The word Euthanasia originates from the Greek language: eu means “good” and Thanatos means “death”. One meaning given to the word is “the intentional termination of life by another at the explicit request of the person who dies”.

The word itself has a number of applications so I will try to explain their differences. Please remember I do not hold any claims to formal training, I am simply a lay person wanting Legislative Change for Choice and Dignity in dying, with appropriate safeguards to prevent abuse of it.

Passive Euthanasia: Not much used in the debate now, but refers to withdrawal of treatment that allows death to occur more quickly, but usually without any other (or minimal) medical assistance. 

Active Euthanasia: This involves causing the death of a person through direct action, in response to a request from that person, alternatively known as a Mercy Death, and is implemented due to intolerable pain and suffering. Active euthanasia is, in fact, a palliative act. That is not to deny that death is hastened but that the primary act of VE is to relieve suffering, not to kill. The intention to hasten death is a distant secondary intention. (You need an understanding Lawyer)

Physician Assisted Suicide: The doctor supplies information and or the means of committing suicide (eg prescription for lethal dose of sleeping pills or a method for suffocation whilst drugged etc) The reason for this assistance is that the patient has reached a stage where intolerable suffering, with no expectation of longtime relief, is the reality. (You need an understanding Doctor)

Non Involuntary Euthanasia: This term is used by some to describe the killing of a person who has not explicitly requested aid in dying. This is most often done to patients who are in a Persistent Vegetative State and probably will never regain consciousness.

Involuntary Euthanasia: Means hastening death against the express wishes of the person, and equates with murder.

MURDER: defined in the Webster dictionary as the crime of unlawfully killing a person especially with malice, to kill brutally. Does it follow that a soldier is guiltier of murder than a “friend” who assists a loved one to die, not with malice or brutality but gently as possible? and mostly out of love. The dictionary does not differentiate between soldier & saint.

Palliate or Palliative Care: Webster: To ease without curing, to cover with excuses and apologies…. Macquarie Dictionary: To lessen the severity of (Latin: covered with a cloak). 

Death happens regardless. Do we have the drawn out version for the sake of the suffering person with no hope of a return to normality, or the healthy relatives who will walk again in the sunshine to live another day. It should be a legally binding choice.

Advocates of voluntary euthanasia contend that if a person is 

    (a) Suffering from a terminal illness
    (b) Unlikely to benefit from the discovery of a cure for that illness during 
        what remains of life expectancy
    (c) As a direct result of the illness, either suffering intolerable pain, or 
        only has available a life that is unacceptably harsh (because the illness 
        has to be treated in ways which lead to her being unacceptably dependent 
        on others or on technological means of life support) (eg Nancy Crick in 
        Queensland, Aust.)
    (d) Has an enduring, voluntary and competent wish to die ( or has, prior to 
        losing the competence to do so, expressed a wish to die in the event that 
        conditions A,B & C are satisfied) and
    (e) Unable without assistance to commit suicide.

Then there should be legal and medical provision to enable the person to be allowed to die or be assisted to die.

Of course, I believe there are illnesses that are not terminal, but one could wish they were, to be included in the above definitions.

Whilst the Medical Staff defines and refines effective palliative care the unfortunate person is left in pain, while the trial and errors continue at their expense. Mind you, all this exploratory medical technology will end in death regardless, mostly by the nature of the disease. This is why “Choice” should be a Right of Passage to Die!. At a point in all our lives, the money, time, effort and suffering spent ends in Death regardless!. To say the ill are exhausted at some point, by life itself, is a very genuine expression. Sometimes Death is the Friend.

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In an article published in the World Right-to-Die Newsletter, Winter 2006 provides a quintessential example of why a hastened death can be a preferred option for many, regardless of religious or ethical consideration.   It is appropriate for the circumstances:

This is an excerpt from a recent letter to the President of Italy from a man with advanced muscular dystrophy.

"euthanasia is not a "dignified death" but an appropriate death....all patients want to be cured, not to die. Between wishes and hopes, time passes relentlessly, and with the passage of time, hopes grow weaker and the desire to be cured becomes a desire the shorten the course of desperation before reaching that natural end....Pope Benedict XV1 has defended "the inviolable dignity of human life, from conception (to?) its natural end." But what is natural about a hole in the belly and a pump that fills it with fats and proteins? What is natural about a hole in the windpipe and a pump that blows air into the lungs? What is natural about a body kept biologically functional with the help of artificial respirators, artificial food, artificial hydration, artificial intestinal emptying, of death artificially postponed?."
 

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The New York Times Opinion-Editorial page printed this on 10 May:- 2005

The Line Between Life and Death  
By GARY KALKUT AND NANCY NEVELOFF DUBLER

LATE last month, New York's major newspapers reported that a 13-year-old boy had "died" after he was taken off "life support." That assertion reflected a fundamental misunderstanding of death as defined by the laws of all 50states. In fact, the boy had died more than a week earlier - from a severe brain infection - after transfer to the hospital where we work. In the interim, advanced medical technology supported his organs, not his life. 

Death shouldn't be this hard to understand, yet it often is. According to the 1987 New York State Public Health Regulation, death occurs when either the heart or the brain irreversibly ceases to function. Before medical technology provided breathing machines, there was no meaningful distinction between brain and cardiac death. Once the brain stopped sending signals to the lungs to breathe - on account of a stroke or head injury, for example - the heart would stop within minutes. Now that machines can deliver oxygen to the lungs, however, the heart can continue to beat for days without any signal from the brain. 

 The way this subject has been addressed in recent news stories could leave a person bewildered, but the facts are actually straightforward. Brain death should not be confused with a persistent vegetative state or a coma. In brain death, the entire brain irreversibly ceases to function. Everything shuts down: the cerebral cortex, which controls higher functions, as well as the brainstem, which regulates automatic actions like heartbeat and breathing. In a persistent vegetative state, the cerebral cortex has been destroyed, leaving the person incapable of thought or memory, but the brainstem remains intact and functional. A person in a persistent vegetative state can live for years without a mechanical ventilator or other technological support. That was Terry Schiavo's situation. There was no question that she was alive. Her heart and lungs received signals from her brainstem - they didn't need machines to sustain their activity. 

Then there's coma, which is just a general term for lack of responsiveness. A person can fall into a coma for any number of reasons. The coma can be temporary, as it is during general anesthesia, or permanent, as sometimes happens following injury. Only detailed neurological testing can determine the extent of brain injury or its prognosis. 

The 13-year-old boy who died this April was not in a coma or a persistent vegetative state. He died of a brain infection a week before he was taken off mechanical support. The obligation of a hospital after the death of a patient is to turn its expertise toward supporting the family. After this child passed away, his family's personal tragedy was laid bare in court and in the news media, as a result of a dispute between the family's lawyer and our hospital over the continued use of a respirator.

With a better understanding of death, this could have been avoided. The dead are not kept alive on life support, and they don't die again when machines are stopped. We need to make this clear if we wish to honor the dead, protect vulnerable families and use the astonishing medical technology at our disposal to heal those whom we can actually help.

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