GET THE FACTS: Euthanasia, assisted suicide, and palliative care are not the same

Though end-of-life care has been debated for decades, well-meaning Americans have been misled by those who intentionally conflate palliative care with euthanasia and assisted suicide — but only one of these options is ethical.

Some U.S. states have in recent years passed legislation allowing doctors to become both killers and suicide accomplices. While marketed to the public as a "compassionate" way to help people facing so-called "terminal" diagnoses, behind the scenes, health insurance companies and governments have touted how "assisted dying" saves them money.

Alongside this financial incentive to kill people rather than treat them, assisted suicide and euthanasia laws in other nations have been expanded to allow non-terminal individuals to end their lives — including those with chronic and manageable conditions, those with mental health conditions, and even children, who are clearly too young to make such "choices" for themselves.

Key Takeaways:

• Euthanasia is an act in which a doctor deliberately kills a patient through lethal injection.

• Assisted suicide is when a doctor prescribes a deadly drug cocktail to a patient, who takes the drugs without supervision.

• Palliative care focuses on relieving a person's symptoms, offering pain management, and decreasing stress in order to improve the person's quality of life. It isn't just for those who are dying, but for anyone dealing with serious illness at any stage, along with other treatments.

• Hospice care is palliative care for individuals with six months or less to live.

• Neither palliative care nor hospice care involves killing patients or helping them to kill themselves.

• Ordinary care, including food and water, should never be withdrawn from individuals; however, 'extraordinary' care, such as life support or chemotherapy, can be ethically ceased.

The Details:

End-of-life care will continue to be a major pro-life issue as more states consider legalizing so-called 'assisted dying' (or one of its many other popular euphemisms).

• Currently, 12 states allow assisted suicide: Oregon, Washington, California, Montana, Colorado, New Mexico, Maine, Vermont, Delaware, Hawaii, New Jersey, and Illinois — where efforts are underway to repeal that state's pro-death law.

• No U.S. states currently allow euthanasia, which is permitted in Canada, the Netherlands, Belgium, Luxembourg, Colombia, Spain, New Zealand, Ecuador, and Australia. Switzerland allows assisted suicide but does not allow euthanasia.

Neither euthanasia nor assisted suicide is ethical, but there is a key difference between them, and both differ from palliative care, which is the only ethical option for end-of-life care.

Euthanasia explained

Euthanasia, often confused with assisted suicide, is when a doctor deliberately acts to kill a patient, typically through lethal injection, at the request of the patient or sometimes without the patient's consent if the patient is unable to consent.

The National Institutes of Health (NIH) defines euthanasia this way:

The hastening of death of a patient to prevent further sufferings. Active euthanasia refers to the physician deliberate act, usually the administration of lethal drugs, to end an incurably or terminally ill patient’s life.

"Incurably or terminally" ill could be understood to mean chronic conditions that are not necessarily going to cause imminent death but do not currently have a cure and could cause death if left untreated. These would include diabetes, cystic fibrosis, anorexia, and treatable cancers.

🇨🇦 In Canada, most requests approved under the country's Medical Assistance in Dying (MAiD) Act are carried out by euthanasia.

Passive euthanasia can sometimes be viewed as simply allowing a patient to die naturally, but it involves removing ordinary care, such as food and hydration, so that a patient dies a long and painful death of starvation and dehydration. Though the patient is not "actively" killed, it still involves causing the person's death.

★ IMPORTANT DISTINCTION: In euthanasia, the doctor or practitioner is directly causing the patient's death.

Assisted Suicide explained

Assisted suicide is not doctor-inflicted, but doctor-assisted.

In assisted suicide, the patient requests a prescription for a lethal drug cocktail from a doctor/practitioner that the patient then takes on his or her own timeline.

Assisted suicide is legal in 12 U.S. states, and flies in the face of every suicide prevention campaign ever attempted by the government or anti-suicide organizations. While society views suicide as tragic, it largely views assisted suicide as compassionate — and the reasons are discriminatory. But the truth is:

• Suicide isn't tragic only when the person who dies is young and able-bodied.

• Suicide is always tragic, even if the person is chronically ill, disabled, or near death.

To say or believe otherwise is an ableist notion that discriminates against certain people to the point of allowing eugenic deaths to be carried out. Life with illness and disability is still worth living, but legalized assisted suicide spreads the lie that some people are better off dead.

Assisted suicide and euthanasia both discriminate against individuals deemed "unhealthy" — and they do so under the guise of compassion.

★ IMPORTANT DISTINCTION: In euthanasia, the doctor actively kills the patient, and in assisted suicide, the doctor prescribes the lethal drugs that the patient will take on their own time, potentially alone, and without supervision.

Palliative Care explained

Palliative care and hospice do not involve killing patients or helping patients to kill themselves.

Palliative care is medical care for individuals with serious, chronic, or life-threatening illnesses. It focuses on relieving symptoms, managing pain, and decreasing stress in order to improve the person's quality of life.

It isn't exclusively for patients who are actively dying, but for anyone dealing with serious illness at any stage, and is coupled with treatments to heal them or get them as healthy as possible.

The Center for Advanced Palliative Care explained:

Palliative care is provided by a specially-trained team of doctors, nurses, social workers, chaplains, and other specialists who work together with a patient’s other doctors to provide an extra layer of support.

Palliative care is based on the needs of the patient, not on the patient’s prognosis. It is appropriate at any age and at any stage in a serious illness, and it can be provided along with curative treatment.

Research links palliative care to (according to the Cleveland Clinic):

• improved patient and caregiver satisfaction

• less anxiety and depression

• improved quality of life

• longer life expectancy

Hospice care is a subtype of palliative care for patients who have been diagnosed with a terminal illness and have been given six months or less to live. When curative treatments have been stopped, hospice care begins. Like palliative care, it focuses on comfort, symptom relief, and improving the patient's quality of life when a cure is not possible.

★ IMPORTANT DISTINCTION: Palliative care (and thereby hospice care) is the only ethical end-of-life option because it does not directly cause the person's death, but cares for the person as natural death approaches.

Extraordinary vs Ordinary Care

The terms "extraordinary care" and "ordinary care" are often used by medical professionals when discussing the care of an individual who is facing death. The difference between them is clear — one allows natural death to occur, while the other causes death.

• Ordinary care includes food, water, exercise, and basic medical care.

As previously stated, removing ordinary care from a person — such as food or water — is unethical because, starvation and dehydration would cause the person's death rather as opposed to the illness (and that death would be agonizing). We are morally obligated to provide everyone with ordinary care.

• Extraordinary care includes any mechanical assistance or treatment that could be considered excessively burdensome and unlikely to cause significant benefits to the patient's condition and life.

If the treatment, such as life support or chemotherapy, is shown to no longer have a benefit to the patient and will not lead to the patient's recovery, those extraordinary treatments can be stopped and natural death allowed to occur. It does not mean that no efforts are ever made to save the person's life — such as chemotherapy — but it means that if chemotherapy is not working and there are no other options, the person is not forced to continue with a burdensome treatment that will not add time or quality to their lives.

Why It Matters:

In a recent article for The Michigan Daily, Rudy Net conflated assisted death and euthanasia with palliative care, blurring the lines and confusing readers. He wrote:

With the advancement of modern medicine, our skill in extending life is unprecedented, as is our ability to prolong suffering. Human life can be sustained beyond what is comfortable for patients, a fact made worse considering this often occurs against a patient’s will if they are in an incapacitated state — a coma, for example, or severe dementia — and their surrogate decision-maker insists on continuing life support or demands treatment.

The continuation of life in a body being ravaged by incurable disease reduces a patient’s final moments to a series of medical intrusions and inescapable pain. According to the National Library of Medicine, a desire for a hastened death among terminally ill patients increased from 17% to 45% in light of worsening conditions, particularly the loss of physical function, intractable pain and the perceived loss of dignity and control.

Given the suffering that patients go through in an often futile effort to prolong life, is it just to deny autonomy over one’s own body?

But this is a distortion of the facts.

Prolonging suffering in "an often futile effort to prolong life" through extraordinary means such as "life support" is not the opposite of assisted suicide. Assisted suicide and euthanasia intentionally kill. Extraordinary means are treatments that prolong life to save life, and stopping extraordinary means when they are no longer beneficial or are causing additional suffering with no improvement to quality or length of life, is not the same as intentional killing.

Withdrawing extraordinary care is not euthanasia.

In addition, the reason "a hastened death among terminally ill patients" may have increased says more about the cruel lack of compassion plaguing today's society, in which ableism has a strong hold, than it does about patients' wishes.

Many studies have shown that people who request assisted suicide do so because they are depressed, hopeless, have no support, and are afraid of being a burden — not because they are seeking to prevent pain or because they want to die.

Strikingly, many of these reasons are the same reasons that people who are not ill commit suicide.

When someone is suffering in this way, offering them help, support, assistance, and care are compassionate; offering to kill them isn't. Studies have shown that offering help can be highly effective, with one report finding that 72% of older people who expressed a wish to die changed their minds within two years after their feelings of loneliness and depression had improved.

Truly respecting human dignity matters.

The Bottom Line:

Understanding the differences between assisted suicide, euthanasia, palliative care, hospice, and extraordinary vs. ordinary care is important for everyone who is caring for a sick or elderly person, and when dealing with medical professionals who may be pressuring a person to undergo assisted death.