Euthanasia refers to deliberately ending someone’s life, usually to relieve suffering. Doctors sometimes perform euthanasia when it’s requested by people who have a terminal illness and are in a lot of pain.

It’s a complex process and involves weighing many factors. Local laws, someone’s physical and mental health, and their personal beliefs and wishes all play a role.

Read on to learn more about the different types of euthanasia, when they’re used, and where they’re legal.

There are several types of euthanasia. What’s chosen depends on a variety of factors, including someone’s outlook and level of consciousness.

Assisted suicide vs. euthanasia

Assisted suicide is sometimes called physician-assisted suicide (PAS). PAS means a doctor knowingly helps someone end their life. This person is likely experiencing persistent and unending suffering. They may have also received a terminally ill diagnosis. Their doctor will determine the most effective, painless method.

In many cases, doctors will provide people with a drug they can take to end their life. A lethal dose of opioids, for example, may be prescribed for this. In the end, it’s up to the person to decide whether they take the drug.

With euthanasia, a doctor is allowed to end the person’s life by painless means. For example, an injection of a lethal drug may be used.

Active vs. passive

When most people think of euthanasia, they think of a doctor directly ending someone’s life. This is known as active euthanasia. Purposely giving someone a lethal dose of a sedative is considered active euthanasia.

Passive euthanasia is sometimes described as withholding or limiting life-sustaining treatments so that a person passes more quickly. A doctor may also prescribe increasingly high doses of pain-killing medication. Overtime, the doses may become toxic.

This makes the distinction between passive euthanasia and palliative care blurry. Palliative care focuses on keeping people as comfortable as possible at the end of their life.

For example, a palliative care doctor might allow someone approaching death to stop taking a medication that causes unpleasant side effects. In other cases, they might allow someone to take a much higher dose of a pain medication to treat severe pain. This is often a standard part of good palliative care. Many don’t consider it euthanasia.

Voluntary vs. nonvoluntary

If someone makes a conscious decision to seek help with ending their life, it’s considered voluntary euthanasia. The person must give their full consent and demonstrate that they fully understand what will happen.

Nonvoluntary euthanasia involves someone else making the decision to end someone’s life. A close family member usually makes the decision. This is generally done when someone is completely unconscious or permanently incapacitated. It usually involves passive euthanasia, such as withdrawing life support from someone who’s showing no signs of brain activity.

People have debated over the ethics and legality of euthanasia and PAS for centuries. Today, laws about euthanasia and PAS are different across states and countries.

In the United States, PAS is legal in:

  • Washington
  • Oregon
  • California
  • Colorado
  • Montana
  • Vermont
  • Washington, D.C.
  • Hawaii (beginning in 2019)

Each of these states and Washington, D.C. have different legal requirements. Not every case of PAS is legal. In addition, many states currently have PAS measures on legislative ballots, so this list may grow.

Outside the United States, PAS is legal in:

  • Switzerland
  • Germany
  • Japan

Euthanasia, including PAS, is legal in several countries, including:

  • the Netherlands
  • Belgium
  • Luxembourg
  • Colombia
  • Canada

Euthanasia is a topic of ongoing debate. There’s been a good amount of research done about people’s opinions about it and how frequently it’s actually used.

Opinions

A 2013 poll in the New England Journal of Medicine found that 65 percent of people in 74 countries were against PAS. In the United States, 67 percent of people were against it.

However, a majority in 11 of the 74 countries voted in favor of PAS. Plus, a majority of voters in 18 U.S. states expressed support for PAS. Washington and Oregon, which had legalized PAS at the time of the poll, weren’t among those 18 states. This suggests that opinions about euthanasia and PAS are rapidly changing.

By 2017, a Gallup poll found a large shift in attitudes in the United States. Almost three-quarters of people surveyed supported euthanasia. Another 67 percent said doctors should be allowed to assist patients with suicide.

Interestingly, a study in the United Kingdom found that the majority of doctors weren’t in favor of voluntary euthanasia and PAS. Their main objection was based on religious issues.

Prevalence

In countries where it’s legal, a 2016 review found euthanasia accounts for 0.3 to 4.6 percent of deaths. More than 70 percent of those deaths were related to cancer.

The review also found that in Washington and Oregon, doctors write less than 1 percent of prescriptions for assisted suicide.

There are many arguments both for and against euthanasia and PAS. Most of these arguments fall into four main categories:

Morality and religion

Some people believe euthanasia is murder and find it unacceptable for moral reasons. Many also argue that the ability to decide your own death weakens the sanctity of life. In addition, many churches, religious groups, and faith organizations argue against euthanasia for similar reasons.

Physician judgement

PAS is only legal if someone is mentally capable of making the choice. However, determining someone’s mental capabilities isn’t very straightforward. One study found that doctors aren’t always capable of recognizing when someone is fit to make the decision.

Ethics

Some doctors and opponents of PAS are concerned about the ethical complications doctors could face. For more than 2,500 years, doctors have taken the Hippocratic oath. This oath encourages doctors to care for and never harm those under their care.

Some argue that the Hippocratic oath supports PAS since it ends suffering and brings no more harm. On the other hand, some debate it results in harm to the person and their loved ones, who must watch their loved one suffer.

Personal choice

“Death with dignity” is a movement that encourages legislatures to allow people to decide how they want to die. Some people simply don’t want to go through a long dying process, often out of concern of the burden it puts on their loved ones.

Making decisions about PAS for yourself or a loved one is extremely difficult, even if everyone’s in complete agreement.

The National Hospice and Palliative Care Organization offers many free resources on their website through their CaringInfo program. This program is designed to help people navigate complicated end-of-life issues, from state laws to finding spiritual support.

The National Institute on Aging also has great resources. They provide important questions to ask and tips for talking to doctors and other medical professionals about end-of-life care.

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