What is Euthanasia?

Euthanasia is the termination of a very sick person's life in order to relieve them of their suffering.

A person who undergoes euthanasia usually has an incurable condition. But there are other instances where
some people want their life to be ended.

In many cases, it is carried out at the person's request but there are times when they may be too ill and the
decision is made by relatives, medics or, in some instances, the courts.

The term is derived from the Greek word euthanatos which means easy death.

Euthanasia is against the law in the UK where it is illegal to help anyone kill themselves. Voluntary euthanasia
or assisted suicide can lead to imprisonment of up to 14 years.

The issue has been at the centre of very heated debates for many years and is surrounded by religious, ethical
and practical considerations.

The ethics of euthanasia

Euthanasia raises a number of agonising moral dilemmas:

 is it ever right to end the life of a terminally ill patient who is undergoing severe pain and suffering?

 under what circumstances can euthanasia be justifiable, if at all?

 is there a moral difference between killing someone and letting them die?
At the heart of these arguments are the different ideas that people have about the meaning and value of human
existence.

Should human beings have the right to decide on issues of life and death?

There are also a number of arguments based on practical issues.

Some people think that euthanasia shouldn't be allowed, even if it was morally right, because it could be abused
and used as a cover for murder.

Killing or letting die

Euthanasia can be carried out either by taking actions, including giving a lethal injection, or by not doing what
is necessary to keep a person alive (such as failing to keep their feeding tube going).

'Extraordinary' medical care

It is not euthanasia if a patient dies as a result of refusing extraordinary or burdensome medical treatment.

Euthanasia and pain relief

It's not euthanasia to give a drug in order to reduce pain, even though the drug causes the patient to die sooner.
This is because the doctor's intention was to relieve the pain, not to kill the patient. This argument is sometimes
known as the Doctrine of Double Effect.
 Mercy killing

Very often people call euthanasia 'mercy killing', perhaps thinking of it for someone who is terminally ill and
suffering prolonged, unbearable pain.

Why people want euthanasia

Most people think unbearable pain is the main reason people seek euthanasia, but some surveys in the USA and
the Netherlands showed that less than a third of requests for euthanasia were because of severe pain.

Terminally ill people can have their quality of life severely damaged by physical conditions such as
incontinence, nausea and vomiting, breathlessness, paralysis and difficulty in swallowing.

Psychological factors that cause people to think of euthanasia include depression, fearing loss of control or
dignity, feeling a burden, or dislike of being dependent.

Forms of euthanasia

Euthanasia comes in several different forms, each of which brings a different set of rights and wrongs.

Active and passive euthanasia

In active euthanasia a person directly and deliberately causes the patient's death. In passive euthanasia they don't
directly take the patient's life, they just allow them to die.

This is a morally unsatisfactory distinction, since even though a person doesn't 'actively kill' the patient, they are
aware that the result of their inaction will be the death of the patient.

Active euthanasia is when death is brought about by an act - for example when a person is killed by being given
an overdose of pain-killers.

Passive euthanasia is when death is brought about by an omission - i.e. when someone lets the person die. This
can be by withdrawing or withholding treatment:

 Withdrawing treatment: for example, switching off a machine that is keeping a person alive, so that they
die of their disease.

 Withholding treatment: for example, not carrying out surgery that will extend life for a short time.
Traditionally, passive euthanasia is thought of as less bad than active euthanasia. But some people think active
euthanasia is morally better.

Read more about the ethics of passive and active euthanasia

Voluntary and involuntary euthanasia

Voluntary euthanasia occurs at the request of the person who dies.

Non-voluntary euthanasia occurs when the person is unconscious or otherwise unable (for example, a very
young baby or a person of extremely low intelligence) to make a meaningful choice between living and dying,
and an appropriate person takes the decision on their behalf.
 Non-voluntary euthanasia also includes cases where the person is a child who is mentally and emotionally able
to take the decision, but is not regarded in law as old enough to take such a decision, so someone else must take
it on their behalf in the eyes of the law.

Involuntary euthanasia occurs when the person who dies chooses life and is killed anyway. This is usually called
murder, but it is possible to imagine cases where the killing would count as being for the benefit of the person
who dies.

Read more about the ethics of voluntary and involuntary euthanasia

Indirect euthanasia

This means providing treatment (usually to reduce pain) that has the side effect of speeding the patient's death.

Since the primary intention is not to kill, this is seen by some people (but not all) as morally acceptable.

A justification along these lines is formally called the doctrine of double effect.

Assisted suicide

This usually refers to cases where the person who is going to die needs help to kill themselves and asks for it. It
may be something as simple as getting drugs for the person and putting those drugs within their reach.

Overview of pro-euthanasia arguments

Arguments in favour of euthanasia can be broken down into a few main categories:

Arguments based on rights

 People have an explicit right to die

 A separate right to die is not necessary, because our other human rights imply the right to die

 Death is a private matter and if there is no harm to others, the state and other people have no right to
interfere (a libertarian argument)
Practical arguments

 It is possible to regulate euthanasia

 Death is a private matter and if there is no harm to others, the state and other people have no right to
interfere (a libertarian argument)

 Allowing people to die may free up scarce health resources (this is a possible argument, but no authority
has seriously proposed it)

 Euthanasia happens anyway (a utilitarian or consequentialist argument)

Philosophical arguments

 Euthanasia satisfies the criterion that moral rules must be universalisable

 Euthanasia happens anyway (a utilitarian or consequentialist argument)

 Is death a bad thing?

 Arguments about death itself

 Is death a bad thing?

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Regulating euthanasia

Those in favour of euthanasia think that there is no reason why euthanasia can't be controlled by proper
regulation, but they acknowledge that some problems will remain.

For example, it will be difficult to deal with people who want to implement euthanasia for selfish reasons
or pressurise vulnerable patients into dying.

This is little different from the position with any crime. The law prohibits theft, but that doesn't stop bad people
stealing things.

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People have the right to die

Human beings have the right to die when and how they want to

In...cases where there are no dependants who might exert pressure one way or the other, the right of the
individual to choose should be paramount. So long as the patient is lucid, and his or her intent is clear beyond
doubt, there need be no further questions.
The Independent, March 2002
Many people think that each person has the right to control his or her body and life and so should be able to
determine at what time, in what way and by whose hand he or she will die.

Behind this lies the idea that human beings should be as free as possible - and that unnecessary restraints on
human rights are a bad thing.

And behind that lies the idea that human beings are independent biological entities, with the right to take and
carry out decisions about themselves, providing the greater good of society doesn't prohibit this. Allied to this is
a firm belief that death is the end.

Religious objections

Religious opponents disagree because they believe that the right to decide when a person dies belongs to God.

Secular objections

Secular opponents argue that whatever rights we have are limited by our obligations. The decision to die by
euthanasia will affect other people - our family and friends, and healthcare professionals - and we must balance
the consequences for them (guilt, grief, anger) against our rights.

We should also take account of our obligations to society, and balance our individual right to die against any
bad consequences that it might have for the community in general.
 These bad consequences might be practical - such as making involuntary euthanasia easier and so putting
vulnerable people at risk.

There is also a political and philosophical objection that says that our individual right to autonomy against the
state must be balanced against the need to make the sanctity of life an important, intrinsic, abstract value of the
state.

Secular philosophers put forward a number of technical arguments, mostly based on the duty to preserve life
because it has value in itself, or the importance of regarding all human beings as ends rather than means.

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Other human rights imply a right to die

Without creating (or acknowledging) a specific right to die, it is possible to argue that other human rights ought
to be taken to include this right.

The right to life includes the right to die

 The right to life is not a right simply to exist

 The right to life is a right to life with a minimum quality and value

 Death is the opposite of life, but the process of dying is part of life

 Dying is one of the most important events in human life

 Dying can be good or bad

 People have the right to try and make the events in their lives as good as possible

 So they have the right to try to make their dying as good as possible

 If the dying process is unpleasant, people should have the right to shorten it, and thus reduce the
unpleasantness

 People also have obligations - to their friends and family, to their doctors and nurses, to society in general

 These obligations limit their rights

 These obligations do not outweigh a person's right to refuse medical treatment that they do not want

 But they do prevent a patient having any right to be killed

 But even if there is a right to die, that doesn't mean that doctors have a duty to kill, so no doctor can be forced
to help the patient who wants euthanasia.
The right not to be killed

The right to life gives a person the right not to be killed if they don't want to be.

Those in favour of euthanasia will argue that respect for this right not to be killed is sufficient to protect against
misuse of euthanasia, as any doctor who kills a patient who doesn't want to die has violated that person's rights.
 Opponents of euthanasia may disagree, and argue that allowing euthanasia will greatly increase the risk of
people who want to live being killed. The danger of violating the right to life is so great that we should ban
euthanasia even if it means violating the right to die.

The rights to privacy and freedom of belief include a right to die

This is the idea that the rights to privacy and freedom of belief give a person the right to decide how and when
to die.

The European Convention on Human Rights gives a person the right to die

 Not according to Britain's highest court.

 It concluded that the right to life did not give any right to self-determination over life and death, since the
provisions of the convention were aimed at protecting and preserving life.
English law already acknowledges that people have the right to die

This argument is based on the fact that the Suicide Act (1961) made it legal for people to take their own lives.

Opponents of euthanasia may disagree:

 The Suicide Act doesn't necessarily acknowledge a right to die;

 it could simply acknowledge that you can't punish someone for succeeding at suicide

 and that it's inappropriate to punish someone so distressed that they want to take their own life.
Euthanasia opponents further point out that there is a moral difference between decriminalising something, often
for practical reasons like those mentioned above, and encouraging it.

They can quite reasonably argue that the purpose of the Suicide Act is not to allow euthanasia, and support this
argument by pointing out that the Act makes it a crime to help someone commit suicide. This is true, but that
provision is really there to make it impossible to escape a murder charge by dressing the crime up as an assisted
suicide.

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Libertarian argument

This is a variation of the individual rights argument.

 If an action promotes the best interests of everyone concerned and violates no one's rights then that action is
morally acceptable

 In some cases, euthanasia promotes the best interests of everyone involved and violates no one's rights

 It is therefore morally acceptable

Objections to this argument

Opponents attack the libertarian argument specifically by claiming that there are no cases that fit the conditions
above:
 people sometimes think things are in their best interests that are not morally acceptable

 The arguments that euthanasia is intrinsically wrong fit in here

 people are sometimes wrong about what's in their best interests

 people may not realise that committing euthanasia may harm other people

 euthanasia may deprive both the person who dies and others of benefits

 euthanasia is not a private act - we cannot ignore any bad effects it may have on society in general
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Medical resources

Euthanasia may be necessary for the fair distribution of health resources

This argument has not been put forward publicly or seriously by any government or health authority. It is
included here for completeness.

In most countries there is a shortage of health resources.

As a result, some people who are ill and could be cured are not able to get speedy access to the facilities they
need for treatment.

At the same time health resources are being used on people who cannot be cured, and who, for their own
reasons, would prefer not to continue living.

Allowing such people to commit euthanasia would not only let them have what they want, it would free valuable
resources to treat people who want to live.

Abuse of this would be prevented by only allowing the person who wanted to die to intitiate the process, and
by regulationsthat rigorously prevented abuse.

Objections to this argument

This proposal is an entirely pragmatic one; it says that we should allow euthanasia because it will allow more
people to be happy. Such arguments will not convince anyone who believes that euthanasia is wrong in
principle.

Others will object because they believe that such a proposal is wide-open to abuse, and would ultimately lead
to involuntary euthanasia because of shortage of health resources.

In the end, they fear, people will be expected to commit euthanasia as soon as they become an unreasonable
burden on society.

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Moral rules must be universalisable

One of the commonly accepted principles in ethics, put forward by Immanuel Kant, is that only those ethical
principles that could be accepted as a universal rule (i.e. one that applied to everybody) should be accepted.
So you should only do something if you're willing for anybody to do exactly the same thing in exactly similar
circumstances, regardless of who they are.

The justification for this rule is hard to find - many people think it's just an obvious truth (philosophers call such
truths self-evident). You find variations of this idea in many faiths; for example "do unto others as you would
have them do unto you".

To put it more formally:

A rule is universalisable if it can consistently be willed as a law that everyone ought to obey. The only rules
which are morally good are those which can be universalised.
The person in favour of euthanasia argues that giving everybody the right to have a good death through
euthanasia is acceptable as a universal principle, and that euthanasia is therefore morally acceptable.

This alone does not justify euthanasia

This is sound, but is not a full justification.

If a person wants to be allowed to commit euthanasia, it would clearly be inconsistent for them to say that they
didn't think it should be allowed for other people.

But the principle of universalisability doesn't actually provide any positive justification for anything - genuine
moral rules must be universalisable, but universalisability is not enough to say that a rule is a satisfactory moral
rule.

Universalisability is therefore only a necessary condition, not a sufficient condition for a rule to be a morally
good rule.

So, other than showing that one pre-condition is met, universalisibility doesn't advance the case for euthanasia at
all.

How similar can situations be?

Every case is different in some respect, so anyone who is inclined to argue about it can argue about whether the
particular differences are sufficent to make this case an exception to the rule.

Universal exceptions to universal rules

Oddly enough, the law of universalisability allows for there to be exceptions - as long as the exceptions are
themselves universalisable. So you could have a universal rule allowing voluntary euthanasia and universalise
an exception for people who were less than 18 years old.

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Euthanasia happens anyway

Euthanasia happens - better to make it legal and regulate it properly

Sounds a bit like "murder happens - better to make it legal and regulate it properly".
When you put it like that, the argument sounds very feeble indeed.

But it is one that is used a lot in discussion, and particularly in politics or round the table in the pub or the
canteen.

People say things like "we can't control drugs so we'd better legalise them", or "if we don't make abortion legal
so that people can have it done in hospital, people will die from backstreet abortions".

What lies behind it is Utilitarianism: the belief that moral rules should be designed to produce the greatest
happiness of the greatest number of people.

If you accept this as the basis for your ethical code (and it's the basis of many people's ethics), then the
arguments above are perfectly sensible.

If you don't accept this principle, but believe that certain things are wrong regardless of what effect they have on
total human happiness, then you will probably regard this argument as cynical and wrong.

A utilitarian argument for euthanasia

From a utilitarian viewpoint, justifying euthanasia is a question of showing that allowing people to have a good
death, at a time of their own choosing, will make them happier than the pain from their illness, the loss of
dignity and the distress of anticipating a slow, painful death. Someone who wants euthanasia will have already
made this comparison for themselves.

But utilitarianism deals with the total human happiness, not just that of the patient, so that even euthanasia
opponents who agree with utilitarianism in principle can claim that the negative effects on those around the
patient - family, friends and medical staff - would outweigh the benefit to the patient.

It is hard to measure happiness objectively, but one way to test this argument would be to speak to the families
and carers of people who had committed assisted suicide.

Opponents can also argue that the net effect on the whole of society will be a decrease in happiness. The only
way to approach this would be to look at countries where euthanasia is legal. However, as no two countries are
alike, it seems impossible to extricate the happiness or unhappiness resulting from legal assisted suicide, from
any happiness or unhappiness from other sources.

Even if you agree with the utilitarian argument, you then have to deal with the arguments that suggest that
euthanasia can't be properly regulated.

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Is death a bad thing?

Why ask this question?

If death is not a bad thing then many of the objections to euthanasia vanish.

If we put aside the idea that death is always a bad thing, we are able to consider whether death may actually
sometimes be a good thing.
 This makes it much easier to consider the issue of euthanasia from the viewpoint of someone who wants
euthanasia.

Why is death a bad thing?

We tend to regard death as a bad thing for one or more of these reasons:

 because human life is intrinsically valuable

 because life and death are God's business with which we shouldn't interfere

 because most people don't want to die

 because it violates our autonomy in a drastic way

The first two reasons form key points in the arguments against euthanasia, but only if you accept that they are
true.

The last two reasons why death is a bad thing are not absolute; if a person wants to die, then neither of those
reasons can be used to say that they would be wrong to undergo euthanasia.

People don't usually want to die

People are usually eager to avoid death because they value being alive, because they have many things they
wish to do, and experiences they wish to have.

Obviously, this is not the case with a patient who wishes to die - and proper regulation will weed out people
who do not really want to die, but are asking for other reasons.

Violation of autonomy

Another reason why death is seen as a bad thing is that it's the worst possible violation of the the wishes of the
person who does not want to die (or, to use philosophical language, a violation of their autonomy).

In the case of someone who does want to die, this objection disappears.

Being dead, versus not having been born

Some people say that being dead is no different from not having been born yet, and nobody makes a fuss about
the bad time they had before they were born.

There is a big difference - even though being dead will be no different as an experience from the experience of
not having yet been born.

The idea is that death hurts people because it stops them having more of the things that they want, and could
have if they continued to live.

Someone who makes a request for euthanasia is likely to have a bad quality of life (or a bad prognosis, even if
they are not yet suffering much) and the knowledge that this will only get worse. If that is the case, death will
not deprive them of an otherwise pleasant existence.
 Of course, most patients will still be leaving behind some things that are good: for example, loved ones and
things they enjoy. Asking for death does not necessarily mean that they have nothing to live for: only that the
patient has decided that after a certain point, the pain outweighs the good things.

Overview of anti-euthanasia arguments

It's possible to argue about the way we've divided up the arguments, and many arguments could fall into more
categories than we've used.

Ethical arguments

 Euthanasia weakens society's respect for the sanctity of life

 Accepting euthanasia accepts that some lives (those of the disabled or sick) are worth less than others

 Voluntary euthanasia is the start of a slippery slope that leads to involuntary euthanasia and the killing of
people who are thought undesirable

 Euthanasia might not be in a person's best interests

 Euthanasia affects other people's rights, not just those of the patient
Practical arguments

 Proper palliative care makes euthanasia unnecessary

 There's no way of properly regulating euthanasia

 Allowing euthanasia will lead to less good care for the terminally ill

 Allowing euthanasia undermines the committment of doctors and nurses to saving lives

 Euthanasia may become a cost-effective way to treat the terminally ill

 Allowing euthanasia will discourage the search for new cures and treatments for the terminally ill

 Euthanasia undermines the motivation to provide good care for the dying, and good pain relief

 Euthanasia gives too much power to doctors

 Euthanasia exposes vulnerable people to pressure to end their lives

 Moral pressure on elderly relatives by selfish families

 Moral pressure to free up medical resources

 Patients who are abandoned by their families may feel euthanasia is the only solution
Historical arguments

 Voluntary euthanasia is the start of a slippery slope that leads to involuntary euthanasia and the killing of
people who are thought undesirable
Religious arguments

 Euthanasia is against the word and will of God

 Euthanasia weakens society's respect for the sanctity of life

 Suffering may have value

 Voluntary euthanasia is the start of a slippery slope that leads to involuntary euthanasia and the killing of
people who are thought undesirable
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Against the will of God

Religious people don't argue that we can't kill ourselves, or get others to do it. They know that we can do it
because God has given us free will. Their argument is that it would be wrong for us to do so.

They believe that every human being is the creation of God, and that this imposes certain limits on us. Our lives
are not only our lives for us to do with as we see fit.

To kill oneself, or to get someone else to do it for us, is to deny God, and to deny God's rights over our lives and
his right to choose the length of our lives and the way our lives end.

The value of suffering

Religious people sometimes argue against euthanasia because they see positive value in suffering.

Down through the centuries and generations it has been seen that in suffering there is concealed a particular
power that draws a person interiorly close to Christ, a special grace.
Pope John Paul II: Salvifici Doloris, 1984
The religious attitude to suffering

Most religions would say something like this:

We should relieve suffering when we can, and be with those who suffer, helping them to bear their suffering,
when we can't. We should never deal with the problem of suffering by eliminating those who suffer.
The nature of suffering

Christianity teaches that suffering can have a place in God's plan, in that it allows the sufferer to share
in Christ's agonyand his redeeming sacrifice. They believe that Christ will be present to share in the suffering
of the believer.

Pope John Paul II wrote that "It is suffering, more than anything else, which clears the way for the grace which
transforms human souls."

However while the churches acknowledge that some Christians will want to accept some suffering for this
reason, most Christians are not so heroic.

So there is nothing wrong in trying to relieve someone's suffering. In fact, Christians believe that it is a good to
do so, as long as one does not intentionally cause death.

Dying is good for us

Some people think that dying is just one of the tests that God sets for human beings, and that the way we react to
it shows the sort of person we are, and how deep our faith and trust in God is.
Others, while acknowledging that a loving God doesn't set his creations such a horrible test, say that the process
of dying is the ultimate opportunity for human beings to develop their souls.

When people are dying they may be able, more than at any time in their life, to concentrate on the important
things in life, and to set aside the present-day 'consumer culture', and their own ego and desire to control the
world. Curtailing the process of dying would deny them this opportunity.

Eastern religions

Several Eastern religions believe that we live many lives and the quality of each life is set by the way we lived
our previous lives.

Those who believe this think that suffering is part of the moral force of the universe, and that by cutting it short
a person interferes with their progress towards ultimate liberation.

A non-religious view

Some non-religious people also believe that suffering has value. They think it provides an opportunity to grow
in wisdom, character, and compassion.

Suffering is something which draws upon all the resources of a human being and enables them to reach the
highest and noblest points of what they really are.

Suffering allows a person to be a good example to others by showing how to behave when things are bad.

M Scott Peck, author of The Road Less Travelled, has written that in a few weeks at the end of life, with pain
properly controlled a person might learn

how to negotiate a middle path between control and total passivity, about how to welcome the responsible care
of strangers, about how to be dependent once again ... about how to trust and maybe even, out of existential
suffering, at least a little bit about how to pray or talk with God.
M Scott Peck
The nature of suffering

It isn't easy to define suffering - most of us can decide when we are suffering but what is suffering for one
person may not be suffering for another.

It's also impossible to measure suffering in any useful way, and it's particularly hard to come up with any
objective idea of what constitutes unbearable suffering, since each individual will react to the same physical and
mental conditions in a different way.

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Sanctity of life

This argument says that euthanasia is bad because of the sanctity of human life.

There are four main reasons why people think we shouldn't kill human beings:
 All human beings are to be valued, irrespective of age, sex, race, religion, social status or their potential for
achievement

 Human life is a basic good as opposed to an instrumental good, a good in itself rather than as a means to an
end

 Human life is sacred because it's a gift from God

 Therefore the deliberate taking of human life should be prohibited except in self-defence or the legitimate
defence of others
We are valuable for ourselves

The philosopher Immanuel Kant said that rational human beings should be treated as an end in themselves and
not as a means to something else. The fact that we are human has value in itself.

Our inherent value doesn't depend on anything else - it doesn't depend on whether we are having a good life that
we enjoy, or whether we are making other people's lives better. We exist, so we have value.

Most of us agree with that - though we don't put it in philosopher-speak. We say that we don't think that we
should use other people - which is a plain English way of saying that we shouldn't treat other people as a means
to our own ends.

We must respect our own value

It applies to us too. We shouldn't treat ourselves as a means to our own ends.

And this means that we shouldn't end our lives just because it seems the most effective way of putting an end to
our suffering. To do that is not to respect our inherent worth.

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The slippery slope

Many people worry that if voluntary euthanasia were to become legal, it would not be long before involuntary
euthanasia would start to happen.

We concluded that it was virtually impossible to ensure that all acts of euthanasia were truly voluntary and that
any liberalisation of the law in the United Kingdom could not be abused.
We were also concerned that vulnerable people - the elderly, lonely, sick or distressed - would feel pressure,
whether real or imagined, to request early death.
Lord Walton, Chairman, House of Lords Select Committee on Medical Ethics looking into euthanasia,
1993
This is called the slippery slope argument. In general form it says that if we allow something relatively
harmless today, we may start a trend that results in something currently unthinkable becoming accepted.

Those who oppose this argument say that properly drafted legislation can draw a firm barrier across the slippery
slope.

Various forms of the slippery slope argument

 If we change the law and accept voluntary euthanasia, we will not be able to keep it under control.

 Proponents of euthanasia say: Euthanasia would never be legalised without proper regulation and control
mechanisms in place
Doctors may soon start killing people without bothering with their permission.

 Proponents say: There is a huge difference between killing people who ask for death under appropriate
circumstances, and killing people without their permission

 Very few people are so lacking in moral understanding that they would ignore this distinction

 Very few people are so lacking in intellect that they can't make the distinction above

 Any doctor who would ignore this distinction probably wouldn't worry about the law anyway
Health care costs will lead to doctors killing patients to save money or free up beds:

 Proponents say: The main reason some doctors support voluntary euthanasia is because they believe that they
should respect their patients' right to be treated as autonomous human beings

 That is, when doctors are in favour of euthanasia it's because they want to respect the wishes of their patients

 So doctors are unlikely to kill people without their permission because that contradicts the whole motivation
for allowing voluntary euthanasia

 But cost-conscious doctors are more likely to honour their patients' requests for death

 A 1998 study found that doctors who are cost-conscious and 'practice resource-conserving medicine' are
significantly more likely to write a lethal prescription for terminally-ill patients [Arch. Intern. Med., 5/11/98,
p. 974]

 This suggests that medical costs do influence doctors' opinions in this area of medical ethics
The Nazis engaged in massive programmes of involuntary euthanasia, so we shouldn't place our trust in the
good moral sense of doctors.

 Proponents say: The Nazis are not a useful moral example, because their actions are almost universally
regarded as both criminal and morally wrong

 The Nazis embarked on invountary euthanasia as a deliberate political act - they didn't slip into it from
voluntary euthanasia (although at first they did pretend it was for the benefit of the patient)

 What the Nazis did wasn't euthanasia by even the widest definition, it was the use of murder to get rid of
people they disapproved of

 The universal horror at Nazi euthanasia demonstrates that almost everyone can make the distinction between
voluntary and involuntary euthanasia

 The example of the Nazis has made people more sensitive to the dangers of involuntary euthanasia
Allowing voluntary euthanasia makes it easier to commit murder, since the perpetrators can disguise it as active
voluntary euthanasia.

 Proponents say: The law is able to deal with the possibility of self-defence or suicide being used as disguises
for murder. It will thus be able to deal with this case equally well
 To dress murder up as euthanasia will involve medical co-operation. The need for a conspiracy will make it
an unattractive option
Many are needlessly condemned to suffering by the chief anti-euthanasia argument: that murder might lurk
under the cloak of kindness.
A C Grayling, Guardian 2001
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Devalues some lives

Some people fear that allowing euthanasia sends the message, "it's better to be dead than sick or disabled".

The subtext is that some lives are not worth living. Not only does this put the sick or disabled at risk, it also
downgrades their status as human beings while they are alive.

The disabled person's perspective

Part of the problem is that able-bodied people look at things from their own perspective and see life with a
disability as a disaster, filled with suffering and frustration.

Some societies have regarded people with disabilities as inferior, or as a burden on society. Those in favour of
eugenics go further, and say that society should prevent 'defective' people from having children. Others go
further still and say that those who are a burden on society should be eliminated.

People with disabilities don't agree. They say:

 All people should have equal rights and opportunities to live good lives

 Many individuals with disabilities enjoy living

 Many individuals without disabilities don't enjoy living, and no-one is threatening them

 The proper approach to people with disabilities is to provide them with appropriate support, not to kill them

 The quality of a person's life should not be assessed by other people

 The quality of life of a person with disabilities should not be assessed without providing proper support first
Opposition to this argument

Supporters of euthanasia would respond that this argument includes a number of completely misleading
suggestions, and refute them:

 Dying is not the same as never having been born

 The debate is nothing to do with preventing disabled babies being born, or preventing people with disabilities
from becoming parents

 Nobody is asking for patients to be killed against their wishes - whether or not those patients are disabled

 The euthanasia procedure is intended for use by patients who are dying, or in a condition that will get worse -
most disabilities don't come under that category

 The normal procedure for euthanasia would have to be initiated at the patient's request
 Disabled people who are not mentally impaired are just as capable as able-bodied people of deciding what
they want

 Protections will be in place for patients who are mentally impaired, whether through disability or some other
reason

 It is possible that someone who has just become disabled may feel depressed enough to ask for death, which
is why any proposed system of euthanasia must include psychological support and assessment before the
patient's wish is granted

 All people should have equal rights and opportunities to live, or to choose not to go on living
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Patient's best interests

A serious problem for supporters of euthanasia are the number of cases in which a patient may ask for
euthanasia, or feel obliged to ask for it, when it isn't in their best interest. Some examples are listed below:

 the diagnosis is wrong and the patient is not terminally ill

 the prognosis (the doctor's prediction as to how the disease will progress) is wrong and the patient is not
going to die soon

 the patient is getting bad medical care and their suffering could be relieved by other means

 the doctor is unaware of all the non-fatal options that could be offered to the patient

 the patient's request for euthanasia is actually a 'cry for help', implying that life is not worth living now but
could be worth living if various symptoms or fears were managed

 the patient is depressed and so believes things are much worse than they are

 the patient is confused and unable to make sensible judgements

 the patient has an unrealistic fear of the pain and suffering that lies ahead

 the patient is feeling vulnerable

 the patient feels that they are a worthless burden on others

 the patient feels that their sickness is causing unbearable anguish to their family

 the patient is under pressure from other people to feel that they are a burden

 the patient is under pressure because of a shortage of resources to care for them

 the patient requests euthanasia because of a passing phase of their disease, but is likely to feel much better in
a while
Supporters of euthanasia say these are good reasons to make sure the euthanasia process will not be rushed, and
agree that a well-designed system for euthanasia will have to take all these points into account. They say that
most of these problems can be identified by assessing the patient properly, and, if necessary, the system should
discriminate against the opinions of people who are particularly vulnerable.
 Chochinov and colleagues found that fleeting or occasional thoughts of a desire for death were common in a
study of people who were terminally ill, but few patients expressed a genuine desire for death. (Chochinov HM,
Tataryn D, Clinch JJ, Dudgeon D. Will to live in the terminally ill. Lancet 1999; 354: 816-819)

They also found that the will to live fluctuates substantially in dying patients, particularly in relation to
depression, anxiety, shortness of breath, and their sense of wellbeing.

Other people have rights too

Euthanasia is usually viewed from the viewpoint of the person who wants to die, but it affects other people too,
and their rights should be considered.

 family and friends

 medical and other carers

 other people in a similar situation who may feel pressured by the decision of this patient

 society in general
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Proper palliative care

Palliative care is physical, emotional and spiritual care for a dying person when cure is not possible. It includes
compassion and support for family and friends.

Competent palliative care may well be enough to prevent a person feeling any need to contemplate euthanasia.

You matter because you are you. You matter to the last moment of your life and we will do all we can to help
you die peacefully, but also to live until you die.
Dame Cicely Saunders, founder of the modern hospice movement
The key to successful palliative care is to treat the patient as a person, not as a set of symptoms, or medical
problems.

The World Health Organisation states that palliative care affirms life and regards dying as a normal process; it
neither hastens nor postpones death; it provides relief from pain and suffering; it integrates the psychological
and spiritual aspects of the patient.

Making things better for patient, family and friends

The patient's family and friends will need care too. Palliative care aims to enhance the quality of life for the
family as well as the patient.

Effective palliative care gives the patient and their loved ones a chance to spend quality time together, with as
much distress removed as possible. They can (if they want to) use this time to bring any unfinished business in
their lives to a proper closure and to say their last goodbyes.

Palliative care should aim to make it easier and more attractive for family and friends to visit the dying person.
A survey (USA 2001) showed that terminally ill patients actually spent the vast majority of their time on their
own, with few visits from medical personnel or family members.
 Spiritual care

Spiritual care may be important even for non-religious people. Spiritual care should be interpreted in a very
wide sense, since patients and families facing death often want to search for the meaning of their lives in their
own way.

Palliative care and euthanasia

Good palliative care is the alternative to euthanasia. If it was available to every patient, it would certainly reduce
the desire for death to be brought about sooner.

But providing palliative care can be very hard work, both physically and psychologically. Ending a patient's life
by injection is quicker and easier and cheaper. This may tempt people away from palliative care.

Legalising euthanasia may reduce the availability of palliative care

Some fear that the introduction of euthanasia will reduce the availability of palliative care in the community,
because health systems will want to choose the most cost effective ways of dealing with dying patients.

Medical decision-makers already face difficult moral dilemmas in choosing between competing demands for
their limited funds. So making euthanasia easier could exacerbate the slippery slope, pushing people towards
euthanasia who may not otherwise choose it.

When palliative care is not enough

Palliative care will not always be an adequate solution:

 Pain: Some doctors estimate that about 5% of patients don't have their pain properly relieved during the
terminal phase of their illness, despite good palliative and hospice care

 Dependency: Some patients may prefer death to dependency, because they hate relying on other people for
all their bodily functions, and the consequent loss of privacy and dignity

 Lack of home care: Other patients will not wish to have palliative care if that means that they have to die in
a hospital and not at home

 Loss of alertness: Some people would prefer to die while they are fully alert and and able to say goodbye to
their family; they fear that palliative care would involve a level of pain-killing drugs that would leave them
semi-anaesthetised

 Not in the final stages: Other people are grateful for palliative care to a certain point in their disease, but
after that would prefer to die rather than live in a state of helplessness and distress, regardless of what is
available in terms of pain-killing and comfort.
There should be no law or morality that would limit a clinical team or doctor from administering the frequent
dosages of pain medication that are necessary to free people's minds from pain that shrivels the spirit and leaves
no time for speaking when, at times, there are very few hours or days left for such communication.
Dr. David Roy, Director of the Centre for Bioethics, Clinical Research Institute of Montreal
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Fears about regulation

 Euthanasia opponents don't believe that it is possible to create a regulatory system for euthanasia that will
prevent the abuse of euthanasia.

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It gives doctors too much power

This argument often appears as 'doctors should not be allowed to play God'. Since God arguments are of no
interest to people without faith, it's presented here with the God bit removed.

Doctors should not be allowed to decide when people die:

 Doctors do this all the time

 Any medical action that extends life changes the time when a person dies and we don't worry about that

 This is a different sort of decision, because it involves shortening life

 Doctors take this sort of decision all the time when they make choices about treatment

 As long as doctors recognise the seriousness of euthanasia and take decisions about it within a
properly regulatedstructure and with proper safeguards, such decisions should be acceptable

 In most of these cases the decision will not be taken by the doctor, but by the patient. The doctor will provide
information to the patient to help them make their decision
Since doctors give patients the information on which they will base their decisions about euthanasia, any
legalisation of euthanasia, no matter how strictly regulated, puts doctors in an unacceptable position of power.

Doctors have been shown to take these decisions improperly, defying the guidelines of the British Medical
Association, the Resuscitation Council (UK), and the Royal College of Nursing:

 An Age Concern dossier in 2000 showed that doctors put Do Not Resuscitate orders in place on elderly
patients without consulting them or their families

 Do Not Resuscitate orders are more commonly used for older people and, in the United States, for black
people, alcohol misusers, non-English speakers, and people infected with Human Immunodeficiency Virus.
This suggests that doctors have stereotypes of who is not worth saving
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Pressure on the vulnerable

This is another of those arguments that says that euthanasia should not be allowed because it will be abused.

The fear is that if euthanasia is allowed, vulnerable people will be put under pressure to end their lives. It would
be difficult, and possibly impossible, to stop people using persuasion or coercion to get people to request
euthanasia when they don't really want it.

I have seen . . . AIDS patients who have been totally abandoned by their parents, brothers and sisters and by
their lovers.
In a state of total isolation, cut off from every source of life and affection, they would see death as the only
liberation open to them.
In those circumstances, subtle pressure could bring people to request immediate, rapid, painless death, when
what they want is close and powerful support and love.
evidence to the Canadian Senate Committee on Euthanasia and Assisted Suicide
The pressure of feeling a burden

People who are ill and dependent can often feel worthless and an undue burden on those who love and care for
them. They may actually be a burden, but those who love them may be happy to bear that burden.

Nonetheless, if euthanasia is available, the sick person may pressure themselves into asking for euthanasia.

Pressure from family and others

Family or others involved with the sick person may regard them as a burden that they don't wish to carry, and
may put pressure (which may be very subtle) on the sick person to ask for euthanasia.

Increasing numbers of examples of the abuse or neglect of elderly people by their families makes this an
important issue to consider.

Financial pressure

The last few months of a patient's life are often the most expensive in terms of medical and other care.
Shortening this period through euthanasia could be seen as a way of relieving pressure on scarce medical
resources, or family finances.

It's worth noting that cost of the lethal medication required for euthanasia is less than £50, which is much
cheaper than continuing treatment for many medical conditions.

Some people argue that refusing patients drugs because they are too expensive is a form of euthanasia, and that
while this produces public anger at present, legal euthanasia provides a less obvious solution to drug costs.

If there was 'ageism' in health services, and certain types of care were denied to those over a certain age,
euthanasia could be seen as a logical extension of this practice.

Is there a duty to die?

Is there a duty to die?

It sounds an odd question - most of us would say 'no', except perhaps for military and similar personnel in
certain circumstances.

After all, when we say someone did their duty when they gave up their life to save others, we often mean that
they did an act of heroism, well beyond the call of duty.

But some cultures, and some modern thinkers, think that there is a duty on a person to die in certain
circumstances.

The ideas of John Hardwig

The philosopher John Hardwig re-opened this debate with an article in 1997. He says that an individual is not
the only person who will be affected by decisions over whether they live or die. So, when deciding whether to
live or die, a person should not consider only themselves; they should also consider their family and the people
who love them.

What produces a duty to die?

Hardwig thinks that we may have a duty to die when the burden of caring for us seriously compromises the lives
of those who love us:

 they may be physically exhausted by caring for us

 they may be emotionally exhausted by caring for us

 they may be financially destroyed by the cost of our healthcare

 they may be financially destroyed by having to give up work to care for us

 their home may become a place of grief and sickness

 other family members may be neglected as all attention is focussed on us

Hardwig says that there are no general rules - each case will be different, and he openly admits

I can readily imagine that, through cowardice, rationalisation, or failure of resolve, I will fail in this obligation to
protect my loved ones. If so, I think I would need to be excused or forgiven for what I did.

John Hardwig

Nor does Hardwig think that a person should make their final decision without consulting their family - although
he points out the difficulties in doing this.

What makes a duty to die more likely?

He goes on to list various features of a person's situation that make it more likely that they have a duty to die:

 a duty to die is more likely when continuing to live will impose significant burdens on our family and
loved ones

 a duty to die becomes greater as we grow older, because we will sacrifice less of our life

 a duty to die is more likely if we have already lived a full life

 there is a greater duty to die if our loved ones' lives have already been difficult or impoverished

 a duty to die is more likely if our loved ones have already made great contributions or sacrifices to
make our life a good one

 the duty to die is reduced if we can adapt well to our disease or disability

 the duty to die is reduced if we still make significant contributions (not just money) to the lives of
others

 a duty to die is more likely when the part of us that is loved will soon be gone or seriously
compromised

 there is a greater duty to die to the extent that we have lived a relatively lavish lifestyle instead of
saving for illness or old age

It is one of the tragedies of our lives that someone who wants very much to live can nevertheless have a duty to
die.

John Hardwig

Islam and medical ethics

Islam considers medical ethics the same as ethics in other areas of life. Islamic medical ethics is restating
general ethical principles using medical terminology and with medical applications.

Modern medicine has caused some ethical dilemmas in relation to end-of-life decisions and what is or is not
euthanasia.

Euthanasia and suicide in Islam

Muslims are against euthanasia. They believe that all human life is sacred because it is given by Allah, and that
Allah chooses how long each person will live. Human beings should not interfere in this.

Life is sacred

Euthanasia and suicide are not included among the reasons allowed for killing in Islam.

Do not take life, which Allah made sacred, other than in the course of justice.

Qur'an 17:33

Allah decides how long each of us will live

When their time comes they cannot delay it for a single hour nor can they bring it forward by a single hour.

Qur'an 16:61

And no person can ever die except by Allah's leave and at an appointed term.

Qur'an 3:145

Suicide and euthanasia are explicitly forbidden

Destroy not yourselves. Surely Allah is ever merciful to you.

Qur'an 4:29

The Prophet said: "Amongst the nations before you there was a man who got a wound, and growing impatient
(with its pain), he took a knife and cut his hand with it and the blood did not stop till he died. Allah said, 'My
Slave hurried to bring death upon himself so I have forbidden him (to enter) Paradise.' "

Sahih Bukhari 4.56.669

End of life decisions and DNR orders

Many devout Muslims believe that Do Not Resuscitate (DNR) orders represent a soft form of euthanasia which
is strictly forbidden in Islam. Muslims cannot kill, or be complicit in the killing of another, except in the
interests of justice.

However, the Islamic Code of Medical Ethics states "it is futile to diligently keep the patient in a vegetative state
by heroic means... It is the process of life that the doctor aims to maintain and not the process of dying". This
means doctors can stop trying to prolong life in cases where there is no hope of a cure.

According to the Islamic Medical Association of America (IMANA) "When death becomes inevitable, as
determined by physicians taking care of terminally ill patients, the patient should be allowed to die without
unnecessary procedures."

IMANA say that turning off life support for patients deemed to be in a persistent vegetative state is permissible.
This is because they consider all mechanical life support procedures as temporary measures.

While turning off a life-support is allowed, hastening death with the use of certain pain-killing drugs is not
allowed as this would equate to euthanasia.

udaism, euthanasia and suicide

...The message of Judaism is that one must struggle until the last breath of life. Until the last moment, one has to
live and rejoice and give thanks to the Creator...
Dr Rachamim Melamed-Cohen, Jewsweek, March, 2002

The Jewish tradition regards the preservation of human life as one of its supreme moral values and forbids doing
anything that might shorten life. However, it does not require doctors to make dying last longer than it naturally
would.

 Jewish law and tradition regard human life as sacred, and say that it is wrong for anyone to shorten a
human life

 this is because our lives are not ours to dispose of as we feel like

 all life is of infinite value, regardless of its duration or quality, because all human beings are made in
the image of God

 saving someone from pain is not a reason to kill them

 nor is it lawful to kill oneself to save oneself from pain

 but there is a limit to the duty to keep people alive

 if someone's life is ending and they are in serious pain, doctors have no duty to make that
person suffer more by artificially extending their dying moments

 it is also acceptable to ask God in prayer to remove a person from their pain and suffering

Active euthanasia

Jewish law forbids active euthanasia and regards it as murder. There are no exceptions to this rule and it makes
no difference if the person concerned wants to die.

Shortening life

It is wrong to shorten a life even if it would end very soon, because every moment of human life is considered
equal in value to many years of life.

The value of human life is infinite and beyond measure, so that any part of life - even if only an hour or a second
- is of precisely the same worth as seventy years of it, just as any fraction of infinity, being indivisible, remains
infinite.

Lord Jakobovits, former UK Chief Rabbi

So even if a person is a goses (this word means someone who has started to die and will die within 72 hours),
any action that might hasten their death - for example closing the eyes or moving a limb - is prohibited.

Passive euthanasia

Jewish law says that doctors (and patients) have a duty to preserve life, and a doctor must do everything he/she
can to save a patient's life - even if the patient doesn't want them to.

But this isn't the end of it. There is some freedom for doctors in cases where a patient is terminally ill.

Although a doctor cannot do anything that hastens death, "if there is something which is preventing the soul
from departing" a doctor can remove whatever is preventing the dying person's soul from departing.

In more modern language this means that if something is an impediment to the natural process of death and the
patient only survives because of it, it is permitted under Jewish law to withdraw that thing.

So if a patient is certain to die, and is only being kept alive by a ventilator, it is permissable to switch off the
ventilator since it is impeding the natural process of death.

The relevance of pain

Rabbi Moshe Feinstein and Rabbi Shlomo Zalman Auerbach have ruled that a dying patient should not be kept
alive by artificial means where the treatment does not cure the illness but merely prolongs the patient's life
temporarily and the patient is suffering great pain.

Pain relief medicine can be given even though it may hasten death, as long as the dose is not certain to kill, and
the intention is not to kill but to relieve pain.

Hastening one's own death

Human beings don't have the right to kill themselves, so someone who is terminally ill and in great pain cannot
take action to speed their own death. Even if they are mentally fit to make that choice, the rule that life is sacred
prevents them from shortening their life.

A passage in the Talmud tells the story of Rabbi Chanina ben Teradion, who was being burned alive by the
Romans. His pupils urged him to end his suffering quickly by opening his mouth and inhaling the flames. He
replied, "It is better that He who gave [me my soul] should take it rather than I should cause injury to myself."

It's also against Jewish law to help someone to kill themselves, since one is not allowed to enable another person
to break Jewish law.

Does the rule ban treatment that may kill?

Doctors are commanded to do their best to heal the sick and prevent suffering. So it's OK for a doctor to put a
patient through life-endangering treatment if that is likely to extend the patient's life or reduce their pain.

Biblical precedents

The first example of Jewish euthanasia comes in the Bible:

And a certain woman threw an upper millstone upon Abim'elech's head, and crushed his skull.

Then he called hastily to the young man his armor-bearer, and said to him, "Draw your sword and kill me, lest
men say of me, 'A woman killed him.'" And his young man thrust him through, and he died.

Judges 9:53-54

There's a more famous case at the start of 2 Samuel, where the seriously injured King Saul orders a young
soldier to kill him, rather than let him be captured alive. When King David heard what the young soldier had
done, he had him executed; to show that euthanasia was equivalent to murder, and that the defense of superior
orders was valueless.

n December 2009, the Independent MSP Margo Macdonald, who has Parkinson's Disease, put forward a bill in
the Scottish Parliament to legalise assisted suicide.

The End of Life Assistance Bill would have allowed people whose lives become intolerable through a
progressive degenerative condition, a trauma or terminal illness to seek a doctor's help in dying. It also proposed
a series of safeguards which would prevent abuse of the legislation.

The vote took place in December 2010 and MSPs were permitted to vote freely based on their consciences,
rather than along party lines.

The End of Life Assistance Bill was defeated by 85 votes to 16 with two abstentions.

Top

2009: Clarification on assisted suicide law for England and Wales

After a number of legal challenges by Debbie Purdy, a multiple sclerosis sufferer who wanted to know if her
husband would be prosecuted for helping her to die, the law on assisted suicide in England and Wales was
clarified in September 2009.
It was ruled that the decision to prosecute would be based on factors including the nature of the victim's illness.
All cases would be investigated by the police but discretion will still be used, the Director of Public
Prosecutions said.

Assisting suicide was to remain illegal and carried a jail term of up to 14 years, but the implication was that it
was unlikely that legal action would be taken against people if they assisted the suicide of a friend or relative
who had a settled and informed wish to die.

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2006: Assisted Dying Bill

The House of Lords has blocked a bill that would allow terminally ill people to be helped to die.

Lord Joffe's bill, which had its second reading on Friday 12th May 2006, proposed that after signing a legal
declaration that they wanted to die, a patient's doctor could prescribe a lethal dose of medication that the patient
could take themselves.

Only people with less than six months to live, who are suffering unbearably and deemed to be of sound mind
and not depressed would be able to end their life under Lord Joffe's proposal.

Peers spent the day in a passionate debate on whether or not it was right to allow a person who was terminally ill
to be given drugs they could then use to end their own life.

Lord Joffe said: "We must find a solution to the unbearable suffering of patients whose needs cannot be met by
palliative care."

Peers backed an amendment to delay the bill for six months by 48 votes. (148 were in favour and 100 opposed.)

Lord Joffe said the move was intended to end the debate, but pledged to reintroduce his bill at a later date.

The government has said it will not block a further hearing of the bill.

The debate highlighted divisions between supporters of the right to die and those who want better palliative
care.

Amongst those Lords against the bill were the Archbishop of Canterbury Dr Rowan Williams, Lady Finlay, a
professor in palliative care and Cardinal Cormac Murphy O'Connor, Archbishop of Westminster. They urged
more to be done instead to improve palliative care for terminally ill patients. These Lords were also supported
by disability campaigners.

Opponents to the bill demonstrated outside Parliament and submitted a petition to Downing Street which was
signed by 100,000 people.

The bill's supporters said doctors should be able to prescribe drugs so a terminally ill person suffering terrible
pain could choose to end his or her life.

These included Labour's Baroness David aged 92. She said:

If I were terminally ill, I believe I would be the only person with the right to decide how I died, and whether I
preferred palliative care to assisted dying.

It would provide me with an additional option on how to end my life, which I would find tremendously
reassuring.

Baroness David, Labour peer

Mark Slattery, of the charity Dignity in Dying, formerly the Voluntary Euthanasia Society, said the campaign to
introduce an assisted dying bill would continue. Julia Millington of the ProLife Alliance welcomed the Lords'
decision and stated they would continue to resist any change in the law.

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Religious leaders

2005: Religious leaders made a strong stand

Britain's faith leaders joined forces to protest against plans to revive the controversial right-to-die Bill in
Parliament.

Nine leading figures representing the major faith groups spoke out against Lord Joffe's proposals. Under the
proposed legislation the terminally ill would be able to choose to die and then receive help to commit suicide.

But in an open letter to both Houses of Parliament, the religious leaders condemned the bill, saying:

Assisted suicide and euthanasia will radically change the social air we all breathe by severely undermining
respect for life. ...

We, the undersigned, hold all human life to be sacred and worthy of the utmost respect and note with concern
that repeated attempts are being made to persuade Parliament to change the law on intentional killing so as to
allow assisted suicide and voluntary euthanasia for those who are terminally ill.

2005 open letter to the Houses of Parlliament from Britain's religious leaders

Right to die

The letter was published after Lord Joffe announced plans to re-introduce his private member's bill which would
give terminally ill people the right to die.

The 73-year-old peer planned to revamp the legislation and bring it back to Parliament in early November. This
was the third time he has introduced a bill to allow voluntary euthanasia or assisted suicide since 2003.

His previous legislation - the Assisted Dying for the Terminally Ill bill - ran out of parliamentary time before the
General Election.

But it prompted a House of Lords select committee review of the law on assisted suicide. The committee's
report was debated in the Lords on October 10, 2005.

Providing alternatives

Representatives of Britain's faith groups argued that the suffering of the terminally ill and dying could be
minimised through rapid advances in palliative care.

Providing good care does not require any change in the law but a reprioritisation of NHS resources in order to
ensure that adequate training is given to doctors and nurses and that centres of palliative care exist where they
can be accessed by those who need them. The argument that assisted suicide or euthanasia is necessary to deal
with the suffering of terminal illness is false.

2005 open letter to the Houses of Parlliament from Britain's religious leaders

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Other countries

Euthanasia in other countries

The letter also pointed to studies from Holland where euthanasia has been legal since 2001.

The Netherlands has the most liberal assisted suicide laws in the world. Under Dutch law, doctors can
administer a lethal dose of muscle relaxants and sedatives to terminally ill patients at a patient's request.

Britain's religious leaders claim that one in every 32 deaths in the Netherlands is a result of legal or illegal
euthanasia. In January 2005, a report in the Dutch Journal of Medicine alleged there had been 22 cases of illegal
euthanasia involving infants born with spina bifida.
"A similar law here could lead to some 13,000 deaths a year and Dutch pro-euthanasia groups are now,
moreover, campaigning for further relaxations of the law - for example, to encompass people with dementia,"
said the faith leaders.

They also claimed that many doctors in Oregon in the US, where the Death with Dignity Act of 1994 legalised
assisted suicide, were reluctant to help patients to die. In the UK, the religious leaders maintain that the largest
most recent surveys show that most British doctors do not favour a change in the law.

Amending the bill

After the debate in the House of Lords in early October, Lord Joffe indicated that he might be prepared to
amend his proposals so doctors would not be required to administer a lethal injection.

Instead, the bill would allow doctors to indirectly help people die by prescribing drugs for patients to take
themselves. This procedure is known as physician-assisted suicide.

The British Government is neutral on the issue of voluntary euthanasia but has indicated that Lord Joffe's
revised bill may be given parliamentary time when it is introduced in November.

The bill is unlikely to become law but an amended version could win support from the medical community.

In another unprecedented move, the British Medical Association dropped its historic opposition to euthanasia
during 2005, adopting a neutral stance on the issue.