’s decision and foresees that he will die, although certainly does not intend for him to die. I am aware that, strictly speaking, “life-saving” and “life-sustaining” treatments are not the same things: life-saving treatment is curative whereas life-sustaining treatment is not. However, life-saving treatment also sustains life, i.e., it allows life to continue. Hence, it is reasonable to consider life-saving treatment as a subset of (i.e., a form of) life-sustaining treatment, so conflating the two is acceptable here. Secondly, sometimes achieving a cure is unlikely, and aiming at that cure can produce more harm than good by prolonging suffering and delaying a likely death; intervention against these odds can sometimes be considered inappropriate. A difficult course of surgery, chemotherapy, and radiotherapy with only a 5 per cent chance of success might fall into this category provided that the patient does not request the treatment. Finally, curative treatment might be inappropriate on economic grounds. Unfortunately, demand for medical resources usually exceeds supply, so difficult decisions as to who will receive life-saving treatment and who will not are sometimes unavoidable. Suppose that two patients need a hospital bed with a mechanical ventilator but only one is available; without the bed both patients will die. It is inappropriate in one sense to provide the bed to the patient with the lower chance of being cured (call him “A”) than to the patient with the higher chance of being cured (call him “B”). This is the case irrespective of whether A consents to or expressly does not consent to B getting the bed or if A does not consent at all because he lacks the capacity to do so. For these reasons, merely foreseen letting die is possible in non-terminally ill patients irrespective of whether it is voluntary, nonvoluntary, or involuntary; avoiding inappropriate treatment is the sole end being aimed at. Footnote 6

Finally, consider partially intended letting die. This is ruled out in non-terminally ill patients for the same reasons that partially intended killing and assisting suicide were ruled out. In patients who are not already dying, hastening or bringing about death can be more easily avoided than in patients who are dying, and in non-terminally ill patients death is usually a more significant outcome than avoiding inappropriate treatment. Therefore, if bringing about or hastening death is partially intended, then it can reasonably be claimed that it was actually fully intended, since otherwise the death could have been avoided altogether.

Now, consider the third table:

Whilst acknowledging the debate on the whole brain versus higher brain definition of death—and therefore whether or not patients in permanent comas or PVSs are actually living persons—suppose that they are living persons for the sake of taxonomic inclusiveness. Consider the practice with the (****) next to it. This practice is in table 3 because the patient is in a permanent coma or PVS but was once fully conscious. It is in the “killing” row because the patient is killed, e.g., the doctor administers the patient a lethal injection of pentobarbital. It is in the “fully intended” column because the doctor fully intends to kill the patient with the injection. Finally, it is in the “voluntary” sub-row because the patient provides informed consent to the lethal injection; he voluntarily requested it via an ACD written before he entered his permanent coma or PVS. It is contentious as to whether or not ACDs really are capable of providing informed consent to future medical decisions; again, suppose that they can for the sake of taxonomic inclusiveness.

Consider the practice with the (*****) next to it. Unlike before, this practice is in the “letting die” row because the patient is allowed to die by WWIFLSTs. It is in the “fully intended” column because the doctor fully intends for the WWIFLSTs to hasten or bring about the patient’s death. Finally, it is in the involuntary sub-row because the patient expressly did not consent to WWIFLSTs; he wrote in an ACD before he entered his permanent coma or PVS that he wanted to be kept alive for as long as possible. It should be noted that almost all interlocutors would argue that this does not entail any ethical obligation on the doctor to provide futile treatments (even if the patient has requested it), and that the doctor also has an ethical obligation not to inappropriately use scarce medical resources; however, these are now ethical evaluations which are separate to the value-neutral task of taxonomically defining each end-of-life practice.

The “assisting suicide” row is empty in table 3 because patients in permanent comas or PVSs cannot initiate voluntary movements; they physically cannot commit suicide.

Now, consider the fourth table:

The reasoning in table 3 applies to table 4 with one exception: patients who have never been and never will be fully conscious (i.e., infants born with severe neurological defects) could not have left ACDs and so cannot consent to, or expressly not consent to, future medical decisions. Hence, all decisions made must be nonvoluntary. A surrogate decision-maker (such as a parent) can make decisions on behalf of the patient that are deemed to be in the patient’s best interests, although the patient himself is not actually providing this informed consent so it is necessarily nonvoluntary from his perspective.

Adding the Sixth Building Block

Now turning to the sixth suffering-status building block, in the context of end-of-life decision making most fully conscious patients will be suffering (either physically, or at least emotionally/psychologically or socially), irrespective of whether or not they are terminally ill. As discussed in section 1, many believe that any discussion surrounding euthanasia or assisted suicide in the absence of suffering is misplaced; however, we have also explored counterarguments to this claim, so for the sake of taxonomic inclusiveness this suffering versus not suffering dichotomy can be included. All of the practices in tables 1 and 2 can therefore be duplicated. For example, the first practice in table 1 discussed, marked with the (^) symbol, now becomes two practices: (^ A ) in a person who is suffering, and (^ B ) in a person who is not suffering. Regarding patients who are in permanent comas or PVSs, as discussed in section 1 it is contentious as to whether or not these patients are capable of experiencing suffering; if they can, then each practice in tables 3 and 4 is also duplicated, whereas if they cannot, then the practices in these tables are not duplicated. Note that I have not defined a middle “partially suffering” category owing to the metaphysical difficulty of drawing a non-arbitrary line on the spectrum of suffering, as discussed earlier.

Overlapping Practices

To complicate matters, many of the practices delineated in these four tables are not mutually exclusive. WWIFLSTs, and the administration of opioids or sedatives, almost always occur in conjunction. It may be the case that one of the two brings about death, or both may be individually sufficient to bring about death (resulting in overdetermination), or both may be required to bring about death (thereby both “contributing to” or “hastening” death). Determining which of these is the case in practice is another problem altogether, which falls beyond the scope of this essay. However, this overlap is less problematic than it appears prima facie; in all of these cases, both practices at least “hasten” death, irrespective of whether or not they are necessary or sufficient to “bring it about.” Hence, both practices fall within the hybrid “hastens or brings about death” category used in the taxonomy.

Although it might seem that some aspects of a single end-of-life practice may occur concurrently and contradict each other, it is reasonable to claim that certain aspects of the practice trump each other. There cannot be a clash within the patient’s medical condition-status or consciousness-status; a patient cannot be terminally ill and not terminally ill at the same time or fully conscious or in a permanent coma or PVS at the same time. Similarly, there cannot be a clash within the suffering-status; a patient cannot be simultaneously suffering and not suffering. However, there could prima facie be a concurrent killing (e.g., via opioids and sedatives) and a letting die (via WWIFLSTs), the former of which might be “fully intended” and “involuntary,” and the latter of which might be “merely foreseen” and “voluntary.” But it would be nonsensical to claim that someone is killed and allowed to die at the same time, or that their hastening or bringing about of death is simultaneously fully intended and merely foreseen, or simultaneously voluntary and involuntary. Clearly “killing” trumps “allowing to die,” “fully intended” trumps “partially intended,” which in turn trumps “merely foreseen,” and “involuntary” trumps “nonvoluntary,” which in turn trumps “voluntary.” In this case, the patient is involuntarily killed with the full intention of killing him, rather than voluntarily being allowed to die with his death being a merely foreseen consequence of WWIFLSTs.

Why the Value-Neutral Taxonomy Is Important and How It Can Be Utilized

With the view to inclusiveness that I have just adopted there are forty-three end-of-life practices in the four tables (accounting for criteria 1–5). If accounting for the sixth criterion, this number increases to eighty-six. A nifty abbreviation system acting as a set of coordinates could potentially be introduced to quickly identify each of the various practices, although I fear that it would add to the complexity rather than reduce it. Speaking in the specific terms of these end-of-life practices is cumbersome; no wonder interlocutors prefer to use names which lump some of them together. However, the fundamental problem is that different interlocutors group different combinations of these eighty-six practices together under the same names of “euthanasia” and “assisted suicide.” This may result in debaters unwittingly talking past each other, which is entirely counterproductive and potentially dangerous given the tangible impact that such decisions have on patients and their families. Neil et al. ( 2007 ) and van der Heide et al. ( 2003 ) recognize these dangers; accordingly, they deliberately avoid use of the terms “euthanasia” and “assisted suicide” altogether.

I acknowledge that the terms “killing” and ‘suicide” have negative connotations and might be criticized as reflecting an ethical bias. I want to stress that I really am only using these terms as value-neutral denotations. If this was considered an overwhelming concern, each of these contentious words could be substituted for other placeholders without affecting any of the arguments or conclusions laid forth in this essay.

There are two approaches moving forward based on this taxonomy. The first is to take the most orthodox component of the six building blocks, and to define the corresponding single end-of-life practice as “euthanasia” (i.e., the paradigm case offered initially), or to take a few of the most orthodox components of the building blocks, and define the set of corresponding end-of-life practices as “euthanasia” (i.e., the paradigm case and other practices similar to it). The same strategy applies for “assisted suicide.” The second and probably more grounded approach—albeit not mutually exclusive with the first—is to be wary of and consider each of the practices individually, since it might be that two very similar practices (which may be lumped together under the same name of “euthanasia”) may differ in that one ought to be ethical and the other unethical, or that legislation ought to be written such that one is deemed legal and the other illegal. Otherwise, there is the most serious threat that a specific end-of-life practice may be unwittingly assigned an incorrect ethical and/or legal status.

The complexity of this schema makes it inappropriate for daily clinical use by physicians on their ward rounds. However, I envisage that it may be utilized as a solid platform upon which substantive ethical and legal discussion—unscathed by ambiguous and value-loaded terms—can continue. I anticipate its usefulness at the meta- and normative-ethical levels. In particular, bioethical thought experimentation in the spirit of Foot, Thomson, Rachels, and Singer would be benefited when arguing for ethical connections and disconnections between the various delineated end-of-life practices. I also anticipate its usefulness as an aid for careful policymaking, along with benefiting the design of any future empirical studies which could then be more reliably interpreted and compared. If nothing else, I hope that the taxonomy at least promotes a greater appreciation of the range of different practices at the end of life, reveals some of the hidden metaphysical challenges underlying many of these distinctions, and ultimately offers a thorough way to think about the various potentially ethically and legally significant aspects of end-of-life decision-making.

Data Availability

Not applicable.

Change history

25 february 2023.

The original version of this article has been revised: Missing Open Access funding information has been added in the Funding Note.

For the sake of consistency, I will use male characters and pronouns in this essay. Gender is completely irrelevant to all of my examples and to the taxonomy which is eventually developed.

Note that I have chosen to treat withdrawing treatment as an omission, and in doing so lump it together with withholding treatment, even though this metaphysical claim is contestable. There are arguments that withdrawing treatment actually constitutes an action, as well as arguments that the dichotomy between actions and omissions is flawed altogether (Harris 1975 ; Len Doyal 2006 ; Len Doyal and Lesley Doyal 2001 ; Warnock 1998 ; Woollard and Howard-Snyder 2021 ). In my opinion both of these lines of argument are strong and require consideration; however, for the purpose of developing the taxonomy which follows in this essay, I am treating both withdrawing treatment and withholding treatment as omissions, so as to accord with the orthodox use of the terms in the literature (American Academy of Hospice and Palliative Medicine AAHPM 2011 ; Fins, McCarthy, and Limehouse 2017 ; Jonsen, Siegler, and Winslade 2010 ; Karlawish and James 2009 ).

Note that if a patient is simply not asked whether or not he would like to be euthanized, despite him having the capacity and opportunity to answer this question, then according to these definitions the euthanasia is nonvoluntary. However, given how obviously paramount it is to ask this patient such a question, failing to do so would more practically classify the resulting euthanasia as involuntary.

Their definition in full reads: “In summary, we have argued in this section that the death of a human being, A, is an instance of euthanasia if and only if (1) A’s death is intended by at least one other human being, B, where B is either the cause of death or a causally relevant feature of the event resulting in death (whether by action or by omission); (2) there is either sufficient current evidence for B to believe that A is acutely suffering or irreversibly comatose, or there is sufficient current evidence related to A’s present condition such that one or more known causal laws supports B’s belief that A will be in a condition of acute suffering or irreversible comatoseness; (3) (a) B’s primary reason for intending A’s death is cessation of A’s (actual or predicted future) suffering or irreversible comatoseness, where B does not intend A’s death for a different primary reason, though there may be other relevant reasons, and (b) there is sufficient current evidence for either A or B that causal means to A’s death will not produce any more suffering than would be produced for A if B were not to intervene; (4) the causal means to the event of A’s death are chosen by A or B to be as painless as possible, unless either A or B has an overriding reason for a more painful causal means, where the reason for choosing the latter causal means does not conflict with the evidence in 3b; (5) A is a nonfetal organism” (304).

It is worth noting that WWIFLSTs can also sometimes aim at relieving suffering indirectly, via the intermediary step of achieving death, but in this case the death could not have been merely foreseen in the first place; it must have been at least partially intended.

Although recall the grey area surrounding the definition of “terminal illness” encountered earlier: in some senses the Jehovah’s Witness, the patient with the 5 per cent prognosis despite aggressive treatment, and person B are actually terminally ill and are therefore not accounted for by table 2 at all.

American Academy of Hospice and Palliative Medicine. 2011. Statement on withholding and withdrawing nonbeneficial medical interventions. http://aahpm.org/positions/withholding-nonbeneficial-interventions . Accessed October 4, 2021.

American Academy of Hospice and Palliative Medicine. 2013. Statement on artificial nutrition and hydration near the end of life. http://aahpm.org/positions/anh . Accessed October 4, 2021.

American Medical Association. 2016. AMA code of medical ethics chapter 5: Caring for patients at the end of life. https://www.ama-assn.org/delivering-care/ethics/code-medical-ethics-caring-patients-end-life . Accessed October 2, 2021.

Australian and New Zealand Society of Palliative Medicine. 2013. ANZSPM position statement on the practice of euthanasia and physician-assisted suicide. https://www.anzspm.org.au/c/anzspm?a=da&did=1025365 . Accessed October 4, 2021.

Australian Medical Association. 2016. Euthanasia and physician assisted suicide. https://www.ama.com.au/position-statement/euthanasia-and-physician-assisted-suicide-2016 . Accessed October 2, 2021.

Battin, M.P., A. van der Heide, L. Ganzini, G. van der Wal, and B.D. Onwuteaka-Philipsen. 2007. Legal physician-assisted dying in Oregon and the Netherlands: Evidence concerning the impact on patients in “vulnerable” groups. Journal of Medical Ethics 33(10): 591–597.

Article   PubMed   PubMed Central   Google Scholar  

Beauchamp, T., and I. Davidson. 1979. The definition of euthanasia. Journal of Medicine and Philosophy 4(3): 294–312.

Article   CAS   PubMed   Google Scholar  

Bosshard, G., S. Fischer, A. van der Heide, G. Miccinesi, and K. Faisst. 2006. Intentionally hastening death by withholding or withdrawing treatment. Wiener Klinische Wochenschrift 118(11-12): 322–326.

Article   PubMed   Google Scholar  

British Medical Association. 2021. Physician-assisted dying. https://www.bma.org.uk/advice-and-support/ethics/end-of-life/physician-assisted-dying . Accessed October 2, 2021.

Cholbi, M. 2021. Suicide. In The Stanford Encyclopedia of Philosophy , Winter 2021 ed., edited by E.N. Zalta. https://plato.stanford.edu/archives/win2021/entries/suicide/ .

DeGrazia, D. 2021. The definition of death. In The Stanford Encyclopedia of Philosophy , Summer 2021 ed., edited by E.N. Zalta. https://plato.stanford.edu/archives/sum2021/entries/death-definition/ .

Doyal, L. 2006. Dignity in dying should include the legalization of non-voluntary euthanasia. Clinical Ethics 1(2): 65–67.

Article   Google Scholar  

Doyal, L., and L. Doyal. 2001. Why active euthanasia and physician assisted suicide should be legalised: If death is in a patient’s best interest then death constitutes a moral good. BMJ 323(7321): 1079–1080.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Emanuel, E.J. 2018. Palliative and end-of-life care. In Harrison’s principles and practice of internal medicine , 20th ed., edited by J. Jameson, A.S. Fauci, D.L. Kasper, S.L. Hauser, D.L. Longo, and J. Loscalzo, ch. 9. New York: McGraw Hill. https://accessmedicine.mhmedical.com.acs.hcn.com.au/content.aspx?bookid=2129&sectionid=192279852

Eyal, N. 2019. Informed consent. In The Stanford Encyclopedia of Philosophy , Spring 2019 ed., edited by E.N. Zalta. https://plato.stanford.edu/archives/spr2019/entries/informed-consent/ .

Fins, J.J., McCarthy, M.W., and W. Limehouse. 2017. Common indications for ethics consultation. In Principles and Practice of Hospital Medicine , 2nd ed., edited by S.C. McKean, J.J. Ross, D.D. Dressler, and D.B. Scheurer, ch. 33. New York: McGraw Hill. https://accessmedicine.mhmedical.com.acs.hcn.com.au/content.aspx?bookid=1872&sectionid=138889763

Hare, R.M. 1975. Euthanasia. Philosophic Exchange 6(2): 43–52.

Google Scholar  

Harris, J. 1975. The survival lottery. Philosophy 50(191): 81–87.

Hawkins, J., and L.C. Charland. 2020. Decision-making capacity. In The Stanford Encyclopedia of Philosophy , Fall 2020 ed., edited by E.N. Zalta. https://plato.stanford.edu/archives/fall2020/entries/decision-capacity/ .

Jonsen, A.R., M. Siegler, and W.J. Winslade. 2010. Clinical ethics: A practical approach to ethical decisions in clinical medicine, 7th ed. New York: McGraw Hill.

Karlawish, J.H.T., and B.D. James. 2009. Ethical issues. In Hazzard’s Geriatric Medicine and Gerontology , 6th ed., edited by J.B. Halter, J.G. Ouslander, M.E. Tinetti, S. Studenski, K.P. High, and S. Asthana, 399–406. New York: McGraw-Hill.

Kerridge, I., M. Lowe, and C. Stewart. 2013. Ethics and law for the health professions , 4th ed. Sydney: The Federation Press.

Legemaate, J. 2004. The Dutch Euthanasia Act and related issues. Journal of Law and Medicine 11(3): 312–323.

PubMed   Google Scholar  

Materstvedt, L.J., and G. Bosshard. 2009. Euthanasia and physician-assisted suicide. In Oxford Textbook of Palliative Medicine , 4th ed., edited by G. Hanks, N.I. Cherny, N.A. Christakis, M. Fallon, S. Kaasa, and R.K. Portenoy, 304–319. New York: Oxford University Press.

McIntyre, A. 2019. Doctrine of double effect. In The Stanford Encyclopedia of Philosophy , Spring 2019 ed., edited by E.N. Zalta. https://plato.stanford.edu/archives/spr2019/entries/double-effect/ .

Nagel, T. 1974. What is it like to be a bat? Philosophical Review 83(4): 435–450.

Neil, D.A., C. Coady, J. Thompson, and H. Kuhse. 2007. End-of-life decisions in medical practice: A survey of doctors in Victoria (Australia). Journal of Medical Ethics 33(12): 721–725.

Onwuteaka-Philipsen, B.D., A. van der Heide, D. Koper, et al. 2003. Euthanasia and other end-of-life decisions in the Netherlands in 1990, 1995, and 2001. Lancet 362(9381): 395–399.

Pellegrino, E.D. 2005. Some things ought never be done: Moral absolutes in clinical ethics. Theoretical Medicine and Bioethics 26(6): 469–486.

Rachels, J. 1975. Active and passive euthanasia. New England Journal of Medicine 292(2): 78–80.

Royal Dutch Medical Association KNMG. 2011. The role of the physician in the voluntary termination of life. https://www.knmg.nl/advies-richtlijnen/knmg-publicaties/publications-in-english.htm . Accessed October 3, 2021.

Singer, P. 2011. Practical ethics , 3rd ed. New York: Cambridge University Press.

Book   Google Scholar  

van der Heide, A., L. Deliens, K. Faisst, et al. 2003. End-of-life decision-making in six European countries: Descriptive study. Lancet 362(9381): 345–350.

van der Heide A, B.D. Onwuteaka-Philipsen, M.L. Rurup, et al. 2007. End-of-life practices in the Netherlands under the Euthanasia Act. New England Journal of Medicine , 356(19): 1957–1965.

van der Maas, P.J., J.J. van Delden, L. Pijnenborg, C.W. Looman, Central Bureau of Statistics, and The Hague. 1991. Euthanasia and other medical decisions concerning the end of life. Lancet 338(8768): 669–674.

van der Maas, P.J., van Delden, J.J., and L. Pijnenborg. 1992. Euthanasia and other medical decisions concerning the end of life: An investigation performed upon request of the Commission of Inquiry into the medical practice concerning euthanasia. Health policy (Amsterdam, Netherlands) 21(1-2), vi-262.

van der Maas, P.J., G. van Der Wal, I. Haverkate, et al. 1996. Euthanasia, physician-assisted suicide, and other medical practices involving the end of life in the Netherlands, 1990–1995. New England Journal of Medicine 335(22): 1699–1705.

van der Wal, G., and R.J. Dillmann. 1994. Euthanasia in the Netherlands. BMJ 308(6940): 1346–1349.

Warnock, M. 1998. An intelligent person’s guide to ethics . London: Gerald Duckworth & Co. Ltd.

Woollard, F. and F. Howard-Snyder. 2021. Doing vs. allowing harm. The Stanford Encyclopedia of Philosophy , Fall 2021 ed., edited by E.N. Zalta. https://plato.stanford.edu/archives/fall2021/entries/doing-allowing/ .

World Medical Association. 2015. Medical ethics manual , 3rd ed. https://www.wma.net/what-we-do/education/medical-ethics-manual/ . Accessed October 2, 2021.

Young, R. 2021. Voluntary euthanasia. The Stanford Encyclopedia of Philosophy , Winter 2021 ed., edited by E.N. Zalta. https://plato.stanford.edu/archives/win2021/entries/euthanasia-voluntary/ .

Download references

Acknowledgements

The author would like to thank Dr Michaelis Michael and Dr Markos Valaris for their academic guidance during the researching and writing of this essay. He would also like to thank his family and friends for their support and feedback during this time.

Open Access funding enabled and organized by CAUL and its Member Institutions. The author did not receive any funding whilst researching or writing this essay.

Author information

Authors and affiliations.

Department of Philosophy, University of New South Wales, High St, Kensington, Sydney, New South Wales, 2052, Australia

Thomas D. Riisfeldt

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Thomas D. Riisfeldt .

Ethics declarations

Conflicts of interest.

The author does not have any conflicts of interest to declare.

Additional information

Publisher's note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ .

Reprints and permissions

About this article

Riisfeldt, T.D. Overcoming Conflicting Definitions of “Euthanasia,” and of “Assisted Suicide,” Through a Value-Neutral Taxonomy of “End-Of-Life Practices”. Bioethical Inquiry 20 , 51–70 (2023). https://doi.org/10.1007/s11673-023-10230-1

Download citation

Received : 22 March 2022

Accepted : 10 October 2022

Published : 02 February 2023

Issue Date : March 2023

DOI : https://doi.org/10.1007/s11673-023-10230-1

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Euthanasia and assisted suicide
• Assisted dying
• End-of-life issues
• Informed consent
• Palliative care
• Find a journal
• Publish with us
• Track your research

• Academic Departments
• Centers, Institutes & Labs
• Faculty Directory
• Offices & Programs
• Patient Care
• Student Resources
• Faculty Resources

Can't find what you're looking for?

• Centers, Institutes & Labs
• Offices & Programs

This is a site-wide search. if you already know what you're looking for, try visiting a section of the site first to see A-Z listings.

Results for " "

Section Menu

What is euthanasia.

Euthanasia is the practice of ending the life of a patient to limit the patient’s suffering.  The patient in question would typically be terminally ill or experiencing great pain and suffering.

The word “euthanasia” itself comes from the Greek words “ eu ” (good) and “ thanatos ” (death).  The idea is that instead of condemning someone to a slow, painful, or undignified death, euthanasia would allow the patient to experience a relatively “good death.”

Types of euthanasia

Different practices fall under the label “euthanasia.”  Here are some distinctions demarcating different versions.

Active euthanasia : killing a patient by active means, for example, injecting a patient with a lethal dose of a drug.  Sometimes called “aggressive” euthanasia. Passive euthanasia : intentionally letting a patient die by withholding artificial life support such as a ventilator or feeding tube.  Some ethicists distinguish between  withholding  life support and  withdrawing  life support (the patient is on life support but then removed from it). Voluntary euthanasia : with the consent of the patient. Involuntary euthanasia : without the consent of the patient, for example, if the patient is unconscious and his or her wishes are unknown..  Some ethicists distinguish between “involuntary” (against the patient’s wishes) and “nonvoluntary” (without the patient’s consent but wishes are unknown) forms. Self-administered euthanasia : the patient administers the means of death. Other-administered euthanasia : a person other than the patient administers the means of death. Assisted : the patient administers the means of death but with the assistance of another person, such as a physician.

There are many possible combinations of the above types, and many types of euthanasia are morally controversial.  Some types of euthanasia, such as assisted voluntary forms, are legal in some countries.

Mercy-killing:  The term “mercy-killing” usually refers to active, involuntary or nonvoluntary, other-administered euthanasia.  In other words, someone kills a patient without their explicit consent to end the patient’s suffering.  Some ethicists think that

Physician-assisted suicide:  The phrase “physician-assisted suicide” refers to active, voluntary, assisted euthanasia where a physician assists the patient.  A physician provides the patient with a means, such as sufficient medication, for the patient to kill him or herself.

Some instances of euthanasia are relatively uncontroversial.  Killing a patient against their will (involuntary, aggressive/active, other-administered), for instance, is almost universally condemned.  During the late 1930’s and early 1940’s, in Germany, Adolf Hitler carried out a program to exterminate children with disabilities (with or without their parent’s permission) under the guise of improving the Aryan “race” and reducing costs to society.  Everyone now thinks this kind of euthanasia in the service of a eugenics program was clearly morally wrong.

What are key disputes in the controversy over euthanasia?

Advocates of active euthanasia typically argue that killing the patients in question is not worse than letting them die.  Advocates of voluntary euthanasia often claim that patients should have the right to do what they want with their own lives.  Advocates of mercy killing argue that for patients who are in vegetative states with no prospect of recovery, letting them die prevents future needless and futile treatment efforts.  If they are suffering then killing them prevents further suffering.  Advocates of physician-assisted suicide argue that a physician assisting a terminally ill or suffering patient is merely helping the patient who wishes to die with dignity.

Critics of the euthanasia typically argue that killing is always wrong, that nonvoluntary or involuntary euthanasia violates patient rights, or that physician-assisted suicide violates an obligation to do no harm.

Killing vs. letting die : There is dispute over whether killing a patient is really any worse than letting the patient die if both result in the same outcome.

Commonsense morality usually thinks that letting a person die is not as bad as killing a person.  We sometimes condemn letting an innocent person die and sometimes not, but we always condemn killing an innocent person.

Consider different instances of “letting die.”  One might claim that it is wrong to let our neighbor die of an accident if we could easily have saved his or her life by calling an ambulance.  On the other hand, we let starving people in poor countries die without condemning ourselves for failing to save them, because we think they have no right to demand we prevent their deaths.  But if someone killed a neighbor or starving people we would think that wrong.

Likewise, we would condemn a healthcare professional who kills a patient.  But we might accept the healthcare professional who at patient and family request withholds artificial life support to allow a suffering, terminally ill patient to die.

The distinction between killing and letting die is controversial in healthcare because critics charge there is no proper moral basis for the distinction.  They say that killing the above patient brings about the same end as letting the patient die.  Others object to this and claim that the nature of the act of killing is different than letting die in ways that make it morally wrong.

Ordinary vs. extraordinary treatment :  Ordinary medical treatment includes stopping bleeding, administering pain killers and antibiotics, and setting fractures.  But using a mechanical ventilator to keep a patient breathing is sometimes considered extraordinary treatment or care.  Some ethicists believe letting a patient die by withholding or withdrawing artificial treatment or care is acceptable but withholding or withdrawing ordinary treatment or care is not.  This view is controversial.  Some claim the distinction between ordinary and extraordinary treatment is artificial, contrived, vague, or constantly changing as technology progresses

Death intended vs. anticipated : Some ethicists believe that if a suffering, terminally-ill patient dies because of intentionally receiving pain-relieving medications, it makes a difference whether the death itself was intended or merely anticipated.  If the death was intended it is wrong but if the death was anticipated it might be morally acceptable.  This reasoning relies on the moral principle called the principle of double effect.

More Centers, Institutes and Labs

• Baker Research Lab
• Becevic Telehealth Lab
• Biomedical Informatics
• Cardiac Cell Physiology Lab
• Center for Education and Development
• Center for Health Ethics
• Center for Health Policy
• Center for Medical Epidemiology and Population Health (CMEPH)
• Center for Patient-Centered Outcomes Research
• Center for Precision Medicine
• Child Health Research Institute
• Christopher S. Bond Life Sciences Center
• Cognitive Neuroscience Laboratory
• Cosmopolitan International Diabetes Center
• Craniofacial Research Center
• Dalton Cardiovascular Research Center
• Electron Microscopy Core Facility
• Ellis Fischel Cancer Center
• Fay Research Lab
• Functional Assessment Screening Team
• Health Informatics in Diabetes Research (HIDR) Core
• Health Intervention and Treatment Research Lab
• Immunity & Autoimmunity Research Lab
• International Institute of Nano and Molecular Medicine
• Lei Research Lab
• Microcirculation Laboratory
• Missouri Orthopaedic Bioskills Laboratory
• Mizzou OneHealth Biorepository
• Mizzou Sleep Research Lab
• MU Center for Translational Neuroscience
• MU Student Health Center
• MU Surgical Center for Outcomes Research and Effectiveness (MUSCORE)
• Narrative Medicine and Health Innovation Lab
• Pulmonary Imaging Research Lab
• Rural Health Research Center
• Shelden Clinical Simulation Center
• Subramanian Research Lab
• Thompson Center for Autism and Neurodevelopment
• Thompson Laboratory for Regenerative Orthopaedics

Happenings at MU School of Medicine

Stories that inspire.

School of Medicine launches Missouri Health journal

Preoperative Antibiotic Treatment in Pediatric Elbow Fracture Surgery is Not Necessary

Alumni Spotlight: Jennifer Hsu, MD ‘05 and Benson Hsu, MD ‘05

University of Missouri Partnering with State to Address Childhood Immunizations

See All News

Columbia, MO 65212 Contact

Emergency Information

Sign up for our monthly newsletter

Copyright © 2023 — Curators of the University of Missouri . All rights reserved. DMCA and other copyright information . Equal Opportunity/Access/Affirmative Action/Pro Disabled & Veteran Employer . For website issues, contact MU Health Care Communications . Contact the MU School of Medicine .

• Games & Quizzes
• History & Society
• Science & Tech
• Biographies
• Animals & Nature
• Geography & Travel
• Arts & Culture
• On This Day
• One Good Fact
• New Articles
• Lifestyles & Social Issues
• Philosophy & Religion
• Politics, Law & Government
• World History
• Health & Medicine
• Browse Biographies
• Birds, Reptiles & Other Vertebrates
• Bugs, Mollusks & Other Invertebrates
• Environment
• Fossils & Geologic Time
• Entertainment & Pop Culture
• Sports & Recreation
• Visual Arts
• Demystified
• Image Galleries
• Infographics
• Top Questions
• Britannica Kids
• Saving Earth
• Space Next 50
• Student Center
• How is a homicide defined?

Our editors will review what you’ve submitted and determine whether to revise the article.

• Humanities LibreTexts - Euthanasia
• University of Missouri School of Medicine - Center for Health Ethics - Euthanasia
• National Library of Medicine - Culturally sanctioned suicide: Euthanasia, seppuku, and terrorist martyrdom
• Academia - Euthanasia, or Mercy Killing
• Stanford Encyclopedia of Philosophy - Voluntary Euthanasia
• euthanasia - Student Encyclopedia (Ages 11 and up)

Recent News

euthanasia , act or practice of painlessly putting to death persons suffering from painful and incurable disease or incapacitating physical disorder or allowing them to die by withholding treatment or withdrawing artificial life-support measures. Because there is no specific provision for it in most legal systems, it is usually regarded as either suicide (if performed by the patient himself) or murder (if performed by another). Physicians may, however, lawfully decide not to prolong life in cases of extreme suffering, and they may administer drugs to relieve pain even if this shortens the patient’s life. In the late 20th century, several European countries had special provisions in their criminal codes for lenient sentencing and the consideration of extenuating circumstances in prosecutions for euthanasia.

The opinion that euthanasia is morally permissible is traceable to Socrates , Plato , and the Stoics . It is rejected in traditional Christian belief, chiefly because it is thought to contravene the prohibition of murder in the Ten Commandments . The organized movement for legalization of euthanasia commenced in England in 1935, when C. Killick Millard founded the Voluntary Euthanasia Legalisation Society (later called the Euthanasia Society). The society’s bill was defeated in the House of Lords in 1936, as was a motion on the same subject in the House of Lords in 1950. In the United States the Euthanasia Society of America was founded in 1938.

The first countries to legalize euthanasia were the Netherlands in 2001 and Belgium in 2002. In 1997 Oregon became the first state in the United States to decriminalize physician-assisted suicide; opponents of the controversial law, however, attempted to have it overturned. In 2009 the Supreme Court of South Korea recognized a “right to die with dignity” in its decision to approve a request by the family of a brain-dead woman that she be removed from life-support systems.

The potential of modern medical practice to prolong life through technological means has provoked the question of what courses of action should be available to the physician and the family in cases of extreme physical or emotional suffering, especially if the patient is incapable of choice. Passively doing nothing to prolong life or withdrawing life-support measures has resulted in criminal charges being brought against physicians; on the other hand, the families of comatose and apparently terminal patients have instituted legal action against the medical establishment to make them stop the use of extraordinary life support.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• My Bibliography
• Collections
• Citation manager

Save citation to file

Email citation, add to collections.

• Create a new collection
• Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed.

• Search in PubMed
• Search in NLM Catalog
• Add to Search

Euthanasia: an introduction

Affiliation.

• 1 Florida State University, USA.
• PMID: 15154421
• DOI: 10.1111/j.1540-4560.1996.tb01564.x

It has been argued that euthanasia is one of the most pressing social concerns of our times. A review of current scientific and legal materials, however, indicates that this issue is a complex and contentious one that crosses numerous perspectives and theoretical orientations. In order to provide background for the other articles in this collection, we present a brief history of attitudes toward euthanasia. In addition, various terms that are associated with the concept of euthanasia are defined. Finally, this paper provides a framework for the articles that follow by suggesting that three central issues must be addressed in order to resolve the controversies surrounding euthanasia. These are (1) the establishment of standardized criteria of euthanasia eligibility, (2) the investigation of public attitudes regarding acceptable means for engaging in euthanasia, and (3) the evaluation of the roles of professionals who are directly involved in euthanasia decisions. We hope that the following articles will provide insight into these issues.

PubMed Disclaimer

Similar articles

• The role of the psychologist in determining competence for assisted suicide/euthanasia in the terminally ill. Galbraith KM, Dobson KS. Galbraith KM, et al. Can Psychol. 2000 Aug;41(3):174-83. doi: 10.1037/h0086867. Can Psychol. 2000. PMID: 12484401
• At the Vatican, Physicians Debate Euthanasia and Assisted Suicide. Parsa-Parsi RW. Parsa-Parsi RW. South Med J. 2018 May;111(5):243-244. doi: 10.14423/SMJ.0000000000000796. South Med J. 2018. PMID: 29767211 No abstract available.
• Preferences of the Dutch general public for a good death and associations with attitudes towards end-of-life decision-making. Rietjens JA, van der Heide A, Onwuteaka-Philipsen BD, van der Maas PJ, van der Wal G. Rietjens JA, et al. Palliat Med. 2006 Oct;20(7):685-92. doi: 10.1177/0269216306070241. Palliat Med. 2006. PMID: 17060267
• Normatology: a review and commentary with reference to abortion and physician-assisted suicide. Brodie HK, Banner L. Brodie HK, et al. Am J Psychiatry. 1997 Jun;154(6 Suppl):13-9. doi: 10.1176/ajp.154.6.13. Am J Psychiatry. 1997. PMID: 9167540 Review.
• Religion and nurses' attitudes to euthanasia and physician assisted suicide. Gielen J, van den Branden S, Broeckaert B. Gielen J, et al. Nurs Ethics. 2009 May;16(3):303-18. doi: 10.1177/0969733009102692. Nurs Ethics. 2009. PMID: 19372125 Review.
• Search in MeSH
• Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

• Share full article

Advertisement

Supported by

Guest Essay

Melinda French Gates: The Enemies of Progress Play Offense. I Want to Help Even the Match.

By Melinda French Gates

Ms. French Gates is a philanthropist and the founder of the charitable organization Pivotal.

Many years ago, I received this piece of advice: “Set your own agenda, or someone else will set it for you.” I’ve carried those words with me ever since.

That’s why, next week, I will leave the Bill & Melinda Gates Foundation , of which I was a co-founder almost 25 years ago, to open a new chapter in my philanthropy. To begin, I am announcing $1 billion in new spending over the next two years for people and organizations working on behalf of women and families around the world, including on reproductive rights in the United States.

In nearly 20 years as an advocate for women and girls, I have learned that there will always be people who say it’s not the right time to talk about gender equality. Not if you want to be relevant. Not if you want to be effective with world leaders (most of them men). The second the global agenda gets crowded, women and girls fall off.

It’s frustrating and shortsighted. Decades of research on economics , well-being and governance make it clear that investing in women and girls benefits everyone. We know that economies with women’s full participation have more room to grow. That women’s political participation is associated with decreased corruption. That peace agreements are more durable when women are involved in writing them. That reducing the time women spend in poor health could add as much as $1 trillion to the global economy by 2040.

And yet, around the world, women are seeing a tremendous upsurge in political violence and other threats to their safety, in conflict zones where rape is used as a tool of war, in Afghanistan where the Taliban takeover has erased 20 years of progress for women and girls, in many low-income countries where the number of acutely malnourished pregnant and breastfeeding women is soaring.

In the United States, maternal mortality rates continue to be unconscionable , with Black and Native American mothers at highest risk. Women in 14 states have lost the right to terminate a pregnancy under almost any circumstances. We remain the only advanced economy without any form of national paid family leave. And the number of teenage girls experiencing suicidal thoughts and persistent feelings of sadness and hopelessness is at a decade high.

We are having trouble retrieving the article content.

Please enable JavaScript in your browser settings.

Thank you for your patience while we verify access. If you are in Reader mode please exit and  log into  your Times account, or  subscribe  for all of The Times.

Thank you for your patience while we verify access.

Already a subscriber?  Log in .

Want all of The Times?  Subscribe .