In popular media, the question often posed is: should euthanasia be legal?
There are several things about the phrasing of this question that are misleading. First–and this may surprise you–certain forms of euthanasia are in fact legal in the United States. Second, the question regarding euthanasia and legality, as most popular media refers to it, is actually a question of active/voluntary/physician-assisted euthanasia and its subsequent legality. And lastly, contention with regards to euthanasia is most often connected with the idea or possibility of the occurrence of passive or active/involuntary/physician-assisted euthanasia or as it is more commonly called: a form of homicide.
It is clear that popular media does little to distinguish between various forms of euthanasia and at best conflates a large number of issues surrounding euthanasia. This in turn serves to further complicate any discussion regarding it. With that being said and given that the passing/rejecting of some landmark legislation is in the not too distant past, I want to take this opportunity to consider the topic of euthanasia. Because the topic is incredibly complex, this will most likely be one of several posts concerning itself with euthanasia. In this post, I simply intend to present and generally define some terms and provide an overview of euthanasia in the United States*. In (a) later post(s), I intend to look more closely at the euthanasia debate itself.
*Note: I will only be discussing states that have legislation regarding euthanasia; I am not treating states that have case precedents regarding euthanasia (i.e. Montana, Texas, etc.)
The euthanasia debate spans a large number of fields and theoretical orientations and I believe it can be agreed upon that decisions regarding euthanasia are incredibly complicated due to a confluence of factors encompassing religious, medical and philosophical changes over the centuries. The complicated nature of this social issue necessitates defining euthanasia as well as utilizing a structure of conceptualization that is categorical in nature. According to Pfeifer and Brigham (1996), euthanasia, as an overarching concept, refers to any action or inaction by an individual to encourage the death of another who is suffering from a terminal condition. There are three subcategorical distinctions: active and passive; voluntary, nonvoluntary, and involuntary; and physician-assisted and nonphysician assisted. Conceptualizing euthanasia in this manner enables one to concretely and distinctly describe an act of euthanasia (e.g. passive/physician-assisted/ voluntary euthanasia, active/nonphysician assisted/voluntary euthanasia, etc.). Moreover, it also, according to Pfeifer and Brigham (1996), enables one to begin to investigate and gain a more concise understanding of current attitudes toward euthanasia.
The terminology and subsequent definitions you encounter below were taken from the introduction written by Pfeifer and Brigham for the Journal of Social Issues: Psychological Perspectives on Euthanasia (1996) unless otherwise stated.
Active and Passive
Active euthanasia is defined as an act of commission in which a person engages in some direct action in order to hasten the death of a terminally-ill individual.
Passive euthanasia is defined as an act of omission such as the issuance of a DNR instruction by a physician that results in the death of a terminally-ill patient.
Voluntary, Involuntary, and Nonvoluntary
Pfeifer and Brigham (1996) do not distinguish between, and actually conflate, involuntary and nonvoluntary euthanasia. Recently, and in particular among journals concerned with ethics and/or law, a distinction between these two terms is prevalent.
Voluntary euthanasia applies to circumstances in which an individual’s wish to die is known and/or expressed through directives such as verbal statements, living wills, etc.
Harris (2001) and Jackson (2006) are more specific in their language and apply voluntary euthanasia to circumstances in which a patient is able to and does provide informed consent. This encompasses directives such as verbal statements, living wills, etc.
Nonvoluntary euthanasia applies to circumstances in which the individual is unable to specifically indicate his or her wish regarding death.
Harris (2001) and Jackson (2006) are more specific, stating that nonvoluntary euthanasia applies to circumstances in which the patient is unable to give informed consent, for example when a patient is in a persistent vegetative state, if the patient is a child, etc. Nonvoluntary contrasts with involuntary, according to Jackson (2006), as follows:
Involuntary euthanasia applies to circumstances in which euthanasia is performed on a person who is able to provide informed consent, but does not either because they do not wish to be euthanized or because they were not asked.
Physician-assisted and Nonphysician assisted
Physician-assisted euthanasia applies to circumstances in which a physician assists an individual.
Nonphysician assisted euthanasia applies to circumstances in which a nonphysician assists an individual.
Euthanasia in the United States
We have, over the years, witnessed cases and lawsuits arise due to acts involving active/voluntary/physician-assisted euthanasia (i.e. Dr. Kevorkian, etc.); active and passive/voluntary/nonphysician assisted euthanasia (i.e. cases in which someone fulfills the request to die of another); and active and passive/nonvoluntary/physician-assisted euthanasia (i.e. Terri Schiavo, etc.). Given this and the outcomes of these various cases, it is obvious that euthanasia is both contentious and complicated at best nor entirely legal or illegal.
Typically within the United States patients retain rights to refuse medical treatment and elect appropriate management of pain even if it may hasten their death via explicit consent, advanced directives, living wills, etc.. Even though the average American may not conceptualize this as a form of euthanasia, it is. And, more specifically, it is a passive/voluntary/physician-assisted form of euthanasia. In popular media, I have rarely seen these rights referred to, let alone referred to in the context of euthanasia. However, a lot of media attention is given to active euthanasia, especially cases in which the euthanasia is contested by a party to have been involuntary. Active euthanasia of any kind is not legal in most states. However, there are exceptions. According to the Death with Dignity National Center (2012), two states enacted acts legalizing and allowing residents to elect active/voluntary/physician-assisted euthanasia. These two states are Oregon and Washington. In Oregon and Washington, these acts allow “mentally competent, terminally-ill adult state residents to voluntarily request and receive a prescription medication to hasten their death” (Death With Dignity National Center, 2012). The acts passed in both Oregon and Washington have their origins in a movement referred to as the Death with Dignity movement. This movement’s purpose is to provide options ranging from advance directives to physician-assisted dying so that those facing terminal conditions may take control of their own end-of-life care.
Currently, according to the Death with Dignity National Center (2012), there are six states (Hawaii, New York, Massachusetts, New Jersey, Vermont and Pennsylvania) considering death with dignity-related legislation and two states that have banned death with dignity-related legislation concerning active/voluntary/physician-assisted euthanasia (Georgia and Louisiana). In Hawaii, legislation was introduced in 2011 and carried over to the 2012 Regular Session, which adjourned May 3; The bills have not moved forward. In New York, legislation was introduced in February; the legislature enacted clause stricken on May 9th. On November 7th, Massachusetts voters defeated the bill introduced to their legislature by a narrow margin of 51 percent to 49 percent with 96 percent of precincts counted (Boston Globe, 2012). In New Jersey as of September 27th, the legislation has been referred to Assembly Health and Senior Services Committee. In Pennsylvania, their bill was referred to Judiciary committee in February of 2011 and is currently active for consideration. And in Vermont, their bill was referred to Senate Committee on Judiciary in March 2011 and the House Committee on Human Services in February 2011. The bill received a hearing in Senate Judiciary Committee on March 2012. Supporters of the bill worked to give all the Senators an opportunity to vote, and, according to the Death with Dignity National Center (2012), used a Senate rule which allows certain pieces of legislation to be voted on as an amendment instead of as a self-standing bill. Vermont’s legislative session adjourned on May 5th.*
Considering the number of states that have/are entertaining death with dignity-related legislation, it is apparent that the death with dignity movement has made considerable advances both in its visibility and its number of proponents since the late 70s/early 80s. While I am not sure I can agree that euthanasia is “the most pressing social issue of our time” (Pfeifer and Brigham, 1996), I do believe it may be one of the most ethically complicated and contentious.
*NOTE: For more specific information about these bills or the acts in Oregon and Washington, please visit the Death with Dignity National Center website and follow the links to the appropriate resources. You may also visit your state legislature’s website.
Boston Globe, The. (7 Nov 2012). Mass. doctor-assisted suicide measure fails. Retrieved 8 Nov 2012 from http://www.boston.com/news/local/massachusetts/2012/11/07/backers-mass-doctor-assisted-suicide-concede/oXZDcgOUbqwhlqzb63FSPO/story.html.
Death with Dignity National Center. (2012). “Research Center: national efforts.” Retrieved 9 Nov 2012 from http://www.deathwithdignity.org/advocates/national
Harris, N.M. (2001). “The euthanasia debate.”J R Army Med Corps 147 (3): 367–70.
Jackson, J. (2006). Ethics in medicine. Polity. ISBN 0-7456-2569-X.
Pfeifer, J.E., Brigham, J.C. (1996). Psychological Perspectives on Euthanasia. Journal of Social Issues 52 (2): 1-11.