research questions for euthanasia

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123 Euthanasia Essay Questions & Title Ideas

This compilation of research questions on euthanasia offers diverse perspectives. Examine the moral implications of assisted suicide or dissect the legal frameworks governing end-of-life decisions. You can foster informed discussions and critical reflections on one of the hottest ethical dilemmas of our time with the help of euthanasia title ideas below.

⚡ TOP 7 Euthanasia Research Questions

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• Euthanasia Pros and Cons
• Euthanasia & Assisted Suicide Should Not Be Legal
• For and Against Euthanasia: An Ethical Perspective
• Aristotle Theory About Euthanasia – Ethics
• Opinions About Euthanasia: For and Against
• Euthanasia: Advantages and Disadvantages
• Euthanasia Through an Egoism Ethical Theory Lens
• Euthanasia – Mercy Killing or Assisted Suicide This paper will examine moral and ethical concerns surrounding euthanasia, clarify the meaning of the term, present arguments both for and against the practice and conclude with a recommendation to resolve the issue.
• Euthanasia and Morality Debate Euthanasia may be defined as the assistance provided to people who deliberately want to die due to suffering too much pain because of being terminally ill.
• Susan Wolf on Euthanasia: Moral Obligations and Assisted Suicide The article written by Susan Wolf urges the readers to reevaluate their views on euthanasia and assisted suicide.
• Euthanasia: The Legal and Ethical Perspectives The aim of this essay is to explore the legal and ethical perspectives on euthanasia, discuss the perspectives of ethical egoists and social contract ethicists.
• Legalization of Euthanasia: Key Arguments Euthanasia should be legalized as it presupposes an individual’s right to choose and a doctor’s obligation to treat and help the person.
• Law and Medical Ethics: Euthanasia and Physician Assisted Death Euthanasia and physician-assisted suicide are practices that occur in many countries. Some countries and states such as the Netherlands, Belgium, Switzerland and Oregon have made these practices legal.
• Why Euthanasia Should Not Be Legalised Euthanasia legislation is typically championed by individuals who have experienced a loved one dying under unfavorable conditions.
• “Active and Passive Euthanasia” by Rachels The purpose of the paper is to discuss the philosopher’s position and the argument in favor of the claim as well as to analyze them.
• Euthanasia or Assisted Suicide The present paper looks into the issue of physician- or doctor-assisted suicide or euthanasia from a number of perspectives.
• Euthanasia Definition, Types, Pros and Cons The relationship between euthanasia and dying with dignity exemplify the up to date stress on self-determination as an illustration of personal independence.
• Euthanasia – For Legalizing Euthanasia is not the same as other practices such as Physician-Assisted Suicide, Terminal Sedation or Withholding/Withdrawing Life-Sustaining Treatments.
• Ethical Theories Applied to the Euthanasia Issue The main meaning and ethical side of euthanasia is that a person dying from an incurable disease can voluntarily die in the presence of doctors and relatives.
• Legalizing Euthanasia: Nonmaleficence, Beneficence, and Patient Autonomy Physician-assisted suicide is an undeniably controversial topic, which gains more attention from the public the more countries start to legalize it.
• Assisted Euthanasia: Philosophical Perspectives The analysis of assisted euthanasia from the standpoint of one specific concept is impossible due to distinctive views on this phenomenon and unique philosophical ideas.
• Euthanasia from Religious Perspectives The article analyzes the views on euthanasia from the point of view of the Jewish, Christian, and Islamic religions.
• Euthanasia as an Ethical Issue Based on ethics and morality, euthanasia is a practice that cannot be accepted at all. The concept of human value extends beyond the suffering an individual is now enduring.
• Euthanasia: A Child’s Right to Die Euthanasia needs to be considered as a viable option only under specific circumstances, which leave no alternative option for the patient’s dignity.
• The Issue of Euthanasia of Valentina Moreira From the point of view of Christianity, President Michelle Bachelet made the right choice, not allowing an exception for Valentina Moreira and forbidding her euthanasia.
• Aspects of Legalizing Euthanasia The paper states that euthanizing patients is not murdering them because it is considered the art of bringing an inevitable death closer.
• The Problem of Euthanasia Moral Acceptance The concept of euthanasia became a topic of ethical discussion regarding the acceptance of specific procedures directly affecting the personal right to live.
• Euthanasia as a Medical Ethical Dilemma The aim of the work is to analyze the ethical problem of medicine, such as euthanasia, and consider it as an example of a specific situation.
• Animal Shelter Euthanasia Reduction Strategies When it comes to animal shelter euthanasia anywhere in the United States and California in particular, this paper argues that it is unnecessary and should not be legalized.
• The Moral Arguments in Favor of Euthanasia Euthanasia opponents say that using the terms “mercy” and “justice” to justify forced euthanasia is a recipe for possible social chaos.
• The Legalization and Moral Issues about Euthanasia This paper explores the controversial topic of euthanasia and physician-assisted suicide from a legal and moral standpoint.
• Self-Determination Right and Euthanasia The current euthanasia-related discussion aims to identify the moral rightness to kill or let a person die for the good plays an important role.
• Euthanasia from the Ethical Point of View Euthanasia is a controversial aspect of medicine that causes a lot of discussions. The main issue is the ethical side of the problem.
• Euthanasia: Physician-Assisted Suicide, Disability, and Paternalism Involuntary euthanasia, on the other hand, means that such a person would prefer to live but has a condition that would cause their death eventually.
• Euthanasia in Modern World: Ethical & Legal Issues The article provides a detailed overview of the rich empirical evidence on attitudes towards euthanasia and its legal status in the US, Canada, and Europe.
• Americans’ Strong Support for Euthanasia Persists The subject of euthanasia and physician-assisted suicide (PAS) has seen much controversy and debate on its legality, morality, and ethics in the recent past.
• Euthanasia in the Terri Schiavo Case End-of-life care and its elements are associated with many ethical issues because it is not always clear whether euthanasia is necessary.
• The Issues Regarding Euthanasia The paper provides the philosophy regarding euthanasia, how the position aligns with a biblical worldview, and an analysis of the opposing side to the position.
• Euthanasia in Nursing Practice Euthanasia in nursing is a debatable phenomenon, but in the countries where it is legalized, nursing staff should be prepared and educated for it to provide high-quality care.
• Euthanasia as Social and Ethical Problem Euthanasia is an ethical problem concerned with aspects of religion and suicide, justice and privacy, and the role of a doctor in our society.
• Euthanasia as a Method Against Human Suffering The phenomenon of euthanasia and its application in the medical sphere is a vital debate topic addressed by numerous scholars worldwide.
• Decision-Making: Euthanasia in Switzerland Agreeing to euthanasia is one of the hardest decisions to make. Christian values and some ethical principles that govern decision-making, one can make a sound decision.
• Ethical Dilemma: Euthanasia The present paper compares the Christian worldview to own worldview assumptions of euthanasia.
• Medical Ethics: Euthanasia Prohibition The paper summarizes the points and states the reasons for considering euthanasia prohibition illegal. The major argument recapitulates the point of the essay.
• Euthanasia as a Remedy for Patients Despite the immorality of euthanasia in modern society, it is an ethically permissible procedure that follows the major philosophical principles.
• Legalizing Euthanasia: Pros and Cons Euthanasia should be a fundamental right because it gives patients the power to make conscious decisions about their fate.
• Euthanasia: Social Values and Nursing Practice Euthanasia has negative implications as it fails to recognize the value of human life. It also has negative effects on families and it leads to distress and devastation.
• Ethical Considerations Supporting Euthanasia In this paper, the case of the Oregon Death with Dignity Act will be reviewed as an example of legalized assisted dying in the USA.
• Euthanasia: Ethical Theories About the Topic Euthanasia is a controversial topic with many people from all walks of life arguing for and against it. Some academicians think that it cannot be allowed under any circumstances.
• The Morality of Euthanasia Euthanasia is any action directed on putting an end to the life of a human being, fulfilling his/her own desire, and executed by a disinterested person.
• Arguments for Euthanasia Analysis Euthanasia, otherwise known as mercy killing or assisted suicide, has been a controversial subject for many centuries.
• Euthanasia – The Essential Right to Die The phenomenon of euthanasia occurred with the development of social progress and in particular science and technology related to the maintenance of life seriously ill people.

Three Types of Euthanasia

Are you working on your research questions on euthanasia types? Then, you should know that there are three approaches to conducting euthanasia – voluntary (with the patient’s consent), non-voluntary (in the conditions when getting consent is impossible), and involuntary (against the patient’s will).

Euthanasia in Ancient Times

Some of the most intriguing euthanasia research topics are concerned with ancient practices. This procedure was widespread in Ancient Greece and Rome with dying and suffering patients. Various ancient drugs, including hemlock, were used to relieve suffering by hastening death, though Hippocrates was against that method.

Early Euthanasia Movement in the US

With the advent of the modern hospital system in the USA, doctors like Robert Ingersoll and Felix Adler started advocating for voluntary suicide for people suffering from terminal illnesses. Several states attempted to legalize euthanasia via the administration of anesthetics in 1906, but with no success.

Nazi Euthanasia Program

Are you looking for a thrilling euthanasia title? Consider writing about the Nazi euthanasia program. The Nazis held very cruel beliefs about the person’s physical health and considered people with disabilities not deserving the right to live. The 1939 killing of a disabled infant was the first case of state-sanctioned euthanasia and opened a path to over 300,000 murders among the mentally and physically handicapped Germans.

• Euthanasia and Its Current Legal Situation
• Christian and Muslims Attitudes to Euthanasia
• Euthanasia, Environmental Conservation, and Morality
• Assisted Suicide and Euthanasia No Human Life Should and by Unnatural Means
• Critical Thinking About Euthanasia as an Ethical Alternative to a Life of Suffering
• Ethical Arguments for and Against Voluntary Euthanasia
• The Criticisms and Opposition of Euthanasia in Australia
• Circumstances That Justify the Use of Physician-Assisted Suicide and Euthanasia
• Euthanasia Answers the Prayers of the Dying
• The Philosophical, Legal, and Medical Issues on Euthanasia
• Euthanasia, Making the Right Decision for Your Loved Ones
• Christian Ethics: Euthanasia Assignment
• Euthanasia: Current Policy, Problems, and Solution
• The Distinction Between Active and Passive Euthanasia
• Assisted Suicide and Euthanasia – It Is Not Murder, It Is Mercy
• The Factors That Influence the Legalization of Active and Passive Euthanasia in the United States
• Ethical Issues Surrounding the Choice of Euthanasia in the United States
• Euthanasia for Terminally Ill Patients Should Be Legalized
• Legal and Ethical Views on Physician-Assisted Suicide and Euthanasia
• Ethical, Moral and Religious Issues Surrounding Euthanasia

Passive Vs. Active Euthanasia: Which Is More Ethical?

Active euthanasia involves a medical specialist who administers a lethal drug and kills the patient. Passive euthanasia means letting the patient die by withdrawing artificial life support. Both variants cause heated debates. In your euthanasia research paper, you can explore the ethical and legal aspects of these practice types.

Should Involuntary Euthanasia Be Considered as a Type of Murder?

Involuntary euthanasia is the act of killing a person with medical means without their consent and — in most cases — even against their will. This form of euthanasia, though formally dictated by the rationale of ‘mercy killing,’ is regarded as murder because it neglects the person’s fundamental right to life. Move on with your argumentative euthanasia paper on this subject with our suggestions.

What Are the Arguments of Active Euthanasia Advocates?

Euthanasia advocates place a strong emphasis on the person’s right to die and rely on medical assistance in this decision related to the person’s voluntary death. This way, the medical professional can assume the responsibility for taking the patient’s life as their final act of help and the fulfillment of the patient’s will.

Do you want to craft essays about advocacy for euthanasia? You’re sure to benefit from the following topic ideas.

• Euthanasia Law: Legalization of Euthanasia Issues One of the more controversial subjects in the medical field and elsewhere for many years has been the question of euthanasia, otherwise known as mercy killing or assisted suicide
• Blogs on Euthanasia: Rhetorical Analysis Euthanasia is the act or practice of deliberately ending the life of an individual who could either be suffering from a terminal illness or be in an incurable condition.
• Euthanasia for Terminally Ill and Religious Ethics The patient is in his fifties and has been recently diagnosed with amyotrophic lateral sclerosis. He starts thinking of voluntary euthanasia.
• Euthanasia Decision Regarding Christian Worldview This paper has revealed that religious worldviews can guide people to make evidence-based decisions whenever dealing with complex issues, such as suicide and euthanasia.
• Euthanasia in Non-Terminally Ill Patients This paper gives a brief history of euthanasia in non-terminally ill patients, its moral relevance, and arguments surrounding this evidence-based medical practice.
• Biomedical Legislation and Euthanasia Mercy killing can be regarded as an option in various settings as people often have no strength or patience to endure pain. Supporters of the legitimization of euthanasia emphasized this matter.
• Euthanasia and Assisted Suicide in Europe and the US Euthanasia is defined as a deliberate action with the aim of ending a patient’s life to ease the suffering caused by the disease.
• Euthanasia in Public Opinion and Policy-Making Raising awareness of euthanasia is important not only because of the ongoing debate but also because of the topic’s complexity and relations to individual cases.
• Euthanasia-Associated Ethical Challenges in Nursing Rather than legalizing euthanasia, the government and other stakeholders in the health sector should push for the improvement of patient outcomes and nursing practices.
• Raising Awareness: Euthanasia as an Important Part of Modern Society and Care The attitude and approach toward euthanasia have always been complicated since the discussion of euthanasia itself can become extremely controversial.
• Acceptability of Euthanasia: Moral and Humanistic Views Euthanasia is one of the most controversial issues of the modern era that could be discussed in terms of the deontological ethical theory.
• Is Euthanasia Morally Acceptable? This paper discusses should euthanasia be allowed under any circumstances in the cases when the patient is asking for it himself.
• Euthanasia as a Christian Ethical Dilemma The issue of euthanasia has been quite topical over the past few years. It is viewed as inadmissible from the Christian perspective.
• Euthanasia in Christianity and Buddhism This paper provides a discussion on a case study on euthanasia of a man, who finds out he has a severe disease that will disable him within several years.
• Euthanasia Controversy and Supporting Arguments Euthanasia is one of the most controversial issues in the modern health care environment. It can be performed in several assorted forms.
• Euthanasia and Moral Reasoning Voluntary euthanasia may be morally acceptable because a terminally ill patient whose life functions are disrupted cannot live life to its full extent and pursue happiness.
• Moral Doctrine of Active and Passive Euthanasia The paper reviews topics of active euthanasia, the limitations of the conventional moral doctrine, relation between passive euthanasia and intention or voluntary actions.
• Animal Rights & Healthcare: Euthanasia for Quality of Life Pet-owners desire that their ailing pets have painless and stress-free deaths. This eliminates trauma for both a pet and its owner.
• Performing Assisted Euthanasia on Kees de Joode: A Compassionate Choice In the documentary Death Upon Request assisted euthanasia is the result of the patient’s decision, since some people prefer to die in dignity in order not to burden their loved ones.
• Voluntary and Involuntary Euthanasia: Understanding the Differences Voluntary euthanasia occurs due to permission from the patient. Active euthanasia happens when a third party carries out a deliberate act which causes death of a patient.

Killing Vs. Letting Die: Is There a Difference?

Healthcare professionals are divided on the subject of who should administer the lethal drug to the patient. Giving the means and letting the person die is less criminal at first glance, yet doctors are tied to their oath of helping patients and preventing deaths. Make your euthanasia essay interesting to read with the following topics.

Regulating Euthanasia

There is a complex legal framework surrounding euthanasia and its types. For instance, voluntary euthanasia is legally accepted in many countries, including Australia, Spain, Canada, and more. Yet, there are distinctions in laws regarding passive vs. active euthanasia practices. We’ve compiled a list of clever euthanasia titles about relevant laws and policies worldwide.

Secular Objections to Euthanasia

The strongest arguments against euthanasia relate to the doctor’s primary role of protecting and healing instead of killing, the lack of patient competence on the subject of their condition, and the guilt imposed on doctors committing euthanasia. Opponents also claim that euthanasia is a slippery slope to deciding who should live and who should die, which may open legal loopholes for legal murders on many grounds. Discuss the following questions about euthanasia in your following research paper.

The debate over euthanasia is multifaceted, with compelling arguments on both sides. The points below encapsulate the key considerations that fuel the ongoing discourse about this issue. Have a look on arguments for both for and against sides!

✅ Arguments For Euthanasia Essay

❌ Arguments Against Euthanasia Essay

• Are Physician-Assisted Suicide and Euthanasia Ethical?
• What Is the Ethical Issue of Euthanasia?
• What Is the Moral Significance of Euthanasia?
• Should Euthanasia and Assisted Suicide Be Legalized?
• Can Hegelian Dialectics Justify Euthanasia?
• Is Animal Euthanasia Ethical?
• What Does Kantian Ethics Say About Euthanasia?
• How May the Christian Faith Inform the Debate Over Euthanasia?
• Why Passive Euthanasia Is Ethical?
• Why Is Euthanasia a Debate?
• What Are the Advantages of Euthanasia?
• Would You Let Euthanasia End One’s Life?
• What Are Four Arguments Against Euthanasia?
• What Are Two Arguments in Support of Euthanasia?
• Why Euthanasia Should Not Be Legalised?
• What Are the Four Different Types of Euthanasia?
• Why Some Forms of Euthanasia May Be Ethically Justified?
• Why Can Christians Not Accept Euthanasia?
• Is Euthanasia Legal in Australia?
• How Does Euthanasia Work?
• How Do Vets Feel About Euthanasia?
• How Do Different Religions View Euthanasia?
• Why Do Dogs Gasp After Euthanasia?
• How Christians Apply Their Beliefs to Abortion and Euthanasia?
• Where Was Euthanasia First Legalized?
• How Does Brian Clark Use Theatre to Dramatise the Euthanasia Debate?
• Who Came up With the Idea of Euthanasia?
• How a Death Request Should Be Legalized in the Debate About Euthanasia?
• Where Is Euthanasia Legal in Canada?
• Does Euthanasia Hurt?

Once you’ve chosen a topic for your essay, it is vital to formulate a proper thesis statement. With a well-crafted thesis statement, you will have a clear focus and tone, helping readers to anticipate the key ideas and arguments. Let’s see how to do it for an euthanasia essay.

Writing a thesis statement on the complex topic of euthanasia requires precision and consideration of the various aspects and ethical dilemmas. Here are some tips to help you craft an effective thesis statement on euthanasia:

Euthanasia Thesis Statement Examples

Now, let’s look at good examples of thesis statements for euthanasia essay.

Example 1: This essay raises intricate ethical dilemmas of euthanasia at the intersection of individual autonomy and societal values. Exploring cultural, religious, and medical perspectives, it will navigate the complexities surrounding end-of-life choices. Moreover, it promotes an open dialogue that respects personal autonomy and recognizes the broader implications on medical practice and societal norms.

Example 2: The ethical discourse surrounding euthanasia hinges on the balance of compassionate relief from suffering and preserving the sanctity of life. This essay critically examines the moral dimensions of physician-assisted suicide, considering the rights of individuals to die with dignity while addressing the ethical responsibilities of medical professionals.

Example 3: Euthanasia challenges societies to reconcile personal autonomy with the value of life. This essay explores the ethical and legal contours of euthanasia and the implications of its various forms on patients and medical practitioners. It also highlights the need for comprehensive and compassionate end-of-life care options.

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StudyCorgi . "123 Euthanasia Essay Questions & Title Ideas." December 21, 2021. https://studycorgi.com/ideas/euthanasia-essay-topics/.

StudyCorgi . 2021. "123 Euthanasia Essay Questions & Title Ideas." December 21, 2021. https://studycorgi.com/ideas/euthanasia-essay-topics/.

These essay examples and topics on Euthanasia were carefully selected by the StudyCorgi editorial team. They meet our highest standards in terms of grammar, punctuation, style, and fact accuracy. Please ensure you properly reference the materials if you’re using them to write your assignment.

This essay topic collection was updated on October 3, 2024 .

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• v.111(11); 2018 Nov

Euthanasia and assisted dying: what is the current position and what are the key arguments informing the debate?

Andreas fontalis.

1 St George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK

Efthymia Prousali

2 Aristotle University of Thessaloniki, 54124 Thessaloniki Greece

Kunal Kulkarni

3 University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, LE1 5WW, UK

Assisted dying is a highly controversial moral issue incorporating both physician-assisted dying (PAD) and voluntary active euthanasia. End-of-life practices are debated in many countries, with assisted dying receiving different consideration across various jurisdictions. In this paper, we provide an analytic framework of the current position and the main arguments related to the rights and moral principles concerning assisted dying. Assisted dying proponents focus on the respect of autonomy, self-determination and forestalling suffering. On the other hand, concerns are raised regarding the interpretation of the constitutional right to life and balancing this with the premise of assisted dying, alongside the impacts of assisted dying on the doctor–patient relationship, which is fundamentally based on trust, mutual respect and the premise of ‘first do no harm’. Our review is underpinning the interpretation of constitutional rights and the Hippocratic Oath with the premise of assisted dying, alongside the impacts of assisted dying on the doctor–patient relationship. Most clinicians remain untrained in such decision making, with fears against crossing key ethical divides. Due to the increasing number of cases of assisted dying and lack of consensus, our review enables the integration of ethical and legal aspects and facilitates decision making.

Introduction

Assisted dying remains a highly controversial moral issue, with clinical, legal, political, religious and ethical considerations playing an important role. Lack of consensus and ongoing debate are features of modern life, while the law generally sustains a broader, pluralist outlook. Advances in both life-prolonging treatments and palliative care in recent years are inextricably intertwined with this complex topic, resulting in the continuing demand for amendments on current legislations. 1 This review presents an overview of the current status of this topical debate.

Definition and current legal framework

Assisted dying is a general term that incorporates both physician-assisted dying and voluntary active euthanasia . Voluntary active euthanasia includes a physician (or third person) intentionally ending a person’s life normally through the administration of drugs, at that person’s voluntary and competent request. 2 , 3 Facilitating a person’s death without their prior consent incorporates both non-voluntary euthanasia (when the patient is not capable of providing informed consent, e.g. vegetative state, young child) and involuntary euthanasia (against patient’s will). Physician-assisted dying is defined as follows: a physician intentionally helping a person to terminate their life by providing drugs for self-administration, at that person’s voluntary and competent request. 2 , 3 Consequently, in the first case a third person acts resulting in patient’s death, whereas in physician-assisted dying the action is undertaken by the patient who is given lethal medication by a physician. 2

Discussion regarding withholding or withdrawing treatment and requesting assisted death has emerged in association with the simultaneous expansion of palliative care across the world. The World Health Organization defines palliative care is an approach that

improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. 4

It intends to neither hasten nor postpone death. Nonetheless, in practice, terminally ill patients – often with full mental capacity – may develop a loss of self-determination as their condition deteriorates and express a desire for assisted dying to alleviate intractable physical symptoms.

Assisted dying is an emotionally and ethically challenging subject, which understandably receives varying degrees of acceptance among different global jurisdictions. Currently, there is legal provision for assisted dying (or variants) in only four European countries (the Netherlands, Belgium, Switzerland and Luxemburg), Canada, Colombia and the United States of America (USA) states of Oregon, Washington, Montana, Vermont, California, Colorado and Washington, DC, representing nearly 18% of the US population. 5 , 6 Switzerland is the only country which permits the act of assisted dying performed by a non-physician. Moreover, non-Swiss citizens can exploit the Swiss law by visiting Switzerland in order to access assisted dying. 7 In these more tolerant jurisdictions, palliative care is seen as an important link in the same chain as assisted dying in caring for terminally ill individuals, rather than an alternative. Elsewhere in the world, an assisted death remains a criminal offence, prosecutable through various legal routes. For example, in the UK, all forms of assisted dying remain illegal and can be considered under criminal laws of manslaughter or murder, or under the Suicide Act (1961), depending on the circumstances. 6 Prosecution guidelines were first issued by the Director of Public Prosecutions in 2009 following House of Lords ruling in the case of Debbie Purdy, which stated that there was ambiguous guidance regarding when people would be prosecuted for encouraging or assisting suicide. The guidelines suggest that while each case will be assessed on its relative merits, individuals acting in the capacity of a healthcare professional are more likely to be prosecuted for assisting or encouraging suicide, although to date no report-providing doctor or accompanying individual has been prosecuted for helping patients to travel abroad from the UK to end their life. 8 In England and Scotland, three assisted dying bills have been proposed and debated, largely based on the Oregon Death with Dignity Act (1997) from the USA, which permits assisted dying; none were passed.

We performed a systematic search of MEDLINE and EMBASE databases from conception to January 2018. The search terms used were ‘euthanasia’, ‘assisted dying OR death’, ‘assisted suicide’, ‘medical ethics’, ‘autonomy’, ‘end of life’ and ‘sanctity of life’. We also combined free text searching with Medical Subject Headings (MeSH) terms and no restrictions were set in publication date, study design and publication status.

Principles of bioethics

Autonomy and right to life.

Beauchamp and Childress developed a standard approach to bioethics and advocated for four principles that lie at the heart of healthcare ethics and underpin decision-making. 9 , 10 Respect for autonomy is one of the fundamental concepts, in combination with justice , beneficence and non-maleficence .

In medical practice, autonomy describes the right of competent adults to make informed decisions about their own medical care, prior to any investigation or treatment taking place. For a physician, respect for autonomy includes acknowledging and preserving a patient’s right to self-determination and providing the necessary guidance, which would allow for an informed and independent choice, free of coercion.

However, autonomy is far from a straightforward consideration. Onora O'Neill, in an attempt to scrutinise the context of autonomy in her Gifford lectures, makes a clear and compelling distinction between the approach of John Stuart Mill and Kant regarding the subject of autonomy. 11 As O’Neill vividly describes, Mill stretches the bound of choice and ‘sees individuals not merely as choosing to implement whatever desires they happen to have at a given moment, but as taking charge of those desires, as reflecting on and selecting among them in distinctive ways’. 11 The Kantian version of autonomy is guided by a ‘practical reason’. Kant views autonomy as ‘a matter of acting on certain sorts of principles, and specifically on principles of obligation’ rather than a form of self-expression and supports that ‘there can be no possibility of freedom for any one individual if that person acts without reference to all other moral agents’. 12 O’Neill embraces the Kantian view and contextualises it as ‘principled autonomy’ compared to ‘individualistic autonomy’. O’Neill’s work vigorously illustrates the fragility of the concept of autonomy and its contingency on a number of other considerations, particularly the network of human relationships within which it features.

The greatest expression of autonomous self-determination is the right of ‘capacitous’ adults to refuse any proposed intervention (irrespective of rationality), even if this decision could result in harm or death, provided they are capable of freely reaching a decision in the above manner. For this reason, obtaining informed consent from a patient after they have been offered all the relevant information regarding their situation is of paramount importance. During the past decades, the development of liberal democracies has highlighted the significance of self-determination, with healthcare systems increasingly adopting more patient-centred approaches to care decisions. The right to bodily autonomy has also been enshrined under Article 8 ( Table 1 ) of the European Convention on Human Rights (ECHR).

Article 8: Right to respect for private and family life.

Taking the above into consideration, Article 8 encompasses inter alia the right to personal development. In a technical legal sense within the jurisdiction of Swiss law, it includes a patient’s choice to avoid what they consider an undignified and severe end to their life. 14 Proponents of this highly contentious argument claim that seriously ill patients should have a choice in whether or not they wish to continue living with a condition that undermines their inherent dignity and personal identity, 15 without violating the principle of sanctity of life. Therefore, it can be argued that respecting autonomy inherently involves the prima facie right of a patient to control the circumstances and time of death by requesting help in dying. This could minimise the suffering of an individual or their family and improve the quality of the end of the patient’s life, as their wishes would be respected and dignity would be preserved. 16 , 17

A further dimension that can be considered is the treating clinician’s ethical beliefs and values. During their training, most practising clinicians have not experienced the concept of assisted dying as an expected duty in the context of patients’ autonomy. 18 Nevertheless, it is important to consider the magnitude of patients’ autonomy within modern society. Individual liberty ought not to be viewed as absolute and exceptions to Article 8 should be provided in favour of preservation and reverence to life. 17 , 18

The right to life is guaranteed by Article 2 ( Table 2 ) of the European Convention on Human Rights. Under Article 2, the State is enjoined to abstain from the deliberate and illicit taking of life, as well as to protect vulnerable people against actions by which they could jeopardise their lives. The principle of sanctity of life emerges frequently in modern discussion, particularly in Anglo-American bioethics, surrounding public controversy about end of life and abortion issues. Yet, its moral foundation is rarely unriddled and understood. The sanctity of life position asserts that life has sanctity and its value prevails all other values. No individual’s life deserves priority, and sanctity is attributed to life regardless of the physiological status, imminence of death, suffering or individual’s wishes to live or die. 19

Article 2: Right to life.

This argument is often associated, but not fully equated, with religious and cultural traditions that generally object to assisted death, because human life is viewed as God’s sovereign creation. From a religious perspective, God is considered the only one who can determine the beginning and end of human life. The sanctity of life is a value also clearly mirrored under Article 9 of the European Convention on Human Rights, which refers to freedom of thought, conscience and religion. 13 It is notable, though, that Article 2 does not encompass assisted dying, i.e. in situations where a person’s decision to end their life has been taken independently and with absolute perception of what it implied.

The crucial issue is therefore one of balance . Patient autonomy has to be balanced against the principle of sanctity of life. It should be acknowledged though that the autonomy argument is secondary in its applicability on whether assisted dying is ethically permissible and cannot solely guide decisions on what is morally impermissible, as it constitutes only a piece of the puzzle. The right to end a life that an individual finds intolerable has to be considered in association with its resulting impact on other rights, regulations and the responsibilities of healthcare professionals in facilitating assisted dying. 18

As discussed, justice constitutes one of the main four fundamental principles of medical ethics. All individuals in a society should be treated equally and impartially. One of the arguments that has monopolised the debate concerning assisted dying is the ‘slippery slope’. According to this, should assisted suicide be established, then it might be applied in circumstances that fall outside the scope of morally permissible cases, such as in patients who may not be fully competent. 17 Furthermore, if a person is motivated by means other than his own will, for example through external coercion, then patient autonomy is infringed.

In this regard, concerns are raised about vulnerable populations, such as the terminally ill, the mentally incapacitated and the elderly. There remains the understandable fear that assisted dying could potentially lead society toward an attitude that suffering should not be a part of life, interdependency is a burden and the lives of disabled of terminally ill individuals are not worth living. 20 The implications of such an attitude on vulnerable populations is clear, with individuals potentially forced or coerced into assisted dying for reasons other than their own free will.

The slippery slope argument is inordinately complex and controversial evidence exists in the literature in favour of both sides. Cases of assisted dying in the Netherlands grew from 1882 in 2002 to 5306 in 2014. 21 Eight-one cases were concerned with dementia and 41 with mental health-related reasons only in 2014. 6 In the light of data from Holland, the slippery slope argument is supported in a number of respects, e.g. concerns about legislation ‘creep’, lack of availability of good palliative care and fears in the vulnerable and elderly. Early data published from Oregon were also concordant. The number of physician-assisted deaths progressively rose from 16 in 1998 to 71 during 2011; loss of autonomy (88.7%) and ability to participate in enjoyable activities (90.1%) were the two most commonly reported end-of life concerns. 22 In increasingly financially constrained health and social care systems, fears have also been raised regarding the impact of budget-cutting trends and their potential impact on terminally ill individuals for whom the alternatives are only high-cost life-prolonging or quality-enhancing (rather than curative) treatments.

However, recent data summarising the 20 years’ experience in Oregon suggest the opposite. According to the authors, patients requesting an assisted death allegedly belong to a higher than average socioeconomic class and have a higher than average education level. 23 Oregon, the first state in the US to allow assisted dying, employed strict criteria that had an influential role in other jurisdictions. 5 The criteria comprised the agreement of another doctor, the assessment of the patient’s mental capacity and the presence of a terminal illness with less than six months to live. 24 Additional measures to ensure an informed and unforced decision involved adequate pain relief and access to end-of-life care. 25 Assisted dying proponents support that safeguards and regulations in place are very powerful since only one in 50 terminally ill patients have a discussion about the process with their doctor and even fewer complete it. 26

Rhetoric from opponents has raised concerns of whether such safeguards could ever be adequate, which appears to be a key argument in the debate in some jurisdictions as well. Consequently, any future legal permissibility of assisted dying should be developed in conjunction with clear regulatory safeguards to ensure the abuse of assisted dying and protect vulnerable individuals from coercion. 3 . Such safeguards must also preserve societal justice and ensure equitability and availability of healthcare is not a deciding factor in assisted dying decision-making.

The Hippocratic Oath and the principles of beneficence and non-maleficence

The principles of beneficence and non-maleficence , plainly described in the Hippocratic Oath, have been the foundation of medical ethics for many centuries. Beneficence states that a doctor should act in the best interest of the patient. Non-maleficence states ‘first, do no harm’ – ‘ primum non nocere ’. 27 Conformation to these fundamental principles is enshrined within Hippocratic Oath, which involve aiming to benefit, or perhaps most importantly, not doing any harm to a patient. Moreover, modern medical education in most countries follows legal and cultural opposition to an assisted death. Healthcare professionals are therefore currently not adequately trained to participate in assisted dying. Professional opinion also remains divided on whether further involvement would benefit or damage public perception of the profession, given the potential conflict between these two ethical principles. The UK’s medical representative body, the British Medical Association (BMA), has acknowledged this lack of consensus, but clearly concludes with their view that assisted dying should not be made legal in the UK. 28

However, the evolution of decision-making processes in modern medicine, particularly regarding end-of-life decisions, and with patients increasingly at the heart of shared decision-making (e.g. the UK NHS’ ‘no decision about me, without me’ policy), have applied pressure on clinicians to reconsider their collective professional stance on assisted dying. Indeed, an increasing number of legal challenges from patients and assisted dying representative organisations are taking place worldwide to challenge local legislation against an assisted death.

Assisted dying therefore challenges the conflict faced between the ultimate purpose of modern medical and social care and its founding ethical principles. Relief of suffering through an assisted death can be argued as a distinct entity to palliative care, with the former – if safely and carefully considered – potentially an important way of fulfilling a clinician’s duty to preserve autonomy and do good for a patient – for example, in cases where alternatives are treatments which provide no benefit or do not prolong or improve the quality of life of a terminally ill patient. 27 , 29 A further consideration is that of an individual doctor’s ethical and moral beliefs, which are also an important factor should a patient request an assisted death; indeed, the British Medical Association has proposed that should assisted dying legislation be derived, then there should be a clear demarcation between those physicians who do and do not offer this option. 30

Freedom of thought, conscience and religion

A further controversial issue is raised by Article 9 of the European Convention on Human Rights, which protects the rights of freedom of thought, conscience and religion. Its impact on the assisted dying debate centres on whether requesting an assisted, dignified death constitutes a manifestation of belief, therefore falling within the remit of Article 9. Several European Court decisions have determined that individual views are entitled to protection only if they ‘attain a certain level of cogency, seriousness, cohesion and importance’. 31

Seriousness and importance are undoubtedly justified when considering an individual’s decision to end their life. On the other hand, an informed desire to die with dignity may well constitute a coherent and cogent view. For instance, it remains debatable whether approaching death through a solely palliative care lens constitutes a less dignified way to die than assisted dying. 31 Article 9 may therefore provide a preferable framework for decisions relating to the right to die with dignity than Article 8, which focuses on a patients’ autonomy; while the former aims to protect truly coherent and cogent decisions, it may be argued that the latter in isolation could potentially open a bigger door to a broader attitude towards assisted dying. 13

Furthermore, Article 3 should also be considered as a safeguard, as this prohibits torture and degrading treatment. 17 Ultimately, each potential assisted dying case is unique and its various facets should therefore be approached carefully under the scope of relevant legislation (e.g. European Convention on Human Rights Articles 2, 3, 8 and 9), and individual/societal ethical and moral perspectives ( Tables 1 ​ 1 ​ to ​ to4 4 ).

Article 3: Prohibition of torture.

Article 9: Freedom of thought, conscience and religion.

Implications of assisted dying in the doctor–patient relationship

As discussed, a key concern of the medical profession remains the impact of legalisation of assisted dying on the doctor–patient relationship. This relationship is fundamentally based on trust. Although aspects of assisted dying may be considered in conflict with certain underlying ethical obligations placed upon doctors, considering a patient’s autonomous wishes, alongside the moral perspectives of the doctor, is also an important aspect of this relationship. 32 , 33 This quandary is recognised by the Swiss Academy of Medical Sciences in their ethical guidelines, which acknowledges that ‘in certain special cases a doctor’s personal decision to assist a dying patient to commit suicide is in accordance with his or her conscience and has to be respected’. 18

The delicate balance between the views of patients, doctors and society can pose an ethical dilemma, with the potential to serve a disruptive influence on the sanctity of the doctor–patient relationship and negatively distorting how society perceives the role and motives of healthcare professionals. For example, as previously considered, particularly in healthcare systems where doctors play the role of gatekeeper to healthcare, a doctor’s support for an assisted death for a terminally ill individual might be negatively interpreted as a conflict of interest, with a desire to help relieve the social and economic burden of a patient’s illness upon society overriding the patient’s individual interests. Ultimately, should appropriate safeguarding measures be deployed alongside relevant legislation, assisted dying may risk eroding doctors’ professional integrity. 34

Current position of doctors’ professional groups in the UK and the USA

As expected, the discussion around adopting assisted dying has caused much controversy among the doctors’ professional groups and bodies. Several professional organisations in the UK have clearly expressed their opposing views to assisted dying such as the British Medical Association, the Royal College of General Practitioners and the Royal College of Surgeons of England, whereas others maintain a neutral position including the Royal College of Nursing, the Royal College of Psychiatrists and the Royal Pharmaceutical Society. 5 The Royal Society of Medicine has no policy on the issue since ‘its remit is the education of doctors and health professionals and the promotion of debate, not the making of policy’. 35

In the US, the American Medical Association, representing nearly 250,000 members, vehemently opposes legalisation of assisted dying as does the American College of Physicians with more than 150,000 members. 6

Conclusions

The debate surrounding assisted dying is never far from the headlines, particularly while its legal status in most jurisdictions remains inadequate and discursive. However, alongside the evolution of palliative care, there appears to be an increasingly vocal desire for legislation to support assisted dying in selected cases. 21 Developing a sensitive balance between established cultural norms and a progressive, well-balanced, transparent and safe attitude towards assisted dying is key. 24 More patient-centred attitudes towards health and social care increasingly place patients – quite rightly – at the heart of everything health professionals do. Patients’ needs, attitudes and beliefs must be therefore at the forefront of decision-making. However, when considering these alongside the fundamental principles of bioethics as well as legislation and doctors’ own beliefs, conflict can arise, thereby leaving the assisted dying debate in a state of limbo. Whether assisted dying should be legalised (albeit with stringent controls) remains controversial; as considered in this essay, even the basic moral principles can conflict when considering the arguments for and against supporting an assisted death, making consensus building far from straightforward.

Ultimately, individual patients’ autonomy should be balanced with a fundamental right to life, impacts on the individual doctor–patient relationship and wider society and the safeguards required to prevent misuse of any assisted dying regulations. The challenge remains for society to decide where this balance lies, guided by regional religious, cultural and legislative perspectives.

Developing the required ethical competencies among medical professionals is also key; given the current absence of legal support for assisted dying in most jurisdictions, most clinicians remain untrained in such decision-making. Indeed with understandable fears against crossing key ethical divides, physician support for an assisted death tends to be lower than that of patients. 36 Dying is a natural part of human life. With growing demand worldwide, the assisted dying debate will increasingly come to the fore – something healthcare professionals, politicians and legislators cannot ignore.

Declarations

Competing interests.

None declared.

Ethics approval

Ethics approval was not required for this review.

Contributorship

AF and EP conceived, designed the study and performed the literature search. All authors analysed the data and drafted the manuscript. All authors contributed to and approved the final version of the manuscript.

Acknowledgements

Not commissioned; peer-reviewed by David Misselbrook.