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Brief History of Euthanasia

It is believed that euthanasia started in ancient Greece and Rome around the fifth century B.C.
They did this by abortions and every now and then performed a mercy killing. Even though
doctors were supposed to follow the Hippocratic Oath, many did not and therefore would end up
giving patients poison if they asked them to. During the Middle Ages, euthanasia was pretty
much out of the question. If one committed suicide, the law in Europe was for the body to be
dragged through the streets or nailed to a barrel and left to drift downriver (procon.org).
During the Seventeenth and Eighteenth centuries euthanasia was a topic of discussion. However,
people continued to reject euthanasia and assisted suicide. It wasnt until 1828, for the first
American law to make assisted suicide illegal. Although America outlawed euthanasia and
assisted suicide, some states were still trying to get a law passed at the state level. During the
1930s, euthanasia started to gain support in the US and societies who were in favor of it started
to pop up not only in the US, but in England as well. However, World War Two would change
euthanasia forever. Hitler and the Nazis killed hundreds of thousands of people using euthanasia.
Hitler and company did this by gassing, drugs, and starving the people. This put a halt on the
euthanasia movement as Americans grew less fond of euthanasia. A poll asked Americans in
1950 whether euthanasia was okay and only 36 percent answered yes approximately 10
percent less than in the late 1930s (procon.org). The late 20th and early 21st century would be the
time for euthanasia. The Netherlands would be the first country in the world to legalize
euthanasia, and Belgium would legalize it soon after the Netherlands did. Australia did allow
euthanasia for a brief time in the mid-90s as well. In 1998, Oregon would be the first US state to
allow euthanasia and Washington and Montana would follow.

Euthanasia: The practice of intentionally ending a life in order to relievepain and suffering. The word
"euthanasia" comes straight out of the Greek -- "eu", goodly or well + "thanatos", death = the good
death.
It refers to the situation when a doctor induces the death with a lethalinjection, of a patient who is
suffering unrelievably and has persistently requested the doctor to do so.
The Netherlands is the only country in the world where euthanasia is openly practiced. It is not
specifically allowed by statute, but Dutch law accepts a standard defense from doctors who have
adhered to official guidelines. These guidelines hinge on the voluntariness of the request and the
unrelievable-ness of the suffering. Euthanasia and assisted suicide are defined by the State
Commission on Euthanasia. Euthanasia is the intentional termination of life by somebody other than
the person concerned at his or her request. Assisted suicide means intentionally helping a patient to
terminate his or her life at his or her request.
Under Dutch law euthanasia is the termination of life by a doctor at the express wish of a patient.
The request to the doctor must be voluntary, explicit and carefully considered and it must have been
made repeatedly. Moreover, the patient's suffering must be unbearable and without any prospect of
improvement.

Pain relief administered by a Dutch doctor may shorten a patient's life. As is the case in other
countries, in this is seen as a normal medical decision in terminal care and not as euthanasia.

Methods of Euthanasia
There are many ways of initiating euthanasia, and each method can have different outcomes, some very
painful. Regulating methods will not deter users from using plastic bags; it will merely legitimise their use.

Withdrawn or Withheld Treatment

Injections and Drugs

Carbon Monoxide, Helium, Plastic Bags

Dehydration

Nitschke's 'Peaceful' Suicide Pill

Competent adult patients have the right to refuse medical treatment. Such refusals of treatments are morally
and ethically different from euthanasia, and should remain legally different.
Dr Tricia Briscoe said at the 2004 Medical Law Conference:
"The right to refuse treatment flows from a right to inviolability - a right not to be touched, including by
continuing treatment, without one's consent - not from a right to die. Withdrawal of treatment will mean death,
but it will result from the patient's underlying illness."

When, however, an action or medication is withheld from a patient for the primary purpose of causing or
hastening death, this is passive, or indirect, euthanasia. These measures may include the with-holding or
withdrawal of ordinary measures such as food, water (hydration) and oxygen.
Examples of passive euthanasia are:

when food and water is withheld from sick or disabled newborn babies who might otherwise have lived

with-holding or withdrawing food and water from someone who is diagnosed as being in a 'persistent
vegetative state,' has dementia, or who is not improving fast enough (e.g. from a stroke)

'do not resuscitate' orders written on patients' charts

Drugs
In Oregon, a doctor can write a prescription for drugs that are intended to kill the patient. When the prescription
is filled, directions centre around making certain that the patient understands about taking all the pills in a single
dose, dies after taking the prescription.

The lethal drugs are covered by some Oregon health insurance plans. They are paid for by the state Medicaid
program under a funding category called "comfort care."
Research into euthanasia in the Netherlands claimed people awake from comas after taking supposedly fatal
drug doses and suffer side effects such as vomiting and gasping.
To reduce the chances of the euthanasia drugs being vomited up, an anti-emetic must be given.
The study showed that when patients tried to kill themselves using drugs prescribed by a doctor, the medication
did not work as expected in 16% of cases. In a further 7% of cases there were technical problems or
unexpected side effects.
Problems surface so often that doctors felt compelled to intervene in 18% of cases, according to a report in the
New England Journal of Medicine. Even when the doctor directly performed euthanasia, complications
developed in 3% of the attempts. Patients either took longer to die than expected or woke from a drug-induced
coma that was supposed to be fatal in 6% of cases.

Injections
In the Netherlands, the practice is an injection to render the patient comatose, followed by a second injection to
stop the heart.
First a coma is induced by intravenous administration of barbiturates, followed by a muscle relaxant. The
patient usually dies as the result of anoxemia caused by the muscle relaxant. When death is delayed,
intravenous potassium chloride is also given to hasten cardiac arrest.
Starvation and Dehydration
Right-to-die activists often advocate the withdrawal of food and water in order to hasten death. This means of
death is frequently approved when application is made to the courts. Proponents of euthanasia recommend the
use of what is known as Terminal Sedation in combination with the withdrawal of food and water.
Terminal sedation allows for the measured use of sedatives and analgesics for the necessary control of
symptoms such as intolerable pain, agitation, and anxiety, in order to relieve the distress of the patient and of
family members.
If all food and fluids (nutrition and hydration) are removed from a person -- whether that person is a healthy
Olympic athlete who takes food and fluids by mouth or a frail, disabled person who receives them by a feeding
tube -- death is inevitable. That death will occur because of dehydration.
Dr. Helga Kuhse, a leading campaigner for euthanasia, said in 1984: "If we can get people to accept the
removal of all treatment and care - especially the removal of food and fluids - they will see what a painful way
this is to die and then, in the patient's best interest, they will accept the lethal injection."

Gases, plastic bags and the 'peaceful pill'


This method, referred to as 'self deliverance,' is most commonly advocated by right-to-die activists such as

Derek Humphry and Dr Philip Nitschke. In Humphry's book Final Exit describes the method and has been
found in the possession of people who have used the method to commit suicide.
Dr Nitschke developed what he calls the 'CO Genie' - an apparatus that turns out lethal carbon monoxide that
can be made at home. Nitschke has held workshops in Australia and New Zealand teaching people how to
manufacture such devices for themselves.
Dr Nitschke's latest initiative is a barbiturate-based 'peaceful pill.' Nitschke's Peanut Project (named for an old
street term for "Barbiturate") intends holding workshops for small groups of elderly and seriously ill Exit
members from different countries to make their own Peaceful Pill.

Euthanasia: The intentional killing by act or omission of a dependent human being for
his or her alleged benefit. (If death is not intended, it is not an act of euthanasia)
Arguments For Euthanasia:
It provides a way to relieve extreme pain
It provides a way of relief when a person's quality of life is low
Frees up medical funds to help other people
It is another case of freedom of choice
Arguments Against Euthanasia:
Euthanasia devalues human life
Euthanasia can become a means of health care cost containment
Physicians and other medical care people should not be involved in directly causing death
There is a "slippery slope" effect that has occurred where euthanasia has been first been
legalized for only
the terminally ill and later laws are changed to allow it for other people or to be done
non-voluntarily.

1. Right to Die

6. Palliative (End-of-Life) Care

2. Patient Suffering at End-of-Life

7. Healthcare Spending Implications

3. Slippery Slope to Legalized Murder

8. Social Groups at Risk of Abuse

4. Hippocratic Oath and Prohibition of Killing

9. Religious Concerns

5. Government Involvement in End-of-Life Decisions

10. Living Wills

PROS AND CONS


PRO Euthanasia or Physician-Assisted
Suicide

CON Euthanasia or Physician-Assisted Suicide


1. Right to Die

PRO: "The right of a competent, terminally ill person


to avoid excruciating pain and embrace a timely and
dignified death bears the sanction of history and is
implicit in the concept of ordered liberty. The
exercise of this right is as central to personal
autonomy and bodily integrity as rights safeguarded
by this Court's decisions relating to marriage, family
relationships, procreation, contraception, child
rearing and the refusal or termination of life-saving
medical treatment. In particular, this Court's recent
decisions concerning the right to refuse medical
treatment and the right to abortion instruct that a
mentally competent, terminally ill person has a
protected liberty interest in choosing to end
intolerable suffering by bringing about his or her own
death.

CON: "The history of the law's treatment of assisted suicide in this


country has been and continues to be one of the rejection of nearly all
efforts to permit it. That being the case, our decisions lead us to
conclude that the asserted 'right' to assistance in committing suicide is
not a fundamental liberty interest protected by the Due Process Clause."
-- Washington v. Glucksberg(63 KB)
US Supreme Court Majority Opinion
June 26, 1997

A state's categorical ban on physician assistance to


suicide -- as applied to competent, terminally ill
patients who wish to avoid unendurable pain and
hasten inevitable death -- substantially interferes
with this protected liberty interest and cannot be
sustained."
-- ACLU Amicus Brief in Vacco v. Quill(72 KB)
American Civil Liberties Union (ACLU)
Dec. 10, 1996
2. Patient Suffering at End-of-Life
PRO: "At the Hemlock Society we get calls daily
from desperate people who are looking for someone
like Jack Kevorkian to end their lives which have lost
all quality... Americans should enjoy a right
guaranteed in the European Declaration of Human
Rights -- the right not to be forced to suffer. It should

CON: "Activists often claim that laws against euthanasia and assisted
suicide are government mandated suffering. But this claim would be
similar to saying that laws against selling contaminated food are
government mandated starvation.
Laws against euthanasia and assisted suicide are in place to prevent

be considered as much of a crime to make someone abuse and to protect people from unscrupulous doctors and others. They
live who with justification does not wish to continue
are not, and never have been, intended to make anyone suffer."
as it is to take life without consent."
-- Rita Marker, JD
-- Faye Girsh, EdD
Executive Director
Senior Adviser, Final Exit Network,
Kathi Hamlon
"How Shall We Die," Free Inquiry
Policy Analyst
Winter 2001
International Task Force on Euthanasia and Assisted Suicide
"Euthanasia and Assisted Suicide: Frequently Asked Questions,"
www.internationaltaskforce.org
Jan. 2010
3. Slippery Slope to Legalized Murder
PRO: "Especially with regard to taking life, slippery
slope arguments have long been a feature of the
ethical landscape, used to question the moral
permissibility of all kinds of acts... The situation is
not unlike that of a doomsday cult that predicts time
and again the end of the world, only for followers to
discover the next day that things are pretty much as
they were...

CON: "In a society as obsessed with the costs of health care and the
principle of utility, the dangers of the slippery slope... are far from
fantasy...

Assisted suicide is a half-way house, a stop on the way to other forms of


direct euthanasia, for example, for incompetent patients by advance
directive or suicide in the elderly. So, too, is voluntary euthanasia a halfway house to involuntary and nonvoluntary euthanasia. If terminating life
is a benefit, the reasoning goes, why should euthanasia be limited only
We need the evidence that shows that horrible slope to those who can give consent? Why need we ask for consent?"
consequences are likely to occur. The mere
possibility that such consequences might occur, as
-- Edmund D. Pelligrino, MD
noted earlier, does not constitute such evidence."
Professor Emeritus of Medicine and Medical Ethics, Georgetown
University
-- R.G. Frey, DPhil
"The False Promise of Beneficent Killing," Regulating How We Die: The
Professor of Philosophy, Bowling Green State
Ethical, Medical, and Legal Issues Surrounding Physician-Assisted
University
Suicide
"The Fear of a Slippery Slope," Euthanasia and
1998
Physician-Assisted Suicide: For and Against
1998
4. Hippocratic Oath and Prohibition of Killing
PRO: "Over time the Hippocratic Oath has been
modified on a number of occasions as some of its
tenets became less and less acceptable. References
to women not studying medicine and doctors not
breaking the skin have been deleted. The muchquoted reference to 'do no harm' is also in need of
explanation. Does not doing harm mean that we
should prolong a life that the patient sees as a
painful burden? Surely, the 'harm' in this instance is
done when we prolong the life, and 'doing no harm'
means that we should help the patient die. Killing the
patient--technically, yes. Is it a good thing-sometimes, yes. Is it consistent with good medical
end-of-life care: absolutely yes."
-- Philip Nitschke, MD
Director and Founder, Exit International
"Euthanasia Sets Sail," National Review Online

CON: "The prohibition against killing patients... stands as the first


promise of self-restraint sworn to in the Hippocratic Oath, as medicine's
primary taboo: 'I will neither give a deadly drug to anybody if asked for it,
nor will I make a suggestion to this effect'... In forswearing the giving of
poison when asked for it, the Hippocratic physician rejects the view that
the patient's choice for death can make killing him right. For the
physician, at least, human life in living bodies commands respect and
reverence--by its very nature. As its respectability does not depend upon
human agreement or patient consent, revocation of one's consent to live
does not deprive one's living body of respectability. The deepest ethical
principle restraining the physician's power is not the autonomy or
freedom of the patient; neither is it his own compassion or good
intention. Rather, it is the dignity and mysterious power of human life
itself, and therefore, also what the Oath calls the purity and holiness of
life and art to which he has sworn devotion."
-- Leon Kass, MD, PhD
Addie Clark Harding Professor, Committee on Social Thought and the

June 5, 2001

College, University of Chicago


"Neither for Love nor Money," Public Interest
Winter 1989

5. Government Involvement in End-of-Life Decisions


PRO: "We'll all die. But in an age of increased
longevity and medical advances, death can be
suspended, sometimes indefinitely, and no longer
slips in according to its own immutable timetable.
So, for both patients and their loved ones, real
decisions are demanded: When do we stop doing all
that we can do? When do we withhold which
therapies and allow nature to take its course? When
are we, through our own indecision and fears of
mortality, allowing wondrous medical methods to
perversely prolong the dying rather than the living?
These intensely personal and socially expensive
decisions should not be left to governments, judges
or legislators better attuned to highway funding."

CON: "Cases like Schiavo's touch on basic constitutional rights, such as


the right to live and the right to due process, and consequently there
could very well be a legitimate role for the federal government to play.
There's a precedent--as a result of the highly publicized deaths of infants
with disabilities in the 1980s, the federal government enacted 'Baby Doe
Legislation,' which would withhold federal funds from hospitals that
withhold lifesaving treatment from newborns based on the expectation of
disability. The medical community has to have restrictions on what it may
do to people with disabilities - we've already seen what some members
of that community are willing to do when no restrictions are in place."
-- Stephen Drake. MS
Research Analyst, Not Dead Yet
"End of Life Planning: Q & A with Disabilities Advocate," Reno GazetteJournal
Nov. 22, 2003

-- Los Angeles Times


"Planning for Worse Than Taxes," Opinion
Mar. 22, 2005
6. Palliative (End-of-Life) Care
PRO: "Assisting death in no way precludes giving
the best palliative care possible but rather integrates
compassionate care and respect for the patient's
autonomy and ultimately makes death with dignity a
real option...

CON: "Studies show that hospice-style palliative care 'is virtually


unknown in the Netherlands [where euthanasia is legal].' There are very
few hospice facilities, very little in the way of organized hospice activity,
and few specialists in palliative care, although some efforts are now
under way to try and jump-start the hospice movement in that country...

The evidence for the emotional impact of assisted


dying on physicians shows that euthanasia and
assisted suicide are a far cry from being 'easier
options for the caregiver' than palliative care, as
some critics of Dutch practice have suggested. We
wish to take a strong stand against the separation
and opposition between euthanasia and assisted
suicide, on the one hand, and palliative care, on the
other, that such critics have implied. There is no
'either-or' with respect to these options. Every
appropriate palliative option available must be
discussed with the patient and, if reasonable, tried
before a request for assisted death can be
accepted...

The widespread availability of euthanasia in the Netherlands may be


another reason for the stunted growth of the Dutch hospice movement.
As one Dutch doctor is reported to have said, 'Why should I worry about
palliation when I have euthanasia?'"

Opposing euthanasia to palliative care... neither


reflects the Dutch reality that palliative medicine is
incorporated within end-of-life care nor the place of
the option of assisted death at the request of a

-- Wesley J. Smith, JD
Senior Fellow in Human Rights and Bioethics, Discovery Institute
Forced Exit
1997

patient within the overall spectrum of end-of-life


care."
-- Gerrit Kimsma, MD, MPh
Associate Professor in Medical Philosophy
Evert van Leeuwen, PhD
Professor in Philosophy and Medical Ethics
Center for Ethics and Philosophy at Free University
in Amsterdam (Amsterdam, Netherlands)
"Assisted Death in the Netherlands: Physician at the
Bedside When Help Is Requested"
Physician-Assisted Dying: The Case for Palliative
Care & Patient Choice
2004
7. Healthcare Spending Implications
PRO: "Even though the various elements that make
up the American healthcare system are becoming
more circumspect in ensuring that money is not
wasted, the cap that marks a zero-sum healthcare
system is largely absent in the United States...
Considering the way we finance healthcare in the
United States, it would be hard to make a case that
there is a financial imperative compelling us to adopt
physician-assisted suicide in an effort to save money
so that others could benefit..."

CON: "Savings to governments could become a consideration. Drugs for


assisted suicide cost about $35 to $45, making them far less expensive
than providing medical care. This could fill the void from cutbacks for
treatment and care with the 'treatment' of death."
-- International Task Force on Euthanasia and Assisted Suicide
"Frequently Asked Questions," www.internationaltaskforce.org
(accessed May 27, 2010)

-- Merrill Matthews, Jr., PhD


Director, Council for Affordable Health Insurance
"Would Physician-Assisted Suicide Save the
Healthcare System Money?," Physician Assisted
Suicide: Expanding the Debate
1998
8. Social Groups at Risk of Abuse
PRO: "One concern has been that disadvantaged
populations would be disproportionately represented
among patients who chose assisted suicide.
Experience in Oregon suggests this has not been
the case. In the United States, socially
disadvantaged groups have variably included ethnic
minorities, the poor, women, and the elderly.
Compared with all Oregon residents who died
between January 1998 and December 2002, those
who died by physician-assisted suicide were more
likely to be college graduates, more likely to be
Asian, somewhat younger, more likely to be
divorced, and more likely to have cancer or
amytrophic lateral sclerosis... Moreover, although 2.6
percent of Oregonians are African American, no
African American patients have chosen assisted
suicide."

CON: "It must be recognized that assisted suicide and euthanasia will be
practiced through the prism of social inequality and prejudice that
characterizes the delivery of services in all segments of society,
including health care. Those who will be most vulnerable to abuse, error,
or indifference are the poor, minorities, and those who are least
educated and least empowered. This risk does not reflect a judgment
that physicians are more prejudiced or influenced by race and class than
the rest of society - only that they are not exempt from the prejudices
manifest in other areas of our collective life.
While our society aspires to eradicate discrimination and the most
punishing effects of poverty in employment practices, housing,
education, and law enforcement, we consistently fall short of our goals.
The costs of this failure with assisted suicide and euthanasia would be
extreme. Nor is there any reason to believe that the practices, whatever
safeguards are erected, will be unaffected by the broader social and
medical context in which they will be operating. This assumption is naive

and unsupportable."
-- Linda Ganzini, MD, MPH
Professor of Psychiatry and Medicine Senior
Scholar, Center for Ethics in Health Care at Oregon
-- New York State Task Force on Life and the Law
Health & Science University "When Death Is Sought: Assisted Suicide and Euthanasia in the Medical
"The Oregon Experience," Physician-Assisted
Context," newyorkhealth.gov
Dying: The Case for Palliative Care and Patient
1994
Choice
2004
9. Religious Concerns
PRO: "Guided by our belief as Unitarian
Universalists that human life has inherent dignity,
which may be compromised when life is extended
beyond the will or ability of a person to sustain that
dignity; and believing that it is every person's
inviolable right to determine in advance the course of
action to be taken in the event that there is no
reasonable expectation of recovery from extreme
physical or mental disability...

CON: "As Catholic leaders and moral teachers, we believe that life is the
most basic gift of a loving God- a gift over which we have stewardship
but not absolute dominion. Our tradition, declaring a moral obligation to
care for our own life and health and to seek such care from others,
recognizes that we are not morally obligated to use all available medical
procedures in every set of circumstances. But that tradition clearly and
strongly affirms that as a responsible steward of life one must never
directly intend to cause one's own death, or the death of an innocent
victim, by action or omission...

BE IT FURTHER RESOLVED: That Unitarian


We call on Catholics, and on all persons of good will, to reject proposals
Universalists advocate the right to self-determination to legalize euthanasia."
in dying, and the release from civil or criminal
penalties of those who, under proper safeguards, act
-- United States Conference of Catholic Bishops
to honor the right of terminally ill patients to select
"Statement on Euthanasia," on www.usccb.org
the time of their own deaths; and...
Sep. 12, 1991
BE IT FINALLY RESOLVED: That Unitarian
Universalists, acting through their congregations,
memorial societies, and appropriate organizations,
inform and petition legislators to support legislation
that will create legal protection for the right to die
with dignity, in accordance with one's own choice.
-- Unitarian Universalist Association: The Right to
Die With Dignity, 1988 General Resolution
Unitarian Universalist Association
1988
10. Living Wills
PRO: "Living wills can be used to refuse
extraordinary, life-prolonging care and are effective
in providing clear and convincing evidence that may
be necessary under state statutes to refuse care
after one becomes terminally ill.
A recent Pennsylvania case shows the power a
living will can have. In that case, a Bucks County
man was not given a feeding tube, even though his
wife requested he receive one, because his living
will, executed seven years prior, clearly stated that
he did 'not want tube feeding or any other artificial

CON: "Not only are we awash in evidence that the prerequisites for a
successful living wills policy are unachievable, but there is direct
evidence that living wills regularly fail to have their intended effect...
When we reviewed the five conditions for a successful program of living
wills, we encountered evidence that not one condition has been
achieved or, we think, can be. First, despite the millions of dollars
lavished on propaganda, most people do not have living wills... Second,
people who sign living wills have generally not thought through its
instructions in a way we should want for life-and-death decisions... Third,
drafters of living wills have failed to offer people the means to articulate
their preferences accurately... Fourth, living wills too often do not reach

invasive form of nutrition'...


A living will provides clear and convincing evidence
of one's wishes regarding end-of-life care."
-- Joseph Pozzuolo, JD
Professor, Neuman College
Lisa Lassoff, JD
Associate, Reed Smith
Jamie Valentine, JD
Associate, Pozzuolo & Perkiss
"Why Living Wills/Advance Directives Are an
Essential Part of Estate Planning," Journal of
Financial Service Professionals
Sep. 2005

the people actually making decisions for incompetent patients... Fifth,


living wills seem not to increase the accuracy with which surrogates
identify patients' preferences."
-- Angela Fagerlin, PhD
Core Faculty Member, Robert Wood Johnson Clinical Scholar Program,
University of Michigan Medical School
Carl E. Schneider, JD
Chauncey Stillman Professor for Ethics, Morality, and the Practice of
Law, University of Michigan Law School
"Enough: The Failure of the Living Will," Hastings Center Report
2004