euthanasia research paper topics

130 Euthanasia Essay Topics

This compilation of research questions on euthanasia offers diverse perspectives. Examine the moral implications of assisted suicide or dissect the legal frameworks governing end-of-life decisions. You can foster informed discussions and critical reflections on one of the hottest ethical dilemmas of our time with the help of euthanasia title ideas below.

⚡ TOP 7 Euthanasia Research Questions

✍️ euthanasia essay thesis statement, 🏆 best euthanasia essay topics, ⚖️ euthanasia essay arguments for & against, 👍 catchy euthanasia research questions, 💡 simple euthanasia essay topics, 🎓 interesting euthanasia essay ideas, ❓ more topics for an euthanasia essay.

• Euthanasia Pros and Cons
• Euthanasia & Assisted Suicide Should Not Be Legal
• For and Against Euthanasia: An Ethical Perspective
• Aristotle Theory About Euthanasia – Ethics
• Euthanasia: Advantages and Disadvantages
• Opinions About Euthanasia: For and Against
• Euthanasia – Mercy Killing or Assisted Suicide

Once you’ve chosen a topic for your essay, it is vital to formulate a proper thesis statement. With a well-crafted thesis statement, you will have a clear focus and tone, helping readers to anticipate the key ideas and arguments. Let’s see how to do it for an euthanasia essay.

Writing a thesis statement on the complex topic of euthanasia requires precision and consideration of the various aspects and ethical dilemmas. Here are some tips to help you craft an effective thesis statement on euthanasia:

Euthanasia Thesis Statement Examples

Now, let’s look at good examples of thesis statements for euthanasia essay.

Example 1: This essay raises intricate ethical dilemmas of euthanasia at the intersection of individual autonomy and societal values. Exploring cultural, religious, and medical perspectives, it will navigate the complexities surrounding end-of-life choices. Moreover, it promotes an open dialogue that respects personal autonomy and recognizes the broader implications on medical practice and societal norms.

Example 2: The ethical discourse surrounding euthanasia hinges on the balance of compassionate relief from suffering and preserving the sanctity of life. This essay critically examines the moral dimensions of physician-assisted suicide, considering the rights of individuals to die with dignity while addressing the ethical responsibilities of medical professionals.

Example 3: Euthanasia challenges societies to reconcile personal autonomy with the value of life. This essay explores the ethical and legal contours of euthanasia and the implications of its various forms on patients and medical practitioners. It also highlights the need for comprehensive and compassionate end-of-life care options.

• Euthanasia – For Legalizing Euthanasia is not the same as other practices such as Physician-Assisted Suicide, Terminal Sedation or Withholding/Withdrawing Life-Sustaining Treatments.
• Euthanasia Through an Egoism Ethical Theory Lens The paper states that it is possible to justify the factors contributing to the desire for euthanasia through the ethical theory of selfishness.
• Euthanasia and Morality Debate Euthanasia may be defined as the assistance provided to people who deliberately want to die due to suffering too much pain because of being terminally ill.
• Ethical Dilemma: Euthanasia The present paper compares the Christian worldview to own worldview assumptions of euthanasia.
• Euthanasia Decision Regarding Christian Worldview This paper has revealed that religious worldviews can guide people to make evidence-based decisions whenever dealing with complex issues, such as suicide and euthanasia.
• Euthanasia: A Child’s Right to Die Euthanasia needs to be considered as a viable option only under specific circumstances, which leave no alternative option for the patient’s dignity.
• Why Euthanasia Should Not Be Legalised Euthanasia legislation is typically championed by individuals who have experienced a loved one dying under unfavorable conditions.
• Euthanasia from Religious Perspectives The article analyzes the views on euthanasia from the point of view of the Jewish, Christian, and Islamic religions.
• “Active and Passive Euthanasia” by Rachels The purpose of the paper is to discuss the philosopher’s position and the argument in favor of the claim as well as to analyze them.
• Euthanasia and Moral Reasoning Voluntary euthanasia may be morally acceptable because a terminally ill patient whose life functions are disrupted cannot live life to its full extent and pursue happiness.
• Legalizing Euthanasia: Pros and Cons Euthanasia should be a fundamental right because it gives patients the power to make conscious decisions about their fate.
• Euthanasia: Social Values and Nursing Practice Euthanasia has negative implications as it fails to recognize the value of human life. It also has negative effects on families and it leads to distress and devastation.
• Ethical Considerations Supporting Euthanasia In this paper, the case of the Oregon Death with Dignity Act will be reviewed as an example of legalized assisted dying in the USA.
• Euthanasia – The Essential Right to Die The phenomenon of euthanasia occurred with the development of social progress and in particular science and technology related to the maintenance of life seriously ill people.
• Euthanasia for Terminally Ill and Religious Ethics The patient is in his fifties and has been recently diagnosed with amyotrophic lateral sclerosis. He starts thinking of voluntary euthanasia.
• Biomedical Legislation and Euthanasia Mercy killing can be regarded as an option in various settings as people often have no strength or patience to endure pain. Supporters of the legitimization of euthanasia emphasized this matter.
• Medical Ethics: Pet Euthanasia Pet-owners desire that their ailing pets have painless and stress-free deaths. This eliminates trauma for both a pet and its owner.
• Raising Awareness: Euthanasia as an Important Part of Modern Society and Care The attitude and approach toward euthanasia have always been complicated since the discussion of euthanasia itself can become extremely controversial.
• Euthanasia as a Christian Ethical Dilemma The issue of euthanasia has been quite topical over the past few years. It is viewed as inadmissible from the Christian perspective.

The debate over euthanasia is multifaceted, with compelling arguments on both sides. The points below encapsulate the key considerations that fuel the ongoing discourse about this issue. Have a look on arguments for both for and against sides!

✅ Arguments For Euthanasia Essay

❌ arguments against euthanasia essay.

• Euthanasia in Christianity and Buddhism This paper provides a discussion on a case study on euthanasia of a man, who finds out he has a severe disease that will disable him within several years.
• The Issue of Euthanasia of Valentina Moreira From the point of view of Christianity, President Michelle Bachelet made the right choice, not allowing an exception for Valentina Moreira and forbidding her euthanasia.
• Aspects of Legalizing Euthanasia The paper states that euthanizing patients is not murdering them because it is considered the art of bringing an inevitable death closer.
• Ethical Theories Applied to the Euthanasia Issue The main meaning and ethical side of euthanasia is that a person dying from an incurable disease can voluntarily die in the presence of doctors and relatives.
• The Problem of Euthanasia Moral Acceptance The concept of euthanasia became a topic of ethical discussion regarding the acceptance of specific procedures directly affecting the personal right to live.
• Euthanasia as a Medical Ethical Dilemma The aim of the work is to analyze the ethical problem of medicine, such as euthanasia, and consider it as an example of a specific situation.
• Animal Shelter Euthanasia Reduction Strategies When it comes to animal shelter euthanasia anywhere in the United States and California in particular, this paper argues that it is unnecessary and should not be legalized.
• The Moral Arguments in Favor of Euthanasia Euthanasia opponents say that using the terms “mercy” and “justice” to justify forced euthanasia is a recipe for possible social chaos.
• The Legalization and Moral Issues about Euthanasia This paper explores the controversial topic of euthanasia and physician-assisted suicide from a legal and moral standpoint.
• Self-Determination Right and Euthanasia The current euthanasia-related discussion aims to identify the moral rightness to kill or let a person die for the good plays an important role.
• Euthanasia from the Ethical Point of View Euthanasia is a controversial aspect of medicine that causes a lot of discussions. The main issue is the ethical side of the problem.
• Euthanasia: Physician-Assisted Suicide, Disability, and Paternalism Involuntary euthanasia, on the other hand, means that such a person would prefer to live but has a condition that would cause their death eventually.
• Euthanasia in Modern World: Ethical & Legal Issues The article provides a detailed overview of the rich empirical evidence on attitudes towards euthanasia and its legal status in the US, Canada, and Europe.
• Americans’ Strong Support for Euthanasia Persists The subject of euthanasia and physician-assisted suicide (PAS) has seen much controversy and debate on its legality, morality, and ethics in the recent past.
• Euthanasia in the Terri Schiavo Case End-of-life care and its elements are associated with many ethical issues because it is not always clear whether euthanasia is necessary.
• The Issues Regarding Euthanasia The paper provides the philosophy regarding euthanasia, how the position aligns with a biblical worldview, and an analysis of the opposing side to the position.
• Euthanasia in Nursing Practice Euthanasia in nursing is a debatable phenomenon, but in the countries where it is legalized, nursing staff should be prepared and educated for it to provide high-quality care.
• Euthanasia as Social and Ethical Problem Euthanasia is an ethical problem concerned with aspects of religion and suicide, justice and privacy, and the role of a doctor in our society.
• Euthanasia as a Method Against Human Suffering The phenomenon of euthanasia and its application in the medical sphere is a vital debate topic addressed by numerous scholars worldwide.
• The Debate Surrounding Euthanasia as a Method Against Human Suffering: Source Evaluation A study by Emanuel, “Attitudes and Practices of Euthanasia and Physician-Assisted Suicide,” provides a comprehensive examination of current academic positions and available.
• Decision-Making: Euthanasia in Switzerland Agreeing to euthanasia is one of the hardest decisions to make. Christian values and some ethical principles that govern decision-making, one can make a sound decision.
• Euthanasia: The Legal and Ethical Perspectives The aim of this essay is to explore the legal and ethical perspectives on euthanasia, discuss the perspectives of ethical egoists and social contract ethicists.
• Legalizing Euthanasia: Nonmaleficence, Beneficence, and Patient Autonomy Physician-assisted suicide is an undeniably controversial topic, which gains more attention from the public the more countries start to legalize it.
• Euthanasia in Relation to Religion: Pros and Cons Euthanasia is carried out on three different grounds, which include: voluntary aspects, non-voluntary, or else involuntary
• How Many People Died by Euthanasia Debate on euthanasia triggers various ethical, legal as well as moral issues that need to be addressed critically.
• Legalization of Euthanasia: Key Arguments Euthanasia should be legalized as it presupposes an individual’s right to choose and a doctor’s obligation to treat and help the person.
• Euthanasia and Its Current Legal Situation
• Christian and Muslims Attitudes to Euthanasia
• Euthanasia, Environmental Conservation, and Morality
• Assisted Suicide and Euthanasia No Human Life Should and by Unnatural Means
• Critical Thinking About Euthanasia as an Ethical Alternative to a Life of Suffering
• Ethical Arguments for and Against Voluntary Euthanasia
• The Criticisms and Opposition of Euthanasia in Australia
• Circumstances That Justify the Use of Physician-Assisted Suicide and Euthanasia
• Euthanasia Answers the Prayers of the Dying
• The Philosophical, Legal, and Medical Issues on Euthanasia
• Euthanasia, Making the Right Decision for Your Loved Ones
• Christian Ethics: Euthanasia Assignment
• Euthanasia: Current Policy, Problems, and Solution
• The Distinction Between Active and Passive Euthanasia
• Assisted Suicide and Euthanasia – It Is Not Murder, It Is Mercy
• The Factors That Influence the Legalization of Active and Passive Euthanasia in the United States
• Ethical Issues Surrounding the Choice of Euthanasia in the United States
• Euthanasia for Terminally Ill Patients Should Be Legalized
• Legal and Ethical Views on Physician-Assisted Suicide and Euthanasia
• Ethical, Moral and Religious Issues Surrounding Euthanasia
• Ethical Backgrounds of Euthanasia Euthanasia advocates state that every person has a complete right to decide whether to die. These views are opposed by those who state that it violates the sanctity of human life.
• Medical Ethics: Euthanasia Prohibition The paper summarizes the points and states the reasons for considering euthanasia prohibition illegal. The major argument recapitulates the point of the essay.
• Assisted Euthanasia: Philosophical Perspectives The analysis of assisted euthanasia from the standpoint of one specific concept is impossible due to distinctive views on this phenomenon and unique philosophical ideas.
• Euthanasia as a Remedy for Patients Despite the immorality of euthanasia in modern society, it is an ethically permissible procedure that follows the major philosophical principles.
• Law and Medical Ethics: Euthanasia and Physician Assisted Death Euthanasia and physician-assisted suicide are practices that occur in many countries. Some countries and states such as the Netherlands, Belgium, Switzerland and Oregon have made these practices legal.
• The Notion of Euthanasia and Its Execution Prerequisites The primary goal of this paper is to identify the case’s bioethical issue and reflect upon its role in the trial process.
• Euthanasia and Physician Assisted Suicide This paper will discuss Oregon’s Death with Dignity Act and the concepts of physician-assisted suicide and euthanasia that bring essential moral questions.
• Euthanasia: Points For and Against Euthanasia is a terminally ill person’s death, performed at his request with the help of a doctor and certain drugs.
• Euthanasia: Ethical Theories About the Topic Euthanasia is a controversial topic with many people from all walks of life arguing for and against it. Some academicians think that it cannot be allowed under any circumstances.
• Euthanasia: The Medical Evidence and Moral View The question of euthanasia creates numerous debates because of diverse views and opinions regarding the value and meaning of human life.
• The Morality of Euthanasia Euthanasia is any action directed on putting an end to the life of a human being, fulfilling his/her own desire, and executed by a disinterested person.
• Arguments for Euthanasia Analysis Euthanasia, otherwise known as mercy killing or assisted suicide, has been a controversial subject for many centuries.
• Euthanasia Law: Legalization of Euthanasia Issues One of the more controversial subjects in the medical field and elsewhere for many years has been the question of euthanasia, otherwise known as mercy killing or assisted suicide
• Blogs on Euthanasia: Rhetorical Analysis Euthanasia is the act or practice of deliberately ending the life of an individual who could either be suffering from a terminal illness or be in an incurable condition.
• Euthanasia or Assisted Suicide The present paper looks into the issue of physician- or doctor-assisted suicide or euthanasia from a number of perspectives.
• Euthanasia: Assisted Suicide Discussion Euthanasia, otherwise known as mercy killing or assisted suicide, has been a controversial subject for many centuries.
• Euthanasia in Non-Terminally Ill Patients This paper gives a brief history of euthanasia in non-terminally ill patients, its moral relevance, and arguments surrounding this evidence-based medical practice.
• Euthanasia and Assisted Suicide in Europe and the US Euthanasia is defined as a deliberate action with the aim of ending a patient’s life to ease the suffering caused by the disease.
• Euthanasia in Public Opinion and Policy-Making Raising awareness of euthanasia is important not only because of the ongoing debate but also because of the topic’s complexity and relations to individual cases.
• Euthanasia-Associated Ethical Challenges in Nursing Rather than legalizing euthanasia, the government and other stakeholders in the health sector should push for the improvement of patient outcomes and nursing practices.
• Acceptability of Euthanasia: Moral and Humanistic Views Euthanasia is one of the most controversial issues of the modern era that could be discussed in terms of the deontological ethical theory.
• Is Euthanasia Morally Acceptable? This paper discusses should euthanasia be allowed under any circumstances in the cases when the patient is asking for it himself.
• Euthanasia Definition, Types, Pros and Cons The relationship between euthanasia and dying with dignity exemplify the up to date stress on self-determination as an illustration of personal independence.
• Euthanasia Controversy and Supporting Arguments Euthanasia is one of the most controversial issues in the modern health care environment. It can be performed in several assorted forms.
• Moral Doctrine of Active and Passive Euthanasia The paper reviews topics of active euthanasia, the limitations of the conventional moral doctrine, relation between passive euthanasia and intention or voluntary actions.
• Death Upon Request: Euthanasia and Assisted Suicide In the documentary Death Upon Request assisted euthanasia is the result of the patient’s decision, since some people prefer to die in dignity in order not to burden their loved ones.
• Ethical Issues: Euthanasia Debate Voluntary euthanasia occurs due to permission from the patient. Active euthanasia happens when a third party carries out a deliberate act which causes death of a patient.
• Confronting Physician-Assisted Suicide and Euthanasia The article written by Susan Wolf urges the readers to reevaluate their views on euthanasia and assisted suicide.
• Are Physician-Assisted Suicide and Euthanasia Ethical?
• What Is the Ethical Issue of Euthanasia?
• What Is the Moral Significance of Euthanasia?
• Should Euthanasia and Assisted Suicide Be Legalized?
• Can Hegelian Dialectics Justify Euthanasia?
• Is Animal Euthanasia Ethical?
• What Does Kantian Ethics Say About Euthanasia?
• How May the Christian Faith Inform the Debate Over Euthanasia?
• Why Passive Euthanasia Is Ethical?
• Why Is Euthanasia a Debate?
• What Are the Advantages of Euthanasia?
• Would You Let Euthanasia End One’s Life?
• What Are Four Arguments Against Euthanasia?
• What Are Two Arguments in Support of Euthanasia?
• Why Euthanasia Should Not Be Legalised?
• What Are the Four Different Types of Euthanasia?
• Why Some Forms of Euthanasia May Be Ethically Justified?
• Why Can Christians Not Accept Euthanasia?
• Is Euthanasia Legal in Australia?
• How Does Euthanasia Work?
• How Do Vets Feel About Euthanasia?
• How Do Different Religions View Euthanasia?
• Why Do Dogs Gasp After Euthanasia?
• How Christians Apply Their Beliefs to Abortion and Euthanasia?
• Where Was Euthanasia First Legalized?
• How Does Brian Clark Use Theatre to Dramatise the Euthanasia Debate?
• Who Came up With the Idea of Euthanasia?
• How a Death Request Should Be Legalized in the Debate About Euthanasia?
• Where Is Euthanasia Legal in Canada?
• Does Euthanasia Hurt?

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These essay examples and topics on Euthanasia were carefully selected by the StudyCorgi editorial team. They meet our highest standards in terms of grammar, punctuation, style, and fact accuracy. Please ensure you properly reference the materials if you’re using them to write your assignment.

This essay topic collection was updated on January 22, 2024 .

158 Euthanasia Topics & Essay Examples

If you’re writing a euthanasia essay, questions and topics on the subject can be tricky to find. Not with our list!

• 📑 Aspects to Cover in a Euthanasia Essay

🏆 Best Euthanasia Essay Examples & Topics

💡 clever euthanasia titles, 🎓 simple & easy euthanasia essay titles, ✅ most interesting euthanasia topics to write about, ❓ euthanasia essay questions.

Our experts have prepared a variety of ideas for your paper or speech. In the article below, find original euthanasia research questions and essay titles. And good luck with your assignment!

📑 Aspects to Cover in an Euthanasia Essay

Euthanasia is the process of intentional life ending. Its goal is to stop patients’ suffering and pain. In today’s world, euthanasia is a debatable topic, and there are many questions about it.

Euthanasia essays can help students to raise awareness of the process and its aspects. That is why it is crucial to research this issue and write papers on it.

You can discuss various problems in your essay on euthanasia, as there is a broad variety of related issues. You can choose the one you are the most concerned about, search for euthanasia essay questions online or consult your professor.

Here are some examples of euthanasia essay topics and titles we can suggest:

• The benefits and disadvantages of a physician-assisted suicide
• Ethical dilemmas associated with euthanasia
• An individual’s right to die
• Euthanasia as one of the most debatable topics in today’s society
• The ethical dilemma around euthanasia
• The ethics associated with voluntary euthanasia
• Can euthanasia be considered murder?
• Euthanasia debate: Should the government legalize this procedure?
• The legality of physician-assisted suicide in today’s society

Once you have selected one of the euthanasia essay titles, you can start working on your paper. Here are some important aspects to cover:

Start from developing a solid euthanasia essay thesis. You should state the main idea of your paper and your primary argument clearly. A thesis statement can look like this: Euthanasia is beneficial for patients because it prevents them from suffering. Euthanasia can be equal to murder.

• Remember to include a definition of euthanasia and related terms, such as physician-assisted suicide. Your audience should understand what you are talking about in the essay.
• Do not forget to include the existing evidence on the issue. For instance, you can research euthanasia in different countries, the debates around its legalization, and all other aspects related to the problem. Support your claims with facts and cite your sources correctly.
• Legal and ethical questions are some of the most significant aspects you should cover in the essay. Discuss the potential benefits and disadvantages of the procedure, as well as its impact on patients’ families and medical professionals.
• If you are writing an opinion paper, do not forget to state your opinion clearly. Include relevant experience, if possible (for example, if you work at a hospital and patients have asked you about the procedure). Have you met people who could have benefited from euthanasia? Include their stories, if applicable.
• Do not forget to cover the legal aspects of euthanasia in your state. Is it legal to perform some form of euthanasia where you live or work? Do you think it is beneficial for the patients?
• Remember to look at the grading rubric to see what other aspects you should cover in your paper. For example, your professor may want you to state a counter-argument and include a refutation paragraph. Make sure that you follow all of your instructor’s requirements.
• If you are not sure that you have covered all the necessary questions related to your issue, check out related articles and analyze the authors’ arguments. Avoid copying other people’s work and only use it as an inspiration.

Please find our free samples below with the best ideas for your work!

• Euthanasia: Advantages and Disadvantages The most heavily criticized of all such similar actions is involuntary euthanasia which bears the brunt of all severe protests against the issue, with involuntary euthanasia being dubbed as the deprivation of an individual of […]
• Arguments in Favor of Euthanasia Due to the sensitivity of the issue, laws that will protect the rights of both the patient and the physicians who practice euthanasia should be put in place.
• Consequentialism: Euthanasia and Physician-Assisted Suicide People against euthanasia view the consequences of legalization as a gateway to other unethical practices being accepted, which is a slippery slope that could lead to adverse consequences to the fundamental principles and values of […]
• Advantages and Disadvantages of Euthanasia in Modern Society In its turn, this points out to the fact that, in the field of health care, the notion of medicinal compassion organically derives out of the notion of scientific progress, and not out of the […]
• An Argument Against Euthanasia 5 Generally, it is contrary to the duty of the subject of euthanasia and that of those who intend to perform the mercy killing to take one’s life based on their own assessment of the […]
• Why Active Euthanasia is Morally Wrong The issue of active euthanasia has come to the attention of the public over the past decades as more people demand for the right to be assisted to die.
• Euthanasia: Legalisation of a Mercy Killing The fact that the minority of countries and only several states in the US accept euthanasia proves that today people are still not ready to accept it as a mercy.
• Legalizing Euthanasia The are supporters of the idea that only God has the right to take human’s life, on the other hand, the sufferings of the person may be unbearable and they may ask for euthanasia to […]
• The Right to Life and Active Euthanasia The god of every individual should be the only one to bring death to a person and no person should have the authority to accept dying no matter the situation he/she is in.
• The Death Definition and the Need for Euthanasia If the concept of the soul is to be believed in, then one’s death is simply a process that detaches the soul from the body.
• Euthanasia as a Polarizing Issue The example of a plethora of countries shows that the inclusion of assisted suicide is not detrimental to the broad society.
• Rachel’s Stance on Euthanasia: Passive and Active Killing Despite the appealing nature of Rachel’s argument, his claims of equity of killing and letting a person die are not ethically right. A major distinction between killing and witnessing death is the level of responsibility […]
• Euthanasia for Terminally Ill People: Pros & Cons Despite the fact that euthanasia causes a lot of controversy, every person should have the right to end suffering. Permission of euthanasia is the realization of a person’s right to dispose of their body.
• Euthanasia: Arguments for and Against If the disease has reduced a person to a vegetative state and deprived them of consciousness, then their life is no longer fully human and therefore is not considered a blessing.
• Analysis of Ethical Dilemma: Euthanasia One of these is the right to live, which includes much more than the ability to simply exist, and suggests an adherence to a minimum of quality and self-determination.
• Euthanasia-Related Ethical and Legal Issues There are no discussions about whether the person has the right to commit suicide or not because most individuals agree that it is the decision of the adult person who can dispose of their life.
• Euthanasia: Legal Prohibitions and Permits In addition, it is necessary to take into account the right of a suffering person to get rid of the suffering of loved ones.
• Euthanasia: Why Is It Such a Big Problem? Thus, according to the utilitarian viewpoint, there is no problem with euthanasia as along as it is better for the patient. Who is it to decide what is better for the patient?
• Euthanasia and Assisted Suicide as a Current Issue in Nursing Nowadays, even in nations where the procedure of euthanasia and assisted suicide has been legal for decades, this topic continues to be controversial due to ethical and policy issues. However, in the light of the […]
• Euthanasia as Self-Termination Velleman believes that a person should not have the right to end their life as it can make other people suffer, but there is an objection to his opinion related to that person’s own pain.
• Euthanasia and Its Main Advantages However, after realizing the condition is untreatable and having the consent of both the sick person and the relatives, undertaking assisted suicide will enable the patient to evade extreme suffering.
• Euthanasia: Nurses’ Attitudes Towards Death The weakest part of the article is that most of the participants did not clearly define the concept of euthanasia, which casts doubt on the reliability of the sampled data.
• Right to Die With Euthanasia Methods The possible answer is to develop the functionality of both ordinary public hospitals and hospices that are located in their departments. In addition, it is critical to specify the desirable methods of euthanasia.
• “Active and Passive Euthanasia” by James Rachels The second issue about euthanasia that Rachels raises is the difference between killing and allowing one to die. For Rachels, it is necessary to emphasize that killing is sometimes even more humane than allowing one […]
• Arguments Against Legalization of Euthanasia Although the PAS/E should be offered voluntarily to a patient, in some cases it is offered in secret by physicians to patients who are perceived to be dying.
• Euthanasia: The Terri Schiavo Case Analysis The long-term judicial resolution of the Terri Schiavo case was related to the bioethical problem of the humanity of euthanasia, which had many opponents and supporters.
• Can Euthanasia Be Considered Ethical Consequently, from this perspective, the act of euthanasia would be regarded as violence to someone else’s life. As a result, euthanasia is likely to be considered unethical from the point of view of any of […]
• “Active and Passive Euthanasia” and “Sexual Morality” According to Scruton, morality is a constraint upon reasons for action and a normal consequence of the possession of a first-person perspective. For Scruton, sexual morality includes the condemnation of lust and perversion that is, […]
• Nursing Role in Euthanasia Decision and Procedures The weakest point is the lack of analysis of other factors’ influence on the process of euthanasia. The researchers discovered that the role of nurses in euthanasia is underestimated.
• Aspects of Nursing and Euthanasia The subject of the research by Monteverde was to ask people who work in the medical sphere and face the necessity for euthanasia, whether they are for or against it, and why.
• Pros and Cons of Euthanasia from an Ethical Perspective Primarily, this is apparent on American soil, in which some states decriminalized euthanasia, although the supreme court maintained that there is no law that legalized the practice nor the ban of the mentioned act.
• Euthanasia in the Context of Christianity The questions addressed in the paper include the notions of fall and resurrection as means of interpreting suffering, the Christian stance on the value of human life and euthanasia, and the discussion of possible solutions […]
• Nursing Practice and Euthanasia’s Ethical Issues Effective healthcare management is the involvement of all stakeholders, such as CMS, and the federal government in the decision-making process to improve the sustainable growth in the effectiveness of Medicaid.
• Counseling on Euthanasia and End-of-Life Decision The immediate dynamic killing is a clinical demonstration coordinated to the hardship of life, while a doctor helped self-destruction is a demonstration of the doctor where he gives the patient a medicament for taking life.
• Euthanasia and Physician-Assisted Suicide Articles According to the methods of application, there are two main types of euthanasia: “active”, which consists in performing certain actions to accelerate the death of a hopelessly ill person, and “passive”, the meaning of which […]
• Legal and Ethical Issues of Euthanasia Davis argues that there exists a challenge on how to establish a consensus in the competing views regarding the desire for patients to have the choice to die with dignity while under pain and distress […]
• Debates on Euthanasia – Opposes the Use Therefore, the legal system should work hand in hand with healthcare shareholders in distinguishing the limits between the patients’ rights and the physicians’ accountability based on the possible life-limiting treatment choices.
• Active Euthanasia: Ethical Dilema In case of active euthanasia, it is the patient who requests the medical practitioner to end his or her life and the former abides by the wish.
• Euthanasia: Every For and Against Jane L Givens and Susan L Mitchell “Concerns about End-of-Life Care and Support for Euthanasia” Journal of Pain and Symptom Management Article in Press FOR The authors state socio-demographic characteristics of the people are the […]
• Pro Euthanasia in the United States The discussions of euthanasia implementation in the United States began in the early 19th century after the development of ether, which was applied to pain-relieving.
• Human Euthanasia Should Be Allowed It is stated that there is a shift in a social attitude towards human euthanasia, where people are beginning to realize that people’s lives are their rights.
• The Euthanasia in Humans The moral and ethical aspects of medical practice include not only the features of interaction with patients and other interested parties but also deeper nuances. In particular, one of the controversial and acute topics is euthanasia and its acceptability from different perspectives, including both patients’ and healthcare employees’ positions. In addition, religious issues are involved, […]
• Euthanasia: Philosophical Issues at Stake in Rodriguez I will argue that the prohibition of euthanasia contradicts utilitarianism and the principle of quality of life in particular, and can hardly be supported by paternalism since the ban does not benefit an individual’s life.
• “Euthanasia Reconsidered” by Deagle In more detail, there is a clearly discernible introduction that provides the background to the topic, introduces the thesis statement, and state the opinion of the author of the topic discussed.
• Euthanasia Movement in Modern America Euthanasia movements in modern America perfected the art of rhetoric in their communication and this worked for them in terms of winning the heart of the public.
• Euthanasia: The Issue of Medical Ethics In this respect, the position of a physician under the strain of extreme circumstances should be weighed about the value of compassion.
• The Dilemma of Euthanasia It is at this point, when it becomes a contention of professional ethics and moral considerations on the part of Jack and his wife on the one hand, and personal choice on the part of […]
• The Problem of Euthanasia in Animal Shelters Animal shelters are forced to euthanize animals for a number of reasons which includes: Lack of funds to treat sick animals, overcrowding as a result of the increased number of animals brought in by owners […]
• David Velleman’s Views on Euthanasia Velleman is correct in his conviction that in this case, the patient’s decision will be the outcome of a federal right to die; the situation with euthanasia is common to that of abortion with the […]
• Euthanasia: Ethical Debates When a patient is in the final stage of life, sometimes, the disease or the conditions of the patient, cause a lot of physical and psychological suffering.
• Euthanasia Moral and Ethical Agitation If grandma were a dog, most all would agree that the only humane option would be to ‘put her to sleep.’ U.S.citizens are guaranteed certain rights but not the right to wouldie with dignity.’ This […]
• Life-Span Development: Terri Schiavo’s Euthanasia Case Euthanasia is the process of stopping the medical maintenance of a patient’s life when the patient/herself does not want to suffer anymore and the doctors are sure that no improvements in the patient’s condition are […]
• Euthanasia and Other Life Termination Options However, there is a strong case for helping terminally ill patients spend the remainder of their lives with care provided by the medical fraternity and with support from the state and insurance companies. And in […]
• The Problem of Euthanasia Nevertheless, we must recognize that the interruption of life, alone or with the help of doctors, is contrary to one of the basic tenets of Christianity: the more people suffer on earth, the easier it […]
• Euthanasia: Allow Them to Be Free From Body Euthanasia, the practice of deliberately bring about an easy, painless, and moderate death to a person who is in the last days of his life and can no more bear the pain of living, has […]
• Palliative Medicine Replacement for Euthanasia Euthanasia is not about helping ill and dying people to end their pain and bring comfort. Euthanasia undermines the core values of life and decreases the motivation to provide care for the dying.
• Euthanasia in Christian Spirituality and Ethics By examining Christian’s views on the fallenness of the world, the hope of resurrection, and the value of a person’s life, one can see that euthanasia is not a morally acceptable option for a Christian […]
• Euthanasia: A Legalized Right to Die Nothing could be further from the intent of those who favor a limited reconsideration of public policy in the areas of assisted suicide and voluntary active euthanasia.
• Euthanasia and Suicide Issues in Christian Ethics Based on the two perceptions of euthanasia, theological and professional, it is valid to say that assisted suicide is probably not the best way out.
• Euthanasia: Morals, Ethics, and the Value of Life James Rachels however disagrees with the position taken by doctors when it comes to active Euthanasia and argues that, given a case where the patient is in intolerable pain and is certain to die in […]
• Euthanasia. Arguments of Opponents The request of the patient to relieve them from Karma and sufferings that is clarification and healing, nobody gives the right to break life of a physical body.
• Attitudes Related to Euthanasia and Physician-Assisted Suicide Among Terminally Ill Patients Consequently, the outlined safeguard becomes the first line of defense in making sure that only the right individuals with chronic and incurable medical conditions benefit from assisted death.
• Active Euthanasia Legalization Controversy While many people present the notions of medical ethics, the right to life, and the availability of palliative care to oppose active euthanasia, there are those who support it since it is evidence-based in nature […]
• Dying With Dignity: Euthanasia Debate On the other hand, the supporters of the law claim that assisted death is not a suicide, and it allows more end-of-life options for terminally ill patients. The majority of people are concerned with control […]
• Euthanasia Legalization as an Unethical Practice The decision to legalize euthanasia is an idea that societies should ignore since it places many global citizens at risk, fails to provide adequate safeguards, diminishes social values, and undermines the teachings of Islam.
• The Ethics of Euthanasia In the analysis of the claims in favor and against euthanasia, the cause and effect relationships between the factors affecting the choice of euthanasia should be established.
• Today’s Moral Issues: Euthanasia To ensure that the right to life is respect, the law was amended to include assisted or aided suicide as a criminal offense.
• Controversial Issues of Euthanasia Decision We now had to make this difficult decision to end his life and relieve him of all the pain that he was undergoing.
• Confronting Physician-Assisted Suicide and Euthanasia It was because of that pain that led my mother and I to bring her to a Chinese holistic healer who treated her with some sort of secret Chinese medical injection.
• Assisted Suicide and Euthanasia Rights in Canada The article asserts that in the year 1993, Rodriquez petitioned in vain to the Supreme Court of Canada to allow her to undertake euthanasia. In the article, the author asserts that, in the year 1993, […]
• Euthanasia: “Being a Burden” by Martin Gunderson As it was implied in the Introduction, in his article, Gunderson argues in favor of the idea that it is utterly inappropriate to even consider the legalization of voluntary euthanasia, due to a number of […]
• Euthanasia: Fighting for the Right Cause Sommerville is a renowned Samuel Gale Professor of Law at the McGill University in Montreal, the Professor in the Faculty of Medicine, and the Founding Director of the Center for Medicine, Ethics, and Law. The […]
• Euthanasia as a Way of Painless Termination of Life The introduction of the Hippocratic School led to the abolishment of the practice. According to the approach, taking human life is unethical and violation of the core right to life.
• Euthanasia and Other Life-Destroying Procedures From this perspective, it is unethical to decide in favor of an end-of-life procedure on the condition that there are at least minimal chances for a patient’s survival.
• Ethics of Euthanasia and Pain-Relieving This leads to the historical argument that voluntary euthanasia is often the beginning of a slippery slope that gives rise to unintentional euthanasia and the murder of people who are unwanted in society.
• Euthanasia Legalization: Public Policy Debates The requirements of physicians to perform euthanasia and consideration of the second opinion eliminate the violation of legal and ethical stipulations, and thus, control the performance of euthanasia in health care environment. Opponents of euthanasia […]
• Euthanasia: Moral Rationalist View Human beings rely on the available evidence to generate beliefs about life and goals that should be attained, and thus the use of reason leads to success in these objectives.
• Euthanasia: Is It Worth the Fuss? In order to grasp the gist of the deliberations in this essay, it is important to first apprehend what the term euthanasia means and bring this meaning in the context of this essay.
• Active and Passive Euthanasia Analysis and Its Concept The issue of morality is one of the things that have to be mentioned when discussing the concept of euthanasia. In this instance, both the patient and the doctor know that there is no cure […]
• Euthanasia in Today’s Society Euthanasia is the deliberate termination of life with the intention of relieving a patient from pain and suffering. If the prognosis of a patient is gloomy, medical care providers may find it more compassionate to […]
• When Ethics and Euthanasia Conflict? The main aim is to reduce the lifetime of a patient who is terminally ill. There is a deep mistrust of the motivations that fuel euthanasia.
• Religions Views on Euthanasia This essay highlights religious thoughts with regard to the whole issue of euthanasia, bringing into focus the extent to which our society has been influenced by courtesy of the Dr.
• Euthanasia as the Key Controversy of the XXI Century The fact that in the present-day society, human life is put at the top of the entire list of values is a major achievement of the civilization and the fact that the current society is […]
• Euthanasia: Is It the Best Solution? In twentieth century, various agencies erupted to address the practice of euthanasia such as Voluntary Euthanasia Legislation Society in 1935, which was advocating for its legalization in London and the National Society for the Legalization […]
• Euthanasia: Right to Live or Right to Die Euthanasia or mercy killing as it is informally referred is the act of ending a person life if it is deemed to be the only way to help a person get out of their suffering.
• A New Fight to Legalize Euthanasia Before settling down on the conclusion of the need to adopt the practice of euthanasia in our state, it is important to visit some basic aspects that are very key in the issue of euthanasia.
• The Morality of Euthanasia In the meantime the medication and the doctors are not trivial anymore in stopping the pain and the victim despite all the sufferings, he or she is in a vegetative state and there is nothing […]
• The Ethics of Active Euthanasia In support of the euthanasia action, the argument is that there are circumstances when the rule of natural life can be violated.
• Is Euthanasia a Morally Wrong Choice for Terminal Patients? It is imperative to note that for both the opponents and proponents of euthanasia, the quality of life is usually the focal point, even though there is no agreement on the criteria of defining quality […]
• Singer’s Views on Voluntary Euthanasia, Non-voluntary Euthanasia, and Involuntary Euthanasia Hence, if a person consciously consents to die, there are no chances for recovery, and killing is the only way to deprive a patient from pain and suffering, euthanasia can be regarded as voluntary.
• Euthanasia and Assisted Suicide The final act that results in the death of the person is however usually performed by the person intending to die after the provision of information, advice and even the ways through which he or […]
• Euthanasia Authorization Debate Euthanasia, which is equivalent to the termination of life, can be equated to a total breach of the principle of the sacredness of life, as well as the breach of the legal right of human […]
• Moral and Ethical Concerns of Euthanasia in Healthcare In the matter of euthanasia, professionals ought to decide between the overall good of the dying patient and that of other stakeholders.
• Good and Harm to Humanity of the Use a Euthanasia An Overview of Euthanasia The meaning of euthanasia has changed over the years from how it was originally construed to what it means to the contemporary world.
• Euthanasia and Meaning of Life The meaning of life is the most general aspect of judging about the requirements that must be set out by laws and people’s morals in regarding to the voluntary or involuntary taking of that life.
• Euthanasia: Your Right to Die? Although both positions can be supported with a lot of arguments, people should change their absolutely negative vision of euthanasia because the right to die with the help of physicians can be considered as one […]
• Euthanasia and Human’s Right to Die Trying to support human life with the help of modern equipment is a good idea, however, not in case there are no chances for a person to live without that equipment.
• Euthanasia Moral Permissibility Secondly, the application of voluntary euthanasia should not be regarded as the only way of reducing the pain that a patient can experience.
• Euthanasia (Mercy Killing) In some circumstances, the family and friends of the patient might request the hospital to terminate the life of the patient without necessarily informing the patient.
• Euthanasian Issues in Modern Society Is it possible to find the relief in the life which is full of pain and agony for those people who suffer from serious diseases and have only a little chance to get rid of […]
• Euthanasia From a Disciple of Jesus Christ in Today’s World Another form of euthanasia is that of Assisted Suicide where the person intending to end his/her life is provided with the necessary guidance, means as well as information as to how to go about the […]
• Euthanasia and Modern Society Towards this end Battin asserts that “the relief of pain of a patient is the least disputed and of the highest priority to the physician” in direct reference to sole and major reason of carrying […]
• Euthanasia: Moral Issues and Clinical Challenges Therefore, any law that rejects euthanasia is a bad one because it denies the patients the right and the liberty to die peacefully.
• Ethical Issues Surrounding the Choice of Euthanasia in the United States
• The Advantages and Disadvantages of the Legalization of Euthanasia
• Confronting Physician-Assisted Suicide and Euthanasia
• The Difference Between Active and Passive Euthanasia
• Euthanasia: Current Policy, Problems, and Solution
• The Permit and Legalization of Euthanasia for the Terminally Ill Patients
• Moral and Religious Differences Between Euthanasia and Suicide
• The Criticisms and Opposition of Euthanasia in Australia
• Assisted Suicide and Euthanasia It Is Not Murder, It Is Mercy
• The Factors That Influence the Legalization of Active and Passive Euthanasia in the United States
• Roman Catholic Church’s Teachings on Abortion and Euthanasia
• The Different Reasons Why People Are Against Euthanasia
• Religious and Ethical Arguments in Favour of Euthanasia
• The Moral and Ethical Views on the Goal of Euthanasia
• Euthanasia and the Role of Politics and Religion
• The Philosophical, Legal, and Medical Issues on Euthanasia
• General Information About Euthanasia and the Legality of Suicide in Australia
• The Nazi Euthanasia Programme Based on Racial Purity Theories
• Dr. Jack Kevorkian’s Role in Physician-Assisted Suicide and Euthanasia
• Utilitarian and Libertarian Views on Euthanasia
• The Moral and Religious Differences, if Any, Between Euthanasia and Suicide
• Biblical World View About the Euthanasia, Suicide, and Capital Punishment
• The Truth About Euthanasia and Assisted Suicide
• Tracing Back the Origins of the Practice of Euthanasia During the Greeks and Roman Times
• The Causes and Effects of Euthanasia and the Moral Right To Die
• The Arguments Against Euthanasia From a Standpoint of a Catholic Christian in the United States of America?
• Why Should Active Euthanasia and Physician-Assisted Suicide Be Legalized?
• What Are the Good and Bad Sides of Euthanasia?
• Do People Have To Commit Suicide by Euthanasia (Suicide by a Doctor)?
• What Is the Difference Between Passive and Active Euthanasia?
• What Are the Social Issues and Ethical Values of Euthanasia?
• What Is the Current Legal Situation Regarding Euthanasia?
• How Does Prohibition of Euthanasia Limit Our Rights?
• What Is the American Medical Association’s Attitude to Euthanasia?
• Can Hegelian Dialectics Justify Euthanasia?
• What Are the Viewpoints and Studies of the Legalization of Euthanasia in the United States?
• Why Does Parenting Make Euthanasia More Acceptable?
• What Are the Negative Arguments Against Euthanasia?
• Voluntary Euthanasia: What’s Right and Wrong?
• Why Can Christians not Accept Euthanasia?
• Can Euthanasia Help the Terminally Ill?
• What Are the Top Ten Reasons for Legalizing Euthanasia?
• Should Non Voluntary Euthanasia Be Legal?
• What Is the Difference Between Doctor-Assisted Suicide and Euthanasia?
• Why Should Euthanasia and Assisted Suicide Be Legalized?
• What’s Wrong With Involuntary Euthanasia?
• Why Are There So Different Views on Abortion and Euthanasia?
• How Would Christians Respond to the Issue of Abortion and Euthanasia?
• What Are the Objections To Legalizing Euthanasia in Hong Kong?
• How Does Euthanasia Devalue Human Life?
• What Are the Views and Arguments About Euthanasia?
• How May the Christian Faith Inform the Debate Over Euthanasia?
• What Does Euthanasia Mean to Society Today?
• What Are the Religious and Ethical Considerations to the Issue of Euthanasia?
• Euthanasia and Assisted Suicide – Who Wants It?
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101 Euthanasia Essay Topic Ideas & Examples

Inside This Article

Euthanasia, also known as assisted suicide or mercy killing, is a controversial topic that has sparked heated debates around the world. There are strong arguments both for and against euthanasia, with proponents arguing for the right to die with dignity and opponents concerned about the potential for abuse and the sanctity of life.

If you are tasked with writing an essay on euthanasia, it can be challenging to come up with a unique and interesting topic. To help you get started, we have compiled a list of 101 euthanasia essay topic ideas and examples to inspire your writing.

• The ethics of euthanasia: exploring the moral implications of assisted suicide
• The right to die: should individuals have the right to choose when and how they die?
• Physician-assisted suicide: should doctors be allowed to help patients end their lives?
• The role of religion in the euthanasia debate
• Euthanasia and quality of life: should suffering patients be allowed to end their lives?
• The slippery slope argument: is legalizing euthanasia a slippery slope towards euthanizing vulnerable populations?
• Euthanasia and mental illness: should patients with mental illness be allowed to access euthanasia?
• The impact of euthanasia on families and loved ones
• Euthanasia and the elderly: should elderly patients be allowed to choose euthanasia as an end-of-life option?
• The legal status of euthanasia around the world
• Euthanasia and disability: should disabled individuals have access to euthanasia?
• Euthanasia and palliative care: exploring alternative options for end-of-life care
• Euthanasia and autonomy: should individuals have the right to make decisions about their own deaths?
• Euthanasia and healthcare costs: exploring the economic implications of end-of-life care
• Euthanasia and cultural differences: how different cultures view and approach euthanasia
• The role of hospice care in the euthanasia debate
• Euthanasia and suicide prevention: how do we balance the right to die with the need to prevent suicide?
• Euthanasia and children: should minors be allowed to access euthanasia?
• Euthanasia and the Hippocratic Oath: should doctors be allowed to assist in ending a patient's life?
• Euthanasia and the right to refuse treatment: should patients have the right to refuse life-saving treatment?
• Euthanasia and end-of-life decision-making: how can we ensure that patients' wishes are respected?
• Euthanasia and mental capacity: should patients with diminished mental capacity be allowed to access euthanasia?
• Euthanasia and the right to die at home: exploring options for dying at home with dignity
• Euthanasia and medical ethics: how do we balance the principles of beneficence and autonomy in end-of-life care?
• Euthanasia and the medical profession: should doctors be required to provide euthanasia if requested by a patient?
• Euthanasia and organ donation: should patients be allowed to donate their organs after euthanasia?
• Euthanasia and the role of the family: how do families navigate end-of-life decisions?
• Euthanasia and the law: should euthanasia be legalized or remain illegal?
• Euthanasia and patient consent: how do we ensure that patients are making informed decisions about euthanasia?
• Euthanasia and mental health: how does euthanasia impact the mental health of patients and families?
• Euthanasia and the right to die with dignity: should individuals have the right to die on their own terms?
• Euthanasia and terminal illness: should patients with terminal illnesses be allowed to access euthanasia?
• Euthanasia and the role of the state: should the state have a say in end-of-life decisions?
• Euthanasia and the philosophy of death: how do different philosophies view the concept of death and dying?
• Euthanasia and the disabled: should disabled individuals be protected from euthanasia?
• Euthanasia and the criminal justice system: should euthanasia be treated as a criminal act?
• Euthanasia and the right to life: how do we balance the right to life with the right to die?
• Euthanasia and the sanctity of life: should life be considered sacred and inviolable?
• Euthanasia and the role of government: how should governments regulate euthanasia?
• Euthanasia and end-of-life care: how can we provide compassionate care to patients at the end of life?
• Euthanasia and

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137 Euthanasia Research Topics & Essay Examples

📝 euthanasia research papers examples, 🏆 best euthanasia essay titles, 🎓 simple research topics about euthanasia, ❓ euthanasia research questions, 📣 euthanasia discussion questions.

• Physician Assisted Suicide The issues of the practice of Physician Assisted Suicide are contentious for most people. This paper is an argument against the use of PAS as a tool of ending human suffering.
• Medical Ethics: End of Life Issue - the Right to Die The paper elaborates on different types of euthanasia. At the same time, the paper reveals the differences between them. The paper further tackles the ethical issues raised by each type.
• Death with Dignity Act: Physician-Assisted Suicide The paper enumerates the fundamental aspects regarding the Death with Dignity Act (DDA) as well as the Physician-Assisted Suicide (PAS).
• Death with Dignity Act in Oregon The Death with Dignity Act (DDA) sets up the procedures and safeguards related to the application and administering of the prescription medications.
• Euthanasia and Assisted Suicide There are critical ethical, legal, religious, and political concerns that bedevil the controversial practice of euthanasia/PAS.
• Assisted Suicide: Ethical Dilemma and Stakeholders in Euthanasia This paper examines the assisted suicide ethical dilemma and euthanasia stakeholders ✚ safeguards for euthanasia in ⚖️ the Death with Dignity law in Oregon.
• Euthanasia Debates, Death and Dying The issue of voluntary euthanasia elicits heated debates. The contention is usually based on religious views concerning whether individuals can decide the fate of life.
• Utilitarianism and Euthanasia: Ethical View on Assisted Suicide Want to learn about utilitarianism and euthanasia? ✅ Read our essay example to discover the utilitarianism view on euthanasia ✚ Bentham utilitarian calculus.
• Euthanasia in Non-Terminally Ill Patients This paper reviews history and social context of euthanasia in non-terminally ill patients, its moral relevance, and arguments surrounding this evidence-based medical practice.
• Physician-Assisted Suicide as Liberation from Suffering Physician-Assisted Suicide, the death of a patient as a result of being aided to undertake a life-ending act by a physician, is a contentious issue of importance in society.
• Medical and Religious Ethics in Death and Dying The paper is devoted to the investigation of a particular ethical dilemma presented in a patient’s case study and religious perspectives on it.
• Why Euthanasia Should Be Legalized and Regulated The essay discusses the reasons why euthanasia should be legalized all over the world but most importantly it should also be a carefully regulated aspect.
• Feeding Tubes: Techniques, Problems and Solutions The problem of maintaining the life of severely ill patients has been a highly controversial topic for a long time. Many clinicians emphasize the drawbacks of inserting feeding tubes.
• Assisted Suicide Controversy in Medical Ethics Assisted suicide is one of the most controversial topics in the field of health care. There are valid arguments presented on both sides of the discussion.
• Significance of Euthanasia in Society Euthanasia is an issue that has stirred a lot of controversy in many countries and at international forums as to whether it should be legalized or illegalized.
• Research of the Euthanasia An Euthanasia doen't harm society and even underlines the humane qualities of people, who are able to differentiate right from wrong and offer help to others in their time of need.
• Euthanasia and Physician-Assisted Suicide: Interesting Facts The generic definition of euthanasia states that it is an omission or an action that, by intension or itself, causes death alleviating suffering.
• Euthanasia: Ethical Issues in Nursing and the Impact of Technology Wondering about euthanasia ✚ ethical issues in nursing? ✅ Check this paper to learn about euthanasia: ethical dilemma and its relation to technology.
• Voluntary Euthanasia: Arguments for and Against The purpose of this article is to briefly consider the problem of euthanasia from the point of view of supporters and opponents of this practice.
• Nurses Intention and Motivation to Practice Euthanasia The research aims at investigating the determinants of nurses "intentions and motivations to practice euthanasia".
• Euthanasia. Effectiveness or Necessity Euthanasia remains the controversial topic as far as there is no direct answer concerning its effectiveness or necessity.
• Euthanasia: Discussion and Ethical Position Euthanasia still remains a controversial topic because of the patient’s inalienable right to life, and the ethical responsibilities of the healthcare worker.
• Case Study: An Ethics of Euthanasia Euthanasia is illegal in most of the world countries for a good reason. Statistics show, that developments in countries with legalized euthanasia are quite disturbing.
• Euthanasia-Related Ethical and Legal Issues The ethical issues associated with euthanasia are related to the dilemma of whether it is appropriate and up to a human being to decide to end a life of a person who suffers.
• Legal, Ethical and Moral Issues Facing Nurses in Cases of Patient-Requested Suicide Suicide, whether assisted or unassisted, is a common issue affecting practitioners in nursing, clinical and biomedical fields. Legal, moral, and ethical decision is required.
• Professional Values, Ethics, and Law Small mistakes by healthcare practitioners may lead to loss of life. In addition, errors in their activities may lead to the development of life-threatening conditions.
• Euthanasia Should Be Illegal Because of Its Harm The goal of healthcare providers is to help patients improve their well-being and promote health, and euthanasia distorts these values.
• Pros and Cons of Physically-Assisted Suicide The paper discusses that even though physician-assisted suicide contradicts ethics, the evidence shows the prevalence of towards the practice among terminally ill patients.
• Euthanasia & Physician-Assisted Suicide (PAS) This paper discusses euthanasia and physician-assisted suicide, whether it is ethical, and analyzes alternatives to PAS – hospice and palliative care.
• Physician-Assisted Suicide is a Basic Right Physician-assisted suicide has been a subject of numerous debates for as long as it has been available. PAS is legal in Colorado and some other states in the US.
• Euthanasia & Physician Assisted Suicide The medical definition of euthanasia states that it is the practice or method of performing specific actions by a doctor at a patient's request.
• Euthanasia and Arguments in Favor Despite the advantages of practicing assisted suicide in critical situations, some countries or people are against it, terming it unethical conduct which violates human rights.
• The Problem of Euthanasia The problem of euthanasia lies at the intersection of a huge complex of disciplines and the full discussion of it requires the participation of specialists.
• Euthanasia & Physician Assisted Suicide (PAS) The problem of euthanasia goes beyond the scope of purely medical issues since it confronts moral, socio-economic, philosophical, legal, and political aspects.
• The Problems With Medical Research and Euthanasia
• Business Ethics Decision Situation in Veterinary Practice The paper analyses a business ethics decision situation in veterinary practice and an ethics dilemma witnessed in veterinary practice as a client.
• Active and Passive Euthanasia Is Not a Morally Relevant Problem
• Analysing Biopower and Agency Linked to Euthanasia Philosophy
• Top Ten Reasons for Legalizing Euthanasia
• Euthanasia as Physician-Assisted Suicide Among patients there are people who do not recognize euthanasia. Nevertheless, we must recognize that the interruption of life is contrary to the basic tenets of Christianity.
• Legalizing Euthanasia for Terminally Ill Patients Is Necessary
• Assisted Suicide and Euthanasia – It Is Not Murder, It Is Mercy
• Circumstances That Justify the Use of Physician-assisted Suicide and Euthanasia
• Arguments for Legalizing Euthanasia
• Assisted Suicide: Euthanasia and Self-Determination Although assisted suicide is legal in certain parts of the world, in most places, the debate about whether it should be legal continues.
• Philosophy & Arguments Against Euthanasia
• The Argument for the Legalization of Euthanasia in British Columbia
• Critical Thinkings About Euthanasia as an Ethical Alternative to a Life of Suffering
• Vincent Humbert and Euthanasia in France
• Why Euthanasia Should Be Legal From the perspective of ethical theories, euthanasia should be legalized because it promotes dignified death.
• Dying With Better Dignity: From Euthanasia To Advanced Dying Culture
• Hinduism and Buddhist Perspective of Suicide and Euthanasia
• Australian Governments’ and Catholic Church’s Attitudes on the Practice of Euthanasia
• Utilitarian and Libertarian Views on Euthanasia
• Aristotle’s Virtue Theory on Euthanasia This paper will explore Aristotle’s virtue theory and use its concepts to discuss euthanasia, a controversial contemporary issue.
• Death With Dignity Act: Ethical Dilemma Regarding Euthanasia
• The Nazi Euthanasia Programme Based on Racial Purity Theories
• Arguments Against Legalized Euthanasia
• About Should Euthanasia Be Permitted in Cases of Terminally Ill Patients
• Euthanasia: Status and Medical Implications This paper presents a debate in which the idea of euthanasia is rejected with totality based on the conviction that euthanasia ignores the importance and value of a human’s life.
• Euthanasia and the Current Legal Position of Euthanasia
• Euthanasia and the Hippocratic Oath
• Nonvoluntary Euthanasia Means Causing Death in Violation of the Patient’s Consent
• Facts About Euthanasia and the Oregon Death With Dignity Act
• Capital Punishment Reintroduction in the UK The death penalty is what they call the “execution sentence for murder and other capital crimes, serious crimes or grave crimes such as murder, treason, rape and the like.
• Customize Your Death: Why Some Forms of Euthanasia May Be Ethically Justified
• United States Legal System and Euthanasia Cases
• Demystifying Assisted Suicide and Euthanasia
• Euthanasia and the Case of Comatose Elderly Patients
• States’ Laws on Physician-Assisted Suicide and Euthanasia The State passed the “Oregon Death with Dignity Act” in the year 1994. The law allows physician-assisted dying with certain restrictions.
• Critically Consider the Ethical and Legal Arguments for and Against Euthanasia
• America Needs Voluntary Euthanasia and Assisted Suicide
• Euthanasia: Comparing Kantian and Utilitarian Ideas
• Ethical Issues Surrounding the Choice of Euthanasia in the United States
• Suicide and Long Term Grief in Significant Others in Relation to Dying The reasons behind suicide and the qualitative essence of suicide-related grief cannot be assessed outside of affected people’s ability to operate with highly abstract categories.
• Euthanasia, Physician-assisted Suicide, and Our Aged and Frail Population
• Understanding Euthanasia and the Controversy Surrounding It in the US
• Can Hegelian Dialectics Justify Euthanasia?
• Why Should Active Euthanasia and Physician-assisted Suicide Be Legalized?
• What Is the Attitude Towards Euthanasia in the Netherlands?
• Why Are Euthanasia and Abortion So Often Compared?
• Should a Physician Discourage Voluntary Euthanasia?
• How Active Euthanasia Works?
• Are Physician-assisted Suicide and Euthanasia Ethical?
• How Has Euthanasia Changed in the 21st Century?
• What Are the Main Objections to the Legalization of Euthanasia in Hong Kong?
• How Does Brian Clark Use Theatre to Dramatise the Euthanasia Debate?
• What Are the Bioethical Problems of Euthanasia in Modern Conditions?
• What’s Wrong With Involuntary Euthanasia?
• Why Does Euthanasia Open the Door for Legalized Killing?
• Euthanasia: When the Pain of Dying Exceeds the Pleasure of Living?
• What Does Euthanasia Mean to Society Today?
• In Which Countries Is Euthanasia Legalized?
• How May the Religious Faith Inform the Issue Over Euthanasia?
• Does Euthanasia Answer the Prayers of the Dying?
• How Does Parenting Make Euthanasia More Acceptable?
• Euthanasia: Why Do People Want To Die Earlier?
• Euthanasia: Should Doctors Intervene at the End of Life?
• Why Euthanasia Devalues Human Life?
• What Is the History of the Emergence of Euthanasia?
• What Are the Three Main Reasons Why Euthanasia Should Be Legalized?
• Voluntary Euthanasia: What’s Right and Wrong?
• What Medications Are Used in Euthanasia?
• What Are the Main Drugs That Are Used for Euthanasia?
• Is Euthanasia a Humane and Dignified Solution?
• Can Euthanasia Help the Terminally Ill?
• What Is the Law in Oregon Regarding Euthanasia?
• What Are the Key Ethical Considerations Surrounding Euthanasia?
• Is Euthanasia Morally Justified for Animals?
• Why Is the Role of Doctors in Euthanasia a Controversial Issue?
• What Is the Double Effect of Euthanasia?
• How Do Different Countries Approach the Involvement of Doctors in Euthanasia?
• What Is the Most Humane Form of Euthanasia?
• How Does the Physician-Patient Relationship Influence Euthanasia Decisions?
• What Does Euthanasia Do to the Brain?
• How Do End-of-Life Care and Euthanasia Differ in the Medical Community?
• What Is the Difference Between Voluntary and Passive Euthanasia?
• How Do Cultural and Religious Beliefs Influence Doctors’ Views on Euthanasia?
• What Is the Moral Philosophy of Euthanasia?
• Why Is It Important for Doctors to Maintain Open Communication with Patients About Euthanasia?
• What Ethical Principles Underlie the Practice of Euthanasia?
• Is Euthanasia Sometimes Morally Permissible?
• How Can Medical Ethics and Guidelines Evolve to Address the Challenges of Euthanasia?
• Should Passive Euthanasia Be Allowed?
• How Does Euthanasia Affect the Moral and Ethical Compass of Medical Professionals?
• What Are the Most Common Reasons Patients Seek Euthanasia?
• Is Euthanasia a Serious Option to Escape Pain or Misery?
• What Is the Gunshot Method of Euthanasia?
• Why Is Euthanasia Often Considered a Last Resort in Medical Care?
• Is Human Euthanasia Legal in Any US State?
• How Do Different Cultures and Societies View the Practice of Euthanasia?
• What Legal Frameworks Exist for Euthanasia Around the World?
• Why Are Christians Against Euthanasia?
• How Has Euthanasia Shaped Public Opinion and Attitudes Toward Death?
• Should People with Mental Illnesses Have the Right to Euthanasia?
• How Can Euthanasia Laws Be Safeguarded Against Abuse and Misuse?
• Why Is Psychological Evaluation Essential in Euthanasia Decision-Making?

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Euthanasia and physician-assisted suicide: a systematic review of medical students’ attitudes in the last 10 years

Alejandro gutierrez-castillo.

1 Researcher, School of Medicine, Monterrey Institute of Technology and Higher Education, Nuevo León México, Mexico.

Javier Gutierrez-Castillo

Francisco guadarrama-conzuelo, amado jimenez-ruiz.

2 Neurology Resident, Department of Neurology, National Institute of Medical Science and Nutrition Salvador Zubirán, Ciudad de México, México.

Jose Luis Ruiz-Sandoval

3 Professor, Department of Neurology, Civil Hospital of Guadalajara “Fray Antonio Alcalde”, Jalisco, México.

This study aimed at examining the approval rate of the medical students’ regarding active euthanasia, passive euthanasia, and physician-assisted-suicide over the last ten years. To do so, the arguments and variables affecting students’ choices were examined and a systematic review was conducted, using PubMed and Web of Science databases, including articles from January 2009 to December 2018.

From 135 identified articles, 13 met the inclusion criteria. The highest acceptance rates for euthanasia and physician-assisted suicide were from European countries. The most common arguments supporting euthanasia and physician-assisted suicide were the followings: ( i ) patient’s autonomy (n = 6), ( ii ) relief of suffering (n = 4), and ( ii ) the thought that terminally-ill patients are additional burden (n = 2). The most common arguments against euthanasia were as follows: ( i ) religious and personal beliefs (n = 4), ( ii ) the “slippery slope” argument and the risk of abuse (n = 4), and ( iii ) the physician’s role in preserving life (n = 2). Religion (n = 7), religiosity (n = 5), and the attributes of the medical school of origin (n = 3) were the most significant variables to influence the students’ attitude. However, age, previous academic experience, family income, and place of residence had no significant impact.

Medical students' opinions on euthanasia and physician-assisted suicide should be appropriately addressed and evaluated because their moral compass, under the influence of such opinions, will guide them in solving future ethical and therapeutic dilemmas in the medical field.

Introduction

Death by itself is not part of an ethical dilemma, as all lives are bound to end since the moment of conception, and human beings confront death through their personal beliefs, religion, and cultural context. Regardless of the natural and unavoidable causes of death, debate over death focuses on how to control it as well as on who and how should perform the death-related practices in medical field. The important role of physicians in this debate is that they are often both the judge and the executor of such practices ( 1 ). Several physicians believe that the idea of promoting death is against Hippocratic Oath and their primary role as healer, while others may reject the idea based on their moral or religious values ( 1 ).

The issues on control over death can be divided into two broad categories: euthanasia and physician-assisted suicide (PAS). Euthanasia is further divided into active euthanasia (AE) or passive euthanasia (PE), according to the role that the physician plays in the process. The term PE is no longer used in some countries, and the term Therapy Withdrawal (TW) is replaced as the physician’s role is limited to suspending treatment or stopping additional measures that artificially prolong life. In TW, the physician acts as a mere observer while the disease advances and ends the patient’s life. However, in AE, the physician operatively engages in ending patient's life by administering a toxic substance that accelerates death ( 2 ). In PAS, the physician intentionally helps the patient to commit suicide by providing drugs for their self-administration at the patient’s competent and voluntary request ( 3 ). The differences among aforementioned approaches have implications that surpass their moral approval, as the medical actions involved in these approaches are regulated by law. According to the American Medical Association (AMA), AE and PAS are in conflict with physicians’ healing role. Furthermore, their management are quite challenging, if not completely impossible, and they entail grave risks to the society ( 4 ). However, PE, described as withdrawal or withholding life-sustaining treatment, is ethically acceptable for a patient capable of decision-making, and if an intervention is not expected to achieve the patients’ goals for care or desired quality of life ( 4 ).

The contributions of this study are as follows: ( i ) quantitative assessment of medical students’ approval rate for AE, PE and PAS over the last ten years, ( ii ) analysis of the most common arguments validating such practices, and ( iii ) evaluation of the variables that can influence a personal position on the topic. This study aimed at answering the following questions: What is the percentage of euthanasia or PAE approval among medical students? What are the most common arguments associated with the approval or rejection of euthanasia or PAE? What are the variables affecting the approval or rejection of euthanasia and PAE?

This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) ( 5 ) ( Figure 1 ).

PRISMA flowchart

The literature searches in April 2019, included articles published between January 2009 and December 2018, and focused on PubMed and Web of Science as the primary electronic databases. The databases were searched using the following search strings: (medical students) AND (euthanasia OR Physician-assisted suicide).

Our review focused on original cross-sectional descriptive studies in English whose main population, or part of it, was composed of medical students and quantified their personal views regarding the legalization or practice of PAS or euthanasia.

Only original descriptive articles that quantitatively addressed the first focused question in the last ten years were included. The excluded cases were the followings: ( i ) Review articles, book chapters, conference papers, and letters to the editor; ( ii ) Non-neutral reports, where the authors expressed their views or stated an opinion on the topic; ( iii ) Articles whose main population consisted of physicians, nurses, or any group other than undergraduate medical students; ( iv ) Articles for which the complete text could not be found online; and, ( v ) Articles written in languages other than English.

Records were initially screened according to the titles and abstracts. Relevant abstracts and articles without an abstract were selected for full-text review. Articles selected in the first screening were carefully read and analyzed to determine whether they addressed the first focused question and whether they fulfilled the inclusion criteria. Further analyses were made to determine if they described any argument or variable that could persuade medical students to take a positive or negative side.

A total of 135 articles were identified after the database search (63 in PubMed and 72 in Web of Science); 97 non-duplicate documents were screened by the title and abstract. From the 25 articles eligible for full-text review, 13 fulfilled the inclusion criteria and were selected for further analysis ( 6 - 18 ). Reasons for exclusion of 12 remaining articles were as follows: ( i ) use of a language other than English (n = 2); ( ii ) absence of a full-text version online (n = 3); ( iii ) inclusion of a study population different than undergraduate medical students (n =3); and, ( iv ) failure to address the first focused question (n = 4).

From the 13 selected articles, seven ( 6 - 12 ) were published between 2014 and 2018 and six ( 13 - 18 ) were published between 2009 and 2013. Two studies were from Africa ( 7 , 9 ), four were from America ( 6 , 8 , 12 , 14 ), one was from Asia ( 15 ), and six were from Europe ( 10 , 11 , 13 , 16 - 18 ). The countries involved included Austria (n = 1) ( 18 ), Belgium (n = 1) ( 11 ), Brazil (n = 1) ( 12 ), Canada (n = 1) ( 14 ), Germany (n = 1) ( 10 ), Greece (n = 1) ( 18 ), Mexico (n = 2) ( 6 , 14 ), Pakistan (n = 1) ( 15 ), Poland (n = 2) ( 13 , 16 ), and South Africa (n = 2) ( 7 , 9 ).

Eight articles addressed the approval rate of medical students regarding legalization of AE, PE or PAS ( 7 - 9 , 11 , 13 , 15 - 17 ); ten stated a positive attitude toward AE exclusively ( 6 - 12 , 15 , 17 , 18 ); six addressed acceptance of PE ( 6 , 9 , 10 , 12 , 14 , 18 ); and, six addressed acceptance of PAS ( 7 , 8 , 10 , 14 , 15 , 18 ). Two articles addressed the students’ personal views on AE, PE or PAS, whether exclusively or conjunctively ( 13 , 16 ). The results are summarized in Table 1 .

Percentage of approval for AE, PE, and PAS, as well as the legalization of euthanasia or PAS.

Out of eight articles that addressed the positive views on legalization of the procedures, the lowest acceptance rate was 26% ( 13 ) and the highest 97% ( 11 ). The lowest and highest acceptance rates were as follows: ( i ) 14.2% ( 15 ) and 52% ( 18 ) for AE, ( ii ) 45.7% ( 12 ) and 83.3% ( 10 ) for PE, and ( iii ) 32.8% ( 15 ) and 69.7% ( 18 ) for PAS. The highest acceptance rates in the four scenarios were observed among students in European countries ( 10 - 12 , 15 ), while the lowest acceptance rates were related to Pakistan ( 15 ) and Brazil ( 12 ).

Eight articles ( 6 - 8 , 11 , 15 - 18 ) were related to second main question addressing students’ arguments for or against the practice of AE, PE or PAS. The most common arguments supporting AE, PE or PAS practice were as follows: ( i ) patients’ autonomy (n = 6) ( 6 - 8 , 11 , 16 , 17 ); ( ii ) relief of suffering or beneficence (n = 4) ( 7 , 11 , 16 , 17 ); and, ( iii ) the thought that terminally-ill patients are additional burden (n = 2) ( 11 , 18 ). Less relevant arguments included the followings: ( i ) legality of the procedure ( 6 ); ( ii ) educational or clinical experience ( 8 ); and, ( iii ) quality of life or life expectancy ( 18 ). The most common arguments against AE, PE or PAS were the followings: ( i ) religious or personal beliefs (n = 4) ( 7 , 8 , 15 , 18 ); and, ( ii ) “slippery slope” argument or risk of abuse (n = 4) ( 7 , 8 , 16 , 18 ); and, ( iii ) physicians’ responsibility to preserve life ( 7 , 18 ). The results are summarized in Table 2 .

Students’ arguments in favor or against the practice of euthanasia or PAS

Regarding the third focused question, 11 articles ( 6 - 9 , 11 , 12 , 14 - 18 ) highlighted variables that could cause the medical students to approve or disapprove AE, PE or PAS practices. Religion was the most significant variable that had a negative impact (n = 7) ( 6 - 8 , 11 , 12 , 14 , 16 ), followed by religiosity (n = 5) ( 6 , 12 , 14 , 15 , 18 ) as the second most significant variable. Moreover, university of origin for the medical students (n = 3) ( 12 , 14 , 16 ) and previous experience with euthanasia or palliative sedation in a relative (n = 1) ( 11 ) were other named variables. Non-significant variables included the followings: ( i ) age (n = 3) ( 6 , 12 , 17 ); ( ii ) previous academic experience regarding end-of-life decisions (n = 2) ( 11 , 16 ); ( iii ) family income (n = 1) ( 12 ); and, ( iv ) size or place of residence (n = 1) ( 16 ). Variable of gender in influencing the students’ opinions showed mixed results: significant ( 6 , 16 ) and non-significant ( 11 , 12 , 14 , 17 , 18 ). Similarly, for variable of medical students’ current academic year, three studies considered it to be significant ( 9 , 15 , 17 ) and one study reported it as irrelevant ( 6 ). The summarized results are shown in Table 3 .

Significant variables that affect the posture of medical students towards euthanasia or PAS

Despite the great diversity of opinions regarding AE, PE and PAS, the percentage of approval for AE was lower than those of PE or PAS in all analyzed scenarios ( 6 - 18 ). Regarding AE approval, the study of Kontaxakis et al. was the only one that reported an acceptance percentage higher than 50%, under special circumstances ( 18 ). If these results are compared to those of other groups, such as general population ( 19 ) or post-graduate students ( 11 ), the approval rate is usually higher than 50%. In contrast, physicians tend to show a negative attitude toward the topic ( 19 , 20 ). The relevance of clinical experience, as a variable that could influence the acceptance of euthanasia or PAS, was discussed by Marais et al. ( 9 ) and Hassan et al. ( 15 ), who reported different results depending on whether the students were at preclinical level (without active experience with patients) or on clinical rotations. Marais et al. stated that higher clinical-level correlated to medical students’ greater empathy towards patients and respect for their autonomy. This correlation was demonstrated by a 20% difference in acceptance rate for AE between preclinical and clinical students, which dropped to 10% when they were asked if they will perform an assisted-dying procedure ( 9 ). Hassan et al. found lower acceptance rate for euthanasia or PAS among senior medical students; the attitude toward euthanasia, however, split to 50% against and 50% undecided, highlighting a higher percentage of indecision among seniors than freshmen ( 15 ). Seniors stated that through clinical exposure, medical students become more aware that some diseases are incurable ( 15 ). However, a 2018 study by the authors of article ( 6 ) did not identify academic rank as a variable that could influence medical students’ attitude toward this topic. That study focused only on preclinical students in the first three years of medical school, justifying the uniformity of opinions and highlighting that exposure to patients affected medical students’ views regardless of their academic school year.

Until now, AE has been legalized in Belgium ( 11 ), the Netherlands ( 19 ), Luxemburg ( 19 ), Colombia ( 21 ), Uruguay ( 21 ), and Canada ( 8 ); Three countries where AE is legal are European ( 11 , 19 ), which justify that why the majority of the papers that met the present study’s inclusion criteria were published in this continent where the debate is open. In Belgium, the only country included in this study where AE is currently legalized, Roelans et al. reported that the approval percentage of the legalization of euthanasia to be 97% ( 11 ); a real legal environment, along with personal or professional experience in scenarios of assisted death, can create more favorable attitude among medical students ( 11 ). In Canada, another country where these practices are legalized, the study by Bator et al. was performed a year before the Canadian laws’ modification to abolish the penalization of euthanasia ( 8 ). These political discussions may affect medical students’ attitude toward acceptance.

Religion is defined as a moral institution with a unified system of values, beliefs and practices related to what is considered sacred ( 22 - 23 ). Religion is one of the most common variables mentioned by researchers to influence medical students’ views on euthanasia ( 6 - 8 , 11 , 12 , 14 - 16 , 18 ). Moreover, religion affects several other areas of medicine, such as adherence to treatment or the decision-making process in high-risk procedures ( 22 ). In seven studies that described religion as a relevant variable, five found Catholicism to be the most frequently self-reported religion ( 6 , 11 , 12 , 14 , 16 ), and less frequently ones were Christianity ( 7 ) and Islam ( 15 ). Conversely, the medical students who considered themselves atheists or those who did not actively practice any religion tended to have a more positive view towards AE, PE, and PAS for both patients and themselves ( 8 , 11 , 12 , 14 - 16 , 18 ). Different, sometimes conflicting views can be observed among various religions. In 2007, Sprung et al. studied the attitude of physicians towards PE; Catholics, Protestants and those with no religious affiliation compared to Jews, Greek Orthodoxies or Muslims had higher acceptance rate for therapy withdrawal ( 23 ). According to the Roman Catholic religion, practitioners are not obligated to ward off death at all costs, but they should not deliberately intervene to accelerate this process ( 24 ). The principle of “sanctity of life” categorizes life as a basic value as it establishes a direct relationship with God, and condemns any intervention that seeks to end this relationship ( 24 ). This principle could explain a more negative attitude toward AE and a mildly open posture toward PE. Studies that described a majority of the Catholic population and addressed the attitude of PE had acceptance rate higher than 50%, except one study from Poland ( 16 ). Leppert et al. did not separate the opinions in favor of or against AE, PE, or PAS, and considered that the students’ view could be influenced by the statements of the last Polish Pope, John Paul II ( 16 ). Regarding Islam, negative attitude is generally stated toward the topic ( 7 , 15 , 23 ). The Quran forbids self-harm and consenting to end life, which can be related to terminally-ill patients consenting to euthanasia ( 25 ). In Islam, death is not the final destination, and therefore a believer should keep facing difficulties despite suffering to stay alive ( 25 ). However, the concept of religion has to be differentiated from religiosity or religiousness, referring to the influence of religion on daily life and intrinsic values. A positive experience with religion, mainly described as a growing spirituality or closeness to God, empowers patients to undertake greater risks in their treatments ( 22 ). Regarding euthanasia, the greater the religiosity, the more opposition towards euthanasia ( 6 , 15 ). This association is in line with our previous study’s findings, where the participants who were described as strong believers showed a predominant negative view towards AE and PAS as well as inflexibility to change their original position in different scenarios ( 6 ). Similarly, Hassan et al. reported the lowest acceptance rate for AE, in a study involving predominately Muslim participants, which 17% of them identified themselves as very religious ( 15 ).

The main arguments on euthanasia are related to the bioethical principles. Autonomy, the most common argument stated by the medical students to support this practice ( 6 - 8 , 11 , 16 , 17 ), derives from the Greek auto (self) and nomos (rule) and refers to the individuals’ ability to make independent choices about their treatment ( 7 ). However, the state of autonomy in relation to euthanasia varies depending on whether autonomy is considered an intrinsic or moral value. In the former, patients would have free will in decision-making about their life or death ( 26 ), and in the latter —according to the Kantian perspective—death threatens autonomy by eliminating the individual who would otherwise exercise autonomy ( 27 ). Another argument to support euthanasia is relief from suffering, based on the principle of beneficence, as it considers the induction of death as a better alternative to avoid unnecessary suffering ( 28 ). The opponents of euthanasia argue that the elimination of suffering by death may not be the best alternative considering the followings: ( i ) increasing interest and research on palliative care and ( ii ) management of patients’ psychiatric conditions (e.g., depression), which may adequately relieve their suffering ( 28 , 29 ). The most common arguments against these practices were as follows: ( i ) personal and religious beliefs ( 7 , 8 , 15 , 18 ); ( ii ) risk of abuse, sometimes referred to as the “slippery slope” argument ( 7 , 8 , 16 , 18 ); and, ( iii ) the physicians’ role in preserving life ( 7 , 18 ). According to the argument of the “slippery slope”, if specific types of actions receive permission, then society will be coerced in permitting further morally wrong actions ( 30 , 31 ). As a classic example of this argument, in the Netherlands, where initially euthanasia was only approved for terminally-patients, the criteria were later expanded to allow euthanasia for chronically-ill patients and those suffering from severe psychiatric conditions. Subsequently, euthanasia was legally allowed for incompetent patients, including children ( 31 ). Opponents of the “slippery slope” argument state that for euthanasia to be considered as part of the risk of abuse argument, it must initially be condemned as morally wrong, an argument that in their opinion is dependent merely on personal experience ( 31 ). The final argument against euthanasia is the Hippocratic Oath’s view of the physicians’ role as healers. The Hippocratic Oath was first proclaimed in 400 BC and established one of the earliest codes of ethics for the medical profession ( 32 ). Because of its tradition and relevance, it is still frequently taken by medical students during their training or upon its completion. One of its lines states that physicians will not give poison to anyone though asked to do so, nor they would suggest such a plan ( 6 ), a line that contradicts modern-day views of euthanasia. This presumptive allegiance to the Hippocratic Oath may explain why students from newer, urban, public, and bigger universities usually have a more positive attitude towards euthanasia and PAS than students from older schools with more traditional values ( 12 , 14 , 16 ).

The relevance of understanding the medical students’ attitudes towards euthanasia and PAS lies not only in their values as present-time insights, but also as input data to generate strategies that optimize their education and address future medical dilemmas. Even though medical students usually have sufficient knowledge about euthanasia ( 15 ), they lack understanding of end-of-life care. Eyigör stated that most medical students believe that they have not received a complete education on palliative care or training on communication skills regarding palliative-care patients ( 33 ). A better understanding of end-of-life care, including euthanasia and PAS, for medical students, is essential, even if these practices are not currently legalized in their countries as related debates on the topic are not expected to end shortly.

A major limitation of this study was the use of non-standardized questionnaires to research the main focused questions, as they provide varied responses that are difficult to categorize and analyze adequately. Even if a students’ view on euthanasia or PAS is markedly positive or negative, the format of the questionnaire may not accurately address the real answer. Moreover, questions asked directly may obtain different answers than those asked indirectly; questions with clinical case scenarios or with only binary true or false answers could further alter the results. Another limitation was the use of only two electronic databases, which could narrow results. This limitation could also limit the number of countries included in the study, which may prevent the global perspective from being reflected.

Seeking a global perspective from medical students over a particular course and then describing that perspective is complex. This complexity is not only due to the great diversity of opinions, but also due to the geographical, social, cultural, and temporal context influencing their decisions. This study aimed to objectively describe the medical students’ attitude towards AE, PE, and PAS practices as well as to analyze the variables and arguments surrounding these practices. To summarize, PE and PAS are more accepted than AE, and the most critical arguments in favor of these practices are the respect for autonomy and the relief of suffering. Personal beliefs and the social role of the physician as a healer are the most common arguments against these practices. Even though a consensus may not be reached easily or soon, continuing the discussion about end-of-life decisions is essential because the debates over these practices and the necessity for such decisions will unavoidably linger. Medical students must be aware of different perspectives on the topic to make an informed decision in related circumstances.

Citation to this article:

Gutierrez-Castillo A, Gutierrez-Castillo J, Guadarrama-Conzuelo F, Jimenez-Ruiz A, Ruiz-Sandoval JL. Euthanasia and physician-assisted suicide: a systematic review of medical students’ attitudes in the last 10 years. J Med Ethics Hist Med. 2020; 13: 22

Conflict of Interests

The authors declare that they have no conflict of interests.

Euthanasia and Assisted Suicide: A Guide to the Evidence

Introduction

This evidence guide has been written to inform the debate about whether to legalise physician assisted suicide or euthanasia in the United Kingdom.  Most of the sources cited here are also relevant to the debates on assisted suicide or euthanasia in other countries.

You can skim to get a sense of the different issues at stake and where to find further information, especially the most reliable information that is freely available online.  

This guide aims to be useful for:

• students (especially of the medical professions, law, philosophy, and bioethics)
• research assistants to officials or parliamentarians.  

More than this, it is offered to anyone who is concerned about these issues and wishes to assess the evidence. 

It is important to remember, as has recently been pointed out , ‘that the medical literature is, in general, favourably disposed toward the empirical and the new [… resultantly] articles defending the ethical status quo (i.e., against PAS) tend to be shut out of the medical literature because they are not reporting anything new and, therefore, cannot have any data. The result is an impression of growing acceptance of PAS, but it really represents an artefact of a scientific bias’. It is hoped that this guide contributes to redressing this scientific bias.

Along with references for the source-data and official reports on assisted suicide and euthanasia in various countries, it identifies some useful articles that have been published in Peer Review Journals (PRJ). Publishing in a PRJ is no guarantee of the truth of an article’s conclusions, for especially in law, ethics and public policy academics frequently argue for opposite conclusions. However, being published in a PRJ is a sign that other academics have considered the argument to be well-structured and the sources of evidence to be clearly identified. This provides a good starting point for debate. Unfortunately, most PRJ material is not free to the general reader but is available only through universities or by subscription. Nevertheless, some PRJ articles are free online and sometimes there are freely available discussions based on the article. At a minimum the abstract of the article will generally be available free online. In this bibliography, all PRJ articles will be identified with an asterisk * . Where the full text of a PRJ is freely available this will be indicated by * (full text available) . Where the published version is not freely available, a pre- or post-print draft occasionally will be. This means that the full text can be read, but the article has none of the publisher’s formatting.

Many articles on euthanasia and assisted suicide have been published since the original version of this evidence guide in 2015. We have updated the guide to include new literature and the changes to legislation regarding euthanasia and assisted suicide throughout the world since that time. The guide is intended to be indicative rather than fully comprehensive, and we intend to update the resources periodically in the future.

DA Jones, R Gay and CM Wojtulewicz

Oxford, April 2022

Abbreviations

EAS = euthanasia and/or assisted suicide.

PAS / AS = physician-assisted suicide / assisted suicide

1. Parliamentary Reports

Since 1990 within the United Kingdom there have been three parliamentary reports on assisted euthanasia or suicide, each of which has been critical of such proposals. The most recent, and the most relevant to the Bills before the House of Lords and the House of Commons, is the 2015 Report of the Health and Sport Committee of the Scottish Parliament.

House of Lords Select Committee on Medical Ethics (HL Paper 21-I of 1993-4). There is no copy of the report available online, but a summary was provided by Lord Walton of Detchant (its chair) in a statement to the House of Lords recorded in Hansard.

House of Lords Assisted Dying for the Terminally Ill Committee 5 April 2005 (Mackay Committee ) On this committee’s findings see also I Finlay, VJ Wheatley, and C Izdebski. ‘The House of Lords Select Committee on the Assisted Dying for the Terminally Ill Bill: implications for specialist palliative care.’ Palliative medicine 19.6 (2005): 444-453 . *

Scottish Parliament Health and Sport Committee 6th Report, 2015 (Session 4): Stage 1 Report on Assisted Suicide (Scotland) Bill . This Committee was ‘not persuaded by the argument that the lack of certainty in the existing law on assisted suicide makes it desirable to legislate to permit assisted suicide... there are ways of responding to suffering (such as increased focus on palliative care and on supporting those with disabilities), which do not raise the kind of concerns about crossing a legal and ethical “Rubicon” that are raised by assisted suicide’. [292, 294]

The House of Lords introduced the Assisted Dying Bill 2021 [HL] , proposed by Baroness Meacher, which was given a second reading on 22 October 2021 . 

House of Commons Library Debate Pack 22 January 2020, ‘The Law on Assisted Dying’ , by Elizabeth Rough and Nikki Sutherland.

Current challenges in the culture of healthcare in the UK 

If legalised, assisted suicide or euthanasia would be implemented in the context of the NHS. In this regard it is important to be realistic about the current state of healthcare in the UK and failures that can occur and that have occurred, for example, in Mid Staffordshire and in the implementation of the Liverpool Care Pathway for the Dying Patient. These problems were not confined to one Trust or one Pathway but reflect cultural challenges within the NHS. How might assisted suicide or euthanasia be implemented in an environment of targets and ‘tick-boxes’ that sometimes operate to the detriment of patient care? 

Mid Staffordshire NHS Foundation Trust Public Inquiry (Francis Report)

Independent Review of the Liverpool Care Pathway: More Care, Less Pathway (Neuberger Report)

2. Official Statistics from Jurisdictions with Assisted Suicide or Euthanasia

Statistics for rates and characteristics of death by assisted suicide or euthanasia are available for fifteen jurisdictions: Canada, the Netherlands, Belgium, Luxembourg, Switzerland, Victoria (Australia) , and, in the USA, the District of Columbia , and the states of California, Colorado, Hawaii, Oregon, Maine, New Jersey, Vermont and Washington . Assisted suicide is legal in Montana and New Mexico, but there are no official reports on the practice. 

Such statistics are only as reliable as the questions asked and the means of data collection and in all cases rely on self-reporting. In Flanders (Belgium) it has been shown that official figures underestimate rates by approximately 50% (see section 5.4 below). Official reports tend to gloss the figures and readers should beware of ‘spin.’ Nevertheless, with these caveats, official figures remain an important source of evidence for the impact of legalising assisted suicide or euthanasia.

In Belgium euthanasia was legalised in 2002 and reports have been produced every two years. These are available (in French) here.  

In Luxembourg euthanasia was legalised in 2009 and reports are produced every two years. Luxembourg has a small population (less than 1% of the UK population) and thus the number of cases is small. Nevertheless, over 6 years it is possible to see some patterns (a general increase in cases, an increase in non-cancer cases, more cases of women than men). The fifth report (for 2017-2018) is available here. The sixth report (for 2019-2020) was completed in March 2021, but is not available for download.

In the Netherlands euthanasia was effectively decriminalised by a court decision in 1984. This was the basis of a legal statute in 2001 legalising euthanasia and physician assisted suicide. Since 2002 the Netherlands has produced an annual report on the cases notified to the five regional euthanasia committees. These are available (in English once the year is selected).  

In Switzerland , since 1942, inciting or assisting suicide has been illegal when it is for selfish motives (such as financial gain). Since 1982 this law has provided legal space for the organisation EXIT to promote assisted suicide for those ‘with unbearable symptoms or with unacceptable disabilities’. There are two government reports from the Federal Statistical Office, one in 2012 and latest, for 2014, published in 2016 and revised in 2017 . There are also statistics for assisted suicide by sex and age for 2003-2019 , published by the Federal Statistical Office. Dignitas has released statistics from 1998-2021 .

North America

Canada passed euthanasia and assisted suicide into law in 2016 (termed ‘medical assistance in dying’ or MAID). Further changes in the law, widening eligibility criteria, were introduced in March 2021 (though not effective until March 2023). The Second Annual Report on Medical Assistance in Dying (2020) shows that ‘MAID’ deaths increased by 34.2% from 2019.

The District of Columbia legalised assisted suicide in 2016 and has produced one statistics report in 2018.

California legalised assisted suicide in 2015 and has produced reports each year since. They can be found here.

Colorado legalised assisted suicide in 2016, and has produced reports each year since. They can be found here.

Hawaii passed assisted suicide into law in 2018, which came into effect in January 2019. The 2019 and 2020 legislative reports can be found here.  

Oregon legalised physician assisted suicide in 1997 and produces annual reports. Helpfully the latest report (2021) includes data from previous years. Note that the figure for the number of deaths in the most recent year covered by the report will generally be inaccurate as deaths are recorded against the year of the lethal prescription. For example, if a lethal prescription given in 2012 were used in 2013 the death would be recorded as due to assisted suicide in the 2012 figures. Reports from all individual years can be accessed here.

Maine introduced assisted suicide in 2019 and its reports can be found here.

New Jersey also passed assisted suicide into law in 2019 and its 2019 and 2020 data summaries can be found here.

Vermont legalised physician assisted suicide in 2013 for terminally ill patients. The latest report can be seen here (issued Jan 15 2022).

Washington legalised physician assisted suicide in 2009 following the Oregon model (Washington borders Oregon and to a great extent shares a common culture and history). Washington also produces annual reports.  

Victoria (Australia) legalised euthanasia and assisted suicide (under the umbrella term ‘voluntary assisted dying’ or VAD) in 2017, which came into effect in June 2019. Statistics are issued approximately every 6 months, and the data can be found here.

There are common patterns which emerge in each of these jurisdictions: in every jurisdiction numbers have increased over time and continue to do so; there has also been a shift from permitting assisted suicide for cancer victims to include other diseases. In Europe this includes non-terminal conditions such as neuro-psychiatric conditions and multiple co-morbidities (for example, those associated with old age). Supposed safeguards such as psychiatric referral have also declined in frequency (see below for further details). Essentially, the practice has become more widespread and more routine.

3. Public Opinion on Euthanasia and Assisted Suicide

Within the political debate on assisted suicide and euthanasia, both sides, but especially advocates of a change in the law, frequently appeal to surveys of public opinion. In polls, there is a consistent majority of public opinion that expresses support for legalising assisted suicide or euthanasia.

In the UK polls typically show between 70-80% support for legalising assisted suicide. Support drops to around 60% for euthanasia. See for example:

Ipsos-Mori Poll for The Economist (June 2015)

80% believe those accompanying a family member or friend abroad to receive assisted suicide should not be prosecuted. This drops to 74% when informed that current law in England and Wales is that assistance is punishable by up to 14 years in prison. 65% think the law should be changed to permit assistance in travelling abroad, see:

Ipsos-Mori Poll for Dignity in Dying (June 2009)

A 2019 poll commissioned by Dignity in Dying shows net support for assisted suicide law at 84%; but it must be noted that the procedure is referred to as ‘assisted dying’ rather than ‘assisted suicide’ (see the section below on wording of polls):

Populus Poll for Dignity in Dying (March 2019)

Gallup Poll (USA, 2013)

It should be noted that 73% think there ‘ is a difference between a terminally ill adult seeking assistance to end their life and suicide ’, see YouGov / Dignity in Dying (August 2021) . However, the proposed legislation (Assisted Dying Bill [HL] 2021) has the effect of amending the Suicide Act 1961 (as amended by the Coroners and Justice Act 2009) so that it is no longer and offence to ‘encourage or assist’ suicide.

On the issue of correct terminology and the use of euphemism, see:

David Albert Jones, ‘Defining the Terms of the Debate: Euthanasia and Euphemism’, Briefing Papers: Euthanasia and Assisted Suicide (Anscombe Bioethics Centre, Oxford: 2021)

In the UK, 78% are concerned that, as a society, as much as possible ought to be done to reduce suicide rates. 51% are concerned that people would see themselves as a burden and feel pressured into taking their own life if assisted suicide were legal, see:

ComRes Care Not Killing Assisted Suicide Poll (February 2019)

In a 2018 poll, although 75% were in favour of a change in the law, 60% did not know anyone close to them who had died who would have considered assisted suicide had it been available to them, see:

ComRes Daily Mirror Assisted Dying Poll (June 2018)

When participants are exposed to counter arguments to legislation, support wavers. In one poll from 73% to 43%:

Care Not Killing, “‘Assisted Dying’ and Public Opinion” (2014)

ComRes CARE Assisted Suicide Poll (2014)

The Mackay committee produced a very useful critical review on the state of evidence at that time (2005) in relation to public opinion on assisted suicide and euthanasia ( Chapter 6 and Appendix 7 ).

‘ The key conclusion of this report is that, although some idea of the basic attitude of the general public is available through research sources, this does not amount to an authentic picture of public opinion which is in any way comprehensive. Deliberative research techniques, unused so far for this subject, which can produce an account of informed public opinion, are recommended if a proper understanding of public opinion is to be achieved .’ ( Appendix 7 , para 17) 

In 2022, it remains the case that ‘ Research sponsors frequently appear to have been more concerned to achieve statistics for media consumption than to work towards achieving a comprehensive understanding of public and health sector attitudes’ (Appendix 7, para 2).

The flaws in most yes/no polls are methodological and are not corrected merely by conducting more polls of a similar kind. Qualitative research is needed to uncover the complexities of the issue and/or the complexities of people’s attitudes to the issue. For example, a study in the Journal of Medical Ethics showed that, if people were given a range of choices (and not just one), more individuals were in favour of legal sanctions against euthanasia than were in support of it.

Hagelin, J, T Nilstun, J Hau, and H-E Carlsson. ‘Surveys on Attitudes towards Legalisation of Euthanasia: Importance of Question Phrasing’. Journal of Medical Ethics 30, no. 6 (1 December 2004): 521–23. https://doi.org/10.1136/jme.2002.002543. * (full text available).

This complexity is also shown in qualitative research with nurses and with dying cancer patients. See here:

Berghs, M, B. Dierckx de Casterlé, and C. Gastmans, ‘The Complexity of Nurses’ Attitudes toward Euthanasia: A Review of the Literature’. Journal of Medical Ethics 31, no. 8 (August 2005): 441–46. https://doi.org/10.1136/jme.2004.009092. * (full text available).

Jaklin, A., N. Olver, and I. Eliott, ‘Dying Cancer Patients Talk about Physician and Patient Roles in DNR Decision Making’. Health Expectations 14, no. 2 (2011): 147–58. https://doi.org/10.1111/j.1369-7625.2010.00630.x * (full text available).

It is worth highlighting the following conclusion from the latter study: ‘ Survey studies showing majority support for euthanasia have typically required individuals to make judgements about hypothetical and abstracted scenarios. Under such conditions, individuals are likely to draw upon the readily available and socially approved discourses of autonomy and compassion, and voice approval. To conclude that this legitimises euthanasia as social policy is to deny the import of other factors that feature when individuals have opportunity to do more than endorse or reject euthanasia ’.

These complexities are by no means peculiar to the issues of assisted suicide and euthanasia, they apply more generally to use of public opinion in ethical debates around public policy. For such reasons government engagement with the public typically employs mixed methods: public events, open online consultations, stakeholder events, and representative opinion polls. The UK government’s Code of Practice on Consultation makes it clear that consideration of public opinion should give particular weight to the views of ‘any groups or sectors... that may be disproportionately affected by the proposals ’ (3.4). [In the case of assisted suicide and euthanasia this would be people who are dying, those who are living with disabilities, their carers, and healthcare professionals, especially doctors who care for the dying.] Consultations should not just ask for conclusions but ‘ the evidence given by consultees to back up their arguments. Analysing consultation responses is primarily a qualitative rather than a quantitative exercise ’ (6.1). 

These principles of good practice should apply also when judging the competing claims to how ‘the public’ thinks of assisted suicide and euthanasia.

Wording of polls

Support for euthanasia and assisted suicide in public opinion polls is subject to ‘ over 20% variation in mean support ’ where there are ‘ increasing levels of favourable wording’, and that ‘[a]llusions to hopelessness had an especially strong effect on increasing support for EPAS [euthanasia and physician-assisted suicide] ’:

Grove, Graham, Ian Hughes, Melanie Lovell, and Megan Best. ‘Content Analysis of Euthanasia Polls in Australia and New Zealand: Words Do Matter’. Internal Medicine Journal 51, no. 10 (2021): 1629–35. https://doi.org/10.1111/imj.15377. * (full text available after embargo ).

See also: L. Parkinson et al. ‘Cancer patients’ attitudes towards euthanasia and physician-assisted suicide: The influence of question wording and patients’ own definitions on responses’, Journal of Bioethical Enquiry , 2(2) (2005): 82-89 * (full text available).

Aghababaei, Naser, Hojjatollah Farahani, and Javad Hatami. ‘Euthanasia Attitude; A Comparison of Two Scales’. Journal of Medical Ethics and History of Medicine 4 (12 October 2011): 9 . * (full text available).

Another reason to be cautious of such polling (and opinion polls more generally) is that they do not necessarily reflect how people actually vote when given the opportunity. Most ballot initiatives in the USA on this issue have in fact failed , despite opinion polls seeming to show strong support. Those which have passed (Oregon, Washington, and Colorado) only secured modest majorities (51%, 58%, and 65% respectively).

4. Medical Opinion on Euthanasia and Assisted Suicide

Whereas simple yes / no public opinion polls typically find a significant majority in favour of legalising assisted suicide or euthanasia, opinion among the medical profession is generally opposed.

In March 2019, the Royal College of Physicians (RCP) adopted a position of neutrality , based on a survey of fellows’ and members’ views . 43.4% thought the RCP should be opposed to a change in the law, 31.6% thought the RCP should support such a change, and 25% thought the RCP should be neutral. While this shift was interpreted by some in the media as a move in favour of legalisation, they stated that, ‘ So that there can be no doubt, the RCP clarifies that it does not support a change in the law to permit assisted dying at the present time ’.

Although the Royal College of Radiographers (RCR) does not hold a position on ‘assisted dying’, in 2019 they polled their fellows and members , asking what they thought the RCR Faculty of Clinical Oncology’s position should be on whether or not there should be a change in the law on ‘assisted dying’. The response rate was only 34% (540 complete responses), but 42.9% thought the RCR position should be ‘opposed’, 26.9% thought ‘in favour’, and 30.3% thought ‘neutral’.

The 70th General Assembly of the World Medical Association (October 2019) stated that ‘ the WMA is firmly opposed to euthanasia and physician-assisted suicide ’.

In 2020, the Royal College of General Practitioners (RCGP) decided not to change its position of opposition to ‘assisted dying’, and would not review this for five years ‘ unless there are significant developments ’. 

The decision was based on a 2019 Savanta ComRes consultation of RCGP members . Only 41% of respondents thought the RCGP should support a change in the law if ‘ there is a regulatory framework and appropriate safeguarding processes in place ’. Only 7% thought ‘ GPs should be responsible for prescribing drugs for assisted dying (provided that a formal verification process is in place) ’. There was also reluctance to the idea of referring a patient (only 46% support) or supporting/counselling whilst a decision is being made (only 42% support).

The British Medical Association (BMA) changed its position on 14th September 2021 from opposition to a position of neutrality on the subject of ‘physician-assisted dying’. This was preceded by a survey of BMA members’ views on the subject (Kantar, February 2020). The response rate was 19.35% (28,986 members out of 152,004).

50% of respondents were personally supportive of ‘physician-assisted dying’ as a practice. But the percentage of those willing to participate in some way in ‘physician-assisted dying’ was only 36%. There is stronger opposition in general to euthanasia than there is for assisted suicide.

The Association for Palliative Medicine of Great Britain and Ireland (APM) urged parliamentarians to reject the Assisted Dying Bill [HL] 2021 in a briefing statement in October 2021 . A 2021 APM member survey found that 67% of respondents thought that ‘ patients and families think they are definitely or probably practicing covert euthanasia ’, showing a prevalence of misconceptions about palliative care among the public. 87% ‘ felt there has not been good enough press coverage of good deaths ’.

A study in New Zealand showed that medical students were less likely to support euthanasia / assisted suicide towards the end of their studies compared with the beginning, which is ‘ most likely due to their time in medical education ’, see:

Nie, Luke, Kelby Smith-Han, Ella Iosua, and Simon Walker. ‘New Zealand Medical Students’ Views of Euthanasia/Assisted Dying across Different Year Levels’. BMC Medical Education 21, no. 1 (23 February 2021): 125. * (full text available).

Research in Norway in 2014 and 2016 shows that only 9.1% of doctors in the Institute for Studies of the Medical Profession ‘strongly agree’ or ‘partially agree’ with PAS:

Gaasø, Ole Marius, Karin Isaksson Rø, Berit Bringedal, and Morten Magelssen. ‘Doctors’ Attitudes to Assisted Dying’. Tidsskrift for Den Norske Laegeforening: Tidsskrift for Praktisk Medicin, Ny Raekke 139, no. 1 (15 January 2019). * (full text available).

Disparity between support and willingness to be involved

Evidence from Canada and Australia show high levels of disparity between those who support euthanasia/assisted suicide in principle, and those who are willing to participate in the procedure.

Sellars, Marcus, Mark Tacey, Rosalind McDougall, Barbara Hayes, Bridget Pratt, Courtney Hempton, Karen Detering, et al. ‘Support for and Willingness to Be Involved in Voluntary Assisted Dying: A Multisite, Cross-Sectional Survey Study of Clinicians in Victoria, Australia’. Internal Medicine Journal 51, no. 10 (2021): 1619-1628 . * ( embargoed until 01/10/2022)

Bouthillier, Marie-Eve, and Lucie Opatrny. ‘A Qualitative Study of Physicians’ Conscientious Objections to Medical Aid in Dying’. Palliative Medicine 33, no. 9 (October 2019): 1212–20. * (full text available).

The RCR poll of fellows and members in 2019 (see above) showed that 37.3% supported a change in the law to permit ‘assisted dying’, with 46.9% opposed. But when asked, regardless of support or opposition, if they would ‘participate directly’ should the law change, 56.1% said ‘no’ and 23.2% said ‘yes’.

Religious views on End-of-Life Issues

Pew Research Center, ‘Religious Groups’ Views on End-of-Life Issues’, November 21 2013.

In the UK, a study of the influence of religious beliefs on medical students’ attitudes to EAS showed that among those surveyed (with 68.5% professing belief in God), ‘ the majority of students did not agree with euthanasia and physician-assisted suicide in the study scenario. Those who had a belief in god were more likely to disagree with actions that hasten death. The findings show that this was particularly the case with students from a Muslim background ’. See:

Pomfret, Suzie, Shaya Mufti, and Clive Seale. ‘Medical Students and End-of-Life Decisions: The Influence of Religion’. Future Healthc J 5, no. 1 (1 February 2018): 25–29. https://doi.org/10.7861/futurehosp.5-1-25 . * (full text available)

5. Causes of Concern where Euthanasia and / or Assisted Suicide (EAS) is Legal (Part 1)

Euthanasia and / or assisted suicide is legal in a number of places in the world. In some cases, legalisation happened nearly 30 years ago, although there has been a rapid growth in the last 10 years in the number of jurisdictions where, in particular, assisted suicide is permitted under certain conditions.

The British Medical Association have produced a map which shows at a glance where euthanasia and / or assisted suicide is legal.

Commonly there is a requirement for reporting data and monitoring of practice in places where EAS is permitted (see section 2 above). Such reports, along with other data and analysis provides a body of evidence which highlights several aspects of the practice, including reasons for concern. This section provides information from such data which highlight problematic aspects of euthanasia and assisted.

Ever increasing number of people dying by EAS following legalisation

Belgium and the Netherlands provide data over a long period of time, and therefore are amongst the most studied jurisdictions. An obvious cause of concern from both places is that EAS have shown large incremental increases over time. 

Figures 1 and 2 below show the number of deaths attributed to EAS since the early 2000s in Belgium and the Netherlands, showing the increasing numbers over time. Looking more closely, comparing the number of deaths in each country over the ten-year period between 2008 and 2018, we see significant increases, with EAS making up:

• 0.78% of deaths in Belgium in 2008, rising to 2.4% of deaths by 2018 
• 1.7% of deaths in 2008 and 3.9% of deaths in 2018 in the Netherlands (4.1% in 2020)

In other jurisdictions, similar increases are seen. In Canada, for example, the increase in deaths since legalisation of PAS was very steep, rising from 1,018 in 2016 to 7,595 in 2020, a 7.5-fold increase in just four years , representing 0.38% of all deaths in 2016, increasing to 2.5% of all deaths in 2020. In Switzerland, between 2009 and 2019, the number of AS deaths increased more than 4-fold from 297 to 1,196 (see Figure 3 below).

The number of deaths due to AS in Canada in 2020 is the highest total number of deaths due to EAS reported in any country in the world at 7,595, with the Netherlands the next highest number, recording its highest ever number at 6,938 in 2020 . It should be a cause for concern that in places where EAS is legal to practice, increasing numbers of people choose to end their own lives, or to ask for others to end them for them.

5. Causes of Concern where Euthanasia and / or Assisted Suicide (EAS) is Legal (Part 2)

Terminology of the Legislation

In many places where EAS is legally practised, the language surrounding the legislation could be argued to minimise the reality of the practices employed and the nature of the acts involved; namely a direct act by a medical practitioner with the intention of ending the life of a person (euthanasia), and the writing of a prescription for drugs knowing that they will be used by a person to bring about the end of their own life (physician-assisted suicide).

To accurately assess the ethics and effects of a particular law or practice it is important that terminology is clear and unequivocal in what it describes. ‘Assisted dying’ for example may mean PAS, or EAS. On this point see:

Jones, David Albert. ‘Defining the Terms of the Debate – Euthanasia and Euphemism’. Briefing Papers: Euthanasia and Assisted Suicide. Oxford: The Anscombe Bioethics Centre, 2021.

For an ‘ overview of the terminology, evolution and current legislative picture of assisted dying practices around the globe ’ see:

Mroz, Sarah, Sigrid Dierickx, Luc Deliens, Joachim Cohen, and Kenneth Chambaere. ‘Assisted Dying around the World: A Status Quaestionis’. Annals of Palliative Medicine 10, no. 3 (March 2021): 3540553–553. https://doi.org/10.21037/apm-20-637. * (full text available)

Figure 3 below gives the name for the legislation allowing EAS in various jurisdictions. 

Extension of eligibility criteria for EAS

Following legalisation, legislation can extend eligibility from those terminally ill to other non-terminal conditions (children, mentally ill, etc.), see:

Patton, Michaela, and Keith Dobson. ‘Proposal for the Extension of Rights to Medical Assistance in Dying (MAiD) to Mature Minors in Canada’. Canadian Psychology/Psychologie Canadienne 62, no. 3 (2021): 318–25. https://doi.org/10.1037/cap0000219 * (full text available).

The logic of EAS eligibility for the terminally ill can be applied in the same way both to the chronically ill, and to justify non-voluntary euthanasia ( i.e. for those incapable of requesting euthanasia). This is referred to as the ‘slippery slope’. See:

Keown, John. ‘Voluntary Euthanasia & Physician-Assisted Suicide – The Two “Slippery Slope” Arguments’. Briefing Papers: Euthanasia and Assisted Suicide. Oxford: The Anscombe Bioethics Centre, 2021.

Keown, John. ‘Euthanasia in the Netherlands: Sliding down the Slippery Slope’. Notre Dame J.L. Ethics & Pub. Pol’y 9, no. 2 (1995): 407–48. * (full text available).

These concerns, including (among others) the EAS for psychiatric indications and evidence in practice of non-voluntary euthanasia are best considered by examining evidence from the four jurisdictions which the longest history of EAS: Switzerland (1982); The Netherlands (1984); Oregon (1997); and Belgium (2002).

5.1 Switzerland

Assisted suicide in Switzerland is performed almost entirely through organisations such as EXIT and Dignitas. Since 1982 (when EXIT was founded) there have been only two official government reports, one in 2012 and another in 2014, and these are dependent on data provided by assisted suicide organisations. Media reporting of UK citizens dying in Switzerland plays a significant role in the UK debate, but it should be noted that most of those individuals would not qualify under current proposals for ‘Assisted Dying’, as they were not expected to die within six months. If the law changed in the UK either people would continue to go to Switzerland (which would have fewer restrictions) or the option of assisted suicide in Switzerland would place pressure on the UK to extend its practice to those who are not terminally ill. Research on the experience of assisted suicide in Switzerland is not reassuring.

In Switzerland, since 1942, inciting or assisting suicide has been illegal when it is for selfish motives (such as financial gain). Since 1982 this law has provided legal space for the organisation EXIT to promote assisted suicide for those ‘with unbearable symptoms or with unacceptable disabilities.’ There are two government reports from the Federal Statistical Office, one in 2012 and latest, for 2014, published in 2016 and revised in 2017 . There are also statistics for assisted suicide by sex and age for 2003-2019 , published by the Federal Statistical Office. Dignitas has released statistics from 1998-2021 .

A systematic study of 43 consecutive cases of assisted suicide in Switzerland from 1992 to 1997 found that in 10 cases (23%), the time between first contact with EXIT and the completed assisted suicide was less than a week and in 4 cases (9%) it was less than a day. In 6 cases (14%) the person had previously been treated in a psychiatric institution. In 11 cases (26%) there was no serious medical condition recorded on file, and in 5 cases (12%) the stated reason for seeking assisted suicide was bereavement. The authors of the study conclude that in the 1990s assisted suicide was ‘performed by lay-people who act without outside control and violate their own rules’.

Frei, Andreas, et al. ‘Assisted suicide as conducted by a “Right-to-Die”-society in Switzerland: a descriptive analysis of 43 consecutive cases.’ Swiss Medical Weekly 131.25-26 (2001): 375-380. * (full text available).

A later study found that between the 1990s and 2001-2004 the rate of assisted suicide for non-fatal diseases increased from 22% to 34% and concluded that ‘ weariness of life rather than a fatal or hopeless medical condition may be a more common reason for older members of Exit Deutsche Schweiz to commit suicide ’.

Fischer, S., Huber, C.A., Imhof, L., Imhof, R.M., Furter, M., Ziegler, S.J., Bosshard, G. ‘Suicide assisted by two Swiss right-to-die organisations’. Journal of Medical Ethics 34, no. 11 (2008): 810-814. * (full text available).

A study in 2014 found that assisted suicide in Switzerland was associated with living alone and divorce and was significantly more frequent among women. In 16% of deaths by assisted suicide no medical condition was listed. 

Steck, Nicole, Christoph Junker, Maud Maessen, Thomas Reisch, Marcel Zwahlen, and Matthias Egger. ‘Suicide Assisted by Right-to-Die Associations: A Population Based Cohort Study’. International Journal of Epidemiology 43, no. 2 (April 2014): 614–22.  * (full text available).

Research on trends from 1991 to 2008 showed ‘ a tripling of assisted suicide rates in older women, and the doubling of rates in older men ’.

Steck, Nicole, Marcel Zwahlen, and Matthias Egger. ‘Time-Trends in Assisted and Unassisted Suicides Completed with Different Methods: Swiss National Cohort’. Swiss Medical Weekly , no. 25 (14 June 2015). https://doi.org/10.4414/smw.2015.14153 . * (full text available).

Between 2009 and 2019 , the number of assisted suicide deaths increased from 297 to 1196 (an increase of over 400%).

Research showed that requests for assisted suicide were not based on symptom burden but on fear of loss of control. Moreover, those seeking assisted suicide had misconceptions about palliative care.

Gamondi, C., M. Pott, and S. Payne. ‘Families’ Experiences with Patients Who Died after Assisted Suicide: A Retrospective Interview Study in Southern Switzerland’. Annals of Oncology 24, no. 6 (1 June 2013): 1639–44. https://doi.org/10.1093/annonc/mdt033. * (full text available).

Until 2006 assisted suicide had not occurred in Switzerland in a hospital setting. The difficulties of introducing it into hospital and the concerns of the palliative care team are set out below.

Pereira, J, P Laurent, B Cantin, D Petremand, and T Currat. ‘The Response of a Swiss University Hospital’s Palliative Care Consult Team to Assisted Suicide within the Institution’. Palliative Medicine 22, no. 5 (1 July 2008): 659–67. https://doi.org/10.11 . * (full text available).

There is also research from Switzerland on the negative impact on family members of witnessing assisted suicide.

Wagner, B., J. Müller, and A. Maercker. ‘Death by Request in Switzerland: Posttraumatic Stress Disorder and Complicated Grief after Witnessing Assisted Suicide’. European Psychiatry 27, no. 7 (October 2012): 542–46. https://doi.org/10.1016/j.eurpsy.2010.1 *

Assisted suicide in Switzerland is most well known in the UK because of people travelling from the UK to die by assisted suicide. A detailed study of ‘suicide tourism’ shows numbers are increasing, the proportion of cancer is decreasing and the proportion of mental illness and multiple co-morbidities is increasing. Among reasons for assisted suicide the largest single cause, with 223 cases, was cancer, but 37 cited Parkinson’s disease, 37 gave arthritis as a reason, 14 cases were for mental illness, and 40 gave as a reason impairment of eyesight and/or hearing. 

Gauthier, Saskia, Julian Mausbach, Thomas Reisch, and Christine Bartsch. ‘Suicide Tourism: A Pilot Study on the Swiss Phenomenon’. Journal of Medical Ethics 41, no. 8 (1 August 2015): 611–17. https://doi.org/10.1136/medethics-2014-102091. * (full text available).

A study from 2016 shows that there has been an increase in the practices of voluntary and non-voluntary euthanasia in Switzerland, which are both illegal. Additionally, there has been a ‘ substantial increase in the use of continuous deep sedation until death, from 4.7% of all deaths in 2001 to 17.5% in 2013 [...] this practice was therefore more common in Switzerland than in either Belgium (12.0% in 2013) or the Netherlands (12.3% in 2010) ’.

Bosshard, Georg, Ueli Zellweger, Matthias Bopp, Margareta Schmid, Samia A. Hurst, Milo A. Puhan, and Karin Faisst. ‘Medical End-of-Life Practices in Switzerland: A Comparison of 2001 and 2013’. JAMA Internal Medicine 176, no. 4 (April 2016): 555–56. * (full text available).

5.2 The Netherlands

In addition to annual reports, based on notified cases of euthanasia there have been a series of studies of end-of-life practices at 5-year intervals since 1990. These were nationwide studies of a stratified sample from the national death registry. Questionnaires were sent to physicians attending these deaths and were returned anonymously. The first is commonly termed the Remmelink Report and subsequent reports followed the same pattern. Both the annual reports and the five yearly studies show incremental increases in deaths by euthanasia over time. Deaths by assisted suicide are less frequent, in part because they are associated with complications.

In the Netherlands euthanasia was effectively decriminalised by a court decision in 1984. This was the basis of a legal statute in 2001 legalising euthanasia and physician assisted suicide. Since 2002 the Netherlands has produced an annual report on the cases notified to the five regional euthanasia committees. These are available (in English once the year is selected) .

The first two reports showed evidence of a number of deaths without explicit patient request (in other words non-voluntary euthanasia). The rates were 0.8% and 0.7% being equivalent to 1,000 and 900 deaths in per year. The reaction of supporters was generally to dismiss the significance of these figures, rather than to see them as a possible cause for concern. 

Maas, Paul J. van der, Gerrit van der Wal, Ilinka Haverkate, Carmen L.M. de Graaff, John G.C. Kester, Bregje D. Onwuteaka-Philipsen, Agnes van der Heide, Jacqueline M. Bosma, and Dick L. Willems. ‘Euthanasia, Physician-Assisted Suicide, and Other Medical Practices Involving the End of Life in the Netherlands, 1990-1995’. New England Journal of Medicine 335, no. 22 (28 November 1996): 1699-1705. * (full text available).

Keown, John. ‘Euthanasia in the Netherlands: Sliding down the Slippery Slope’. Notre Dame Journal of Law, Ethics & Public Policy 9, no. 2 (1 January 2012): 407-448. * (full text available).

Van Delden, Johannes J. M., Loes Pijnenborg, and Paul J. Van Der Maas. ‘Reports from The Netherlands. DANCES WITH DATA’. Bioethics 7, no. 4 (1993): 323–29. https://doi.org/10.1111/j.1467-8519.1993.tb00222.x. *

Cohen-Almagor, Raphael. ‘Non-Voluntary and Involuntary Euthanasia in the Netherlands: Dutch Perspectives’. Issues in Law & Medicine 18 (2003): 239-257. * (full text available).

For such reasons the law and practice of euthanasia and assisted suicide in the Netherlands has been criticised several times by the United Nations Human Rights Committee.

UN Human Rights Committee (HRC), UN Human Rights Committee: Concluding Observations: Netherlands, 27 August 2001, CCPR/CO/72/NET  

UN Human Rights Committee (HRC), Concluding observations of the Human Rights Committee: Netherlands, 25 August 2009, CCPR/C/NLD/CO/4  

The 2019 report expresses its concern by stating ‘ The Committee is concerned, however, at the limited ex ante review of decisions to terminate life, including the legal and ethical implications of such decisions (art. 6) ’. (para. 28). See:

UN Human Rights Committee (HRC), UN Human Rights Committee: ‘Concluding Observations on the 5th Periodic Report of the Netherlands’, 126th session, 22 August 2019. CCPR/C/NLD/CO/5

Results from the most recent 5-yearly study (published in 2017 and providing data from 1990, 1995, 2001, 2005, 2010 and 2015) show that deaths classified as ‘ ending life without explicit patient request ’ have declined from 0.8% in 1990 0.3% in 2015. However, overall numbers of deaths by euthanasia have almost tripled (from 1.7% to 4.5%) Another matter of concern is the steep rise in cases of continuous deep sedation (from 8.2% in 2005to 18.3% in 2015), which is in addition to the rise in deaths by ‘ intensified alleviation of symptoms ’ (from 18.8% of deaths in 1990 to 35.8% of deaths in 2015). The presence of so many deaths with, or by, continuous deep sedation or drugs for intensified alleviations of symptoms confounds the data as either may be used as equivalent to (voluntary) euthanasia or to life ending without request. See:

Van der Heide, Agnes, Johannes JM Van Delden, and Bregje D. Onwuteaka-Philipsen. ‘End-of-life decisions in the Netherlands over 25 years.’ New England Journal of Medicine 377.5 (2017): 492-494. *

The latest annual report (for 2020) shows that the total number of deaths by euthanasia continues to increase. There were 6,938 deaths by euthanasia or assisted suicide notified in 2020, up 9.1% on the previous year, and constituting 4.1% of all deaths in the Netherlands for 2020 (which must be taken in conjunction with the fact that there was an excess of around 15,000 deaths in the Netherlands in 2020). In 2 cases, coronavirus infection was the grounds for euthanasia, and coronavirus infection plus other medical conditions in a further 4 cases. 

There are no data on euthanasia for either mental illness or dementia prior to 2012 (before this they are presumably considered under ‘other conditions’). In the 2013 report the category is changed from ‘mental illness’ to ‘mental disorders’, and from 2014 on is referred to as ‘psychiatric disorders’. Figure 1 ( data source ) below shows the figures for these conditions.

5.2 The Netherlands (cont’d)

From 2012-2020 euthanasia for psychiatric disorders has increased by over 600% and for dementia by over 400%.

This increase in euthanasia or assisted suicide for non-terminal conditions reflects opinion among professionals, with a significant number (between 24% and 39%) in favour of euthanasia or assisted suicide for individuals who experience mental suffering due to loss of control, chronic depression or early dementia. A third of doctors and 58% of nurses were in favour of euthanasia in the case of severe dementia, given the presence of an advance directive. 

Kouwenhoven, Pauline SC, Natasja JH Raijmakers, Johannes JM van Delden, Judith AC Rietjens, Maartje HN Schermer, Ghislaine JMW van Thiel, Margo J Trappenburg, et al. ‘Opinions of Health Care Professionals and the Public after Eight Years of Euthanasia Leg i slation in the Netherlands: A Mixed Methods Approach’. Palliative Medicine 27, no. 3 (1 March 2013): 273-80. * (post print text available).

Other research shows a wide variation among general practitioners, consultants and members of the euthanasia committees in their judgement of whether the patient’s suffering is sufficient for euthanasia.

Rietjens, J. a. C., D. G. van Tol, M. Schermer, and A. van der Heide. ‘Judgement of Suffering in the Case of a Euthanasia Request in The Netherlands’. Journal of Medical Ethics 35, no. 8 (1 August 2009): 502–7. https://doi.org/10.1136/jme.2008.028779. *

While euthanasia is defined as ending life on request, the Netherlands has extended life ending without request to newborn infants with disabilities. A description of the protocol (known as the Groningen protocol) is given by two authors who helped develop this practice.

Verhagen, A. A. E., and P. J. J. Sauer. ‘End-of-Life Decisions in Newborns: An Approach From the Netherlands’. Pediatrics 116, no. 3 (1 September 2005): 736–39. https://doi.org/10.1542/peds.2005-0014. * (full text available).

While euthanasia and assisted suicide are requested to secure an easeful death, complications are well documented, especially in assisted suicide. A study in 2000 found that ‘ complications [such as spasm, gasping for breath, cyanosis, nausea or vomiting] occurred in 7% of cases of assisted suicide, and problems with completion [a longer-than-expected time to death, failure to induce coma, or re-awakening of the patient] occurred in 16% ’ because of which ‘ physicians who intend to provide assistance with suicide sometimes end up administering a lethal medication themselves. ’ This is not only a problem of the past; in the 2020 report there were 6,705 cases of euthanasia (‘termination of life on request’), 216 cases of assisted suicide and 17 cases involving a combination of the two ( i.e. , cases which began as assisted suicide, but had to be completed by euthanasia). 

Groenewoud, Johanna H., Agnes van der Heide, Bregje D. Onwuteaka-Philipsen, Dick L. Willems, Paul J. van der Maas, and Gerrit van der Wal. ‘Clinical Problems with the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands’. New England Journal of Medicine 342, no. 8 (24 February 2000): 551–56. 

https://doi.org/10.1056/NEJM200002243420805. * (full text available).

Lastly, euthanasia is possible above the age of 12 and below the age of 1. But in 2020, the Netherlands Paediatric Association (Nederlandse Vereinging voor Kindergeneeskunde) expressed the position that the law be extended to allow the termination of life of children between the ages of 1 and 12 under certain conditions. See also the letter to parliament by Hugo de Jonge, the former Minister of Health, Welfare and Sport.

The most important evidence for practice in Oregon is provided by annual reports on the Death with Dignity Act. This section also highlights some aspects that been raised in relation to Oregon practice but are not based on the reports. See also research on the impact of assisted suicide on suicide prevention (section 7, below).

According to the latest official Oregon report, the most frequent end-of-life concern cited by people requesting assisted suicide is not pain but ‘loss of autonomy’ (90.9%), followed by decreased ability ‘to engage in activities making life enjoyable’ (90.2%), ‘loss of dignity’ (73%), ‘burden on family, friends/caregivers’ (48.3%), and ‘losing control of bodily functions’ (43.7%) and only then ‘inadequate pain control or concern about it’ (27.5%), (in each case citing accumulated data for 1998-2021). Evidently, most of these concerns relate to disability and increased dependence. The concern about feeling one is a ‘burden’ on others is significant, much more so than fear of pain (which, also, should not be conflated with actual pain).

From the same report it is clear that in only 14.6% of cases was the prescribing physician present at the time of death (only 11.6% in 2020), that only 3.3% were referred for psychiatric evaluation (only 0.8% in 2021), and that in 56.7% of cases the person was dependent on Medicare/Medicaid insurance or other governmental insurance (up to 78.9% in 2021).

According to Oregon’s Prioritized List of Health Services 2022 cancer treatment is limited according to relative life expectancy, for example, ‘[t]reatment with intent to prolong survival is not a covered service for patients who have progressive metastatic cancer [...]’(Guidance Note 12, GN-5). In contrast ‘It is the intent of the Commission that services under ORS 127.800-127.897 (Oregon Death with Dignity Act) be covered for those that wish to avail themselves to those services’ (Statements of Intent, SI-1). 

[N.B. The Statements of Intent and Guidance Notes come after the 160 pages of the prioritised list.] 

Health Evidence Review Commission, Prioritized List of Health Services (1 January 2022) . 

It should be noted that the drugs that are used for assisted suicide are also used in execution by lethal injection in the United States. This dual use is causing availability problems with supply of the drugs.

Jaquiss, Nigel. ‘Penalized By The Death Penalty’ Willamette Week 21 May 2014.

A good overview of practice in Oregon, including some case studies as well as statistical evidence, shows problems with doctor shopping, suspect coercion and lack of sufficient psychiatric evaluation.

Hendin, Herbert, and Kathleen Foley. ‘Physician-Assisted Suicide in Oregon: A Medical Perspective’. Michigan Law Review 106, no. 8 (2008): 1613–39 . * (full text available).

Kenneth Stevens has shown that from 2001 to 2007 a majority (61%, 165 out of 271) of the lethal prescriptions were written by a minority (18%, 20 out of 109) of the participating physicians. More striking still, just 3 physicians were responsible for 23% of lethal prescriptions (62 out of 271).

Stevens Jr., Kenneth R. ‘Concentration of Oregon’s Assisted Suicide Prescriptions & Deaths from a Small Number of Prescribing Physicians’. Physicians for Compassionate Care Education Foundation, 18 March 2015.

See also ‘Five Oregonians to Remember’ PCCEF, 27 December 2007.

5.4 Belgium

Though Belgium legalised euthanasia in 2002, eighteen years after the Netherlands (in 1984), its number of deaths are near that of the Netherlands. There were 5,015 reported cases in 2019 (more than six times the 822 reported cases in 2009). According to research conducted by Chambaere (see below) these official figures underreport euthanasia by around 50%. What is more worrying is that research indicates that more than 1,000 patients a year (1.7% of all deaths) have their lives ended deliberately without having requested it. This figure has not declined with time. Since legalisation in 2002, reports have been produced every two years. These are available (in French) here.

For a critical analysis of euthanasia in Belgium, see:

Jones, David Albert, Chris Gastmans, and C. MacKellar, eds. Euthanasia and Assisted Suicide: Lessons from Belgium . Cambridge Bioethics and Law. Cambridge, UK and New York, NY: Cambridge University Press, 2017. (This book can be ordered here ).

Devos, Timothy (ed.). Euthanasia: Searching for the Full Story: Experiences and Insights of Belgian Doctors and Nurses , Cham: Springer International Publishing, 2021. https://link.springer.com/book/10.1007/978-3-030-56795-8. (free e-book)

Belgian law came to prominence with the decision in February 2014 to extend euthanasia to children. This caused concern among clinicians and bioethicists in other countries.

Siegel, Andrew M., Dominic A. Sisti, and Arthur L. Caplan. ‘Pediatric Euthanasia in Belgium: Disturbing Developments’. JAMA 311, no. 19 (21 May 2014): 1963–64. https://doi.org/10.1001/jama.2014.4257. *

Carter, Brian S. ‘Why Palliative Care for Children Is Preferable to Euthanasia’. American Journal of Hospice and Palliative Medicine® 33, no. 1 (1 February 2016): 5–7. https://doi.org/10.1177/1049909114542648. * (full text available).

For background to the original 2002 law and its initial implementation see:

Cohen-Almagor, Raphael. ‘Euthanasia Policy and Practice in Belgium: Critical Observations and Suggestions for Improvement’. Issues in Law & Medicine 24, no. 3 (2009): 187–218. * (full text available) 

See also a report analysing ten years of euthanasia practice in Belgium. 

E de Diesbach, M de Loze, C Brochier and E Monterol. Euthanasia in Belgium: 10 years on European Institute of Bioethics (April 2012).

Research shows that the cases that are not reported are also less likely to involve a written request, less likely to involve specialist palliative care, and more likely to be performed by a nurse.

Smets, T., J. Bilsen, J. Cohen, M. L. Rurup, F. Mortier, and L. Deliens. ‘Reporting of Euthanasia in Medical Practice in Flanders, Belgium: Cross Sectional Analysis of Reported and Unreported Cases’. BMJ 341, no. oct05 2 (5 October 2010): c5174–c5174. * (full text available).

Research on nurses in Belgium in 2007 showed that cases of life-ending without request were almost as common as cases of euthanasia, and that in 12% of euthanasia cases and 45% of life-ending without request it was a nurse who administered the lethal dose, actions which went ‘beyond the legal margins of their profession’.

Inghelbrecht, E., J. Bilsen, F. Mortier, and L. Deliens. ‘The Role of Nurses in Physician-Assisted Deaths in Belgium’. Canadian Medical Association Journal 182, no. 9 (15 June 2010): 905–10. https://doi.org/10.1503/cmaj.091881. * (full text available).

On the ongoing issue of high levels of intentional life-ending without consent in Belgium see: 

Cohen-Almagor, Raphael. ‘First Do No Harm: Intentionally Shortening Lives of Patients Without Their Explicit Request in Belgium’. Journal of Medical Ethics , 4 June 2015. https://papers.ssrn.com/abstract=2614587. * (full text available).

Research has also shown that, in Belgium, continuous deep sedation is used with the intention or co-intention to shorten life in 17% of cases, but that it is rarely instituted at the request of the patient (only in 12.7% of cases).

Papavasiliou, Evangelia, Kenneth Chambaere, Luc Deliens, Sarah Brearley, Sheila Payne, Judith Rietjens, Robert Vander Stichele, and Lieve Van den Block. ‘Physician-Reported Practices on Continuous Deep Sedation until Death: A Descriptive and Comparative Study’. Palliative Medicine 28, no. 6 (1 June 2014): 491-500. https://doi.org/10.1177/0269216314530768 * (full text available).

Recent research (published in 2015) shows that while rates of euthanasia increase there has been no improvement in reporting and no reduction in cases of life-ending without request.

Chambaere, Kenneth, Robert Vander Stichele, Freddy Mortier, Joachim Cohen, and Luc Deliens. ‘Recent Trends in Euthanasia and Other End-of-Life Practices in Belgium’. The New England Journal of Medicine 372, no. 12 (19 March 2015): 1179–81 . * (full text available).

In the face of evidence of widespread ending of life without request some researchers have sought to excuse these actions because a third of such patients had, ‘at some point’ in the past, either explicitly or ‘implicitly’ expressed a wish that their lives be ended. However, the very attempt to downplay concerns about deaths deliberately brought about without an explicit request itself illustrates the degree to which non-voluntary euthanasia in Belgium is tolerated and is not regarded as shocking or as a practice in urgent need of correction. 

Chambaere, K., J. L. Bernheim, J. Downar, and L. Deliens. ‘Characteristics of Belgian “Life-Ending Acts without Explicit Patient Request”: A Large-Scale Death Certificate Survey Revisited’. CMAJ Open 2, no. 4 (2 December 2014): E262–67. * (full text available).

On the distinction between expressing a wish to die, a wish to hasten death, and a request, see:

Monforte-Royo, Cristina, Christian Villavicencio-Chávez, Joaquín Tomás-Sábado, and Albert Balaguer. ‘The Wish to Hasten Death: A Review of Clinical Studies’. Psycho-Oncology 20, no. 8 (2011): 795–804. https://doi.org/10.1002/pon.1839. * (full text available).

Data from the annual reports shows that an increasing percentage of those dying by euthanasia mention a combination of physical and psychical suffering (78.8% in 2018 and 82.8% in 2019), with figures for solely physical pain reducing (17.7% in 2018 and 12.8% in 2019) and suffering for solely psychic reasons increasing (3.5% in 2018 and 4.3% in 2019).

Stories of individual cases are no substitute for quantitative research, but they help show the possible human meaning behind these statistics. Some illustrative examples are given below.

‘Marc and Eddy Verbessem, Deaf Belgian Twins, Euthanized’ The World Post 15 January 2013 . 

Waterfield, ‘Belgian killed by euthanasia after a botched sex change operation’ Telegraph 01 Oct 2013.

E O’Gara ‘Physically healthy 24-year-old granted right to die in Belgium’ Newsweek 29 June 2015.

Associated Press, ‘Belgian Court Acquits 3 Doctors in Landmark Euthanasia Case’ Courthouse News Service 31 January 2020.

Further example cases from Belgium are described here:

Beuselinck, Benoit. ‘Euthanasia Case Studies from Belgium: Concerns about Legislation and Hope for Palliative Care’. Briefing Papers: Euthanasia and Assisted Suicide. Oxford: The Anscombe Bioethics Centre, 2021.

6. Disability and the Impact of Assisted Suicide and Euthanasia

Groups representing people with disabilities have been at the forefront of opposition to the legalisation of assisted suicide and euthanasia. Arguments from this perspective, especially in popular publications and comment pieces, have been criticised as reflecting and/or feeding on fears without showing that these fears are reasonable. However, there is also more critical reflection from this perspective, including discussion of empirical evidence relevant to assessing these concerns.

Some opinion polls among disabled people find considerable support for legalising ‘assisted dying’ .

These results are similar to opinion polls in the general population and should be treated with the same caution (see above on the wording of polls).  It is important also to take into account polls that identify concerns among disabled people that legal changes could put pressure on disabled people to end their lives prematurely .

An interesting exchange on this issue by two people with disabilities was conducted by Carol Gill and Andrew Batavia.  Batavia argues that empirical data is irrelevant to the issue which, in his view, is about values, and centrally the value of autonomy.  He is in favour of legalising assisted suicide.

Batavia, A. I. ‘The Relevance of Data on Physicians and Disability on the Right to Assisted Suicide: Can Empirical Studies Resolve the Issue?’ Psychology, Public Policy, and Law: An Official Law Review of the University of Arizona College of Law and the University of Miami School of Law 6, no. 2 (June 2000): 546-58. *

In response Gill presents data, which is relevant to the perception of disability and its role (implicitly or explicitly) in decisions to grant requests for assistance in suicide.  For example, she cites research that shows that among 153 emergency care providers, only 18% of physicians, nurses, and technicians imagined they would be glad to be alive with a severe spinal cord injury.  In contrast, 92% of a group of 128 persons with high-level spinal cord injuries said they were glad to be alive.

Gill, CJ. ‘Health professionals, disability, and assisted suicide: An examination of relevant empirical evidence and reply to Batavia (2000).’ Psychology, Public Policy, and Law 6.2 (2000): 526-45. *

Unfortunately, neither of these papers is freely available online.  However, another very interesting paper by Gill provides a good sense of what a critical and empirically informed disability perspective looks like.  More generally, the Disability and Health Journal (in which this paper appears) is a useful source for articles on disability and assisted suicide.

Gill, CJ. ‘No, we don't think our doctors are out to get us: Responding to the straw man distortions of disability rights arguments against assisted suicide’. Disability and Health Journal 3.1 (2010): 31-38 . * (full text available)

Probably the most influential article arguing that the evidence shows no negative impact of assisted suicide or euthanasia on vulnerable groups (including people with disabilities) is by Margaret Battin.

Battin, Margaret P, Agnes van der Heide, Linda Ganzini, and Gerrit van der Wal. ‘Legal Physician‐assisted Dying in Oregon and the Netherlands: Evidence Concerning the Impact on Patients in “Vulnerable” Groups’. Journal of Medical Ethics 33, no. 10 (October 2007):591-597. * (full text available)

The methodology and conclusions of this paper have been criticised by Ilora Finlay and Rob George.

Finlay, I. G., and R. George. ‘Legal Physician-Assisted Suicide in Oregon and The Netherlands: Evidence Concerning the Impact on Patients in Vulnerable Groups--Another Perspective on Oregon’s Data’. Journal of Medical Ethics 37, no. 3 (March 2011): 171–74 . https://doi.org/10.1136/jme.2010.037044 . *

A detailed discussion of Battin’s evidence and counter-evidence from other expert witnesses is found in the Irish Divisional Court case Fleming v Ireland [2013] IEHC 2 (especially para 67) .

‘ [T]he the expert evidence offered by Dr. O’Brien and Professor George to the effect that relaxing the ban on assisted suicide would bring about a paradigm shift with unforeseeable (and perhaps uncontrollable) changes in attitude and behaviour to assisted suicide struck the Court as compelling and deeply worrying… The Court finds the evidence of these witnesses, whether taken together or separately, more convincing than that tendered by Professor Battin, not least because of the somewhat limited nature of the studies and categories of person studied by Professor Battin… ’

Battin’s argument is also criticised by Pereira on the basis that “safeguards” are largely illusory.

Pereira, J. ‘Legalizing Euthanasia or Assisted Suicide: The Illusion of Safeguards and Controls’. Current Oncology 18, no. 2 (April 2011): e38. https://doi.org/10.3747/co.v18i2.883. * (full text available).

Similarly, a detailed discussion of the evidence from Oregon from a disability perspective concludes that ‘ Battin et al.’s interpretation that people with physical disabilities or chronic illnesses are not at increased risk for DWD does not seem to be supportable given available data’ .

CE Drum, G White, G Taitano and W Horner-Johnson, ‘The Oregon Death with Dignity Act: results of a literature review and naturalistic inquiry’. Disability and health journal , 2010, 3(1): 3-15 . * (full text available).

If disability includes mental illness, then there is clearly a group of patients who are prima facie endangered by assisted suicide. In Oregon there has been a decline in the “safeguard” of referral for psychiatric evaluation whereas in Belgium and Switzerland mental illness can itself be a basis for euthanasia or assisted suicide. A study published in the BMJ shows how far the euthanising of psychiatric patients has progressed in Belgium: of 100 patients who requested euthanasia for psychiatric reasons, 73 ‘ were medically unfit for work (they were either receiving disability living allowances or had taken early retirement) ’, i.e. most were categorised as having a disability. Of the 100, 38 were referred for further psychiatric evaluation, after which 17 were approved for euthanasia and 10 died by euthanasia during the study period. Of the 62 people not referred, 31 were approved for euthanasia and 25 died by euthanasia during the study period. These patients suffered from a variety of conditions including mood disorders (58 including 10 who were bipolar), borderline personality disorder (27), schizophrenia and other psychotic disorders (14), post-traumatic stress disorder (13), eating disorders (10), autism spectrum disorder (7), attention deficit hyperactivity (1) as well as other diagnoses, often combining diagnoses ( e.g. , a mood disorder and personality disorder). During the period of the study 6 participants died by (non-assisted) suicide, one from anorexia nervosa and one from palliative sedation. None were terminally ill.

Thienpont L, Verhofstadt M, Van Loon T, et al. ‘Euthanasia requests, procedures and outcomes for 100 Belgian patients suffering from psychiatric disorders: a retrospective, descriptive study’. BMJ Open 2015;5: e007454. doi:10.1136/bmjopen-2014-007454 * (full text available).

Disability makes assessment of ‘ decisional capacity ’ difficult. A study of cases in the Netherlands shows that the ‘ Dutch EAS due care criteria are not easily applied to people with intellectual disabilities and/or autism spectrum disorder, and do not appear to act as adequate safeguards. ’ See:

Tuffrey-Wijne, Irene et al. “Euthanasia and assisted suicide for people with an intellectual disability and/or autism spectrum disorder: an examination of nine relevant euthanasia cases in the Netherlands (2012-2016).”  BMC medical ethics  vol. 19,1 17. 5 Mar. 2018, doi:10.1186/s12910-018-0257-6 * (full text available).

Tuffrey-Wijne, Irene et al. “‘Because of His Intellectual Disability, He Couldn’t Cope.’ Is Euthanasia the Answer?”. Journal of Policy and Practice in Intellectual Disabilities , vol. 16, no. 2 (June 2019):113-116, https://doi.org/10.1111/jppi.12307 * (post-print draft version available).

EAS in the Netherlands for psychiatric disorders shows that patients are ‘ mostly women, of diverse ages, with complex and chronic psychiatric, medical, and psychosocial histories ’. See:

Kim, Scott Y H et al. “Euthanasia and Assisted Suicide of Patients With Psychiatric Disorders in the Netherlands 2011 to 2014.”  JAMA Psychiatry vol. 73,4 (2016): 362-8. doi:10.1001/jamapsychiatry.2015.2887 * (full text available).

Concern is also expressed over safeguards for the disabled, stemming from the myriad of problems the disabled face, such as ‘ subtle pressure, despair at living in a world where their daily existence is seen as one of inevitable suffering or, exhaustion from fighting for the accommodations required to live a life of dignity and pursue their chosen lifestyle and purposes ’. See:

Stainton, Tim. “Disability, vulnerability and assisted death: commentary on Tuffrey-Wijne, Curfs, Finlay and Hollins.”  BMC Medical Ethics vol. 20,1 89. 27 (Nov. 2019), doi:10.1186/s12910-019-0426-2 * (full text available).

With respect to more recent developments in Canada regarding EAS for mentally ill patients, see:

Komrad, Mark S. ‘First, Do No Harm: How Canadian Law Allows for Euthanasia and Assisted Suicide for Patients with Psychiatric Disorders’. Briefing Papers: Euthanasia and Assisted Suicide (Anscombe Bioethics Centre, Oxford: 2021).

On the changing social attitude to those living with dementia and how euthanasia poses a threat to living and dying well with dementia, see:

Matthews, Pia. ‘Dignity in Living: Addressing Euthanasia by Affirming Patient Personhood in Dementia’. Briefing Papers: Euthanasia and Assisted Suicide. Oxford: The Anscombe Bioethics Centre, 2021.

7. Suicide Prevention and the Impact of Assisted Suicide

Sometimes advocates of assisted suicide are happy to use this terminology, as for example in the ‘Assisted Suicide (Scotland) Bill’ (introduced in 2011), which was rejected by the Scottish Parliament in 2015. Other proponents avoid this language and prefer ‘dying / death with dignity’, ‘assisted dying/death’ or ‘medical aid in dying’. However, evidence indicates no sharp distinction between assisted suicide and non-assisted suicide. Evidence also suggests legalising assisted suicide ‘normalises’ suicide and is associated with increases in suicide. 

Evidence from the USA shows that the legalisation of ‘ assisted suicide is associated with a significant increase in total suicide (inclusive of assisted suicide) and no reduction in non-assisted suicide .’ 

Jones, David Albert and David Paton ‘How does legalization of physician-assisted suicide affect rates of suicide?, Southern Medical Journal , 108.10 (2015): 599-604. * (pre-print draft available).

The association of legalising assisted suicide and a ‘ significant increase in total suicides ’ is also supported by more recent research on data from the USA. Paton and Sourafel also conclude that ‘ [i]t is possible that there is some substitution from unassisted suicide to assisted suicide but that this is balanced out by an increase in unassisted suicide arising from, for example, a reduction in societal taboos associated with suicide ’. See:

Sourafel, Girma, and David Paton. ‘Is Assisted Suicide a Substitute for Unassisted Suicide?’ European Economic Review , 9 April 2022, 104113. https://doi.org/10.1016/j.euroecorev.2022.104113. * (pre-proof text available).

In Europe, the introduction of euthanasia and assisted suicide has resulted in ‘ considerable increases in suicide (inclusive of assisted suicide) and in intentional self-initiated death ’. See:

 Jones, David Albert. ‘Euthanasia, Assisted Suicide, and Suicide Rates in Europe’, Journal of the Ethics of Mental Health 11 (2022):1-35. * (full text available).

Restricting access to means of suicide appear to be ‘ particularly effective in contexts where the method is popular, highly lethal, widely available, and/or not easily substituted by other similar methods ’. See:

Sarchiapone, Marco, Laura Mandelli, Miriam Iosue, Costanza Andrisano, and Alec Roy. ‘Controlling access to suicide means.’ International journal of environmental research and public health 8, no. 12 (2011): 4550-4562, doi: 10.3390/ijerph8124550 * (full text available).

It is argued that ‘assisted death’ of a kind legalised in Oregon, is not assisted suicide because (1) with ‘assisted death’ the person is terminally ill and (2) (non-assisted) suicide is typically the result of depression. However, according to one UK study, ‘at least 10 percent of [non-assisted] suicides nationally involve[ed] some form of serious physical illness (either chronic or terminal)’. See:

Bazalgette, L., W Bradley, J Ousbey. The Truth about Suicide (London: Demos, 2011)  

Similarly in Switzerland ‘ In 53% of cases, causes of death registrations for [non-assisted] suicide do not contain any information about concomitant diseases. If no information is available, this may mean various things: either no disease was present or it was unknown. If information is available, 56% of entries cite depression. In the remaining 44% of entries, a physical disease is mentioned. Physical diseases include a range similar to that of assisted suicide (G11). ’ (emphasis added)

Similarly, a report on suicide in Oregon found that 25% of men and 26% of women who died by suicide had had physical health problems, and in the over-65 cohort, 66% of men and 56% of women had physical health problems, including conditions such as cancer, heart disease, and chronic pain.

Shen, X., L Millet. Suicide in Oregon: Trends and Risk Factors 2012 Report . Oregon Health Authority, Portland, Oregon.

The vulnerability of older people, those living alone and those with physical illness was highlighted in a report by the New York Task Force in 1994. The Task Force also found that depression was prevalent in this population, but largely undiagnosed and untreated (see especially chapter 2 of the report).

New York State Task Force on Life and the Law, ‘When Death is Sought: Assisted Suicide and Euthanasia in the Medical Context’ (1994).  

Similarly, in a study of 178 Compassion & Choices clients, of those who, in the study period, obtained lethal medication 3 out of 18 (17%) fulfilled the criteria for depression and of those who died by assisted suicide by the end of the study 3 out of 9 (33%) met the criteria for depression.

Ganzini, L., E. R Goy, and S. K Dobscha. ‘Prevalence of Depression and Anxiety in Patients Requesting Physicians’ Aid in Dying: Cross Sectional Survey’. BMJ 337, no. 2 (7 October 2008): a1682–a1682. https://doi.org/10.1136/bmj.a1682. * (full text available).  

It has been argued that legalising assisted suicide could, paradoxically, delay or inhibit suicide. This has been argued by Lord Falconer and others, but a particularly clear statement is provided by EXIT.  

However, in Oregon between 1999 (two years after PAS was introduced) and 2010 the suicide rate among those aged 35-64 increased by almost 50% (compared to 28% nationally).

See also the report on high rates of suicide in Portland, Oregon. This increase is without counting assisted suicides, which rose in Oregon by 44% in 2013 alone .

According to the Swiss government report , ‘ From 1995 to 2003, the absolute number of suicides fell considerably. Since then, it has more or less remained stable while cases of assisted suicide have increased considerably since 2008 in particular. In 2014, for 7 cases of suicide observed, 5 cases of assisted suicide were seen (G7) ’. 

Determination of eligibility for EAS may also have an effect on vulnerability. Looking at the situation in Canada, Isenberg-Grzeda et al conclude that ‘ Clinicians must be vigilant and prepared for the possibility of heightened risk, including risk of self-harm, after a finding of ineligibility for assisted death ’. See:

Isenberg-Grzeda, E., S. Bean, C. Cohen, and D. Selby, ‘Suicide attempt after determination of ineligibility for assisted death: A case series’ Journal of pain and symptom management 60, no. 1 (2020): 158-163 *

It must be noted that if suicide follows on from a determination of ineligibility for EAS, that person’s death would be considered suicide. However, it would not be considered ‘suicide’ if he or she had been eligible and died as a result of the provision of EAS. This highlights the broader point that euphemistic expressions such a ‘assisted dying’ or ‘medical aid in dying’ simply rename what is correctly termed ‘suicide’.

Suicide Contagion

A Swiss study indicates evidence for suicide contagion following media reports of assisted suicide: 

Frei, Andreas, Tanja Schenker, Asmus Finzen, Volker Dittmann, Kurt Kraeuchi, and Ulrike Hoffmann-Richter. ‘The Werther Effect and Assisted Suicide’. Suicide and Life-Threatening Behavior 33, no. 2 (June 2003): 192–200. https://doi.org/10.1521/suli.33.2.19 *

Research on the impact of reporting assisted suicide in Oregon has also suggested such an effect.

Stark, Paul. ‘Assisted suicide and contagion’ MCCL White Paper, May 2015 .

This evidence coheres with what is known about suicide, that it increases if the means are more widely available and if it is normalised, see for example, Euregenas (European Regions Enforcing Actions Against Suicide) Suicide Prevention Toolkit for Media Professionals .

See also Preventing Suicide: A Resource for Media Professionals, Update 2017 . Geneva: World Health Organization; 2017 (WHO/MSD/MER/17.5). Licence: CC BY-NC-SA 3.0 IGO.

Evidence of suicide rates among veterinarians (which are significantly higher than the average among the population) is generally understood to be due to access to lethal drugs.

Witte, T.K., E.G. Spitzer, N. Edwards, K.A. Fowler, and R. J. Nett. ‘Suicides and Deaths of Undetermined Intent among Veterinary Professionals from 2003 through 2014’. Journal of the American Veterinary Medical Association 255, no. 5 (2019):595-608. * (full text available).

Research also shows that positive ‘suicide role models’ reinforce high rates of suicide in a population:

Stack, Steven, and Augustine J. Kposowa. ‘The Association of Suicide Rates with Individual-Level Suicide Attitudes: A Cross-National Analysis*’. Social Science Quarterly 89, no. 1 (2008): 39–59. https://doi.org/10.1111/j.1540-6237.2008.00520.x . * (full text available).

Werther and Papageno Effects

Suicides are also associated with the way that suicide is presented in the media. The ‘Werther effect’ refers to media presentations of suicides (fictional and real) and their effect on an increase in suicide rates. The ‘Papageno effect’ refers instead to the preventative effect of media portrayals which depict people coping despite difficult life circumstances and suicidal ideation.

A survey of studies on the two effects shows that ‘ suicide contagion is more likely to occur after extensive media coverage with a content rich in positive definitions of suicide ’. Factors that increase the likelihood of imitation are, for example, ‘ the celebrity status of the suicide victim, similar demographic characteristics and the media audience, and media reports on a new suicide method’ . At the same time, different media portrayals can ‘ have an educative or preventative effect and can reduce the risk of contagion ’. See:

Domaradzki, J. ‘The Werther Effect, the Papageno Effect or No Effect? A Literature Review’. International Journal of Environmental Research and Public Health 18, no. 5 (1 March 2021): 2396. https://doi.org/10.3390/ijerph18052396 . * (full text available).

Studies of the Werther and Papageno effects focus on media portrayals of suicide, but ‘ [g]uidance is needed for media reporting of assisted suicide ’ as well. See:

Jones, David Albert. ‘Assisted dying and suicide prevention’ Journal of Disability & Religion , 22.3 (2018): 298-316 . * (pre print text available online).

A 2021 survey of members of the Association for Palliative Medicine of Great Britain and Ireland showed that ‘ There is also a significant degree of frustration at the media narrative regarding end of life care, which clinicians view as being driven by assisted suicide lobbying. There is concern that poor portrayal of palliative care in the media has led patients and families to have a skewed understanding of palliative care, and there is fear that patients are in a position of ignorance at a vulnerable moment in their lives ’.

8. Gender and the Impact of Assisted Suicide and Euthanasia

Proponents of a change in the law frequently invoke choice (for example the US organisation ‘Compassion & Choices’ or the Scottish organisation ‘My Life, My Death, My Choice’).  This language is very similar to ‘pro-choice’ language in relation to abortion, and so it might seem that feminists who are in favour of increased access to legal abortion would also support legalisation of EAS.  This argument is indeed accepted by some feminists; however, it has been challenged by a number of feminists who argue that EAS would have a disproportionately negative impact on women.

Wolf, SM. ‘Gender, Feminism, and Death: Physician-Assisted Suicide and Euthanasia’ in Feminism & Bioethics: Beyond Reproduction . New York: Oxford University Press, 1996, pp. 282-317.

Wolf argues that a legal right to abortion (which she supports) does not imply a legal right to assisted suicide.

Wolf, SM. ‘Physician-assisted suicide, abortion, and treatment refusal: Using gender to analyze the difference’ in R Weir, ed. Physician-Assisted Suicide . Indiana University Press, 1997, pp. 167-201 .

On this point see also:

Spindelman, Marc. ‘Are the Similarities between a Woman’s Right to Choose an Abortion and the Alleged Right to Assisted Suicide Really Compelling?’ U. Mich. J. L. Reform 29, no. 775 (1996): 775-856. * (full text available).

Whereas, in the West, the rate of suicide is much higher among men than women (roughly four times), PAS (in Oregon and Washington) is roughly equal between men and women, and rates of assisted suicide in Switzerland reveal a higher proportion of women; this is also true of the suicides assisted by Kervorkian.

Canetto, Silvia Sara, and Janet D. Hollenshead. ‘Gender and Physician-Assisted Suicide: An Analysis of the Kevorkian Cases, 1990–1997’. OMEGA - Journal of Death and Dying 40, no. 1 (2000): 165–208. *

Kohm, Lynne Marie, and Britney N. Brigner. ‘Women and Assisted Suicide: Exposing the Gender Vulnerability to Acquiescent Death’. Cardozo Women’s Law Journal 4 (1997): 241. * (full text available).

Canetto, Silvia Sara, and Janet D. Hollenshead. ‘Older Women and Mercy Killing’. OMEGA - Journal of Death and Dying 42, no. 1 (1 February 2001): 83–99. https://doi.org/10.2190/NRB4-JH8B-VBCW-WM7J. *

Canetto, Silvia Sara, and John L. McIntosh. ‘A Comparison of Physician-Assisted/Death-With-Dignity-Act Death and Suicide Patterns in Older Adult Women and Men’. The American Journal of Geriatric Psychiatry , June 2021, S1064748121003559. https://doi.org/10.1016/j.jagp.2021.06.003   *

George, Katrina. ‘A Woman’s Choice? The Gendered Risks of Voluntary Euthanasia and Physican-Assisted Suicide’. Medical Law Review 15, no. 1 (1 March 2007): 1–33. https://doi.org/10.1093/medlaw/fwl017. *

It has also been argued that a feminist account of relational autonomy gives more ground to be cautious about permitting assisted suicide.

Donchin, Anne. ‘Autonomy, Interdependence, and Assisted Suicide: Respecting Boundaries/Crossing Lines’. Bioethics 14, no. 3 (2000): 187–204. https://doi.org/10.1111/1467-8519.00190. *

Canetto, Sylvia Sara. ‘If Physician-Assisted Suicide Is the Modern Woman’s Last Powerful Choice, Why Are White Women Its Leading Advocates and Main Users?’ Professional Psychology: Research and Practice 50, no. 1 (2019): 39–50. *

For a study of the larger number of women who receive EAS for a psychiatric condition in Belgium and the Netherlands, and its relation to questions of suicide prevention, see:

Nicolini, Marie E., Chris Gastmans, and Scott Y. H. Kim. ‘Psychiatric Euthanasia, Suicide and the Role of Gender’. The British Journal of Psychiatry 220, no. 1 (January 2022): 10–13. https://doi.org/10.1192/bjp.2021.95. *

Data from Switzerland demonstrates not only an increase in total assisted suicides year on year, but also the disproportionately large number of women dying by assisted suicide.

9. Links to Some Campaign Organisations and Further Resources

Whichever side of the argument you find more cogent, it is useful to look at the opposite view and the counter-arguments and evidence they produce, such as it is. Campaign organisations are, by their nature, one sided, but at the very least they raise questions and identify some relevant evidence.

Organisations in favour of legalising assisted suicide or euthanasia

In 2005 the Voluntary Euthanasia Society (founded 1935) changed its name to ‘Dignity in Dying.’  Its immediate aim is legalising physician assisted suicide for the terminally ill not, currently, euthanasia.

http://www.dignityindying.org.uk/

In 2009 Michael Irwin left the Dignity in Dying to found the Society for Old Age Rational Suicide which campaigns for assisted suicide for people who are not dying, but are tired of living. In 2015, the organisation changed its name to ‘My Death, My Decision’.

https://www.mydeath-mydecision.org.uk/

The largest organisation in the USA to campaign in favour of assisted suicide is Compassion & Choices (successor to the Hemlock Society which was founded in 1980).

http://www.compassionandchoices.org/

Also founded in 1980, The World Federation of Right to Die Societies no longer counts Dignity in Dying or Compassion & Choices as ‘members,’ but has links to them as ‘other right to die societies’.

https://wfrtds.org

EXIT founded in 1982 is the main organisation that arranges assisted suicide for Swiss citizens. 

http://www.exit.ch/en/

Organisations opposed to legalising assisted suicide and euthanasia

Founded in 2005, Care Not Killing is a UK-based alliance of individuals, disability and human rights groups, healthcare providers, and faith-based bodies opposed to assisted suicide and euthanasia.

http://www.carenotkilling.org.uk/

In 2021 the Better Way campaign was founded to oppose assisted suicide and to set out a positive, alternative vision for the UK.  Its website contains information about the Canadian experience of euthanasia and assisted suicide.

https://www.betterwaycampaign.co.uk/canada/

The Euthanasia Prevention Coalition (EPC) has an international scope.  There is also a European arm.

https://www.epcc.ca/

https://www.epce.eu/

For a disability perspective see Not Dead Yet and the rather more British (and understated) Not Dead Yet UK.

http://www.notdeadyet.org/

http://notdeadyetuk.org/

For an American perspective critical of assisted suicide see the websites of Physicians for Compassionate Care Education Foundation, the Patients’ Rights Council and ‘Choice’ is an Illusion.

https://www.pccef.org/

https://www.patientsrightscouncil.org/site/

https://www.choiceillusion.org/

News and comment

The excellent and free bioethics news service Bioedge frequently includes stories on these issues.

https://bioedge.org/end-of-life-issues/euthanasia/

Alex Schadenberg (chair of EPC) has a blog, which is also very useful for news stories.

https://alexschadenberg.blogspot.co.uk/

Living and dying well is not a campaign organisation, but presents research and analysis of evidence relevant to (and critical of) assisted suicide and euthanasia.

https://www.livinganddyingwell.org.uk/

Further academic resources

This guide is intended only as an introduction to some of the resources for assessing the evidence and arguments for and against assisted suicide and euthanasia.  It is, of necessity, selective as there are many hundreds of official reports, legal cases and journal articles on these topics. Students should research independently making use of academic indices and databases such as EBSCO, Lexis Nexis, Philosophers’ Index, PhilPapers and MEDLINE. You should also ‘follow the footnotes’ reading the sources invoked by or criticised by the article you are reading.

The search engine Pubmed gives access to the MEDLINE database, which includes very many medical journals and also journals of medical ethics, and medically related humanities and social sciences.  Unlike other indices it is freely accessible and is a good place for the non-specialist to begin more serious research.

https://www.ncbi.nlm.nih.gov/pubmed

Anscombe Bioethics Centre Briefing Papers

Beuselinck, Benoit. ‘Euthanasia Case Studies from Belgium: Concerns About Legislation and Hope for Palliative Care’. Briefing Papers: Euthanasia and Assisted Suicide. Oxford: The Anscombe Bioethics Centre, 2021.

Jones, David Albert. ‘Defining the Terms of the Debate: Euthanasia and Euphemism’. Briefing Papers: Euthanasia and Assisted Suicide. Oxford: The Anscombe Bioethics Centre, 2021.

Keown, John. ‘Voluntary Euthanasia & Physician-assisted Suicide: The Two “Slippery Slope” Arguments’. Briefing Papers: Euthanasia and Assisted Suicide. Oxford: The Anscombe Bioethics Centre, 2022.

Komrad, Mark. ‘First, Do No Harm: How Canadian Law Allows for Euthanasia and Assisted Suicide for Patients with Psychiatric Disorders’. Briefing Papers: Euthanasia and Assisted Suicide. Oxford: The Anscombe Bioethics Centre, 2021.

Pontifical Academy for Life. ‘Position Paper of the Abrahamic Monotheistic Religions on Matters Concerning the End of Life (28 October 2019)’.

Symons, Xavier. ‘The Principle of Autonomy – Does it Support the Legalisation of Euthanasia and Assisted Suicide?’. Briefing Papers: Euthanasia and Assisted Suicide. Oxford: The Anscombe Bioethics Centre, 2022.

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Euthanasia and the Law: The Rise of Euthanasia and Relationship With Palliative Healthcare

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Research Paper

In general, one can choose death by euthanasia and physician-assisted suicide. Broadly understood, euthanasia means “good death”; however, current usage depicts a specific kind of dying, which is usually accomplished by the act of someone other than the one who dies. Physician-assisted suicide is a particular form of suicide, or dying, where a physician who possesses relevant knowledge and skills assists the one who wishes to die. Various religious perspectives offer ways to deal with the challenges presented by death and dying, pain and suffering, freedom and responsibility in health care, and the value of human life. All of these are present at the intersection of euthanasia, physician-assisted suicide, and religion.

Typically, euthanasia and physician-assisted suicide occur in the context of health care when patients face death and dying. Death and dying are fundamental to (and inevitable in) the human condition. Historically, death and dying happened as a consequence of incurable disease, unforeseen accident, war, or murderous action. With euthanasia and physician- assisted suicide, however, one can take control over the circumstances, the mode, and the health state at the time of death. This represents a technological transformation of the dying process—a transformation that many argue brings about individual and social goods (philosopher Daniel Callahan refers to this kind of phenomenon as “technological brinkmanship”; see Callahan 2000, 40–41).

As the Hippocratic Oath indicates, the ethical, legal, and theological issues of euthanasia and physician-assisted suicide are not necessarily new. Dating back several centuries, the oath prohibits a Hippocratic physician from prescribing poisons and other materials for his patient (see Edelstein 1967; Rietjens et al. 2006; Ramsey 1974; Campbell 1994). Interestingly, this is not lost in a Christian version of the Hippocratic Oath: “Neither will I give poison to anybody though asked to do so, nor will I suggest such a plan” (Lammers and Verhey 1998, 108).

Nevertheless, the advances in medicine have brought new energy to this topic. Because many diseases remain incurable, the best that health care providers can do is manage one’s painful symptoms as her illness marches on a path, often with intense suffering, before it ends in death. Many patients who have metastatic and terminal cancer experience this tragedy. For many commentators, this represents an intolerable reality. Instead, they wish to take matters into their own hands and seek voluntary euthanasia or physician assistance in their suicide.

From the perspective of various religions, these two practices—euthanasia and physician- assisted suicide—raise several ethical, legal, and theological issues. However, before discussing these issues, we will review the traditional distinctions of the term euthanasia. Then we will identify and describe the major ethical and legal issues in euthanasia and physician-assisted suicide. Finally, we will conclude with an overview of public policy considerations regarding both of these practices.

Traditional Distinctions of Euthanasia

Here, euthanasia is to be understood as the voluntary and intentional ending of a person’s life. Many ethicists have made three critical distinctions in the debates over euthanasia. First, there is a distinction between voluntary and involuntary euthanasia. Voluntary euthanasia happens either by or at the request of the recipient of the act. Involuntary euthanasia occurs without the consent of the individual, either because the patient is incompetent, because the patient’s wishes are not known, or because it is a policy to end the life of a person with certain traits (e.g., Nazi euthanasia policies). Most discussions of euthanasia reject any consideration of involuntary euthanasia, particularly in this last sense.

Second, there is a distinction between active and passive euthanasia. Active euthanasia occurs when someone performs an action that results in the death of the patient. Thus, one understands active euthanasia positively as the commission of a death- inducing action. Passive euthanasia occurs when someone does not perform an action, which results in the death of the patient. Thus, one understands passive euthanasia negatively as the omission of a life-preserving action. An example of active euthanasia is a doctor’s injecting a lethal dose of drugs into a patient to bring about the patient’s death. An example of passive euthanasia is a doctor’s intent to kill a patient by refusing to administer antibiotics to a patient suffering from a treatable form of pneumonia. (There may be other morally justifiable reasons and circumstances why the physician would not provide antibiotics to a patient without intending the patient’s death per se, but, for the sake of this example, we will consider the pneumonia to be the patient’s only diagnosis.)

Third, there is a distinction between direct and indirect euthanasia. Here, one’s intention plays a key role in establishing whether the action is direct or indirect. In addition, the Principle of Double Effect is applicable, which enables one to determine the nature of the agent’s intent and whether the action is morally permissible. (In short, ethicists use the Principle of Double Effect to determine whether an act that produces both good and bad effects is morally permissible.) In direct euthanasia, an agent intends the death of the patient as the sole end. In indirect euthanasia, an agent does not intend the death of the patient either as the end sought or as a means to a further end. However, many prefer not to use the term indirect euthanasia, because this may confuse foregoing or withdrawing treatment with the intentional killing of a patient.

Historically, many confuse the last two distinctions: an active euthanasia act was direct; a passive euthanasia act was indirect. However, this is misleading because (1) there are two sets of criteria that distinguish these two terms (i.e., observation in the former, and the Principle of Double Effect in the latter), and (2) one distinction is descriptive of the action (i.e., commission versus omission), the other distinction is evaluative of the action (i.e., direct euthanasia is not morally permissible whereas an indirect euthanasia might be). Therefore, some ethicists suggest that these distinctions remain separate and avoided.

Additional reasons exist for avoiding these terms and they include the following: First, using the generic term euthanasia to speak of both direct killing and withdrawing therapy is confusing methodologically and psychologically. Second, many ethicists debate whether there is in fact a moral difference between active and passive euthanasia. Limiting the term euthanasia to the intentional killing of an individual at least circumvents that debate. Third, some ethicists think it is better to identify the moral legitimacy of foregoing or withdrawing a therapy as a separate issue. In this instance, one is focusing on benefit to the patient, which precludes considerations of killing the patient.

Many bioethicists frequently discuss the ethics of voluntary euthanasia in connection with the ethics of physician-assisted suicide. In fact, many see physician-assisted suicide as a form of voluntary euthanasia. However, there are key differences. First, suicide is a self-induced interruption of the life process and typically occurs in a nonmedical context; that is, many individuals who commit suicide in general are not suffering from a life- threatening disease. Second, while voluntary euthanasia and physician-assisted suicide may share motivations (e.g., mercy, compassion, and respect of autonomy), the ways in which one performs them differ significantly. In voluntary euthanasia, a physician or another person commits the act. In physician-assisted suicide, a physician cooperates but does not commit the act. Instead, the physician helps the patient commit the act. Third, many debate the distinction between voluntary euthanasia and palliative care. This does not occur in the context of physician-assisted suicide. Therefore, there are important issues to untangle in considering voluntary euthanasia in the continuum of care in modern hospitals. There is less of a need to disentangle issues between physician-assisted suicide and other forms of medical care.

Indeed, one study compared the clinical practices of terminal sedation (which is, according to the study, a palliative care protocol that induces a coma to relieve pain) and euthanasia in the Netherlands (Rietjens et al. 2006). These researchers found that both practices frequently involve patients who suffer from cancer. On the one hand, clinicians tended to use terminal sedation to address severe physical and psychological suffering in dying patients; on the other hand, clinicians tended to engage in euthanasia to protect patients’ dignity during their last phase of life. In addition, clinicians employing terminal sedation tended to order benzodiazepines and morphine; clinicians participating in euthanasia tended to order barbiturates. Furthermore, the time interval between the administration of the drug and the patients’ deaths ranged from one hour to seven days for terminally sedated patients and tended to be less than one hour for euthanized patients.

Ethical Issues in Euthanasia

Several ethical issues involved in the debates over euthanasia and physician-assisted suicide remain controversial despite the lengthy debates over them. These issues relate to the various legal and theological issues, too. Here is a survey of some major ethical issues: human dignity, patient autonomy, prevention of harm, protection of the marginalized, and protection of professional integrity in health care.

First, among the most well known ethical issues in the debates over euthanasia and physician-assisted suicide is human dignity. Despite its pervasive use, the term suffers from ambiguity. At least two fundamental ways exist in which human dignity functions in ethical debates: as an expression of (1) intrinsic worthiness or (2) attributed worthiness. In the first sense, one may understand human dignity as an expression of intrinsic or inherent worthiness. This may directly relate to certain religious beliefs; in the Judeo- Christian traditions, the belief that God created humankind in his own image and likeness translates to an inviolable intrinsic worth. In contrast, one may understand human dignity as an attributed worth. On the one hand, one may suffer indignity as a result of the conditions or properties of one’s life—for example, many would consider it undignified to live with a very poor quality of life as in complete dependence on machines to live and being bed-ridden. On the other hand, one may suffer indignity as the consequence of others’ actions—for example, ignoring the incontinence of a bed-bound patient or neglecting senile elderly patients because of some repugnance to old age.

As a form of intrinsic worth, one may argue against euthanasia and physician-assisted suicide because such actions violate human dignity: intentionally killing a patient can never be an expression of respect for human dignity. As a form of attributed worth, one may argue for euthanasia and physician-assisted suicide because such actions may prevent such indignities. This is why some proponents suggest that euthanasia or physician-assisted suicide is a form of “death with dignity.” However, in a now famous article, “The Indignity of ‘Death with Dignity,’ ” the late theologian Paul Ramsey refuted this claim (Ramsey 1974).

Second, patient, or personal, autonomy relates to human dignity; here, autonomy is an exercise of self-rule whereby one controls the circumstances, the mode, and one’s health status at the time of one’s death. The fear of losing control over one’s life is a powerful motivator for euthanasia or physician-assisted suicide. Individuals who seek physician-assisted suicide often do not want to live long enough to experience that loss of control and independence. For them, living in such circumstances could be a nightmare. When proponents of euthanasia and physician-assisted suicide seek a right to die, their concept of patient autonomy supports this right.

In these ways, one uses patient autonomy in support of voluntary euthanasia and physician-assisted suicide. However, this may confuse different notions of freedom. Indeed, the loss of control may seem like a loss of freedom, but, in general, this is only one kind of freedom lost: the freedom of choice. Alternatively, if one thinks of freedom as freedom of being—or freedom to be fully human—then a choice of death may be the ultimate imprisonment. That is, if humans are fundamentally relational (a belief prevalent among the world’s major religions), then a choice to end all of one’s relationships in choosing death would be an act that denies a basic aspect of what it means to be human.

Notwithstanding this alternative, if individuals experience suffering and indignity (i.e., the loss of control or the corresponding fear) as they approach death during a terminal illness, this may be more of a critique of society’s inability to address the needs of the dying (Cahill 2005). In this sense, society may be effectively abandoning patients by not giving them the support and environment they need to flourish even in the last moments of physical life. Such circumstances make euthanasia and physician-assisted suicide logical choices.

Third, the prevention of harm is another ethical issue one finds in the debates over euthanasia and physician-assisted suicide. There are two aspects to this issue. On the one hand, proponents call for legalizing euthanasia or physician-assisted suicide (or both) as a way to regulate the practices. The intent behind this is to prevent harms to patients that are a direct consequence of the acts of euthanasia or physician-assisted suicide themselves. For example, without proper training or sufficient regulations, a patient may obtain and use an inadequate dose of lethal drugs. This may cause harm, because such a dose might not induce death and could leave the patient in an undesirable state (e.g., coma). On the other hand, proponents argue for euthanasia and physician-assisted suicide as a means of preventing harms related to the illness the patient has or the treatments that the patient would need to endure (e.g., chemotherapy). In this sense, the patient prevents the harms by bypassing both the experience of the disease process and the risks or burdens of the treatments for the disease.

Of course, some opponents to euthanasia and physician-assisted suicide find this line of reasoning difficult to accept. For them, it seems illogical to prevent harm by causing the end of the patient’s life. For some, the options of euthanasia and physician-assisted suicide are seen as failures of the health care system to deal adequately with the pain and symptoms of terminal illness and the dying process. Many claim that, with appropriate and accessible palliative care (pain and symptom management) and hospice care, the need or desire for euthanasia and physician-assisted suicide would diminish. However, this may not be as true as some hope: as discussed above, a principal concern is the loss of control, not the experience of pain per se.

Fourth, the protection of marginalized groups from a socially instituted policy of euthanasia constitutes another ethical issue. Here, the principal concern is to protect those who do not exercise autonomy in choosing euthanasia and who, in fact, may resist it. Therefore, this ethical issue results when involuntary euthanasia becomes a social practice supported by political power. This particular issue lives in the shadows of the Holocaust and Nazi euthanasia policies. Despite this tragic episode in human history, contemporary debates persist. For example, some proponents claim that involuntary euthanasia may be justifiable for the severely handicapped.

This issue also incorporates elements of a slippery slope argument. In this case, opponents claim that legalizing voluntary euthanasia and physician-assisted suicide jeopardizes the disabled and other marginalized groups, because such decisions reflect a belief that certain lives are not worth living. Opponents are concerned that the disabled community represents certain kinds of life that those who would support euthanasia would not want to live. Thus, even if legalized euthanasia was restricted to voluntary forms and physician-assisted suicide, such practices are only a short step away from involuntary euthanasia of the severely disabled and then (with one more short step) from the moderately or even slightly disabled. For these opponents, it would be quite possible to slip and tumble down the slope to widespread involuntary euthanasia.

To take this perspective further, if involuntary euthanasia of the severely handicapped never became a reality, there remains a concern that a culture that supports voluntary euthanasia would undermine programs and relationships that promote the livelihood and well-being of persons who are physically and mentally challenged. Thus, there may be decreasing support for social assistance programs and increasing pressure to participate in euthanasia or assisted suicide.

Finally, the practices of euthanasia and physician-assisted suicide may undermine the professional integrity of medicine (and other health care professions like nursing). On the one hand, health care professionals do not want to abandon their patients at the end of life. On the other hand, health care professionals—as helping and healing professionals providing care—do not want to confuse their role or contribute in any way to an erosion of their professional ethos as healers. One concern is that this erosion may have a social consequence of confusing the role of healer and the role of executioner. In these circumstances, the trust in the physician-patient relationship is at risk; if physicians can no longer deal with death and dying appropriately and abandon their patients, patients will not trust doctors to be with them as they face their most difficult health crisis. Similarly, if a doctor supports euthanasia or physician-assisted suicide, a patient may be confronted with a doctor who may see euthanasia and physician-assisted suicide as the “easy way out” and may not trust her professional judgment about what is in her best interests.

Legal Issues in the United States

In 1991 and 1992, citizens in Washington and California, respectively, voted on two referenda; these referenda sought to sanction legally both euthanasia and physician-assisted suicide, or physician-assisted dying. In both cases, voters defeated these referenda by very narrow margins—about 54 percent to 46 percent in both cases. However, in 1994, the citizens of Oregon were asked to vote on Measure 16, which asked, “Shall law allow terminally ill adult Oregon patients voluntary informed choice to obtain physician’s prescription for drugs to end life?” (quoted in Campbell 1994, 9). In this case, the measure passed, which ultimately led to the Oregon Death with Dignity Act (see “The Oregon Death with Dignity Act,” in Beauchamp et al. 2008, 404–406). The critical difference between this Oregon statute and those proposed in Washington and California is its restriction to physician-assisted suicide.

When Oregonian voters approved this measure in November 1994 by a very narrow margin, Oregon became “the only place in the world where doctors may legally help patients end their lives” (Egan 1994, A1). However, that was not the end of the story. The day before the measure was to become law, its enactment was blocked by a court challenge. In August 1995, a federal judge ruled the measure unconstitutional because “with state-sanctioned and physician-assisted death at issue, some ‘good results’ cannot outweigh other lives lost due to unconstitutional errors and abuses” (“Judge Strikes Down Oregon’s Suicide Law,” A15).

In March 1996, the legal situation changed radically for the nine western states in the jurisdiction of the United States Court of Appeals for the Ninth Circuit, including Oregon. In an 8–3 ruling, this court struck down a Washington State statute that made assisting in a suicide a felony. While this ruling held only for the states in the Ninth Circuit, a very critical precedent was set. The grounds for the ruling were privacy and autonomy. Judge Stephen Reinhardt, writing for the majority, said: “Like the decision of whether or not to have an abortion, the decision how and when to die is one of ‘the most intimate and personal choices a person may make in a lifetime,’ a choice ‘central to personal dignity and autonomy’ ” (Lewin 1996, A14). The ruling also argued that not only doctors should be protected from prosecution “but others like pharmacists and family members ‘whose services are essential to help the terminally ill patient obtain and take’ medication to hasten death” (Lewin 1996, A14). Thus, the window opened for a round of appeals and argumentation. Later, a unanimous ruling of the three-judge Second Circuit Court of Appeals in New York reinforced this ruling in April 1996. This court stated “that doctors in New York State could legally help terminally ill patients commit suicide in certain circumstances” (Bruni 1996, A1). As the ruling was appealed, a critical countrywide debate began.

Additionally, Michigan passed a law explicitly prohibiting physician-assisted suicide; this was in response to the activities of Jack Kevorkian, whose activities include physician- assisted suicide. However, this law has passed out of existence because of specific time limits. Furthermore, Kevorkian was brought to trial for acts committed while this law was in effect but was found not guilty based on the jury’s decision that his intent was to relieve pain, not to cause death. Notwithstanding this, another murder charge was brought against Kevorkian in 1999. In this case, he was convicted and sentenced to prison.

Finally, three United States Supreme Court cases have become landmark cases in the legal and ethical debates over physician-assisted suicide. In 1997, the U.S. Supreme Court adjudicated on two related cases (Beauchamp et al. 2008). First, the main question before the Court in Vacco v. Quill was whether New York’s prohibition on assisting suicide violated the Equal Protection Clause of the Fourteenth Amendment. The Court held that it did not. Second, the main question before the Court in Washington v. Glucksberg was whether the “liberty” (i.e., the right to refuse wanted life-saving medical treatment) specifically protected by the due process clause includes a right to commit suicide, which includes a right to assistance in suicide. The Court held that the right to assistance in suicide is not a fundamental liberty interest protected by the due process clause. In the 2006 case of Gonzalez v. Oregon, the main question before the Court was whether the Controlled Substances Act allows the U.S. attorney general to prohibit doctors from prescribing regulated drugs for use in physician-assisted suicide, notwithstanding a state law prohibiting it (Beauchamp et al. 2008, 413–418). The Court of Appeals held that the interpretive rule exercised by the attorney general to restrict use of certain drugs was invalid; the Supreme Court held that the Court of Appeals was correct: its decision was affirmed.

In summary, these cases have three implications. One, they demonstrate that it is not unconstitutional for states to ban assisted suicide while protecting patients’ rights to refuse life-sustaining treatment. Two, one cannot claim that physician-assisted suicide is a fundamental liberty interest protected in the same way as the right to refuse treatment. Finally, the executive branch at the federal level cannot use the Controlled Substances Act to restrict physician-assisted suicide at the state level (which basically protected the practice of physician-assisted suicide in Oregon).

Public Policy Considerations

In the end, there are many public policy considerations in the debates over euthanasia and physician-assisted suicide. However, there are four major considerations. The first consideration is, of course, the legalization and institutionalization of euthanasia and/or physician-assisted suicide. Here, institutionalization means the systematic integration of those interventions as organizational policy and professional practices. The legal issues in the United States mentioned above will continue to shape the possibility of legalization (or criminalization) of these practices. The second consideration is the fair availability and access to alternatives at the end of life; that is, public policy on euthanasia or physician-assisted suicide ought to consider adequate home health services, palliative care, and hospice as legitimate options to euthanasia and physician-assisted suicide. A third consideration includes adequate and necessary protections for marginalized individuals— especially the disabled, elderly, and sick—in society. If any public policy is to legitimize euthanasia and physician-assisted suicide, robust protections for these marginalized groups will be necessary. Finally, a fourth consideration is the protections for the health care professions, which ought to seek a separation between the roles of helping and healing and the roles of death-causing or -assisting. This will include sensitivity to the potential for conflicts of interest, reimbursement schedules, and the authenticity of both patient and provider judgments that choosing death is freely chosen. Many of the safeguards in Oregon’s statute recognize these and other procedural issues involved in implementing a policy of physician-assisted suicide.

Also check the list of 100 most popular argumentative research paper topics .

Bibliography:

• Beauchamp, Tom L., et al., Contemporary Issues in Bioethics, 7th ed. Belmont, CA: Thomson Wadsworth, 2008.
• Bruni, Frank, “Federal Ruling Allows Doctors to Prescribe Drugs to End Life.” New York Times (April 3, 1996): A1.
• Cahill, Lisa Sowle, Theological Bioethics: Participation, Justice, and Change. Washington, DC: Georgetown University Press, 2005.
• Callahan, Daniel, The Troubled Dream of Life: In Search of a Peaceful Death. Washington, DC: Georgetown University Press, 2000.
• Callahan, Daniel, What Kind of Life? The Limits of Medical Progress. Washington, DC: Georgetown University Press, 1995.
• Campbell, Courtney S, “The Oregon Trail to Death: Measure 16.” Commonweal 121, no. 14 (August 1994).
• Edelstein, Ludwig, “The Hippocratic Oath: Text, Translation and Interpretation.” In Ancient Medicine, ed. Oswei Temkin and C. Lillian Temkin. Baltimore: Johns Hopkins University Press, 1967.
• Egan, Timothy, “Suicide Law Placing Oregon on Several Uncharted Paths.” New York Times (November 25, 1994): A1.
• Foley, Kathleen, and Herbert Hendin, eds., The Case against Assisted Suicide: For the Right to Endof- Life Care. Baltimore: Johns Hopkins University Press, 2002.
• Gorsuch, Neil M., The Future of Assisted Suicide and Euthanasia. Princeton, NJ: Princeton University Press, 2006.
• “Judge Strikes Down Oregon’s Suicide Law,” New York Times (August 4, 1995): A15.
• Keown, John, ed., Euthanasia Examined: Ethical, Clinical, and Legal Perspectives. New York: Cambridge University Press, 1995.
• Lammers, Stephen E., and Allen Verhey, eds., On Moral Medicine: Theological Perspectives in Medical Ethics, 2d ed. Grand Rapids, MI: William B. Eerdmans, 1998.
• Lewin, Tamar, “Ruling Sharpens Debate on ‘Right to Die,’ ” New York Times (March 8, 1996): A14.
• McLean, Sheila, The Case for Physician Assisted Suicide. London: Pandora, 1997.
• Mitchell, John B., Understanding Assisted Suicide: Nine Issues to Consider. Ann Arbor: University of Michigan Press, 2007.
• Ramsey, Paul, “The Indignity of ‘Death with Dignity.’ ” Hastings Center Studies 2, no. 2 (May 1974): 47–62.
• Rietjens, Judith A.C., et al., “Terminal Sedation and Euthanasia: A Comparison of Clinical Practices.” Archives of Internal Medicine 166 (2006): 749–753.

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EUTHANASIA: A STUDY INTO THE ETHICAL AND LEGAL DIMENSIONS

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Euthanasia, or physician-assisted suicide, raises several questions regarding legality and ethics. On one hand, patients should have the right to control their demise- (the right to die with dignity is an intrinsic facet of the right to life under Article 21), whereas terminal illness which brings not only an enormous amount of pain but also emotional suffering and psychological agony, questions the worth of such a life- shouldn’t patients have the option to avoid this trauma? Consequently, is individual will to die more significant than the state’s restrictions on the same? On the other hand, practices such as active euthanasia raise legal concerns as a policy, since legalizing euthanasia gives surrogate decision-makers the ability to decide in case of incompetent patients based on nebulous tests, while power structures threaten the patients too. As a result of promoting euthanasia in a society as complex and diverse as India’s, will patients from vulnerable communities such as women, Dalits, girl children be subjected to discriminatory’ or forced’ euthanasia? Does the Slippery Slope Argument’ (which predicts the same that legalizing euthanasia will lead on to more number of nonvoluntary cases of euthanasia) hold?. Previous studies on e uthanasia have evaluated the effects of it as a public policy, as well as, its necessity as an individual right. Further, studies have also been conducted on active and passive euthanasia, the philosophy behind euthanasia, and the problems raised by this practice. Through my study, I aim to contribute to these areas of research by focusing on the need for euthanasia, its various types, its effects on the individual in question, as well as, society as a whole. With the fulfillment of this research, I would like to answer some of the questions I have raised, and reach conclusions regarding the morality of euthanasia, and whether it should or should not be legalized. The goal of this research project is to evaluate euthanasia as a legal, ethical, and personal practice, taking into consideration the history of such cases, the legal status of the concept in various countries, and a comparative analysis of the same with India. Moreover, through this research, I hope to address legal, as well as, ethical and moral issues, raised by e uthanasia, analyze them, and, combine them into one line of thought. In this regard, the innovative use of a unique questionnaire designed for various categories of stakeholders, as well as, completed a literature review of the research that has taken place so far have enabled this research. As a result, the results have been analyzed and comprehended in an interesting yet simple language for the study to reach maximum readers. Moreover, the research is an attempt to break down multiple facets of e uthanasia, and question the ethicality of euthanasia, the certain harms it poses to society as a public policy and regulation that would be required to legalize active euthanasia. Furthermore, should alternatives such as hospice care and palliative care should be considered before opting for euthanasia? Thus I will first analyze the ethicality or ethical portion regarding euthanasia, followed by its possible impacts, benefits, and fallouts in society, supported by appropriate logical reasoning. This will help understand the two dimensions of both passive as well as active forms of euthanasia. I will proceed to compare and contrast euthanasia with other alternatives, such as palliative care and conclude with the help of my understanding and views on the matter.

[ Armaan Gandhi (2020); EUTHANASIA: A STUDY INTO THE ETHICAL AND LEGAL DIMENSIONS Int. J. of Adv. Res. 8 (Sep). 155-164] (ISSN 2320-5407). www.journalijar.com

Article DOI: 10.21474/IJAR01/11645       DOI URL: http://dx.doi.org/10.21474/IJAR01/11645

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Euthanasia Research Paper Topics & Ideas 2023

Published 16 October, 2023

Students who are assigned with a research paper on euthanasia can find certain difficulties to accomplish it professionally. This is because students required help in writing a research paper from the professionals of My Research Topics to deal with the research work of the paper. Sample research paper on euthanasia is also given to the students by the experts so that a good quality research paper could be written on similar topics by the students easily.

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Thesis Statement

There have been many instances of Euthanasia which forced human beings on social and security grounds to go on slaying innocent people for the good cause.

Anti-Thesis Statement

Although euthanasia is a major problem it could be dealt with by the intelligent minds of society come out of it.

Introduction

Euthanasia is a situation when people kill or murder someone for the sake of a good purpose so that the suffering of that person could be minimized. Today there are many areas in which this technique is being used by the masses to help people in lowering down their troubles. Some consider this as good but others are not in favor of practicing euthanasia by equating it with suicide.

Well, we cannot generalize the statement on the grounds of one or two people’s statements about this topic. Certain research and arguments need to be given to cope up with such sensible situations. Here are some facts that will throw light upon the positive and negative aspects of euthanasia along with suitable examples. So go through them to understand a complete concept of euthanasia before making a perspective on it.

Here are certain arguments that will help you to get through the situation thoroughly. It gives a deep understanding of the use of euthanasia in different situations and their cause along with the results associated with it. If you are assigned with a research paper on euthanasia make sure that your research paper deals with the following aspects of the topic to cover all the issues associated with it.

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Importance of Euthanasia in different Areas

There are certain stages in human life that force them to involve in the pursuit of euthanasia. These stages are described in the following points for the better clarity of people and students. So grab the idea and write a good research paper that is assigned to you by the professors in Colleges and Universities.

• Euthanasia is important at the security level of the nation; there are many people who are in the intelligence wing of the nations serving in different countries to provide secret information regarding the conspiracies hatched by the enemy nations. But sometimes out of their misfortune, these people are caught by the hand of the enemy nation who torture them to the core. In order to save such torture, the head of the intelligence branch gives orders many times to shot their team member dead that are trapped on the hand of enemies.
• Other situations arise on social grounds where excessive violence to a person, be that a man or woman or it might be a case of a child happens in a family. This type of euthanasia is also considered when there occurs a situation to save someone from disgrace on social grounds.
• Economic and political situations are other examples where we can have glimpses of euthanasia every other day. People have to kills their families under the pressure of financial situations where children are dying of hunger for days and days.

Drawbacks caused by Euthanasia

The cause behind euthanasia is generous but still, we cannot consider it good for the people who are becoming the victim of these situations. It could be a bad phase of life that can improve with time and might it be possible to have a good time as well. To cap it all euthanasia is performed by the people having pessimism in their life and we should not support such ideologies at any cost as they can engulf our societies within no time along with our values.

Euthanasia on Socio-Economic Grounds

Socio-economic conditions of the people of a particular society as described above also push the people towards their poor situations of committing these types of work. So we should also give a thought to preventing such situations in society to save the lives of people.

The above arguments show that euthanasia is a situation that people find hard to deal with owing to many opposite forces working in their surroundings. So it is very important to deal with this issue intelligently so that we can save the lives of common people who are pushed into such situations due to the financial crisis in their life. It could be done by taking certain good decisions by the intelligentsia of society.

In case you are not able to keep your work of writing research paper professionals of My Research Topics are giving assistance in writing a euthanasia research paper to the students. So make sure that you are taking this help to deal with the assignments of writing a good quality research paper for the best score in assignments.

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