Euthanasia is defined as a practice of intentionally ending one’s life to escape pain and suffering. Originating from the Greek language, the word means “a good death”.  The ancient Greeks believed that it was a matter of honour for a warrior to die a good death in battle against a worthy adversary. Euthanasia has long been a controversial, delicate and emotive topic, but it’s good to understand its definition. In this article I wish to shed light on some of its many grey areas.

Euthanasia or Assisted Suicide?

Although the terms are often used as synonyms, definitions of euthanasia and assisted suicide can vary. According to an article from Medical News Today, the main differences between the two are as follows:

• Euthanasia occurs when a doctor is allowed by law to end a person’s life using a painless method, on the condition that the patient and their family agree.

• Assisted suicide is when a doctor assists a patient to commit suicide if they request it in order to terminate persistent and unstoppable suffering. This is done by providing drugs for self-administration, at that person’s voluntary and competent request.

Voluntary versus Involuntary

Euthanasia can also be classed as voluntary or involuntary. It is voluntary if conducted with full consent. Voluntary euthanasia is currently legal in Belgium, Luxembourg, The Netherlands, Switzerland, and the states of Oregon and Washington in the U.S. It is involuntary if conducted without consent. The decision is made by another person, because the patient is unable to make the decision.

Passive versus Active

Technically speaking, passive euthanasia is when life-sustaining treatments are withheld. The definitions are somewhat ambiguous. If a doctor prescribes increasing doses of strong painkilling medications, such as opioids, this may ultimately be toxic for the patient. While some may argue this as being passive euthanasia, others might claim it isn’t, since there’s no intention to take one’s life.

Active euthanasia is when someone uses lethal substances, or intervenes to end a patient’s life, on request of the patient or someone else. Active euthanasia is more controversial, and more likely to involve religious, moral, ethical, and empathetic arguments.

Euthanasia throughout History

One of the strongest arguments against euthanasia is the Hippocratic Oath, which all doctors take, and an oath which dates back some 2,500 years. Originally, the oath stated the following: “I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.” Nowadays, there are variations of it. One states: “If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty.”

Of course, some feel that the original oath is outdated, because the world has changed since the time of Hippocrates. Many countries have an updated, modernised version, while in others, like Pakistan, doctors still abide by the original. As more treatments become available, for instance, the possibility of extending life, irrelevant of its quality, is an increasingly complex issue.

In places where euthanasia or assisted suicide are legal, they’re responsible for a total of between 0.3 and 4.6% of deaths, over 70% of which relate to cancer. In Oregon and Washington states, fewer than 1% of physicians write prescriptions that will assist suicide per year.

Consistent with a study carried out across six European countries by EURELD (European end-of-life decisions) between 2001-2002, 36% to 51% of all deaths were a direct result of medical end-of-life decisions (apart from Italy, where the figure was 22%). In virtually half of these cases, healthcare professionals decided to stop, limit or withhold treatment, whether or not the patient had explicitly asked. In the other half of cases, they decided to ease pain and symptoms by increasing medication to a level which may accelerate death.

Even in countries where euthanasia is legal, only a small percentage of all deaths (0.1% in Italy, and from 0.2% in Sweden to 3.4% in the Netherlands) occurred as a result of the administration of lethal drugs, whether voluntary or involuntary. Such end-of-life decisions are carried out in very different ways, which often fall outside the space of our current definition and understanding of euthanasia.

There is no doubt that euthanasia is as delicate a topic as it is complex. And it is because of this very complexity each case must be dealt with individually, whilst keeping the person’s wishes at the forefront of any decision made.