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Euthanasia

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

Definition
Current usage As of 2024, dictionary definitions focus on euthanasia as the act of killing someone to prevent further suffering. There is no sense of whether the person agrees or is proactive in the situation. Past discussions on key elements In 1974 euthanasia was defined as the "painless inducement of a quick death". However, it is argued that this approach fails to properly define euthanasia, as it leaves open a number of possible actions that would meet the requirements of the definition but would not be seen as euthanasia. In particular, these include situations where a person kills another, painlessly, but for no reason beyond that of personal gain, or accidental deaths that are quick and painless but not intentional. Another approach incorporated the notion of suffering into the definition. This approach is included in Marvin Khol and Paul Kurtz's definition of it as "a mode or act of inducing or permitting death painlessly as a relief from suffering". Counterexamples can be given: such definitions may encompass killing a person suffering from an incurable disease for personal gain (such as to claim an inheritance), and commentators such as Tom Beauchamp and Arnold Davidson have argued that doing so would constitute "murder simpliciter" rather than euthanasia. Similarly, Heather Draper speaks to the importance of motive, arguing that "the motive forms a crucial part of arguments for euthanasia, because it must be in the best interests of the person on the receiving end." Draper argued that any definition of euthanasia must incorporate four elements: an agent and a subject; an intention; causal proximity, such that the actions of the agent lead to the outcome; and an outcome. Based on this, she offered a definition incorporating those elements, stating that euthanasia "must be defined as death that results from the intention of one person to kill another person, using the most gentle and painless means possible, that is motivated solely by the best interests of the person who dies." Prior to Draper, Beauchamp and Davidson had also offered a definition that included these elements. Their definition specifically discounts fetuses to distinguish between abortions and euthanasia: Wreen, in part responding to Beauchamp and Davidson, offered a six-part definition: Wreen also considered a seventh requirement: "(7) The good specified in (6) is, or at least includes, the avoidance of evil", although, as Wreen noted in the paper, he was not convinced that the restriction was required. In discussing his definition, Wreen noted the difficulty of justifying euthanasia when faced with the notion of the subject's "right to life". In response, Wreen argued that euthanasia has to be voluntary and that "involuntary euthanasia is, as such, a great wrong". Although the EPAC Ethics Task Force argued that both non-voluntary and involuntary euthanasia could not be included in the definition of euthanasia, there is discussion in the literature about excluding one but not the other. The word "euthanasia" was first used in a medical context by Francis Bacon in the 17th century to refer to an easy, painless, happy death, during which it was a "physician's responsibility to alleviate the 'physical sufferings' of the body." Bacon referred to an "outward euthanasia"—the term "outward" he used to distinguish from a spiritual concept—the euthanasia "which regards the preparation of the soul." ==Classification==
Classification
Euthanasia may be classified into three types, according to whether a person gives informed consent: voluntary, non-voluntary and involuntary. There is a debate within the medical and bioethics literature about whether or not the non-voluntary (and by extension, involuntary) killing of patients can be regarded as euthanasia, irrespective of intent or the patient's circumstances. In the definitions offered by Beauchamp and Davidson and, later, by Wreen, consent on the part of the patient was not considered one of their criteria, although it may have been required to justify euthanasia. However, others see consent as essential. Voluntary euthanasia Voluntary euthanasia is conducted with the consent of the patient. Active voluntary euthanasia is legal in Belgium, Luxembourg and the Netherlands. Passive voluntary euthanasia is legal throughout the US per Cruzan v. Director, Missouri Department of Health. When the patient brings about their own death with the assistance of a physician, the term assisted suicide is often used instead. Assisted suicide is legal in Switzerland and the U.S. states of California, Oregon, Washington, Montana and Vermont. Non-voluntary euthanasia Non-voluntary euthanasia is conducted when the consent of the patient is unavailable. Passive euthanasia entails the withholding treatment necessary for the continuance of life. Active euthanasia entails the use of lethal substances or forces (such as administering a lethal injection), and is more controversial. While some authors consider these terms to be misleading and unhelpful, they are nonetheless commonly used. In some cases, such as the administration of increasingly necessary, but toxic doses of painkillers, there is a debate whether or not to regard the practice as active or passive. == History ==
History
'', by Jacques-Louis David (1787), depicting Socrates preparing to drink hemlock, following his conviction for corrupting the youth of Athens Euthanasia was practiced in Ancient Greece and Rome: for example, hemlock was employed as a means of hastening death on the island of Kea, a technique also employed in Massalia. Euthanasia, in the sense of the deliberate hastening of a person's death, was supported by Socrates, Plato and Seneca the Elder in the ancient world, although Hippocrates appears to have spoken against the practice, writing "I will not prescribe a deadly drug to please someone, nor give advice that may cause his death" (noting there is some debate in the literature about whether or not this was intended to encompass euthanasia). The concept of euthanasia in the sense of alleviating the process of death goes back to the medical historian Karl Friedrich Heinrich Marx, who drew on Bacon's philosophical ideas. According to Marx, a doctor had a moral duty to ease the suffering of death through encouragement, support and mitigation using medication. Such an "alleviation of death" reflected the contemporary zeitgeist, but was brought into the medical canon of responsibility for the first time by Marx. Marx also stressed the distinction of the theological care of the soul of sick people from the physical care and medical treatment by doctors. Euthanasia in its modern sense has always been strongly opposed in the Christian tradition. Thomas Aquinas opposed both and argued that the practice of euthanasia contradicted our natural human instincts of survival, as did Francois Ranchin (1565–1641), a French physician and professor of medicine, and Michael Boudewijns (1601–1681), a physician and teacher. Other voices argued for euthanasia, such as John Donne in 1624, and euthanasia continued to be practised. In 1678, the publication of Caspar Questel's De pulvinari morientibus non-subtrahend, ("On the pillow of which the dying should not be deprived"), initiated debate on the topic. Questel described various customs which were employed at the time to hasten the death of the dying, (including the sudden removal of a pillow, which was believed to accelerate death), and argued against their use, as doing so was "against the laws of God and Nature". Beginnings of the contemporary euthanasia debate In the mid-1800s, the use of morphine to treat "the pains of death" emerged, with John Warren recommending its use in 1848. A similar use of chloroform was revealed by Joseph Bullar in 1866. However, in neither case was it recommended that the use should be to hasten death. In 1870 Samuel Williams, a schoolteacher, initiated the contemporary euthanasia debate through a speech given at the Birmingham Speculative Club in England, which was subsequently published in a one-off publication entitled Essays of the Birmingham Speculative Club, the collected works of a number of members of an amateur philosophical society. From there it proved to be influential, and other writers came out in support of such views: Lionel Tollemache wrote in favour of euthanasia, as did Annie Besant, the essayist and reformer who later became involved with the National Secular Society, considering it a duty to society to "die voluntarily and painlessly" when one reaches the point of becoming a 'burden'. Popular Science analyzed the issue in May 1873, assessing both sides of the argument. Kemp notes that at the time, medical doctors did not participate in the discussion; it was "essentially a philosophical enterprise ... tied inextricably to a number of objections to the Christian doctrine of the sanctity of human life". Robert Ingersoll argued for euthanasia, stating in 1894 that where someone is suffering from a terminal illness, such as terminal cancer, they should have a right to end their pain through suicide. Felix Adler offered a similar approach, although, unlike Ingersoll, Adler did not reject religion. In fact, he argued from an Ethical Culture framework. In 1891, Adler argued that those suffering from overwhelming pain should have the right to commit suicide, and, furthermore, that it should be permissible for a doctor to assist – thus making Adler the first "prominent American" to argue for suicide in cases where people were suffering from chronic illness. Both Ingersoll and Adler argued for voluntary euthanasia of adults suffering from terminal ailments. The first attempt to legalise euthanasia took place in the United States, when Henry Hunt introduced legislation into the General Assembly of Ohio in 1906. Hunt did so at the behest of Anna Sophina Hall, a wealthy heiress who was a major figure in the euthanasia movement during the early 20th century in the United States. Hall had watched her mother die after an extended battle with liver cancer, and had dedicated herself to ensuring that others would not have to endure the same suffering. Towards this end she engaged in an extensive letter writing campaign, recruited Lurana Sheldon and Maud Ballington Booth, and organised a debate on euthanasia at the annual meeting of the American Humane Association in 1905 – described by Jacob Appel as the first significant public debate on the topic in the 20th century. Although this event was kept a secret for over 50 years, the death of George V coincided with proposed legislation in the House of Lords to legalise euthanasia. Nazi Euthanasia Program , where over 18,000 people were killed A 24 July 1939 killing of a severely disabled infant in Nazi Germany was described in a BBC "Genocide Under the Nazis Timeline" as the first "state-sponsored euthanasia". The Telegraph noted that the killing of the disabled infant—whose name was Gerhard Kretschmar, born blind, with missing limbs, subject to convulsions, and reportedly "an idiot"— provided "the rationale for a secret Nazi decree that led to 'mercy killings' of almost 300,000 mentally and physically handicapped people". While Kretchmar's killing received parental consent, most of the 5,000 to 8,000 children killed afterwards were forcibly taken from their parents. Its code name Aktion T4 is derived from  4, a street address of the Chancellery department which recruited and paid personnel associated with the program. In modern terms, the use of "euthanasia" in the context of Aktion T4 is seen to be a euphemism to disguise a program of genocide, in which people were killed on the grounds of "disabilities, religious beliefs, and discordant individual values". Compared to the discussions of euthanasia that emerged post-war, the Nazi program may have been worded in terms that appear similar to the modern use of "euthanasia", but there was no "mercy" and the patients were not necessarily terminally ill. The Right Reverend Robert E. McCormick stated that: The petition brought tensions between the American Euthanasia Society and the Catholic Church to a head that contributed to a climate of anti-Catholic sentiment generally, regarding issues such as birth control, eugenics, and population control. However, the petition did not result in any legal changes. ==Debate==
Debate
Historically, the euthanasia debate has tended to focus on a number of key concerns. According to euthanasia opponent Ezekiel Emanuel, proponents of euthanasia have presented four main arguments: a) that people have a right to self-determination, and thus should be allowed to choose their own fate; b) assisting a subject to die might be a better choice than requiring that they continue to suffer; c) the distinction between passive euthanasia, which is often permitted, and active euthanasia, which is not substantive (or that the underlying principle–the doctrine of double effect–is unreasonable or unsound); and d) permitting euthanasia will not necessarily lead to unacceptable consequences. Pro-euthanasia activists often point to countries like the Netherlands and Belgium, and states like Oregon, where euthanasia has been legalized, to argue that it is mostly unproblematic. Similarly, Emanuel argues that there are four major arguments presented by opponents of euthanasia: a) not all deaths are painful; b) alternatives, such as cessation of active treatment, combined with the use of effective pain relief, are available; c) the distinction between active and passive euthanasia is morally significant; and d) legalising euthanasia will place society on a slippery slope, which will lead to unacceptable consequences. In the United States in 2013, 47% nationwide supported doctor-assisted suicide. This included 32% of Latinos and 29% of African-Americans. Some US disability rights organizations have also opposed bills legalizing assisted suicide. A 2015 Populus poll in the United Kingdom found broad public support for assisted dying; 82% of people supported the introduction of assisted dying laws, including 86% of people with disabilities. An alternative approach to the question is seen in the hospice movement which promotes palliative care for the dying and terminally ill. This has pioneered the use of pain-relieving drugs in a holistic atmosphere in which the patient's spiritual care ranks alongside physical care. It 'intends neither to hasten nor postpone death'. ==Legal status==
Legal status
Eligibility for euthanasia varies across jurisdictions where it is legal. Some countries, such as Belgium and the Netherlands, allow euthanasia for mental illness. West's Encyclopedia of American Law states that "a 'mercy killing' or euthanasia is generally considered to be a criminal homicide" and is normally used as a synonym of homicide committed at a request made by the patient. Not all homicide is unlawful. Two designations of homicide that carry no criminal punishment are justifiable and excusable homicide. Physician-assisted suicide is thus not classified as euthanasia by the US State of Oregon, where it is legal under the Oregon Death with Dignity Act, and despite its name, it is not legally classified as suicide either. Unlike physician-assisted suicide, withholding or withdrawing life-sustaining treatments with patient consent (voluntary) is almost unanimously considered, at least in the United States, to be legal. The use of pain medication to relieve suffering, even if it hastens death, has been held as legal in several court decisions. In a historic judgment, the Supreme Court of India legalized passive euthanasia. The apex court remarked in the judgment that the Constitution of India values liberty, dignity, autonomy, and privacy. A bench headed by Chief Justice Dipak Misra delivered a unanimous judgment. Common Cause (India) was the main petitioner in the case, filed in 2005. ==Health professionals' sentiment==
Health professionals' sentiment
A 2010 survey in the United States of more than 10,000 physicians found that 16.3% of physicians would consider halting life-sustaining therapy because the family demanded it, even if they believed that it was premature. Approximately 54.5% would not, and the remaining 29.2% responded "it depends". The study also found that 45.8% of physicians agreed that physician-assisted suicide should be allowed in some cases; 40.7% did not, and the remaining 13.5% felt it depended. Similarly, a 2017 Doctors.net.uk poll reported in the British Medical Journal stated that 55% of doctors believe assisted dying, in defined circumstances, should be legalised in the UK. In 2019, the World Medical Association issued a statement during its 70th Assembly declaring itself opposed to euthanasia and assisted suicide. ==Religious views==
Religious views
Christianity Broadly against A number of Christian denominations take a stance against euthanasia. The Roman Catholic Church condemns euthanasia and assisted suicide as morally wrong. As paragraph 2324 of the Catechism of the Catholic Church states, "Intentional euthanasia, whatever its forms or motives, is murder. It is gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator". Because of this, per the Declaration on Euthanasia, the practice is unacceptable within the Church. The Evangelical-Lutheran Churches teach that "Anything which aims for the death of those who suffer is murder, which God strictly prohibits in His Law." The Orthodox Church in America, along with other Eastern Orthodox Churches, also opposes euthanasia stating that "euthanasia is the deliberate cessation of human life, and, as such, must be condemned as murder." Among Protestant denominations, the Episcopal Church passed a resolution in 1991 opposing euthanasia and assisted suicide stating that it is "morally wrong and unacceptable to take a human life to relieve the suffering caused by incurable illnesses." • Catholic ChurchEvangelical Lutheran Church in America • Methodist Churches • Church of the NazareneSalvation ArmyUnited Methodist ChurchReformed Church in America • Pentecostal Churches • Assemblies of God • Restorationist Churches • The Church of Jesus Christ of Latter-day SaintsSeventh-day Adventist Church The United Church of Canada accepts passive euthanasia under some circumstances, but is in general against active euthanasia, with growing acceptance now that active euthanasia has been partly legalised in Canada. The Waldensians take a liberal stance on euthanasia and allow the decision to lie with individuals. Islam Euthanasia is a complex issue in Islamic theology; however, in general it is considered contrary to Islamic law and holy texts. Among interpretations of the Qur'an and Hadith, the early termination of life is a crime, be it by suicide or helping one commit suicide. The various positions on the cessation of medical treatment are mixed and considered a different class of action than direct termination of life, especially if the patient is suffering. Suicide and euthanasia are both crimes in almost all Muslim majority countries. Judaism There is much debate on the topic of euthanasia in Judaic theology, ethics, and general opinion (especially in Israel and the United States). Passive euthanasia was declared legal by Israel's highest court under certain conditions and has reached some level of acceptance. Active euthanasia remains illegal; however, the topic is actively under debate with no clear consensus through legal, ethical, theological and spiritual perspectives. Hinduism Although there is no absolute consensus, Hinduism generally views euthanasia as a serious act that conflicts with core principles such as Dharma (duty), Karma (actions and their consequences), and Ahimsa (non-violence). ==See also==
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