Euthanasia is the act of either painlessly causing the death or failing to prevent death from occurring from natural causes in an individual with a terminal illness or in an irreversible coma. The term is derived from the Greek words eus (good) and thanatos (death). Although advances in medical technology have made it possible to prolong the life of patients with no hope of recovery, at times the quality of life of the terminally ill individualis called into question.

The term "negative" or "passive euthanasia" is used to describe the practiceof withholding or withdrawing extraordinary means of preserving life. The term "positive" or "active euthanasia" involves any direct intervention to causedeath, such as injecting a lethal drug or participating in a form of assisted suicide in which another person provides the means for the patient to die.Active euthanasia is sometimes called mercy killing.

The right to refuse life support has been a widely accepted concept among thegeneral public and physicians alike. There is no law in the United States that requires a competent person to receive life support involuntarily. In 1976, the New Jersey Supreme Court ruled that doctors could disconnect a mechanical respirator keeping a comatose patient alive because being connected to a machine prevented the patient from dying with dignity.

Beginning in 1977, all states recognized advance directives after Californiabecame the first to pass a state law the Death with Dignity statute legalizing the living will, a document prepared while an individual is alive and competent. It provides guidance to the health care team in the event the person isno longer capable of making decisions. The directive states the individual'spreferences concerning life support measures and organ donation and may giveauthority to another person to make decisions for the terminally ill patientwho may be comatose.

In 1990, the United States Supreme Court ruled that individuals who make their wishes known have the right to have life-sustaining treatment discontinued,even such routine ones as antibiotics, ventilation, nutrition, and hydration. In most states, family members or court-appointed surrogates can make all decisions for individuals whose expressed wishes are unknown.

Passive euthanasia raises many legal issues, as in cases in which parents anddoctors decide not to pursue extraordinary life-saving measures for childrenborn with severe birth defects. The problem is intensified because machinesthat can artificially maintain breathing and heart function have altered thedefinition of death. Since the advent of advanced medical technology, the definition of death was broadened to include brain death lack of electrical activity for a period long enough to preclude a return to functioning.

Even more controversial than passive euthanasia is active euthanasia, which remains illegal worldwide. However, societies advancing the cause of positiveeuthanasia have existed since 1935 in England and in 1938 in the United States.

Australia's Northern Territory legalized active euthanasia in the mid-1990s,but the law was overturned. Active euthanasia has been widely accepted in theNetherlands, where physicians are not prosecuted if they follow strict procedures and patients persistently and voluntarily request to die.

In the United States, while doctors have sometimes assisted terminally ill patients commit suicide without punishment, the Michigan authorities sought tohalt the highly publicized suicides assisted by Dr. Jack Kevorkian, retired Michigan pathologist and right-to-die advocate.

The United States Supreme Court upheld laws forbidding physician-assisted suicide in 1997 but left the door open for states, such as Oregon, to pass legislation permitting the practice. The Hemlock Society is one controversial group that has lobbied for right-to-die legislation on a national level.

Defenders of active euthanasia and assisted suicide point out that many people suffer uncontrollable pain that can only be relieved by active intervention. In these cases, they argue, the results are the same as forgoing life support. Opponents argue that active euthanasia brings with it the risk that society may become more tolerant of killing, eventually making involuntary killingand killing for societal convenience acceptable. They also claim that activekilling is intrinsically different from withholding treatment, since the disease rather than human action causes death.

The euthanasia issue has sparked much debate in the United States among physicians, religious leaders, lawyers, and the general public over the question of what constitutes actively causing death and what constitutes merely allowing death to occur naturally. The physician is faced with deciding whether themeasures used to keep patients alive are extraordinary on a case-by-case basis.

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