Overcoming Conflicting Definitions of “Euthanasia,” and of “Assisted Suicide,” Through a Value-Neutral Taxonomy of “End-Of-Life Practices”

**Background:** The terms 'euthanasia' and 'assisted suicide' are used inconsistently across bioethical literature, medical organizations, and legal frameworks, leading to confusion, ambiguity, and bias that impede ethical debate, clinical communication, and policymaking. The author argues that establishing unambiguous definitions is essential for fruitful discourse. Previous work by Beauchamp and Davidson (1979) attempted to define euthanasia using five criteria, but the author contends that definitional disagreement remains rampant.

**Methods:** The author first reviews definitions from global and national medical organizations (World Medical Association, British Medical Association, American Medical Association, Australian Medical Association), Dutch empirical literature (the Remmelink Reports), and independent bioethicists. From this review, six disputed definitional factors are identified: (1) killing versus letting die, (2) fully intended versus partially intended versus merely foreseen deaths, (3) voluntary versus nonvoluntary versus involuntary decisions, (4) terminally ill versus non-terminally ill patients, (5) patients who are fully conscious versus those in permanent comas or persistent vegetative states (PVSs), and (6) patients who are suffering versus those who are not. These factors are then distilled into six 'building blocks' and combined to create a taxonomy of end-of-life practices across four tables based on consciousness and terminal illness status.

**Key Results:** The taxonomy delineates 43 distinct end-of-life practices when considering the first five building blocks (type-status, intention-status, voluntariness-status, medical condition-status, and consciousness-status), and 86 practices when the sixth building block (suffering-status) is included. The taxonomy maps practices across four patient categories: (1) fully conscious, terminally ill patients; (2) fully conscious, non-terminally ill patients; (3) patients in permanent comas or PVSs who were once fully conscious; and (4) patients who have never been and never will be fully conscious (e.g., newborns with severe neurological defects). The author notes that many practices are not mutually exclusive and establishes a trumping hierarchy (killing trumps letting die, fully intended trumps partially intended trumps merely foreseen, involuntary trumps nonvoluntary trumps voluntary). The paradigm case of euthanasia is identified as voluntary, fully intended killing of a suffering, fully conscious, terminally ill patient. The paradigm case of assisted suicide is identical except the patient self-administers lethal drugs provided by a physician.

**Clinical Implications:** The taxonomy provides a value-neutral framework to replace the ambiguous and value-laden terms 'euthanasia' and 'assisted suicide.' The author recommends two approaches moving forward: (1) defining 'euthanasia' and 'assisted suicide' based on the most orthodox components of the building blocks, or (2) considering each of the 86 practices individually to avoid assigning incorrect ethical or legal statuses to similar but distinct practices. The taxonomy is intended for use in meta-ethical and normative-ethical analysis, policymaking, and the design of empirical studies, rather than for daily clinical use. The author acknowledges that the terms 'killing' and 'suicide' may carry negative connotations but stresses they are used as value-neutral placeholders that could be substituted.