Introduction
End of life issues concern the medical and ethical care of patients with advanced, incurable disease who are approaching death. Euthanasia, a deliberate act or omission intended to end a patient's life in order to relieve suffering, is the most contested part of this field. This note explains the key definitions, the distinctions that separate euthanasia from acceptable end of life care, the legal and ethical positions, and a practical approach for the physician.
Key definitions and classification
Euthanasia is the intentional killing of a person, by an act or by an omission, for the purpose of ending suffering that the person experiences as unbearable. The intention to cause death is essential. A death that is only a foreseen, unintended consequence of treatment given for another purpose is not euthanasia.
Active and passive measures
The traditional distinction is between active and passive measures. Its moral significance is debated, but it remains central in law and clinical practice:
- Active measures directly cause death, for example giving a lethal injection. These are euthanasia in the strict sense.
- Passive measures withhold or withdraw treatment, such as ventilation, dialysis, artificial nutrition or antibiotics, so that the underlying disease takes its course.
- Withdrawing a treatment that a competent patient refuses, or that is not in the patient's best interests, is lawful and ethically required in most systems. It is not euthanasia, even when death follows soon after.
- Giving analgesia, including opioids, for pain relief is acceptable even if it may shorten life, provided the intention is symptom control and the dose is proportionate to the symptom. This is the principle of double effect.