Jumat, 21 September 2012

ciri-ciri makanan sehat

Inilah Ciri-ciri Makanan Yang Sehat


Makanan adalahsalah satu komponen  yang terkait lagsung dengan kondisi kesehatan sesorang. Makanan berpengaruh sangat besar untuk mewujudkan kondisi kesehatan yang prima bagi sesorang. Makanan pula yang dapat menyebabkan suatu penyakit menggejala bahkan sampai diderita oleh seseorang.  Ada banyak jenis-jenis penyakit yang timbul dari makanan yang di konsumsi secara tidak seimbang.  Misalnya : kegemukan ( Obesitas ), Diabetes dll.
Menyadari pentingnya makanan sebagai salah satu factor penentu kesehatan, maka selpastanya jika kemudian kita mengetahui dan memahami ciri-ciri makanan yang yang sehat. Yaitu makanan yang layak di konsumsi untuk menunjang terciptanya kondisi tubuh yang sehat.

Inilah ciri-ciri makanan yang sehat.

1.  Mengandung cukup zat gizi
Makanan yang sehat adalah makanan ayng secara kimia mengandung zat-zat gizi yang di butuhkan oleh tubuh.  Zat gizi yang dimaksud adalah :
                a.  Karbohidrat sebagai sumber energy utama
b.  Protein sebagai komponen pembangun sel dan jaringan tubuh
c.   Lemak sebagai komponen sel dan jaringan , sebagai pelarut vitamin  dan cadangan energy.
d.  Vitamin sebagai  komponen yang memperlancar proses metabolism e di dalam sel
e.  Mineral sebagai  komponen yang turut serta membangun struktur tubuh dan ikut memperlancar proses pisiologis di dalam sel.
f.    Serat  untuk membantu kelancaran mekanisme pencernaan di dalam saluran pencernaan.
g.  Air sebagai pelarut berbagai zat gizi yang lain.
2.  Tidak mengandung zat-zat berbahaya
Suatu makanan terkadang tampak sehat /segar jika di lihat sepintas, namun kondisi seperti itu belum menjadi jaminan jika makanan tersebut benar-benar sehat. Segar memang di perlukan untuk menjamin ketersediaan zat gizi di dalamnya, tetapi jika kesegaran yang tampak tersebut  di sebabkan oleh factor lain yang merupakan perlakuan khusus pada bahan makanan tersebut. Misalnya bahan makanan dari tumbuhan yang tampak segar karena  pertumbuhannya di bantu oleh pemberian pestisida yang berlebihan.  Atau bahan makanan olahan yang tampak segar karena  pemberian zat-zat pengawet. Hal –hal seperti itu sesungguhnya dapat berdampak merugikan di dalam tubuh.
Pengawet,  pewarna,   penyedap rasa, ( zat aditif ) adalah beberapa zat yang banyak menimbulkan penyakit didalam tubuh.  
Bahan pengawet
Bahan pengawet yang di toleransi oleh BPOM dalam jumlah terbatas adalah : Benzoat, propionat, nitrit, nitrat, sorbat dan sulfit. Dan yang berbahaya adalah formalin dan boraks. Kedua pengawet terakhir ini banyak di salah guankan untuk mengawetkan makanan sehingga bisa tahan lama.
Bahan pewrna
Bahan pewrna untuk memberi tampilan yang menarik pada makanan, Bahan ini ada yang di alami dan sintesis. Bahan pewarna alamai biasanya diambil dari klorofil ( zat hijau daun ) untuk membei zat hijau atau karoten dari wortel untuk memberi warna orange. Pewarna sintesis di ambil dari zat kimia yang di buat melalui serangkaian reaksi kimia. Misalnya: Warna kuning : tartrazin, sunset yellow, Warna merah : allura, eritrosin, amaranth, Warna biru : biru berlian.
Beberapa zat pewarna yang sesungguhnya tidak untuk makanan tetapi di gunakan mewarnai makanan tertentu. Zat tersebut merupakan pewarna tekstil seperti rodamin b.
Bahan pewarna buatan berbahaya jika di konsumsi secara terus menerus dan secara berlebihan. Pewarna non makanan berbahaya karena zat tersebut memang bukan untuk makanan dan tidak untuk di konsumsi.
Zat penyedap rasa.
Penyedap rasa ada yang alami dan ada pula yang sintesis. Penyedap rasa alami seperti cuka, merica, garam, gula, dll lebih aman dan relatif tidak menimbulkan efek samping. Kecuali di konsumsi secara berlebihan.
Penyedap rasa buatan mengandung monosodium glutamat ( MSG ) adalah penyedap sintesis yang banyak di gunakan secara luas di berbagai jenis makanan baik fast food maupun makan yang di sajikan di dalam rumah tangga. MSG adalah zat kimia yang dapat mempengaruhi kerja saraf. Konsumsi yang terus menerus akan menyebabkan daya ingat ( memori ) sesorang menjadi lebih lambat.
3.  Segar . Makanan yang di konsumsi belum terlalu lama waktu berselang antara  waktu di panen dengan waktu konsumsi. Hal ini untuk menjamin ketersediaan zat gizi yang terkandung di dalamnya.
Mengkonsumsi makanan yang alami yang tidak menggunakan bahan –bahan sintesis jelas jauh lebih baik dan aman bagi kesehatan tubuh.  Hanya saja kebutuhan pada makanan yang cepat saji, praktis dan menarik membuat kita sulit lepas dari makan olahan yang serba mengandung zat aditif.

Memiminalkan konsumsi makanan tersebut dan  cermat memperhatikan kandungan / komposisi suatu makan  merupakan hal sangat baik di lakukan.  

sumber : sehatdansehat.blogspot.com
pukul : 17.18

Makanan sehat non kolesterol

Berikut ini merupakan makanan Sehat yang dapat anda sajikan di acara-acara besar. selain sehat makanan dibawah ini juga sangat lezat. Mau tahu apa saja makanan sehat t`pi tidak mengandung kolestrol?. Bacalah artikel dibawah ini:

1.Daging Kalkun Panggang

daging kalkun 566x360 Makanan Sehat Tanpa Kolesterol
Kulit daging kalkun & ayam mengandung lemak jenuh yang cukup tinggi yang menyebabkan kadar kolesterol meningkat
Solusi: pilih daging putih karna mengandung lemak lebih rendah daripada daging merah dan konsumsi juga bagian dada daging kalkun.

2. Kentang Manis

kentang manis Makanan Sehat Tanpa Kolesterol
Merupakan sayuran yg memiliki banyak nutrisi tapi menjadi tidak sehat jika diolah bersama dengan marshmallows, mentega dan gula.
Solusi: Jika menggunakan mentega dan gula, cukup dgn setengah takaran maka kalori dan lemak akan hilang tanpa menghilangkan cita rasanya

3. Camilan Penyerta Minuman

cemilan Makanan Sehat Tanpa Kolesterol
Pada acara-acara keluarga, makanan kecil penyerta minuman biasanya mengandung lemak sangat tinggi meski ukurannya kecil.
Solusi: Pilihlah udang dan buah-buahan segar sebagai makanan penutup yang bernutrisi dan rendah kalori

4. Pancake Kentang

pancake kentang Makanan Sehat Tanpa Kolesterol
Pancake kentang ukuran medium mengandung lebih dari 250 kalori yg dapat menambahkan berat badan
Solusinya: Gunakan minyak zaitun. Disarankan utk mengkonsumsi beberapa potong pancake kentang dengan saus apel tanpa pemanis di atasnya

5. Popcorn Karamel

caramel popcorn Makanan Sehat Tanpa Kolesterol
Tambahan karamel gula maupun cairan pemanis lainnya dapat membuat popcorn berlemak tinggi
Solusinya: Buatlah popcorn yang tawar. Dengan kenikmatan yang sama, Anda terhindar dari kalori ekstra

6.Egg Nog

eggnog Makanan Sehat Tanpa Kolesterol
Alkohol, heavy cream, telur dan gula dalam secangkir egg nog mengandung sekitar 340 kalori dan 19 gram lemak
Solusinya: Buatlah egg nog rendah kalori dengan skim milk dan gula buatan

7. Cakes Dan Cookies

cakes Makanan Sehat Tanpa Kolesterol
Godaan dari makanan tinggi karbohidrat meningkat ketika ada perayaan maupun acara keluarga.
Solusinya: Konsumsi makanan ringan yang mengandung karbohidrat kompleks, seperti sereal / crackers gandum.

8. Buttery Mashed Potatoes

PerfectMashedPotatoes Makanan Sehat Tanpa Kolesterol
Jenis makanan ini biasanya mengandung banyak susu, mentega dan garam & mengandung 238 kalori
Solusi: Lelehkan kentang tanpa susu, mentega, ataupun garam. Aduk bersama sodium rendah dan air kaldu ayam tanpa lemak
 
sumber : uniqpost.com
pukul17.15

kesehatan tubuh

Setiap orang, pasti ingin hidup bahagia. Dan, kunci untuk hidup bahagia hanya ada satu. Apakah itu uang? Ya, dengan uang, kita bisa membeli apapun yang kita butuhkan. Kita bisa makan makanan enak dan cukup, dan menikmati segala fasilitas yang kita inginkan. Tapi, bukan itu. Satu hal yang kita butuhkan untuk mendapatkan hidup bahagia adalah kesehatan.
Bila anda sehat, maka anda akan dapat menikmati hidup ini. Bayangkan bila anda mempunyai banyak uang, tapi, anda terus digrogoti oleh penyakit yang mematikan. Uang anda akan habis untuk mengobati penyakit anda dan anda tidak dapat menikmati hidup anda. Jadi, kesehatan anda adalah hal yang terpenting dalam hidup anda.
Untuk menjaga kesehatan tubuh anda, ada 9 cara mudah yang bisa anda lakukan.
1. Anda Harus Menjaga Pola Makan Anda
Gunakan pola makan yang sehat, seperti banyak mengkonsumsi sayur dan buah. Tetapi, bukan berarti anda tidak diperbolehkan untuk mengkonsumsi makanan berlemak atau gorengan. Boleh, asal tidak berlebihan.
2. Rajin Olahraga
Jalan kaki atau jogging adalah olahraga sederhana yang dapat anda lakukan. Dan, sebaiknya anda melakukan olahraga setidaknya 1 jam seminggu. Anda bisa membaginya menjadi 10 menit perhari atau 15 menit tiap dua hari sekali.
3. Hindari Alkohol, Narkoba dan Kebiasan yang Tidak Menyehatkan
Bila anda minum alkohol untuk menghangatkan tubuh, mengapa tidak ganti aja dengan STMJ.
4. Istirahat yang Cukup
Tidur adalah obat paling mujarab untuk mengatasi rasa lelah dan kurang stamina.
5. Menjaga Kebersihan
Sering kali penyakit datang dari tempat yang kotor atau bila anda malas untuk membersihkan rumah anda.
6. Kontrol Tingkat Stress Anda
Tidak dapat dipungkiri, bahwa, kesehatan pikiran anda mempunyai pengaruh besar bagi kesehatan tubuh anda. Anda bisa berlibur bersama keluarga anda atau pasangan anda, dan melupakan sejenak semua masalah yang terjadi di kantor anda. Dengan ini, pikiran anda akan menjadi segar kembali.
7. Bersosialisasi
Dengan bersosialisasi, anda akan dapat menyegarkan otak anda dan membuat hidup anda lebih berwarna.
8. Konsumsi Vitamin Tambahan
Hal ini diperlukan, bila anda mempunyai banyak pekerjaan yang tidak memungkinkan anda untuk beristirahat yang cukup dan makan teratur.
9. Check up Secara Rutin
Hal ini penting, karena, apabila ditemukan ada masalah kesehatan dalam tubuh anda, maka anda dapat segera mengatasinya.
Jadi, hidup sehat dan menjaga kesehatan tubuh anda sebenarnya sangatlah mudah. Anda hanya perlu menjadikan semua langkah yang disebutkan diatas sebagai rutinitas anda dan yang paling penting, anda harus menikmatinya. Bila anda bisa melakukan hal tersebut, maka, hidup bahagia bukan lagi hanya impian anda.

pukul : 16.58

manfaat air putih

Sudah menjadi kebiasaan saya dan keluarga untuk minum air putih setiap pagi saat bangun tidur, sebelum sarapan, ternyata manfaatnya sangat terasa terutama dalam memperlancar sistem pencernaan, efek nya badan terasa lebih ringan dan bugar sepanjang hari. Belakangan diketahui selain untuk memperlancar sistem pencernaan ternyata banyak lagi manfaat lain dari air putih jika kita disiplin meminumnya setiap pagi.


Khasiat serta manfaat air putih jika diminum setiap pagi


Para ahli kesehatan menyebutkan bahwa 70% tubuh kita terdiri dari air, sehingga kurang minum bisa berakibat kurangnya cairan tubuh dan mengalami dehidrasi. Pada saat tidur tubuh kita banyak mengeluarkan cairan karena proses metabolisme sel-sel tubuh kita terus bekerja, sehingga tidak bisa di tawar-tawar lagi bahwa minum air putih secukupnya pada saat bangun tidur bisa mengganti cairan tubuh yang hilang. berikut beberapa manfaat air putih bagi tubuh terutama jika rutin diminum setiap pagi.

Membantu menghilangkan racun dalam tubuh
Dengan minum air putih setiap pagi akan membantu kerja ginjal dalam proses menawarkan racun dalam tubuh

Menyegarkan kulit
Kulit juga banyak memerlukan cairan, sehingga para wanita mempercayai bahwa dengan minum air putih secukupnya setiap pagi akan membantu memperlambat efek-efek penuaan pada kulit.

Menambah kebugaran tubuh
Air putih juga bisa membuat tubuh menjadi bugar sehingga bisa menjaga suasana hati menjadi lebih baik sepanjang hari.

Mencagah timbulnya batuk dan flu ringan
Segeralah minum air putih terutama secara rutin di pagi hari ketika kita mulai merasakan sakit tenggorokan, Dengan tambahan berdoa dan berfikiran positif Insya Allah flu dan batuk tidak jadi menyerang tubuh kita.

Menambah kesuburan
Air putih juga dipercaya akan meningkatkan hormon-hormon reproduksi baik bagi pria maupun wanita.

Mencegah terjadinya stroke dan serangan jantung
Menurut sebuah penelitian, air putih dipercaya bisa mencegah terjadinya stroke dan serangan jantung.

Selain itu air putih ternyata juga sangat baik bagi anak bahkan bayi walaupun hal ini masih menimbulkan pro da kontra. Namun demikian perlu diperhatikan bahwa minum air putih secara berlebihan sekaligus juga tidak baik bagi tubuh, jadi minumlah air putih secukupnya di pagi hari pada saat bangun tidur, antara 1 – 2 gelas, insya Allah tubuh tetap bugar , terhindar dari berbagai macam penyakit, suasana hati menjadi senang dan kehidupan rumah tangga pun menjadi semakin harmonis.


sumber: www.gayabunda.com
pukul : 16.51

Penyakit Hemofilia

Apa Itu Hemofilia ?
99743 hit(s)
 
Hemofilia berasal dari bahasa Yunani Kuno, yang terdiri dari dua kata yaitu haima yang berarti darah dan philia yang berarti cinta atau kasih sayang.
Hemofilia adalah suatu penyakit yang diturunkan, yang artinya diturunkan dari ibu kepada anaknya pada saat anak tersebut dilahirkan.
Darah pada seorang penderita hemofilia tidak dapat membeku dengan sendirinya secara normal. Proses pembekuan darah pada seorang penderita hemofilia tidak secepat dan sebanyak orang lain yang normal. Ia akan lebih banyak membutuhkan waktu untuk proses pembekuan darahnya.
Penderita hemofilia kebanyakan mengalami gangguan perdarahan di bawah kulit; seperti luka memar jika sedikit mengalami benturan, atau luka memar timbul dengan sendirinya jika penderita telah melakukan aktifitas yang berat; pembengkakan pada persendian, seperti lulut, pergelangan kaki atau siku tangan. Penderitaan para penderita hemofilia dapat membahayakan jiwanya jika perdarahan terjadi pada bagian organ tubuh yang vital seperti perdarahan pada otak.

Hemofilia A dan B
Hemofilia terbagi atas dua jenis, yaitu :
- Hemofilia A; yang dikenal juga dengan nama :
 
- Hemofilia Klasik; karena jenis hemofilia ini adalah yang paling banyak kekurangan faktor pembekuan pada darah.
- Hemofilia kekurangan Factor VIII; terjadi karena kekurangan faktor 8 (Factor VIII) protein pada darah yang menyebabkan masalah pada proses pembekuan darah.
   
- Hemofilia B; yang dikenal juga dengan nama :
 
- Christmas Disease; karena di temukan untuk pertama kalinya pada seorang bernama Steven Christmas asal Kanada
- Hemofilia kekurangan Factor IX; terjadi karena kekurangan faktor 9 (Factor IX) protein pada darah yang menyebabkan masalah pada proses pembekuan darah.

Bagaimana ganguan pembekuan darah itu dapat terjadi?
Gangguan itu dapat terjadi karena jumlah pembeku darah jenis tertentu kurang dari jumlah normal, bahkan hampir tidak ada. Perbedaan proses pembekuan darah yang terjadi antara orang normal (Gambar 1) dengan penderita hemofilia (Gambar 2).
Gambar 1
dan Gambar 2 menunjukkan pembuluh darah yang terluka di dalam darah tersebut terdapat faktor-faktor pembeku yaitu zat yang berperan dalam menghentukan perdarahan.
a. Ketika mengalami perdarahan berarti terjadi luka pada pembuluh darah (yaitu saluran tempat darah mengalir keseluruh tubuh), lalu darah keluar dari pembuluh.
b. Pembuluh darah mengerut/ mengecil.
c. Keping darah (trombosit) akan menutup luka pada pembuluh.
d. Faktor-faktor pembeku da-rah bekerja membuat anyaman (benang - benang fibrin) yang akan menutup luka sehingga darah berhenti mengalir keluar pembuluh.
Gambar 1
 
   
a. Ketika mengalami perdarahan berarti terjadi luka pada pembuluh darah (yaitu saluran tempat darah mengalir keseluruh tubuh), lalu darah keluar dari pembuluh.
b. Pembuluh darah mengerut/ mengecil.
c. Keping darah (trombosit) akan menutup luka pada pembuluh.
d. Kekurangan jumlah factor pembeku darah tertentu, mengakibatkan anyaman penutup luka tidak terbentuk sempurna, sehingga darah tidak berhenti mengalir keluar pembuluh.
Gambar 2

Seberapa banyak penderita hemofilia ditemukan ?
Hemofilia A atau B adalah suatu penyakit yang jarang ditemukan. Hemofilia A terjadi sekurang - kurangnya 1 di antara 10.000 orang. Hemofilia B lebih jarang ditemukan, yaitu 1 di antara 50.000 orang.

Siapa saja yang dapat mengalami hemofilia ?
Hemofilia tidak mengenal ras, perbedaan warna kulit atau suku bangsa.
Hemofilia paling banyak di derita hanya pada pria. Wanita akan benar-benar mengalami hemofilia jika ayahnya adalah seorang hemofilia dan ibunya adalah pemabawa sifat (carrier). Dan ini sangat jarang terjadi. (Lihat penurunan Hemofilia)
Sebagai penyakit yang di turunkan, orang akan terkena hemofilia sejak ia dilahirkan, akan tetapi pada kenyataannya hemofilia selalu terditeksi di tahun pertama kelahirannya.

Tingkatan Hemofilia
Hemofilia A dan B dapat di golongkan dalam 3 tingkatan, yaitu :
 Berat  Kurang dari 1% dari jumlah normalnya
 Sedang  1% - 5% dari jumlah normalnya
 Ringan  5% - 30% dari jumlah normalnya
Penderita hemofilia parah/berat yang hanya memiliki kadar faktor VIII atau faktor IX kurang dari 1% dari jumlah normal di dalam darahnya, dapat mengalami beberapa kali perdarahan dalam sebulan. Kadang - kadang perdarahan terjadi begitu saja tanpa sebab yang jelas.
Penderita hemofilia sedang lebih jarang mengalami perdarahan dibandingkan hemofilia berat. Perdarahan kadang terjadi akibat aktivitas tubuh yang terlalu berat, seperti olah raga yang berlebihan.
Penderita hemofilia ringan lebih jarang mengalami perdarahan. Mereka mengalami masalah perdarahan hanya dalam situasi tertentu, seperti operasi, cabut gigi atau mangalami luka yang serius. Wanita hemofilia ringan mungkin akan pengalami perdarahan lebih pada saat mengalami menstruasi.
 
Sumber : Canadian Hemophilia Society, What is Hemophilia ? - 1999, World Federation of Hemophilia, Hemophilia in Pictures - 1998. Waktu : 16.34 

Selasa, 18 September 2012

euthanesia

or mercy killings performed on animals, see Animal euthanasia.
Euthanasia (from the Greek: εὐθανασία meaning "good death": εὖ, eu (well or good) + θάνατος, thanatos (death)) refers to the practice of intentionally ending a life in order to relieve pain and suffering.
There are different euthanasia laws in each country. The British House of Lords Select Committee on Medical Ethics defines euthanasia as "a deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering".[1] In the Netherlands, euthanasia is understood as "termination of life by a doctor at the request of a patient".[2]
Euthanasia is categorized in different ways, which include voluntary, non-voluntary, or involuntary. Voluntary euthanasia is legal in some countries and U.S. states. Non-voluntary euthanasia is illegal in all countries. Involuntary euthanasia is usually considered murder.[3]
As of 2006, euthanasia is the most active area of research in contemporary bioethics.[4]

Contents

Definition

Like other terms borrowed from history, "euthanasia" has had different meanings depending on usage. The first apparent usage of the term "euthanasia" belongs to the historian Suetonius who described how the Emperor Augustus, "dying quickly and without suffering in the arms of his wife, Livia, experienced the 'euthanasia' he had wished for."[5] The word "euthanasia" was first used in a medical context by Francis Bacon in the 17th century, to refer to an easy, painless, happy death, during which it was a "physician's responsibility to alleviate the 'physical sufferings' of the body." Bacon referred to an "outward euthanasia"—the term "outward" he used to distinguish from a spiritual concept—the euthanasia "which regards the preparation of the soul."[6]
In current usage, one approach to defining euthanasia has been to mirror Suetonius, regarding it as the "painless inducement of a quick death".[7] However, it is argued that this approach fails to properly define euthanasia, as it leaves open a number of possible actions which would meet the requirements of the definition, but would not be seen as euthanasia. In particular, these include situations where a person kills another, painlessly, but for no reason beyond that of personal gain; or accidental deaths which are quick and painless, but not intentional.[8][9]
Thus another approach is to incorporate the notion of suffering into the definition.[8] The definition offered by the Oxford English Dictionary incorporates suffering as a necessary condition, with "the painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma",[10] and this approach can be seen as a part of other works, such as Marvin Khol and Paul Kurtz's "a mode or act of inducing or permitting death painlessly as a relief from suffering".[11] However, focusing on this approach to defining euthanasia may also lead to counterexamples: such definitions may encompass killing a person suffering from an incurable disease for personal gain (such as to claim an inheritance), and commentators such as Tom Beauchamp & Arnold Davidson have argued that doing such would constitute "murder simpliciter" rather than euthanasia.[8]
The third element incorporated into many definitions is that of intentionality – the death must be intended, rather than being accidental, and the intent of the action must be a "merciful death".[8] Michael Wreen argued that “the principal thing that distinguishes euthanasia from intentional killing simpliciter is the agent's motive: it must be a good motive insofar as the good of the person killed is concerned”,[12] a view mirrored by Heather Draper, who also spoke to the importance of motive, arguing that "the motive forms a crucial part of arguments for euthanasia, because it must be in the best interests of the person on the receiving end."[9] Definitions such as that offered by the House of Lords Select Committee on Medical Ethics take this path, where euthanasia is defined as "a deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering."[1] Beauchamp & Davidson also highlight Baruch Brody's "an act of euthanasia is one in which one person ... (A) kills another person (B) for the benefit of the second person, who actually does benefit from being killed".[13]
Draper argued that any definition of euthanasia must incorporate four elements: an agent and a subject; an intention; a causal proximity, such that the actions of the agent lead to the outcome; and an outcome. Based on this, she offered a definition incorporating those elements, stating that euthanasia "must be defined as death that results from the intention of one person to kill another person, using the most gentle and painless means possible, that is motivated solely by the best interests of the person who dies."[14] Prior to Draper, Beauchamp & Davidson had also offered a definition which includes these elements, although they offered a somewhat longer account, and one that specifically discounts fetuses in order to distinguish between abortions and euthanasia:[15]
"In summary, we have argued ... that the death of a human being, A, is an instance of euthanasia if and only if (1) A's death is intended by at least one other human being, B, where B is either the cause of death or a causally relevant feature of the event resulting in death (whether by action or by omission); (2) there is either sufficient current evidence for B to believe that A is acutely suffering or irreversibly comatose, or there is sufficient current evidence related to A's present condition such that one or more known causal laws supports B's belief that A will be in a condition of acute suffering or irreversible comatoseness; (3) (a) B's primary reason for intending A's death is cessation of A's (actual or predicted future) suffering or irreversible comatoseness, where B does not intend A's death for a different primary reason, though there may be other relevant reasons, and (b) there is sufficient current evidence for either A or B that causal means to A's death will not produce any more suffering than would be produced for A if B were not to intervene; (4) the causal means to the event of A's death are chosen by A or B to be as painless as possible, unless either A or B has an overriding reason for a more painful causal means, where the reason for choosing the latter causal means does not conflict with the evidence in 3b; (5) A is a nonfetal organism."[16]
Wreen, in part responding to Beauchamp & Davidson, offered a six part definition:
"Person A committed an act of euthanasia if and only if (1) A killed B or let her die; (2) A intended to kill B; (3) the intention specified in (2) was at least partial cause of the action specified in (1); (4) the causal journey from the intention specified in (2) to the action specified in (1) is more or less in accordance with A's plan of action; (5) A's killing of B is a voluntary action; (6) the motive for the action specified in (1), the motive standing behind the intention specified in (2), is the good of the person killed."[17]
Wreen also considered a seventh requirement: "(7) The good specified in (6) is, or at least includes, the avoidance of evil", although as Wreen noted in the paper, he was not convinced that the restriction was required.[18]
In discussing his definition, Wreen noted the difficulty of justifying euthanasia when faced with the notion of the subject's "right to life". In response, Wreen argued that euthanasia has to be voluntary, and that "involuntary euthanasia is, as such, a great wrong".[18] Other commentators incorporate consent more directly into their definitions. For example, in a discussion of euthanasia presented in 2003 by the European Association of Palliative Care (EPAC) Ethics Task Force, the authors offered: "Medicalized killing of a person without the person's consent, whether nonvoluntary (where the person in unable to consent) or involuntary (against the person's will) is not euthanasia: it is murder. Hence, euthanasia can be voluntary only."[19] Although the EPAC Ethics Task Force argued that both non-voluntary and involuntary euthanasia could not be included in the definition of euthanasia, there is discussion in the literature about excluding one but not the other.[18]

Classification of euthanasia

Euthanasia may be classified according to whether a person gives informed consent into three types: voluntary, non-voluntary and involuntary.[20][21]
There is a debate within the medical and bioethics literature about whether or not the non-voluntary (and by extension, involuntary) killing of patients can be regarded as euthanasia, irrespective of intent or the patient's circumstances. In the definitions offered by Beauchamp & Davidson and, later, by Wreen, consent on the part of the patient was not considered to be one of their criteria, although it may have been required to justify euthanasia.[8][22] However, others see consent as essential.

Voluntary euthanasia

Euthanasia conducted with the consent of the patient is termed voluntary euthanasia. Active voluntary euthanasia is legal in Belgium, Luxembourg and the Netherlands. Passive voluntary euthanasia is legal throughout the U.S. per Cruzan v. Director, Missouri Department of Health. When the patient brings about his or her own death with the assistance of a physician, the term assisted suicide is often used instead. Assisted suicide is legal in Switzerland and the U.S. states of Oregon, Washington and Montana.

Non-voluntary euthanasia

Euthanasia conducted where the consent of the patient is unavailable is termed non-voluntary euthanasia. Examples include child euthanasia, which is illegal worldwide but decriminalised under certain specific circumstances in the Netherlands under the Groningen Protocol.

Involuntary euthanasia

Euthanasia conducted against the will of the patient is termed involuntary euthanasia.

Passive and active euthanasia

Voluntary, non-voluntary and involuntary euthanasia can all be further divided into passive or active variants.[23] A number of authors consider these terms to be misleading and unhelpful.[1]
Passive euthanasia entails the withholding of common treatments, such as antibiotics, necessary for the continuance of life.[1]
Active euthanasia entails the use of lethal substances or forces, such as administering a lethal injection, to kill and is the most controversial means.

History

According to the historian N. D. A. Kemp, the origin of the contemporary debate on euthanasia started in 1870.[24] Nevertheless, euthanasia was debated and practiced long before that date. Euthanasia was practised in Ancient Greece and Rome: for example, hemlock was employed as a means of hastening death on the island of Kea, a technique also employed in Marseilles and by Socrates in Athens. Euthanasia, in the sense of the deliberate hastening of a person's death, was supported by Socrates, Plato and Seneca the Elder in the ancient world, although Hippocrates appears to have spoken against the practice, writing "I will not prescribe a deadly drug to please someone, nor give advice that may cause his death" (noting there is some debate in the literature about whether or not this was intended to encompass euthanasia).[25][26][27]
Euthanasia was strongly opposed in the Judeo-Christian tradition. Thomas Aquinas opposed both and argued that the practice of euthanasia contradicted our natural human instincts of survival.,[28] as did Francois Ranchin (1565–1641), a French physician and professor of medicine, and Michael Boudewijns (1601–1681), a physician and teacher.[26]:208[29] Nevertheless, there were voices arguing for euthanasia, such as John Donne in 1624,[30] and euthanasia continued to be practised. Thus in 1678, the publication of Caspar Questel's De pulvinari morientibus non subtrahend, ("On the pillow of which the dying should not be deprived"), initiated debate on the topic. Questel described various customs which were employed at the time to hasten the death of the dying, (including the sudden removal of a pillow, which was believed to accelerate death), and argued against their use, as doing so was "against the laws of God and Nature".[26]:209–211 This view was shared by many who followed, including Philipp Jakob Spener, Veit Riedlin and Johann Georg Krünitz.[26]:211 In spite of opposition, euthanasia continued to be practised, involving techniques such as bleeding, suffocation and removing people from their beds to be placed on the cold ground.[26]:211–214
Suicide and euthanasia were more acceptable under Protestantism and during the Age of Enlightenment,[29] and Thomas More wrote of euthanasia in Utopia, although it is not clear if More was intending to endorse the practise.[26]:208–209 Other cultures have taken different approaches: for example, in Japan suicide has not traditionally been viewed as a sin, and accordingly the perceptions of euthanasia are different from those in other parts of the world.[31]

Beginnings of the contemporary euthanasia debate

In the mid-1800s, the use of morphine to treat "the pains of death" emerged, with John Warren recommending its use in 1848. A similar use of chloroform was revealed by Joseph Bullar in 1866. However, in neither case was it recommended that the use should be to hasten death. In 1870 Samuel Williams, a schoolteacher, initiated the contemporary euthanasia debate through a speech given at the Birmingham Speculative Club, which was subsequently published in a one-off publication entitled Essays of the Birmingham Speculative Club, the collected works of a number of members of an amateur philosophical society.[32]:794 Williams' proposal was to use chloroform to deliberately hasten the death of terminally ill patients:
That in all cases of hopeless and painful illness, it should be the recognized duty of the medical attendant, whenever so desired by the patient, to administer choloroform or such other anaesthetic as may by-and-bye supersede chloroform – so as to destroy consciousness at once, and put the sufferer to a quick and painless death; all needful precautions being adopted to prevent any possible abuse of such duty; and means being taken to establish, beyond the possibility of doubt or question, that the remedy was applied at the express wish of the patient.
—Samuel Williams (1872) ,  Euthanasia Williams and Northgate: London.[32]:794
The essay was favourably reviewed in The Saturday Review, and an editorial speaking against the essay appeared in The Spectator.[24] From there it proved to be influential, and other writers came out in support of such views: Lionel Tollemache wrote in favour of euthanasia, as did Annie Besant, the essayist and reformer who later became involved with the National Secular Society, considering it a duty to society to "die voluntarily and painlessly" when one reaches the point of becoming a 'burden'.[24][33] Popular Science also analyzed the issue in May 1873, assessing both sides of the argument.[34] Nevertheless, Kemp notes that at the time, medical doctors did not participate in the discussion; it was "essentially a philosophical enterprise... tied inextricably to a number of objections to the Christian doctrine of the sanctity of human life".[24]

Early euthanasia movement in the United States

Felix Adler, circa 1913, the first prominent American to argue for permitting suicide in cases of chronic illness
The rise of the euthanasia movement in the United States coincided with the so-called Gilded Age – a time of social and technological change that encompassed an "individualistic conservatism that praised laissez faire economics, scientific method, and rationalism", along with major depressions, industrialisation and conflict between corporations and labor unions.[32]:794 It was also a time that saw the development of the modern hospital system, seen as a factor in the emergence of the euthanasia debate.[35]
Robert Ingersoll argued for euthanasia, stating in 1894 that where someone is suffering from a terminal illness, such as terminal cancer, they should have a right to end their pain through suicide. Felix Adler offered a similar approach, although, unlike Ingersoll, Adler did not reject religion, instead arguing from an Ethical Culture framework. In 1891, Alder argued that those suffering from overwhelming pain should have the right to commit suicide, and, furthermore, that it should be permissible for a doctor to assist – thus making Adler the first "prominent American" to argue for suicide in cases where people were suffering from chronic illness.[36] Both Ingersoll and Adler argued for voluntary euthanasia of adults suffering from terminal ailments.[36] However, Dowbiggin argues that by breaking down prior moral objections to euthanasia and suicide, Ingersoll and Adler made it possible for others to stretch the definition of euthanasia.[37]
America also saw the first attempt to legalise euthanasia, when Henry Hunt introduced legislation into the General Assembly of Ohio in 1906.[38]:614 Hunt did so at the behest of Anna Hall, a wealthy heiress who was a major figure in the euthanasia movement during the early 20th century in the United States. Hall had watched her mother die after an extended battle with liver cancer, and had dedicated herself to ensuring that others would not have to endure the same suffering. Towards this end she engaged in an extensive letter writing campaign, recruited Lurana Sheldon and Maud Ballington Booth, and organised a debate on euthanasia at the annual meeting of the American Humane Association in 1905 – described by Jacob Appel as the first significant public debate on the topic in the 20th century.[38]:614–616 Hunt's bill called for the administration of an anesthetic to bring about a patient's death, so long as the person is of lawful age and sound mind, and was suffering from a fatal injury, an irrecoverable illness or great physical pain. It also required that the case be heard by a physician, required informed consent in front of three witnesses, and then required the attendance of three physicians who had to agree that the patient's recovery was impossible. A motion to reject the bill outright was voted down, but the bill itself failed to pass, 79 to 23.[32]:796[38]:618–619
Along with the Ohio euthanasia proposal, 1906 also witnessed the creation of a second bill: Assemblyman Ross Gregory introduced a proposal to permit euthanasia to the Iowa legislature. However, the Iowa legislation was far broader in scope than that offered in Ohio. It allowed for the death of any person of at least ten years of age who suffered from an ailment that would prove fatal and cause extreme pain, should they be of sound mind and express a desire to artificially hasten their death. In addition, it allowed for infants to be euthanised if they were sufficiently deformed, and permitted guardians to request euthanasia on behalf of their wards. The proposed legislation also imposed penalties on physicians who refused to perform euthanasia when requested: a 6–12 month prison term and a fine of between $200 and $1000 dollars. Unsurprisingly, the proposal proved to be controversial.[38]:619–621 It engendered considerable debate but failed to pass, having been withdrawn from consideration after being passed to the Committee on Public Health.[38]:623
After 1906 the euthanasia debate reduced in intensity, resurfacing periodically but not returning to the same level of debate until the 1930s in the United Kingdom.[32]:796

1930s

In January 1936, King George V was given a fatal dose of morphine and cocaine in order to hasten his death. At the time he was suffering from cardiorespiratory failure, and the decision to end his life was made by his physician, Lord Dawson.[39] Although this remained a secret for over 50 years, the death of George V coincided with proposed legislation in the House of Lords to legalise euthanasia. The legislation came through the British Volunteer Euthanasia Legalisation Society (now known as Dignity in Dying),[40] which was formed in 1935, although its formation can be traced back to a 1931 speech by Dr Charles Killick Millard.[24]
Euthanasia opponent Ian Dowbiggin argues that the early membership of the Euthanasia Society of America (ESA) reflected how many perceived euthanasia at the time, often seeing it as a eugenics matter rather than an issue concerning individual rights.[36] Dowbiggin argues that not every eugenist joined the ESA "solely for eugenic reasons", but he postulates that there were clear ideological connections between the eugenics and euthanasia movements.[36]
A 24 July 1939 killing of a severely disabled infant in Nazi Germany was described in a BBC "Genocide Under the Nazis Timeline" as the first "state-sponsored euthanasia".[41] Parties that consented to the killing included Hitler's office, the parents, and the Reich Committee for the Scientific Registration of Serious and Congenitally Based Illnesses.[41] The Telegraph noted that the killing of the disabled infant—whose name was Gerhard Kretschmar, born blind, with missing limbs, subject to convulsions, and reportedly "an idiot"— provided "the rationale for a secret Nazi decree that led to 'mercy killings' of almost 300,000 mentally and physically handicapped people".[42] While Kretchmar's killing received parental consent, afterwards, most of the 5,000 to 8,000 killed children were forcibly taken from their parents.[41][42]

Nazi Euthanasia Program (Action T4)

Nazi poster that reads "60,000 Reichsmark is the lifetime cost to the community of this genetic defective. Member of the [German] race, that's your money".[43]
The "euthanasia campaign" of mass murder gathered momentum on 14 January 1940 when the "handicapped" were killed with gas vans and killing centres, eventually leading to the deaths of 70,000 adult Germans.[44] Professor Robert Jay Lifton, author of The Nazi Doctors and a leading authority on the T4 program, contrasts this program with what he considers to be a genuine euthanasia. He explains that the Nazi version of "euthanasia" was based on the work of Adolf Jost, who published The Right to Death (Das Recht auf den Tod) in 1895. Lifton writes: "Jost argued that control over the death of the individual must ultimately belong to the social organism, the state. This concept is in direct opposition to the Anglo-American concept of euthanasia, which emphasizes the individual's 'right to die' or 'right to death' or 'right to his or her own death,' as the ultimate human claim. In contrast, Jost was pointing to the state's right to kill. [...] Ultimately the argument was biological: 'The rights to death [are] the key to the fitness of life.' The state must own death—must kill—in order to keep the social organism alive and healthy."[45]
In modern terms, the use of "euthanasia" in the context of Action T4 is seen to be a euphemism to disguise a program of genocide, in which people were killed on the grounds "disabilities, religious beliefs, and discordant individual values".[46] Compared to the discussions of euthanasia that emerged post-war, the Nazi program may have been worded in terms that appear similar to the modern use of the euthanasia, but there was no "mercy" and the patients were not necessarily terminally ill.[46] Despite these differences, historian and euthanasia opponent Ian Dowbiggin writes that "the origins of Nazi euthanasia, like those of the American euthanasia movement, predate the Third Reich and were intertwined with the history of eugenics and social Darwinism, and with efforts to discredit traditional morality and ethics."[36]:65

Euthanasia debate

Historically, the euthanasia debate has tended to focus on a number of key concerns. According to euthanasia opponent Ezekiel Emanuel, proponents of euthanasia have presented four main arguments: a) that people have a right to self-determination, and thus should be allowed to choose their own fate; b) assisting a subject to die might be a better choice than requiring that they continue to suffer; c) the distinction between passive euthanasia, which is often permitted, and active euthanasia, which is not, is not substantive (or that the underlying principle–the doctrine of double effect–is unreasonable or unsound); and d) permitting euthanasia will not necessarily lead to unacceptable consequences. Pro-euthanasia activists often point to countries like the Netherlands and Belgium, and states like Oregon, where it has been made legal to argue that it is mostly unproblematic.
Similarly, Emanuel argues that there are four major arguments presented by opponents of euthanasia: a) not all deaths are painful; b) alternatives, such as cessation of active treatment, combined with the use of effective pain relief, are available; c) the distinction between active and passive euthanasia is morally significant; and d) legalising euthanasia will place society on a slippery slope,[47] which will lead to unacceptable consequences.[32]:797–8

Legal status

West's Encyclopedia of American Law states that "a 'mercy killing' or euthanasia is generally considered to be a criminal homicide"[48] and is normally used as a synonym of homicide committed at a request made by the patient.[49]
The judicial sense of the term "homicide" includes any intervention undertaken with the express intention of ending a life, even to relieve intractable suffering.[49][50][51] Not all homicide is unlawful.[52] Two designations of homicide that carry no criminal punishment are justifiable and excusable homicide.[52] In most countries this is not the status of euthanasia. The term "euthanasia" is usually confined to the active variety; the University of Washington website states that "euthanasia generally means that the physician would act directly, for instance by giving a lethal injection, to end the patient's life".[53] Physician-assisted suicide is thus not classified as euthanasia by the US State of Oregon, where it is legal under the Oregon Death with Dignity Act, and despite its name, it is not legally classified as suicide either.[54] Unlike physician-assisted suicide, withholding or withdrawing life-sustaining treatments with patient consent (voluntary) is almost unanimously considered, at least in the United States, to be legal.[55] The use of pain medication in order to relieve suffering, even if it hastens death, has been held as legal in several court decisions.[53]
Some governments around the world have legalized voluntary euthanasia but generally it remains as a criminal homicide. In the Netherlands and Belgium, where euthanasia has been legalized, it still remains homicide although it is not prosecuted and not punishable if the perpetrator (the doctor) meets certain legal exceptions.[56][57][58][59]

Physician sentiment

A survey in the United States of more than 10,000 physicians came to the result that approximately 16% of physicians would ever consider halting life-sustaining therapy because the family demands it, even if believed that it was premature. Approximately 55% would not, and for the remaining 29%, it would depend on circumstances.[60]
This study also stated that approximately 46% of physicians agree that physician-assisted suicide should be allowed in some cases; 41% do not, and the remaining 14% think it depends.[60]
In the United Kingdom, the pro-assisted dying group Dignity in Dying cite conflicting research on attitudes by doctors to assisted dying: with a 2009 Palliative Medicine-published survey showing 64% support (to 34% oppose) for assisted dying in cases where a patient has an incurable and painful disease, while 49% of doctors in a study published in BMC Medical Ethics oppose changing the law on assisted dying to 39% in favour.[61]