What “Euthansia” Is, and Is Not

If you ask most people to define “euthanasia”, they will pause a little, then say it has something to do with helping someone who is old, or sick, or suffering, to die. They rarely consider the various complicated scenarios that crop up.

Here is a terse set of distinctions sent by a physician friend with whom a few of us were having a debate surrounding Canada’s recent law legalizing euthanasia.

Before reading, I think it is useful to keep in mind that euthanasia is not about “letting” someone die of natural causes, keeping them as pain-free and comfortable as possible along the way, with nursing, food, water, etc., as distinct from keeping them alive artificially.

Rather, euthanasia is always about “making” someone die by the administration of life-ending drugs, injections, etc.

Note: MAiD = Medical Aid in Dying

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Euthanasia = making someone die (with the intent to end suffering, or for some other cause deemed compassionate by those who have legalized the killing procedure and those who administer it).

Voluntary Active Euthanasia (VAE) = patient consents, doc/nurse does it.
Non voluntary Active Euthanasia (NVAE) = patient can’t consent, doc does it
Involuntary Active Euthanasia (IAE) = patient doesn’t want it, doc does it
Assisted Suicide (AS) = patient given means to end own life (patient self-administers)
MAiD = VAE for the most part.
AS often requires VAE if the AS isn’t successful (eg, person not quite dead).
Issues:
MAiD changes the ontology of medicine. No one want to debate this very much.
Giving patients the right to universal access to MAiD creates a duty for others to offer and pay for it.
Finally, “Hard cases make bad laws”. No one need die in pain. Terminal sedation means we can all pass quietly. Intent to relieve suffering by “turning up the morphine” often hastens death. It’s been done forever. This is very different from giving meds with the intent to cause death.

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