Dying with dignity: The legal status of euthanasia and assisted suicide varies a lot in Europe from legalisation, authorisation under restriction to strict prohibition. This topic is not only a question of health and treatments, but also of ethics, religion, and politics, on which the EU has not yet taken a stance. What stance, if any, should the European Union adopt on euthanasia and assisted suicide?                            By Illia Koshytskyi (UA)Introduction to the topicBy definition, the word euthanasia means ‘good death’, in other words, death without pain, without suffering. In the twentieth century, during the Third Reich, the word gained a negative connotation when it was improperly used in Nazi policies aimed at eliminating lives that were considered not worthy of existing. Subsequently, discussions on the topic resurfaced. Euthanasia is a type of assisted suicide – suicide committed by someone with assistance from another person. From a moral, medical, and legal point of view there is a significant difference between ‘killing’ and ‘letting die’. Therefore euthanasia is divided into an active or passive acts; the first of which denotes the deliberate act of inducing death without the patient suffering (using, for example, lethal injections), and the second refers to when the patient dies because the medical professionals either don’t do something necessary to keep the patient alive, or when they stop doing something that is keeping the patient alive (e.g. switching off life-support machines or disconnecting a feeding tube). Euthanasia in political arena has created both agreements and rivalries. Many politicians would rather steer clear from this sensitive field than tackle it straightforward. This is evident in democracies all over the world since they believe in giving everybody certain rights of choice. Currently, the practice of euthanasia is allowed in the Netherlands, Belgium and Luxembourg. As for the assisted suicide, it is allowed in the Netherlands, Belgium, Luxembourg, Switzerland and Germany. Although the criteria adopted for these practices are different in each country, the profile of patients who seek euthanasia is almost invariably the same. Therefore, it raises the question of developing a unified legal framework for getting euthanised within the EU. According to the recent poll by the Reuters, the majority of citizens in the EU believe that voluntary euthanasia is ethical and should be legalised. However, the opposite part of the EU citizens, as well as some political parties and religious groups still raise a lot of points against the legalisation of euthanasia, which inhibits the development of a common legal framework for practicing euthanasia and assisted suicide within the EU. RelevanceThose in favor of euthanasia argue that a civilised society should allow people to die in dignity and without pain, and should allow others to help them do so if they cannot manage it on their own. They say that our bodies are our own, and we should be allowed to do what we want with them. So it’s wrong to make anyone live longer than they want. In fact, making people go on living when they don’t want to violates their personal freedom and human rights. However, the opposing part of EU citizens has raised a number of points against the legalisation of euthanasia. First of all, even if euthanasia becomes accepted legally, there are some who still feel it is morally wrong. Moral purists would argue there is no difference between masterful inactivity of withholding treatment, including the switching-off of ventilators and active euthanasia. Some pediatricians along with other EU citizens state that they do not have the moral right to decide who should live and who would die. Moreover, they think that there is no difference between both types and euthanasia and active killing since both involve taking someone’s life.As for the religion aspect of the problem, most church leaders have also argued the law is immoral. However, their stance differs from one religion to another according to the ideology of corresponding religious group and the Holy Scriptures. Moreover, opinion polls have suggested broad support for the changes in Belgium, which is mostly Catholic. In 1980, Pope John Paul II was not left behind in the issue. He issued a Declaration on Euthanasia in 1980 which opposed mercy killing but allowed individuals the right to refuse measures for sustaining life. Voluntary euthanasia violates historically accepted codes of medical ethics. One of the fundamental principles of medical ethics is “primus non nocere” (first do no harm). The euthanasia as a kind of assisted suicide means directly helping someone to kill themselves. Hence, implementing euthanasia would directly harm a person. Charles Tannock, former Member of the EP believes that it is degrading for a doctor, as a healer, to initiate the act of death. On the other hand, the euthanasia is an act of helping someone to stop their suffering. Once we perceive it like this, implementing euthanasia would not violate the previously mentioned medical ethics. Nevertheless,     Furthermore, another important issue to be considered when speaking of religion and morals is the sanctity of life. It is a principle of implied protection regarding aspects of sentient life which are said to be holy, sacred, or otherwise of such value that they are not to be violated. Helga Kuhse, Australian philosopher and bioethicist, argued against the traditional view that allowing someone to die is morally different from killing. Therefore, getting or implementing euthanasia would mean that the sentient life would be violated. As a result of numerous protests by the EU citizens and religious groups, the euthanasia stays illegal in most countries. Although, doctors do sometimes carry out illegal euthanasia. The Netherlands became the first to allow euthanasia by enabling their Supreme Court to allow voluntary euthanasia in 1984 with the official legalisation in 2001. However, Euthanasia has been known to be regularly practiced in the Netherlands since 1973. The development of euthanasia legislation follows the opinion polls showing a marked increase of approval, from 40% in 1966 to more than 70% support continuously since 1990. Furthermore, research carried out in Flanders, Belgium found the rate prior to legalisation was unclear, with separate surveys reporting rates of 0.3% of all deaths in the region (in 2001-02) and 1.1% (in 1998). The rate has risen steadily since legalisation in 2002 to 4.6% of all deaths in the most recent survey in 2013.Euthanasia, though reported to be regularly practiced, was a criminal act in the Netherlands until 1973 when, in the Postma Case, Geertruida Postma, a doctor, was convicted for giving her terminally ill mother a lethal injection. Euthanasia and physician-assisted suicide were legalized on Apr. 1, 2002 by the Termination of Life on Request and Assisted Suicide (Review Procedures) Act for Dutch citizens over 12 years old. The rules are strict and cover only patients with an incurable condition who face unbearable suffering. The patient has to be in full possession of mental faculties and each case has to have a second medical opinion before euthanasia is carried out in a medically appropriate way. After the event, it is referred to a regional review committee including a doctor, a legal expert and a medical ethicist.Additionally, there were cases when people committed suicide at home on their own because of the refusal of the legal right to die under medical supervision. One of such cases happened in France. Refused by a court in Dijon the right to die under medical supervision, Chantal Sebire was found dead at home. According to prosecutors, she had taken a “deadly dose” of barbiturates. As for now, under the “end of life” law, doctors in France are advised to avoid taking extreme measures to keep dying or brain-dead patients alive. However, such cases may contribute to the change in the French law and the euthanasia might be decriminalised in France in the nearest future. The possible change in law could help to decrease the level of suicides committed at home in France, which also applies to other EU countries.Medical life-taking without patient consent is also common. Since the Dutch define euthanasia only as ‘life-taking by a doctor on the patient’s request’, the entity of non-voluntary euthanasia (NVE) is not officially recognised. Instead, an innocuous-sounding acronym is used – LAWER, for ‘life-terminating acts without explicit request’. This practice was first discovered by an official survey in 1990, yet when this survey was repeated five years later all that could be concluded was that ‘life-taking without the patient’s explicit request seems to have decreased slightly’. In two test cases in different courts in 1995, doctors were exonerated after taking the lives of deformed new-borns, though such victims were of course incapable of consent. Nevertheless, without a direct consent from a patient, de juro LAWER cases violate both the basic principles of human rights and the Dutch law on the legalisation of euthanasia.Belgium was the second country to legalise euthanasia in 2002 after the Netherlands. Moreover, in 2014 the country has legalised euthanasia for terminally ill children. In order to be euthanised, the patient must be conscious of their decision, a request must be approved by parents and medical team, the illness must be terminal and finally, the patient must be in great pain with no treatment available to alleviate their distress. Parents, doctors and psychiatrists would have to agree before a decision is made. Some pediatricians have warned vulnerable children could be put at risk and have questioned whether a child can really be expected to make such a difficult choice. Belgium was the first country to allow euthanasia for minors of any age, raising the question of the legalisation of euthanasia for children. The Netherlands also allows euthanasia for minors, but they must be aged over 12 years old and get parental backing or over 16 to be euthanised without their consent. Thus, it also raises the question of developing a unified legal framework for all the EU countries regarding the legal age for being euthanised.Luxembourg’s parliament has voted to legalise euthanasia, after a passionate public debate in 2008. However, the grand duke has not signaled that he would not sign euthanasia bill into law even though the Chamber of Deputies approved it. It is a predominantly Catholic country and the medical profession was broadly against the legislation. Nevertheless, both assisted suicide and euthanasia were decriminalised even without the signature of the grand duke. The proposed new law on euthanasia and assisted suicide would allow those with incurable conditions to die if they asked repeatedly to do so and had the consent of two doctors and a panel of experts.Regardless their legal power, some of the existing laws on the legalisation of euthanasia contradict to existing laws on the basics of human rights. For instance, the Dutch law contravenes Article 2 of the 1950 European Convention for the Protection of Human Rights and Fundamental Freedoms on the protection of life. Such cases require further detailed legal revision, which might have not been done previously by the Dutch government. Moreover, the newly created laws on the legalisation of euthanasia in other Member States must be developed in accordance with the existing local and global policies on human rights. For instance, under the 1961 Suicide Act, it is a criminal offense in Britain, punishable by 14 years’ imprisonment, to assist, aid or counsel somebody in relation to taking their own life. However, the local authorities may decide not to prosecute cases of euthanasia after taking into account the circumstances of the death. Furthermore, the Dutch law requires that the patient be resident in the Netherlands. Thanks to the current legal loophole, residents of any country worldwide, including all the Member States, could get legally euthanised in the Netherlands. The changes in Belgian law enabled a Belgian doctor, Professor Pete Hoebeke, to invite Chantal Sebire (from France – case outlined above) to end her life at his hospital in Ghent. This fear of ‘euthanasia tourists’ has surfaced in Italy when a Turin magistrate raised the specter of an Italian suspected of assisting the passage to the Netherlands of ill people to die. On the other hand, a clause in the Dutch law insisting on a well-established relationship between doctor and patient is designed to prevent this. Nevertheless, a patient could be put into the hospital for a short-time treatment, which will legally establish the required relationship between the patient and his doctor, allowing the last to implement euthanisia. Another problem to be considered is the legalisation of euthanasia and assisted suicide for mentally ill people. In the Netherlands, doctors may perform euthanasia — not only for terminal physical illness but also upon the “voluntary and well-considered” request of those suffering “unbearably” from incurable mental conditions. However, in some cases, suffering mentally ill people might not be able to make a conscious statement and express their decision to be euthanised because of the severeness of their illness. On the other hand, this illness might bring lots of pain and suffering to the mentally ill person, making it legal in some countries to euthanise him/her by the consent of a special medical commission. However, such kind of euthanasia creates a legal loophole for the human rights violation and basically means that the doctor would kill the patient without his consent, which could be equate to a murder both in terms of legal frames and morals.Actors The European Association of Palliative Care (EPAC) is a membership organisation dedicated to the promotion and development of palliative care throughout Europe. The EPAC Ethics task Force is working on researching different aspects of palliative care and euthanasia. They have officially stated that the medicalised killing of a person, whether involuntary or non-voluntary is a murder and euthanasia can only be voluntary that is with the consent of the patient.The UN Human Rights Committee is the body of independent experts that monitors implementation of the International Covenant on Civil and Political Rights by its State parties. All States parties are obliged to submit regular reports to the Committee on how the rights are being implemented. The Committee criticised the Dutch model, accusing it of having the potential for routine and insensitive mercy killings, where pressure could be brought to bear to avoid the legal safeguards.Belgium’s Federal Control and Evaluation Committee on Euthanasia European Court of Human Rights is the judiciary arm of the ECHR, which examens the cases of human rights violation raised by the EU citizen against the Member State`s government.EU citizens: the EU is founded on the principles of liberty, democracy and respect for human rights. Therefore the EU citizens play the major role in the legalisation of euthanasia.Pediatricians: Belgian pediatricians were the first ones to oppose the new law on the legalisation of euthanasia. They signed an open letter against the law, claiming that there was no urgent need for it and that modern medicine is capable of alleviating pain.PatientsHolland’s Regional Euthanasia Review Committees: the committee is responsible for reviewing mercy killing in the Netherlands. According to the Dutch law, in order to be euthanised, a patient has to sign a legal statement that the choice to die is rational and reasoned, which needs to be further . A second medical concurring opinion is required, which is then reviewed by a regional commission. However, the commission reviews the case only after the death of a patient.The Royal Dutch Medical Association (KNMG) is the professional organisation for physicians of the Netherlands. Their main objectives are to improve the quality of medical care and healthcare in general, and to improve public health. They have developed and outlined the main guidelines for the practice of euthanasia and physician-assisted suicide. Non-Governmental organisations that advocate for and against various various euthanasia-related policies within the EU (e.g. Dignity in Dying and care not killing).The World Medical Association, which represents 9 million physicians worldwide, condemns euthanasia and advises physicians not to practice it where it is permitted.The Coalition of Physicians for Social Justice is an active non profit organisation, who has been creating innovative healthcare programs and advocating for accessible healthcare for all. Since more than a decade of work, they have created many programmes in healthcare, which might be used in the EU Member States as an alternative to euthanasia.Religious groups:Buddhism: according Buddhist thought, assisted suicide and euthanasia constitute deliberate killing of another person, which contradicts the fundamental Buddhist principle of refraining from killing a living being.Catholicism: the stance is not clear. The Roman Catholic Church acknowledges the fact that moral decisions regarding a person’s life must be made according to one’s own conscience and faith. It also recognizes the story of the Good Samaritan, who assisted his neighbour in suicide in the name of love. On the other hand, they teach their followers that the act of euthanasia is unacceptable because it is perceived as a sin, as it goes against the Ten Commandments. Furthermore, Pope Francis affirms that death is a glorious event and should not be decided for by anyone other than God.Judaism: The conclusion of the majority of later rabbinic authorities, and accepted normative practice within Judaism, is that suicide and assisted suicide can not be sanctioned even for a terminal patient in intractable pain.Muslims are against euthanasia. They believe that all human life is sacred because it is given by Allah, and that Allah chooses how long each person will live. Human beings should not interfere in this.Measures in placeEuropean Convention of Human Rights (ECHR) is an international treaty to protect human rights and fundamental freedoms in the Member countries of  and has been in place Council of Europe. The Article 2 defines the main principles of a person’s right to life, which must be considered when developing a law on the legalisation of euthanasia.Declaration on Euthanasia by the Catholic Church (1980) in which Pope John Paul II opposed mercy killing but allowed individuals the right to refuse measures for sustaining life.Dutch Law on Legalisation of euthanasia (2001)The doctrine of the sanctity of life: According to the “sanctity-of-life” view, all human lives are equally valuable and inviolable, and it would be wrong to base life-and-death medical decisions on the quality of the patient’s life.Article 293 of the Dutch Penal Code provides that a person who takes the life of another person at that person’s ‘express and serious’ request is punishable by imprisonment for a maximum of 12 years or by fine. That means that the current law contradicts to the Dutch law on legalising euthansia.British Suicide Act (1961) sets the criminal liability framework within the UK for comitting or assisting in suicide. According to the current law, both the euthanasia and assisted suicide are punishable by 14 years’ imprisonment.The “end of life” law (France): under the “end of life” law, doctors are advised to avoid taking extreme measures to keep dying or brain-dead patients alive. Active euthanasia, even at a patient’s request, remains illegal.Termination of Life on Request and Assisted Suicide (Review Procedures) Act for Dutch citizens over 12 years old: the Act states that physicians who perform the procedures will be exempt from criminal liability and set forth criteria for physicians to follow to legally euthanize or assist in the suicide of a patient.Netherlands guidelines for the practice of euthanasia and physician-assisted suicide (2007) developed by the KNMG outlines the main guidelines and legal framework on implementing different types of euthanasia and assisted suicide within the Netherlands. Nevertheless, the KNMG do not accept any liability for any harm, damage or loss stemming from any inaccuracies in the document.In December, 2017 Italy’s Senate gave final approval to a law allowing Italians to write living wills and refuse artificial nutrition and hydration, the latest step in the Roman Catholic nation’s long-running and agonizing debate over euthanasia and end-of-life issues. That means that Italy became one step closer to the legalisation of euthanasia.Moreover, in November, 2017 Pope Francis repeated the church’s opposition to euthanasia but also rejected the “therapeutic obstinacy” sometimes practiced by doctors when the benefits of heroic therapies to patients are debatable, negligible or non-existent. That means that the Catholic church is getting closer to the acceptance of the legalisation of euthanasia in the countries, where the government is highly influenced by the church. Linkshttp://hanselawreview.eu/wp-content/uploads/2016/08/Vol2No1Art04.pdfhttps://euthanasia.procon.org/view.resource.php?resourceID=000136https://www.youtube.com/watch?v=SWWkUzkfJ4M https://www.youtube.com/watch?v=eo8Hn0DEcpw