Answer of 15 questions

1, Why are people for euthanasia?
 

Arguments based on rights

• People have an explicit right to die
• A separate right to die is not necessary, because our other human rights imply the right to die
• Death is a private matter and if there is no harm to others, the state and other people have no right to interfere (a libertarian argument)

Practical arguments

• It is possible to regulate euthanasia
• Death is a private matter and if there is no harm to others, the state and other people have no right to interfere (a libertarian argument)
• Allowing people to die may free up scarce health resources (this is a possible argument, but no authority has seriously proposed it)
• Euthanasia happens anyway (a utilitarian or consequentialist argument)

Philosophical arguments

• Euthanasia satisfies the criterion that moral rules must be universalisable
• Euthanasia happens anyway (a utilitarian or consequentialist argument)
• Is death a bad thing?

Arguments about death itself

• Is death a bad thing?

2, Why are people against euthanasia other than religious reasons?
 

Ethical arguments

• Euthanasia weakens society's respect for the sanctity of life
• Accepting euthanasia accepts that some lives (those of the disabled or sick) are worth less than others
• Voluntary euthanasia is the start of a slippery slope that leads to involuntary euthanasia and the killing of people who are thought undesirable
• Euthanasia might not be in a person's best interests
• Euthanasia affects other people's rights, not just those of the patient

Practical arguments

• Proper palliative care makes euthanasia unnecessary
• There's no way of properly regulating euthanasia
• Allowing euthanasia will lead to less good care for the terminally ill
  • Allowing euthanasia undermines the committment of doctors and nurses to saving lives
  • Euthanasia may become a cost-effective way to treat the terminally ill
  • Allowing euthanasia will discourage the search for new cures and treatments for the terminally ill
  • Euthanasia undermines the motivation to provide good care for the dying, and good pain relief
• Euthanasia gives too much power to doctors
• Euthanasia exposes vulnerable people to pressure to end their lives
  • Moral pressure on elderly relatives by selfish families
  • Moral pressure to free up medical resources
  • Patients who are abandoned by their families may feel euthanasia is the only solution

Historical arguments

• Voluntary euthanasia is the start of a slippery slope that leads to involuntary euthanasia and the killing of people who are thought undesirable

3. Can euthanasia affect society in a  economic way ? how?
    Jean Thorne, director of the Oregon Dept. of Human Services, called Schmidt's hospitalisation "a tragic circumstance", "but as we cut back the safety net, we're going to see similar cases... 8,500 people lost pharmaceutical coverage when the medically needy program was cut. But beyond that we have another 100,000 who are going to lose their coverage on July 1: that's the date the Oregon Health Plan eliminates coverage for the working poor. And there's close to 500,000 people in Oregon without any coverage at all." (Source: Doctors and Ethics Autumn 2003 newsletter) 

Compare the cost of thousands of dollars for treatment or a mere $35.00 for drugs in an assisted suicide in Oregan.

Due to the cost effective nature of euthanasia this will be the trend in the future, there will be more and more people who are led to believe this is the only viable option to their condition as any care or containment of their condition will not be covered. Compare the cost of thousands of dollars for treatment or a mere $35.00 for drugs in an assisted suicide. In Oregon, assisted suicide is referred to as "comfort-care."





4. Can one  who has a terminal ill be manipulated by people around to get euthanized?

Euthanasia and assisted suicide - EAS - doesn't just affect the individual. What hasn't been discussed very much, at least in the media, is the effect it can have on the family of the patient.

In the normal course of an illness, loved ones, friends and family are all going to be involved in the dying process.

Having to watch a loved one's symptoms get worse, sometimes over a long period of time, can be very harrowing.

In his book Death as a Salesman - What's Wrong with Assisted Suicide, anti-euthanasia activist Brian Johnston says:

"In addition to their own emotional needs, it is the family and friends, more than anyone else, who will influence the mood and mindset of the patient. They may, even unwittingly, reinforce negative thoughts and attitudes.

"...the gravely ill are emotionally vulnerable, and depressed family members may unconsciously reinforce, or even suggest 'suicidal' thoughts. 1 Sometimes it is the family members who are in even greater emotional need than the patient." 2

If assisted suicide and active voluntary euthanasia were legal and readily available, opponents are concerned that those who are chronically or terminally ill and the elderly, might feel obligated to opt for death, so as not to be a burden on relatives or other caregivers.

Unbearable suffering 
Unbearable suffering is one of the most frequent reasons used by EAS advocates to justify legalisation. On the subject of pain medication given to terminally ill patients, a study in the Journal of the American Medical Association said:

"Surprisingly the drugs were given nearly as often "for the comfort" of the patient's family as they were give to reduce the suffering of the patient themselves... [Additionally] in four out of every five cases, nurses who had discretion in administering drugs said that they were treating the patients for the comfort of their loved ones." 3

Family conflictConflict often arises due to differing opinions and beliefs of various family members. A family member or friend with an Enduring Power of Attorney, or who has been appointed Guardian, may face battles about continuing, withholding or withdrawing medical treatment.

When decisions are made and carried out without family consultation and/or agreement, the resulting bitterness may split a family apart, sometimes forever. 

Financial pressures
The ageing of the New Zealand population means that the number of older people needing treatment and support will continue to increase unless older people are healthier in the future. The proportion of people over 65 in the population will double in the next 40 years.

Families, it is feared, may pressure patients to choose assisted suicide to avoid spending money that the patient otherwise could leave to the family. Or, family members may exert pressure because they are spending too much of their own money. Patients themselves may opt for assisted suicide to save money as a duty to their loved-ones. 

Later regrets 
While many family members who have had a loved one die by euthanasia or assisted suicide have said how they feel at peace with the decision, there are some who find it hard to live with it.

After Rebecca Badger, one of Dr Jack Kevorkian's 'clients', killed herself her daughter Christy discovered the diagnosis of Multiple Sclerosis was wrong. The autopsy showed that her mother did not have MS and, if she had sought a second opinion instead of assisted suicide, might still be alive today. Christy describes the Kevorkian-suicide experience and what has followed in one word: "Overwhelming." 4

Family members of assisted suicide patients have found that neighbors and coworkers sometimes react callously to this controversial kind of death.

Another of Kevorkian's clients, Linda Henslee arrived in Michigan a few days early to spend more time with her daughters. Encamped in a motel room, the women made videotapes, sorted old photographs, organized a family scrapbook -- and enjoyed their favorite foods: champagne, strawberries, shrimp and chocolate eclairs.

In spite of it all, Dawn Henslee said, the aftermath has been "the most horrifying experience that I've ever been through."

While Henslee found the invasion of reporters disturbing - she found the callous responses of other people just as troubling.

"For months, we didn't have time to grieve properly -- and people didn't treat us like we were grieving, either," Henslee said. "The guy who came to pick up the hospital bed that mother had used, told us: 'Normally, I would say I'm sorry, but I guess this is what she wanted.' He didn't think this was a loss for us." 

Sending a negative message
Many EAS opponents believe that establishing an option of assisted suicide or euthanasia would have negative consequences not only for patients who receive assisted dying, but for many others.

Some fear a general reduction of respect for human life if official barriers to killing are removed, citing high youth suicide figures. They believe that grieving and/or depressed family members may kill themselves at a later date. 

A report published by the UK Voluntary Euthanasia Society (VES) on 9th September 2003 , stated “30% of suspects in reported mercy killing cases end up committing suicide.” The chief executive of VES, Deborah Annetts is quoted as saying, “Behind the statistic of 30% of mercy killers going on to commit suicide, there lies a huge amount of suffering.” 5

Ms Annetts' interpretation of the statistic is that 'mercy killers' commit suicide because they are fearful of prosecution. 

The fear of prosecution is unlikely to be uppermost in their minds, because it is a known fact that the Courts more often than not tend toward leniency in ‘mercy killing' cases. It seems just as likely that the person who has assisted a loved one to die may have begun to suffer guilt, remorse and despair.

5. What country practices euthanasia the most? Why?

Country	Is euthanasia allowed?	Is Assisted Suicide (AS) allowed?
Australia	•> Euthanasia is now illegal in Australia. •> It was once legal in the Northern Territory, by the Rights of the Terminally Ill Act 1995. In 1997, the Australian Federal House of Representatives passed an anti-euthanasia bill which overturned the 1995 Act.	> AS is illegal in Australia.
Belgium	2002: •> Belgium legalised euthanasia in 2002, the second EU country to do so after the Netherlands [1]. •> The Belgian Act on Euthanasia allows adults who are in a "futile medical condition of constant and unbearable physical or mental suffering that cannot be alleviated" to request voluntary euthanasia. 2012: •> Belgium is considering a significant change to its decade-old euthanasia law that would allow minors and Alzheimer's sufferers to seek permission to die [2].	•> The law does not refer to assisted suicide. •> Doctors who practise euthanasia commit no offence if they respect the prescribed conditions and procedures, and have verified that: a. the patient is an adult or a mature minor who must be a least 15 years old person possessing legal capacity and aware of what he or she is doing when he or she formulates the request (which must be made in writing); b. the request is made voluntarily, carefully and repeatedly, and is not the result of outside pressure; c. the patient’s medical state is hopeless, and he or she is experiencing constant, unbearable physical or mental suffering, which cannot be relieved and is caused by a serious and incurable injury or pathological condition [3]. •> Advance directives: In a similar approach to the Netherlands, Belgium recognises the validity of advanced directives for euthanasia. This enables physicians to practice euthanasia on persons who are no longer capable of expressing their wishes, but who have done so in writing when they still had capacity.
Canada	•> Euthanasia and assisted suicide are illegal in Canada under the Criminal Code. 2013: •> A draft euthanasia bill is due to be proposed in the Quebec parliament later this year, following the publication of the Menard report in January. It recommended specific amendments to Quebec's laws to make euthanasia legal and safe [4].	•> Euthanasia and assisted suicide are illegal in Canada under the Criminal Code. •> A survey of Canadian Medical Association (CMA) members' views on major end-of-life issues has found that only 20% of respondents would be willing to participate if euthanasia is legalized in Canada, while twice as many (42%) would refuse to do so. Almost a quarter of respondents (23%) are not sure how they would respond, while 15% did not answer [5].
France	2012: > In December the French government has announced that it will introduce legislation allowing assisted suicide and some forms of euthanasia. •> A government-commissioned report has recommended that France allow doctors to “accelerate death” for terminally-ill patients who want to end their lives [6]. •> It is anticipated that legislation could be presented to the National Assembly as early as June 2013. •> A poll conducted in late 2012 found that French people overwhelmingly support medically-assisted suicide [7]. 2005: •> The French senate approved a law granting terminally ill patients the right to end their life. This allows for doctors to stop giving medical assistance when it "has no effect other than maintaining life artificially” [8].	2012: •> The French government has announced that it will introduce legislation allowing assisted suicide and some forms of euthanasia. •> The report recommends that doctors should be given the authority to green-light an “acceleration of death” under three circumstances: a. When the patients concerned are able to make a request explicitly, or that instructions had been given in advance before their situation had deteriorated leaving them unable to give instructions. b. Doctors could withdraw life-supporting treatment or nourishment when requested by the patient’s family and when the patient is considered unconscious. c. Doctors would be able to withdraw treatment when it is merely keeping a body alive in a vegetative state [9].
Germany	••> Active euthanasia is illegal. Such an act is punishable by up to five years in prison in Germany.	•> Assisted suicide is legal in Germany. 2010: •> A ruling by Germany's Federal Court of Justice stated that it is not a criminal offence to cut off the life support of a dying person if that person has given consent. •> This does not legalise active assisted suicide. •> The German Medical Association has issued new guidelines for assisted suicide which allow doctors to make conscientious decisions about whether to assist ill patients in dying. The new text states: “The doctor's assistance with suicide is not a medical duty.”[10] •> Many of the clients who travel to Switzerland to seek help in suicide are Germans and, at one point, Dignitas suggested it might set up a German office in Hanover.
Italy	•> Euthanasia is illegal. •> Italian law does uphold the patient's right to refuse care. This potential contradiction has resulted in several cases which have divided Italians. •> In a country where the influence of the Roman Catholic Church remains strong, the debate is especially passionate and opposition to euthanasia remains strong.	•> Assisted suicide is illegal.
Luxembourg	2009: •> Luxembourg became the third European country to legalise euthanasia, after the Netherlands and Belgium. •> Following a vigorous public debate, Luxembourg's parliament has voted to legalise euthanasia. A predominantly Catholic country, the medical profession was broadly against the legislation. •> Head of state, Grand Duke Henri, refused to sign off on the bill, triggering a constitutional crisis. As a result, Luxembourg’s parliament voted for legislation to give the monarch a purely ceremonial role [11]. •> Euthanasia and assisted suicide is permitted for those with incurable conditions to die if they asked repeatedly to do so and had the consent of two doctors and a panel of experts.	2009: •> Euthanasia and assisted suicide were legalized in the country in April. •> Doctors who carry out euthanasia and assisted suicides would not face "penal sanctions" or civil suits for damages and interest [12].
The Netherlands	2002: > The Netherlands was the first country in the world to legalise euthanasia in 2002. Since the early 1970s it had been widely tolerated. •> The rules are strict and cover only patients with an incurable condition who face unbearable suffering. Key criteria included: a. The patient has to be in full possession of mental faculties. b. Each case has to have a second medical opinion before euthanasia is carried out in a medically appropriate way. c. After the event, it is referred to a regional review committee including a doctor, a legal expert and a medical ethicist.	2002: •> Assisted suicide has been lawful since April.
Switzerland	•> All forms of active euthanasia like administering lethal injection remain prohibited in Switzerland. •> According to Swiss law, a person can be prosecuted only if helping someone commit suicide out of self-interested motivation.	1930s •> Since the 1930s assisted suicide has been legal in Switzerland, where the activities of the Dignitas clinic have made international news. Non-physicians can be involved.
USA	> Active euthanasia remains illegal in most of the United States. •> There have been several attempts in the last 20 years to legalise euthanasia and assisted suicide.	1997: •> State of Oregon: Since 1997, the Oregon Death with Dignity Act has been in place for 10 years. It gives terminally ill, mentally competent people the option of an assisted death. 2008: •> Assisted suicide in the state of Washington was made legal based on a similar legal model as legislation in the state of Oregon legislation (the vote took place alongside the presidential election November 2008). •> 58% of Washingtonians voted in favour of a change in the law in a voter initiative - the law will not come into effect instantaneously, and may face challenges (as the Oregon law did when it was endorsed in a similar voter initiative). •> On December 5, state of Montana - state District Court judge Dorothy McCarter ruled competent, terminally ill patients have the right to self-administer lethal doses of medication as prescribed by a physician. Physicians who prescribe such medications will not face legal punishment [13].

6. Are doctors who practice euthanasia considered murderer?
   Conflicts are ubiquitous in medicine, but it is difficult to imagine a physician facing a more calamitous accusation than that of murder or euthanasia.1 In 2005, my colleagues and I published an article describing such accusations following the care of dying patients.2 While it is important for law enforcement to identify and prosecute the rare medical personnel who are bona fide criminals, we were more interested in learning about unjustly charged practitioners. Our review found that doctors from any specialty providing terminal care could become the object of allegations, although many of these physicians worked under the rubric of palliative care. As a result, we subsequently developed an online research survey to be administered to members of a national palliative medicine professional society because these practitioners are most likely to be involved in the management of end-of-life cases. The overall survey findings have just been published,3 and 25 of 633 respondents (4%) reported having been formally investigated for hastening a patient's death when that was not their intention—13 while using opiates for symptom relief and 6 for using various medications while discontinuing mechanical ventilation. In one-third of these cases, a fellow member of the health care team initiated the charges against the physician. In this commentary, I intend to explore the implications of another question from the survey—one about humor and its double-edged qualities in the end-of-life setting. I will then speculate as to why accusations of hastening death are occurring and specifically why medical colleagues are charging physicians on their team with engaging in this practice.

We asked all 633 respondents, “In the last year, how often have any of the following people ‘humorously’ referred to you as promoting death, for example by calling you ‘Dr Death’?” The survey's completion rate was 53%, the median age of the respondents was 50 years, and most (78%) were attending physicians. Nearly three-quarters of the sample (72%) reported having been the object of humorous comments at least once during the prior year. As illustrated in the Figure, most of the respondents reported that these remarks came from fellow physicians (59%), although comments also came from other health care professionals (49%), the participants' own friends or family members (47%), patients' family or friends (31%), and patients (21%).

FIGURE

Data about humorous accusations from a survey of 633 palliative care specialists regarding accusations of hastening a patient’s death.

Such jibes are not usually meant to be offensive, and each specialty in medicine is the target of some form of gallows humor. Like swearing, humor during private discourse can signal confederacy, intimacy, or understanding, while simultaneously purging negative emotions. Freud wrote extensively about jokes, maintaining that they are a means by which forbidden thoughts and feelings that society suppresses are introduced into the conscious mind.4 He proposed a number of interpretations to understand humor, including that wit contains and denatures a tremendous amount of hostility, laughter provides emotional catharsis, and jokes reveal more about societal attitudes at a particular time than about the particular individuals at which they are directed. Like the survey results, what jokes illustrate about medical society is that doctors and nurses are members of a pluralistic culture that clearly contains within it conflicting beliefs about end-of-life care, specifically hastening death.

When it comes to end-of-life care, I find an important insight contained in Woody Allen's quip, “I don't want to achieve immortality through my work. I want to achieve it through not dying.” Fear of death is basic to the human condition, and this same anxiety no doubt underlies many of our colleagues' comments. However, Burt5 has suggested a more dire explanation. He hypothesizes that in Western cultural tradition, including medicine, death is not merely a fearful event but one that invariably carries with it an aura of wrongfulness and intrinsic immorality. Burt explains that choosing death through physician-patient decisions to discontinue or withhold life-prolonging treatments is “emotionally” experienced as a “murderous” hastening of death. He believes that it is virtually impossible to disentangle beneficent and aggressive motives in any individual case and that an intrinsic tension or ambivalence always accompanies such practices.

Most clinicians who care for dying patients would take umbrage at the suggestion that they actually kill patients. Palliative medicine philosophically relies on Thomas Aquinas' principle of double effect (it may be permissible to bring about as a foreseeable side effect a harmful event that would be impermissible to cause intentionally, particularly when the potential benefit outweighs the side effect's harm).5 It takes the position that shortening the process of dying (eg, through suppressing respiration) to ameliorate terminal suffering is entirely justifiable. However, clinicians may neither fully appreciate nor accept that the double effect seems to many to be a philosophical “sleight of hand.” There are probably thousands of physicians and millions of Americans who believe it is improper to cite this or any principle to justify truncating life.6Such individuals often instead maintain philosophies that are either vitalist (human existence needs to be maintained as long as possible, at any cost, and without regard to quality of life) or theist (it is a mortal sin to attempt to assume what is rightfully God's control over the manner of one's death).1

In the United States, a societal schism became apparent following the court-ordered removal of Terri Schiavo's feeding tube; vivid images were repeatedly broadcast of protestors marching on Hospice House Woodside in Pinellas County, Florida, with placards denouncing “Hospice Auschwitz” and “Murderers!”7Although similar sentiments had been expressed in the Karen Ann Quinlan, Nancy Cruzan, and other seminal right-to-die cases, until the Schiavo-Schindler family feud, most Americans were unaware of a societal fault line running through end-of-life care.8 Specific practices, including administering narcotics for symptom relief, even unto death, and stopping life-support treatments (especially artificial nutrition and hydration) are anathema to a segment of the population, even though they are routine in most medical settings and accepted by mainstream bioethics and the law.9 According to one recent poll, 29% of the general public endorse a preference for using every possible medical intervention in order to prolong patients' lives rather than relieving pain and enhancing quality of life.10

This is not merely an American but a global conflict.1 Eluana Englaro has been called “Italy's Terri Schiavo.” Englaro remained in a persistent vegetative state for 17 years until her father and doctors finally disconnected the feeding tube in 2009 after a ruling by Italy's top court. Englaro's death occurred while Italy's Senate was in the midst of debating a law that would have forced the Udine hospice facility to resume tube feedings. Following the announcement of her demise, a moment of respectful silence was observed; it was then abruptly broken by lawmakers screaming, “Murderers!” Cardinal Javier Lozano Barragán, the Vatican's equivalent of a health minister, said in an interview, “To withdraw food and water from [Englaro] means only one thing, and that is deliberately killing her … . May the Lord forgive those who brought her to this point.”1

In Canada, the Rasouli decision refers to an ongoing dispute between the physicians and the wife of a 60-year-old man who sustained severe and diffuse brain damage after postoperatively contracting bacterial meningitis. The spouse disagrees with the medical team's recommendation to discontinue life support and initiate comfort care.11 The case is likely to be adjudicated by the Supreme Court of Canada, but the latest ruling prevents the doctors from Toronto's Sunnybrook Health Sciences Centre from withdrawing a ventilator and tube feeding and withholding antibiotics. The lower courts have decreed that the physicians must seek approval from Ontario's Consent and Capacity Board, an independent, extramedical tribunal that reviews and makes decisions on behalf of people who cannot act for themselves.

Can the involvement of the legal system be avoided? Treating accusations as risk management phenomena and robustly managing them by paying greater attention to communication and conscientious documentation can ameliorate, but not entirely forestall, dissension among health care professionals. Vigorously investigating and exposing sources of disagreement among stakeholders on the health care team can help these conflicts to be addressed within hospital walls. Hospitals can create multiple avenues—e-mails, voice mails, meetings—for staff to express concerns about patient care (a practice that is always preferable to staff members calling the local district attorney). There should be a low threshold for allowing and requesting ethics consultations, while grand rounds and other academic forums can deliberately present controversial topics to make the “hidden curriculum” point that it is acceptable to have and air differing views.

Although our survey spotlights accusations made against medical staff, concerns about the possibility of criminal or civil litigation should not become an excuse for treatment on demand, overtreatment of catastrophically ill patients, undertreatment of pain, or denial of directives requesting a shift from curative to palliative care.12 Even in the face of potential accusations of euthanasia or murder, clinicians ought not to be bullied into compromising their management of dying patients and won't be if they know their institution has protocols for dealing with accusations when they arise.

I want to reemphasize that the diverse opinions that medical staff hold about terminal care may reflect doctors' and nurses' international origins, as well as wide-ranging religious beliefs within American society. Furthermore, our pluralistic society maintains and respects these differing views. Even though the palliative medicine ethos is the current, predominant philosophy in American hospitals, it is important to appreciate that health care personnel who misunderstand clinical decisions or take offense with them can produce harmful allegations and generate distressing investigations. Medical staff have different faiths, backgrounds, and countries of origin, and all of these factors may contribute to these clinical disagreements. We live and work together in a pluralistic society that hopefully accepts and respects differing views.

Although caring for dying patients is always a serious matter, it would be a mistake to conclude that physicians ought to cease joking about death with their colleagues. Freud's understanding of humor seems newly trenchant. Levity must remain an acceptable defense mechanism in medicine for coping with the weightiest of medical duties: helping patients to die with grace and dignity.13

7. Does euthanasia contribute to people who needs donation for organs?
   Several Dutch and Belgian doctors have proposed legal reforms to increase the popularity of combining euthanasia and organ donation in the Netherlands and Belgium.

Writing in the Journal of Medical Ethics, they report valuable unpublished information about the prevalence of the procedure. So far, it has been performed only about 40 times in the two countries. However, there is “a persisting discrepancy between the number of organ donors and the number of patients on the waiting lists for transplantation” – which euthanasia patients could help to balance.

The authors stress that euthanasia is not a cure-all for the organ shortage. Most euthanasia patients suffer from cancer, which is a contraindication for organ transplantation. However, 25 to 30% of them do not, so there is obviously a real possibility of expanding the supply.

Furthermore, the authors say, public perception of this formerly abhorrent practice is increasingly positive:

“transplant coordinators in Belgium and the Netherlands notice a contemporary trend towards an increasing willingness and motivation to undergo euthanasia and to subsequently donate organs as well, supported by the increasing number of publications in popular media on this topic.”

Ethically, the procedure is basically uncontroversial as long as the patient is not pressured to donate, they contend.

“In the context of organ donation after euthanasia, the right of self-determination is a paramount ethical and legal aspect. It is the patient's wish and right to die in a dignified way, and likewise his wish to donate his organs is expressed. Organ donation after euthanasia enables those who do not wish to remain alive to prolong the lives of those who do, and also—compared with ‘classical’ donation after circulatory death—allows many more people to fulfil their wish to donate organs after death.”

However, there are some legal hitches in both countries. In the Netherlands, unlike Belgium, euthanasia is regarded as an “unnatural death” which has to be reported to the public prosecutor. This could delay donations. If the law were changed to allow the cause of death to be reported as the underlying condition, the procedure would be more expeditious. And “In Belgium, the current policy of determination of death by three independent physicians could be abandoned, facilitating a more lean procedure with only one physician.”

Public perceptions need to be managed as well. At the moment, it is necessary to maintain a strict separation between the request for euthanasia and the need for the organ. Partly this is needed to ensure that the donor is not being pressured. But the public also needs to have confidence that physicians will give objective advice. 

Finally, there is the tradition of the dead donor rule “that donation should not cause or hasten death”. The authors imply that this could be scrapped for euthanasia volunteers:

“Since a patient undergoing euthanasia has chosen to die, it is worth arguing that the no-touch time (depending on the protocol) could be skipped, limiting the warm ischaemia time and contributing to the quality of the transplanted organs. It is even possible to extend this argument to a ‘heart-beating organ donation euthanasia’ where a patient is sedated, after which his organs are being removed, causing death.”

The article’s proposals were not received with great enthusiasm in the UK where there is a simmering debate on assisted dying. Tory MP Fiona Bruce told the Daily Mail: “The paper confirms the worst fears expressed by Parliament when the House of Commons conclusively voted to stop the legalisation of assisted suicide in this country. The possibility of euthanasia achieved through live organ donation, such as by removing a patient's beating heart, as posited in this paper is shocking and chilling.”

And Lord Carlile of Berriew, a Liberal Democrat peer who is a leading lawyer, said: “I have extreme concerns about the ghoulish nature of the combined euthanasia and organ donation systems in the Netherlands and Belgium. Both can result in unbearable and irresistible pressure on an individual to die, and on a doctor to encourage death.”

8. Is euthanasia getting bigger and expected around the world or discouraged?
    Please a look at the Euthanasia Regulation World map.
    https://ethicslab.georgetown.edu/euthanasia-map/

9. Should it be legal for people to get euthanized even if they don't have a terminal illness?
 ZURICH, November 6, 2008 (LifeSIteNews.com) – A recent study has revealed that a large number of non-terminally ill men and women are seeking assisted suicide in Switzerland, which has some of the most liberal laws in the world governing the controversial practice.  Conservative bioethicists have responded saying they not surprised by the findings, claiming that the roots established by the euthanasia movement have created a slippery slope that will ultimately lead to a universal human “right to die.”

Researchers from the University of Zurich and the Zurich University of Applied Sciences examined the cases of 421 people who obtained assisted suicides in Switzerland between 2001 and 2004.  The study focused on the two assisted-suicide groups, Dignitas and Exit, who helped 274 and 147 people, respectively, commit suicide. 

They found that 79 percent of the 274 people with Dignitas and 67 percent of the 147 with Exit were terminally ill; the remaining individuals were not terminally ill when they committed suicide.  The study also found that 91 percent of those who died with Dignitas were foreigners, compared to the three percent of foreigners choosing Exit.

Susan Fischer, who co-authored the review on assisted suicides in Zurich said, "Being tired of life and in very poor health are becoming more frequent reasons to seek help to commit suicide than in the past."

Other experts go one step further, saying that reasons such as suffering or being tired of life are accidentals to the main campaign by the assisted suicide/euthanasia movement, which is focused on establishing a universal human “right to die.”

"This is not new, because the right to die movement for a long time had been promoting the concept of euthanasia for those people who are tired of living," said Alex Schadenberg, executive director of the Euthanasia Prevention Coalition, in a LifeSiteNews.com interview.  "All it means is that the people at the Dignitas and Exit clinics have fulfilled these ideals by offering death on demand.  They have gone where other places are planning to go."

Schadenberg related how he witnessed a Dutch speaker at a 2006 right to die conference promoting a universal human right to die. "The Swiss, in their clinics, are fulfilling what the other groups are fighting to achieve.  This is not about terminal illness, or suffering. It’s about their final goal which is the universal human right to die."

Exit officially rejected the study in a statement. But in an interview with Reuters, Bernhard Sutter of Exit’s board admitted that about one third of the people committing suicide with Exit are people not suffering from a fatal disease, but are in a "bad state."

"We help only people with fatal diseases or who are very seriously ill. For the last 12 years, the number suffering from fatal diseases has always been the same, between 65 and 75 percent. The rest, maybe a third or less, are very ill," said Sutter.

Prominent bioethicist Wesley Smith also addressed the growing assisted suicide trend, alluding to the fact that the umbrella of circumstances in which assisted suicide or euthanasia are permitted will only be broadened as the practice becomes more socially accepted.

Anyone pondering the issue rationally, he said, "would realize that once assisted suicide/euthanasia consciousness becomes widely accepted, the categories of the terminated expand. And now, waddya know, a study of assisted suicide in Switzerland shows that an increasing number of the cases have been of people who are not terminally ill."

"Expect that trend to continue as the idea that ending life is an acceptable answer to human suffering digs deeper into the world’s moral bedrock," finished Smith.

In related news, the November fourth vote saw Washington become the second US state allowing legal assisted suicide.  Initiative 1000, the Washington "Death with Dignity Act," which allows physicians to prescribe a fatal dose of medication to patients whom a doctor feels is likely to die within six months, passed in the state 59% to 41%.

10. If euthanasia gets legal around the world, will it encourage people to die instead of try?
 Just as one of the slogans used by abortion activists says 'If you don't want an abortion, don't have one'. Right-to-die activists contend that if Euthanasia and/or Assisted Suicide (EAS) are legalised, they will only impact on those who choose to use those options. In other words, those who don't want assisted suicide won't be effected, so what's the problem?

Personal autonomy 
The English poet John Donne composed a Meditation, 'No Man is an Island', which goes like this:

No man is an island, Entire of itself. Each is a piece of the continent, A part of the main. If a clod be washed away by the sea, Europe is the less. As well as if a promontory were.

As well as if a manner of thine own Or of thine friend's were. Each man's death diminishes me, For I am involved in mankind. Therefore, send not to know For whom the bell tolls, It tolls for thee.

Dr Peter Saunders MBChB FRACS, a New Zealander who is now practicing in the UK, wrote in his Twelve Reasons... Why Euthanasia Should Not be Legalised:

We are not free to do things which limit or violate the reasonable freedoms of others. No man is an island. No person makes the decision to end his or her life in isolation. There are others who are affected: friends and relatives left behind, and the healthcare staff involved in the decision-making process.

Western society no longer recognises suicide as a crime, but still appreciates that a person's decision to take his or her own life can have profound, often lifelong effects on the lives of others. There may be guilt, anger or bitterness felt by those left behind. Personal autonomy is never absolute. The effect of personal decisions on others now living or in future generations must also be considered. 1

Medical research

The drive to find cures for illnesses, especially fatal ones is what has led researchers to make so many discoveries in the past, especially in the 20th century. Dr Saunders points out that "Medical research is essential if medicine is to advance further," and goes on to say:

"When the focus changes from curing the condition to killing the individual with the condition, this whole process is threatened." 2

Dr Leo Alexander, who was the Chief US Medical Consultant at the Nuremberg War Trials after World War II, wrote in Medical Science Under Dictatorship about the experiments undertaken by the Nazi doctors in the Concentration Camps:

Whatever proportions these crimes finally assumed, it became evident to all who investigated them that they had started from small beginnings. The beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians. It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as life not worthy to be lived.

This attitude in its early stages concerned itself merely with the severely and chronically sick. Gradually the sphere of those to be included in this category was enlarged to encompass the socially unproductive, the ideologically unwanted, the racially unwanted and finally all non-Germans. But it is important to realize that the infinitely small wedged-in lever from which this entire trend of mind received its impetus was the attitude toward the non-rehabilitable sick.

It is, therefore, this subtle shift in emphasis of the physicians' attitude that one must thoroughly investigate. It is a recent significant trend in medicine, including psychiatry, to regard prevention as more important than cure. Observation and recognition of early signs and symptoms have become the basis for prevention of further advance of disease. 3

Those advocates and activists who work for the EAS legalisation vehemently deny any possibility that what happened in Nazi Germany could happen today. In doing so they ignore historical record. Many of the German doctors who participated in the T4 euthanasia programme did so for reasons of compassion for the mentally and physically handicapped.

Compassion

Dr Karl Brandt was appointed by Hilter to head the bureaucracy and implement the infanticide programme. At his trial after the war he defended his actions saying:

"My underlying motive was the desire to help individuals who could not help themselves... such considerations should not be regarded as inhuman. Nor did I feel it in any way to be unethical or immoral... I am convinced that if Hippocrates were alive today he would change the wording of his oath... in which a doctor is forbidden to administer poison to an invalid even on demand... I have a perfectly clear conscience about the part I played in the affair. I am perfectly conscious that when I said yes to euthanasia I did so with the greatest conviction, just as it is my conviction today that it is right." 4

Brandt was condemned to death and hanged following the Nuremberg War Crimes Trials.

Hospice and palliative care

Hospice teaches that a request for suicide by a patient means that a need exists that is not being met. As the history of the hospice movement demonstrates, once such unmet needs are fulfilled, suicidal desires often disappear.

In testimony given before the British House of Lords, Zbigniew Zylicz, one of the few palliative care experts in the Netherlands, attributed Dutch deficiencies in palliative care to the easier alternative of euthanasia. 

Although the Dutch government has attempted to stimulate palliative care at six major medical centres throughout the Netherlands, established more than 100 hospices and provide for training professionals caring for terminally ill patients, many physicians choose the easier option of euthanasia rather than train in palliative care. 5 

The situation would appear to be similar in Oregon. A survey of Oregon physicians who received the first 142 requests for assisted suicide since the law went into effect showed that in only 13% of cases was a palliative care consultation recommended, and it is not know how many of these recommendations were actually implemented. 6 

The World Health Organization has recommended that governments not consider assisted suicide and euthanasia until they have demonstrated the availability and practice of palliative care for their citizens.

Doctor/patient trustEAS opponents frequently point out the if it is legalised it will compromise and undermine the relationship between a doctor and his or her patient. There will be doctors who will refuse to administer deadly drugs, or even refer patients to a doctor who will, as a matter of conscience. Advocates say that there will be a 'right' for doctors to refuse. 

In the abortion controversy, doctors who regard abortion as murder are expected to violate their conscious by refering their patient to a doctor who will agree to refer for abortion.

Opponents say that EAS will change the role of doctor from healers, especially for disabled patients. 

Critics also say cases such as that of UK doctor Harold Shipman, who used his position as a doctor to kill up to 250 patients, show how easy it would be to abuse a system under which doctors were given more powers.

Duty to die

Dr Saunders says, "Many elderly people already feel a burden to family, carers and a society which is cost conscious and may be short of resources. They may feel great pressure to request euthanasia." 7

One of the biggest concerns for disabled rights organisations is that, if euthanasia is legalised, the 'right to die' will soon become a 'duty to die.'

American 'Dr Death' Jack Kevorkian told a Michigan Court in August 1990:

"The voluntary self-elimination of individual and (sic) mortally diseased and crippled lives taken collectively can only enhance the preservation of public health and welfare." 8

Duty to kill

Doctors and Hospital Boards are increasingly winning Court battles that give them the right to withdraw and withhold treatment from disabled and terminally ill patients. Those opposed to EAS believe that this is happening for economic reasons.

Individual autonomy has increasingly given way to decision-making by health care professionals and bioethicists, whose "futile care theory" measures the value of human life according to the financial cost of keeping the individual alive.

In Holland where euthanasia is legal many people now carry ?anti-euthanasia passports' because they are afraid they may be killed if admitted to hospital. 9

Voluntary euthanasia leads to involuntary euthanasia 
In the Netherlands, voluntary euthanasia has progressed to involuntary euthanasia. In 1990 a Dutch Government study found that over 1,000 people had been killed without their consent. In 1995 the number was 900.

The Lancet, estimated that in 2001, Dutch doctors euthanised some 3,000 patients, assisted in the suicide of about 140 patients - but ended "life without patient's explicit request" for some 840 patients. 

Professor Raphael Cohen-Almagor of the University of Haifa wrote a paper for Issues in Law & Medicine in 2003. In and interview, Dr Frank Koerselman, told Cohen-Almagor about an 85- year-old patient with pneumonia and depression. The man's family didn't want Dutch doctors to treat him. The patient's doctor was ready to take the easy way out. 

Koerselman said that he had to order security guards to remove the family so that he could question the patient in private. Then the patient opted for treatment, got it and was discharged from the hospital in very good condition, physically and mentally.

In the Netherlands the courts are now permitting euthanasia, not only for the competent terminally ill, but also for infants with serious handicaps, comatose patients, and even people suffering from severe depression. 

Society is brutalised 
Professor David Richmond, in an article on Capital Punishment and Euthanasia, wrote, "...these two issues are linked much more closely than some might think at first glance. Can we logically both eschew capital punishment and endorse legalised euthanasia?" He goes on to say:

"The pro-euthanasia lobby talks enthusiastically about 'autonomy' and 'choice'. The truth is that when euthanasia is legalised, personal autonomy and choice are dangerously compromised. Moreover, legalising euthanasia - like capital punishment - has the power to brutalise society."

One of the main reasons Capital Punishment has been abolished in many countries is, as Prof. Richmond points out, because of the cases where people have been executed and later exonerated (been found innocent of the crime). As he says, doctors also make mistakes in diagnosing patients. 

11. Does euthanasia prevent doctors from discovering cures for illnesses?
     No concrete study on this topic.

12. How did people(society) reacted to the very first euthanasia case?
     Euthanasia comes from the Greek words, Eu (good) and Thanatosis (death) and it means "Good Death, "Gentle and Easy Death." This word has come to be used for "mercy killing." In this sense euthanasia means the active death of the patient, or, inactive in the case of dehydration and starvation.

The first recorded use of the word euthanasia was by Suetonius, a Roman historian, in his De Vita Caesarum--Divus Augustus (The Lives of the Caesars--The Deified Augustus) to describe the death of Augustus Caesar:

"...while he was asking some newcomers from the city about the daughter of Drusus, who was ill, he suddenly passed away as he was kissing Livia, uttering these last words: "Live mindful of our wedlock, Livia, and farewell," thus blessed with an easy death and such a one as he had always longed for. For almost always, on hearing that anyone had died swiftly and painlessly, he prayed that he and his might have a like euthanasia, for that was the term he was wont to use. "

Augustus' death while termed "a euthanasia" was not hastened by the actions of any other person.

Withdrawal or with-holding treatment was practiced in history, the correct term for this is orthothanasia, which means 'passive death.' In this method, the actions of curing the patient are never applied and his death is made easy in a passive form. In orthothanasia, the action of killing is not applied, but, passive actions are present in order to provide death.

The place of euthanasia in the history of medical ethics
The actions of easy death have been applied for hopeless patients who have been suffering extreme pain since ancient ages.

These actions were forbidden from time to time. In Mesopotamia, Assyrian physicians forbade euthanasia. Again in the old times incurable patients were drowned in the River Ganges in India. In ancient Israel, some books wrote that frankincense was given to kill incurable patients.

Jewish society, following the teaching of the Bible and the sixth command "thou shall not kill", had rejected centuries ago every theory on shortening the life of handicapped or disadvantaged people. Judaism considered life to be sacred and equated suicide and euthanasia with murder. Dr Immanuel Jakobovits, former Chief Rabbi of England explained:

"Cripples and idiots, however incapacitated, enjoy the same human rights (though not necessarily legal competence) as normal persons... One human life is as precious as a million lives, for each is infinite in value..."

In Sparta, it was the common practice for each newborn male child to be examined for signs of disability or sickliness which, if found, led to his death. This practice was regarded as a way to protect the society from unnecessary burden, or as a way to 'save' the person from the burden of existence. 

In ancient Greece, suicide of the patient who was suffering extreme pain and had an incurable terminal illness was made easy and for this reason, the physician gave medicine (a poisoned drink) to him. Plato wrote: "Mentally and physically ill persons should be left to death; they do not have the right to live." 

Pythagoras and his pupils were completely against suicide due to their religious beliefs that the Gods place the man as the protector of the earthly life and he is not allowed to escape with his own will.

The first objection to euthanasia came from the Hippocratic Oath which says "I will not administer poison to anyone when asked to do so, nor suggest such a course."

In ancient Rome, euthanasia was a crime and this action was regarded as murder. However, history notes that sickly newborn babies were left outside, overnight, exposed to the elements.

In the Middle Ages in Europe, Christian teaching opposed euthanasia for the same reason as Judaism. Christianity brought more respect to human beings. Accordingly, every individual has the right to live since God creates human beings and they belong to Him and not themselves. Death is for God to decree, not man. 

Like Judeo-Christian teaching, Islam also teaches that God is the only one who creates and the only one who may take life away. 

15th - 17th Centuries
Sir Thomas More (1478-1535) is often quoted as being the first prominent Christian to recommend euthanasia in his book Utopia, where the Utopian priests encourage euthanasia when a patient was terminally ill and suffering pain (but this could only be done if the patient consented). "...if a disease is not only distressing but also agonising without cessation, then the priests and public officials exhort this man...to free himself from this bitter life...or else to permit others to free him..." The problem with using this quote is that More, a devout Catholic, wrote Utopia as a work of satire.

The English philosopher, Francis Bacon (1561-1621), was the first to discuss prolongation of life as a new medical task, the third of three offices: Preservation of health, cure of disease and prolongation of life. Bacon also asserts that, 'They ought to acquire the skill and bestow the attention whereby the dying may pass more easily and quietly out of life.' Bacon refers to this as outward euthanasia, or the easy dying of the body, as opposed to the preparation of the soul. It appears unlikely he was advocating 'mercy killing', more likely  he was promoting what we would term better 'palliative' care.

18th - 19th Centuries
In Prussia, in the 18th century, 1st June 1794, a law was passed that reduced the punishment of a person who killed the patient with an incurable disease. 

1828 - Earliest American statute explicitly to outlaw assisting suicide.

The earliest American statute explicitly to outlaw assisting suicide was enacted in New York in 1828, Act of Dec. 10, 1828, ch. 20, §4, 1828 N. Y. Laws 19 (codified at 2 N. Y. Rev. Stat. pt. 4, ch. 1, tit. 2, art. 1, §7, p. 661 (1829)), and many of the new States and Territories followed New York's example. Between 1857 and 1865, a New York commission led by Dudley Field drafted a criminal code that prohibited "aiding" a suicide and, specifically, "furnish[ing] another person with any deadly weapon or poisonous drug, knowing that such person intends to use such weapon or drug in taking his own life."

Until the end of the nineteenth century, euthanasia was regarded as a peaceful death, and the art of its accomplishment. An often quoted nineteenth century document is, 'De euthanasia medica prolusio,' the inaugural professorial lecture of Carl F. H. Marx, a medical graduate of Jena. 'It is man's lot to die' states Marx. He argued that death either occurs as a sudden accident or in stages, with mental incapacity preceding the physical. Philosophy and religion may offer information and comfort, but the Physician is the best judge of the patient's ailment, and administers alleviation of pain where cure is impossible. 

Marx did not feel that that his form of euthanasia, which refers to palliative medicine without homicidal intention, was an issue until the nineteenth century. 

The prevailing social conditions of the latter nineteenth century began to favour active euthanasia. Darwin's work and related theories of evolution had challenged the existence of a Creator God who alone had the right to determine life or death.

The first popular advocate of active euthanasia in the nineteenth century, was a schoolmaster, not a doctor. In 1870 Samuel Williams wrote the first paper to deal with the concept of 'medicalised' euthanasia. He stated:

"In all cases it should be the duty of the medical attendant, whenever so desired by the patient, to administer chloroform, or any other such anaesthetics as may by and by supersede chloroform, so as to destroy consciousness at once, and put the sufferer at once to a quick and painless death; precautions being adopted to prevent any possible abuse of such duty; and means being taken to establish beyond any possibility of doubt or question, that the remedy was applied at the express wish of the patient."

Though reprinted many times, the paper was seemingly ignored by the British medical profession, and in 1873 Lionel Tollemache took up his arguments in the Fortnightly Review. Writing under the clear influence of utilitarianism and social Darwinism, he described the incurable sick as a useless to society and burdensome to the healthy. 

Although his views were simply dismissed as revolutionary, similar views were emerging with the new science of eugenics, as ideas of sterilising the mentally ill, those with hereditary disorders, and the disabled, became fashionable. 

In 1889, the German philosopher, Nietsche, said that terminally ill patients are a burden to others and they should not have the right to live in this world.

In 1895, a German lawyer, Jost, prepared a book called "Killing Law." Jost stressed that only hopelessly ill patients who wanted death, must be let die. According to Jost, life sometimes goes down to zero in value. Thus, the value of the life of a patient with an incurable illness is very little. 

The 20th CenturyThe efforts of legalization of euthanasia began in the USA in the first years of the 20th century. The New York State Medical Association recommended gentle and easy death. Even more active euthanasia proposals came to Ohio and Iowa state legislatures in 1906 and 1907 but these proposals were rejected.

In 1920, two German professors published a small book with the title 'Releasing the destruction of worthless animals' which advocated the killing of people whose lives were "devoid of value." This book was the base of involuntary euthanasia in the Third Reich. 

In this book, authors Alfred Hoche, M.D., a professor of psychiatry at the University of Freiburg, and Karl Binding, a professor of law from the University of Leipzig, also argued that patients who ask for "death assistance" should, under very carefully controlled conditions, be able to obtain it from a physician. 

Alfred Hoche also wrote an essay, which he published as "Permitting the Destruction of Life Not Worthy of Life." It embraced euthanasia as a proper and legal medical procedure to kill the weak and vulnerable so as not to taint the human gene. 
The reduction of punishment in mercy killing was accepted in Criminal Law in 1922 in Russia. But this law was abolished after a short while.

A French physician, called Dr.E.Forgue. published an article, named "Easy death of incurable patients" in La Revue de Paris, in 1925, and pointed out that killing an incurable patient wasn't a legal condition. But, Liege Bar said that killing an incurable patient with his free consent had to be forgiven. 

The laws that accept euthanasia as a legal condition are present in two countries of South America. According to Uruguay Penal Code, a Judge must not punish a person for mercy killing. A person must also be forgiven for this kind of killing in Colombia.

Adolf Hitler admired Hoche's writing and popularised and propagandised the idea. In 1935,the German Nazi Party accepted euthanasia for crippled children and "useless and unrehabilitive" patients.

Before 1933, every German doctor took the Hippocratic Oath, with its famous "do no harm" clause. The Oath required that a doctor's first duty is to his patient. The Nazis replaced the Hippocratic Oath with the Gesundheit, an oath to the health of the Nazi state. Thus a German doctor's first duty was now to promote the interests of the Reich.

Anyone in a state institution could be sent to the gas chambers if it was considered that he could not be rehabilitated for useful work. The mentally retarded, psychotics, epileptics, old people with chronic brain syndromes, people with Parkinson's disease, infantile paralysis, multiple sclerosis, brain tumours etc. were among those killed. The consent of the patient was absent in this type of euthanasia. This kind was applied by order.

Many people don't realise that, prior to the extermination of Jews by Nazi Germany, in the so-called "final solution," as many as 350,000 Germans were sterilized because their gene pool was deemed to be unsuitable to the Aryan race, many because of physical disability, mental deficiency or homosexuality. 

In 1936 the Voluntary Euthanasia Society was founded in England. The next year the English Parliament (the House of Lords) rejected a proposal to legalise euthanasia. In opinion polls of those years, euthanasia supporters had around 60% of the votes. 

According to a questionnaire in 1937, 53% of American physicians defended euthanasia. Approximately 2000 physicians and more than 50 religious ministers were among the members of the American Euthanasia Society. At that time, a majority of physicians in some American cites defended this subject. 
In 1938, the Euthanasia Society of America was established in New York. 

1939 Nazi Germany (From "The History Place" web site) 
"In October of 1939, amid the turmoil of the outbreak of war, Hitler ordered widespread "mercy killing" of the sick and disabled. Code named "Aktion T 4", the Nazi euthanasia program to eliminate "life unworthy of life" at first focused on newborns and very young children. Midwives and doctors were required to register children up to age three who showed symptoms of mental retardation, physical deformity, or other symptoms included on a questionnaire from the Reich Health Ministry."

"The Nazi euthanasia program quickly expanded to include older disabled children and adults. Hitler's decree of October, 1939, typed on his personal stationery and back dated to Sept. 1, enlarged 'the authority of certain physicians to be designated by name in such manner that persons who, according to human judgment, are incurable, can, upon a most careful diagnosis of their condition of sickness, be accorded a mercy death.'"

On August 3, 1941, the Catholic Bishop Clemens August Count of Galen, openly condemned the Nazi euthanasia programme in a sermon. This brought a temporary end to the programme. Read here

A law proposal that accepted euthanasia, was offered to the government in Great Britain in 1939. According to this proposal, a patient had to write his consent as a living will which must be witnessed by two persons. The will of the patient had to be accepted in the reports of two physicians. One of these physicians was the attending physician, the other one was the physician of the Ministry of Health. The will of the patient had to be applied after 7 days and most of the relatives of the patient had again to speak with him 3 days before the killing action. But this proposal wasn't accepted.

In 1973 Dr. Gertruida Postma, who gave her dying mother a lethal injection, received light sentence in the Netherlands. The case and its resulting controversy launched the euthanasia movement in that country.

The Dutch Voluntary Euthanasia Society (NVVE) launched its Members' Aid Service in 1975, to give advice to the dying. It received twenty-five requests for aid in the first year.

In 1976 Dr Tenrei Ota, upon formation of the Japan Euthanasia Society (now the Japan Society for Dying with Dignity), called for an international meeting of existing national right-to-die societies. Japan, Australia, the Netherlands, the United Kingdom, and the United States were all represented. This first meeting enabled those in attendance to learn from the experience of each other and to obtain a more international perspective on right to die issues. 

In 1978, Jean's Way was published in England by Derek Humphry, describing how he helped his terminally ill wife to die. The Hemlock Society was founded in 1980 in Santa Monica, California, by Derek Humphry. It advocated legal change and distributed how-to-die information. This launched the campaign for assisted dying in America. Hemlock's national membership grew to 50,000 within a decade. Right to die societies also formed the same year in Germany and Canada.

The Society of Euthanasia assembled in Oxford in the last months of 1980, hosted by Exit, The Society for the Right to Die with Dignity. It consisted of 200 members represented 18 countries. Since its founding, the World Federation has come to include 38 right to die organisations, from around the world, and has held fifteen additional international conferences, each hosted by one of the member organisations.

On 5 May, 1980, the Catholic Church issued a Declaration on Euthanasia. Read here

In 1984, The Netherlands Supreme Court approved voluntary euthanasia under certain conditions.

In 1994, Oregon voters approved Measure 16, a Death With Dignity Act ballot initiative that would permit terminally ill patients, under proper safeguards, to obtain a physician's prescription to end life in a humane and dignified manner. The vote was 51-49 percent. 

In 1995, Australia's Northern Territory approved a euthanasia bill. It went into effect in 1996 and was overturned by the Australian Parliament in 1997. Only four deaths took place under this law, all performed by Dr Philip Nitschke.

On 13 May, 1997, the Oregon House of Representatives voted 32-26 to return Measure 16 to the voters in November for repeal (H.B. 2954). On 10 June, the Senate votes 20-10 to pass H.B. 2954 and return Measure 16 to the voters for repeal. On 4 November 1997 the people of Oregon voted by a margin of 60-40 percent against Measure 51, which would have repealed the Oregon Death with Dignity Act, l994. The law officially took effect (ORS 127.800-897) on 27 October, l997.

In 1998, the Oregon Health Services Commission decided that payment for physician-assisted suicide could come from state funds under the Oregon Health Plan so that the poor would not be discriminated against.

In 1999, in the United States, Dr. Jack Kevorkian was sentenced to 10-25 years imprisonment for the 2nd degree murder of Thomas Youk after showing a video of his death, by lethal injection, on national television. Kervorkian's first appeal was rejected in 2001. Kevorkian helped a number of people die and even though he had been previously prosecuted, he remained free of criminal charges until 1999.

In 2000, The Netherlands approved voluntary euthanasia. The Dutch law allowing voluntary euthanasia and physician-assisted suicide took effect on the 1st of February, 2002. For 20 years previously, it had been permitted under guidelines.

Into the Third Millenium
In 2002 Belgium passed a similar law to the Dutch, allowing both voluntary euthanasia and physician-assisted suicide.

In New Zealand in March 2004 Lesley Martin was convicted of the attempted murder of her terminally ill mother. She served seven months of a fifteen-month prison sentence, before being released on a good behaviour bond, and subsequently failed, in two attempts, to appeal against the conviction.

Switzerland, once known in the tourism business for its spectacular alpine landscape, the watches and chocolate, has a new claim to fame as the world's death Mecca. Physically and mentally vulnerable patients have been lining up for a one-way trip to Zurich.

In 2000 three foreigners committed suicide in Zurich. In 2001, the number of death tourists to Zurich rose to thirty-eight, plus twenty more in Bern. Most of the deaths occurred in an apartment rented by Dignitas, one of the four groups that have taken advantage of Switzerland's 1942 law on euthanasia to help the terminally ill die.

Dignitas has assisted the suicides of 146 people over the last four years. The Swiss parliament has been alarmed and there is a move to ban the 'suicide tourism' and to place tougher bans on assisted suicide.

When it was established in 1942, the Swiss euthanasia law was meant mainly to offer the opportunity for a dignified death to those with just two or three weeks to live.

In the past few years, though, it has been applied to patients with a range of ailments -- those with terminal illnesses or with acute mental disabilities, and even those suffering unbearable distress, such as a musician, for example, who has gone deaf.

There are several requirements under the Swiss law. People who opt for euthanasia must be rationally capable of making the decision to die. They must perform the final act -- usually the drinking of a lethal dose of barbiturates -- without assistance. And the event must be witnessed by a nurse or physician, and two other people.

   
13. Who get to choose the final decision that the patient with a terminal ill can get euthanized?
It varies from cases and situations such as voluntary euthanasia or non voluntary euthanasia.

14. When did the concept of euthanasia spread around the world?
     1950-1979

1950 - World Medical Association Condemns Euthanasia; Poll Shows Declining Support for Physician-Assisted Suicide

The World Medical Association votes to recommend to all national medical associations that euthanasia be condemned "under any circumstances." In the same year, the American Medical Association issues a statement that the majority of doctors do not believe in euthanasia.

When an opinion poll in 1950 asked Americans whether they approved of allowing physicians by law to end incurably ill patients' lives by painless means if they and their families requested it, only 36 percent answered 'yes,' approximately 10 percent less than in the late 1930s."

Ian Dowbiggin, PhD  A Merciful End: The Euthanasia Movement in Modern America, 2003

1952 - Groups Petition the United Nations to Amend the Declaration of Human Rights to Include Euthanasia

The British and American Euthanasia Societies submit a petition to the United Nations Commission on Human Rights to amend the UN Declaration of Human Rights to include "the right of incurable sufferers to euthanasia or merciful death... Inasmuch as this right is, then, not only consonant with the rights and freedoms set forth in the Declaration of Human Rights but essential to their realization, we hereby petition the United Nations to proclaim the right of incurable sufferers to euthanasia."

Eleanor Roosevelt, the Chairperson of the Commission, did not present the petition to the Commission.

Marjorie Zucker, PhD  The Right to Die Debate: A Documentary History, 1999

1962 - Pauline Taylor Becomes President of the Euthanasia Society of America

Charles Potter dies and theologian Joseph Fletcher assumes Potter's unofficial title as the chief philosopher of the euthanasia movement.

Fletcher fashions a new rationale for euthanasia based primarily on the notion of patient autonomy."

Pauline Taylor becomes president of the Euthanasia Society of America (ESA).

"Taylor...began the ESA's soul-searching process that led to a major shift in the philosophy for the entire American euthanasia movement. She believed the ESA in the past had overemphasized the soundness of an individual's decision to have his or her life ended if terminally ill and in unbearable pain... Taylor concluded that the time was ripe to...begin convincing the public that letting someone die, instead of resorting to extreme measures, was both humane and ethically permissible."

Euthanasia became a more acceptable concept after World War2. More details athttp://euthanasia.procon.org/view.timeline.php?timelineID=000022

15. What kind of people(group) tend to be for euthanasia?
     Non religious people. Families and relatives who do not want to see family member suffer from pain. People who have experienced it before.