Non-voluntary euthanasia

Non-voluntary euthanasia (sometimes known as mercy killing) is euthanasia conducted where the explicit consent of the individual concerned is unavailable, such as when the person is in a persistent vegetative state.^[1] It contrasts with involuntary euthanasia, where euthanasia is performed against the will of the patient.^[2][3]

The decision can be made based on what the incapacitated individual would have wanted, or it could be made on substituted judgment of what the decision maker would want were he or she in the incapacitated person's place, or finally, the decision could be made by the doctor by their own decision.^[4]

Newborns and euthanasia

When a newborn's life is contested, the parents are the ones who determine their child’s future. The parents and the doctor both take part in making the decision. When there is persistent disagreement, the case may be taken to court where the decision is made. The factors taken into consideration when deciding the fate of a newborn include the cost of the treatment and the quality of life the newborn will have. The cost of the treatment includes medical resources and their availability.^[5] The newborn’s quality of life will depend on whether the treatment is applied, continued or ceased. This can also be classified as a crime under certain laws without the approval of parents. There are ongoing debates about parents' roles in choosing euthanasia for their children, and whether this can be considered voluntary euthanasia. Specifically, if considered voluntary euthanasia it is because the parents authorized it and they have a say in the life of their children.^[6] If this act is considered non-voluntary euthanasia it is because the patients were newborns and they could not speak for themselves.

History of non-voluntary euthanasia and infanticide

Ancient Greece

The first historical example of euthanasia pertaining to the practice of eugenics comes from the time of Ancient Greece. In Ancient Greece this act was often carried out for philosophical or supposedly rational thought, usually by withdrawing care rather than a physical extermination.^[7]

Ancient Greece is documented as the original pioneers of eugenic thought, and practiced eugenics in numerous hard and soft forms. The rationality for these acts was that eugenics would improve the purity of all mankind.^[8] One form of eugenics used by the Ancient Greeks was the form of nonvoluntary euthanasia called infanticide. This act of ancient selectivity sought out the young who violated the ancient Greek canons of philosophical perception concerning eugenics and purity, and without explicit request would withdraw care of the selected individuals instead of physically termination an act coined “exposure”.^[7] Thus the Ancient Greek style of infanticide defines itself as the first form of nonvoluntary euthanasia. It satisfies the criteria because it was based on philosophical or rational eugenic thought, no explicit request for euthanasia, and ultimately unwilling death.

Harry Haiselden and Baby Bollinger

Baby Bollinger, born to Allen and Anna Bollinger, was born with various physical abnormalities in 1915.^[9] The surgeon Harry J. Haiselden advised the Bollinger parents to forgo the surgery that could have saved the baby’s life. Haiselden then brought this case to the public through a press conference and argued that a “mercy killing” was more humane.^[10] Haiselden drew supporters and critics alike through his support for euthanasia in the United States. Unlike Jack Kevorkian, Haiselden did not assist patients who wished to be euthanized. Instead, Haiselden chose to euthanize babies who were born with deformities.^[11]

The Baby Bollinger case brought Haiselden into the public light as he began advocating for euthanasia aggressively. Haiselden chose to advocate for euthanasia under the idea of “mercy killings”. After the Bollinger case Haiselden began withholding life-saving treatment for babies and advocating to euthanize individuals who cannot take care of themselves.^[10]

Euthanasia in the Netherlands

Severe hydrocephalus. Infants like this can be subject to non-voluntary euthanasia in the Netherlands if the parents and doctors decide it is the best choice for their child. In other jurisdictions, the doctors involved may be prosecuted.

The practice and regulation of euthanasia and assisted suicide in the Netherlands has been described as a stepping stone by G. van der Wal and R. J. Dillmann.^[12] Although euthanasia and assisted suicide can be seen as morally similar because it results in death, the important difference is the choice given to the patient in question. Of the 5000 requests in the Netherlands, the most important reasons for requests were futile suffering, avoidance of humiliation, and unbearable suffering. Despite the free decisions of patients, in about 1000 of the cases, doctors prescribed drugs with the explicit goal of shortening the patient's life without the explicit request of the patient.^[12] Although there are legal avenues for assisted suicide, patients are still faced with the decisions of care givers.

The Dutch practice is not a result of scarce resources because the whole Dutch population is insured. Instead, this is an attempt by the government to end the needless suffering of its citizens.^[12] Although there is good intention behind the law, there are still problems such as obtaining explicit requests from the patients and the grey area of influencing the decision making process by doctors. Despite these problems, new research by Katrina Hedberg et al. show no evidence to justify the grave and important concern often expressed about the potential for abuse — namely, the fear that legalised physician‐assisted dying will target the vulnerable or pose the greatest risk to people in vulnerable groups.^[13]

Although there is no fear for abuse by some, research by John Koewn shows otherwise. In a new report, he shows that about 1000 deaths were hastened without the explicit request of the patient. Doctors do not always tell the truth in reporting their euthanasia patients. As a result, doctors and nurses tend to break the law in certain circumstances.^[14]

Legal status

Active non-voluntary euthanasia is illegal in all countries in the world, although it is practised in the Netherlands on infants (see Groningen Protocol) under an agreement between physicians and district attorneys that was ratified by the Dutch National Association of Pediatricians.^[15]

Passive non-voluntary euthanasia (withholding life support) is legal in India, Albania, and many parts of the United States and is practiced in English hospitals.^[16][17]

Arguing for legalization, Len Doyal, a professor of medical ethics and former member of the ethics committee of the British Medical Association, said in 2006 that "[p]roponents of voluntary euthanasia should support non-voluntary euthanasia under appropriate circumstances and with proper regulation".^[18]

Arguing against legalization is activist Peter Saunders, campaign director for Care Not Killing, an alliance of Christian and disability groups, who called Doyal's proposals "the very worst form of medical paternalism whereby doctors can end the lives of patients after making a judgment that their lives are of no value and claim that they are simply acting in their patients' best interests".^[19]

Slippery slope debate

Non-voluntary euthanasia is cited as one of the possible outcomes of the slippery slope argument, in which it is claimed that permitting voluntary euthanasia to occur will lead to the support and legalization of non-voluntary and involuntary euthanasia,^[20] although some ethicists have contested this idea.^[21][22][23]

References