Figuring Out Euthanasia: What Does It Really Mean?

Posted on July 9, 2015 By Rachel MacNair

By Rachel MacNair, Vice President of Consistent Life, and Director, Institute for Integrated Social Analysis

A lot of people when asked their position on “euthanasia” will assume you’re talking about animals being “put to sleep.” Proponents will call it “death with dignity.” The phrase “assisted suicide” is more common when it’s presented as a political issue, but that only covers one kind of euthanasia.

Source: The Child Who Never Grew (1950), Ch. 2

Picture credit: Wikimedia Commons; Quote from izquotes.com

So, for definitions:

Involuntary euthanasia means the targeted person doesn’t want to die but is being killed anyway; it only specifies that the motivation for the killing is beneficial (or at least it’s being presented as such).
Non-voluntary euthanasia means the targeted person isn’t in a position to say yes or no. That person is either not considered mentally competent or is unconscious in a long-term way. It’s presumed that being killed would be good for this person without needing to consult her or him.
Voluntary euthanasia is where a person (with safeguards, presumably unpressured) desires to be killed. This is where current debate mainly is, with some countries and U.S. states legalizing it.

Another classification that applies to all three types above is:

Active euthanasia means deliberately killing someone by means of an act – shooting, smothering, giving a lethal injection, etc.
Passive euthanasia means intentionally bringing about someone’s death by omitting something necessary to keep her alive.

Passive euthanasia is the trickiest, because it’s the most ambiguous. So here are some parameters:

If a person could survive just fine if, say, his or her diabetes or pneumonia were treated, but would die if it isn’t, and the reason for withholding treatment is the person has disabilities or for any other reason her or his death is desired, then that’s passive euthanasia. It’s killing, and pretense otherwise is playing with words.

But if a person is not treated due to medical neglect, with apathy about whether that person lives or dies, and the motivation is racism or misogyny or disdain for those with disabilities, or quite commonly that the person lives in poverty, then that’s an outrage, but it’s not passive euthanasia. Being callous about causing death is not the same as deliberately intending to cause death – though of course they’re connected.

If a conscious person who’s terminally ill is quite firm that she doesn’t wish to eat, in full knowledge this makes death inevitable, force-feeding is not required. People do have a right to turn down medical care or any other impositions on their bodies. If she’s refusing to eat because it makes her feel sick, or even simply because she’s not hungry, then this isn’t passive euthanasia. But if her refusal to eat is intended to bring about her own death, then she is committing suicide by passive euthanasia. But she still has a legal right not to eat, if she is competent.

A DNR Order – Do Not Resuscitate – can be a reasonable decision if a person makes it for herself and is days away from dying. It can become passive euthanasia if decided by other people for a person who could live several more years if resuscitated, and especially if that person didn’t want the DNR.

If a person decides that she’d rather have laughter therapy instead of the chemotherapy her doctor recommends, her doctor may take the attitude that this is suicidal. But it isn’t suicide by passive euthanasia if she has no intent to die. People have the right to select what treatment they will and won’t have, doctors’ opinions notwithstanding, and the best we can do is educate and do further research; in some cases, after all, the laughter therapy may actually work better.

If a person does something incredibly dangerous in order to help other people, as for instance happens all the time with firefighters, this is admirable and doesn’t constitute any form of euthanasia or actual suicide — as long as surviving the event is desired, even if it isn’t a likely outcome.

If a person jumps out of a high-rise window to escape a burning fire, that’s not suicide the way jumping out of a window normally would be. The purpose is to avoid death by fire. If some quirk were to occur and the person survived the fall, the response would be one of delight and good fortune, not disappointment at not having died.

And, finally, deciding that the medical care is not working and is more of a burden than a help, and therefore stopping it, is not necessarily passive euthanasia. It’s done in hospices all the time. People who decide to go home once the doctors say there’s nothing more the doctors can do because those people prefer to die at home rather than in a sterile hospital are making a reasonable choice. Death is not what they want; they are handling the inevitable.

This is what makes this issue more difficult than others – executions and abortions, after all, are much more clearly defined. Involuntary euthanasia is clearly wrong, non-voluntary is liable to be an exercise in bigotry, and “voluntary” can so often be pressured as to make its voluntariness questionable. But truly voluntary does mean the death isn’t inflicted by others, which is quite qualitatively different. Active euthanasia is, by definition, clearly killing, and so opposing it is clear cut. But whether “pulling the plug” in any given instance constitutes passive euthanasia or is instead a reasonable medical decision is much murkier and way more complicated. In this case, intent matters crucially.

Cartoon used with permission of Dave Lupton, aka Crippen

So here are the connections to the other issues:

The targets of any kind of euthanasia have been shown over and over again to be disproportionately ethnic minorities, women, the poor, and especially people with disabilities.
The reasoning of “choice” and “bodily autonomy” is so closely connected to the rhetoric on abortion that the connection comes up frequently among both proponents and opponents.
The death penalty can be understood as active euthanasia for the (presumably) guilty. There have indeed been convicts who request euthanasia in Europe as an alternative to spending life in jail, which would be a back-door way of re-introducing the death penalty there. In the USA, it is not uncommon for capital offenders to abandon further appeals and “volunteer” to be executed, in effect requesting active euthanasia rather than more life in prison.
The connection of euthanasia to the Nazis and World War II is so blatant as to help account for why people are nervous about legalizing it – and it’s crucial that we never forget. We must learn from experience.
Common dynamics for all socially-approved violence apply, especially euphemisms to cover the brutal reality, and the slippery slope whereby small beginnings lead to greater and greater violence until people have gotten acclimated and no longer regard as shocking what used to be seen as shocking at the beginning of the process. Once killing people for “good reasons” comes to be accepted, the boundaries of what constitute good reasons become debatable. CL urges that we not take that first step.

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For others of our blog posts on euthanasia, see:

How Euthanasia and Poverty Threaten the Disabled

What’s Cruel for the Incarcerated is Cruel for the Terminally Ill

Reflections on the Charlie Gard Case

Will for Life – Double Down

Historical Black Voices: Racism Kills

The Creativity of the Fore-closed Option