Which countries allow euthanasia? Ethical issues of euthanasia

• November 3, 2019
• Tips for tourists
• Elena Spi

In medical practice, there is such a patient’s right - an unauthorized decision about care, but only a few know in which countries euthanasia is allowed. Switzerland has long attracted tourists not only for its landscapes, but also for its opportunities to die without suffering. This is prohibited in Russia and the UK. Probably, bills are built not only on the basis of the will of the people. Moral standards, ethical and ecclesiastical speculations and arguments are taken into account.

What is euthanasia?

Euthanasia is the act of ending the life of a very sick person to put them out of their suffering. The person who undergoes this procedure usually has a terminal condition. But there are other cases where some patients want their life to end. Therefore, attitudes towards euthanasia vary, but among patients they are predominantly positive, since not everyone is ready to put up with pain and suffering before death.

In many cases this is done at the request of the patient, but there are situations where they may be too ill and the decision is made by relatives, doctors or, in some cases, the court. It would be fair to understand why euthanasia is allowed somewhere, but in other countries it is strictly prohibited for religious reasons:

1. The term is derived from the Greek word euthanatos, which means easy death.
2. Euthanasia is illegal in the UK, where it is illegal to help someone kill themselves.
3. Voluntary euthanasia, or assisted suicide, can lead to imprisonment for up to 14 years.

This issue has been at the center of heated debate for many years and is surrounded by religious, ethical and practical considerations.

Attitudes towards euthanasia

The procedure raises a number of tantalizing moral dilemmas:

1. Is it ever right to end the life of a terminally ill patient who is experiencing severe pain and suffering?
2. Under what circumstances can euthanasia be justified, if at all?
3. Is there a moral difference between killing someone and letting them die?

These arguments are based on people's different ideas about the meaning and value of human existence. Therefore, patients themselves often ask questions about which countries allow euthanasia. Perhaps this gives them the opportunity to go to a place where the person, in his opinion, will receive help.

Should people have the right to decide matters of life and death? This is an eternal question that will never be firmly and unambiguously resolved. There are also a number of arguments based on practical issues. For example, is euthanasia allowed in Russia or not, and why are people not allowed to resolve such situations on their own?

Some people think that the procedure should not be allowed, even if it was morally right, because it can be abused and used as a cover for murder.

Right to death - euthanasia

Nowadays, the socio-ethical and moral-humanistic aspects of the problem of death are attracting increasing attention in connection not only with the increasingly widely recognized and aggravated personal dilemmas and alternatives of life, but also with the success of biomedical research, in particular resuscitation, which promotes a return to life people, including even those in a state of clinical death.

Already, many scientists are raising the question that biology, the science of life, should be supplemented with new ideas about the biology of death. Many moral and humanistic dilemmas arise here that go beyond traditional views. For example, the “right to death” in discussions where two opposing positions collide, recognizing, on the one hand, the unlimited freedom of the individual in resolving these issues, and on the other, its complete subordination to public and state interests (the concept of the so-called paternalism).

To some extent, the term “right to death” sounds paradoxical: after all, for centuries, the prerequisite for all human rights was the most important, fundamental of them - the right to life. In general, any of the ever proclaimed human rights can be considered as the deployment, expansion or specification of this fundamental right, for each of them is necessarily one of the manifestations of life, the satisfaction of any vital needs, interests, aspirations.

Voluntary death - suicide - was condemned by religion, to the point that suicides were forbidden to be buried in cemeteries. Nowadays, thanks to the intensive development of medicine, the question of life and death sometimes turns out to be a matter of choice. Moreover, this choice is made not only by the person whose life and death are in question, but also by other persons.

When the process of death is under extrapersonal control, then the “right to die” becomes a problem: the question arises, is the right to life not only a right, but also a duty or obligation, should society protect a person’s life against his will? Moreover, in modern discussions about the “right to die” they do not mean suicide as the action of an active subject, but a dying person acting as a passive object whose onset of death is artificially slowed down.

And it is no coincidence that the problems of euthanasia (Greek: euthanasia) - painless death, quiet “blessed” death, especially of a doomed person, and prolongation of life by artificial means become central in discussions about paternalism.

Modern philosophers, lawyers, doctors, and theologians seek to resolve two fundamental questions: can euthanasia have a moral justification at all, and if so, under what conditions should it be legalized? When addressing these issues, many scientists take an anti-paternalistic position, believing that the most important moral principle, which, as far as possible, should be elevated to law, is the right of freedom of choice. They proceed from the premise that interference with an individual’s freedom of action, including his decision to hasten his death, is morally unjustified if he does not thereby harm others, and the act of euthanasia as a manifestation of individual freedom should not then be prohibited by law.

The reasoning of anti-paternalists is often structured as follows: modern medical technology has significantly increased and continues to intensively increase the possibilities of prolonging life, but dying people themselves sometimes notice the gradual destruction of their natural nature, all forms of activity and are not only subjected to constant physical suffering, but are also aware of their burdensomeness for their loved ones. In such cases, according to antipaternalists, it is immoral not to allow the person to die.

Scientists who are inclined towards paternalism consider euthanasia unacceptable, putting forward the following main arguments against the moral legitimacy of taking a person’s life. Firstly, human life is inviolable and therefore euthanasia should not be used under any circumstances. The reasons for turning to the sacramentality of human life are different (they can rest on religious grounds or on the conviction that the sanctity of human life is the core of social order, etc.). Secondly, euthanasia is subject to abuse by doctors, family members or other interested parties. Thirdly, euthanasia contradicts the principle “as long as there is life, there is hope” and does not take into account the possibility of a doctor’s erroneous diagnosis. The use of euthanasia in these cases leads to irreversible consequences. In addition, after the death of a patient who has undergone euthanasia, a new drug may become available that can cure a previously incurable disease.

Many scientists are trying, on the basis of a philosophical definition of life, to solve the very specific question of when a person’s death occurs, giving the doctor the right to turn off artificial life support devices (that is, to use the so-called “passive” euthanasia ). Two main points of view are discussed: one argues that a person’s life should be protected until the very last moment, and the other considers it possible to state the fact of death and turn off the devices after the death of the cerebral cortex. The severity and relevance of this issue is also due to the increasingly widespread practice of organ transplantation. To eliminate the possibility of doctors being too hasty when declaring the death of a donor from whom organs are taken for future transplantation, it was considered necessary that the death of a possible donor be certified by a medical team independent of those performing the transplant.

Thus, today philosophical reflections on life and death are also necessary for solving specific problems arising in connection with the development of biology, medicine and healthcare. Scientific humanism also seeks moral support for a person in the face of death, including what belongs, so to speak, to the culture of dying. Not fantastic dreams and hopes, not panicky negative emotions and painful mental tension in the face of death, but an honest and courageous approach to it of an individual who has wisely decided these issues for himself as an organic part of his life - this is the philosophical basis that is affirmed by the scientific, real humanism.

Real philosophical humanism provides such an ideal that defines the meaning of human life in its individual, personal and universal, social parameters. This ideal affirms at the same time the dialectical relationship between the natural-biological and the social, the finite and the infinite, the death and immortality of man, who receives his completed forms in that which alone corresponds to his essence in the material and spiritual culture of mankind.

This is what ultimately underlies the regulating role of morality both in a person’s individual life and in his attitude towards death. And this allows us to assert that only in the immortality of the mind and humanity of man is the immortality of humanity. This is the global purpose of man and humanity, their responsibility for preserving life and intelligence on our planet, without which it is impossible to overcome all the threats posed by irrationality and anti-humanism. Apparently, centuries and millennia will pass before the potentialities of reason and humanity contained in man are fully realized. And this will be the true history of human development in a truly human, reasonable and humane society.

But the question of the meaning of human life also has another side, relating to the real, natural-biological infinity of humanity and the immortality of its mind, as well as to the possibility of other forms of life and mind, other extraterrestrial civilizations in the infinite Universe. This extremely interesting aspect of the issue is intensively discussed in modern scientific and philosophical literature. The cosmization of humanity, its emergence in the future into the endless expanses of the Universe will change in many ways our ideas about time, which, apparently, will be associated with a new understanding of the meaning of human life, its duration, death and immortality, will lead to an awareness of the cosmic destiny and responsibility of man and humanity.

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Suicide or the right to care?

Most people believe that unbearable pain is the main reason why people agree to euthanasia, but some studies in the US and the Netherlands found that less than a third of requests for euthanasia were due to severe pain.

In terminally ill people, quality of life may be seriously impaired by physical conditions such as:

• incontinence;
• nausea and vomiting;
• dyspnea;
• paralysis;
• difficulty swallowing.

Psychological factors that make people consider the procedure include depression, fear of loss of control or dignity, feelings of burden, or aversion to dependency. Where euthanasia is permitted, such situations are not considered murder.

The term “mercy killing” is distinguished and used in situations where the patient suffers greatly. Killing is stopping the taking of measures that would allow a person to survive.

The following are not euthanasia:

1. Discontinuation of medically futile treatment when the burden of such treatment outweighs the benefit.
2. Providing treatment aimed at relieving pain and other symptoms, even though the treatment very rarely may result in some predictable risk of shortening life, known as the "double effect," when the doctor reduces pain rather than ending life processes.
3. When a mentally competent person decides to refuse treatment. Doctors cannot force patients to undergo treatment against their will, and it is legal for a patient to refuse treatment. If the patient dies, it is not euthanasia.

Arguments for the procedure may be as follows:

1. It does not include stopping or starting medically futile treatment, alleviating pain when the goal is to eliminate the pain but not the patient, or withholding medical treatment from a competent patient. Euthanasia is illegal in the UK under the common law crime of murder.
2. Voluntary euthanasia is when a competent patient agrees but does not commit to making a decision to end his life.
3. Assisted suicide is when someone helps another person commit suicide. In the UK it is illegal under the Suicide Act 1961, which states that a person "who aids, abets, counsels or procures the suicide of another person or the attempt of another to commit suicide is liable on indictment."

If such actions are not self-interested, then this is the norm for both parties. They also introduce the definition of a person's living will: a document prepared by a mentally competent person in which a person states that he does not want to receive medical treatment and care if he becomes incompetent in the future and can no longer express his wishes himself.

Active and passive forms

Many people who are closely confronted with this issue do not quite understand how active euthanasia differs from passive euthanasia, so it is worth describing each category separately:

1. Passive (delayed syringe method). When using this form, the provision of medical care to the patient, which could be aimed at prolonging his life, is stopped. Accordingly, such a decision brings the patient’s imminent death closer. This is often seen as the patient’s right to refuse medical services, operations, and medications. In other words, voluntary euthanasia occurs.
2. Active. The main types of euthanasia, active and passive, are largely similar, because the sequence of actions is approximately the same. Only in the case of an active form does a doctor or other official make a purposeful and conscious decision to end the patient’s life for certain professional reasons.

Interesting: Arguments For and Against

Active and passive forms of euthanasia are questions for numerous disputes and discussions, on which the world and Russian communities have not yet formulated a final opinion.

Ethical norm of euthanasia

Palliative care is the comprehensive care of patients with an incurable, progressive illness that is expected to end in death, providing physical measures such as pain control and psychological, social and spiritual support. This guides the management of hospitals in whose countries the act of “help” is allowed. At the same time, ethical problems of euthanasia remain, because some may use such measures for their own purposes. It is no secret that it is enough to pay for the procedure. And different cities have their own prices.

Five important conditions for euthanasia

Before performing euthanasia, doctors make sure that five important conditions are met for the patient:

• the patient has physical and psychological suffering and there is no way to eliminate it;
• the patient has repeatedly expressed a desire to die, and these requests have been recorded;
• the patient was informed about the irreversibility of the procedure, and he consciously made the appropriate decision;
• alternative assistance was provided but did not help or was rejected;
• the decision is made by a council of doctors.

Where is euthanasia allowed?

The following is a list. It helps you find out exactly which countries allow euthanasia.

1. Netherlands - legally allowed by the Supreme Court since 1984. It began to be used legally and officially in 2002. It is performed exclusively on terminally ill patients.
2. Belgium - since 2002 you can officially do this. Allowed for everyone who experiences physical pain and suffering. Since 2014, child euthanasia has been legalized.
3. Switzerland has the most liberal attitude towards the process of dying. In Zurich, up to 200 people die every year from the “injection”.
4. USA - each state sets its own rules. However, in Oregon, Washington, Montana, Vermont and California, the procedure is officially permitted.
5. Luxembourg - can be carried out since 2009. The rules are the same as in Belgium. You can only choose a doctor yourself, and relatives can be present.
6. Colombia - Euthanasia was carried out legally for the first time in 2015. The government allowed a sick 79-year-old man to commit suicide within the walls of the hospital.
7. Canada, where euthanasia is officially allowed, previously provided for a punishment (until 2015) of 14 years in prison. This provision has now been found to breach the Charter of Human Rights to Care.

Above is a list of countries where euthanasia is allowed. To this day, many cannot understand why such measures were not allowed before. Now children can be given an injection that will ease their suffering, however, if the children themselves want it. Accordingly, parents decide for children under 7 years old.

The Netherlands has allowed euthanasia. Many countries have accepted voluntary deaths, but not Russia

Netherlands

In the Netherlands, euthanasia is permitted if the patient is suffering unbearably and provided that he has made a statement. The document must contain information about under what conditions he should be helped to die. Most often, before carrying out the patient’s will, the doctor simply consults with one of the specialists. However, in the case of dementia, the Supreme Court considered it necessary to consult two experts. This was reported by the BBC.

At the same time, the court only legalized the already existing practice, noted the Associated Press. So, last year, a doctor who performed euthanasia for a 74-year-old woman in 2021 was acquitted. According to the prosecution, the elderly lady could have changed her mind from the moment she expressed in writing her desire to die in the current situation. The court emphasized that the acquittal of the doctor complies with the law.

The agency noted that euthanasia for severe forms of dementia is quite rare in the Netherlands. Voluntary death became legal in the state on April 1, 2002. Over the past 18 years, there have been fewer than 20 similar cases of dementia.

The Netherlands became the first country to legalize euthanasia. Moreover, assistance in committing suicide is not punishable by law.

Switzerland

Switzerland is probably the most famous country where the right to die is enshrined in law. This is due to the now popular Dignitas clinic. The name of the establishment is translated from Latin as “dignity”. It was his staff who helped many terminally ill foreigners who come to this hospital to die.

Zurich, where the clinic is located, has already been nicknamed the place of “suicide tourism.” Euthanasia has been legal there since 1941, and about 200 people voluntarily take their own lives there every year. Local laws are considered the most liberal in terms of euthanasia. Thus, the legislation allows “assistance in committing suicide” in cases where “those who help do not have selfish motives.”

Belgium

Belgium followed the Netherlands in legalizing euthanasia in 2002. However, according to local laws, doctors can help a patient die only if they have been monitoring him for a long time. “Suicide tourism” has not caught on here, since for the procedure the client must be a Belgian citizen and reside in the state on a permanent basis.

In this case, patients must be in “a hopeless medical condition and experience constant intolerable physical or mental suffering that cannot be relieved.”

Eight years ago, Belgium became the first country to officially allow the euthanasia of children. The minimum age after which patients can request death is not specified in the law.

USA

The patient’s right to voluntarily die has been legalized in eight states. The procedure varies in each region and is only available to adults.

Maine was one of the last states to allow end of life. There, receiving lethal drugs is not classified as suicide, although opponents of the practice still call the procedure “medically-assisted suicide.” Proponents of euthanasia are confident that it should be designated as “physician-assisted death.”

The first state to allow euthanasia was Oregon. Doctors there have had the right to prescribe appropriate drugs since 1997. Then they passed a law called “Death with Dignity.”

Canada

Canada has also legalized euthanasia. There, doctors were allowed to help patients with incurable diseases in the terminal stage die, that is, when the imminent occurrence of death is not in doubt.

Australia

This summer, euthanasia laws were implemented in Australia. Cancer patient Kerry Robertson became the first person to take advantage of the innovation. She lost her life with the assistance of doctors in a nursing home in the Australian city of Bendigo, which is located in the state of Victoria. It was he who became the first state in the country to legalize end of life.

New Zealand

In the fall of 2021, New Zealand parliamentarians passed a bill that allows euthanasia for seriously ill citizens. 70 members of parliament voted for the adoption of the document. 50 people spoke against it. The project was prepared for two years. Only seriously ill people who had less than six months to live were allowed to die voluntarily.

Luxembourg

In Luxembourg, euthanasia and assisted suicide have been legal since 2009. The law is similar to the Belgian version. It emphasizes “the right of doctors to freedom of conscience.”

Colombia

Colombia introduced euthanasia for the first time five years ago. A 79-year-old Colombian man who suffered from very painful oral cancer won the right to die. At the same time, local Catholics oppose this practice. Church hospitals that were about to begin euthanasia were even threatened with closure.

Germany

In February of this year, Germany also decided to legalize euthanasia. The Constitutional Court of Germany has allowed assistance in voluntary death. According to the judges, the right to die at one's own discretion is a personal human right. It includes the freedom to commit suicide or seek the assistance of a third party to end one's life. This was noted by the chairman of the highest court of Germany, Andreas Voskule.

Moreover, just five years ago, the German Bundestag outlawed organizations that promote euthanasia on a commercial basis.

Russia is not ready?

Russian Health Minister Veronika Skvortsova noted this fall that the ministry will not change its attitude towards the euthanasia procedure anytime soon. But, in her opinion, this issue must be resolved not only at the government level, but also based on the opinion of the people, therefore “the population will have to decide whether they are ready to agree to this or not.”

“In countries this is decided by referendum, since different countries have different faiths. It creates a different worldview. There are different ways to get rid of suffering, including drugs. This is something that is actively developing in our country,” the minister concluded.

How is the procedure performed?

Knowing which countries have euthanasia, you can inquire about the procedures. The most common prescription is for intravenous injection. The medicine can be purchased for 200-400 dollars (equivalent to the country’s currency). There are also several types of procedures, which are carried out accordingly in different ways.

However, when a patient is denied action or medication for the primary purpose of causing or hastening death, it is passive or indirect euthanasia. These measures may include withholding or eliminating normal measures such as food, water (hydration), and oxygen. To reduce the chance that euthanasia medications will cause vomiting, an antiemetic should be given.

In the Netherlands, the practice involves giving the patient a comatose injection followed by a second injection to stop the heart. Coma is first induced by intravenous barbiturates and then a muscle relaxant. The patient usually dies as a result of muscle relaxant-induced anoxemia. When death is delayed, intravenous potassium chloride also precipitates cardiac arrest.

Types of euthanasia: which path to the next world can you choose?

Assistance is provided by a specialist doctor after a positive decision of the commission. Measures are being taken to help decide on such an action. They are distinguished not by the composition of the substance introduced orally, but by the procedure that ultimately leads to death:

1. Injections - a lethal drug is injected that affects the respiratory tract, the person dies due to the concentration of poison in the blood.
2. Disconnection from the artificial respiration apparatus only after biological death has been established.
3. A person who is in a comatose state (less than 4 weeks) cannot be disconnected from mechanical ventilation, accordingly, the injection can be administered if he regains consciousness and measures are taken to euthanize him.
4. When a person voluntarily stops taking medications because they do not want to continue treatment that may or may not help them get better (voluntary drug withdrawal).
5. The right to euthanasia can be obtained if the patient is in pain - painkillers do not help, and the patient cannot endure it without permission.

However, there is an important nuance! Euthanasia or deliberate poisoning with lethal substances is not euthanasia, since only those substances that help to pass painlessly into another world should be used for the procedure.

Types of euthanasia

The classification of euthanasia is based on the method of its implementation and the initiator of this action.

Active euthanasia is the administration of a specific medication that shortens the patient’s life.

Passive euthanasia is the cessation of artificial support of the body’s vital functions.

Voluntary euthanasia – the patient himself expresses his desire to die.

Involuntary euthanasia - the decision is made by a council of doctors based on the expressed will of relatives. This usually occurs if the patient himself cannot express his will because he is unconscious or comatose.

Opinions of doctors and experts

Above we have already given a list with a reminder about which countries allow euthanasia. In Russia, this procedure is prohibited by law. Moreover, any refusal of resuscitation or treatment prescribed by a doctor after emergency hospitalization is considered a refusal to live. After all, it is specific measures that help save a person, and if you do not adhere to this, the patient voluntarily dooms himself to death. In such cases, people should not be allowed to leave hospitals or be discharged at their request or at the request of their parents.

Incurable patients can resort to killing substances if they have drawn up a notarized request in advance, which specifies how and how to proceed in the event of a fatal illness. At the same time, they often bequeath their organs to other people, if this is possible in their situation. Do not confuse resuscitation with euthanasia - these are different things, since no one can say at what point the heart will stop.

Other cases: prescribing painkillers to patients. The illustrative story with Dr. Khorinyak caused a flurry of bewilderment, because the doctor helped a terminally ill patient not feel pain, relieving him of suffering. Lawyers stated in the media that the drugs had no effect on the speed of death; on the contrary, they helped the patient fight for 3 years to preserve his life:

1. The hopelessly ill are those who cannot be cured. We can only hope for a miracle, which is not excluded in medical practice. Sometimes cancer patients recover when doctors give no chance.
2. Hospice and palliative care are the only option for patients doomed to die.
3. But the hospice in Zheleznogorsk is not ready to provide assistance and use the euthanasia procedure. The doctors turned out to be unprepared for such actions - this would mean taking responsibility for the death of the patient.

Some people resort to the help of Swiss colleagues. Tourists come there for euthanasia, paying for treatment, procedure and stay in the ward. The cost of services can vary between 4-8 thousand euros.

The attitude of the church towards euthanasia

Many argue that the right to choose when to die is a basic human right. At the same time, the ban on euthanasia is a punishment, because it is the Lord who decides the fate of a person. A mortal does not have the right to be born and die where he wants.

While those who belong to the Christian religion may argue that the time, place and manner of death should be left in the hands of God. But there are other religions that believe that dying in an act of religious fanaticism is a fundamental right and leads to an afterlife in heaven.

All this may be "true" in the eyes of believers, but whenever a question of procedure arises, the argument almost immediately turns into "suicide", defined as death by one's own hand. Similar opinions on euthanasia have been documented. However, there remain countries that fully support human rights.

Is it allowed among children?

Euthanasia for children is not yet legal in countries where it is performed for adults. However, in Belgium and the Netherlands it is already possible, and Canada is preparing to change laws. Doctors and the government of the Netherlands have arguments in favor of euthanasia among children. But not all citizens are able to accept such arguments as opposed to their conjectures - voluntary death for a child.

There, children under the age of 12 are allowed to be euthanized, with parental permission required until age 17. Infanticide is also openly practiced by Dutch doctors, although it is technically illegal. Indeed, the Groningen Protocol, a bureaucratic checklist published by Dutch pediatricians, outlines which terminally ill and disabled children may have such a right. Let's take a closer look:

1. The Supreme Court of Canada upheld the right to assisted suicide in 2015, followed by legislation in national and provincial parliaments. The law generally ensures that the procedure is available to adults experiencing intractable suffering—as defined by the patient—in circumstances where death is reasonably foreseeable.
2. There are currently serious discussions about extending this license to children. This development is especially troubling for the United States, given that Canada is its closest cultural cousin.
3. The Canadian medical establishment has made its agreement clear. The Pediatric Society previously released a position paper entitled "Medical Assistance in Dying: A Children's Perspective." The document is not at all critical of extending the law on euthanasia to minors.
4. Moreover, the statement contains recommendations on how to carry out child euthanasia, if the law allows it. By refusing to oppose legalization or even make a single substantive argument against moral propriety, the public is implicitly supporting policies that would allow the killing of sick and disabled children.

A staggering 11.2% of respondents reported that they had already had “preliminary discussions” with parents about killing their seriously ill mature children, while child euthanasia remains illegal in Canada.

What about euthanasia for "never competent children":

1. Forty-five respondents reported receiving written requests from parents to euthanize their children.
2. Half of the requests were for children under one year of age. Child suicide, Dutch style.
3. Thirty-two percent of doctors surveyed said they would approve the procedure for minor children "in rare cases involving terminal illness or intractable pain, as long as the process is closely supervised."

Whether euthanasia will be allowed in Russia or not is still unknown. But the authorities are not yet ready to discuss such disputes within the framework of the law.