Shameful questions about euthanasia Can it be considered murder? Is it allowed in Russia and who is against it?

Euthanasia is the termination of the life of a terminally ill person. It is called a “dignified” or “good death”, since its goal is to end the suffering of the patient with his consent or with the permission of loved ones. The practice of voluntary death was welcomed back in Ancient Greece, when suicide of the elderly and disabled was encouraged. Today, such a procedure causes heated debate: in 5 countries it is legalized, another 5 states are pondering the legality of “voluntary murder”.

Story

The term “euthanasia” was first used in the 16th century by the philosopher Francis Bacon to define the act of easy death. The idea, then as now, is to help a terminally ill patient die. In case of an incurable disease, a person can voluntarily ask a doctor for a lethal injection in order to die without pain and suffering. Since the twentieth century, euthanasia has gained particular popularity. But the criminal and distorted use of this practice by the Nazis completely discredited the idea itself.

Content:

• Story
• Modern Application
• Types of euthanasia
• Euthanasia procedure
• How does a person feel
• Legislative regulation in countries around the world
• Suicide tourism
• Pros and cons
• Statistics
• Is there an alternative

At the dawn of the last century, eugenics, the science of selection of the human species, was gaining momentum in Europe. In Germany in the 20s of the last century, people who promoted the idea of ​​​​the purity of the Aryan race were obsessed with it. The idea took root in society that the nation needed to be cleansed of “defects.” This category included patients with mental disorders, hereditary diseases, and congenital pathologies. Over time, the list of undesirables expanded, and it began to include everyone who was unable to work or was simply not liked by the authorities. Books and scientific works were published on the topic of sterilization and disposal of patients.

In 1923, the work “Permission to destroy life unworthy of life” fell into the hands of Adolf Hitler. The work belonged to two professors - psychiatrist Alfred Goha and lawyer Karl Binding. It was about the legality of the physical destruction of the mentally retarded, criminals and seriously ill people. These ideas will form the basis of future “death camps.” The unofficial mass use of forced euthanasia in Germany began in 1939, before which it was considered murder. The Knauer family turned to the Fuhrer for permission to euthanize their son, since he was severely crippled. The boy was euthanized in a Leipzig clinic, and in the same year an office was organized to handle such cases.

All children under 3 years of age were required to undergo a “peer assessment,” during which they were determined to be terminally ill. Those who could not become full-time workers in the future were euthanized. Adults with severe pathologies and mental disorders were sterilized. By 1940, the term “children” in documents began to apply to persons under 17 years of age, and a little later “child euthanasia” began to be applied to all age groups. There were discussions about the method of killing in the circles of responsible persons; injections were considered an economically unprofitable method. Criminologist Albert Widman proposed a quick and affordable option - carbon monoxide.

The following people ended up in the “gas chambers”:

• people with mental disorders;
• epileptics;
• disabled people;
• Gypsies, Jews and Poles;
• patients who have been treated for more than 5 years.

Such killings were called euthanasia only because of the sonority of the term; in documents they were sometimes called “disinfection” and codenamed “T-4.” By 1941, the mass disappearances had caused outrage among the clergy, aristocracy and some politicians. By the end of that year, Hitler issued an official decree to stop “disinfection,” but the program was unofficially stopped only after World War II. During the hostilities, soldiers with injuries, children and adults, and captives of the non-Aryan race were also subjected to “euthanasia.”

The trials of the perpetrators and those responsible for “T-4” began only in 1950. Only a few received punishment in the trials. Most of the psychiatrists who advocated killing continued their medical practice, and their trials never took place. Falkenhauser, the head physician of one of the mental hospitals who practiced starvation as “euthanasia,” was sentenced to 3 years in prison for hundreds of starvation deaths. Only in 2001 did the German Society of Psychiatry admit its guilt and ask for forgiveness from the relatives of the victims.

On the last journey - while still alive

One of the most controversial types of medical tourism is suicide or euthanasia tourism. Citizens of countries where euthanasia is prohibited resort to suicide tourism, and there is an absolute majority of such people in the world. Terminally ill patients, for whom the disease begins to bring unbearable suffering, seek help from clinics in the country where euthanasia of foreigners is legally permitted, with a request to end their suffering along with their lives. What kind of tradition is this, and where do voluntary suicide bombers go? In fact, there are very few places in our world where a person can be helped to die. And this is connected with the history of euthanasia.

The term “euthanasia” is formed by combining two Greek words: ev - good, noble and thanatos - death. This term is many centuries old - it was introduced into scientific circulation back in the 16th century by the English philosopher Francis Bacon. But euthanasia was first legalized only in the 20th century.

In 1920, the book “Permission to Take Life” by A. Hoch and K. Binding was published, which seriously influenced the medical minds of the European continent, but euthanasia was still banned. The Netherlands became the pioneers in the legalization of voluntary death. In 1984, the Supreme Court of this country declared euthanasia acceptable, and in 2001, the Netherlands legalized euthanasia and introduced it into the healthcare sector first not only in Europe, but also in the world.

Modern Application

Today, the practice that the Reich used under the name “euthanasia” is recognized as a crime. Because of this, the perception of easy death in society has been greatly distorted; most states consider it murder. However, in 2001 the Netherlands legalized this procedure. Since then, a fierce debate has begun about the legality of euthanasia for humanitarian reasons. In countries where it is permitted, the “good death” is applied to terminally ill people for whom medicine cannot help. Also, in countries where it is legal, euthanasia can be performed on newborns with brain atrophy. Children and adults who live only with the help of life-supporting equipment are helped to die with the consent of their relatives.

To perform euthanasia, doctors must be completely sure that the patient cannot be saved. For these purposes, the patient undergoes a comprehensive examination, including by a psychiatrist. Even after a personal request to “die with dignity,” the patient needs to make two statements, with long breaks between them. Switzerland has allowed euthanasia for mentally ill people if their illness cannot be cured. The Swiss Federal Tribunal argued its decision by arguing that mental disorders in some cases cause as much suffering as physical ones.

Cost of voluntary death

When discussing the issue of a “good death”, you need to know how much euthanasia costs and where it is allowed to be organized: in a hospital or perhaps it can be carried out at home. Thus, the approximate cost of assisted death in Switzerland is 4,000 euros. There are several organizations there that accompany the patient from his very arrival in the country, providing all the necessary assistance: both legal and medical. In Belgium, for example, the cost of the procedure itself is already included in the citizen’s insurance package; all that remains is to buy a kit costing about €60 (approximate price $70).

Types of euthanasia

Depending on whether the doctor is directly involved in the process, two forms of the “act of easy death” are distinguished: active and passive. Also, on the part of the patient, the process can be voluntary or involuntary (from an aesthetic point of view, it is not called “forced”).

Passive

This type of life termination is also called the “delayed syringe method.” They speak of a passive form when the patient is not helped by treatment. In this case, medical care aimed at prolonging life is stopped. The patient receives only symptomatic therapy, for example, pain relief. This type of procedure allows a person to pass away naturally and without suffering. Some of the supporters of this idea doubt that such a process can even be called “euthanasia.”

Active

The active form of the process causes more controversy and doubt. It implies the direct participation of a health care worker in the death of a person. It is used only in precedent cases. In Switzerland, anyone can request it, including healthy relatives or spouses of a deceased person. To carry out the act, the doctor must introduce or give the patient a substance that will gently stop the body’s functioning. Typically, this is a large dose of painkillers that lead to death in your sleep.

The controversy surrounding this form of euthanasia is caused by the fact that not every health worker is ready to take on such responsibility. Even in countries where the service is legalized, only certain specialists are ready to carry out the procedure.

Voluntary

Proponents of euthanasia call voluntary death the exercise of the right to die. Everyone has the right to manage their own life, and decent care is part of this right. A voluntary procedure occurs when the patient himself asks the doctor to end his life. Realization of the idea requires a long period and testing of all possible treatment methods. The patient also works with a psychiatrist. For people with mental disorders, confirming a desire to die is quite difficult. Therefore, such an opportunity is currently only available in Switzerland.

Involuntary

Involuntary euthanasia is a very controversial issue for doctors and relatives of the patient. It occurs when the patient cannot independently express the desire to leave. At the same time, it must be precisely proven that there is no chance of returning him to a full life. An additional factor in the decision is the pain the person may be experiencing. Without the consent of the patient himself, euthanasia can be used only in countries where it is permitted and after a unanimous decision of a council of doctors and relatives.

Euthanasia procedure

Each state that has legalized euthanasia has its own regulations for its implementation. The legislation clearly controls the criminal legal side of the issue. Medicine is responsible for the accuracy of arguments about human incurability.

General factors for the procedure:

1. The patient must be terminally ill, feel a desire to die and declare this at least 2 times.
2. If the patient is conscious, he must sign the application for the procedure himself.
3. To euthanize an unconscious person, a statement from relatives is required.
4. The process is possible only if the patient’s quality of life is too reduced and there is no chance of recovery.
5. The application is reviewed by a council of doctors and legal authorities.

If the decision is made to carry out an active “act of dying with dignity”, the process takes place in two stages. First, the patient is injected intravenously with painkillers, and within half an hour the person is immersed in anesthesia. After this, barbiturate-based substances are introduced, which stop the respiratory function. A doctor monitors the procedure to make sure that the person actually leaves without suffering.

The passive form may take an indefinite period of time. A person receives all the medications so that his condition does not bring agony. However, the patient, without receiving drugs to prolong life, dies from the very cause of his condition. Euthanasia is also carried out at the request of relatives if a person has been on life support for a long time and there is no chance of recovery. In such cases, the authorities must ensure that relatives do not benefit financially from the death of the patient.

How does a person feel

The question of how the patient feels during the process is very theoretical. Doctors also argue about it, some of whom support the idea, while others do not. It has been suggested that the patient may feel as if he is suffocating. The author of this theory remains unknown, but he has a lot of followers. This is argued by the fact that barbiturates slowly depress the central nervous system, stopping breathing. The “opposition” of this assumption believes that this is unfounded, since the person at this moment is in a state of deep anesthesia. It is just as impossible to answer the question of what a person feels during euthanasia as it is to answer the question: what happens after death.

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.

Legislative regulation in countries around the world

Such a controversial procedure requires a solid legislative basis. In countries where it is legalized, doctors act within the law. In some countries, only the passive form is allowed. However, even where it is considered murder, passive euthanasia is still used, although it is not brought up for general discussion.

Legalization

Only a small part of states abroad are ready to give a person the right to make an independent decision about death. “Easy death” is fully legalized in:

• Canada;
• the Netherlands;
• Switzerland;
• Belgium;
• Luxembourg.

In the US, this service is legal only in California, Oregon, Montana, Vermont. In Washington, euthanasia was legalized, but banned in 2012. In some European countries the passive form is allowed. There is no clear prohibition on “easy death” in:

• Israel;
• Germany;
• Albania;
• Spain;
• France.

On March 9, 2021, the Constitutional House of India legalized only passive euthanasia. In states where the procedure is permitted, it can be applied to citizens over 18 years of age. The main requirement for euthanasia of a child is his awareness of what is happening. In 2014, Belgium allowed a “good death” for young children if there are all legal and medical justifications for this. Also in Belgium, the attending doctor can prescribe a kit for the procedure if the patient requests it. The patient carries out forced suicide himself with the help of a set of drugs and instructions.

Prohibition on the procedure

Active euthanasia is equivalent to premeditated murder in those countries where it is not permitted by separate law. Behind the scenes, a passive form of the procedure is carried out in almost all states. The moment when a patient receives only symptomatic treatment without a prognosis for prolonging life is passive euthanasia. Active in most countries is considered as assistance in suicide or premeditated murder.

In Russia, the project “On the Protection of Citizens’ Health” prohibits doctors from “satisfying a patient’s request to hasten his death.” The doctor is criminally liable for any assistance in the intentional suicide of a patient. According to this law, active euthanasia remains prohibited. In cases where it is impossible to save the patient, the same passive form is used.

In the Australian state of Northern Territory, a bill has been in force since 1995 that allowed assisted death. But already in 1997 the law was repealed. In 2021, it became known that another Australian state, Victoria, would legalize the “right to an easy death” in 2020.

The most controversial attitude towards euthanasia can be found in Japanese laws. In 1995, a doctor from Yokohama was sentenced to 2 years in prison for killing his patient. The patient was suffering from the last stage of cancer and was expected to live a few more days. After the verdict was passed, the court listed the conditions for “assisted dying”:

1. The sufferer must have unbearable pain.
2. All methods of pain relief have already been tried and have not yielded results.
3. The patient himself expressed a desire to die.
4. The patient's imminent death is inevitable.

Despite this list of criteria, the Japanese Constitution prohibits any type of euthanasia and makes it a criminal offense. The controversy about its legalization in the “land of the rising sun” has been going on since 1962.

Medical assistance in death is prohibited in all post-Soviet countries. There is a clearly negative attitude towards such actions in all Islamic states. However, the Sunnah and the Koran, the main religious and legislative scriptures, allow refusal of treatment. Thus, in Islam, anyone can refuse treatment, thereby gaining the right to a passive form of the procedure.

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.

Suicide tourism

You can obtain the right to assisted death only in a few states. In this regard, a service such as medical or suicide tourism has appeared. Seriously ill people who cannot undergo euthanasia in their own country come specifically for this purpose to places where it is permitted. So far, only Sweden and Zurich (Switzerland) officially accept “tourists”. There are clinics in these countries that provide this service to both local residents and foreigners.

The scientific publication Journal of Medical Ethics claims that over the past 5 years the number of foreigners who came to Zurich for an “easy death” has doubled. In May 2011, a referendum was held in which Zurich residents had to vote for or against the abolition of suicide tourism. 84.5% of respondents voted for euthanasia to remain legal.

Pros and cons

Such a sensitive topic cannot go unnoticed by the public. Few people remain neutral on the question of whether euthanasia is permissible in principle and what its pros and cons may be. Supporters and opponents of this idea, as a rule, start from different dogmas and aspects. Some rely on religion, others on moral and ethical standards. Hence there are two fundamentally different opinions.

Religion

The main opponent of artificially stopping life is religion. Despite completely different dogmas, world faiths have almost identical attitudes towards euthanasia. In any religion, life is the highest gift and good, something absolutely sacred. Hence the strong resistance to euthanasia.

In Christianity, as in many other religions, only God has the right to give and take life. Therefore, suicide or murder is considered the highest sin, equated to a challenge to God. Only those suicides who were in a state of mental disorder at the time of their unauthorized death are not considered sinners. This position applies to all branches of Christianity: Protestantism, Orthodoxy, Catholicism.

Judaism regards shortening one's life by even a minute as a mortal sin. The main argument of the Jews is that the body does not belong to man. We use it temporarily as a vessel, but we cannot fully manage it ourselves. Even passive euthanasia, according to the rabbis, goes beyond Jewish religious principles.

Hinduism, including all its manifestations, is more ambiguous about this procedure. This extensive religion is based on the idea of ​​karma - the law of consequences from actions. If a person lived his life well and left it well, good things await him in rebirth. "Good" care occurs when a Hindu:

• located at home (or on the banks of the Ganges River);
• conscious and said goodbye to his family;
• There should be no bowel movements in the form of vomiting, urination, or bleeding.

Hence, artificially prolonging life in agony and unconsciousness is considered a bad end. Consciously and honorably leaving through voluntary euthanasia is permissible in Hinduism if a person does it on his own and does not regret his departure.

Buddhism actively supports end-of-life care, that is, palliative care. Active euthanasia is unacceptable in this teaching. Since Buddhism is not centralized, its interpretation varies greatly depending on the region. Thus, some Buddhists refuse treatment, including pain relief. This allows them to face death with dignity and a clear mind.

Islam is also categorically against artificially stopping life. No one can compare himself with Allah and decide who lives and who dies. However, patience and submission to the will of God are important qualities for Muslims, so arbitrary refusal of therapy is allowed. It is also permitted not to artificially prolong life if reason has faded. The moral and legal problem is to accurately establish where reason has faded and where it has not yet.

Bioethics

An integral participant in euthanasia is a doctor, even if we are talking about a passive and voluntary form. In this case, the medic needs to either stop saving the person or kill him. Both violate bioethical norms. Any negative action or inaction in saving a person contradicts the Hippocratic oath: “I will not give anyone the deadly means they ask from me and will not show the way for such a plan.”

There are not many doctors who wholeheartedly support this idea. To commit such an act, the doctor needs to violate both professional ethics and his own morality. The situation is even more complicated with seriously ill children or unconscious patients. Not many doctors agree to intentionally end someone's life. Some experts view euthanasia as selfishness: “I can’t kill myself, so do it for me.”

WHO, in a 1987 declaration, defines the act of interrupting the life of a patient, even at his request or the request of relatives, as unethical actions. Nevertheless, this practice has already been legalized in several countries, and other states are discussing the possibility of legalizing it. And where it is “in law”, someone will conduct it. This means that even among doctors there is a split in opinion. Some people view lethal injection as the only way to help a person avoid suffering.

In 1952, the UN received a petition from doctors, scientists and prominent cultural figures from Great Britain and the USA. The petition stated that the right of a terminally ill person to demand an easy death should be added to the Universal Declaration of Human Rights. The appeal collected 2,500 signatures, but was rejected by the UN as inhumane.

A 1994 survey of Russian doctors showed that half of respondents over the age of 41 “have never thought about whether euthanasia is acceptable.” Among doctors aged 21 to 30 years, 49% agree with the procedure. A survey of medical students in 2000 found that 78.4% were in favor of euthanasia.

Modern ethics

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The survey described above shows that the majority of young doctors have a positive attitude towards carrying out the “act of a good death”. In the modern world, ideas about the human right to choose and responsibility for one’s own life are increasingly developing. Euthanasia in the 21st century is far from new, but it still remains a revolutionary practice. The trend of gradual legalization suggests that over time humanity will either improve treatment methods or accept the fact of euthanasia.

Voluntary death and religion

The concept of euthanasia has existed for a long time, and opinions about it have varied. Representatives of the Abrahamic religions (Judaism, Christianity and Islam) believe that God gave life to man and only he has the right to take it away at the right time. Accordingly, a doctor who interrupts the life of a patient goes against God's providence and violates the commandment prohibiting killing.

A patient who asks for such a service, according to believers, does this under the influence of a mind clouded by torment, and, therefore, one cannot agree with his arguments. No one receives more suffering than he is entitled to atone for his sins. The cessation of artificial life support is not condemned.

The killing of a person is not approved by Buddhists, who consider it unacceptable in any form. In their opinion, if a person is seriously and incurably ill, then there is a good reason for this. Intervention in the course of someone else's life by a doctor tarnishes his karma, because death is a stage of rebirth, and if it is interrupted, it will be unfavorable. This is interpreted in a similar way in Hinduism.

Statistics

The UN and WHO do not provide global reports on the development of assisted death. However, statistics from individual countries show a sad demand for such a service. In the Netherlands and Belgium, the annual increase in euthanasia performed has been 5% since 2008. Statistics Switzerland published data for the period 1998 to 2009. In 1998, 43 deaths were registered, in 2009 there were already 300 deaths from euthanasia. In Zurich, 300 foreigners receive this kind of “charity service” every year, and this figure is growing.

Every year the number of people over the age of 80 who have resorted to an “easy death” is decreasing. The number of cancer patients under the age of 40 who have resorted to euthanasia is steadily growing. Such indicators are associated with an increase in cases of malignant tumors and the lack of a cure. According to data from Switzerland, 44% of cases of “legal suicide” are cancer patients, 25% are diseases of the cardiovascular system and central nervous system, and another 3% are depression.

Doctor Death

Jacob Kevorkian, known under the nickname Doctor Death, has become a prominent figure in world medical practice advocating euthanasia. His criminal case in the late 90s of the last century caused a real shock among the world community. A retired military doctor from Michigan was convinced of the human right to die and boldly proved this with his activities. In 1989, he developed and built a medical machine called “Mercitron” (from the English “mercy”), which consists of several bottles with toxic components, a simple apparatus for mixing them and a dropper that delivers a lethal dose of analgesics and toxic drugs into the patient’s blood. In this case, the patient himself had to press a special button so that no one could accuse Dr. Kevorkian of premeditated murder.

On June 4, 1990, Kevorkian's first patient, who suffered from Alzheimer's disease, committed suicide with the help of Mercitron. And then things quickly moved forward. The procedure usually took place in the backyard of Kevorkian's home or in his special minivan. For 8 years, from 1990 to 1998, more than 130 people used Mercitron.

Sometimes Doctor Death resorted to another method of euthanasia. He sent some of his clients to the next world by letting them breathe carbon monoxide through a special mask. He left the bodies of the dead in motel rooms, hospital waiting rooms and morgues.

At the same time, Kevorkian did not hide his active medical life position at all. He was not stopped by attempts by law enforcement agencies to stop his activities. He publicly burned court summonses, and if he appeared at meetings, he made bright and incendiary speeches, openly inviting the authorities to either legalize euthanasia or try to stop him, Jack Kevorkian.

He was tried four times but was acquitted due to insufficient evidence. In 1999, Doctor Death was eventually charged with murder after euthanizing one of his 52-year-old patients. As the main evidence, the prosecution provided a video recording of the act of euthanasia, which, by the will of Dr. Kevorkian himself, was in the public domain. By court decision, Jack Kevorkian was sentenced to imprisonment for a period of 10 to 25 years in the Michigan State Penitentiary. After 8 years of imprisonment, for good behavior, 79-year-old Jack Kevorkian was released two years early with a strict ban on carrying out the euthanasia procedure. In 2011, at the age of 83, this amazing man and doctor died of pneumonia.