Good Death Within Its Historical Context and as a Contemporary Challenge: A Philosophical Clarification of the Concept of “Euthanasia”

The word euthanasia evokes emotions, regardless of the way it is used. When pronounced, instead of a rational discourse, separate camps of irreconcilable proponents and opponents are drawn up. Both fight for dignity, liberty, autonomy, rights and humaneness. Few debates in the area of health care result in such polarization of opinions as euthanasia. While for some people euthanasia is a manifestation of the individual’s autonomy equal with a responsible control of one’s destiny, a compassionate responsiveness to someone’s immense suffering or a clinical imperative to act in the patient’s best interest, for other people, euthanasia is tantamount to or merely a euphemism for killing, the violation of human life and an infringement of the human right to life, being contradictory to the sanctity of life doctrine and facilitating the abuse of vulnerable persons. The controversies surrounding the moral acceptability of euthanasia and its decriminalization are characteristic of the intellectual confrontations in medical ethics and in public debates during the last decades of the twentieth century and they remain a challenge for our ageing societies in the twenty first century. As Keown (2002, p. 9) points out, “given the absence of any universally agreed definition of ‘euthanasia’ it is vital to be clear about how the word is being used in any particular context. The cost of not doing so is confusion.“ This confusion is, among others, created by semantic substitutions in which euthanasia is not distinguished from “physician assisted dying”, from “assisted suicide” or from “physician assisted suicide” (Quill & Battin, 2004; Young, 2007), or being simply replaced by very general terms like “assisted death” (Lewis, 2007; Lewy, 2011), under which not only euthanasia but also assisted suicide is usually subsumed. The general public, especially in countries other than ones such as the Netherlands or Belgium, use general terms such as “assisted death” or “assisted dying” while generally not differentiating between euthanasia and assisted suicide, not understanding euthanasia in the sense used by legislation in countries where euthanasia has been legalized. This use of a broad notion of euthanasia results in various clinical situations being discussed under the scope of “euthanasia”. Once euthanasia is merged with “assisted death“, then under the term “euthanasia” similar but distinct clinical situations such as medical futility, life sustaining treatment,