Euthanasia and Medical Ethics

This assignment discusses the contentious issue of euthanasia, focusing on the balance between personal autonomy, dignity, compassion, ending suffering, protecting the vulnerable, promoting good palliative care, and redefining the physician's role in death and dying. It explores laws and debates surrounding assisted suicide and palliative care in various countries, including the Netherlands, Belgium, Oregon, Washington, Montana, Switzerland, and Great Britain.

Abstract:
The issue of euthanasia is now an ethical question for doctors whose patients are
terminally ill or in a permanent vegetative state. On one hand, we have the "right to
self-determination", on the other hand, there is the code of medical ethics. The
advocates of euthanasia believe that everybody has the right to choose the quality
of life and the end to it. However, the critics argue that the request of euthanasia
made by a terminally ill patient is not done in sound or rational mind. The
"sacredness of life" concept intensely provided by different religions opposes the
right of self-killing.
There is uncertainty of opinion on this matter, which has been debated since long.
Our present discussion will deal with the meaning of euthanasia and its sanctity all
over the world. The article highlights some advantages and disadvantages of
euthanasia practice.
Key words: Euthanasia, ethics and legal issues.
Introduction:
The topic of euthanasia is controversial and ambiguous amongst the common
public, legal and medical professionals. The term euthanasia originated from the
Greek entries for "eu" and "thanatos" Taken in its common usage however,
euthanasia refers to the termination of a person's life, usually with terminal or
incurable illness. [1] Euthanasia means easy death, mercy killing or voluntary
death. In other words, "euthanasia is the termination of the life of the terminally ill
patients at their request or in their interest" [2] This question of ending the life of a
sufferer who, at his request and in the interests of him, has raised moral and ethical
questions, such as: has that person the right to demand the end of his life
(autonomy)? Should the doctor continue his infusion for the purpose of relieving his
severe pain (beneficence)? Whether the act is justifiable. Is it ethical for a medical
health-care provider who holds a Hippocratic Oath (not to harm his patients), to end
the life of such a terminally ill patient?.
The act of another party always entails euthanasia. If more than one thing The
individual participated in a sequence of actions leading to death, which is then
called suicide, if the last person acting in the sequence is the person who dies. If
someone else is the last actor, even if the person who dies agrees that death is
called a murder, even if the one who dies agrees. Euthanasia always has a
particular motive. Intent is the specific objective and the desired results of an act;
the reasons we have are "motifs” Those intentions. Those intentions. The motive is
always necessary for euthanasia Become mercy, and that motive must be altruism,
and its core value. This is what we are talking about. The concept is so embedded in
society that euthanasia is often described as the killing of mercy. Harold Shipman, a

British doctor and serial assassin, is killed and not euthanistic when injecting lethal
patients into the elderly The doses of stupidity so that money left him in their will
could be inherited. Even if his actions actually alleviated some suffering, his motive
invalidates a euthanasia claim. When is a murder euthanasia considered? The
concept of "euthanasia" means a "good" death and the act should therefore fulfil
commonly agreed criteria for Such criteria may be that they are rapid, relatively
painless, and cause Mindful if any, e.g., fear or anxiety, or deep repentance. Death
should not deliberately inspire horror or repulsion, or accompany signs of the dying
person's suffering. The reason is not to be punished. Capitulating, for example,
could be fast and even relatively painless, but it would generally not be seen as an
act of euthanasia because it was usually meant to inspire terror in victims and
witnesses and to punish the recipient.
Different kinds of Euthanasia
Passive euthanasia - The act of deliberation is intended to end the suffering of an
incurably terminally sick woman, typically by careful administering of lethal
medicines. It's a committee act. [1]
“Passive” Euthanasia: A Problematic Term
Purpose and prospect are crucial facets of when an act constitutes euthanasia,
constitutes some form of murder or is indeed a killing act at all in moral and legal
terms. The main purpose of inducing death is euthanasia and suicide. Foresight
includes the design of future results that we may or may not hope for. Any actions
can fairly be supposed to destroy, but may be performed mostly for motives other
than suicide. One example is the discontinuation of medical procedures on an
independent patient's behalf. Patients in the USA have a fundamental right to
decide when they will be doing and we not only value their autonomy but also
comply with the rules as we withhold those therapies. Because we aim at respecting
freedom and not murdering, physician removal in these conditions is neither
suicide, nor euthanasia and even killing, but, considering its foreseen
consequences, death isn't the primary purpose. Some scholars characterize the
denial of life-sustaining services when death is practically a guaranteed
consequence, but not the primary purpose with the word "passive euthanasia." Nine
and a half years after the legitimate right of her parents to quit her ventilator
treatment, Karen Ann Quinlan survived. Her parents commented that their purpose
never was to destroy Karen but to let her live her life, however brief it might be,
without the unworthiness of unnecessary counselling. The law itself acknowledges
the critical distance between motive and foresight: premeditated (intentional)
assassinations are treated differently from.
This includes intentional removal or withdrawal of life-long medication which leads
to the death of the patient. [3] An act of omitting, for example, inability to save
terminally sick people and/or life cycles or life spans, disconnection of feeding
tubes, etc., implies providing for a continuing internal organic degradation
mechanism without the assistance or replacement of essential functions. "Letting
Die" means giving way to a constant inner organic process. The exhumation or
expulsion from a fan of an incurably diseased patient is thus not killing in its real

sense. Nevertheless, it reflects a bodily act leading to death. Exhumation does not
allow death to occur; it merely changes the time of death. [4]
The word passive euthanasia was not unexpectedly defined as a mistake. This
procedure is not recognized as euthanasia in Australia like other countries across
the world. Bartels and Otlowski [1] state that withholding or elimination of life-
long medication "has become an established part of medical practice and is
relatively non-controversial" In reality "passive euthanasia’s" is identified as
"misleading" by the House of Lords Committee on Medicinal Ethics.[5]
Voluntary euthanasia is described as the euthanasia conducted on the patient request.
Involuntary euthanasia means that the patient does not want to relieve their pain, and is in fact the product
of murder, as euthanasia is done. [6] This is against the patient's wishes.
Non-voluntary euthanasia requires cases in which the patient cannot give his permission. Such symptoms may
exist whether the patient is in a comatose or has undergone serious psychiatric illness with serious brain trauma,
etc.
Assisted Suicide or Physician Assisted Suicide (PAS)
Suicide is aided by offering knowledge, advice and means to take a life of the person deliberately. The physician
aided by suicidal methods, for example by supplying knowledge and medications, when a physician purposely
encourages people, on their appeal, to end his life. [6]
Philosophy and religious context
Neither religious supports euthanasia nor proposes it. Islamic authority does not accept the freedom of the individual
to willingly die, relying on a compelling reading of the holy Koran. There are two key explanations for Islamic
claims regarding euthanasia
Existence is holy and the grounds for killing in Islam are not euthanasia/suicide. Allah defines the amount of time
that we exist and supports the purpose in two verses. [7] [5].
Present legal position of Euthanasia in Different Countries
Euthanasia in Netherlands: Active voluntary and physician assisted suicide are
permitted under certain conditions pursuant to the Termination of Life on Request and
Assisted Suicide (Review Procedures) Act 2002.[3]
The Act creates an exemption from
criminal prosecution for physicians who "have compiled with requirements of due care
mentioned in the Act" as well as reporting the case.[10]
Euthanasia may be performed on
adults and in children older than twelve years of age.[1, 3]
Euthanasia in Belgium: Active voluntary euthanasia is legal under the Act Concerning Euthanasia which came
into effect in 2002. Euthanasia can only be granted to those whose suffering involves "a serious and incurable
disorder caused by illness or accident". It imposes an age restriction of eighteen years of age. This act does not
make mention of assisted suicide or physician assisted suicide.[1, 3]
Euthanasia in Switzerland: Euthanasia is illegal, but assisted suicide is not crime when the motives of the
person assisting are for altruistic reasons and not out of self interest. However, there is no law that
regulates this practice.
Euthanasia in Luxembourg: Euthanasia is legal under the Palliative Care/Euthanasia Act 2009, where

it is regulated by a living will or advanced directive. Doctors need to consult with a colleague to assess
whether patients are terminally ill and are suffering from a "grave & incurable condition", and have
repeatedly requested to die.[3]
Euthanasia in Australia: In Australia, active voluntary euthanasia, assisted suicide and physician assisted
suicide (PAS) are illegal. The prohibition of euthanasia and assisted suicide is established in the criminal
legislation of each Australian state, as well as the common law in the states of New South Wales, South
Australia and Victoria. There was a period when the Northern Territory permitted euthanasia and PAS
under the "Rights of Terminally Ill Act (1995)". The act came into effect in 1996 and made Northern
territory the first place in the world to legally permit active voluntary euthanasia and PAS. This Act was
short lived after the Federal Government overturned it in 1997 with the "Euthanasia Laws Act 1997".
This Act denied states the power to legislate to permit euthanasia or assisted suicide.[11]
Euthanasia in UK: Currently in 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
legalized, 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.[4]
Euthanasia in USA: In Oregon, "The Death with Dignity Act" came into effect in 1997 and in
Washington the Washington "Death with Dignity Act" was passed in 2008. These acts have remained
alive despite challenged in the US Supreme Court. Both the above acts permit a competent terminally and
hopelessly ill patient to seek lethal drugs from their doctor. They are required to make two verbal and one
written application which need to be accompanied by a witness; and obtain consent of two doctors. In
terms of performing the task, it is the patient who takes the lethal drugs themselves, and the doctor does not
administer it. These acts specifically prohibit euthanasia, which is defined as the administration of lethal
drugs to the patient by a person other than the patient.[11]
Euthanasia - Indian Perspective
It can be said that in a country like India which is plagued with innumerable problems like illiteracy, poverty,
starvation, infectious disease, lack of basic medical care and facilities the issue of euthanasia seems to be little
irrelevant. In India, euthanasia has no legal status. The practice of euthanasia is still very much considered as
a clear act of offence. Section 309 of IPC deals with attempt to commit suicide and Section 306 deals with
abetment of suicide - both acts are punishable offence. Recently there has been a sincere effort to
decriminalize and abolish Sec 309 of IPC, with a view not to punish the person who has attempted suicide
since such acts are usually done in utter despair mental condition.
The Honorable Supreme Court has clearly indicated that the "Right to Life" guaranteed by Article 21 of the
constitution does not include the right to die. The court held that Article 21 is a provision guaranteeing
protection of life and personal liberty and by no stretch imagination can extinction of life be read into it.
"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" and warrants
punishment under sec 309 of IPC.
The Medical Council of India, in a meeting of its ethics committee in Feb 2008 in relation to euthanasia
opined: Practicing euthanasia shall constitute unethical conduct. However, on specific occasions, the question
of withdrawing supporting devices to sustain cardio-pulmonary function even after brain death shall be
decided by a team of doctors and not merely by treating physician alone.[12]

In a path-breaking judgement, the Supreme Court on Monday 7th March 2011, allowed "passive euthanasia"
of withdrawing life support to patients in permanently vegetative state (PVS) but rejected outright active
euthanasia of ending life through administration of lethal substances. The apex court while framing the
guidelines for passive euthanasia asserted that it would now become the law of the land until Parliament
enacts a suitable legislation to deal with the issue. Refusing mercy killing of Aruna Shanbaug, lying in a
vegetative state for 37 years in a Mumbai hospital, a two- judge bench of justices Markandeya Katju and
Gyan Sudha Mishra, laid a set of tough guidelines under which passive euthanasia can be legalised through
high court monitored mechanism. The bench also asked Parliament to delete Sec 309 IPC as it has become
"anachronistic though it has become constitutionally valid". "A person attempts suicide in depression, and
hence he needs
help, rather than punishment", Justice Katju writing the judgement said. The apex court said though there is
no statutory provision for withdrawing life support system from a person in permanently vegetative state, it
was of the view that "passive euthanasia" could be permissible in certain cases for which it laid down
guidelines and cast the responsibility on high courts to take decisions on pleas for mercy killings.[13]
Methodology
Arguments for and against legalizing Euthanasia
Every patient has a right to decide about his mode of treatment including when and how they should die
based upon the principles of autonomy and self-determination. Autonomy is a concept granting right to a
patient to make decisions relating to their health and life. A patient's own decision taken after all
consideration cannot be argued and challenged. It is his wish either to continue his treatment or withdraw it,
even though the outcome may result into his death. It is argued that as a part of our human rights, there is a
right to make our own decisions and a right to a dignified death. [1]
Beneficence - Advocates of euthanasia expresses the view that the fundamental moral values of society,
compassion and mercy, require that no patient be allowed to suffer unbearably and relieving patient from
their pain and suffering by performing euthanasia will do more good than harm. [14]
According to the proponents of PAS, it becomes ethical and justified when the quality of life of the
terminally ill patient becomes so low that death remains the only justifiable means to relieve suffering. Lack
of any justifiable means of recovery and the dying patient himself making the choice to end his life are
conditions which make euthanasia more justifiable. [15]
In short, it is the extension of patient's right of
autonomy to determine what treatment to be accepted or refused.
Against
Society and various religions believe in the sanctity of life which must be respected and preserved. The
Christian view sees life as a gift from God, who ought not to be offended by taking of that life. [1]
Similarly
the Islamic faith says that "it is the sole prerogative of God to bestow life and to cause death". The
withholding and withdrawing of treatment is permitted when it is futile, as this is seen as allowing the
natural course of death. [16]
Euthanasia is considered as intentionally killing of one human being by another human being which is
equivalent to murder especially active voluntary euthanasia.
Critics of euthanasia argue that the patient's requests for euthanasia are rarely autonomous as most of them

suffering from terminally ill diseases and may not be in sound or rational mind while making such decisions. The
Universal Declaration of Human Rights highlights the importance that "Everyone has the right to life", and
euthanasia contravenes the "right to life".[6]
Right to life does not include right to die.
The Role of Palliative care: It is often argued that pain and suffering experienced by patients can be relieved by
administering appropriate palliative care, making euthanasia a futile measure. According to Norval and
Gwynther[14]
"requests for euthanasia are rarely sustained after good palliative care is established".
Hippocratic Oath and medical profession: Hippocratic Oath which guides the medical profession states, "I will
prescribe regimen for the good of my patients according to my ability and my judgement and never do any harm to
anyone. To please no one will I prescribe a deadly drug, nor give advice that may cause his death". Thus hastening
the death of a patient by means of PAS is in strict contradiction of the medical code of ethics. Any attempt to
practice euthanasia will completely erode the trust and confidence built in the doctor-patient relationship. A
doctor's role is to save the life of a patient and not to terminate it.
Patients from lower socio economic class maybe coerced or forced to request euthanasia by the family members to
curb financial burden involved in the treatment of such terminally ill patient.
Conclusion
The issue of euthanasia is still a contentious issue and the heart of debate is the patient's quality of life and his
right of autonomy. Doctors are at the center of this ethical dilemma as ultimately they are going to perform PAS
and practicing it would seriously undermine and jeopardize the objectives of medical profession. Medical science
is progressing, and we now have better means of controlling the unbearable pain of a terminally ill patient. Even
life of such patients can be prolonged by artificial means. Though these efforts will improve the quality of life,
these methods may prove very costly for the patient's family. Also considering the low ethical levels prevailing in
the society one cannot rule out the possibility of use of such request of passive euthanasia by unscrupulous
relatives for ulterior motives. Though the recent Supreme Court judgment gave a big boost to the proponents of
euthanasia, there is still a scope of its misuse. Major issues concerned with it need to be efficiently and
effectively
addressed before it becomes a law. By that time, maybe the state and the law can
play the role of parents patriae as suggested in the above landmark judgment
The moral limits of relieving suffering at the end of life, and where our
responsibilities as physicians should lie, are more frequently debated as populations
age and the diseases and disabilities of old age present increasing challenges. In
the balance are crucial issues: personal autonomy, dignity, compassion, ending
suffering, protection of the vulnerable, promotion of good palliative care, and
redefinition of the role of the physician in death and dying. In the last 15 years, the
Netherlands, Belgium, and three states (Oregon, Washington and Montana) have
passed laws permitting physician-assisted suicide and/or euthanasia. In Switzerland,
the law even permits assisted suicide by non-physicians. Debate about assisted
suicide is currently in full swing in Great Britain, where prosecution of family