What is euthanasia?

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

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

Types of euthanasia

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

Active euthanasia: killing a patient by active means, for example, injecting a patient with a lethal dose of a drug.  Sometimes called “aggressive” euthanasia.

Passive euthanasia: intentionally letting a patient die by withholding artificial life support such as a ventilator or feeding tube.  Some ethicists distinguish between withholding life support and withdrawing life support (the patient is on life support but then removed from it).

Voluntary euthanasia: with the consent of the patient.

Involuntary euthanasia: without the consent of the patient, for example, if the patient is unconscious and his or her wishes are unknown..  Some ethicists distinguish between “involuntary” (against the patient’s wishes) and “nonvoluntary” (without the patient’s consent but wishes are unknown) forms.

Self-administered euthanasia: the patient administers the means of death.

Other-administered euthanasia: a person other than the patient administers the means of death.

Assisted: the patient administers the means of death but with the assistance of another person, such as a physician.

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

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

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

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

What are key disputes in the controversy over euthanasia?

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

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

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

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

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

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

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

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

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