Euthanasia - Types, Arguments For and Against

TOPIC DISCUSSION
Presenter
Tejas Shah
Chair
Dr. Dweep Chand Singh
EUTHANASIA
TYPES, ARGUMENTS FOR AND AGAINST

WHAT IS EUTHANASIA?
 EUTHANASIA comes from the Greek words: Eu (good) and
Thanatos (death) and it means “Good Death”, “Gentle and Easy
Death.”
 Now it means “the act of inducing an easy death”, usually
referring to acts which terminate or shorten life painlessly in order
to end suffering where there is no prospect of recovery.
 This word has come to be used for “mercy killing”.
 It is the act or practice of ending a life of a person either by a
lethal injection or suspension of medical treatment.

WHAT IS EUTHANASIA? (cont..)
 The word "euthanasia" was first used in a medical context by
Francis Bacon in the 17th century, to refer to an easy, painless,
happy death, during which it was a “physician's responsibility to
alleviate the 'physical sufferings' of the body”.
 Euthanasia is the most active area of research in contemporary
bioethics.

WHAT IS EUTHANASIA? (cont..)
 According to the World Medical Association euthanasia means:
 Deliberate and intentional action with a clear intention to end
another person’s life under the following conditions:
 The subject is a competent informed person with incurable
illness
 Who voluntarily asked for ending his life;
 The person who is acting knows about the state of this person
and about his wish to die and is doing this action with an
intention to end life of this person;
 The action is done with compassion and without any personal
profit

THE DILEMMA
 Arguments about euthanasia often hinge on the “right to life”
and the “right to die”.
 The first is a widely accepted basic human right and moral
value, based on the fact that people generally want to live.
 But what should we do when seriously ill people no longer
want to live? Do they have a right to die?
 Sufferers sometimes wish to commit suicide but do not have the
physical strength or the means to do it painlessly.

THE DILEMMA (cont..)
 Like many problems of medical ethics, this has become more
pressing recently.
 A century ago most people died quite quickly (and probably
painfully) if they had serious injuries or illnesses.
 Nowadays they can be treated, sometimes cured, and often kept
alive.
 Codes of conduct formulated centuries ago, for example those
found in sacred texts, or the Hippocratic Oath, cannot necessarily
help us with twentieth century problems of medical ethics.

WHEN DOES THE QUESTION OF
EUTHANASIA ARISE?
3PART

WHAT ARE THE VARIOUS OCCASIONS?
 The question of euthanasia arises on three occasions
 At the beginning of life (at birth)
 At the end of natural life (terminal stage) and
 When a person is severely impaired as a result of brain
damage (unforeseen mishap)

AT BIRTH
 In case of severely physically and mentally handicapped infants
 Decision rests on the parents or on the doctors aided by the law
of the land
 The decision should be based on :
 quality of life the child can expect and its consequent impact
on the parents, society and the resources of the State and also
 care of the child after death of the parents

AT TERMINAL STAGE
 The dying conscious patient can give his own consent or decision
as to continue or not the ongoing treatment if he wishes to.
 No moral obligation on doctors to preserve life at any cost.

UNFORESEEN MISHAP
 When a person is severely impaired as a result of brain damage
either due to violence, poisoning or natural causes where the brain
suffers from hypoxic brain damage from which it cannot recover
irrespective of the treatment given his/her life can be sustained
by artificial means but only in a state of suspended animation.
 This gives rise to the confusion whether the treatment is prolonging
life or death !!
 In such cases he may be allowed to die in comfort and with dignity
(such a step would also save the resources of the State for more
rational uses)

WHAT ARE THE TYPES OF
EUTHANASIA?
4PART

WHAT ARE THE TYPES OF EUTHANASIA?
Active or Positive
Passive or Negative
Voluntary
Involuntary
Non-Voluntary

WHAT ARE THE TYPES OF EUTHANASIA? (cont..)
 VOLUNTARY EUTHANASIA, sometimes called “assisted suicide”,
is used in cases where the sufferer has made it clear that s/he
wishes to die and has requested help to bring this about.
 When the euthanasia is practiced with the expressed desire and
consent of the person concerned.
 INVOLUNTARY EUTHANASIA occurs when no consent or wish to
die is expressed by the sufferer.
 When the euthanasia is practiced against the will of the person.

To define this type further –
 NON-VOLUNTARY EUTHANASIA – where patients cannot express a
wish to die – patients in comas, infants, profound mentally
retarded, severely brain damaged, cases of extreme senile
dementia, those who cannot communicate for other reasons
 INVOLUNTARY EUTHANASIA - where patients can express a wish
to die but don't (this equates to murder).

The way in which the euthanasia is carried out can also be defined –
 ACTIVE, or DIRECT, EUTHANASIA involves specific actions (e.g.
lethal drugs or injections) intended to bring about death.
 It means a positive merciful act to end useless sufferings and a
meaningless existence. It is an act of commission for example
by giving large doses of a drug to hasten death.

 PASSIVE EUTHANASIA is the practice, widely carried out and
generally judged to be legal, where patients are allowed to die,
by withdrawing treatment and/or nourishment. A common
practice of this is a patient signing a ‘Do Not Resuscitate’ (DNR)
document.
 It implies discontinuing or not using extraordinary life sustaining
measures to prolong life. Others include act of omission such as
failure to resuscitate a terminally ill or incapacitated patient
(e.g. a severely defective new-born infant).

 Other methods include disconnecting a feeding tube, not carrying
out a life-extending operation or not giving life-extending drugs
etc.
 ‘Letting die’ ... means to give way to an ongoing inner-organismic
process of disintegration, without supporting or substituting vital
functions.
 Therefore the extubation [removal from a ventilator] of an
incurably ill patient, though a physical action with subsequent
death, is not killing in its proper meaning...

 The extubation does not produce the effect of death; it only
influences the time of its occurrence.
 Calahan (1992) has aptly illustrated this difference of causality:
 The lethal injection kills both the ill as well as the healthy
person;
 the discontinuation of life sustaining treatment, however, only
causes the death of the mortally ill, whereas on the healthy it
would have no effect at all."

 WITHDRAWING TREATMENT: For example switching off a machine
that keeps the person alive.
 WITHHOLDING TREATMENT: For example not carrying out a
surgery that will extend life of the patient for a short time.
 INDIRECT EUTHANASIA (sometimes referred to as "the double
effect") is the practice of providing treatment, normally pain
relief, which has the side-effect of hastening death. This is also
widely practised and generally considered legal if killing was not
the intention.

WHAT IS ETHICAL CONTRADICTION?
5PART

ETHICAL CONTRADICTION
 DOCTOR-ASSISTED SUICIDE: Someone 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.
 When it is a doctor who helps another person to kill themselves
it is called “physician assisted suicide or doctor assisted
suicide”.
 In doctor assisted-suicide, the doctor provides the patient with
medical know-how (i.e. discussing painless and effective medical
means of committing suicide) enabling the patient to end his /
her own life.

ETHICAL CONTRADICTION (cont..)
 THE HIPPOCRATIC OATH and International code of medical
ethics pose ethical contradiction for the doctors.
 Hippocrates mentions euthanasia in the Hippocratic Oath, which
was written between 400 and 300 B.C.
 The original 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
on one hand and protect and prolong his life on the other.

ETHICAL CONTRADICTION (cont..)
 The first can be used in favour of the doctrine of euthanasia but
the second counters the doctrine.
 American Medical Association hold it inconsistent with the ethics
of advanced medical technology.
 Legalization would cause loss of hope, fear of medical
institutions, and involuntary euthanasia.

WHAT ARE THE RELIGIOUS AND
PHILOSOPHICAL ARGUMENTS?
6PART

RELIGIOUS AND PHILOSOPHICAL BACKGROUND
 SECULAR HUMANISTS think that in a lot of circumstances
voluntary euthanasia is the morally right course of action to take.
 But many religious people, however, think that euthanasia is
always morally wrong, regardless of whether the suffering person
really wants to die.
 Most religions disapprove of euthanasia for a number of reasons:
1. God has forbidden it (that says 'you must not kill').
2. Human life is sacred.
3. Human beings are made in God's image.
4. God gives people life, so only God has the right to take it away.

RELIGIOUS AND PHILOSOPHICAL BACKGROUND (cont..)
ISLAM:
 Muslims are against euthanasia.
 They believe that all human life is sacred because it is given by
Allah, and that Allah chooses how long each person will live.
 IMANA (the Islamic Medical Association of America) says that
turning off life support for deemed to be in a persistent vegetative
state is permissible.
 This is because they consider all mechanical life support
procedures as temporary measures.

CHRISTIANITY:
 Christians are mostly against euthanasia.
 The arguments are usually based on the beliefs that life is given
by God, and that human beings are made in God's image.
 Some churches also emphasize the importance of not interfering
with the natural process of death.
 Life is a gift from God, Christianity requires us to respect every
human being.

JUDAISM:
 Jewish medical ethics have become divided, over euthanasia
and end of life treatment since the 1970s.
 Generally, Jewish thinkers oppose voluntary active euthanasia,
often vigorously, though there is some backing for voluntary
passive euthanasia in limited circumstances.

SHINTO:
 In Japan, where the dominant religion is Shinto, 69% of the
religious organizations agree with the act of voluntary passive
euthanasia.
 In Shinto, the prolongation of life using artificial means is a
disgraceful act against life.

BUDDHISM:
 An important value of Buddhism teaching is compassion.
 Compassion is used by some Buddhists as a justification for
euthanasia because the person suffering is relieved of pain.
 However, it is still immoral "to embark on any course of action
whose aim is to destroy human life, irrespective of the quality of
the individual's motive."

WHAT IS THE HUMANIST VIEW?
7PART

THE HUMANIST VIEW
 HUMANISTS are non-religious people who live by moral principles
based on reason and respect for others, not obedience to
dogmatic rules.
 They promote happiness and fulfilment in this life because they
believe it is the only one we have.
 Humanist concern for quality of life and respect for personal
autonomy lead to the view that in many circumstances voluntary
euthanasia is the morally right course.

THE HUMANIST VIEW (cont..)
 People should have the right to choose a painless and dignified
end, either at the time or beforehand, perhaps in a "living will".
 The right circumstances might include:
 extreme pain and suffering;
 helplessness and loss of personal dignity;
 permanent loss of those things which make life worth living for
this individual.
 To postpone the inevitable with no intervening benefit is not a
moral act.

 Individuals should be allowed to decide on such personal matters
for themselves;
 If someone in possession of full information and sound judgement
decides that her continued life has no value, her wishes should be
respected.
 While humanists generally support voluntary euthanasia, they
also uphold the need for certain safeguards.
 These may include counselling,
 the prevention of pressure on patients,
 clear witnessed instructions from the patient,
 the involvement of several doctors,
 no reasonable hope of recovery–measures.

 There is no rational moral distinction between allowing someone
to die and actively assisting them to die in these circumstances:
 The intention and the outcome (the death of the patient) are
the same in both cases,
 But the more active means is probably the more compassionate
one.

WHAT ARE THE ARGUMENTS FOR
AND AGAINST EUTHANASIA?
8PART

ARGUMENTS FOR
 Euthanasia provides a way to relieve extreme pain.
 Euthanasia provides a way of relief when a person’s
quality of life is low.
 Euthanasia frees up medical funds to help other people.
 It is another case of freedom of choice – the right to
commit suicide.
 People should not be forced to stay alive.
 Speedy termination of physical and emotional suffering.
 Organs can be put to good use.
 Relieve mental suffering for the patient and his relatives.

ARGUMENTS AGAINST
 Euthanasia demeans and devalues the sanctity of human life.
 Euthanasia can become a means of health care cost containment.
 Euthanasia will become non-voluntary.
 Euthanasia would not only be for people who are terminally ill.
 It amounts to murder and it is only God who can take away human
life.
 It destroys life, which has potential that could be yet unknown to
the patient, doctor or the family members.
 It discourages scientists who are looking for a cure for incurable
ailments.
 An irreversible damage.

WHAT IS THE LEGAL POSITION IN
DIFFERENT COUNTRIES?
9PART

TRENDS OF EUTHANASIA IN DIFFERENT COUNTRIES
 Laws around the world vary greatly with regard to euthanasia, and
are constantly subject to change as cultural values shift and
better palliative care, or treatments become available.
 It is legal in some nations, while in others it may be criminalized.
 In some countries there is a divisive public controversy over the
moral, ethical, and legal issues of euthanasia.
 Those who are against euthanasia may argue for the sanctity of
life, while proponents of euthanasia rights emphasize alleviating
suffering, and preserving bodily integrity, self-determination,
and personal autonomy.

TRENDS OF EUTHANASIA IN DIFFERENT COUNTRIES (cont.)
 Countries which have legitimized euthanasia:
 The Netherlands
 Belgium
 Oregon and Washington in the USA
 Switzerland (only assisted suicide)
 India (only passive euthanasia)

THE NETHERLANDS
 Amidst the ongoing debates, the Netherlands became the first
testing ground for the world since it legalized euthanasia on 28th
November 2000.
 Passed by a vote of 104 to 40, the law provides for the addition of
a special “criminal liability exclusion” clause to Article 293 and
294 of the Dutch Penal Code that deals with the offence of
homicide.

THE NETHERLANDS (cont..)
 Allowed for children aged between 12 and 16 years of age, with the
consent of their parents/guardians and for individuals aged 16 years
and over..
 Certain conditions and criteria of practising euthanasia:
 the patient has to be competent and the request voluntary and
intentional,
 the patient has to suffer unbearably,
 euthanasia has to be the last choice,
 euthanasia can be done only by a doctor.

BELGIUM
 The euthanasia law was adopted in 2001.
 Allowed only if the patient is an adult.
 This law defines conditions for doctors to avoid penal punishment.

SWITZERLAND
 Assisted suicide is legitimized, not euthanasia done directly by
patient’s doctor.
 The patient himself commits suicide at special clinics.
 The doctor prescribes a poison which causes death – the patient
himself has to drink the poison, otherwise it is a murder,
considered as a crime.
 “Suicide tourism” – foreigners can come to Switzerland and
commit assisted suicide.

UNITED STATES OF AMERICA
 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.
 Supporters advances arguments of civil rights of terminally ills.
 Opposers say it is to eradicate inconveniently ill elders, ‘the baby
boomers’.

UNITED STATES OF AMERICA (cont..)
 Moreover, some states in the USA including Washington D.C. have
laws that recognise the ‘living wills’ (law to say in advance that
one does not want to be kept alive with artificial means when
there is no hope).
 Impunity of euthanasia has been guaranteed in two states – Ohio
and Iowa.
 With certain conditions e.g.: the patient must be considered
competent and aware of their situation.

UNITED KINGDOM
 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 (i.e. if a doctor gives a patient, in great pain,
a bottle of morphine to take (to commit suicide) when the pain
gets unbearable).
 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, by a 4-1 margin.

CZECH REPUBLIC
 The discussion about euthanasia was completely forbidden in the past by the
communist party – it could be only made after the year 1990.
 Legal norms do not include the term “euthanasia”, but it is indirectly
regulated by numbers of norms, particularly by penal (criminal) code and
civil code.
 The penal code: “If the culprit kills another person out of compassion to
accelerate his unavoidable near death and thereby liberates this person from
cruel pain caused by incurable illness, the court can exceptionally mitigate
the sentence or can refrain from punishment”.

OTHER COUNTRIES
 In Japan : Only “passive” euthanasia is permitted for patients who
have been in a Coma for more than 3 months.
 While in Egypt, or in Islamic countries in general, the popular
Egyptians’ Scholar Sheikh, recently issued a fatwa, equating
euthanasia with murder but allowing the with-holding of
treatment that is deemed useless.

OTHER COUNTRIES (cont..)
 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.
 In Australia, a computerized injection system is in use to
accomplice euthanasia.
 Though not approved, the legal position in Germany, Switzerland,
Poland etc. are comparatively liberal.

LEGAL VALIDITY IN INDIA
10PART

INDIA
 Passive euthanasia is legal in India.
 On 7 March 2011 the Supreme Court of India legalised passive
euthanasia by means of the withdrawal of life support to patients
in a permanent vegetative state.
 The decision was made as part of the verdict in a case involving
Aruna Shanbaug, who had been in a Persistent Vegetative State
(PVS) for 42 years until her death in 2015.

INDIA (cont..)
 The Supreme Court specified two irreversible conditions to permit
Passive Euthanasia:
 The Brain-Dead for whom the ventilator can be switched off
 Those in a Persistent Vegetative State (PVS) for whom the feed
can be tapered out and pain-managing palliatives be added,
according to laid-down international specifications

INDIA (cont..)
The following guidelines were laid down:
 A decision has to be taken to discontinue life support
 either by the parents or the spouse or other close relatives, or
 in the absence of any of them, such a decision can be taken
even by a person or a body of persons acting as a next friend.
 It can also be taken by the doctors attending the patient.
 However, the decision should be taken bona fide in the best
interest of the patient.

INDIA (cont..)
 Even if a decision is taken by the near relatives or doctors or next
friend to withdraw life support, such a decision requires approval
from the High Court concerned.
 When such an application is filled the Chief Justice of the High
Court should forthwith constitute a Bench of at least two Judges
who should decide to grant approval or not.

INDIA (cont..)
 A committee of three reputed doctors to be nominated by the
Bench, who will give report regarding the condition of the patient.
 Before giving the verdict a notice regarding the report should be
given to the close relatives and the State.
 After hearing the parties, the High Court can give its verdict.

SUMMARY
 Euthanasia refers to acts which terminate or shorten life
painlessly in order to end suffering where there is no prospect of
recovery.
 Euthanasia is the most active area of research in contemporary
bioethics.
 Secular humanists advocate in a lot of circumstances voluntary
euthanasia is the morally right course of action.

SUMMARY (cont..)
 But many religious people, however, think that euthanasia is
always morally wrong, regardless of whether the suffering person
really wants to die.
 Euthanasia can be active or passive, voluntary or involuntary.
 Passive euthanasia remains legal in many nations, whereas, active
euthanasia remains legal in some and while in others it may be
criminalized.
 Passive euthanasia is legal in India.

REFERENCES
 Euthanasia.com. Euthanasia Pros and Cons. Web. 10 December 2011.
<http://www.euthanasia.com/prosoncs.html>.
 Kliment, O. Legalizace eutanázie v České republice. Bakalářská práce. Brno: Právnická
fakulta MU, 2008. 36 p.
 Marker, R. L., Hamlon, K. Euthanasia and Assisted Suicide: Frequently Asked Questions.
2010. Web. 10 December 2011.
<http://www.patientsrightscouncil.org/site/frequently-asked-questions->.
 Munzarová, M. Eutanazie, nebo paliativní péče? Praha: Grada Publishing, 2005. 108 p.
 Munzarová, M. a kol. Proč NE eutanazii aneb Být, či nebýt? Kostelní Vydří:
Karmelitánské nakladatelství, 2008. 87 p.
 Náhlíková, J. Eutanázie – správná volba? Bakalářská práce. Brno: Fakulta pedagogická
MU, 2008. 49 p.
 Špinková, M., Špinka, Š. Euthanasie. Víme, o čem mluvíme? Praha: Hospicové občanské
sdružení Cesta domů, 2006. 42 p.
 P.N.Murkey & Konsam Suken Singh, J Indian Acad Forensic Med, 30(2) Euthanasia
[Mercy Killing]

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