EUTHANASIA AND ASSISTED SUICIDE

Meanings of Terms

The word Euthanasia comes from the Greek language: eu means "good" and thanatos means "death". The meaning of the word has evolved from "good death". It now refers to the act of ending another person's life, at their request, in order to minimize suffering.

It comes in two main forms:

Passive Euthanasia: Hastening the death of a person by removing life support instruments (e.g. turning off a respirator) or by stopping medical procedures, medications etc. It is performed on terminally ill, suffering persons so that natural death will occur sooner. It is also done on persons in a Persistent Vegetative State - a person with massive brain damage who is in a coma from which they will not recover.
Active Euthanasia: Causing the death of a person through a direct action.

The term Assisted Suicide is vaguely related to Euthanasia. It usually refers to a situation in which information and/or the means of committing suicide (e.g. drugs, carbon monoxide gas) are given to a person so that they can terminate their own life without further assistance. Some people use the term to mean the same as "Active Euthanasia".

Beliefs about Suicide and Euthanasia

Traditional Christian beliefs concerning suicide were well documented by Thomas Aquinas (circa 1225-1274). He condemned suicide because:
- it violates one's natural desire to live
- it harms other people
- life is the gift of God and is thus only to be taken by God
Michel de Montaigne (1533-1592) was the first major dissenter among European writers. He wrote 5 essays which touched on the subject of suicide, arguing that suicide should be considered a matter of personal choice, and that it is a rational option under some circumstances.

These two basic positions remain the prime motivators in today's debates.

The Political Battle over Euthanasia

Discussions about euthanasia often get mired in a mountain of emotional accusations, such as charges that the "most vulnerable" of humans are "besieged by euthanasia practitioners" and that families must fight "anti-life assaults on their loved ones" which "threaten the lives of those who are medically vulnerable".

In reality, the basic question posed by euthanasia is: should a person:

who is terminally ill, and
who feels that their life is not worth living because of intractable pain, and/or loss of dignity, and/or loss of capability and
who repeatedly and actively asks for help in committing suicide and
who is of sound mind and not suffering from treatable depression

be given the option to request assistance in dying?

Euthanasia is not:

Whether a particular person should request aid in dying. The question is whether people in general should be given the choice to request euthanasia
Whether a person should be allowed to commit suicide. In most jurisdictions, suicide is a legal act, and has been so for decades.
Whether an otherwise healthy person who is going through a period of depression should be given help in committing suicide. They would not be given such assistance
Whether a person's family should be allowed to initiate euthanasia; a request for aid in dying would have to come from the terminally ill person
Whether death squads should periodically visit hospitals and nursing homes in order to kill people who are no longer contributing to society. This is a red herring.

Ultimately, euthanasia is a question of choice. About 0.003% of the world's population can legally ask and receive help in dying. They are the citizens of Australia's Northern Territories. For the remaining 99.997% of us, euthanasia is illegal, the only lawful option is to remain alive, often in intractable pain, until our body finally collapses.

Groups which oppose a woman's choice in abortion often oppose choice in euthanasia as well. The main opposition comes from some:

conservative religious groups, who oppose personal freedom of choice in many areas of life
medical associations who are dedicated to saving and extending life, and feel uncomfortable about helping people end their lives
groups concerned with disabilities, who fear that euthanasia is the first step down a slippery slope that will lead to the involuntary termination of the lives of disabled people

Ethical Questions Raised by Euthanasia

A large percentage of terminally ill patients are in intractable pain and/or experience an intolerably poor quality of life. They would prefer to end their life rather than continue until their body finally gives up. Should they be given assistance in dying?
Suicide is a legal act that is theoretically available to all. But a person who is terminally ill or who is in a hospital setting or is disabled may not be able to exercise this option. In effect, they are being discriminated against. Should they be given the same access to the suicide option as able-bodied people have?
Many faith groups within Christian, Muslim, Jewish and other religions believe that God gives life and therefore only God should take it away. Suicide would then be "considered as a rejection of God's sovereignty and loving plan". They feel that we are all stewards of our own lives, and that suicide should not be an option. This is an important factor for a person who is considering euthanasia and who happens to be a member of one of these religious groups. However, it seems fundamentally unjust to use a religious argument to decide public policy. There are substantial numbers of adults who have religious beliefs which treat euthanasia as a morally desirable option in some cases. There are also many secularists, atheists, agnostics etc who disagree with such a religiously based argument.
Many faith groups believe that human suffering can have a positive value for the terminally ill person and for caregivers. For them, suffering can be "a divinely appointed opportunity for learning or purification". A Roman Catholic document mentions that "some Christians prefer to moderate their use of painkillers, in order to accept voluntarily at least a part of their sufferings and thus associate themselves in a conscious way with the sufferings of Christ crucified". Again, these seems like poor arguments to justify denying euthanasia to persons with dissenting beliefs.
Many people argue that pain experienced by terminally ill people can be controlled to tolerable levels through proper management. However, tens of millions of individuals in North America do not have access to adequate health care, and so pain control is not available to all. Anticipated cutbacks to health funding will increase the suffering of terminally ill people, and will make aid in dying more important.
By making assisted suicide and/or euthanasia available, some people will be pressured into accepting assistance in dying by their families. This pressure may sometimes occur in very subtle forms. This is an important argument in favor of strict controls that would confirm that a patient is not being influenced by others.
Some people wish to die because they are suffering from clinical depression. This is another argument in favor of strict controls to confirm that a patient requesting aid in dying is "of sound mind".
In an age when medical funding is restricted and being continually reduced, is it ethical to engage in extremely expensive treatment of terminally ill people in order to extend their lives by a few weeks against their will? The money used in this way is not available for pre-natal care, infant care, etc where it would save lives.
Some people argue that patients would be frightened that their physicians might kill them. This is not a valid concern, since only the patient could request assistance in dying. The doctor would continue to work to meet the wishes of their patients.

Public Opinion on Euthanasia

Many polls have been taken. However, the results probably vary according to the precise question asked. Recent results show support for euthanasia at:

60% in the US
74% in Canada
80% in Britain
81% in Australia

Ballot measures have been proposed in three states of the United States. They showed support at:

46% in Washington (1991)
46% in California (1992)
51% in Oregon (1994)

Church Statements about Euthanasia and Assisted Suicide

The Roman Catholic, Lutheran and Episcopal churches have issued formal statements opposing these practices. All Fundamentalist and Evangelical faith groups are believed to be opposed. The Unitarian-Universalist church issued a statement in 1988 in support of euthanasia and assisted suicide choice, if there are proper precautions in place to avoid abuse. Similar statements were made by the United Church of Christ (Congregational), and the Methodist Church on the US West coast. Other churches seem to be heavily divided on the issue. Most religious bodies do not oppose passive euthanasia.

Current Legal Status of Euthanasia

In Canada, a law to enable Euthanasia would be created at the Federal level and would apply throughout the country. In many other countries (e.g. the United States, Australia, etc) it is a decision of the individual states.

United States: Citizens in the state of Oregon approved Ballot Measure 16 in 1994-NOV which would legalize euthanasia under limited conditions. The National Right to Life Committee obtained a court injunction to delay implementation of the measure. An appeal was scheduled for 1996-SPRING.
On 1996-MAR-7, The 9th US Circuit Court of Appeals declared unconstitutional a state of Washington law that criminalized physician assisted suicide for terminally ill patients. The court ruled by an 8 to 3 majority that the law violates the right to liberty and equal protection guaranteed by the 14 Amendment to the US constitution:
```
	"No state shall make or enforce any law which
	shall abridge the privileges or immunities of
	citizens"
```
30 states have specific laws which specifically criminalize assisted suicide. This ruling only affects Western states and territories: Alaska, Arizona, California, Guam, Hawaii, Idaho, Montana, Nevada, N. Mariana Islands, Oregon and Washington.
The court said "when patients are no longer able to pursue liberty or happiness and do not wish to pursue life, the state's interest in forcing them to remain alive is less compelling....A mentally competent, terminally ill adult, having lived nearly the full measure of his life, has a strong liberty interest in choosing a dignified and humane death rather than being reduced to a child-like state of helplessness, diapered, sedated, incompetent ". The decision was condemned by the American Medical Association, the Roman Catholic Church and the anti-abortion lobby. It was greeted with enthusiasm by AIDS activists.
On 1996-APR-3, the 2nd US Circuit Court of Appeals declared unconstitutional a state of New York law that criminalized physician assisted suicide for terminally ill patients. A panel of 3 judges found that the law violates the equal protection guaranteed by the 14 Amendment to the US constitution. This ruling only affects 3 states: Connecticut, New York and Vermont.
On 1996-APR-18, the Attorney General of the state of New York asked that the ruling be suspended for a short time, while the State appeals the decision to the US Supreme Court.
Australia: Their Northern Territory passed a law on 1995-MAY-25 which was assented to on 1995-JUN-16. It will permit active euthanasia, under careful controls, in 1999 when certain prerequisites are met. The Northern Territory consists of about 1/6 the land mass of Australia but only has a population of about 168,000 people. The law started as a private member's bill Rights of the Terminally Ill Bill 1995, sponsored by Marshall Perron. It was opposed by the Australian Medical Association and a variety of right-to-life groups. A "conscience vote" was allowed in which members were free to vote independently of party discipline. Similar bills are being introduced in other Australian states.
A survey conducted by Newspoll in 1995-JUL found 81% of Australian adults support voluntary euthanasia. This is an increase over an earlier result of 79% in 1994-JUL. A poll by the Roy Morgan Research Centre in 1995-JUN showed similar results: 78% in favor. This is an increase from 66% in 1986. A separate poll showed that 60% of doctors and 78% of nurses in Victoria favored voluntary euthanasia.
Holland: Euthanasia is illegal in this country. However, a law was passed in 1993 which prevents doctors from being prosecuted for euthanasia if:
- the patient is in intolerable pain
- the patient has repeatedly asked to die.
- two doctors agree on the procedure
- relatives are consulted
Japan: On 1995-MAR-28, the District Court in Yokahama found a doctor guilty of murdering a terminally ill cancer patient who was expected to die within a few days. He received a two-year prison term, which was suspended. The court then listed four conditions under which mercy killing would be permitted in Japan:
1. the patient is suffering in unbearable physical pain
2. death is inevitable and imminent
3. all possible measures have been taken to eliminate the pain with no other treatment left open
4. the patient has clearly expressed his or her will to approve the shortening of his or her life.
"Judge Matsuura said Dr.Tokunaga's action did not meet all these conditions, arguing that the patient had made no clear expressions about his physical pain nor about his will to approve euthanasia. The doctor's action cannot be viewed as euthanasia and represents illegal termination of the patient's life, he said."

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References

Dr. W.C. Jones, "The Doctor Game", 1995-DEC-30, published in "Kingston This Week" and many other Canadian newspapers
Helga Kuhse (ed.),"Willing to Listen-Wanting to Die", Penguin Books, Ringwood, (1994)
Max Charlesworth, "Bioethics in a Liberal Society", Cambridge Uni. Press, Oakleigh, (1993)

Internet Sites dealing with Euthanasia

Lycos has 1054 documents on Euthanasia. See: http://lycos.cs.cmu.edu
Yahoo lists a number of WWW sites, covering various positions on euthanasia. See: http://www.yahoo.com/Society_and_Culture/Death/Euthanasia/index.html
The Compassionate Healthcare Network, opposes Euthanasia. They maintain a WWW site which describes a number of agencies opposed to Euthanasia, including:
- Citizens United Resisting Euthanasia (CURE, Ltd.).
- International Anti-Euthanasia Task Force
See: http://www.awinc.com/partners/bc/commpass/lifenet/euthan1.htm
ERGO, the Euthanasia Research & Guidance Organization promotes voluntary assisted suicide for terminally and irreversibly ill with unbearable suffering. They include a list of "right-to-die" agencies from around the world, movies which have dealt with the topic, a list of books on euthanasia, etc. See: http://www.efn.org/~ergo/
VESS, the Voluntary Euthanasia Society of Scotland maintains a WWW site with an A-Z interactive glossary, information on Living Wills, case histories, mailing lists, and a Values History Centre. See: http://www.netlink.co.uk/users/vess/fastaccs.html
The Pro-Life Activist's Encyclopedia, published by The American Life League describes a number of cases which have defined the status of euthanasia in the US. See: http://jupiter.ee.pitt.edu/~frezza/plae/encyc107.html
Report of the "Special Committee on Euthanasia and Assisted Suicide, 1995" of the Canadian Senate is at: http://www.magi.com/~sencom/report.html
Report of the "New York State Task Force on Life and Law" is at: http://www.magi.com/~sencom/report.html
The text of the Oregon law permitting voluntary euthanasia is at: http://www.islandnet.com/~deathnet/ergo_orlaw.html

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