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Euthanasia and physician-assisted death

Ezekiel J Emanuel, MD, PhD
Section Editors
Kenneth E Schmader, MD
Robert M Arnold, MD
Deputy Editor
Diane MF Savarese, MD


Euthanasia and physician-assisted death (PAD) burst into the United States public arena in 1988 with the publication of "It's over, Debbie" [1]. This article stirred an emotional debate, with many people criticizing what they saw as nonvoluntary euthanasia involving a lethal injection delivered by a physician who did not know the patient and who had only ambiguous evidence of her wishes ("Let's get this over with") [2,3]. The case later turned out to be a fabrication. A later (true) case report describing a patient with a terminal illness who made an intensely personal decision for physician assisted death, involving a self-administered drug prescribed only after extensive discussion with her own physician, was received with less criticism and more balanced discussion; it was eventually considered by a grand jury, which recommended against indicting her physician [4]. These two cases, in a sense, set the stage for the current disputes in the United States over physician-assisted dying. Less volatile discussion, as well as practice, had already begun elsewhere, especially in the Netherlands. In recent years, much of the developed world – those countries with long-life expectancies, highly developed healthcare systems, and mortality characterized primarily by diseases with long downhill courses (cancer, heart and other organ system failure, and dementia) – have seen the emergence of end-of-life debates and increasing pressures for legalization of assisted dying.

Many physicians, particularly those in the fields of oncology and palliative care, will be faced with a request for assistance in dying over their professional lifetimes. No matter where clinicians stand ethically and morally on the permissibility of this practice and regardless of whether these practices are legally permitted or prohibited in a given jurisdiction, clinicians have to carefully consider and decide how they will respond to these requests [1-4].

In the past decade, studies have shown significant gains in understanding about attitudes of physicians and the public towards euthanasia and PAD in the United States and elsewhere, as well as the practices themselves. This review will discuss the following aspects of euthanasia and PAD:


Ethical arguments for and against


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Literature review current through: Mar 2017. | This topic last updated: Mar 16, 2017.
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