Right to die
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The right to die is a concept rooted in the belief that individuals have the
autonomy In developmental psychology and moral, political, and bioethical philosophy, autonomy is the capacity to make an informed, uncoerced decision. Autonomous organizations or institutions are independent or self-governing. Autonomy can also be ...
to make fundamental decisions about their own lives, including the choice to end them or undergo
voluntary euthanasia Voluntary euthanasia is the purposeful ending of another person's life at their request, in order to relieve them of suffering. Voluntary euthanasia and physician-assisted suicide (PAS) have been the focus of intense debate in the 21st century, ...
, central to the broader notion of health freedom. This
right Rights are law, legal, social, or ethics, ethical principles of freedom or Entitlement (fair division), entitlement; that is, rights are the fundamental normative rules about what is allowed of people or owed to people according to some legal sy ...
is often associated with cases involving terminal illnesses or incurable
pain Pain is a distressing feeling often caused by intense or damaging Stimulus (physiology), stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sense, sensory and emotional experience associated with, or res ...
, where
assisted suicide Assisted suicide, sometimes restricted to the context of physician-assisted suicide (PAS), is the process by which a person, with the help of others, takes actions to end their life. Once it is determined that the person's situation qualifie ...
provides an option for individuals to exercise control over their
suffering Suffering, or pain in a broad sense, may be an experience of unpleasantness or aversion, possibly associated with the perception of harm or threat of harm in an individual. Suffering is the basic element that makes up the negative valence (psyc ...
and
dignity Dignity is a human's contentment attained by satisfying physiological needs and a need in development. The content of contemporary dignity is derived in the new natural law theory as a distinct human good. As an extension of the Enlightenment- ...
. The debate surrounding the right to die frequently centers on the question of whether this decision should rest solely with the individual or involve external authorities, highlighting broader tensions between
personal freedom Civil liberties are guarantees and freedoms that governments commit not to abridge, either by constitution, legislation, or judicial interpretation, without due process. Though the scope of the term differs between countries, civil liberties of ...
and societal or legal restrictions. Religious views on the matter vary significantly, with some traditions such as
Hinduism Hinduism () is an Hypernymy and hyponymy, umbrella term for a range of Indian religions, Indian List of religions and spiritual traditions#Indian religions, religious and spiritual traditions (Sampradaya, ''sampradaya''s) that are unified ...
('' Prayopavesa'') and
Jainism Jainism ( ), also known as Jain Dharma, is an Indian religions, Indian religion whose three main pillars are nonviolence (), asceticism (), and a rejection of all simplistic and one-sided views of truth and reality (). Jainism traces its s ...
(''
Santhara (IAST: ), also known as ''samlehna'', ''santhara'', ''samadhi-marana'' or ''sanyasana-marana'', is a supplementary vow to the ethical code of conduct of Jainism. It is the religious practice of voluntarily fasting to death by gradually redu ...
'') permitting non-violent forms of voluntary death, while others, including
Catholicism The Catholic Church (), also known as the Roman Catholic Church, is the List of Christian denominations by number of members, largest Christian church, with 1.27 to 1.41 billion baptized Catholics Catholic Church by country, worldwid ...
,
Islam Islam is an Abrahamic religions, Abrahamic monotheistic religion based on the Quran, and the teachings of Muhammad. Adherents of Islam are called Muslims, who are estimated to number Islam by country, 2 billion worldwide and are the world ...
and
Judaism Judaism () is an Abrahamic religions, Abrahamic, Monotheism, monotheistic, ethnic religion that comprises the collective spiritual, cultural, and legal traditions of the Jews, Jewish people. Religious Jews regard Judaism as their means of o ...
, consider suicide a moral transgression.


Ethics

The preservation and
value of life The value of life is an economic value used to quantify the benefit of avoiding a fatality. It is also referred to as the cost of life, value of preventing a fatality (VPF), implied cost of averting a fatality (ICAF), and value of a statistical l ...
have led to many medical advancements when it comes to treating patients. New devices and the development of
palliative care Palliative care (from Latin root "to cloak") is an interdisciplinary medical care-giving approach aimed at optimizing quality of life and mitigating or reducing suffering among people with serious, complex, and often terminal illnesses. Man ...
have allowed humans to live longer than before. Prior to these medical advancements and care, the lifespans of those who were unconscious, minimally unconscious, and in a vegetative state were short as they were unable to receive assistance with basic needs such as breathing and feeding. The advancement of medical technology raises the question about the quality of life of patients who are no longer conscious. For example, the right to
self-determination Self-determination refers to a people's right to form its own political entity, and internal self-determination is the right to representative government with full suffrage. Self-determination is a cardinal principle in modern international la ...
questions the definition of quality and sanctity of life—if one had the right to live, then the right to die must follow suit. There are questions in ethics as to whether or not a right to die can coexist with a right to life. If it is argued that the right to life is inalienable, then it cannot be surrendered and therefore may be incompatible with a right to die. A second debate exists within
bioethics Bioethics is both a field of study and professional practice, interested in ethical issues related to health (primarily focused on the human, but also increasingly includes animal ethics), including those emerging from advances in biology, me ...
over whether the right to die is universal, only applies under certain circumstances (such as
terminal illness Terminal illness or end-stage disease is a disease that cannot be cured or adequately treated and is expected to result in the death of the patient. This term is more commonly used for progressive diseases such as cancer, rather than fatal injur ...
), or if it exists at all. It is also stated that 'right to live' is not synonymous to 'obligation to live.' From that perspective, the right to live can coexist with the right to die. The right to die is supported and rejected by many. Arguments for this right include: * If one had a right to live, then one must have the right to die, both on their terms. * Death is a natural process of life thus there should not be any laws to prevent it if the patient seeks to end it. * What we do at the end of our lives should not be of concern to others. * If euthanasia is strictly controlled, we can avoid entering a slippery slope and prevent patients from seeking alternative methods which may not be legal. Arguments against include: * It can lead to a slippery slope; if we allow patients this right, it can expand and have dire consequences. * Give rise to pressuring those to end their lives or the lives of others; ethically immoral by human and medical standards. * "Throwing away" patients who are deemed no longer capable to be part of society. * Decrease in palliative end-of-life care due to the expectation of terminal patients to exercise their right to die. A court in the American state of
Montana Montana ( ) is a landlocked U.S. state, state in the Mountain states, Mountain West subregion of the Western United States. It is bordered by Idaho to the west, North Dakota to the east, South Dakota to the southeast, Wyoming to the south, an ...
for example, has found that the right to die only applies to those with life-threatening medical conditions.
Physician-assisted suicide Assisted suicide, sometimes restricted to the context of physician-assisted suicide (PAS), is the process by which a person, with the help of others, takes actions to end their life. Once it is determined that the person's situation qualifie ...
advocate
Ludwig Minelli Ludwig A. Minelli (born 5 December 1932) is a Swiss lawyer. He is the founder of Dignitas, an organization that helps permanently ill people to end life in a manner which relieves pain and suffering. He is also the founder and general secretary ...
,
euthanasia Euthanasia (from : + ) is the practice of intentionally ending life to eliminate pain and suffering. Different countries have different Legality of euthanasia, euthanasia laws. The British House of Lords Select committee (United Kingdom), se ...
expert Sean W. Asher, and bioethics professor
Jacob M. Appel Jacob M. Appel (born February 21, 1973) is an American polymath, author, bioethicist, physician, lawyer, and social critic.Nagamatsu, Sequoia "A Few Words with the Ubiquitous Jacob M. Appel" ''Prince Mincer'' Journal http://primemincer.com/ con ...
, in contrast, argue that ''all'' competent people have a right to end their own lives. Appel has suggested that the right to die is a test for the overall freedom of a given society. A professor in social work, Alexandre Baril, proposed to create an ethic of responsibility "based on a harm-reduction, non-coercive approach to suicide. esuggest that assisted suicide should be an option for suicidal people." He argued that the voice of suicidal people is viewed as illegitimate and that there are 'injunctions to live and to futurity' where suicidal subjects are oppressed and silenced. Baril suggests the word suicidism to describe the " ..oppressive system (stemming from non-suicidal perspectives) functioning at the normative, discursive, medical, legal, social, political, economic, and epistemic levels in which suicidal people experience multiple forms of injustice and violence .. He suggests creating safer spaces and listening to suicidal people without forcing the 'will to live' upon them. The 1991 Patient Self-Determination Act passed by the
US Congress The United States Congress is the legislature, legislative branch of the federal government of the United States. It is a Bicameralism, bicameral legislature, including a Lower house, lower body, the United States House of Representatives, ...
at the request of the financial arm of Medicare does permit elderly Medicare/Medicaid patients (and by implication, all "terminal" patients) to prepare an advance directive in which they elect or choose to refuse life-extending and/or life-saving treatments as a means of shortening their lives and thus suffering unto certain death. Under the Act, the treatment refused in an advance directive does not have to be proved to be "medically futile" under some existing due-process procedure developed under state laws, such as TADA in Texas. The right to die, also known as the right to death, is an ethical and legal concept that supports the freedom of a human being to end their life or undergo voluntary euthanasia. This right is generally associated with individuals suffering from a terminal illness or lacking the will to continue living, and it may allow them to terminate their own life, refuse life-prolonging treatment, or opt for assisted suicide or euthanasia. The question of who should be able to exercise this right is often central to the debate. Some scholars and philosophers, such as David Benatar, approach this debate in terms of antinatalism. Since human beings do not have the power to act at the time of their birth, no one should have
authority Authority is commonly understood as the legitimate power of a person or group of other people. In a civil state, ''authority'' may be practiced by legislative, executive, and judicial branches of government,''The New Fontana Dictionary of M ...
over a person's decision to continue living or to die. Supporters of the right to die often connect it to the idea that a person's body and life belong solely to themselves, and they should have the
freedom Freedom is the power or right to speak, act, and change as one wants without hindrance or restraint. Freedom is often associated with liberty and autonomy in the sense of "giving oneself one's own laws". In one definition, something is "free" i ...
to dispose of them as they see fit, understanding that the right to life does not imply a duty or obligation to live. However, a legitimate state interest in preventing irrational suicides is typically opposed. For example, Avital Pilpel and Lawrence Amsel argue: "Contemporary advocates of rational suicide or the right to die generally demand, for reasons of rationality, that the decision to end one's life be an
autonomous In developmental psychology and moral, political, and bioethical philosophy, autonomy is the capacity to make an informed, uncoerced decision. Autonomous organizations or institutions are independent or self-governing. Autonomy can also be defi ...
choice of the individual (i.e., not due to pressure from doctors or family to 'do what is right' and commit suicide), that the choice be 'the best option in these circumstances' (desired by Stoics or utilitarians), as well as other natural conditions, such as the stability of the decision, the absence of
impulsivity In psychology, impulsivity (or impulsiveness) is a tendency to act on a whim, displaying behavior characterized by little or no forethought, reflection, or consideration of the consequences. Impulsive actions are typically "poorly conceived, pre ...
, the absence of mental illness, deliberation, etc."


By country

As of 2023, some forms of voluntary euthanasia are legal in
Australia Australia, officially the Commonwealth of Australia, is a country comprising mainland Australia, the mainland of the Australia (continent), Australian continent, the island of Tasmania and list of islands of Australia, numerous smaller isl ...
,
Belgium Belgium, officially the Kingdom of Belgium, is a country in Northwestern Europe. Situated in a coastal lowland region known as the Low Countries, it is bordered by the Netherlands to the north, Germany to the east, Luxembourg to the southeas ...
,
Canada Canada is a country in North America. Its Provinces and territories of Canada, ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, making it the world's List of coun ...
,
Colombia Colombia, officially the Republic of Colombia, is a country primarily located in South America with Insular region of Colombia, insular regions in North America. The Colombian mainland is bordered by the Caribbean Sea to the north, Venezuel ...
,
Luxembourg Luxembourg, officially the Grand Duchy of Luxembourg, is a landlocked country in Western Europe. It is bordered by Belgium to the west and north, Germany to the east, and France on the south. Its capital and most populous city, Luxembour ...
, the
Netherlands , Terminology of the Low Countries, informally Holland, is a country in Northwestern Europe, with Caribbean Netherlands, overseas territories in the Caribbean. It is the largest of the four constituent countries of the Kingdom of the Nether ...
,
New Zealand New Zealand () is an island country in the southwestern Pacific Ocean. It consists of two main landmasses—the North Island () and the South Island ()—and List of islands of New Zealand, over 600 smaller islands. It is the List of isla ...
,
Spain Spain, or the Kingdom of Spain, is a country in Southern Europe, Southern and Western Europe with territories in North Africa. Featuring the Punta de Tarifa, southernmost point of continental Europe, it is the largest country in Southern Eur ...
and
Switzerland Switzerland, officially the Swiss Confederation, is a landlocked country located in west-central Europe. It is bordered by Italy to the south, France to the west, Germany to the north, and Austria and Liechtenstein to the east. Switzerland ...
.


Australia

As euthanasia is a health issue, under the Australian constitution this falls to state and territory governments to legislate and manage. Euthanasia was legal within the
Northern Territory The Northern Territory (abbreviated as NT; known formally as the Northern Territory of Australia and informally as the Territory) is an states and territories of Australia, Australian internal territory in the central and central-northern regi ...
during parts of 1996–1997 as a result of the territory parliament passing Rights of the Terminally Ill Act 1995. As a territory and not a state, the federal government under
Prime Minister A prime minister or chief of cabinet is the head of the cabinet and the leader of the ministers in the executive branch of government, often in a parliamentary or semi-presidential system. A prime minister is not the head of state, but r ...
John Howard John Winston Howard (born 26 July 1939) is an Australian former politician who served as the 25th prime minister of Australia from 1996 to 2007. He held office as leader of the Liberal Party of Australia. His eleven-year tenure as prime min ...
amended the Northern Territory (Self-Government) Act 1978 (amongst others) to ensure that territories of Australia are no longer able to legislate on euthanasia. However, this was repealed in December 2022 with the passing of Restoring Territory Rights Act. The federal government is not able to legislate restrictions on health issues for the Australian states and territories in the same manner. Voluntary assisted dying schemes have been in effect in the following states; Victoria since 19 June 2019,
Western Australia Western Australia (WA) is the westernmost state of Australia. It is bounded by the Indian Ocean to the north and west, the Southern Ocean to the south, the Northern Territory to the north-east, and South Australia to the south-east. Western Aust ...
since 1 July 2021,
Tasmania Tasmania (; palawa kani: ''Lutruwita'') is an island States and territories of Australia, state of Australia. It is located to the south of the Mainland Australia, Australian mainland, and is separated from it by the Bass Strait. The sta ...
since 23 October 2022,
Queensland Queensland ( , commonly abbreviated as Qld) is a States and territories of Australia, state in northeastern Australia, and is the second-largest and third-most populous state in Australia. It is bordered by the Northern Territory, South Austr ...
since 1 January 2023, and
South Australia South Australia (commonly abbreviated as SA) is a States and territories of Australia, state in the southern central part of Australia. With a total land area of , it is the fourth-largest of Australia's states and territories by area, which in ...
since 31 January 2023.
New South Wales New South Wales (commonly abbreviated as NSW) is a States and territories of Australia, state on the Eastern states of Australia, east coast of :Australia. It borders Queensland to the north, Victoria (state), Victoria to the south, and South ...
was the final state to pass legislation for assisted dying in May 2022, which went into effect on 28 November 2023.


Belgium

In 2002, the Belgian parliament legalized euthanasia.


Canada

In August 2011, a
British Columbia British Columbia is the westernmost Provinces and territories of Canada, province of Canada. Situated in the Pacific Northwest between the Pacific Ocean and the Rocky Mountains, the province has a diverse geography, with rugged landscapes that ...
Supreme Court In most legal jurisdictions, a supreme court, also known as a court of last resort, apex court, high (or final) court of appeal, and court of final appeal, is the highest court within the hierarchy of courts. Broadly speaking, the decisions of ...
judge requested to speed up a right to die lawsuit so that Gloria Taylor could have a doctor assist her in dying by suicide. She had
Lou Gehrig's disease Amyotrophic lateral sclerosis (ALS), also known as motor neuron disease (MND) or—in the United States—Lou Gehrig's disease (LGD), is a rare, terminal neurodegenerative disorder that results in the progressive loss of both upper and lo ...
. She died of an infection in 2012. On February 6, 2015, the
Supreme Court of Canada The Supreme Court of Canada (SCC; , ) is the highest court in the judicial system of Canada. It comprises nine justices, whose decisions are the ultimate application of Canadian law, and grants permission to between 40 and 75 litigants eac ...
ruled that denying the right to assisted suicide was unconstitutional. The court's ruling limits physician-assisted suicides to "a competent adult person who clearly consents to the termination of life and has a grievous and irremediable medical condition, including an illness, disease or disability, that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition." The ruling was suspended for 12 months to allow the Canadian parliament to draft a new, constitutional law to replace the existing one. The court decision includes a requirement that there must be stringent limits that are "scrupulously monitored." This will require the death certificate to be completed by an independent medical examiner, not the treating physician, to ensure the accuracy of reporting the cause of death. The
Canadian Medical Association The Canadian Medical Association (CMA; ) is a national, voluntary association of physicians and medical learners that advocates on national health matters. Its primary mandate is to drive positive change in health care by advocating on key hea ...
(CMA) reported that not all doctors were willing to assist in a patient's death due to legal complications and went against what a physician stood for. Many physicians stated that they should have a voice when it comes to helping a patient end their life. However, the belief in late 2015 was that no physician would be forced to do so but the CMA was offering educational sessions to members as to the process that would be used. On June 17, 2016, legislation passed both houses of the
Parliament of Canada The Parliament of Canada () is the Canadian federalism, federal legislature of Canada. The Monarchy of Canada, Crown, along with two chambers: the Senate of Canada, Senate and the House of Commons of Canada, House of Commons, form the Bicameral ...
and received
Royal Assent Royal assent is the method by which a monarch formally approves an act of the legislature, either directly or through an official acting on the monarch's behalf. In some jurisdictions, royal assent is equivalent to promulgation, while in othe ...
to allow euthanasia within Canada.


Colombia

On 20 May 1997, the Constitutional Court of Colombia decriminalised piety homicide, for terminally ill patients, stating that "the medical author cannot be held responsible for the assisted suicide of a terminally ill patient" and urged
Congress A congress is a formal meeting of the representatives of different countries, constituent states, organizations, trade unions, political parties, or other groups. The term originated in Late Middle English to denote an encounter (meeting of ...
to regulate
euthanasia Euthanasia (from : + ) is the practice of intentionally ending life to eliminate pain and suffering. Different countries have different Legality of euthanasia, euthanasia laws. The British House of Lords Select committee (United Kingdom), se ...
"in the shortest time possible". On 15 December 2014, the Constitutional Court had given the Ministry of Health and Social Protection 30 days to publish guidelines for the healthcare sector to use in order to guarantee terminally ill patients, with the wish to undergo euthanasia, their right to a dignified death.


Germany

In February 2020, the
Federal Constitutional Court The Federal Constitutional Court ( ; abbreviated: ) is the supreme constitutional court for the Federal Republic of Germany, established by the constitution or Basic Law () of Germany. Since its inception with the beginning of the post-W ...
ruled that the
right to personal identity The right to personal identity is recognised in international law through a range of declarations and conventions. From as early as birth, an individual's identity is formed and preserved by registration or being bestowed with a name. However, perso ...
in German constitutional law encompasses a right to self-determined death, which in turn contains a right to suicide. Notably, this right is not limited to terminally ill patients, instead finding its limits within the requirement for the choice to be autonomous. The ruling has sparked controversy, with opponents arguing that the ruling may enable peer pressure into assisted suicide.


India

Since 2018, the Supreme Court of India has legalized passive euthanasia in India during a case involving Aruna Shanbaug under strict conditions, namely that the patient's consent (or relatives) is needed, and that the patient must be terminally ill or vegetative state.


Netherlands

The
Netherlands , Terminology of the Low Countries, informally Holland, is a country in Northwestern Europe, with Caribbean Netherlands, overseas territories in the Caribbean. It is the largest of the four constituent countries of the Kingdom of the Nether ...
legalized
voluntary euthanasia Voluntary euthanasia is the purposeful ending of another person's life at their request, in order to relieve them of suffering. Voluntary euthanasia and physician-assisted suicide (PAS) have been the focus of intense debate in the 21st century, ...
in 2002. Under Dutch law, euthanasia and assisted suicide can only be performed by doctors, and that is only legal in cases of ''"hopeless and unbearable"'' suffering. In practice, this means that it is limited to those with serious and incurable medical conditions (including
mental illness A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...
) and in considerable suffering like pain, hypoxia or exhaustion. Helping somebody to die by suicide without meeting the qualifications of the Dutch euthanasia law is illegal. These criteria concern the patient's request, the patient's suffering (unbearable), the infaust prognosis (hopeless), the information provided to the patient, the absence of reasonable alternatives, consultation of another physician and the applied method of ending life.


New Zealand

Euthanasia is legal in New Zealand. In 2015, a lawyer with cancer Lecretia Seales brought a case ('' Seales v Attorney-General'') to the High Court to challenge
New Zealand law The law of New Zealand uses the English common law system, inherited from being a part of the British Empire. There are several sources of law, the primary ones being acts enacted by the New Zealand Parliament and case law made by decisions o ...
for her right to die with the assistance of her GP, asking for a declaration that her GP would not risk conviction. However
legislation Legislation is the process or result of enrolling, enacting, or promulgating laws by a legislature, parliament, or analogous governing body. Before an item of legislation becomes law it may be known as a bill, and may be broadly referred ...
to legalize euthanasia for terminally ill patients was voted upon in the 2020 general election and was voted in favour of legalisation. The End Of Life Choice Bill took effect on 7 November 2021.


Peru

Peru legally forbids euthanasia. In 2020, a legal challenge to the law was launched by Ana Estrada, aimed at decriminalizing the practice.


United States

The term ''right to die'' has been interpreted in many ways, including issues of suicide, passive euthanasia, active euthanasia, assisted suicide, and physician-assisted suicide. In the United States, public support for the right to die by physician-assisted suicide has increased over time. In a 2005 survey, the Pew Research Center found that 70% of participants say that there are circumstances in which a patient should be allowed to die; however, only 46% of participants approved of laws permitting doctors to assist patients in ending their lives. In May 2018, a Gallup poll report announced that 72% of responders said that doctors should legally be allowed to help terminally ill patients die. However, framing effects of using language such as "suicide" rather than "ending one's life" have the potential to lower approval rates by 10-15%. A 2014 survey of physicians revealed that 54% of respondents agreed that physician-assisted suicide should be allowed. In a rigorous survey of physicians in 1996, less than 20% of physicians reported that they received requests from patients to be euthanized, and less than 5% complied. In 2020, the Oregon Death with Dignity Act data summary revealed that the number of prescriptions for lethal doses of medications increased by 25% since 2019, and have been steadily increasing since 1998. Of patients who received these prescriptions, 66% eventually died from ingesting the medications.


Major right to die cases


=Karen Quinlan

= The right to die movement in the United States began with the case of Karen Quinlan in 1975 and continues to raise bioethical questions about one's quality of life and the legal process of death. Quinlan, 21, lost consciousness after consuming alcohol and tranquilizers at a party. She soon began to experience respiratory problems, which then prevented oxygen from flowing to her brain. That led her to slip into a comatose state in which a respirator and a feeding tube were used to keep her alive and breathing. Quinlan did not have a proxy or living will and had not expressed her wishes if something ever happened to her to those around her, which made it difficult to decide what the next step should be. Quinlan's parents understood that their daughter would never wake up and that prolonging her life may be more damaging and it would not be of quality life. Her father sought out the right to be Quinlan's legal guardian and petitioned for the removal of the respirator that was keeping her alive. The court, however, argued that the removal of the ventilator, which would lead to Quinlan's death, would be considered unlawful, unnatural, and unethical. Quinlan's lawyer made the counterargument that the removal of the respirator would allow Quinlan to have a natural death, which is natural and ethical. The Quinlans won the court case and were appointed as the legal guardians of their daughter. The respirator was removed in 1976, but Quinlan continued to live without the ventilator until 1985. The case continues to raise bioethical questions of one's quality of life and the legal process of death. It also brings up many important issues that are still being addressed to this day. One of the critical points that the Quinlan case brings up is the patient's right to deny or withdraw treatment. Cases in which the patient rejected or withdrew treatment were then unheard of and went against medical ethics in preserving one's life. Debates on allowing patients the right to self-determination were controversial, and they would be evaluated for the next couple of decades from state to state. The case also brought up whether family members and those who are close to the patient are allowed in the decision-making process. Since Quinlan had no written documentation, voiced no decision, and appointed no proxy, a lengthy legal battle was caused between the Quinlan family and the state in determining Quinlan's best interest and determining if she would want to live or die. That had a significant influence on the use and establishment of advance directives, oral directives, proxies, and living wills.


=Nancy Cruzan

= Another major case that further propagated the right to die movement and the use of living wills, advance directives and use of a proxy was ''
Cruzan v. Director, Missouri Department of Health ''Cruzan v. Director, Missouri Department of Health'', 497 U.S. 261 (1990), was a List of landmark court decisions in the United States, landmark decision of the Supreme Court of the United States involving a young adult incompetence (law), incom ...
''. In 1983, Cruzan had a car accident, which left her permanently in a vegetative state. Her status as an adult and lack of an advance directive, living will, or proxy led to a long legal battle for Cruzan's family in petitioning for the removal of her feeding tube, which was keeping her alive since the accident. Cruzan had mentioned to a friend that under no circumstances would she want to continue to live if she were ever in a vegetative state, but this was not a strong enough statement to remove the feeding tube. Eventually, the Cruzan family won the case and had their daughter's tube removed. The case brought great debate if the right to die should be approved from state to state or as a whole nation.


=Terri Schiavo

= The Terri Schiavo case occurred between 1990 and 2005. This case was controversial due to a disagreement between Schiavo's immediate family members and her husband. In the Quinlan and Cruzan cases, the family was able to make a unanimous decision on the state of their daughters. Schiavo suffered from a cardiac arrest which led to her collapse and soon after began to have trouble breathing. The lack of oxygen to her brain caused irreversible brain damage, leaving her in a vegetative state and required a feeding tube and ventilator to keep her alive. Schiavo left no advance directive or had a discussion with her parents or husband about what she may have wanted if something were to happen to her. Soon after, her husband was appointed as her legal guardian. Years later, her husband decided to remove Schiavo's feeding tube since the chances of her waking up were slim to none. Schiavo's family, however, argued against this decision and brought this case to court. The case was very turbulent and occurred over some years and involved the state and its legislators before a decision was made. This brought up bioethical debates on the discontinuation of Schiavo's life vs. allowing her to continue living in a permanent vegetative state. Those who were for preserving Schiavo's life stated that removing the tube would be ethically immoral since they do not know what she would have wanted. They challenged her physical and mental state and stated that she might have some consciousness; thus she deserved to continue living. Those for removing the tube argued for self-determination and that her quality of life was diminished. The Schiavo case is the most recent and significant right to die case that propagates the thought of having an advance directive or living will. It also further looks into other complications that can arise, such as family disagreements, which should have been accounted for when dealing with a right to die case. ;See also * ''
Washington v. Glucksberg ''Washington v. Glucksberg'', 521 U.S. 702 (1997), was a List of landmark court decisions in the United States, landmark decision of the U.S. Supreme Court, which unanimously held that a right to assisted suicide in the United States was not prote ...
'' * '' Vacco v. Quill''


Legislation

As the health of citizens is considered a police power left for individual states to regulate, it was not until 1997 that the US Supreme Court made a ruling on the issue of assisted suicide and one's right to die. That year, the Supreme Court heard two appeals arguing that New York ('' Vacco v. Quill'') and Washington (''
Washington v. Glucksberg ''Washington v. Glucksberg'', 521 U.S. 702 (1997), was a List of landmark court decisions in the United States, landmark decision of the U.S. Supreme Court, which unanimously held that a right to assisted suicide in the United States was not prote ...
'') statutes that made physician-assisted suicide a felony violated the equal protection clause of the Fourteenth Amendment. In a unanimous vote, the Court held that there was no constitutional right to physician-assisted suicide and upheld state bans on assisted suicide. While in New York has maintained statutes banning physician-assisted suicide, the Court's decision also left it open for other states to decide whether they would allow physician-assisted suicide or not. Since 1994, the following states in the US have passed assisted suicide laws: Oregon (Death with Dignity Act, 1994), Washington (Death with Dignity Act, 2008), Vermont (Patient Choice and Control at the End of Life Act, 2013), California (End of Life Option Act, 2015), Colorado (End of Life Options Act, 2016), District of Columbia (D.C. Death with Dignity Act, 2016), Hawaii (Our Care Our Choice Act, 2018), Maine (Death with Dignity Act, 2019), New Jersey (Aid in Dying for the Terminally Ill Act, 2019), and New Mexico (Elizabeth Whitefield End of Life Options Act, 2021) passed legislation that provides a protocol for the practice of physician-assisted suicide. The law in these states allows terminally ill adult patients to seek lethal medication from their physicians. In 2009, the Montana Supreme Court ruled that nothing in state law prohibits physician-assisted suicide and provides legal protection for physicians in the case that they prescribe lethal medication upon patient request. In California, the governor signed a controversial physician-assisted-suicide bill, the California End of Life Option Act, in October 2015 that passed during a special legislative session intended to address Medi-Cal funding, after it had been defeated during the regular legislative session. In early 2014, New Mexico Second District Judge Nan Nash ruled that terminally ill patients have the right to aid in dying under the state constitution, i.e., making it legal for a doctor to prescribe a lethal dose of medication to a terminally ill patient. The ultimate decision will be made with the outcome of New Mexico's Attorney General's appeal to the ruling. Organizations have been continuously pushing for the legalization of self-determination in terminally ill patients in states where the right to end one's life is prohibited. Medical Perspective The American Medical Association (AMA) is the national association that advocates for physicians and provides guidance for the best practices for delivering health care. The AMA is responsible for maintaining the Code of Ethics, which consists of two parts: the Principles of Medical Ethics and Opinions of the AMA's Council on Ethical and Judicial Affairs. The role of physicians in patient's right to die is debated within the medical community, however, the AMA provided an opinion statement on the matter. Opinion statement regarding physician-assisted suicide Patients who are terminally ill or suffering from debilitating illnesses may decide that they prefer to die rather than continue suffering. Physicians commit themselves to " do no harm" and by participating in assisted suicide physicians would inherently be causing harm to their patients. Rather than participating in assisted suicide, physicians should provide palliative care to minimize patient suffering. These are recommendations for physicians from the Code of Medical Ethics Opinion 5.7 regarding end of life care: * Should not abandon a patient once it is determined that a cure is impossible. * Must respect patient autonomy. * Must provide good communication and emotional support. * Must provide appropriate comfort care and adequate pain control.


Religion

Hinduism Hinduism () is an Hypernymy and hyponymy, umbrella term for a range of Indian religions, Indian List of religions and spiritual traditions#Indian religions, religious and spiritual traditions (Sampradaya, ''sampradaya''s) that are unified ...
accepts the right to die for those who are tormented by terminal diseases or those who have no desire, no ambition, and no responsibilities remaining. Death is allowed by non-violent means such as fasting to the point of starvation ( Prayopavesa).
Jainism Jainism ( ), also known as Jain Dharma, is an Indian religions, Indian religion whose three main pillars are nonviolence (), asceticism (), and a rejection of all simplistic and one-sided views of truth and reality (). Jainism traces its s ...
has a similar practice named ''
Santhara (IAST: ), also known as ''samlehna'', ''santhara'', ''samadhi-marana'' or ''sanyasana-marana'', is a supplementary vow to the ethical code of conduct of Jainism. It is the religious practice of voluntarily fasting to death by gradually redu ...
''. Other religious views on suicide vary in their tolerance and include denial of the right as well as condemnation of the act. In the Catholic faith, suicide is considered a grave sin.


See also

Initiatives * Advance Directives Act (Texas) * Initiative 1000 (Washington) * Oregon Death with Dignity Act Groups * Compassion & Choices of Oregon * Death with Dignity National Center * Dignitas * Exit International * World Federation of Right to Die Societies * Final Exit Network Films * '' How to Die in Oregon'' documentary film * ''
Right to Die? ''Right to Die?'', also known as ''The Suicide Tourist'', is a documentary film directed by Canadian John Zaritsky about the assisted suicide of Craig Colby Ewert (1947–2006), a 59-year-old retired university professor who suffered from amyot ...
'' documentary film * ''
The Sea Inside ''The Sea Inside'' () is a 2004 psychological drama film co-written and directed by Alejandro Amenábar, who also co-produced, scored and edited. It is based on the real-life story of Ramón Sampedro (played by Javier Bardem), who was left quadr ...
'' drama film * '' Whose Life Is It Anyway?'' drama film Books * '' Final Exit'' Individuals *
Elizabeth Bouvia Elizabeth Bouvia (born c. 1958 - March 29, 2014) was a figure in the American right-to-die movement. Her case attracted nationwide attention in this area as well as in medical ethics. History On September 3, 1983, Bouvia, at the age of 26, admitte ...
* Eluana Englaro * Edward Brongersma * Betty and George Coumbias * David Goodall * Tirhas Habtegiris * James Harden-Hickey *
Derek Humphry Derek Humphry (29 April 1930 – 2 January 2025) was a British and American journalist and author. He was a proponent of legal assisted suicide and the right to die. In 1980 he co-founded the Hemlock Society and in 2004 after the Society dissol ...
* Richard Huxtable * Jack Kevorkian * Brittany Maynard *
Philip Nitschke Philip Haig Nitschke (; born 8 August 1947) is an Australian humanist, author, former physician, and founder and director of the pro-euthanasia group Exit International. He campaigned successfully to have a legal euthanasia law passed in Austral ...
* Haleigh Poutre *
Diane Pretty Diane Pretty (15 November 1958 – 11 May 2002) was a British woman from Luton who was the focus of a debate about the laws of euthanasia in the United Kingdom during the early part of the 21st century. She had attempted to change British law so s ...
* Karen Ann Quinlan * Sue Rodriguez * Jo Roman *
Terri Schiavo The Terri Schiavo case was a series of court and legislative actions in the United States from 1998 to 2005, regarding the care of Theresa Marie Schiavo (née Schindler) (; December 3, 1963 – March 31, 2005), a woman in an irreversible ...
* Ramón Sampedro * Piergiorgio Welby Other related * Advocacy of suicide *
Assisted suicide Assisted suicide, sometimes restricted to the context of physician-assisted suicide (PAS), is the process by which a person, with the help of others, takes actions to end their life. Once it is determined that the person's situation qualifie ...
*
Bioethics Bioethics is both a field of study and professional practice, interested in ethical issues related to health (primarily focused on the human, but also increasingly includes animal ethics), including those emerging from advances in biology, me ...
/
Medical ethics Medical ethics is an applied branch of ethics which analyzes the practice of clinical medicine and related scientific research. Medical ethics is based on a set of values that professionals can refer to in the case of any confusion or conflict. T ...
*
Bodily integrity Bodily integrity is the inviolability of the physical body and emphasizes the importance of personal autonomy, self-ownership, and self-determination of human beings over their own bodies. In the field of human rights, violation of the bodily int ...
*
Coup de grâce A coup de grâce (; ) is an act of mercy killing in which a person or animal is struck with a melee weapon or shot with a projectile to end their suffering from mortal wounds with or without their consent. Its meaning has extended to refer to ...
*
Do not resuscitate A do-not-resuscitate order (DNR), also known as Do Not Attempt Resuscitation (DNAR), Do Not Attempt Cardiopulmonary Resuscitation (DNACPR), no code or allow natural death, is a medical order, written or oral depending on the jurisdiction, indica ...
*
End-of-life care End-of-life care is health care provided in the time leading up to a person's death. End-of-life care can be provided in the hours, days, or months before a person dies and encompasses care and support for a person's mental and emotional needs, phy ...
*
Euthanasia Euthanasia (from : + ) is the practice of intentionally ending life to eliminate pain and suffering. Different countries have different Legality of euthanasia, euthanasia laws. The British House of Lords Select committee (United Kingdom), se ...
* Force feeding *
Free will Free will is generally understood as the capacity or ability of people to (a) choice, choose between different possible courses of Action (philosophy), action, (b) exercise control over their actions in a way that is necessary for moral respon ...
*
Freedom of choice Freedom of choice describes an individual's opportunity and autonomy to perform an action selected from at least two available options, unconstrained by external parties. In politics In the abortion debate, for example, the term "freedom of c ...
* Philosophy of suicide *
Right to life The right to life is the belief that a human (or other animal) has the right to live and, in particular, should not be killed by another entity. The concept of a right to life arises in debates on issues including: capital punishment, with some ...
*
Letting die In non-consequentialist ethical thought, there is a moral distinction between killing and letting die. Whereas killing involves intervention, letting die involves withholding care (for example, in passive euthanasia), or other forms of inaction ...
*
Liberty Liberty is the state of being free within society from oppressive restrictions imposed by authority on one's way of life, behavior, or political views. The concept of liberty can vary depending on perspective and context. In the Constitutional ...
*
Living will An advance healthcare directive, also known as living will, personal directive, advance directive, medical directive or advance decision, is a document in which a person specifies what actions should be taken for their health if they are no longe ...
* Patient refusal of nutrition and hydration *
Self-ownership Self-ownership, also known as sovereignty of the individual or individual sovereignty, is the concept of property in one's own person, expressed as the moral or natural right of a person to have bodily integrity and be the exclusive controlle ...


References


Further reading

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"Uit Vrije Wil – Burgerinitiatief voltooid leven"
{{DEFAULTSORT:Right To Die Autonomy Euthanasia Suicide Human rights by issue