Euthanasia and Assisted Suicide

While medical life-ending behavior occurs in a great many jurisdictions, only very few have explicitly legalized euthanasia, physician-assisted suicide, or both. There are various forms of medical life-ending behavior that are classified as euthanasia. These include “active voluntary euthanasia,” when medical intervention takes place, at a patient's request, to end the patient's life; “passive voluntary euthanasia,” when medical treatment is withdrawn or withheld from a patient, at the patient's request, to end the patient's life; “active nonvoluntary euthanasia,” when medical intervention takes place, without the patient's request, to end the patient's life; and “passive nonvoluntary euthanasia,” when medical treatment or life support is withdrawn or withheld from a patient, without the patient's request, to end the patient's life.

In addition, there is physician-assisted suicide: suicide using a lethal substance prescribed, prepared, or given to a patient by a doctor for self-administration for assisting the patient to commit suicide. Finally, the term double effect is reserved for the administration of drugs (usually large doses of opioids) with the intention of relieving pain, but foreseeing that this might hasten death, even though the hastening of death is not actually intended. The Australian Senate Legal and Constitutional Legislation Committee has used this definition.

Guidelines are usually in place to control medical conduct when it comes to double effect and passive nonvoluntary euthanasia (for instance in the case of severely brain-damaged newborns). Active euthanasia, to further a patient's request or not, usually remains a crime and often is classified as murder. The three jurisdictions with an exception to this rule are the state of Oregon in the United States and the neighboring European countries of the Netherlands and Belgium. There was a fourth jurisdiction, Australia's Northern Territory, but its Rights of the Terminally Ill Act 1995 was overruled within a year of its enactment by the Australian federal government and currently is defunct.

The legal frameworks in Oregon, Belgium, and the Netherlands differ considerably. What they have in common, however, is that they allow medical doctors exclusively to engage in medical life-ending conduct, which can only occur in response to a patient's repeated and considered request, and which is only available to seriously ill patients who can invoke the law to have their life terminated.

Euthanasia is an emotional issue that strikes at the core of the belief systems of proponents and opponents alike, as acutely evidenced by the Terri Schiavo case in Florida in 2005 and the Diane Pretty case in the United Kingdom in 2004. Opponents appeal to the sanctity of life, on one hand, and warn of compromising the medical profession, on the other. Legalization would cause role conflict for medical doctors. Opponents also warn of the slippery slope: legalization of certain life-ending conduct might make other [Page 517]life-ending conduct in the course of time more acceptable and frequent, which would erode the core civil right to life.

Opponents tend to remind us of the practice of nonvoluntary euthanasia of undesirables (such as the severely disabled) during the Nazi regime in Germany. Proponents argue that the decision whether to die or not is ultimately a personal choice. It is often couched in terms of the “right to die,” although arguably there is no such right anywhere, as doctors are never compelled to comply with any request, and only seriously ill patients might appeal to such a right anyway. Rather, the issue is whether there is a right to request to be helped to die, and what obligation that puts on medical professionals.

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