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Essay: Euthanasia research – concept and value of life, laws, case studies

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  • Published: 3 February 2022*
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As we as a general population have aged diseases which were rare only a few decades ago are manifesting themselves. Dementia related conditions, cancer wasting diseases have now reached their peak epidemic proportion.

Medical technology has progressed over recent years to a point where bodies can be kept alive by artificial means. As a result today many patients face long enduring periods attached to wires and tubes. Many of them ask to be helped to die instead of enduring these indignities and dying in agony.

Life and death as concepts have invited many a thinker, philosopher, writer and physician to define or describe them. Sometimes attempts have been made or efforts have been undertaken to gloriously paint the pictures of both in many a colour and shade. Swami Vivekananda expects one to understand that life is the lamp that is constantly burning out and further suggests that if one wants to have life, one has to die every moment for it. John Dryden, an illustrious English author, considers life a cheat and says that men favour the deceit. No one considers that the goal of life is the grave. Léon Montenaeken would like to describe life as short, a little hoping, a little dreaming and then good night. The famous poet Dylan Thomas would state ―do not go gentle into that good night.‖ One may like to compare life with constant restless moment spent in fear of extinction of a valued vapour; and another may sincerely believe that it is beyond any conceivable metaphor. A metaphysical poet like John Donne, in his inimitable manner, says:-

―One short sleep past, we wake eternally, And death shall be no more; death, thou shalt die‖.

Some would say with profound wisdom that life is to be lived only for pleasure and others with equal wise pragmatism would proclaim that life is meant for the realization of divinity within one because that is where one feels the ―self, the individuality and one‘s own real identity.

Dharmaraj Yudhisthira may express that though man sees that death takes place every moment, yet he feels that the silence of death would not disturb him and nothing could be more surprising than the said thought. Yet others feel that one should never be concerned about the uncertain death and live life-embracing hedonism till death comes, death is complicated and life is a phenomenon, which possibly intends to keep away from negatives that try to attack the virtue and vigour of life from any arena. In spite of all the statements, references and utterances, be it mystical, philosophical or psychological, the fact remains, at least on the basis of conceptual majority, that people love to live – whether at eighty or eighteen – and do not, in actuality, intend to treat life like an ―autumn leaf. As Alfred Tennyson says: ―No life that breathes with human breath has ever truly longed for death. The perception is not always the same at every stage. There comes a phase in life when the spring of life is frozen, the rain of circulation becomes dry, the movement of body becomes motionless, the rainbow of life becomes colourless and the word ̳life‘ which one calls a dance in space and time becomes still and blurred and the inevitable death comes near to hold it as an octopus gripping firmly with its tentacles so that the person ―shall rise up never

DEFINITION: Euthanasia is derived from a Greek Term which means ‘good death’ is the practice of intentionally ending a life to relieve pain and suffering. It is also commonly known as ‘Mercy Killing’. It is delivered by an intravenous injection of sodium pentobarbital. “a deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering”. Euthanasia and assisted suicide involve taking deliberate action (‘intention’) to end or assist in ending the life of another person on compassionate ground.

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.”

However, the laws of Euthanasia differ from country to country and this affects the perspective of looking at this term in both positive and negative ways.

Euthanasia is divided into three parts, namely:

  • Voluntary Euthanasia
  • Non Voluntary Euthanasia
  • Involuntary Euthanasia

Voluntary Euthanasia: It is conducted with the consent of the patient. Active voluntary euthanasia is legal in Belgium, Luxembourg and the Netherlands.

Non voluntary Euthanasia: It is conducted when the consent of the patient is unavailable. One of the examples includes child euthanasia, which is illegal worldwide but compensated under certain specific circumstances in the Netherlands under the Groningen Protocol. There is also a debate whether non voluntary euthanasia can be disregarded and not given the term ‘euthanasia’ as it is more of a crime as killing of patients occurs without any consent.

Involuntary Euthanasia: is conducted against the will of the patient. This too has been undergoing a debate of whether terminalisation of the term ‘euthanasia’ is possible because it is a crime.

Voluntary, non-voluntary and involuntary types can be further divided into passive or active variants.

  • Passive euthanasia consists of the withholding treatment necessary for the continuance of life.
  • Active euthanasia consists of the use of lethal substances or forces (such as administering a lethal injection), it is regarded as controversial.

The place of euthanasia in the history of medical ethics

The actions of easy death have been applied for patients who have been suffering extreme pain since ancient ages. Euthanasia has been forbidden from time to time Assyrian physicians forbade euthanasia in Mesopotamia. In India during the old times incurable patients were drowned in the River Ganges. Some books state that frankincense was given to kill incurable patients in Israel. Since the Jews follow the teaching of the bible and the 10 commandments, the 6th commandment being ‘THOU SHALL NOT KILL’ they rejected any possible theory of shortening someone life even if the person is physically disabled or incapable to live. In the middle ages in europe, Christians opposed euthanasia for the same reason the Jews did and so did Islam oppose to euthanasia. They all put out one argument that states that God is the only one who decides when a person should die. In ancient Greece, physicians gave people who were suffering something called the poisoned drink to help end their misery. Although Pythagoras and his pupils were against euthanasia saying that its not what God intended and that people should die as and when God intended for them to do so. In Rome euthanasia was a crime and was regarded as murder although history states that in Rome sick newborn babies were left out overnight exposed to elements.

The first objection to euthanasia came from the Hippocratic oath that doctors takes which stated that ‘I will not administer poison to anyone when asked to do so, now will I suggest such a course.’

Is Euthanasia legal?

People have debated over the ethics and legality of euthanasia and Physician Assisted Suicide for centuries. Today laws about euthanasia and PAS are different across states and countries. There are certain restrictions by law to PAS in addition many states currently have PAS measures on legislative ballots and so the list may grow.

Mentioned below are some countries with legal PAS-

Inside the United States:

  • Washington
  • California
  • Colarado
  • Vermount
  • Montana
  • Washington DC
  • Hawaii [beginning in 2019]

Outside the united states:

  • Switzerland
  • Germany
  • Japan
  • Belgium
  • Luxemberg
  • Colombia
  • Canada

The number of states/countries that allow the practice of PAS is growing by everyone state per 50 months. Although this may not be accurate as these are fluctuations in the scale.

Animal Euthanasia

Euthanasia is considered to be the most compassionate, kindest and a painless method of putting an animal to sleep. However, even today many animals around the world have to face a painful death because of the use of many unacceptable, cruel and outdated methods.

Many animal shelters and support groups cannot house all the unwanted, injured, abandoned and diseased animals and await their natural death. As a result, these so called unwanted and surplus animals become victims of inhumane methods which rarely provide instant death and the animal has to suffer a lot before it can die. These methods include suffocating the animals by locking them in gas chambers, electrocuting them, decompression, shooting, drowning or poisoning them. These methods aren’t just cruel, but they also cause the animal a lot of trauma. The animals go through a lot of horror and stress when they see their other friends struggling. As a result, it is always better to euthanize animals because at least they can die in peace instead of having a traumatic death. Some shelters have undertaken euthanasia and have bid farewell to the other cruel ways. It also frees the animal from living a life with some incurable illness. Euthanasia should always be performed by a well trained veterinarian, who is also caring at the same time. However, the decision to perform euthanasia should never be taken haphazardly because animal euthanasia imposes a lot of ethical and moral concerns on the veterinarian performing it. Many a times, the animal does not necessarily need to be euthanized, in such cases, alternative methods like looking out for other medical aid, or in case of an abandoned animal, finding a new shelter should be taken into consideration. Animal euthanasia has been legalised all over the world, however, it should be performed with caution and shouldn’t be misused.

An equally difficult dilemma is faced by veterinarians when an animal they are treating is going through a painful and incurable phase, and its owners aren’t ready to get it euthanized. Euthanizing your furry pal can be an emotionally draining situation for everyone, however, when relevant and needed it surely benefits the animal as it is freed from a traumatic and a stressful phase and can die a peaceful death.

There have been cases wherein owners have got their healthy pets euthanized only because they felt that they were burden for them and couldn’t be looked after. It is the duty of the veterinarian and animal shelters to do a thorough medical check of the animal before having it euthanized.

Finally, as a civilised human being we must always remember that just like us our furry friends too have the right to survive with dignity and also depart from this world in a dignified manner.

Cultural views on Euthanasia

As we know that the Supreme Court has recognised the right to die with dignity as a fundamental right, there still are some major hurdles that surely will be posed by the religious communities who mostly oppose euthanasia in India.

THE QUESTION IS : HOW WILL INDIA ACCEPT PASSIVE EUTHANASIA?

Now that medical professionals claim that passive euthanasia is already common in most of the hospitals all across the country; the probable reason behind this is that many poor terminally ill patients or their family members choose to withdraw treatment because of the huge costs involved in the same.But there are some who can afford such treatment, thus maintaining life.

Earlier diseases outcome was discussed in terms of cure but now as we are now in a contemporary world full of diseases like AIDS, cancer, diabetes, hypertension, mental illness we are now to debate in terms of care, since cure is distant.

Public health experts said it is essential to assess the mental health status of individuals seeking euthanasia.The main reasons for opting euthanasia are:

  • Depression
  • Hopelessness
  • Pain & lack of care.

If patients are taken good care of then they themselves can overcome their decision on euthanasia. Also studies were conducted to check this and it was found that when patients get adequate palliative care the request for euthanasia decreases. People are actually not aware of modern pain management techniques….

India does not have a comprehensive law on End of Life decision making. However the Supreme Court is one step forward in handing control over to the individual.

I personally feel that as a society we need to normalise death and remove the taboo around discussing it.All doctors need to be aware of the basic principles of palliative care so that we can atleast offer care when cure is no longer possible!

Also that the INDIAN attitude towards life and death needs to be modified..

Because no one will kill themselves for selfish motives or something like that its basically when a person is unable to bear with painful situations or cant afford the costly modern techniques that they will opt PAS( Physician assisted suicide) or Euthanasia. Therefore there is need to educate the society, about the plus points of Euthanasia, as to why a person should have the freedom to go for it and also under what circumstances, thus creating awareness.

But still the debate on Euthanasia in India is more confusing as there is a law here that punishes individuals who even try to commit suicide. Bearing in mind the present day conditions of our country I probably feel that there will soon be a day when EUTHANASIA will be officially accepted in our country mostly by all cultures!

Arguments for or against active euthanasia that are based upon ethical and moral and religious believes are impossible to resolve on the basis of logical arguments or empirical facts; these arguments are related to cultural practices and views. But practices and values can change over time, some practices that were considered barbaric and horrible at one time in history have now become acceptable in the 21st century. One of the central and main issues in the acceptance of euthanasia is weighing society’s obligations to provide an easier access to death against society’s obligations to provide the means for diminishing suffering and pain of those who wish to die a premature death by euthanasia.

A five-judge bench, headed by Justice J. S. Verma, in Gian Kaur vs State of Punjab in 1994 had held that both assisted suicide and euthanasia were unlawful. The bench stated that the right to life did not include the right to die, hence overruling the two-judge bench decision in P. Rathinam vs Union of India which struck down section 309 of Indian Penal Code (attempt to suicide) as unconstitutional.

In the Gian Kaur case, the apex court held that Article 21 speaks of life with dignity, and only aspects of life which make it more dignified could be read into this Article, thereby pointing out that the right to die was inconsistent with it.

Passive euthanasia has recently been legalized in India [march 2018] but the patient must consent through living will and must be either terminally ill or in vegetative state. This decision was made keep in mind the case of Aruna Shanbaug the sad part is that they rejected her plea for euthanasia and she had to suffer and live being in a coma for 42 years and then dying by getting pneumonia. Although active euthanasia is still illegal in India but I guess it’s a start for all of us. But we genuinely hope some day our government and the world sets aside their religious and cultural beliefs and realizes that its wrong to keep a person suffering for a long period of time. Its devastating to kill someone but if that means putting an end to their misery then I don’t think its really wrong.

CASE STUDIES ON EUTHANASIA-

CASE STUDY 1.

On the night of Nov 27,1973, A 25 years old bubbly, spunky nurse, Miss Aruna) from Kerala, was strangulated by a dog chain. She was then sodomized in the basement of Mumbai’s King Edward Memorial Hospital by a ward boy a day before she was proceeding for her weeding with her Doctor Fiancée. The ward boy walked free from jail after seven years of imprisonment and is supposedly working in a Delhi Hospital.

The strangulation caused hypoxic damage to her brain cells and left her paralyzed, blind and deaf – virtually a vegetable and did not see sun-light for three and half decades. She had been lying in an old room with no contact to the outside world. She was religiously and sincerely fed by the sisters of the hospital; also looked after by the hospital. No one from her family was concerned about her existence. Her parents expired. Pinki Virani, a journalist from Mumbai brought this incidence to light through newspaper and published a book on Aruna’s state. Pinki Virani, in 1999 single handedly filed a case saying Aruna should be allowed to die with dignity. The Supreme Court admitted the plea. On 07 March 2011 Supreme Court passed its landmark Judgment on passive euthanasia though it rejected the appeal of mercy killing in case of Aruna.

CASE STUDY 2.

A 77 years old brain dead South Korean woman died one Sunday more than 200 days after being taken off life support, in the country’s first case of legal euthanasia in Seoul. A woman identified only by her family name, Kim, was pronounced dead in afternoon, 202 days after her life support system was removed in accordance with her family’s wishes and a court order. A court in December 2008 approved the family’s request, saying that the patient had no chance of recovery and that her wish to die could be inferred. The higher Court upheld the lower court’s decision in favour of the children. According to the doctors of University Health System, that runs the Hospital, she continued to breathe on her own after her respirator was removed on 23 June 2009. This case has stoked up huge public debate over a person’s right to “die with dignity.”

THE SUPREME COURT’S VERDICT-

  • An adult human being of conscious mind is fully entitled to refuse medical treatment or to decide not to take medical treatment and may decide to embrace the death in natural way.
  • Euthanasia as the meaning of words suggest is an act which leads to a good death. Some positive act is necessary to characterize the action as Euthanasia. Euthanasia is also commonly called “assisted suicide” due to the above reasons.
  • We are thus of the opinion that the right not to take a life saving treatment by a person, who is competent to take an informed decision is not covered by the concept of euthanasia as it is commonly understood but a decision to withdraw life saving treatment by a patient who is competent to take decision as well as with regard to a patient who is not competent to take decision can be termed as passive euthanasia, which is lawful and legally permissible in this country.
  • The right of patient who is incompetent to express his view cannot be outside of fold of Article 21 of the Constitution of India.
  • We also are of the opinion that in cases of incompetent patients who are unable to take an informed decision, “the best interests principle” be applied and such decision be taken by specified competent medical experts and be implemented after providing a cooling period to enable aggrieved person to approach the court of law.
  • An advance medical directive is an individual’s advance exercise of his autonomy on the subject of extent of medical intervention that he wishes to allow upon his own body at a future date, when he may not be in a position to specify his wishes. The purpose and object of advance medical directive is to express the choice of a person regarding medical treatment in an event when he looses capacity to take a decision. The right to execute an advance medical directive is nothing but a step towards protection of aforesaid right by an individual.
  • Right of execution of an advance medical directive by an individual does not depend on any recognition or legislation by a State and we are of the considered opinion that such rights can be exercised by an individual in recognition and in affirmation of his right of bodily integrity and self-determination.

Student 1 – I think it was high time someone actually brought up euthanasia and I’m so glad we were given this opportunity to do so. I did know a little bit about our topic but doing further research actually helped enlighten me about how people support everything else in life but are afraid to support something that could actually end one’s horrible suffering. Doing this project as a group really helped us learn and grow and realize that we as different individuals may have different ideas but at the end of the day its working together and in harmony that makes it fun.

Student 2 – I wasn’t much aware about euthanasia before, because of this project I got to learn about it. I got to learn a lot about life and sciences while browsing for this project. Also because this was a group activity I got to know the views of my group mates regarding euthanasia and also was able to understand it from different perspectives.

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