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Just as abortion targets vulnerable human life at its earliest stages, euthanasia and assisted suicide threaten elderly, sick and disabled persons, often masked by euphemisms such as "aid in dying" and "death with dignity."
Euthanasia is the intentional killing by act or omission of a dependent human being for his or her alleged benefit.
Euthanasia can be voluntary, involuntary (against the expressed wishes of the patient) or non-voluntary (when the person who is killed makes no request and gives no consent). Active euthanasia is euthanasia by performing an action, such as administering a lethal injection; passive euthanasia (euthanasia by omission) is euthanasia by not providing necessary and ordinary (usual and customary) care or food and water. Passive euthanasia, as defined here, is different than allowing a natural death by withholding or withdrawing artificial life support.
Assisted suicide is when someone provides an individual with the information, guidance and means to take his or her own life with the intention that they be used for this purpose. Physician-assisted suicide is when a doctor is the one who assists, such as by prescribing a lethal dose of medication.
The only difference between assisted suicide and other forms of euthanasia is which person performs the final act that kills the patient. If a doctor performs the final act (e.g., an injection), it is euthanasia; if the patient performs the final act himself (e.g., ingesting pills), it is assisted suicide.
Euthanasia, assisted suicide in practice
Euthanasia can take different forms. Here are the ways in which it occurs today.
Assisted suicide: Physician-assisted suicide is currently legal in the American states of Oregon, Washington, Vermont and (arguably) Montana and New Mexico. No other states have legalized it. It is also legal in the countries of Belgium, the Netherlands, Switzerland and Luxembourg.
Oregon's Death with Dignity Act has been in place since late 1997 and has served as a model for other states. From 1997 through 2012, 1,050 Oregon patients received lethal prescriptions and 673 patients went on to kill themselves, according to the Oregon Health Authority (based on reported cases); the annual number of deaths has risen almost every year. Only 6.2 percent of patients committing suicide were first referred for psychiatric evaluation. The most common reasons cited for suicide were loss of autonomy, inability to make life enjoyable, and "loss of dignity."
Minnesota law prohibits intentionally advising, encouraging or assisting another person in taking his or her own life (Minnesota Statutes section 609.215, subdivision 1). In 2014 the Minnesota Supreme Court struck down the ban on "advising" or "encouraging," but the law against "assisting" suicide remains in place.
Active euthanasia: Active euthanasia is currently legal in the Netherlands, Belgium and Luxembourg. The Netherlands has the longest history of legalized euthanasia and offers the best example of its effects.
Thousands of euthanasia deaths occur in the Netherlands each year. Only a tiny fraction of Dutch patients are referred for psychiatric evaluation before being euthanized. Patients need not be terminally ill, and some patients who merely suffer from depression or anxiety are killed. The Netherlands also permits active euthanasia of disabled babies (in which the doctor actively kills the child), a form of infanticide.
Dutch national surveys have shown that many patients are euthanized without their explicit consent (they are usually, but not always, incompetent), and doctors are rarely prosecuted for doing so. Increasing, euthanasia is considered justified even when a patient has not requested it—if the physician thinks it is necessary to provide a "humane" and "dignified" death. The Dutch experience shows that once a "right" to euthanasia is accepted, killing becomes very difficult to contain.
Involuntary denial of care by providers: Many ethicists and physicians argue that health care providers should be able to deny lifesaving treatment, nutrition and hydration due to patients' perceived inadequate "quality of life"—even against the express will of patients and their families. Most states (excluding Minnesota) may allow doctors and hospitals to disregard advance directives when they call for treatment, food or fluids.
Starvation and dehydration: Food and fluids—at least when provided with the assistance of tubes—are typically regarded as "medical treatment" rather than basic, ordinary care. Such nutrition is routinely denied to those unable to make decisions for themselves by others who act as surrogate decision makers. Frequently, therefore, patients with severe cognitive disabilities who have never consented to the rejection of food and fluids are starved and dehydrated to death. The case of Terri Schindler Schiavo is one example of this kind of non-voluntary, passive euthanasia.
Rationing of health care: The rationing of health care can mean denying lifesaving treatment, food and fluids against the will of patients, based on degree of disability or perceived "quality of life." The threat of rationing has grown due to the increasing emphasis on providers containing costs and the passage of the Affordable Care Act (also known as Obamacare) in 2010.
Why euthanasia is wrong
Euthanasia and assisted suicide are wrong in principle and dangerous in practice. Euthanasia is morally wrong because it is the intentional killing of an innocent human being. The norm against killing is grounded in the inherent dignity and right to life of the human person, regardless of age, ability (or disability), health and condition of dependency. Euthanasia, the Hippocratic Oath teaches, is contrary to the very nature and purpose of the medical profession.
This does not mean that a patient's life must be sustained by all means in all circumstances. Allowing a natural death is not the same as intentional killing. Nor is it necessarily wrong to hasten the end of life through treatment aimed at controlling symptoms—because the intent is to comfort the patient, not to kill. In either case it is the underlying disease or injury that causes death, not the actions of the doctor or patient.
Dangerous in practice
Euthanasia is dangerous in practice for a variety of reasons:
In places where active euthanasia or assisted suicide has been approved, psychiatric evaluation is not required, leading to the deaths of some depressed or mentally ill patients who would have wanted to live had they received appropriate treatment.
The legal availability of euthanasia opens the door to pressure, coercion and even outright elder abuse. Indeed, 38.6 percent of patients committing suicide in Oregon have expressed concern about being a "burden" on others. And prescribing physicians are generally not present at the time of death.
Terminal diagnoses and diagnoses of a persistent vegetative state or similar conditions sometimes turn out to be wrong; some patients have received such a diagnosis only to live happily for many more years. But patients are denied any chance when they are killed.
Assisted suicide and euthanasia are unlikely to be limited to the terminally ill. That restriction is not recognized in the Netherlands, and the reasons and arguments for euthanasia (see below) do not apply only to the terminally ill.
The acceptance of assisted suicide leaves little rational basis for rejecting active euthanasia. The "right to die," many euthanasia advocates argue, should not be denied to people whose disability prevents them from ingesting pills on their own.
The acceptance of voluntary euthanasia can easily lead to non-voluntary euthanasia, as it has in the Netherlands. A doctor's subjective judgment of the patient's "quality of life" can come to be the primary consideration, regardless of the patient's wishes.
Answering the arguments for euthanasia
Proponents of euthanasia and assisted suicide argue that it should be legal to relieve patients of unbearable pain and suffering. But the data show that very few patients who seek assisted suicide do so because they physically suffer (they seek suicide because they are depressed or fear losing autonomy or becoming a burden). Indeed, modern palliative care can treat pain in virtually all circumstances. The solution to suffering is to improve access to quality pain management—to end the suffering, not the sufferer.
Advocates of euthanasia also contend that it must be allowed as a matter of personal autonomy: Patients have a right to choose the timing and manner of their deaths. But the value of a life doesn't disappear because someone decides or feels that it does. Moreover, many suicidal patients are influenced by anxiety and depression (which should be treated) and are not acting rationally.
Some argue that euthanasia is justified when a patient faces a diminished "quality of life" and is unable to do the things that made life enjoyable for him or her. But it is clearly false to suppose that disabled and elderly persons cannot enjoy life and find meaning, purpose and happiness. And the worth of human life simply does not depend on physical or mental capacities. Every human life is worth living because every human life, regardless of ability or disability, is intrinsically valuable.
Alternatives to euthanasia
Euthanasia or suicide should never seem like the only option. Depressed and suffering patients should be treated. Lonely and isolated patients should be cared for. No one should ever feel that his or her life is worthless or meaningless—because every person matters. The answer to disease and disability is love and compassion, not killing.
Proposals to legalize physician-assisted suicide continue to surface in states across the country. Meanwhile, any person who becomes unable to speak for himself or herself due to illness or disability is in danger of being denied lifesaving medical treatment or nutrition and hydration.
A measure of protection is possible by preparing an advance directive. Advance directives are legal documents that allow people to specify their treatment wishes in the event that they become unable to make health care decisions for themselves. A pro-life advance directive, which expresses a preference for life and guards against euthanasia, is available.
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