The State Commission on Euthanasia defined euthanasia as the intentional termination of life by someone other than the patient at the patient's request, while physician-assisted suicide is the intentional assistance given the patient to terminate his or her life and upon his or her request (Philipsen 1997). It is also called "mercy-killing" in describing it as an act of kindness meant to end suffering.

The Hemlock Society, based in Eugene, Oregon, maintains a political arm, which evolved initiatives for the legalization of euthanasia and physician-assisted suicide, or euthanasia/PAS in Washington in 1991 and California in 1992 (Gula 1999). Grounds for the initiatives were the fear of enduring unceasing pain, entrapment by medical machines, the loss of bodily integrity and personal dignity and being a source and cause of emotional and financial drain on loved ones. They lost only narrowly to the "no" votes in the States at 54:46%, which led the Society to change focus on PAS to give more control to the terminally or incurably ill patient (Gula). In 1994, Oregon passed the Death with Dignity Act by a 51:49% vote and made it the first State to legalize PAS. The statutes of Washington and New York went into constitutional review. In June 1997, the Supreme Court ruled in Washington v Glucksberg and Vacco v Quill that PAS is not a constitutional right and set each State free to whether to legally permit PAS within its territory. It encouraged continuing debate on this hotly-disputed issue on the basis of morality, legality and practicality (Gula).

A Roman Catholic priest and physician Michael Manning and professors Edward Larson and Darrell Amundsen opposed euthanasia, stating that, while both Graeco-Roman and Enlightenment thinkers had accepted the idea and grounds for euthanasia, the Judeao-Christian religion had not. Yale University professor of surgery Charles McKhann, however, questioned their position and argued that PAS should be adopted as an acceptable last resort (Gula 1999). For his part, theology dean Richard A. McCormick suggested a way out of the unacceptable for euthanasia proponents by reducing and confining their argument to simply "pulling the plug off." Unfortunately, PAS is not confined to pulling the plug but included a selection from among modes of medical treatment or management, or a refusal to treat altogether. Voluntary active euthanasia is different from PAS. Voluntary active euthanasia is the deliberate intervention of someone other than the patient to directly end the patient's life. The patient must be terminally ill, but competent enough to make a full voluntary and persistent request for help to end his or her life. The request is most often granted by giving the patient a lethal injection to end his or her suffering by terminating his or her life (Gula 1999). On the other hand, PAS grants the request by informing the patient on how to terminate his or her life and suffering, but the patient performs the lethal act himself or herself. This typical act may be the taking of a lethal dose of poison by swallowing pills, self-injection or inhaling gas, based on physician's prescription. PAS makes both the patient and the physicians share the responsibility for the act (Gula).

The arguments for and against euthanasia have been organized under three themes, namely, autonomy, killing vs. allowing to die, and beneficence. Proponents of euthanasia strongly advocate that a person has the right to die and die with dignity, as he or she has the right to control his or her body and life. This meant to them that the person has the right to determine when, how and by whose hand he or she must die (Gula 1999). Leading proponent Jack Kevorkian insisted that absolute autonomy was the fundamental moral value of the human being.

Advocates of Christian beliefs and dogmas maintain that God creates life and puts it into the charge and stewardship of man only and only God can take that life (Gula 1999). Larson and Amundsen took this Judeo-Christian view that limits human autonomy and interprets freedom as not only having control but also in losing it or by submitting to what cannot be controlled. Freedom to them means the willingness to suffer and accepting our created state and powerlessness before the kind of death designed for us.

Euthanasia is not just a moral, legal or practical issue. The issue goes beyond the exercise of individual autonomy (Gula 1999). It is also a social one, as it involves another person to perform it or help in performing it and a society that allows it. It affects social care for the dying and the overall attitude towards life and death. Individual interest is valuable to society, but the common good is always superior to individual autonomy with which common good has always been in conflict. This continuing conflict demands a resolution and a position to take whereby the good of the whole may be better served. In his book, Michael Manning warned about certain things and asked certain questions in the event that euthanasia/PAS would be legalized as a medical option. He said that it would discriminate against vulnerable groups, such as people afflicted with AIDS, Alzheimer's spinal cord injuries, which are considered a burden to society. It could reshape its view on mental and physical deterioration or aging, suffering, adult children's obligation to their parents and how these parents feel towards their children (Gula). Such legislation could also affect or direct the disabled self-view and their relation to and meaning in society, the physician's view and attitude towards terminally or incurably ill patients, the distribution of society's resources and the legality of refusing euthanasia/PAS by the terminally or incurably ill.

Manning, Larson and Amundsen suggested that the practice of allowing euthanasia/PAS in the Netherlands could weaken the law against killing. Voluntary or involuntary euthanasia/PAS has been allowed in the Netherlands as a normal medical option restricted to physicians (Scheper 1994). Its Committee on the Study of Medical Practice can permit the option in alleviating pain or symptoms by 1) prescribing high doses of drugs that can speed up the patient's death as a consequence; 2) withholding or withdrawing treatment as explicitly, repeatedly and seriously requested by the patient; 3) withholding or withdrawing treatment considered medically useless; or 4) in deciding to end the patient's life without requiring his or her explicit request when the process of irreversible loss of vital functions has begun. The Dutch government agreed with the Committee on the first three grounds as normal medical practice, but not in the fourth and last, which should be at least the subject of a judicial review when granted (Scheper).

Clause 293 of the Penal Code of the Netherlands prohibits euthanasia and PAS. But a review of all the judgments rendered up to the mid-70s led to a decision to exempt physicians and only physicians from the prohibition and only under special circumstances (Scheper 1994). The decision was later affirmed and extended by the Royal Dutch Medical Association and the State Commission on Euthanasia and the Dutch government (Scheper 1994). These special conditions require the explicit and repeated request by the patient to eliminate all doubt as to his or her desire to die; severe mental or physical suffering without prospect of relief; a well-informed, free and enduring decision on the patient's part; exhaustion of all options for other forms of care or the patient's well-informed refusal for refusing these options; consultation with a colleague physician and pastors, nurses or other persons. Because euthanasia is not a natural cause of death, the physician cannot sign a death certificate but instead inform the municipal coroner about it. The municipal coroner should report the matter to the public prosecutor who consults with the Inspector of Health as to whether to prosecute the physician or not. If he is prosecuted and convicted by the lower court, the physician can appeal at the Court of Appeal and at the Supreme Court. It is actually a difficult and straining process and the greatest care and precision are required (Sheper)

The Utecht University Hospital makes the process more complicated with more detailed requirements, i.e., the free and enduring verbal or written request made by the patient himself or herself must be without the influence of any companion; the somatic disease must be incurable and intolerable for the patient; deliberation and decision by a team of attending physicians and other attending care-takers; a report by this team to an ad hoc group, whether the team agrees to the request or not; evaluation and analysis by the ad hoc group if the request is a real one for euthanasia or only a life support; a discussion with the patient and then the family; a decision that will strive towards a unanimous decision, all considerations accurately written on the patient's record; a unanimous decision is further discussed with the head of the department and simultaneously submitted to the medical director of the hospital. If a unanimous position cannot be reached at this point, the hospital director nominates a committee for consultation…