Euthanasia and Other Medical Decisions at the End of Life: Societal Control and Cultural Aspects

textabstractDeath is a socially and culturally embedded phenomenon.1 It is inevitably understood and experienced within a complex web of cultural meanings that differ within and across countries. During the past century, acute death due to infectious diseases has to a great extent been replaced by death due to conditions that involve a more protracted dying process, such as cancer and cardiovascular diseases.2 Currently, approximately 70% of all deaths are non-sudden3 and are likely to involve some form of end-of-life care. Advances in medicine have greatly improved the possibilities to treat seriously ill patients and to prolong life and postpone death. It is also increasingly recognized that prolonging life is not always the most appropriate goal of medicine. Preserving quality of life and alleviating the patient’s suffering are other important care goals at the end of life. In some cases hastening of death can be an acceptable or even desired result of end of life care as well. Euthanasia, that is, deliberately ending a person’s life at the person’s request, and physician-assisted suicide, where the person self-administers lethal medication that is prescribed by a physician, are among the most controversial acts