Debate: Assisted suicide

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Should assisted suicide be legalized?

Background and context

Assisted Suicide, also called Voluntary Euthanasia, is currently a contentious issue in many countries. The question in the debate is this: if a terminally ill person decides that they wish to end their life, is it acceptable for others to assist them? This would normally take the form of a doctor administering a lethal injection, which would end their life painlessly. A clear distinction must be made with involuntary euthanasia, by which someone is ‘put down’ against their wishes, and which is simply murder by another name.

Euthanasia or assisted suicide is illegal in most countries around the world. In the United States, Dr Jack Kervorkian – nicknamed ‘Doctor Death’ for his actions beliefs – has campaigned for a change in the law for many years, and assisted in the suicide of at least 45 people. He was found guilty of second degree murder and imprisoned in 1999 after a widely publicized trial. He was released on June 1, 2007, on parole due to good behavior. Those that practice euthanasia continue to risk charges of murder and prison sentences. However, in Oregon and California, state legislation has been passed to allow for euthanasia in special circumstances and within a heavy regulatory framework in which third party ethicists attempt to ensure the appropriateness of euthanasia cases.

Euthanasia is legal in a few modern democracies: the Netherlands, Belgium, Switzerland. In the Netherlands, voluntary euthanasia has been legal since 1983, with some 3,000 people requesting it each year. In Australia, assisted suicide was legalised in the Northern Territory with the backing of a substantial majority of the local population, but was then overthrown by the Federal Senate before anyone could actually use the new law.

This debate revolves around numerous questions: Is euthanasia an appropriate response to the excruciating pain of terminally ill patients who desire to die? Or, is euthanasia never justified? Is it appropriate for governments to effectively force people to live through their pain by denying them the right to euthanasia? Are there sufficient pain medications in existence to override concerns surrounding pain? Is this an insufficient solution because it simply puts people in a "drugged state"? Do people general have a right to die or to commit suicide? Does the government have a compelling interest to stop them? Is the "sanctity of life" a sufficient reason to stop them? Does euthanasia violate the "sanctity of life"? Do exceptions exist to the "sanctity of life" in which it is acceptable to end life prematurely? Does the government have the right to define the "sanctity of life" or should individuals and families be able to make their own determination about when life is "sacred" and when it may cease to be? Does criminalizing euthanasia violate the notion of "equal protection" by enabling those on life-support to withdraw support and effectively commit suicide, while denying persons with terminal illnesses, but whom aren't on life support, an opportunity to die quickly? Are non-treatment approaches to speeding death, such as "pulling the tubes", justified? Or, do they needlessly subject patients to pain that could otherwise be prevented through euthanasia? Is euthanasia "unnatural" or not "how God intended" death to occur? Do doctors have a right to assist in euthanasia (assisted suicide)? Or does this give them too much power? Are doctors sufficiently trained in administering euthanasia? Is it their place to do so? Or, does the Hippocratic Oath restrict them from this practice? What is the role of physicians? Are they healers only? Or can they participate in decisions regarding ending a life? Is it reasonable to place these burdens on doctors? Does it traumatize them? Do the families of terminally-ill loved ones have an interest in euthanasia? Do they appear to support it? Would the legalization of euthanasia allow greater family awareness and involvement in any choice? Will families abuse euthanasia, possibly pressuring their loved ones to pursue the option out of a selfish desire to avoid the burden of caring for him or her until death. Can third-party regulators help reduce the risk of these abuses occurring? Are wider abuses a significant concern surrounding euthanasia? Would the legalization of the practice open a slippery slope to abuses? Will doctors begin pressuring individuals to commit suicide (euthanasia)? Will doctors make moves to euthanise the disabled? Will doctors aggressively implement involuntary euthanasia? Will regulations be capable of constraining a slippery slope from developing? Can appropriate criteria be created for eligibility for euthanasia, and can those criteria be regulated and enforced? Are the poor at risk simply because they are less able to afford health care, which may give an incentive to health care providers to euthanize an individual in order to cut costs? Will euthanasia become a cynical option for insurance companies to cut costs? Or, is it a legitimate consideration that euthanasia may reduce health care costs? Will it reduce the incentive of doctors to provide strong palliative care, causing them to ask, "what's the point if we have euthanasia"?

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"Right to die"? Does every citizen have a "right to die" at a time of choice?

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Yes

• The right to life includes a right to die. Every right includes a choice. The right to speech does not remove the option to remain silent; the right to vote brings with it the right to abstain. In the same way, the right to choose to die is implicit in the right to life.

• Opponents of euthanasia erroneously argue that human death is always wrong; exceptions exist. It is acceptable to take a life in self-defense. It is acceptable to send soldiers into war to die and kill to achieve certain ends. It is acceptable to risk human life in missions into space. And, it is considered acceptable by some (actually many conservatives that oppose euthanasia) to execute criminals. Clearly, life is not inviolable in modern society. It can be violated or risked for certain, highly valuable ends (security, justice, discovery). The question with euthanasia, therefore, is not whether life can be violated for certain ends (it can). The question is whether it can be a justified trade-off, and if so, how to ensure that euthanasia is only performed when it is fully justified under the criteria we set forth.

• Right to die allows opponents to not participate. Allowing the right to die means that opponents can still exercise their rights by choosing not to particpate, whereas refusing this right disenfranchises those who may want to choose the time and manner of their death without harming others. Therefore allowing this right is more democratic.

• Sanctity-of-life ideologies trample the lives of the dying that call for euthanasia. If we were to assume that euthanasia is wrong, than we would also have to assume that the pleas of the dying for euthanasia are wrong too. Can we disregard these pleas as merely the dying wishes of individuals that have become desperate and irrational? If we disregard these pleas, aren't we essentially telling the dying that their wishes are wrong and, in fact, immoral? That is, in effect, what opponents of euthanasia are saying to the dying that make these pleas. At a minimum, the state is simply denying individuals their dying wish, angering, and even alienating them. Is this a good way for the state to honor the dying and their lives? No. In this way, denying euthanasia violates the sanctity of the lives of the dying that call for it. Aren't these the only sanctified lives at hand that matter? Or, is the purpose to walk all over the dying in order to uphold a self-righteous belief among the living about the "sanctity of life".

• Euthanasia doctors don't "kill", they help individuals die who want to Some opponents argue that euthanasia is about permitting doctors and/or families to kill their ill loved ones. This is not the general euthanasia proposal, which is to allow patients with exceptional circumstances to seek euthanasia and receive it if they are eligible. The choice is in the hands of the patient, not the family or doctors, so it cannot be termed "killing". Rather, its about helping terminal patients die who want to die.

• The state can't stop people from defining their existence and choosing death The United States Court of Appeals for the Second Circuit stated in its 1996 Opinion from Quill v. Vacco: - "What concern prompts the state to interfere with a mentally competent patient's 'right to define [his] own concept of existence, of meaning, of the universe, and of the mystery of human life,' [Planned Parenthood v. Casey] when the patient seeks to have drugs prescribed to end life during the final stages of a terminal illness? The greatly reduced interest of the state in preserving life compels the answer to these questions: 'None'..."[1]

• There is no compelling state interest in preventing euthanasia When the freedom of the individual to do what they want is prevented by the state, it must be because a clear, compelling state interest exists. It is not clear that any such interests exists in the case of euthanasia. Certainly, there is no benefit to the state when a dying patient is loudly crying for euthanasia and the state blocks the procedure. The only state interest that could be involved is the notion of the "dignity of life", but this is highly, highly contested, with great public opposition to the notion that life is inviolable in cases of an excruciating, terminal illness. Does the state have an interest in opposing this public opinion? Where is the interest?

• Criminalizing euthanasia violates the right to equal protection The United States Court of Appeals for the Second Circuit stated in its 1996 Opinion from Quill v. Vacco: - "...It seems clear that New York does not treat similarly circumstanced persons alike: those in the final stages of terminal illness who are on life-support systems are allowed to hasten their deaths by directing the removal of such systems; but those who are similarly situated, except for the previous attachment of life-sustaining equipment, are not allowed to hasten death by self-administering prescribed drugs..."

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No

• Euthanasia is contrary to the dignity and preciousness of life Patrick Lee. "Personhood, Dignity, Suicide, and Euthanasia". The National Catholic Bioethics Quarterly." Autumn 2001, Vol.1 No.3 - "[...]A thing (as opposed to a state or property) can be valuable in one of two ways (keeping in mind the above distinctions): First, it might be valuable as a vehicle or carrier of what is per se valuable. If human beings were valuable in that way, then they would not be per se valuable, but only the states or properties that they bore or carried would be of per se value. Or, secondly, a thing might be valuable because it is per se valuable, that is, it is valuable for its own sake, and not as a means toward what it enables to be instantiated. But, human beings must be valuable in the second way rather than in the first way. For if they were valuable only as mere vehicles for what is per se valuable, then it would always be morally right to kill one child, provided one agreed to replace him with two others. No human beings would have more than replaceable value. None would have the kind of value that almost all of us recognize that at least some human beings do have. So, human beings are intrinsically valuable, that is, valuable per se. This means that they themselves are valuable, not just as vehicles for what is valuable.

So, since what I am is a living bodily entity, and the thing which I am is intrinsically valuable, it follows that this bodily entity itself is intrinsically valuable. To deny that is to denigrate one's bodily life, to demean one's bodily person. Suicide and euthanasia necessarily involve a denigration of the very thing which you and I are, our bodily lives. The choice of suicide or euthanasia unavoidably involves a denial of the intrinsic dignity of the human person."

• Dignity of human life must override any individual will to be euthanized The dignity and inviolability of life is an absolute principle. It does not matter if a dying person does not appreciate that dignity and desires to be euthanized; the dignity of their life and life in general still must be protected.

• The state does not force anyone to stay alive; it just doesn't euthanize Euthanasia.com, an anti-euthanasia website. "Reasons for Euthanasia". Retrieved April 30th, 2008 - "3. Should people be forced to stay alive? No. And neither the law nor medical ethics requires that "everything be done" to keep a person alive. Insistence, against the patient's wishes, that death be postponed by every means available is contrary to law and practice. It would also be cruel and inhumane. There comes a time when continued attempts to cure are not compassionate, wise, or medically sound. That's where hospice, including in-home hospice care, can be of such help. That is the time when all efforts should be placed on making the patient's remaining time comfortable. Then, all interventions should be directed to alleviating pain and other symptoms as well as to the provision of emotional and spiritual support for both the patient and the patient's loved ones."

• There is no comparison between a presumed right to die and other rights When you choose to remain silent, for instance, you may change your mind at a later date; when you choose to die, you have no such second chance. Similarly, participating in someone’s death is also to participate in depriving them of all choices they might make in the future. That euthanasia is irrevocable in this way is the problem.

• Nobody has the right to take another's life, including with euthanasia Nobody has the authority to take the life of another individual. Nor do they have the authority to euthanize an individual. And, if a doctor or family merely provides the poison, they can, nevertheless, be seen like accomplices to a crime.

• Euthanasia is different than taking a life in self-defense; the life is innocent. It is justified to take another life in self-defense. But, this is very different than euthanasia; it is out of self-defense. Euthanasia, in contrast, involves taking an innocent life.

• It is a moral duty to attempt to prevent suicide in general; euthanasia too. If someone is threatening to kill themselves it is your moral duty to try to stop them. You would not, for example, simply ignore a man standing on a ledge and threatening to jump simply because it is his or her choice; and you would definitely not assist in his suicide by pushing him. In the same way, you should try to help a person with a terminal illness, not help them to die.

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Ending pain: Is euthanasia justified to end the pain of a terminally ill patient?

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Yes

• Individuals have a right to die when life becomes excruciating or undignified Those who are in the late stages of a terminal disease have a horrific future ahead of them: the gradual decline of their body, the failure of their organs and the need for artificial support. In some cases, the illness will slowly destroy their minds, the essence of themselves; even if this is not the case, the huge amounts of medication required to ‘control’ their pain will often leave them in a delirious and incapable state. Faced with this, it is surely more humane that those people be allowed to choose the manner of their own end, and die with dignity.

Chantal Sebire, a 52- year-old Dijon schoolteacher, suffering from a rare disease that has left her disfigured by facial tumors, said in 2008 to Time magazine: "I no longer accept this enduring pain, and this protruding eye that nothing can be done about. I want to go out celebrating, surrounded by my children, friends, and doctors before I'm put to sleep definitively at dawn."[2]

From the Time article, "Making a Case for Euthanasia". Mar. 15, 2008, "Sebire and her backers retort that preventing her from getting medical assistance to end her life swiftly and painlessly ensures months or years of additional torment from pain. Her death will come, they say, after a long coma that will reduce her to being nothing but an inanimate burden on her family."

• Forcing a person to stay on life support in excruciating pain is cruel French President Nicholas Sarkozy said in a 2007 campaign speech, "when I hear debates on euthanasia, I tell myself that while I respect the principles, the convictions, at the bottom of my heart I still say there are limits to the suffering that can be imposed on a human."[3]

• Euthanasia can be appropriate when a person is no longer themselves. The most sacred element of a person is their identity as individual and a soul. Once this is lost, much of the sanctity and fulfillment in life is lost. While this is not a full justification for euthanasia, it is a salient factor.

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No

• Life is an intrinsic good that cannot be traded in to end suffering The future which lies ahead for the terminally ill is of course terrifying, but society’s role is to help them live their lives as well as they can. This can take place through counselling, helping patients to come to terms with their condition.

• Euthanasia is falsely based on the idea that the ill can lose their identity Supporters of euthanasia sometimes argue that the ill are no longer the person they were, and therefore that their lives have no more meaning, and that euthanasia can relieve any suffering that this causes. But, human identity must be defined as connected with the continued existence of the body, even if mental capacities are entirely diminished. Even if a personality is gone, the continued dignity of the bodily identity must be respected.

• If Euthanasia is for 6-month terminal patients, why not let them live it out? Euthanasia is typically proposed only for the terminally ill; those who are not expected to live beyond six months. But, six months is not a very long time. Isn't it reasonable to expect the terminally ill to live out these six months or less until their death, especially when modern medicine can reduce any pain and make the process tolerable?

• Pain can't justify euthanasia, it can be made tolerable with modern medicines Modern palliative care is immensely flexible and effective, and helps to preserve quality of life as far as is possible. There is no need for terminally ill patients ever to be in excruciating pain, even at the very end of the course of their illness. There are some difficulties with using pain medicines that are regulated substances. Many doctors recommend that, at a minimum, the first step before considering euthanasia is to loosen the regulations on these substances so that terminally ill, pained patients can be more fully relieved of their pains.

• People should not be euthanized because they are in a "drugged state" Euthanasia advocates, having built a case largely on the pain of the terminally ill, respond to the notion of advanced pain treatment by arguing that it is undignified for individuals to be in a "drugged state". Yet, a "drugged state" can hardly be cited as a sufficient reason for euthanasia. As long as there is no unbearable pain, there is not much of a case for euthanasia.

• Assisted suicide makes everyone think they can do suicide on their own.

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Vs. "non-treatment": Is euthanasia better than withdrawing life support (non-treatment)?

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Yes

• Individuals have a right to hasten death, not merely to refuse treatment Compassion in Dying v. Washington. United States 9th Circuit Court of Appeals. March 6, 1996 - "While some people refer to the liberty interest implicated in right-to-die cases as a liberty interest in committing suicide, we do not describe it that way. We use the broader and more accurate terms, 'the right to die,' 'determining the time and manner of one's death,' and 'hastening one's death' for an important reason. The liberty interest we examine encompasses a whole range of acts that are generally not considered to constitute 'suicide.' Included within the liberty interest we examine, is for example, the act of refusing or terminating unwanted medical treatment...

Casey and Cruzan provide persuasive evidence that the Constitution encompasses a due process liberty interest in controlling the time and manner of one's death -- that there is, in short, a constitutionally recognized 'right to die.'"[4]

• Removing life support causes an excruciating death; euthanasia is more humane The Terri Shiavo case is illustrative of the situation created by the illegality of euthanasia. A choice was made that Terri Shiavo's death was imminent and that should should be allowed to die. Without the option of euthanasia, her feeding tubes were removed, and she was starved to death. How is that more moral than euthanasia? Forcing patients to starve to death or go into cardiac arrest, simply because the option of euthanasia does not exist, is a cruel alternative.

• Euthanasia is better than non-treatment ways to shorten lives and end suffering Doctors are allowed to make non-treatment decisions in special cases in order to shorten the life of a patient and end their suffering. This is a roundabout form of "euthanasia" that causes patients far more harm than a real euthanasia would. Doctors should be allowed to use euthanasia to avoid having to make these Non-Treatment decisions.

• Life can be prolonged unnaturally; euthanasia is a necessary cut-off option Life can be kept "alive" for longer and longer periods with modern technologies and techniques. Is this natural? No. Is it excessive? It certainly can be. When keeping life "alive" becomes an excessive exercise in medicine and technology, a cut-off point become necessary. That cut-off point is euthanasia. This argument will become increasingly relevant into the future, as human-beings are kept alive with dozens of test tubes and transplants.

• When life can only continue "unnaturally", "unnatural" euthanasia is OK Opponents of euthanasia talk about the importance of allowing nature to run its course with human life, and for humans to die a natural death (or as God intended), as opposed to induced by euthanasia. Yet, if "natural-death" is the criteria for right kind of death, then hospitalization, IVs, medication, and all other sorts life-support would be wrong. And, yet, this is precisely what is used to the extreme to keep alive, artificially, many individuals that would otherwise die a "natural" death. In this way, an "unnatural" life is often the only alternative to an "unnatural" death through euthanasia. Since neither alternative is "natural" or as "God intended", we must decide if euthanasia is appropriate on other criteria. Since this "natural death" argument is central to the opposition to euthanasia, we will find that the remaining case against euthanasia is dramatically weakened.

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No

• While a right to refuse treatment may exist, a right to assisted suicide does not It is justifiable for a person to refuse treatment. This respects the individual's right to not be touched or affected by other individuals. But, euthanasia is different in the sense that it involves other individuals in the process of the death of the individual.

• Withdrawing life-support should not be to end life, but for other purposes This means that withdrawing life-support should never be equivalent in intent to euthanasia. That is, it should never have the explicit purpose of ending a life. In Terri Shiavo's case, for instance, the explicit purpose of withdrawing life-support was to end her life. This was wrong, and is the reason why it was so widely opposed. Instead, withdrawing life support or denying it from the beginning must be about a broader desire to, for instance, live life naturally and without artificial support, spend as much time as possible with family without the interruption of life-support, or to live life naturally without the interruptions, discomfort or pain of life support. And, of course, withdrawing or denying life-support can also include death as the end result, but that death should never be the central purpose of the act.

• The alternative to euthanasia is a natural death without life support. The "natural death" alternative to euthanasia is not keeping someone alive via life support until they die on life support. That would, indeed, be unnatural. The natural alternative is, instead, to allow them to die off of life support.

• Euthanasia is not a natural death, or as God intended. It is important that man not attempt to play God or nature in subjecting another individual to euthanasia. Rather, patients should be allowed to live and die naturally. God or nature intended man to die in a certain way (ie. "naturally"). By euthanizing the individual, a person is deprived of this natural human experience and its diverted from the intentions of the Maker.

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Doctors: Are doctors well suited to (or even obligated to) facilitate euthanasia?

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Yes

• Euthanasia doctors don't "kill", they help individuals die who want to It is false to claim that the state or doctors are choosing to euthanize individuals. Doctors and the state make no choice at all, accept to permit and empower individuals to make their own choice to die or not. Any argument against euthanasia that is premised on the notion that it is wrong for one individual to kill or harm another misses this critical point; euthanasia only involves governments and doctors allowing patients to harm/kill themselves. It is a case of of the state and doctors allowing individuals to exercise their own liberties, rather than of the state or doctors taking any liberties away from the patient.

• Trained physicians are qualified to aid patients in decision to die Margaret Battin, Ph.D. Distinguished Professor of Philosophy and Adjunct Professor of Internal Medicine, Division of Medical Ethics, University of Utah. "Is a Physician Ever Obligated to Help a Patient Die?," Regulating How We Die. 1998: "Suicide assisted by a humane physician spares the patient the pain and suffering that may be part of the dying process, and grants the patient a 'mercifully' easy death."

• The antiquated text of the Hippocratic oath should not prevent euthanasia

• Doctors are obligated to reduce patient suffering by enabling euthanasia

• Doctors are often put into an impossible position of denying requests to assist in suicide. A good doctor will form close bonds with their patients, and will want to give them the best quality of life they can. However, when a patient has lost or is losing their ability to live with dignity and expresses a strong desire to die, they are legally unable to help. To say that modern medicine can totally eradicate pain is a tragic over-simplification of suffering. While physical pain may be alleviated, the emotional pain of a slow and lingering death, of the loss of the ability to live a meaningful life, can be horrific. A doctor’s duty is to address his or her patient’s suffering, be it physical or emotional. As a result, doctors will in fact already help their patients to die – although it is not legal, assisted suicide does take place. It would be far better to recognise this, and bring the process into the open, where it can be regulated. True abuses of the doctor-patient relationship, and incidents of involuntary euthanasia, would then be far easier to limit.

• Doctor will not be alone in choosing euthanasia; family, patient, and a third party regulator will be included.

• If an individual doctor opposes euthanasia, another one can perform the procedure. There is no necessity to force any given doctor into performing euthanasia. If a doctor strongly opposes euthanasia, it's OK, another doctor can be found to perform the procedure.

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No

• Euthanasia gives too much power to doctors to kill

• The first promise of the Hippocratic oath is to never euthanize patients The relevant portion of the Hippocratic oath reads, "I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone. To please no one will I prescribe a deadly drug nor give advice which may cause his death." This oath is the center piece of medical practice and ethics. How can euthanasia be practiced in the medical profession when it so clearly violates its principal ethical code.

• Euthanasia contradicts the physicians fundamental role as healer The physician has always acted as healer. Euthanasia contradicts this basic role.

• Physicians can never be obligated to facilitate euthanasia Some suggest that physicians have an obligation to end the suffering of patients by subjecting them to euthanasia. Yet, physicians may have strong beliefs against the practice, particularly on the basis that human life should never be intentionally ended under any circumstance. Who is to say that they are wrong? Furthermore, physicians never signed any piece of paper that states an obligation to euthanize patients in circumstances of extreme suffering. Finally, the Hippocratic oath, the main oath taken by physicians, directly forbids physicians from performing euthanasia. Certainly, it is a stretch any physician would be obligated to perform the procedure.

• Euthanasia violates the guiding principle of medical ethics is to do no harm a physician must not be involved in deliberately harming their patient. Without this principle, the medical profession would lose a great deal of trust; and admitting that killing is an acceptable part of a doctor’s role would likely increase the danger of involuntary euthanasia, not reduce it.

• Legalizing euthanasia places an unreasonable burden on doctors The daily decisions made in order to preserve life can be difficult enough; to require them to also carry the immense moral responsibility of deciding who can and cannot die, and the further responsibility of actually killing patients, is unacceptable. This is why the vast majority of medical professionals oppose the legalisation of assisted suicide: ending the life of a patient goes against all they stand for. Many doctors that have performed euthanasia are traumatized or deeply, negatively affected by the experience.

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Families: Do the families of patients have an interest in euthanasia?

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Yes

• Euthanasia helps families that don't want to see their loved one suffer. As was mentioned above, euthanasia is an immediate and painless way to end a life that is too painful. Many families don't want to see their loved ones suffer and the patient doesn't want them to suffer either. Euthanasia provides an option to end a life before it even enters the terminal "death-bed" stage of suffering, or it allows families to choose to end a "death bed" existence with dignity and peace instead of simply pulling the plugs to, in some case, starve their loved one to death.

• Euthanasia is a family decision, not a state decision Charlie Crist, former Attorney General of Florida and current governor, was quoted in an April 20, 2006 article in the AZ Republican, entitled "Attorney General Says Bush Had Schiavo Case Wrong" - "I am pro-life and I respect life.. There are some decisions that ought to be left to God and family... Had I been governor, I would not have done the same thing [as Jeb Bush]... These kinds of end-of-life matters do not belong in government."[5]
  • Euthanizing disabled persons is a family decision not a state one

• Most people that believe euthanasia is wrong never sat by a bed side. Some advocates of euthanasia note that those that have come out of a "bed-side" death very frequently become advocates of euthanasia. In the same vein, they argue that those making decisions against euthanasia have not been in the same "bed-side" situation, and if they had been, they would probably change their position.

• Legalizing euthanasia would allow more open family dialogue on the choice. Where euthanasia is currently illegal, it is a lonely, desperate act, carried out in secrecy and often as a cry for help. The impact on the family who remain can be catastrophic. By legalizing assisted suicide, the process can be brought out into the open. In some cases, families might have been unaware of the true feelings of their loved one; being forced to confront the issue of their illness may do great good, perhaps even allowing them to persuade the patient not to end their life. In other cases, it makes them part of the process: they can understand the reasons behind their decision without feelings of guilt and recrimination, and the terminally ill patient can speak openly to them about their feelings before their death.

• Third party euthanasia regulators can ensure against abuse (family, doctor...)

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No

• Families will abuse euthanasia merely to reduce family strains. Families often have a direct interest in seeing an ill family member die. First, they may not have the money to support the costs of keeping the patient alive. Second, they may not want to go through the burden of supporting and comforting a loved one in a long downward spiral toward their death. These are strong incentives for family members to pressure their ill family member into euthanasia, even if the individual does not want it. Legalizing euthanasia would open the door to this kind of pressure. Even the most well regulated system would have no real way to ensure that this does not happen.

• Family members may oppose the decision of a loved one to be euthanized. Many may resent a loved one’s decision to die, and would be either emotionally scared or estranged by the prospect of being in any way involved with their death.

• The ill will feel pressure to seek euthanasia to avoid burdening family The dying have a profound sense of shame and guilt, being in the condition that they are, and causing their family substantial burdens and strains. If euthanasia is available, they may choose it simply out of this sense of guilt, which would be wrong. No regulations can prevent this from occurring, particularly because the patient would give the appearance of choosing euthanasia completely voluntarily. And, it would be voluntary, but in the context of guilt, rather than self-interest.

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Abuse: Could legalization avoid opening a slippery slope to abuse and murder?

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Yes

• Euthanasia will not create a slippery slope to legal murder R.G. Frey, D.Phil, Professor of Philosophy, Bowling Green State University. "The Fear of a Slippery Slope," Euthanasia and Physician-Assisted Suicide: For and Against. 1998 - "Especially with regard to taking life, slippery slope arguments have long been a feature of the ethical landscape, used to question the moral permissibility of all kinds of acts... The situation is not unlike that of a doomsday cult that predicts time and again the end of the world, only for followers to discover the next day that things are pretty much as they were...

We not only can distinguish between [voluntary and non-voluntary] cases [of euthanasia] but do...

We need the evidence that shows that horrible slope consequences are likely to occur. The mere possibility that such consequences might occur, as noted earlier, does not constitute such evidence."[6]

• Euthanasia abuses are less likely if practice is brought into open. It is common when a practice is criminalized that it is taken into the shadows and performed without regulation and, subsequently, abusively. This is no less the case with euthanasia.

• Eligibility for euthanasia requires that patients meet strict criteria. The criteria involved in the proposals to legalize euthanasia are very detailed and would be enforced very strictly. Breaking from these criteria even minutely would be very difficult, which means that the potential of a slippery slope to forced euthanasias, murders, and other abuses is virtually impossible. While minor infractions of the criteria are possible, the gloomy "slippery slope" scenarios argued by opponents of euthanasia are virtually impossible.

• History does not suggest doctors coerce patients into euthanasia There is very little historical evidence of doctors actually coercing patients into accepting euthanasia against their will. Part of the reason is that it is a major leap from patients having to request euthanasia to doctors forcing it upon them. It reality, it is not a very plausible leap, particularly with the number of checks that would be in place against such abuses, upon legalization.

• Third party euthanasia regulators can ensure against abuse (family, doctor...)

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No

• Euthanasia creates a slippery slope to legal murder Wesley Smith, J.D., Consultant to the International Task Force on Euthanasia, writes in his 2000 book Culture of Death: The Assault on Medical Ethics in America. - "Oregon is sliding down the same slippery slope as did the Netherlands. Once killing is redefined from bad to good, the protective guidelines for assisted suicide, which advocates assure us will keep the practice of hastening death corralled, are also quickly redefined, at least in practice, as obstacles to be overcome. Then they are attacked, ignored, or reinterpreted, while potential violations go essentially uninvestigated - to the point where they eventually become irrelevant."[7]

• Dutch doctors have abused legal euthanasia in their country Richard Fenigsen, "Dutch euthanasia revisited, " Issues in Law & Medicine, Winter 1997 v13 n3 p301-311 - "Dr. Fenigsen says the Dutch are not on a slippery slope, "Dutch doctors who practice euthanasia are not on a slope. From the very beginning they have been at the bottom." Dr Fenigsen found "involuntary euthanasia…is rampant. . ..a staggering 62% of all newborns' and infants' deaths resulted from 'medical decisions,'" further to this, in 1995 alone there were 900 lethal injections given to patients who had not requested euthanasia.. It revealed that 189 were fully competent and could have been consulted about their consent but were not. Fenigsen concludes that "those who contend that it is possible to accept and practice ‘voluntary’ euthanasia and not allow involuntary totally disregard the Dutch reality.”[8]

• Difficult to ensure assisted suicide is voluntary Euthanasia.com. "Arguments Against Euthanasia". Retrieved April 29th, 2008 - "3. Euthanasia will only be voluntary, they say Emotional and psychological pressures could become overpowering for depressed or dependent people. If the choice of euthanasia is considered as good as a decision to receive care, many people will feel guilty for not choosing death. Financial considerations, added to the concern about "being a burden," could serve as powerful forces that would lead a person to "choose" euthanasia or assisted suicide.

People for euthanasia say that voluntary euthanasia will not lead to involuntary euthanasia. They look at things as simply black and white. In real life there would be millions of situations each year where cases would not fall clearly into either category. Here are two:

Example 1: an elderly person in a nursing home, who can barely understand a breakfast menu, is asked to sign a form consenting to be killed. Is this voluntary or involuntary? Will they be protected by the law? How? Right now the overall prohibition on killing stands in the way. Once one signature can sign away a person's life, what can be as strong a protection as the current absolute prohibition on direct killing? Answer: nothing."

• Euthanasia threatens vulnerable minority groups (below)

• Euthanasia will desensitize public to idea of killing to solve problems Euthanasia will give the impression that it is OK to kill or to commit suicide when faced with a problem. This is a bad example to set.

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Abuse, disabled: Does euthanasia open the door to abusing the disabled?

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Yes

• Disabled would have to seek euthanasia in order to receive it The argument that the legalization of euthanasia will increase deaths of disabled by euthanasia is premised on the faulty notion that the government and doctors are actually forcing euthanasia on people. Individuals must ask for euthanasia, it can never be forced upon them. Therefore, the only way that euthanasia's legalization could increase the death of the disabled is if disabled people more frequently asked for euthanasia. There is no evidence that disabled would request the practice any more than other dying and suffering people.
• Euthanasia would not deny protections for disabled against murder
• History does not suggest euthanasia leads to murder of disabled
• Government can adequately regulate euthanasia in cases involving disabled
• Evidence suggests that the majority of disabled support euthanasia
• Regulations lower risks of euthanasia causing disabled to be viewed as "valueless"
• Denying the disabled the "right to die" will cause them painful deaths As mentioned before, everyone has a right to end their pain. Right now, suicide is allowed in many countries while euthanasia aren't. This is a clear discrimination toward the patients who is not able to end their lives without any help of others.

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No

• Euthanasia threatens vulnerable disabled groups Robert Burgdorf Jr., J.D., The National Council on Disability. "Assisted Suicide: A Disability Perspective". March 24, 1997 - "Current evidence indicates clearly that the interests of the few people who would benefit from legalizing physician-assisted suicide are heavily outweighed by the probability that any law, procedures, and standards that can be imposed to regulate physician-assisted suicide will be misapplied to unnecessarily end the lives of people with disabilities and entail an intolerable degree of intervention by legal and medical officials in such decisions. On balance, the current illegality of physician-assisted suicide is preferable to the limited benefits to be gained by its legalization. At least until such time as our society provides a comprehensive, fully-funded, and operational system of assistive living services for people with disabilities, this is the only position that the National Council on Disability can, in good conscience, support."[9]

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Poor: Could legal euthanasia avoid jeopardizing the vulnerable poor?

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Yes

• Poor people that can't afford health care won't then seek euthanasia Opponents of Euthanasia sometimes argue that the poor are vulnerable in the event of the legalization of Euthanasia because they can't afford health care, and so will seek euthanasia instead. This is premised on the false notion that death can somehow be a good alternative to the inability to do something else. Unless a poor person doesn't want to live anymore, they will not seek euthanasia as an alternative to unaffordable health care.

• Hospitals won't re-focus resources on euthanizing the disadvantaged In Compassion in Dying v. Washington (1996), the United States 9th Circuit Court of Appeals, in a decision delivered by Circuit Judge Stephen Reinhardt - "One of the [lower court] majority's prime arguments is that the statute [outlawing physician-assisted suicide] is necessary to protect 'the poor and minorities from exploitation,'-- in other words, to protect the disadvantaged from becoming the victims of assisted suicide. This rationale simply recycles one of the more disingenuous and fallacious arguments raised in opposition to the legalization of abortion. It is equally meretricious here... The argument that disadvantaged persons will receive more medical services than the remainder of the population in one, and only one, area -- assisted suicide -- is ludicrous on its face."[10]

• Euthanasia is mainly utilized by non-vulnerable, well-educated groups Death With Dignity National Center. "Frequently Asked Questions". www.deathwithdignity.org. January 22, 2006 - "To date, persons who have chosen to use the [Oregon Death with Dignity] law have been well educated, have had excellent health care, have had good insurance, have had access to hospice and have been well supported financially, emotionally and physically."[11]

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No

• Euthanasia threatens the vulnerable poor Euthanasia.com. "Arguments Against Euthanasia". Retrieved April 29th, 2008 - "2. Euthanasia can become a means of health care cost containment

"...physician-assisted suicide, if it became widespread, could become a profit-enhancing tool for big HMOs. "

"...drugs used in assisted suicide cost only about $40, but that it could take $40,000 to treat a patient properly so that they don't want the "choice" of assisted suicide..." ... Wesley J. Smith, senior fellow at the Discovery Institute.

Perhaps one of the most important developments in recent years is the increasing emphasis placed on health care providers to contain costs. In such a climate, euthanasia certainly could become a means of cost containment.

In the United States, thousands of people have no medical insurance; studies have shown that the poor and minorities generally are not given access to available pain control, and managed-care facilities are offering physicians cash bonuses if they don't provide care for patients. With greater and greater emphasis being placed on managed care, many doctors are at financial risk when they provide treatment for their patients. Legalized euthanasia raises the potential for a profoundly dangerous situation in which doctors could find themselves far better off financially if a seriously ill or disabled person 'chooses' to die rather than receive long-term care."

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Palliative care: Does euthanasia advance or undermine end-of-life palliative care?

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Yes

• Assisted suicide increases interest in improving end-of-life care Barbara Coombs Lee, J.D. President, Compassion & Choices. "A Right to Die?". PBS Newshour. November 26, 1997 - "Palliative care has been the main beneficiary of the Oregon Death with Dignity Act [which legalized physician-assisted suicide] so far. Since its passage, we've seen a great resurgence of interest in the medical community in palliative care. Hospice referrals have increased by 20 percent, and now Oregon leads the nation in prescription of morphine. This has a salutary effect on end of life care."[12]

• There is no reason why euthanasia would damage palliative care

• Euthanasia can only be performed after exhausting palliative options This obviously means that there is no "either/or" situation involved with euthanasia. It is, rather, and "and" situation. Palliative care is given and only when it is exhausted can euthanasia be performed.

• Third party euthanasia regulators can ensure against abuse (family, doctor...)

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No

• Euthanasia option can disincentivize sound end-of-life palliative care Physicians for Compassionate Care. "Top 10 FAQs". www.pccef.org. 2006 - "Once a patient has the means to take their own life, there can be decreased incentive to care for the patient's symptoms and needs. The case of Michael Freeland is an example. Michael had been given a lethal prescription and when his doctors were planning for his discharge to his home from the hospital, one physician wrote that while he probably needed attendant care at home, providing additional care may be a 'moot point' because he had 'life-ending medication'. His assisted suicide doctor did nothing to care for his pain and palliative care needs. This seriously ill patient was receiving poor advice and medical care because he had lethal drugs."

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Healthcare costs: Would it reduce health care costs? Is this a good or bad thing?

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Yes

• Euthanasia is not fundamentally driven by a desire to cut costs While it is true that a correlation appears to exist in the interests of for-profit health-care companies and euthanasia, this does not mean that the drive for euthanasia is at all driven by these cynical considerations. Certainly ethical boundaries can be put in place to prevent profit from influencing considerations over euthanasia.

• Euthanasia would reduce health care costs While this is, again, not a driving consideration behind euthanasia, it is true that euthanasia could reduce health care costs. This should be seen only as an added benefit to implementing the practice. Leonard M. Fleck, Professor of Philosophy and Medical Ethics at Michigan State University's Medical School. Quoted in an April 7, 1996 New York Times article, "The Right to Suicide, Some Worry, Could Evolve Into a Duty to Die" - "The need for health care rationing is inescapable because the parameters for adding care expand each day... The moral challenge is to come up with approaches that are open, rational and democratic, but that limit marginally beneficial and non-costworthy care. In my opinion, there are no good options given the current situation, but assisted suicide is the least worst option."[13]

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No

• Euthanasia is driven by a cynical desire to cut health care costs Rita Marker, J.D. Executive Director, International Task Force on Euthanasia and Assisted Suicide. "Assisted Suicide and Cost Containment," www.internationaltaskforce.org. 1999 - "Cost containment well could become the engine that pulls the legislative train along the track to death on demand. Those who advocate dismantling the barriers that now protect patients from assisted suicide recognize the power of cost containment."[14]

• Euthanasia would not cut health care costs by very much Ezekiel Emanuel, M.D., and Margaret Battin, M.D., New England Journal of Medicine. "What Are the Potential Cost Savings From Legalizing Physician-Assisted Suicide?". July 19th, 1998. - "In the Netherlands, approximately 3,100 cases of euthanasia and 550 cases of physician-assisted suicide occur annually, representing 2.3 percent and 0.4 percent, respectively, of all deaths...

Assuming that 2.7 percent of patients who die each year (62,000 Americans) would choose physician-assisted suicide...we estimate that legalizing physician-assisted suicide and euthanasia would save approximately $627 million in 1995 dollars. This amount is less than 0.07 percent of total U.S. health care expenditures...

Physician-assisted suicide is not likely to save substantial amounts of money in absolute or relative terms...for the nation as a whole."[15]

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Religion: What is the role of faith in the euthanasia debate?

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Yes

• Religious opposition to Euthanasia should not be considered in law

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No

• Many passages in the Bible indicate opposition to euthanasia
• Opposition to euthanasia is not supported only be religious arguments

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Public support: Is there public support for Euthanasia?

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Yes

• Euthanasia is legal in the Netherlands, Belgium and Switzerland.
• In America, roughly 75% of the public support Euthanasia.

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No

• There is no precedent of support of Euthanasia in the United States.

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Pro/con resources

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Yes

• Bruce Crumley. "Making a Case for Euthanasia". Time. Mar. 15, 2008

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No

• "Euthanasia violates human dignity, Pope says". Feb. 25, 2008
• Patrick Lee. "Personhood, Dignity, Suicide, and Euthanasia". The National Catholic Bioethics Quarterly." Autumn 2001, Vol.1 No.3
• Euthanasia.com. "Arguments Against Euthanasia". Retrieved April 29th, 2008
• Angarola RT, Joranson DE. "Pain and euthanasia: the need for alternatives". APS Bulletin. 1992
• Gudrun Schultz. "Euthanasia? How Can a Secular Society Claim Anyone is 'Better Off Dead'? Palliative care expert gives presentation to Canadian MPs". October 31, 2006
• Ms. Diane Coleman, President Not Dead Yet. "Testimony Before the United States Senate Judiciary Subcommittee On the Constitution, Civil Rights and Property Rights". May 25, 2006
• Jennifer Mesko, managing editor. "Friday Five: Pro-Life Hero Rita Marker". January 18th, 2008
• Devon Williams, associate editor of Citizen Link. "Friday Five: Pro-Life Hero Wesley J. Smith". January 25th, 2008

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Pro/con videos

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Yes

Piero Welby to the Italian President: I want euthanasia". December 20th, 2006[16]

"French Woman's Death Revives Euthanasia Debate". Posted on YouTube March 20th, 2008.[17]

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No

President Bush on Terri Schiavo. Posted on YouTube, December 29th, 2007.

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Activist groups: Where do the relevant interest and activist groups stand?

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Yes

• Compassion in Dying
• Euthanasia Guidance and Resource Organization
• Hemlock Society USA
• Partnership for Caring

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No

• Aging with Dignity
• Citizens United Resisting Euthanasia (CURE)
• Euthanasia.com
• International Anti-Euthanasia Task Force

See also

• Debate: Euthanasia of individuals in a permanent vegetative state

External links

• Pros and Cons of Euthanasia
• Compassion and Choice (formerly Hemlock Society)
• PBS Frontline: The Kervorkian Verdict
• Euthanasia World Dirctory (formerly Final exit)
• Euthanasia.Com (anti-euthanasia site)
• Dignitas (German language site)
• Voluntary Euthanasia Society of New Zealand
• Christian Medical Fellowship collection of articles
• LifeSite - North American pro-life site
• Dignity in Dying
• BBC special report

Books:

• Final Exit: The practicalities of self-deliverance and assisted suicide for the dying ^{Derek Humphrey}
• A Chosen Death : The Dying Confront Assisted Suicide ^{Lonny Shavelson}
• Euthanasia and Physician-Assisted Suicide (For and Against) ^{Gerald Dworkin}
• Euthanasia : Opposing Viewpoints (Opposing Viewpoints Series) ^{James Torr}
• The Ethics of Euthanasia (At Issue Series) ^{Daniel Leone}
• Euthanasia and Physician-Assisted Suicide: Killing or Caring? ^{Michael Manning}
• Euthanasia -- Choice and Death (Contemporary Ethical Debates) ^{Henry Toledano}
• Ethical Eye - Euthanasia: National And European Perpsectives

Videos

"Dying for Euthanasia - 44-min Documentary". November 20th, 2007.[18]