This chapter completes and complements the life-and-death debate begun in our analysis of abortion. Euthanasia has hovered on the outskirts of social policy's radar, with most governments reluctant to focus on such a controversial subject. As degenerative conditions become more prevalent and average life spans creep upwards, however, it seems likely that euthanasia will become more and more crucial to social policy debates in the 21st century.

This chapter will therefore be mainly concerned with the following question:

Is euthanasia justified and, if so, when?

First of all, what do we mean by euthanasia? The term implies deliberately assisting someone to die in order to benefit that person (Kuhse, 1993). It is usual to distinguish between its active and passive forms, although we will see shortly why that distinction is not always easy to maintain. Active euthanasia involves killing someone through direct actions, while passive euthanasia occurs when someone is allowed to die, whether through direct action (for example, by withdrawing medication) or non-intervention; active and passive euthanasia are therefore often categorised as ‘killing’ and ‘letting die’, respectively. The question of whether they are continuous with one another or qualitatively distinct is crucial, as we shall see. This distinction cuts across a further one, between voluntary, non-voluntary and involuntary euthanasia. Voluntary euthanasia occurs with the fully informed request of the adult, whether this is made currently or has been made in the past. Non-voluntary euthanasia occurs without such consent, for example, when a coma patient is insentient, thought incapable of recovery and has left no prior instructions. Involuntary euthanasia occurs when someone's life is ended even though they are indicating (or have in the past indicated) their wish to go on living, or when they are capable of giving consent but are not asked to. These various categories are charted in Table 10.1.

As simple as this table may appear, it contains a legal and ethical minefield. Can we make pragmatic and moral distinctions between active and passive euthanasia? How do we decide whether someone is fully informed or competent enough to make relevant decisions? What constitutes consent, particularly when communicative powers are lacking? How far can proxies and doctors be permitted to respond to changing circumstances after the patient becomes insensible? What should happen when proxies and doctors disagree?