1 This article does not seek to reopen a debate on the “good death.” Many discussions of euthanasia begin with such a warning, and understandably so given the sensitive and infinitely contested nature of the issue. For centuries, philosophers, religious figures, doctors, jurists, historians, and thinkers of all kinds and from all walks of life have considered whether we have the right to end a person’s life with and only with a view to doing him good, to improving his fate, and providing a solution to his desperation.
As we will soon discover, the vocabulary must be carefully chosen, precise, and definite, but as many have previously observed, the available terminology is in fact plentiful if not somewhat overabundant, varied, evolving, and not yet truly defined in both the medical and legal spheres. This is an important point to which we will shortly return, as it is words that explain, outline the motive, and ultimately enable us to decide whether we are indeed dealing with euthanasia, with all the moral and legal consequences that this has, not only for the perpetrator but also his friends and family and those of the victim.
This is reflected by the fact that when the Observatory National de la Fin DE Vie (the French National End of Life Observatory) decided to launch a wide-ranging debate on the subject of end of life care and thus euthanasia, it began by attempting to build a glossary, in order to enable the public to participate. Moreover, there are innumerable variations depending on geography, i.e. the country in question, its public morality, and its legal, or sometimes more importantly religious, ethics.
2 But the greatest distinction in terms of vocabulary consists of the opposition, once again modern in nature, between euthanasia and suicide. Many of his fellow rulers were not so fortunate, and there is a long list of emperors who ended their days with an awful or difficult death.
This final sense comes closest to the meaning that we give the word today, but the connotations of pain and the unbearable nature of a life of unspeakable suffering did not necessarily figure in the desire for death. There must have been instances in which the pain produced by various diseases, which could not be treated or healed, resulted in the desire for death, but this is not the essence of the meaning handed down to us by classical authors.
This is why Titus Flavius Josephus (37-100 AD) stands out as one of the few writers to record a case of euthanasia in the sick: four lepers who chose to be massacred by the enemy rather than suffer the long decline of leprosy. 6 The “Thou shalt not kill” of the Old Testament has had so many weighty consequences that it is difficult to fully comprehend them today.
Any “unnatural” death, or one deemed suspicious, was considered to be homicide, murder, or assassination, and any harm to human life, by a third party or by oneself, was fated to result in punishment, which was carried out on corpses as well as the living. Aristocrats practiced another form of suicide, however: euthanasia by duels and combats in which they could throw themselves into the melee without fearing condemnation and even transforming it into an act of heroism, a true feat.
It was even believed that individuals must endure long-suffering, like Christ on the cross, to redeem their sins, as reflected in the prayer “From sudden and unexpected death; Good Lord, deliver us.” No-one thought to prevent this redemptive pain, and doctors were in any case entirely incapable of doing so. Euthanasia must have been carried out, and perhaps more widely than ever, but this had to be in absolute secrecy on pain of the wrath of both royal and ecclesiastical justice.
Most significantly, the period saw a rediscovery of ancient writers, including the Epicureans with their gentle death that spared the body, mind, and soul of suffering. Suicide remained taboo, but it became possible to consider relieving the suffering of the sick and dying, or even give them the choice between life and death.
In Hamlet, first performed in 1600, Shakespeare asks “To be or not to be,” and in Utopia Thomas More (1478-1535) dares speak of “voluntary death” in cases where “incurable disorders” are accompanied by “torturing, lingering pain, without hope of recovery or ease.” It was not until the eighteenth century that Scottish philosopher David Hume (1711-76) developed the first theories that removed the guilt from suicide in the face of the divine and social order. But as is well-known, it was Francis Bacon (1561-1626) who, in his work The Advancement of Learning (1605 and 1623) provided the first true modern description of euthanasia : “I esteem it the office of a physician not only to restore health, but to mitigate pain and colors; and not only when such mitigation may conduce to recovery, but when it may serve to make a fair and easy passage.
10 Yet the subject remained so unthinkable that the great French dictionaries of the seventeenth and eighteenth centuries (Richest, Further, Dictionary DE l’Academic Franchise, and so on) have no entry for euthanasia. Only one dictionary dared include it, and in doing so wrote its name into the history of euthanasia : the Dictionary universal Francois ET Latin, a work led by the Jesuits and published from 1704 onward, originally in Trevor.
The final edition of 1771 is the first dictionary in the French language to include an entry on the word euthanasia, defining it as a gentle and easy death, the exit um facile of Suetonius that Augustus was accorded. Subsequent nineteenth-century dictionaries (Little from 1863, and Larousse from 1864) all followed suit in defining it as a gentle, peaceful, painless death, but did not go as far as evoking the intervention of a third party: in a word, they still ignored assisted dying.
Attitudes had however begun to change, as demonstrated by the suppression of the prohibition on suicide and associated punishments by the French revolutionaries in 1790. It became increasingly common to die in hospital, and third parties therefore began to play a role in death through intervention from the new therapeutic possibilities that were being studied, discovered, and developed.
In Lyon, Jeanne Garnier and the Dames du Claire (1842) laid the foundations for the medicalization of death, and in Brittany in 1839 the Little Sisters of the Poor, an order founded by St. Jeanne Juan, formed the first modern institution officially dedicated to providing end of life care for the elderly poor and destitute. In Ireland, Mary Aiken head founded the order of the Religious Sisters of Charity in 1815, and opened the first in a long line of hospices in Dublin.
An important step was taken by doctor Nicely Saunders (1918-2005), who introduced the concept of “total pain.” But in parallel, voluntary euthanasia leagues began to develop in the Anglo-American world. Unfortunately this movement also opened the door to staggering aberrations, with the US first amendment allowing the creation in 1992 of The Church of Euthanasia.
Its slogans are explicit, and require no commentary: “Save the Planet, Kill Yourself!,” “Thou Shalt not Procreate,” and even “Leave Animals in Peace and Eat Humans.” It is hardly surprising that debates about euthanasia are impassioned, enduring, and intractable! 13 If we define palliative care as the medicalization of seriously ill patients in the terminal phase of disease, which seeks to allow them to end their lives in the best possible manner, by trying to relieve pain and emphasize their dignity, if not even a certain quality of life, it is possible to oppose euthanasia and palliative care, with the latter aiming to prevent the former.
Yet it can be argued that one does not preclude the other, and that the true result is further harm, weariness, drawn out final moments and, ultimately, more time and inefficiency. Physicians from the Erasmus hospital in Brussels responded, in 2012: “Furthermore, unlike what is happening in France, we do not oppose palliative care and euthanasia but support the idea of continuous care.” We are inclined to forget that palliative care represents immense progress that was desired by many patients for a very long time.
As we will see, in many countries around the world, it is one of the most accepted and utilized methods for practicing the only form of euthanasia permitted. 15 It cannot be denied that the medical establishment, already torn between the absolute respect for patient life and the obligation to relieve patient suffering invoked by the Hippocratic Oath has, through its admirable research and the incredible advances of medical science, created its very own rock and a hard place.
But again this is a simplistic view that considers neither compassion, nor the wishes of the individual concerned, nor the conscience of physicians, nor changing minds and societies. 16 From the end of the last century to the present day, countries have gradually been changing their laws and their attitudes to euthanasia, generally under pressure from public opinion following one or more particularly difficult, sensitive, or distressing cases.
17 The modern history of the decriminalization of euthanasia began in the United States, in Ohio, where in 1906 the General Assembly proposed a law designed to allow patients to ask for their lives to be ended following approval by a committee. In 1922 there was an attempt to decriminalize active euthanasia for the perpetrator, but like the Russian Criminal Code, it only lasted a few months.
In the meantime the world experienced the horrors of the Nazi regime and its “Indented” (which translates as “compassionate death,” a repulsive distortion of what it meant in practice). Quebec, in 2014, and the whole of Canada one year later, legalized medically assisted dying and voluntary euthanasia, despite a storm of opposition from religious quarters.
In Europe, Benelux demonstrated once again since its formation during the Second World War that the region forms a specific entity, with laws legalizing euthanasia being passed in the Netherlands in 2001, Belgium in 2002, and Luxembourg in 2008. Conditions do however apply: in essence, patients must provide informed consent, and their illness must be terminal and cause great suffering.
These countries privilege the free will of patients who, if they can no longer express their wishes, must have anticipated their decision in written form, without which active euthanasia is prohibited. Germany, Spain, Hungary, Slovenia, Norway, Sweden, and Denmark allow passive euthanasia, while Italy has begun to accept the withdrawal of care in cases that are agreed to be incurable.
In Asia, euthanasia is allowed in China in the hospital setting for terminally ill patients who have expressly requested it, but remains prohibited in Japan despite the country’s aging population. The Bennett law on the rights of patients and end of life care was adopted on April 22, 2005, and maintains the prohibition of active euthanasia.
But it prohibits futile medical care as “unreasonable obstinacy,” and some treatments may be withdrawn once they are no longer of use, as is the case with terminal sedation as of 2016. 1) states that “Every person has the right to a dignified end of life and to be accompanied by the best possible pain relief.
Health professionals are to implement available means for this right to be respected.” The patient’s wishes are notably incorporated by introducing the ability to draw up advance directives, and the legal text emphasizes that patient dignity should be preserved. This has resulted in a whole host of semantic convolutions and a huge number of circumstances outlining euthanasia that all try to frame the act without overstepping that sacrosanct line.
Among the conditions included, we note that the intervention of a third person is an essential component for characterizing euthanasia, in comparison to suicide. The key adjectives for describing euthanasia are clearly voluntary and involuntary, active and passive, direct or indirect; but for some, such qualifications are still insufficient.
Some authors believe this distinction to be redundant, but it speaks in fact to the value of the intention behind the life-threatening action, with members of the medical establishment admitting to using a combination of factors with a view to providing the gentlest, if not quickest, possible death. Between “do,” “do not do,” and “give,” the legal scholar cannot help himself from once again observing the quality of Roman law, which was already grouping all human actions into these three categories over two thousand years ago.
21 Although the majority of these imagined situations are very real, there is a certain aspect of wordplay here, and some authors even describe cases that are almost impossible in practice. 22 We therefore perceive the huge technical contradiction that euthanasia intrinsically opposes to its legalization; the law must be general and abstract, must apply to all, and must not enter into particular cases.
And how can the law attribute a quantitative value to human dignity, or compassion; how can it measure the unbearable nature of pain? 23 Making active euthanasia widely available would inevitably run the risk of truly unchecked abuses (in both senses of the word), but not legislating on euthanasia runs the other risk: a legal void, incrimination by default, denial of justice, and leaving thousands of sick and dying people with no solution to their suffering and their own end.
We can no longer allow suffering, nor can we continue to leave the door open to all acts, whether therapeutic or not, to be justified if they are described as euthanasia. 24 Amid the endless permutations we must also consider individual beliefs, in the name of the same freedom by which the right of terminally ill patients to choose their own death is justified.
27 Protestants oppose euthanasia, but in the latest text published by the French Protestant Federation and the National Council of French Evangelicals in 2014 they aligned themselves with the Bennett law and rejected all decriminalization of euthanasia, advocating deep sedation in extreme cases to allow patients to pass away without suffering, and arguing that in the countries where it had been trialed, permitting euthanasia or assisted suicide had opened the door to an inevitable and uncontrollable expansion of the practice. 29 Islam may appear a little more open on the subject, with some declaring support for passive euthanasia, primarily to prevent futile medical care and where there appear to be no further options, by virtue of surah VI, entitled “The Cattle,” which states that “But whoever is forced , neither desiring nor transgressing , then indeed your Lord is Forgiving and Merciful.” This has been used to support euthanasia in very rare cases such as in the presence of extreme suffering and absolute necessity, although, as its name indicates, the verse refers to dietary laws.
31 Other religions have never had insurmountable difficulties with euthanasia, although the majority of them consider human life to be sacred. Buddhism is therefore inclined to leave the choice up to individuals while considering euthanasia as an act of compassion toward the dying patient, since taking his life allows him to re-enter the cycle of reincarnation, to be liberated, and reach a higher plane of existence.
It should also be specified that, in the case of non-voluntary euthanasia, the consent of the sole friend or family member always presents great difficulties, for them and for the whole of society. 32 Hinduism presents a very particular case due to its deep-rooted respect for all life, and the influence of British colonial rule.
The episode is reported by Leon Duet in Souvenirs DES milieux litterers, polities, critiques ET medical DE 1915 (Paris: Novella Libraries National, 1915), in chapter II, entitled Levant la doubler. See Éric Fournier, Choir SA Mort: Les debate DE l’euthanasia (Paris: PUF, 2012), 39.
On this point, see Nicolas Almoner, Bernard Baggier, and Philippe Stellar, L’euthanasia (Paris: PUF, 2006), 39 to 41. Samlekhanâ is when an individual has reached the last stage of the purity of their life, i.e. spiritual peace, and commits suicide by way of starvation.
The Greeks had both an adverb, verb, and noun designating what they referred to as a gentle, beautiful death, but this did not have the restrictive meaning we commonly give it today as involving the intervention of a third party. The latter went on to become illegal and was condemned for many centuries, with Judaism, Christianity, and Islam all sharing the same absolute respect for human life as a gift from God.
Portent, l’Antiquity a Bain Conn LE suicide sous la formed’one euthanasia. Pews one tongue period interdict ET condemned sans appeal LE suicide come l’euthanasia ET LES religions juices, Cheyennes ET musulmanes part agent touts LE respect absolute DE la vie humane, Creek par Died.
“Le paper s’eleven contra ‘one cause compassion’ quit justified l’euthanasia.” Camille Chretien, June 9, 2016. “Euthanasia: Le ‘suicide assist’ preconize par la ‘Conference DES citizens.’” Alexei, December 16, 2013.