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Essay on Euthanasia: 100, 200 and 300 Words Samples

• Updated on  
• Feb 22, 2024

Essay on Euthanasia: Euthanasia refers to the act of killing a person without any emotions or mercy. Euthanasia is an ethnically complex and controversial topic, with different perspectives and legal regulations on different topics. School students and individuals preparing for competitive exams are given assigned topics like essays on euthanasia. The objective of such topics is to check the candidate’s perspectives and what punishment should be morally and legally right according to them. 

If you are assigned an essay on euthanasia, it means your examiner or teacher wants to know your level of understanding of the topic. In this article, we will provide you with some samples of essays on euthanasia. Feel free to take ideas from the essays discussed below.

Master the art of essay writing with our blog on How to Write an Essay in English .

Table of Contents

• 1 Essay on Euthanasia in 150 Words
• 2.1 Euthanasia Vs Physician-Assisted Suicide
• 2.2 Euthanasia Classification
• 3 Is Euthanasia Bad?

Essay on Euthanasia in 150 Words

Euthanasia or mercy killing is the act of deliberately ending a person’s life.  This term was coined by Sir Francis Bacon. Different countries have their perspectives and laws against such harmful acts. The Government of India, 2016, drafted a bill on passive euthanasia and called it ‘The Medical Treatment of Terminally Ill Patient’s Bill (Protection of Patients and Medical Practitioners). 

Euthanasia is divided into different classifications: Voluntary, Involuntary and Non-Voluntary. Voluntary euthanasia is legal in countries like Belgium and the Netherlands, with the patient’s consent. On one side, some supporters argue for an individual’s right to autonomy and a dignified death. On the other hand, the opponents raise concerns about the sanctity of life, the potential for abuse, and the slippery slope towards devaluing human existence. The ethical debate extends to questions of consent, quality of life, and societal implications.

Also Read: Essay on National Science Day for Students in English

Essay on Euthanasia in 350 Words

The term ‘Euthanasia’ was first coined by Sir Francis Bacon, who referred to an easy and painless death, without necessarily implying intentional or assisted actions. In recent years, different countries have come up with different approaches, and legal regulations against euthanasia have been put forward. 

In 2016, the government of India drafted a bill, where euthanasia was categorised as a punishable offence. According to Sections 309 and 306 of the Indian Penal Code, any attempt to commit suicide and abetment of suicide is a punishable offence. However, if a person is brain dead, only then he or she can be taken off life support only with the help of family members.

Euthanasia Vs Physician-Assisted Suicide

Euthanasia is the act of intentionally causing the death of a person to relieve their suffering, typically due to a terminal illness or unbearable pain. 

Physician-assisted suicide involves a medical professional providing the means or information necessary for a person to end their own life, typically by prescribing a lethal dose of medication.

In euthanasia, a third party, often a healthcare professional, administers a lethal substance or performs an action directly causing the person’s death.

It is the final decision of the patient that brings out the decision of their death.

Euthanasia Classification

Voluntary Euthanasia

It refers to the situation when the person who is suffering explicitly requests or consents to euthanasia. A patient with a terminal illness may express his or her clear and informed desire to end their life to a medical professional.

Involuntary

It refers to the situation when euthanasia is performed without the explicit consent of the person, often due to the individual being unable to communicate their wishes.

Non-Voluntary

In this situation, euthanasia is performed without the explicit consent of the person, and the person’s wishes are unknown.

Active euthanasia refers to the deliberate action of causing a person’s death, such as administering a lethal dose of medication.

It means allowing a person to die by withholding or withdrawing treatment or life-sustaining measures.

Euthanasia and assisted suicide are a defeat for all. We are called never to abandon those who are suffering, never giving up but caring and loving to restore hope. — Pope Francis (@Pontifex) June 5, 2019

Also Read: Essay on Cleanliness

Is Euthanasia Bad?

Euthanasia is a subjective term and its perspectives vary from person to person. Different cultures, countries and religions have their own set of values and beliefs. Life is sacred and gifted to us by god or nature. Therefore, intentionally causing death goes against moral and religious beliefs. 

However, some people have raised concerns about the potential for a slippery slope, where the acceptance of euthanasia could lead to the devaluation of human life, involuntary euthanasia, or abuse of the practice. Some even argue that euthanasia conflicts with their traditional medical ethics of preserving life and prioritizing the well-being of the patient.

Today, countries like the Netherlands and Belgium have legalised euthanasia. In India, the USA and the UK, it is a punishable offence with varying sentences and fines. Euthanasia is a complex and controversial topic and creating a law against or for it requires a comprehensive study by experts and the opinions of all sections of society. 

Ans: Euthanasia refers to the act of killing a person without any emotions or mercy. Euthanasia is an ethnically complex and controversial topic, with different perspectives and legal regulations on different topics.

Ans: The term ‘Euthanasia’ was first coined by Sir Francis Bacon, who referred to an easy and painless death, without necessarily implying intentional or assisted actions. In recent years, different countries have come up with different approaches, and legal regulations against euthanasia have been put forward.  In 2016, the government of India drafted a bill, where euthanasia was categorised as a punishable offence. According to Sections 309 and 306 of the Indian Penal Code, any attempt to commit suicide and abetment of suicide is a punishable offence. However, if a person is brain dead, only then he or she can be taken off life support only with the help of family members.

Ans: Belgium and the Netherlands have legalised euthanasia. However, it is banned in India.

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Arguments in Favor of Euthanasia Essay

• To find inspiration for your paper and overcome writer’s block
• As a source of information (ensure proper referencing)
• As a template for you assignment

Mankind has always struggled to deal with numerous illnesses that have been in existence at different periods of time. Different treatment alternatives have been employed ranging from those by traditional medicine men to the modern scientific methods.

All these efforts have been motivated by the desire to remain alive for as long as one can (Buse 7). However, there are situations when living is more problematic and either the victim or other stakeholders contemplate ending life. This is referred to as euthanasia.

It is the act of deliberately terminating life when it is deemed to be the only way that a person can get out of their suffering (Johnstone 247). Euthanasia is commonly performed on patients who are experiencing severe pain due to terminal illness.

For one suffering from terminal illness, assisted death seems to be the better way of ending their suffering. The issue of euthanasia has ignited heated debate among the professionals as well as the law makers and the general public (Otlowski 211).

The physicians should do everything humanly possible to save lives of their patients, however, euthanasia should be considered as the only alternative to save extreme cases like the terminally ill patients from their perpetual pain and suffering.

Euthanasia can either be active/voluntary, non-voluntary, or involuntary. In voluntary euthanasia, the patient suffering from terminal illness may give consent to be assisted end his/her prolonged severe pain through death (Bowie and Bowie 215).

The patient may also decline to undergo burdensome treatment, willingly terminating treatment procedures like removal of life support machinery, and simply starving. Non-voluntary euthanasia, on the other hand, involves who cannot make sound decisions.

They may be too young, in a coma, senile, mentally challenged, or other severe brain damage (Gorsuch 86). Involuntary euthanasia involves ending the life of the patient without his/her consent. This usually happens when the patient is willing to live despite being in the most dangerous situations.

For instance, an infantry man has his stomach blown up by an explosive and experiences great pain. The army doctor, realizing that the soldier would not survive and has no pain relievers decide to spare the man further suffering and executes him instantly.

Also, a person could be seen on the 10 th floor of a building on fire, the person’s clothes are on fire and cries out for help. The person on ground has a rifle and decides to shoot him dead with a strong conviction that the individual would have experience a slow and painful death from the fierce fire.

Due to the sensitivity of the issue, laws that will protect the rights of both the patient and the physicians who practice euthanasia should be put in place.

A patient has the right to demand or refuse a given form of medication as long as it will alleviate their suffering (Bowie and Bowie 216). It amounts to violation of the patient’s rights if the physician does not respect the will of the patient.

Each one has a right to determine what direction their lives should take and is their own responsibility (Buse 7). A study conducted among adult Americans indicates that about 80% of them support the idea.

They argue that someone suffering from terminal illness, a condition which no medical intervention can reverse, should be allowed to undergo euthanasia. It is inappropriate to subject an individual into a slow but painful death. Such an individual ought to be assisted to end his/her life in order to avoid a prolonged painful death.

The laws guiding the practice of euthanasia in the state of Oregon are quite clear. Active euthanasia should only be performed on a patient who is 18 years and above, of sound mind and ascertained by at least three medical doctors that assisted death is the only alternative of helping the patient (Otlowski 212).

Under such a situation, the doctor prescribes the drugs but is not allowed to administer them. The patient in question takes the drug (s) voluntarily without any assistance from the doctor. The patient will then die in dignity, without any intense pain that living with the condition would bring.

It is evident that some terminal illness may not present unbearable pain to the patient. Instead, a chronically ill patient who is in a no-pain state will not be in a humanly dignified state. The patient of doctor may propose euthanasia as the better treatment alternative.

This has been occasioned by the advancement in the field of medicine where pain can be significantly control (Buse 8). All patients are entitled to pain relief. However, most physicians have not been trained on pain management and hence the patients are usually left in excruciating pain (Johnstone 249).

Under such a condition, the patient suffers physically and emotionally causing depression. Leaving the patient in this agonizing state is unacceptable and euthanasia may be recommended.

Moreover, the physician who practices euthanasia should be protected by the law. This can be achieved by giving him/her the ‘right’ to kill. A doctor handling a patient who is in excruciating pain should be in a position to recommend euthanasia so as to assist the patient have a dignified death.

It is not required by law or medical ethics that a patient should be kept alive by all means. Hence, the patient should be allowed to demand death if he/she considers it necessary (Gorsuch 88).

It would be inhumane and unacceptable to postpone death against the wish of the patient. It would also be unwise to insist on curing a condition which has been medically regarded as irreversible or incurable.

Most terminal illnesses are very expensive to cure although they are known to be incurable. The patient as well as family members ought to be relieved of the accompanying financial burden (Buse 8). The patient, considering the amount of money and other resources used in an attempt to keep him alive, may demand to be assisted to die.

This can only be possible through euthanasia (Johnstone 253). In fact, spending more on the patient would only serve to extend the individual’s suffering. Human beings are caring by nature and none would be willing to live their loved ones to suffer on their own.

They would therefore dedicate a lot of time providing the best care that they can afford. Some would even leave their day to day activities in order to attend to the terminally or chronically ill relative or friend.

Euthanasia, therefore, serves to spare the relatives the agony of constantly watching their family member undergo intense suffering and painful death. In most occasions, attempts to keep a patient alive would mean that he/she be hospitalized for a very long period of time (Bowie and Bowie 216).

Terminally ill patients in hospitals imply that facilities would be put under great pressure at the expense of other patients who would benefit from using the same services. These facilities include; bed space, medical machines, drugs, human resource, among others. Even if they were to be given homecare, a lot of time resource and facilities would be overstretched.

Other than the issue of homecare and the financial obligations that may arise, there is also the issue of personal liberty and individual rights. Those who front this argument explain that the patient has the right to determine when and how they die.

Since the life of a person belongs to that person only, then the person should have the right to decide if he or she wants to end it, if ending life would also mean ending irreversible suffering (CNBC News para 4).

This mean that individual undergoing great and irreversible suffering have the power to chose “a good death” and thus decide when they want to die (para 7).. Furthermore, these patients are dependent on life sustaining medication, which adds only adds the misery.

This brings forth the question about whether such patients can be forced to take life sustaining drugs if the said drugs only lead to extended life full of suffering.

The law should provide for such individuals to refuse to take such drugs and also to request drugs that will lead to end of their misery, even it if mean that these drugs will end their lives.

Therefore patients in this condition should be allowed the legal tight to end their miseries through assisted suicide.

Those who oppose any form of euthanasia argue that a terminally ill patient or a person suffering irreversible pain from an incurable disease should be assisted to live by all means including any medical procedure that guarantees that they live the longest possible period.

This argument is valid but has logical flows. The argument presupposes that such patients need to be prevented from dyeing through any possible means. In reality though, this efforts are futile as when a patient has determined that death is the easier way out of the misery they are suffering, the emotional distress will only pull them closer to death (Morgan 103).

Furthermore, such efforts to prolong the patients’ lives do not prevent death, as but just postpone it at the same time extending the patients suffering. This is because such patient’s life is hanging by the thread and they have been brought near to death by the virtue of their illness.

In severe cases such patient may result to suicide, as in the case of Sue Rodriguez, Canadian woman who suffered Lou Gehrig’s disease, and was refused the right for assisted death (CNBC News para 2). As such efforts to prolong their lives pushed them closer to death

While some countries such as The Netherlands, Belgium and Denmark have embraced the idea of euthanasia, others have move at a snails pace in this direction. Canada, one of the most developed countries is such countries.

Euthanasia is still illegal in Canada and any person found trying it is subject to prosecution. Furthermore, any person found to have assisted another person commit suicide is also liable to prosecution for up to 14 years in prison.

Still in Canada, the law after many years of legal battle has differentiated euthanasia and assisted suicide. Assisted suicide is what is otherwise referred to as active euthanasia where a terminally ill patient asks for help to end life.

The law in Canada has also allowed for these patients to refuse life sustaining medication if such medication does not in any way improve the quality of their lives (CNBC para 17).

If the law acknowledges the power of a person to refuse such medication then it must also allow such a person the legal right to determine the condition and the manner in which they die. This means that there is light, though, at the end of the tunnel for Canadians patients who may wish to end their lives.

Such argument for any form of euthanasia tends to conglomerate around two valid arguments. First, if a terminally ill patient who is suffering extreme and irreversible pain is determined to be of sound mind and is adult then such patients should be allowed to make judgment about their lives.

If such a patient decides that ending their lives will be end their misery, then no doctor has the legal as well as moral obligation of coercing the patient to continue taking medication that only prolongs their suffering (Morgan 145).

If doctors manage to successfully administer the drugs against the wishes of such a patient, they will have committed an assault against the patient and this is a legal as well as a professional misconduct (Morgan 146). Secondly, the desires of such a patient are supreme.

This means that the patients’ right to self determination overrides the fundamental but not absolute belief that life is holy and should only be ended by the maker.

Therefore such patient’s should be treated as competent enough to make decisions about their lives and that no medical officer has the legal or moral right to determine that such a patient is wrong. Any medical help provide to such a patient thus be for the benefit of the patient.

From a religious point of view, it can be argued that God is love and people of God should demonstrate compassion. If someone is undergoing intense pain and a slow but sure death, it would be evil to allow such a person to experience the full extent (Gorsuch 89).

Euthanasia would therefore be the better option. Helping the patient have a dignified death can be the best show of agape love. There is also the issue of quality of life where if someone is leading low quality or worthless life, then one should opt for euthanasia.

The essay has discussed several points in favor of euthanasia as an alternative when it comes to treating people suffering from terminal illness or responding to perplexing situations where death is the ultimate end although one may go through severe pain and agonizing moments.

It has also highlighted three main forms of euthanasia; voluntary/active, non-voluntary, and involuntary. Anyone can argue against the points raised in this essay but it would be difficult to justify why an individual should be allowed to suffer for a long time either willingly or unwillingly.

The doctors should do everything humanly possible to save lives of their patients, however, euthanasia should be considered as the only alternative to save extreme cases like the terminally ill patients from their perpetual pain and suffering.

Works Cited

Bowie, Bob & Bowie, Robert A. Ethical Studies: Euthanasia (2 nd ed). Neslon Thornes, 2004, Pp. 215-216.

Buse, Anne-Kathrin. Euthanasia: Forms and their Differences . GRIN Verlag, 2008, Pp. 7-8.

CNBC news. “ The Fight for the Right to Die. ” CNBC Canada . 2011.

Gorsuch, Neil M. Euthanasia- The Future of Assisted Suicide . Princeton University Press, 2009, Pp. 86-93.

Johnstone, Megan-Jane. Euthanasia: Contradicting Perspectives (5 th ed). Elsevier Health Sciences, 2008, Pp. 247-262.

Morgan, John. An Easeful Death?: Perspectives On Death, Dying And Euthanasia. S ydney: Federation press Pty Ltd. 1996. Print.

Otlowski, Margaret. Euthanasia and the Common Law . Oxford University Press, 2000, Pp. 211-212.

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IvyPanda. (2019, May 6). Arguments in Favor of Euthanasia. https://ivypanda.com/essays/argument-for-euthanasia-essay/

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Euthanasia – Arguments in Favour and Against

Last updated on April 7, 2024 by ClearIAS Team

Euthanasia is the deliberate act of ending a person’s life to relieve them of suffering. It is a complex and ethically sensitive topic that has sparked debates and discussions worldwide. There are different forms of euthanasia, and it is regulated differently in various countries.

Euthanasia (“good death”) is the practice of intentionally ending a life to relieve pain and suffering. It is also known as ‘mercy killing’.

In many countries, there is a divisive public controversy over the moral, ethical, and legal issues of euthanasia. Euthanasia is categorized in different ways, which include voluntary, non-voluntary, or involuntary. Euthanasia is also classified into active and passive Euthanasia.

Table of Contents

Voluntary, Non-Voluntary, and Involuntary Euthanasia

• Voluntary euthanasia: It is conducted with the consent of the patient and is termed voluntary euthanasia. Voluntary euthanasia is legal in some countries. Jurisdictions, where euthanasia is legal, include the Netherlands, Colombia, Belgium, and Luxembourg.
• Non-Voluntary euthanasia: It is conducted where the consent of the patient is unavailable and is termed non-voluntary euthanasia. Non-voluntary euthanasia is illegal in all countries. Examples include child euthanasia, which is illegal worldwide but decriminalized under certain specific circumstances in the Netherlands under the Groningen Protocol.
• Involuntary euthanasia: It is conducted against the will of the patient and is termed involuntary euthanasia. Involuntary euthanasia is usually considered murder.

Passive vs Active euthanasia

Voluntary, non-voluntary, and involuntary euthanasia can all be further divided into passive or active variants.

• Passive euthanasia entails the withholding of common treatments, such as antibiotics, necessary for the continuance of life.
• Active euthanasia entails the use of lethal substances or forces, such as administering a lethal injection, to kill and is the most controversial means.

Euthanasia debate

Euthanasia raises profound ethical and moral questions. Supporters argue that it can be a compassionate and dignified way to end suffering, particularly in cases of terminal illness.

Opponents argue that it raises significant ethical concerns, including the potential for abuse, coercion, and mistakes in diagnosing terminal conditions.

Arguments in Favor

Historically, the euthanasia debate has tended to focus on several key concerns. According to euthanasia opponent Ezekiel Emanuel, proponents of euthanasia have presented four main arguments:

• that people have a right to self-determination, and thus should be allowed to choose their fate
• assisting a subject to die might be a better choice than requiring that they continue to suffer
• the distinction between passive euthanasia, which is often permitted, and active euthanasia, which is not substantive (or that the underlying principle–the doctrine of double effect–is unreasonable or unsound);
• permitting euthanasia will not necessarily lead to unacceptable consequences. Pro-euthanasia activists often point to countries like the Netherlands and Belgium, and states like Oregon, where euthanasia has been legalized, to argue that it is mostly unproblematic.
• Constitution of India: ‘Right to life’ is a natural right embodied in Article 21 but euthanasia/suicide is an unnatural termination or extinction of life and, therefore, incompatible and inconsistent with the concept of ‘right to life’. The State must protect life and the physician’s duty to provide care and not to harm patients. Supreme Court in Gian Kaur Case 1996 has held that the right to life under Article 21 does not include the right to die.
• Caregiver’s burden: Right-to-die supporters argue that people who have an incurable, degenerative, disabling, or debilitating condition should be allowed to die in dignity. This argument is further defended by those, who have chronic debilitating illness even though it is not terminal such as severe mental illness. The majority of such petitions are filed by the sufferers or family members or their caretakers. The caregiver’s burden is huge and cuts across various financial, emotional, time, physical, mental, and social domains.
• Refusing care: The right to refuse medical treatment is well recognized in law, including medical treatment that sustains or prolongs life. For example, a patient suffering from blood cancer can refuse treatment or deny feeds through a nasogastric tube. Recognition of the right to refuse treatment gives way to passive euthanasia.
• Encouraging organ transplantation: Mercy killing in terminally ill patients provides an opportunity to advocate for organ donation. This, in turn, will help many patients with organ failure waiting for transplantation. Not only does euthanasia give the ‘Right to die‘ for the terminally ill, but also the ‘Right to life‘ for the organ needy patients.

Arguments against

Emanuel argues that there are four major arguments presented by opponents of euthanasia:

• not all deaths are painful;
• alternatives, such as cessation of active treatment, combined with the use of effective pain relief, are available;
• the distinction between active and passive euthanasia is morally significant; and
• legalizing euthanasia will place society on a slippery slope, which will lead to unacceptable consequences
• Euthanasia weakens society’s respect for the sanctity of life.
• Euthanasia might not be in a person’s best interests, for example, getting old-aged parents killed for property will.
• Belief in God’s miracle of curing the terminally ill.
• The prospect of a discovery of a possible cure for the disease shortly.
• Proper palliative care makes euthanasia unnecessary.
• There is no way of properly regulating euthanasia.
• Allowing euthanasia will lead to less good care for the terminally ill.
• Allowing euthanasia undermines the commitment of doctors and nurses to save lives.
• Euthanasia may become a cost-effective way to treat the terminally ill.
• Allowing euthanasia will discourage the search for new cures and treatments for the terminally ill.
• Euthanasia gives too much power to doctors.

Euthanasia in India

Passive euthanasia is legal in India. On 7 March 2011, the Supreme Court of India legalized passive euthanasia using the withdrawal of life support to patients in a permanent vegetative state. The decision was made as part of the verdict in a case involving Aruna Shanbaug, who had been in a Persistent Vegetative State (PVS) for 42 years until she died in 2015.

The Aruna Shanbaug Case

In March 2011, the Supreme Court of India passed a historic judgment permitting Passive Euthanasia in the country. This judgment was passed after Pinki Virani’s plea to the highest court in December 2009 under the Constitutional provision of “Next Friend”. It’s a landmark law which places the power of choice in the hands of the individual, over government, medical or religious control which sees all suffering as “destiny”. The Supreme Court specified two irreversible conditions to permit Passive Euthanasia Law in its 2011 Law:

• The brain-dead for whom the ventilator can be switched off.
• Those in a Persistent Vegetative State (PVS) for whom the feed can be tapered out and pain-managing palliatives be added, according to laid-down international specifications.

The same judgment law also asked for the scrapping of 309 , the code that penalizes those who survive suicide attempts. In December 2014, the Government of India declared its intention.

PIL filed by Common Cause

However, on 25 February 2014, a three-judge bench of the Supreme Court of India termed the judgment in the Aruna Shanbaug case to be ‘inconsistent in itself’ and referred the issue of euthanasia to its five-judge Constitution bench on a PIL filed by Common Cause , which case is the basis of the current debate.

Then, the CJI referred to an earlier Constitution Bench judgment which, in the Gian Kaur case , “did not express any binding view on the subject of euthanasia; rather it reiterated that the legislature would be the appropriate authority to bring change.” Though that judgment said the right to live with dignity under Article 21 was inclusive of the right to die with dignity, it did not conclude the validity of euthanasia, be it active or passive.

“So, the only judgment that holds the field about euthanasia in India is the ruling in the Aruna Shanbaug case, which upholds the validity of passive euthanasia and lays down an elaborate procedure for executing the same on the wrong premise that the Constitution Bench in Gian Kaur had upheld the same,” the CJI said.

Common Cause Case: In 2018, the Supreme Court issued a significant judgment in the Common Cause case. The court recognized the right to die with dignity as a fundamental right and permitted passive euthanasia. It provided guidelines for the process and conditions under which passive euthanasia could be allowed.

Government’s endorsement of Passive Euthanasia

On December 23, 2014, the Government of India endorsed and re-validated the Passive Euthanasia judgment law in a Press Release, after stating in the Rajya Sabha as follows: The Hon’ble Supreme Court of India, while dismissing the plea for mercy killing in a particular case, laid down comprehensive guidelines to process cases relating to passive euthanasia.

Thereafter, the matter of mercy killing was examined in consultation with the Ministry of Law and Justice and it has been decided that since the Hon’ble Supreme Court has already laid down the guidelines, these should be followed and treated as law in such cases. At present, there is no legislation on this subject and the judgment of the Hon’ble Supreme Court is binding on all.

The court rejected active euthanasia using lethal injection. In the absence of a law regulating euthanasia in India, the court stated that its decision becomes the law of the land until the Indian parliament enacts a suitable law. Active euthanasia, including the administration of lethal compounds to end life, is still illegal in India, and in most countries.

As India had no law about euthanasia, the Supreme Court’s guidelines are law until and unless Parliament passes legislation. The following guidelines were laid down:

• A decision has to be taken to discontinue life support either by the parents the spouse or other close relatives, or in the absence of any of them, such a decision can be taken even by a person or a body of persons acting as a next friend. It can also be taken by the doctors attending the patient. However, the decision should be taken bona fide in the best interest of the patient.
• Even if a decision is taken by the near relatives or doctors or next friend to withdraw life support, such a decision requires approval from the High Court concerned.
• When such an application is filled, the Chief Justice of the High Court should forthwith constitute a Bench of at least two Judges who should decide whether to approve or not. A committee of three reputed doctors to be nominated by the Bench, will report the condition of the patient. Before giving the verdict, a notice regarding the report should be given to the close relatives and the State. After hearing the parties, the High Court can give its verdict.

A law commission had proposed legislation on “passive euthanasia”, it said. According to the Centre, the decision to come out with a bill was taken after considering the directives of the apex court, the law commission’s 241st report, and a private member bill introduced in Parliament in 2014.

The Centre said that initially, a meeting was held under the chairmanship of B.P. Sharma, secretary in the Health and Family Welfare Ministry, on May 22, 2015, to examine the draft of The Medical Treatment of Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill and the draft of The Euthanasia (Regulation) Bill.

This move to introduce a bill is a welcome step to clear the grey areas in the Euthanasia debate. Students can also link to this issue while answering questions on:

• Judicial activism: SC framing laws when the parliament hasn’t. Just like the Visaka case.
• Ethical dilemma in Paper 4 .

In India,  euthanasia has no legal aspect , and there is no penal law yet introduced in the IPC that specifically deals with euthanasia.

• However, the Supreme Court of India legalized passive euthanasia in 2018 with some conditions, allowing patients to withdraw medical support if they go into an irreversible coma.
• Passive euthanasia is a matter of ‘living will’, and an adult in their conscious mind is permitted to refuse medical treatment or voluntarily decide not to take medical treatment to embrace death naturally, under certain conditions.
• Individuals are only allowed to draft a living will while in a normal state of health and mind.
• Active euthanasia remains illegal in India.

Read:  Living wills

Article by: Jishnu J Raju

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Reader Interactions

February 11, 2016 at 3:48 pm

excellent one..

February 24, 2016 at 8:34 pm

Giving passive euthanasia to a patient who is already dead (not literally) is a right choice.Its better than making them as well as others to suffer.

July 20, 2017 at 4:28 pm

so very true.

July 1, 2016 at 10:58 pm

If the patient does not wants to suffer and himself asking for euthanasia then voluntary euthanasia should be made legal because it will be difficult for him to live than to die. But in case of involuntary euthanasia, there should be some specific time limit upto which the patient’s relatives must wait for him to recover but if there is no improvement like in case of coma , after 7-10 years , there is less chances of the patient to recover. In such cases , involuntary euthanasia should be made legal.

March 16, 2017 at 12:37 pm

no it is not possible If the patient tends to recover over a period of time or suddenly he becomes normal then the involuntary euthanasia will become very dangerous

March 16, 2017 at 12:35 pm

Very Very Useful

June 26, 2018 at 8:12 am

Helpful source I can use to rely on research. Thank you so much, clear IAS.

May 17, 2019 at 9:58 pm

Thanku for quality content

May 23, 2020 at 10:27 pm

“Mercy Killing ” is a responsible debate . It mainly depends on persons will on his /her life.

July 2, 2020 at 2:26 pm

Euthanasia should not be accepted as there is always some hope for better.

May 24, 2021 at 11:57 am

If under Article 21 of the constitution, right to live with dignity is inclusive of right to die with dignity, then why should the provisions under the Euthanasia act be restricted to the old and dying patients. There are a lot of people in their 60s and 70s with limited financial resources, who feel neglected / unwanted by the family who would like to die with dignity rather than be dependent on their children or the other members of family. They may be in good health but would still like to self determine to end their life with dignity. In such cases the law should allow for such people to adopt active Euthanasia. Such people could be persuaded to donate their organs which will help save other lives.

August 25, 2021 at 9:40 am

euthanasia cannot be legalised because of its higher probability of misuse. whether it is for property, money or because of any family problem

August 4, 2022 at 12:11 pm

A thought for all: If you do not have a choice to life, i.e. choose to be born then how can choosing your own means of death, be fair or valid? Something you cannot create or re-created is not yours to manage. My say: God is the giver of life and He alone should take it. Our sufferings are a means of learning, loving, understanding and above all our closeness to Almighty God.

June 28, 2023 at 6:36 pm

ur death is already written whether you take it or god does so doesnt matter

September 19, 2022 at 12:47 pm

I can’t put my dog to sleep for I am as old as he; and despite our handicaps he also wants to live like me.

Boghos L. Artinian

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Euthanasia - Essay Samples And Topic Ideas For Free

Euthanasia, also known as assisted dying or mercy killing, remains a deeply contested ethical and legal issue. Essays could delve into the various forms of euthanasia, such as voluntary, non-voluntary, and involuntary euthanasia, discussing the moral and legal implications of each. The discourse might extend to the examination of the cultural, religious, and societal attitudes towards euthanasia, exploring how different societies and religious groups perceive the right to die. Discussions could also focus on the experiences of countries and regions that have legalized euthanasia, examining the impact on healthcare practices, legal frameworks, and societal attitudes. Moreover, the broader implications of euthanasia on medical ethics, patient autonomy, and the sanctity of life could be explored to provide a comprehensive understanding of the complexities surrounding euthanasia and the ongoing debates on its legalization and practice. A substantial compilation of free essay instances related to Euthanasia you can find at Papersowl. You can use our samples for inspiration to write your own essay, research paper, or just to explore a new topic for yourself.

Euthanasia: is it Ethical

While doing research on the topic of Euthanasia and Physician Assisted Suicide, I have come to see that people have a hard time believing that this should be an option for people who have terminal illnesses. Euthanasia is the painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma and Physician Assisted Suicide (PAS) is The voluntary termination of one's own life by administration of a lethal substance with the direct or indirect […]

Arguments for and against Euthanasia

Euthanasia is also known as physician-assisted suicide or good death. It refers to the method where animals that are suffering or in discomfort are helped to rest in death. Many pet owners consider Euthanasia a more compassionate manner of bidding their beloved animals goodbye. In the case of people, many states have not legalized euthanasia for people with dementia or those suffering from incurable diseases. Euthanasia creates an ethical dilemma on three main lines: legal, medical, and philosophical. There are […]

Ethics Behind Physician-Assisted Suicide

Assisted suicide is the act of intentionally killing yourself with the assistance of someone else. In the United States, physician-assisted suicide is when a physician provides a patient, who meets the criteria of having a terminal illness, with medication in order to terminate their life to relieve pain and/or suffering. Physician-assisted suicide is often confused with euthanasia. Euthanasia is illegal in the US. It requires a doctor, or another individual, to administer the medication to the patient. Other terms for […]

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Why Euthanasia should be Legalised

Did you know that the word euthanasia comes from Greek which means good death? However, Only 9 out of the 196 countries in the world have legalised euthanasia or assisted death, including the Netherlands, Belgium, Switzerland and Japan. - posted on Deccan Chronicle. These are all first world countries that value freedom and I strongly believe that Euthanasia should be extended to all other countries. There are 4 different types of euthanasia voluntary, involuntary, active and passive euthanasia. First, I […]

The Ban on Euthanasia

Imagine your girl best friend gets into a car crash. After the incident, you find out she suffered major spinal cord damage and her legs will be paralyzed for the rest of her life. You go to visit her in the hospital the same week but arrive to shocking news. She tells you she has lost the will to live and wants to be euthanized, or painlessly killed. She tells you she is worried about how this accident will affect […]

Assisted Suicide the Rights we have

The right to assisted suicide is one of the most controversial topics ever discussed because of the fact that other people control your life when you are unable to. But some people think that they can stop you from dying even though death is inevitable when one is terminally ill. They think that because of religious and moral reasons they could stop someone from ending their own life. Assisted suicide also known as ""Euthanasia"" is used to make a painless […]

Economic Benefits of Euthanasia

Euthanasia is assisted suicide, it is an action taken by a doctor with consent of the patient in order to relieve immense pain and suffering. However, is the overall process of Euthanasia beneficial for the economy? Based on research, euthanasia is beneficial to the economy, and saves a vast amount of money for families for hospital stays, private insurance companies, taxpayers, and medicare each year. For a hospital stay, the average cost per inpatient day is $2,534.00 for a local […]

Euthanasia Debate

The intention to deliberately help someone accelerate the death of an incurable patient, even to stop his or her suffering has never been an easy task. The ethics of euthanasia is one that has been debated over since the fourth century B.C. Euthanasia is translated from Greek as "good death" or "easy death. At first, the term referred to painless and peaceful natural deaths in old age that occurred in comfortable and familiar surroundings. Today the word is currently understood […]

Physician-assisted Suicide: Right to Die

You may have heard of Physician-assisted suicide before, but what exactly is it? Physician-Assisted suicide is when someone who is terminally ill and completely competent of making choices the right to take their own life, legally with the help of a doctor. Though it seems as if they should be able to do that, in most states the law does get in the way of that. There are ethical and moral issues surrounding this issue. Regardless of those issues, those […]

Religious Perspectives on Euthanasia

Death is one of the most important things that religions deal with. All faiths offer meaning and explanations for death and dying; all faiths try to find a place for death and dying within human experience. Most religions disapprove of euthanasia. Some of them absolutely forbid it. Virtually all religions state that those who become vulnerable through illness or disability deserve special care and protection and that proper end of life care is a much better thing than euthanasia. Religions […]

Active and Passive Euthanasia

Euthanasia is the termination of a terminally ill person's life in order to relieve patients of their severe and untreatable pain. It is further broken down into two types: active and passive. In this paper, I will be focusing on active euthanasia and will argue that it is morally justifiable for a physician to alleviate agony for a patient and their family via direct action. Active euthanasia is morally permissible when a patient explicitly states their consent due to the […]

Physician Assisted Suicide: Medical Practice

Physician assisted suicide is when a physician provides a patient with the necessary means and information to help the patient perform a life ending act. Physician assisted suicide is when is when a person gets prescribed a lethal dose of medication from their physician that they can take when they get ready too. Physician assisted suicide has become an option for those around the world and even legal in certain States in the US. This option is legal in 6 […]

The Controversy over Euthanasia

Euthanasia, as defined by the Merriam-Webster Dictionary, is the act or practice of killing or permitting the death of hopelessly sick or injured individuals (such as persons or domestic animals) in a relatively painless way for reasons of mercy. The growing euthanasia epidemic has raised a profusion of controversy in recent years due to the legal and moral implications. Although described as relatively painless,euthanasia is something that should be methodically and thoroughly thought through because of the permanent effect it […]

Euthanasia and Death Penalty

Euthanasia and death penalty are two controversy topics, that get a lot of attention in today's life. The subject itself has the roots deep in the beginning of the humankind. It is interesting and maybe useful to learn the answer and if there is right or wrong in those actions. The decision if a person should live or die depends on the state laws. There are both opponents and supporters of the subject. However different the opinions are, the state […]

Physician Assisted Suicide: the Growing Issue of Dying with Dignity and Euthanasia

Is someone wanting to die with dignity more important than the conscience of a doctor who provides care for others? The issue of physician-assisted death can be summed up by simply saying it has a snowball effect. What starts as physician-assisted death turns into euthanizing and from there it could end up in the killing of patients without their full comprehension as to what they agreed to. The solution to this issue is accepting there is a problem and figuring […]

Definition of Euthanasia

Euthanasia defined as an intentionally ending of the life of the terminally ill person in order to relieve pain or suffering, done by a physician, legally. This is not to be confused with the similar physician assisted suicide, the suicide of patient suffering from an incurable disease, effected by the taking of lethal drug by a doctor for this purpose. It is legal in only a few places of the world, and the laws vary by the places. That means […]

Physician Assisted Suicide

Healthcare isn't as perfect as we think it should be considering there are so many medications and treatments that can help restore or cure one's illness. When needing the assistance of a healthcare facility, there are many different challenges that can impact patients and their families. Challenges that include life or death decision making, insurance coverage, the need for medications, cost of services, and so on. As these challenges may seem as if they are minor to some, they truly […]

Euthanasia and Physician-Assisted Suicide

In a documentary, Charles Scott was a man who loved to read, sing, and enjoy being outdoors. He was diagnosed with lymphoma. Struggling every day just to breathe after walking 10 steps to the bathroom and dealing with his eyesight deteriorating, He found life to be full of pain instead of joy. He found no want in having to wait through multiple medications, operations, pain, hospice, and finally him dying suffocating trying to catch his breath” he wished to die […]

Physician-Assisted Euthanasia/Suicide

Part 1: Ethical Question Should doctors have a choice to opt out of assisting terminally ill patients with euthanasia/suicide? Part 2: Introduction Some people think being a physician is an exciting job for the most part. However, physicians have the task of making tough decisions that could hurt many people emotionally. The morality of assisted euthanasia and suicide has been questioned by many people. Some may consider euthanasia and suicide immoral any wrong. Unfortunately, euthanasia and suicide may be the […]

Arguments for Legalizing Euthanasia

I once heard euthanasia is a heart-wrenching kindness and i believe that to be true.Although we as vet techs know it is the right thing to do, being apart of ending there pain and suffering,it is hard being the one to end it knowing the bond an animal has with its owner.Everyone has their own thoughts about this topic and how we prefer to handle it.There are different tolerances everyone has on how it should be done and what the […]

Why Active Euthanasia and Physician Assisted Suicide should be Legalized

This reference source gives us an overview of why euthanasia should be legalized. It goes into depth about how patients and doctors are affected by the decision to end a person's life, and moral issues, and whether it is right or wrong to purposely end someone's life. This source highlights that euthanasia should be in the best interest of the patient who is suffering from an illness, such as an incurable disease or a serious health issue. Doctors should be […]

Physician-assisted Suicide is not Federally Mandated

Physician-assisted suicide is not federally mandated due to the lack of bipartisanship in Congress, the principles of federalism, and contributions from conservative organizations and interest groups. The attitudes and moral acceptability about certain behaviors and actions differ significantly among Republicans and Democrats. According to a 2007 survey, 62% of Democrats support doctors assisting a terminally ill patient to commit suicide, while only 49% of Republicans support this notion (Gallup, Inc 2007). 59% of Democrats also find physician-assisted suicide to be […]

Physician-assisted Suicide and Euthanasia

Physician-assisted suicide and euthanasia have become some of the most highly controversial topics discussed in medicine, making those who have medicine as an occupation question the morality behind the act. A common misconception people often times make is confusing the fact that physician-assisted suicide and voluntary active euthanasia as the same thing. The NCI dictionary of cancer terms states euthanasia is accessibility to ""[a]n easy or painless death or the intentional ending of the life of a person suffering from […]

Euthanasia and Physician Assisted Suicide

Sometimes people criticize euthanasia and physician-assisted suicide from what is called "pro-life" perspectives and other times from "pro-death" perspectives; each perspective has a different argument about their position and the side they are on in this debate. This paper will review some of these arguments that have been made to date, as well as some of the more recent developments in this issue (Dieterle 129). To begin with, many people argue that euthanasia and physician-assisted suicide are morally acceptable because […]

Hinduism and Buddhist Perspective of Suicide and Euthanasia

The principle of ahimsa, or no violence, is fervently held in Hinduism and is reflective in followers' everyday lives. This concept extends to oneself as well as others. For one, suicide is condemned in this religion because all life is considered sacred. Humans life is perceived as precious because only through one of the three human realms can liberation be achieved. Other living things, such as insects and animals, do not receive the same opportunity, so it is crucial followers […]

Euthanasia – One of the most Debated Topics Today

The topic of euthanasia is one of the most debated topics today. Elderly patients can be pressured into a decision they don't want to make. Citizens can also be unfairly euthanized as well. Euthanasia should stay illegal due to the obligation to elderly patients, non permitted euthanization, of an individual, and which can open hopefully widen perspective on this issue, as well as many others. Euthanasia is a complex topic that can't be described simply and without depth. Euthanasia can […]

Physician-assisted Suicide Debate

Let's say a patient is in incredible pain or has an incurable illness and the patient can only be kept alive by machines or by enduring their pain. Should any patient who is in these circumstances be allowed to choose death over this life? Many people go against assisted suicide because of religion and or whatever they believe in. Another reason why people may disagree is that the patients who are not in the right mind and or are too […]

Ethics and Challenges of Euthanasia

As there are other patients who have a higher chance of living, euthanizing the patient was the more practical option. Euthanasia advocates argue that futile care may harm others. For instance, a young child with an acute respiratory disease, who has a potentially higher chance of getting cured, could not get a bed and ventilator in the ICU because others were using it even though they are not getting any personal benefit from the treatment (Niederman & Berger, 2010). This […]

Euthanasia: Merciful Death or Playing God

A death by suicide. Just hearing the word suicide can send chills down one's spine. How could someone get to the point of self-termination? Why would anybody ever consider such a terrible way to die? The thing is, suicide does not have to be a terrible or scary way to die if one is faced with insurmountable troubles accompanying an untreatable disease. With assistance from licensed professionals, it can give those suffering a painless option if they so choose to […]

What is Euthanasia?

Euthanasia is a easy death, some may say euthanasia is a undeviating act for taking a life through prescription drugs. A patient that has a short expand of life can address such an issue with their healthcare provider. Counseling can be provided before the final decision is made by doctor and the patient. At anytime the patient reserves the right to with draw from the process. The patient however must have good reason for the process before a doctor will […]

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How To Write An Essay On Euthanasia

Introduction to the concept of euthanasia.

When embarking on an essay about euthanasia, it’s crucial to begin with a clear definition of what euthanasia entails. Euthanasia, often referred to as "mercy killing," is the act of intentionally ending a person's life to relieve them of suffering, typically from a terminal illness or an incurable condition. In your introduction, outline the various types of euthanasia, such as voluntary, non-voluntary, and involuntary, and the ethical, legal, and moral questions they raise. This introductory segment sets the stage for an in-depth exploration of the arguments for and against euthanasia and its implications in the realms of medicine, ethics, and law.

Exploring the Arguments For and Against Euthanasia

The body of your essay should delve into the complex arguments surrounding euthanasia. On one hand, proponents argue that euthanasia is a compassionate response to unbearable suffering, respecting an individual's right to choose death over prolonged pain. They may also cite the importance of dignity in death and the reduction of medical costs for terminally ill patients. On the other hand, opponents raise concerns about the sanctity of life, the potential for abuse, and the slippery slope towards non-voluntary or involuntary euthanasia. They may also discuss the moral obligations of medical professionals to preserve life. This section should present a balanced view of the debate, providing a comprehensive understanding of the various perspectives on euthanasia.

Ethical and Legal Considerations

A crucial aspect of your essay should be an examination of the ethical and legal considerations surrounding euthanasia. Discuss the ethical principles involved, such as autonomy, beneficence, non-maleficence, and justice. Explore how different countries and cultures view and legislate euthanasia, noting the variations in legal frameworks and the criteria required for it to be carried out. This analysis should provide insight into the complexities of legalizing and regulating euthanasia, and the ethical dilemmas faced by healthcare providers, patients, and their families.

Concluding with Personal Reflections and Broader Implications

Conclude your essay by summarizing the key points and offering personal reflections on the topic. Reflect on the implications of euthanasia for society and the field of healthcare. Consider how advances in medical technology and changes in societal attitudes might influence the future of euthanasia. Your conclusion should not only provide closure to your essay but also encourage further thought and dialogue on this sensitive and contentious issue, highlighting the ongoing importance of ethical deliberation in decisions about life and death.

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Euthanasia: Right to life vs right to die

Suresh bada math.

Department of Psychiatry National Institute of Mental Health & Neuro Sciences (Deemed University) Bangalore 560 029, India

Santosh K. Chaturvedi

The word euthanasia, originated in Greece means a good death 1 . Euthanasia encompasses various dimensions, from active (introducing something to cause death) to passive (withholding treatment or supportive measures); voluntary (consent) to involuntary (consent from guardian) and physician assisted (where physician's prescribe the medicine and patient or the third party administers the medication to cause death) 2 , 3 . Request for premature ending of life has contributed to the debate about the role of such practices in contemporary health care. This debate cuts across complex and dynamic aspects such as, legal, ethical, human rights, health, religious, economic, spiritual, social and cultural aspects of the civilised society. Here we argue this complex issue from both the supporters and opponents’ perspectives, and also attempts to present the plight of the sufferers and their caregivers. The objective is to discuss the subject of euthanasia from the medical and human rights perspective given the background of the recent Supreme Court judgement 3 in this context.

In India abetment of suicide and attempt to suicide are both criminal offences. In 1994, constitutional validity of Indian Penal Code Section (IPC Sec) 309 was challenged in the Supreme Court 4 . The Supreme Court declared that IPC Sec 309 is unconstitutional, under Article 21 (Right to Life) of the constitution in a landmark judgement 4 . In 1996, an interesting case of abetment of commission of suicide (IPC Sec 306) came to Supreme Court 5 . The accused were convicted in the trial court and later the conviction was upheld by the High Court. They appealed to the Supreme Court and contended that ‘right to die’ be included in Article 21 of the Constitution and any person abetting the commission of suicide by anyone is merely assisting in the enforcement of the fundamental right under Article 21; hence their punishment is violation of Article 21. This made the Supreme Court to rethink and to reconsider the decision of right to die. Immediately the matter was referred to a Constitution Bench of the Indian Supreme Court. The Court held that the right to life under Article 21 of the Constitution does not include the right to die 5 .

Regarding suicide, the Supreme Court reconsidered its decision on suicide. Abetment of suicide (IPC Sec 306) and attempt to suicide (IPC Sec 309) are two distinct offences, hence Section 306 can survive independent of Section 309. It has also clearly stated that a person attempts suicide in a depression, and hence he needs help, rather than punishment. Therefore, the Supreme Court has recommended to Parliament to consider the feasibility of deleting Section 309 from the Indian Penal Code 3 .

Arguments against euthanasia

Eliminating the invalid : Euthanasia opposers argue that if we embrace ‘the right to death with dignity’, people with incurable and debilitating illnesses will be disposed from our civilised society. The practice of palliative care counters this view, as palliative care would provide relief from distressing symptoms and pain, and support to the patient as well as the care giver. Palliative care is an active, compassionate and creative care for the dying 6 .

Constitution of India : ‘Right to life’ is a natural right embodied in Article 21 but suicide is an unnatural termination or extinction of life and, therefore, incompatible and inconsistent with the concept of ‘right to life’. It is the duty of the State to protect life and the physician's duty to provide care and not to harm patients. If euthanasia is legalised, then there is a grave apprehension that the State may refuse to invest in health (working towards Right to life). Legalised euthanasia has led to a severe decline in the quality of care for terminally-ill patients in Holland 7 . Hence, in a welfare state there should not be any role of euthanasia in any form.

Symptom of mental illness : Attempts to suicide or completed suicide are commonly seen in patients suffering from depression 8 , schizophrenia 9 and substance users 10 . It is also documented in patients suffering from obsessive compulsive disorder 11 . Hence, it is essential to assess the mental status of the individual seeking for euthanasia. In classical teaching, attempt to suicide is a psychiatric emergency and it is considered as a desperate call for help or assistance. Several guidelines have been formulated for management of suicidal patients in psychiatry 12 . Hence, attempted suicide is considered as a sign of mental illness 13 .

Malafide intention : In the era of declining morality and justice, there is a possibility of misusing euthanasia by family members or relatives for inheriting the property of the patient. The Supreme Court has also raised this issue in the recent judgement 3 . ‘Mercy killing’ should not lead to ‘killing mercy’ in the hands of the noble medical professionals. Hence, to keep control over the medical professionals, the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 discusses euthanasia briefly in Chapter 6, Section 6.7 and it is in accordance with the provisions of the Transplantation of Human Organ Act, 1994 14 . There is an urgent need to protect patients and also medical practitioners caring the terminally ill patients from unnecessary lawsuit. Law commission had submitted a report (no-196) to the government on this issue 15 .

Emphasis on care : Earlier majority of them died before they reached the hospital but now it is converse. Now sciences had advanced to the extent, life can be prolonged but not to that extent of bringing back the dead one. This phenomenon has raised a complex situation. Earlier diseases outcome was discussed in terms of ‘CURE’ but in the contemporary world of diseases such as cancer, Aids, diabetes, hypertension and mental illness are debated in terms best ‘CARE’, since cure is distant. The principle is to add life to years rather than years to life with a good quality palliative care. The intention is to provide care when cure is not possible by low cost methods. The expectation of society is, ‘cure’ from the health professionals, but the role of medical professionals is to provide ‘care’. Hence, euthanasia for no cure illness does not have a logical argument. Whenever, there is no cure, the society and medical professionals become frustrated and the fellow citizen take extreme measures such as suicide, euthanasia or substance use. In such situations, palliative and rehabilitative care comes to the rescue of the patient and the family. At times, doctors do suggest to the family members to have the patient discharged from the hospital wait for death to come, if the family or patient so desires. Various reasons are quoted for such decisions, such as poverty, non-availability of bed, futile intervention, resources can be utilised for other patients where cure is possible and unfortunately majority of our patient's family do accordingly. Many of the terminally ill patients prefer to die at home, with or without any proper terminal health care. The societal perception needs to be altered and also the medical professionals need to focus on care rather in addition to just cure. The motive for many euthanasia requests is unawareness of alternatives. Patients hear from their doctors that ‘nothing can be done anymore’. However, when patients hear that a lot can be done through palliative care, that the symptoms can be controlled, now and in the future, many do not want euthanasia anymore 16 .

Commercialisation of health care : Passive euthanasia occurs in majority of the hospitals across the county, where poor patients and their family members refuse or withdraw treatment because of the huge cost involved in keeping them alive. If euthanasia is legalised, then commercial health sector will serve death sentence to many disabled and elderly citizens of India for meagre amount of money. This has been highlighted in the Supreme Court Judgement 3 , 17 .

Research has revealed that many terminally ill patients requesting euthanasia, have major depression, and that the desire for death in terminal patients is correlated with the depression 18 . In Indian setting also, strong desire for death was reported by 3 of the 191 advanced cancer patients, and these had severe depression 19 . They need palliative and rehabilitative care. They want to be looked after by enthusiastic, compassionate and humanistic team of health professionals and the complete expenses need to be borne by the State so that ‘Right to life’ becomes a reality and succeeds before ‘Right to death with dignity’. Palliative care actually provides death with dignity and a death considered good by the patient and the care givers.

Counterargument of euthanasia supporters

Caregivers burden : ‘Right-to-die’ supporters argue that people who have an incurable, degenerative, disabling or debilitating condition should be allowed to die in dignity. This argument is further defended for those, who have chronic debilitating illness even though it is not terminal such as severe mental illness. Majority of such petitions are filed by the sufferers or family members or their caretakers. The caregiver's burden is huge and cuts across various domains such as financial, emotional, time, physical, mental and social. Hence, it is uncommon to hear requests from the family members of the person with psychiatric illness to give some poison either to patient or else to them. Coupled with the States inefficiency, apathy and no investment on health is mockery of the ‘Right to life’.

Refusing care : Right to refuse medical treatment is well recognised in law, including medical treatment that sustains or prolongs life. For example, a patient suffering from blood cancer can refuse treatment or deny feeds through nasogastric tube. Recognition of right to refuse treatment gives a way for passive euthanasia. Many do argue that allowing medical termination of pregnancy before 16 wk is also a form of active involuntary euthanasia. This issue of mercy killing of deformed babies has already been in discussion in Holland 20 .

Right to die : Many patients in a persistent vegetative state or else in chronic illness, do not want to be a burden on their family members. Euthanasia can be considered as a way to upheld the ‘Right to life’ by honouring ‘Right to die’ with dignity.

Encouraging the organ transplantation : Euthanasia in terminally ill patients provides an opportunity to advocate for organ donation. This in turn will help many patients with organ failure waiting for transplantation. Not only euthanasia gives ‘Right to die’ for the terminally ill, but also ‘Right to life’ for the organ needy patients.

Constitution of India reads ‘right to life’ is in positive direction of protecting life. Hence, there is an urgent need to fulfil this obligation of ‘Right to life’ by providing ‘food, safe drinking water and health care’. On the contrary, the state does not own the responsibility of promoting, protecting and fulfilling the socio-economic rights such as right to food, right to water, right to education and right to health care, which are basic essential ingredients of right to life. Till date, most of the States has not done anything to support the terminally ill people by providing for hospice care.

If the State takes the responsibility of providing reasonable degree of health care, then majority of the euthanasia supporters will definitely reconsider their argument. We do endorse the Supreme Court Judgement that our contemporary society and public health system is not matured enough to handle this sensitive issue, hence it needs to be withheld. However, this issue needs to be re-examined again after few years depending upon the evolution of the society with regard to providing health care to the disabled and public health sector with regard to providing health care to poor people.

The Supreme Court judgement to withhold decision on this sensitive issue is a first step towards a new era of health care in terminally ill patients. The Judgment laid down is to preserve harmony within a society, when faced with a complex medical, social and legal dilemma. There is a need to enact a legislation to protect terminally ill patients and also medical practitioners caring for them as per the recommendation of Law Commission Report-196 15 . There is also an urgent need to invest in our health care system, so that poor people suffering from ill health can access free health care. Investment in health care is not a charity; ‘Right to Health’ is bestowed under ‘Right to Life’ of our constitution.

The pros and cons of legalising euthanasia

Help to end suffering for terminal patients could put disabled, elderly and unwell people at risk, opponents warn

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Pro: an end to suffering

Con: losing legal protection, pro: ending 'mercy killings', con: 'slippery slope', pro: shifting opinion, con: religious concerns.

 Demonstrations calling for the decriminalisation of assisted dying are to take place in central London today to coincide with a debate among MPs in Westminster.

The Commons debate – which will not be followed by a vote – was triggered after a petition backed by campaigner Esther Rantzen gained more than 200,000 signatures.

Rantzen, who has stage four lung cancer, revealed last year that she had joined the assisted dying clinic Dignitas, in Switzerland, but that under current UK law her family could be at risk of prosecution if they helped her travel there to end her life.

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"The Great British Bake Off" judge Prue Leith, actor Susan Hampshire and rights campaigner Peter Tatchell are all expected to attend the protests calling for a change in the law. A previous bill in favour of assisted dying was defeated in the Commons by 330 votes to 118 in 2015.

Also known as euthanasia , assisted dying is a controversial issue for legislatures worldwide, with widely cited arguments both for and against a practice that is legal in some countries while totally taboo in others.

It is currently banned in England, Wales, and Northern Ireland – although not a specific criminal offence in Scotland – and carries a maximum prison sentence of 14 years.

Allowing patients to end their suffering is not only morally justified but also essential to upholding the right to personal and bodily autonomy, advocates argue.

A major parliamentary inquiry set up last year to explore whether assisted dying should be legalised in the UK received tens of thousands of submissions from people facing "uncontrollable" pain and "unbearable suffering", which palliative care alone cannot fix,  The Guardian reported.

Paul Lamb, a paralysed former builder from Leeds who died in June 2021, had  lost his legal case to challenge UK laws on assisted dying seven months earlier.

"I cannot understand, in a civilised society like ours, why I should be forced to suffer when millions of people around the world already have the choice I asked for," he said in November 2020.

It is currently a criminal offence under the 1961 Suicide Act to help someone take their own life, punishable by up to 14 years in prison.

Some people believe that legalising euthanasia would put too much power in the hands of doctors, who could abuse their position, or relatives.

Rita Marker, executive director of the International Task Force on Euthanasia and Assisted Suicide in the US, has argued: "Euthanasia and assisted suicide are not about the right to die. They are about the right to kill."

The UK's anti-euthanasia  Care Not Killing alliance said that the law is also in place to protect the vulnerable "from being pressured into ending their lives".

Making her case against any law change, Ilora Finlay, a crossbench peer and palliative care physician, told the parliamentary inquiry that legalising euthanasia in Britain could result in between 5,800 and 58,000 assisted deaths a year, based on extrapolated data from countries where it is already legal. "Such demand would divert an already stretched workforce of NHS clinicians," she said. 

According to  Dignity in Dying , 44% of people would break the law and help a loved one to die, risking 14 years in prison.

In 2022 the Crown Prosecution Service (CPS) said it was considering revising its stance on so-called mercy killings so that defendants are less likely to face criminal charges.

"We are not decriminalising any offence," Max Hill, director of public prosecutions and head of the CPS, told the  i news site, but in offences "born solely out of compassion", justice can sometimes "be achieved by not prosecuting".

Campaigners claim that UK police are also increasingly turning a blind eye to people travelling to other countries to assist loved ones to end their life.

Opponents argue that normalising euthanasia would be a move towards legalised murder.

This "slippery slope is real", said James Mildred of Care (Christian Action Research and Education), which campaigns against assisted suicide. In a 2018 article in  The Economist , Mildred cited "a steady increase year on year in the number of people being killed or helped to commit suicide by their doctors" in countries that have legalised assisted suicide, as the rules are loosened over time.

"Critics say this is happening in Canada," said  New Scientist , "with the criteria for assisted dying having expanded once already and a further change planned for next year." Canada, which introduced Medical Assistance in Dying, or MAID, in 2016, has seen the number of people choosing to end their life rise steadily ever since, with  MAID deaths comprising 4.1% of all deaths in 2022. 

There has been a significant shift in recent years among both the public and professional medical opinion regarding assisted dying for people with a terminal illness.

Polling for  The Guardian last August found 65% of people in the UK believe it should become legal for a doctor to assist an adult of sound mind with less than six months to live to voluntarily end their own life, subject to High Court confirmation.

Dignity in Dying claims this number is even higher, and also that 54% of GPs are supportive or neutral to a law change on assisted dying. 

Many religious people, especially Catholics, believe that life is the ultimate gift and that taking that away is usurping power that belongs to God only. 

In 2020, the Vatican reiterated the Roman Catholic Church's opposition to assisted suicide and euthanasia, describing them as "intrinsically evil" acts "in every situation or circumstance",  The New York Times reported. 

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Ethical perspectives regarding Euthanasia, including in the context of adult psychiatry: a qualitative interview study among healthcare workers in Belgium

• Monica Verhofstadt 1 ,
• Loïc Moureau 2 ,
• Koen Pardon 1 &
• Axel Liégeois 2 , 3  

BMC Medical Ethics volume  25 , Article number:  60 ( 2024 ) Cite this article

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Introduction

Previous research has explored euthanasia’s ethical dimensions, primarily focusing on general practice and, to a lesser extent, psychiatry, mainly from the viewpoints of physicians and nurses. However, a gap exists in understanding the comprehensive value-based perspectives of other professionals involved in both somatic and psychiatric euthanasia. This paper aims to analyze the interplay among legal, medical, and ethical factors to clarify how foundational values shape the ethical discourse surrounding euthanasia in both somatic and psychiatric contexts. It seeks to explore these dynamics among all healthcare professionals and volunteers in Belgium.

Semi-structured interviews were conducted with 30 Dutch-speaking healthcare workers who had encountered patients requesting euthanasia for psychiatric conditions, in Belgium, from August 2019 to August 2020. Qualitative thematic analysis was applied to the interview transcripts.

Participants identified three pivotal values and virtues: religious values, professional values, and fundamental medical values encompassing autonomy, beneficence, and non-maleficence, linked to compassion, quality care, and justice. These values interwove across four tiers: the patient, the patient’s inner circle, the medical realm, and society at large. Irrespective of their euthanasia stance, participants generally displayed a blend of ethical values across these tiers. Their euthanasia perspective was primarily shaped by value interpretation, significance allocation to key components, and tier weighting. Explicit mention of varying ethical values, potentially indicating distinct stances in favor of or against euthanasia, was infrequent.

The study underscores ethical discourse’s central role in navigating euthanasia’s intricate landscape. Fostering inclusive dialogue, bridging diverse values, supports informed decision-making, nurturing justice, and empathy. Tailored end-of-life healthcare in psychiatry is essential, acknowledging all involved actors’ needs. The study calls for interdisciplinary research to comprehensively grasp euthanasia’s multifaceted dimensions, and guiding policy evolution. While contextualized in Belgium, the implications extend to the broader euthanasia discourse, suggesting avenues for further inquiry and cross-cultural exploration.

Peer Review reports

Medical assistance in dying is allowed in 27 jurisdictions in the world and if so, it is mainly restricted to the terminally ill (see BOX 1 in OSF) [ 1 ]. Medical assistance in dying entails that a patient’s death request can be granted via euthanasia , defined as the intentional termination of life by a physician at the patient’s explicit request, which is currently decriminalised in Australia, Belgium, Canada, Colombia, Luxembourg, the Netherlands, Spain, and New Zealand. In addition, it can be granted by means of assisted suicide , also defined as the intentional termination of life by a physician at the patient’s explicit request, but in these cases, the lethal drugs are provided by a physician and self-administered by the patient at a time of the latter’s own choosing (e.g., Australia, Austria, Switzerland, United States). In some countries, not only a physician, but also a nurse practitioner can be involved in the procedure (e.g., Canada, New Zealand).

Euthanasia has been legal in Belgium since 2002, positioning the country as a pioneer in this field with two decades of euthanasia practice [ 2 ]. According to Belgian legislation, individuals can be deemed eligible for euthanasia when they are, among other criteria, in a medically futile state characterized by constant and unbearable physical or psychological suffering resulting from a serious and incurable disorder caused by accident or illness [ 2 ]. Belgium is one of the few countries that does not exclude people from assisted dying who suffer predominantly from irremediable psychiatric conditions (see BOX 2 in OSF for all legal criteria in Belgium). As regards prevalence, euthanasia accounted for up to 3.1% of all registered deaths in 2023 in Belgium [ 3 ]. Whereas most registered euthanasia deaths concerned the terminally ill (approximately 84%), predominantly suffering from cancer, only 48 or 1.4% of euthanasia deaths concerned non-terminally ill adults predominantly suffering from psychiatric conditions. Since euthanasia was legalised, in total 457 such euthanasia cases have been reported, less than 1.5% of all registered euthanasia cases in Belgium [ 3 , 4 , 5 , 6 , 7 , 8 , 9 ].

However, this is only the tip of the iceberg, as there is reason to believe that the total number of requests for euthanasia in Belgium (regardless of outcome), is at least 10 times higher. For instance, recent annual reports from Vonkel, an end-of-life consultation centre in Belgium, revealed around 100 unique patients per year applying for euthanasia for psychiatric reasons. Less than 10% of those euthanasia requests were reported to be carried out [ 10 , 11 , 12 ]. Moreover, a recent survey among psychiatrists working in Flanders, Belgium, revealed that 8 out of 10 respondents had been confronted at least once throughout their career with patients requesting euthanasia for psychiatric reasons [ 13 ]. The survey also showed that, although three-quarters are supportive of not excluding the option of euthanasia for this specific patient group [ 14 ], the majority is hesitant to be actively engaged in a euthanasia procedure [ 13 , 14 ]. The literature ascribed the reluctance to the complexity of euthanasia assessment in this patient group, inherently high in professional and emotional demands [ 15 , 16 , 17 , 18 , 19 ]. The complexity was for a large part described in terms of the practical considerations surrounding euthanasia requests and assessment, e.g., whether and when these patients can meet the legal criteria.

There is thus reason to believe that healthcare workers’ overarching ethical considerations influence their attitudes on euthanasia in general and in the context of psychiatry specifically, and their practice. As empirical in-depth studies are lacking, this area is largely understudied. To date, only two recent qualitative studies among Dutch physicians emphasised the value-based reasons for euthanasia decision-making, but did not [ 20 ] or only summarily [ 21 ] scratch the specific context of psychiatry. Another recent qualitative study among Dutch physicians, including psychiatrists, emphasized the value-based reasons for supportive attitudes towards euthanasia, e.g. the value of self-determination, compassion, fairness, and suicide prevention, versus the value-based reasons for not supporting euthanasia, e.g. the mission of medicine of hope and healing [ 22 ]. Furthermore, a recent systematic review described the main ethical challenges surrounding the euthanasia practice in the context of psychiatry [ 23 ]. However, this ethical debate was mainly concentrated on the permissibility and implementation of euthanasia from a practical-clinical point of view, e.g. whether euthanasia in the context of psychiatry should be permitted, and why the legal requirements can (not) be adequately embedded in the field of psychiatric medicine. How practically and juridically relevant these considerations may be, they remain the outcome of ethical values being weighed up, which means that no single consideration can be considered ethically irrelevant, neutral, or value-free. Moreover, the review was based on articles that have been selected in a timeframe in which sound empirical data regarding euthanasia in the context of psychiatry were largely lacking.

Also, the overarching value-based views of other professionals involved in psychiatric euthanasia practice have not yet been studied. This is striking, as a recent Belgian survey study revealed that that half of the psychiatric nurses (53%) are frequently and directly confronted with such euthanasia requests [ 24 ], but in-depth insights into their value-based views are lacking. Furthermore, there are many more formal caregivers, other than psychiatric nurses, involved in euthanasia assessment procedures. End-of-life centres employ e.g., paramedical personnel such as psychologists, psychiatric nurses for intake and registration purposes, and well-trained volunteer personnel such as buddies, entrusted with the task to help these patients to cope with the euthanasia procedure. In addition, rehabilitation-oriented support groups (REAKIRO) were established to help these patients (and their relatives) in walking the tightrope of life and death [ 25 ]. All of these caregivers may also have an unacknowledged but influential role in these euthanasia assessment procedures, and therefore, an interesting perspective to reflect on euthanasia legislation and practice. Gaining insight into healthcare workers’ ethical considerations related to euthanasia in psychiatry will lay bare the ethical foundations underlying current practice and is important to inform and spark further debate around this extremely thorny issue, and to promote sound ethical analysis.

Hence, the purpose of this research is to explore healthcare workers’ ethical considerations regarding euthanasia in general and euthanasia concerning adults suffering predominantly from psychiatric conditions in particular.

Theoretical research framework

Our research was guided by the framework of ‘critical social constructionism’ [ 26 ], providing a nuanced perspective that diverges from the acknowledgment of an objective reality. This approach intricately examines the interplay of personal, social, and societal dimensions within the phenomena under study. It necessitates an acknowledgment of the layered complexities influencing our understanding of phenomena such as euthanasia, a notion supported by both our prior research [ 27 ] and additional studies [ 23 , 28 ].

Our interpretation of the data was informed by social constructionism, which recognizes the role of internalized societal norms in shaping individuals’ perceptions of reality over time. Furthermore, we embraced a contextualist epistemology [ 29 ], acknowledging the contextual influence on knowledge formation among both researchers and participants. This methodological approach aimed to capture diverse lived experiences (e.g., diversity in clinical and euthanasia trajectories) and perspectives, including varied attitudes toward euthanasia based on specific relationships (e.g., professional healthcare worker or volunteer). Consequently, we maintained a reflexive stance regarding the potential impact of our individual experiences and identities on our analyses and interpretations, as elaborated in the Ethical Considerations section.

Study design

The qualitative research design consisted of semi-structured face-to-face interviews with healthcare workers in Flanders and Brussels, Belgium.

Participants

All participants were Dutch-speaking and had at least one concrete experience with euthanasia requests and procedures concerning adults with psychiatric conditions in the period 2016–2020, either as professional or volunteer healthcare workers. We adopted a broad recruitment approach, with a particular focus on all healthcare providers directly involved in medical practice rather than in managerial or policy-making roles. No further exclusion criteria were employed.

Recruitment and interview procedure

Purposive sampling was used to ensure diversity and heterogeneity in terms of: participants’ affiliation with institutions holding different stances on ‘euthanasia and psychiatry’; being to a different extent confronted with these euthanasia procedures as regards the amount of experiences (sporadically versus regularly); the nature of the experiences (e.g. confronted with or engaged in euthanasia procedures that were still under review or that had been rejected, granted, performed or withdrawn); and their specific role as professional or volunteer healthcare worker.

Participants were recruited via assistance of our contact persons at: (1) the end-of-life consultation centre Vonkel; (2) the Brothers of Charity; (3) the rehabilitation-oriented centre REAKIRO in Louvain; and (4) the Review Belgian Euthanasia Law for psychological suffering (REBEL) group, a group of Belgian physicians (e.g. psychiatrists), therapists (e.g. psychologists) as well as academics who express their concern on euthanasia in the context of psychiatry via the media. Participants were also recruited via a notice on the sites, newsflashes and/or in the online newsletters of LEIF (Life End Information Forum), Recht op Waardig Sterven (the Flemish Right to Die with Dignity Society) and Vlaamse Vereniging voor Psychiatrie (Flemish Psychiatric Association).

Potential participants contacted MV or a study assistant by phone or mail. The patients were then given an information letter and informed consent form that consisted of 2 main parts. All interviews were conducted by MV or a study assistant, who both have experience in conducting interviews on end-of-life topics. Interviews were held at the participant’s location of choice, except for five interviews which were held online via video call by Whereby 14 due to the Covid-19 crisis lockdown regulations. Interviews lasted between 55 min and 2 h, and were audio recorded (the online video interviews were recorded by Whereby’s software and immediately transferred in an mp.3 format).

Measurements

The interview guide (see OSF) contained the following consecutive questions of importance to the present report: (1) What is your personal stance regarding euthanasia as a legalised medical end-of-life option? and (2) What is your personal stance regarding euthanasia in the context of psychiatry?

Data management and analysis

We used a model of sampling-based saturation, namely inductive thematic saturation, that relates to the emergence of new themes (defined as 7 consecutive interviews without new themes) [ 30 ]. We continued to recruit and conduct interviews so that the sample would be heterogenous in terms of socio-demographics, clinical profile, and clinical setting. In particular, our focus was on recruiting individuals with the following profiles: psychologists, male psychiatric nurses and moral consultants/spiritual caregivers employed in residential psychiatric settings ( n  = 5).

All interviews were then transcribed verbatim and de-identified by the interviewers.

We made use of hybrid inductive and deductive coding and theme development by means of a 2-staged process. Stage 1 consisted of an inductive data-driven thematic coding procedure.

We made use of these four phases; (1) identification and coding of all transcripts; (2) the placing of the codes in subthemes, i.e., arguments in favour versus critical concerns; (3) the placing of these subthemes in overarching main themes, i.e., different stakeholders (patient/medicine/society); (4) the comparison and discussion of the findings (with all co-authors). In addition to the inductive approach, we also used a deductive, theory-driven template approach during stage 2. We made use of these four phases; 1) the development of an ethical interpretation framework (see OSF). The framework consists of four key concepts, each involving a multitude of ethical concepts: (a) ethical theories and methodologies, (b) ethical values, (c) basic ethical virtues, and (d) dialogue/decision making ethics; 2) the identification of codes that fit the ethical framework and the theory-driven renaming of these codes; 3) the placing of some of the subthemes in an additional main theme; and 4) the comparison and discussion of the findings (with all co-authors).

Ethical considerations

The research team comprised two experienced clinical psychologists, one specializing in euthanasia within the cancer patient population and the other skilled in conducting interviews on this sensitive topic within the adult psychiatric context. Additionally, two ethicists with expertise in assisted dying, including euthanasia, were part of the team. Some authors also have backgrounds in psychiatric practice, including outpatient and residential settings, while others bring expertise through personal experiences. Furthermore, all contributing authors have personal and/or professional connections with individuals navigating death ideation, offering diverse perspectives on euthanasia. Additionally, some authors hold religious beliefs, while others maintain a more agnostic stance. These perspectives vary depending on the predominant viewpoints adopted—whether that of the patient, a close relation, a clinician, an ethicist, or policy stances. To mitigate potential undue influence on data interpretation, three team assemblies were convened. These sessions served to share firsthand encounters from interviews and their outcomes, fostering reflection and deliberation among team members. This proactive measure was implemented to prevent both personal and professional biases from affecting the interpretation of the data.

The main characteristics of the 30 participants are listed in Table  1 . The sample consisted of 16 physicians, 7 other care professionals (ranging from psychiatric nurses to mobile support teams), and 7 volunteers, all of whom were engaged in one or more euthanasia procedures predominantly based on psychiatric conditions.

The participating physicians held various roles regarding the handling of euthanasia requests:

1 physician refused to discuss the request with the patient on principle grounds.

7 physicians managed the clarification of euthanasia requests from their own patients or referred them to colleagues for further clarification.

10 physicians provided one of the two legally required formal advices or an additional advice on the euthanasia request.

5 physicians performed the act of euthanasia.

3 physicians held a more normative, dissuasive stance against euthanasia in the context of psychiatry but were willing to explore and discuss the euthanasia request with the patient.

The sample further included 14 non-physicians, among them members holding one or more roles:

2 members were part of mobile teams providing psychiatric care and support in the patient’s home setting.

3 were psychiatric nurses working either in a general hospital or in a psychiatric residential setting.

2 were Experts by Experience, individuals with a history of mental distress trained to provide support for individuals new to the euthanasia procedure and/or rehabilitation approaches.

3 were buddies, individuals entrusted with assisting and supporting the patient throughout the euthanasia procedure.

3 were moral consultants/spiritual caregiver, tasked with offering various forms of existential guidance and support to patients considering euthanasia, including religious, moral, and/or other perspectives.

5 were consultants at end-of-life information and/or consultation centers responsible for patient intake.

Participants’ ethical considerations regarding euthanasia, in the broadest context of medicine

As can be seen from the coding structure in Table  2 , we ordered coding categories on the level of 1) the individual patient, 2) the patient’s social inner circle, 3) the (para)medical field, and 4) the society. Note that words used verbatim by the interviewees (often interview fragments instead of quotes, as to better illuminate the complexities and nuances of interviewees’ first-hand lived experiences) from the transcribed interviews are incorporated that provide both additional insightful details and reveal the at times interwoven nature of the analysed codes.”

The level of the individual patient

On the level of the individual patient, the following five ethical considerations were distinguished: (1) autonomy, (2) dignity, (3) quality of life, (4) compassion, and (5) the meaning and transformative value of suffering.

First, Autonomy was a recurrent theme in all the interviews. Some participants expressly valued individual autonomy , and more specifically its following two underpinning characteristics: (1) self-determination in terms of the fundamental right for each individual to direct the course of one’s own life, which also includes ‘taking control over the timing and circumstances of one’s end-of-life’, and (2) freedom of choice , as they strongly believed that individuals are free to choose what meaning and purpose they assign to their lives. According to them, as each individual should be enabled ‘to live according to one’s own value system’, so should the ending of one’s life also be congruent with one’s own value system. Hence, in their opinion, euthanasia should remain ‘one of the many options to die’.

Other participants called this individualistic approach of autonomy ‘unrealistic’ or even ‘delusional’, as it shies away from: (1) the relational account of autonomy, in which a true autonomous decision was seen as the outcome of a decision-making process which is shaped by individual, social and contextual components, and (2) the internalised downside of autonomy, as the feeling underpinning many euthanasia requests, namely ‘not wanting to be a burden to others’ may lead to ‘self-sacrifice’ and ‘the duty to die’ under the false pretence of autonomy. In addition, some pointed to the power of susceptibility and subliminality, as human beings are subliminal creatures whose behaviour is continuously influenced on both a subconscious and even conscious level. Consequently, internalised pressure cannot be excluded when a patient requests euthanasia. One psychiatrist even stated that ‘ there exists no such thing as a free will, as human beings are always manipulated in many areas of human life and functioning’ .

“I believe that that there should still be places in society where you could die without considering euthanasia. While many people today are facing dementia, and you almost must…. Interviewer: Yes. “Yes, like how should I deal with it? Should I exit life before it becomes inevitable dementia or something similar? Because I think that in a neo-liberal society, many people internalize the idea that at some point, it becomes a moral duty to step aside. They feel obliged to eliminate themselves. Self-elimination. In a neo-liberal model, as long as you can keep up and contribute, everything is fine. But if you can’t keep up, well, if you cannot fully exercise autonomy, then… Essentially, you should hold your honour and step aside.” (spiritual caregiver)

Second, participants mentioned euthanasia as an option to die with dignity . For those in favour of the Law, euthanasia is considered (1) a ‘dignified way of dying’ when everything that leads up to death, including individual, medical, and social needs and expectations, is consistent with one’s own sense of integrity, belief-system and lifestyle, and (2) a ‘good death’, when referring to the literal meaning of the concept ‘euthanasia’, namely ‘a soft and gentle passing’. Other participants raised concerns on the reference to euthanasia and dignified dying in the same breath, as if “ other ways of dying are not or less dignified ”.

Third, the value of quality of life underpinned the arguments made in favour of the Law on Euthanasia, as (1) life itself should not be prolonged unnecessarily, (2) meaningless suffering should be prevented, and (3) a good life should pertain to all stages in life, from the very beginning until the very end, which is feasible if quality of dying circumstances can be guaranteed. As one buddy stated: “ Living a full and good life implies dying a good death ”. Other participants made use of this value underpinning their argument against euthanasia, based on (1) the “protect-worthiness” of life itself and (2) the suffering that must be considered an inherent feature of the human condition.

Fourth, and seamlessly fitting with the former value, divergent courses also emerged regarding the aspect of how to deal with suffering . Some participants were in favour of euthanasia out of compassion in terms of (1) bringing a kind of relief to the patient when providing her the prospect of an end to the suffering and (2) ending the suffering once it has become ‘useless and meaningless’ and ‘disclosing the limits of the carrying capacity of the self’. Some participants referred to the insufficient degree of quality of life in some patients and valued euthanasia as sort of ‘ compensation for a life gone wrong’.

Others considered the option of euthanasia as compromising patients’ ability to accept, bear and cope with suffering experiences by offering the opportunity ‘to quickly resign from it’.

Some participants referred to the dynamic features and hence, the potential enriching value of suffering. They believed that one can and must revolt against the perception of pointless suffering, as suffering may offer unique opportunities to achieve personal growth through the realisation of self-actualising tendencies amidst the suffering and though all kinds of hardship and adversity in life. Therefore, the real challenge is to support the sufferer to (re)gain the ability to transform the suffering by means of redefining, accepting, and making sense of it. One psychiatrist referred to the Myth of Sisyphus and stated:

A rock that must be pushed up the mountain, which is terrible, and then Sisyphus lets the rock fall back down, and he must start all over again. And what is the purpose of that suffering? Pushing the rock up? It’s absurd, really, but still. I find it so vital, human, uh, yes. That is something that inspires me enormously and often makes me, well, yes, vitality and suffering, suffering is inherent to being, of course, and one can suffer, of course, that is very serious suffering, terrible suffering. I know that. But well, accept suffering, right? I’m not glorifying suffering, no, I don’t belong to that category. Some Catholics do that; the suffering of Christ, we must… No, not at all. Suffering is inherent to life. Interviewer: It’s just more bearable for some than for others. Interviewee: Then it’s our task to make it more bearable. Yes. (…) Look, that sets a dynamic in motion. By dynamic, I also mean movement. A euthanasia request is often rigid. I am for movement. That’s what Eastern philosophy teaches us too, that everything moves, and we must keep that movement and that the question may change or that people may also discover things. Or indeed, a suffering that is even more exposed, but on which one can then work. There is still much to do, yes, before the ultimate and final act of euthanasia, by a doctor for all sakes, should be considered. (psychiatrist)

The level of the patient’s inner circle

On the level of the social inner circle, the following three ethical considerations were distinguished: (1) involvement, (2) connectedness, and (3) attentiveness.

Some participants stressed that euthanasia can only be a soft and thus ‘good’ way of dying, if the patient’s social inner circle can be involved in the euthanasia procedure and if sufficient support to them can be provided. All participants in favour of the legal framework on euthanasia echoed the importance of the social circle being involved in an early stage of the euthanasia procedure, as the prospect of the end of life may challenge a patient’s ability of staying and feeling connected . If the euthanasia request is to be carried out, it offers a unique opportunity for both the patient and her social inner circle of consciously being present and sharing goodbyes. Other participants considered this reasoning as potentially deceiving, as concern was raised regarding the trap of false assumptions, in terms of words being left unspoken and the bottling up of one’s own needs for the sake of the other.

As the third doctor, I was asked to provide advice about someone, and the [adult child] was present, a charming [adult child]. The [adult child] was also very friendly but didn’t say much. The man explained why he himself wanted euthanasia and so on. To be honest, at first, I thought, “Well, this won’t take long,” because there were many arguments and reports I had received, but as the conversation went on, I started to feel something different. It turned into a very long conversation, during which the [adult child] also had their say. In short, the father believed that he couldn’t burden his children. He was a kind man who knew what he wanted, and his children were inclined to follow his idea, to follow his vision. However, the children thought, “Yes, we are actually going to agree with our father, and we’ll allow it,” but deep down, they still wanted to take good care of him. The father didn’t want them to take care of him, and there were many other things, but after that long conversation with the [adult child] and the father, and everything else, like, “We’ll still celebrate Christmas together,” there was a complete turnaround. The other physicians involved accepted this very well, and they said, “Okay, for us, it wasn’t clear. (physician)

In addition, concern was raised regarding the inner circle’s respect of individual patient autonomy and freedom of choice outweighing their r esponsibility and accountabilit y to take care for one another and to act according to all these subjects’ best interest.

Consequently, divergent discourses on the virtue of attentiveness emerged. Whereas for some, the euthanasia procedure may offer a unique opportunity for both the patient and her relatives to be better prepared for death and for the bereaved to better cope with grief, others pointed to the inner circle’s continued grappling with unresolved feelings and perceived helplessness after such a fast-track to death.

Yes, and sometimes I also see people, family members after such euthanasia, yeah, I’ve experienced it several times. They say things like, “Yes, I supported it, but I didn’t know it would affect me like this,” you know? They try to convince themselves, saying, “It was good, it was good, and I stand behind it.” Yeah, you are hardly allowed to do otherwise, but you feel that inner struggle in them, you know? Like, “Was it really okay?” But you can’t question it because you think, “Poor them,” but you still feel it, like, “How sad, how sad. (psychiatrist)

The level of medicine

The following five ethical considerations were distinguished: (1) professional duties, (2) responsibility to alleviate suffering, (3) subsidiarity, (4) professional integrity, and (5) monologic versus dialogic approaches.

First and as regards professional duties, it was (only) reported by some physicians that the physician’s duty is “ to provide good care, which includes good end-of-life care ”. Hence, physicians are the ones who should have euthanasia “as a tool in their end-of-life toolbox”. Others held a different stance and referred to Hippocrates’ Oath when stating that the physician’s duty is to save life at all costs.

Second, all the participants agreed that clinicians have the responsibility to alleviate the patient’s suffering . Whereas some welcomed the option of euthanasia due to the experienced limits of palliative care, that in some cases is deemed an insufficient response to intractable suffering, others stated that euthanasia is not needed as physicians have proper palliative care in their toolbox to alleviate all kinds and degrees of suffering.

Third and as regards the subsidiarity principle , opinions differed on the use of a palliative filter, i.e., whether a consultation with specialist palliative care units should precede euthanasia.

Fourth and as regards professional integrity , some participants relativized the physicians’ executive autonomy. As one psychiatrist stated “because in the end, we do not decide whether someone might die or not. We only decide whether we want to be of help and assist in it.” All the ones in favour of the current legal framework echoed that as physicians are the ones that have better access to the lethal drugs and the technical expertise to end the patient’s life in more efficacious ways than non-physicians, they should remain entrusted with euthanasia assessment procedures. Others (only physicians) criticized the Belgian legislator for placing too much power in the physicians’ hands so that the latter “ can play for God instead of using their pharmacological and technical know-how to save lives ”.

Fifth, and as regards the decision-making process, most participants valued the ethical principle of shared decision-making between the patient and her physicians, and some even preferred a triadic dialogue in which the patient, her relevant health carers and her social inner circle is involved in euthanasia assessment procedures. For most of them, this type of extended or relational autonomy is considered as best clinical euthanasia practice, especially when death is not foreseeable. According to some non-physicians, a strict dyadic patient-physician approach is to be preferred when death is reasonably foreseeable in a patient with sufficient mental competence. In this event, no intermediary should be tolerated as the medical secret is considered ‘sacred’. One participant elaborated further on this strict dyadic approach and said:

“ But actually, in my opinion, the request for euthanasia is something between two people. So…. Interviewer: The singular dialogue? “So, a relationship between the patient and the doctor, yes. That’s what I think. And I do understand that the legislation exists, primarily to protect the doctor against misuse or accusations, because euthanasia used to happen before too, but in secret. But for me as a doctor, it would be enough if a patient whom I’ve known for years, followed for years, maybe 20 years, 30 years, 40 years, and who is terminally ill, asks me in private, ‘I want it.’ For me, it doesn’t need to be more than that for me to say, ‘yes.’ So, there’s no need for a whole set of legislation, except of course to protect myself, maybe from the heirs who might have a different idea about it, yes, but I find it beautiful. And they say, you know, our legislation is such that you can write your euthanasia request on the back of a beer coaster and that’s enough, you know? But how it used to be, euthanasia happened just as well, that’s what I heard from my older colleagues. But it was done in private. Actually, that is the most beautiful sign of trust between a doctor and a patient. ” (Physician and consultant)

Others, all physicians without a favourable stance on euthanasia, considered medical paternalism morally justified in the end-of-life context, as (1) physicians have more intimate knowledge of the patient and are thus best placed to act in the patient’s best interests, (2) only the independent evaluation from well-trained and experienced physicians may rule out external or internalized pressure from the patient’s social inner circle, and (3) some patients may show impaired decision-making capacity when confronted with the end of life.

The level of society

As regards the origins and impact of euthanasia legislation on the level of society, the following four ethical themes emerged: (1) protection, (2) dignified dying, (3) solidarity, and (4) distributive justice.

First and as regards protection , some participants valued the existence of a legal framework for an ‘underground’ practice before 2002. According to them, this framework was highly needed to protect the patient against malicious practices and the physician against being charged for murder when ensuring herself that all the legal requirements are met.

So, I believe that it should be well-regulated in a state. In a country, it should be well-regulated. You can either be in favour of it, have reservations, or question it, but when it happens and many people want it or think it’s okay, then it should be regulated. And those, like me, who may be against it, have doubts about it, or wonder, “Is this really necessary?” I would say, or “Does it align with our purpose?” the existential comments that you can make about it, we must accept it because it would be terrible if it, well, it would be even worse if it happened in the underground, like before those laws were established, that’s, yeah. So, I think the laws should exist. Whether I would have made those laws is a different question, or whether I would vote for the parties in parliament that, you know, that support it, that’s another question, but apparently, here in North-western Europe, the need for those practices exists, and it should be regulated properly. And yes, it shouldn’t be left to amateurs or something like that, that’s not the intention. Yes, well, it serves to protect, both in terms of health and to ensure that it doesn’t become a business, of course. I’d prefer it to be integrated into the healthcare system rather than turning it into a profit-driven and exploitative affair for some others. So, that’s…. (psychiatric nurse)

Critical concerns were raised on the lack of protection of the most vulnerable people, i.e., the mentally ill and the elderly. Some of them referred to the amended Law in 2014, that also allowed minors to die by means of euthanasia – be it under more strict circumstances, inter alia, when based on unbearable physical suffering resulting from a medically terminal condition – and feared that the Law will be amended again, so it would no longer exclude the people suffering from dementia or for groups without serious incurable illness, e.g., the elderly with a perceived ‘completed life’.

Second, a major societal shift in thoughts regarding what constitutes dignified dying was reported. For some, the Law on Euthanasia reflects a nascent movement of death revivalism, in terms of people reclaiming control over their dying process. In this respect, euthanasia is deemed a counterreaction to the former dominant paternalistic attitude in Western society to systematically marginalise conversations on death and dying, e.g., due to the mechanisms of denial, avoidance, and postponement, and with the line between life and death increasingly held in physician’s hands, which has left many people ill-equipped to deal with dying and death. The current broad public support for euthanasia is seen as the individual patient taking back the decision-making process of dying and death in her own hands. They further considered euthanasia as a logical consequence of living an artificially prolonged life due to e.g., advances in medicine, that have not necessarily enhanced the quality of life.

“ One thing I also consider is that a part of our lives is artificially prolonged, you know. We don’t live longer because we are healthier, but because we have good pills or better surgical procedures, so we can afford to buy our health. So that part of life is still valuable to me, it’s not less valuable, but it’s artificially extended. So, I think we should keep that in mind, that we can prolong something artificially and maybe even go beyond a point where it no longer works. Interviewer: Beyond the expiration date? That’s what I was looking for (laughs). So, in that sense, I believe we should keep in mind that we can artificially extend something and then maybe, even if it’s just that artificial part, stop or be allowed to stop when the person no longer wants to, I think that makes perfect sense. ” (psychiatrist)

Others provided arguments against the increased death revivalism, referring to euthanasia as a ‘fast-track to death’ resulting in ‘the trivialisation of death’ in the face of formerly known and experienced Art of Dying. For instance, the current societal tendency to avoid suffering and the fear of dying may lead to patients (too quickly) resigning from a slow track to death, in which there is time to e.g., hold a wake.

But I won’t just grab a syringe, fill it up, and administer a lethal injection, you know? I follow the symptoms. And if they become uncomfortable, then I’ll increase the dosage so they can rest peacefully and not have to suffer. That’s what I call a dignified death. And if the family can be present, sometimes it takes a while for them to arrive, and they’ll say, “Come on, even a dog is not allowed to suffer that long.” Meanwhile, the person is just lying peacefully. But that too. Everything should, even that, should progress, and there isn’t much time left for vigil and, yes, I don’t want to romanticize it, but sometimes you see so much happening between families. There’re all kinds of things happening in those rooms, with the family, reconciliations being made. Memories being shared. “Oh, I didn’t know that about our father.“, an aunt walking in and telling a story. Well, so much still happens. I don’t want to romanticize it, but to say that all that time is useless, that’s not true either. And at the farewell, there’s always, the time, you think there’s time for it, but people are still taken aback when an infusion is given, that it can happen within a minute, even if they’re behind it and have been informed beforehand. Just a minute… and it’s done. The banality of death, it’s almost like that. (psychiatrist)

These and other participants also criticised ‘the romanticised image of euthanasia’, that masks the economics of the death system, taking financial advantage of ‘patients not wanting to be a burden to society’.

Third and consequently, divergent discourses on the value of solidarity emerged. For some, decades of civic engagement pointed to the need of death revivalism and patient empowerment, that resulted in the current legal framework. Others strongly criticised the lack of solidarity underpinning the legal framework on the following three counts: 1) the emphasis on patient autonomy is deemed a ’societal negligence in disguise’, as citizens are no longer urged to take care of others, 2) equating autonomy and dignity in euthanasia debates leads to the trap of viewing the ill or the elderly as having ‘undignified’ lives, and 3) wealth over health has become the credo of the current neoliberal society, as the Law on Euthanasia discourages further investments in health care but settles on the ‘commodification’ of health care.

“ I believe that we should take care of each other and especially care for the most vulnerable in our society. We shouldn’t just leave them to fend for themselves. I don’t think the motto should be all about autonomy, autonomy, and then the flip side, saying, “figure it out on your own.” That’s not acceptable. We have a responsibility to take care of each other. We are meant to care for one another. In biblical terms, we are each other’s keeper, right? “Am I my brother’s keeper?” Yes, I am my brother’s keeper. I must take care of each other, take care of others. So, I think in the long term, speaking maybe 100 years from now, people might say, “Sorry, that was a real mistake in the way they approached things.” I don’t know, but that’s looking at it from a meta-level, as historians call it, “longue durée,” and combining it with a neoliberal model, right? Neoliberalism and euthanasia thinking, it would be interesting to do a doctoral thesis on how they fit together perfectly. How they fit together perfectly… They are no longer patients, they are no longer clients, and I also don’t like the word ‘clients.’ They have become ‘users’. Sorry, but that’s our Dutch translation of the English word ‘consumers’ right? It’s like buying Dash detergent or a car; you buy care, just like the Personal Budget for people with disabilities. You buy your care, sorry, this goes against the very essence of what care fundamentally is. Care is a relationship between people; it’s not something you buy. It’s not something you say, “It’s a contract, and I want that.” It doesn’t work like that. [raising voice] The burden is on society. [end of raising voice] And when the money runs out, you have nothing left. If you can’t buy it, then it doesn’t come. “Here’s your little package,” that’s how it’s translated, and it’s always a hidden cost-cutting operation, let’s be very honest about it, a nice story, but it’s always a hidden cost-saving measure. I see right through that story, but well, big stories are always told, and they are always about saving money. [raising voice] It doesn’t bring anything, right? [end of raising voice] People’s self-reliance, they must stay at home, etc. How many people would benefit from going to a care centre, not at the end of their lives, but just because they feel totally lonely at home, but they can’t get in because nobody wants them there, as they don’t bring any profit. ” (spiritual caregiver)

Fourth, critical concerns were expressed concerning the lack of (distributive) justice due to the many existing misperceptions and misconceptions regarding medical end-of-life options that need to be uncovered. For instance, many people would be unaware of euthanasia and palliative sedation can both be dignified ways of dying, with euthanasia functioning as a fast-track and palliative sedation functioning as slow track to death. Also, the evolution of death literacy was contested: there was a sense that patients did not become more death literate, as many of them have insufficient knowledge of the content of the many end-of-life documents in circulation.

Yeah, I mean, you see, and I hear many people saying, “My papers are in order.” I won’t say every day, but I hear it almost every day, “My papers are in order.” That’s also something. It’s an illusion of control, right? Because what papers are they talking about? “My papers are in order.” When you ask them about it, they themselves don’t really know what that means, some kind of ‘living will’, ‘an advance care plan’, but yeah, with all… A living will or advance care plan is not that simple either, and then they think, “Oh, if I get dementia and I don’t recognize anyone anymore, they will give me an injection.” Ah yes, but then we are in a different domain, and that’s a whole other… But yeah, people are not well-informed, I find. They have totally wrong ideas and sometimes fear the wrong things, don’t know what is possible and what is not, and they also let themselves believe all kinds of things. Well, there are many misconceptions out there. (psychiatrist)

Participants’ ethical considerations regarding the additional procedural criteria for people with a non-terminal illness

As can be seen from the coding structure in Table  3 , participants made use of the principle justice to motivate their stance on additional (procedural) criteria that people with a non-terminal illness must meet before euthanasia can be carried out, in comparison with people with terminal illness. Those in favour of the additional procedural criteria referred to the differences between the terminally ill and the non-terminally ill regarding the aspect of content (i.e., the difference between general life expectancy and healthy life expectancy) and the aspect of time (i.e., the probability verging on certainty concerning the terminally ill versus the rough estimation concerning the non-terminally ill). Some of them also referred to the legal proceedings and stated that the Law was meant only for people with terminal illnesses to die by means of euthanasia. Others were of the opinion that it concerns only an arbitrary difference due to 1) the vagueness of the concept ‘naturally foreseeable’, i.e., suffering from a terminal illness, and the subjectivity of the calculated course and prognosis of e.g., degenerative somatic illnesses and dementia. A few participants said that this is beside the question, as one’s individual carrying capacity trumps the course and prognosis of an illness.

Participants’ ethical considerations regarding adults with psychiatric conditions

As can be seen from the coding structure in Table  4 , when asked about participants’ stances on euthanasia in the context of psychiatry, we distinguished value-based themes at the level of (1) the patient, (2) the field of psychiatry, and (3) society in general.

The level of the patient

Justice was the main value-based principle that emerged at the level of the patient. Participants in favour of not legally amending additional procedural criteria in the context of psychiatry stated that every patient with a non-terminal illness should receive equal end-of-life care options. The main counterargument given concerned the differences in patient profile, as some questioned whether the mentally ill can meet the legal criteria or stated that extreme caution is needed and thus additional criteria are in place due to the factor of e.g., ambiguity, impulsivity, and manipulation in the mentally ill.

“I find, the way the procedure is conducted for psychiatric suffering, I find it only natural that they handle it more cautiously because it’s indeed less… It’s not so easy to determine everything, is there really no other option left? And then I understand somewhere that time must be taken to investigate all of that. Because some of these people can be very impulsive, and that impulsivity needs to be addressed somewhere, of course. You also have people who can use their setbacks in the sense of, ‘I’ve been through all that, so I deserve euthanasia.’ And those are the people you need to single out because that’s just… I think those are also people who, with the necessary guidance, can still get out of it. Do you understand? It’s a form of self-pity, in a way. I think there might be resilience there, but they haven’t tapped into it themselves yet; it’s a kind of deflection or something. People with a history of, who say ‘I’ve experienced this and that, so I don’t need it anymore, just give me euthanasia, I deserve that. I’ve been through all that.’ While maybe, if they see, that’s still worth something to me, who knows, maybe that can still happen. They’re people who give up a little too quickly.” (Moral consultant)

Regarding the field of medicine, the following four value-based considerations emerged: (1) justice, (2) responsiveness to suffering, (3) protection, and (4) proportionality.

First, and as regards the principle of justice , participants in favour of equal procedural criteria for all non-terminally ill pointed to the indissociable unity of soma and psyche. A few physicians went one step further and reported that some psychiatric conditions can be considered terminal, e.g., suicidality, or predominantly of somatic nature, e.g., anorexia. The main counterarguments in this respect were (1) the firm belief in the inexistence of irremediableness in psychiatry (only mentioned by some physicians) or (2) that more caution is needed due to the higher level of subjectivity in terms of diagnostics, prognosis, and outcome.

Second, arguments against the distinction between the somatically versus the mentally ill were based on the attitude of responsiveness to the extreme extent and duration of mental suffering that can also render the mentally ill in a medically futile situation and the field of psychiatry empty-handed.

And many of the psychiatric patients I see suffer more than the average ALS patient who has to endure it for three years. In my experience, we’re less advanced in psychiatry compared to most other medical fields. You can easily say “we don’t know” in other areas of medicine and people will understand, but when it comes to psychiatric conditions, it’s different. Doctors might admit “it’s not working” or “there’s no trust,” and they might refer patients elsewhere or even refuse further appointments. I’ve even told a judge during a forced admission, “There’s simply no treatment available.” Yes, sometimes it’s just over and society must accept that there’s no solution. I’m not saying euthanasia is the solution for everyone, but I think it can be an option for some people. (Psychiatrist)

Other participants were not blind to the deep suffering, but strongly believed in the ground principle and core strength of psychiatry, namely the beneficial effect of hope. In addition, they pointed to the differences in the nature and course of somatic versus psychiatric illnesses when stating that considerably more time is needed in psychiatry, with inclusion of the therapeutic effect of hope to become effective.

“And I also believe that collectively, within psychiatry, we can and must provide additional support to endure profound despair. So, even in the face of seemingly endless hopelessness, we must maintain hope, look towards the future with trust, and continuously offer encouragement to those who feel hopeless. Our unwavering optimism and support convey the message that together, we can overcome. Because individuals who suffer from severe mental illness are treatable, I consider myself to be a genuinely optimistic psychiatrist. I have witnessed individuals who have harbored feelings of hopelessness and despair for extended periods, sometimes even decades, undergo profound transformations and experience significant improvement, and in some cases, complete recovery.” (Psychiatrist)

Third, participants in favour of the current legal framework reported that allowing euthanasia for the mentally ill was needed in the light of protection , as it might protect the patient against brutal suicides and also against therapeutic tenacity that more often occurs in psychiatry. Other participants in favour of, as well as participants against the current framework held a different stance on the following two counts: (1) allowing euthanasia conflicts with the aim of psychiatry to prevent suicide at all costs, and (2) the mentally ill are insufficiently protected by the Law as there are insufficient built-in safeguards against therapeutic negligence.

But usually with a psychiatric condition, death isn’t imminent. That’s the tricky part, you know? How many suicides do we have here? But anyway, I have an issue with that, using euthanasia as a kind of antidote against, well, against suicide, that’s a completely different matter. But death and psychiatry, why do we have all those government programs against suicide then? Isn’t that dying as a result of a psychiatric condition? (Psychiatrist, supportive of maintaining euthanasia option in psychiatric settings)

Fourth and as regards proportionality , a few participants with a normative stance against euthanasia in the context of psychiatry argued that psychiatric patients may not be allowed to die by means of euthanasia for as long as the field of psychiatry is under-resourced. They pointed to e.g., the lack of sufficient crisis shelters with a 24/7 availability and the lack of palliative approaches in the field of psychiatry. Instead of allowing euthanasia, they argue ‘to jolt the Belgian government’s conscience on mental health policies’. As a revolution to defeat the built-up inequalities in the field of medicine and knowing that palliative and rehabilitation initiatives in psychiatry require time.

“I oppose euthanasia in psychiatry. Compared to somatic medicine, psychiatry lags behind by 50 years. While physical pain can be managed with medication, there’s insufficient research on treatments for psychological suffering. Promising options like psilocybin and ketamine show potential in easing existential mental struggles. Magnetic stimulation can also alleviate depression, yet access remains limited. Unfortunately, these treatments are underused and under-researched. Many patients aren’t informed about these alternatives to euthanasia. It’s frustrating to see reluctance in exploring these options, especially when they offer hope to long-suffering patients. Utilizing these methods in psychiatric settings carries no risk of addiction. However, current restrictions impede access to these treatments, depriving patients of viable alternatives.” (Shortened excerpt from an interview with a psychiatrist)

When taking a societal perspective, no new arguments emerged from the respondents strongly in favour of the current euthanasia legislation, other than the main value of justice described in the subsection above. According to some, the current Law on Euthanasia busts some myths on the malleability of life and medical omnipotence, and even on psychiatric illnesses as a ‘Western phenomenon’, with e.g., depression and suicidality as a consequence of material wealth instead of a neurologic issue in the brain (only reported by some non-physicians).

There are quite a few people who consider the whole issue of the unbearable nature of psychological suffering a luxury problem, you know? They say something like, “Yeah, where are the suicide rates, to put it in equivalent terms, the lowest in the world? In Africa, because they obviously don’t have the luxury to concern themselves with that. They are already happy if they have a potato on their plate every day.” This is a viewpoint held by many, right? They call it a luxury problem, a modern, typical Western luxury problem. And perhaps there is some truth to it, right? But there are other causes of mortality there, which are much higher, such as child mortality, for example. (non-physician)

Counterarguments were also given and pointed to the value of (distributive) Justice. First, euthanasia was considered as ‘a logical but perverse consequence of systemic societal inequities’ on the one hand and the ‘further evolution towards the commodification or commercialisation of health care in individualised Western societies’ on the other. This would then lead to another vicious circle, with a rapidly growing ‘perception of vulnerable patient groups as irremediable’ and hence less likely to receive potentially beneficial treatment or other interventions. Some took a more radical stance against euthanasia in psychiatry, as they were convinced that euthanasia is nothing but ‘a perverse means to cover societal failures’. In addition, some participants with permissive stances on euthanasia in the context of psychiatry pointed to gender disparities in euthanasia requestors. This was based on the evidence that in the context of psychiatry, many more females request and die by means of euthanasia than males, and proportionally more female patient suffering from psychiatric disorders request and die by means of euthanasia compared to their fellow peers suffering from life-limiting or predominantly somatic conditions.

Finally, some respondents said that they could understand and, in some cases, even support euthanasia in some individual cases, but felt uncomfortable with its impact on the societal level. They pointed to the vicious circle of stigma and self-stigma that may impede the mentally ill to fully participate in societal encounters. In the long run, this type of societal disability may lead to vulnerable patients no longer wanting to perceive themselves a burden to society or to remain ‘socially dead’.

While considering their ethical perspectives towards euthanasia, participants weigh up various values related to and intertwining with the following levels: (1) the patient, (2) the patient’s inner circle, (3) the field of medicine, and (4) society in general. Overall, the participants shared an amalgam of ethical values on each of these four levels, regardless of their stance on euthanasia. It was mainly the interpretation of some values, the emphasis they placed on the key components underpinning each value and the importance they attach to each of the four levels, that determined their stance towards euthanasia. It was uncommon for different ethical values to be explicitly mentioned, which could distinguish distinct stances for or against euthanasia.

As regards euthanasia in the context of psychiatry, the focus has primarily been on arguments for and against euthanasia [ 23 ]. However, our study takes a more comprehensive approach, exploring the issue from a wider range of perspectives. This approach allowed us to uncover more complex insights that may have been overlooked if we had only considered it as a black-and-white issue.

Both the systematic review of Nicolini et al. [ 23 ] and our study emphasized fundamental ethical domains such as autonomy, professional duties, and the broader implications of euthanasia on mental healthcare. While our findings aligned with those of the systematic review, our inquiry delved deeper into psychiatry-specific considerations, including the influence of sudden impulses and feelings of hopelessness. This underscores the importance of healthcare professionals carefully assessing the timing and contextual aspects of such decisions within psychiatric contexts, ensuring individuals receive timely and tailored support and interventions.

Furthermore, our study extended beyond the boundaries of medical discourse, addressing broader societal ramifications. Participants engaged in discussions about ‘social death,’ a phenomenon that describes the marginalization of individuals despite their physical existence. This discussion highlighted entrenched structural inequities and societal attitudes perpetuating social alienation, particularly affecting marginalized demographics, including individuals grappling with mental health issues. Advocating for societal inclusivity and supportive measures, our study strongly emphasized the need to foster a sense of unity and respect for everyone’s worth, regardless of their circumstances.

Interpretation of the main findings

We make explicit and discuss the values corresponding to the four classical principles of biomedical ethics, in particular beneficence, non-maleficence, respect for autonomy and justice [ 31 ]. We place these values in the context of different ethical approaches, such as religious, professional, emancipatory, social, societal, and virtue-oriented approaches (see the ethical interpretation framework in OSF).

In the discussion section, therefore, the following main values and virtues are addressed: (1) the values of beneficence and non-maleficence in a religious perspective, (2) those same values in the professional context, (3) the value of autonomy in the contemporary emancipation paradigm, (4) the virtue of compassion stemming from virtue ethics theory, (5) the value of quality care in a social approach, and (6) the value of justice in societal policy contexts.

Beneficence and non-maleficence: religious perspective

In the realm of euthanasia debates, the interplay of religious beliefs and the values of ‘beneficence’ (the act of doing good) and ‘non-maleficence’ (do no harm) has emerged as a pivotal point of contention, often giving rise to divergent perspectives on this complex ethical issue [ 32 , 33 ]. Some religious traditions staunchly oppose medical end-of-life decisions, including euthanasia and abortion, viewing them as morally wrong and as disruptive to the natural order of life and death. The principle of ‘sanctity of life’ forms the bedrock of their belief system, underscoring the significance they attach to preserving life at all costs, as an embodiment of beneficence [ 34 , 35 ]. Conversely, those who argue for the ethical consideration of euthanasia emphasize the concept of beneficence in alleviating suffering and granting autonomy to individuals in their final moments. However, intriguingly, our examination of the topic has revealed a nuanced relationship between religious beliefs and attitudes toward euthanasia. While some individuals in our sample expressed strong religious convictions ( n  = 5) and even considered themselves as practicing Catholics, they did not necessarily adopt a firm normative stance against euthanasia, signifying a complex balancing of beneficence and possible maleficence within their belief system. Conversely, certain participants who held steadfastly against euthanasia ( n  = 3) did not identify with any religious belief system, yet their position was firmly grounded in their perception of potential maleficence associated with medical intervention in life and death decisions. This observation aligns with recent studies highlighting the intricate and multifaceted nature of religiosity, where individuals within various religious frameworks may hold diverse beliefs and values surrounding beneficence and non-maleficence [ 36 , 37 ]. Moreover, it underscores the powerful influence of societal culture on shaping personal perspectives on euthanasia, and how these views are entwined with the values of beneficence and non-maleficence [ 36 , 37 ].

Beneficence and non-maleficence: professional values

Second, a profound division arises between proponents and opponents, particularly in the field of medicine, where interpretations of the Oath of Hippocrates play a central role. At its core, the Oath emphasizes the deontological values of beneficence and non-maleficence, as physicians are bound by a prohibition against administering a deadly drug to ‘anyone,’ even at their explicit request, highlighting the reverence for the sanctity of life inherent in medical practice. This interpretation has led some to perceive active euthanasia as contrary to these sacred principles of preserving life. The notion of beneficence, understood as promoting the well-being of patients, appears to be in tension with the act of intentionally ending a life. Critics argue that euthanasia undermines the fundamental duty of physicians to protect and preserve life. Additionally, the principle of ‘non-maleficence,’ which entails not harming the patient or their life, is seen by some as being in accordance with the ‘sanctity of life’. However, the Oath also recognizes the significance of alleviating relentless suffering, opening the door to a nuanced debate on how these timeless principles align with the modern concept of euthanasia. As the discourse unfolds, perspectives emerge, with some viewing euthanasia as a compassionate form of care, that respects the autonomy and dignity of patients facing terminal illness or unbearable suffering. Advocates argue that euthanasia can be an act of beneficence, providing relief from pain and allowing individuals to die with dignity and control over their own fate. On the other hand, opponents of euthanasia steadfastly uphold the sanctity of life principle, viewing it as an ethical imperative that must not be compromised. They argue that intentionally ending a life, even in the context of relieving suffering, undermines the fundamental values of medical ethics and the intrinsic worth of every human life. For these individuals, euthanasia represents a profound ethical dilemma that conflicts with the near sanctity of medical ethics and the value of preserving life [ 38 , 39 , 40 ].

Autonomy: contemporary emancipation paradigm

The principle of autonomy emerges as one of the most prominent and contentious values in our contemporary emancipation paradigm. Autonomy, grounded in the belief in individual self-governance, is often cited as a foundational ethical principle in euthanasia legislation, emphasizing the significance of an individual’s capacity to make choices aligned with their own personal values and desires [ 31 ]. However, the discussion on autonomy extends beyond pure individualism, with considerations for relational autonomy, recognizing that individuals are not isolated entities but are shaped by their relationships, communities, and broader societal structures [ 41 ]. Within the context of euthanasia, the complexities of autonomy become evident as participants in the debate strived to find a delicate balance. On one hand, they stress the importance of respecting a patient’s individual autonomy in end-of-life decisions, ensuring that their choices are honoured and upheld. Simultaneously, they acknowledge the necessity of accounting for the patient’s social context and broader community when considering euthanasia as a compassionate option. Nevertheless, concerns are raised by some about the potential risks posed by euthanasia legislation, particularly for the most vulnerable individuals, such as the elderly and the mentally ill. These concerns centre on the negative consequences that may arise when individual autonomy is exercised without consideration for others or for societal well-being, and the concept of “social death,” which refers to the marginalization and exclusion of individuals from social relationships and networks due to illness or disability [ 42 , 43 ].

Amidst these complexities, the ethical value of autonomy stands as a paramount consideration. However, its application necessitates thoughtful consideration and balance with other values, including justice, equality, and societal responsibility. Recent reflections on “relational autonomy” have prompted critical evaluations of the idea of pure autonomy, emphasizing the need to delve deeper into the micro, meso, and macro levels that underpin autonomy and address potential conflicts between individual and relational autonomy [ 44 ]. Further, it highlights the imperative to take the broader societal context into account when grappling with the ethical challenges associated with euthanasia [ 45 ].

Compassion: virtue ethics

Our study confirms that while the value of autonomy holds importance, it is not the sole determinant in the ethical considerations surrounding euthanasia [ 46 ]. In this complex discourse, numerous other ethical values and virtues come to the fore, including the significance of compassion towards suffering individuals and the imperative of alleviating their distress. Notably, compassion is not merely a singular principle, but rather a profound ground attitude or virtue that motivates individuals to empathize with the pain of others and take actions to provide relief.

As revealed in our research, participants who opposed euthanasia did not invoke religious frameworks; instead, they explored diverse philosophical approaches to comprehend suffering and compassion. Among these, non-Western philosophies emphasized embracing suffering as an intrinsic aspect of life, acknowledging the impermanence of all things, including suffering. Additionally, the existentialist perspective of Albert Camus underscored suffering’s innate connection to human existence, leading to deeper self-understanding and comprehension of the world.

These philosophical viewpoints find relevance in the realm of ethics as well. Virtue ethics, in particular, highlights the significance of cultivating virtues such as courage and resilience, while narrative ethics emphasizes storytelling as a means to gain profound insight and reflection on experiences of suffering [ 47 , 48 ]. Such narratives foster empathy and create a shared sense of experience and community.

Our results show that, for some, suffering may hold positive value in various ways. The nature and intensity of suffering, alongside an individual’s values and virtues, beliefs, and coping capacity, significantly influence the ethics of euthanasia decision-making. An intricate approach that recognizes the multifaceted impacts of suffering becomes essential, acknowledging that various factors could potentially influence the experience of suffering as well as the interpretation of the consequences of the suffering experience. It’s possible that this approach doesn’t solely depend on the quantity of suffering or even its nature. Instead, it could be related to the delicate balance between one’s ability to endure suffering, the burden it places on them, and the (ir)remediableness of this burden, which can vary greatly among individuals as well as it might change over time. Such an approach aims to alleviate relentless suffering and, in certain cases, relieve unnecessary and enduring distress without consistently imposing interpretations upon it. Thus, acknowledging that, experiences of suffering are inherent to life and might act as drivers for personal development, fostering resilience, empathy, and a deeper apprehension of life’s essence, while it also might represent something irremediable, underscores the significance of a broader meaning of the concept of compassion as guiding principle in euthanasia discussions. These discussions further extend to the recognition of the dynamic trajectory inherent to the burden of suffering, as well as its potential for temporal evolution within the individual experiences of the afflicted. Such recognition not only fosters a more intricate understanding of the complex interplay between suffering and resilience but also highlights the acknowledgment that there may be moments when suffering becomes unendurable, surpassing the individual’s capacity to cope. This dimension introduces a layer of intricacy to the ethical considerations inherent in these discussions, thus necessitating a nuanced approach that contemplates the potentialities as well as the constraints of human endurance and the associated ethical ramifications.

Quality care: social approach

Examining euthanasia debates from a sociological perspective sheds light on the influence of societal inequalities in healthcare access and quality on the practice of euthanasia, and how it can shape personal, relational, and societal values, leading to the normalization or culturalization of euthanasia [ 49 ]. A noteworthy finding in this context is the contrasting perspectives on the evolving process of dying, transitioning from being perceived as in God’s hands to a more medical realm, where proponents of euthanasia view medicine as a catalyst for granting individuals greater control over the timing, manner, and circumstances of their own deaths. They envision the opportunity to be surrounded by loved ones and maintain consciousness while embracing the option of euthanasia, which they believe improves the quality of life at the end.

Proponents also emphasize additional benefits, such as enhanced transparency and regulation, ensuring ethical conduct through regulatory measures. They express concerns about a cultural environment where certain physicians adopt paternalistic attitudes and resist accepting death, prioritizing the extension of life as a moral imperative. In contrast, critical voices argue that death and dying have become increasingly medicalized, leading to their institutionalization. Some critics further contend that this medicalization has devalued the dying process and commodified life itself, leading patients, and families to increasingly rely on medical interventions at life’s end.

Moreover, as shared by some of the interviewees, the growing acceptance of medical assistance in dying may raise concerns. It’s conceivable that this evolving attitude could contribute to a perception of death undergoing a shift in seriousness, resulting in decisions about one’s life conclusion being made with less comprehensive thought and insufficient reflection. Consequently, this scenario could potentially lead individuals who are more susceptible to experiencing feelings of life’s insignificance, weariness, or sense of being ‘through with life’, to lean towards considering euthanasia. However, this inclination might also be driven by a lack of sufficient access to the necessary, long-term quality mental health care that would otherwise facilitate the pursuit of a life imbued with adequate significance, comfort, and dignity, achievable through appropriate (mental) healthcare.

Earlier research indicates that Belgium’s psychiatric care system has been grappling with underfunding and fragmentation, leading to individuals falling through the gaps in the mental health safety net [ 50 ]. One critical aspect is, e.g., the inadequate investment in long-term, intensive care, which is precisely the kind of support that individuals grappling with such existential questions may require.

Hence, in the context of euthanasia debates, the value of quality care emerges, encompassing the principle of beneficence, which emphasizes the obligation to provide good care and enhance the overall well-being of individuals. Ethical considerations go beyond the individual’s right to autonomy, extending to societal factors that influence healthcare practices and attitudes towards euthanasia. Addressing the impact of healthcare disparities and the medicalization of dying becomes imperative to ensure ethical and compassionate decision-making that upholds the true value of quality care and respect for human dignity.

Justice: societal policy contexts

In the context of euthanasia in somatic versus psychiatric medicine, ethical considerations regarding euthanasia often revolve around the fundamental value of justice [ 23 , 51 , 52 ]. Some respondents in our study emphasized the need for parity between somatic and psychiatric illnesses, recognizing that there should be no distinction between patients suffering from either. They argued that upholding the principle of justice demands equal treatment and recognition of the suffering experienced by individuals with psychiatric illnesses.

However, for others, achieving justice requires acknowledging and addressing the unique challenges faced by patients predominantly suffering from psychiatric illnesses. A comprehensive and integrated healthcare approach is proposed, where mental health is regarded as an integral part of overall health. This approach involves allocating the same level of attention and resources to psychiatric medicine as given to somatic illnesses, aiming to combat stigma and discrimination towards individuals with psychiatric conditions. Equitable treatment during life and at the end of life becomes the focus.

Yet, the Belgian context of psychiatry presents significant challenges. The field is characterized by underfunding and fragmented care, particularly for individuals with longstanding and complex psychiatric problems [ 53 ]. Additionally, the end-of-life care for psychiatric patients is still underdeveloped, and palliative psychiatry is in its early stages, lacking a uniformly agreed-upon definition or clear implementation guidelines [ 54 ]. In response, Belgium is exploring the “Oyster Care” model, designed to provide flexible, personalized care for individuals with severe and persistent mental illness who may be at risk of neglect or overburdened by psychiatric services [ 55 ]. This model aims to create a safe “exoskeleton” or supportive environment for patients, recognizing that recovery, reintegration, and resocialization might not be attainable for everyone with certain psychiatric conditions [ 55 ].

However, the integration of Oyster Care in today’s psychiatric practice is still limited and requires further development. Emphasizing the value of justice calls for continued efforts to enhance and refine psychiatric care, ensuring that individuals with psychiatric illnesses receive equitable treatment throughout their lives, including end-of-life care decisions [ 55 , 56 ].

Implications for future research, policy, and practice

In terms of policy and practice, our findings indicate that the discourse surrounding euthanasia extends beyond legal or medical considerations and encompasses fundamental ethical values that underpin our society. These values may not always be aligned and can create ethical dilemmas that are challenging to address. A value-centred approach to the euthanasia debate necessitates a constructive ethical dialogue among various actors involved, including patients, healthcare practitioners, and the wider community. This conversation should strive to comprehend the diverse values involved and endeavour to achieve a balance between these values. Additionally, ethical dialogue might encourage individuals to reflect on their own assumptions and beliefs, leading to more informed and thoughtful decision-making on ethical and moral issues. Ultimately, ethical dialogue can promote a more just and equitable society that prioritizes empathy, understanding, and mutual respect.

It is also crucial to acknowledge that patients with somatic illnesses and those with psychiatric illnesses may have different needs and expectations regarding the end of life. Hence, end-of life healthcare must be sensitive to the unique needs of each group. This recognition of differences does not justify unequal treatment or discrimination based on the type of illness. Instead, it involves addressing the different needs and expectations of each patient group while ensuring equitable and high-quality care for all.

As regards research, most articles on euthanasia legislation to date placed the emphasis on what other countries and states can learn from the Belgian and Dutch euthanasia practice. In addition, what can be learned is mainly restricted to the evidence and reflections on factual issues from a global practical-clinical perspective. Consequently, one of the main ethical, clinical, and societal issues remains unrequited, namely the impact of legislation and its consequences on an intrapersonal, interpersonal, medical, social, and societal level. Although cultural diversity is recently put high on the research agenda concerning general health care and mental health care, it is largely understudied in the context of end-of-life decisions and largely ignored in the context of psychiatry. Fewer articles have focused on what the latter countries may learn from those not implementing or not considering euthanasia legislation. In an increasingly diverse society, rapidly evolving in terms of fluidity and multi-ethnicity, cross-cultural research can help us learn from one another. To address the many dimensions of euthanasia, there is a need for input from a variety of academic fields, including sociology, anthropology, communication studies, and history. Further interdisciplinary research in all these areas could help inform policy and practice related to euthanasia.

Strengths and limitations

This is the first empirical in-depth interview study that uncovered the underlying ethical considerations of a variety and relatively large sample of health care professionals and volunteers in Belgium, a country with one of the most permissive legislative frameworks regarding euthanasia, as – unlike in some other countries – it does not exclude adults with psychiatric conditions per definition. Belgium is also one of the pioneering countries with such a legislative framework and can boast on two decades of euthanasia legislation and implementation.

We succeeded in providing a unique and representative sample of participants, varying in gender, work setting and expertise, and stances regarding euthanasia. Finally, and unlike former scientific studies that focused on either the somatic or psychiatric context, we now gauged for participants’ ethical perspectives on euthanasia in both fields of medicine.

There are also several limitations to our study. We may have experienced selection bias, as our sample of non-physicians had varying ages, but the sample of physicians was mostly older than 60. In addition, some interviews had to be postponed or cancelled due to COVID-19 restrictions and, potentially, due to legal and emotional concerns surrounding a high-profile euthanasia case being brought to court. Additionally, our sample exhibited heterogeneity regarding worldview (religious or non-religious), but possibly not regarding other culture-sensitive aspects, like migration background. As our qualitative research focused on exploring themes, narratives, and shared experiences rather than on ensuring high participation rates for statistical generalizability, drawing definitive conclusions regarding the prevalence of each opinion (pro/ambivalent/critical/against), the level of experience, or perspective across the entire spectrum of euthanasia practice is beyond the scope of our study.

Finally, although there is a growing number of countries and states around the globe with a legislative framework on euthanasia, all the legal frameworks differ from one another, so the results of our study cannot be generalized to the specific euthanasia context in e.g., Switzerland or Canada.

Our study illuminates the foundational values guiding perceptions of euthanasia, including autonomy, compassion, quality care, and justice, which permeate through four interconnected tiers: the patient, their inner circle, the medical community, and society at large. Despite varied stances on euthanasia, participants demonstrated a convergence of ethical principles across these tiers, shaped by nuanced interpretations and considerations. While explicit discussions of distinct ethical values were infrequent, their profound impact on euthanasia perspectives underscores the importance of ethical discourse in navigating this complex issue. By fostering inclusive dialogue and reconciling diverse values, we can promote informed decision-making, justice, and empathy in end-of-life care, particularly in psychiatric settings. Interdisciplinary research is essential for a comprehensive understanding of euthanasia’s dimensions and to inform policy development. While our study is rooted in Belgium, its implications extend to the broader euthanasia discourse, suggesting avenues for further exploration and cross-cultural understanding.

Data availability

The datasets generated and/or analysed during the current study are not publicly available due reasons of privacy and anonymity, but are available from the corresponding author on reasonable request, following procedures from all 3 Medical Ethics Committees involved. To access the supplementary materials, see the Open Science Framework repository at https://osf.io/26gez/?view_only=af42caddb2554acfb7d1d5aabd4dec7a . Upon publication of this paper, the repository will be made public, and a shorter link will be provided.

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Acknowledgements

The authors wish to thank prof. dr. Kenneth Chambaere and prof. dr. Kurt Audenaert for their preliminary advice regarding the ethics of the research methodology, dr. Steven Vanderstichelen for his help with the interviews (i.e., conducting and transcribing) and all the participants for sharing their professional and in some cases also personal experiences during the interview. We’d also like to thank prof. dr. Kenneth Chambaere for the supervision during the conducting of the interviews and his feedback on the ‘near to final’ draft.

MV is funded by the Research Foundation Flanders via research project (G017818N) and PhD fellowship (1162618 N).

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The article has been developed with the following authors’ contributions: MV was responsible for the study methodology and managed ethical approval; MV conducted most of the interviews and wrote the main manuscript texts. AL drafted the ethical interpretation framework. MV, LM, KP and AL were responsible for the coding structure and data interpretation and performed a critical review and revision of the final manuscript.

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Correspondence to Monica Verhofstadt .

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This research project was performed in accordance with the Declaration of Helsinki and the European rules of the General Data Protection Regulation. It received ethical approval from the Medical Ethics Committee of the Brussels University Hospital with reference BUN 143201939499, from the Medical Ethics Committee of Ghent University Hospital with reference 2019/0456, and from the Medical Ethics Committee of the Brothers of Charity with reference OG054-2019-20. The interviews were held after obtaining informed consent from all the participants.

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MV has received research grants from the Research Foundation Flanders; no other relationships or activities that could appear to have influenced the submitted work were declared. All other authors declare that they do not have any competing interest.

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Verhofstadt, M., Moureau, L., Pardon, K. et al. Ethical perspectives regarding Euthanasia, including in the context of adult psychiatry: a qualitative interview study among healthcare workers in Belgium. BMC Med Ethics 25 , 60 (2024). https://doi.org/10.1186/s12910-024-01063-7

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"The Apprentice" long con persists today, even beyond its host's many convictions

Before thursday's guilty verdicts, a published account from an unmuzzled producer revealed how his show made trump, by melanie mcfarland.

Fun though it may be to pretend Fox News host Jeanine Pirro guzzles a box of wine before “ The Five ” cameras go live, on Thursday’s episode she was soberly carrying her Orange Leader’s water .

Pirro was one of several experts the network called on for reactions to a Manhattan jury finding Donald Trump guilty on all 34 felony counts of falsifying business records related to the Stormy Daniels hush-money case. Fox contributor and George Washington University Law Professor Jonathan Turley was saddened by the glee New Yorkers took in Trump's guilt. “You know that if there's a tendency in our politics to not treat people as people,” he said. He went on to add, “Regardless of how you feel about this case, that's a sad moment for a country.”

Pirro’s feelings were, shall we say, less measured. “We went over a cliff!”

Several times Pirro called Daniels a “hooker" and insisted Manhattan District Attorney Alvin Bragg ’s case was riddled with errors along with accusing him (yet again) of being funded by George Soros.

But the phrase she kept returning to her in her tirades was fascinating. To Pirro, nefarious liberal forces are using “their hunger for power, and their hunger to be in control to destroy a man who is the strongest man I've ever met, to put some halfwit in the White House!”

She raved on, “They had to do this because Donald Trump was winning with women, with minorities, with the underserved. He is the guy that America is relying on right now to stand up and say, ‘I can be strong for all of you.’”

She said it again after her other panelists on “The Five” offered their thoughts: “Donald Trump is the strongest man I've ever met!” she said again, not the napping, flatulent defendant described by other journalists. He is not a convicted felon who, among other cases against him, owes writer E. Jean Carroll $91 million after two civil juries found him liable for sexually abusing her and committing multiple acts of defamation. He is Atlas.

Or, Jesse Watters ’ view, “This man's life is a Greek tragedy! From billionaire bankrupt, TV star, Hollywood Walk of Fame. Divorces, marriages, children. And that was even before he entered politics. And then you have investigations, and hoaxes, and a pandemic. And now they're trying to incarcerate this person! And the only way this act ends is if he is reelected.”

This was not the way some of us expected Thursday to end – not even New York County Supreme Court judge Juan Merchan, who presided over the trial and was on the verge of dismissing the jury for the day when their verdict came in. After all, the day began with a Slate exclusive written by  Bill Pruitt, a former story producer on “ The Apprentice ."

Pruitt’s first-person recollection of who Trump was before his NBC hit politically legitimized him may not have been entirely eye-opening, but he is the closest person yet to the heart of Mark Burnett’s production to have been privy to decisions and details contenders would not have witnessed. As for why it took him this long to burden himself, he shares that what he describes as an “expansive non-disclosure agreement” has expired.

Pirro might be pleased to know that his 20-year-old memory of Trump’s stature confirms part of Pirro’s, recalling his first pre-series premiere impression of Trump as “surprisingly tall" before describing what it was like to shake his hand. “His eye contact is limited but thorough. He is sizing me up. He looks like a wolf about to rip my throat out before turning away, offering me my first glimpse at the superstructure — his hairstyle — buttressed atop his head with what must be gallons of Aqua Net.”

Much of what Pruitt says supports what so many of us know, the most important being that the show gave Trump and his decrepit building a reputational glow-up. Pruitt described the “Before” state of Trump’s offices as “cramped, and a lot of the wood furniture is chipped or peeling.” The now-shuttered Trump Taj Mahal Casino in Atlantic City, where part of the finale was set, is recalled by Pruitt as a dump with stinking carpet.

But his job was to make viewers believe that whatever Trump touches turns to gold, part of what he calls “a long con [that] played out over a decade”:

No one involved in "The Apprentice" — from the production company or the network to the cast and crew — was involved in a con with malicious intent. It was a TV show, and it was made for entertainment. I still believe that. But we played fast and loose with the facts, particularly regarding Trump, and if you were one of the 28 million who tuned in, chances are you were conned.

Have you ever been pickpocketed? Fooled by a phone scam? Rare is the adult who hasn’t been hoodwinked by somebody somewhere. In most cases our pride takes the brunt of the sting; in the worst those violations are devastating.  Hopefully, we recover and our resilience kicks in. We tell ourselves it wasn’t so bad. We vow to be more careful in the future.

But with each successful take the con artists become bolder and more pervasive to the point that it’s not simply one flimflammer but a vast apparatus. "The Apprentice" was the conduit to Trump gaining entry to Fox News, the GOP and gullible voters who believed his fantasy of being an accomplished self-made master of capitalism. 

“The Apprentice” con continues through right-wing pundits currying Trump's favor by casting him as Goliath and David in one flesh, battling a justice system specifically weaponized against him. That sounds a lot better than taking the L for once, and in a criminal case decided by 12 everyday New Yorkers whose participation was agreed upon by the prosecutors and Trump’s legal team.

The most effective scams fool targets into thinking they’re in on the get-rich-quick scheme. One recent trend known as pig slaughtering persuades the unsuspecting to dump all their money in a cryptocurrency scam only to discover they've been left with nothing when they go to cash out an account that never existed. Pruitt likens the “Apprentice” deception to the classic “pig in a poke” con — a similar premise, only involving livestock — as he sets up the squealer near the end, revealing Trump used a racist term casually in his presence.

Pruitt begs to differ. He writes that was in the room as Trump’s advisers assessed the first season’s two finalists – Bill Rancic, a white entrepreneur from Chicago, and the Harvard-educated Goldman-Sachs broker Kwame Jackson . When first season “Apprentice” judge Carolyn Kepcher strongly advocated for Jackson to win, Pruitt recalls Trump saying, “Yeah, but, I mean, would America buy a [N word] winning?”

Adding a new spike to this long railroad track is Pruitt’s verification that this and other conversations between Trump and his advisers with producers present were recorded.

“The Apprentice” con continues through right-wing pundits currying Trump's favor by casting him as Goliath and David in one flesh.

The production did this out of caution, in case the Federal Communications Commission were to investigate any claims the producers influenced the outcome. That would have run afoul of regulations established in the wake of the famous 1950s quiz show scandals.

He also surmises tapes probably no longer exist or have been somehow lost; Manigault Newman says she heard the recording. Still, he’s the third person directly connected to “The Apprentice” to insist that Trump is a virulent racist.

Jackson declaratively sounded that warning before Trump won the presidential election in 2016, days after the audio of the “Access Hollywood” tape leaked. Other political careers were ended by less damning evidence. Trump won the Electoral College anyway.

On Thursday Pruitt’s insights further illuminated the rot at the core of sycophantic verdict reaction posts from the likes of Sen. Tim Scott, R-S.C. Scott, who invoked America’s “two-tier justice system” and accused Joe Biden of “weaponizing the justice system of the United States of America against a political opponent.”

The hush money trial is related to state charges, not federal – but Scott and others know Trump’s fandom doesn't care.

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As MSNBC’s Joy Reid  brought up Thursday, mentioning Scott alongside Marco Rubio, R.-Fla., and U.S. Rep. Byron Donalds, R-Fla., “They know damn well, who normally ends up at the bottom of this criminal justice system.”

She went on to offer, “They understand fully because they have lived in the bodies of Black men, those two Black men. And they're willing to sell themselves cheap. . . . For them it can be absolutely dirt cheap, free — that's the cheapest it can be — to sell your soul and the lives and memory of all of the Black men and women and brown men and women who have suffered in the criminal justice system . . . where they won't have any of the benefits that Donald Trump has used to kill every case but this one.

NBC and Mark Burnett’s illusionists created Trump out of a tarnished man buried in debt who even back then required heavy editing to appear competent.

“The one good thing that happened here,” Reid concluded, “is that this case was brought in a state that no Republican controls. . . .  Thank God for the state of New York, Donald Trump's home state, because there was no way for him to interfere with the process of justice.”

The con Pruitt describes is still bearing fruit in the form of a riven electorate and separate mediaspheres. Where pundits like Reid pointed out that this was evidence of the system working and praised the jurors for their bravery, the closed right-wing system complained the case was “rigged” and ripe for appeal.

But its potency also shows itself in the legend that the likes of Watters and other right-wing performers are feverishly gilding. Not by listing his merits or accomplishments – how could they? Instead, they wax rhapsodically about an unjustly dethroned Midas that, as Pruitt says, NBC and Burnett’s illusionists created out of a tarnished man buried in debt who even back then required heavy editing to appear competent.

This wasn't far from assessments CNN contributors made Friday morning following the ex-president and current felon's rambling jeremiad. “It was, I think, surprisingly incoherent, surprisingly all over the place,” said senior political reporter Nia-Malika Henderson.

“He wants to make this argument about age against Biden, but here he was looking, you know, kind of like an old man who was just ranting and raving in a self-involved way . . . this wasn’t a great outing for him.”

No matter. There’s always sequel potential. Once the magic wore off “The Apprentice,” we were served “The Celebrity Apprentice.” Already our cable networks have forgotten the price our democracy paid after handing Trump an estimated $5 billion in free media coverage back in 2016.

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We’ll never know if that might have been different, for better or worse, had Pruitt or others been free to caution us about the “Apprentice” long con.

All we can be sure of is that now, whether people believe them is secondary to the horror of knowing an unsettling number of Americans embrace Pirro’s strongman vision. They’re on board with unapologetic racism and misogyny and resent his being held accountable for a crime that isn’t related to some undefinable “woke” fantasy.

On Thursday, 12 ordinary New Yorkers created another Must-See Thursday by tearing 34 holes in the “might makes right” fantasy that informs the MAGA vision of their place in the world.

“This is something that we have to step back and say, ‘We are too good for this!'” Pirro ranted. She’s half-right. There’s always a chance to pause any grift, that kick of intuition that ignites our suspicion that something is wrong. Americans passed that break many seasons ago and have learned to ignore the blare of democracy’s emergency broadcast system. Moments like these make us pay attention if only to let us know that this is who we are.

about this topic

• Stormy Daniels doc shows how disbelieving one woman can be a blueprint for our democracy under Trump
• Jeff Zucker's legacy of ruining networks
• Tom Arnold Hunts for the Trump Tapes

Melanie McFarland is Salon's award-winning senior culture critic. Follow her on Twitter: @McTelevision

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