What Is Euthanasia? Meaning, History and Key Terms

In December 2007, the novelist Terry Pratchett told the world he had a rare form of Alzheimer's disease. He was 59. He had written dozens of best-selling Discworld novels. Now his brain was slowly losing the ability to see shapes, to read easily, and to do small tasks like buttoning a shirt (Wikipedia).

He described the illness like this: "Imagine a very, very slow-motion car crash." Nothing much seems to happen. The radio still plays. The heater is on. But you know how it will end.

Something surprised him. People did not avoid him. They came closer. Strangers stopped him on city streets, in theatre queues and on planes. They wanted to tell him about their mother, their husband, their grandmother. More and more, they wanted to talk about one subject: how people die, and who gets to choose.

In February 2010, he gave the BBC's Richard Dimbleby Lecture, called Shaking Hands With Death. His illness made reading hard, so his friend, the actor Tony Robinson, read most of it aloud. Pratchett asked for a law to allow an assisted death for people with a serious, incurable illness. He also asked for a tribunal, a small panel with a lawyer and a doctor, to protect vulnerable people. It would turn away anyone acting from "trivial or transient distress". He ended with these words:

"If I knew that I could die, I would live. My life, my death, my choice." — Terry Pratchett, 2010 (The Guardian)

Many people agreed with him. Many others, including disability campaigners, doctors and faith leaders, disagreed strongly. Both groups were trying to protect something they valued.

That is what this guide is about. Euthanasia means a doctor or nurse deliberately ending a person's life, at that person's clear request, to relieve suffering. It is one of the hardest questions in medicine, law and ethics. This page explains the words, the history, the research and the main arguments. It does not tell you what to think.

Assisted dying is a regulated medical process for assessed, eligible patients in some places. It is not a response to suicidal feelings or emotional pain. If you are struggling right now, please talk to someone now.

The word joins two Greek words: eu, meaning "good", and thanatos, meaning "death". So euthanasia means "good death" or "dying well".

At first, it simply described a peaceful death, not a medical act. The Roman writer Suetonius tells a story about the emperor Augustus. Whenever Augustus heard that someone had died quickly and without pain, he prayed for "a like euthanasia" for himself and his family (Suetonius, Augustus 99). Augustus died in 14 CE. The Greek word itself is older.

In the 1600s, the English thinker Francis Bacon gave the word a medical meaning. He wrote that doctors had a duty to ease the bodily suffering of the dying, not only to try to cure disease (Wikipedia).

The meaning we use today arrived in 1870. A schoolteacher, Samuel Williams, gave a talk to the Birmingham Speculative Club in England. He proposed that doctors should be allowed to end a dying patient's life, quickly and painlessly, when the patient asked. This was the start of the modern debate.

So the word has changed jobs. It began as a wish, the kind of thing an emperor prayed for. It became the name of a medical act, and then of a political fight.

The most useful question is simple: whose hand takes the final step?

• Euthanasia: a doctor or nurse gives the medication, at the patient's request.
• Assisted suicide: a doctor prescribes the medication, and the patient takes it themselves.
• Withdrawing or withholding treatment: a patient refuses, or stops, a treatment such as a ventilator, dialysis or a feeding tube. The illness then takes its course.

Here is an analogy. Imagine a locked door. In assisted suicide, the doctor hands the patient a key, and the patient decides whether to use it. In euthanasia, the doctor turns the key, at the patient's clear request. In withdrawing treatment, nobody turns a key. Someone stops holding the door shut.

Withdrawing treatment is legal in almost every country. It is part of ordinary medicine. A competent adult may refuse any treatment, even one that keeps them alive. Some people call this "passive euthanasia". Most doctors, and most laws, avoid that term. They say the doctor does not cause the death; the disease does.

Not everyone accepts that line. In 1975, the philosopher James Rachels published "Active and Passive Euthanasia" in the New England Journal of Medicine. He wrote that "the bare difference between killing and letting die does not, in itself, make a moral difference." He also argued that a quick death is, in many cases, more humane than a slow one (Rachels, NEJM 1975). His paper is still taught in medical schools, and still argued over.

There is one more idea you will meet: the doctrine of double effect. It goes back to the medieval thinker Thomas Aquinas. It says an action with a good aim, such as easing pain, can be right. This is true even if a bad side effect, such as an earlier death, is foreseen but not intended (Stanford Encyclopedia of Philosophy). Many hospitals and faiths rely on it. In fact, careful pain relief very rarely shortens life. The same encyclopedia calls the belief that it often does a "mistaken assumption". That matters, because the fear can lead families and doctors to leave pain under-treated.

Palliative sedation is different again. It lowers a person's awareness when suffering near the end of life cannot be controlled any other way. Its aim is comfort, not death. Our guide to the types of euthanasia explains each form in more detail.

You will see many words for similar things. Each word carries a point of view. Here are the most common ones, in plain English.

• Euthanasia: a doctor or nurse ends a patient's life at the patient's request. The clinician performs the final act.
• Assisted suicide: a doctor provides medication, and the patient takes it themselves. Supporters often dislike the word "suicide" here. Pratchett said it was used "wrongly"; he preferred "assisted death".
• Physician-assisted death (PAD): an umbrella term for both, when a doctor is involved.
• MAID: in Canada, Medical Assistance in Dying. It covers both forms. In the US, Medical Aid in Dying means the patient always takes the medication themselves.
• Voluntary assisted dying (VAD): the term used in Australia.
• Voluntary, non-voluntary and involuntary euthanasia: voluntary means the person asked. Non-voluntary means the person could not ask, for example because of a coma. Involuntary means against the person's will. Involuntary euthanasia is murder everywhere, and no country's law allows it.
• Mercy killing: an older term that stresses the kind motive. It is used less today, because it sounds informal and can hide the question of consent.
• Right to die: the legal and moral claim that people may choose the time and manner of their death, especially when facing terminal illness.
• Death with dignity: a movement, and the name of several US laws, that stresses the patient's own choice.

How is it different from suicide? Suicide is a death a person causes alone, often in a crisis. It is a public health tragedy, and prevention work tries to stop it. Legal euthanasia involves a medical team, long assessments and a request repeated over time. Many people asking for euthanasia are physically unable to act alone.

How is it different from murder? Murder is the unlawful killing of a person. Where euthanasia is legal, it needs the patient's explicit, informed consent, strict medical rules, and a report to an official review body. Its stated aim is to relieve suffering, not to cause harm. Outside those rules, the same act is a serious crime.

For more words, see our glossary.

Ancient Greece and Rome. Many ancient thinkers valued a "good death." Some accepted ending life in hopeless illness. But the Hippocratic Oath, the famous doctors' promise, took a firm line: "I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan" (US National Library of Medicine). Two surprises: the Oath never says "First, do no harm," though that phrase is often linked to it. And most modern medical schools do not require the original Oath.

The Middle Ages. As Christianity spread, the idea of the sanctity of life shaped the law. It held that life is a gift from God, and only God may take it. Helping someone die was treated as murder.

1870 to 1940. After Samuel Williams's talk, the idea spread. In 1906, a bill to allow euthanasia went before the Ohio legislature in the US. It failed, by 79 votes to 23 (Wikipedia). Britain's Voluntary Euthanasia Legalisation Society was founded in 1935. The Euthanasia Society of America followed in 1938 (Wikipedia). Historians note links between some early campaigners and the eugenics movement, which judged some lives less worthy than others.

The Nazi "euthanasia" programme. From 1939, Nazi Germany ran a programme known as Aktion T4. It murdered disabled people and psychiatric patients, without consent, and called it "euthanasia." Its own records counted 70,273 victims in its first, central phase, which officially ended in August 1941. Killings went on in other forms until 1945. Historians estimate about 200,000 victims in Germany and Austria, and about 100,000 more elsewhere in Europe. Staff from the programme later helped run the death camps of the Holocaust (Wikipedia). This was not euthanasia in any modern sense. It was mass murder. But it explains why the word still frightens many people, and why disability groups watch every new law closely.

The care revolution (1960s). Cicely Saunders trained as a nurse, then as a medical social worker, and finally as a doctor. In 1967 she opened St Christopher's Hospice in London. It was the first hospice to combine expert pain control, compassionate care, teaching and research (St Christopher's). She taught the idea of "total pain": physical, emotional, social and spiritual. She wanted dying people to hear one message:

"You matter because you are you, and you matter to the end of your life." — Dame Cicely Saunders (King's College London)

Saunders was strongly against legal euthanasia (Saunders archive). She believed good care would remove most reasons to ask for it.

In 1969, the psychiatrist Elisabeth Kübler-Ross published On Death and Dying, based on interviews with dying patients. It made her "five stages" famous: denial, anger, bargaining, depression and acceptance. She, too, opposed euthanasia. She believed it stopped people from finishing their "unfinished business" (Wikipedia). Later research tested the stages in grieving families. A 2007 Yale study followed 233 bereaved people for up to two years. Acceptance was the most common response from the start. Yearning, not disbelief, was the strongest painful feeling. The feelings did peak in roughly the order the stage idea predicts, but they overlapped heavily (Maciejewski et al., JAMA 2007). Evidence: mixed. The stages are a loose pattern, not a fixed ladder.

The modern movement (1970s onwards). In 1973, a Dutch court found Dr Geertruida Postma guilty of ending the life of her seriously ill mother, who had asked her many times. The court gave her only "a one-week suspended sentence and a year's probation". About 2,000 people from her home town signed a statement supporting her. Outside the courthouse, friends each handed her a single flower (TIME). The public outcry led to the founding of the Dutch Right to Die Society (NVVE) that year (NVVE). The Netherlands then tolerated euthanasia under court-made rules for almost 30 years.

Opinion was moving elsewhere too. In 1947, only 37% of Americans told Gallup that doctors should be allowed to end a patient's life on request. By 1973, 53% agreed (Gallup).

Most assisted dying laws began in one of three ways. The public voted, a parliament passed a law, or one ill person went to court. Our guide to famous euthanasia cases tells the human stories behind these rulings.

• 1994, Oregon (US): voters passed the Death with Dignity Act. After legal challenges, it took effect on 27 October 1997 (Oregon Health Authority).
• 1997, Colombia: in ruling C-239/97, the Constitutional Court protected doctors from punishment when a terminally ill patient freely asked for help to die. It wrote that the right to live with dignity implies the right to die with dignity (Constitutional Court). In 2021, ruling C-233/21 removed the need for a terminal illness. It said serious, incurable illness with intense suffering could be enough.
• 2002, the Netherlands and Belgium: formal euthanasia laws came into force in both countries.
• 2002, Pretty v United Kingdom: Diane Pretty had motor neurone disease and was paralysed from the neck down. She asked that her husband not be prosecuted if he helped her die. The European Court of Human Rights refused. It said "no right to die" can be derived from the right to life (Wikipedia).
• 2006, Gonzales v Oregon: the US Supreme Court ruled 6 to 3 against the federal government. The Attorney General could not use national drug laws to stop Oregon's doctors from following state law (Cornell LII).
• 2015, Carter v Canada: Canada's Supreme Court, in a unanimous ruling, struck down the ban for "a competent adult person who clearly consents to the termination of life and has a grievous and irremediable medical condition" (Wikipedia). Parliament passed Canada's MAID law in 2016. Read how Kay Carter and Gloria Taylor won the Carter case.

What has changed recently? The past year moved fast, in both directions.

• United States: medical aid in dying is now legal in 13 states and Washington, D.C. (Compassion & Choices). Delaware's law took effect on 1 January 2026 (Death with Dignity). New York's took effect on 5 August 2026 (NY Department of Health). Illinois's began on 12 September 2026. Two days before, a federal judge refused a request from disability rights advocates to block it (Capitol News Illinois).
• Uruguay: its Dignified Death law (Law 20.431) passed in October 2025. The health ministry published its detailed rules in April 2026 (Presidency of Uruguay).
• France: an "aid in dying" law was formally adopted in August 2026, after the Constitutional Council upheld it. It covers adults with an incurable condition causing unbearable pain, and lets health workers refuse on grounds of conscience (The Guardian).
• Jersey: the island's law received Royal Assent on 9 July 2026. The service is planned to start in late 2027 (Government of Jersey).
• England and Wales: in June 2025, MPs passed an assisted dying bill by 314 votes to 291, but it stalled in the House of Lords (Wikipedia). On 11 September 2026, MPs rejected a new bill, from Labour MP Lauren Edwards, by 286 votes to 270 (The Guardian).
• Canada: people whose only condition is a mental illness are not eligible for MAID. On 7 October 2026, Justice Minister Sean Fraser said a new bill will keep that exclusion with no end date (CBC News).

As of October 2026, some form of assisted dying is legal in at least 14 countries. For each country's rules, see our legal landscape section and our guide to where euthanasia is legal.

This question goes straight back to Terry Pratchett. Alzheimer's slowly damages the mind that has to make the choice. Almost every assisted dying law requires a person to have mental capacity. That means being able to understand the decision, weigh it and express it, at the time of the request. Many people with dementia lose that ability before their illness ends.

Countries answer this problem in different ways.

• The Netherlands allows a written advance request in some cases. In 2025, 499 reported euthanasia cases involved a form of dementia. Most of those people could still decide for themselves. Review committees assessed 11 cases of people who were no longer able to decide about their request (RTE).
• Belgium's 2002 law does not allow euthanasia for people with advanced dementia, and does not allow an advance request for it. In December 2025, the country's Bioethics Advisory Committee recommended changing the law to allow such requests (RTBF).
• Canada's government said in October 2026 that its new bill will "open the door" to advance consent. This would apply when an incurable illness will later remove a person's capacity to decide. The details are still to be worked out in Parliament (CBC News).

Supporters say advance requests respect the person someone was when they could still choose. Critics ask a hard question. What if the person with dementia now seems content, and cannot confirm the earlier wish? Who speaks for them then: their past self, or their present self? There is no easy answer, and thoughtful people disagree.

Where it is legal, assisted dying is rare but rising. These are the latest official figures.

Sources: Health Canada, RTE, Belgian Federal Commission via RTBF, Oregon Health Authority. Oregon's 2025 count may still rise as late death records arrive.

The landmark review. In 2016, Ezekiel Emanuel and colleagues published a major review in JAMA. It covered polls, surveys and official data from the US, Canada and Europe, from 1947 to 2016. Euthanasia and assisted suicide made up between 0.3% and 4.6% of all deaths where legal. More than 70% of cases involved cancer. Typical patients were older, white and well educated. And pain was mostly not the main reason people asked (Emanuel et al., JAMA 2016).

What people say they fear. Oregon asks doctors about each patient's concerns. In 2025, the top three were losing autonomy (89%), being less able to enjoy life's activities (89%) and losing dignity (65%). Cancer was the most common illness (61%), and 92% of patients were in hospice care. About 6% lived longer than six months after their prescription (Oregon Health Authority).

In Canada in 2024, the median age was 77.9. About 96% of people had a natural death that was "reasonably foreseeable". About 95% said they had lost the ability to do things that gave life meaning. About half also said they felt a burden on family, friends or carers (Health Canada). That "burden" figure worries critics most.

Are the safeguards working? Emanuel's review found no evidence, in any place studied, that vulnerable groups were receiving assisted death at higher rates than the general population. In the Netherlands in 2025, review committees found that doctors had failed the legal care criteria in 7 of 10,341 cases (RTE).

How strong is this evidence? Mixed. The counts are solid. But most data come from doctors' own reports, and unreported cases cannot be counted. Critics say a system can follow its rules and still fail people, for example if poor housing or loneliness shapes a request. For the full numbers, see our statistics section.

This may be the most important research question. If better care removed most requests, the debate would look very different. Here is what the best studies show.

The SUPPORT study (1995). This huge US study followed 9,105 seriously ill adults in five teaching hospitals. The findings shocked doctors. Only 47% of physicians knew when their patients wanted to avoid resuscitation. 38% of those who died had spent at least 10 days in intensive care. For half of conscious patients who died in hospital, families reported moderate to severe pain at least half the time. A two-year effort to improve communication then failed to change these results (SUPPORT, JAMA 1995). Evidence: strong that hospital dying often went badly. The study is old, but its warning shaped modern palliative care.

Early palliative care (2010). Jennifer Temel and colleagues studied 151 people with advanced lung cancer. Half, chosen at random, got normal cancer care. The other half also got palliative care from the start. The palliative group had better quality of life. Fewer had depressive symptoms (16% vs 38%). Fewer received aggressive treatment at the end of life (33% vs 54%). And they lived longer: a median of 11.6 months, against 8.9 months (Temel et al., NEJM 2010). Evidence: strong for quality of life and mood. Early for longer survival, because it came from one hospital and was not the main question the trial was designed to answer.

Dignity therapy (2011). Harvey Chochinov's team tested a short therapy. Dying patients talk about what matters most in their lives, and the conversation becomes a written document for their family. In a trial of 441 patients in Canada, the US and Australia, it did not reduce measured distress. But patients said it helped them, improved their sense of dignity, and changed how their families saw and valued them (Chochinov et al., Lancet Oncology 2011). Evidence: mixed.

The access gap. Worldwide, only about 14% of people who need palliative care receive it, according to the World Health Organization (WHO). The 2022 Lancet Commission on the Value of Death put it simply: "The story of dying in the 21st century is a story of paradox." Many people are overtreated in hospitals, while even more die without basic pain relief (Lancet 2022).

The surgeon Atul Gawande made a related point in his 2014 book Being Mortal. He argued that the real goal is a good life to the very end, not only a good death. He also wondered whether the Dutch system of assisted death had slowed the growth of palliative care there (The New York Times).

What does this mean? Good care clearly helps, and it is too often missing. But in Canada, 74% of people who received MAID in 2024 had also received palliative care (Health Canada). So for some people, good care and a request for assisted death exist side by side. Read more in our palliative care section.

Thoughtful people land on both sides. Here are the strongest arguments, put fairly.

For legal assisted dying:

• Autonomy: adults make their own medical choices. Why not this one, if they are dying?
• Compassion: some suffering cannot be relieved, even with the best care.
• Safety through rules: assisted deaths already happen in secret. A law brings them into the open, with checks and reports.
• Peace of mind: in Oregon in 2025, doctors wrote 637 prescriptions, and 400 people are so far known to have died after taking the medication. Some people never use it. Knowing the option exists may ease fear. This was Pratchett's point: "If I knew that I could die, I would live."

Against legal assisted dying:

• Sanctity of life: many faiths and thinkers hold that deliberately ending an innocent life is always wrong.
• Trust in doctors: in 1989, the physician and ethicist Leon Kass argued that patients' trust would suffer once doctors were "licensed to kill." He asked readers to imagine being old, poor, ill and alone in a city hospital late at night. A nurse comes in with an injection. "How soundly will you sleep?" (Kass, The Public Interest, 1989)
• Pressure on the vulnerable: people may feel a duty to die to spare their families or the health system.
• The slippery slope: laws that start with terminal illness may widen over time. Canada and Colombia have both widened their rules through court rulings and new laws.

The disability rights critique. Some disability groups oppose these laws. Not Dead Yet, in the US, says it fights "the dangerous idea that some lives are not worth living" (Not Dead Yet). In January 2021, three United Nations human rights experts, including the special rapporteur on the rights of persons with disabilities, gave a warning. They said laws for people who are not terminally ill tend to rest on "ableist assumptions" about the quality and worth of disabled people's lives (The Globe and Mail). Many disabled people point out that the reasons people give, such as losing independence or needing help with daily care, describe their own everyday lives.

The philosophers. Rachels argued that, if letting die is accepted, a quicker and kinder death cannot be worse. The philosopher Philippa Foot, in a 1977 essay, explored when a life might no longer be a good for the person living it. Her work is also cited for a warning: people can be wrong about whether their own life is still worth living (Stanford Encyclopedia of Philosophy). Supporters say safeguards exist to catch exactly that kind of error. Critics doubt they always can.

Notice that both sides use the word "dignity." One side means the dignity of choice. The other means the dignity every life has, whatever its condition. Our arguments for and against and ethics and philosophy sections go deeper.

Most major faiths oppose deliberately ending a life. But most also accept stopping treatment that only prolongs dying, and all stress care for the dying.

• Catholic Church: the 2020 letter Samaritanus bonus calls euthanasia "an intrinsically evil act, in every situation or circumstance." But giving up "extraordinary and/or disproportionate" treatment is not euthanasia, it says. It is an acceptance of the human condition in the face of death. It calls palliative care "a precious and crucial instrument" (Vatican). Some Protestant churches hold more varied views.
• Islam: the Islamic Code of Medical Ethics, adopted in Kuwait in 1981, says "a doctor shall not take away life even when motivated by mercy." A Shia ruling by Ayatollah Ali Khamenei says it is not obligatory to keep a dying person alive or delay death, but any act that causes death is not allowed (Grove et al., 2022).
• Judaism: Jewish law treats a dying person (a goses) as fully alive, and forbids any act that hastens death. But a 13th-century rabbi taught that if someone is chopping wood near a dying person's house, the noise should be stopped, so as not to hold the soul back. In the 1500s, Rabbi Moses Isserles built on this. He ruled that one may remove something that only blocks a natural death (My Jewish Learning). Modern rabbis still use this idea when discussing life support.
• Hinduism: the principle of ahimsa (non-harm) and beliefs about karma lead many Hindus to oppose euthanasia. But researchers note that views both against and in favour exist side by side (Grove et al., 2022).
• Buddhism: most teachers see intentional killing as harmful. There is no single authority that speaks for all Buddhists, so views differ between traditions (Grove et al., 2022).

Personal belief and official teaching often differ. In Gallup's 2024 poll, 67% of Americans who seldom or never attend religious services called doctor-assisted suicide morally acceptable. Only 29% of weekly attenders agreed (Gallup). See our religious views section for more.

We are living longer. By 2050, about 2.1 billion people will be aged 60 or over, double the number in 2020. The number aged 80 or over will triple, to about 426 million (WHO). More people will face long illnesses and hard choices.

Medicine can keep us alive longer than ever. Ventilators, feeding tubes and intensive care save many lives. But they raise a new question: when does extending life become extending dying? Many patients now say how they live matters as much as how long. Others say every day of life has value, whatever its quality.

Money, and a common myth. It is often said that most health spending happens in the last year of life. A 2017 study of nine countries found it is much lower: from 8.5% of all health spending in the US to 11.2% in Taiwan (French et al., Health Affairs 2017). Cost should never drive a decision to die. But critics fear that, in stretched health systems, it quietly could.

Words shape opinion. In 2024, Gallup asked Americans whether doctors should be allowed to end a patient's life "by some painless means" if the patient and family ask. 71% said yes. A second question asked about doctors helping a patient "commit suicide." Support was 66% (Gallup). The two questions also describe slightly different acts, so the gap is a hint, not proof. Still, it shows why the words on this page matter.

You do not need to decide today. But these questions may help you think clearly, alone or with your family.

• If you became seriously ill, what would matter most to you: more time, less pain, staying at home, or something else?
• Who would speak for you if you could not speak? Have you told them what you want? Our patient rights section explains advance directives.
• Do you see a moral difference between stopping a treatment and taking an action? Why?
• What safeguards would make you feel safe, whatever your view?
• Whose voices are missing when you think about this: disabled people, doctors, faith communities, families?

Terry Pratchett never had an assisted death. He lived for more than seven years after his diagnosis. He kept writing, often by dictating to his assistant. In 2011 he made a BBC documentary, Choosing to Die. He gave a large gift to Alzheimer's research. In 2012 he told an interviewer: "I thought I'd be a lot worse than this by now, and so did my specialist." He died at home in March 2015, aged 66 (Wikipedia).

For decades, Death had been a character in his books, a tall figure who speaks in capital letters. After Pratchett died, his assistant posted one last line in that voice: "AT LAST, SIR TERRY, WE MUST WALK TOGETHER" (Wikiquote).

The UK law he hoped to change has still not changed. In September 2026, MPs voted against it once more. Some people see that as a failure of compassion. Others see it as wise caution, and a protection for people who could be put at risk.

Pratchett himself understood both fears. In the same lecture, he said the government "cannot sidestep the responsibility to ensure the protection of the vulnerable." He wanted wisdom and compassion to "stand side-by-side with the law." Cicely Saunders disagreed with him about the law. But she spent her life showing that the dying still matter, to the very end.

Perhaps that is the common ground. Every side wants people to die without needless suffering, and without pressure. The disagreement is about how to get there.

If this topic touches your own life, please talk to your doctor about care and comfort options. And if you are struggling with thoughts of ending your life, that is a different kind of pain, and it deserves help right now. Find someone to talk to.