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The Netherlands, which is often in the forefront of liberal social movements, ruled voluntary euthanasia was acceptable in 1984, provided doctors followed strict guidelines. Belgium, Luxembourg, and Albania have also passed legislation allowing human euthanasia.
Oregon was the first state that legalized assisted suicide. The Oregon statute, which went into effect in October 1997, provides that a doctor may prescribe, but not administer, a lethal dose of medication to a patient who has less than six months to live. Two doctors must agree that the patient is mentally competent and that the decision was voluntary. By April of 1999, twenty three patients had been prescribed the drugs under the statute, and fifteen of them used the drugs to commit suicide. Washington and Montana passed legislation in 2008 that allows physicians to assist in PAS and not face prosecution. With the implementation of euthanasia, the process of authorizing euthanasia remains a major problem.
Where there is no hope of medical relief from totally unbearable pain and suffering, and one has otherwise lived long enough and well, euthanasia can be an ethical option. The question is how does one know for sure that the pain someone is experiencing is ‘severe enough’ to warrant euthanasia? Even if a particular proposal for euthanasia has merit, how can we prevent its use (or misuse) by mentally depressed people or by those without adequate rational capacity? We must also ensure that opportunistic psychologists or doctors aren’t bribed to kill, for that would not be euthanasia but murder. Given the many potential risks that emerge with the practice of euthanasia, rigorous procedural regulation need to be applied.
The question of who qualifies for assisted suicide and active voluntary euthanasia is perhaps the most critical issue to be addressed. The question cannot be simply settled by determining who has a good reason for death. We cannot settle the question of who should be eligible simply by settling the question of who has a good reason for death. When considering legislation in this area, we must also take into account the potential for mistakes and abuse. This possibility increases dramatically the more eligibility is liberalized, for instance, to allow assisted suicide and active voluntary euthanasia on children or those with a mental illness significantly increases the potential for abuse.
Limiting eligibility to those whose prognosis is for imminent death, within six months or a year could minimize the consequences of abuse and mistakes. There are problems with such an eligibility requirement; often it is difficult for physicians to provide an accurate prognosis regarding how long a person has left to live. This restriction seems subjective since it is not clear why the prediction of death should be a determining factor, it would exclude persons with incurable, but not imminently terminal, progressive illnesses. The perpetual suffering of persons who are not close to death may be of even greater consequence than that of a person whose death is imminent.
A person or their family with an illness that is not terminal ought not to be excluded from seeking such avenues as euthanasia. Non-terminal illnesses such as Alzheimer's can lead to unmitigated impairment of mental or physical capacities, and can progress to a point where the patient can no longer end their life in a dignified and peaceful way without assistance, even though death from the disease may not be inevitable. Quadriplegia is another such condition, that in the person’s judgment their life is no longer worth living, and with no significant increase in the individuals potential to recover from their medical condition, is such a limitation necessary?
The condition should be incurable or irreversible. If the condition which is producing the suffering can be cured or reversed, the patient's reason for preferring death over life will likely wane. There may a-rise