euthanasia should be legal essay

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Home — Essay Samples — Social Issues — Euthanasia — Why Euthanasia Should Be Legal: Analysis of Arguments and Counterarguments

Why Euthanasia Should Be Legal: Analysis of Arguments and Counterarguments

• Categories: Assisted Suicide Euthanasia Right to Die

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Table of contents

Introduction, why euthanasia should be legal, works cited, counterarguments.

• Corder, Mike. “Dutch Euthanasia Center Sees 22% Rise in Requests in 2019.” WAVY.com, 7 Feb. 2020, www.wavy.com/news/health/dutch-euthanasia-center-sees-22-rise-in-requests-in-2019/. Accessed 10 March 2020.
• Davis, Jacky. “Kevin Davis Deserved Choice.” Dignity in Dying, www.dignityindying.org.uk/story/kevin-davis/. Accessed 13 March 2020.
• De La Torre, Esther B. The Right to Assisted Suicide , www.lonestar.edu/rightto-assist-suicide.htm. Accessed 19 March 2020.
• “Euthanasia Laws - Information on the Law about Euthanasia.” Information on the Law about Euthanasia - Suicide, Life, Act, and Mercy - JRank Articles, law.jrank.org/pages/11858/Euthanasia.html. Accessed 10 March 2020.

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Why Euthanasia Should Be Legal Essay

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Introduction, is euthanasia a solution to poor quality of life, does euthanasia offer the best quality of death, ethical considerations regarding euthanasia, public acceptability of euthanasia, healthcare professionals’ views on euthanasia.

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• 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

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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

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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.

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Thomas D G Frost

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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

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

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• Assisted dying
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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.

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Should Physician-Assisted Suicide or Euthanasia be Legalized in the United States? A Medically Informed Perspective

• IMPRESSIONISTIC REPORTING
• Published: 08 November 2023
• Volume 63 , pages 1058–1074, ( 2024 )

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• W. Craig Fowler 1 , 2 &
• Harold G. Koenig   ORCID: orcid.org/0000-0003-2573-6121 3 , 4 , 5 , 6  

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There is a pressing debate in the United States concerning the implied physicians’ obligation to do no harm and the status of legalizing physician-assisted suicide (PAS). Key issues that underpin the debate are important to consider. These include: (1) foundational medical beginnings; (2) euthanasia’s historical and legal background context; and (3) the key arguments held by those for and against legalization of PAS. This paper reviews the major claims made by proponents for the legalization of PAS and the associated complexities and concerns that help underscore the importance of conscience freedoms. Relief of suffering, respect for patient autonomy, and public policy arguments are discussed in these contexts. We argue here that the emphasis by healthcare providers should be on high quality and compassionate care for those at the end of life’s journey who are questioning whether to prematurely end their lives. If medicine loses its chief focus on the quality of caring—even when a cure is not possible—it betrays its objective and purpose. In this backdrop, legalization of PAS harms not only healthcare professionals, but also the medical profession’s mission itself. Medicine’s foundation is grounded in the concept of never intentionally to inflict harm. Inflicting death by any means is not professional or proper, and is not trustworthy medicine.

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Alliance Vita.org. (2019). Euthanasia in the Netherlands: I.Summary II.Statistical Data III.Legislatioin IV.Large Number of Infringements Recorded V.Laxism of Oversight Bodies VI.Uneasiness from Medical Staff VII.Criticisms from Outside the Netherlands [Review]. Retrieved 3–13–23 from https://www.alliancevita.org/wp-content/uploads/2019/08/euthanasia-in-the-netherlands.pdf

American Academy of Medical Ethics. (2021). AAME Statement on Physician-Assisted Suicide (PAS) and Euthanasia Retrieved 3–13–23 from https://ethicalhealthcare.org/physician-assisted-suicide/

American Medical Association. (2021). Ethics: Physician-Assisted Suicide . AMA. Retrieved 3–13–23 from https://code-medical-ethics.ama-assn.org/ethics-opinions/physician-assisted-suicide

American Osteopathic Association. (2022). Policy Statement H346-A/17: Physician Assisted Death Retrieved 3–13–23 from http://policysearch.wpengine.com/wp-content/uploads/H346-A2017-PHYSICIAN-ASSISTED-DEATH.pdf

American Psychiatric Association (2023). What is depression? Retrieved on 7–22–23 from https://www.psychiatry.org/patients-families/depression/what-is-depression .

Ansseau, M., Dierick, M., Buntinkx, F., Cnockaert, P., De Smedt, J., Van Den Haute, M., & Vander Mijnsbrugge, D. (2004). High prevalence of mental disorders in primary care. Journal of Affective Disorders, 78 (1), 49–55. https://doi.org/10.1016/s0165-0327(02)00219-7

Article   CAS   PubMed   Google Scholar  

Aznar, J. (2021). Opinion of physicians and the general population on the legalization of euthanasia and assisted suicide. Cuadernos De Bioética, 32 (104), 23–36. https://doi.org/10.30444/cb.85

Article   PubMed   Google Scholar  

Barsness, J. G., Regnier, C. R., Hook, C. C., & Mueller, P. S. (2020). US medical and surgical society position statements on physician-assisted suicide and euthanasia: A review. BMC Medical Ethics, 21 (1), 111. https://doi.org/10.1186/s12910-020-00556-5

Article   PubMed   PubMed Central   Google Scholar  

Beville, K. (2014). Dying to kill: a christian perspective on euthanasia and assisted suicide . Christian Publishing House.

Blackstone, E., & Youngner, S. J. (2018). When slippery slope arguments miss the mark: A lesson from one against physician-assisted death. Journal of Medical Ethics, 44 (10), 657–660. https://doi.org/10.1136/medethics-2018-104931

Boer, T. A. (2011). Euthanasia. In Green, J. B., Lapsley, J., Miles, R., & Verhey, A. (eds.), Dictionary of Scripture and ethics . Grand Rapids, MI: Baker Books.

Bollen, J. A. M., Ten Hoopen, R., van der Hoeven, M., Shaw, D., Brierley, J., Ysebaert, D., van Heurn, L. W. E., & van Mook, W. (2019). Organ donation after euthanasia in children: Belgian and Dutch perspectives. Archives of Disease in Childhood, 104 (9), 827–830. https://doi.org/10.1136/archdischild-2018-315560

Boudreau, J. D., & Somerville, M. (2014). Euthanasia and assisted suicide: A physician’s and ethicist’s perspectives. Medicolegal and Bioethics, 4 (1), 1–11. https://doi.org/10.2147/MB.S73197

Article   Google Scholar  

Bridge, J. A., Greenhouse, J. B., Ruch, D., Stevens, J., Ackerman, J., Sheftall, A. H., Horowitz, L. M., Kelleher, K. J., & Campo, J. V. (2020). Association between the release of netflix’s 13 reasons why and suicide rates in the united states: An interrupted time series analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 59 (2), 236–243. https://doi.org/10.1016/j.jaac.2019.04.020

Britannica (2022a). States with Legal Physician-Assisted Suicide. Britannica ProCon . Retrieved 3–13–23 from https://euthanasia.procon.org/states-with-legal-physician-assisted-suicide/

Britannica (2022b). Euthanasia & Physician-Assisted Suicide (PAS) around the World. Britannica ProCon . Retrieved 3–13–23 from https://euthanasia.procon.org/euthanasia-physician-assisted-suicide-pas-around-the-world/

British Medical Association. (2020). Get Informed Have Your Say: Physician-assisted dying 2020 BMA member survey [Information Pack]. Retrieved on 4–20–22 from https://www.bma.org.uk/media/2353/bma-physician-assisted-dying-info-pack-april-2020.pdf

Brown, P. J., Rutherford, B. R., Yaffe, K., Tandler, J. M., Ray, J. L., Pott, E., Chung, S., & Roose, S. P. (2016). The depressed frail phenotype: The clinical manifestation of increased biological aging. American Journal of Geriatric Psychiatry, 24 (11), 1084–1094. https://doi.org/10.1016/j.jagp.2016.06.005

CA (2023). CA to pay $300K for trying to force religious doctors to end patients' lives. Retrieved on 8–2–23 from https://adflegal.org/press-release/ca-pay-300k-trying-force-religious-doctors-end-patients-lives .

Caplan, A. L., & Curlin, F. A. (2017). Physician-Assisted Dying: The Antithesis of Medicine, Says Doc. Retrieved April 20, 2022, from https://www.medscape.com/viewarticle/874232

Chakraborty, R., El-Jawahri, A. R., Litzow, M. R., Syrjala, K. L., Parnes, A. D., & Hashmi, S. K. (2017). A systematic review of religious beliefs about major end-of-life issues in the five major world religions. Palliative & Supportive Care, 15 (5), 609–622. https://doi.org/10.1017/s1478951516001061

CMDA. (2022). Physician—Assisted Suicide. Standards 4 Life, A resource publication of Christian Medical & Dental Associations . https://cmda.org/standards-4-life/

CMDA. (2022). Right of Conscience. Standards 4 Life, A resource publication of Christian Medical & Dental Associations . https://cmda.org/standards-4-life/

Collett, T. S. (2004). Protecting the health care provider's right of conscience. Center for Bioethics and Human Dignity . http://www.cbhd.org/resources/healthcare/collett_2004-04-27

Dahlgren, J. (2015). [Christian doctors and medical students: The issue of freedom of conscience is far greater than the abortion issue]. Lakartidningen, 112 . (Kristna läkare och medicinstuderande:--Frågan om samvetsfrihet är långt större än abortfrågan.)

Dierickx, S., Deliens, L., Cohen, J., & Chambaere, K. (2015). Comparison of the Expression and Granting of Requests for Euthanasia in Belgium in 2007 vs 2013. JAMA Internal Medicine, 175 (10), 1703–1706. https://doi.org/10.1001/jamainternmed.2015.3982

Dugdale, L. S., & Callahan, D. (2017). Assisted death and the public good. Southern Medical Journal, 110 (9), 559–561. https://doi.org/10.14423/smj.0000000000000690

Dugdale, L. S., Lerner, B. H., & Callahan, D. (2019). Pros and cons of physician aid in dying. Yale Jounal of Biology and Medicine, 92 (4), 747–750.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6913818/

Google Scholar  

Euthanasia. (2015). In Compton’s Encyclopedia . Compton’s Encyclopedia.

Fontalis, A., Prousali, E., & Kulkarni, K. (2018). Euthanasia and assisted dying: what is the current position and what are the key arguments informing the debate? Journal of the Royal Society of Medicine, 111 (11), 407–413. https://doi.org/10.1177/0141076818803452

Geisler, N. L. (2010). Christian ethics: Contemporary issues and options . Grand Rapids, MI: Baker Academic.

González, H. M., Vega, W. A., Williams, D. R., Tarraf, W., West, B. T., & Neighbors, H. W. (2010). Depression care in the United States: too little for too few. Archives of General Psychiatry, 67 (1), 37–46. https://doi.org/10.1001/archgenpsychiatry.2009.168

Grudem, W. (2018). Christian Ethics: An Introduction to Biblical Moral Reasoning . Crossway.

Ha, J., & Yang, H.-S. (2021). The Werther effect of celebrity suicides: Evidence from South Korea. PLoS ONE, 16 (4), e0249896–e0249896. https://doi.org/10.1371/journal.pone.0249896

Article   CAS   PubMed   PubMed Central   Google Scholar  

Hagelin, J., Nilstun, T., Hau, J., & Carlsson, H. E. (2004). Surveys on attitudes towards legalisation of euthanasia: importance of question phrasing. Journal of Medical Ethics, 30 (6), 521–523. https://doi.org/10.1136/jme.2002.0025434

Humphry, D. (2011). Final Exit . Norris Lane Press/ERGO.

Jones, D. A., & Paton, D. (2015). How does legalization of physician-assisted suicide affect rates of suicide? Southern Medical Journal, 108 (10), 599–604. https://doi.org/10.14423/smj.0000000000000349

Khawaja, M., & Khawaja, A. (2021). The ethics of dying: deciphering pandemic-resultant pressures that influence elderly patients’ medical assistance in dying (MAiD) decisions. International Journal of Environmental Research and Public Health, 18 (16), 8819. https://doi.org/10.3390/ijerph18168819

Kheriaty, A. (2015). Social contagion effects of physician-assisted suicide: Commentary on “how does legalization of physician-assisted suicide affect rates of suicide?” Southern Meical Journal, 108 (10), 605–606. https://doi.org/10.14423/smj.0000000000000346

Kim, E., & Levy, R. J. (2020). The role of anaesthesiologists in lethal injection: a call to action. Lancet, 395 (10225), 749–754. https://doi.org/10.1016/s0140-6736(19)32986-1

Kirchhoffer, D. G., & Lui, C. W. (2021). Public reasoning about voluntary assisted dying: An analysis of submissions to the Queensland Parliament. Australia. Bioethics, 35 (1), 105–116. https://doi.org/10.1111/bioe.12777

Koenig, H. G. (1993). Legalizing physician-assisted suicide: Some thoughts and concerns. Journal of Family Practice, 37 (2), 171–179.

CAS   PubMed   Google Scholar  

Kussmaul, W. G., 3rd. (2017). The slippery slope of legalization of physician-assisted suicide. Annals of Interal Medicine, 167 (8), 595–596. https://doi.org/10.7326/m17-2072

Lindblad, A., Löfmark, R., & Lynöe, N. (2009). Would physician-assisted suicide jeopardize trust in the medical services? An empirical study of attitudes among the general public in Sweden. Scandinavian Journal of Public Health, 37 (3), 260–264. https://doi.org/10.1177/1403494808098918

Lysaught, M. T., Kotva, J., Lammers, S. E., & Verhey, A. (2012). On Moral Medicine: Theological Perspectives on Medical Ethics . Wm. B. Eerdmans Publishing.

Magelssen, M., Supphellen, M., Nortvedt, P., & Materstvedt, L. J. (2016). Attitudes towards assisted dying are influenced by question wording and order: A survey experiment. BMC Medical Ethics, 17 (1), 24. https://doi.org/10.1186/s12910-016-0107-3

Manning, M. (1998). Euthanasia and Physician-Assisted Suicide : Killing or Caring? Paulist Press.

McCullough, L. B. (2018). Historical dictionary of medical ethics . Rowman & Littlefield.

Meilaender, G. (2020). Bioethics: A Primer for Christians (Fourth (Edition). William B. Eerdmans Publishing Company.

Miles, S. H. (2005). The Hippocratic Oath and the ethics of medicine . Oxford University Press.

Mitchell, A. J., Vaze, A., & Rao, S. (2009). Clinical diagnosis of depression in primary care: a meta-analysis. Lancet, 374 (9690), 609–619. https://doi.org/10.1016/s0140-6736(09)60879-5

Moreland, J.P., & Rae, S.B. (2000). Body & Soul: Human Nature & the Crisis in Ethics . Westmont, IL: IVP Academic.

Nath, U., Regnard, C., Lee, M., Lloyd, K. A., & Wiblin, L. (2021). Physician-assisted suicide and physician-assisted euthanasia: evidence from abroad and implications for UK neurologists. Practical Neurology, 21 (3), 205–211. https://doi.org/10.1136/practneurol-2020-002811

Nelson, T., & Anderson, J. K. (1997). Moral dilemmas . Nashville, Tennessee: Thomas Nelson.

Niederkrotenthaler, T., Braun, M., Pirkis, J., Till, B., Stack, S., Sinyor, M., Tran, U. S., Voracek, M., Cheng, Q., Arendt, F., Scherr, S., Yip, P. S. F., & Spittal, M. J. (2020). Association between suicide reporting in the media and suicide: systematic review and meta-analysis. British Medical Journal, 368 , m575. https://doi.org/10.1136/bmj.m575

Niederkrotenthaler, T., Kirchner, S., Till, B., Sinyor, M., Tran, U. S., Pirkis, J., & Spittal, M. J. (2021). Systematic review and meta-analyses of suicidal outcomes following fictional portrayals of suicide and suicide attempt in entertainment media. EClinicalMedicine, 36 , 100922–100922. https://doi.org/10.1016/j.eclinm.2021.100922

Oregon Public Health Division, C. F. H. S. (2022). Oregon Death with Dignity Act : 2021 Data Summary . Retrieved 3–13–23 from https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year24.pdf

Pesut, B., Greig, M., Thorne, S., Storch, J., Burgess, M., Tishelman, C., Chambaere, K., & Janke, R. (2020). Nursing and euthanasia: A narrative review of the nursing ethics literature. Nursing Ethics, 27 (1), 152–167. https://doi.org/10.1177/0969733019845127

Pirkis, J., Blood, R. W., Beautrais, A., Burgess, P., & Skehans, J. (2006). Media guidelines on the reporting of suicide. Crisis, 27 (2), 82–87. https://doi.org/10.1027/0227-5910.27.2.82

Rae, S. B. (2009). Moral Choices: An Introduction To Ethics (Third (Edition). Zondervan.

Rajkumar, R. P. (2021). Physician-assisted suicide in dementia: Paradoxes, pitfalls and the need for prudence. Frontiers in Sociology, 6 , 815233. https://doi.org/10.3389/fsoc.2021.815233

Reidenberg, D., Niederkrotenthaler, T., Sinyor, M., Bridge, J. A., & Till, B. (2020). 13 Reasons why: The evidence is in and cannot be ignored. Journal of the American Academy of Child and Adolescent Psychiatry, 59 (9), 1016–1018. https://doi.org/10.1016/j.jaac.2020.01.019

Rosenstein, D. L. (2011). Depression and end-of-life care for patients with cancer. Dialogues in Clinical Neuroscience, 13 (1), 101–108. https://doi.org/10.31887/DCNS.2011.13.1/drosenstein

Sade, R. M., & Kavarana, M. N. (2017). Surgical ethics: today and tomorrow. Future Cardiology, 13 (6), 567–578. https://doi.org/10.2217/fca-2017-0057

SB 471 (2023). SB 471. Refusal of end-of-life options Act. Retrieved on 8–2–23 from https://nmlegis.gov/Legislation/Legislation?Chamber=S&LegType=B&LegNo=471&year=23 .

Schemmer, K. E. (2012). Tinkering With People: What You Need to Know About the Medical Ethics Crisis . Xulon Press.

Simpson, A. I. F. (2018). Medical assistance in dying and mental health: A legal, ethical, and clinical analysis. Canadian Journal of Psychiatry, 63 (2), 80–84. https://doi.org/10.1177/0706743717746662

Sulmasy, D. P., Finlay, I., Fitzgerald, F., Foley, K., Payne, R., & Siegler, M. (2018). Physician-assisted suicide: Why neutrality by organized medicine is neither neutral nor appropriate. Journal of General Internal Medicine, 33 (8), 1394–1399. https://doi.org/10.1007/s11606-018-4424-8

Sulmasy, D. P., Travaline, J. M., Mitchell, L. A., & Ely, E. W. (2016). Non-faith-based arguments against physician-assisted suicide and euthanasia. The Linacre Quarterly, 83 (3), 246–257. https://doi.org/10.1080/00243639.2016.1201375

Sulmasy, L. S., & Mueller, P. S. (2017). Ethics and the Legalization of Physician-Assisted Suicide: An American College of Physicians Position Paper. Annals of Internal Medicine, 167 (8), 576–578. https://doi.org/10.7326/m17-0938

Till, B., Strauss, M., Sonneck, G., & Niederkrotenthaler, T. (2015). Determining the effects of films with suicidal content: a laboratory experiment. British Journal of Psychiatry, 207 (1), 72–78. https://doi.org/10.1192/bjp.bp.114.152827

Tylee, A., & Gandhi, P. (2005). The importance of somatic symptoms in depression in primary care. Primary Care Companion to the Journal of Clinical Psychiatry, 7 (4), 167–176. https://doi.org/10.4088/pcc.v07n0405

World Medical Association. (2021). WMA declaration on euthanasia and physician-assisted suicide . World Medical Association. https://www.wma.net/policies-post/declaration-on-euthanasia-and-physician-assisted-suicide/

Zworth, M., Saleh, C., Ball, I., Kalles, G., Chkaroubo, A., Kekewich, M., Miller, P. Q., Dees, M., Frolic, A., & Oczkowski, S. (2020). Provision of medical assistance in dying: A scoping review. British Medical Journal Open, 10 (7), e036054. https://doi.org/10.1136/bmjopen-2019-036054

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Acknowledgements

Both authors acknowledge that they are opposed to physician-assisted suicide (which some call voluntary euthanasia) and all other forms of euthanasia except certain forms of passive euthanasia, where the competent patient decides to refuses life-sustaining measures such as CPR, medication, food, and/or water at the end-of-life to hasten their death.

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Fowler, W.C., Koenig, H.G. Should Physician-Assisted Suicide or Euthanasia be Legalized in the United States? A Medically Informed Perspective. J Relig Health 63 , 1058–1074 (2024). https://doi.org/10.1007/s10943-023-01939-9

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Intelligence Squared U.S.

Debate: should physician-assisted suicide be legal.

Bioethicist Peter Singer argues that, under certain circumstances, people should have the right to die at a time of their choosing. Samuel La Hoz/Intelligence Squared U.S. hide caption

Bioethicist Peter Singer argues that, under certain circumstances, people should have the right to die at a time of their choosing.

Since Oregon legalized physician-assisted suicide for the terminally ill in 1997, more than 700 people have taken their lives with prescribed medication — including Brittany Maynard, a 29-year-old with an incurable brain tumor, who ended her life earlier this month.

Advocates of assisted-suicide laws believe that mentally competent people who are suffering and have no chance of long-term survival, should have the right to die if and when they choose. If people are have the right to refuse life-saving treatments, they argue, they should also have the freedom to choose to end their own lives.

Opponents say that such laws devalue human life. Medical prognoses are often inaccurate, they note — meaning people who have been told they will soon die sometimes live for many months or even years longer. They also argue that seriously ill people often suffer from undiagnosed depression or other mental illnesses that can impair their ability to make an informed decision.

At the latest event from Intelligence Squared U.S. , two teams addressed these questions while debating the motion, "Legalize Assisted Suicide."

Before the debate, the audience at the Kaufman Music Center in New York was 65 percent in favor of the motion and 10 percent against, with 25 percent undecided. After the debate, 67 percent favored the motion, with 22 percent against, making the team arguing against the motion the winner of this debate.

Those debating:

Web Resources

FOR THE MOTION

Peter Singer is a philosopher and author, best known for his work in ethics. He is the Ira W. DeCamp Professor of Bioethics in the University Center for Human Values at Princeton University, a position that he now combines with the part-time position of Laureate Professor at the University of Melbourne. Some of his more recent books include The Point of View of the Universe and The Life You Can Save: Acting Now to End World Poverty . In 2014 the Gottlieb Duttweiler Institute ranked him third on its list of Global Thought Leaders, and Time has ranked him among the world's 100 most influential people. An Australian, in 2012 he was made a Companion to the Order of Australia, his country's highest civilian honor.

Andrew Solomon is a writer, lecturer and a professor of clinical psychology at Columbia University. Solomon's newest book, Far From the Tree: Parents, Children, and the Search for Identity , won the National Book Critics Circle award for nonfiction and was chosen as one of the New York Times "Ten Best Books" of 2012. Solomon's previous book, The Noonday Demon: An Atlas of Depression won the National Book Award for nonfiction and was a finalist for the Pulitzer Prize. He is a director of the University of Michigan Depression Center and Columbia Psychiatry; a member of the board of visitors of Columbia University Medical Center; serves on the national advisory board of the Depression Center at the University of Michigan, and on the advisory board of the Depression and Bipolar Support Alliance. In 2011, he was appointed special advisor on Lesbian, Gay, Bisexual, and Transgender Mental Health at the Yale School of Psychiatry.

Dr. Daniel Sulmasy, with debate partner Ilora Finlay, argues that policies legalizing physician-assisted suicide are unethical. Samuel LaHoz/Intelligence Squared U.S. hide caption

Dr. Daniel Sulmasy, with debate partner Ilora Finlay, argues that policies legalizing physician-assisted suicide are unethical.

AGAINST THE MOTION

Baroness Ilora Finlay , a leading palliative care physician, is president of the British Medical Association, president of the Chartered Society of Physiotherapy, and is a past president of the Royal Society of Medicine. She has led the Palliative Care Strategy Implementation Board in Wales since 2008, and chaired the Welsh Medical and Dental Academic Advisory Board since 2012. Finlay was a general practitioner in inner-city Glasgow before returning to Cardiff to work full-time in care of the terminally ill. She works at the Velindre Cancer Centre, covering South East Wales when clinically on call. Finlay started the Marie Curie Hospice in Wales and since 2008 has responsibility on behalf of Welsh Government for strategic oversight of all hospice and palliative care services in Wales. Since 2001, Finlay has been an Independent Crossbench Peer in the House of Lords.

Dr. Daniel Sulmasy is the Kilbride-Clinton Professor of Medicine and Ethics in the Department of Medicine and Divinity School at the University of Chicago, where he serves as associate director of the MacLean Center for Clinical Medical Ethics and as director of the Program on Medicine and Religion. Sulmasy was appointed to the Presidential Commission for the Study of Bioethical Issues by President Obama in 2010. His research interests encompass both theoretical and empirical investigations of the ethics of end-of-life decision-making, ethics education and spirituality in medicine. He is the author or editor of six books, including Safe Passage: A Global Spiritual Sourcebook for Care at the End of Life . He also serves as editor-in-chief of the journal, Theoretical Medicine and Bioethics .

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The pros and cons of legalising euthanasia

Help to end suffering for terminal patients could put disabled, elderly and unwell people at risk, opponents warn

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Pro: an end to suffering

Con: losing legal protection, pro: ending 'mercy killings', con: 'slippery slope', pro: shifting opinion, con: religious concerns.

 Demonstrations calling for the decriminalisation of assisted dying are to take place in central London today to coincide with a debate among MPs in Westminster.

The Commons debate – which will not be followed by a vote – was triggered after a petition backed by campaigner Esther Rantzen gained more than 200,000 signatures.

Rantzen, who has stage four lung cancer, revealed last year that she had joined the assisted dying clinic Dignitas, in Switzerland, but that under current UK law her family could be at risk of prosecution if they helped her travel there to end her life.

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"The Great British Bake Off" judge Prue Leith, actor Susan Hampshire and rights campaigner Peter Tatchell are all expected to attend the protests calling for a change in the law. A previous bill in favour of assisted dying was defeated in the Commons by 330 votes to 118 in 2015.

Also known as euthanasia , assisted dying is a controversial issue for legislatures worldwide, with widely cited arguments both for and against a practice that is legal in some countries while totally taboo in others.

It is currently banned in England, Wales, and Northern Ireland – although not a specific criminal offence in Scotland – and carries a maximum prison sentence of 14 years.

Allowing patients to end their suffering is not only morally justified but also essential to upholding the right to personal and bodily autonomy, advocates argue.

A major parliamentary inquiry set up last year to explore whether assisted dying should be legalised in the UK received tens of thousands of submissions from people facing "uncontrollable" pain and "unbearable suffering", which palliative care alone cannot fix,  The Guardian reported.

Paul Lamb, a paralysed former builder from Leeds who died in June 2021, had  lost his legal case to challenge UK laws on assisted dying seven months earlier.

"I cannot understand, in a civilised society like ours, why I should be forced to suffer when millions of people around the world already have the choice I asked for," he said in November 2020.

It is currently a criminal offence under the 1961 Suicide Act to help someone take their own life, punishable by up to 14 years in prison.

Some people believe that legalising euthanasia would put too much power in the hands of doctors, who could abuse their position, or relatives.

Rita Marker, executive director of the International Task Force on Euthanasia and Assisted Suicide in the US, has argued: "Euthanasia and assisted suicide are not about the right to die. They are about the right to kill."

The UK's anti-euthanasia  Care Not Killing alliance said that the law is also in place to protect the vulnerable "from being pressured into ending their lives".

Making her case against any law change, Ilora Finlay, a crossbench peer and palliative care physician, told the parliamentary inquiry that legalising euthanasia in Britain could result in between 5,800 and 58,000 assisted deaths a year, based on extrapolated data from countries where it is already legal. "Such demand would divert an already stretched workforce of NHS clinicians," she said. 

According to  Dignity in Dying , 44% of people would break the law and help a loved one to die, risking 14 years in prison.

In 2022 the Crown Prosecution Service (CPS) said it was considering revising its stance on so-called mercy killings so that defendants are less likely to face criminal charges.

"We are not decriminalising any offence," Max Hill, director of public prosecutions and head of the CPS, told the  i news site, but in offences "born solely out of compassion", justice can sometimes "be achieved by not prosecuting".

Campaigners claim that UK police are also increasingly turning a blind eye to people travelling to other countries to assist loved ones to end their life.

Opponents argue that normalising euthanasia would be a move towards legalised murder.

This "slippery slope is real", said James Mildred of Care (Christian Action Research and Education), which campaigns against assisted suicide. In a 2018 article in  The Economist , Mildred cited "a steady increase year on year in the number of people being killed or helped to commit suicide by their doctors" in countries that have legalised assisted suicide, as the rules are loosened over time.

"Critics say this is happening in Canada," said  New Scientist , "with the criteria for assisted dying having expanded once already and a further change planned for next year." Canada, which introduced Medical Assistance in Dying, or MAID, in 2016, has seen the number of people choosing to end their life rise steadily ever since, with  MAID deaths comprising 4.1% of all deaths in 2022. 

There has been a significant shift in recent years among both the public and professional medical opinion regarding assisted dying for people with a terminal illness.

Polling for  The Guardian last August found 65% of people in the UK believe it should become legal for a doctor to assist an adult of sound mind with less than six months to live to voluntarily end their own life, subject to High Court confirmation.

Dignity in Dying claims this number is even higher, and also that 54% of GPs are supportive or neutral to a law change on assisted dying. 

Many religious people, especially Catholics, believe that life is the ultimate gift and that taking that away is usurping power that belongs to God only. 

In 2020, the Vatican reiterated the Roman Catholic Church's opposition to assisted suicide and euthanasia, describing them as "intrinsically evil" acts "in every situation or circumstance",  The New York Times reported. 

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BOSS Magazine

Studying The Reasons Why Euthanasia Should Be Legal

Explore the compelling reasons why euthanasia should be legal. Learn the multifaceted debate surrounding the topic and the arguments that underscore compassion.

by BOSS Editorial | Published: August 21, 2023 | Updated: August 21, 2023 2:22 pm

Euthanasia basically means a painless death. It is an intentional practice to end someone’s life to limit their suffering. It is due to unbearable pain or a terminal illness. But the specific circumstances of physician-assisted death vary. The practice is also regulated in the jurisdictions where it is legal.

Many people argue euthanasia should be legal since it ends the suffering of terminally ill patients. But, whether the practice should be legal involves several factors. Individual rights, medical ethics, and the preservation of human dignity. Here’s a more in-depth look at these aspects.

What Is Euthanasia?

To understand euthanasia better, it means ending a person’s life to limit their suffering. For example, people who are terminally ill give their consent to a physician to euthanize them. The entire procedure is done in the presence of many medical professionals. It also involves ethical consideration, patient consent, psychological evaluation, and documentation.

College students often debate if euthanasia should be legalized, especially when writing research papers. Even specialists in the field don’t always agree on the issue. Students can prepare their euthanasia essays by using free examples provided by experts for submission in college. The samples include expert opinions both for and against the issue. You can familiarize yourself with each point in the paper and draw your own conclusions on the topic. After all, professors value undergraduates’ own opinions on the essays.

Forms of euthanasia

There are various forms of euthanasia:

• Voluntary:   A person wishes to end life due to suffering. It is considered a voluntary decision and should be respectfully carried out.
• Non-Voluntary: A family member or medical professional usually makes decisions on the patient’s behalf. Because the patient is in a state where they cannot provide consent.
• Involuntary: The most debatable and morally unacceptable form. It involves ending a person’s life against their wishes or without their knowledge.
• Active: Taking active steps to end a person’s life by administering lethal doses of medication.
• Passive: Allowing a person to die by withholding or withdrawing life support.
• Assisted: Prescribing a lethal dose of medication that the person can self-administer. It is considered a distinct form of active euthanasia and is legal in some jurisdictions.
• Physician-Assisted: A medical professional provides the means for a patient to end their life.

Understanding The Controversial Nature Of Euthanasia

The human euthanasia debate stems from various factors. Some of the key reasons that make it controversial include:

#1 – Ethical Dilemma

Euthanasia is about ending a person’s life. It raises questions about the value of human life, autonomy, and the balance between preserving life and alleviating suffering.

#2 – Religious Beliefs

Ending a life is morally wrong. Many religious traditions have strong arguments for physician-assisted death. They believe life is holy and gifted by God. It shouldn’t be taken away by human will.

#3 – Legal Implications

The laws surrounding assisted dying differ across states and countries. Some places allow various forms, while others prohibit the procedure entirely.

#4 – Societal Differences

People have different mentalities towards death, autonomy, and the role of medicine. It leads to contrasting opinions and arguments for euthanasia.

Examining The Debate About Euthanasia Legalization

The debate on whether euthanasia should be legal in all states sheds light on various perspectives. Those who support the notion focus on the right to refuse care, the burden on caregivers, compassion, and more.

A person has the right to refuse medical treatment, including treatment that prolongs life. For example, a person who has blood cancer can refuse treatment. It leads to passive euthanasia. Also, many people suffer from incurable, degenerative, and disabling conditions. Caregivers or family members file petitions about the huge financial, emotional, and social burden.

Essay examples about euthanasia legalization show a society’s empathy towards the sufferer. It emphasizes the essential requirement of comprehensive regulations. Laws are necessary to prevent potential abuses. It makes sure the practice proceeds over controlled circumstances. Some countries where assisted death is legal are the Netherlands and Belgium.

The Pros And Cons of Legalizing Euthanasia

Research papers on euthanasia involve both the advantages and disadvantages of the procedure. Here are the most vital points.

• It respects an individual’s right to make decisions about their life.
• It offers an option to relieve suffering and pain in the case of a terminal illness.
• Reduces the burden on families who can’t afford the expenses associated with prolonged end-of-life care.
• Encourages organ transplantation.
• Human life is gifted to us once. Religious people believe only God is entitled to take it back.
• The ethical responsibility of medical professionals is to preserve life and promote healing.
• Vulnerable individuals may be forced to end their lives.
• Legalizing euthanasia may divert attention and resources from developing better patient care.

Arguments In Favor Of Legalizing Euthanasia

The ongoing debate sheds light on compelling reasons why euthanasia should be legal . To begin with, it alleviates unendurable pain and suffering. For patients with terminal illnesses, it is a humane alternative to agony. Further, the procedure respects an individual’s right to their body. It forms the cornerstone of modern ethics. Euthanasia also preserves a patient’s quality of life. Individuals get to choose a dignified way to escape conditions that rob them of happiness.

Furthermore, mercy killing reduces the burden on families. Prolonged treatment might be costly in some instances. Legalizing physician-assisted death alleviates the burden of caregiving. It reflects a compassionate response to the plight of those in insurmountable pain.

Final Thoughts

The topic of legalizing euthanasia is a complicated and ethically charged one. A clash of values, principles, and beliefs happens. Supporters argue legalization upholds the ideals of compassion, personal autonomy, and relief from extreme suffering. But reasons to be against euthanasia focus on the sanctity of life, the potential slippery slopes, and the ethical obligation of medical professionals.

Deciding to legalize the procedure involves analyzing the pros and cons. The different cultural and religious points of view should be carefully considered. It will be a balancing act between safeguarding individual autonomy and protecting vulnerable individuals.

By: BOSS Editorial

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Legalizing euthanasia or assisted suicide: the illusion of safeguards and controls

Euthanasia or assisted suicide—and sometimes both—have been legalized in a small number of countries and states. In all jurisdictions, laws and safeguards were put in place to prevent abuse and misuse of these practices. Prevention measures have included, among others, explicit consent by the person requesting euthanasia, mandatory reporting of all cases, administration only by physicians (with the exception of Switzerland), and consultation by a second physician.

The present paper provides evidence that these laws and safeguards are regularly ignored and transgressed in all the jurisdictions and that transgressions are not prosecuted. For example, about 900 people annually are administered lethal substances without having given explicit consent, and in one jurisdiction, almost 50% of cases of euthanasia are not reported. Increased tolerance of transgressions in societies with such laws represents a social “slippery slope,” as do changes to the laws and criteria that followed legalization. Although the initial intent was to limit euthanasia and assisted suicide to a last-resort option for a very small number of terminally ill people, some jurisdictions now extend the practice to newborns, children, and people with dementia. A terminal illness is no longer a prerequisite. In the Netherlands, euthanasia for anyone over the age of 70 who is “tired of living” is now being considered. Legalizing euthanasia and assisted suicide therefore places many people at risk, affects the values of society over time, and does not provide controls and safeguards.

1. INTRODUCTION

Euthanasia is generally defined as the act, undertaken only by a physician, that intentionally ends the life of a person at his or her request 1 , 2 . The physician therefore administers the lethal substance. In physician-assisted suicide ( pas ) on the other hand, a person self-administers a lethal substance prescribed by a physician.

To date, the Netherlands, Belgium, and Luxembourg have legalized euthanasia 1 , 2 . The laws in the Netherlands and Luxembourg also allow pas . In the United States, the states of Oregon and Washington legalized pas in 1997 and 1999 respectively, but euthanasia remains illegal 3 . The situation in the state of Montana is currently unclear; a bill legalizing pas was passed by the state legislature in 2010, but was recently defeated by the state’s Senate Judiciary Committee.

In the Netherlands, euthanasia and pas were formally legalized in 2001 after about 30 years of public debate 1 . Since the 1980s, guidelines and procedures for performing and controlling euthanasia have been developed and adapted several times by the Royal Dutch Medical Association in collaboration with that country’s judicial system. Despite opposition, including that from the Belgian Medical Association, Belgium legalized euthanasia in 2002 after about 3 years of public discourse that included government commissions. The law was guided by the Netherlands and Oregon experiences, and the public was assured that any defects in the Dutch law would be addressed in the Belgian law. Luxembourg legalized euthanasia and pas in 2009. Switzerland is an exception, in that assisted suicide, although not formally legalized, is tolerated as a result of a loophole in a law dating back to the early 1900s that decriminalizes suicide. Euthanasia, however, is illegal 4 . A person committing suicide may do so with assistance as long as the assistant has no selfish motives and does not stand to gain personally from the death. Unlike other jurisdictions that require euthanasia or assisted suicide to be performed only by physicians, Switzerland allows non-physicians to assist suicide.

In all these jurisdictions, safeguards, criteria, and procedures were put in place to control the practices, to ensure societal oversight, and to prevent euthanasia and pas from being abused or misused 5 . Some criteria and procedures are common across the jurisdictions; others vary from country to country 5 , 6 . The extent to which these controls and safeguards have been able to control the practices and to avoid abuse merits closer inspection, particularly by jurisdictions contemplating the legalization of euthanasia and pas . The present paper explores the effectiveness of the safeguards and the “slippery slope” phenomenon.

2. SAFEGUARDS AND THEIR EFFECTIVENESS

2.1. voluntary, written consent.

In all jurisdictions, the request for euthanasia or pas has to be voluntary, well-considered, informed, and persistent over time. The requesting person must provide explicit written consent and must be competent at the time the request is made. Despite those safeguards, more than 500 people in the Netherlands are euthanized involuntarily every year. In 2005, a total of 2410 deaths by euthanasia or pas were reported, representing 1.7% of all deaths in the Netherlands. More than 560 people (0.4% of all deaths) were administered lethal substances without having given explicit consent 7 . For every 5 people euthanized, 1 is euthanized without having given explicit consent. Attempts at bringing those cases to trial have failed, providing evidence that the judicial system has become more tolerant over time of such transgressions 5 .

In Belgium, the rate of involuntary and non-voluntary euthanasia deaths (that is, without explicit consent) is 3 times higher than it is in the Netherlands 8 , 9 . (“Involuntary euthanasia” refers to a situation in which a person possesses the capacity but has not provided consent, and “non-voluntary euthanasia,” to a situation in which a person is unable to provide consent for reasons such as severe dementia or coma). A recent study found that in the Flemish part of Belgium, 66 of 208 cases of “euthanasia” (32%) occurred in the absence of request or consent 10 . The reasons for not discussing the decision to end the person’s life and not obtaining consent were that patients were comatose (70% of cases) or had dementia (21% of cases). In 17% of cases, the physicians proceeded without consent because they felt that euthanasia was “clearly in the patient’s best interest” and, in 8% of cases, that discussing it with the patient would have been harmful to that patient. Those findings accord with the results of a previous study in which 25 of 1644 non-sudden deaths had been the result of euthanasia without explicit consent 8 .

Some proponents of euthanasia contend that the foregoing figures are misrepresentative, because many people may have at some time in their lives expressed a wish for or support of euthanasia, albeit not formally. The counterargument is that the legal requirement of explicit written consent is important if abuse and misuse are to be avoided. After all, written consent has become essential in medical research when participants are to be subjected to an intervention, many of which pose far lesser mortality risks. Recent history is replete with examples of abuse of medical research in the absence of explicit informed consent.

2.2. Mandatory Reporting

Reporting is mandatory in all the jurisdictions, but this requirement is often ignored 11 , 12 . In Belgium, nearly half of all cases of euthanasia are not reported to the Federal Control and Evaluation Committee 13 . Legal requirements were more frequently not met in unreported cases than in reported cases: a written request for euthanasia was more often absent (88% vs. 18%), physicians specialized in palliative care were consulted less often (55% vs. 98%), and the drugs were more often administered by a nurse (41% vs. 0%). Most of the unreported cases (92%) involved acts of euthanasia, but were not perceived to be “euthanasia” by the physician. In the Netherlands, at least 20% of cases of euthanasia go unreported 7 . That number is probably conservative because it represents only cases that can be traced; the actual number may be as high as 40% 14 . Although reporting rates have increased from pre-legalization in 2001, 20% represents several hundred people annually.

2.3. Only by Physicians

The involvement of nurses gives cause for concern because all the jurisdictions, with the exception of Switzerland, require that the acts be performed only by physicians. In a recent study in Flanders, 120 nurses reported having cared for a patient who received life-ending drugs without explicit request 15 . Nurses performed the euthanasia in 12% of the cases and in 45% of the cases without explicit consent. In many instances, the physicians were absent. Factors significantly associated with a nurse administering the life-ending drugs included the nurse being a male working in a hospital and the patient being over 80 years of age.

2.4. Second Opinion and Consultation

All jurisdictions except for Switzerland require a consultation by a second physician to ensure that all criteria have been met before proceeding with euthanasia or pas . In Belgium, a third physician has to review the case if the person’s condition is deemed to be non-terminal. The consultant must be independent (not connected with the care of the patient or with the care provider) and must provide an objective assessment. However, there is evidence from Belgium, the Netherlands, and Oregon that this process is not universally applied 10 , 13 . In the Netherlands, for example, a consultation was not sought in 35% of cases of involuntary euthanasia 7 . In 1998 in the Netherlands, 25% of patients requesting euthanasia received psychiatric consultation; in 2010 none did 16 . Moreover, non-reporting seems to be associated with a lack of consultation by a second doctor 14 .

In Oregon, a physician member of a pro-assisted-suicide lobby group provided the consultation in 58 of 61 consecutive cases of patients receiving pas in Oregon 17 . This raises concerns about the objectivity of the process and the safety of the patients, and raises questions about the influence of bias on the part of these physicians on the process.

Networks of physicians trained to provide the consultation role when euthanasia is sought have been established in the Netherlands (Support and Consultation on Euthanasia in the Netherlands) and Belgium [Life End Information Forum ( leif )] 18 . Their role includes ensuring that the person is informed of all options, including palliative care. However, most leif physicians have simply followed a 24-hour theoretical course, of which only 3 hours are related to palliative care, hardly sufficient to enable a leif member to provide adequate advice on complex palliative care needs 19 . The development of expertise in palliative care, as in any other specialty, requires a considerable amount of time. In the United Kingdom, it involves a 4-year residency program, and in Australia and the United States, 3 years.

Oregon requires that a patient be referred to a psychiatrist or psychologist for treatment if the prescribing or consulting physician is concerned that the patient’s judgment is impaired by a mental disorder such as depression. In 2007, none of the people who died by lethal ingestion in Oregon had been evaluated by a psychiatrist or a psychologist 20 , despite considerable evidence that, compared with non-depressed patients, patients who are depressed are more likely to request euthanasia and that treatment for depression will often result in the patient rescinding the request 21 – 23 . In a study of 200 terminally ill cancer patients, for example, the prevalence of depressive syndromes was 59% among patients with a pervasive desire to die, but only 8% among patients without such a desire 21 . Despite that finding, many health professionals and family members of patients in Oregon who pursue pas generally do not believe that depression influences the choice for hastened death 24 .

A recent Oregon-based study demonstrated that some depressed patients are slipping through the cracks 25 . Among terminally ill patients who received a prescription for a lethal drug, 1 in 6 had clinical depression. Of the 18 patients in the study who received a prescription for the lethal drug, 3 had major depression, and all of them went on to die by lethal ingestion, but had been assessed by a mental health specialist.

There is evidence, therefore, that safeguards are ineffective and that many people who should not be euthanized or receive pas are dying by those means. Of concern, too, is the fact that transgressions of the laws are not prosecuted and that the tolerance level for transgressions of the laws has increased. Moreover, as the next section will explore, the boundaries of what constitutes “good” practices with respect to euthanasia and pas continue to change, and some of the current practices would just a few decades ago have been considered unacceptable in those jurisdictions that have legalized the practices.

3. THE “SLIPPERY SLOPE” ARGUMENT

The “slippery slope” argument, a complex legal and philosophical concept, generally asserts that one exception to a law is followed by more exceptions until a point is reached that would initially have been unacceptable. The “slippery slope” argument has, however, several interpretations 26 , some of which are not germane to the euthanasia discussion. The interpretations proposed by Keown in 2002 27 appear very relevant, however. He refers to these collectively as a “practical slippery slope,” although the term “social slippery slope” may be more applicable. The first interpretation postulates that acceptance of one sort of euthanasia will lead to other, even less acceptable, forms of euthanasia. The second contends that euthanasia and pas , which originally would be regulated as a last-resort option in only very select situations, could, over time, become less of a last resort and be sought more quickly, even becoming a first choice in some cases.

The circumvention of safeguards and laws, with little if any prosecution, provides some evidence of the social slippery slope phenomenon described by Keown 5 , 28 . Till now, no cases of euthanasia have been sent to the judicial authorities for further investigation in Belgium. In the Netherlands, 16 cases (0.21% of all notified cases) were sent to the judicial authorities in the first 4 years after the euthanasia law came into effect; few were investigated, and none were prosecuted 5 . In one case, a counsellor who provided advice to a non-terminally ill person on how to commit suicide was acquitted 29 . There has therefore been an increasing tolerance toward transgressions of the law, indicating a change in societal values after legalization of euthanasia and assisted suicide.

In the 1987 preamble to its guidelines for euthanasia, the Royal Dutch Medical Association had written “If there is no request from the patient, then proceeding with the termination of his life is [juristically] a matter of murder or killing, and not of euthanasia.” By 2001, the association was supportive of the new law in which a written wish in an advance directive for euthanasia would be acceptable, and it is tolerant of non-voluntary and involuntary euthanasia 7 , 30 , 31 . However, basing a request on an advance directive or living will may be ethically problematic because the request is not contemporaneous with the act and may not be evidence of the will of the patient at the time euthanasia is carried out.

Initially, in the 1970s and 1980s, euthanasia and pas advocates in the Netherlands made the case that these acts would be limited to a small number of terminally ill patients experiencing intolerable suffering and that the practices would be considered last-resort options only. By 2002, euthanasia laws in neither Belgium nor the Netherlands limited euthanasia to persons with a terminal disease (recognizing that the concept of “terminal” is in itself open to interpretation and errors). The Dutch law requires only that a person be “suffering hopelessly and unbearably.” “Suffering” is defined as both physical and psychological, which includes people with depression. In Belgium, the law ambiguously states that the person “must be in a hopeless medical situation and be constantly suffering physically or psychologically.” By 2006, the Royal Dutch Medical Association had declared that “being over the age of 70 and tired of living” should be an acceptable reason for requesting euthanasia 32 . That change is most concerning in light of evidence of elder abuse in many societies, including Canada 33 , and evidence that a large number of frail elderly people and terminally ill patients already feel a sense of being burden on their families and society, and a sense of isolation. The concern that these people may feel obliged to access euthanasia or pas if it were to become available is therefore not unreasonable, although evidence to verify that concern is not currently available.

In Oregon, although a terminal illness with a prognosis of less than 6 months to live has to be present, intolerable suffering that cannot be relieved is not a basic requirement (again recognizing that the concept of “intolerable suffering” is in itself ambiguous). This definition enables physicians to assist in suicide without inquiring into the source of the medical, psychological, social, and existential concerns that usually underlie requests for assisted suicide. Physicians are required to indicate that palliative care is a feasible alternative, but are not required to be knowledgeable about how to relieve physical or emotional suffering.

Until 2001, the Netherlands allowed only adults access to euthanasia or pas . However, the 2001 law allowed for children aged 12–16 years to be euthanized if consent is provided by their parents, even though this age group is generally not considered capable of making such decisions 5 . The law even allows physicians to proceed with euthanasia if there is disagreement between the parents. By 2005, the Groningen Protocol, which allows euthanasia of newborns and younger children who are expected to have “no hope of a good quality of life,” was implemented 34 , 35 . In 2006, legislators in Belgium announced their intention to change the euthanasia law to include infants, teenagers, and people with dementia or Alzheimer disease 36 .

In Belgium, some critical care specialists have opted to ignore the requirement that, in the case of non-terminally-ill patients, an interval of 1 month is required from the time of a first request until the time that euthanasia is performed. One specialist reported that, in his unit, the average time from admission until euthanasia was performed for patients that seemed to be in a “hopeless” situation was about 3.5 days 37 . Beneficence, this specialist argued, was the overriding principle.

Initially, euthanasia in the Netherlands was to be a last-resort option in the absence of other treatment options. Surprisingly, however, palliative care consultations are not mandatory in the jurisdictions that allow euthanasia or assisted suicide, even though uncontrolled pain and symptoms remain among the reasons for requesting euthanasia or pas 38 . Requests by the Belgian palliative care community to include an obligatory palliative care consultation (“palliative filter”) were denied 19 . From 2002 to 2007 in Belgium, a palliative care physician was consulted (second opinion) in only 12% of all cases of euthanasia 31 . Palliative care physicians and teams were not involved in the care of more than 65% of cases receiving euthanasia. Moreover, the rates of palliative care involvement have been decreasing. In 2002, palliative care teams were consulted in 19% of euthanasia cases, but by 2007 such involvement had declined to 9% of cases. That finding contradicts claims that in Belgium, legalization has been accompanied by significant improvements in palliative care in the country 39 . Other studies have reported even lower palliative care involvement 8 , 13 . It must be noted that legalization of euthanasia or pas has not been required in other countries such as the United Kingdom, Australia, Ireland, France, and Spain, in which palliative care has developed more than it has in Belgium and the Netherlands.

The usefulness of a single palliative care assessment has been challenged—even when it is an obligatory requirement, as is the case at the University Hospital of the Canton of Vaud, Lausanne, Switzerland (the first hospital to allow, in 2005, assisted suicide in Switzerland 40 ) 41 . Among U.K. palliative care physicians, 63% feel that a single assessment is insufficient to fully evaluate and address the needs of a person requesting euthanasia or pas 42 . A similar number of U.K. psychiatrists have expressed similar concerns 43 , 44 , and only 6% of Oregon psychiatrists are comfortable providing consultations for patients requesting pas 45 .

Originally, it was the view of the Supreme Court of the Netherlands, the Royal Dutch Medical Association, and the ministers of Justice and Health that euthanasia would not be an option in situations in which alternative treatments were available but the patient had refused them. When this view conflicted with the accepted ethical principle that patients are allowed to refuse a treatment option, the law was altered to allow access to euthanasia even if the person refused another available option such as palliative or psychiatric care. One consequence of the change is that, the appropriateness of suicide prevention programs may begin to be questioned, because people wanting to commit suicide should, on the basis of autonomy and choice, have the same rights as those requesting euthanasia.

There are other examples that a “social slippery slope” phenomenon does indeed exist. In Switzerland in 2006, the university hospital in Geneva reduced its already limited palliative care staff (to 1.5 from 2 full-time physicians) after a hospital decision to allow assisted suicide; the community-based palliative care service was also closed (JP. Unpublished data). Of physicians in the Netherlands, 15% have expressed concern that economic pressures may prompt them to consider euthanasia for some of their patients; a case has already been cited of a dying patient who was euthanized to free a hospital bed 46 . There is evidence that attracting doctors to train in and provide palliative care was made more difficult because of access to euthanasia and pas , perceived by some to present easier solutions, because providing palliative care requires competencies and emotional and time commitments on the part of the clinician 47 , 48 . At the United Kingdom’s parliamentary hearings on euthanasia a few years ago, one Dutch physician asserted that “We don’t need palliative medicine, we practice euthanasia” 49 . Compared with euthanasia cases, cases without an explicit request were more likely to have a shorter length of treatment of the terminal illness 10 .

Advocates of euthanasia have largely ignored these concerns about the “social slippery slope” and have opted to refute the “slippery slope” argument on the basis that legalizing euthanasia and pas has not led to exponential increases in cases of euthanasia or pas or in a disproportionate number of vulnerable persons being euthanized 7 , 26 , 30 . However, there is evidence that challenges those assertion.

The number of deaths by euthanasia in Flanders has doubled since 1998 30 . Of the total deaths in this Flemish-speaking part of Belgium (population 6 million), 1.1%, 0.3%, and 1.9% occurred by euthanasia in 1998, 2001, and 2007 respectively 30 (about 620, 500, and 1040 people respectively in those years). The requirement of the law to report euthanasia cases (aided by laxity in prosecuting cases that fall outside the requirement) may explain some, but not all, of the increase 31 . Chambaere et al. 10 reported in the Canadian Medical Association Journal that in Belgium, euthanasia without consent had decreased from 3.2% in 1998 to 1.8% in 2007. But a closer review of the original study shows that the rate had declined to 1.5% in 2001 and then increased again to 1.8% in 2007 30 .

In Holland, the overall rate of euthanasia was 1.7% of all deaths in 2005, down from 2.4% and 2.6% in 2001 and 1995 respectively, but no different from 1990 when the rate was 1.7% 7 . However, the Dutch government’s official statistics indicate a rise of 13% in 2009 compared with 2008; euthanasia now accounts for 2% of all deaths. Given the increasing numbers, interest in developing facilities that provide euthanasia (similar to those of the Swiss pro–assisted suicide group Dignitas) has recently been increasing. In Oregon, although the number of cases of pas remain very small relative to the population, the rate has been increasing: 24 prescriptions were written in 1998 (16 of which led to deaths by pas ), 67 prescriptions in 2003 (43 of which led to deaths by pas ), and 89 in 2007 50 .

In Belgium, the rates of involuntary and non-voluntary euthanasia have decreased; together they accounted for 3.2%, 1.5%, and 1.8% of all deaths in 1998, 2001, and 2007 respectively (1800, 840, and, 990 people respectively in those years) 30 . In the Netherlands, the rate decreased from 0.7% in 2001 to 0.4% in 2005 7 . The actual rate is probably higher, given the large number of unreported cases. Notwithstanding the decrease, the rates are perturbing.

Battin et al. 51 examined data from Oregon and the Netherlands and concluded, as have others 30 , that there was no evidence that vulnerable people, except for people with aids , are euthanized disproportionately more. “Vulnerable” was defined in that study as individuals who are elderly, female, uninsured, of low educational status, poor, physically disabled or chronically ill, younger than the age of majority, affected with psychiatric illnesses including depression, or of a racial or ethnic minority. Finlay and George challenged the study on the basis that vulnerability to pas or euthanasia cannot be categorized simply by reference to race, sex, or other socioeconomic status. Other characteristics, such as emotional state, reaction to loss, personality type, and the sense of being a burden are also important 52 . Patients are also vulnerable to the level of training and experience that their physicians have in palliative care and to the personal views of their physicians about the topic. For example, one study showed that the more physicians know about palliative care, the less they favour euthanasia and pas 53 .

Two recent studies further contradict the findings by Battin and colleagues. Chambaere et al. found that voluntary and involuntary euthanasia occurred predominantly among patients 80 years of age or older who were in a coma or who had dementia 10 . According to them, these patients “fit the description of vulnerable patient groups at risk of life-ending without request.” They concluded that “attention should therefore be paid to protecting these patient groups from such practices.” In another study, two of the factors significantly associated with a nurse administering life-ending drugs were the absence of an explicit request from the patient and the patient being 80 years of age or older 15 .

4. THE RESPONSE

What can be done, then, when the best of palliative care is unable to address suffering?

Zylicz, a palliative care specialist who has worked extensively in the Netherlands with people requesting euthanasia and pas , provides a taxonomy to understand the reasons underlying the requests and provides stepping stones for addressing the requests. The requests can be classified into five categories (summarized by the abbreviation abcde ) 54 :

• Being afraid of what the future may hold
• Experiencing burnout from unrelenting disease
• Having the wish and need for control
• Experiencing depression
• Experiencing extremes of suffering, including refractory pain and other symptoms

Strategies are available to begin to address severe refractory symptoms, to treat depression, and to deal with the fear that some people have of what the future with a terminal disease may hold. Approximately 10%–15% of pain and other physical symptoms (such as dyspnea and agitated delirium) cannot be controlled with first- and second-line approaches and become refractory. For these symptoms, there is the option of palliative sedation. Palliative sedation is defined as “the monitored use of medications intended to induce a state of decreased or absent awareness (unconsciousness) in order to relieve the burden of otherwise intractable suffering in a manner that is ethically acceptable to the patient, family and health-care providers in patients that are imminently dying” 55 . Its intent is not to hasten death, which differentiates it from euthanasia. The goal is to achieve comfort at the lowest dose of sedative possible (usually with midazolam infusion, not with opioids) and at the lightest level of sedation. Some patients therefore achieve comfort at light levels of sedation, allowing them to continue interacting with family; in others, comfort is achieved only at deep levels of sedation.

Studies have shown that losing a sense of dignity and hope and taking on a sense of burden prompt some people to seek euthanasia and pas 21 – 23 , 56 . Strategies to improve the sense of dignity, based on empirical studies that have explored the concept of dignity within palliative care, have been shown to work 57 . Similar strategies need to be developed in the areas of hope and burden.

Given effective palliation, including palliative sedation for patients with refractory symptoms, the only remaining issue is that of legalizing “on-demand” euthanasia and pas when there is no terminal disease or when the person is tired of living or has a mental illness. Legalizing euthanasia and assisted suicide in these circumstances is most concerning and would have major implications over time, including changing a society’s values and making suicide prevention programs redundant because people wishing to commit suicide would then be entitled to do so.

In 30 years, the Netherlands has moved from euthanasia of people who are terminally ill, to euthanasia of those who are chronically ill; from euthanasia for physical illness, to euthanasia for mental illness; from euthanasia for mental illness, to euthanasia for psychological distress or mental suffering—and now to euthanasia simply if a person is over the age of 70 and “tired of living.” Dutch euthanasia protocols have also moved from conscious patients providing explicit consent, to unconscious patients unable to provide consent. Denying euthanasia or pas in the Netherlands is now considered a form of discrimination against people with chronic illness, whether the illness be physical or psychological, because those people will be forced to “suffer” longer than those who are terminally ill. Non-voluntary euthanasia is now being justified by appealing to the social duty of citizens and the ethical pillar of beneficence. In the Netherlands, euthanasia has moved from being a measure of last resort to being one of early intervention. Belgium has followed suit 37 , and troubling evidence is emerging from Oregon specifically with respect to the protection of people with depression and the objectivity of the process.

The United Nations has found that the euthanasia law in the Netherlands is in violation of its Universal Declaration of Human Rights because of the risk it poses to the rights of safety and integrity for every person’s life. The UN has also expressed concern that the system may fail to detect and to prevent situations in which people could be subjected to undue pressure to access or to provide euthanasia and could circumvent the safeguards that are in place.

Autonomy and choice are important values in any society, but they are not without limits. Our democratic societies have many laws that limit individual autonomy and choice so as to protect the larger community. These include, among many others, limits on excessive driving speeds and the obligation to contribute by way of personal and corporate income taxes. Why then should different standards on autonomy and choice apply in the case of euthanasia and pas ?

Legislators in several countries and jurisdictions have, in just the last year, voted against legalizing euthanasia and pas in part because of the concerns and evidence described in this paper. Those jurisdictions include France, Scotland, England, South Australia, and New Hampshire. They have opted to improve palliative care services and to educate health professionals and the public.

6. CONFLICT OF INTEREST DISCLOSURES

The author has no financial conflict of interest to declare.

7. REFERENCES

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Why euthanasia should not be legalised

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Why active euthanasia and physician assisted suicide should be legalised

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In response to the editorial regarding the legalisation of active euthanasia and physician-assisted suicide,1 I present the following arguments against the legalisation of active euthanasia.

Active euthanasia is unnecessary because alternative treatments exist

It is widely believed that there are only two options for patients with terminal illness: either they die suffering or receive euthanasia. Recent research in palliative medicine has shown that virtually all unpleasant symptoms experienced in terminal illness can be relieved or alleviated by existing techniques.

Requests for active euthanasia are rarely free and active.

A person with terminal illness is vulnerable, lacking the skills and knowledge to alleviate their symptoms. It is very difficult for him to be entirely objective about his own situation. Their capacity for decision-making may equally be affected by confusion, dementia or symptoms, which could be relieved with appropriate treatment. Patients who on admission say "let me die" usually after effective treatment are grateful that their request was not acceded to.

Active euthanasia gives too much power to doctors

Ironically, active euthanasia legislation makes doctors less accountable and gives them more power. Patients generally decide in favour of euthanasia on the basis of information given to them by doctors. If a doctor confidently suggests a certain course of action, it can be difficult for a patient to resist. However, diagnoses may be mistaken and prognoses may be widely misjudged. Active euthanasia gives the medical practitioner power, which in turn can be abused.

Active euthanasia leads inevitably to involuntary euthanasia

When active euthanasia has been previously accepted and legalised, it has led inevitably to inactive euthanasia.

Holland is moving rapidly down the slippery slope with the public conscience changing quickly to accept such action as acceptable. The Royal Dutch Medical Association has recommended that the termination of the lives of patients suffering from dementia is acceptable under certain conditions. Case reports include a woman killed at her own request for reasons of "mental suffering".[2]

Such a progression requires only four accelerating factors: favourable public opinion, willing doctors, economic pressure and a law allowing it. In most Western countries the first three ingredients are present already. When legislation comes into effect and political and economic interests are brought to bear, the generated momentum inevitably follows.

Dr Liz Croton SHO A&E City Hospital NHS Trust, Dudley Rd,Birmingham B18 7QH [email protected]

1. Doyle L, Doyle L. Why active euthanasia and physician assisted suicide should be legalised. BMJ 2001:323;1079-80.

Competing interests: No competing interests