Euthanasia refers to intentionally ending a life to relieve suffering. It has been debated for centuries, with perspectives varying among medical ethics, religions, and cultures. While some jurisdictions have legalized certain forms with strict rules, euthanasia remains illegal in most places due to views that human life should not be directly terminated. The document traces discussions and practices of euthanasia over time, including its origins in ancient Greece, debates in various eras, modern laws, types (active vs. passive, voluntary vs. involuntary), religious views, and the paradox it poses for medical ethics codes.

2. Euthanasia
• Euthanasia comes from the Greek words: Eu (good) and
Thanatosis (death) and it means "Good Death, "Gentle and
Easy Death." 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.

3. • 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

4. REVIEW
 According to the historian N. D. A. Kemp, the origin of the
contemporary debate on euthanasia started in 1870.
Nevertheless, euthanasia was debated and practiced long
before that date --
 Hippocrates (ca. 460 BC - ca. 370 BC)- Euthanasia was
practiced in Ancient Greece and Roman civilizations as they
opined that there was no need to preserve the life of a person
who had no interest in living, or who thought life as a burden.

5.  1300s- According to the English jurisdiction of the suicide as
well as helping people to kill themselves were considered as a
criminal act. Mercy killing was also not supported by the
ascendancy of Christianity (12th till 15th century).
 1828-The first law against assisted killing, known as anti-
euthanasia was passed in New York.

6.  1870- In this year, Samuel Williams suggested the use of
morphine and analgesic medications for assisting quick and
painless death.
 1885- Exactly 15 years after Samuel Williams raised the
proposal, the American Medical Association strongly denied
the use of analgesic for euthanasia.
 Beginning of 20th century - mercy killing and assisted killing
already entered the minds of the public.

7.  1905-A bill for making it legal was circulated in Ohio, but it failed.
A similar bill was introduced in the next year, which also failed.
 1935-The first group for legalization of euthanasia, called Voluntary
Euthanasia Legislation Society (VELS), was founded by a group of
doctors in London.
 1938- A similar organization, known as National Society for the
Legalization of Euthanasia (NSLE) came into existence. Till date,
many cases of physician-assisted suicide have been fought in the
court.

8.  1940- Non-voluntary euthanasia was practiced for the first
time by German physicians, to eliminate the diseased and
disabled Germans in closed gas chambers. The main purpose
of the program was to get rid of handicapped children and
people with psychiatric problems.
 1945- It was estimated that 300,000 Germans had been killed.
 20th century- Marked the formation of several organizations
for addressing the concerns regarding euthanasia.

9. 1986- Doctor Joseph Hassman was charged guilty for administering a
lethal dose of Demerol to his mother-in-law. He was fined and
sentenced to two years imprisonment for the act.
1994-Netherlands it is the first country where euthanasia has been
allowed.
1999- Euthanasia became a public issue, with the imprisonment of Dr.
Jack Kevorkian for conducting voluntary euthanasia on Thomas Youk ,
who was in the final stage of ALS . Kevorkian was charged with
second-degree murder, and he served eight years in prison . It was
claimed that he had exercised euthanasia for at least 130 other patients.

10. • 2001: The euthanasia law was adopted in Belgium -this law
defines conditions for doctors to avoid penal punishment.
• 2008: U.S. state of Washington legalizes assisted suicide

11.  The debate on euthanasia and assisting suicide is still
going on, and is expected to continue in the coming years.
 There are both pros and cons of euthanasia and whether to
stand for or against mercy killing depends on the ideology
and understanding of each individual.
 In a survey, approximately 60 - 80 percent people in the
western countries favor physician-assisted suicide for
terminally ill patients.

12. Types of euthanasia
Passive
Active
Voluntary
Involuntary
Assisted
Indirect

13. • Active euthanasia
o It is when death is brought by an act for example taking a high
dose of drugs, lethal injection.
o To end a person’s life by the use of drugs, either by oneself or
by the aid of a physician.
• Passive euthanasia
o When death is brought by an omission eg: When someone lets
the person die, this can be done by withdrawing or
withholding treatment.

14. • 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.

15. • Voluntary euthanasia is committed with the willing or
autonomous cooperation of the subject. This means that the
subject is free from direct or indirect pressure from others.
• Non voluntary euthanasia occurs when the patient is
unconscious or unable to make a meaningful choice between
living and dying, and an appropriate person takes that decision
for him/her.
• This is usually called murder, but it is possible to imagine
cases where the killing would count as a favor for the patient.

16. • Indirect euthanasia
o This means providing treatments -mainly to reduce pain- that has a side
effect of shortening the patient’s life.
o Since the primary intent wasn’t to kill, it is morally accepted by some
people.
• Assisted suicide
This usually refers to cases where the persons who are going to die need
help to kill themselves and ask for it.
o It may be something as simple as getting drugs for the person, and
putting those drugs within their reach.

17. Laws
• In Europe, Euthanasia is only legal in the Netherlands and Belgium, provided
certain conditions are met.
 The patient’s request must be voluntary and well considered.
 The patient must be suffering unbearable physical or mental suffering, with no
prospect of relief.
 The patient must be informed about their situation and prospects.
 At least one other, independent, doctor must be consulted.
• In Belgium euthanasia is only allowed if the patient is an adult.
• However, in the Netherlands euthanasia is 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.

18. • Assisted suicide is legal in the Netherlands , Switzerland and the state of
Oregon in the US but have certain conditions eg : the patient must be
considered competent and aware of their situation .
• 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.

22. Religions
Those in favor of euthanasia argue that a civilized society should allow
people to die in dignity and without pain.
They add that as suicide is not a crime, euthanasia should not be a
crime.
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.

23. Religious views on euthanasia
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 ) say 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.

24. 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.

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

26. 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."

28. Euthanasia and code of medical ethics
• Euthanasia presents a paradox in the code of medical ethics.
• It involves a contradiction within the Hippocratic oath, which is essentially
the promise to prolong and protect life even when a patient is in the late
and most painful stages of a fatal disease.
• The paradox lies in the fact that while an attempt to prolong life violates the
promise to relieve pain, relief of pain by killing violates the promise to
prolong and protect life.
• This argument of ‘conflict of duties’ was used by the defence in a crucial
case decided by the Dutch High Court in 1984, known as the Alkmaar case.

29.  In this case, a 95 years old lady was unable to eat or drink and subsequently
lost consciousness. On regaining consciousness, she pleaded with her
doctor several times to put an end to her suffering. After discussing with his
assistant physicians and the son of the patient, the doctor agreed to her
request for euthanasia. Later, charged with mercy killing,
 in his defence, the doctor argued that his legal duty to preserve and prolong
life had been in conflict with his duty as a physician to relieve his patient’s
unbearable suffering.
 Though the lower court and the court of appeals rejected this argument,
the High Court suggested that this matter should be considered taking into
account ‘responsible medical opinion’, measured by the ‘prevailing
standards of medical ethics’.

30. The Concept of Living Will
• What if the person doesn’t want to die?
• What if his relatives or family members who are trusted to make a
reasonable and informed decision on the patient’s behalf are impregnated
with malicious and selfish motives?
In order to keep these possibilities at bay, many countries have adopted
concept of living will.
o A living will is a document wherein a person specifies as to how would he
as a patient want to be treated or what actions should be taken for their
health if they become seriously ill or are no longer in a position to make
decisions for themselves or communicate them because of their illness or
incapacity.

31. o Living wills are also called active declarations.
o A living will is thus not an instrument of euthanasia, but a
request to the doctors in advance to give or not to give certain
medical treatments.
Living will has certain advantages –
a) Respects a patient’s right to reject certain medical treatment.
b) They guide family members and relatives in taking difficult
yet crucial decisions.
c) Knowing what the patient wants helps doctors give
treatment accordingly.

32. Euthanasia And Law of Torts
The only assurance that a professional can render to the patient is that he possesses the
required skill and competence while performing the task undertaken.
A medical professional owes certain duties towards the patient –
1. A duty of care in deciding whether to undertake a particular case.
2. A duty of care in deciding what treatment to give.
3. A duty of care to be exercised while administering that treatment properly.
A breach of any of these duties can give the patient a right to sue under negligence.
• Under common law, a doctor cannot lawfully operate on an adult person of sound
mind without their consent.
• But if the person is incapable due to some reasons to give consent the doctor can
undertake the treatment if that is in the best interests of the patient or can save his
life.
• Same is the case of an insensate person who has no chance of recovery if that
patient gives his consent through a living will or otherwise for removal of the
crucial life support system.

33. Euthanasia in torts –
• Imposing a tortuous liability in euthanasia cases can lead to
recovery for assault, battery or intentional infliction of mental
stress.
• Involuntary euthanasia is a battery no matter whether the
person administering it is a specialist or not.
• In action under tort law for euthanasia, it is not always that the
physician is liable.

34. Legal Status of Euthanasia In India
• In India euthanasia in any form wasn’t legal until the very recent Aruna Shaunbaug Case which
reignited the long existing debate in India between right to life and right to die.
• Article 21 has been one of the most controversial elements in the Indian Constitutional history. It
states that –
“No person shall be deprived of his life and personal liberty except according to the procedure
established by law”
The whole debate revolves around the single question whether right to life as provided
under Article 21 also includes right to die? If the provision provides for right to a dignified life, then it
should also include right to die. But inclusion of right to die under Article 21 would contradict with
Section 309 of IPC which states-
“Whoever attempts to commit suicide and does any act towards commission of such offence shall be
punished with simple imprisonment of a term which may extend to one year”

35. • 'Right to Die' is not a fundamental right under Article 21.
• Right to die is included in Article 21 of Constitution came up
for consideration for the first time in Maruti Shripathi Dubal
v. State of Maharashtra Case.
• The Court held that the right to life also includes the right to
die, but did not clearly explain how, life includes death.
Apparently the two cannot coexist. Death is the absence of
life.

36. On 26 April 1994 in P. Rathinam v. Union of India, a two-
judge bench of the Supreme Court through Justice B.L.
Hansaria invalidated section 309 of IPC, on the ground that it
‘violet Article 21’.
On March 21, 1996 in Gian Kour v. State of Punjab, a five
judge Bench of the Court overruled Rathinam and upheld the
validity of section 309 .
It held that 'right to life, under Article 21 of the Constitution,
does not include right to die or right to be killed.

37. • The court made it clear that the 'Right to Life,' including the right to live with
human dignity, would include the existence of such a right till the end of natural
life.
• This also includes the right to a dignified life up to the point of death, including a
dignified procedure of death.
• This may include the right of a dying man to die with dignity, when his life is
ebbing out.
• However, according to the court, the ‘Right to Die’ with dignity at the end of life is
not to be confused with the 'Right to Die' an unnatural death.
• The Court support the views of permitting the termination of life in such cases (e.g.
a dying man, who is terminally ill and is totally dependent on life support systems),
by accelerating the process of natural death, when it was certain and imminent.

38. Aruna Shanbaug case
• Aruna Shanbaug was a nurse working at
the King Edward
Memorial Hospital in Mumbai on 27
November 1973 when she was strangled
and sodomized by Sohanlal Walmiki,a
sweeper.
• During the attack she was strangled with a
chain, and the deprivation of oxygen has
left her in a vegetative state ever since.
• She has been treated at KEM since the
incident and is kept alive by feeding tube.
• On behalf of Aruna, her friend Pinki
Virani, a social activist, filed a petition in
the Supreme Court arguing that the
"continued existence of Aruna is in
violation of her right to live in dignity

39. • The Supreme Court made its decision
on 7 March 2011.
• The court rejected the plea to
discontinue Aruna's life support but
issued a set of broad guidelines
legalising passive euthanasia in India.
• The Supreme Court's decision to
reject the discontinuation of Aruna's
life support was based on the fact the
hospital staff who treat and take care
of her did not support euthanizing her.

40. • For 42 years, she lived as a comatose patient under ventilation
in an almost vegetative state under the care of KEM hospital,
Mumbai.
• She died on 23 May 2015 on removal of life support system.
• She became the face of Indian Euthanasia debate.

41. • In January 2016 on the PIL(Public interest litigation) filed by the NGO ‘Common
Cause’ which emphasized on the ‘living will’ option to be provided to patients, a
constitutional bench of Supreme Court sat down to solve the prevailing
inconsistencies on euthanasia legislation.
• It was argued that ventilators can be torturous and financially draining and possibly
against the patient’s will too.
• The Constitution Bench, led by Justice Anil R. Dave, said it will wait till 20 July
for the government or Parliament to finalize a law on passive euthanasia.
• Medical Treatment of Terminally Ill Patient (Protection of Patients and Medical
Practioners) Bill, 2006 is still pending in the parliament.
• 241st Law Commission also recommended passive euthanasia to be “allowed with
certain safeguards”.

42. Recommendations
 State considers saving lives of its citizens as its duty and
ultimate responsibility for it being a welfare state.
 Deliberately keeping someone alive in utmost painful
condition against his or her wishes, they are doing no welfare.
 For people who are terminally ill but are mentally conscious, it
becomes a horror to see the quality of their lives deteriorate to
worst in front of their eyes and also of their loved ones who
keep on spending lakhs and crores on their treatment only to
see them die ultimately.

43. • It would be more correct to look at it as a way to end the consistent
pain, suffering and torture in a person’s life.
• In India, life of a person has always been considered as most sacred
of all as per its scriptures but the same scriptures mention practices
like Jauhar, etc.
• Jauhar, was the Hindu custom of mass self-immolation by women
in parts of the Indian subcontinent, to avoid capture, enslavement
and rape by invaders, when facing certain defeat during a war.
• Even in Mahabharata, Bheeshma had a boon to live as long as he
wished but then why is he allowed to die on a death bed of arrows as
Pandavas watch him die, is it not suicide? Or murder?

44. • Here are few recommendations that can prove useful in the current Indian
legal environment –
# Section 309 should be deleted from Indian Penal Code as there is nothing
that can hold back those who want to end their lives due to some reason or
the other.
# Those who survive an attempt to commit suicide are mentally and
emotionally distressed and require medical and psychological help rather
than punishment.
# Passive euthanasia and Physician Assisted suicide should be legalized as
recommended by 241st Law Commission.
# Advance healthcare directives and the facility of living will should be
provided to citizens in India. Through living will a person would be able to
easily specify his or her decision in relation to the treatment administered to
him and will thus be able to make an informed consent regarding the same.
# Like United Sates, living wills should be made a legal document in India,
that is, enforceable in the court of law. It should be signed in the presence
of a qualified physician and should be attested by a lawyer.

45. • # In order to counter the misuse of euthanasia option by relatives or
near kin or even the doctors for that matter, a euthanasia panel must
be set up comprising of skilled doctors, lawyers and a representative
from the government who can give proper decision on case to case
basis.
# If a person is no longer in the position to give an informed consent
for euthanasia, the legal guardian or near and dear ones and family
members should decide on his behalf and in their absence, the
matter should go to the court.
# Before euthanasia is finalized for a patient a final recommendation
should be taken from at least 2 doctors who are not related to each
other or to the patient. So that it can be assured that apart from
euthanasia, there does not exist any other option through which the
patient’s life could be saved.
Every person who has a Right to Life should also have a universal
right to relief from pain and suffering.