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However, those supporting euthanasia argue that unlike the murderous Nazi euthanasia program designed by Hitler and his followers, twenty-first-century proposals are based on voluntary requests by individuals in situations of physical suffering and would be sanctioned by laws passed by democratic governments.

In the United States the debate over euthanasia distinguishes between active and passive euthanasia. Active euthanasia, also called voluntary active euthanasia by those who distinguish it from the kind of euthanasia practiced by the Nazis, involves the hastening of death through the administration of lethal drugs, as requested by the patient or another competent individual who represents the patient's wishes.

By contrast, passive euthanasia involves forgoing medical treatment, knowing that such a decision will result in death. This action is not considered illegal because the underlying illness, which is permitted to run its natural course, will ultimately cause death.


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It is generally accepted in the United States that terminally ill individuals have a right to refuse medical treatment, as do those who are sick but not terminally so. However, some people think that allowing patients to forgo medical treatment is a practice tantamount to enabling suicide and is therefore morally reprehensible.

The debate about euthanasia in the United States has been expanded to include the question of whether a competent, terminally ill patient has the right to physician-assisted suicide, in which a physician provides the means such as lethal drugs for the patient to self-administer and commit suicide.

The distinction between the two actions, euthanasia and physician-assisted suicide, is at times difficult to define: for example, a patient in the latter stages of amyotrophic lateral sclerosis also known as Lou Gehrig 's disease is physically unable to kill him- or herself; there-fore, a physician who aids in such a person's suicide would technically be performing euthanasia.

Different religions and cultures have viewed suicide in different ways. Ancient Romans who dishonored themselves or their families were expected to commit suicide to maintain their dignity and, frequently, the family property.

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Early Christians were quick to embrace martyrdom as a guarantee of eternal salvation, but during the fourth century St. Augustine of Hippo — discouraged the practice. He and later theologians were concerned that many Christians who were suffering in this world would see suicide as a reasonable and legitimate way to depart to a better place in the hereafter.

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The view of the Christian theologian St. Thomas Aquinas ? Even though Islam and Judaism also condemn the taking of one's own life, Buddhist monks and nuns have been known to commit suicide by self-immolation burning themselves alive as a form of social protest.

In a ritual called suttee, which is now outlawed, widows in India showed devotion to their deceased husbands by being cremated with them, sometimes throwing themselves on the funeral pyres, although it was not always voluntary. Widowers men whose wives had died , however, did not follow this custom. Quasi-religious reasons sometimes motivate mass suicide. In more than nine hundred members of a group known as the People's Temple killed themselves in Jonestown, Guyana.

In a group called Heaven's Gate also committed mass suicide in California. The devastating terrorist attacks of September 11, , were the result of a suicidal plot enacted by religious extremist groups. Suicide bombings in other parts of the world have also been attributed to extremist groups that have twisted or misinterpreted the fundamental tenets of Islam to further their political objectives.

The Japanese people have traditionally associated a certain idealism with suicide. During the twelfth century samurai warriors practiced voluntary seppuku ritual self-disembowelment to avoid dishonor at the hands of their enemies. Some samurai committed this form of slow suicide to atone for wrongdoing or to express devotion to a superior who had died. Even as recently as , the famed author Yukio Mishima — publicly committed seppuku. During World War II — Japanese kamikaze pilots inflicted serious casualties with suicidal assaults in which they would purposely crash their planes into enemy ships, killing themselves along with enemy troops.

Suicide is still practiced in modern Japan.

For example, in several government officials and businessmen hanged themselves in separate incidents involving scandals that attracted public attention. The reasons given for the suicides ranged from proclaiming innocence to assuming responsibility for wrongdoing. However, Japan's high level of suicides goes beyond such practices. Reasons proposed for the high number of Japanese suicides include bullying at school, online suicide pacts, unemployment, and old age, with the root cause being depression.

Both Japan and the United States have about the same number of suicides each year, but Japan has half the population. Except for certain desperate medical situations, suicide in the United States is generally considered an unacceptable act, the result of irrationality or severe depression. It is often referred to as a permanent solution to a short-term problem. In spite of this generally held belief, suicide was the eleventh-leading cause of death in the United States in See Table 4.

There were nearly 1. Nevertheless, since the national suicide rate has dropped from See Table 6. However, the rate is up from a low of In the suicide rate for men 18 people per , was four times that for women 4. Over the decades, the male suicide rate has ranged from. In that year the female suicide rate was up, resulting in the male suicide rate being only 2. The racial group with the lowest suicide rate in was African-American females 1.

In addition, adults aged seventy-five to eighty-four years had the lowest suicide rate of all age groups. Each is responsible for registering vital events: births, deaths, marriages, divorces, and fetal deaths. Suicide data are compiled as part of the death data. The CDC received funding in to expand the system to seventeen states.

Eventually, the system will include the fifty states, all U. Figure 6. These data are collected from a variety of sources, including death certificates, police reports, medical examiner and coroner reports, and crime laboratories. The two most common reasons found for suicide in and were depression and other mental health problems. Gopal K.

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The researchers report that the rate of suicide in rural populations of males increased between and , whereas the rate of suicide in urban populations of males decreased over the same period. Even though the rates are lower for females and the changes are not as dramatic, a decrease was also noted in the suicide rate for urban females, whereas the suicide rate among rural females remained relatively stable.

In explaining these differences, Singh and Siahpush suggest that both rural and urban areas have experienced profound social and demographic changes during the past three decades. However, they contend that change has affected life in rural areas more than in urban areas. They note that high levels of social isolation, as often occurs in rural areas, are correlated with high suicide rates. Hirsch agrees with Singh and Siahpush's observations and suggests that high rates of suicide in rural areas are not only a U.

Suicide rates among young people aged fifteen to twenty-four years nearly tripled between and , from 4. Rates among young adults aged twenty-five to thirty-four years increased as well, but not as dramatically; they increased 1. However, the young adult rates were higher than the suicide rates among young people. Suicide rates dropped from to and then remained relatively stable through In suicide was the third-leading cause of death among people aged fifteen to twenty-four and the second-leading cause of death among people aged twenty-five to thirty-four.

Differences exist among racial groups in suicide rates. For example, the overall suicide rate among African-American males is lower than that of white males. In the fifteen- to twenty-four-year-old age group, suicide rates for white males ranged from 1. In the suicide rate for white males aged fifteen to twenty-four years was 1.

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The suicide rates for both groups of young men rose from to and decreased by The rate for white males of this age group remained relatively stable through , but decreased further for African-American males in and In the highest suicide death rate among youths aged fifteen to twenty-four was By this rate fell to Males of all races and ages are more likely to die from suicide attempts than are females of the same race and age. However, among high school students, females. As shown in Table 6. More female Also, more female 2. However, in only 3. Even though death rates from suicide declined among young adults aged fifteen to nineteen between and , the percentage of high school students who attempted suicide increased from 7.

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The percentage of students injured during a suicide attempt also rose from 1. The percentage of high school students who attempted suicide in was highest among ninth graders and decreased with increasing grade level. The percentage of suicide attempts requiring medical attention followed the same pattern: a higher percentage of the suicide attempts of ninth graders required medical attention than did those of older students, and this percentage decreased as the grade level increased.

Hispanic students. In addition, suicide attempts were the highest among high school students living in North Carolina In its collection of suicide-related statistics, the CDC has data on the percentage of high school students who feel sad or hopeless, who seriously consider attempting suicide, and who make a suicide plan.

In , Approximately Table 6. The use of firearms was the method most frequently used by ten- to fourteen-year-olds from to for both males and females. The use of firearms by fifteen- to nineteen-year-old males decreased steadily from to , with a slight increase in Poisoning ranked low in this age group from through , as it did in the ten- to fourteen-year-old group.

The use of firearms was also the most widely used means of committing suicide in those aged twenty to twenty-four in to This pattern was also seen in the general population in The rate of death by firearms 5. Other methods were used much less frequently. The statistics in this section underscore the urgent need for prevention, education, and support programs to help teens and young adults at risk.