Euthanasia: A Confounding and Intricate Issue

Euthanasia is a term that often sparks heated debate, regardless of whether people are “for” or “against”. It is one of the most-debated ethical issues in recent decades as revealed by the considerable number of scientific publications, media coverage of specific cases, but also proposed bills in many countries. Despite it's popularity and the fact that public opinion polls indicate increasing support, euthanasia is still illegal in most countries. Nevertheless, one of the most significant challenge in order to have an informed debate on this issue is to determine what euthanasia essentially is. In popular discourse, for example, euthanasia is often associated with expressions such as “wanting to die with dignity”, “not wanting to be kept alive against one’s wishes”, “not wanting to suffer”, and “wanting to die rather than live in a certain condition”. But, logically, if in most countries euthanasia is illegal, does this mean that these wishes run counter to current practices, or even that dying with dignity be against the law? Of course not, but in the context of the debate on the legalisation of euthanasia, it is legitimate to wonder about the meaning of this loaded term. Among members of the public and even health care practitioners, the term euthanasia is apparently used to refer to situations ranging from the last injection allowing a person to pass from life to death in a context of incurable illness, through withholding treatment that would do more harm than good (futile treatment) and withdrawing life support that keeps the person alive (mechanical ventilation, feeding and hydration tubes), to relieving the pain and other symptoms of persons at the end of life whose next breath may well be their last. The use of adjectives “passive” and “active” with the term euthanasia, to describe legal and illegal practices, is undoubtedly associated with this common clustering of concepts. Given this situation, the objectives of this chapter are to delineate exactly what is meant by the term euthanasia, and to see how the variable interpretations of this term can lead to confusion and misunderstanding that often render debate pointless. Part 2 describes what euthanasia is now considered to consist in, and puts it in perspectives with other types of end-of-life decisions that characteristically arise in medical practice. Part 3 lists studies that have attempted to clarify people’s understandings of euthanasia and particularly in relation to other end-of-life practices. Part 4 discusses the interpersonal, societal and political issues raised by these varied understandings of euthanasia according to various groups.