When we hear the phrase voluntary euthanasia people generally think of

one of two things: the active termination of life at the patient's request as it

occurs in the Netherlands (or similar proposals in other countries); or the

Nazi extermination program of murder. Many people have beliefs about

whether euthanasia is right or wrong, often without being able to define it

clearly. Some people take an extreme view, while many fall somewhere

between the two camps. Dictionary definitions avail us little, as there will

always be large groups of people that claim it means something else. The

apparent derivation a gentle and easy death (from the Greek, eu - thanatos)

hardly describes what we mean. Even extending the definition to include

bringing about of this, especially in the case of incurable and painful

disease (Oxford English Dictionary) hardly covers it - hospices often

succeed in bringing about a peaceful death, but they don't perform

euthanasia!

In the Netherlands, the only country where euthanasia is openly practised,

euthanasia is defined as "the intentional termination of life by another at the

explicit request of the person who dies" (Netherlands State Commission on

Euthanasia). The argument then often centres on the voluntariness of the

request. How can one be sure that it is voluntary? Supporters of the

voluntary euthanasia movement generally believe that it would be possible to

devise sufficient safeguards to ensure that the request was voluntary and that

people could never feel pressured.

The Dutch are critical of their own system and are continually refining and

testing it - though generally they feel that it respects human rights and is part

of good medicine. They get rid of the word voluntary since the explicit

request is part of their definition of euthanasia. An explicit request is

objectively observable, whereas voluntariness depends somewhat on

interpretation. (Some opponents of euthanasia suggest that the true will is

impaired if one is asking to die and that therefore there is no voluntariness.

Most people would agree if the person was emotionally distraught over, say,

being jilted by a lover, or if the person was psychiatrically of unsound mind,

but most of us view more considered statements as voluntary, especially if

we are unable to find any evidence to the contrary.

Obviously the Dutch definition needs careful implementation to ensure

voluntariness, and the Dutch attempt to do this by a series of safeguards

within a close doctor-patient relationship, a high standard and availability of

palliative care, and general public support. There is much debate over

whether we could have a similar system in, say, Britain, but we feel that the

present system is unsatisfactory and so we press for reform.

One of the few certainties of life is death, but in the twentieth century it is

still a taboo subject. The "forbidden" nature of death adds to the unnamed

fears and worries that most people feel when asked to confront the idea of

their own death. Yet once people can overcome their reluctance to discuss

the subject, most often what is revealed is not the fear of death itself, but the

manner of dying. The difficulty of thinking about "death with dignity" is that

it implies that one day you, or someone you love, may be in a position to

want that choice.

No one can prevent death finally, but we can and should ensure that the

dying process is a gentle and peaceful one. When life consists of a few

agonising, drugged weeks, many patients beg their doctors to help them die,

and many doctors, mindful of the ethics of their profession, feel forced to

refuse. Those who, out of compassion, accede to such a request, know they

are breaking the law and putting their careers at risk.

This is the dilemma which faces all of us now. Should we, as potential

patients, have the legal right to ask our doctors to help us die when the end

of life is in sight and our suffering severe?

Did Dr. Kevorkian go too far in portraying Youk's death on national TV?

Dr. Kevorkian brought the issue of death into the homes of millions of Americans. Death has always

been a major taboo unless it is portrayed through Hollywood's violent disregard for human life. Mr.

Youk's death was a peaceful, and dignified one. Most Americans are not given the choice to have

such a gentle death. Many patients die slowly, extremely sedated, incompetent and incontinent or by

choosing to hasten their death by refusing food and hydration. Mr. Youk received quality hospice

care and chose a peaceful ending. The choice that Thomas Youk made should be a choice that

everyone has available to discuss with his or her families and make by their own accord

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