Euthanasia (Greek: ευθανασία - ευ "good", θανατος "death") refers to assisted dying. The assistance ends the life of a person or an animal, in a painless or minimally painful way. Euthanasia is most often performed in a merciful way, in order to end suffering. This article discusses euthanasia in humans; a separate article covers animal euthanasia.
This topic is often highly charged emotionally, politically, and morally. Terminology and laws shift over time and geographically and globally, causing a great deal of confusion.
Firstly there is some debate as to whether euthanasia refers to "letting die" or "allowing to die." (See terms: informed consent, decisional capacity, surrogate decision making, Living wills, Do Not Resuscitate) In the United States and the Netherlands, "letting die" or "allowing to die" refer to areas which the state consider ethically and legally acceptable and permissible. This includes the withholding and withdrawing of medical treatment such as dialysis or feeding tubes or hydration and nutrition. The last two being things which are associated with "love and caring" in most cultures. While the concept of holding off on those two things may be counterintuitive, as a body's major organ systems try to shut down, a dying person often feels most comfortable without any fluids or food. To do otherwise is like "force feeding" a body that does not "want" or need to be fed or hydrated, and doing so may actually cause physical discomfort and suffering.
In the UK this is usually only accepted when a newly born baby is born with certain physical or mental disorders.
In most other countries removing or denying treatment would usually be seen as murder. Usually, because in a growing number of law cases over the last 20 years, the jury has sided with the defendant.
Next are several summary statements defining what euthanasia can include,. These are followed by expanded definitions of each. Euthanasia (assisted dying) may employ methods that are either indirect or direct. Indirect methods of euthanasia are defined by a individual him or herself taking the final step inducing death. Direct methods are defined by the involvement of others (clinicians) who take the final step inducing death. Direct euthanasia can either be voluntary, nonvoluntary or involuntary. (See Karl Binding and Alfred Hoche for one of the first uses of the three types of euthanasia.)
Indirect euthanasia involves the indirect involvement of a clinician (e.g. physician, clinical nurse practitioner, pharmacist) as an agent who participates only by providing the means for a patient to induce his/her own death. This could mean writing or filling a prescription for medications in a quantity large enough to cause death when taken by the patient. This kind of assistance is currently legal in the American state of Oregon. It became legal in 1998 as a result of the "Death with Dignity Act" which was passed in the state in 1994. In politically and emotionally loaded terms, this is frequently referred to as physician-assisted suicide.
Direct euthanasia involves the direct involvement of a clinician as agent in inducing a patient’s death. (e.g. administering a lethal drug by injection.) Direct euthanasia is not currently legal anywhere in the US, but both direct and indirect euthanasia are legal in Belgium and the Netherlands.
Voluntary euthanasia occurs with the fully-informed request of a decisionally-competent adult patient or that of their surrogate (proxy). (Example: Thomas Youk, with ALS was assisted by Jack Kevorkian.)
A large part of the controversy surrounding euthanasia focuses upon the slippery slope argument. The fear is that indirect euthanasia and/or voluntary direct euthanasia will lead to acceptance of the nonvoluntary and involuntary types of euthanasia.