Euthanasia

Euthanasia (Greek: ?????????, "good death") is the practice of killing a person or animal, in a painless or minimally painful way, for merciful reasons, usually to end their suffering. This article discusses euthanasia in humans; a separate article covers animal euthanasia.

Legislation and national political movements

Switzerland

Switzerland is the only country in which assisted suicide is legal, even if it is performed by a non-physician, provided there are no selfish reasons involved. Also, Switzerland is the only country which allows foreign citizens to be assisted to commit suicide, even if they are not physically but psychologically suffering. Actually, there is only one organization (Dignitas) which provides such help in dying. Euthanasia (mercy killing) is however illegal.

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Australia

Euthanasia was legalized in Australia's Northern Territory, by the Rights of the Terminally Ill Act 1995. However, this law was soon made ineffective by an amendment by the Commonwealth to the Northern Territory (Self-Government) Act 1978. (The powers of the Northern Territory legislature, unlike those of the State legislatures, are not guaranteed by the Australian Constitution.) Three people had already been legally euthanised, however, before the Commonwealth government made this amendment.

Related Topics:
Australia - Northern Territory - Rights of the Terminally Ill Act 1995

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Although it has for some time been a crime in most Australian states to assist another to commit suicide, prosecutions have been rare. In Queensland recently (2002) a group of relatives and friends who provided moral support to an elderly lady who committed suicide were extensively investigated by police, but no charges were laid. The Commonwealth government is now trying to hinder euthanasia and to further inhibit discussion of the concept by the passage of the Criminal Code Amendment (Suicide Related Materials Offences) Bill 2004. That Bill will probably become law (an Act) sometime after the conservative government gains control of the Senate on July 1, 2005.

Related Topics:
July 1 - 2005

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Belgium

After an extensive discussion the Belgian parliament legalised euthanasia in late September 2002. The new legislation, however, institutes a complicated process, which has been criticized as an attempt to establish a bureaucracy of death. Nevertheless, euthanasia is now legal and its proponents in the country hope that it will stop many illegal practices (it is said that several thousand illegal acts of euthanasia have been carried out in Belgium each year).

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Canada

On January 28, 2005, Marcel Tremblay of Kanata, Ontario held a press conference to announce plans to kill himself, saying his life with pulmonary fibrosis was unbearable. After attending his own living wake, the 78-year-old man committed suicide at 11:51 pm Eastern time.http://www.cbc.ca/story/canada/national/2005/01/28/assisted-suicide-050128.html He had previously said he would be surrounded by his wife and adult children while he placed a bag over his head and filled it with helium. Tremblay said that he publicized his suicide plans to help change laws over assisted suicide. His lawyer said police were satisfied that Tremblay had a sound mind and that authorities would not intervene. Canada decriminalized committing suicide and attempting to commit suicide in 1972.

Related Topics:
Kanata, Ontario - Pulmonary fibrosis

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In the early 1990s, 42-year-old Sue Rodriguez, who had amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease), fought to overturn the law against assisted suicide. She lost her court battle, but died by assisted suicide with the help of an anonymous doctor. Under Canada's Criminal Code, assisted suicide is illegal and punishable by up to 14 years in prison.

Related Topics:
Sue Rodriguez - Amyotrophic lateral sclerosis - ALS - Lou Gehrig's disease

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The Netherlands

In the Netherlands the Termination of Life on Request and Assisted Suicide (Review Procedures) Act took effect on April 1, 2002. It legalizes euthanasia and physician assisted suicide in certain circumstances.

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The law recognized a practice that had been tolerated for some 20 years.

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From the time that euthanasia first came to be widely practiced in the Netherlands, it was formally subject to review by boards of doctors in each hospital. The law essentially codified what had already become tolerated practice and unofficial law by judgments in the courts.

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The law permits euthanasia and physician assisted suicide when each of the following conditions is fulfilled:

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• the patient has asked repeatedly
• the patient's suffering is unbearable with no prospect of improvement
• the doctor has prior to the act consulted an independant colleague.
• the patient has to be at least 12 years old; patients between 12 and 16 years of age require consent of their parents

The doctor must also report the cause of death to the municipal coroner in accordance with the relevant provisions of the Burial and Cremation Act. A regional review committee assesses whether a case of termination of life on request or assisted suicide complies with the due care criteria. Depending on its findings, the case will either be closed or brought to the attention of the Public Prosecutor. Finally, the legislation offers an explicit recognition of the validity of a written declaration of will of the patient regarding euthanasia (a "euthanasia directive"). Such declarations can be used when a patient is in coma or otherwise unable to state whether they want euthanasia or not.

Related Topics:
Coroner - A written declaration of will - Coma

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The legislation has wide support among the socially libertarian Dutch, who have one of the world's highest life expectancies. There is however persistent opposition, mainly organized by the churches.

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Euthanasia remains a criminal offense in cases not meeting the law's specific conditions, with the exception of several situations that are not subject to the restrictions of the law at all, because they are considered normal medical practice:

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• stopping or not starting a medically useless treatment
• stopping or not starting a treatment at the patient's request
• speeding up death as side-effect of treatment necessary for alleviating serious suffering

Euthanasia of children under the age of 12 remains technically illegal, however Dr. Eduard Verhagen has documented several cases and, together with colleagues and prosecutors, has developed a protocol to be followed in those cases. Prosecutors will refrain from pressing charges if this Groningen protocol is followed.

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Statistics and methods

In 2003, in the Netherlands 1626 cases were officially reported of euthanasia in the sense of a physician causing death (1.2 % of all deaths). Usually the sedative sodium thiopental is intravenously administered to induce a coma, and after making sure the patient is in a deep coma, typically after some minutes, a muscle relaxant is administered to stop the breathing and cause death.

Related Topics:
Sedative - Sodium thiopental - Intravenous - Coma - Muscle relaxant - Breathing

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:Officially reported were also 148 cases of physician assisted suicide (0.14 % of all deaths), usually by drinking a strong barbiturate potion. The doctor is required to be present for two reasons:

Related Topics:
Barbiturate - Potion

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• to make sure the potion is not taken by a different person, by accident (or, theoretically, for "unauthorized" suicide or perhaps even murder)
• to monitor the process and be available to apply the combined procedure mentioned below, if necessary.

In two cases the doctor was reprimanded for not being present while the patient drank the potion. They did not realize that this is required.

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Forty-one cases were reported to combine the two procedures: usually in these cases the patient drinks the potion, but this does not cause death. After a few hours, or earlier in the case of vomiting, the muscle relaxant is administered to cause death.

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By far, most reported cases concerned cancer patients. Also, in most cases the procedure was applied at home.

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Note that some medical authorities and investigative reporters claim there are substantial numbers of euthanasias in the Netherlands performed without consultation or official notice - see links below.

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United States

Oregon

In contrast to the rest of the United States, the state of Oregon has legalized physician-assisted suicide (but not euthanasia: a physician or anyone else may not directly kill). Residents have voted for it at the Oregon Ballot Measure 16 (1994), and voted against repealing it at the Oregon Ballot Measure 51 (1997). Oregon's law has been attacked by various organizations, and federal government parties that support those organizations, ever since it was first enacted .

Related Topics:
Oregon - Oregon Ballot Measure 16 (1994) - Oregon Ballot Measure 51 (1997)

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Former Attorney General John Ashcroft, a longtime opponent of assisted suicide, maintains that Oregon's law violates the Controlled Substances Act because the prescriptions do not have a "legitimate medical purpose", and proposes that physicians who prescribe controlled substances to assist with suicides should have their medical licenses revoked. http://www.law.com/jsp/article.jsp?id=1108389918088 The issue of whether the federal government or the State of Oregon has jurisdiction over this issue is now before the United States Supreme Court.

Related Topics:
Attorney General - John Ashcroft - Controlled Substances Act - Medical license

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Statistics and methods

In 2003, in Oregon 42 cases of physician assisted suicide were reported (0.14 % of all deaths), all by drinking a strong barbiturate potion. The doctor is not required to be present; in 12 cases he/she was.

Related Topics:
2003 - Barbiturate - Potion

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Since 1998, 171 Oregonians have relied on the assisted suicide law.

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There were three cases of regurgitation. In each case at least one third of the potion was retained, which caused death anyway, though in one case only after 48 hours.

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The time from ingestion to unconsciousness was 1 to 20 minutes (median 4 minutes), the time from ingestion to death 5 minutes to 48 hours (median 20 minutes).

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By far, most reported cases concerned cancer patients. Also, in most cases the procedure was applied at home.

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Florida

A controversial case is that of Terri Schiavo and the legislation inspired by her in Florida, under Governor Jeb Bush. In 1990, Schiavo collapsed in her home due to a cardiac arrest. She spent the next 15 years on a feeding tube in the local hospice center. Her husband fought to have the feeding tube removed, but her parents fought to have it stay. In March of 2005, the feeding tube was removed. Two weeks later, on March 31, 2005, Schiavo died.

Related Topics:
Terri Schiavo - Jeb Bush - 1990 - Cardiac arrest - Feeding tube - Hospice - March - 2005 - March 31

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