Euthanasia Euthanasia is defined as intentionally ending one's life when suffering from a terminal illness or severe disability (Youdin, 2016). Euthanasia is further separated into active euthanasia, which is intentionally causing death, usually through a lethal dose of medication, and passive euthanasia occurs when life-sustaining support is withdrawn. This can occur through the removal of a respirator, feeding tube, or heart-lung machine. Physician-assisted dying is a form of active euthanasia whereby a physician prescribes the means by which a person can die. The United States federal government does not legislate physician- assisted dying as laws are handled at the state level (ProCon.org, 2018). Nine states and the District of Columbia (D.C.) currently allow physician-assisted dying. The person seeking physician-assisted dying must be: (1) at least 18 years of age, (2) have six or less months until expected death, and (3) obtain two oral (or least 15 days apart) and one written request from a physician (ProCon.org, 2016). Table 10.2 lists the 9 states and D.C. that allow physician-assisted dying and the date the act was passed. Table 10.2 Nine States and D.C. Allow Legal Physician-Assisted Dying State Oregon Washington Montana Vermont California D.C. Colorado Hawaii Date Passed Passed November 8, 1994, but enacted October 27, 1997 November 4, 2008 December 31, 2009 May 20, 2013 September 11, 2015 October 5, 2016 November 8, 2016 April 5, 2018 New Jersey March 25, 2019 June 12, 2019 Maine Source Since 1997 in Oregon, 2,216 people had lethal prescriptions written and 1459 patients (65.8%) died from the medication as of January 2019 (Death with Dignity, 2019) (see Figure 10.19). Figure 10. 19 250 200 Prescriptions written DWDA deaths Number 150 100 50 0 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 '12 '13 '14 '15 '16 '17 '18 *As of January 22, 2019 See Table 2 for detailed information Source Year 454 Canada and several European countries, including Switzerland, Belgium, Luxembourg, and the Netherlands also allow physician-assisted dying. As of 2014, Belgium is the only country that allows the right to die to those under the age of 18. Stricter conditions were put in place for children, including parental consent, the child must be suffering from a serious and incurable disease, the child must understand what euthanasia means, and the child's death must be expected in the near future (Narayan, 2016). Figure 10.20 Hippocratic Oath and Euthanasia Source The practice of physician-assisted dying is certainly controversial with religious, legal, ethical, and medical experts weighing in with opinions. The main areas where there is disagreement between those who support physician-assisted dying and those who do not include: (1) whether a person has the legal right to die, (2) whether active euthanasia would become a "slippery slope" and start a trend to legalize deaths for individuals who may be disabled or unable to give consent, (3) how to interpret the Hippocratic Oath and what it exactly means for physicians to do no harm, (4) whether the government should be involved in end-of-life decisions, and (5) specific religious restrictions against deliberately ending a life (ProCon.org, 2016). Not surprisingly, there are strong opinions on both sides of this topic. According to a 2013 Pew Research Center survey, 47% of Americans approve and 49% disapprove of laws that would allow a physician to prescribe lethal doses of drugs that a terminally ill patient could use to commit suicide (Pew Research Center, 2013). Attitudes on physician-assisted dying were roughly the same in 2005, when 46% approved and 45% disapproved. Religious Practices after Death Funeral rites are expressions of loss that reflect personal and cultural beliefs about the meaning of death and the afterlife. Ceremonies provide survivors a sense of closure after a loss. These rites and ceremonies send the message that the death is real and allow friends and loved ones to express their love and duty to those who die. Under circumstances in which a person has been lost and presumed dead or when family members were unable to attend a funeral, there can continue to be a lack of closure that makes it difficult to grieve and to learn to live with loss. Although many people are still in shock when they attend funerals, the ceremony still provides a marker of the beginning of a new period of one's life as a survivor. The following are some of the religious practices regarding death, however, individual religious interpretations and practices may occur (Dresser & Wasserman, 2010; Schechter, 2009). Hindu: The Hindu belief in reincarnation accelerates the funeral ritual, and deceased Hindus are cremated as soon as possible. After being washed, the body is anointed, dressed, and then placed on a stand decorated with flowers ready for cremation. Once the body has been cremated, the ashes are collected and, if possible, dispersed in one of India's holy rivers.