Defining the terms
Although euthanasia and assisted suicide share ethical similarities, they are distinct practices and require clear definitions.
Assisted suicide involves deliberately assisting another person by providing the environment or means for them to end their own life. The individual carries out the act, not a third party, and it requires a clear, voluntary request.
Voluntary euthanasia occurs when an individual has the mental and physical capacity to seek help to die and explicitly asks for it.
Nonvoluntary euthanasia occurs when the individual no longer has the capacity to request help and their wishes are unknown.
The terms active and passive euthanasia are widely used, although many authors consider them misleading. Active euthanasia involves deliberate steps to end a patient's life. Passive euthanasia involves withholding treatments necessary to sustain life.
Limitation of treatment (LOT) refers to withdrawing or not implementing life support or other interventions that, given a poor prognosis, are considered futile and merely prolong a clinical situation with no reasonable expectation of improvement.
New legislation in Austria
In December 2021, Austria approved legislation allowing assisted suicide following a constitutional court ruling. Adults who are terminally ill or have a permanent, debilitating condition may opt for an assisted death.
Two doctors must assess each case, one of whom must specialise in palliative medicine. After approval, patients must wait 12 weeks to reflect on their decision, or 2 weeks if terminally ill. If they proceed, they may obtain the required medication from a pharmacy after notifying a lawyer or notary.
Previously, assisting suicide carried a penalty of up to 5 years in prison. The federal court lifted the absolute ban in 2020, ruling that it violated the right to self-determination. The governing Austrian People's Party and Greens, along with the Social Democrats and Liberal Neos Party, supported the new law. The far-right Freedom Party opposed it.
Ethical debates
Morality and autonomy
Morality is often defined as performing acts believed to be right and beneficial rather than harmful. The libertarian argument centres on autonomy: respecting a person's autonomous decision to die is seen as morally necessary. Autonomy requires allowing individuals to act on their own desires.
However, this conflicts with medical ethics, particularly the principle of non-maleficence, often summarised as do no harm. The debate focuses on whether autonomy should outweigh beneficence and whether individuals should be protected from the consequences of their own choices.
Kantian perspectives
Kantian ethics emphasises life's inherent value as an end in itself. Life deserves respect regardless of condition. Human dignity is not based on productivity or contribution but on the intrinsic worth of human life.
Utilitarian claims
Utilitarian arguments focus on outcomes. Decisions should maximise overall utility. Given the significant financial costs of long-term medical treatment, a utilitarian may argue that allowing euthanasia could reduce societal burdens. This directly challenges Kantian claims about inherent value.
Medical implications
Critics fear that legalising euthanasia or assisted suicide may lead to reduced investment in healthcare or discourage doctors from promoting hope among seriously ill patients.
Philosopher Peter Singer counters this by noting that only around 3 per cent of deaths in the Netherlands involve euthanasia, suggesting medical progress is not impaired. Others argue that medical advancements have extended life far beyond natural limits, meaning euthanasia among elderly patients may not drastically shorten life.
Legal implications
Law aims to protect the innocent and vulnerable, and protection from killing is a cornerstone of legal systems. Euthanasia debates challenge this notion of protection.
Europe shows extreme variation in euthanasia laws. The Netherlands legalised euthanasia in 2001, followed by Belgium in 2002. Both euthanasia and assisted suicide remain illegal in the UK and France, where the practice is considered premeditated murder or poisoning. High-profile cases such as Rémy Salvat and Chantal Sébire reignited debate in France, but the law remains unchanged.
Concerns often centre on the slippery slope. Studies show that more than 400 people in the Netherlands have died through euthanasia without giving consent. Belgium extended euthanasia to children in 2012. Reported euthanasia deaths in the Netherlands rose from 1882 in 2002 to 6091 in 2016.
These trends raise concerns about bracket creep, where euthanasia becomes an easier, cheaper or faster solution. Critics argue that such extensions undermine trust in palliative care, which aims to provide hope and belonging for those facing illness.
At the European level, the European Court of Human Rights has been cautious. Article 2 of the European Convention on Human Rights protects the right to life, making legal recognition of a right to death difficult.
Despite ethical arguments supporting euthanasia and assisted suicide, the legal system's commitment to protecting life has created significant practical barriers to implementation.
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