A General History of Euthanasia

What we would term euthanasia, has been both practised and condemned by various cultures and civilasions since time immemorial.
  • In ancient times physicians had a dual role: one to cure, the other was to kill.
  • Hippocrates separated the cure and kill functions of physicians.
  • The prevailing social conditions of the latter nineteenth century began to favour active euthanasia.
  • In 1933 the Nazis replaced the Hippocratic Oath with the Gesundheit, an oath to the health of the Nazi state.
  • Campaigns for the legalisation of euthanasia are widespread in many countries, with activists challenging through the legal system where they fail in legislature.
Euthanasia comes from the Greek words, Eu (good) and Thanatosis (death) and it means "Good Death, "Gentle and Easy Death." This word has come to be used for "mercy killing." In this sense euthanasia means the active death of the patient, or, inactive in the case of dehydration and starvation.

The first recorded use of the word euthanasia was by Suetonius, a Roman historian, in his De Vita Caesarum--Divus Augustus (The Lives of the Caesars--The Deified Augustus) to describe the death of Augustus Caesar:

"...while he was asking some newcomers from the city about the daughter of Drusus, who was ill, he suddenly passed away as he was kissing Livia, uttering these last words: "Live mindful of our wedlock, Livia, and farewell," thus blessed with an easy death and such a one as he had always longed for. For almost always, on hearing that anyone had died swiftly and painlessly, he prayed that he and his might have a like euthanasia, for that was the term he was wont to use. "

Augustus' death while termed "a euthanasia" was not hastened by the actions of any other person.

Withdrawal or with-holding treatment was practiced in history, the correct term for this is orthothanasia, which means 'passive death.' In this method, the actions of curing the patient are never applied and his death is made easy in a passive form. In orthothanasia, the action of killing is not applied, but, passive actions are present in order to provide death.

The place of euthanasia in the history of medical ethics
The actions of easy death have been applied for hopeless patients who have been suffering extreme pain since ancient ages.

These actions were forbidden from time to time. In Mesopotamia, Assyrian physicians forbade euthanasia. Again in the old times incurable patients were drowned in the River Ganges in India. In ancient Israel, some books wrote that frankincense was given to kill incurable patients.

Jewish society, following the teaching of the Bible and the sixth command "thou shall not kill", had rejected centuries ago every theory on shortening the life of handicapped or disadvantaged people. Judaism considered life to be sacred and equated suicide and euthanasia with murder. Dr Immanuel Jakobovits, former Chief Rabbi of England explained:
"Cripples and idiots, however incapacitated, enjoy the same human rights (though not necessarily legal competence) as normal persons... One human life is as precious as a million lives, for each is infinite in value..."
In Sparta, it was the common practice for each newborn male child to be examined for signs of disability or sickliness which, if found, led to his death. This practice was regarded as a way to protect the society from unnecessary burden, or as a way to 'save' the person from the burden of existence. 

In ancient Greece, suicide of the patient who was suffering extreme pain and had an incurable terminal illness was made easy and for this reason, the physician gave medicine (a poisoned drink) to him. Plato wrote: "Mentally and physically ill persons should be left to death; they do not have the right to live." 

Pythagoras and his pupils were completely against suicide due to their religious beliefs that the Gods place the man as the protector of the earthly life and he is not allowed to escape with his own will.

The first objection to euthanasia came from the Hippocratic Oath which says "I will not administer poison to anyone when asked to do so, nor suggest such a course."

In ancient Rome, euthanasia was a crime and this action was regarded as murder. However, history notes that sickly newborn babies were left outside, overnight, exposed to the elements.

In the Middle Ages in Europe, Christian teaching opposed euthanasia for the same reason as Judaism. Christianity brought more respect to human beings. Accordingly, every individual has the right to live since God creates human beings and they belong to Him and not themselves. Death is for God to decree, not man. 

Like Judeo-Christian teaching, Islam also teaches that God is the only one who creates and the only one who may take life away. 

15th - 17th Centuries
Sir Thomas More (1478-1535) is often quoted as being the first prominent Christian to recommend euthanasia in his book Utopia, where the Utopian priests encourage euthanasia when a patient was terminally ill and suffering pain (but this could only be done if the patient consented). "...if a disease is not only distressing but also agonising without cessation, then the priests and public officials exhort this man...to free himself from this bitter life...or else to permit others to free him..." The problem with using this quote is that More, a devout Catholic, wrote Utopia as a work of satire.

The English philosopher, Francis Bacon (1561-1621), was the first to discuss prolongation of life as a new medical task, the third of three offices: Preservation of health, cure of disease and prolongation of life. Bacon also asserts that, 'They ought to acquire the skill and bestow the attention whereby the dying may pass more easily and quietly out of life.' Bacon refers to this as outward euthanasia, or the easy dying of the body, as opposed to the preparation of the soul. It appears unlikely he was advocating 'mercy killing', more likely  he was promoting what we would term better 'palliative' care.

18th - 19th Centuries
In Prussia, in the 18th century, 1st June 1794, a law was passed that reduced the punishment of a person who killed the patient with an incurable disease. 

1828 - Earliest American statute explicitly to outlaw assisting suicide.

The earliest American statute explicitly to outlaw assisting suicide was enacted in New York in 1828, Act of Dec. 10, 1828, ch. 20, §4, 1828 N. Y. Laws 19 (codified at 2 N. Y. Rev. Stat. pt. 4, ch. 1, tit. 2, art. 1, §7, p. 661 (1829)), and many of the new States and Territories followed New York's example. Between 1857 and 1865, a New York commission led by Dudley Field drafted a criminal code that prohibited "aiding" a suicide and, specifically, "furnish[ing] another person with any deadly weapon or poisonous drug, knowing that such person intends to use such weapon or drug in taking his own life."

Until the end of the nineteenth century, euthanasia was regarded as a peaceful death, and the art of its accomplishment. An often quoted nineteenth century document is, 'De euthanasia medica prolusio,' the inaugural professorial lecture of Carl F. H. Marx, a medical graduate of Jena. 'It is man's lot to die' states Marx. He argued that death either occurs as a sudden accident or in stages, with mental incapacity preceding the physical. Philosophy and religion may offer information and comfort, but the Physician is the best judge of the patient's ailment, and administers alleviation of pain where cure is impossible. 

Marx did not feel that that his form of euthanasia, which refers to palliative medicine without homicidal intention, was an issue until the nineteenth century. 

The prevailing social conditions of the latter nineteenth century began to favour active euthanasia. Darwin's work and related theories of evolution had challenged the existence of a Creator God who alone had the right to determine life or death.

The first popular advocate of active euthanasia in the nineteenth century, was a schoolmaster, not a doctor. In 1870 Samuel Williams wrote the first paper to deal with the concept of 'medicalised' euthanasia. He stated:

"In all cases it should be the duty of the medical attendant, whenever so desired by the patient, to administer chloroform, or any other such anaesthetics as may by and by supersede chloroform, so as to destroy consciousness at once, and put the sufferer at once to a quick and painless death; precautions being adopted to prevent any possible abuse of such duty; and means being taken to establish beyond any possibility of doubt or question, that the remedy was applied at the express wish of the patient."

Though reprinted many times, the paper was seemingly ignored by the British medical profession, and in 1873 Lionel Tollemache took up his arguments in the Fortnightly Review. Writing under the clear influence of utilitarianism and social Darwinism, he described the incurable sick as a useless to society and burdensome to the healthy. 

Although his views were simply dismissed as revolutionary, similar views were emerging with the new science of eugenics, as ideas of sterilising the mentally ill, those with hereditary disorders, and the disabled, became fashionable. 

In 1889, the German philosopher, Nietsche, said that terminally ill patients are a burden to others and they should not have the right to live in this world.

In 1895, a German lawyer, Jost, prepared a book called "Killing Law." Jost stressed that only hopelessly ill patients who wanted death, must be let die. According to Jost, life sometimes goes down to zero in value. Thus, the value of the life of a patient with an incurable illness is very little. 

The 20th Century
The efforts of legalization of euthanasia began in the USA in the first years of the 20th century. The New York State Medical Association recommended gentle and easy death. Even more active euthanasia proposals came to Ohio and Iowa state legislatures in 1906 and 1907 but these proposals were rejected.

In 1920, two German professors published a small book with the title 'Releasing the destruction of worthless animals' which advocated the killing of people whose lives were "devoid of value." This book was the base of involuntary euthanasia in the Third Reich. 

In this book, authors Alfred Hoche, M.D., a professor of psychiatry at the University of Freiburg, and Karl Binding, a professor of law from the University of Leipzig, also argued that patients who ask for "death assistance" should, under very carefully controlled conditions, be able to obtain it from a physician. 

Alfred Hoche also wrote an essay, which he published as "Permitting the Destruction of Life Not Worthy of Life." It embraced euthanasia as a proper and legal medical procedure to kill the weak and vulnerable so as not to taint the human gene. 

The reduction of punishment in mercy killing was accepted in Criminal Law in 1922 in Russia. But this law was abolished after a short while.

A French physician, called Dr.E.Forgue. published an article, named "Easy death of incurable patients" in La Revue de Paris, in 1925, and pointed out that killing an incurable patient wasn't a legal condition. But, Liege Bar said that killing an incurable patient with his free consent had to be forgiven. 

The laws that accept euthanasia as a legal condition are present in two countries of South America. According to Uruguay Penal Code, a Judge must not punish a person for mercy killing. A person must also be forgiven for this kind of killing in Colombia.

Adolf Hitler admired Hoche's writing and popularised and propagandised the idea. In 1935,the German Nazi Party accepted euthanasia for crippled children and "useless and unrehabilitive" patients.

Before 1933, every German doctor took the Hippocratic Oath, with its famous "do no harm" clause. The Oath required that a doctor's first duty is to his patient. The Nazis replaced the Hippocratic Oath with the Gesundheit, an oath to the health of the Nazi state. Thus a German doctor's first duty was now to promote the interests of the Reich.

Anyone in a state institution could be sent to the gas chambers if it was considered that he could not be rehabilitated for useful work. The mentally retarded, psychotics, epileptics, old people with chronic brain syndromes, people with Parkinson's disease, infantile paralysis, multiple sclerosis, brain tumours etc. were among those killed. The consent of the patient was absent in this type of euthanasia. This kind was applied by order.

Many people don't realise that, prior to the extermination of Jews by Nazi Germany, in the so-called "final solution," as many as 350,000 Germans were sterilized because their gene pool was deemed to be unsuitable to the Aryan race, many because of physical disability, mental deficiency or homosexuality. 

In 1936 the Voluntary Euthanasia Society was founded in England. The next year the English Parliament (the House of Lords) rejected a proposal to legalise euthanasia. In opinion polls of those years, euthanasia supporters had around 60% of the votes. 

According to a questionnaire in 1937, 53% of American physicians defended euthanasia. Approximately 2000 physicians and more than 50 religious ministers were among the members of the American Euthanasia Society. At that time, a majority of physicians in some American cites defended this subject. 
In 1938, the Euthanasia Society of America was established in New York. 

1939 Nazi Germany (From "The History Place" web site)
"In October of 1939, amid the turmoil of the outbreak of war, Hitler ordered widespread "mercy killing" of the sick and disabled. Code named "Aktion T 4", the Nazi euthanasia program to eliminate "life unworthy of life" at first focused on newborns and very young children. Midwives and doctors were required to register children up to age three who showed symptoms of mental retardation, physical deformity, or other symptoms included on a questionnaire from the Reich Health Ministry."

"The Nazi euthanasia program quickly expanded to include older disabled children and adults. Hitler's decree of October, 1939, typed on his personal stationery and back dated to Sept. 1, enlarged 'the authority of certain physicians to be designated by name in such manner that persons who, according to human judgment, are incurable, can, upon a most careful diagnosis of their condition of sickness, be accorded a mercy death.'"

On August 3, 1941, the Catholic Bishop Clemens August Count of Galen, openly condemned the Nazi euthanasia programme in a sermon. This brought a temporary end to the programme. Read here

A law proposal that accepted euthanasia, was offered to the government in Great Britain in 1939. According to this proposal, a patient had to write his consent as a living will which must be witnessed by two persons. The will of the patient had to be accepted in the reports of two physicians. One of these physicians was the attending physician, the other one was the physician of the Ministry of Health. The will of the patient had to be applied after 7 days and most of the relatives of the patient had again to speak with him 3 days before the killing action. But this proposal wasn't accepted.

In 1973 Dr. Gertruida Postma, who gave her dying mother a lethal injection, received light sentence in the Netherlands. The case and its resulting controversy launched the euthanasia movement in that country.

The Dutch Voluntary Euthanasia Society (NVVE) launched its Members' Aid Service in 1975, to give advice to the dying. It received twenty-five requests for aid in the first year.

In 1976 Dr Tenrei Ota, upon formation of the Japan Euthanasia Society (now the Japan Society for Dying with Dignity), called for an international meeting of existing national right-to-die societies. Japan, Australia, the Netherlands, the United Kingdom, and the United States were all represented. This first meeting enabled those in attendance to learn from the experience of each other and to obtain a more international perspective on right to die issues. 

In 1978, Jean's Way was published in England by Derek Humphry, describing how he helped his terminally ill wife to die. The Hemlock Society was founded in 1980 in Santa Monica, California, by Derek Humphry. It advocated legal change and distributed how-to-die information. This launched the campaign for assisted dying in America. Hemlock's national membership grew to 50,000 within a decade. Right to die societies also formed the same year in Germany and Canada.

The Society of Euthanasia assembled in Oxford in the last months of 1980, hosted by Exit, The Society for the Right to Die with Dignity. It consisted of 200 members represented 18 countries. Since its founding, the World Federation has come to include 38 right to die organisations, from around the world, and has held fifteen additional international conferences, each hosted by one of the member organisations.

On 5 May, 1980, the Catholic Church issued a Declaration on Euthanasia. Read here

In 1984, The Netherlands Supreme Court approved voluntary euthanasia under certain conditions.

In 1994, Oregon voters approved Measure 16, a Death With Dignity Act ballot initiative that would permit terminally ill patients, under proper safeguards, to obtain a physician's prescription to end life in a humane and dignified manner. The vote was 51-49 percent. 

In 1995, Australia's Northern Territory approved a euthanasia bill. It went into effect in 1996 and was overturned by the Australian Parliament in 1997. Only four deaths took place under this law, all performed by Dr Philip Nitschke.

On 13 May, 1997, the Oregon House of Representatives voted 32-26 to return Measure 16 to the voters in November for repeal (H.B. 2954). On 10 June, the Senate votes 20-10 to pass H.B. 2954 and return Measure 16 to the voters for repeal. On 4 November 1997 the people of Oregon voted by a margin of 60-40 percent against Measure 51, which would have repealed the Oregon Death with Dignity Act, l994. The law officially took effect (ORS 127.800-897) on 27 October, l997.

In 1998, the Oregon Health Services Commission decided that payment for physician-assisted suicide could come from state funds under the Oregon Health Plan so that the poor would not be discriminated against.

In 1999, in the United States, Dr. Jack Kevorkian was sentenced to 10-25 years imprisonment for the 2nd degree murder of Thomas Youk after showing a video of his death, by lethal injection, on national television. Kervorkian's first appeal was rejected in 2001. Kevorkian helped a number of people die and even though he had been previously prosecuted, he remained free of criminal charges until 1999.

In 2000, The Netherlands approved voluntary euthanasia. The Dutch law allowing voluntary euthanasia and physician-assisted suicide took effect on the 1st of February, 2002. For 20 years previously, it had been permitted under guidelines.

Into the Third Millenium
In 2002 Belgium passed a similar law to the Dutch, allowing both voluntary euthanasia and physician-assisted suicide.

In New Zealand in March 2004 Lesley Martin was convicted of the attempted murder of her terminally ill mother. She served seven months of a fifteen-month prison sentence, before being released on a good behaviour bond, and subsequently failed, in two attempts, to appeal against the conviction.

Switzerland, once known in the tourism business for its spectacular alpine landscape, the watches and chocolate, has a new claim to fame as the world's death Mecca. Physically and mentally vulnerable patients have been lining up for a one-way trip to Zurich.

In 2000 three foreigners committed suicide in Zurich. In 2001, the number of death tourists to Zurich rose to thirty-eight, plus twenty more in Bern. Most of the deaths occurred in an apartment rented by Dignitas, one of the four groups that have taken advantage of Switzerland's 1942 law on euthanasia to help the terminally ill die.

Dignitas has assisted the suicides of 146 people over the last four years. The Swiss parliament has been alarmed and there is a move to ban the 'suicide tourism' and to place tougher bans on assisted suicide.

When it was established in 1942, the Swiss euthanasia law was meant mainly to offer the opportunity for a dignified death to those with just two or three weeks to live.

In the past few years, though, it has been applied to patients with a range of ailments -- those with terminal illnesses or with acute mental disabilities, and even those suffering unbearable distress, such as a musician, for example, who has gone deaf.

There are several requirements under the Swiss law. People who opt for euthanasia must be rationally capable of making the decision to die. They must perform the final act -- usually the drinking of a lethal dose of barbiturates -- without assistance. And the event must be witnessed by a nurse or physician, and two other people.