Introduction and basic conceptual distinctions
Last update: October 2012
Contact: Lisa Tambornino
I. Introduction and basic conceptual distinctions
On the one hand, the term Euthanasia (see module Euthanasia) may denote "assistance throughout the dying process", that is, support and accompaniment during the time leading up to death. In this sense, euthanasia entails the support of the dying person by giving care, pain-relieving treatment and personal comfort. As such, its urgent necessity in the dying process is undisputed. Yet on the other hand "euthanasia" can also denote "assistance in achieving death", then entailing the killing or "letting die" of a dying, seriously ill or suffering person in accordance with their own express or assumed wishes or interests.
The issue of "assistance in achieving death" is discussed in the context of varying situations.
The debate frequently distinguishes four types of euthanasia in the sense of "assistance in achieving death":
- "Letting die"/"Passive euthanasia": renunciation of life-prolonging measures (while continuing to give "basic care" and pain-relief treatment
- "Indirect euthanasia"/"Indirect active euthanasia": pain-relief treatment while tolerating a (non-intended) risk of shortening the patient's life span
- "Assisted suicide"/"Support for voluntary death" / "physician-assisted": assisted suicide e.g. by procuring and supplying the lethal drug
- "Active euthanasia"/"Direct active euthanasia"/"Termination of life on request": Intentional and active acceleration or bringing about of death. Contrary to indirect euthanasia, death is not only tolerated but intended. Contrary to assisted suicide, the ultimate decisive impulse is not given by the patient but by a third party.
The range of meaning of the term euthanasia is a wide one. It includes dying persons, seriously or incurably (physically or mentally) ill persons who are suffering inbearably or who see no purpose in continuing to live and thus express an urgent desire to be "released" through euthanasia. It also includes patients who are in a long-term coma or whose consciousness is already impaired in the terminal phase of a disease who can lo longer personally express any opinion regarding the implementation or termination of medically and technically viable, but therapeutically doubtful life-prolonging measures. It ranges to seriously damaged newborn babies incapable of expression, whose life expectancy is very short or who are expected to suffer greatly in life.
However, not all forms of "letting die" are being summarized under the keywords "medically assisted suicide" or "euthanasia". Any therapeutic, palliative (meaning analgetic) or life-prolonging intervention requires the consent of the patient. If the patient refuses a certain measure and its omission leads to the patient's premature death, this situation is widely regarded as the manifestation of a patient's "right to a natural death".
From a medical-ethical perspective, there is a general responsibility of the physician to preserve life, but not under all circumstances. Furthermore, life-prolonging measures cannot be responsible if they are ineffective, if their efficiency is questionable or if they involve disproportionately large suffering for the patient. The differentiation between the usage of "ordinary" and "exceptional" treatment methods (see module Ordinary and extraordinary treatment) are being discussed here, both from the medical perspective as well as from the moral perspective.