The cover art by Hugh Syme features an elderly woman hanging babies by their feet on a seemingly endless clothesline. According to bassist David Ellefson, the artwork concept was directly inspired from a line of the title track, "We've been hung out to dry". He explained that the title track "was probably the strongest representation of how we feel about the young people who listen to our music and what their future holds for them. It's like you have a choice, you can become proactive or you can choose 'Youthanasia'." The title is a combination of the words "youth" and "euthanasia". Mustaine has stated that the idea for the title stems from hearing about Jack Kevorkian, as well as the declining state of well-being of young people, specifically referring to issues like drugs, crime and violence, and a lack of parenting.