Euthanasia and End Of Life Care

1. Euthanasia and End Of Life
Care
ANYURYSM- ‘S’

2. • The term euthanasia derived from the Greek word “eu” and
“thanatos” which means “good death” or “easy death”.
• It is also known as Mercy Killing.
• The ancient Greeks viewed illness as a bothersome affliction and
allowed sick individuals to seek the approval of the state to commit
suicide
Introduction

3. Euthanasia refers to “the intentional termination of a
person’s life, usually but not always at that person’s
request, and usually in the context of terminal illness and/or
incurable suffering”.
The Australian Psychological Society
Introduction

4. • While most Greek philosophers supported euthanasia to Aristotle,
suicide was an offence against the state.
• In 1516, for instance, Sir Thomas More wrote Utopia in which
patients living in an ideal society were encouraged to commit suicide
if they were suffering from a terminal illness or experiencing
unrelenting pain.
Background

5. • Hippocratic oath, which was written between 400 and 300 B.C.
The oath states: “To please no one will I prescribe a deadly drug nor
give advice which may cause his death.”
• According to him, a doctor is to relieve the pain of his patient in one
hand and protect and prolong his life on the other hand
Background

6. • 1930’s and early 1940’s, the Nazi’s adoption of the word
“euthanasia” to describe its “mass extermination programme” .
• In Germany, euthanasia was employed to murder over 100,000 and
All the killings were committed without the patient’s consent and
generally without the patient being aware of the impending act.
• The General Assembly of the World Medical Association
Background

7. 1) Active or Positive: It is an act of Commission. It means a positive
merciful act to end useless sufferings and meaningless existence. For
example by giving large doses of a drug to hasten death.
2) Passive or Negative: It is an act of Omission. It means
discontinuing or not using extraordinary life sustaining measures to
prolong life. For example discontinuing a feeding tube, or not carrying
out a life –extending operation or not giving life extending drugs etc.
-------------------------------------------------------------------------------------------------
Reddy KSN. The essentials of Forensic medicine & Toxicology, 26th edition. 2007;41
Types of Euthanasia

8. 3) Voluntary: Euthanasia practiced with the expressed desire and
consent of the person concerned.
4) Involuntary: Euthanasia practiced against the will of the person
5) Non- Voluntary: Euthanasia practiced in persons who are incapable
of making their wishes known .For example in persons with irreversible
coma or severely defective infants.
------------------------------------------------------------------------------------------------
Reddy KSN. The essentials of Forensic medicine & Toxicology, 26th edition. 2007;41
Types of Euthanasia

9. ‘Doctor provides an individual with the information, guidance, and
means to take his or her own life with the intention that they will be
used for this purpose’
-------------------------------------------------------------------------------------------
Murkey P.N. & Singh K.S. Euthanasia ( mercy Killing). Review article. - J. Ind. Acad. Forensic
Med. &Toxicol. Vol-30 no.2, 2008;92-95
Physician assisted suicide (PAS)

10. • Jack Kevorkian was a U.S.-based physician who assisted in more
than 150 patient suicides.
• Infamous in 1990, when he assisted in the suicide of Janet Adkins, a
45-year-old Alzheimer's patient from Michigan .
• Kevorkian agreed to assist her in a public park, inside his
Volkswagen van. Kevorkian attached the IV, and Adkins
administered her own painkiller and then the poison.
• The State of Michigan immediately charged Kevorkian with Adkins'
murder.
Dr. death

11. • On March 26, 1999, a jury in Oakland County convicted Jack
Kevorkian of second-degree murder and the illegal delivery of a
controlled substance and was sentenced to 25 years in prison .
• In 2010, HBO announced that a film about Kevorkian's life,
called You Don't Know Jack featuring a film legend Al Pacino as
Kevorkian
• He died on June 3, 2011, at the age of 83 .

12. • Ethical/Moral
-To respect sufferers’ autonomy
-This argument rests on the ideal of being able at all times to exercise
as much control over one’s own life as is possible.
• To allow individuals to value “quality of life” over “sanctity of life”
• To end suffering
Arguments in Favour
of Euthanasia

13. • To reduce reliance on life support systems and/or advanced medical
knowledge
• To reduce risk of premature suicides
• To reduce the legal jeopardy of those who implement euthanasia
• Changes in professional and public attitudes to euthanasia
Arguments in Favour
of Euthanasia

14. • Ethical/moral
• Absolute respect for human life
• Possibility of coercion, loss of autonomy
• Poor decision-making by the sufferer
• Conflicts of interest
• Difficulty of enforcement and monitoring
• Reduction of efforts in diagnosis, treatment, and care
• Adequacy of modern medical and palliative care
Arguments Against Euthanasia
Being Available

15. • The Canadian law allows a person to refuse medical treatment and
the medical profession accepts the ‘living will’, but the law does not
allow the doctor to actively help someone to kill himself.
• However, amidst the ongoing debates, the Netherlands became the
first testing ground for the world since it legalized euthanasia on
28th November 2000.
Trends Of Euthanasia In Different
Countries

16. • Australia also has a voluntary euthanasia law which is statedly
working well. In Australia, a computerized injection system is in use
to accomplice euthanasia.
• The euthanasia law was adopted in 2001 in Belgium . This law
defines conditions for doctors to avoid penal punishment.
• Physician Assisted suicide is legitimized in Switzerland.
Trends Of Euthanasia In
Different Countries

17. • Currently in the UK, any person found to be assisting suicide is
breaking the law and can be convicted of assisting suicide or
attempting to do so
• Although two-thirds of Britons think it should be legal, a recent
'Assisted Dying for the Terminally- Ill' Bill was turned down in the
lower political chamber, the House of Commons
Trends Of Euthanasia
In Different Countries

18. • In USA the practice of euthanasia is a clear offence too theoretically,
but in real practice the judgements of different courts during trial of
euthanasia cases seem to be liberal.
• Physician Assisted Suicide (PAS) is legal in Oregon and Washington
State in the US.
Trends Of Euthanasia
In Different Countries

19. India
• Like almost in all other countries, euthanasia has no legal status .
The practice of euthanasia is a clear act of offence, either a suicide
and assistance to commit suicide or a murder.
• The latest judgement of Supreme Court declares that : Right to DIE
is not included in the Right to LIFE under Article 21 of Indian
Constitution.
Trends Of Euthanasia
In Different Countries

20. • Article 21 is a provision guaranteeing protection of life and personal
liberty and by no stretch of imagination can imply ‘EXTINCTION OF
LIFE’.
• ‘Right to life’ is a natural right embodied in Article 21 but suicide is
an unnatural termination or extinction of life and therefore not
compatible and inconsistent with the concept of ‘right to life’
Trends Of Euthanasia
In Different

22. • In Nov 27 ,1973 , Aruna Ramchandra Shanbaug, aged 24 a nurse at
KEM hospital Mumbai was attacked by Sohanlal, a sweepwer
working in the same hospital.
• Assaulted in the basement , strangulated with a dog chain resulting
in cervical injury and brain stem contusion due to lack of adequate
02 .
Incident

23. • Based on her assessment since 1982, Pinki Virani, a National award
winning Journalist, Social activist filed a petition ( criminal ), number
105 , of 2009 in Supreme Court on India , for mercy killing on Behalf
of Aruna under article 32 of constitution on India.
• She pleaded Supreme court to have Aruna stopped being fed and
let her die peacefully.

24. • On 24 January 2011, the Supreme Court of India responded by
setting up a medical panel to examine her.
• However, it turned down the mercy killing petition on 7 March 2011
but legalized passive euthanasia.

25. • Assessment of the patient
• Treatment/counselling of the patient as appropriate;
• An advocacy role for the patient and/or relatives and/or carers
• educating decision makers, clinical staff, patients and the public in
the psychological aspects of euthanasia and what psychologists can
offer in the area
• facilitating others’ professional development in the area
• conducting research in the area and disseminating knowledge;
Roles for psychologists
could include:

26. • There exists an inherent tension between respecting individual
autonomy and relieving people from unbearable suffering while still
protecting the principle of valuing human life remains.
• Any liberalizing of laws in relation to euthanasia needs to achieve
respect for individual rights and prevent abuse, without becoming
too unwieldy, bureaucratic and time consuming to be practical.
Conclusion

27. • The decision-making process raises many difficult psychological
issues. It is clearly apparent that every case where a patient
requests assistance to die should be assessed individually.
• Policy makers should consider these issues seriously and to bring
them to the attention of other professionals and policy makers.

28. 1. Reddy KSN. The essentials of Forensic medicine & Toxicology, 26th edition.
2007;41
2. 2. Murkey P.N. & Singh K.S. Euthanasia ( mercy Killing). Review article. - J.
Ind. Acad. Forensic Med. &Toxicol. Vol-30 no.2, 2008;92-95
3. G S Neeley “The Right to SelfDirected Death: Reconsidering an Ancient
Proscription” 35 Catholic Law 111 (1995) at 116.
4. 4 New York Task Force on Life and the Law When Death is Sought:
AssistedSuicide and Euthanasia in the Medical Context (May 1994) at 79.
5. J Scherer and R Simon Euthanasia and the Right to Die: A Comparative View
(Rowman & Littlefield Publishers, Lanham 1999)
References

30. Thank you