Types of Euthanasia: Active vs Passive, Voluntary and MAID

In 2001, Diane Pretty, a mother of two, lived in Luton, England. She had motor neurone disease. This illness slowly stops the nerves that control the muscles. By then she was paralysed from the neck down. She spoke with the help of a computer (BBC News, 2002).

Diane feared how her illness would end. She wanted to choose the time of her death. But her body had taken away one thing: she could not act alone. Any help would have to come from someone else's hands. So she asked for a promise that her husband, Brian, would not be prosecuted if he helped her.

In England, helping someone end their life was a crime, and it still is. Prosecutors refused to give that promise. The House of Lords, then the UK's highest court, agreed with them. Diane took her case to the European Court of Human Rights.

On 29 April 2002, seven judges ruled against her. All seven agreed. The right to life, they said, cannot be read as "the diametrically opposite right, namely a right to die" (Pretty v United Kingdom). They accepted that the ban could interfere with her right to a private life. But they said a country may use a firm ban to protect vulnerable people.

After the ruling, Diane spoke through her computer: "The law has taken all my rights away." Brian said he was glad to have his wife with him "a little longer". He was also sad, he said, that her choice had "been taken away from her" (BBC News).

Not everyone saw her case the same way. Rachel Hurst, a disability rights campaigner, warned: "It would be a slippery slope and many people who did not want to die could be affected" (BBC News). Diane Pretty died in a hospice near her home 12 days after the ruling, aged 43.

Her story shows why the types of euthanasia matter. Diane could legally refuse any treatment. Some people call that "passive euthanasia". Some countries let a doctor prescribe medicine that a patient then takes; that is assisted suicide. But Diane could not take anything herself. What she needed was another person's hands, and in her country that was a crime.

Same illness, same wish. Yet the label decides whether an act is normal care, a closely checked medical act, or a serious crime.

This page explains each type in plain words. It does not tell you what to think. It shows what each term means, where it is legal in 2026, what the research shows, and why people disagree.

Think of a map with two lines. One line asks: how does death come about? The other asks: whose choice was it? Every type sits somewhere on this map.

How death comes about:

• Active: someone does something that directly causes death. In legal systems, a doctor or nurse practitioner gives medication.
• Passive: treatment that keeps a person alive is stopped (withdrawn) or not started (withheld). The illness then causes death.
• Assisted: a doctor provides medication, and the person takes it themselves. This is called physician-assisted suicide, or "aid in dying".

Whose choice it was:

• Voluntary: a person with full mental capacity asks for it, clearly and more than once.
• Non-voluntary: the person cannot ask, for example because of a coma, advanced dementia or young age. Others decide, sometimes guided by an earlier written wish.
• Involuntary: the person could have been asked but was not, or said no. This is murder in every country.

The two lines combine. The form most laws allow is "voluntary active euthanasia". Stopping treatment for a person in a long-term coma is "non-voluntary passive". Here is an overview:

A note on words. Many doctors dislike the term "passive euthanasia". They say stopping useless treatment is ordinary good medicine. Supporters of assisted dying often dislike the word "suicide" and prefer "aid in dying". Opponents say softer words hide what is happening. The words a person uses often show which side they are on. This page uses each common term and says when it is disputed.

In active euthanasia, a doctor (or, in some places, a nurse practitioner) gives medication that ends the patient's life. Where it is legal, it is almost always voluntary. The patient must ask for it, and the law sets strict conditions first.

Where it is legal: the Netherlands, Belgium, Luxembourg, Canada, Spain, Colombia, New Zealand, Ecuador and Uruguay, plus all six Australian states and the Australian Capital Territory. Australia's Northern Territory passed a law in August 2026, but its service is not running yet (ABC News). Uruguay's law has been in use since 21 April 2026 (Presidency of Uruguay).

Colombia shows how a court can start this process. In 1997, its Constitutional Court ruled that a doctor who ends the life of a consenting terminally ill patient should not be punished (Ruling C-239/97). In 2021, the court widened this. It now also covers people with a serious, incurable illness or injury causing intense suffering, even if they are not dying (Ruling C-233/21).

How common it is:

• Netherlands, 2025: 10,341 cases were reported, 5.97% of all deaths. In 98.15% of them, the doctor gave the medication. Only 1.70% were assisted suicide. Review committees found 7 cases that did not meet the legal standards of care (RTE annual report 2025).
• Belgium, 2025: 4,486 cases, about 4% of all deaths, according to the Federal Commission's figures (European Institute of Bioethics).
• Canada, 2024: 16,499 people received medical assistance in dying, 5.1% of all deaths. Patients may take the medication themselves, but Health Canada says "very few" have chosen this since 2016 (Health Canada).

So when people can choose, nearly all of them ask a clinician to give the medication.

The main arguments. Supporters say it is a kind act when suffering cannot be relieved. They also make a fairness argument. People like Diane Pretty cannot take medicine themselves. A law that allows only assisted suicide leaves them out. Critics say doctors should never deliberately cause death. They fear it changes how patients trust doctors. They also worry that numbers keep rising: the Dutch share of deaths was 4.5% in 2015 (Kouwenhoven et al., 2018) and almost 6% in 2025.

Passive euthanasia means letting a person die by stopping or not starting treatment that keeps them alive. The illness, not a medicine, causes death.

• Withdrawing treatment means stopping something already in use. Examples are a breathing machine (ventilator), kidney dialysis or a feeding tube.
• Withholding treatment means not starting it. Examples are not trying to restart the heart (no CPR), not starting chemotherapy, or not moving a patient to intensive care.

In most countries, an adult with mental capacity may refuse any treatment, even if refusing will lead to death. Doctors may also stop treatment that no longer helps. This is legal even in countries that ban every other type on this page. For this reason, many experts say it should not be called euthanasia at all. They call it "withholding or withdrawing life-sustaining treatment".

This is also where the world's religions agree most. The Catholic Church says giving up "disproportionate" treatment "is not the equivalent of suicide or euthanasia" (Samaritanus bonus, 2020). Most Muslim scholars allow withholding or withdrawing useless life support (Ghaly, 2022). A leading Buddhist ethicist says it is justified to refuse or withdraw treatment that is "futile or too burdensome" (Keown, 2005).

A recent example from India. In 2018, India's Supreme Court said people have a right to die with dignity. This includes making a living will: a written statement of the treatment you want or refuse. But the steps it set out were so hard to follow that the court simplified them in January 2023 (Mani et al., 2023). On 11 March 2026, the court allowed its first case. Harish Rana, 32, had been in a vegetative state since a head injury in 2013. His father asked the court to let doctors stop the artificial feeding that kept him alive. The court agreed (Al Jazeera).

What goes wrong when no one talks. The SUPPORT study (JAMA, 1995) followed 9,105 seriously ill adults in five US hospitals. Only 47% of doctors knew when their patients did not want CPR. 46% of do-not-resuscitate orders were written in the last two days of life. Families said half of conscious patients who died had moderate or severe pain at least half the time. A two-year effort to improve communication did not change these results (SUPPORT, 1995).

Evidence: strong for the problem (a very large, careful study), but the data are old and from the US only. The lesson still holds. "Passive" decisions happen every day, and they go best when people have said what they want in advance.

The whole active–passive split rests on one idea: that causing death is worse than allowing it. In 1975, the philosopher James Rachels challenged this in the New England Journal of Medicine. He argued that the difference "has no moral importance" in itself. He also said active euthanasia can be "more humane" than a slow death after treatment stops (Rachels, 1975).

Rachels told a story about two men, Smith and Jones. Each will inherit money if his six-year-old cousin dies. Smith kills the boy. Jones plans to do the same, but the boy has an accident first. Jones could save him, but he just watches. Is Jones really any better than Smith? Most people say no. If so, Rachels argued, "letting die" is not automatically better than "killing".

Other philosophers disagree. Philippa Foot, the British philosopher who first described the famous "trolley problem", argued that doing harm and allowing harm are morally different. She and others also said a person's intention matters (Stanford Encyclopedia of Philosophy: Doing vs. Allowing Harm).

This is where the doctrine of double effect comes in. It goes back to Thomas Aquinas. It says an act with a bad side effect can be allowed if four things are true:

1. The act itself is not wrong.
2. You intend only the good effect.
3. The bad effect is not the way you reach the good one.
4. The good outweighs the bad.

Doctors use it to explain strong pain relief near death. The aim is comfort. A shorter life may be a side effect. The US Supreme Court relied on this idea in 1997, in Vacco v Quill, when it upheld New York's ban on assisted suicide (Stanford Encyclopedia of Philosophy).

Critics of double effect say intentions are hard to check from outside. Supporters say intention is exactly what separates care from killing.

Ask yourself: if a dying person's life ends one day sooner, does it matter to you whether a machine was switched off or a medicine was given? Why, or why not?

Voluntary euthanasia happens when a person with full mental capacity asks for help to die. Their informed, free consent is the centre of every law that allows it.

Most laws require that:

• the person understands their illness, the likely future, the other options and what the decision means
• the request is clear, repeated, and usually in writing with witnesses
• no one is pressuring them
• at least two doctors (or nurse practitioners) check eligibility separately
• the request can be withdrawn at any time

Who asks, and why? In Oregon in 2025, the most common concerns were losing autonomy (89%), being less able to enjoy life's activities (89%) and loss of dignity (65%). Fewer people named pain or fear of pain (37%), or being a burden on family (40%). The median age was 76, 61% had cancer, and 92% were in hospice care (Oregon Health Authority, 2025 report).

Canada shows a similar pattern. In 2024, 95% named loss of ability to do meaningful activities. Nearly three in four (74.1%) had received palliative care (Health Canada).

The largest review of the evidence, by Ezekiel Emanuel and colleagues in JAMA (2016), found that pain is mostly not the main reason people ask. More than 70% of cases involved cancer. Typical patients were older, white and well educated. The authors found no evidence that vulnerable groups received euthanasia at higher rates than others (Emanuel et al., 2016).

Evidence: mixed. The review is large and careful. But most data come from doctors' own reports, and they mostly predate Canada's wider 2021 law. Critics say reports cannot show quiet pressure or what was never offered.

Why critics worry. In 2021, three United Nations human rights experts warned that older and disabled people "may feel subtly pressured" to end their lives early. They said this can come from the attitudes of people around them, or from missing services and support (UN experts' statement, via ECLJ). Canada's figures add to this debate. Among people whose death was not expected soon, 44.7% listed isolation or loneliness as part of their suffering. Among those near death, it was 21.9% (Health Canada).

One more point matters here. A wish to die is common in serious illness, and it often changes over time. Depression is treatable. Laws require doctors to check decision-making capacity and to look for distress that can be eased.

Non-voluntary euthanasia happens when a person cannot give consent at that moment. They may be in a coma, have advanced dementia, or be a young child.

Two very different situations fall under this label.

1. Stopping treatment for someone who cannot decide. This is common and legal in most countries. Family or a legal guardian decides. They try to choose what the person would have wanted (called "substituted judgement"), or what is in their best interests. A living will, if there is one, guides them. Harish Rana's case in India is an example.

2. Actively ending a life without a current request. This is allowed only in a few narrow cases:

• Dementia with a written advance request (the Netherlands). In 2025, Dutch committees reviewed 499 euthanasia cases involving dementia. In 492, the person could still decide for themselves. In 11, they no longer could, and doctors acted on an earlier written statement (RTE key figures 2025).
• Advance requests (Quebec, Canada). Since 30 October 2024, some people can make an advance request while they are still able to decide. They must have a serious, incurable illness that will take away their capacity, such as early Alzheimer's disease (Éducaloi).
• Children aged 1 to 12 (the Netherlands). Since 2024, a doctor and the parents may decide together to end the life of a child who is dying and suffering without hope of relief. The child is consulted if possible. A committee of four doctors, a lawyer and an ethicist reviews each case (Government of the Netherlands). In 2026, the authorities confirmed the first reported case under these rules (CBS News). Separate rules cover newborn babies.

Belgium removed its age limit for children in 2014. But that is different. The child must be able to understand and must ask, so it counts as voluntary.

The hard questions. Can an earlier written wish speak for a person who now seems content? Who decides what a child's "best interests" are? Supporters say advance requests let people keep control over a future they fear. Critics say the person you become may want something different from the person who wrote the request.

Involuntary euthanasia means ending a person's life when they could have been asked but were not, or when they said no. It is murder in every country. No law, anywhere, allows it.

The word "euthanasia" carries a dark history. From 1939 to 1941, the Nazi government ran the "T4" programme, named after its office address in Berlin, Tiergartenstrasse 4 (Holocaust Memorial Day Trust). The programme's own records counted 70,273 victims. Later research found many more (Aktion T4). In total, close to 250,000 disabled people were murdered under the Nazi regime. The Nazis called this "euthanasia". It was murder, without consent, of people the state saw as a burden.

This history still shapes the debate. Most supporters of legal assisted dying say T4 has nothing to do with their cause: consent is the whole difference. Many disability rights groups reply that the danger is not consent itself, but a culture that sees disabled lives as less valuable. The US group Not Dead Yet says it fights "the dangerous idea that some lives are not worth living" (Not Dead Yet).

The difference is one question: whose hand takes the final step? In physician-assisted suicide, a doctor prescribes medication, and the patient decides whether and when to take it. In euthanasia, the doctor gives it.

Where assisted suicide (but not euthanasia) is legal:

• Switzerland: helping is legal if the helper has no selfish motive.
• Austria (since 2022) and Germany (by a 2020 court ruling, with no new law yet).
• Italy: by a 2019 Constitutional Court ruling, under strict conditions.
• The United States: 13 states and Washington, D.C., as of October 2026 (Compassion & Choices).
• France: its law came into effect on 19 August 2026 but is not in use yet. The patient must take the medicine themselves, unless they physically cannot; then a health worker can help (The Guardian).

Many people never use the prescription. In Oregon in 2025, doctors wrote 637 prescriptions. 358 people (56%) died after taking the medication. 100 (16%) did not take it and later died of other causes. For 179 (28%), the outcome was not yet known. Since 1997, 5,520 people have received prescriptions, and 3,691 (67%) died from taking them. These deaths were about 1% of all deaths in Oregon in 2025 (Oregon Health Authority; OHA news release). For some people, simply having the option seems to matter more than using it.

A key US ruling. In Gonzales v Oregon (2006), the US Supreme Court ruled 6–3 for Oregon. The federal government could not use drug laws to stop doctors from prescribing under the state's law (Gonzales v Oregon).

The debate about the final step. Supporters of self-administration say it is a strong safeguard: the last act clearly belongs to the patient. But it shuts out people who cannot move, people like Diane Pretty. That is why France allows help when the patient physically cannot act. Opponents of any change say this shows how one exception leads to the next.

What changed in Diane Pretty's country. In 2010, after another court case, England's prosecutors published a policy listing factors for and against prosecuting someone who helps. It did not change the law: "only Parliament can change the law" (Crown Prosecution Service). On 11 September 2026, MPs voted 286 to 270 against a bill that would have allowed assisted dying for terminally ill adults in England and Wales (BBC News). Six months earlier, on 17 March 2026, the Scottish Parliament had rejected its own bill by 69 votes to 57 (Scottish Government). Jersey, a Crown Dependency with its own laws, went the other way. Its assisted dying law received Royal Assent on 9 July 2026, and a service is planned for late 2027 (Government of Jersey).

MAID is a newer term. The same four letters mean different things in different countries. Our guide to euthanasia vs assisted suicide vs MAID sets the three terms side by side.

In Canada, MAID means Medical Assistance in Dying. It covers both forms: a clinician gives the medication, or the patient takes it. It began with Carter v Canada (2015). One of the people who brought the case was Gloria Taylor, who had ALS. The Supreme Court ruled unanimously that the total ban was unconstitutional. It applied to a competent adult who "clearly consents" and has a "grievous and irremediable medical condition" causing lasting, intolerable suffering (Carter v Canada). Parliament passed a law in 2016.

In 2021, Canada removed the rule that natural death must be "reasonably foreseeable". This created two tracks. For people whose death is not expected soon ("Track 2"), assessments must take at least 90 days (Justice Canada). In 2024:

• 16,499 people received MAID (5.1% of all deaths)
• 95.6% were on Track 1, and 732 people (4.4%) were on Track 2
• cancer was the main condition in 63.6% of Track 1 cases
• the median age was 77.9
• 6.8% of providers were nurse practitioners

(Health Canada)

Mental illness. People whose only condition is a mental illness cannot get MAID. The law still says this exclusion ends on 17 March 2027. But on 7 October 2026, Justice Minister Sean Fraser said the government will bring in a bill this autumn. It would keep the exclusion with no end date. He gave two reasons: poor access to mental health care in some communities, and no agreement among experts on when a mental illness is incurable. He said the same bill would also "open the door" to advance requests across Canada, like Quebec's (CBC News).

In the US, MAID means Medical Aid in Dying. The patient must always take the medication themselves. Laws usually require a terminal illness with six months or less to live, adult age and mental capacity. New York's law took effect on 5 August 2026 (New York State Department of Health). Illinois's law began on 12 September 2026, after a judge refused a request from disability rights advocates to block it (Capitol News Illinois).

Palliative sedation uses medicine to lower a dying person's awareness. It is used when suffering, such as severe pain, agitation or breathlessness, cannot be relieved any other way. The aim is comfort, not death. It is sometimes called terminal sedation.

It comes in two main forms:

• Proportional sedation: the doctor gives only as much as needed to ease symptoms. The person may stay partly aware.
• Continuous deep sedation: the person stays deeply asleep until death, usually in the last days of life.

The European Association for Palliative Care calls sedation "an important and necessary therapy" for carefully selected patients. It also warns that careless use can be "harmful and unethical" (EAPC framework, 2009). The Catholic Church accepts deep palliative sedation at the end of life (Samaritanus bonus).

It is becoming much more common. In the Netherlands, continuous deep sedation was used in 8.2% of all deaths in 2005, 12.3% in 2010 and 18.3% in 2015. That is more often than euthanasia. When asked about intention, 60% of doctors said they did not aim to shorten life. 38% said they took a shorter life into account. 2% said shortening life was their aim. A palliative care expert was consulted for only 1 in 5 patients (Rietjens et al., 2019).

Where the line blurs. A study of Dutch deaths in 2015 looked at one group of cases. Doctors had given medication at the patient's request, with the explicit intention to hasten death. In 82% of these cases, doctors called it euthanasia, assisted suicide or ending of life. But 17% called it palliative or terminal sedation. The authors concluded that the legal line between euthanasia and palliative care "may not always be clear in clinical practice" (Overbeek et al.).

Evidence: strong on how often sedation is used, from large national surveys with high response rates. Early on why it is rising. Critics call some sedation "slow euthanasia", especially when fluids are also stopped. Palliative care doctors answer that intention and careful clinical judgement are what separate the two.

Most faiths draw the same line in the same place. They accept stopping treatment that only prolongs dying. They reject actively ending a life. But there is real variety inside each tradition.

Catholic Church. The Vatican letter Samaritanus bonus (2020) calls euthanasia "an intrinsically evil act, in every situation or circumstance". It also condemns aggressive, pointless treatment, and it sums up the duty of care in one line: "to cure if possible, always to care" (Samaritanus bonus).

Islam. The Islamic Code of Medical Ethics (1981) says a doctor "shall not take a positive measure to terminate the patient's life". This is the mainstream view. Most scholars allow withholding or withdrawing life support that only prolongs dying, though some disagree (Ghaly, 2022). In 1986, the International Islamic Fiqh Academy ruled that a person whose whole brain has irreversibly stopped working may be taken off life support (IIFA Resolution 17).

Judaism. Jewish law forbids active euthanasia. Views on aid in dying have shifted in one movement. In 1997, the Conservative movement's law committee approved a ruling against assisted suicide by 21 votes to 2. In 2020, it approved a new ruling by Rabbi Elliot Dorff, by 9 votes to 5. It allows aid in dying in limited cases where the law permits it (Dorff, 2020). Orthodox authorities generally continue to forbid it.

Buddhism. "Euthanasia is rejected by most Buddhists as contrary to the First Precept, which prohibits intentional killing," writes the scholar Damien Keown. This applies even when the motive is compassion. But refusing futile treatment is allowed (Keown, 2005).

Hinduism. Most Hindus believe helping someone die brings bad karma and breaks ahimsa, the principle of doing no harm. Some Hindus see it differently: they say helping to end a painful life can be a good deed (BBC Religions).

Here are the landmark studies behind this page, with an honest label for each.

• Emanuel et al., JAMA 2016 (review of laws, polls and official data from 1947 to 2016). Euthanasia and assisted suicide were 0.3% to 4.6% of deaths where legal. Cases rose after legalisation. Pain was mostly not the main reason. Mixed: broad, but based on reported cases (PubMed).
• Official annual reports (Oregon, Canada, the Netherlands, Belgium). These count every reported case. Strong for numbers and stated reasons. Limited for unreported cases and hidden pressure.
• SUPPORT, JAMA 1995 (9,105 patients). End-of-life decisions in hospitals were often made late, and pain was common. Strong, but old and US-only (PubMed).
• Temel et al., NEJM 2010 (151 patients with advanced lung cancer). Early palliative care improved quality of life. Depression symptoms fell (16% vs 38%), and patients lived longer (11.6 vs 8.9 months), despite less aggressive treatment near the end. Strong design, but one cancer type and one hospital (PubMed).
• Chochinov et al., Lancet Oncology 2011 (441 patients). Dignity therapy helps patients record what matters most to them. It did not reduce distress on the main measures. But patients said it helped them and their families more than the other options. Mixed (PubMed).
• Dutch sedation studies (2019 and later). Continuous deep sedation more than doubled between 2005 and 2015. Strong for how often; early for why (PubMed).

What the research cannot settle is the moral question. Data can show who asks and why. It cannot tell you whether a society should say yes.

The types on this page are tools for thinking clearly, not answers. Here are some questions you can ask yourself, or talk about with people you love:

• If you were very ill, which treatments would you want stopped, and when? Have you written this down?
• Does it matter to you whether a machine is switched off or a medicine is given?
• Should a law treat people who cannot move, like Diane Pretty, the same as people who can?
• Can a written wish from your past speak for the person you may become?
• What would make you feel safe that no one was pressured?

Dame Cicely Saunders opened St Christopher's Hospice in London in 1967. It became the model for modern hospice care. Her best-known words are: "You matter because you are you, and you matter to the end of your life" (King's College London).

Diane Pretty's story ends with the same tension. The judges who ruled against her wrote that they "cannot but be sympathetic" to her fear of a distressing death (Pretty v United Kingdom). Yet they decided that the law could protect others by saying no to her. Twenty-four years later, lawmakers in England, Wales and Scotland have again said no. In the same year, France passed its law, Jersey's law received Royal Assent, and New York and Illinois opened their services.

Brian Pretty's words hold both sides of the debate: glad for the extra time with his wife, sad that her choice was gone. Whatever you believe, the types of euthanasia matter because they decide which of those feelings the law listens to.