Euthanasia is ending a life before its natural end, motivated by a concern for the welfare of the killed person. It is this motivation that distinguishes euthanasia from simple homicide or suicide and it is sometimes called ‘‘mercy killing’’ for this reason.
In cases of voluntary euthanasia, the persons killed made requests for their lives to be ended prematurely, often in cases of terminal illness. In cases of involuntary euthanasia, the persons killed expressed no such desire, and may have even expressed an opinion to the contrary. This may seem incongruous with the idea of euthanasia being motivated out of a concern for the welfare of the person, but in such cases the persons may be considered incapable of fully understanding their own best interests. The most extreme examples of involuntary euthanasia occurred in Nazi Germany when thousands of disabled people were killed by the state, although these killings were also motivated by the prevailing theory of eugenics.
Ancient civilizations differed in their approaches towards people choosing to end their own life; some viewed it as taboo, others saw ending one’s life to retain dignity as laudable. The Western tradition was most heavily influenced by Judeo-Christian views that suicide was against God’s will, and these views were incorporated into laws. The American colonies followed the English tradition of viewing suicide as a crime, a position that continued until changes in the latter part of the twentieth century to encourage attempted suicides to seek medical attention.
For many theorists the right to privacy places some aspects of life beyond state regulation. These claims of privacy are most compelling when they concern intimate aspects of one’s life and the control of one’s own body (Griswold v. Connecticut  and Roe v. Wade ). Some extend this reasoning and argue that individuals should be able to decide when they want to end their lives by doing harm to that body; they argue that there is a right to die. Under this theory, laws preventing one from ending one’s own life are unwarranted intrusions into a person’s autonomy.
Those seeking their own death may want assistance, either because their medical condition renders them incapable of taking their own life, or because they want to make sure that any attempt is both successful and as painless as possible. Medical professionals are uniquely placed in that they have both extensive contact with seriously ill people and the ability to hasten their death through refraining from treating them, or administering drugs to ensure a painless death. However, requests to assist a patient seeking death conflict with the Hippocratic oath sworn by all doctors to ‘‘neither prescribe nor administer a lethal dose of medicine to any patient even if asked nor counsel any such thing.’’
Active euthanasia entails an intervention to bring about the death of the subject, frequently a lethal dose of medication; a doctor who assists in this violates the Hippocratic oath and such conduct is illegal in the United States. The 1980s and 1990s saw a determined effort by some states, particularly in the West, to make euthanasia easier, and in 1994 Oregon legalized physician-assisted suicide by referendum. However, due to court challenges it was not implemented until after a second referendum in 1997. The highest-profile euthanasia advocate was Dr. Jack Kevorkian, who assisted in many deaths and was later imprisoned in 1999. The U.S. Supreme Court ruled that the Due Process Clause of the Fourteenth Amendment does not confer a right to physicianassisted suicide (Washington v. Glucksberg ).
Internationally, there are only a few countries that explicitly permit physician-assisted suicide. Switzerland legalized euthanasia in 1947, but it was the legalization of physician-assisted suicide in the Netherlands (2000) and Belgium (2002) that reignited the international debate on euthanasia.
Passive euthanasia entails failing to take action that would otherwise save the life of the subject. There is considerable debate as to what falls within the scope of the passive category from complying with a ‘‘do not resuscitate’’ order, not providing life-saving medication, or even withholding food and water. It is considered to be legally, medically, and ethically sound to refrain from life-giving treatment if the patient so desires. In the United States, a person can refuse medical treatment, and actions that violate this constitute an assault, forming the legal and ethical justification for allowing passive euthanasia. The Supreme Court has ruled that the Due Process Clause does not extend this right to relatives of a patient incapable of making his or her wishes known (Cruzan v. Missouri ). This has contributed to the rise of so called ‘‘living wills,’’ documents drawn up in advance specifying under what conditions medical treatment should be withheld.
The active/passive distinction in euthanasia is considered to be extremely important from the standpoint of the Supreme Court and medical ethicists, although others maintain that this is a false distinction and that both are morally equivalent actions taken with the understanding that a hastened death will be the result. In addition, many question allowing someone to choose a potentially slow and painful death through refusing medical treatment, but denying them the chance to die quickly and relatively painlessly with medical assistance. The consequences of this distinction are felt most by people who, because of their condition, are incapable of quickly ending their own life, although the Supreme Court refused an Equal Protection Clause challenge to this distinction in Vacco v. Quill (1997).
Euthanasia is an extremely controversial topic in an aging society with the medical capacity to prolong life to an extent far greater than previously possible. Advocates cite the importance of allowing people to die with dignity, rather than to live on in pain, and to allow them to make their own decisions to end their own lives as peacefully and painlessly as possible. Those opposed to euthanasia are concerned that this would lead to the deaths of those who do not want to die, either through social pressure to cease being a burden on their families and request euthanasia, or the well-meaning but misguided carrying out involuntary euthanasia. As medical technology advances, the importance of this issue will increase, although the chances of resolution seem remote.
GAVIN J. REDDICK
References and Further Reading
Cases and Statutes Cited
See also Ballot Initiatives; Kevorkian, Jack; Oregon’s Death with Dignity Act (1994); Penumbras; Privacy; Privacy, Theories of; Reproductive Freedom; Substantive Due Process; Theories of Civil Liberties