Euthanasia: Historical Background, Euthanasia Trends & Present Scenario Across Different Countries, Types, Supporting & Opposing Arguments of Euthanasia

Euthanasia is a practice in which a person who is suffering from a painful and incurable disease or debilitating physical disorder, is put to death after the patient’s consent.

Withholding the treatment the patient was going through, or withdrawing artificial life-support measures, are also ways of allowing them to die peacefully.^[1]

Euthanasia is derived from Greek, where “Eu” means good, and “Thanatos” means death, thereby implying “good death.”^[2]

Euthanasia is popularly known as “mercy killing.” According to this concept, patient suffering should be given higher priority than patient life. And so euthanasia highlights that a person in such a condition where current treatment can bring no improvement in the patient’s health, and reasonable alternatives are absent, has the right to die with dignity.

• In the era before Hippocrates (father of medicine), Euthanasia was a common practice. Physicians took it for granted that they had the right to kill patients, without asking for their permission, when they felt that no treatment could save them.
• However, in the 5th century BC, the famous Hippocratic oath came by, which stated: “I will give no deadly medicine to any one if asked, nor suggest any such counsel.”
• In 1920, a book called “Permitting the Destruction of Life not Worthy of Life” by Alfred Hoche and Karl Binding was published. It was highlighted here that the patients who wish for “death assistance,” should be provided by a doctor, under extremely controlled situations.
• Soon after this, to promote Euthanasia, The Euthanasia Society of England was formed in 1935.
• And then, in 1939, the Nazis misused the concept of Euthanasia by establishing their “Aktion T4” Nazi Euthanasia program. Through this, they conducted widespread mercy killing of newborns and small children who were either very sick, diagnosed with Downs Syndrome, or disabled. They promoted the concept of eliminating “ life unworthy of life.”
• It was in 1996 that Australia’s Northern Territory became the world’s first jurisdiction to legalize euthanasia.
• The Netherlands, in 2001, was the first country to legalize euthanasia.^[3]

According to the current situation, states that have legalized both, euthanasia and assisted suicide are as follows-

1. The Netherlands- Here anyone, above the age of 12, can appeal for this. If the child is below 16 years of age, he/she requires parental concern.
2. Belgium- Euthanasia was legalized here in 2002. No age restriction is present in this country; however, the prime requisite is that there should be the presence of terminal illness.
3. Colombia- In Colombia also, only terminal patients can demand euthanasia.
4. Luxembourg- Since 2009, euthanasia and assisted suicide has been made legal in Luxembourg. According to recent data, it was seen that by the end of 2018, 71 people used this right.^[5]
5. Canada- The minimum age requirement, in this case, is 18 years. Also, the patient should be mentally competent enough to make the right decision.^[4]

Assisted suicide is legal in countries like Japan, Switzerland, Germany, the United States of Washington, Oregon, Colorado, New Jersey, Hawaii, Vermont, Montana, California, etc.

Euthanasia can be of the following types –

Active Euthanasia- It involves a physician’s direct action to end the life of the patient to prevent further suffering. It is practiced only if there is a patient’s consent. It can be done in various ways-

• Administration of a lethal dose of a drug.
• Asphyxiation, whereby a person is deprived of oxygen, can also be done. Carbon monoxide is the most popularly used gas for this purpose.

Passive Euthanasia- Withholding or halting the medical treatment that was appropriate for continuing the life of the patient. It can also include discontinuing the essential requirements, like the supply of food and water, thereby hastening the death of the patient, due to starvation and severe dehydration. It is done at the request of the patient and after analyzing his medical condition. It is comparatively more uncomfortable and slower than the active euthanasia process.

Voluntary Euthanasia- In this, the physician’s act of terminating the life of the patient is only after the patient’s consent to do so and is based on his wishes.

Involuntary Euthanasia- The patient’s consent is not taken into consideration while making this decision, and euthanasia is conducted against his wishes to do so.

Nonvoluntary Euthanasia- This type of euthanasia is practiced in those patients who are mentally not in a state making a decision. Since the patient is not mentally competent in this case, so are the family members who usually decide on their behalf. Ex- The patient is in a state of brain dead or permanent or irreversible coma.

Legitimate Medical Euthanasia- It involves the administration of a treatment, having side effects that help in hastening the death of the patient. Its main aim is to reduce the pain of the patient.

Assisted Suicide- In this type, a patient who desires to take his own life is provided with all the necessary assistance and help to do so. However, the final step is made by the patient himself.^[6]

1. The request for death through Euthanasia should only come from the patient who is terminally ill, and his sufferings are unbearable. It should be voluntary, and the patient’s desire to not live anymore is very genuine.
2. The ongoing medical treatment administered to the patient has no prospect of bringing improvement in the patient’s condition. There are also no other effective alternatives in treating the patient.
3. The patient is aware of his condition and is willing to die for his relief and because of his family, country or any other reason.
4. A physician must conduct euthanasia under proper medical care and attention.
5. Proper safety measures must be incorporated to avoid the misuse of euthanasia by the doctors. Also, it should be ensured that under no circumstances, the doctor intends to cause harm to the patient.

For decades now, euthanasia has been a much-debated topic, with many controversies going around it ever since its inception. Let’s look at the few common arguments generally raised in this regard-

1. Freedom of choice: If a person has the right to live, he must also have a right to die peacefully.
2. The prime motive behind euthanasia is to provide a painless death to a patient already suffering from an incurable disease and intolerably extreme pain. So, euthanasia helps rather than harming
3. As in many underdeveloped and developing nations, there is already a lack of adequate medical facilities like medical professionals and hospital beds. It is due to insufficient funds. So supporters of euthanasia believe that if we have to choose between those patients whose ailment can be treated and then those who wish to die, it’s preferable to choose the former. In case of limited medical facilities, priority should be given to those for whom those said facilities hold a higher value.
4. Burden for the Caregiver- Apart from giving relief to the patient, it also provides comfort to the family members of the patient from the various problems that they go through. The issues range from emotional, social, mental to financial. It reduces their grief of seeing their loved one in immense incurable pain.
5. Legal Point Of View- According to Article 21 of our Constitution, living with dignity is clearly stated. So if a person is living with pride, that is even below the minimum level, then he should have the right to end it.
6. Paving Way For Organ Transplantation- Conducting euthanasia in terminally ill patients, can, in turn, bring a ray of hope in the lives of a patient who is suffering from organ failure and waiting for organ transplantation. Thereby euthanasia also promotes the right of life for the needy patients.
7. The supporters also believe that every right given to people in a society has the risk of getting abused, but still, it’s provided. Then why deny this right of dying peacefully? ^[7]

1. Some people are of a belief that life is sacred, and therefore no one has the right to end it apart from god, no matter what. It disrespects human life.
2. The painful sufferings that one face is because of his/her karma. Therefore, it devalues the karma ideology.
3. It is also against the basic morals and public policy. Moreover, as medical ethics promotes caregiving to the patients, nursing and healing them, so, euthanasia, on the contrary, is entirely against all this. It doesn’t encourage them to live life but instead ends it.
4. Slippery slope- The threat associated with legalizing euthanasia is that it can be misused to promote more involuntary and nonvoluntary euthanasia. It is also called the slippery slope fallacy.
5. Euthanasia can also encourage other groups of people like disabled people to opt for this practice, as this may seem like a more comfortable escape from the problem. It won’t encourage people to fight all odds and live life to the fullest despite all the challenges.
6. Since the foundation of a doctor-patient relationship is mutual trust among each other. So, euthanasia can lower the value of such relations and have a damaging effect on social attitudes. Patients won’t be able to trust physicians anymore.
7. Sometimes patients also come to make such decisions by getting influenced by the external pressure of society, family, etc. They usually feel they are a burden to their family, and hence euthanasia would be the most appropriate option.
8. There have been many times in the past where patients have come out of a coma miraculously after several years.^[7,8]

In a landmark verdict, the Supreme Court of India, on 9th March 2018, gave legal sanction to passive euthanasia or withdrawing the treatment essential for continuing the life of a terminally ill patient or who is in a vegetative state.^[9]

Under this verdict, the apex court mentioned the importance of “living will.” Through this will, the patients will give their consent to withholding the medical treatment being given to them to speed up their death.

• On 11 May 2005, an NGO-” Common Cause” filed a PIL to the Supreme Court. The plan was to seek permission for carrying out passive euthanasia in terminally ill patients.
• After that, a series of legislative meetings took place on this matter for years. No substantial moves were made until the Aruna Shabaug case came over.
• Shanbaug case- Lead to the issuing of a broad set of guidelines legalizing passive euthanasia in the nation.

She was a nurse in King Edward Memorial Hospital, Mumbai, who was brutally strangled and raped by a sweeper on 27 November 1973. This act left her paralyzed with severe brain damage.

Pinki Virani, a social activist and friend of Aruna, filed a petition arguing that she should be allowed to die, as she was already “virtually dead.” But, the plea was rejected by the Supreme Court as the hospital staff said that she responded to food, etc.

However, this sparked a debate on India’s take on euthanasia and the court laid out guidelines that changed the euthanasia laws for the first time, and allowed passive euthanasia on certain grouds.

Aruna Shabaug passed away on 18 May 2015 after spending 42 years in a vegetative state.^[10,11]

However, the judgment passed on 9th March 2018 also makes it very clear that no other form of euthanasia except passive euthanasia is valid till the time any legislation is passed in that regard.

Euthanasia or commonly called mercy killing is a practice of intentionally ending the life of a terminally ill patient or who is in a vegetative state. It is done when the patient is facing extreme unbearable pain due to conditions with no hope of revival.

Based on the patient’s willingness, euthanasia can be of three types that is voluntary, involuntary, and non-voluntary euthanasia. Active euthanasia, passive euthanasia & assisted suicide are also types of euthanasia depending upon the procedure involved.

Euthanasia has been a highly controversial topic around the globe as it revolves around issues of life and death. For some people, it violates the necessary foundation of patient care and medical ethics. On the contrary, others feel that it is essential for providing relief to an incurably ill patient’s life. Only a few countries have legalized both Euthanasia and assisted suicide, although, in many countries, euthanasia alone has been legalized. Countries like Japan, Switzerland, few states of the US, etc. have only made assisted suicide legal.

The need of the hour is to have strict and stringent guidelines in nations where euthanasia has been legalized and ensure they are being implemented. Also, importance should be given to make reporting of all the euthanasia cases mandatory, see whether it is being conducted after taking the second opinion and under proper medical assistance.

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