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The applied ethical issue of euthanasia, or mercy

killing, concerns whetherit is morally permissible for a third party, such as a physician, to end
the life of a terminally ill patient who is in intense pain.

The euthanasia controversy is part of a larger issue concerning the right
to die. Staunch defenders of personal liberty argue that all of us are
morally entitled to end our lives when we see fit. Thus, according to these
people, suicide is in principle morally permissible. For health care
workers, the issue of the right to die is most prominent when a patient in
their care (1) is terminally ill, (2) is in intense pain, and (3)
voluntarily chooses to end his life to escape prolonged suffering. In these
cases, there are several theoretical options open to the health care
worker. First, the worker can ignore the patient’s request and care can
continue as usual. Second, the worker can discontinue providing life-
sustaining treatment to the patient, and thus allow him to die more
quickly. This option is called passive euthanasia since it brings on death
through nonintervention. Third, the health care worker can provide the
patient with the means of taking his own life, such as a lethal dose of a
drug. This practice is called assisted suicide, since it is the patient,
and not technically the health care worker, who administers the drug.

Finally, the health care worker can take active measures to end the
patient’s life, such as by directly administering a lethal dose of a drug.

This practice is called active euthanasia since the health care worker’s
action is the direct cause of the patient’s death. Active euthanasia is the
most controversial of the four options and is currently illegal in the
United States. However, several rights to die organizations are lobbying
for the laws against active euthanasia to change.

Two additional concepts are relevant to the discussion of euthanasia.

First, voluntary euthanasia refers to mercy killing that takes place with
the explicit and voluntary consent of the patient, either verbally or in a
written document such as a living will. Second, nonvoluntary euthanasia
refers to the mercy killing of a patient who is unconscious, comatose, or
otherwise unable to explicitly make his intentions known. In these cases it
is often family members who make the request. It is important not to
confuse nonvoluntary mercy killing with involuntary mercy killing. The
latter would be done against the wishes of the patient and would clearly
count as murder.

Like the moral issues surrounding suicide, the problem of euthanasia has a
long history of philosophical discussion. On the whole, ancient Greek
thinkers seem to have favored euthanasia, even though they opposed suicide.

An exception is Hippocrates (460-370 BCE), the ancient Greek physician, who
in his famous oath states that “I will not prescribe a deadly drug to
please someone, nor give advice that may cause his death.” The entire oath
is presented below, which places emphasis on the value of preserving life
and in putting the good of patients above the private interests of
physicians. These two aspects of the oath make it an important creed for
many heath care workers today. In medieval times, Christian, Jewish, and
Muslim philosophers opposed active euthanasia, although the Christian
Church has always accepted passive euthanasia.

During the Renaissance, English humanist Thomas More (1478-1535) defended
Euthanasia in book Utopia (1516). More describes in idealic terms the
function of hospitals. Hospital workers watch after patients with tender
care and do everything in their power to cure ills. However, when a patient
has a torturous and incurable illness, the patient has the option to die,
either through starvation or opium. In New Atlantis (1627), British
philosopher Francis Bacon (1561-1626) writes that physicians are “not only
to restore the health, but to mitigate pain and dolours; and not only when
such mitigation may conduce to recovery, but when it may serve to make a
fair and easy passage.”
Types of Euthanasia
Apart from the above classifications three types of euthanasia may be
identified, depending upon the sentience of the individual.

Voluntary euthanasia
This is the truest and fullest form of euthanasia wherein the individual
requests euthanasia – either during illness or before, if complete
incapacitation is expected (coma would be an example).

Non-Voluntary euthanasia
Where an individual lacks sentience (in a coma, for example) and hence
cannot decide, or distinguish, between life and death. Famously notable as
“turning off life-support”, it is often done when resusitation is not
expected, or after severe brain damage.

Involuntary euthanasia
Where an individual may distinguish between life and death – and may fully
realise the difference between them, but who death is imposed upon. If, for
example, a man is going to experience severe agony and does not consent to
death, euthanasia may be imposed upon him.

In Nazi Germany the term “euthanasia” (Euthanasie) referred to the
systematic killing of deformed children and mentally ill adults under the T-
4 Euthanasia Program. This has tainted the word in German-speaking
countries; the alternate term is “Sterbehilfe”, which means “help to die.”
Arguments for and against euthanasia
Proponents of euthanasia state that people should be allowed to decide that
they do not want to live any more, and that terminally ill patients are
respected more by having their suffering end than by being kept alive
against their will. Philosopher Peter Singer has been one of the most
outspoken proponents of euthanasia, arguing from a utilitarian
philosophical point of view.

Arguments from opponents of euthanasia can be divided in two main
categories: religious and prudential.

Many religious people, primarily Christians, object that it is not loving
to kill someone, and that pain medications are good enough that suffering
is preventable if doctors have the will. Many religions also regard one’s
life as from God and that either it is His (not yours), or throwing it away
insults Him.

The second type of argument against euthanasia is that it is not prudent to
advocate it; that eventually we all may be suffering, and if we think
ahead, we may think it better if the doctors on whom we depend are not
tempted to perform euthanasia. If euthanasia were to be allowed, it is
feared by some, doctors might press people into euthanasia to reduce
medical costs, or because their family wants them to die.

It should be noted that doctors routinely and legally provide medical
treatment to the terminally ill involving the use of large quantities of
pain-killing drugs, primarily to relieve the patient’s pain, but in doses
that may suppress bodily functions and thus shorten the life of the

However, as the goal of the treatment is the relief of suffering rather
than the shortening of life (even if that is a known consequence) doctors
who oppose euthanasia argue vigorously that such treatment is not

It should be noted that in about a quarter even of the medically supervised
euthanasias there are ‘complications’, like respiratory paralysis that make
the death anything but pleasant.

Legislation and national political movements
Euthanasia was legalised in Australia’s Northern Territory, by the Rights
of the Terminally Ill Act 1995. This law was soon however made ineffective
by the an amendment by the Commonwealth government to the Northern
Territory (Self-Government) Act 1978. (The powers of the Northern Territory
legislature, unlike those of the State legislatures, are not guaranteed by
the Australian Constitution.) Three people had already been legally
euthanasied, however, before the Commonwealth government made this

After an extensive discussion the Belgian parliament legalised euthanasia
in late September 2002. The new legislation, however, institutes a
complicated process, which has been criticized as an attempt to establish a
bureaucracy of death. Nevertheless, euthanasia is now legal and its
proponents in the country hope that it will stop many illegal practises (it
is said that several thousand illegal acts of euthanasia have been carried
out in Belgium each year).

The Netherlands
In The Netherlands the Reviewing Termination of Life on Request and
Assisted Suicide Act has taken effect from April 1, 2002. This legislation
has wide support among the liberal Dutch.

According to the new legislation, euthanasia and assistance with suicide
will continue to be criminal offences, except if all conditions are
fulfilled, and it is carried out by a physician who follows the correct

The law states that euthanasia is only allowed when the patient has asked
repeatedly, when the patient’s suffering is unbearable and desperate, and
when the doctor has prior to the act consulted a colleague. The doctor must
also report the cause of death to the municipal coroner in accordance with
the relevant provisions of the Burial and Cremation Act. A regional review
committee assesses whether a case of termination of life on request or
assisted suicide complies with the due care criteria. Depending on its
findings, the case will either be closed or brought to the attention of the
Public Prosecutor. Finally, the legislation offers an explicit recognition
of the validity of a written declaration of will of the patient regarding
euthanasia. Such declarations can be used when a patient is in coma or
otherwise unable to state whether they want euthanasia or not.

From the time that euthanasia first came to be widely practiced in the
Netherlands, it was formally subject to review by boards of doctors in each
hospital. The law as created basically made official what had already
become unofficial law by judgments in the courts.

The Netherlands has an excellent health care system and one of the world’s
highest expected life lengths. The right to euthanasia is supported by a
majority of the traditionally libertarian Dutch people.

United States
In the United States, the most common form of euthanasia is withholding
tube-feeding to elderly and incapacitated patients. This is generally
considered an abuse when the patient might recover. These patients die
protracted deaths by dehydration. However, it is so common in some areas
that the family must actively prevent it, or it will occur.

Contrary to the rest of the United States, Oregon residents have twice
voted for the legalization of assisted suicide. As of 2002, it is estimated
that nearly 100 terminally ill patients have committed doctor assisted
suicide since the law went into effect in 1997. It is difficult to
determine accurate figures, since doctors are not required by law to report
when they have granted the patient’s request. Oregon’s law has been
attacked by various organizations, and federal government parties that
support those organizations, ever since it was first enacted. (See Oregon
Ballot Measure 16 (1994), Oregon Ballot Measure 51 (1997).)
Euthanasia and the Law
A severely handicapped or terminally ill person should have the right to
choose to live or die. The right to live; the right to choose to live or
should not only be a right allocated for bodied individuals of sound mind
for all human beings. Euthanasia is a controversial issue which encompasses
morals, values and beliefs of our society.

Euthanasia, literally defined means “good death”. There are two types
of euthanasia, active and passive. Active euthanasia is the intentional
of a person by medical personnel either by a lethal injection or by denying
ordinary means of survival. The act of euthanasia called “passive
is committed by denying or withholding ordinary medical care to a patient.

Currently, under Canadian law euthanasia is prohibited. In Holland
euthanasia has been accepted, in principle for terminally- ill patients, on
request. It comes to be seen as practice for those whose “quality of life”
judged by themselves as worthless. Even though euthanasia is not yet legal
Holland, it is legally tolerated. Doctors are rarely prosecuted and even
rarely convicted. If euthanasia were to be decriminalized in Canada certain
restrictions would have to be put into place, to ensure that a patient’s
are not infringed upon. A living will should be made when the patient is of
lucid mind. Also, a council should be selected and outlined in the living

The council should be chosen by the patient, when the patient is of sound
and is able to make decisions. The council might consist of the patient’s
family, doctor or any other he or she feels have the same view or
perception of

Presently in Canada a living will is not a legally binding document. A
living will is a document prepared and sighed in advance of illness, in
which a
person may specify which treatment or care is to be withheld or withdrawn
him or her in certain situations. It is extremely general, trying to cover
wide range of accidents or illnesses and possible treatments. Living wills
created to protect the individual who is unable to participate in decisions
regarding their medical care. In Canada, even with a living will in many
any decisions on the removal of medical care must be passed through the
system. This system must be amended. The living will should be made a
binding document. In the United States, living wills have become legally
binding documents, in most states. The recognition of the living will as a
legally binding document is one of the first necessary step required in the
legalization of euthanasia ant the recognition of ones right to their own

Every person has the right to choose to live or die. This statement is
a reality for most individuals, but for many terminally ill or permanently
disabled patients this right cannot be exercised. Many patients lose
control of
the function of their arms and or legs and become completed dependent. The
question then becomes, “When does ones quality of life reach such a low
that life then becomes not worth living?”. A person, at any time, should be
able to make this decision. Under the existing law Canadians are not
this right, the right to their own life. An example of the absence of the
“right to die”, can be seen through the examination of a case from 1990. A
woman named Michelle Frenette wanted to be disconnected from the respirator
which was keeping her alive. Her doctors refused to disconnect her from the
respirator without a court order. Michelle’s family could not afford to go
court, and legal aid does not provide assistance in such cases. So,
lay there, for two years until her eventual death. She should have been
able to
end her life, without having to obtain a court order, when she felt that
quality of life had been reduced to such a level that it was no longer
living. In this particular case the law prevented and discriminated against
Michelle and her inherent right to freedom of choice.

When a person decides wheth…

Euthanasia In Canada
There is considerable debate today, both among the public
and the politicians, about euthanasia. While the government is
hesitatant to venture into morals and ethics, it appears that
euthanasia is gaining more press coverage, in light of the Sue
Rodriguez and Robert Latimer cases. Indeed, the issue is
difficult to resolve, and despite few advances, the government
has enacted penalties in the Criminal Code to punish assisted
suicide. Without reservation, euthanasia is illegal in Canada. An
increasing number of people are turning to doctor-assisted
suicide. As a result of a more liberal political arena, more
people are agreeing that some form of euthanasia must be
acceptable in specific circumstances. Politicians, and the
courts, claim that the country is not yet ready for such a
climate. The characterization of pro-euthanasia advocates by
their counterparts as selfish, taking the easy way out,
diserespectful of life, and challenging human dignity is
misconstrued. Pro-euthanasia groups advocate self-dignity,
personal choice, economic well-being, happiness, family support,
and individual rights.

The word euthanasia simply means good death, but has come to
mean causing death with intent, whether by doing something
(commission), or by omitting something(omission). Euphemisms of
the pro-euthanasia movement, include “right to die”, and “death
with dignity”. The term “passive euthanasia” is often applied to
the withdrawal of useless treatment that is onlyprolonging the
dying of a person. This needs to be differentiated from
withdrawing of something that is actually keeping them alive, the
withdrawl of which actually causes their death. It has been
pointed out that the pro-life lobby will be split and discredited
if there is an insistence by some that all technological means
must be used whenever possible to prolong life. No ethical doctor
insists on the use of burdensome, ineffective of futile measure,
commonly called ‘disproportionate’, when refused by the patient
or family. Doctors must necessarily in all patients discontinue
curative or therapeutic efforts at the time when death is
imminent and inevitable. Patients may request all measures to be
attempted if they desire but it cannot be demanded that life
always be prolonged as much as possible, without fuelling the
“right to die” movement.

Allowing death to occur when the patient specifically
refuses further therapy is to acknowledge the natural limit of
autonomy. This does not extend to refusal of basic care and does
not mean the withdrawal of comfort measures. In 1991, the BC
Royal Commission concluded that “the person who is dying should
have the right to determine the form and time of death…There is
a right to commit suicide, and a physician should be allowed to
assist a person who chooses to exercise that right.” The Right to
Die Society in Canada, based in Victoria,
“Affirms the right of any mature individual who is
chroniclally or terminally ill to choose the time, place, and
means of his or her death. Suicide and euthanasia are a
legitimate response to the declining quality of life which many
individuals experience as they growq older, or whicfh they
suffer as a result of accidents or congential disabilities.”
This society actively lobbies politically for active euthanasia,
and provides counselling to every member who wishes to know about
assistance-in-dying. Similarly, the Canadian Medical Association
has run a series of articles on euthanasia. Eike Kluge, the
former CMA ethicist, is outspokenly pro-euthanasia. A recent
article published as a discussion article stated, “What a strange
world we live in, that we are kinder to our animals than we are
to human beings.” His colleague, Ethics Committee Chairman, Dr.

Arthur Parsons, asked “Who is going to get into the lifeboat? Is
it better to keep a severely retarded person alive, or spend your
tight resources on bypass surgery for a father of four?” This
brings up two important issues, the first, that euthanasia is
still used for animals, despite being called “putting to sleep”,
and secondly, the issue of money and the costliness of keeping a
person alive. Research shows that the most expensive term of care
for a patient is the final six months prior to their deaths. The
financial burden for a seemingly hopeless case is unbearable, not
just for the family, but for the patient as well. The patient, in
their last few days, should not have to worry about being a
financial burden, but the truth is, healthcare is expensive. As
Dr. Parsons argued, it may be better to supply those crucial
healthcare dollars to the father of four who requires surgery
because the chances of success are phenomenally better than the
comatose or terminally ill patient.

Current euthanasia advocates have erealized that active
euthanasia is too difficult to push through Parliament. They have
elected to go through assisted suicide which opens the door to
active euthanasia. Svend Robinson has proposed Bill C385 which
would amend the Criminal Code to allow doctors to assist in the
suicide of a patient who is terminal and requests this. In 1972,
suicide was decriminalized in Canada, keeping with the
understanding that suicide is not a rational act and these people
need help, not incarceration if the suicide attempt was
unsuccessful. The BC Commission into health care costs stated
that suicide is a right and that physicians should be empowered
to assist patients who choose to exercise that right. As it
stands now, Section 241 of the Criminal Code states that it is
illegal to counsel or assist someone to commit suicide. Section
14 presently reads “no person is entitled to consent to have
death inflicted on him”. These laws exist to protect the
vulnerable, and people open to coercion. It also recognizes that
suicidee is not a rational act, being an act of desperation and
depression out of hopelessness and helplessness. Because
something is not illegal does not make it a right. In other
words, your right to suicide is my obligation to assist your
suicide. This obligation clearly does not exist as Justice Melvin
found in the Sue Rodriguez case.

Sue Rodriguez, a 42 year old woman who has Amyotrophic
Lateral Sclerosis, commonly known as Lou Gehrig’s disease,
appealed to the Supreme Court of Canada to strike down the
section of the Criminal Code that makes aiding suicide illegal. A
graphic article published in The Globe and Mail, September 1992,
written by John Hofsess, the director of the right to Die
Society, describes her plight with this progressively paralysing
disease as “condemned to die”. Her future is described as a
“helpless, drooling, physically atrophied captive of this
disease, dependent on other people and machines for an ever
attenuated form of mere biological exsistence”. Her lawyers
argued that Section 241 of the Criminal Code, which makes it an
offence to assist aqnyone to commit suicide, violates Section 7
of the Charter of Rights, which guaratntees liberty and security
of the person. The Justices stressed the significant difference
between palliative care nad physician-assisted suicide, saying
Rodriguez failed to show her right to fundamental justice is
infringed by the existing criminal law. University of Manitoba
law professor Barney Sneiderman says charges are rarely laid
because the Crown recognizes that juries generally sympathize
with doctors who end the agony of dying patients. Some doctors
fear that even providing a patient with the means to commit
suicide, for example, prescribing enough pills that might be
hoarded and used for an overdose, would constitute aiding or
abetting the action of euthanasia. But Sneiderman argues that the
courts would likely requrie prosectors to prove intent. A doctor
might suspect a patient was harding pills, but because the ipills
were not prescribed for thepurpose of aiding a suicide, the
doctor would probably have a good defence. For illustration,
Sneiderman says an Edmonton doctor was charged under Section 217,
saying a person has a legal duty to perform an act if not doing
it would endanger life, and Section 219, which defines criminal
negligence and includes both acts and omissions that wou
Justices Proudfoot and Hollinrake, both agreed with Justice
McEarchern, the sole dissenter, that the legality of physician-
assisted suicide is a matter for Parliament to decide.

Euthanasia, practice of mercifully ending a person’s life in order to
release the person from an incurable disease, intolerable suffering, or
undignified death. The word euthanasia derives from the Greek for “good
death” and originally referred to intentional mercy killing. When medical
advances made prolonging the lives of dying or comatose patients possible,
the term euthanasia was also applied to a lack of action to prevent death.

Active euthanasia involves painlessly putting individuals to death for
merciful reasons, as when a doctor administers a lethal dose of medication
to a patient. Passive euthanasia involves not doing something to prevent
death, as when doctors refrain from using an artificial respirator to keep
alive a terminally ill patient.

In voluntary euthanasia, a person asks to die (by either active or passive
euthanasia). Nonvoluntary euthanasia refers to ending the life of a person
who is not mentally competent to make an informed request to die, such as a
comatose patient.

Euthanasia differs from assisted suicide, in which a patient voluntarily
brings about his or her own death with the assistance of another person,
typically a physician. In this case, the act is a suicide (intentional self-
inflicted death), because the patient actually causes his or her own death.

Euthanasia has been accepted in some forms by various groups or societies
throughout history. In ancient Greece and Rome helping others die or
putting them to death was considered permissible in some situations. For
example, in the Greek city of Sparta newborns with severe birth defects
were put to death. Voluntary euthanasia for the elderly was an approved
custom in several ancient societies. However, as Christianity developed and
grew powerful in the West, euthanasia became morally and ethically
abhorrent and was viewed as a violation of God’s gift of life. Today most
branches of Christianity, Judaism, and Islam condemn active euthanasia,
although some permit restricted forms of passive euthanasia.

Following traditional religious principles, Western laws have generally
treated the act of assisting someone in dying as a form of punishable
homicide (unlawful killing). However, in modern times laws have become more
secular. Those who wish to legalize euthanasia have argued that, under
principles of individual liberty (such as those expressed in the
Constitution of the United States), individuals have a legal right to die
as they choose. Most countries (including the United States), however, have
not fully adopted this position and retain restrictions on euthanasia.

The first organizations to promote the legalization of voluntary euthanasia
in the United States and Great Britain formed in the 1930s. For several
decades these organizations remained small and had little impact. However,
in the late 1970s the pro-euthanasia movement gained significant momentum
after a highly publicized incident in the United States. In 1975 a 21-year-
old woman named Karen Ann Quinlan suffered a respiratory arrest that
resulted in severe and irreversible brain damage and left her in a coma.

Several months later, after doctors informed them that their daughter’s
recovery was extremely unlikely, Quinlan’s parents requested that
artificial means of life support be removed. The hospital refused this

After a lengthy legal battle, in 1976 the Quinlans obtained a court order
allowing them to remove the artificial respirator that was thought to be
keeping their daughter alive. The New Jersey Supreme Court ruled that the
Quinlans could disconnect the device so that the patient could “die with
dignity.” This decision spawned increased discussion of the scope of
patients’ rights to control their death. (Although the respirator was
removed in 1976, Quinlan began to breathe on her own. She lived until 1985
without ever regaining consciousness.)
In the early 1990s the decision of Nancy B. v. Hotel-Dieu de Quebec in
Canada played a similar role in promoting public awareness of the issues
surrounding euthanasia. In this case, a young woman paralyzed as a result
of the rare disease known as Guillain-Barr syndrome wished to have the
artificial breathing mechanism that kept her alive disconnected. Concluding
that such refusal of treatment was permissible, in January 1992 a Qubec
superior court judge authorized the woman’s physician to remove the

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As laws have evolved from their traditional religious underpinnings,
certain forms of euthanasia have been legally accepted. In general, laws
attempt to draw a line between passive euthanasia (generally associated
with allowing a person to die) and active euthanasia (generally associated
with killing a person). While laws commonly permit passive euthanasia,
active euthanasia is typically prohibited.

|A| |In the United States|
| | |and Canada |
Laws in the United States and Canada maintain the distinction between
passive and active euthanasia. While active euthanasia is prohibited,
courts in both countries have ruled that physicians should not be legally
punished if they withhold or withdraw a life-sustaining treatment at the
request of a patient or the patient’s authorized representative. These
decisions are based on increasing acceptance of the doctrine that patients
possess a right to refuse treatment.

Until the late 1970s, whether or not patients possessed a legal right of
refusal was highly disputed. One factor that may have contributed to
growing acceptance of this right is the ability to keep individuals alive
for long periods of time-even when they are permanently unconscious or
severely brain-damaged. Proponents of legalized euthanasia believe that
prolonging life through the use of modern technological advances, such as
respirators and kidney machines, may cause unwarranted suffering to the
patient and the family. As technology has advanced, the legal rights of the
patient to forgo such technological intervention have expanded.

Every U.S. state has adopted laws that authorize legally competent
individuals to make advanced directives, often referred to as living wills.

Such documents allow individuals to control some features of the time and
manner of their deaths. In particular, these directives empower and
instruct doctors to withhold life-support systems if the individuals become
terminally ill. Furthermore, the federal Patient Self-Determination Act,
which became effective in 1991, requires federally certified health-care
facilities to notify competent adult patients of their right to accept or
refuse medical treatment. The facilities must also inform such patients of
their rights under the applicable state law to formulate an advanced
directive. Patients in Canada have similar rights to refuse life-sustaining
treatments and formulate advanced directives.

Only one U.S. state, Oregon, has enacted a law allowing physicians to
actively assist patients who wish to end their lives. However, Oregon’s law
concerns assisted suicide rather than active euthanasia. It authorizes
physicians to prescribe lethal amounts of medication that patients then
administer themselves.

In response to modern medical technology, physicians and lawmakers are
slowly developing new professional and legal definitions of death.

Additionally, experts are formulating rules to implement these definitions
in clinical situations-for example, when procuring organs for
transplantation. The majority of states have accepted a definition of brain
death-the point when certain parts of the brain cease to function-as the
time when it is legal to turn off a patient’s life-support system, with
permission from the family.

|B| |In Other|
| | |Countries|
In 1995 the Northern Territory of Australia became the first jurisdiction
to explicitly legalize voluntary active euthanasia. However, the federal
parliament of Australia overturned the law in 1997. In 2001 The Netherlands
became the first country to legalize active euthanasia and assisted
suicide, formalizing medical practices that the government had tolerated
for years. Under the Dutch law, euthanasia is justified (not legally
punishable) if the physician follows strict guidelines. Justified
euthanasia occurs if (1) the patient makes a voluntary, informed, and
stable request; (2) the patient is suffering unbearably with no prospect of
improvement; (3) the physician consults with another physician, who in turn
concurs with the decision to help the patient die; and (4) the physician
performing the euthanasia procedure carefully reviews the patient’s
condition. Officials estimate that about 2 percent of all deaths in The
Netherlands each year occur as a result of euthanasia.

In 2002 the parliament of Belgium legalized active euthanasia under limited
conditions. Like the Dutch law, the Belgian law allows physicians to
perform euthanasia only for patients who are suffering unbearably with no
hope of improvement. The patient must make a voluntary, well-considered,
and repeated request to die, and the request must be put in writing. Other
physicians must be consulted to confirm the patient’s condition.

Additionally, each act of euthanasia must be reported to a government
commission for review.

|IV| |Prevalence |
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Although establishing the actual prevalence of active euthanasia is
difficult, studies suggest that the practice is not common in the United
States. In a study published in 1998 in the New England Journal of
Medicine, only about 6 percent of physicians surveyed reported that they
had helped a patient hasten his or her own death by administering a lethal
injection or prescribing a fatal dose of medication. (Eighteen percent of
the responding physicians indicated that they had received requests for
such assistance.) However, one-fifth of the physicians surveyed indicated
that they would be willing to assist patients if it were legal to do so. No
comparable data are available for Canada. However, in 1998 the Canadian
Medical Association (CMA) proposed that a study of euthanasia and physician-
assisted suicide be undertaken due to poor information on the subject.

|V| |Ethical |
| | |Concerns|
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The issue of euthanasia raises ethical questions for physicians and other
health-care providers. The ethical code of physicians in the United States
has long been based in part on the Hippocratic Oath, which requires
physicians to do no harm. However, medical ethics are refined over time as
definitions of harm change. Prior to the 1970s, the right of patients to
refuse life-sustaining treatment (passive euthanasia) was controversial. As
a result of various court cases, this right is nearly universally
acknowledged today, even among conservative bioethicists (see Medical

The controversy over active euthanasia remains intense, in part because of
opposition from religious groups and many members of the legal and medical
professions. Opponents of voluntary active euthanasia emphasize that health-
care providers have professional obligations that prohibit killing. These
opponents maintain that active euthanasia is inconsistent with the roles of
nursing, caregiving, and healing. Opponents also argue that permitting
physicians to engage in active euthanasia creates intolerable risks of
abuse and misuse of the power over life and death. They acknowledge that
particular instances of active euthanasia may sometimes be morally
justified. However, opponents argue that sanctioning the practice of
killing would, on balance, cause more harm than benefit.

Supporters of voluntary active euthanasia maintain that, in certain cases,
relief from suffering (rather than preserving life) should be the primary
objective of health-care providers. They argue that society is obligated to
acknowledge the rights of patients and to respect the decisions of those
who elect euthanasia. Supporters of active euthanasia contend that since
society has acknowledged a patient’s right to passive euthanasia (for
example, by legally recognizing refusal of life-sustaining treatment),
active euthanasia should similarly be permitted. When arguing on behalf of
legalizing active euthanasia, proponents emphasize circumstances in which a
condition has become overwhelmingly burdensome for a patient, pain
management for the patient is inadequate, and only a physician seems
capable of bringing relief. They also point out that almost any individual
freedom involves some risk of abuse and argue that such risks can be kept
to a minimum by using proper legal safeguards.