Euthanasia

Euthanasia or mercy killing refers to the deliberate act of ending someone’s life to alleviate pain and suffering. In this article, you will learn definition, types, advantages and disadvantages, legal aspects of euthanasia in India, advantages and disadvantages, global position on Euthanasia, different religion’s view on Euthanasia, providing key insights for GS Paper-II Polity and Governance section of UPSC IAS Exam.

Table of Content

• What is Euthanasia?
• Types of Euthanasia
• Active vs passive euthanasia
• Difference between Suicide and Euthanasia
• Global position on Euthanasia
• Euthanasia in India
• Courts verdict in cases of Euthanasia in India
• Different Religions Over Euthanasia
• Arguments against euthanasia
• Reasons to legalise euthanasia
• Conclusion         
• Frequently Asked Questions       

What is Euthanasia?

• Meaning: Euthanasia refers to the deliberate act of ending someone’s life to alleviate pain and suffering.
• The term is derived from the Greek words “eu” meaning “good” and “thanatos” meaning “death,” thus signifying a “good death.”
• It involves intentionally terminating the life of an individual who is enduring a terminalillness or an incurable condition, either through medical injection or by withholding any extraordinary medical treatment.
  • This is done in order to relieve them of unbearable pain or suffering.
• Euthanasia is also known as “Mercy Killing,” as a person who is suffering from a painful condition chooses to end their life in a painless manner.
• It is viewed as a compassionate and gentle way to release individuals from incurable diseases.
• Its purpose is to provide a less painful end to the life of a terminally ill or disabled patient, ensuring they can pass away with dignity.
• The intention behind euthanasia is to offer a peaceful death to someone who is already suffering and has no hope of recovery.
• Historically, before the late 20th century, several European countries had special provisions for lenient sentencing and the consideration of circumstances in case of prosecutions for euthanasia.
  • Euthanasia was morally permissible as per the Socrates, Plato, and the Stoics.

Types of Euthanasia:

Based on choice of the person:

• Voluntary euthanasia– when the person who is killed has requested to be killed.
• Non-voluntary euthanasia– when the person who is killed made no request and gave noconsent.
  • It is done when the person is unable to communicate his wishes due to being in coma.
• Involuntary euthanasia– when the person who is killed had expressed his wish to the contrary.
  • It is involuntary when the person killed gives his consent not to die.

Based on the method used:

• Active euthanasia: means intentionally causing the death of a person through directintervention.
  • It is also known as “Positive Euthanasia” or “Aggressive Euthanasia“.
  • It is a deliberate action taken to end a life that is deemed without meaning.
  • Example: it can be achieved by administering a lethal dose of medication or injection.
  • Active euthanasia is a quicker method of causing death, but it is considered illegal in all its forms.
  • Arguments in favour of active euthanasia:
    • It can be a compassionate and ethical choice as it empowers individuals to control their own lives and deaths, especially when facing unbearable pain or terminal illnesses.
    • Active euthanasia is viewed as a direct and swift way to alleviate suffering, providing a humane and dignified option for those experiencing intense physical or emotional distress.
  • Arguments against active euthanasia:
    • Intentionally causing another person’s death goes against the sanctity of life and undermines medical ethics, which prioritizes preserving and promoting life.
    • It can lead to potential abuses and the risk of sliding down a slippery slope, where the practice may expand beyond the limits and may put vulnerable groups at risk.
  • Legality: Some countries, like the Netherlands, Belgium, Colombia, and Canada, have established laws that permit or decriminalize certain forms of active euthanasia under specific circumstances.
  • Many other countries consider active euthanasia illegal and permits only passive euthanasia, which involves withholding or withdrawing life-sustaining treatment.
• Passive euthanasia: means to intentionally causing death by withholding essential and necessary care, including food and water.
  • It is also known as “Negative Euthanasia” or “Non-Aggressive Euthanasia,”.
  • It involves discontinuing, withdrawing, or removing artificial life support systems.
  • It is slower and may cause more discomfort as compared to active euthanasia.
  • In many cases, voluntary passive euthanasia is legally accepted, and some instances of non–voluntary passive euthanasia are also considered legal.
  • In cases of passive euthanasia, the decision to withhold or withdraw treatment shall align with the ethical guidelines and legal frameworks, which vary across different countries and jurisdictions.
  • Sometimes, obtaining consent from the patient, their family, or a legal representative may be necessary.
  • Passive euthanasia aims to honour the patient’s autonomy and prevent unnecessary suffering by refraining from interventions that may prolong their pain without any significant benefits.
  • Arguments in favour of passive euthanasia:
    • It upholds the principle of autonomy by allowing patients to pass away with dignity.
    • In situations where medical interventions would only extend the suffering without offering any chance of recovery or improvement, permitting a natural death can be a compassionate choice.
  • Arguments against passive euthanasia:
    • Intentionally causing or hastening death, even indirectly, contradicts the principle of preserving life and may be considered a form of abandonment or neglect.
    • Providing palliative sedation or care and appropriate pain management can alleviate suffering without actively causing death.

Active vs passive euthanasia

Difference between Suicide and Euthanasia:

Suicide	Euthanasia
In suicide, an individual willingly takes their own life through actions like stabbing, poisoning, or other means.	In euthanasia, a third person takes action to end someone else’s life. In this case, a person actively or passively assists in the killing of another individual.
It is a deliberate act of ending one’s life, often due to depression or reasons such as love-related issues, academic or job-related failures.
Assisted suicide is when someone intentionally helps another person commit suicide such as by providing the method to do so. In assisted suicide, the patient retains complete control over the process leading to death, as they perform the act themselves, and another person merely provides assistance.	Euthanasia can be active, where a doctor administers a lethal injection to the patient, or passive, where a doctor withdraws life support systems.

Global position on Euthanasia:

• Netherlands: the first country to legalize both euthanasia and assisted suicide in 2002.
• England: the laws regarding euthanasia are subject to variations and changes over time, influenced by cultural values and advancements in palliative care and treatments.
  • A person has the right to refuse life-sustaining treatment as part of their autonomy and self-determination rights.
• Australia: The NorthernTerritory of Australia had first legalized euthanasia through the Rights of the Terminally Ill Act in 1996.
  • Later, the Euthanasia Laws Act of 1997 had also legalized it.
• Assisting euthanasia is a crime in most Australian states, prosecutions have been rare.
• Albania: Albania has legalized euthanasia under the Rights of the Terminally Ill Act of 1995, making any form of voluntaryeuthanasialegal.
  • Passive euthanasia is permitted if three or more family members consent to the decision.
• Belgium: voluntary euthanasia was legalized through the “Belgium Act on Euthanasia” in 2002.
• Ireland: euthanasia is illegal and the Irish Medical Council’s Ethical Guidelines strictly denies the medical professionals to take part in it.
• Canada: patients have the right to reject life-sustaining treatments, but they are not permitted to request euthanasia or assisted suicide.
• U.S.A: While active euthanasia is prohibited, physicians are not held liable if they withhold or withdraw life-sustaining treatment upon the patient’s request or the request of the patient’s authorized representative.
• The United Kingdom: Euthanasia is illegal in the United Kingdom, but euthanasia of disabled newborns is permitted.
• Switzerland: suicide is not a crime, but assisting suicide is only a crime if the motive is selfish.
  • Physician-assisted suicide is legal in Switzerland, and it does not require the patient to be terminally ill or involve a physician.
  • The only requirement is that the motive must be unselfish.

Euthanasia in India:

• Since 2018, passive euthanasia has been legalised in India but patients must first give their consent through a living will, and must be either terminally ill or in a vegetative state.
• Before euthanasia was allowed in India, Leaving Against Medical Advice (LAMA) used to be signed which transferred the full responsibility from the physician to the patient for the discontinuation of his living therapies.
• In 2006, the 196thReport of Law Commission of India titled as ‘Medical Treatment to Terminally Ill Patients (Protection of Patients and Medical Practitioners)’.
  • The report stated that “a doctor who obeys the instructions of a competent patient to withhold or withdraw medical treatment is not an offence.”
  • It had recognised the patient’s decision to not receive medical treatment, as it did not constitute an attempt to commit suicide under Section 309 of theIndian PenalCode (IPC).
• In 2008, the Law Commission’s ‘241st Report On Passive Euthanasia: A Relook’ has proposed legislation on ‘passive euthanasia’, and also prepared a draft Bill.

Courts verdict in cases of Euthanasia in India:

Aruna Ramchandra Shanbaug vs Union Of India & Ors- the most decisive court case:

• The Supreme Court of India had legalised passive euthanasia by means of the withdrawal of life support to patients in a permanent vegetative state.
• The Supreme court has made a distinction between ‘active’ and ‘passive’, by allowing the passive euthanasia onlyin certain situations.
• Active euthanasia, including the administration of lethal compounds for the purpose of ending life, is still illegal in India.

M.S Dubal vs. State of Maharastra:

• The Bombay High Court have held that right to life under Article 21 of the Indian Constitution includes ‘right to die’.
  • Article 21: no person shall be deprived of his life or personal liberty except according to the procedure established by law.

Chenna Jagadeeswar vs. State of AP:

• The Andhra Pradesh High Court has stated that right to die is not a fundamental right under Article 21 of the Constitution.

P Rathinam vs Union Of India:

• The Supreme Court of India has observed has stated that the ‘right to live’ includes ‘right not to live’ i.e right to die or to terminate one’s life.
• In 1994, Section 309 of the IPC had mandated prison of up to one year in case for attempt to suicide.
  • This was invalidated by the Supreme Court.

Gain Kaur vs State of Punjab:

• The Supreme Court has overruled the P.Rathainam’s case and held that right to life under Article 21 does not include right to die or right to be killed.

Common Cause vs. Union of India & Anr

• The Supreme Court laid down the guidelines for ‘living wills’, under the allowed passiveeuthanasia.
  • The guidelines have been updated and simplified.
• A living will must be signed by the individual seeking euthanasia in the presence of two independent witnesses and countersigned by a notary or gazetted officer.
• Also, the treatingphysician must constitute two board of three expertmedical practitioners from specific but various fields of medicine, with at least 5 years of experience.
  • They will decide whether to carry out the living will or not.
• The medical board has to grant permission within 48 hours.
• In case the medical boards refuse such permission, kin can approach the High Court which will then form a fresh medical team.
• The approval by the medical board must be intimated to a Judicial Magistrate of First Class (JMFC).

Different Religions Over Euthanasia:

Christianity:

• Christian denominations hold differing views on euthanasia.
• Some emphasize the sanctity of life and consider intentionally causing another person’s death as morally unacceptable.
• Instead, they advocate for providing palliative care and support to alleviate suffering without actively ending life.
• On the other hand, certain denominations, like the United Church of Christ, have liberal perspectives and support the right to choose euthanasia in specific circumstances.

Islam:

• Islamic teachings oppose euthanasia as it goes against Allah’s will.
• Life is considered a sacred gift from God, and Muslims are encouraged to protect and preserve it.
• Islamic ethics prioritize providing comfort and pain relief through palliative care for the terminally ill, while actively causing death is typically considered forbidden.

Judaism:

• Jewish views on euthanasia differ, but many teachings lean toward preserving life and prohibiting active euthanasia.
• However, there are diverse opinions within Judaism, and some interpretations may allow for limited forms of passive euthanasia in cases where death is imminent, and suffering is severe.

Hinduism:

• Hinduism encompasses a wide range of beliefs, leading to varying views on euthanasia among individuals and communities.
• The principle of ahimsa (non-violence) holds significance, and intentionally causing harm or death may be seen as contrary to this value.
• Nevertheless, some Hindus may consider passive euthanasia acceptable in situations of extreme suffering and incurable illnesses.

Buddhism:

• Buddhist teachings emphasize compassion and alleviating suffering.
• While the tradition generally opposes intentionally causing death, there is no unified stance on euthanasia.
• Some Buddhists may support relieving unbearable suffering through compassionate means, such as palliative care, while others may advocate accepting the natural process of death without intervention.

Jainism:

• Tenets of Jainism has concept of ‘Sallkhana’, meaning ‘fast unto death’, which is the practice of religiously nominated self-build death.
  • Sallekhana is also known as samlehna, santhara, samadhi-marana or sanyasana–marana.

Arguments against euthanasia:

• Human life is considered a divine gift, and taking someone’s life goes against moral and ethical principles.
• Euthanasia stands in direct contradiction to medical ethics, morals, and societal norms.
  • The medical field is offering possibilities to treat even the most seemingly incurable diseases.
  • Instead of endorsing the termination of a patient’s life, medical practitioners shall focus on supporting patients to endure their painful journey with strength.
• Decision-making regarding euthanasia often involves the patient’s relatives, leading to moral and psychological pressure on the patient to make such a drastic choice.
• Legalizing euthanasia raises concerns about vulnerable groups being at risk of considering this option for themselves.
  • Disabled groups may oppose euthanasia’s legalization, fearing they might feel compelled to choose euthanasia, perceiving themselves as burdens on society.
• The “slippery slope”effect is a main concern where initial legalization for terminally ill patients could pave the way for changes in the law, by leading to non-voluntary or involuntary euthanasia acceptance.
  • Accepting euthanasia as an option might negatively impact societal attitudes and the doctor–patient relationship which relies on mutual trust, and legalizing euthanasia might erode this trust.
• If suicide is not allowed, euthanasia should be treated similarly as the desire for euthanasia arises from a state of despair and hopelessness, just like suicide.
  • Proper care and instilling hope in patients can alleviate such tendencies.
• Legalizing euthanasia could result in patients losing trust in doctors and relatives, as discussions about a painless dignified death might be seen as a euphemism for assisted murder.
• A society had witnessed miracles, especially in life-and-deathsituations, where patients have emerged from comas after extended periods.
  • The essence of human life lies in hope, and such possibilities should not be overlooked.

Reasons to legalise euthanasia:

• Euthanasia respects patients’ decisions and prioritizes individual well-being over societal interests, but denying a person right to choose their day may infringe their dignity and human rights.
• Human life should uphold dignity, and forcing an undignified existence is contradictory to personal choice-a fundamental principle.
• In resource-constrained countries like India, limited funds and hospital space can be better utilized to save lives rather than prolonging the suffering of those who wish to end their lives.
• Diverting medical resources from terminally ill patients to those with better chances of recovery will be a more rational approach.
• Article 21 of the Indian Constitution guarantees the right to live with dignity, butif a person’s quality of life falls below the minimum level of dignity, they should have the right to end their life.
• Euthanasia’s intent is altruistic and compassionate, aiming to ease the suffering of those with painful and incurable diseases, focusing on providing help rather than harm.
• Euthanasia not only alleviates the unbearable pain experienced by patients but also relieves the mental anguish of their relatives.
• Instead of focusing on potential abuse, the emphasis shall be on the positive impact it can have.
• According to utilitarianism perspective voluntary active euthanasia and physician-assisted suicide is morally right when the act leads to happiness for the individual and society.

Conclusion

Granting such a right to terminally ill patients might be abused, but every right carries the risk of misuse. In contrast to euthanasia and physician-assisted suicide, the palliative sedation does not aim to cause death, but to relieve suffering. Thus, palliative sedation as an alternative to euthanasia must be promoted more in order to maintain faith of the general public on medical sciences. The right to euthanasia in India is only limited to passive euthanasia and that too in extreme cases.

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FAQs(Frequently Asked Questions)