We have a right to die with dignity. The medical profession has a duty to assist

argumentative essay voluntary euthanasia

Distinguished Professor of Philosophy and Director: Centre for Applied Ethics, Stellenbosch University

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Anton van Niekerk is director of the Centre for Applied Ethics and Head of the Unit for Bioethics in that Centre. The Unit receives an annual contribution from Mediclinic, but that is not for the exclusive use of Anton van Niekerk.

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argumentative essay voluntary euthanasia

Euthanasia represents one of the oldest issues in medical ethics. It is forbidden in the original Hippocratic Oath, and has consistently been opposed by most religious traditions since antiquity – other than, incidentally, abortion, which has only been formally banned by the Catholic Church since the middle of the 19th century.

Euthanasia is a wide topic with many dimensions. I will limit myself in this article to the issue of assisted death, which seems to me to be one of the most pressing issues of our time.

Desmond Tutu, emeritus archbishop of Cape Town, raised it again on his 85th birthday in an article in the Washington Post. He wrote:

I have prepared for my death and have made it clear that I do not wish to be kept alive at all costs. I hope I am treated with compassion and allowed to pass onto the next phase of life’s journey in the manner of my choice.

Assisted death can take the form of physician assisted suicide (PAS) . Here a suffering and terminal patient is assisted by a physician to gain access to a lethal substance which the patient himself or herself takes or administers. If incapable of doing so, the physician – on request of the patient – administers the lethal substance which terminates the patient’s life.

The latter procedure is also referred to as “voluntary active euthanasia” (VAE). I will not deal with the issue of involuntary euthanasia –where the suffering patient’s life is terminated without their explicit consent -– a procedure which, to my mind, is ethically much more problematic.

Passive form of euthanasia

The term “voluntary active euthanasia” suggests that there also is a passive form of euthanasia. It is passive in the sense that nothing is “actively” done to kill the patient, but that nothing is done to deter the process of dying either, and that the termination of life-support which is clearly futile, is permitted.

However, the moral significance of the distinction between “active” and “passive” euthanasia is increasingly questioned by ethicists. The reason simply is the credibility of arguing that administering a lethal agent is “active”, but terminating life support (for example switching off a ventilator) is “passive”. Both clearly are observable and describable actions, and both are the direct causes of the patient’s death.

There are a number of reasons for the opposition to physician assisted suicide or voluntary active euthanasia. The value bestowed on human life in all religious traditions and almost all cultures, such as the prohibition on murder is so pervasive that it is an element of common, and not statutory, law.

Objections from the medical profession to being seen or utilised as “killers” rather than saviours of human life, as well as the sometimes well-founded fear of the possible abuse of physician assisted suicide or voluntary active euthanasia, is a further reason. The main victims of such possible abuse could well be the most vulnerable and indigent members of society: the poor, the disabled and the like. Those who cannot pay for prolonged accommodation in expensive health care facilities and intensive care units.

Death with dignity

In support of physician assisted suicide or voluntary active euthanasia, the argument is often made that, as people have the right to live with dignity, they also have the right to die with dignity. Some medical conditions are simply so painful and unnecessarily prolonged that the capability of the medical profession to alleviate suffering by means of palliative care is surpassed.

Intractable terminal suffering robs the victims of most of their dignity. In addition, medical science and practice is currently capable of an unprecedented prolongation of human life. It can be a prolongation that too often results in a concomitant prolongation of unnecessary and pointless suffering.

Enormous pressure is placed upon both families and the health care system to spend time and very costly resources on patients that have little or no chance of recovery and are irrevocably destined to die. It is, so the argument goes, not inhumane or irreverent to assist such patients – particularly if they clearly and repeatedly so request – to bring their lives to an end.

I am personally much more in favour of the pro-PAS and pro-VAE positions, although the arguments against do raise issues that need to be addressed. Most of those issues (for example the danger of the exploitation of vulnerable patients) I believe, can be satisfactorily dealt with by regulation.

Argument in favour of assisted suicide

The most compelling argument in favour of physician assisted suicide or voluntary active euthanasia is the argument in support of committing suicide in a democracy. The right to commit suicide is, as far as I am concerned, simply one of the prices we have to be willing to pay as citizens of a democracy.

We do not have the right, and we play no discernible role, in coming into existence. But we do have the right to decide how long we remain in existence. The fact that we have the right to suicide, does not mean that it is always (morally) right to execute that right.

It is hard to deny the right of an 85-year-old with terminal cancer of the pancreas and almost no family and friends left, to commit suicide or ask for assisted death. In this case, he or she both has the right, and will be in the right if exercising that right.

Compare that with the situation of a 40-year-old man, a husband and father of three young children, who has embezzled company funds and now has to face the music in court. He, also, has the right to commit suicide. But, I would argue, it would not be morally right for him to do so, given the dire consequences for his family. To have a right, does not imply that it is always right to execute that right.

My argument in favour of physician assisted suicide or voluntary active euthanasia is thus grounded in the right to suicide, which I think is fundamental to a democracy.

Take the case of a competent person who is terminally ill, who will die within the next six months and has no prospect of relief or cure. This person suffers intolerably and/or intractably, often because of an irreversible dependence on life-support. This patient repeatedly, say at least twice a week, requests that his/her life be terminated. I am convinced that to perform physician assisted suicide or voluntary active euthanasia in this situation is not only the humane and respectful, but the morally justified way to go.

The primary task of the medical profession is not to prolong life or to promote health, but to relieve suffering. We have a right to die with dignity, and the medical profession has a duty to assist in that regard.

  • Assisted suicide
  • Voluntary euthanasia
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argumentative essay voluntary euthanasia

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Voluntary Euthanasia

The entry sets out five conditions often said to be necessary for anyone to be a candidate for legalized voluntary euthanasia (and, with appropriate qualifications, physician-assisted suicide), outlines the moral case advanced by those in favor of legalizing voluntary euthanasia, and discusses the five most important objections made by those who deny that voluntary euthanasia is morally permissible and who are, in consequence, opposed to its being legalized.

1. Introduction

2. five conditions often proposed as necessary for candidacy for voluntary euthanasia, 3. a moral case for voluntary euthanasia, 4. five objections to the moral permissibility of voluntary euthanasia, other internet resources, related entries.

When a person performs an act of euthanasia, she brings about the death of another person because she believes the latter’s present existence is so bad that he would be better off dead, or believes that unless she intervenes and ends his life, his life will very soon become so bad that he would be better off dead. Accordingly, the motive of the person who performs an act of euthanasia is to benefit the one whose death is brought about. (This also holds for many instances of physician-assisted suicide, but use of the latter term is usually restricted to forms of assistance which stop short of the physician ‘bringing about the death’ of the patient, for example, those involving means that have to be activated by the patient.)

It is important to emphasize the motive of benefiting the person who is assisted to die because well-being is a key value in relation to the morality of euthanasia (see Section 3 below). Nonetheless, the defensibility of the contention that someone can be better off dead has been the subject of extensive philosophical deliberation. Those who claim that a person can be better off dead believe this to be true when the life that remains in prospect for that person has no positive value for her (a possibility which is discussed by e.g., Foot, 1977; McMahan 2002; Bradley 2009), whereas some of those who hold that a person’s life is inviolable deny that a person can ever be better off dead (e.g., Keown in Jackson and Keown 2012). A Kant-inspired variant on this latter position has been advanced by Velleman (1999). He considers that a person’s well-being can only matter if she is of intrinsic value and so that it is impermissible to violate a person’s rational nature (the source of her intrinsic value) for the sake of her well-being. Accordingly, he holds that it is impermissible to assist someone to die who judges that she would be better off dead and competently requests assistance with dying. The only exception is when a person’s life is so degraded as to call into question her rational nature, albeit he thinks it unlikely that anyone in that position will remain competent to request assistance with dying. This position appears to be at odds with the well-established right of a competent patient to refuse life-prolonging medical treatment, at least when further treatment is refused because she considers that her life no longer has value for her and further treatment will not restore its value to her. (For further reasons to reject arguments for the inviolability of the life of a person, including Velleman’s, see e.g., McMahan 2002; Young 2007; Sumner 2011.)

Because our concern will be with voluntary euthanasia – that is, with those instances of euthanasia in which a clearly competent person makes a voluntary and enduring request to be helped to die (or, by extension, when an authorised proxy makes a substituted judgment by choosing in the manner the no-longer-competent person would have chosen had he remained competent) – a second key value is the competence of the person requesting assistance with dying. There will be occasion to mention non-voluntary euthanasia – instances of euthanasia where a person lacks the competence at the time when a decision is to be made to request euthanasia and has not previously competently declared a preference for it via an advance directive (see the entry on advance directives ) – only when consideration is given to the claim that permitting voluntary euthanasia will lead via a slippery slope to permitting non-voluntary euthanasia. Nothing will be said here about involuntary euthanasia , where a competent person’s life is brought to an end despite an explicit expression of opposition to euthanasia, beyond saying that, no matter how honorable the perpetrator’s motive, such a death is, and ought to be, unlawful.

Debate about the morality and legality of voluntary euthanasia has been, for the most part, a phenomenon of the second half of the twentieth century and the beginning of the twenty first century. Certainly, the ancient Greeks and Romans did not believe that life needed to be preserved at any cost and were, in consequence, tolerant of suicide when no relief could be offered to a dying person or, in the case of the Stoics and Epicureans, when a person no longer cared for his life. In the sixteenth century, Thomas More, in describing a utopian community, envisaged such a community as one that would facilitate the death of those whose lives had become burdensome as a result of ‘torturing and lingering pain’. But it has only been in the last hundred years that there have been concerted efforts to make legal provision for voluntary euthanasia. Until quite recently there had been no success in obtaining such legal provision (though assisted suicide, including, but not limited to, physician-assisted suicide, has been legally tolerated in Switzerland for a number of decades). However, the outlook changed dramatically in the 1970s and 80s because of a series of court cases in The Netherlands which culminated in an agreement between the legal and medical authorities to ensure that no physician would be prosecuted for assisting a patient to die as long as certain guidelines were strictly adhered to (see Griffiths, et al., 1998). In brief, the guidelines were established to permit physicians to practise voluntary euthanasia in those instances in which a competent patient had made a voluntary and informed request to be helped to die, the patient’s suffering was unbearable, there was no way of making that suffering bearable that was acceptable to the patient, and the physician’s judgements as to diagnosis and prognosis were confirmed after consultation with another physician.

The first legislative approval for voluntary euthanasia was achieved with the passage in the parliament of Australia’s Northern Territory of a bill enabling physicians to practise voluntary euthanasia. Subsequent to the Act’s proclamation in 1996, it faced a series of legal challenges from opponents of voluntary euthanasia. In 1997 the challenges culminated in the Australian National Parliament overturning the legislation when it prohibited Australian territories from enacting legislation to permit voluntary euthanasia on constitutional grounds. Australia is a federation consisting of six states and two territories. Unlike the territories, the states do have the constitutional right to enact such legislation and in 2017 the state of Victoria did just that. The legislation came into effect in 2019. In 2019, a second state, Western Australia, enacted legislation to enable voluntary medically assisted death. The legislation became effective in 2021. In 2021 three further states, Tasmania, South Australia and Queensland enacted legislation to enable voluntary medically assisted death which will come into force in 2022 for the first two, and 2023 for the third. In 2022 NSW enacted legislation which will come into force in 2023 thereby ensuring that voluntary medically assisted death will be available in each of the states by the end of 2023.

In November 2000, The Netherlands passed legislation to legalize the practice of voluntary euthanasia. The legislation passed through all the parliamentary stages early in 2001. The Belgian parliament passed similar legislation in 2002 and Luxembourg followed suit in 2009. (For a very helpful comparative study of relevant legislation see Lewis 2007. See also Griffiths, et al. 2008.)

In Oregon in the United States, legislation was introduced in 1997 to permit physician-assisted suicide after a referendum strongly endorsed the proposed legislation. Later in 1997 the Supreme Court of the United States ruled that there is no constitutional right to physician-assisted suicide; however, the Court did not preclude individual states from legislating in favor of physician-assisted suicide (so the Oregon legislation was unaffected). Since that time the Oregon legislation has been successfully utilised by a significant number of people and similar legislation has been passed in the state of Washington in 2009, in Vermont in 2013, and more recently still in California, Colorado, Hawaii, Maine, New Jersey, New Mexico and the District of Columbia. A series of judicial decisions in the state of Montana in 2008 and 2009 established that the state could not prohibit physician-assisted suicide but legislation has not yet been introduced to codify the legal situation. A number of the remaining states are currently considering physician-assisted suicide bills.

A similar legal position to that in Montana has obtained in the nation of Colombia since the late 1990s as a result of a majority ruling by its Constitutional Court in favor of the legality of physician-assisted suicide. In 2021, Spain legalized voluntary euthanasia. In Austria and Germany courts have authorised physician-assisted suicide but no legislative backing for the practice has been introduced, while in Italy legislation for voluntary medically assisted death has been passed in one house of the bicameral parliament and in Portugal there is legislation in place for physician-assisted suicide which is currently under review for its constitutionality.

In Canada, the province of Quebec introduced legislation permitting medical aid in dying in 2014. The legislation came into effect in 2016 at around the same time that the Canadian National Parliament passed legislation permitting both physician-assisted suicide and voluntary euthanasia throughout all of the Canadian federation. (For a brief account of events leading up to the enactment of the various pieces of legislation in the United States and in Canada see Sumner 2017.)

New Zealand held a referendum in 2019 which resulted in approval for the introduction of legislation for voluntary medically assisted death. The legislation comes into effect late in 2021.

With that brief sketch of the historical background in place, we will proceed first to consider the conditions that those who have advocated making voluntary medically assisted death legally permissible have typically insisted should be satisfied. Consideration of the proposed conditions will establish a framework for the moral interrogation that will follow in Sections 3 and 4. Section 3 will outline the positive moral case put forward by those who want voluntary euthanasia and physician-assisted suicide to be legally permissible. Section 4 will be devoted to scrutinising the most important of the objections that have been levelled against that case by those opposed to the legalization of voluntary euthanasia and physician-assisted suicide.

Advocates of voluntary euthanasia typically contend that if a person

  • is suffering from a terminal illness;
  • is unlikely to benefit from the discovery of a cure for that illness during what remains of her life expectancy;
  • is, as a direct result of the illness, either suffering intolerable pain, or only has available a life that is unacceptably burdensome (e.g., because the illness has to be treated in ways that lead to her being unacceptably dependent on others or on technological means of life support);
  • has an enduring, voluntary and competent wish to die (or has, prior to losing the competence to do so, expressed a wish to be assisted to die in the event that conditions (a)-(c) are satisfied); and
  • is unable without assistance to end her life,

then there should be legal and medical provision to facilitate her being allowed to die or assisted to die.

It should be acknowledged that these conditions are quite restrictive, indeed more restrictive than many think appropriate. In particular, the first condition restricts access to voluntary euthanasia to those who are terminally ill . While that expression is not free of all ambiguity, for present purposes it can be agreed that it does not include those who are rendered quadriplegic as a result of accidents, or sufferers from motor neurone disease, or individuals who succumb to forms of dementia like Alzheimer’s Disease, to say nothing of those afflicted by ‘existential suffering’. Those who consider that cases like these show the first condition to be too restrictive (e.g., Varelius 2014) may, nonetheless, agree that including them as candidates for legalized voluntary euthanasia is likely to make it far harder in many jurisdictions to gain sufficient support for legalization (and so to make it harder to help those terminally ill persons who wish to die). Even so, they believe that voluntary euthanasia should be permitted for those who consider their lives no longer worth living, not just for for the terminally ill. The fifth condition further restricts access to voluntary euthanasia by excluding those capable of ending their own lives, and so may be thought unduly restrictive by those who would wish to discourage terminally ill patients from attempting suicide. There will be yet others who consider this condition to be too restrictive because competent patients can always refuse nutrition and hydration (see, e.g., Bernat, et al., 1993; Savulescu 2014). Though this is true, many competent dying persons still wish to have access to legalized medically assisted death, rather than having to rely on refusing nutrition and hydration, so that they may retain control over the timing of their deaths and avoid needlessly prolonging the process of dying.

The second condition is intended simply to reflect the fact that it is normally possible to say when someone’s health status is incurable. So-called ‘miracle’ cures may be proclaimed by sensationalist journalists, but progress toward medical breakthroughs is typically painstaking. If there are miracles wrought by God that will be quite another matter entirely, but it is at least clear that not everyone’s death is thus to be staved off.

The third condition recognises what many who oppose the legalization of voluntary euthanasia do not, namely, that it is not only a desire to be released from pain that leads people to request help with dying. In The Netherlands, for example, pain has been found to be a less significant reason for requesting assistance with dying than other forms of suffering like frustration over loss of independence (see e.g., Marquet, et al., 2003; Onwuteaka-Philipsen, et al., 2012; Emanuel, et al., 2016). Sufferers from some terminal conditions may have their pain relieved but have to endure side effects that, for them, make life unbearable. Others may not have to cope with pain but, instead, with having to rely on forms of life support that simultaneously rob their lives of quality (as with, e.g., motor neurone disease). Yet others struggle with psychological distress and various psychiatric conditions and believe these conditions ought to be counted among the forms of suffering that qualify competent individuals to access medical assistance with dying. There has been greater recognition of, and support for, this position in The Netherlands and Belgium than elsewhere, probably because legislation in those jurisdictions makes the role of unbearable suffering central to the determination of the eligibility of competent individuals for medical assistance with dying. Even so, inclusion of these forms of suffering highlights legitimate issues to do with the competence of at least some of those who suffer from them. (For a helpful recent study of the handling of requests for assistance with dying by psychiatric patients in The Netherlands see Kim, et al., 2016.)

A final preliminary point is that the fourth condition requires that the choice to die not only be uncoerced and competent but that it be enduring. The choice is one that will require time for reflection, and, almost certainly, discussion with others, so should not be settled in a moment. Nonetheless, as with other decisions affecting matters of importance, adults are presumed to choose voluntarily and to be competent unless the presence of defeating considerations can be established. (See the entry on decision-making capacity .) The burden of proof of establishing lack of voluntariness, or lack of competence, is on those who refuse to accept an adult person’s choice. There is no need to deny that this burden can sometimes be met (e.g., by pointing to the person’s being in a state of clinical depression). The claim is only that the onus falls on those who assert that an adult’s choice is not competent.

Clearly the five conditions set out above are likely to require some refinement if complete agreement is to be reached but there is sufficient agreement for us to proceed without further ado to consideration of the cases for and against legalization of voluntary euthanasia. (However, for a fuller discussion of issues concerning the definition of ‘euthanasia’ see, e.g., Beauchamp and Davidson 1979.)

One central ethical contention in support of voluntary euthanasia is that respect for persons demands respect for their autonomous choices as long as those choices do not result in harm to others. Respect for people’s autonomous choices is directly connected with the requirement for competence because autonomy presupposes competence (cf., Brock 1992). People have an interest in making important decisions about their lives in accordance with their own conception of how they want to live. In exercising autonomy, or self-determination, individuals take responsibility for their lives; since dying is a part of life, choices about the manner of their dying and the timing of their death are, for many people, part of what is involved in taking responsibility for their lives. Many are concerned about what the last phase of their lives will be like, not merely because of fears that their dying might involve them in great suffering, but also because of the desire to retain their dignity, and as much control over their lives as possible, during this phase. A second contention in support of voluntary euthanasia was mentioned at the beginning of this entry, namely the importance of promoting the well-being of persons. When someone is suffering intolerable pain or only has available a life that is unacceptably burdensome (see the third condition above), and he competently requests medical assistance with dying, his well-being may best be promoted by affording him that assistance. When harnessed together, the value to individuals of making autonomous choices, and the value to those individuals who make such choices of promoting their own well-being, provide the moral foundation for requests for voluntary euthanasia. Each consideration is necessary for moral justification of the practice, but taken in isolation neither suffices (see, e.g., Young 2007, 2017; Sumner 2011, 2017).

The technological interventions of modern medicine have had the effect of stretching out the time it takes for many people to die. Sometimes the added life this brings is an occasion for rejoicing; sometimes it drags out the period of significant physical and intellectual decline that a person undergoes with the result that life becomes no longer worth living. Many believe there is no single, objectively correct answer as to when, if at all, a person’s life becomes a burden and hence unwanted. If they are right, that simply points up the importance of individuals being able to decide autonomously for themselves whether their own lives retain sufficient quality and dignity to make life worth living. Others maintain that individuals can be in error about whether their lives continue to be worth living (cf., Foot 1977). The conditions outlined above in Section 2 are intended by those who propose them to serve, among other purposes, to safeguard against such error. But it is worth adding that in the event that a person who considers that she satisfies those conditions is judged by her medical attendants to be in error about whether it would be worth her continuing to live, the likely outcome is that those attendants will refuse to provide medical assistance with dying. (Evidence that will be mentioned below shows that this happens frequently in jurisdictions in which medically assisted dying has been legalized.) Unless a patient is able to be transferred to the care of other medical professionals who accept her assessment, she will have to rely on her own resources (e.g., by refusing nutrition and hydration). Even so, other things being equal, as long as a critically ill person is competent, her own judgement of whether continued life is a benefit to her ought to carry the greatest weight in any end-of-life decision making regardless of whether she is in a severely compromised and debilitated state. The idea that a competent individual’s autonomous judgment of the value to her of continued life should trump an assessment by others of her well-being should not be thought surprising because precisely the same happens when a competent patient refuses life-prolonging treatment.

Suppose, for the sake of argument, that it is agreed that we should respect a person’s competent request for medical assistance with dying (e.g., so as to enable her to achieve her autonomously chosen goal of an easeful death). It might be thought that in such an eventuality different moral concerns will be introduced from those that arise in connection with competent refusals. After all, while competent patients are entitled to refuse any form of medical treatment, they are not entitled to insist on the administration of forms of medical treatment that have no prospect of conferring a medical benefit or are not being provided for reasons to do with scarcity of medical resources or affordability. While each of these points is sound, it remains the case that medical personnel have a duty to relieve suffering when that is within their capacity. Accordingly, doctors who regard medical assistance with dying as an element of appropriate medical care will consider it morally permissible to agree to a request for assistance with dying by a competent dying patient who wishes to avoid unnecessary suffering. The reason for claiming only that this is morally permissible rather than morally obligatory will be explained in a subsequent paragraph. (For further reflections on the issue of responses to requests for medical assistance see, for instance, Dworkin in Frey, et al. 1998; Sumner 2011; Young 2017.)

Notwithstanding this response, as was seen earlier, at least some proponents of voluntary medically assisted dying wish to question why medical assistance with dying should be restricted to those covered by, in particular, the first three conditions set out above in Section 2. If people’s competent requests for medically assisted death should be respected why impose any restrictions at all on who may have access to medically assisted death? Why, for example, should those suffering from depression, or forms of dementia, not be eligible for medically assisted dying? Most proponents of voluntary medically assisted dying hold that there are at least two reasons for restricting access to it to those who satisfy the conditions set out earlier (or, a modified set that takes account of the concerns canvassed in the discussion of those proposed conditions). First, they contend that there are political grounds for doing so, namely, that because legalizing medically assisted dying for competent individuals is politically contested, the best hope for its legalization lies in focusing on those forms of suffering most likely to effect law reform. That is why some proponents deny the eligibility even of sufferers from conditions like ‘locked-in’ syndrome, motor neurone disease, and multiple sclerosis for voluntary medically assisted dying since, strictly, they are not terminally ill, and reliance has to be placed in consequence on their claim to be suffering unbearably. Second, and relatedly, most proponents of the legalization of medical assistance with dying have been cautious about supporting medically assisted death for those suffering from, for example, depression and dementia, because not only are they not terminally ill, but their competence to request assistance with dying is apt to be called into question, particularly in instances where they have given no prior indication of their preference for such assistance. Restricting access to medical assistance with dying to those whose suffering is less likely to be disputed avoids becoming embroiled in controversy. Some critics of the restrictive approach (e.g., Varelius 2014) take a harder line still and claim that it should not even be necessary for a person to be suffering from a medical condition to be eligible for medical assistance with dying; it should be enough to be ‘tired of life’. Only in a few jurisdictions, viz., Switzerland, The Netherlands and Belgium, has this issue been seriously broached. Regardless of what may happen in those jurisdictions, those seeking the legal provision of medical assistance with dying in other jurisdictions seem likely to maintain that if such assistance is to be seen as a legitimate form of medical care it has to be provided in response to a medical condition (rather than because someone is ‘tired of life’), and, indeed, restricted to those who satisfy the conditions outlined earlier in Section 2 (or some similar set of conditions). In short, these latter hold that making an autonomous request for assistance with dying is necessary, but should not be sufficient, for triggering such assistance.

There is one final matter of relevance to the moral case for voluntary medically assisted death on which comment must be made. The comment concerns a point foreshadowed in a previous paragraph, but it is also linked with the remark just made about the insufficiency of an autonomous request for assistance with dying to trigger that assistance. It is important to make the point that respect has to be shown not only for the dying person’s autonomy but also for the professional autonomy of any medical personnel asked to lend assistance with dying. The value (or, as some would prefer, the right) of self-determination does not entitle a patient to try to compel medical professionals to act contrary to their own moral or professional values. Hence, if voluntary euthanasia is to be legally permitted, it must be against a backdrop of respect for professional autonomy. Similarly, if a doctor’s view of her moral or professional responsibilities is at odds with her patient’s competent request for euthanasia, she should make provision, where it is feasible to do so, for the transfer of the patient to the care of a doctor who faces no such conflict. Given that, to date, those who contend that no scope should be permitted for conscientious objection within medical practice have garnered very little support for that view, making use of referrals and transfers remains the most effective means of resolving such disagreements.

Opponents of voluntary euthanasia have endeavored in a variety of ways to counter the very straightforward moral case that has been laid out above for its legalization (see, for example, Keown 2002; Foley, et al. 2002; Biggar 2004; Gorsuch 2006). Some of the counter-arguments are concerned only with whether the moral case warrants making the practice of voluntary euthanasia legal, whereas others are concerned with trying to undermine the moral case itself. In what follows, consideration will be given to the five most important counter-arguments. (For more comprehensive discussions of the morality and legality of medically assisted death see Keown 2002; Biggar 2004; Gorsuch 2006; Young 2007; Sumner 2011.)

4.1 Objection 1

It is sometimes said (e.g., Emanuel 1999; Keown in Jackson and Keown 2012) that it is not necessary nowadays for people to die while suffering from intolerable or overwhelming pain because the provision of effective palliative care has improved steadily, and hospice care is more widely available. Some have urged, in consequence, that voluntary euthanasia is unnecessary.

There are several flaws in this contention. First, while both good palliative care and hospice care make important contributions to the care of the dying, neither is a panacea. To get the best palliative care for an individual involves trial and error, with some consequent suffering in the process; moreover, even the best care fails to relieve all pain and suffering. Perhaps even more importantly, high quality palliative care commonly exacts a price in the form of side-effects such as nausea, incontinence, loss of awareness because of semi-permanent drowsiness, and so on. A rosy picture is often painted as to how palliative care can transform the plight of the dying. Such a picture is misleading according to those who have closely observed the effect of extended courses of treatment with drugs like morphine. For these reasons many skilled palliative care specialists acknowledge that palliative care does not enable an easeful death for every patient. Second, even though the sort of care provided through hospices is to be applauded, it is care that is available to only a small proportion of the terminally ill and then usually only in the very last stages of the illness (typically a matter of a few weeks). Notwithstanding that only relatively few of the dying have access to hospice care it is worth drawing attention to the fact that in, Oregon, to cite one example, a high proportion of those who have sought physician-assisted suicide were in hospice care. Third, and of greatest significance for present purposes, not everyone wishes to avail themselves of palliative or hospice care. For those who prefer to die on their own terms and in their own time, neither option may be attractive. As previously mentioned, a major source of distress for many dying patients is the frustration that comes with being unable to satisfy their autonomous wishes. Fourth, as also indicated earlier, the suffering that occasions a desire to end life is not always traceable to pain caused by illness. For some, what is intolerable is their forced dependence on others or on life-supporting machinery; for these patients, the availability of effective pain control is not the primary concern. (In relation to the preceding matters see Rietjens, et al., 2009 and Onwuteaka-Philipsen et al. 2012 for findings for The Netherlands; and, for Oregon, Ganzini, et al. 2009.)

4.2 Objection 2

A second, related objection to the moral and legal permissibility of voluntary euthanasia turns on the claim that we can never have sufficient evidence to be justified in believing that a dying person’s request to be helped to die is competent, enduring and genuinely voluntary.

It is certainly true that a request to die may not reflect an enduring desire to die (just as some attempts to commit suicide may reflect only temporary despair). That is why advocates of the legalization of voluntary euthanasia have argued that a cooling off period should normally be required before euthanasia is permitted to ensure that the request is enduring. That having been said, to claim that we can never be justified in believing that someone’s request to die reflects a settled preference for death is to go too far. If a competent person discusses the issue with others on different occasions over time, and remains steady in her resolve, or privately reflects on the issue for an extended period and does not waver in her conviction, her wish to die surely must be counted as enduring.

But, it might be asked, what if a person is racked with pain, or mentally confused because of the measures taken to relieve her pain, and is, in consequence, unable to think clearly and rationally about the alternatives? It has to be agreed that a person in those circumstances who wants to die should not be assumed to have a truly voluntary and enduring desire to die. However, there are at least two important points to make about those in such circumstances. First, they do not account for all of the terminally ill, so even if it is acknowledged that such people are incapable of agreeing to voluntary euthanasia that does not show that no one can ever voluntarily request help to die. Second, it is possible in at least some jurisdictions for a person to indicate, in advance of losing the capacity to give competent consent, how she would wish to be treated should she become terminally ill and suffer either intolerable pain or an unacceptable loss of control over her life (cf., for instance, Dworkin 1993). ‘Living wills’ or ‘advance directives’ are legal instruments for giving voice to people’s wishes while they are capable of giving competent, enduring and voluntary consent, including to their wanting help to die. As long as they are easily revocable in the event of a change of mind (just as civil wills are), they should be respected as evidence of a well thought-out conviction. (For more detailed consideration of these instruments see the entry on advance directives .)

Perhaps, though, what is really at issue in this objection is whether anyone can ever form a competent, enduring and voluntary judgement about being better off dead, rather than continuing to suffer from an illness, prior to suffering such an illness (cf., Keown in Jackson and Keown 2012). If this is what underlies the objection it is surely too paternalistic to be acceptable. Why is it not possible for a person to have sufficient inductive evidence (e.g., based on the experience of the deaths of friends or family) to know her own mind, and act accordingly, without having had direct experience of such suffering?

4.3 Objection 3

According to the traditional interpretation of the ‘doctrine of double effect’ it is permissible to act in a way which it is foreseen will have a bad effect, provided only that

  • the bad effect occurs as a side-effect (i.e., indirectly) to the achievement of the act that is directly aimed at;
  • the act directly aimed at is itself morally good or, at least, morally neutral;
  • the good effect is not achieved by way of the bad, that is, the bad must not be a means to the good; and
  • the bad effect must not be so serious as to outweigh the good effect.

Hence, it is permissible, according to the doctrine of double effect, to, for example, alleviate pain (a good effect) by administering a drug such as morphine, knowing that doing so will shorten life, but impermissible to administer the same drug with the direct intention of terminating a patient’s life (a bad effect). This latter claim is said to apply regardless of whether the drug is given at the person’s request.

This is not the appropriate forum for a full consideration of the doctrine, for which see the entry on the doctrine of double effect . However, there is one very important criticism to be made of the application of the doctrine that has direct relevance to the issue of voluntary euthanasia.

On the most plausible reading, the doctrine of double effect can be relevant to the permissibility of voluntary euthanasia only when a person’s death is bad for her or, to put it another way, a harm to her. Sometimes the notion of ‘harm’ is understood simply as damage to a person’s interests whether consented to or not. At other times, it is understood, more strictly, as damage that has been wrongfully inflicted. On either understanding of harm, there can be instances in which death for a person does not constitute a harm for her because it will either render her better off, or, as some would insist, no worse off, when compared with remaining alive. Accordingly, in those instances, the doctrine of double effect can have no relevance to the debate about the permissibility of voluntary euthanasia. (For extended discussions of the doctrine of double effect and its bearing on the moral permissibility of voluntary euthanasia see, e.g., McIntyre 2001; Woodward 2001; Cavanaugh 2006; Young 2007; Sumner 2011.)

4.4 Objection 4

As was noted earlier in Section 3, there is a widespread belief concerning the moral acceptability of so-called passive (voluntary) euthanasia, wherein life-sustaining or life-prolonging measures are withdrawn or withheld in response to a competent patient’s request. The reason why passive (voluntary) euthanasia is said to be morally permissible is that the patient is simply allowed to die because steps are not taken to preserve or prolong life. This happens, for example, when a dying patient requests the withdrawal or the withholding of measures whose administration would be medically futile, or unacceptably burdensome. By contrast, active (voluntary) euthanasia is said to be morally impermissible because it is claimed to require an unjustifiable intentional act of killing to satisfy the patient’s request (cf., for example, Finnis, 1995; Keown in Jackson and Keown 2012).

Despite its popularity and widespread use, the distinction between passive and active euthanasia is neither particularly clear nor morally helpful. (For a fuller discussion, see McMahan 2002.) Whether behavior is described in terms of acts or omissions (a distinction which underpins the alleged difference between active and passive voluntary euthanasia and that between killing a person and letting her die), is often a matter of pragmatics rather than anything of deeper moral importance. Consider, for instance, the practice (once common in hospitals) of deliberately proceeding slowly to a ward in response to a request to provide assistance for a patient who has been assigned a ‘not for resuscitation’ code. Or, consider ‘pulling the plug’ on a respirator keeping an otherwise dying patient alive, as against not replacing the oxygen supply when it runs out. Are these acts or omissions? If the answers turn on merely pragmatic considerations the supposed distinction between passive euthanasia and active euthanasia will be hard to sustain.

Even supposing that the distinction between acts and omissions, and the associated distinction between killing and letting die, can be satisfactorily clarified (on which see the entry doing v. allowing harm ), there remains the issue of whether these distinctions have moral significance in any particular circumstance. Consider a case of a patient suffering from motor neurone disease who is completely respirator dependent, finds her condition intolerable, and competently and persistently requests to be removed from the respirator so that she may die. Even the Catholic Church in recent times has been prepared to agree that it is permissible, in a case like this, to turn off the respirator. No doubt this has been because the Catholic Church considers such a patient is only being allowed to die. Even were it to be agreed, for the sake of argument, that such a death should be regarded as an instance of letting die, this concession would not show that it would have been morally worse had the patient been killed at her request (active voluntary euthanasia) rather than being allowed to die (passive voluntary euthanasia). Indeed, supporters of voluntary medically assisted death maintain that since death is beneficial in such an instance (or, at the very least, leaves the dying person no worse off), actively bringing about the death is morally to be preferred to just allowing it to happen because the desired benefit is achieved sooner.

Opponents of voluntary euthanasia claim, however, that the difference between active and passive euthanasia is to be found in the agent’s intention: if someone’s life is intentionally terminated she has been killed, whereas if she is just no longer being aggressively treated, her death should be attributed to the underlying disease. Many physicians would say that their intention in withholding or withdrawing life-sustaining medical treatment in such circumstances is simply to respect the patient’s wishes. This is plausible in those instances where the patient competently requests that aggressive treatment no longer be given (or, the patient’s proxy makes such a request). But it will often be implausible. In many cases the most plausible interpretation of a physician’s intention in withholding or withdrawing life-sustaining measures is that it is to end the patient’s life. Consider the palliative care practice of ‘terminally sedating’ a patient after a decision has been made to cease aggressive treatment. Suppose (as sometimes happens) that this is then followed by withholding artificially supplied nutrition. In these latter instances the best explanation of the physician’s behavior is that the physician intends thereby to end the life of the patient. What could be the point of the action, the goal aimed at, the intended outcome, if not to end the patient’s life? (Cf. Winkler 1995.) No sense can be made of the action as being intended to palliate the patient’s diseased condition, or to keep the patient comfortable. Nor is it appropriate to claim that what kills the patient is the underlying disease. What kills the patient is the act of depriving her of nutrition (i.e., of starving her to death). The point can be generalized to cover many more instances involving either the withdrawal or the withholding of life-sustaining medical treatment. In short, there is no good reason to think that whereas so-called passive voluntary euthanasia is morally acceptable active voluntary euthanasia never can be.

But we can go further. Giving titrated doses of morphine that reach levels beyond those needed to control pain, or removing a respirator from a sufferer from motor neurone disease, seem to many of us to amount to intentionally bringing about the death of the person being cared for. To be sure, as was acknowledged above, there are circumstances in which doctors can truthfully say that the actions they perform, or omissions they make, will bring about the deaths of their patients even though it was not their intention that those patients would die. So, for instance, if a patient refuses life-prolonging medical treatment because she considers it futile, it can be reasonable to say that her doctor’s intention in complying with the request was simply to respect her wishes. Nevertheless, as we have seen, there are other circumstances in which it is highly stilted to claim, as some doctors continue to do, that they had no intention of bringing about death.

These considerations should settle matters but do not do so for those who maintain that killing, in medical contexts, is always morally unjustified – a premise that underwrites much of the debate surrounding this fourth objection. But this underlying assumption is open to challenge and has been challenged by, for instance, Rachels 1986 and McMahan 2002. One of the reasons the challengers have given is that there are cases in which killing a competent dying person when she requests assistance with dying, is morally preferable to allowing her to die, namely, when taking the latter option would serve only to prolong her suffering against her wishes. Further, despite the longstanding legal doctrine that no one can justifiably consent to be killed (on which more later), it surely is relevant to the justification of an act of killing that the person killed has autonomously decided that she would be better off dead and so asks to be helped to die.

4.5 Objection 5

It is sometimes said that if society allows voluntary euthanasia to be legalized, we will then have set foot on a slippery slope that will lead us eventually to support other forms of euthanasia, including, in particular, non-voluntary euthanasia. Whereas it was once the common refrain that that was precisely what happened in Hitler’s Germany, in recent decades the tendency has been to claim that experience with legalized euthanasia in The Netherlands and Belgium, in particular, has confirmed the reality of the slippery slope.

Slippery slope arguments come in various versions. One (but not the only) way of classifying them has been to refer to logical, psychological and arbitrary line versions. The common feature of the different forms is the contention that once the first step is taken on a slippery slope the subsequent steps follow inexorably, whether for logical reasons, psychological reasons, or to avoid arbitrariness in ‘drawing a line’ between a person’s actions. (For further discussion see, e.g., Rachels 1986; Brock 1992; Walton 1992.)

We need first to consider whether, at the theoretical level, any of these forms of argument is powerful enough to refute the case for the legalization of voluntary euthanasia. We will then be in a position to comment on the alleged empirical support from the experiences of Hitler’s Germany and, more recently, of legalized euthanasia in The Netherlands and elsewhere, for the existence of a slippery slope that will supposedly come into being with the legalization of voluntary euthanasia.

To begin with, there is nothing logically inconsistent in supporting voluntary euthanasia while maintaining the moral inappropriateness of non-voluntary euthanasia. Undoubtedly, some advocates of voluntary euthanasia wish also to lend their support to some acts of non-voluntary euthanasia, for example, for those in persistent vegetative states who have never indicated their wishes about being helped to die, or for certain severely disabled infants for whom the outlook is hopeless. (See, e.g., Kuhse and Singer 1985; Singer 1994; Stingl 2010; Sumner 2017.) Others believe that the consent of the patient is strictly required if euthanasia is appropriately to be legalized. The difference is not a matter of logical acumen; it is to be explained by reference to the importance placed on key values by the respective supporters. Thus, for example, those who insist on the necessity for a competent patient request for medical assistance with dying typically believe that such a request is the paramount consideration in end-of-life decision making (even when it is harnessed to the value of individual well-being), whereas those who consider a person’s best interests to be the paramount consideration are more likely to believe in the justifiability of instances of non-voluntary euthanasia like those mentioned above.

Next, it is hard to see why moving from voluntary to non-voluntary euthanasia is supposed to be psychologically inevitable. Why should those who support the legalization of voluntary euthanasia, because they value the autonomy of the individual, find it psychologically easier, in consequence, to endorse the killing of those who are not able competently to request assistance with dying? What reason is there to believe that they will, as a result of their support for voluntary euthanasia, be psychologically driven to endorse a practice of non-voluntary euthanasia?

Finally, since there is nothing arbitrary about distinguishing voluntary euthanasia from non-voluntary euthanasia (because the line between them is based on clear principles), there can be no substance to the charge that only by arbitrarily drawing a line between them could non-voluntary euthanasia be avoided were voluntary euthanasia to be legalized.

What, though, of Hitler’s Germany and the recent experience of legalized voluntary euthanasia in The Netherlands and elsewhere? The former is easily dismissed as an indication of an inevitable descent from voluntary euthanasia to non-voluntary. There never was a policy in favor of, or a legal practice of, voluntary euthanasia in Germany in the 1920s to the 1940s (see, for example, Burleigh 1994). There was, prior to Hitler coming to power, a clear practice of killing some disabled persons. But it was never suggested that their being killed was justified by reference to their best interests; rather, it was said that society would be benefited. Hitler’s later revival of the practice and its widening to take in other groups such as Jews and gypsies was part of a program of eugenics , not euthanasia.

Since the publication of the Remmelink Report in 1991 into the medical practice of euthanasia in The Netherlands, it has frequently been said that the Dutch experience shows that legally protecting voluntary euthanasia is impossible without also affording shelter to the non-voluntary euthanasia that will follow in its train (see, e.g., Keown 2002). In the period since that report there have been a further four national studies of the practice of euthanasia in The Netherlands. These studies were carried out in 1995, 2001, 2005 and 2010 respectively (see, e.g., Rietjens, et al. 2009; Onwuteaka-Philipsen, et al. 2012). The findings from these national studies have consistently shown that there is no evidence for the existence of such a slippery slope. Among the specific findings the following are worth mentioning: of those terminally ill persons who have been assisted to die about sixty per cent have clearly been cases of voluntary euthanasia as it has been characterised in this entry; of the remainder, the vast majority of cases were of patients who at the time of their medically assisted deaths were no longer competent. It might be thought that these deaths ought to be regarded as instances of non-voluntary euthanasia. But, in fact, it would be inappropriate to regard them as such. Here is why. For the overwhelming majority of these cases, the decisions to end life were taken only after consultation between the attending doctor(s) and close family members, and so can legitimately be thought of as involving substituted judgements. Moreover, according to the researchers, the overwhelming majority of these cases fit within either of two common practices that occur in countries where voluntary euthanasia has not been legalized, namely, that of terminal sedation of dying patients, and that of giving large doses of opioids to relieve pain while foreseeing that this will also end life. In a very few cases, there was no consultation with relatives, though in those cases there were consultations with other medical personnel. The researchers contend that these instances are best explained by the fact that families in The Netherlands strictly have no final legal authority to act as surrogate decision-makers for incompetent persons. For these reasons the researchers maintain that non-voluntary euthanasia is not widely practised in The Netherlands.

That there have only been a handful of prosecutions of Dutch doctors for failing to follow agreed procedures (Griffiths, et al., 1998), that none of the doctors prosecuted has had a significant penalty imposed, that a significant proportion of requests for medical assistance with dying are rejected as unjustifiable, and that the Dutch public have regularly reaffirmed their support for the agreed procedures suggests that, contrary to the claims of some critics, the legalization of voluntary euthanasia has not increased the incidence of non-voluntary euthanasia. A similar picture to the one in The Netherlands has emerged from studies of the operation of the law concerning physician-assisted suicide in Oregon. Indeed, in a recent wide-ranging study of attitudes and practices of voluntary euthanasia and physician-assisted suicide covering two continents, a prominent critic of these practices has concluded (in agreement with his co-authors) that little evidence exists of abuse, particularly of the vulnerable (see Emanuel, et al., 2016). Unfortunately, insufficient time has elapsed for appropriate studies to be conducted in the other jurisdictions that have legalized either voluntary euthanasia or physician-assisted suicide. Finally, some commentators have pointed out that there may, in reality, be more danger of the line between voluntary and non-voluntary euthanasia being blurred if euthanasia is practised in the absence of legal recognition, since there will, in those circumstances, be neither transparency nor monitoring (which cannot be said of The Netherlands, Belgium, Oregon and so on).

None of this is to suggest that it is not necessary to ensure the presence of safeguards against potential abuse of legally protected voluntary euthanasia. This is particularly important for the protection of those who have become incompetent by the time decisions need to be taken about whether to assist them to die. Furthermore, it is, of course, possible that the reform of any law may have unintended effects. However, if the arguments outlined above are sound (and the experience in the The Netherlands, Belgium and Luxembourg, along with the more limited experience in several states in the United States, is, for the present, not only the best evidence we have that they are sound, but the only relevant evidence), that does not seem very likely.

It is now well-established in many jurisdictions that competent patients are entitled to make their own decisions about life-sustaining medical treatment. That is why they can refuse such treatment even when doing so is tantamount to deciding to end their life. It is plausible to think that the fundamental basis of the right to decide about life-sustaining treatment – respect for a person’s autonomy and her assessment of what will best serve her well-being – has direct relevance to the legalization of voluntary euthanasia (see, e.g., Dworkin in Frey et al., 1998; Young 2007, 2017; Sumner 2011). In consequence, extending the right of self-determination to cover cases of voluntary euthanasia does not require a dramatic shift in legal policy. Nor do any novel legal values or principles need to be invoked. Indeed, the fact that suicide and attempted suicide are no longer criminal offences in many jurisdictions indicates that the central importance of individual self-determination in a closely analogous context has been accepted. The fact that voluntary euthanasia and physician-assisted suicide have not been more widely decriminalized is perhaps best explained along a similar line to the one that has frequently been offered for excluding the consent of the victim as a justification for an act of killing, namely the difficulties thought to exist in establishing the genuineness of the consent. But, the establishment of suitable procedures for giving consent to voluntary euthanasia and physician-assisted suicide is surely no harder than establishing procedures for competently refusing burdensome or otherwise unwanted medical treatment. The latter has already been accomplished in many jurisdictions, so the former should be achievable as well.

Suppose that the moral case for legalizing voluntary euthanasia and physician-assisted suicide does come to be judged more widely as stronger than the case against legalization, and they are made legally permissible in more jurisdictions than at present. Should doctors take part in the practice? Should only doctors perform voluntary euthanasia? These questions ought to be answered in light of the best understanding of what it is to provide medical care. The proper administration of medical care should promote the welfare of patients while respecting their individual self-determination. It is these twin values that should guide medical care, not the preservation of life at all costs, or the preservation of life without regard to whether patients want their lives prolonged should they judge that life is no longer of benefit or value to them. Many doctors in those jurisdictions where medically assisted death has been legalized and, to judge from available survey evidence, in other liberal democracies as well, see the practice of voluntary euthanasia and physician-assisted suicide as not only compatible with their professional commitments but also with their conception of the best medical care for the dying. That being so, doctors of the same conviction in jurisdictions in which voluntary medically assisted death is currently illegal should no longer be prohibited by law from lending their professional assistance to competent terminally ill persons who request assistance with dying because of irremediable suffering or because their lives no longer have value for them.

  • Beauchamp, T. and A. Davidson, 1979, “The Definition of Euthanasia”, The Journal of Medicine and Philosophy , 4: 294–312.
  • Bernat, J., B. Gert, and R. Mognielnicki, 1993, “Patient Refusal of Hydration and Nutrition: An Alternative to Physician Assisted Suicide or Voluntary Euthanasia”, Archives of Internal Medicine , 153: 2723–2728.
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  • Dworkin, R., 1993, Life’s Dominion: An Argument About Abortion, Euthanasia, and Individual Freedom , New York: Random House.
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  • Emanuel, E., B. Onwuteaka-Philipsen, J. Urwin, and J. Cohen, 2016, “Attitudes and Practices of Euthanasia and Physician-Assisted Suicide in the United States, Canada and Europe”, Journal of the American Medical Association , 316: 79–90.
  • Finnis, J., 1995, “A Philosophical Case Against Euthanasia” in J. Keown (ed.), Euthanasia Examined: Ethical, Clinical and Legal Perspectives , Cambridge: Cambridge University Press.
  • Foley, K. and H. Hendin (eds.), 2002, The Case Against Assisted Suicide: For the Right to End-of-Life Care , Baltimore: The Johns Hopkins University Press.
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  • Frey, R., G. Dworkin and S. Bok, 1998, Euthanasia and Physician-Assisted Suicide , Cambridge: Cambridge University Press.
  • Ganzini, L., E. Goy and S. Dobscha, 2009, “Oregonians’ Reasons for Requesting Physician Aid in Dying”, Archives of Internal Medicine , 169: 489–492.
  • Gorsuch, N., 2006, The Future of Assisted Suicide and Euthanasia , Princeton, New Jersey: Princeton University Press.
  • Griffiths, J., A. Bood, and H. Weyers, 1998, Euthanasia and Law in the Netherlands , Amsterdam: Amsterdam University Press.
  • Griffiths, J., H. Weyers, and M. Adams, 2008, Euthanasia and Law in Europe , Oxford: Hart Publishing.
  • Jackson, E., and J. Keown, 2012, Debating Euthanasia , Oxford: Hart Publishing.
  • Keown, J., 2002, Euthanasia, Ethics and Public Policy: an argument against legalization , New York: Cambridge University Press.
  • Kim, S., R. De Vries and J. Peteet, 2016, “Euthanasia and Assisted Suicide of Patients with Psychiatric Disorders in The Netherlands 2011 to 2014”, Journal of the American Medical Association Psychiatry , 73: 362–368.
  • Kuhse, H. and P. Singer, 1985, Should the Baby Live?: The Problem of Handicapped Infants , Oxford: Oxford University Press.
  • Lewis, P., 2007, Assisted Dying and Legal Change , Oxford: Oxford University Press.
  • Marquet, R., A. Bartelds, G. Visser, P. Spreeuwenberg, and L. Peters, 2003, “Twenty Five Years of Requests for Euthanasia and Physician Assisted Suicide in Dutch General Practice: Trend Analysis”, British Medical Journal , 327: 201–202.
  • McIntyre, A., 2001, “Doing Away With Double Effect”, Ethics , 111: 219–255.
  • McMahan, J., 2002, The Ethics of Killing: Problems at the Margins of Life , New York: Oxford University Press.
  • Onwuteaka-Philipsen, B., A. Brinkman-Stoppelenburg, C. Penning, G. Jong-Krul, J. van Delden and A. van der Heide, 2012, “Trends in end-of-life practices before and after the enactment of the euthanasia law in The Netherlands from 1990-2010: A repeated cross-sectional survey”, The Lancet , 380: 908–915.
  • Rachels, J., 1986, The End of Life: Euthanasia and Morality , Oxford: Oxford University Press.
  • Rietjens, J., P. van der Maas, B. Onwuteaka-Philipsen, J. van Delden, and A. van der Heide, 2009, “Two Decades of Research on Euthanasia from The Netherlands: What Have We Learnt and What Questions Remain?”, Journal of Bioethical Inquiry , 6: 271–283.
  • Savulescu, J., 2014, “A Simple Solution to the Puzzles of End of Life? Voluntary Palliated Starvation”, Journal of Medical Ethics , 40: 110–113.
  • Singer, P. 1994, Rethinking Life and Death: The Collapse of Our Traditional Ethics , Melbourne: Text Publishing.
  • Stingl, M., (ed.), 2010, The Price of Compassion: Assisted Suicide and Euthanasia , Peterborough, Ontario: Broadview Press.
  • Sumner, L., 2011, Assisted Death: A Study in Ethics and Law , Oxford: Oxford University Press.
  • –––, 2017, Physician-Assisted Death: What Everyone Needs to Know , New York: Oxford University Press.
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  • Woodward, P., (ed.), 2001, The Doctrine of Double Effect: Philosophers Debate a Controversial Moral Principle , Notre Dame, Indiana: University of Notre Dame Press.
  • Young, R., 2007, Medically Assisted Death , Cambridge: Cambridge University Press.
  • –––, 2017, “An Argument in Favor of the Morality of Voluntary Medically Assisted Death” in M. Cholbi (ed.), Euthanasia and Assisted Suicide: Global Views on Choosing to End Life , Santa Barbara: Praeger.
How to cite this entry . Preview the PDF version of this entry at the Friends of the SEP Society . Look up topics and thinkers related to this entry at the Internet Philosophy Ontology Project (InPhO). Enhanced bibliography for this entry at PhilPapers , with links to its database.
  • Medically Assisted Dying , an annotated bibliography authored by Robert Young (La Trobe University)
  • Eight Reasons Not to Legalize Physician Assisted Suicide , by David Albert Jones, online resource at the Anscombe Bioethics Centre website.

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Euthanasia and assisted dying: the illusion of autonomy—an essay by Ole Hartling

Read our coverage of the assisted dying debate.

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  • Ole Hartling , former chairman
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  • hartling{at}dadlnet.dk

As a medical doctor I have, with some worry, followed the assisted dying debate that regularly hits headlines in many parts of the world. The main arguments for legalisation are respecting self-determination and alleviating suffering. Since those arguments appear self-evident, my book Euthanasia and the Ethics of a Doctor’s Decisions—An Argument Against Assisted Dying 1 aimed to contribute to the international debate on this matter.

I found it worthwhile to look into the arguments for legalisation more closely, with the hope of sowing a little doubt in the minds of those who exhibit absolute certainty in the matter. This essay focuses on one point: the concept of “autonomy.”

(While there are several definitions of voluntary, involuntary, and non-voluntary euthanasia as well as assisted dying, assisted suicide, and physician assisted suicide, for the purposes of brevity in this essay, I use “assisted dying” throughout.)

Currently, in richer countries, arguments for legalising assisted dying frequently refer to the right to self-determination—or autonomy and free will. Our ability to self-determine seems to be unlimited and our right to it inviolable. The public’s response to opinion poll questions on voluntary euthanasia show that people can scarcely imagine not being able to make up their own minds, nor can they imagine not having the choice. Moreover, a healthy person answering a poll may have difficulty imagining being in a predicament where they simply would not wish to be given the choice.

I question whether self-determination is genuinely possible when choosing your own death. In my book, I explain that the choice will always be made in the context of a non-autonomous assessment of your quality of life—that is, an assessment outside your control. 1

All essential decisions that we make are made in relation to other people. Our decisions are affected by other people, and they affect other people. Although healthy people find it difficult to imagine themselves in situations where they do not decide freely, it is also true that all of us are vulnerable and dependent on others.

Yet autonomy in relation to assisted dying is often viewed in the same way as our fundamental right to choose our own course in life. If we are able to control our lives, then surely we can also control our death. Autonomy with respect to your own death, however, is already halved: you can choose to die if you don’t want to live, but you cannot choose to live if you are about to die.

Decisions about your own death are not made in normal day-to-day contexts. The wish to die arises against a backdrop: of desperation, a feeling of hopelessness, possibly a feeling of being superfluous. Otherwise, the wish would not be there. Thus, it is under these circumstances that the right to self-determination is exercised and the decision is made. Such a situation is a fragile basis for autonomy and an even more fragile basis for decision making. The choice regarding your own death is therefore completely different from most other choices usually associated with the concept of autonomy.

Here are just some of the critical matters that would arise if assisted dying were legalised.

A duty to die

The possibility of choosing to die would inhabit everyone’s consciousness—the patient, the doctor, the relatives, and the care staff—even if not formulated as an out-and-out offer. But if a law on assisted dying gives the patient a right to die, that right may turn into a duty to die. How autonomously can the weakest people act when the world around them deems their ill, dependent, and pained quality of life as beyond recovery?

Patients can find themselves directly or indirectly under duress to choose that option if they consider themselves sufficiently pained and their quality of life sufficiently low. Patients must be at liberty to choose assisted dying freely, of course—that is how it is presented—but the point is that the patient cannot get out of having to choose. It has been called the “prison of freedom.”

Internalised external pressure

Pressure on the patient does not have to be direct or articulated. As pointed out by the US professor of biomedical ethics Daniel Sulmasy it may exist as an “internalised external pressure.” 2 Likewise, the French bioethicist Emmanuel Hirsch states that individual autonomy can be an illusion. The theologian Nigel Biggar quotes Hirsch saying that a patient “may truly want to die, but this desire is not the fruit of his freedom alone, it may be—and most often is—the translation of the attitude of those around him, if not of society as a whole which no longer believes in the value of his life and signals this to him in all sorts of ways. Here we have a supreme paradox: someone is cast out of the land of the living and then thinks that he, personally, wants to die.” 3

The end of autonomy

An inherent problem of autonomy in connection with assisted dying is that a person who uses his or her presumed right to self-determination to choose death definitively precludes himself or herself from deciding or choosing anything. Where death is concerned, your right to self- determination can be exerted only by disposing of it for good. By your autonomy, in other words, you opt to no longer have autonomy. And those around must respect the right to self-determination. The respect refers to a person who is respected, but this is precisely the person who disappears.

Danish philosopher Johannes Sløk, who supported legalisation, said, “The actual concept of death has no content, for death is the same as nothing, and one cannot choose between life and nothing. Rather, therefore, one must speak of opting out; one opts out of life, without thereby choosing anything else. Death is not ‘something other’ than life; it is the cessation or annihilation of life.”

Autonomy is a consistent principle running through the care and management of patients and is enshrined in law. However, a patient’s autonomy means that he or she has the right to decline any treatment. It does not entail a right to have any treatment the patient might wish for. Patients do not have the right to demand treatment that signifies another’s duty to fulfil that right. If that were so, autonomy would be the same as “autocracy”—rule of the self over others. Even though patients have the right to reject any intervention, they do not have the right to demand any intervention. Rejecting any claim that the person might make is not a violation of a patient’s self- determination—for example, there may be sound medical reasons for not complying with a demand. The doctor also has autonomy, allowing him or her to say no. Refusing to kill a person or assist in killing cannot be a violation of that person’s autonomy.

The killing ban

Assisted dying requires the doctor’s moral and physical help. It is a binding agreement between two people: the one who is to be killed and the one who is to kill or assist in killing. But our society does not condone killing as a relationship between two legally competent, consenting people. Exemptions from the killing ban involve war or self-defence and are not justified on the grounds that the killing is done for the “benefit” of someone else.

Valuation of a life

If the action is to be decriminalised, as some people wish, it means the doctor will have to enter into deliberations and arguments for and against a request for assisted dying each time. That is, whether he or she is willing to grant it. The alternative would be to refer the patient to another doctor who might be willing to help—that doctor would still have to assess whether the patient’s life was worth preserving.

Thus, autonomy is not the only factor or even always the key factor when deciding whether assisted dying can be granted. It is not only the patient’s own evaluation that is crucial. The value of the patient’s life must also be assessed as sufficiently low. This demonstrates the limitation of the patient’s self-determination.

Relieving suffering

If a competent and legally capable person must have the option of voluntarily choosing assisted dying in the event of unbearable suffering, why does suffering have to be a requirement? The answer is straightforward: our concepts of assisted dying imply that compassion must form a crucial aspect of the decision—mercy killing and compassionate killing are synonyms. But this leads instantly to the question of why we should not also perform assisted dying on people who are not in a position to ask for it themselves but are also suffering.

Some people find the reasoning unproblematic. It stands to reason that relieving suffering is a duty after all. But in this context it is not unproblematic, because it effectively shifts the focus from the autonomy claimed. According to prevailing ideas about autonomy, patients initially evaluate their quality of life themselves, but ultimately it is those around them who end up gauging that quality and the value of their life. That is to say, the justification for assisted dying is borne on the premise that certain lives are not worth living rather than the presence of a request. The whole point is that in the process, respect for the right to self-determination becomes relative.

Autonomy is largely an illusion in the case of assisted dying. 1 A patient overwhelmed by suffering may be more in need of compassion, care, and love than of a kind offer to help end his or her life. It is not a question of whether people have a right to say that they are unworthy. It is a question of whether they have a right to be believed when saying it.

Ole Hartling is a physician of over 30 years standing, doctor of medical sciences at the University of Copenhagen, professor of health promotion at the University of Roskilde, and an author and co-author of several books and scientific articles published mainly in Scandinavia. Between 2000 and 2007 he was a member of the Danish Council of Ethics and its chair for five years. During this time, the council extensively debated the ethics of euthanasia and assisted dying.

Competing interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

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How To Write A Vivid Euthanasia Argumentative Essay?

Jared Houdi

Table of Contents

Researching the topic

Euthanasia (good death from Greek) is the practice of intentional life ending aiming to relieve patients’ pain and suffering. The topic of its use is fiercely debated all over the world.

People have divided into two camps: some say Euthanasia is the matter of choice, even when it comes to choosing death. Another group claims that doctors mustn’t be empowered to offer death to people who may not even realize the decision they make.

Every country where Euthanasia is legal has its own specific legislative base of its use. Nevertheless, there is one aspect of this topic that unites all the people together: the issue is considered from the moral and ethical perspective.

Euthanasia argumentative essay: the basics

The topics for an argumentative essay writing are usually two-sided: voting for or against the topic, agree or disagree with the statement, choose one option or another.

Writing any argumentative assay requires highlighting both possible points of view, no matter what is your own. Remember, you should explain both sides equally correct and impartial.

So let’s take a closer look into the details…

How to write a Euthanasia thesis statement?

Before writing an essay on Euthanasia you have to think about your own attitude towards the topic. It will help you write a good thesis statement.

…Why you need it?

The thesis is the representation of the essay’s main idea. You’ll have to clarify both sides of the topic, sure. Still, you also need to express your own point of view. And that is made with the thesis statement in the first place.

You may clearly state your opinion in the thesis, like:

“Injecting a medication to a hopeless patient is a murder.”
“Taking life from a person who wants to end up sufferings is mercy.”

Also, you can try to intrigue your readers and present your thesis as a question with no answer provided right away. Like:

“Helping people die: is it murder or mercy?”
“Would you personally use your right for euthanasia if there was no chance to get better?”

Variations are welcomed.

Euthanasia essay introduction: general recommendations

Most professional essay writing services agree that writing an introduction is always the hardest thing. You get the fear of the blank paper, writer’s block, and the stress from remembering all the requirements you should ideally follow.

… Sounds familiar?

There are no reasons to be that stressed, actually. The web is full of info, interesting statistics, law variations, and personal stories.

A combination of those would be both, catchy and informative, that’s all you need for a perfect intro.

Start with some background information to help your reader understand the subject better.

What kind of info would be relevant?

  • A brief definition of Euthanasia.
  • When it might be allowed.
  • Laws of the countries where it is permitted.
  • Personal stories of friends/relatives.
  • Stories of doctors and nurses.

All of that can be easily found online. Your goal here would rewrite it in your style, make it appealing to read and combined logically. End your introduction with the thesis statement. You already know how it’s done.

Specifics of Euthanasia essay main body

The main body for an argumentative essay should consist of two parts, one for each point of view. Once you express your point of view in the introduction, then it would be logical to start the main body from it.

Still, it is far from being obligatory. You may start with whatever you find more comfortable.

Like, f.e., you decide to start by talking about the positive aspects of Euthanasia. List the statements using words “firstly,” “secondly,” “moreover,” etc. Begin with the weakest argument and move up to the most solid one you have.

Provide the reader with some positive examples, including personal stories, if they fit in, try to find shreds of evidence of euthanasia practice in your country.

Here are some ideas for statements in favor of Euthanasia:

  • A patient’s life can be worse than death.
  • It is better to die from Euthanasia than from suicide.
  • Euthanasia can help in saving budget funds. Saved money may help somebody else.
  • Some people don’t want to see how their relatives suffer hopelessly.
  • Death from Euthanasia can be more humane than natural.

Once you finish with the arguments for the first part, go on representing the opposite point of view. A good idea to begin the second paragraph with phrases like “on the other hand,” “the other side of the coin is,” “however,” etc.

List a couple of statements against Euthanasia. You may also search for some scandals including the illegal activity of doctors who made such decision without consulting the patient’s relatives.

Here are several ideas that might be helpful.

  • Life is the primary integral right and can’t be taken away.
  • If there are many organizations and measures to prevent suicides, why should we offer death to someone?
  • Each aspect of Euthanasia can’t be foreseen in the law.
  • It’s impossible to define who may/may not be offered the Euthanasia.
  • What if the person who chose Euthanasia could recover and live the life to its fullest?

What to write in Euthanasia essay conclusion?

In conclusion, you sum up all the ideas highlighted in your essay, without adding new ones. Start with phrases like “to sum up,” “to conclude,” “in conclusion,” “on balance,” “in a nutshell,” etc.

Here you should also express your point of view and paraphrase the thesis you used in the introduction. For uttering your point, use inputs like “my point of view is,” “I strongly believe,” “I am convinced,” “to tell you the truth,” and so on.

How to create a Euthanasia essay outline?

An outline is a brief sketch of your essay. If you need to write it, select the main ideas of your work and write them down in a couple of sentences.

The sketch outline for an essay on Euthanasia may be like:

“Th work is about the problem of Euthanasia. I highlight some statements for and against the use of Euthanasia and support them with top examples. In conclusion, I explain my personal position on this question.”

The full version of an outline would look something like this…

Introduction

  • Hook sentence
  • Thesis statement
  • Transition to Main Body
  • History of Euthanasia
  • Euthanasia statistics in countries where it is legal
  • Impact of legal Euthanasia on people’s life
  • Negative consequences of illegal Euthanasia
  • Transition to Conclusion
  • Unexpected twist or a final argument
  • Food for thought

The use of Euthanasia argumentative essay example

This topic is pretty vast. It can be both good and bad for you. Due to the variety of topics within the issue of Euthanasia, it might be easy to find something you are genuinely interested in.

On the other hand, there are dozens of various materials, thousands of articles, and billions of opinions you should consider before writing. Sometimes it might be difficult for you to get a full picture.

Therefore, a sample of the essay on this topic is presented here. It follows all the standards of an argumentative essay and shows you how this type of work may be completed.

On balance…

I’d say that it’s great to work with such an ambiguous topic. You’ll definitely benefit from training your persuasive and analytical skills while working on this essay.

Hope you’ve found some inspiration here, good luck!

Not excited to write an essay on euthanasia? Buy argumentative essay instead! Luckily, we’ve got dozens of writers, who are 100% fit for the job. Order an essay and save time for yourself!

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Why Euthanasia Should Be Legal: Analysis of Arguments and Counterarguments

  • Categories: Assisted Suicide Euthanasia Right to Die

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Words: 1865 |

10 min read

Published: Aug 14, 2023

Words: 1865 | Pages: 4 | 10 min read

Table of contents

Introduction, why euthanasia should be legal, works cited, counterarguments.

  • Corder, Mike. “Dutch Euthanasia Center Sees 22% Rise in Requests in 2019.” WAVY.com, 7 Feb. 2020, www.wavy.com/news/health/dutch-euthanasia-center-sees-22-rise-in-requests-in-2019/. Accessed 10 March 2020.
  • Davis, Jacky. “Kevin Davis Deserved Choice.” Dignity in Dying, www.dignityindying.org.uk/story/kevin-davis/. Accessed 13 March 2020.
  • De La Torre, Esther B. The Right to Assisted Suicide, www.lonestar.edu/rightto-assist-suicide.htm. Accessed 19 March 2020.
  • “Euthanasia Laws - Information on the Law about Euthanasia.” Information on the Law about Euthanasia - Suicide, Life, Act, and Mercy - JRank Articles, law.jrank.org/pages/11858/Euthanasia.html. Accessed 10 March 2020.

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argumentative essay voluntary euthanasia

Arguments in Favor of Euthanasia Essay

Mankind has always struggled to deal with numerous illnesses that have been in existence at different periods of time. Different treatment alternatives have been employed ranging from those by traditional medicine men to the modern scientific methods.

All these efforts have been motivated by the desire to remain alive for as long as one can (Buse 7). However, there are situations when living is more problematic and either the victim or other stakeholders contemplate ending life. This is referred to as euthanasia.

It is the act of deliberately terminating life when it is deemed to be the only way that a person can get out of their suffering (Johnstone 247). Euthanasia is commonly performed on patients who are experiencing severe pain due to terminal illness.

For one suffering from terminal illness, assisted death seems to be the better way of ending their suffering. The issue of euthanasia has ignited heated debate among the professionals as well as the law makers and the general public (Otlowski 211).

The physicians should do everything humanly possible to save lives of their patients, however, euthanasia should be considered as the only alternative to save extreme cases like the terminally ill patients from their perpetual pain and suffering.

Euthanasia can either be active/voluntary, non-voluntary, or involuntary. In voluntary euthanasia, the patient suffering from terminal illness may give consent to be assisted end his/her prolonged severe pain through death (Bowie and Bowie 215).

The patient may also decline to undergo burdensome treatment, willingly terminating treatment procedures like removal of life support machinery, and simply starving. Non-voluntary euthanasia, on the other hand, involves who cannot make sound decisions.

They may be too young, in a coma, senile, mentally challenged, or other severe brain damage (Gorsuch 86). Involuntary euthanasia involves ending the life of the patient without his/her consent. This usually happens when the patient is willing to live despite being in the most dangerous situations.

For instance, an infantry man has his stomach blown up by an explosive and experiences great pain. The army doctor, realizing that the soldier would not survive and has no pain relievers decide to spare the man further suffering and executes him instantly.

Also, a person could be seen on the 10 th floor of a building on fire, the person’s clothes are on fire and cries out for help. The person on ground has a rifle and decides to shoot him dead with a strong conviction that the individual would have experience a slow and painful death from the fierce fire.

Due to the sensitivity of the issue, laws that will protect the rights of both the patient and the physicians who practice euthanasia should be put in place.

A patient has the right to demand or refuse a given form of medication as long as it will alleviate their suffering (Bowie and Bowie 216). It amounts to violation of the patient’s rights if the physician does not respect the will of the patient.

Each one has a right to determine what direction their lives should take and is their own responsibility (Buse 7). A study conducted among adult Americans indicates that about 80% of them support the idea.

They argue that someone suffering from terminal illness, a condition which no medical intervention can reverse, should be allowed to undergo euthanasia. It is inappropriate to subject an individual into a slow but painful death. Such an individual ought to be assisted to end his/her life in order to avoid a prolonged painful death.

The laws guiding the practice of euthanasia in the state of Oregon are quite clear. Active euthanasia should only be performed on a patient who is 18 years and above, of sound mind and ascertained by at least three medical doctors that assisted death is the only alternative of helping the patient (Otlowski 212).

Under such a situation, the doctor prescribes the drugs but is not allowed to administer them. The patient in question takes the drug (s) voluntarily without any assistance from the doctor. The patient will then die in dignity, without any intense pain that living with the condition would bring.

It is evident that some terminal illness may not present unbearable pain to the patient. Instead, a chronically ill patient who is in a no-pain state will not be in a humanly dignified state. The patient of doctor may propose euthanasia as the better treatment alternative.

This has been occasioned by the advancement in the field of medicine where pain can be significantly control (Buse 8). All patients are entitled to pain relief. However, most physicians have not been trained on pain management and hence the patients are usually left in excruciating pain (Johnstone 249).

Under such a condition, the patient suffers physically and emotionally causing depression. Leaving the patient in this agonizing state is unacceptable and euthanasia may be recommended.

Moreover, the physician who practices euthanasia should be protected by the law. This can be achieved by giving him/her the ‘right’ to kill. A doctor handling a patient who is in excruciating pain should be in a position to recommend euthanasia so as to assist the patient have a dignified death.

It is not required by law or medical ethics that a patient should be kept alive by all means. Hence, the patient should be allowed to demand death if he/she considers it necessary (Gorsuch 88).

It would be inhumane and unacceptable to postpone death against the wish of the patient. It would also be unwise to insist on curing a condition which has been medically regarded as irreversible or incurable.

Most terminal illnesses are very expensive to cure although they are known to be incurable. The patient as well as family members ought to be relieved of the accompanying financial burden (Buse 8). The patient, considering the amount of money and other resources used in an attempt to keep him alive, may demand to be assisted to die.

This can only be possible through euthanasia (Johnstone 253). In fact, spending more on the patient would only serve to extend the individual’s suffering. Human beings are caring by nature and none would be willing to live their loved ones to suffer on their own.

They would therefore dedicate a lot of time providing the best care that they can afford. Some would even leave their day to day activities in order to attend to the terminally or chronically ill relative or friend.

Euthanasia, therefore, serves to spare the relatives the agony of constantly watching their family member undergo intense suffering and painful death. In most occasions, attempts to keep a patient alive would mean that he/she be hospitalized for a very long period of time (Bowie and Bowie 216).

Terminally ill patients in hospitals imply that facilities would be put under great pressure at the expense of other patients who would benefit from using the same services. These facilities include; bed space, medical machines, drugs, human resource, among others. Even if they were to be given homecare, a lot of time resource and facilities would be overstretched.

Other than the issue of homecare and the financial obligations that may arise, there is also the issue of personal liberty and individual rights. Those who front this argument explain that the patient has the right to determine when and how they die.

Since the life of a person belongs to that person only, then the person should have the right to decide if he or she wants to end it, if ending life would also mean ending irreversible suffering (CNBC News para 4).

This mean that individual undergoing great and irreversible suffering have the power to chose “a good death” and thus decide when they want to die (para 7).. Furthermore, these patients are dependent on life sustaining medication, which adds only adds the misery.

This brings forth the question about whether such patients can be forced to take life sustaining drugs if the said drugs only lead to extended life full of suffering.

The law should provide for such individuals to refuse to take such drugs and also to request drugs that will lead to end of their misery, even it if mean that these drugs will end their lives.

Therefore patients in this condition should be allowed the legal tight to end their miseries through assisted suicide.

Those who oppose any form of euthanasia argue that a terminally ill patient or a person suffering irreversible pain from an incurable disease should be assisted to live by all means including any medical procedure that guarantees that they live the longest possible period.

This argument is valid but has logical flows. The argument presupposes that such patients need to be prevented from dyeing through any possible means. In reality though, this efforts are futile as when a patient has determined that death is the easier way out of the misery they are suffering, the emotional distress will only pull them closer to death (Morgan 103).

Furthermore, such efforts to prolong the patients’ lives do not prevent death, as but just postpone it at the same time extending the patients suffering. This is because such patient’s life is hanging by the thread and they have been brought near to death by the virtue of their illness.

In severe cases such patient may result to suicide, as in the case of Sue Rodriguez, Canadian woman who suffered Lou Gehrig’s disease, and was refused the right for assisted death (CNBC News para 2). As such efforts to prolong their lives pushed them closer to death

While some countries such as The Netherlands, Belgium and Denmark have embraced the idea of euthanasia, others have move at a snails pace in this direction. Canada, one of the most developed countries is such countries.

Euthanasia is still illegal in Canada and any person found trying it is subject to prosecution. Furthermore, any person found to have assisted another person commit suicide is also liable to prosecution for up to 14 years in prison.

Still in Canada, the law after many years of legal battle has differentiated euthanasia and assisted suicide. Assisted suicide is what is otherwise referred to as active euthanasia where a terminally ill patient asks for help to end life.

The law in Canada has also allowed for these patients to refuse life sustaining medication if such medication does not in any way improve the quality of their lives (CNBC para 17).

If the law acknowledges the power of a person to refuse such medication then it must also allow such a person the legal right to determine the condition and the manner in which they die. This means that there is light, though, at the end of the tunnel for Canadians patients who may wish to end their lives.

Such argument for any form of euthanasia tends to conglomerate around two valid arguments. First, if a terminally ill patient who is suffering extreme and irreversible pain is determined to be of sound mind and is adult then such patients should be allowed to make judgment about their lives.

If such a patient decides that ending their lives will be end their misery, then no doctor has the legal as well as moral obligation of coercing the patient to continue taking medication that only prolongs their suffering (Morgan 145).

If doctors manage to successfully administer the drugs against the wishes of such a patient, they will have committed an assault against the patient and this is a legal as well as a professional misconduct (Morgan 146). Secondly, the desires of such a patient are supreme.

This means that the patients’ right to self determination overrides the fundamental but not absolute belief that life is holy and should only be ended by the maker.

Therefore such patient’s should be treated as competent enough to make decisions about their lives and that no medical officer has the legal or moral right to determine that such a patient is wrong. Any medical help provide to such a patient thus be for the benefit of the patient.

From a religious point of view, it can be argued that God is love and people of God should demonstrate compassion. If someone is undergoing intense pain and a slow but sure death, it would be evil to allow such a person to experience the full extent (Gorsuch 89).

Euthanasia would therefore be the better option. Helping the patient have a dignified death can be the best show of agape love. There is also the issue of quality of life where if someone is leading low quality or worthless life, then one should opt for euthanasia.

The essay has discussed several points in favor of euthanasia as an alternative when it comes to treating people suffering from terminal illness or responding to perplexing situations where death is the ultimate end although one may go through severe pain and agonizing moments.

It has also highlighted three main forms of euthanasia; voluntary/active, non-voluntary, and involuntary. Anyone can argue against the points raised in this essay but it would be difficult to justify why an individual should be allowed to suffer for a long time either willingly or unwillingly.

The doctors should do everything humanly possible to save lives of their patients, however, euthanasia should be considered as the only alternative to save extreme cases like the terminally ill patients from their perpetual pain and suffering.

Works Cited

Bowie, Bob & Bowie, Robert A. Ethical Studies: Euthanasia (2 nd ed). Neslon Thornes, 2004, Pp. 215-216.

Buse, Anne-Kathrin. Euthanasia: Forms and their Differences . GRIN Verlag, 2008, Pp. 7-8.

CNBC news. “ The Fight for the Right to Die. ” CNBC Canada . 2011.

Gorsuch, Neil M. Euthanasia- The Future of Assisted Suicide . Princeton University Press, 2009, Pp. 86-93.

Johnstone, Megan-Jane. Euthanasia: Contradicting Perspectives (5 th ed). Elsevier Health Sciences, 2008, Pp. 247-262.

Morgan, John. An Easeful Death?: Perspectives On Death, Dying And Euthanasia. S ydney: Federation press Pty Ltd. 1996. Print.

Otlowski, Margaret. Euthanasia and the Common Law . Oxford University Press, 2000, Pp. 211-212.

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Euthanasia Argumentative Essays Samples For Students

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Dax Cowarts Case Argumentative Essay

Dax cowart’s case.

Dax Cowart should have been allowed to stop treatment. He was 25 years old during the accident and had full knowledge of his own capacity to tolerate the pain of treatments. He was also well aware of the quality of life that he would want for himself. The following sections describe his accident and treatments, relate the stand of Dax Cowart about his treatments, and discuss the rationale for euthanasia in the case of Dax Cowart.

The accident and treatments

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Sample Argumentative Essay On Arguments In Support Of Voluntary Euthanasia

Good example of human rights argumentative essay.

- The legal issue surrounding flag burning and its verdict in relation to human rights - The First Amendment - Comparison between the Arab and Western world on human rights - Conclusion - Drawing comparison through cultural expressions - Debriefing the two authors views - Justification of Argument

Introduction

What are human rights? It’s the rights humans have. Anybody and everybody born on this planet, irrespective of their nationality, sex, color, religion, and language are equal before the law, and are thus, entitled to be treated equally without discrimination.

The majority of people in the countries in the Middle-East, Africa, and to a certain extent, South America, face discrimination, and human rights issues. Can non-government organizations, or the elite society of a country help protect their citizens from human rights issues” On reading In Defense of Professional Human Rights Organizations, by Azzam (2014), and Elites Still Matter When Protecting Human Rights, by Cordero (2014), it is apparent that they both failed to address what needs to be done to protect innocent citizens from human rights violations.

In a report in Human Rights, by an anonymous writer in 2009, said that, Kosba, an Egyptian woman, and a few other Egyptian participants, which included lawyers, journalists, engineers, researchers, pharmacists, and activists, participated in a three-week program on human rights abuse, in the U.S. On completing the program, Kosba voiced her opinion that, human rights in their country could come, “if there is an empowered civil society and a new generation of reformers who are grounded in their faith and freedom.”

Kosba’s view has a lot of authenticity, simply because, here, we have a person who has seen and experienced or heard of human rights discrimination at close range. Her view is a perfect example of what needs to be done to stop human rights violations in her country.

In 2013, as the man who tried to become another Hosni Mubarak, Mohamed Morsi was abdicated from office by the military. The so-called empowered civil society is none other than the government, for, it is the government alone, which can initiate and introduce laws to protect people from injustice. It is governments alone, which has the ethical and legal duty to ensure that their people live with dignity. Human rights cover a wide range of issues. It’s not just providing basic security and amenities to the public; it also covers social, cultural, economic, religious and other humanitarian issues. These are not issues that non-government organizations or the elite club members of a country can address or solve. It has to have the support of the government.

People diagnosed with a terminally ill disease should have the right to choose their fate in order to keep their dignity.

Euthanasia is defined as the intentional killing of a person on compassionate grounds, to relieve the person of misery and pain. In most cases of euthanasia, the affected person is put to sleep by a direct action of using a lethal injection, or terminating an action necessary to maintain life. For euthanasia to occur there must be an intention to act to kill. Euthanasia can be voluntary and involuntary, depending upon the seriousness of the case. Of these, the most common cases relate to voluntary euthanasia, where the affected person asks for mercy killing. Harsh as it may sound, euthanasia harbors around this category, for it is the only accurate, non-emotional word to describe the reality of the action and a word that the law uses

The debate on euthanasia continues to cover the front pages of medical journals and the like, yet, there are no clear winners so far, to address the plea of those who seek mercy killing. Dr. Donald Low produced a video eight days before his death, castigating the medical establishment for forcing unnecessary suffering on terminal patients.

Nursall (2014), reporting on euthanasia in The Star.com, wrote that Ed Hung, “who suffered from ALS, died on Sunday in Switzerland, the only country that allows physician-assisted suicide for non-residents.” The other countries that have similar laws for their residents are Belgium and Holland. Several states in the U.S allow doctors to prescribe fatal drugs to terminally ill patients.

The debate on both, assisted suicide and euthanasia continue to rage, as many people try to take the extreme step on medical and mental grounds. No one in their senses would think of killing themselves unless they face uncertainty of life, and/or excruciating pain. To live or die, is the right of a person, and no one has the right to object to that. As Dr. Low said, just before his death, that the medical establishment had no right to put him through such pain and torture.

There is a popular belief that euthanasia shouldn't be allowed even if it were morally right, because, should the law turn a blind eye to euthanasia, it could be abused and used as a cover for murder (BBC, 2005). This argument clearly shows that it has to be a law, that decides what is right and what is wrong, and not, any non-government organizations or the elite society.

Freedom of speech, freedom of press, freedom of association, freedom of assembly and petition are all expressions that are based on human rights. These are laws passed by legislation, approved by the government and practiced by the judiciary.

In 1984, during the Republican National Convention in Dallas, Texas, a certain Gregory Lee (Joey) Johnson was part of a political demonstration. The protest was against some of President Reagan’s, and some Dallas-based corporation’s policies. In the heat of the moment, and sometime during the march, it came to light that Johnson had burned an American flag in full view of the demonstrators.

While the march was peaceful, and no one was physically injured or threatened with injury, several protestors who were witness to Johnson’s defamation, were offended by his action. Johnson was found guilty and convicted for desecrating the national flag in violation of a Texas statute. He was charged, and the case was allowed by the State Court of Appeals (Apel, 1989).

However, the Texas Court of Criminal Appeals reversed their earlier decision, citing that, the State of Texas, consistent with their opinion of the First Amendment, would not punish Johnson for burning the flag. The court declared that Johnson’s act of burning the flag was an expressive conduct that could be protected by the First Amendment. The First Amendment ensured that there could be no prosecution of Johnson under the present circumstance, and so, concluded that the State could not file criminal charges against Johnson for his act. The statute too, did not meet the State’s goal of preventing breaches of the peace, and so, Johnson was not guilty of causing and serious public disturbances (Apel, 1989).

It would be illogical to even contemplate questioning certain Muslim nations whether they have such freedom available to them. It is the rulers who dictate and pass laws there, and the government is just an entity. The question, therefore, is not whether these countries have such liberties accorded to their citizens, but, can an elite league or a non-government organization, let alone, the government; have the power to overrule the hierarchy in those nations?

In the U.S, the First Amendment was passed into law by the government, and protected by the judiciary. Therefore, such human rights are clearly under the jurisdiction of the government, and not some non-government organizations or elite societies.

Would it be possible for them to disobey the hierarchy and take the matter to their Supreme Court? For a nation like Saudi Arabia, where it is illegal for women to show their face in public places, or drive cars on their own, such luxuries are a distant dream, because it is the law of the hierarchy, and not a law that allows them the freedom of expression.

It can be concluded that while both, Azzam (2014), and Cordero (2014), accept the importance of human rights, they are far less convincing in assessing how human rights issues need to be addressed. True, some elites and non-government organizations do have influence with their governments, but they don’t have the power to influence governments in issues as sensitive as this, which is, a human rights issue. It is only governments that can address the issue of human rights, and not non-government organizations or the elite.

Works cited

Apel, Warren S, (1989), U.S. Supreme Court: TEXAS v. JOHNSON, 491 U.S. 397 (1989) 491 U.S. 397, Certiorari to the Court of Criminals Appeals of Texas, No. 88-155, Retrieved March 22, 2014, from http://www.esquilax.com/flag/texasvjohnson.html Azzam, F, (2014), In defense of 'professional' human rights organizations, Retrieved March 22, 2014, from http://www.opendemocracy.net/openglobalrights/fateh-azzam/in-defense-of-professional-human-rights-organizations Anonymous, (2009), Human Rights, The Washington Report on Middle East Affairs, American Educational Trust, Volume 28(5), ISSN 87554917, p. 58-59 BBC, Religion and Ethics: Ethical Issues, bbc.co.uk, Retrieved March 22, 2014, from http://www.bbc.co.uk/religion/ethics/euthanasia/overview/introduction.shtml Cordero, F, (2014), Elites still matter when protecting human rights, Retrieved March 22, 2014, from http://www.opendemocracy.net/openglobalrights/felipe-cordero/elites-still-matter-when-protecting-human-rights Nursall, K, (2014), Canada's shifting landscape on euthanasia, GTA, Retrieved March 22, 2014, from http://www.thestar.com/news/gta/2014/03/19/canadas_shifting_landscape_on_euthan asia.html Shin, H, B, (2013), Human Rights, Asian Journal of International Law, Cambridge University Press, Volume 3(2), ISSN 20442513, p. 419-420, DOI http://dx.doi.org.ezproxy.apollolibrary.com/10.1017/S2044251313000118

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  • Ann Med Surg (Lond)
  • v.75; 2022 Mar

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Euthanasia and assisted suicide: An in-depth review of relevant historical aspects

Yelson alejandro picón-jaimes.

a Medical and Surgical Research Center, Future Surgeons Chapter, Colombian Surgery Association, Bogotá, Colombia

Ivan David Lozada-Martinez

b Grupo Prometheus y Biomedicina Aplicada a las Ciencias Clínicas, School of Medicine, Universidad de Cartagena, Cartagena, Colombia

Javier Esteban Orozco-Chinome

c Department of Medicine, RedSalud, Santiago de Chile, Chile

Lina María Montaña-Gómez

d Department of Medicine, Keralty Salud, Bogotá, Colombia

María Paz Bolaño-Romero

Luis rafael moscote-salazar.

e Colombian Clinical Research Group in Neurocritical Care, Latin American Council of Neurocritical Care, Bogotá, Colombia

Tariq Janjua

f Department of Intensive Care, Regions Hospital, Minnesota, USA

Sabrina Rahman

g Independent University, Dhaka, Bangladesh

End-of-life care is an increasingly relevant topic due to advances in biomedical research and the establishment of new disciplines in evidence-based medicine and bioethics. Euthanasia and assisted suicide are two terms widely discussed in medicine, which cause displeasure on many occasions and cause relief on others. The evolution of these terms and the events associated with their study have allowed the evaluation of cases that have established useful definitions for the legal regulation of palliative care and public policies in the different health systems. However, there are still many aspects to be elucidated and defined. Based on the above, this review aimed to compile relevant historical aspects on the evolution of euthanasia and assisted suicide, which will allow understanding the use and research of these terms.

  • • The history of euthanasia and assisted suicide has been traumatic.
  • • The church and research have been decisive in the definition of euthanasia.
  • • The legal framework on the use of euthanasia and assisted suicide has been strengthened.

1. Introduction

Euthanasia and assisted suicide are two topics discussed throughout history, mainly because they fall within the scope of life as a human right, which has been universally defended for many years [ 1 ]. However, the mean of the word euthanasia as good death generates conflicts at social, moral, and ethical levels. Mainly because death is a loss, it is difficult to understand it as something positive and; additionally, several historical events such as the Nazi experiments related the term euthanasia more to murder than to a kind and compassionate act [ 1 ]. More current texts mention that euthanasia is the process in which, through the use or abstention of clinical measures, the death of a patient in an incurable or terminal condition can be hastened to avoid excessive suffering [ 2 ].

The difference between euthanasia and assisted suicide is that in the latter, the patient takes the final action; however, both practices can be combined in the term assisted death [ 2 ]. At present, several countries authorize assisted death, including Holland, Luxembourg, and Canada [ 3 ]. Belgium and Colombia have regulations that decriminalize only euthanasia; other places where assisted suicide is legal are Switzerland and five states of the United America states, specifically Oregon, Vermont, Washington, California, and Montana [ 2 , 3 ]. Spain recently joined the list of countries that have legislated on euthanasia through the organic law March 2021 of March 24 that regulates euthanasia in that state in both public and private institutions [ 4 ]. The fact that more and more countries were joining the legislation on euthanasia and assisted suicide has brought to light the opinion of thinkers, politicians, philosophers, and physicians. Several nations have initiated discussions on the matter in their governmental systems. Latin America is trying to advance powerfully in this medical-philosophical field. Currently, in Chile, the “Muerte digna y cuidados paliativos” law, which seeks to regulate the issue of euthanasia and assisted suicide in the country, is being debated in Congress [ 5 ].

It is essential to know the point of view of physicians on euthanasia and assisted suicide, especially taking into account that these professionals who provide care and accompany patients during this moment, which, if approved, would involve the medical community in both public and private health systems. Although it seems easy to think that physicians have a position in favor of the act of euthanasia because they are in direct and continuous contact with end-of-life situations, such as palliative care, terminally ill, and critically ill patients. It is important to remember that the Hippocratic medical oaths taken at the time of graduation of professionals are mostly categorical in mentioning the rejection of euthanasia and assisted suicide [ 6 ]. Furthermore, it is also important to note that many of the oldest universities in the Western world originated through the Catholic Church; and just this creed condemns the practice of euthanasia and continues to condemn it to this day. This situation generates that many medical students in these schools have behaviors based on humanist principles under the protection of faith and religion and therefore reject the possibility of euthanasia [ 7 , 8 ].

The relevance of the topic and the extensive discussion that it has had in recent months due to the COVID-19 pandemic added to the particular interest of bioethics in this topic and the need to know the point of view of doctors and other health professionals on euthanasia and assisted suicide.

2. Origin and meaning of the term euthanasia

The word euthanasia derives from the Greek word “eu” which means good, and the word “thanatos” which means death; therefore, the etymological meaning of this word is “good death”. Over time the evolution of the meaning has varied; even as we will see below was considered a form of eradication of people categorized under the designation of leading a less dignified life. Assisted suicide is a condition in which the patient is the one who carries out the action that ends his life through the ingestion of a lethal drug but has been dispensed in the context of health care and therefore called assisted. This care is provided by a physician trained in the area. However, it requires the prior coordination of a multidisciplinary team and even the assessment by an ethics committee to determine that the patient is exercising full autonomy, free from coercion by the situation he/she is living and free from the fatalistic desires of a psychiatric illness [ 9 ]. In a more literary sense, the word euthanasia meaning of “giving death to a person who freely requests it in order to free himself from suffering that is irreversible and that the person himself considers intolerable” [ 9 ].

Some authors go deeper into the definition and consider that for the meaning of euthanasia, are necessary to consider elements that are essential in the word itself; such as the fact that it is an act that seeks to provoke death and that carried out to eliminate the suffering in the person who is dying. Other elements with a secondary character in the definition are the patient's consent (which must be granted respecting autonomy and freedom in the positive and negative sense; that means the fact must be not be coerced in any way). Another element is the terminal nature of the disease, with an irreversible outcome that generates precariousness and a loss of dignity. The third secondary element is the absence of pain of the death through the use of drugs such as high-potency analgesics, including opioids, high-potency muscle relaxants, and even anesthetic drugs. Finally, the last element is the health context in which the action is performed (essential in some legislations to be considered euthanasia) [ 10 ]. According to the World Health Organization, the union of these two components is the current definition of euthanasia, which describes as “the action performed by a person to cause the painless death of another subject, or not preventing death in case of terminal illness or irreversible coma. Furthermore, with the explicit condition that the patient must be suffering physical, emotional, or spiritual and that affliction is uncontrollable with conventional measures such as medical treatments, analgesics, among others; then the objective of euthanasia is to alleviate this suffering” [ 11 ]. Unfortunately, the term euthanasia has been misused over the years, and other practices have been named with this word. An example of this situation occurred during the Nazi tyranny when the word euthanasia concerned the murder of people with disabilities, mental disorders, low social status, or gay people. At that time, euthanasia was even a simultaneous practice to the Jewish genocide [ 11 ].

Not only has the term been misused; also exists an enormous variability of terms to refer to euthanasia. For example, the laws created to regulate euthanasia have different names around the world; in the Netherlands (Holland), the law that regulates this practice is known as the law of termination of life; in Belgium, it is called euthanasia law, in France, it is called euthanasia law too. In Oregon (USA), it is called the death with dignity act; in California, it is the end of life option act. In Canada is called the medical assistance in dying act. Victoria (Australia) is the voluntary assisted dying bill, but all these denominations refer to the already well-known term euthanasia [ 11 ].

3. Evolution of euthanasia and assisted suicide: digging into historical events

To understand the evolution and relevance of these concepts should analyze the history of euthanasia and assisted suicide; from the emergence of the term, going through its first manifestations in antiquity; mentioning the conceptions of great thinkers such as Plato and Hippocrates; going through the role of the Catholic Church; mainly in the Middle Age, where following the thought of St. Thomas Aquinas, self-induced death or death contemplated by own will, was condemned. Later, with the renaissance age and the resurgence of science, technology, and the arts, the term euthanasia made a transition to a form similar to what we know today from thinkers such as Thomas More and Francis Bacon. Finally, the first signs of eugenics were known in London, Sweden, Germany, and the United States in the twentieth century. There was a relationship with the term euthanasia that was later used interchangeably, especially in the Nazi regime, to denote a form of systemic murder that sought to eradicate those who were not worthy of living a life.

Since the sixties, with emblematic cases, the path towards the decriminalization of euthanasia began in some countries, especially concerning the cessation of extreme support measures in cases of irreversible illness or a terminal condition. The practice has progressed to the appearance of laws on euthanasia in several countries.

4. Euthanasia and assisted suicide in ancient times

In book III of Plato's “The Republic”, the author stated that those who live their lives amidst illnesses and medicines or who were not physically healthy should be left to die; implying that it was thought that people in these conditions suffered so much that their quality of life diminished, which seemed understandable to these thinkers. However, other authors such as Hippocrates and his famous Hippocratic oath sought the protection of the patient's life through medicine, especially in vulnerable health conditions prone to fatal outcomes. This Hippocratic oath is the same oath that permeates our times and constitutes an argument among those who mark their position against euthanasia and assisted suicide [ 12 , 13 ].

Other texts that collect thoughts of Socrates and his disciple Plato point out that it was possible and well understood to think of ceasing to live in the face of a severe illness; to consider death to avoid a long and torturous agony. This fact is compatible with the conception of current euthanasia since this is the end of this health care procedure [ 13 ].

In The Republic, the text by Plato, the physician Heroditus is also condemned for inventing a way to prolong death and over manage the symptoms of serious illnesses, which is currently known as distanasia or excessive treatment prolongs life. This kind of excessive treatment prolongs the sick person's suffering, even leading him to maintain biological signs present but in a state of alienation and absolute dependence on medical equipment such as ventilators and artificial feeding [ 13 ]. However, the strongest indication that Euthanasic suicide was encouraged in Greece lies in other thinkers such as the Pythagoreans, Aristotelians, and Epicureans who strongly condemned this practice, which suggests that it was carried out repeatedly as a method and was therefore condemned by these thinkers [ 12 , 13 ]. According to stoicism, the pain that exceeded the limits of what was humanly bearable was one of the causes for which the wise man separates himself from life. Referring to one of the nuances that euthanasia touches today, that is, at a point of elevated suffering, the dignity and essence of the person are lost, persisting only the biological part but in the absence of the person's well-being as a being. In this sense, Lucius Seneca said that a person should not love life too much or hate it; but that person should have a middle ground and end their life when they ceased to perceive life as a good, worthy, and longed-for event [ 1 , 12 ].

During the Roman Empire and in the territories under its rule, it was believed that the terminally ill who commit suicide had sufficient reasons to do so; so since suicide caused by impatience and lack of resolution to pain or illness was accepted, when there was no access to medicines. In addition, there was little development in medicine during that time, and many of the sick died without treatment [ 12 ]. This situation changed later with the emergence of the Catholic church; in this age, who attempted against own life, was deprived of burial in the ground. Saint Augustine said that the suicide was an abominable and detestable act; from 693 AD, anyone who attempted against his physical integrity was excommunicated. Rejecting to the individuals and their lineage, depriving them of the possibility of attending the funeral and even expelled from cities and stripped of the properties they owned [ 12 , 13 ].

4.1. Euthanasia and assisted suicide in the Middle Age

During the Middle Age, Catholicism governed the sciences, arts, and medicine; the sciences fell asleep. Due to this solid religious tendency and the persistence of Augustinian thought, suicide was not well seen. It was not allowed to administer a lethal substance to a person to end the suffering of a severe or terminal illness [ 9 , 12 ]. People who took their own lives at this time could not be buried “Christianly”; therefore, they did not have access to a funeral, nor to the accompaniment of their family in a religious rite. Physical suffering and pain were then seen as a path to glorification. Suffering was extolled as the form that god purified the sin, similar to the suffering that Jesus endured during his Calvary days. However, a contrary situation was experienced in battles; a sort of short dagger-like weapon was often used to finish off badly wounded enemies and thus reduce their suffering, thus depriving them of the possibility of healing and was called “mercy killing” [ 12 ].

5. Euthanasia in renaissance

With the awakening of science and philosophy, ancient philosophers' thoughts took up again, giving priority to man, the world, and nature, thus promoting medical and scientific development. In their discourse, Thomas More and Francis Bacon refer to euthanasia; however, they give a eugenic sense to the concept of euthanasia, similar to that professed in the book of Plato's Republic. It is precise with these phylosophers that the term euthanasia got its current focus, referring to the acceleration of the death of a seriously ill person who has no possibility of recovery [ 12 ]. In other words, it was during this period that euthanasia acquired its current meaning, and death began to be considered the last act of life. Therefore, it was necessary to help the dying person with all available resources to achieve a dignified death without suffering, closing the cycle of life that ends with death [ 13 , 14 ].

In his work titled “Utopia”, Thomas More affirmed that in the ideal nation should be given the necessary and supportive care to the dying. Furthermore, in case of extraordinary suffering, it can be recommended to end the suffering, but only if the patient agrees, through deprivation of food or with the administration of a lethal drug; this procedure must be known to the affected person and with the due permission of authorities and priests [ 12 , 13 ]. Later, in the 17th century, the theologian Johann Andreae, in his utopia “Christianopolis”, contradicts the arguments of Bacon and Moro, defending the right of the seriously ill and incurably ill to continue living, even if they are disturbed and alienated, advocating for the care based on support and indulgence [ 15 , 16 ]. Similarly, many physicians rejected the concepts of Plato, Moro, and Bacon. Instead, they focused on opposing euthanasia, most notably in the nineteenth century. For example, the physician Christoph Hufeland mentioned that the doctor's job was only to preserve life, whether it was a fate or a misfortune, or whether it was worth living [ 16 ].

5.1. Euthanasia in the 20th century

Before considering the relevant aspects of euthanasia in the 20th century, it is vital to highlight the manuscript by Licata et al. [ 17 ], which narrates two episodes of euthanasia in the 19th century. The first one happened in Sicily (Italy) in 1860, during the battle of Calatafimi, where two soldiers were in constant suffering, one because he had a serious leg fracture with gangrene, and the other with a gunshot wound. The two soldiers begged to be allowed to die, and how they were in a precarious place without medical supplies, they gave them an opium pill, which calmed them until they died [ 17 ]. The second episode reported by Licata et al. [ 17 ] was witnessed by a Swedish doctor named Alex Munthe; who evidenced the pain of many patients in a Parisian hospital. So he decided to start administering morphine to help people who had been seriously injured by wolves and had a poor prognosis; therefore, the purpose of opioid use was analgesia while death was occurring.

It is also important to highlight the manuscript entitled “Euthanasia” by S. Williams published in 1873 in “Popular Science Monthly”, a journal that published texts by Darwin, Edison, Pasteur, and Beecher. This text included the report for the active euthanasia of seriously ill patients without a cure, in which the physicians were advised to administer chloroform to these patients or another anesthetic agent to reduce the level of consciousness of the subject and speed up their death in a painless manner [ 16 ].

Understanding that euthanasia was already reported in the nineteenth century, years after, specifically in 1900, the influence of eugenics, utilitarianism, social Darwinism, and the new currents of thought in England and Germany; it began in various parts around the world, projects that considered the active termination of life, thus giving rise to euthanasia societies in which there were discussions between philosophers, theologians, lawyers, and medical doctors. Those societies discussed diverse cases, such as the tuberculous patient Roland Gerkan, who was considered unfit and therefore a candidate to be released from the world [ 16 ]. The scarcity of resources, famine, and wars were reasons to promote euthanasia as a form of elimination of subjects considered weak or unfit, as argued in texts such as Ernst Haeckel's. However, opponents to the practice, such as Binding and Hoche, defended the principle of free will in 1920 [ 16 ].

5.2. Euthanasia in the time of the Nazis

As mentioned above, the term euthanasia was misused during this period; approximately 275,000 subjects (as reported at the Nuremberg International Military Tribunal 1945–1946), who had some degree of physical or mental disability, were killed during Adolf Hitler's Euthanasia program [ 13 ]. However, the Nazis were not the first to practice a form of eugenics under the name of euthanasia, since the early 1900s in London had already begun the sterilization of the rejected, such as the blind, deaf, mentally retarded, people with epilepsy, criminals, and rapists. This practice spread to different countries like Sweden and the United States [ 13 , 16 ].

For the Nazis, euthanasia represented the systematic murder of those whose lives were unworthy of living [ 13 ]. The name given to this doctrine was “Aktion T4”. At first and by law, from 1939, the hospitals were obliged to account for all disabled newborns, which led to the execution of more than 5000 newborns utilizing food deprivation or lethal injection [ 12 , 18 ].

A year before that law, in 1938, one of the first known cases of euthanasia in children arose in Germany. That history called the story of child K, in which it was the father of the minor who asked Hitler in writing for euthanasia for his son because the child had a severe mental disability and critical morphic disorders. Hitler gave his consent to carry out the procedure on child K, and thus the program began to spread throughout the Aleman territory. Since then, physicians and nurses had been in charge of reporting the newborns with alterations, arising the “Kinderfachabteilugen” for the internment of children who would be sentenced to death after a committee's decision [ 12 , 18 , 19 ]. A list of diseases and conditions that were considered undesirable to be transmitted to Hitler's superior Aryan race was determined; thus, any child with idiocy, mongolism, blindness, deafness, hydrocephalus, paralysis, and spinal, head, and hip malformations were eligible for euthanasia [ 19 ].

Subsequently, the program was extended to adults with chronic illness, so those people were selected and transported by T4 personnel to psychiatric sanatoriums strategically located far away. There, the ill patients received the injection of barbiturate overdoses, and carbon monoxide poisoning was tested as a method of elimination, surging the widely known gas chamber of the concentration camp extermination; this situation occurred before 1940 [ 12 , 19 ]. Again, physicians and nurses were the ones who designated to the patients to receive those procedures; in this case, these health professionals supported Nazi exterminations. They took the patients to the sanatoriums, where psychiatrists evaluated them and designated with red color if they should die and with a blue color if they were allowed to live (this form of selection was similar in children) [ 12 , 13 , 19 ]. In this case, the pathologies considered as criteria for death were those generating disability such as schizophrenia, paralysis, syphilis with sequelae, epilepsy, chorea, patients with chronic diseases with many recent treatments, subjects of non-German origin and individuals of mixed blood [ 19 ]. Once in the sanatoriums, they were informed that they would undergo a physical evaluation and take a shower to disinfect themselves; instead, they were killed in gas chambers [ 12 , 13 ]. Despite the church's action in 1941 against Nazis and after achieving suspension of the Aktion T4 project; the Nazi supporters kept the practices secretly, resuming them in 1942, with the difference that the victims were killed by lethal injection, by an overdose of drugs, or left to starve to death, instead of the use of gas chambers. This new modified form of euthanasia, which did not include gas chambers, became known as “savage euthanasia” [ 12 , 13 , 19 ].

5.3. Euthanasia since the 1960s

In September 1945, trials began for crimes perpetrated by Nazi supporters; the victorious Allied forces conducted these trials at the end of the war. During these tribunals, cases of human experimentation were identified and the public exposure of the Nazi euthanasia program. After the Nuremberg trials and the abolition of Nazi experiments, a series of seven documents emerged, among which the Nuremberg code containing the ten basic principles for human research stood out [ 20 , 21 ].

After these judgments, biotechnology was accelerated, with the apparition of new techniques to intervene in the health-disease process. Additionally, the increase in life expectancy and the appearance of diseases that chronically compromise the state of health of people generated a change in the conception of the critically ill patient and the terminal state of life [ 20 , 21 ]. Cases such as Karen Ann Quinlan brought to the forefront the issue of euthanasia and precisely the control of extreme treatment measures. Karen, a young American woman, was left in a vegetative state due to severe neurological damage following alcohol and barbiturate intoxication. After six months in that state and under the guardianship of a Catholic priest, Karen's parents requested the removal of the artificial respirator, arguing that in her state of consciousness prior to the incident, she had stated that she disagreed with artificially maintaining life in comatose patients. The hospital refused to remove the ventilator, arguing the legal issues for the date, and the parents went to court, which in the first instance granted the hospital the right. Nevertheless, the New Jersey Supreme Court granted Karen Ann's right to die in peace and dignity. Despite the withdrawal of the artificial respirator, he continued to live until 1985, when he finally died [ [21] , [22] , [23] ].

Another important case was Paul Brophy, which also occurred in the United States. Paul was a firefighter in Massachusetts and went into a deep coma due to the rupture of a basilar artery aneurysm; initially, his family advocated for support measures but later requested the hospital to disconnect these means to allow death, as Paul had indicated when he was still conscious. The hospital refused to carry out this procedure, so the family went to court, where the removal of the support measures (gastrostomy) was initially denied. Hence, the family went to the state supreme court, achieving the transfer of Paul to another medical center where the gastrostomy was removed, leading to his death within a few days [ 23 ].

The case of Arthur Koestler, an influential English writer and activist diagnosed with Parkinson's disease and later with leukemia, who served as vice-president of the voluntary euthanasia society (Exit) and wrote a manual book with practical advice for euthanasia called “Guide to Self-Liberation”. He stood out because he applied one of his advice and ingested an overdose of barbiturates, causing his self-death. According to his writings, Koestler was not afraid of death but of the painful process of dying [ 23 ]. In this sense, it was a relevant case because it involved someone who held an important position in an association that advocated euthanasia, in addition to being the author of several works, which made him a recognized public figure [ 23 ].

Baby Doe was a case that also occurred in the United States; it was a small child with Down syndrome who had a tracheoesophageal fistula and esophageal atresia; in this case, surgery was necessary. On the advice of the obstetrician, the parents did not allow surgery, so the hospital managers took the case before a judge who ruled that parents could decide to perform or not the surgery. The case was appealed before a county judge who upheld the parents' power to make the decision, in the course of which the case became public and many families offered to take care of the child; however, before the case reached the supreme court, the child died at six days of age [ 23 ].

In the case of Ingrid Frank, a German woman who was in a quadriplegic state by a traffic accident, who initially sought rehabilitation but later insisted on being allowed to die; it was provided with a drink containing a cyanide solution that she drank. At the same time, she was filmed, which shows a kind of assisted suicide. For that reason, this is another case that deals with this issue and is important to know as background in the development of euthanasia and assisted suicide [ 22 , 23 ].

6. Current and future perspectives

The definition of brain death, the rational use of the concept of euthanasia and assisted suicide, and scientific literacy are the objectives of global bioethics to regulate euthanasia and assisted suicide, which can be accessible in all health systems [ [24] , [25] , [26] , [27] , [28] , [29] , [30] ]. End-of-life care will continue to be a subject of debate due to the struggle between biomedical principles, the different existing legal frameworks, and the general population's beliefs. Medical education and preparation in the perception of death, especially of a dignified death, seems to be the pillar of the understanding of the need to develop medical-legal tools that guarantee the integrity of humans until the end of their existence [ 31 , 32 ]. This is the reason why the new generations of physicians must be trained in bioethics to face these ethical conflicts during the development of their professional careers.

In addition, although the conception of bioethics belongs to the Western world, it is crucial to take into account the point of view of other cultures and creeds, for example, a study carried out in Turkey, where nursing students were questioned, found that many of them understood the reasons for performing euthanasia; however, they know that Islam prohibits it, as well as its legislation, and therefore they would not participate in this type of procedure [ 33 ]. Furthermore, Christianism and Islam prohibit euthanasia, but Judaism also prohibits it; in general, the so-called Abrahamic religions are contrary to any form of assisted death, whether it is active euthanasia, passive, or assisted suicide [ 34 ].

7. Conclusiones

The history and evolution of euthanasia and assisted suicide have been traumatic throughout human history. The church, politics, and biomedical research have been decisive in defining these concepts. Over the years, the legal framework and bioethical concepts on euthanasia have been strengthened. However, there is still much work to educate the general population and health professionals about end-of-life care and dignified death.

It is also important to remember that life is a concept that goes beyond biology. Currently, bioethics seeks to prioritize the concept of dignity, which must be linked to the very definition of life. Although the phrase is often heard that it is not necessary to move to be alive, what is important is that person feels worthy even if they have limited movement. The person's treatment must be individualized in bioethics since each individual is a unique unit. Therefore, medical paternalism must be abandoned. Instead, the subject must be more involved to understand their context and perception of life and dignity.

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All authors equally contributed to the analysis and writing of the manuscript.

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Not commissioned, externally peer reviewed.

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Sabrina Rahman. Independent University, Dhaka, Bangladesh. [email protected] .

Declaration of interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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Euthanasia (Argumentative Essay Sample)

Euthanasia is one of the subjects that have faced intense debate over time, the legalization of euthanasia have been debated for many years with different views presented in terms of  ethical and legal consideration for both patients and health care providers. Healthcare providers are faced with ethical dilemmas when caring for terminally ill patients. They are forced to make tough decisions by using their moral reasoning to overcome some of the ethical dilemmas related to euthanasia.

Euthanasia is viewed as murder, however, ethically; physician has the moral obligation to comply with patients’ decisions. Making such decision to either withhold or withdraw treatment for any patient is not an easy decision to make based on the cultural, religious and legal factors.  Death resulting to euthanasia is different between countries. Patients who experience extreme pain due to the nature of their illness are permitted to die with dignity in several countries while other countries totally condemn the use of euthanasia. Therefore, such individuals are among the few cases that continue to convince stakeholders to legalize euthanasia.

From a religious perspective; religious leaders see euthanasia to be unnecessary because for them, pain and suffering are not only a medical problem it is more than physical pain.  Pain and suffering are as a result of several factors; these include psychosocial, cultural and spiritual. Such views have changed the perspective of the debate about euthanasia.  The other aspect of euthanasia that has been ignored. It is a fact that the doctor has an obligation to fulfill patient’s request.

By not legalizing euthanasia is viewed as violating patient rights as the doctor refuses to help patients die. Even though many people are against euthanasia because it is viewed as murder, those who advocate for its usage view euthanasia from a different perspective. For them, the issue of cost and violation of human rights are the two most important arguments presented during euthanasia debates.  Even though those who support Euthanasia argue that it helps patients die with and help in containing the overall cost of treatment, others view Euthanasia as an immoral act. Other people view euthanasia as patient’s choice, not a physician; therefore, killing patients even when physicians have signed the code of ethics, is in line with the healthcare standards because the patient has the final say. The physician does not violate human rights.

I believe that there are valid reasons for patients to consider euthanasia because it saves both the patient and their family members from many financial burdens associated with terminal diseases. Euthanasia is the choice, and an alternative for patients who suffer immensely and their decision should be respected to help them alleviate suffering.  In many countries where euthanasia is permitted health care cost have been significantly contained. Patients with chronic illnesses do not have much choice but to die peacefully and with dignity.  Terminally ill patients are permitted to request from euthanasia to stop suffering.

Euthanasia remains one of the hot topics among many interest groups; some people believe that it is the only humane way to end suffering. Christians believe that humans have to undergo suffering because it’s part of God’s plan. In this debate considering the political, religious, legal and personal views all these people want to justify their reasons as to why euthanasia should be legalized or not. Euthanasia remains a debatable subject because of the varied views that might be valid to a certain point.

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COMMENTS

  1. We have a right to die with dignity. The medical profession has a duty

    The most compelling argument in favour of physician assisted suicide or voluntary active euthanasia is the argument in support of committing suicide in a democracy. The right to commit suicide is ...

  2. Voluntary Euthanasia

    The entry sets out five conditions often said to be necessary for anyone to be a candidate for legalized voluntary euthanasia (and, with appropriate qualifications, physician-assisted suicide), outlines the moral case advanced by those in favor of legalizing voluntary euthanasia, and discusses the five most important objections made by those who deny that voluntary euthanasia is morally ...

  3. Top 10 Pro & Con Arguments

    1. Legalization. "The right to die should be a matter of personal choice. We are able to choose all kinds of things in life from who we marry to what kind of work we do and I think when one comes to the end of one's life, whether you have a terminal illness or whether you're elderly, you should have a choice about what happens to you….

  4. Focus: Death: Pros and Cons of Physician Aid in Dying

    This essay's authors hold varying views on the ethics of aid in dying; thus, the essay explores the subject without taking a position. ... which includes both "voluntary euthanasia" and "medically-assisted suicide . ... argument is that AID is a safe medical practice, requiring a health care professional. Respect for Patient Autonomy.

  5. Euthanasia and assisted dying: what is the current position and what

    Definition and current legal framework. Assisted dying is a general term that incorporates both physician-assisted dying and voluntary active euthanasia.Voluntary active euthanasia includes a physician (or third person) intentionally ending a person's life normally through the administration of drugs, at that person's voluntary and competent request. 2, 3 Facilitating a person's death ...

  6. Legal And Ethical Issues Of Euthanasia: Argumentative Essay

    Abstract. Euthanasia is one of the issues that has been the subject of intense debate over time. It has been a pertinent issue in human rights discourse as it also affects ethical and legal issues ...

  7. A legal right to die: responding to slippery slope and abuse arguments

    The second argument invoked by opponents of a legal right to die is the argument that such a right will be abused and that no legal safeguards can prevent that abuse. Thus, for example, it has been said that where written voluntary consent to euthanasia is a legal requirement, that consent has not always been obtained.

  8. BBC

    because life and death are God's business with which we shouldn't interfere. because most people don't want to die. because it violates our autonomy in a drastic way. The first two reasons form ...

  9. Euthanasia and assisted dying: the illusion of autonomy—an essay by Ole

    As a medical doctor I have, with some worry, followed the assisted dying debate that regularly hits headlines in many parts of the world. The main arguments for legalisation are respecting self-determination and alleviating suffering. Since those arguments appear self-evident, my book Euthanasia and the Ethics of a Doctor's Decisions—An Argument Against Assisted Dying 1 aimed to contribute ...

  10. How To Write A Vivid Euthanasia Argumentative Essay?

    Euthanasia argumentative essay: the basics. The topics for an argumentative essay writing are usually two-sided: voting for or against the topic, agree or disagree with the statement, choose one option or another. Writing any argumentative assay requires highlighting both possible points of view, no matter what is your own. Remember, you should ...

  11. Arguments In Support Of Voluntary Euthanasia Argumentative Essay

    Voluntary euthanasia involves termination of a patient's life at the patient's instructions to the person other than the patient. It thus involves the termination of a terminally ill person, and is seen as merciful killing. Involuntary euthanasia involves termination of a patient life without the consent of the patient.

  12. Why Euthanasia Should Be Legal: Analysis of Arguments and

    Why Euthanasia Should Be Legal: Analysing the Most Controversial Debate Essay. Voluntary euthanasia is the the deliberate practice of ending a suffering individual's life, in turn releasing them from pointless pain. More and more countries have begun to adopt the legalization of voluntary euthanasia.

  13. Arguments in Favor of Euthanasia

    This is referred to as euthanasia. It is the act of deliberately terminating life when it is deemed to be the only way that a person can get out of their suffering (Johnstone 247). Euthanasia is commonly performed on patients who are experiencing severe pain due to terminal illness.

  14. Argumentative Essay Against Euthanasia

    Argument: Euthanasia or mercy killing is a moral act done out of duty to those in suffering or an act for self-benefit under cover of morality or is it opening door to many illegal issues in the society. Euthanasia should never be legalized in any of its forms else it will be practiced in all cases even where consent of a patient is not taken ...

  15. Euthanasia: Right to life vs right to die

    The word euthanasia, originated in Greece means a good death 1.Euthanasia encompasses various dimensions, from active (introducing something to cause death) to passive (withholding treatment or supportive measures); voluntary (consent) to involuntary (consent from guardian) and physician assisted (where physician's prescribe the medicine and patient or the third party administers the ...

  16. Argumentative Essay On Euthanasia

    Argumentative Essay On Euthanasia. Good Essays. 1764 Words; ... Euthanasia can be categorized in three different ways; voluntary euthanasia, non-voluntary euthanasia, and involuntary euthanasia. Voluntary euthanasia is when a patient agrees to receive assistance to end his or her own life, which is legal in some places around the globe. ...

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    3. Evolution of euthanasia and assisted suicide: digging into historical events. To understand the evolution and relevance of these concepts should analyze the history of euthanasia and assisted suicide; from the emergence of the term, going through its first manifestations in antiquity; mentioning the conceptions of great thinkers such as Plato and Hippocrates; going through the role of the ...

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