There are two main classifications of euthanasia:
- Voluntary euthanasia - this is euthanasia conducted with consent. Since 2009 voluntary euthanasia has been legal in Belgium, Luxembourg, The Netherlands, and Switzerland. 5 states (CA, CO, OR, VT, and WA) and DC legalized physician-assisted suicide via legislation. 1 state (MT) has legal physician-assisted suicide via court ruling..
- Involuntary euthanasia - euthanasia is conducted without consent. The decision is made by another person because the patient is incapable of doing so himself/herself.
There are two procedural classifications of euthanasia:
- Passive euthanasia - this is when life-sustaining treatments are withheld. The definition of passive euthanasia is often not clear cut. For example, if a doctor prescribes increasing doses of opioid analgesia (strong painkilling medications) which may eventually be toxic for the patient, some may argue whether passive euthanasia is taking place - in most cases, the doctor's measure is seen as a passive one. Many claim that the term is wrong, because euthanasia has not taken place, because there is no intention to take life.
- Active euthanasia - lethal substances or forces are used to end the patient's life. Active euthanasia includes life-ending actions conducted by the patient or somebody else.
New York 1828 An anti-euthanasia law was passed in the state of New York in 1828. It is the first known anti-euthanasia law in the USA. In subsequent years many other localities and states followed suit with similar laws. Several advocates, including doctors promoted euthanasia after the American Civil War. At the beginning of the 1900s support for euthanasia peaked in the USA, and then rose up again during the 1930s.
A turning point in the euthanasia debate occurred after a public outcry over the Karen Ann Quinlan (1954-1985) case.
Karen Ann Quinlan Case - when Quinlan was 21 she lost consciousness after returning home from a party. She had consumed diazepam (Valium), dextropropoxyphene (an analgesic in the opioid category), and alcohol. She collapsed and stopped breathing twice for 15 minutes. She was hospitalized and eventually lapsed into a persistent vegetative state.
Several months later, while being kept alive on a ventilator, her parents asked the hospital to discontinue active care, so that she could be allowed to die. The hospital refused, there were subsequent legal battles, and a tribunal eventually ruled in her parent's favor. Quinlan was removed from the mechanical ventilation in 1976 - but she went on living in a persistent vegetative state until 1985, when she died of pneumonia.
Even today, Quinlan's case raises important questions in moral theology, bioethics, euthanasia, legal guardianship and civil rights. Health care professionals say her case has had an impact on medical and legal practice worldwide.
Since Quinlan's case, formal ethics committees now exist in hospitals, nursing homes and hospitals. Many say the development of advance health directives (living wills) occurred as a result of her case. In 1977, California legalized living wills, with other states soon following suit.
Quinlan's case paved the way for legal protection of voluntary passive euthanasia.
Derek Humphry (born 1930), a British-born American journalist founded the Hemlock Society in Santa Monica, California. At the time it was the only group in the USA to provide information to terminally ill patients in case they wished to hastened death. The society also campaigned and contributed financially to drives to amend legislation. In 2003 Hemlock merged with End of Life Choices, changing their name to Compassion and Choices.
In 1990 the Supreme Court approved the use of non-active euthanasia.
Dr. Jack Kevorkian (1928), an American pathologist, right-to-die activist, painter, composer, and instrumentalist, was tried and convicted in 1992 for a murder displayed on TV. He had already become infamous for encouraging and assisting people in committing suicide. He claimed to have assisted at least 130 patients to that end. He famously said that "dying is not a crime."
Oregon 1994 - Oregon voters approved the Death with Dignity Act in 1994, allowing physicians to assist terminal patients who were not expected to survive more than six months. The US Supreme Court adopted such laws in 1997. In 2001 the Bush administration tried unsuccessfully to use drug law to stop Oregon in 2001, in the case Gonzales v. Oregon. Texas introduced non-active euthanasia legally in 1999.
Terri Schiavo case - a seven-year long legal case which dealt with whether Terri Schiavo, a patient diagnosed as being in a persistent vegetative state for many years, could be disconnected from life support. In 1993, Michael Schiavo, her husband and guardian, asked the nursing home staff not to resuscitate her - however, the staff convinced him to withdraw the order.
In 1998, Michael petitioned the Sixth Circuit Court of Florida to remove her feeding tube under Florida Statutes Section 765.401(3). However, Robert and Mary Schindler (Terri's parents) argued that she was conscious and opposed the petition. Michael eventually transferred his authority over the issue to the court. The court concluded that the patient would not wish to continue life-prolonging measures.
Terri Schiavo's feeding tube was withdrawn on April 24, 2001, and reinserted some days later as legal decisions were made. This attracted the attention of the media, and subsequently that of politicians and advocacy groups, especially pro-life and disability rights groups.
Members of the Florida Legislature, the US Congress and even the President of the USA started talking about it. President Bush returned to Washington D.C from a vacation in March 2005 to sign legislation aimed at keeping Schiavo alive. This move turned the case into a national topic for most of the month.
The Schiavo case involved 14 appeals, several motions, petitions and hearings in the Florida courts, five suits in federal district court, Florida legislation was struck down by the Supreme Court of Florida, a subpoena by a congressional committee to qualify Schiavo for witness protection, and some other legal proceedings. Eventually the local court's decision to disconnect Schiavo from life support was acted upon on March 18th, 2005 - Schiavo died on March 31st.
Washington state - the Washington Initiative 1000 made Washington the 2nd state in the USA to legalize doctor-assisted suicide.
37 states have laws prohibiting assisted suicide. 3 states (AL, MA, and WV) prohibit assisted suicide by common law. 4 states (NV, NC, UT, and WY) have no specific laws regarding assisted suicide, may not recognize common law, or are otherwise unclear on the legality of assisted suicide.
The federal government and all 50 states prohibit euthanasia under general homicide laws. The federal government does not have assisted suicide laws. Those laws are generally handled at the state level.