Criminalization of euthanasia

Illegality of doctor-assisted suicide
Denial of the right to euthanasia
Criminality of physician-aided suicide

Nature

In most countries, the criminalization of euthanasia means that doctors will be prosecuted for assisting terminally ill patients to commit suicide.

In the USA, it is legal for a patient to refuse medical treatment and order his life support system stopped, but it is not legal throughout the country to take a lethal dose of a medical treatment. Thus suicide by omission is legal, but by commission is generally not.

In one American state where euthanasia is legal, an ill adult of sound mind with less than 6 months to live can request a prescription of legal drugs. In the Netherlands, doctors must limit euthanasia to the terminally ill who suffer irremediable pain and who have explicitly and frequently asked for death while lucid. A second physician with no ties to the primary doctor or the patient must give an opinion about granting permission, and the death must be reported to the justice officials along with detailed information about it.

Where euthanasia is permitted in the USA, a doctor may write the prescription, but not administer the drugs. In the Netherlands in 1995, the law was tightened to ensure that, whenever possible, the patient should administer the lethal drugs himself.

In the USA, the lethal drugs may be purchased via a state funded medical assistance plan by poor people, a law which is viewed as controversial.

Background

The legality of assisting a voluntary death has been debated publicly in the USA since at least 1890. Euthanasia has been practised in the Netherlands since at least 1973, although the first guidelines for legalizing it were written in 1984. In 1995 in Britain, a Mental Incapacity Bill was prepared with the intention of legalizing euthanasia. In Australia, euthanasia was legalized in 1996, four patients killed themselves, and in 1997 euthanasia was re-criminalized.

Incidence

67% of Americans think that terminally ill people in pain who express the wish to die should be allowed to do so. However, as of 1997, 35 of 50 states had laws against doctor-assisted suicide.

Claim

Assisting a patient to commit suicide is incompatible with the primary goal of medicine, which is to save life.

Most terminally ill patients who ask to die are seriously depressed. Society does not assist other seriously depressed people to commit suicide, perhaps on the assumption that their depression can be alleviated, and then they will not want to kill themselves any more.

In 1997, in the USA the Supreme Court found that patients did not have the right to a doctor-assisted suicide.

Perhaps because of public division on legalizing euthanasia, states have focused on improving palliative care for the terminally ill by legalizing medications for controlling pain. Dutch doctors opposed to euthanasia state that the lack of palliative care facilities in the Netherlands is an undesirable contributor to patient demand for euthanasia.

Counter-claim

Euthanasia, also known as 'mercy killing', has been advocated by small groups of physicians subscribing to the belief that, with adequate safeguards, it should be legalized to allow incurable sufferers to choose immediate death rather than await it in agony. These advocates of euthanasia hold that most of the legal and religious arguments against mercy killing are founded on emotion rather than on reason.

When patients determine their own fate the public attitude toward euthanasia becomes more tolerant.

If doctors are not permitted to assist terminally ill patients to commit suicide, the health insurance companies and managed care regimes in the USA will probably pressure these patients to commit suicide unaided in order to reduce their health care claims. This is a situation that any society should avoid.

In 1996, laws against euthanasia were not considered valid in an American state because they violated the 14th amendment to the constitution of equal protection to all people. Those laws wrongly permit one class of people to end their lives by the withdrawal of medical treatment, but refuse the right to die to another class of people by denying them the right to assisted suicide.

In 1996, laws against euthanasia were not considered valid in an American state because they deprived people of a fundamental liberty, namely the right to define the concept of their existence. This apparently includes determining its endpoint, if so desired.

In the Netherlands, a doctor was acquitted by the Supreme Court of breaking the law following his assistance to the suicide of an inconsolable, but psychologically healthy 50 year old woman whose sons had both died. There is no reason why the right to end one's life in a dignified fashion should be restricted to the terminally ill. Suicide should be legal, with optional assistance from the medical profession.

In the USA as of 1997, about 70% of deaths in hospital occurred because someone decided to withhold treatment. As 80% of people now die in hospital, that means that most people have a managed death of some sort anyhow.

Experience in the Netherlands has shown that if a doctor does not directly assist the patient, the suicide attempt can be messy, and this is not beneficial to the patient, who is already so ill that he may not be able to carry out the lethal procedure properly himself.

One San Francisco doctor has said that whether the Supreme Court legalizes euthanasia or not, it will happen, and there need to be protocols for it.