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= Euthanasia in the United States = Euthanasia or mercy killing is illegal in all fifty states in the United States though it is legal in Canada, Luxembourg, Netherlands, Belgium , and Colombia undefinedand Switzerland. There is debate on the correct terminology, but the key difference between euthanasia and assisted suicide is that in cases of assisted suicide, the individual receives assistance, but ultimately voluntarily causes their own death. In euthanasia the individual does not directly end their life, but another person acts to cause the individual's death.

In the United States, six states and the jurisdiction of Washington DC have legalized physician-assisted suicide, while in the state of Montana it is permissible under a 2009 Supreme Court verdict.

Terminology
The term euthanasia comes from the Greek words "eu"-meaning good and "thanatos"-meaning death, which combined means “well-death” or "dying well". Voluntary euthanasia refers to when the request for death comes from the patient. Passive euthanasia involves withholding nutrition, and active euthanasia refers to when someone other than the patient, like a physician, actively causes the death of the patient with, for example, the lethal injection of drugs. Involuntary Euthanasia does not involve the person's consent, and is considered murder. In non-voluntary Euthanasia consent is non-obtainable, as is the case for comatose patients or children.

All forms of Euthanasia must be clearly distinguished from assisted suicide where one may provide the means including a plan and drugs but the individual actively takes their own life. When a physician intentionally and with the consent of the patient prescribes lethal drugs to be taken by the patient to end their life, it is called physician assisted suicide or physician aid-in dying.

The firm distinction is made that in Euthanasia the physician administers the lethal drug whereas in physician assisted suicide, the patient self-administers the drug prescribed by the physician.

'''Table 1. Summary of Terminology'''

Early history
Debates about the ethics of euthanasia and physician-assisted suicide date from ancient Greece and Rome. After the development of ether, physicians began advocating the use of anesthetics to relieve the pain of death.

Eugenics and the Nazi Involuntary Euthanasia Program
Eugenics is defined as the science of improving the genetic quality of a human population. The first Nazi eugenics policy, the Law for the Prevention of Hereditarily-Diseased Offspring, was passed in July 1933, requiring registration of all patients with psychiatric illness.

As early as 1920, psychiatrist Alfred Hoche and philosopher Karl Binding advocated for legalized euthanasia for those with mental disabilities who in their view possessed only lebensunwertem lebens (‘life unworthy of living’). Aktion T4 began with a "trial" case in late 1938 where Hitler authorized his personal physician Karl Brandt to euthanize a disabled boy at the request of his parents.

In fall of 1939, Euthanasie Programme was underway, under the direction of Dr. Karl Brandt and Philip Bouhler. The headquarters of the operation were at Tiergartenstrasse 4, Berlin and the code name for the program was derived from that address—T-4.There were about 200,000 victims in Germany and Austria from 1939 to 1945, with another additional 100,000 in the Eastern European countries.

History
New York, in 1828 passed a statute explicitly outlawing assisted suicide. Later, In 1870, Samuel Williams first proposed using anesthetics and morphine to intentionally end a patient's life. Over the next 35 years, debates about euthanasia raged in the United States, resulting in an Ohio bill to legalize euthanasia in 1906, a bill that was ultimately defeated.

Euthanasia advocacy in the U.S. peaked again during the 1930's and diminished significantly during and after World War II when the Nazi abuse of involuntary euthanasia turned people’s perception against it. Euthanasia efforts resurged in the 1960’s and 1970’s when California legalized a patient's right to refuse life-prolonging treatment. The state legislature passed the Natural Death Act, allowing for living wills.

Active Euthanasia in the United States
In 1980, Derek Humphrey formed the Hemlock Society in Los Angeles, a grassroots organization that promoted the cause of active euthanasia. Hemlock was merged with End of Life Choices in 2003, which changed its name to Compassion and Choices.

In 1988 there was controversy over an article published in the Journal of American Medicine entitled “It’s over Debbie”. The article described how a gynecology resident had injected a lethal dose of morphine to a terminal ovarian cancer patient.

Jack Kevorkian
Jack Kevorkian, an American pathologist, was involved in the first assisted suicide of a Hemlock society member on June 4, 1990. He went on to create euthanasia devices called the Thanatron and Mercitron that patients could use to end their lives.

The Thanatron had three canisters mounted on a metal frame. Each bottle had a syringe that contained a medication. One contained saline, another contained a sleep-inducing barbiturate called sodium thiopental and the third had a lethal mixture of potassium chloride, which immediately stopped the heart, and a paralytic, pancuronium bromide.

The Mercitron device  employed a gas mask fed by a canister of carbon monoxide which was used by the patient to commit suicide.

On March 26, 1999, Jack Kevorkian was charged with second-degree murder for a videotaped administration of a lethal injection to Thomas Youk, who was suffering from Lou-Gehrig’s disease and had given consent to the injection. Kevorkian served eight years in prison and was released on parole in 2007. He died on June 3, 2011 from thrombosis and complications of liver cancer.

Timothy Quill
Timothy Quill, a physician in Rochester described in an article in the New England Journal of Medicine his rationale and role in the death of a forty five year old woman Diane with leukemia who had requested a humane death. No charges or indictments were brought forth against Dr. Quill and he continues to be an advocate for physician assisted suicide.

Lawrence Egbert
An anaesthesiologist from Maryland, Egbert became the face of the Euthanasia movement after Kevorkian’s conviction. He was a member of the Final Exit Network, an offshoot of the Hemlock society. He claimed to have assisted in hundreds of suicides using asphyxiation by helium. He was stripped of his license in 2014 for his role in six suicides in Maryland.

Recent Non-physician Euthanasia
Recent convictions include one of a man in the state of Washington who shot his wife, who had terminal brain cancer. Her mental state had declined, so she was not be eligible for Washington’s Death with Dignity law. He got a two year sentence.

U.S. public opinion on euthanasia
Reflecting the religious and cultural diversity of the United States, there is a wide range of public opinion about euthanasia and the right-to-die movement in the United States. During the past 30 years, public research shows that views on euthanasia tend to correlate with religious affiliation and culture, though not gender. In a recent Gallup poll in May 2018, 73% of U.S. adults agree with physician assisted death by painless means in patients with terminal illness and suffering. This consistent with the 69% to 70% Gallup polling has recorded since 2013.The party line breakdown is 81% of Democrats and Democratic-leaning independents as well as 67% of Republicans and Republican leaners support euthanasia. The gender gap in this poll was about 65 % women in favor of euthanasia versus 72% men.

Opinion by religious affiliation
In the 2018 Gallup poll 41% of people in the United States who were weekly church goers supported euthanasia as compared to 78% of seldom or never churchgoers who were in favor of euthanasia with about 58% of those who attended church less regularly being in support of the practice. In a 2013 Pew research poll white Protestants (61%) and about half of white Catholics (55%) approve of laws that allow physician-assisted suicide, as did two-thirds of religiously unaffiliated adults. Black Protestants, white evangelical Protestants and Hispanic Catholics disapproved of laws that allow doctor-assisted suicide by a 2-1 margin.

A systematic review from 2017 summarizes the of religious beliefs about major end-of-life issues in the five major world religions. In the United States, physicians with a Roman Catholic affiliation were three times more likely to object to withdrawal of life support, compared to Protestants and Jews, or no religious affiliation. In Belgium, there was a high rate of opposition to euthanasia among orthodox Jews as opposed to non-orthodox Jews.

Opinion by race and gender on Euthanasia in the United States
Earlier studies have shown white Americans to be more accepting of euthanasia than black Americans. They are also more likely to have advance directives and to use other end-of-life measures. African Americans were almost 3 times more likely to oppose euthanasia than white Americans. In Oregon in a 2013 study 66% of African Americans supported euthanasia as opposed to 82% of Whites.

Within both sexes, there are differences in attitudes towards euthanasia due to other influences. For example, one study found that black American women are 2.37 times more likely to oppose euthanasia than white American women. African American men are 3.61 times more likely to oppose euthanasia rthan white American men.

Feminism and Euthanasia
In "Gender, Feminism, and Death: Physician-Assisted Suicide and Euthanasia Susan M. Wolf warns of the gender disparities if euthanasia or physician-assisted suicide were legal. Wolf highlights four possible gender effects: higher incidence of women than men dying by physician-assisted suicide; more women seeking physician-assisted suicide or euthanasia for different reasons than men; physicians granting or refusing requests for assisted suicide or euthanasia because of the gender of the patient; gender affecting the broad public debate by envisioning a woman patient when considering the debate.

Prominent feminist and writer Charlotte Perkins Gilman, who had terminal breast cancer took her own life in 1938 and was an early champion of euthanasia. Sandra Bem, a prominent psychologist and feminist had progressive Alzheimer’s disease and took her life in 2014 in her home.

Netherlands
Netherlands in April 2002 became the first country to legalize euthanasia and reported 6585 assisted deaths in 2017, increasing by 8% from 6091 reported assisted deaths in 2016. Recent controversy has ensued over the rise in assisted deaths and the investigation into the death of a woman with severe dementia.

Belgium
Belgium passed a law in 2002 legalizing euthanasia, becoming the second country in the world to do so. Belgium is the first country in the world that authorized euthanasia at all ages legalizing in February 2014. In 2003, there were 235 euthanasia cases, representing 0.2 percent of nationwide deaths, and in 2013, there were 1,807 cases, which was 1.7 percent of deaths.

Switzerland
Swiss law only allows for providing the means to commit suicide, and reasons for doing so must not be based on self-gain or self-interest.

The Swiss have been tolerant of organizations like Dignitas and Exit which provide assisted dying services for a fee. This has given rise to concerns about death tourism. Recently the Australian scientist David Goodall, a member of Exit international, made headlines when he went to Switzerland for a voluntary death. In 2017, 734 people ended their lives using Exit’s services compared to 723 the year before.

Colombia
Colombia is the only Latin-American country where euthanasia has been legal since 1997. On March 9, 2018, Colombia passed a resolution permitting euthanasia for children.