For many, the most divisive topic in modern day medicine is the issue of euthanasia, or “physician-assisted death”. Although it is a quintessential bioethics topic, there is not yet a universal definition for the term. Euthanasia is essentially the act of a physician or other third party ending a patient’s life in response to severe, persistent, and untreatable pain and suffering [4]. This subject is extremely complex and involves taking many factors into consideration. These include state and national laws, the physical and mental health of a patient, and the religious and personal beliefs of both the physician and patient [3]. Advocates of euthanasia argue that it is ethically valid for patients in permanent, unbearable pain to be able to choose whether or not they want to continue with life. On the other hand, many critics believe that under no circumstances should human life be ended early. With the amount of moral controversy surrounding the topic, it is no surprise that legislators in this country continue to argue about the legality of euthanasia.
The subject of euthanasia first entered the national spotlight in 1870, when Samuel Williams pushed for the legalization of a “quick and painless death” for those dealing with “cases of hopeless and painful illness” [7]. Soon after its conception, this bill was rejected by an overwhelming margin. This effectively ended the debate regarding euthanasia for at least the next few decades. Discussion regarding euthanasia reemerged during the 1970’s when California passed the “Natural Death Act” in 1976 [2]. This gave patients the right to create their own advance directives, which request and allow doctors to withhold or withdraw life sustaining treatments such as mechanical ventilation and cardiopulmonary resuscitation [7]. Today, all states have some form of this law.
In the late 1970’s, The New Jersey Supreme Court made a decision on the first right-to-die case [2]. The ruling gave the parents of Karen Ann Quinlan the right to remove her from a ventilator because she was in a persistent vegetative state [7]. Even nowadays, this case serves as a precedent for many similar scenarios. The World Federation of Right to Die Societies (WFRTDS) was established in 1980 to protect the right of individuals to choose how they wish to end their lives [2]. In 1990, US Congress enacted the “Patient Self-Determination Act”, which forces healthcare providers to comply and follow the advance directives of all patients [2]. Seven years later, the Supreme Court ruled that the Constitution does not guarantee the right to commit suicide with the help of a physician [7]. The issue of euthanasia was again brought to the attention of the general public in 2014, when the 29-year-old and chronically ill Brittany Maynard had to move from California to Oregon in order to guarantee that her “right to die” was protected by law [2].
When discussing euthanasia, it is important to first properly differentiate between the two kinds. “Passive” euthanasia is typically described as withholding or limiting life-sustaining treatments so that a patient is able to die more quickly [3]. Examples include switching off a life-support machine, disconnecting a feeding tube, choosing not to carry out a life-extending operation, and deciding not to prescribe a life-extending drug [1]. This form of euthanasia is considered legal across the United States, mainly due to the fact that it is not viewed as directly killing someone, but instead perceived as letting one die naturally on his or her own [6]. The second, and far more controversial, form of physician-assisted death is called “active” euthanasia. This occurs when a medical professional deliberately takes an action that causes a patient to die [1]. An example would be a physician purposely giving a patient a lethal dose of sedative [3]. In the United States, some form of “active” euthanasia is currently legal in only seven different states: Colorado, Hawaii, Oregon, Vermont, Washington, Montana, and the District of Columbia [5].
The discrepancy in the number of states that have legalized the “passive” versus “active” form of euthanization is likely due to the moral distinction that society makes between the two [1]. We tend to believe that it is acceptable to withhold treatment and allow a patient to die, but that it is never acceptable to kill a patient through a deliberate act. Many are in favor of this type of reasoning since it allows physicians to provide patients with the death that they want without having to deal with the moral problems of intentionally killing someone [1]. On the other hand, critics feel like this distinction is inaccurate since both choosing to let a patient die and taking an action to help a patient die are deliberate, conscious acts.
Differentiating between the two types of euthanasia ultimately depends on one’s personal, moral, and religious beliefs and preferences. Rather than one “right” answer, we must acknowledge that there are multiple valid solutions for how patients in the United States can choose to end their lives. This is a debate that does not appear to have a clear cut solution coming anytime soon. Although the final result of both forms of euthanasia is death, the process to getting there is where differing opinions lie. Regardless, while working towards creating a better solution to this issue, society must stay respectful of the views of various individuals and groups.
References:
1. “Ethics - Euthanasia: Active and Passive Euthanasia.” BBC, BBC.
2. “Euthanasia History.” American Life League.
3. Holland, Kimberly. “What Is Euthanasia? Types, Legal Status, Facts, Controversy, and Tips.” Healthline, Healthline Media.
4. Morrow, Angela. “What Is Euthanasia and Physician-Assisted Suicide?” Verywell Health, Verywellhealth.
5. “Physician-Assisted Suicide Fast Facts.” CNN, Cable News Network, 3 Jan. 2019,
6. Srivastava, Vinod. “Euthanasia: a Regional Perspective.” Annals of Neurosciences, vol. 21, no. 3, Jan. 2014, doi:10.5214/ans.0972.7531.210302.
7. “United States Law And History On Euthanasia.” Law Teacher, 2 Feb. 2018.