Voluntary Active Euthanasia: The Debate

Voluntary active euthanasia refers to a clearly competent patient making a voluntary and persistent request for aid in dying (Brock 1999; Ogubanjo & Knapp van Bogaert 2008). In this case, the individual or a person acting on that individual’s behalf (physician or lay person, depending on the law of the country) takes active steps to hasten death (LaFollette, 1997). That active step can be either the provision of the means (i.e. a lethal drug) for selfadministration (orally or parenterally), or the administration by a tier. The provision of the means to die is called assisted suicide, assistance in dying, or physician assisted suicide. The patient acts last. With voluntary active euthanasia the assistant acts last. Doctor Jack Kevorkian’s (dubbed “doctor death”) “Mercitron” is an example of assisted suicide. The contraption is hooked to the candidate who initiates the delivery of the lethal drug. With voluntary active euthanasia the lethal drug needs to be administered by an assistant because the candidate is physically unable to proceed unaided. In both circumstances, the individual expresses a competent and voluntary wish to die, and the conditions that would make it right to allow or assist a suicide are satisfied. In both cases the aim is to spare that person pain, indignity, emotional and financial burdens. Yet, suicide is seen as morally reprehensible but is not prohibited by any law. Voluntary active euthanasia, on the other hand, is illegal in most countries and the object of conflicting and polarised moral debates. Physician assisted suicide involves an affirmative act, writing a prescription or providing the lethal drug. Voluntary active euthanasia requires the acts of providing and administering the lethal drug. In physician-assisted suicide, the individual who wishes to die poses the final act; in voluntary active euthanasia, because that individual is unable to pose the last act, a proxy acts on his or her behalf. The difference is about the person who acts last. The intention and motivation are the same. Therefore, one might wonder whether the distinction is not a kind of hypocritical hair splitting. It reminds us of the omission/commission debates and of the doctrine of double effect. The doctrine of double effect states that for an action with two consequences, one good and one bad, to be morally permissible the bad consequence may be foreseeable but not intended, and the bad cannot be used to achieve the good. The Dutch debate about indirect euthanasia is a case in point. “Terminal sedation” is legally permissible; it consists of administering large oral doses of barbiturates to induce coma followed by neuromuscular blocking agent to cause death on request of patients hoping their death to be hastened