On April 10 the Dutch Senate voted 46 to 28 to legalize the act of euthanasia. This landmark in bioethics history makes the Netherlands the first nation ever to legalize euthanasia. Under this new legislation, euthanasia is still punishable by up to 12 years of imprisonment unless a number of clinical requirements are met. The requirements are that a patient’s request must be voluntary and carefully considered, suffering must be unbearable and clinical course hopeless. An independent physician must be consulted beforehand and a municipal coroner must be notified following the patient’s death. The law also allows patients a written request for euthanasia to give doctors the right to use their discretion when patients become too physically or mentally ill to decide.

With the legalization of euthanasia in the Netherlands the question of euthanasia is once again opening all over the world. The cases of Karen Ann Quinlan, Baby Doe, Dr. Jack Kevorkian and more are coming into the spotlight all over again and people are once again questioning the right of euthanasia. However there is a lot to euthanasia and the right to decide the right to die requires full knowledge of the subject matter. There is a lot about euthanasia including the meaning, the importance, the history, the methods, the possible future dangers, the controversy, and the available solutions.

First and most importantly is the definition of euthanasia. There are two types of euthanasia and it’s very important that the two are clearly distinguished. The two types are passive and active euthanasia. Passive euthanasia, also known as “mercy-killing”, is known as the practice of “allowing” one to die by withholding or withdrawing life support and is generally accepted. The purpose of passive euthanasia is to discontinue treatment that will not benefit the patient in any way other than prolonging their death.

Active euthanasia is known more as killing someone in an act of kindness, such as injecting a lethal drug to help a person end his or her life to his or her request. Unlike passive euthanasia, active euthanasia is still generally unaccepted. An example of active euthanasia would be the cases of Dr. Jack Kevorkian. Dr. Kevorkian euthanized terminally ill patients who were still active but wanted to die.

Euthanasia is a very important issue all around the world and not just in the Netherlands. In Germany the people absolutely reject the notion of doctor assisted euthanasia. However in Germany assisted suicide is not illegal. There are also many associations dedicated in assisting those who wish to commit suicide in finding a quick painless method to die. In Canada 75% of people in 1991 said that euthanasia was acceptable. Belgium is likely to be the next country to seriously consider the legalization of euthanasia. France and New Zealand have very strong pro-euthanasia lobbies. Euthanasia has become a worldwide issue.

Euthanasia is very important to us because of its common occurrence. An estimated 70% of the 6,000 daily deaths in the US are a result of people agreeing to withdraw a life-support mechanism. At the same time an estimated 10,000 patients remain in a Persistent Vegetative Coma, the oldest of which lasting since 1951. The total annual cost to care for children in vegetative comas range from $120million - $1.2billion. Euthanasia and opportunities for euthanasia probably occur much more often than most anyone would suspect. Its common occurrence is reason enough to seriously consider the passing of euthanasia laws.

Euthanasia is also especially important issue to our world because of our modern technology. Until very recently, doctors did not have the equipment they have today to keep people alive. Doctors couldn’t even resuscitate patients after they had lost respiration or circulation. However with the modern medical technology available to doctors today, doctors can keep terminally ill patients all for months or years in pain or a coma. Doctors can instantly bring treatment to wounded soldiers on the battlefield. The term mortally wounded and the army’s coup de grâce have become obsolete. The 2,500-year-old Hippocratic oath has also become obsolete. In a time when lives can be resuscitated and kept alive so easily by machinery, a doctor’s greatest concern is no longer to keep a patient alive but to give the patient the best treatment he can. Often the best and most rational treatment for the patient is death.

Euthanasia is a very new idea but the concept has deep roots in history. The word euthanasia goes back to the ancient Greeks. In Greek “eu” means “well” and “thanatos” means death so “euthanasia” means, “well death”. The term “death with dignity” often associated with euthanasia was coined by Binding and Hoch in their book The Release of the Destruction of Life Devoid of Value in Germany 1920. Their movement believed everyone had “the right to the complete relief of an unbearable life”. But what is defined as an unbearable life? The ancient Japanese believed that a warrior who has lost in battle or suffered any other kind of dishonor had “an unbearable life” and deserved the right to death. During World War 2 the Nazis believed that Jews, Gypsies, homosexuals, the disabled, the elderly and more to have “unbearable lives”. This resulted in millions of “mercy killings” including 100,000 deaths of the disabled.

Considering how often euthanasia is performed, many people wonder if the methods for euthanasia are painless and humane. There are thousands of ways to die and different physicians will use different methods. The lethal injection and carbon monoxide poisoning are the most common. The most famous of methods for euthanasia would be Dr. Jack Kevorkian’s “suicide device”. Dr. Kevorkian’s “suicide device” works similarly to a lethal injection machine used in executions. The machine was three upside down glass bottles fixed on a metal frame. The machine was made to carefully time the release the contents of each of the three bottles resulting in a painless lethal injection. The first chemical released was a saline solution, the second was a sedative and the third and final chemical was potassium –chloride, a lethal poison.

Dr. Kevorkian’s “suicide device” worked well and efficiently in its objective but that’s not always the case. Problems in euthanasia can include completion problems (longer than expected time till death, failure to administer coma, and waking after coma had been applied), technical problems (failure to administer drugs properly), and complications (e.g. vomiting, nausea, cyanosis, spasm, etc.). As we know from the Dutch, for the 535 patients who had no problems, completion problems occurred on 28 occasions, technical problems affected 24 patients and complications arose in 14 patients. As reported by Dutch doctors, some of these problems were extremely distressing. Some patients kept their eyes open or even sat up during the ordeal. Some complications included tachycardia, excessive mucus production, perspiration and extreme gasping. Of course not all cases worked perfectly but the vast majority of cases did go well. After all medical curriculums cover very little about end-of-life care.

Such pain rarely encountered during death is exactly what the purpose of euthanasia is against. Unfortunately, as was mentioned, it doesn’t always quite work. Atleast the great pain was minimized to a short moment instead of a lifetime, accomplishing exactly the purpose of euthanasia. Doctors have the duty to relieve pain and treat patients and sometimes death is the only treatment available. If procedures can reasonably be expected to only cause suffering without any benefit to the patient, they ought not to be done since they would accomplish nothing. Doctor’s shouldn’t waste their time or the patient’s well being with treatments that do nothing. Even if the available treatment will extend the patient’s life, but only a painful life, the procedure ought not be done. It’d be more like extending suffering instead of extending life. The only true way to relinquish all pain would be to enter unconsciousness. However that would only be equivalent to death since no one would be able to benefit from life while unconscious.

In 1973 at the age of 26, Donald Cowart had more than 65% of his body burned when leaking gas in a field exploded killing his father. When paramedics arrived, Cowart asked the paramedics to kill him but the paramedics were duty-bound to save lives and refused. At the hospital Cowart went under a series of treatments, operations, amputations, as well as several suicide attempts until finally he could return to life. Cowart lost both his eyes, almost all his fingers, and had to learn to walk again. Upon returning to life Cowart completed Law School, changed his named to Dax Cowart, to celebrate his new “more cerebral self”, and now appears at many bioethics conferences. Despite his successful life he still wishes he had been allowed to die. Dax Cowart now advocates for the right for individuals to make their own life-sustaining decisions.

Despite what may seem like the many benefits to euthanasia, there are still many dangers. If euthanasia is legalized, it’s really only a matter of time before a totalitarian society is set up choosing who and who doesn’t have the right to live. We would be no different from the Nazis and the way they euthanized thousands of innocents. We would be playing God deciding who lives and who doesn’t. Granting people the right to their own life-sustaining decisions would also result in incompetents and the depressed with distorted minds about the value of life deciding to die. There are also alternatives to euthanasia in which one can still die in dignity, for example hospices. Also even if a situation looks hopeless, there is always chance, albeit a small one, that the patient will survive awaken from a PVS (Persistent Vegetative State).

Jackie Cole is such a person, who when it seemed impossible that she’d wake up, she did. At age 43 Jackie Cole suffered a stroke with massive bleeding to the head. Doctors didn’t expect her to live much longer than two days but thanks to life-support systems, Jackie survived but in a PVS. Jackie had once stated that if she ever entered a PVS, she would prefer to die. Harrie Cole, Jackie’s husband, tried to obtain the right from a judge to remove life support but was denied. Six days later Jackie awoke from her coma and over the passing months, recovered from her stroke. Harrie Cole wrote this series of events in the book One in a million.

The story the Cole’s or Dax Cowart is what people most likely think of when they think of euthanasia. Someone very near death who wants to end their suffering with death. However very many cases of euthanasia have to deal with infants born with deformities. The famous of such incidents would be the story of Baby Doe. Baby Doe was born a boy on 1982 in Bloomington Indiana. He suffered from severe retardation and a malformed esophagus. The doctors could have performed surgery on the malformed esophagus but the parents refused. Besides that still would have not fixed the retardation. Baby Doe’s parents and doctor felt as though Baby Doe should be allowed to die, but the doctor was hesitant and asked four other doctors whether he should treat the baby or let it die. Two doctors agreed but two others didn’t. They decided to let Baby Doe die so they cut off all nourishment. The hospital management didn’t agree with the course of treatment and went to the county court. The county court ruled that the parents had the right to decide their child’s treatment. The prosecution was still unsatisfied and took the case to the Indiana Supreme Court, which ruled the same. The prosecution wanted to bring the case to the US Supreme Court but Baby Doe was already dead.

People were outraged by the Baby Doe incident. What especially outraged some was the particular manner in which Baby Doe died. Instead of active euthanasia, Baby Doe died of starvation and dehydration. Within a year of the Baby Doe incident, the Department of Health and Human Services under the Reagen administration issued regulations known as the “Baby Doe Guidelines”. Medical and Pediatric groups were angered since this law made treatment necessary for even the truly hopeless situations. Cases that would be classified as truly hopeless include anencephaly (brain-absent infants). Anencephalic infants can be kept alive biologically but have no opportunity for an improved life. In 1984 Congress passed legislation that allowed exemption of infants with an irreversible coma or in a PVS.

Infant euthanasia is one of the biggest issues of euthanasia because the infant isn’t voluntarily choosing his death unlike a case with adults. But for most of these affected infants, they will only enter a life of pain, suffering, and disease only to die early. Active euthanasia quickly and peacefully leads to that last death part without all the suffering in between. Death liberates the infant from a life of pointless, dehumanizing treatment. Active euthanasia would also be more effective than passive euthanasia since passive euthanasia would result in unnecessary suffering.

Brian West is a story of a child who was hopeless from the start but was still forced to go through unnecessary suffering. Brian West was born in 1980 with Down Syndrome and an abnormal esophagus. Because of the Baby Doe guidelines, West had to be kept alive. His parents denied surgery for the esophagus because of a very low success rate. West survived for two years but his life was pure hell. He had numerous visits to the hospital and multiple surgeries. He had several cases of pneumonia and once his heart stopped. Once his stomach acid backed up his esophagus and caused severe burns all over his body. When his parents came to visit, he was screaming in pain. Brian West had to go through two years of hell only to die early because euthanasia was illegal.

Even though euthanasia for infants may seem to provide many advantages, there are also very many dangers. The real only cause for infant euthanasia is because the parents are selfish. They simply want a child who’ll grow up to be a rocket scientist or track star. As soon as they hear they can’t, they suddenly want to kill the child. This is the biggest step we can take into become a totalitarian society. We would be no different from the Nazis deciding who lives and who dies. Disabled children are still children and deserve a chance at life just as much as any other child. So called “hopeless” situations are simply not given a chance and may even have surprising outcomes.

Baby Jane Doe, was one of those “hopeless” situations that turned out surprisingly. Baby Jane was born in 1983 before the revision of the Baby Doe regulations. Baby Jane Doe had spina bifida, a genetic disorder that results in an opening in the spine, some kidney damage and excess fluid to the brain. Baby Jane Doe seemed to be a hopeless cause but she ended up surviving much longer than any doctors expected. After four months her brain was drained of fluids and after six months her spine closed on its own. Baby Jane Doe now attends a school for the handicapped in a wheel chair. Her intelligence is above educable and below below-normal intelligence.

When faced with terminal illness, euthanasia is not the only way to go. There are some alternative treatments. One mentioned was hospices. Hospices are basically institutes for the terminally ill to live out the rest of their lives in a friendly home-like setting. Their purpose is to help people accept death and try to make as much out of whatever remainder of their life they had. Cicely Sanders established the first hospice, Saint Christopher’s outside London, in 1967 after she saw how poorly doctors treated terminally ill patients. In 1974 the first hospice started in America in Connecticut and since, over 1,800 hospices have been opened nationwide. Despite how great a hospice may sound, there are still some who would object to how hospices are run. Hospices want patients to die naturally and thus strictly restrict any medical intervention. This includes the restriction of painkillers resulting in a very physically painful existence for patients staying at a hospice. Hospice management say they carry the restriction of all medical intervention to prevent corrupt doctors from performing unnecessary last minute treatments for more money.

Some solutions have been made to solve some problems of euthanasia and these solutions include Living Wills and Durable Power of Attorney orders. A large problem with euthanasia is that the patient is often incapacitated and therefore unable to consent to his or her own death. A living will is a legal document stating a person’s wishes concerning medical treatment when that person is incapacitated. It puts in advance that person’s wishes to be killed or not when placed in such a situation. The problem with living wills is that the patient has no idea what his situation will be ahead of time. Therefore he has no prior knowledge of his particular situation and living wills are not detailed enough to account for every kind of situation.

Another solution would be a Durable Power of Attorney order. A Power of Attorney order is a legal statement that states exactly who a patient would want to make the decision for life or death when that patient is incapacitated. The patient is basically asking for someone to act on his behalf when he himself is incapable. Unlike living wills, Power of Attorney can adjust to any particular situation since someone is at the scene. Power of Attorney also prevent any possible problems that someone close may be acting in negligence or not in good faith. The problem is that the chosen directive may have become incompetent or the patient may have been incompetent when choosing a directive. Also it is not a requirement that the directive have nothing to gain from the patient’s death. The directives even have the right to act over a doctor giving even more opportunity to benefit off of the patient’s death.

There is still also the option of Do-Not-Resuscitate orders. Do-Not-Resuscitate Orders, called DNRs for short, are a long-standing practice. They are a legal form given to terminally or chronically ill patients to sign if they do not wish to be resuscitated if their breathing or heart ever stops. At home or hospice patients wear special arm or leg bands stating their DNR for paramedics so that they will not be revived.

There’s no reason why the government should restrict people from deciding when they’re own lives are no longer worth living. People deserve to have their own choice concerning their own lives and there’s absolutely no reason why anyone should stop them. Everyone will agree that everyone has they’re own different set of morals and they’re own different set of beliefs so there’s no reason why everyone’s own different choice of death should be the same. It’s their own choice for their own life and as the saying goes, to each their own. If the patient is mentally unstable, if they still suffer intolerable pain and many doctors and family agree that euthanasia would be the best choice, then they should be let to die. Otherwise, they should seek mental help.

Living wills and Durable Power of Attorney orders also need to be used more often too. Quite often they are not used because people who live ordinary, safe lives don’t expect to one-day wind up incapacitated near death in a hospital. They may not be perfect systems but the advantages presented by such options far outweigh the risks, especially Durable Power of Attorney. Living wills may be unable to adjust to a particular situation but atleast they portray a patient’s general opinions on death. Durable Power of Attorney even adjusts to ever kind of situation and it’s the patient who chooses their directive and they know that their chosen directive will make the right choice.

The question of infant euthanasia is much more difficult problem and will probably remain a question for much longer. Infant euthanasia is somewhat similar to abortion and abortion has already been debated for decades. Infant euthanasia will probably be debated for decades as well. Infant euthanasia is a true step into becoming a totalitarian choose who lives who dies society. Parents would be choosing which infants will live and which will die to their own preferences. Birth may even become a trial and error quest in search of the perfect child for parents. Infant euthanasia should be done only in very hopeless situations. A bioethics council largely composed of pediatricians should define exactly what is hopeless.

The debate over euthanasia is a debate that is happening right here and right now. Euthanasia is one of the hottest new controversies in the news especially with the Netherlands most recent reform. Right now the world seems to be heading in the favor of euthanasia. As mentioned before many nations are already dominantly pro-euthanasia and some nations are very near to seriously considering its legalization. The United States is likely to follow. The reform to euthanasia will happen anytime soon but will likely happen in the future. However the future does hold many unknowns. Who knows what might happen?