The entry sets out five individually necessary conditions for anyone to be a candidate for legalised voluntary euthanasia (or, in some usages, physician-assisted suicide), outlines the moral case advanced by those in favour

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Voluntary Euthanasia

The entry sets out five individually necessary conditions for anyone to be a candidate for legalised voluntary euthanasia (or, in some usages, physician-assisted suicide), outlines the moral case advanced by those in favour of legalising voluntary euthanasia, and discusses six of the more important objections made by those opposed to the legality of voluntary euthanasia.

* 1. Introduction

* 2. Five Individually Necessary Conditions for Candidacy for Voluntary Euthanasia

* 3. A Moral Case for Voluntary Euthanasia

* 4. Six Objections to the Moral Permissibility of Voluntary Euthanasia

* Bibliography

* Other Internet Resources

* Related Entries

. Introduction

When a person commits an act of euthanasia he brings about the death of another person because he believes the latter's present existence is so bad that she would be better off dead, or believes that unless he intervenes and ends her life, it will become so bad that she would be better off dead. The motive of the person who commits an act of euthanasia is to benefit the one whose death is brought about. (Though what was just said also holds for many instances of physician-assisted suicide, some wish to restrict the use of the latter term to forms of assistance which stop short of the physician 'bringing about the death' of the patient, such as those involving mechanical means which have to be activated by the patient.)

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. There shall be occasion to mention non-voluntary euthanasia -- instances of euthanasia where a person is either not competent to, or unable to, express a wish about euthanasia, and there is no one authorised to make a substituted judgment (wherein a proxy chooses as the no longer competent patient would have chosen had she remained competent) -- in the context of considering 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 honourable the perpetrator's motive, such a death is, and ought to be, unlawful.

Debate about the morality and legality of voluntary euthanasia is, for the most part, a phenomenon of the second half of the twentieth century. Certainly, the ancient Greeks and Romans did not consider life needed to be preserved at any cost and were, in consequence, tolerant of suicide in cases where no relief could be offered to the dying or, in the case of the Stoics and Epicureans, where 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 has been legally tolerated in Switzerland for many years). However, in the nineteen seventies and eighties a series of court cases in The Netherlands culminated in agreement being reached 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 instances where a competent patient had made a voluntary and informed decision to die, the patient's suffering was unbearable, there was no way of making that suffering bearable which was acceptable to the patient, and the physician's judgements as to diagnosis and prognosis were confirmed after consultation with another physician. In the nineteen nineties the first legislative approval for voluntary euthanasia was achieved with the passage of a bill in the parliament of Australia's Northern Territory to enable 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 (the Australian Capital Territory and the Northern Territory) from enacting legislation to permit euthanasia. In Oregon in the United States legislation was introduced in 1997 to permit physician-assisted suicide when a second referendum clearly 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 favour of physician-assisted suicide. The Oregon legislation has, in consequence, remained operative and has been successfully utilised by a number of people. In November 2000 The Netherlands passed legislation to legalise the practice of voluntary euthanasia. The legislation passed through all the parliamentary stages early in 2001 and so became law. The Belgian parliament passed similar legislation in May 2002.

With that brief sketch of the historical background in place, we now proceed to set out the conditions which those who have advocated making voluntary euthanasia legally permissible have wished to insist should be satisfied. The conditions are stated with some care so as to focus the moral debate about legislation. Second, we shall go on to outline the positive moral case underpinning the push to make voluntary euthanasia legally permissible. Third, we shall then consider the more important of the morally grounded objections which have been advanced by those opposed to the legalisation of voluntary euthanasia.

2. Five Individually Necessary Conditions for Candidacy for Voluntary Euthanasia

Advocates of voluntary euthanasia contend that if a person is

(a) suffering from a terminal illness;

(b) unlikely to benefit from the discovery of a cure for that illness during what remains of her life expectancy;

(c) as a direct result of the illness, either suffering intolerable pain, or only has available a life that is unacceptably burdensome (because the illness has to be treated in ways which lead to her being unacceptably dependent on others or on technological means of life support);

(d) has an enduring, voluntary and competent wish to die (or has, prior to losing the competence to do so, expressed a wish to die in the event that conditions (a)-(c) are satisfied); and

(e) unable without assistance to commit suicide,

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

It should be acknowledged that these conditions are quite restrictive, indeed more restrictive than some would think appropriate. In particular, the conditions concern access only to voluntary euthanasia for 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 the bringing about of the death of, say, victims of accidents who are rendered quadriplegic or victims of early Alzheimer's Disease. Those who consider that such cases show the first condition to be too restrictive may nonetheless accept that including them would, at least for the time being, make it far harder to obtain legal protection for helping those terminally ill persons who wish to die. The fifth condition further restricts access to voluntary euthanasia by excluding those capable of ending their own lives, and so will not only be thought unduly restrictive by those who think physician-assisted suicide a better course to follow, but will be considered morally much harder to justify by those who think health care practitioners may never justifiably kill their patients. More on this anon.

The second condition is intended simply to reflect the fact that we normally are able to say that someone's health status is incurable. So-called 'miracle' cures may be spoken of 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.
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The third condition recognises what many who oppose the legalisation of voluntary euthanasia do not, namely that it is not only release from pain that leads people to want to be helped to die. In The Netherlands, for example, it has been found to be a less significant reason for requesting assistance with dying than other forms of suffering and frustration with loss of independence. 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 be ...

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