Euthanasia: Understanding the Qualifying Factors and Legality

Euthanasia refers to compassionately letting, promoting, or causing the death of a dying person. It is most often used for a person who has a life-ending illness and is in extreme pain. The word euthanasia has its roots in the words "eu" and "thanatos," meaning a "good death."

Though euthanasia is often used to reduce the pain of dying organisms, it presents complex issues when used in humans. Whether the practice is active versus passive and voluntary versus involuntary can further impact how it is viewed.

Euthanasia vs. Assisted Suicide

Many people refer to "euthanasia" and "assisted suicide" interchangeably, but there are key differences between the two.

Similarities

Here is how euthanasia and assisted suicide are similar:

• Both are considered types of assisted death.
• Both involve a subject who has decided to hasten an inevitable and imminent death and has requested help in doing so.
• Both involve a subject who understands that the assistance they request will cause death and shorten the pain of their final hours.
• In both practices, the person or medical professional helping the subject intentionally performs actions they know will cause death.

Differences

Though both practices involve the same outcome, here is how they differ:

• With euthanasia, a healthcare provider, friend, family member, caregiver, or any other person takes action to cause a person's death, usually in the form of a drug injection.
• With assisted suicide, a healthcare provider prescribes a lethal drug, but the subject who wants to die takes the medication themselves.
  

Classifications of Euthanasia

Active vs. Passive Euthanasia

Active euthanasia—sometimes called "aggressive" euthanasia— is when a medical professional or another person performs a deliberate act to cause a person to die, such as an injection of a lethal dose of a drug or an overdose of a drug.

Passive euthanasia is when an action is withheld or stopped to cause or hasten a person's death, such as the removal of a feeding tube or ventilator, refusal to perform a life-extending operation or provide life-extending drugs, or withholding of food, hydration (water), and oxygenation.

Voluntary vs. Involuntary Euthanasia

Voluntary euthanasia is committed by a medical professional or other person with the willing and knowledgeable consent of the subject, usually with the administration of lethal drugs.

Involuntary euthanasia is done when the person is unconscious or unable to give consent, usually when the person is permanently incapacitated. It can be performed based on permission from a court or family members and usually involves an act such as withdrawing life support from a person with no signs of brain activity

Qualifying for "Death With Dignity"

Euthanasia criteria and requirements for assisted suicide can differ by jurisdiction. To have the option to choose "death with dignity," you typically must be:

• An adult resident of a state or jurisdiction where the law allows euthanasia or assisted suicide
• Have the capacity to make and communicate your own healthcare decisions
• Diagnosed with a terminal illness likely to cause death within six months, as confirmed by a healthcare provider
• Capable of self-administering and ingesting prescribed lethal medications without assistance in jurisdictions where only assisted suicide is allowed
• Qualified to participate in euthanasia according to any additional qualifications determined by the jurisdiction

A primary attending physician assists you during the process and writes the lethal end-of-life prescription if you qualify. A second certifying physician must certify that you meet the legal requirements of your jurisdiction.

A variety of drugs are used to promote death. They include barbiturates, benzodiazepines, sedatives, and opioids. However, there is no consensus that a single drug or combination of drugs is most effective for ending a human life.

A retrospective study that examined the experiences of almost 3,557 Canadians who died with medical assistance reported that self-administered medical assistance in dying (MAiD) was rare compared to the use of clinician-assisted medical assistance in dying when both were available.

Researchers reported that the medications given for MAiD exhibited variability, but midazolam, lidocaine, propofol, and rocuronium were given far more often than any alternatives. With these regimens, most patients were immediately unconscious after the procedure started. In most cases, death occurred within three to 15 minutes of the injection.

Legality of Euthanasia

In the United States

In the United States, euthanasia is prohibited by the federal government and all 50 states based on general homicide laws. Some U.S. states allow assisted suicide, often referred to as "medical aid in dying." Laws regarding medical aid in dying exist in the following U.S. states and jurisdictions:

• California
• Colorado
• Hawaii
• Maine
• Montana
• New Mexico
• New Jersey
• Oregon.
• Vermont
• Washington
• Washington, D.C.

Elsewhere in the World

Euthanasia remains illegal in almost every country worldwide. However, this data is constantly evolving. Legislation changes continuously, criteria vary by jurisdiction, and terminology can cloud the definitions of euthanasia versus assisted suicide. In 2024, international human rights organizations indicated that the following countries allow euthanasia:

• Australia (only in Victoria and Western Australia)
• Belgium
• Canada
• Columbia
• Ecuador
• Luxembourg
• The Netherlands
• Spain
  
  

Many more countries allow some form of medical aid in dying or assisted suicide, though the circumstances and criteria can vary. These countries include:

• Austria
• Belgium
• Canada
• Finland
• Germany
• Italy
• Luxembourg
• The Netherlands
• New Zealand
• Spain
• Switzerland
  

Summary

Much of the debate about euthanasia is often muddled by the variety of practices involved. When terms such as assisted suicide and medical assistance in dying enter the debate, the options can be confusing.

Before the issue arises for yourself or a family member, learn about your options for dying with dignity in your state or jurisdiction. Knowing your rights and making your wishes known before the need arises can help you and your family be prepared if the worst occurs.