Euthanasia - intentionally causing the death of a person, the motive being to benefit that person or protect him/her from further suffering.
Euthanasia can be classified into six different categories...
Character of patient's consent:
Voluntary - with the competent consent of the person who will die from the action.
Nonvoluntary - the person's competent wishes regarding euthanasia are not known.
Involuntary - the person who will die due to euthanasia has competently refused euthanasia, but it occurs anyway.
Means used to cause death:
Essentially, the terms active and passive address how close the causal connection is between the action and the individual's death. But, keep in mind that different people interpret these terms differently. I use numbers to distinguish some of the different interpretations. NOTICE - Whether a specific case of euthanasia is "active" or "passive" has nothing to do with whether or not the patient consented to it.
Active - 1. The act of euthanasia is the direct cause of the patient's death. The action did not rely on any other contributing factors except normal bodily processes (ex. the blood stream to carry the poisonous substance throughout the body). Think of it in terms of "this would work on anyone, no matter what their physical condition is like." 2. Active euthanasia is the commission of an action which causes the patient's death, out of mercy for the patient (as opposed to Omission, not doing something). 3. 1 and 2 together lead to the categorization of active euthanasia as killing the patient, as opposed to allowing the patient to die (passive).
NOTE: Active is usually a quicker means of causing death. All forms of active euthanasia are illegal. However, recent federal circuit court decisions have explicitly denied that active euthanasia should be treated differently from passive euthanasia.
Passive - 1. This type of euthanasia is sometimes poetically referred to as "letting nature take its course." Essentially it involves not providing or discontinuing treatments that would be reasonably effective in preventing the patient's death because death is considered to be merciful to the patient (by whoever makes the decision). So, this type of euthanasia relies on other factors for its success in causing death, such as the underlying pneumonia which left untreated kills the patient or the patient's inability to breathe sufficiently without oxygen or respiratory assistance. 2. an inaction, not doing something that would ordinarily be done for a patient with this condition with the intent of causing the patient's death out of mercy for the patient. 3. 1 & 2 together lead to the characterization of passive euthanasia as letting the patient die (as opposed to killing the patient).
NOTE: Passive is usually slower and more uncomfortable than active.
Most forms of voluntary, passive and some instance of nonvoluntary, passive euthanasia are legal.
Many arguments have been made concerning whether active and passive are morally different. The philosopher James Rachels has argued that there is no moral difference between active and passive. He argues that the morally relevant aspects of an action are the motives, intentions, and consequences. Sincethey are the same for active and passive euthanasia, there are no moral differences between these categories, per se. Some differences may exist between actual cases, based on differences with consequences for example, but this is not based on the active/passive distinction.
Some have argued that there is a moral difference based on the fact that active euthanasia leaves no room for a miracle, is outwardly similar to murder and so would be more difficult to distinguish from murder than passive, and does not require the patient to be as ill as passive. Specific exceptions to each of these concerns can be made. But, some have also said that passive euthanasia hinges on a more basic right, the individual's right to privacy (especially protection from interference and bodily invasion). They argue that support for active euthanasia hinges on the weaker right to demand a specific treatment, which has never been a strong patient right in health care.
Assisted Suicide - helping a person kill him or herself.
The main difference between this and euthanasia is that in assisted suicide the patient is in complete control of the process that leads to death because he/she is the person who performs the act of suicide. The other person simply helps (for example, providing the means for carrying out the action).
Many have argued that it would be worse (morally speaking) for health care professionals to engage in assisted suicide or euthanasia, than others because it would undermine the basic values of the health professions. Others argue that these values include providing relief from suffering and that there are rare times when death is the only means of achieving this goal. Germany actually accepts assisted suicide but is against euthanasia, largely because of the issue of patient control. If the patient is performing the action that leads to death it is more likely that this was a voluntary choice for the patient. Thus, there is less risk of abuse.
Pain Relief & Acceleration of Death - Providing pain medication to terminally ill or dying patients which has the side effect of hastening death is not euthanasia or assisted suicide as long as it is necessary to relieve the patients pain and suffering and patient comfort is the primary motive and goal.
Health care professionals have an obligation to relieve pain and suffering and promote the dignity and autonomy of patients in their care. In order to adequately relieve a patients pain and suffering, a physician or nurse practitioner may have to prescribe a treatment that may hasten death for a dying patient. Both the ANA and the AMA explicitly condone this. As long as the intent and goal is to relieve pain and suffering and it is reasonable to believe that this level of medication is necessary to relieve/prevent pain and distress in the dying patient, then it is morally permissible to administer treatment that may have the side effect of hastening death.
One may wonder how to prevent this from being abused by those with bad intentions. A good rule of thumb is to ask whether or not there is another reasonable means by which the patient could be kept comfortable which does not have the death hastening side effect? If so, is it as effective? Is it readily available? If the answers to these questions are yes, then one should question the practice. There may be other justifiable reasons for the use of this medication and dosage. But, in order to be an advocate for patients, we must try to prevent abuses, especially in grey areas like this.
Furthermore, every health care professional has the right to refuse to participate in the provision of care that he/she believes to be unethical or against their moral/religious beliefs. However, care must be transferred to someone of equal or higher expertise. No patient should die in pain because no one is willing to provide him/her with adequate pain relief. However, patients may refuse pain medications based on their own values.
There are many arguments for and against each of the actions discussed above. Read up on these issues and evaluate your own views.
AMA Council on Ethical and Judicial Affairs. AMA Code of Ethics: Current Opinions with Annotations, 150th Anniversary Edition.
ANA. Position Statement on Promotion of Comfort and Relief of Pain in Dying Patients (9/05/91).