Euthanasia and voluntary assisted suicide

This blog examines the philosophical issues of euthanasia and voluntary assisted suicide, which is the painless killing of a human being with an incurable illness or injury, to relieve physical and psychological suffering. Euthanasia involves the intentional taking of life and has been the topic of much religious, moral, ethical, philosophical, legal and human rights discussion in Australia and around the world. This topic is a philosophical issue because there is no clear-cut right or wrong answer to it. Because of this it is a highly contentious and debatable issue, remaining illegal in most countries throughout the world. It is also a philosophical issue because it is one that is concerned with the nature of life with regard to ethics and the deeper meaning of life (and death). It discusses the definition of euthanasia, and some current practices around the world, and in particular in Australia. It will also look at the viewpoints of a few Philosophers with opinions for and against euthanasia and in particular it will discuss why they are for or against it, and the pros and cons of euthanasia and voluntary assisted suicide.

The term ‘euthanasia’ comes from the Greek words ‘eu’ and ‘thanatos’ and simply means an easy pain free death[i]. However, euthanasia is difficult to define. Broadly speaking, the following five definitions[ii] might be used:

1) Involuntary euthanasia refers to the termination of life against the will of the person killed

2) Non-voluntary euthanasia refers to the termination of life without the consent or opposition of the person killed

3) Voluntary euthanasia refers to the termination of life at the request of the person killed

4) Active euthanasia refers to a positive contribution to the acceleration of death

5) Passive euthanasia refers to the omission of steps which might otherwise sustain life.

In point four, the positive contribution to the acceleration of death can be referred to as the principle of double effect. This refers to the side effect being permissible if it is regrettable but inevitable, for example in the case of euthanasia, the giving of drugs to relieve pain is permitted, even if the side effect is the accelerated death of that person.

Dr Philip Nitschke[iii], an Australian medical practitioner based in the Northern Territory was asked in an interview by Monica Attard for ABC television Sunday Profile program on Sunday 15 July 2007 if he believed euthanasia would ever be legalised. He was confident in saying yes, and added “Since the Northern Territory, the Northern Territory was first in the world and that’s amazing and since that time there’s Oregon, there’s Holland, there’s Belgium, there’s Switzerland and there’s going to be other countries and as we see this whole cohort of baby-boomers head through to their twilight years, these are people used to getting their way.”

One such attempt was the Rights of the Terminally Ill Act 1995 (NT)[iv], which allowed for medically assisted voluntary euthanasia at the request of a terminally ill person. On 22 February 1995, the then Chief Minister of the Northern Territory introduced the Rights of the Terminally Ill Bill into the Northern Territory Legislative Assembly as a Private Member’s Bill. The Rights of the Terminally Ill Amendment Act 1996[v]was passed on February 1996. One key feature was that the amended Act required the number of doctors required to examine and certify that a patient met the statutory criteria under the Act to be increased from two to three. This Act also clarified the qualifications that the doctors have. The Rights of the Terminally Ill Act 1995[vi] commenced operation on 1 July 1996. The ‘Euthanasia Laws Bill 1996[vii]’ was later introduced on 9 September 1996 by Mr Kevin Andrews for the House of Representatives, to ensure debate with the direct intention of preventing the Northern Territory, the Australian Capital Territory and Norfolk Island from passing certain laws permitting euthanasia. Ten months later, the federal Parliament made the Rights of the Terminally Ill Act 1995 (NT) inoperative by amending the Federal Parliament of the Northern Territory (Self-Government) Act 1978. The ‘Euthanasia Laws Act 1997’ was assented to on March 27th 2007, and the Rights of the Terminally Ill Act 1995 (NT) was ultimately refuted.

Apart from ‘euthanasia’, other expressions not defined in the Bill are ‘mercy killing’, ‘intentional killing’, ‘palliative care’, ‘dying patient’, ‘medical or surgical measures’ and ‘medical treatment’. The Bill also does not explain what is meant by ‘medical or surgical measures meant for prolonging the life of a patient.’ The meaning of all these terms will determine the scope and effect of the Bill and as none of these terms has a fixed meaning, either legally or ethically, the absence of any definition of the terms in the Bill is problematic[viii]. Interestingly, the Euthanasia Laws Bill 1996 does not define ‘Mercy Killing’. A study of mercy killing cases dealt with by the Australian criminal justice system found that many perpetrators were treated leniently[ix]. As such, one could ask does the Euthanasia Laws Bill prevent reforming the law in relation to mercy killing and could such reform be regarded as having the effect of permitting mercy killing?

Euthanasia has been practised for several decades in the Netherlands, which has allowed the practise under controlled circumstances, but without laws stating such. In 1997 the state of Oregon became the first jurisdiction to enact an assisted-suicide law. The Netherlands and Belgium followed in 2002, legalizing both euthanasia and assisted suicide. In Switzerland, euthanasia and voluntary assisted suicide are not recognised and the Swiss Academy of Medical Sciences excludes assisted suicide from physician activities; however, Swiss physicians and non physicians are not prosecuted for altruistically assisting in rational suicide[x]. There have been several failed attempts to legalise euthanasia and voluntary assisted suicide in Australia.

In his paperEnd-of-Life Decisions in The Netherlands, 1990–2001’, Kerkhof[xi] concluded that the numbers of cases of euthanasia, assisted suicide, and ending of life without the patient’s explicit request in the Netherlands have stabilised over the years from 1995–2001, reducing the validity of one of the arguments against euthanasia. Physicians seem to have become more reluctant in their attitude toward ending life without the patient’s explicit request and the care taken in medical end-of-life decisions has noticeably improved. Kerkhof also states the problem of ending life without the patient’s explicit request is that these cases are very difficult to avoid; they bear a strong resemblance to cases of intensive alleviation of pain with probable life-shortening effects (the double effect), as well as do cases of terminal sedation, in which the shortening of life is usually minimal, the patient is unconscious at the moment of the decision, had nearly always previously expressed his or her wish for euthanasia, and in most cases there were consultations with family members and medical colleagues.

For Karol Wojtyla, Pope John Paul II and philosopher[xii], the understanding and implications of euthanasia were clear and he was against euthanasia, just as he was against other issues such as abortion and women’s roles within the Catholic Church. He believed ethical action found meaning only in the authentic understanding of the person, and that it was through actus homanus alone that the human being could reveal himself. If we kill for compassionate reasons, truth is not a consideration, and therefore such killing “must be called a false mercy, or more accurately a disturbing ‘perversion’ of mercy. True ‘compassion’ leads to sharing another’s pain; it does not kill the person whose suffering we cannot bear”[xiii]. Karol Wojtyla’s view was that the ultimate and most conclusive answer rests in the person as a reflection of God’s perfection. He also believed in what he called the I-thou dimension of community, in that we as humans are closely connected with others, and because thou is other than every single member of the community should be important to us, and should not be deliberately killed no matter what their condition[xiv].

The most infamous proponent of assisted suicide Dr. Jack Kevorkian claimed: “In my view the highest principle in medical ethics – in any kind of ethics – is personal autonomy, self-determination. What counts is what the patient wants and judges to be a benefit or value in his or her own life[xv]. Jack Kevorkian is well known for his controversial views in favour of euthanasia and for his online direction available to the public on how to perform euthanasia via the Mercitron, the final name for machine he devised allowing people to take their own lives. His view is that humans have the right to request and receive euthanasia, based on his belief that human suffering is inhumane and that all individuals have the right to make a choice[xvi].

In surveys of the Canadian general public[xvii], the fact that the participants involved were approaching their own deaths from advanced cancer makes this study persuasive. However, one cannot say if their general attitudes toward the legalisation of euthanasia may not be very different from those of the general population. They also found from a psychological perspective, prominent concerns with isolation and communication difficulties, existential issues regarding the loss of resilience and control, and symptoms of depression and hopelessness being more common among participants with a desire for hastened death. The only other psychological concern that occurred in over 50% of these participants was the sense of being a burden to others.

The term euthanasia versus assisted or voluntary suicide has enormous implications on the loved ones left behind to grieve, and the possible effect of suicide grief rather than grief associated with other death. As the term euthanasia implies, it is a very fine line between it being a more acceptable death or a suicide death. Hunt et al[xviii], and Bryant[xix] suggest the effects of the grief of those family members and loved ones left to grieve following death from euthanasia should be considered in the debate. It is not just the rights of the suffering person, but those of whom will become bereaved. Ross[xx] supports the notion that grief following a ‘normal’ death of a partner or loved one is a three to five year healing and recovery process, and that grief recovery following suicide is at least ten years, if ever. It seems there is very little in the debate on euthanasia, philosophical or otherwise that covers this issue.

In summary, it seems clear that each individual’s viewpoint on euthanasia will remain vehemently divided, based on one’s personal philosophical, religious or other beliefs and experiences. It is evident that physician assisted death is already occurring with the use of pain relieving drugs which speed up the process of death all around the world. What right do we have to impose our religious, philosophical or personal views onto another individual? The biggest debate will surely be the one for non-voluntary assisted suicide due to the implications of its possible abuse by physicians, hospital staff or family members. We could also say voluntary euthanasia is happening in ways we already term suicide.

With regard to dementia, euthanasia is an option many I talk to want legalised. And then, there are others who say, but what if I change my mind, but have no way of telling my legal guardian, once I have lost legal capacity? It is a very personal choice, and I suspect one the baby boomers in Australia are going to force the issue on. We would not treat our beloved pets in the same way we treat our beloved elderly or the sick, terminally ill or not. I find it incredibly sad that there are a few registered nurses who are teaching the elderly how to starve themselves to death, when they no longer want to live. Is this not more inhumane than a gentle injection, which is we would almost all willingly and proactively ask the vet to give to a pet with no quality of life left? Finally, I wonder why someone else has the right to tell me what is best for me, and determine my right to live or die…


[i] Thompson, P. (1995). ‘The law and active euthanasia: whose life is it anyway?’ Journal of Law and Medicine, 2(3), pp. 233-46.

[ii] Zdenkowski, G. (1996), An Occasional Paper of the Human Rights and Equal Opportunity Commission, University of New South Wales.

[iii] ABC (2007). Killing me softly: Dr Philip Nitschke: Sunday Profile, http://www.abc.net.au/sundayprofile/stories/s1979044.htm.

[iv] Parliament of Australia, (1996), Bills Digest 45 1996-97 Euthanasia Laws Bill 1996, http://www.aph.gov.au/library/Pubs/bd/1996-97/97bd045.htm.

[v] Parliament of Australia, (1996). Bills Digest 45 1996-97 Euthanasia Laws Bill 1996, http://www.aph.gov.au/library/Pubs/bd/1996-97/97bd045.htm.

[vi] Office of the High Commissioner for Human Rights (1996), Universal Declaration of Human Rights. United Nations Department of Public information, http://www.unhchr.ch/udhr/lang/eng.htm.

[vii] Human Rights & Equal Opportunity Commission (1996), Human rights and euthanasia, http://www.hreoc.gov.au/pdf/human_rights/euthanasia.pdf/.

[viii] Kuhse, H & Singer, P ‘Active voluntary euthanasia, morality and the law,’ Journal of Law and Medicine, 3(2) November 1995, pp.129-35.

[ix] Otlowski, M . (1993), Mercy killing cases in the Australian criminal justice system, Criminal Law Journal, 17(1), pp.10-39.

[x] Hurst, S., & Mauron, A. (2003), Assisted suicide and euthanasia in Switzerland: Allowing a role for non physicians, British Medical Journal, pp. 271-273.

[xi] Kerkhof, A. (2004), End-of-Life Decisions in The Netherlands, 1990-2001, Crisis: The Journal of Crisis Intervention and Suicide Prevention, 25(3), pp. 97-98.

[xii] Stevenson, K, 2005, Pope John Paul II, Pope John Paul II.

[xiii] Fernandes, A. (2001, December), Euthanasia, Assisted Suicide, and the Philosophical Anthropology of Karol Wojtyla, Christian Bioethics, 7(3), pp. 379-402.

[xiv] Fernandes, A. (2001), Euthanasia, Assisted Suicide, and the Philosophical Anthropology of Karol Wojtyla, Christian Bioethics, 7(3), pp. 379-402.

[xv] Conley, 1992, p. 11, Cited in Fernandes, A. 2001.

[xvi] Nicol, N & Wylie, H (2006), Between the dying the dead: Dr. Jack Kevorkian, the assisted suicide machine, and the battle to legalise euthanasia, Summersdale Publishers, London.

[xvii] Singer, P. A., Choudry, S., Armstrong, J., Meslin, E. M., & Lowy, F. H. (1995), Public opinion regarding end-of-life decisions: Influence of prognosis, practice and process. Social Science and Medicine, 41, pp. 1517–1521.

[xviii] Hunt, R, Fazekas, B. S., Luke, C. G., Priest, K. R. and Roder, D. M. (2002). The Coverage of Cancer Patients by Designated Palliative Services: A Population-Based Study, South Australia, 1999, Palliative Medicine, 16, pp. 403-409.

[xix] Bryant, C. (2003), Handbook of Death and Dying, Sage Publications Inc: USA. pp. 98-101.

[xx] Ross, K. (1987), Living with Death and Dying. MacMillan Publishing Co., Inc.: USA. p 184.

14 thoughts on “Euthanasia and voluntary assisted suicide

  1. On this topic, I need to add that I feel it is time we were all advised to add into our Medical Directives that all medication other than pain relief MUST be stopped at the time our QOL is very compromised, decided by medical staff and legal guardians, or ourselves if we are still competent to make the decision. This might make it easier for drs to take this next SENSIBLE and HUMANE step. Mostly, things like artificial resuscitation and gastric feeding tubes are all that is specified.

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  2. My experience in contrast, is that my wife’s Doctor came to me and asked me to agree to stopping all medication other than pain relief and essential medication prescribed many years before the onset of dementia. I was somewhat put on the spot with the decision, but agreed some days later, and expected the worst. Exactly the opposite happened. That was three years ago.I do not like these decisions as they imply a discretion over someone’s life, but no one else can make them so I just have to face the responsibility.

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    • We had to make the decision to uphold my father in law’s wishes, and it is very sad for everyone. It must have been dreadful to have had to make that decision for your beloved wife… with love and hope.

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  3. Dear Kate,

    Thanks for engaging on this subject.
    I feel compelled to offer some observations:
    You mention that point 4 of your series of definitions includes the principle of double effect. This is not the case. Double effect does not have the character of intending to cause death – intention to cause death is the primary characteristic of euthanasia, but it is not present in double effect which seeks to relieve symptoms even though such relief may contribute to an earlier than expected death (but is NOT intended).
    The most recent reports on the Netherlands data (2010) does show a decreas in deaths where there was no evidence of request or consent (down to 300 in 2010 from 550 in 2005), however, this is no cause for celebration for the 330 persons. Certainly, we do not know whether they would have consented, but they certainly didn’t have that choice! Choice (autonomy) is a big concern here – but it was denied to these folk.
    Further, what has not been highlighted int he media about the Dutch figures is the steep increase int he use of Continuous Deep Sedation from 8.3% of all deaths to 12.3% in 2010. Continuous Deep Sedation to relieve intractable symptoms is indicated in between 2 to 5% of deaths from chronic conditions – but the Dutch figures are at least 8% higher. My Dutch colleagues tell me that this disparity is effectively euthanasia where patients are sedated and then starved and dehydrated to death.
    Certainly, I have no problems with people considering euthanasia & assisted suicide as some kind of compassionate option, but the data points to the reality that, no matter what the regimen, some people will be at risk from abuse.
    I ask you: in pursuit of a ‘good death’in this manner (by legislative change) would you not be concerned that in pursuit of your ends, that others might lose their lives who didn’t want or express such a choice?

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    • Thanks for the update to my knowledge and understanding. In regard to your last comments, there is already risk of abuse, as doctors are making decisions to euthanase people anyway, and have done so for years! In pursuit of a ‘good death’, I would be concerned others might lose their lives, but as it is now, people are dying by suicide, and the label of that death, and the grief that follows is probably worse. The one thing that holds me up with legislative change, is that having been through a suicide grief, I do wonder if the members of a persons’ family, who do not agree with euthanasia, might have a suicide grief reaction… another consideration against legalising euthanasia. There are so many issues to consider, and many I’ve probably not even thought about!

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  4. Kate – thanks for bringing up this topic. As you know, I am a passionate supporter of VE. I have some pretty horrific symptoms from my dementia diagnosis, including untreatable and very high chronic pain, 24/7 constant chronic hunger and 24/7 thirst ……. and my only coping mechanism is to keep mentally distracted. If I evere can’t keep distracted I will be in agony from the hunger as it’s really bad.

    Unfortunately people who support VE will often kill themselves earlier than they wish because they must do it while they still have the mental and physical capabilities. And this is the situation with dementia.

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    • I fully understand your position, and your support of VE, as I always wonder what right does anyone have to deny you it? As suicide as a form of VE is the only option in this country, it brings with it a barrage of complicated grief too. Perhaps go overseas to a country where it is legal when the time comes, so your loved ones don’t feel the burden of suicide grief… just a thought. XOX

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  5. A really important and controversial topic with no right or wrong answer. You are correct it should be a personal decision, when one can not get better and suffers, a person should have the right to make the choice seeing as how they had NO choice in getting the disease. There is no tick list with terminal illnesses, no one is the same though may have the same name it is individual as the person is. I use to ask the nurses how do they not know the Dementia patient is in pain, there is no pain scale. Many of the family use to tell me, their loved one would not have wanted to ‘live’ like that. I hope there is change, I hope religion does not enter this, I hope politicians stay out of if and mostly I hope those that make these hard decisions do what is right for them

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    • Yes, it is a controversial topic, and important.

      What I forgot to add is I’m not sure I personally would want to euthanase myself, but would like the option of withdrawing from all medication except pain relief when my quality of life is reduced significantly. And I don’t want to have to starve myself to death!

      Often in aged care, the doctors refuse to allow this to happen, and stand in the way of allowing a person to die of natural causes. For example, if my dear husband had not flown home from NZ to enforce it, the dr and staff would have gone against dads wishes and sent him to hospital for IV antibiotics, even though the medical directives clearly stated no interventions at the stage he was at, which was palliative… this is a bigger problem that most would realise.

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      • Very good comment, Kate. No-one should be compelled to have life sustaining (pro-longing treatment in these circumstances. What many do not realize is that the law already allows for that and that doctors are protected in law from the risk of prosecution if they, at a patient’s request, simply make a patient comfortable and let nature take its course.

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      • What you and many others may not know Paul, is many doctors treating people in residential aged care facilities will not consider ceasing all medication other than pain relief even with medical directives drawn up – as they usually only refer to life support and gastric feeding tubes. Plus, they will say, but he or she hasn’t got a ‘terminal illness’!!! In my experience, they are still too scared to stop other medications… and will not let nature take its course.

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      • at the hospital I was DON, the Dr, families & I made the decision (informed) to withdraw life saving medications from the seriously Demented. It was a relief not only financially for the families but the patients didn’t suffer and it stopped nurses FORCING medication down the throats of those that spat them out. Simpler, nicer, kinder and is now policy to review ALL patients at least fortnightly. Some of those clients passed away peacefully within weeks others are still alive some 9 months later without medication intervention 😦

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