The problem of euthanasia was formulated in ancient times. However, even then it caused much controversy among physicians, philosophers, and lawyers. The attitude towards the deliberate acceleration of death of a terminally ill person, even with the aim to end his or her suffering, has never been straightforward. However, the relevance and importance of this topic are difficult to overstate as it is associated with the most expensive thing every human possesses, i.e. the life. The following paper is aimed at addressing the issue of euthanasia in order to reveal its essence and classification as well as define if it should be legalized in our society. To achieve the abovementioned goal, the paper is going to provide precise analysis referring to the traditional ideas about euthanasia, examine the right to live and the right to die from a legal point of view, providing the understanding of the cases where euthanasia can be used, as well as identify the moral aspects, the pros and cons of euthanasia, analyzing the experience of the countries which officially authorized it.
The History and Classification of Euthanasia
For the first time, the term ‘euthanasia’ was used by Francis Bacon to refer to an easy death. Later ‘euthanasia’ implied the extermination of the so-called ‘inferior’ lives. This interpretation became widespread in Nazi Germany, where ill infants, mentally ill and the elderly people with disabilities were slaves. The Declaration on Euthanasia 1987 considers euthanasia as the act of intentional deprivation of life of the patient made at the request of the patient or at the application with the request.
In fact, euthanasia is an extremely contradictory issue in modern society. Depending on its definition, some changes in approach to this issue can be seen. Euthanasia can be divided into active and passive, voluntary and involuntary. Each of the abovementioned types is explained below. Passive euthanasia refers to the termination of the life-prolonging medical treatment, which consequently accelerates the natural death.
Active euthanasia implies the provision of drugs or any other means to the patient as well as other actions which entail quick and painless death. In fact, active euthanasia may occur in the following forms:
- the form of the so-called ‘mercy killing’. It occurs when the medical personnel cannot provide any help or treatment to facilitate the sufferings of the hopelessly sick person so that the patient is provided with an overdose of painkillers, which leads to his or her death;
- the form of the so-called ‘suicide euthanasia’. It occurs when the doctor helps a terminally ill person to commit suicide. However, active euthanasia can occur without the aid of a doctor as patients may use the specific device themselves.
Voluntary euthanasia can be carried out by an unequivocal request of the patient or his previously expressed consent provided in a legally valid form to express their will in case of irreversible coma etc. Involuntary euthanasia is carried out without the direct consent of the patient. Based on the abovementioned classification as well as the combination of the possible forms, four variations of euthanasia can be defined: voluntary and active, voluntary and passive, involuntary and active and involuntary and passive euthanasia.
The main feature of euthanasia concept implies the behavior in the form of proactive and passive action. Moreover, this activity should be performed by a specially trained person, i.e. health worker, paramedic, nurse, etc. Another characteristic feature of euthanasia is that these activities are performed by medical workers consciously, that is, in a state in which he could understand the significance of their actions, i.e. the intellectual aspect and the will aspect. Moreover, this activity must be committed deliberately, that is, health care workers should make it consciously and foresee its consequences. The abovementioned facts are precisely the main features that characterize euthanasia as an activity of a certain type.
International Experience of Euthanasia Legalization
In modern history, the problem of euthanasia and voluntary withdrawal from the life of terminally ill people has been widely discussed since the late 1950s of the 20th century. Nevertheless, the conditions for its implementation are well developed and tested in a number of countries where euthanasia is legal.
The Netherlands became the pioneer in the field of voluntary death legalization. In 1993 a special list of 12 mandatory points was issued, which was the basis for the law on euthanasia. The Netherlands became the first country in the world which legalized the right to active euthanasia for the terminally ill patients. According to the law, euthanasia can be applied to the patients who are at least 12 years old. It can be carried out only at the request of the patient if it has been proved that his suffering is unbearable and the disease is incurable so that doctors and medical treatment cannot help. However, even after the conduction of all the abovementioned procedures, the re-consent of the patient is obligatory to provide euthanasia into action.
Euthanasia was legalized in Belgium in 2002. According to the law, euthanasia can be implemented to people older than 18 years, suffering from an incurable disease. Since April 2005, Belgian pharmacies provided special kits to simplify the procedure for the voluntary withdrawal from life. The kit cost about 60 Euros. It included a disposable syringe with poison and other necessary tools for the injection. Nowadays, there is an increase in the incidence of euthanasia in Belgium. In 2014, there were more than 400 cases of ‘mercy killing’ euthanasia.
The so-called ‘assisted suicide to another person’ is allowed in the US state of Oregon. It implies the procedure when a doctor prescribes the patient deadly pills. In the other two regions of the US, according to the decisions of the Second Circuit (New York), and the Ninth Circuit (California, Oregon) courts appeal, the physicians may prescribe the patients the death-causing drugs but are not allowed to practice euthanasia.
In California, after years of discussion and votes on referendums, in 1977 the Law ‘On the right of a man to death’ was adopted; according to it, terminally ill people can apply for a document expressing their desire to disable resuscitative equipment. However, until now no one could use this law as one of the official conditions to provide euthanasia requires the psychiatric approval of the patient’s sanity, while the American Psychiatric Association, in turn, does not allow its members to participate in such procedures.
The attempts to legalize euthanasia have also been undertaken in Australia. In August 2002, the supporters of euthanasia handed out free special ‘suicide kits’, which included a plastic bag with a rubber band for a snug fit to the neck and sleeping pills. As a result, the death would not be caused by suffocation, but by the lack of oxygen. To avoid problems with the authorities, 150 copies of the kits were produced and distributed without any instructions.
In Colombia, euthanasia has been practiced for a relatively long time. In 1997, the Constitutional Court confirmed that the doctor, who fulfilled the desire of the terminally ill patient to have voluntary death, does not bear any responsibility before a court.
In 2004, passive euthanasia was permitted in Israel and France. According to the survey, 85% of the French population supports the legalization of euthanasia in the country.
In Switzerland, euthanasia is banned. However, a person who does not have any benefit while helping others to escape from life, can not be convicted in any crime. In fact, it is estimated that every year this possibility is used by about 100 people, who say goodbye to their lives in Switzerland.
Despite the absence of the official law, euthanasia has already been practiced in the UK. In 2004, the media published the first evidence of death, which was caused by doctors. The Supreme Court of the United Kingdom granted the application of the 43-year-old woman for disabling the respirator which had been supporting her life for a year. This caused the court precedent allowing everyone to use a similar right.
The abovementioned information proves the softening of the attitudes towards the voluntary death of the patient in the legislation and legal practice. It can also be seen in the primarily categorical position of the Vatican, which has changed. In 2002, Pope John Paul II said that the use of medical equipment to save the lives of the patient in some cases may be ‘useless and disrespectful to the patients themselves’.
However, it should be noted that the international community still has no uniform attitude towards euthanasia. The United Nations Human Rights Committee experts express the concern that the law on euthanasia can lead to the occurrence of the legalized deaths which do not cause any emotion. The experts doubt about the ethical aspects of children’s euthanasia as well as the ability to put pressure on patients in order to circumvent the restrictions stipulated by the law. In addition, the experts fear that the legalization of euthanasia in a particular country may give rise to the appearance of a special type of tourism among people who want to commit suicide. Such concerns have arisen after an Italian citizen was suspected of trying to help the terminally ill to go to Holland to have euthanasia.
Moral, Ethical, Religious and Legal Aspects of Euthanasia
The current understanding of the euthanasia phenomenon includes a set of interrelated aspects, among which the most distinguished are biological and medical as well as ethical, legal and religious aspects.
The biological and medical aspect of the issue lies primarily in the establishment of categories of patients, in relation to which the possibility of euthanasia can be considered. The patients whose biological death is imminent and the patients, who are dying, experiencing severe physical suffering can be listed among them. Another category of patients includes those who are in a persistent vegetative state. In this case, the medical side of the issue is the problem of determining the severity of the disease, its incurableness as well as the achievement of this stage in the treatment process, when all possible medical means have been exhausted, establishing an irreversible persistent vegetative state.
The legal challenge is the need to develop legal procedures for the implementation of euthanasia if this procedure is going to be permitted by law.
The religious aspect has the substantial importance for believers as most of the religions support the following idea: no matter how difficult the life is, it is given by God so no one has the right to artificially discontinue it. The main religious doctrines such as Christianity, Islam and Buddhism refer to euthanasia as negative, perceiving phenomenon viewing it as a kind of murder or suicide, which is also one of the main constraints to the legalization of euthanasia.
The Pros and Cons of Euthanasia
The issue of euthanasia has been discussed for many years and causes a lot of opposing views, experiences and theories. For more than 2,000 years, euthanasia had been considered the prohibited practice of medicine. Today euthanasia is permitted under certain circumstances in the Netherlands, Belgium, Luxembourg, Switzerland and some US states. However, many countries are discussing their legalization.
The supporters of euthanasia argue that a civilized society should allow the following actions:
- to allow people to leave life with dignity and without pain;
- to allow other people to help to leave life to those who are terminally ill and can not do it themselves.
The supporters of euthanasia insist that death is a personal matter in case no one is harmed. They claim that people themselves are the masters of their bodies so that they have the right to decide what to do with the body in case of a terminal illness. Therefore, to prolong the life of the person who is suffering from pain is considered to be the infringement of the rights and freedoms when the person is forced to be treated and continue to live, in spite of bad pain and suffering. The supporters of euthanasia argue that if suicide is not a crime, why should euthanasia be considered the one? Euthanasia supporters claim that society is moving forward, changing attitudes towards the obsolete opinions and theories, requiring the new approach to the Hippocratic oath; as the doctor who saves a person from suffering cannot be considered a murderer, then the doctor who continues to give the drugs to the terminally ill patients, cannot be considered humane.
However, euthanasia opponents provide a lot of arguments against its legalization. The most popular arguments against euthanasia imply the following:
- The Hippocratic oath. It means that medical ethics rules out the possibility of the procedure of euthanasia because there is a prohibition in the Hippocratic oath.
- Religion is against euthanasia. Believers say that life is given to man by God, and only God has the right to decide when there is time for a person to die.
- Euthanasia may affect those who do not want to die. The opponents of euthanasia say that the legalization of euthanasia can cause the death of innocent and unwilling people. For example, demented or disabled.
- he lost value and sacredness of life. Euthanasia weakens public respect for the sacred right to life. Through the legalization of euthanasia, society automatically accepts the assertion that some lives (those of disabled or mentally ill) are less valuable than the lives of others.
- No warranties. It means that gradual legalization of murders of so-called ‘uncomfortable or inconvenient’ people as possible. In addition, the law on the legalization of euthanasia does not guarantee the absence of the possibility of contesting it, and as a result, the criminal liability of the doctor since the distinction between euthanasia and murder is very slight and nominal. The absence of the doctor’s fault depends on strict adherence of the physician to the legalized procedure of the transaction.
The legalization of euthanasia can be used by criminal structures. For example, homeless, lonely or just simply ill people can be used as living material to carry out experiments or to provide the forced organ donation. It may sound scary, but a fatal diagnosis can be given to anyone if their kidney, liver, heart or any other organ can be used on the black market. Such criminal system can be established and well developed in case of euthanasia legalization.
- The drugs are not needed. If euthanasia is allowed everywhere, there will be no need for the invention of new drugs to treat incurable diseases.
- The possibility of a medical mistake. It means that it is always possible that even a patient suffering from a fatal illness will recover.
Nowadays, the term ‘euthanasia’ is polysemantic, which harmoniously combines medical, biological, religious, legal, moral, ethical and other aspects. The increased interest in euthanasia has been observed in recent years due to the progress of medicine in the field of critical care and transplantation as well as the development of new techniques of life support, enabling a long time to fight for the life of the patient. There is another significant factor that implies the change of values and moral priorities of modern civilization, the center of which is the idea of human rights, including the right to life, based on the provision of freedom to make choice.
Nowadays, the philosophy of inviolability of human rights and fundamental freedoms, as well as inviolability of life dominates practically all European countries. However, after analyzing modern philosophical views on the relation of life and death, expressed in contemporary literature, it is possible to conclude that the final single and uniform position on euthanasia has not been formed yet, thus the problem of euthanasia has not been solved.
The abovementioned facts state that today euthanasia in any of its manifestations and forms cannot be considered the sufficient legal basis for the deprivation of human life and the appropriate termination of the right to life. This is primarily due to the dominant ethical, medical philosophical, religious, legal and other ideological positions on this problem. Contrary to the existing negative perception of euthanasia, there is a trend towards legalizing passive euthanasia in certain legal orders of developed countries. Considering this factor, it should be noted that the decision to legalize euthanasia should be preceded by a fundamental public debate with the widest possible involvement of lawyers, representatives of medicine, bioethics, philosophy, sociology, religious studies, and other sciences. The focus of the discussion should be on the inadmissibility of abuse.
However, the position expressed in the recommendations of the Council of Europe Parliamentary Assembly is more solid. It claims that the development of the legalization of euthanasia and palliative care as well as the elimination of pain and comprehensive support of the patients, their families and others who take care of the fatally ill and dying people should become the priority.
While analyzing all aspects of euthanasia, the only correct conclusion is that it will result in the emergence of even more contradictions and differences in the legislation. Therefore, it is inappropriate to legalize completely unacceptable from the moral and legal point of view phenomenon which is contrary to the social foundations of any democratic society as well as the social and legal state.
