Clarifying the terms
Euthanasia is the intentional killing by act or omission of a dependent human being for his or her alleged benefit.
Active euthanasia is euthanasia by performing an action, such as administering a lethal injection; passive euthanasia (euthanasia by omission) is euthanasia by not providing necessary and ordinary (usual and customary) care or food and water.
Euthanasia can be voluntary, involuntary (against the expressed wishes of the patient), or non-voluntary (when the person who is killed makes no request and gives no consent, such as in cases when the patient is incompetent and unable to express his or her wishes). Virtually everyone opposes involuntary euthanasia as a form of murder; voluntary and non-voluntary euthanasia, however, are far more controversial.
Assisted suicide is when someone provides an individual with the information, guidance, and means to take his or her own life with the intention that they will be used for this purpose. Physician-assisted suicide is when a doctor is the one who assists, such as by prescribing a lethal dose of medication.
The difference between euthanasia and assisted suicide is which person performs the final act that kills the patient. If a doctor performs the final act (e.g., an injection), it is euthanasia; if the patient performs the final act himself (e.g., ingesting pills), it is assisted suicide.
Euthanasia and assisted suicide are unethical because they are the intentional killing of an innocent human being. But this does not mean that a patient’s life must be sustained by all means in all circumstances. Allowing a natural death—e.g., by withholding or withdrawing burdensome treatment from a terminally ill patient—is not the same as intentional killing. The termination of life support is not the same as euthanasia or assisted suicide.
Euthanasia, assisted suicide in practice
Euthanasia can take different forms. Here are the ways in which it is practiced today.
Assisted suicide: Assisted suicide is currently legal in a number of American states. It is also legal in the countries of Belgium, the Netherlands, Switzerland, Luxembourg, and (more recently) Canada. Oregon’s Death with Dignity Act has now been in place since 1997 and has served as the model for other states. Under the law, a patient may request a lethal prescription from a physician as long as the patient is considered competent and has been diagnosed with a terminal condition and less than six months to live. But the law’s safeguards are substantially lacking.
Active euthanasia: Active euthanasia is currently legal in the Netherlands, Belgium, Luxembourg, and Canada. Thousands of euthanasia deaths occur in the Netherlands and Belgium each year. Dutch law requires, before active euthanasia (or assisted suicide) can be performed, that a patient make a “voluntary and carefully considered” request for death, and that the patient be experiencing “unbearable suffering with no prospect of improvement.” But these guidelines have proven very flexible.
The justifications for euthanasia in Europe have broadened significantly. The Netherlands and Belgium euthanize many people who are suffering “psychologically” (rather than physically), including some patients who are depressed, mentally ill, or even “tired of life.” In both countries, voluntary euthanasia has led to the non-voluntary euthanasia of (usually) mentally incompetent patients. Dutch national surveys indicate that each year hundreds of people are euthanized without their explicit request.
Involuntary denial of care by providers: Many ethicists and physicians argue that health care facilities should be able to deny lifesaving treatment, nutrition, and hydration due to patients’ perceived inadequate "quality of life"—even against the express will of patients and their families. Most states (excluding Minnesota) may allow doctors and hospitals to disregard advance directives when they call for treatment, food, or fluids. Some health care providers have created “futility guidelines” or “futility protocols” that determine when desired treatment should be withheld.
Denial of food and fluids: In most states, food and fluids—at least when provided with the assistance of tubes—are regarded as "medical treatment" rather than basic, ordinary care. Such nutrition is routinely denied to those unable to make decisions for themselves by others who act as surrogate decision makers. Frequently, therefore, people with severe cognitive disabilities who have never consented to the rejection of food and fluids are starved and dehydrated to death.
Rationing of health care: The rationing of health care can mean denying lifesaving treatment, food, and fluids against the will of the patient, based on degree of disability or perceived "quality of life." The threat of rationing has grown due to the increasing emphasis on providers containing health care costs and the passage in the United States of the Affordable Care Act (Obamacare) in 2010.
Euthanasia or suicide should never seem like the only option. Depressed and suffering patients should be treated. Lonely and isolated patients should be cared for. No one should ever feel that his or her life is worthless or meaningless—because every person matters. The answer to disease and disability is love and compassion, not killing.
Proposals to legalize assisted suicide continue to surface in states across the country, including Minnesota. These bills pose various dangers and must be rejected. Meanwhile, any person who becomes unable to speak for himself or herself due to illness or disability is in danger of being denied lifesaving medical treatment or nutrition and hydration.
A measure of protection is possible by preparing an advance directive. Advance directives are legal documents that allow people to specify their treatment wishes in the event that they become unable to make health care decisions for themselves. A pro-life advance directive, which expresses a preference for life and guards against euthanasia, is available.
Just as abortion takes vulnerable human life at its earliest stages, euthanasia and assisted suicide threaten elderly, sick, and disabled persons, often masked by euphemisms such as “aid in dying” and “death with dignity.”