CHAPTER-1

INTRODUCTION

"It is my belief that death is a friend to whom we should be grateful, for it frees
us from the manifold ills which are our lot." (Mahatma Gandhi)

Right to life is a phrase that describes the belief that a human being has a right
to live, particularly the right not to be killed by another person. Right to life is
the most precious, sacrosanct, inalienable and fundamental right of all the
rights as enshrined in the Indian Constitution under Article 21. It has become a
sanctuary for human values and therefore has been rightly termed as the
"fundamental of fundamental rights”.

At present longevity has become a global reality. The benefits of modern

health research, the conquest of childhood diseases, improved sanitation, new
medications and technical procedures have raised the projected life span for
newborns and contributed to dramatic increase in world population.
Unfortunately, not all long-lived individuals die peacefully. When life is
without quality, when pain and discomfort rob life of its significance, some
persons cry out for release through death-a good death.

Every human being has a right to live a dignified life. Human life is
considered as sacred and it is the right of everyone to cross this worldly
mundane the way one wants. No one wants that he has to suffer in a prolonged
way and thus making his end miserable. If one has the right to lead a healthy
life then also he has a right to leave this world in a peaceful and dignified way.

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Life is meaningful only when one enjoys it but when living is a constant pain,
then life becomes futile. Euthanasia which is an act of killing or bringing about
the death of person who suffers from an incurable disease or condition
especially a painful one for reason of mercy has posed a dilemma before our
legislators that whether it should be legalized or not? The question is whether it
is justified to take someone’s life when one is suffering a lot and there are no
chances of any improvement or we should not interfere in the process of God
because only he has the right to take the life. The trend in the world is shifting
towards legalizing passive euthanasia.

Euthanasia has become a complex global issue for the 21st century, with
different cultures wrestling with the variety of ethical, religious and legal
factors involved in helping someone to die legally. Euthanasia which can be
simply defined as "a good death" or perhaps "a beneficent death" has emerged
as a global end of life issue that has special relevance for the elderly, although
the term embraces all ages. 3 Regardless of the way it is used, the word
euthanasia always evokes strong emotions. While for some people euthanasia
is a manifestation of the individual's autonomy at par with a responsible control
of one's destiny, a compassionate responsiveness to someone's immense
suffering or a clinical imperative to act in the patient's best interest, for other
people euthanasia is tantamount to or merely a euphemism for killing, the
violation of human life and an infringement of the human right to life, being
contradictory to the sanctity of life doctrine and facilitating the abuse of
vulnerable persons.

The word euthanasia evokes emotions, regardless of the way it is used. When
pronounced instead of a rational discourse, separate camps of irreconcilable
proponents and opponents are drawn up. Both fight for dignity, liberty,

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autonomy, rights and humaneness. Few debates in the area of health care result
in such polarization of opinions as euthanasia. While for some people
euthanasia is a manifestation of the individual’s autonomy equal with a
responsible control of one’s destiny, a compassionate responsiveness to
someone’s immense suffering or a clinical imperative to act in the patient’s
best interest, for other people, euthanasia is tantamount to or merely a
euphemism for killing, the violation of human life and an infringement of the
human right to life, being contradictory to the sanctity of life doctrine and
facilitating the abuse of vulnerable persons. The controversies surrounding the
moral acceptability of euthanasia and its decriminalization are characteristic of
the intellectual confrontations in medical ethics and in public debates during
the last decades of the twentieth century and they remain a challenge for our
aging societies in the twenty first century.

An analysis of the ethics of euthanasia is a daunting task. It requires the

application of philosophical ethics, the consideration of the doctor patient
relationship, arguments convening the state's responsibility and the limits
thereof, and the interplay between the factors. The axiom that one should
preserve life above all else cuts the Gordian knot. It is not surprising that the
notion of sanctity of life is promoted as an ethical principle, a guide to
professional practice a legislated requirement. Nonetheless, debate continues
concerning the justification of exalting the sanctity of life above other ethical
considerations, such as welfare and wishes of the patient. The sanctity of the
life principle has an abstract, universal character, in contrast to an actual
patient with particular wishes and individual needs. Society struggles to
achieve consensus on this issue.

3
Historically, religious communities have sought to appropriate death within the
life cycle through rituals of remembrance and religious teachings have
emphasized that death brings meaning to mortality. The process of dying is
often portrayed as an invitation to spiritual insight and a key moment in the
cultivation of spiritual identity. The world’s great traditions of moral wisdom
all begin with a strong predisposition to favor the preservation of life, although
the specific reasons for this conviction vary from tradition to tradition. In this
age of life prolonging medicine, the deliberate decision to end a life generates a
significant amount of religious discussion. Ethical concerns from a religious
perspective likely will become even more central when and if euthanasia enters
the mainstream of medical practice and society struggles to achieve consensus
on this issue.

Euthanasia is an easy, pleasant mode of death. The lucidity offered by the

term’s etymology vanishes as soon as one focuses on the evaluative aspect of
the definition and its diachronic changes the idea of what constitutes a “good”
death has changed in different cultures and throughout history, accompanying
eventual shifts in societies’ moral values. Dominated by religion in the past
and by medicine nowadays, “euthanasia” is far from a monolithic term. This
normative aspect of defining what “dying well” means and the many nuances
built into the term over time are reflected in part on current dictionary entries,
such as the : “Euthanasia- the act or practice of killing or permitting the death
of hopelessly sick or injured individuals in in a relatively painless way for
reasons of mercy”

Dr. Bernheim, along with other right to die advocates I encountered, consider
certain forms of suffering gratuitous to human experience. As a result, they

4
believe that an individual should have the choice to end their life if that is the
only means to eliminate their suffering. Although right to die advocates unite
around the general understanding that certain forms of suffering are
meaningless, they differ in their conceptualizations of what constitutes a valid
form of suffering. The purpose of this dissertation is to explore how advocates
conceptualize their vision of assisted-death practices in relation to notions of
severe suffering acting as the underlying reason for hastening of death.
Furthermore, suffering - a term that lacks strict parameters, yet is the core
reason for the right to die movement - will be examined for its potential to
separate the individual from their desire to live

Currently there are only a handful of countries that have successfully

implemented assisted dying laws in various forms. As of 2018 euthanasia is
accessible in Belgium, Luxembourg, and Quebec while physician assisted-
death is legal in Switzerland as well as the United States in Oregon,
Washington, Montana , New Mexico, California and Vermont . A legal
framework that officially allows for both euthanasia and physician-assisted
suicide exists in the Netherlands and Canada.

Within the community of assisted-death supporters and opponents, the

different terminology is important. The term medical aid in dying allows for
the possibility of including both what has been traditionally termed euthanasia
(lethal dose administered by a medical professional) and what is sometimes
referred to as physician assisted-death (a term that implies medical supervision,
but leaves the act of administering the dose to the patient. The commonly used
term ‘assisted suicide’ refers to aid in dying that may or may not be performed
by a medical professional. However, the medical terms used and the reality of
end of life procedures can often enter grey zones of interpretation; although

5
Belgium only recognizes access to euthanasia, “assisted suicide can be
regarded as being the same euthanasia, providing that all the conditions for the
implementation of euthanasia, as prescribed in the law, have been properly
met”. In Belgium, the difference between physician-assisted death and
euthanasia is rarely distinguished, leaving it up to patient preference. Yet,
certain advocates from all over the world will strongly argue for one over the
other based on strong historical and political narratives.

Unbearable suffering of patients is a major topic in granting a request for PAS.

One of the requirements of due care in both the Dutch and the Belgian
euthanasia acts states that the attending physician must be convinced that the
patient requesting PAS is in a situation of unbearable suffering. Patients who
request PAS present their perceived needs in terms of alleviating their
suffering with assistance in dying.

The World Federation of Right-to-Die Societies claims that its member

societies are spread all over the six continents. No two societies, however, are
alike in their philosophy or practice. Nonetheless, all societies have the mission
to attain a right for the individual to make a decision for himself towards the
end of his/her life. In the same way there is a variety of theological and secular
groups who oppose any attempt towards legalizing euthanasia in any form
advocating the sanctity of life, the argument of slippery slope and the medical
professional ethics. Out of this maze of warring ideological and ethical debate,
almost every country around the world is trying to legalize euthanasia or
physician-assisted-suicide.

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1.1 MEANING AND DEFINITION OF EUTHANASIA

The word “Euthanasia” is derived from the Greek words ‘eu’ and ‘thanotos’
which literally mean “good death”. It is otherwise described as mercy killing.
The death of a terminally ill patient is accelerated through active or passive
means in order to relieve such patient of pain or suffering1.

Euthanasia is a term surrounded by a myriad of questions and concerns. It is a

broad heading for several individual practices that aim to either voluntarily or
involuntarily take the life of another judged to be in severe physical pain either
out of mercy for the individual or for the good of the whole. Throughout
history, euthanasia has been practiced, accepted, hated, or rejected. It is not a
cultural discovery afforded by recent technological advances. Its origins can be
traced as far back as first century Rome. Although this practice has survived
for centuries, it has changed with cultural values and technology.

Euthanasia literally has several meaning:

1. Literally “good death”, any peaceful death.

2. Mercy killing.
3. Physician-assisted suicide, when a doctor provides medication to gently
end life.
4. Physician-attended suicide, a physician killing a terminally ill person at
their request, perhaps by injection or at the request of the patient’s
family.

The British House of Lords Select Committee on Medical Ethics defines

euthanasia as "a deliberate intervention undertaken with the express intention

1
From Wikipedia, the free encyclopedia.

7
of ending a life, to relieve intractable suffering"2. In
the Netherlands and Belgium, euthanasia is understood as "termination of life
by a doctor at the request of a patient". The Dutch law however, does not use
the term 'euthanasia' but includes it under the broader definition of "assisted
suicide and termination of life on request"3.

Euthanasia comes from two Greek words meaning “good death”. In practice, it
has come to mean the selective killing of those who are old or sick.
Worldwide, support for the practice appears to be increasing.

Euthanasia has had different meaning depending on usage. Euthanasia made

their appearance in the fourth and third century BCE. It seems that they were
first used by Greek comedy writers, such as Menander, Posidippus and
Cratinus, in scenes in which a glutton enjoys the good things of life so much
that he wishes to die on the spot. Thus, Menander has the tyrant Dionysius say;
“One thing for my own self I desire—and this seems to me the only death
(monos thanatos) that is a one well died (euthanatos)—to lie on my back with
its many rolls of fat, scarce uttering a word, gasping for breath, while I eat and
say: I am rotting away in pleasure”4.

An astrologer from the second century BC, Vettius Valens, describes a

(physically) good death: those who are born under a certain constellation ‘die
well (euthanatousin) falling asleep from food, satiety, wine, intercourse or
apoplexy’5. It is this kind of sudden, gentle death that the emperor Augustus
wished for himself, according to his biographer Suetonius: ‘For always when

2
Harris, NM. (October 2001). "The euthanasia debate". J R Army Med Corps. 147 (3): 367–70.
3 Unlocking Medical Law and Ethics (2nd ed.). Routledge. p. 374.
4
Menander frg. 23 Edmonds (1961)
5
Anthologiarum libri ix 126

8
he heard that somebody had died fast and without pain he bade for himself and
his family a similar euthanasia, for this is the word he used.

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."
Bacon referred to an "outward euthanasia"—the term "outward" he used to
distinguish from a spiritual concept—the euthanasia "which regards the
preparation of the soul"6.

Euthanasia is a mode or act of inducing or permitting death painlessly as a

relief from suffering “painless inducement of a quick death”. However, it is
argued that this approach fails to properly define euthanasia, as it leaves open a
number of possible actions which would meet the requirements of the
definition, but would not be seen as euthanasia. In particular, these include
situations where a person kills another, painlessly, but for no reason beyond
that of personal gain; or accidental deaths that are quick and painless, but not
intentional.

Oxford English Dictionary defines Euthanasia the painless killing of a patient

suffering from an incurable and painful disease or in an irreversible coma 7.
This approach is included in Marvin Khol and Paul Kurtz's definition of it as "a
mode or act of inducing or permitting death painlessly as a relief from
suffering"

Michael Wreen argued that “the principal thing that distinguishes euthanasia
from intentional killing simpliciter is the agents’s motive: it must be a good

6
Francis Bacon:the major works By Francis Bacon, Brian vickers pp 630
7
Oxford dictionaries. Oxford University Press. April 2010.

9
motive insofar as the good of the person killed is concerned”8. Michael Wreen
attempted to provide an analytical definition of euthanasia. It was
obvious for him that “someone must kill a live creature, or let her die, if
euthanasia is to occur. According to Wreen (1998), person A committed an act
of euthanasia if and only if the following conditions were fulfilled:
1. A killed B or let her die.
2. A intended to kill B.
3. The intention specified in (2) was at least partial cause of the action
specified in (1).
4. The causal journey from the intention specified in (2) to the action specified
in (1) is
more or less in accordance with A's plan of action.
5. A's killing of B is a voluntary action.
6. The motive for the action specified in (1), the motive standing behind the
intention
specified in (2), is the good of the person killed.
7. The good specified in (6) is, or at least includes, the avoidance of evil.

This analytical definition of euthanasia, although staying within the former

broad understanding of euthanasia which subsumes “letting die” as well, is
more precise compared to other definitions. However, not specifying who
decides about the good of B, this definition does not take into account the
difference between voluntary and non-voluntary (or involuntary) euthanasia,
which is of crucial importance. So if groups committed to the fundamental
belief that the intentional killing of another person is wrong, despite having
deep sympathy for those people who are suffering, understand euthanasia as

8
Wreen, Michael (1988) “The definition of Euthanasia” Philosophy and Phenomenological Research 48 (4): 637-653

10
the intentional killing by act or omission of a dependent human being for his or
her alleged.

Definitions such as that offered by the House of Lords Select

Committee on Medical Ethics take this path, where euthanasia is defined as
"a deliberate intervention undertaken with the express intention of ending a
life, to relieve intractable suffering"9. Draper argued that any definition of
euthanasia must incorporate four elements: an agent and a subject; an
intention; a causal proximity, such that the actions of the agent lead to the
outcome; and an outcome. Based on this, she offered a definition incorporating
those elements, stating that euthanasia "must be defined as death that results
from the intention of one person to kill another person, using the most gentle
and painless means possible, that is motivated solely by the best interests of the
person who dies”10.

The American Medical Association’s council on Ethical and judicial Affairs

defines the term as: Euthanasia is commonly defined as the act of bringing
about the death of a hopelessly ill and suffering person in a relatively quick and
painless way for reasons of mercy and purpose of relieving the patients from
intolerable and incurable suffering.

So euthanasia can be defined as the act of putting a person to death painlessly

or allowing them to die by withholding medical services, usually because of a
painful and incurable disease. Mercy killing is another term for euthanasia.

The act or practice of ending the life of an individual suffering from a terminal
illness or an incurable condition, as by lethal injection or the suspension of

9
Harris, NM.(Oct 2001).” The euthanasia debate”. J R ARMY Med Corps 147(3):367-70
10
Draper, Heather (1998). "Euthanasia". In Chadwick, Ruth. Encyclopedia of Applied Ethics. 2. Academic Press

11
extraordinary medical treatment for a quiet, painless death. There is no
euthanasia unless death is intentionally caused by what was done or not done.
These acts include not commencing treatment that would not provide a benefit
to the patient, withdrawing treatment that has been shown to be ineffective, too
burdensome or is unwanted, and the giving of high doses of pain-killer that
may endanger life when they have been shown to be necessary.

TYPES OF EUTHANASIA

Euthanasia is normally classified into five types. The types are classified
according to two main considerations: the degree of consent on the part of the
patient and the way in which the procedure is carried out. Euthanasia can be:

1. Voluntary
2. non-voluntary
3. Involuntary
4. Active
5. Passive

Many legal systems in the world treat all forms as criminal homicide. There
are, however, some places where the legality depends on its type.

When euthanasia occurs at the explicit request of a patient, it is referred to

as voluntary euthanasia. A few governments have rendered this form legal or,
if not completely legal, it has been decriminalized. In some countries,
voluntary euthanasia is classified as homicide, but if a doctor can satisfy
certain legal requirements, it is not considered criminal homicide, and he or she
will not be prosecuted.

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Non-voluntary euthanasia is when a person is unable to give his or her
consent to the procedure, such as when he or she is unconscious, comatose or
legally incompetent. It is also referred to as non-voluntary when a person has
previously expressed his or her wish to die under specific circumstances but
cannot at that moment speak for himself or herself. Children generally are
perceived as legally incompetent — for example, children cannot sign legal
contracts — and this logic applies in the case of euthanasia as well. Child
euthanasia is internationally held to be illegal in almost all cases, although
some places might specify particular circumstances in which it is permitted.

Non-voluntary euthanasia is sometimes erroneously confused

with involuntary euthanasia, which is distinct. The term non-voluntary
signifies that the act is carried out without the patient’s consent, and
involuntary means that it is done against the patient’s expressed will. "Slippery
slope" arguments are often made against all forms on the supposition that
legalizing one form of it might someday lead to cases of involuntary
euthanasia.

In terms of procedural distinctions, there are two types: active and

passive. Active euthanasia implies actions being taken to end another’s life,
such as a lethal substance being administered. Passive euthanasia occurs
when life-saving actions or treatments are willingly withheld. An important
idea behind this distinction is that in "passive euthanasia" the doctors are not
actively killing anyone, they are simply not saving him. While we would
usually applaud someone who saves another person's life, we do not normally
condemn someone for failing to do so. If you rush into a burning building and
carry someone out to safety, you will probably be called a hero. But if you see
a burning building and people screaming for help, and you stand on the

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sidelines -- whether out of fear for your own safety, the belief that an
inexperienced and ill-equipped person like yourself would only get in the way
of the professional firefighters, or whatever -- if you do nothing, few would
judge you for your inaction. You would surely not be prosecuted for homicide.
Thus, proponents of euthanasia say that while we can debate whether active
euthanasia should be legal, there can be no debate about passive euthanasia:
You cannot prosecute someone for failing to save a life. Even if you think it
would be good for people to do X, you cannot make it illegal for people
to not do X, or everyone in the country who did not do X today would have to
be arrested. In many parts of the United States and other countries, it is legally
acceptable for a doctor to acquiesce to a patient’s request to cease the use of
life-sustaining treatments.

Other types of euthanasia have been labeled semi-active, semi-passive,

suicidal, and double-effect euthanasia. Semi-active euthanasia takes place
when a physician disconnects a ventilator from a patient who is in a stable,
vegetative state, as from a massive cerebral infraction, and how has no hope of
regaining consciousness. Semi-passive euthanasia occurs when medical
treatment, nutrition or fluids, are withheld from a person in coma, for example,
from post necrotic cirrhosis or cerebral metastases. Suicidal euthanasia is
exemplified by the patients who intentionally overdose on narcotics, causing
his or her own death. The drugs where prescribed for pain relief.

Another class of actions described in the literature has been designated double-
effect euthanasia. From a moral point of view, it is acceptable that a terminally
ill patient choose a treatment for relief of pain that may lead to death. Such
pain remedy is regarded as ethically justified in that the administrator’s
primary intent is to relieve the dying patient’s suffering, although it is possible

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to foresee the ensuing death. Such action must be based on the patient’s or the
family’s consent. In such a situation, the patient’s suffering is given first
priority, even if the side effect is grievous. Many nurses have participated in
such caring situations. The physician has ordered a dose of morphine, which
the nurse no intention of killing the patient. Even so, the patient dies, and the
nurse may, after the patient’s death, feel guilt for causing death. This is
certainly common and anxiety provoking for the staff. However, as it has
written, “Our moral tradition demands that we act courageously, even though
our actions might result in double-effect euthanasia.

The general legal position all over the world seems to be that while active
euthanasia is illegal unless there is legislation permitting it, passive euthanasia
is legal even without legislation provided certain conditions and safeguards are
maintained.

Active euthanasia is a crime all over the world except where permitted by
legislation. In India active euthanasia is illegal and a crime under section 302
or at least section 304 IPC. Physician assisted suicide is a crime under section
306 IPC (abetment to suicide).

Active euthanasia is taking specific steps to cause the patient's death, such as
injecting the patient with some lethal substance, e.g. sodium pentothal which
causes a person deep sleep in a few seconds and the person instantaneously
and painlessly dies in this deep sleep.

A distinction is sometimes drawn between euthanasia and physician assisted

dying, the difference being in who administers the lethal medication. In
euthanasia, a physician or third party administers it, while in physician assisted

15
suicide it is the patient himself who does it, though on the advice of the doctor.
In many countries/States the latter is legal while the former is not.

The difference between "active" and "passive" euthanasia is that in active

euthanasia, something is done to end the patient's life' while in passive
euthanasia, something is not done that would have preserved the patient's life.
An important idea behind this distinction is that in "passive euthanasia" the
doctors are not actively killing anyone; they are simply not saving him.

While we usually applaud someone who saves another person's life, we do not
normally condemn someone for failing to do so. Thus, proponents of
euthanasia say that while we can debate whether active euthanasia should be
legal, there can be no debate about passive euthanasia: You cannot prosecute
someone for failing to save a life.

James Rachel, the well-known contemporary philosopher, argues that active

and passive euthanasia both requires an action by the doctor. Thomas D.
Sullivan combats Rachel’s view by looking into the moral significance of the
intention. This philosophical analysis outlines classical arguments surrounding
the moral permissibility of active and passive euthanasia.

Difference between active and passive euthanasia is by the human decision to

take decision of another’s life. It is common belief that it is wrong to kill
another human. Committing murder requires an action to end another human’s
life, which makes a person responsible for the death of another. Using this
logic, many are unable to find a moral difference between murder and active
euthanasia. Opponent of active euthanasia deem this action wrong because
they believe the decision to end human life in all circumstances is morally
permissible. On the other hand, passive euthanasia allows no one person to

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take responsibility for a death because the life ending decision is not made.
Only treatment is withdrawn so that death happens naturally. In the case of
passive euthanasia, even though there is knowledge of death coming sooner
due to inaction, death still is not intentional.

Passive euthanasia is commonly defined as a situation in which death occurs in

the course of treating a terminally ill person fore going potentially life-
prolonging measures. This definition of the concept has been explained in
broader terms: “it is not considered obligatory to initiate CPR anti
microbiological therapy, mechanical ventilation, or artificial nutrition and
hydration when it I futile or only marginally helpful”. Furthermore, is argued
that patients are really not obliged to accept different kinds of treatment, such
as surgery or organ transplantation, when crucial body organs fail.

Usually there are following recognized types of euthanasia:

1. Active Euthanasia: A deliberate intervention by someone other than the

person whose life is at stake, solely intended to end the life of the
competent, terminally ill patient who makes a fully voluntary and
persistent request for aid in dying.
2. Physician-Assisted Euthanasia: The physician helps to bring on the
death of the patient by providing the means to do it, but the patient
performs the lethal act on himself or herself.
3. Involuntary Active Euthanasia: Intentionally administering medications
or other interventions to cause the patient’s death when the patient was
competent but without the patient’s explicit request and/or full informed
consent e.g., the patient may not have been asked.
4. Non-Voluntary Active Euthanasia: Intentionally administering
medications or otherwise intervening to cause the patient’s death when

17
 the patient was incompetent and mentally incapable of explicitly
requesting it; e.g., the patient may have been in coma.
5. Indirect Euthanasia: Administering narcotics or other medications to
relieve pain with incidental consequence of causing sufficient
respiratory depression to result in the patient’ death.

Other than these types of euthanasia there has been recognized some more
types of euthanasia viz semi-active, semi-passive, suicidal, and double-effect
euthanasia. Semi-active euthanasia takes place when a physician disconnects a
ventilator from a patient who is in a stable, vegetative state, as from a massive
cerebral infraction, and how has no hope of regaining consciousness.

Semi-passive euthanasia occurs when medical treatment, nutrition or fluids, are

withheld from a person in coma, for example, from post narcotic cirrhosis or
cerebral metastases. Suicidal euthanasia is exemplified by the patients who
intentionally overdose on narcotics causing his or her own death. The drugs
where prescribed for pan relief.

In addition to above types of classifications euthanasia is also classified into

pediatric euthanasia, geriatric euthanasia and battle field euthanasia on the
basis of the persons being subjected to euthanasia. They are the euthanasia
administered to sick infants, aged persons and the persons severely wounded in
the battlefield respectively

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 CHAPTER-2

HISTORY AND ORIGIN OF THE CONCEPT

Euthanasia was practiced in Ancient Greece and Rome, hemlock was

employed as means of hastening death on the island of Kea, a technique also
employed in Marseilles. Euthanasia, in the sense of the deliberate hastening of
a person's death, was supported by Socrates, Plato and Seneca the Elder in the
ancient world, although Hippocrates appears to have spoken against the
practice, writing "I will not prescribe a deadly drug to please someone, nor
give advice that may cause his death". Hippocrates mentioned and opposed
euthanasia in Hippocratic oaths (written about 400 B.C). The ancient Greeks
and Romans 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. Euthanasia has been
accepted both legally and morally during the ancient Greek and Roman
societies.

The Romans and Greeks both believe that “dying decently and rationally
mattered immensely”. The Greeks and Romans were sympathetic to active
voluntary euthanasia provided that act was done for the right reasons such as,
to end the suffering of terminal illness. As a result of this moral acceptance of
active voluntary euthanasia under certain circumstances, Greek and Roman
physicians typically did not feel that they had to prolong human life.

In his work “Utopia” (1516), the English thinker Thomas More addressed the
issue of euthanasia, deeming it legitimate in the case of incurable diseases, but
only with the “permission” of priests and magistrates. In 1605, another English

19
philosopher, Francis Bacon, In his work, Euthanasia medica, he chose this
ancient Greek word and, in doing so, distinguished between euthanasia
interior, the preparation of the soul for death, and euthanasia exterior, which
was intended to make the end of life easier and painless, in exceptional
circumstances by shortening life. His new understanding of science indirectly
affected medicine as well: medicine should include both science and art, which
enables a physician to help the patient to die in an easy and natural way.
According to Bacon, medicine should include both scientific knowledge and
practical skills that enable physicians to help their patients die an easy and
peaceful death. When describing this medical art, he uses the term “euthanasia
exteriori” (a good death coming from outside) (Bacon, 2000). Simultaneously a
good death should come from inside
(euthanasia interiori) in a form of a sweet and calm dying while the soul of the
patient is being prepared (caring for the dying). Apparently Bacon makes use
of the term “euthanasia” in the context used by Suetonius when he reported the
death of the emperor Augustus. By euthanasia Bacon means the quiet peaceful
death of a person who is expecting it. The sense of euthanasia is for him to die
non-violently and painlessly, falling asleep. Sleep is to him, similarly to the
ancient understanding, a metaphor for death. To aid such a peaceful death is an
important task of medicine.The actions of easy death have been applied for
hopeless patients who have been suffering extreme pain since ancient ages.

These actions were forbidden from time to time. In Mesopotamia, Assyrian

physicians forbade euthanasia. Again in the old times incurable patients were
drowned in the River Ganges in India. In ancient Israel, some books wrote that
frankincense was given to kill incurable patients.

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In Sparta, it was the common practice for each newborn male child to be
examined for signs of disability or sickliness which, if found, led to his death.
This practice was regarded as a way to protect the society from unnecessary
burden, or as a way to 'save' the person from the burden of existence.

In ancient Greece, suicide of the patient who was suffering extreme pain and
had an incurable terminal illness was made easy and for this reason, the
physician gave medicine to him. Plato wrote: "Mentally and physically ill
persons should be left to death; they do not have the right to live." Pythagoras
and his pupils were completely against suicide due to their religious beliefs that
the Gods place the man as the protector of the earthly life and he is not allowed
to escape with his own will.

In the Middle Ages in Europe, Christian teaching opposed euthanasia for the
same reason as Judaism. Christianity brought more respect to human beings.
Accordingly, every individual has the right to live since God creates human
beings and they belong to Him and not themselves. Death is for God to decree,
not man.

The enlightenment of the mid seventeenth century, sparked a new interest in

secularist, naturalist, individualist, and anti-clerical thoughts. Thinkers like
Hume, Voltaire, and Montesquieu viewed suicide as a matter of personal
liberty. They believed that given a proper education any man would be capable
of making rational choices, which should be respected by virtue of his
autonomy, that might well lead him to end his life. David Hume contended that
suicide, and by extension euthanasia, were inherent personal rights. As a result
of these beliefs, these thinkers condemned the laws regarding suicide and
euthanasia as an attack on personal liberty that was needless and useless. These

21
thinkers viewed euthanasia as, “an eminently rational act under many
circumstances” that was “immune to religious condemnation”. Towards the
end of the eighteenth century, the masses began to view these enlightenment
ideas, as the result of the French revolution, the reign of terror, and the
Napoleonic wars. Consequently, people viewed enlightenment notions
regarding suicide and euthanasia with contempt and adopted, once again,
traditionally Judeo-Christian views on the subject.

The earliest American statute explicitly to outlaw assisting suicide was enacted
in New York in 1828, Act of Dec. 10, 1828, and many of the new States and
Territories followed New York's example. Between 1857 and 1865, a New
York commission led by Dudley Field drafted a criminal code that prohibited
"aiding" a suicide and, specifically, "furnishing another person with any deadly
weapon or poisonous drug, knowing that such person intends to use such
weapon or drug in taking his own life."

Until the end of the nineteenth century, euthanasia was regarded as a peaceful
death, and the art of its accomplishment

H. Marx, a medical graduate of Jena argued that death either occurs as a

sudden accident or in stages, with mental incapacity preceding the physical.
Philosophy and religion may offer information and comfort, but the Physician
is the best judge of the patient's ailment, and administers alleviation of pain
where cure is impossible.

The first popular advocate of active euthanasia in the nineteenth century, was a
schoolmaster, not a doctor. In 1870 Samuel Williams wrote the first paper to
deal with the concept of 'medicalised' euthanasia. He stated:
"In all cases it should be the duty of the medical attendant, whenever so desired

22
by the patient, to administer chloroform, or any other such anaesthetics as may
by and by supersede chloroform, so as to destroy consciousness at once, and
put the sufferer at once to a quick and painless death; precautions being
adopted to prevent any possible abuse of such duty; and means being taken to
establish beyond any possibility of doubt or question, that the remedy was
applied at the express wish of the patient”.

As Jewish and Christian notions about the sanctity of life and the inherent
worth of the individual spread, euthanasia became increasingly rejected.
People from both Christian and Jewish backgrounds held that all people are
created in the image of God and therefore worthy of respect and care. As
Christianity and Judaism spread, their influence grew and affirmed the
legitimacy of the Hippocratic oath. Ancient culture and thought were
revolutionized by both the Jewish diaspora and the immergence of Christianity.
Early church fathers, in the first few centuries A.D., rejected euthanasia as a
form of homicide and viewed it as an affront to God. According to this view,
those who practice it are committing murder and those who receive it are
rejecting the gift of life given by God. Other world religions, within the first
millennium, such as Hinduism, Sikhism, Buddhism, and Islam held that it was
wrong for one to, “kill themselves or others in order to relive misery”.

Robert Ingersoll argued for euthanasia, stating in 1894 that where someone is
suffering from a terminal illness, such as terminal cancer, they should have a
right to end their pain through suicide. Felix Adler offered a similar approach,
although, unlike Ingersoll, Adler did not reject religion. In fact, he argued from
an Ethical Culture framework. In 1891, Alder argued that those suffering from
overwhelming pain should have the right to commit suicide, and, furthermore,
that it should be permissible for a doctor to assist – thus making Adler the first

23
"prominent American" to argue for suicide in cases where people were
suffering from chronic illness. Both Ingersoll and Adler argued for voluntary
euthanasia of adults suffering from terminal ailments.

The first attempt to legalise euthanasia took place in the United States, when
Henry Hunt introduced legislation into the General Assembly of Ohio in 1906.
Hunt did so at the behest of Anna S. Hall, a wealthy heiress who was a major
figure in the euthanasia movement during the early 20th century in the United
States. Hall had watched her mother die after an extended battle with liver
cancer, and had dedicated herself to ensuring that others would not have to
endure the same suffering.

The New York State Medical Association recommended gentle and easy death.
Even more active euthanasia proposals came to Ohio and Iowa state
legislatures in 1906 and 1907 but these proposals were rejected.

In 1920, two German professors published a small book with the title
'Releasing the destruction of worthless animals' which advocated the killing of
people whose lives were "devoid of value." This book was the base of
involuntary euthanasia in the Third Reich. In this book, authors Alfred Hoche,
M.D., a professor of psychiatry at the University of Freiburg, and Karl
Binding, a professor of law from the University of Leipzig, also argued that
patients who ask for "death assistance" should, under very carefully controlled
conditions, be able to obtain it from a physician. Alfred Hoche also wrote an
essay, which he published as "Permitting the Destruction of Life Not Worthy
of Life." It embraced euthanasia as a proper and legal medical procedure to kill
the weak and vulnerable so as not to taint the human gene.

24
Adolf Hitler admired Hoche's writing and popularised and propagandised the
idea. In 1935,the German Nazi Party accepted euthanasia for crippled children
and "useless and unrehabilitive" patients.

Before 1933, every German doctor took the Hippocratic Oath, with its famous
"do no harm" clause. The Oath required that a doctor's first duty is to his
patient. The Nazis replaced the Hippocratic Oath with the Gesundheit, an oath
to the health of the Nazi state. Thus a German doctor's first duty was now to
promote the interests of the Reich. Anyone in a state institution could be sent
to the gas chambers if it was considered that he could not be rehabilitated for
useful work. The mentally retarded, psychotics, epileptics, old people with
chronic brain syndromes, people with Parkinson's disease, infantile paralysis,
multiple sclerosis, brain tumour etc. were among those killed. The consent of
the patient was absent in this type of euthanasia. This kind was applied by
order. Many people don't realise that, prior to the extermination of Jews by
Nazi Germany, in the so-called "final solution," as many as 350,000 Germans
were sterilized because their gene pool was deemed to be unsuitable to the
Aryan race, many because of physical disability, mental deficiency or
homosexuality.

In January 1936, King George V was given a fatal dose of morphine and
cocaine to hasten his death. At the time he was suffering from cardio-
respiratory failure, and the decision to end his life was made by his physician,
Lord Dawson11. Although this event was kept a secret for over 50 years, the
death of George V coincided with proposed legislation in the House of Lords
to legalise euthanasia12.

11
Ramsay, J H R (28 May 2011). "A king, a doctor, and a convenient death". British Medical Journal. 308 (1445): 1445.
12
Gurney, Edward (1972). "Is There a Right to Die – A Study of the Law of Euthanasia". Cumberland-Samford Law Review. 3:
237.

25
In 1936 the Voluntary Euthanasia Society was founded in England. The next
year the English Parliament (the House of Lords) rejected a proposal to legalise
euthanasia. In opinion polls of those years, euthanasia supporters had around
60% of the votes.

In 1937, 53% of American physicians defended euthanasia. Approximately

2000 physicians and more than 50 religious ministers were among the
members of the American Euthanasia Society. At that time, a majority of
physicians in some American cites defended this subject. In 1938, the
Euthanasia Society of America was established in New York.

In October of 1939, amid the turmoil of the outbreak of war, Hitler ordered
widespread "mercy killing" of the sick and disabled. Code named "Aktion T
4", the Nazi euthanasia program to eliminate "life unworthy of life" at first
focused on newborns and very young children. Midwives and doctors were
required to register children up to age three who showed symptoms of mental
retardation, physical deformity, or other symptoms included on a questionnaire
from the Reich Health Ministry."The Nazi euthanasia program quickly
expanded to include older disabled children and adults. Hitler's decree of
October, 1939, typed on his personal stationery and back dated to Sept. 1,
enlarged 'the authority of certain physicians to be designated by name in such
manner that persons who, according to human judgment, are incurable, can,
upon a most careful diagnosis of their condition of sickness, be accorded a
mercy death”.

In 1939A law proposal for acceptance of euthanasia, was offered to the

government of Great Britain. According to this proposal, a patient had to write
his consent as a living will which must be witnessed by two persons. The will
of the patient had to be accepted in the reports of two physicians. One of these

26
physicians was the attending physician, the other one was the physician of the
Ministry of Health. The will of the patient had to be applied after 7 days and
most of the relatives of the patient had again to speak with him 3 days before
the killing action. But this proposal wasn't accepted.

On 6 January 1949, the Euthanasia Society of America presented to the New

York State Legislature a petition to legalize euthanasia, signed by 379 leading
Protestant and Jewish ministers, the largest group of religious leaders ever to
have taken this stance. A similar petition had been sent to the New York
Legislature in 1947, signed by approximately 1,000 New York physicians.
Catholic religious leaders criticized the petition, saying that such a bill would
"legalize a suicide-murder pact" and a "rationalization of the fifth
commandment of God. The Right Reverend Robert E. McCormick stated that:

"The ultimate object of the Euthanasia Society is based on the Totalitarian

principle that the state is supreme and that the individual does not have the
right to live if his continuance in life is a burden or hindrance to the state. The
Nazis followed this principle and compulsory Euthanasia was practiced as a
part of their program during the recent war. We American citizens of New
York State must ask ourselves this question: 'Are we going to finish Hitler's
job?13

The petition brought tensions between the American Euthanasia Society and
the Catholic Church to a head that contributed to a climate of anti-Catholic
sentiment generally, regarding issues such as birth control, eugenics, and
population control. However, the petition did not result in any legal changes.14

13
The Moncton Transcript. "Ministers Ask Mercy Killing." 6 January 1949.
14
Dowbiggin, Ian (2003). A merciful end: the euthanasia movement in modern America. Oxford University Press. pp. 10–13.

27
Euthanasia was also advocated in the United States during the 1930s. In 1938,
the New York Times announced the formation of a national euthanasia society
that eventually became known as the Euthanasia Society of America. In 1939,
the group had drafted a proposed law permitting voluntary euthanasia. Dr.
Foster Kennedy, the group's president, also called for the legalization of
euthanasia for babies born with birth defects. The incipient euthanasia
movement in the United States grew quiescent in the aftermath of the
Holocaust as the world recoiled in horror to the news that between 1939 and
1945, German doctors killed more than 200,000 disabled people, including
infants and the mentally retarded people.

After the war, organized euthanasia groups continued to exist in the United
States but made little headway until the early 1980s, when societal changes
that began in the 1960s and the resulting weakening of traditional moral
values, as well as intellectual support by some within the medical
intelligentsia, provided fertile ground for renewed euthanasia advocacy. In a
dramatically short period of time, legalized euthanasia went from an
"unthinkable" prospect to one of the most contentious and controversial issues
debated in the public square.

There have been several attempts in the United States to legalize euthanasia
and assisted suicide through state initiatives. The first attempt came in 1988,
when euthanasia supporters attempted to qualify an initiative for the ballot
in California, which would have permitted physicians to administer lethal
injections for terminally ill patients who asked to have their deaths hastened.
The attempt failed to garner enough signatures to qualify for the ballot.
However, in 1991, Initiative 119, a similar proposal, was successfully placed
on Washington's ballot. After initial polling showed voter support in excess of

28
70 percent, the initiative lost 54 to 46 percent. The pattern repeated itself in
California in 1992, when a virtually identical proposal appeared on the
California ballot in November 1992 as Proposition 161. After initial support in
excess of 70 percent, the measure also lost by a margin of 54 to 46 percent.

Two years later, in Oregon, Measure 16—the Oregon Death with Dignity
Act—qualified for the November 1994 ballot. Unlike the earlier failed
initiatives, Measure 16 limited its scope to legalizing physician-assisted
suicide. The measure passed narrowly, 51 to 49 percent. The law was soon
overturned as a violation of the equal protection clause of the Fourteenth
Amendment to the U.S. Constitution. However, this decision was itself
overturned by the Ninth Circuit Court of Appeals on procedural grounds (Lee
v. Oregon ). The United States Supreme Court refused to review the Ninth
Circuit's opinion. An attempt by opponents to repeal Measure 16 through
another ballot initiative, Measure 51, failed in November 1997 by a margin of
60 to 40 percent. The law was in effect as of 1999.

Vacco v. Quill (117 S. Ct. 2293 (1997)), the Supreme Court ruled against
assisted-suicide advocates who had argued that New York's law proscribing
assisted suicide violated the equal protection clause of the Fourteenth
Amendment. They argued that since it is legal for terminally ill persons to
refuse life-sustaining medical treatment and die immediately but illegal for
terminally ill people who do not require life support to secure immediate death
through physician-assisted suicide, New York violated its constitutional
obligation to treat similarly situated people equally. In rejecting the argument,
the Supreme Court ruled that the New York law actually treated similarly
situated people alike: all patients are permitted to refuse unwanted treatment
and none are allowed legal access to assisted suicide. The Court also ruled that

29
there was a significant and rational distinction between refusing life-sustaining
treatment and seeking assisted suicide. In the former circumstance, the doctor's
intention may be to simply stop performing useless procedures when a patient
will not benefit, while in assisted suicide, the doctor must without a doubt
intend for the patient's death. Kevorkian's campaign began on 4 June 1990,
when he assisted the suicide of Janet Adkins, a woman diagnosed with early
Alzheimer's disease. At the time, Michigan had no law against assisted suicide
and Kevorkian was not arrested. His next publicly acknowledged assisted
suicide was conducted on 23 October 1991, when Kevorkian made headlines
for assisting the suicide of two women at the same location, one with multiple
sclerosis and another who complained of chronic, severe pelvic pain.
Kevorkian was arrested for murder but the case was dismissed. The
prosecution appealed and the state legislature hastily cobbled together a poorly
worded, temporary criminal statute proscribing assisted suicide intended to
"stop Kevorkian." Kevorkian openly defied the law and was arrested, tried, and
acquitted.

In Washington v. Glucksburg(117 S. Ct. 2258 (1997), the Supreme Court

justices voted 9–0 that "the asserted 'right' to assistance in committing suicide
is not a fundamental liberty interest protected by the Due Process Clause of the
Fourteenth Amendment." The decision also emphasized that state laws banning
assisted suicide were consistent expressions of the individual states
commitment to protecting all human life.

In Vacco v. Quill (117 S. Ct. 2293 (1997)), the Supreme Court ruled against
assisted-suicide advocates who had argued that New York's law proscribing
assisted suicide violated the equal protection clause of the Fourteenth
Amendment. They argued that since it is legal for terminally ill persons to

30
refuse life-sustaining medical treatment and die immediately but illegal for
terminally ill people who do not require life support to secure immediate death
through physician-assisted suicide, New York violated its constitutional
obligation to treat similarly situated people equally. In rejecting the argument,
the Supreme Court ruled that the New York law actually treated similarly
situated people alike: all patients are permitted to refuse unwanted treatment
and none are allowed legal access to assisted suicide. The Court also ruled that
there was a significant and rational distinction between refusing life-sustaining
treatment and seeking assisted suicide. In the former circumstance, the doctor's
intention may be to simply stop performing useless procedures when a patient
will not benefit, while in assisted suicide, the doctor must without a doubt
intend for the patient's death .Law actually treated similarly situated people
alike: all patients are permitted to refuse unwanted treatment and none are
allowed legal access to assisted suicide. The Court also ruled that there was a
significant and rational distinction between refusing life-sustaining treatment
and seeking assisted suicide. In the former circumstance, the doctor's intention
may be to simply stop performing useless procedures when a patient will not
benefit, while in assisted suicide, the doctor must without a doubt intend for
the patient's death.

The Netherlands has the most experience with physician-hastened death. Both
euthanasia and assisted suicide remain crimes there but doctors who end their
patient’s lives will not be prosecuted if they have followed legal guidelines
such as:

 The request must be made entirely of the patient's own free will.
 The patient must have a long-lasting desire for death.
 The patient must be experiencing unbearable suffering.

31
 There must be no reasonable alternatives to relieve suffering other than
euthanasia.
 The euthanasia or assisted suicide must be reported to the coroner.

These guidelines are similar to those proposed in legalization proposals in the

United States, although the Oregon law requires a terminal illness, a limitation
not included in the Dutch guidelines. On the other hand, the Oregon guidelines
do not require that the patient be experiencing unbearable suffering or that
there be no reasonable alternatives to relieve suffering other than assisted
suicide.

On October 27, 1997 physician-assisted suicide became a legal medical option

for terminally ill Oregonians. The Oregon Death with Dignity Act requires that
the Oregon Health Division (OHD) monitor compliance with the law. The Act
states that ending one’s life in accordance with the law does not constitute
suicide. However, they have used the term “physician-assisted suicide” rather
than “Death with Dignity” to describe the provisions of this law because
physician-assisted suicide is the term used by the public, and by the medical
literature, to describe ending life through the voluntary self-administration of
lethal medications, expressly prescribed by a physician for that purpose. The
Death with Dignity Act legalizes physician assisted suicide, but specifically
prohibits euthanasia, where a physician or other person directly administers a
medication to end another’s life.

There are few countries in the world that allow euthanasia and assisted
suicide. However, the legislation in these countries is completely clear and
does not allow exceptions. Life and death are facts that happen and what
should be sought is to shed all prejudice in regard to the treatment that must be
given to a terminal patient or who has a serious illness. The ethics committees

32
of each hospital must take into account the conditions of the patient, their
relatives, their quality of life situation and the prospective of improvement. In
fact, it is important to wait and demand from the State that the health system is
first and foremost effective and that it has a wide coverage in which all people
can have access to treatments that guarantee their quality of life, in the first
place. After this, we can begin to analyze each specific case, from a
compassionate perspective, of love, of respect for the human rights of the other
and of the transcendence of life, because humans are spiritual beings having a
corporeal experience.

Euthanasia is a highly emotive and sensitive subject, causing disputes and

misunderstandings. As many authors have pointed out, the term euthanasia,
despite its frequent exposure in public media and in academic literature, does
not reflect a clear set of concepts and definitions to be used in euthanasia
debates. Thus, such debates often wind up inadequately formed and
ineffectual, causing more frustration than solutions. It has become clear that
any euthanasia discussion should be preceded by clarifications of the
terminology to be used; semantics followed by ethics.
Nevertheless the concept of euthanasia is not a new topic. It has been
demonstrated that both the concept of euthanasia and the euthanasia discourse
have their roots in Antiquity. The diverse notions of euthanasia as they have
appeared through history were described and their relevance to present day
discussions was highlighted.
Euthanasia is a deliberate act of terminating the life of a competent
(autonomous) patient in the terminal stage of an illness, performed by a
physician upon the explicit and lasting request of this patient and that patient’s
sake. So euthanasia, being different from both assisted suicide and physician

33
assisted suicide, also differs from other instances of end-of-life decisions such
as the withholding or withdrawing of life support or terminal sedation.

2.1 A SHORT HISTORY AND IMPORTANT EVENTS OF

EUTHANASIA
 1906 – First euthanasia bill drafted in Ohio. It does not succeed.
 1935 – Formation of a voluntary euthanasia society in England. Later
known as “Exit” or “The voluntary Euthanasia Society” by Lord
Moynihan and Dr. Killick Millard.
 1936 – King George v receives euthanasia from Lord Dawson
unofficially. Voluntary Euthanasia Bill presented to the House of Lords,
which was rejected.
 1938 – The Euthanasia society of America is founded by the Rev.
Charles Potter in New York
 1939 – “In October of 1939 amid the turmoil of the outbreak of war
Hitler ordered widespread “mercy killing” of the sick and disabled.
 1954 – Joseph Fletcher publishes Morals and Medicine, predicting the
coming controversy over the right to die.
 1957 – Pope Pius XII issues catholic doctrine distinguishing ordinary
from extraordinary means for sustaining life.
 1958 – Oxford law professor Glanville Williams publishes “The
sanctity of Life and the Criminal Law”, proposing that voluntary
euthanasia be allowed for competent, terminally ill patients.
 1958 – Lael Wertenbaker publishes Death of a Man describing how she
helped her husband commit suicide. It is the first book in this genre.
 1967 – The first living will is written by attorney Luis Kutner and his
arguments for it appear in the Indiana Law Journal.

34
 1967 – A right-to-die bill is introduced by Dr. Walter W. Sackett in
Florida’s legislature. It arouses extensive debate but is unsuccessful.
 1968 – The doctor of Harvard Medical School proposes redefining
death to include brain death as well as heart-lung death. Gradually this
definition is accepted.
 1969 – Voluntary euthanasia bill introduced in the Idaho legislation. It
fails
 1969 – Elizabeth Kubler-Ross publishes On Death and Dying, opening
discussion of the once-taboo subject of death.
 1970 – The Euthanasia society (US) finishes distributing 60,000 living
wills.
 1973 – The American Hospital Association adopts a "Patient's Bill of
Rights" which recognizes the right of patients to refuse treatment.
 1973 – Dr. Gertruida Postma, who gave her dying mother a lethal
injection, receives light sentence in the Netherlands. The furor launches
the euthanasia movement in that country (NVVE).
 1974 – The Euthanasia Society of America marked a renewed
dedication in pursuing the legalization of active euthanasia, a
reenergized campaign to seek euthanasia laws through the political
process.
 1975 – Dutch Voluntary Euthanasia Society launches its Member’s Aid
service to give advice to the dying. Receives 25 requests for aid in the
first year.
 1976 – The New Jersey Supreme Court allowed Karen Ann Quinlan’s
parents to disconnect the respiratory that keeps her alive, saying it is
affirming the choice Karen herself would have made. Quinlan case
becomes a legal landmark. But she lives for another eight years.

35
 1976 – California Governor Edmund G. Brown Jr. signs the California
Natural Death Act into law and California becomes the first state in the
nation to grant terminally ill persons the right to authorize withdrawal of
life-sustaining medical treatment when death is believed to be
imminent.
 1977 – Eight states, California, New Mexico, Arkansas, Nevada, Idaho,
Oregon, North Carolina, and Texas had signed right-to-die bills into
law.
 1977 – A people’s initiative asking the Swiss Federal Parliament to
install euthanasia for incurable ill people in the Swiss canton of Zurich
is passed by 203,148 votes to 144822. But the Federal Parliament does
not follow the initiative.
 1978 – Doris Portwood publishes landmark book Commonsense
Suicide: The Final Right. It argues that old people in poor health might
justifiably kill themselves.
 1978 – Whose Life Is It Anyways? , a play about a young artist who
becomes quadriplegic, is staged London and on Broadway, raising
disturbing questions about the right to die. A film version appears in
1982. Simultaneously, Jean’s Way is published in England by Derek
Humphry, describing how he helped his ill wife to die.
 1980 – The World Federation of Right to Die Societies was founded. Its
membership included dozens of organizations from countries around the
world that were concerned with euthanasia and the right to die.
 1980 – Derek Humphry forms the Hemlock Society, a grassroots
euthanasia organization, in Los Angeles. It advocates legal change and
distribute how to die information. This launches the campaign for
assisted dying in America. Hemlock’s national membership will grow to

36
 50,000 within a decade. Right to die societies is also formed the same
year in France Germany and Canada.
 1980 – Pope John Paul II issues the Declaration on Euthanasia,
opposing mercy killing but permitting increased use of painkillers and a
patient's refusal of extraordinary means for sustaining life.
 1980 – World Federation of Right-to-Die societies is formed in Oxford,
England. It comprises of 27 groups from 18 nations.
 1981 – Hemlock publishes how-to suicide guide’ Let Me Die Before I
Wake, the first such book on open sale.
 1982 – EXIT ADMD Suisse Romnade (French speaking part of
Switerland) is founded, followed in April by EXIT (Deutsche Schweiz)
German speaking part of Switzerland as well as Italian speaking part.
Both give at first only information to their member, and after atleast
three months of membership also printed advice how to ends one’s own
life. Later they began to offer assistance to suicide; first with a
combination of medicaments, later with pentobarbital sodium prescribed
by a physician. Assistance to suicide in Switzerland is possible for
everybody since there is no law regulating it. The basis is Article 115 of
the Swiss Criminal code saying that abetting and helping to suicide for
selfish motive is punished up to five year of imprisonment; if somebody
acts without selfish motive, there is no crime.
 1983 – Famous author Arthur Koestler, terminally ill, commits suicide a
year after publishing his reasons. His wife Cynthia, not dying chooses to
commit suicide with him.
 1984 – American Medical Association Supports Withholding or
Withdrawing Life-Prolonging Medical Treatment in Certain
Circumstances. A physician can withhold or withdraw treatment from a

37
 patient who is close to death, and may also discontinue life support of a
patient in a permanent coma.
 1984 – The Netherlands Supreme Court approves voluntary euthanasia
and physician-assisted suicide under strict condition.
 1985 – Betty Rollin publishes “Last Wish” , her account of helping her
mother to die after a long losing battle with breast cancer. The book
becomes a bestseller.
 1986 – Roswell Gilbert, 76, sentenced in Florida to 25 years without
parole for shooting his terminally ill wife. Granted clemency five years
later.
 1987 – The California State Bar Conference passes Resolution #3-4-87
to become the first major public body to approve of physician aid in
dying.
 1988 – The Unitarian Universalist Association of Congregations passes
a national resolution titled "The Right to Die With Dignity." The
resolution favors aid in dying for the terminally ill, thus the Unitarian
Universalist Association of Congregations becomes the first religious
body to affirm a right to die.
 1988 – The Journal of the American Medical Association publishes an
anonymous article entitled "It's Over Debbie." The article describes how
a gynecology resident in a large private hospital had injected a patient
suffering from painful ovarian cancer with an overdose of morphine.
The article stirs controversy and debate, and many condemn the resident
for what he had done.
 1990 – By the early 1990s, the growing interest in the right-to-die
movement became apparent in public opinion surveys. These showed
that more than half of the American public was now in favor of

38
 physician-assisted death and membership of the Hemlock Society rose
dramatically to reach 50,000... With increased public interest, the stage
was set for an explosive swell of activity: in the courts, in professional
medical journals and institutions, and, most significantly, in the homes
of the American people.
 1990 – Dr. Jack Kevorkian assists Janet Adkins, a Hemlock Society
member, in committing suicide in Michigan. Adkins' death is the first of
many suicides in which Dr. Kevorkian assists.
 1990 – Cruzan v. Director, Missouri Department of Health comes
before the United States Supreme Court. The case receives national
attention, as it is the first right-to-die case that the court has agreed to
hear. In 1983, a car acccident had left Nancy Cruzan permanently
unconscious (by most accounts). Her parents requested to withdraw her
feeding tube, but the Missouri Supreme Court refused. The United
States Supreme Court ruled that a competent person has a
constitutionally protected right to refuse any medical treatment, but
upholds Missouri's right to insist on clear and convincing evidence as to
the wishes of patients who do not have decision-making capacity. In
light of the ruling, the Cruzan's lawyer goes back to court with new
evidence as to Nancy's prior wishes, and Nancy's feeding tube is
removed. She dies on December 26th, 1990.
 1990 – Congress passes the Patient Self-Determination Act, requiring
hospitals that receive federal funds to tell patients that they have a right
to demand or refuse treatment.
 1991 – Choice in Dying is formed by the merger of two aid in dying
organizations, Concern for Dying and Society for the Right to Die. The

39
 new organization becomes known for defending patients' rights and
promoting living wills.
 1991 – Washington State introduces ballot Initiative 119 to legalize
"physician-aid-in-dying." The initiative is defeated.
 1992 – California Death with Dignity Act Is Defeated, Act, which
would have allowed physicians to hasten death by actively
administering or prescribing medications for self administration by
suffering, terminally ill patients.
 1993 – Compassion in Dying is founded in Washington state to counsel
the terminally ill and provide information about how to die without
suffering and 'with personal assistance, if necessary, to intentionally
hasten death'. The group sponsors suits challenging state laws against
assisted suicide.
 1994 – The New York State publishes a report that argues against the
legalization of physician-assisted suicide.
 1994 – The Oregon Death-With-Dignity Act is passed, becoming the
first law in American history permitting physician-assisted suicide.
 1997 – President Clinton signs the Assisted Suicide Funding Restriction
Act of 1997, which prohibits the use of federal funds to cause a patient's
death.
 1997 – The Supreme Court said in Washington v. Glucksberg and Vacco
v. Quill that right to die does not have any constitutional provision.
 1997 – Oregonians vote 60 to 40 percent in favor of keeping the Death
with Dignity Act.
 1998 – Jack Kevorkian showed a videotape on National Channel of him
administering a lethal injection to Thomas Youk, a man suffering from
Lou Gehrig's disease.

40
 1998 – Michigan introduces Proposal B to legalize physician-assisted
suicide. The proposal fails by a vote of 29% to 71%.
 1999 – A Michigan court convicts Jack Kevorkian for the murder of
Thomas Youk and sentences him to 10-25 years in prison.
 2000 – Maine introduces a ballot initiative, the Maine Death with
Dignity Act that reads "Should a terminally ill adult, who is of sound
mind, be allowed to ask for and receive a doctor's help to die?" The
initiative is defeated by a margin of 51% to 49%.
 2001 – The Netherlands officially legalizes euthanasia.
 2003 – US Attorney-General John Ashcroft asks the 9th Circuit Court
of Appeals to reverse the finding of a lower court judge that the Oregon
Death With Dignity Act of 1994 does not contravene federal powers.
 2005 – The Terri Schiavo case garners national media attention. Terri
Schiavo had been brain damaged since 1990 when, aged 26, her heart
stopped beating temporarily and oxygen was cut off to her brain. In
1998, her husband Michael Schiavo filed a petition to have her feeding
tube removed. Seven years of legal battles ensued between Michael
Schiavo and Terri's parents, the Schindlers. After a Florida Circuit
Judge ruled that Terri Schiavo's feeding tube be removed and the
Florida Supreme Court overturned "Terri's Law," a law intended to
reinsert the feeding tube, the United States Supreme Court refuses for
the sixth time to intervene in the case. Terri Schiavo dies on Mar. 31,
2005, 13 days after her feeding tube is removed.
 2006 – US Supreme Court, in a 6-3 opinion in Gonzales v. Oregon,
holds that the Controlled Substances Act does not authorize the
Attorney General to ban the use of controlled substances for physician-
assisted suicide. Oregon's Death with Dignity Law is upheld.

41
 2007 – Jack Kevorkian sentenced on Apr. 13, 1999 to 10-25 years in
prison for his role in the euthanasia of Thomas Youk is released on
paroled after serving 8 years.
 2008 – The Luxembourg parliament adopts a law legalizing physician-
assisted suicide and euthanasia.
 2008 – Washington voters approve the Washington Death with Dignity
Act making Washington the second US state to legalize physician-
assisted suicide.
 2008 – Montana district judge Dorothy McCarter rules in the case
of Baxter v. State of Montana that Montana residents have the legal
right to physician assisted suicide, thus making it the third US state to
legalize physician aid in dying.
 2009 – The Montana Supreme Court affirmed 4-3 in the case of Baxter
v. State of Montana that physician-assisted suicide is not "against public
policy" in Montana. The Court further ruled that state law protects
doctors in Montana from prosecution for helping terminally ill patients
die. The court declined to rule on the larger question of whether
physician-assisted suicide is a right guaranteed under Montana's
Constitution.
 2011 – Dr. Jack Kevorkian, the medical pathologist who willfully
helped dozens of terminally ill people end their lives, becoming the
central figure in a national drama surrounding assisted suicide, died on
June 3, 2011. He was 83.

 2011 – The Supreme Court specified two irreversible conditions to

permit Passive Euthanasia Law in its 2011 Law: (I) The brain-dead for
whom the ventilator can be switched off (II) Those in a Persistent
Vegetative State (PVS) for whom the feed can be tapered out and pain-

42
 managing palliatives be added, according to laid-down international
specifications. The same judgement also asked for the scrapping of 309,
the code which penalises those who survive suicide-attempts.

 2012 – Massachusetts voters rejected the Death with Dignity

ballot measure by less than 60,000 votes. The measure would have
legalized physician-assisted suicide by allowing doctors to prescribe a
lethal dosage of medicine to people with less than six months to live.

 2013 – Vermont’s Governor Peter Shumlin signed the "End of Life

Choices” bill into law, which is the first time physician-assisted suicide
has been made legal in the United States via the legislative process. Like
the laws in Oregon and Washington, Vermont’s law implements
safeguards to govern physicians who are now allowed to prescribe
death-inducing medication to terminally ill residents of the state.
 2013 – Physician-Assisted Suicide Ruled Legal by New Mexico Judge.
 2014 – Belgium became the world’s first country to lift all age
restrictions on euthanasia. King Philippe of Belgium signed legislation
that allows children with terminal and incurable illnesses to choose to be
euthanized. The child must be "near death, in 'constant and unbearable
physical' pain with no available treatment." The child must also have
"capacity of discernment and be conscious at the moment of the
request." The request has to be made in writing, confirmed and agreed
upon by the treating physician, confirmed by a second opinion from an
outside doctor, and then the child must undergo psychological testing to
confirm that the child understands the request fully and that test has to
be certified in writing by the psychiatrist. The treating physician is then
required to meet with the child’s parents or legal representative to obtain

43
 their consent in writing. The Netherlands has similar legislation but
prohibits euthanasia for children under 12 years of age.
 2015 – Canada's Supreme Court struck down the country's law that bans
doctor-assisted suicide Friday. The court said the law denies people the
right 'to make decisions concerning their bodily integrity and medical
care' and leaves them 'to endure intolerable suffering.'
 2015 – South African Court Allows Assisted Suicide for terminally ill
man. Robin Stransham-Ford, a 65-year-old man diagnosed with
terminal prostate cancer in 2013, was granted the right to have a doctor
help him end his life by the High Court in Pretoria. Dignity South
Africa, the group that helped bring the case to court, noted that Mr.
Stransham "died peacefully of natural causes" the same day the ruling
was given. State prosecutors had planned to appeal the ruling before
learning of his death. Assisted suicide remains illegal in South Africa,
but Dignity South Africa hoped the ruling would "set in motion the
process of legalizing assisted dying in South Africa." The National
Prosecuting Authority of South Africa stated that the ruling was
"precedent-setting" and could have "far-reaching implications."
 2015 – New Mexico Court Ruling Allowing Physician-Assisted Suicide
Struck Down by Higher Court.
 2015 – California becomes the fifth state to allow so-called physician-
assisted suicide, following Oregon, Washington, Montana, and
Vermont. The new law is modeled after Oregon's. It permits physicians
to provide lethal prescriptions to mentally competent adults who have
been diagnosed with a terminal illness and face the expectation that they
will die within six months.

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 2016 – Physician-Assisted Suicide becomes Legal in Canada.
Physician-assisted suicide can now be performed legally starting with
no restrictions under the Criminal Code. Bill permits physician-assisted
suicide only in cases where the patient's death is 'reasonably
foreseeable.'
 2016 – First Belgian minor granted Euthanasia or Physician-Assisted
Suicide. A 17-year-old has committed doctor-assisted suicide in
Belgium, the first minor to do so under rules adopted in 2014 allowing
euthanasia for people of all ages.
 2016 – Colorado is only the sixth state to approve some form of
physician-assisted death. Its bill was modeled after Oregon's law,
Colorado Public Radio reports. The law requires patients to self-
administer a doctor-prescribed drug.
 2017 – District of Columbia becomes seventh jurisdiction in United
States to legalize Physician-Assisted Suicide.
 2017 – The Australian state of Victoria on Wednesday became the
country's first to legalize assisted dying. After two and a half years of
debate and amendments, Victoria's Lower House ratified the euthanasia
bill, handing a victory to the state government of Premier Daniel
Andrews, who had lobbied heavily for the law. The law allow
Victorians with a terminal, incurable illness — and, in most cases, a life
expectancy of less than six months — to obtain a lethal drug within 10
days of requesting it.
 2017 – Nine State Medical Associations Drop Opposition to Physician-
Assisted Suicide.
 2018 – Hawaii Legalizes Physician-Assisted Suicide it is eighth U.S.
jurisdiction where physician-assisted suicide is legal. The Hawaii

45
 legislation is modeled after the law in Oregon. It allows doctors to
prescribe life-ending drugs to terminally ill patients who are mentally
competent and have a prognosis of six months or less to live. Two
doctors must confirm the terminal diagnosis. The patient must make two
separate requests for life-ending drugs, with a 20-day waiting period
between the first and second request.
 2018 – 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) until her death in 2015. In March 2018, the Supreme Court
of India, passed a historic judgement-law permitting Passive Euthanasia
in the country. This judgment was passed in wake of Pinki Virani’s plea
to the highest court in December 2009 under the Constitutional
provision of “Next Friend”.

2.2 INTERNATIONAL LANDMARK CASES

Euthanasia, either as the "good death" from classical Greek or "mercy killing"
to end unbearable suffering in the dying, has long been a topic of interest in
western civilization. In recent years, public awareness of this discussion about
control over the time of one's death has been informed by a series of well-
publicized events. Dr. Jack Kevorkian and Derek Humphrey and great
supporters of euthanasia campaign and voluntary organizations like “Right-to-
Die” and lot of terminally ill patients and their relatives insisted that patients in

46
a persistent vegetative state, or one who has lost the will to live due to a
terminal a painful disease, be allowed to die according to his own wishes,
peacefully and with minimum pain in his last moments.

Dr. Jack Kevorkian was a pioneer of revolution of voluntary euthanasia, in the

form of Physician Assisted Suicide in the early 90s. In this procedure, the
physicians provide the patient with the lethal drug or agent so that the patient
can kill himself. This era marked the beginning of a series of assisted suicide
cases by the retired pathologists which continued today unabated by the law.
Dr.Jack Koverkian was known as ‘Dr. Death’, since at least 1956, when he
conducted a study picturing patient’s eyes as they die. Results established that
blood vessels in the cornea contract and become invisible as the heart stops
beating. In a 1958 article, he suggested that death row inmates be euthanized
and their bodily organ harvested. In 1960 he proposed using condemned
prisoners for medical experiments. In 1989, quadriplegic, too handicapped to
kill himself, publicly asked for assistance and Dr. Kevorkian began tinkering
on a suicide machine. But a different patient, Janet Kinsen, a 54 year old
Alzeimher patient was the first to test the device. Dr. Kevorkian then provided
services to at least 45 and possibly more satisfied customers. Dr. Kevorkian’s
death machine I a very unique innovation indeed whereby, a patient can end
his life himself. It consists of an injection, which initially injects normal slime
after the patient drips a solution of sedative follows, which is automatically
followed by paralyzing agent and finally by KCI. A recent modification of this
machine allows the patient to inhale CO through a mask via a rubber canister
connected to a cylinder. Dr. Jack has used this machine with minor variations,
to allow his patients to die painlessly at a time chosen by them. In 1997,
however, the US Supreme Court ruled that Americans who want to kill

47
themselves but are physically unable to do so have no constitutional rights to
end their lives.

Derek Huphry, is a journalist and an author who has spent the last 30 years
campaigning for physician assisted death to be an option for the terminally and
hopelessly ill. He started this campaign in 1975 after the death of his wife Jean
from Bone Cancer, which had become so painful and distressing that she took
her own life with his help. There have been many landmark cases which have
influenced the masses regarding euthanasia.

Re. Quinlan. N.J.1976

Karen Ann Quinlan a 21-year-old New Jersey resident, on April 14, 1975,
after an evening out with friends during which she consumed alcohol and
sedatives, stopped breathing and lapsed into a coma. After five months, doctors
diagnosed Quinlan as being in a persistent vegetative state; her parents, who
believed there was no chance of her returning to consciousness and who
wanted to end her suffering, requested that Quinlan be disconnected from the
machines that were sustaining her. When her doctors refused, they took the
case to court — in what became one of the first "right to die" case in U.S.
legal history. The court case soon became center of a national debate on the
definition of life and the right to die; it was considered a case of first
impressions. Ordinary people found themselves wrestling with fundamental
questions of life and death, as medical and legal issues blended into sociology
and theology.

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The Quinlans lost their petition in Superior Court, but they persisted, and
brought their case before the NJ Supreme Court. Led by legal Counsel Paul
Armstrong, now retired Honorable Paul W. Armstrong the NJ Supreme Court
set several legal and medical precedents in its 7-to-0 decision on March 31,
1976.

The court held a new interpretation of the right of privacy, and that Miss
Quinlan’s interest in having her life-support systems disconnected exceeded
the state’s interest in preserving life, so long as medical authorities saw ”no
reasonable possibility” that she would recover. The court also ruled that no one
could be held criminally liable for removing the life-support systems, because
the woman’s death ”would not be homicide, but rather expiration from existing
natural causes.”
The unanimous decision also ruled that Joseph Quinlan be appointed as Karen
Ann’s guardian and that whatever decision he made regarding her care “should
be accepted by society, the overwhelming majority of whose numbers would,
we think, in similar circumstances exercise such a choice in the same way for
themselves or for those closest to them.” This gave the family the right to
determine her medical treatment, including discontinuing extraordinary means.

After the court ruling Karen Ann was gradually weaned from the respirator,
and continued to breathe on her own. That year she was moved to Morris View
Nursing Home where she lived for nine years being fed through a nasogastric
tube. Karen died in her room at the Morris View Nursing Home on June 11,
1985 at 7:01 pm from respiratory failure brought on by acute pneumonia.

Quinlan case led to the creation of living wills, often called advance
directives. These documents outline the personal wishes of an individual in
regard to their choices of “extraordinary means” to maintain life if there is no

49
hope of recovery and to be able to die with dignity. The living will provides a
means that no one else should have to be under the personal burden of making
those decisions for their loved one.

Cruzan v Missouri of Health, U.S.1990

Nancy Cruzan was involved in a serious car wreck which resulted in a

persistent vegetative state. After finding that Cruzan had virtually no chance of
recovery, her parents (Petitioners) requested that the hospital remove terminate
her artificial nutrition and hydration procedures. It was understood that this
would lead to her death. The hospital employees refused to honor the request
without court approval. Under Missouri law, evidence of the incompetent’s
wishes to withdraw the treatment must be proved by clear and convincing
evidence. The Cruzans filed for and received a court order for the feeding tube
to be removed. The trial court ruled that constitutionally, there is a
"fundamental natural right ... to refuse or direct the withholding or withdrawal
of artificial death prolonging procedures when the person has no more
cognitive brain function ... and there is no hope of further recovery.” The court
ruled that Nancy had effectively 'directed' the withdrawal of life support by
telling a friend earlier that year that if she were sick or injured, "she would not
wish to continue her life unless she could live at least halfway normally. The
state of Missouri and Nancy's guardian ad litem both appealed this decision. In
a 4–3 decision, the Supreme Court of Missouri reversed the trial court's
decision. It ruled that no one may refuse treatment for another person, absent
an adequate living will "or the clear and convincing, inherently reliable
evidence absent here. The Cruzans appealed, and in 1989 the Supreme Court of
the United States agreed to hear the case.

50
The legal question was whether the State of Missouri had the right to require
"clear and convincing evidence" for the Cruzans to remove their daughter from
life support. Specifically, the Supreme Court considered whether Missouri was
violating the Due Process Clause of the Fourteenth Amendment by refusing to
remove Nancy's feeding tube. The Due Process Clause provides: "[N]or shall
any State deprive any person of life, liberty, or property, without due process
of law.”15.

Cruzan was the first "right to die" case the Supreme Court had ever heard, and
it proved divisive for the Court.16 In a split 5-4 decision, the Court found in
favor of the Missouri Department of Health and ruled that nothing in the
Constitution prevents the state of Missouri from requiring "clear and
convincing evidence" before terminating life-supporting treatment, upholding
the ruling of the Missouri Supreme Court. Reflecting the controversiality of the
"end of life" issue, five Justices wrote separate opinions about the case.

In a majority opinion by Chief Justice Rehnquist, the Court ruled that

competent individuals have the right to refuse medical treatment under the Due
Process Clause. However, with incompetent individuals, the Court upheld the
state of Missouri's higher standard for evidence of what the person would want
if they were able to make their own decisions. This higher evidentiary standard
was constitutional, the Court ruled, because family members might not always
make decisions that the incompetent person would have agreed with, and those
decisions might lead to actions (like withdrawing life support) that would be
irreversible.

15
"Constitution of the United States: Amendments 11-27". Charters of Freedom. United States National Archives and Records
Administration. Retrieved March 22, 2016.
16
Stefan, Susan (March 2016). Rational Suicide, Irrational Laws. Oxford University Press. ISBN 978-0199981199.

51
Washington v. Glucksberg 521 U.S. 702, 1997

Dr. Harold Glucksberg, a physician; four other physicians; three terminally-ill

patients; and the non-profit organization Compassion in Dying challenged
Washington State's ban against assisted suicide in the Natural Death Act of
1979. They claimed that assisted suicide was a liberty interest protected by the
Due Process Clause of the Fourteenth Amendment to the United States
Constitution. The plaintiff asserted that the Washington ban was
unconstitutional, arguing that the existence of a liberty interest protected by the
Fourteen Amendment allows mentally competent, terminally ill adult to
commit physician-assisted suicide. The court held that the right to assisted
suicide is not a fundamental liberty interest protected by the Due Process
Clause since its practice has been, and continues to be offensive to our national
traditions and practices.

The Chief Justice wrote the majority opinion for the court. His decision
reversed the Ninth Circuit's decision that the ban on physician-assisted suicide
was a violation of the Due Process wrote the majority opinion for the court.
His decision reversed the Ninth Circuit's decision that the ban on physician-
assisted suicide was a violation of the Due Process Clause. The Court held that
because assisted suicide is not a fundamental liberty interest, it was not
protected under the Fourteenth Amendment. As previously decided in Moore
v. East Cleveland, liberty interests not "deeply rooted in the nation's history"
do not qualify as being a protected liberty interest.

Assisted suicide, the court found, had been frowned upon for centuries and a
majority of the states had similar bans on assisted suicide. Rehnquist found the
English common law penalties associated with assisted suicide particularly

52
significant. For example, at early common law the state confiscated the
property of a person who committed suicide.

The Court felt that the ban was rational in that it furthered such compelling
state interests as the preservation of human life and the protection of the
mentally ill and disabled from medical malpractice and coercion. It also
prevented those moved to end their lives because of financial or psychological
complications. The Court also felt that if it declared physician-assisted suicide
a constitutionally protected right, it would start down the path to voluntary and
perhaps involuntary euthanasia.

Vacco v.Quill 526 U.S. 793 1997

Dr. Timothy E. Quill, along with other physicians and three seriously ill
patients, challenged the constitutionality of the New York State's ban on
physician-assisted suicide. New York's ban, while permitting patients to refuse
lifesaving treatment on their own, has historically made it a crime for doctors
to help patients commit or attempt suicide, even if patients are terminally ill or
in great pain.

The District Court ruled in favor of the New York statute. In its decision, the
court stated that the State of New York had a rational, legitimate interest in
preserving life and protecting vulnerable persons; as such, the law was not
unconstitutional. The District Court said that this was a matter of legislation,
and, if the ban were to be repealed, it would take an act of New York's
legislature (or a binding referendum by the voters) to do so.

53
The Court of Appeals for the Second Circuit reversed the District Court's
judgment. The Appeals Court reasoned that, even though the law itself applied
as a general rule to all persons, a fact that the District Court noted in
determining its constitutionality, it did not treat all competent patients equally
when they were near death and wished to end their lives. To this effect, the
Appeals Court said that, for example, a patient attached to a life support device
was allowed to require its removal, while a person under identical
circumstances could not demand that a doctor administer drugs to ensure the
patient's death. It agreed with the contention that removing life support devices
was identical to requesting physician-assisted euthanasia, and thereby reversed
the lower court's finding.

The Court began its opinion by stating that the New York law did not infringe
upon fundamental right. The court said, the judiciary must look to the
Constitution, rather than to the stated "importance" of a right, when
determining whether that right was, indeed, fundamental. Because New York's
ban did not infringe upon a fundamental right, and because respondents were
not claiming that the "right to die" was fundamental, the Court reiterated its
policy of according such laws a great deal of leeway.

People v. Kevorkian Michigan, 2001

Fifty-two years old Thomas Youk was suffering from Lou Gehrig's disease.
He requested Jack Kevorkian to help him in getting rid of his life. Defendant
Jack twice videotaped himself interacting with Youk. In the first videotape,
defendant went to Youk's home to discuss his condition. In the second
videotape, defendant administered a lethal drug to Youk. Defendant later was a
guest on the television news show 60 Minutes, during which segments from

54
both videotapes were shown. The jury saw the videotapes and the 60 Minutes
interview at defendant's trial. Nevertheless, defendant attempted to persuade
the jury not to convict him because the murder he was charged with
committing was, in his view, a “mercy killing.”

A Michigan jury found Dr. Jack Kevorkian guilty of second degree murder in
the death of Thomas Youk. On his trial, Dr. Kevorkian failed to convince the
judge that his proposed witnesses, Mr. Youk's wife and brother, were relevant
to the defence. Aside from the videotape which showed how much Mr Youk
was suffering while he was alive, no testimony was presented about Mr.
Youk's condition and his apparent desire to end his life.

Bush v. Schiavo Florida 2004

On February 25, 1990, at age 26, Schiavo sustained a cardiac arrest at her
home in St. Petersburg, Florida. She was successfully resuscitated, but had
massive brain damage due to lack of oxygen to her brain and was left
comatose. After two and a half months without improvement, her diagnosis
was changed to that of a persistent vegetative state. For the next two years,
doctors attempted speech and physical therapy and other experimental therapy,
hoping to return her to a state of awareness, without success. In
1998,, Schiavo's husband, Michael, petitioned the Sixth Circuit Court of
Florida to remove her feeding tube pursuant to Florida law. He was opposed by
Terri's parents, Robert and Mary Schindler. The court determined that Schiavo
would not have wished to continue life-prolonging measures, and on April 24,
2001, her feeding tube was removed for the first time, only to be reinserted
several days later. On February 25, 2005, a Pinellas County judge again
ordered the removal of Terri Schiavo's feeding tube. Several appeals and

55
federal government intervention followed, which included U.S. President
George W. Bush returning to Washington D.C. to sign legislation moving the
case to the federal courts. After appeals through the federal court system
upheld the original decision to remove the feeding tube, staff at the Pinellas
Park hospice facility disconnected the feeding tube on March 18, 2005, and
Schiavo died on March 31, 2005.

Gonzales v. Oregon 2006

In 1994 Oregon enacted the Death with Dignity Act, the first state law
authorizing physicians to prescribe lethal doses of controlled substances to
terminally ill patients. Attorney General John Ashcroft declared in 2001 that
physician-assisted suicide violated the Controlled Substances Act of 1970
(CSA). Ashcroft threatened to revoke the medical licenses of physicians who
took part in the practice. Oregon sued Ashcroft in federal district court. That
court and, later the Ninth Circuit, held Ashcroft's directive illegal. The courts
held that the CSA did not authorize the attorney general to regulate physician-
assisted suicide, which was the sort of medical matter historically entrusted to
the states.

Rodriguez v. British Columbia (Attorney General) [1993] 3 S.C.R.

Sue Rodriguez was a 42-year-old suffering from amyotrophic lateral sclerosis

(ALS or "Lou Gehrig's disease") was diagnosed in 1992. By 1993, it was found
that she would not live more than a year, and so she began a crusade to strike
down section 241(b) of the Criminal Code, which made assisted suicide illegal,
to the extent it would be illegal for a terminally ill person to commit
"physician-assisted" suicide.

56
She applied to the Supreme Court of British Columbia to have section 241(b)
of Criminal Code struck down because it allegedly violated sections 7 (the
right to "life, liberty, and security of the person), section 12 (protection against
"cruel and unusual punishment") and section 15(1) of the Canadian Charter of
Rights and Freedoms (equality).

The Supreme Court of British Columbia found that the provision did not
violate any principles of fundamental justice. It examined the long history of
the prohibition of suicide and concludes that it reflects part of the fundamental
values of society and so could not be in violation of fundamental justice.

The Court also rejected the claim that the provision violated the section 12
right against cruel and unusual treatment or punishment as a mere prohibition
did not fall within the meaning of treatment.

Lastly, the court considered the section 15 equality challenge. Court noted the
issue is best not resolved under this right, but in assuming it did violate section
15, court found it was clearly saved under section 1.

Airedale NHS Trust v. Bland 1993

Bland was injured in the Hillsborough disaster when he was seventeen and a
half years old and was left in a persistent vegetative state. He remained in this
state for over two years with no sign of improvement, whilst being kept alive
by life support machines. Bland could breathe by himself but required feeding
via a tube and received full care. The doctors that were treating Bland were
granted approval to remove of the tube that was feeding him. This decision was
then appealed to the House of Lords by the Solicitor acting on Bland’s behalf.
The Houe Of Lords permitted non voluntary euthanasia in this case.

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Re Award of Court (1995) 2 ILRM

This case came before the Supreme Court in 1995. It concerned a woman who
had been in a near- Persistent Vegetative State for 23 years. She was unable to
communicate, move or swallow and was fed by gastrostomy (PEG) tube. The
Ward’s family asked the court to have the PEG tube removed. The institution
where the Ward was cared for had ethical objections to discontinuing life
supports especially discontinuing the PEG tube because they understood this as
aiding the progression towards dying. In reaching its decision in favour of
removing the tube, the Supreme Court regarded as relevant a number of rights
protected under the Irish Constitution. These included the right to autonomy or
self-determination, the right to privacy, the right to dignity, the right to bodily
integrity, the right to life and the right to die and the right to equality.

The Court stated that the fact that the woman lacked decision-making capacity
did not diminish her rights. To distinguish between people with capacity and
people without capacity would be ‘invidious’. Bearing in mind the significance
of the woman’s rights, the Supreme Court decided that decisions such as this
should be made on the basis of the best interests of the person taken from the
point of view of a ‘prudent and loving’ parent. In their decision to allow the
withdrawal of the PEG tube, the Supreme Court took the view that the
provision of nutrition and hydration via the artificial means of PEG feeding
was equivalent to medical treatment and, as such, could be justifiably
withdrawn because it was considered to be ineffective and burdensome to the
Ward.

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Brongersma case

In 1998 Dr.Phillip Sutorius helped 86 years old Edward Brongersma to die,

even though he had no serious physical or mental illness. Mr Brongersma had
often spoken with Sutorius of his wish to die. He suffered from physical
decline and struggled with his “pointless and empty existence.” At that time
euthanasia was not legal in Netherlands but unofficially allowed under the
same conditions determined in the April law. The case generated public debate
in the Netherlands about the definition of unbearable suffering. A lower court
found the doctor not guilty of violating the euthanasia law, ruling that being
tired of life constituted unbearable suffering. The public prosecutor appealed
the verdict. In his closing argument chief prosecutor said that suffering could
and should be medically determined. In the appeal Sutorius was not granted
prison as sutorius followed the procedure outlined in the law.

The case of Geertruida Postma

In 1971 Dr. Geertruida Postma granted an elderly nursing home patient's

request to die by injecting the patient with morphine and ending her life. The
patient was her seventy-eight-year-old mother, who was partially paralyzed
and was tied to a chair to keep her from falling. Dr. Postma was found guilty of
murder, and was charged under article 293 of the penal code, but her penalty
consisted of a one-week suspended jail sentence and one-year probation.

At the court-session an inspector of health seen as the expert declared that an

average physician in Holland left the idea that life always should be prolonged
until the bitter end. However, there are certain conditions he said:

 The patient's wish to die must be expressed clearly and repeatedly.

59
  The patient's decision must be well informed and voluntary.
 The patient must be suffering intolerably, with no hope of relief;
however, the patient does not have to be terminally ill.
 The physician must consult with at least one other physician.
 The physician must notify the local coroner that death resulting from
unnatural causes has occurred.

In the same year, the Royal Dutch Medical Association (KNMG) issued a
statement supporting the retention of article 293 but arguing that the
administration of pain relieving drugs and the withholding or withdrawal or
futile treatment could be justified even if death resulted.

The Chabot case

A psychiatrist, Dr. Chabot, was approached by a Mrs. B with a request for

euthanasia. Mrs. B had a long history of depression, related most closely to the
deaths of her two adult sons several years previously; she was separated from
an alcoholic and abusive husband. She had continued to suffer from depression
despite several previous episodes of psychiatric treatment and had made a
couple of previous suicide attempts many years ago. Mrs. B stated that she
suffered acutely from her depression; that nothing in life gave her any pleasure
and that she felt no hope for the future; and that she wanted to die. Dr. Chabot
interviewed her on several occasions at length, and recommended some newer
forms of psychiatric treatment; Mrs. B. rejected them all, saying that she had
no reason to believe that these new treatments would be any more successful
than her old ones. Eventually, after consulting several other physicians (who
did not, however, actually interview or examine Mrs. B.), Dr. Chabot provided
a lethal drug which Mrs. B. administered to herself. He was prosecuted and

60
was found guilty of having failed to follow a technical guideline required of
Dutch physicians. He was charged under article 294 of the penal code.

In 1993 the criminal court ruled that the absence of physical suffering or a
terminal stage of illness, not automatically excludes a case from the defence of
necessity. What matters is the amount of suffering, not the origin. However,
extra carefulness should be taken into account, and therefore the court held that
for the defence to apply the patient should have been examined by an
independent medical expert. Accordingly, the defence of necessity failed, Dr.
Chabot was found guilty of an offence under article 294.

2.3 Landmark judgement of some important Indian cases of Euthanasia

State v Sanjay Kumar (1985)17

In 1985, Delhi High Court while acquitting a young boy, Sanjay Kumar, who
attempted to commit suicide by consuming ‘Tik Twenty’ strongly advocated
for deletion of section 309, I.P.C. from the statute book and held that the
continuation of section 309 of Indian Penal Code is an anachronism unworthy
of society like ours. Instead of sending the young boy to the psychiatric clinic
society, gleefully send him to mingle him with the criminals. Medical clinics
are needed for such social misfits; but police and prison never.

In this case a Division Bench of High Court of Delhi criticized section 309 of
the Indian Penal Code, 1860 which makes an attempt to commit suicide
punishable is an anachronism and unworthy Indian Penal Code observed that
“continuance of section 309 of Indian Penal Code is an anachronism unworthy
of human society like ours”. It also observed that there is no justification for a

17
State v. Sanjay Kumar 1985 Cri LJ 931,(Delhi)

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provision like section 309 Indian Penal Code to be on the statute book. The
Bench in that case found that the law u/s167, Criminal Procedure Code had
been wrongly applied, but did not send the case for retrial because it felt that
there is no justification to subject the accused to any further misery at the hand
of the court and therefore, upheld the acquittal of the accused.

C.Jagadeswar v. State of Andhra Pradesh18

In C. Jagadeswar v. State of Andhra Pradesh the High Court held that section
309 of IPC was valid as it did not offended Articles 14 and 21 of the
Constitution. It was stated that section 309 give enough discretion to the court
in dealing with different situations in which suicide can take place and
whatever differences there may be as to what constitute suicide. Suicide is
capable of broad definition and there is no doubt that suicide is intentional
taking of one’s life. In certain cases Probation of Offender Act can be pressed
into service. Whose section 12 enables the court to ensure that no stigma or
disqualification is attached to such person. Further on prosecution being
launched it is always open to an accused to take the plea that his act did not
constitute suicide whereupon the court would decide that aspect also.

Naresh Marotrao Sakhre v. Union of India19

In Naresh Marotrao Sakhre v. Union of India, Lodha J. observed that

Euthanasia and suicide are different. “Suicide by its very nature is an act of
self-killing or self-destruction, an act of terminating one’s own act and without
the aid or assistance of any other human agency. Euthanasia or mercy killing
on the other hand means and implies the intervention of other human agency to

18
Chhena Jagadeswar v.State of Andhra Pradesh (1983)Cri.L.J 549
19
Naresh Marotrao Sakhre v. union of India 1995 Cri L.J 96 (Bom)

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end the life. Mercy killing is thus not a suicide and an attempt at mercy killing
is not covered by the provisions of section 309. The two concepts are both
factually and legally distinct. Euthanasia or mercy killing is nothing but
homicide whatever the circumstances in which it is effected.”

P. Rathinam v. Union of India20

In 1994 a Division Bench of Supreme Court comprising of two justice, while

striking down section 309 of IPC, the apex court said ‘it is cruel and irrational
provision violative of Article 21 of the constitution’. Expanding the scope of
Article 21 the court upheald that, ‘right to life’ include ‘right not live a forced
life’; i.e, to end one’s life if one so desires.

In P.Rathinam v. Union of India he court overruled Chenna Jagadeeswar v.

State of AndhraPradesh and held that section 309 of the Indian Penal Code
deserves to be effaced from the statute book to humanize our peal laws. It is
cruel and irrational provision, and itmay result in punishing a person again who
has suffered agony and would be undergoing ignominy because of his failure
to commit suicide. Then an act of suicide cannot be called as against religion,
morality or public policy, and an act of attempted has not baneful effect on
society. Further, suicide or attempt to commit suicide cause no harm to others,
because of which State’s interference with the personal liberty of the
concerned person is not called for. It was held that section 309 violates Article
21, and so it is void.

20
P.Rathinam v. Union of India AIR 1994SC 1844

63
Gian Kaur v. State of Punjab (1996)

GianKaur and her husband Harbans Singh had been charged for abetting
suicide of their daughter-in-law Kulwant Singh. They had fearlessly poured
kerosene on her and they had a clear intention to see her dead. This was
challenged by the Trial Court. On appeal it came before the High Court.

The prosecution referred to P. Rathinam’s case to justify their actions. They

held that criminalising commission or abetment of suicide (Secions 309 and
306 of IPC) would be a cruel and unreasonable act. A person who has
committed suicide since he is suffering from a sever grievance is made to
further suffer if he fails in his attempt to do so. Beside, suicide is a personal
choice. It does not have any religious, moral or social consequences. It does
not affect another person’s liberty and does not cause harm to another person.
So there is no reason it must be declared illegal. Moreover it was contended
that since ‘freedom of speech and expression’ included freedom not to speak or
‘freedom to carry out any business’ included freedom not to do business,
similarly ‘right to life’ under Article 21 of Constitution of India automatically
includes the right to die. This implies that the provisions of Sections 306 and
309 are unconstitutional as they deprive a person from exercising his
constitutional right to die. It was argued that the ambit of ‘right to live’ must be
widened from including a merely ‘animal existence’ to a ‘right to live with
dignity’.

The defence distinguished between the ‘right to die’ and the ‘right to die with
dignity’. The former implies that the death is unnatural whereas the latter
implies the right to live with dignity until the natural span of one’s life. Thus

64
‘right to life’ under Article 21 of Constitution of India does not include ‘right
to die’. Sections 306 and 309 of the IPC are in tune with the constitution.

The High Court upheld the judgement of the Trial Court and thereby rejected
the appeal. Since the act of committing suicide is itself illegal, the act of
abetting suicide is also automatically a punishable offence. Thus Gian Kaur
and her husband were sentenced to six years’ imprisonment and fine of Rs.
2000 each.

K. Venkatesh case

Venkatesh, a 25-year-old muscular dystrophia patient, wanted to be granted the

right to die. He sought to enforce the right so that he could donate organs
before they were affected by his illness. The plea was rejected a day before his
death by the Andhra Pradesh high court. The court ruled that the petition
sought to violate the Transplantation of Human Organs Act, 1995, which had
no provisions that allowed individuals to donate organs before they were brain
dead. The court's caution in this case is understandable considering the
implications of easing restrictions in organ transplant. However, the order
indirectly reiterated the stated legal position that an individual had no right to
end his life voluntarily. Our Constitution guarantees the right to life. The right
to life is incomplete without the right to death. The karma of life is a wheel that
is completed only when birth is complemented by death. The right to die is
built into the right to live. The state has every obligation to legally ensure the
protection of life; protection in this case limited to prevention of homicide.
However, the Indian state has expanded its territory to be the arbiter even in
cases of suicide and euthanasia. Section 309 of the Indian Penal Code holds

65
suicide a criminal act while euthanasia or mercy killing has been left open for
debate.

Aruna Shanbaug case

Aruna Shanbaug was a nurse working at the King Edward Memorial Hospital,
Parel, 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". 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 that the hospital staff who treat
and take care of her did not support euthanizing her.

While rejecting Pinki Virani's plea for Aruna Shanbaug's euthanasia, the court
laid out guidelines for passive euthanasia. According to these guidelines,
passive euthanasia involves the withdrawing of treatment or food that would
allow the patient to live.

The following guidelines were laid down:

1. 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

66
 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.
2. Even if a decision is taken by the near relatives or doctors or next friend
to withdraw life support, such a decision requires presence of two
witnesses and countersigned by first class judicial magistrate. To be
approved by medical board set up by hospital.

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 CHAPTER-3

LEGAL ASPECT OF EUTHANASIA

3.1 INTERNATIONAL LEGAL ASPECT

Euthanasia is a controversial subject, not only because there are many moral
dilemmas associated with it, but also in what constitutes its definition. At the
extreme ends of disagreement, some schools of thought are of the opinion that
euthanasia, also known as physician assisted suicide or physician aid in dying,
is a merciful act of dying. At the other end, there are opponents of euthanasia
who believe that this method is a form of murder. Euthanasia is a debatable
issue. It is not just a medical ethical problem, it also has philosophical, legal,
religious and political dimensions. This debate is a continuing one as some
people are of the view that life is sacred and no one has got the right to end it
whereas on the other hand some say that life belongs to oneself and so each
person has got the right to decide what he wants to do with it even if it amounts
to dyeing. The argument for legalization of euthanasia is that the individual’s
freedom entails liberty or choice in all matter as long as the rights of any other
person are not infringed upon. The argument against legalizing euthanasia is
that it will lead to disrespect or human life.

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.

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Laws of euthanasia vary greatly from country to country and from individual to
individual. Euthanasia has been at the centre for a moral debate for long. The
individual’s right over his/her life and the value placed on human life by the
society seem polar opposites in this debate. Opponents of euthanasia maintain
that there is a clear moral distinction between merely allowing to die and
actually causing or deliberately hastening someone's death. For some it is a
crucial moral discernment; for others, it represents either casuistry or moral
fiction.

The topic of euthanasia is one that is shrouded with much ethical debate and
ambiguity. Various types of euthanasia are recognised, with active voluntary
euthanasia, assisted suicide and physicianassisted suicide eliciting the most
controversy. [1] Broadly speaking, these terms are used to describe the
termination of a person’s life to end their suffering, usually through the
administration of drugs. Euthanasia is currently illegal in all Australian states,
refl ecting the status quo of most countries, although, there are a handful of
countries and states where acts of euthanasia are legally permitted under
certain conditions.

Advocates of euthanasia argue that people have a right to make their own
decisions regarding death, and that euthanasia is intended to alleviate pain and
suffering, hence being ascribed the term “mercy killing.” They hold the view
that active euthanasia is not morally worse than the withdrawal or withholding
of medical treatment, and erroneously describe this practice as “passive
euthanasia.” Such views are contested by opponents of euthanasia who raise
the argument of the sanctity of human life and that euthanasia is equal to
murder, and moreover, abuses autonomy and human rights. Furthermore, it is
said that good palliative care can provide relief from suffering to patients and

69
unlike euthanasia, should be the answer in modern medicine. This article will
define several terms relating to euthanasia in order to frame the key arguments
used by proponents and opponents of euthanasia. It will also outline the legal
situation of euthanasia in Australia and countries abroad.

In Australia, active voluntary euthanasia, assisted suicide and physician-

assisted suicide are illegal. In general, across all Australian states and
territories, any deliberate act resulting in the death of another person is defined
as murder. 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 common law states of New South Wales, South Australia and Victoria.

The prohibition of euthanasia and assisted suicide in Australia has been the
status quo for many years now. However, there was a period when the
Northern Territory permitted euthanasia and physician-assisted suicide under
the Rights of Terminally Ill Act (1995). The Act came into effect in 1996 and
made the Northern Territory the first place in the world to legally permit active
voluntary euthanasia and physician assisted suicide. Under this Act, competent
terminally ill adults who were aged 18 or over, were able to request a physician
to help them in dying. This Act was short-lived however, after the Federal
Government overturned it in 1997 with the Euthanasia Laws Act 1997.
The Euthanasia Laws Act 1997 denied states the power to legislate to permit
euthanasia or assisted suicide. There have been a number of attempts in various
Australian states, over the past decade and more recently, to legislate for
euthanasia and assisted suicide, but all have failed to date, owing to a majority
consensus against euthanasia.

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In April 2002, the Netherlands became the first country to legalise euthanasia
and assisted suicide. It imposed a strict set of conditions: the patient must be
suffering unbearable pain, their illness must be incurable, and the demand must
be made in "full consciousness" by the patient. In 2010, 3,136 people were
given a lethal cocktail under medical supervision

The legal debate concerning euthanasia in the Netherlands took off with the
"Postma case" in 1973, concerning a physician who had facilitated the death of
her mother following repeated explicit requests for euthanasia.[2] While the
physician was convicted, the court's judgment set out criteria when a doctor
would not be required to keep a patient alive contrary to their will. This set of
criteria was formalized in the course of a number of court cases during the
1980s.

Termination of Life on request and Suicide Act took effect on April 1, 2002. It
legalizes euthanasia and physician assisted suicide in very specific cases, under
very specific circumstances.[3] The law was proposed by Els Borst,
the D66minister of Health. The procedures codified in the law had been a
convention of the Dutch medical community for over twenty years.

The law allows medical review board to suspend prosecution of doctors who
performed euthanasia when each of the following conditions are fulfilled:

 the patient's suffering is unbearable with no prospect of improvement

 the patient's request for euthanasia must be voluntary and persist over time
(the request cannot be granted when under the influence of others,
psychological illness or drugs)
 the patient must be fully aware of his/her condition, prospects, and options

71
 there must be consultation with at least one other independent doctor who
needs to confirm the conditions mentioned above
 the death must be carried out in a medically appropriate fashion by the
doctor or patient, and the doctor must be present
 the patient is at least 12 years old (patients between 12 and 16 years of age
require the consent of their parents)

The doctor must also report the cause of death to the municipal coroner in
accordance with the relevant provisions of the Burial and Cremation Act. A
regional review committee assesses whether a case of termination of life on
request or assisted suicide complies with the due care criteria. Depending on its
findings, the case will either be closed or, if the conditions are not met, brought
to the attention of the Public Prosecutor.

.In Switzerland, assisted suicide is allowed by law under certain

circumstances. Article 115 of the Swiss penal code reads as follows:

"A person who, for selfish motives, persuades or assists another person to
commit suicide will be punished with imprisonment up to five years."

This law has been used by EXIT, the Swiss Society for Humane Dying, to
legally assist up to 120 terminally ill patients to die each year. They argue that
in helping such people to die, they have an absence of 'selfish motives', and
therefore they have so far been able to exploit this law and avoid prosecution.
Their preconditions for supplying such help are as follows:

The person applying for assisted suicide has to be:

72
1. 18 years or older
2. Mental competence
3. A member of EXIT
4. Resident of Switzerland
5. Suffering from a serious illness and/or unbearable health troubles with poor
prognosis
6. Wanting to die with the help of EXIT

The diagnosis and prognosis of the disease must be confirmed by a physician.

Once a patient has personally contacted EXIT asking for help in dying, a
volunteer from the society visits the patient to establish that this request is the
genuine wish of a mentally competent adult, who has not been coerced or
influenced by another in any way. The patient is requested to obtain
confirmation from their doctor of the diagnosis and prognosis of the illness. A
decision as to whether help in dying can be given to this patient or not is made
by a doctor of EXIT, who in doubtful cases consults with a lawyer and a
psychiatrist.

Once it has been decided to help, an EXIT volunteer assists the patient to die
with a lethal dose of drugs, always with a witness present (a close friend or
relative). Immediately after the death, the police are called. The prosecution
attorney, the coroner, a criminologist and other officials will show up to find
out whether or not laws have been violated. Up until now, no EXIT helper has
had to appear before the court for helping a person commit suicide.

In German-speaking countries, the term "euthanasia" is generally avoided

because of its association with the eugenicist policies of the Nazi era. The law

73
therefore tends to distinguish between “assisted suicide” and "active assisted
suicide".

In Germany and Switzerland, active assisted suicide – ie a doctor prescribing

and handing over a lethal drug – is illegal. But German and Swiss law does
allow assisted suicide within certain circumstances. In Germany, assisted
suicide is legal as long as the lethal drug is taken without any help, such as
someone guiding or supporting the patient's hand. In Switzerland, the law is
more relaxed: it allows assisted suicide as long as there are no "self-seeking
motives" involved. Switzerland has tolerated the creation of organisations such
as Dignitas and Exit, which provide assisted dying services for a fee.

In a recent survey, two-thirds of Germans said they would support a law that
enabled active assisted suicide too. But the government has announced it wants
to tighten the law around assisted suicide, with the health minister, stating that
he wants to ban organisations like Dignitas in Germany.

Belgium passed a law in 2002 legalising euthanasia, becoming the second

country in the world to do so. The law says doctors can help patients to end
their lives when they freely express a wish to die because they are suffering
intractable and unbearable pain. Patients can also receive euthanasia if they
have clearly stated it before entering a coma or similar vegetative state.

Assisted suicide is not mentioned in the law, which does not specify a method
of euthanasia. As Jacqueline Herremans, president of the Association for the
Right to Die with Dignity, says: "We don't make a distinction in the
semantics." However, the physician has to be present at the bedside of the
patient to their last breath, unlike the Oregon model where the doctor gives
only the prescription of drugs.

74
Belgian euthanasia cases rose to 1,807 in 2013, compared with 1,432 in 2012,
708 in 2008 and 235 in 2003. Just over half of cases last year were aged 70 or
over, and 80% of the applications were made by Dutch-speakers.

In February2014, Belgium became the first country to legalise euthanasia for

children. There is no age limit for minors seeking a lethal injection, but they
must be conscious of their decision, terminally ill, close to death and suffering
beyond any medical help. They also need the assent of their parents to end
their lives.

In Canada Voluntary active euthanasia, called "physician assisted dying", is

legal in Canada for all people over the age of 18 who have a terminal illness
that has progressed to the point where natural death is "reasonably
foreseeable." To prevent suicide tourism, only people eligible to claim
Canadian health insurance may use it. Legalization of the practice came in
2015/2016 as a result of a series of Supreme Court rulings striking down
Canada's ban on medically assisted suicide.

On 6 February 2015, the Supreme Court of Canada unanimously ruled

in Carter v Canada (AG) that Canadian adults who are mentally competent and
suffering intolerably and permanently have the right to a doctor's help in dying.
The court however suspended its ruling for 12 months to give the government
an opportunity to write legislation and draft new laws and policies around
assisted dying. In January 2016 the court granted an additional 4-month
extension to its ruling suspension to allow time for the newly elected Liberal
government to consult with Canadians on drafting a law to comply with the
ruling. As an interim measure, it also ruled that provincial courts can now
begin approving applications for euthanasia until the new law passes.

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A parliamentary committee report tasked with studying the issue in light of the
Supreme Court of Canada's ruling recommended that anyone experiencing
“intolerable suffering” should be able to seek a doctor’s help to die. On April
14, 2016, Canada's federal Liberal government introduced legislation to
legalize assisted dying under more restrictive conditions than recommended by
the committee, allowing access to only those with terminal illnesses for whom
death is “reasonably foreseeable.

The Northern Territory of Australia was the first place in the world to pass
laws allowing a physician to end the life of a terminally ill patient. The Rights
of the Terminally Ill Act was passed by the Northern Territory Parliament on
25 May 1995. This act then became law on 1 July 1996.9,25,26

Under the Act, the consent of two doctors and a psychiatrist was required. The
patient had to be aged 18 or over, with a sound mind and suffering from a
terminal illness with an unacceptable amount of pain or suffering. Moreover,
there must be no other palliative care options “reasonably available to the
patient to alleviate the patient's pain and suffering to levels acceptable to the
patient”. The physician who assisted a patient in terminating his life would not
be subject to civil or criminal action or professional disciplinary action for
anything done in good faith and without negligence in compliance with this
Act. There was a 7 day waiting period, followed by a 48 h ‘cooling off'
period.25–27.

Mr Bob Dent, a 66-year-old Darwin resident suffering from carcinoma of the

prostate, became the first person in the world to die under euthanasia
legislation. On 22 September 1996, Dr. Philip Nitschke, the leading supporter

76
of euthanasia in the Territory, helped him to die with a computer-linked
machine that allowed the patient to administer the lethal injection by himself.

However, just 6 months after the first death under the Act, the Rights of the
Terminally Ill Act was overturned by the Australian Federal Senate. This
brought the end of the world's first law legalizing euthanasia

Euthanasia is illegal in Australia on a federal level but states and territories

have legislated on the issue. It was legal for a period in the Northern Territory
and in November 2017 legislation to allow assisted suicide passed the
Parliament of Victoria but will not come into effect until mid-2019.[1] A
patient can elect not to receive any treatment for a terminal illness and can also
elect to have their life support turned off. The Commonwealth government
subsequently tried to hinder euthanasia with the passage of the Criminal Code
Amendment (Suicide Related Materials Offences) Bill of 2004.

France's Parliament approved new "end of life" legislation on 29 january,

creating a new "right" for terminal or gravely ill patients to obtain "deep and
continuous sedation until death" on demand. The French National Assembly
and the Senate both voted for the same text after it had been streamlined by a
mixed parliamentary committee, following a protracted battle between the two
chambers seeking to modify the bill. While it stops short of euthanasia and
assisted suicide, the "Claeys-Leonetti law" – the names of its two proponents,
one socialist, the other a supposed conservative – is ambiguous enough to be
considered a step toward euthanasia, and in some ways it is even more extreme
than Dutch and Belgian euthanasia laws.

Both the National Assembly and the Senate voted by a show of hands, making
it difficult to know which representatives and senators voted for or against.

77
The law's main novelty resides in its proclamation of a "right to a dignified end
of life including the best possible alleviation of suffering." This goes beyond
best palliative care – even though the bill does call for that – insofar as "a
dignified end of life" is at its best a subjective notion and at its worst a way of
suggesting that some ends are not "dignified."

Passive euthanasia is now possible in Sweden because of new medical

guidelines which allow doctors to halt life-extending treatment if a patient
asks. Swedish law says doctors should respect the will of patients and should
not kill them. Doctors had previously interpreted that as banning them from
withholding treatment. But the rules were reassessed after a 35-year-old man
who had spent years on a respirator was unable to persuade doctors to turn off
his life-support and travelled to Switzerland to end his life.

The Swedish Society of Medicine now advises doctors to respect the wishes of
patients who are capable of making their own decisions, well-informed and
aware of all the alternatives. Swedish doctors are not generally in favour of
euthanasia. A recent survey suggested that 84% of them would never consider
helping a patient die, even if the patient asked for it and it was legal.

Euthanasia is a deeply divisive political and religious issue in Spain. Socialist

Prime Minister Jose Luis Rodriguez Zapatero legalised same-sex marriage in
his first term of office, but a campaign promise to set up a congressional
committee on euthanasia was not followed through.

In 2007, the Socialists joined the opposition Popular Party in voting against the
legalisation of euthanasia as a way of ensuring the right to a dignified death.
Although opinion polls suggest popular support for euthanasia, Spain has been

78
rocked by a high-profile case involving allegations of sedation causing the
premature deaths of 400 terminally ill patients.

In 2005, Madrid anaesthetist Luis Montes and several other doctors at a

hospital in Leganes were placed under investigation by a regional health chief.
It was not until early 2008 that all 15 doctors were cleared of any wrongdoing,
but the case is reported to have led many doctors to have shied away from
sedating patients out of fear of court action.

Assisted suicide is not illegal in Switzerland and can have the involvement of
non-physicians.
Hundreds of Europeans have travelled to Zurich to end their lives because of
Dignitas, an organisation set up in 1998 to help people with terminal illnesses.
They are provided with a lethal dose of barbiturates which they have to take
themselves. But Dignitas was forced to move from the flat it was using because
of opposition from residents in the area. At one point, those using its services
were told to use hotel rooms and, according to one report, one man decided to
die in his car. According to Swiss law, a person can be prosecuted only if
helping someone commit suicide out of self-interested motivation. Dignitas'
staff work as volunteers.

Poland is a predominantly Catholic country and has strongly condemned

euthanasia.
In 2007, Poland's then conservative government argued that plans for a
Europe-wide day of protest against the death penalty should be met with
parallel condemnation of abortion and euthanasia.

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It also raised the prospect that the European Charter of Fundamental Rights -
which is a legally binding part of the Lisbon Treaty - could pave the way for
euthanasia.

Euthanasia and assisted suicide are illegal under English law. Assisted suicide
is illegal under the terms of the Suicide Act (1961) and is punishable by up to
14 years' imprisonment. Trying to kill oneself is not a criminal act. Depending
on the circumstances, euthanasia is regarded as either manslaughter or murder.
The maximum penalty is life imprisonment.
The only exception is "passive euthanasia", which is where treatment that
might extend someone's life is withdrawn - such as a life machine being turned
off.

The only alternatives for terminally ill patients in the UK are hospice care or
refusing treatment, which mentally capable patients have the right to do.

Euthanasia is illegal in most of the United States. Physician aid in dying

(PAD), or assisted suicide, is legal in the states of Washington DC, California,
Colorado, Oregon, Vermont, Hawaii, and Washington; its status is disputed in
Montana. The key difference between euthanasia and assisted suicide is who
administers the lethal dose of medication: Euthanasia entails the physician or
another third party administering the medication, whereas in assisted suicide it
is the patient's prerogative to self-administer the medication in order to end
their life.

Euthanasia advocacy in the U.S. peaked during the 1930s and diminished
significantly during and after World War II. Euthanasia efforts were revived
during the 1960s and 1970s, under the right-to-die rubric, physician assisted

80
death in liberal bioethics, and through advance directives and do not resuscitate
orders.

Several major court cases advanced the legal rights of patients, or their
guardians, to practice at least voluntary passive euthanasia (physician assisted
death). These include the Karen Ann Quinlan case (1976), Brophy and Nancy
Cruzan cases. More recent years have seen policies fine-tuned and re-stated, as
with Washington v. Glucksberg (1997) and the Terri Schiavo case. The
numerous legislative rulings and legal precedents that were brought about in
the wake of the Quinlan case had their ethical foundation in the famous 1983
report completed by the President’s Commission for the Study of Ethical
Problems in Medicine, under the title "Deciding to Forgo Life-Sustaining
Treatment"

The Commission sustained in its findings that it was morally acceptable to give
up a life-supporting therapy and that withholding or withdrawing such a
therapy is the same thing from an ethical stand-point, while artificial feeding
and other life-supporting therapy are of the same importance for the patients
and doctors. Before this report, to withdraw a medical therapy was regarded as
much more serious decision than not to start a therapy at all, while artificial
feeding was viewed as a special treatment. By 1990, barely a decade and a half
after the New Jersey Supreme Court’s historic decision, patients were well
aware that they could decline any form of medical therapy if they simply
choose to do that either directly or by expressing their wish via appointed
representative.

Euthanasia is illegal in the Philippines. In 1997, the Philippine Senate

considered passing a bill legalizing passive euthanasia. The bill met strong

81
opposition from the country's Catholic Church. If legalized the Philippines
would have been the first country to legalize euthanasia. Under current laws,
doctors assisting a patient to die can be imprisoned and charged with
malpractice

Since 1933 the Penal Code of Uruguay, contains article 37,which accept
Compassionate Homicide, the first legal document that include euthanasia. It's
important to say that this legal document didn't use this denomination. In
another article, 127, the judge could waive the doctor, if this action was made
by patient pledge and the doctor had an honorable reputation. The main source
of this Penal Code was a Spanish penalist, that introduce this concept in his
book "Libertad de amar y derecho a morir: ensayos de un criminalista sobre
eugenesia, eutanasia, endocrinología", published in Madrid/Spain, in 1928. The
first proposal to understand Euthanasia as homicide was made by Ruy Santos
in his MD thesis. He made a difference between Euthanasia as homicide and
Euthanasia as suicide, probably the first citation about Assisted Suicide.

In South Korea The National Assembly and The Ministry of Health and
Welfare voted in favor of active and passive euthanasia and went into effect
since February of 2018, and has announced to issue a "Well-Dying" Bill.
However, the topic and debate of euthanasia in South Korea sparked for a long
time, starting back in December 4, 1997 when a doctor was sent to prison for a
major duration for voluntarily cutting life support of a brain-dead patient who
injured himself from a head trauma upon the request of his wife. This incident
is well known in Korea as 'Boramae Hospital Incident'. Another incident that
sparked further debate was from the imprisonment of a father who plugged off
a respirator for his brain-dead son. Reports indicate that South Korea has

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previously legalized passive euthanasia, but maintained the illegality of active
suicide as of December 2015, under the name "Death with Dignity" Bill.

Patients who qualify for active or passive euthanasia in South Korea are
reserved for the terminally ill with a nonexistent chance of recovery. Patients
who have a beneficial reaction to any medications, or is not in a rapidly
deteriorating state of health leading to imminent death may not be qualified.
Patients must have a confirmation of a registered physician and a doctor to die
under dignity, and comatose patients must have the approval of both guardians.

Euthanasia is a delict under the laws of Peru, although there have been some
attempts to reform them. In October 2009, the Reviser Special Commission of
the Penal Code of the Parliament expressed its support of a proposal that tried
to amend article 112 of the Penal Code, but it did not succeed. However, at the
beginning of 2015, the case of the Chilean woman young Valentina Maureira,
who suffered from cystic fibrosis, an incurable disease, and who asked that
euthanasia be allowed in her country, attracted the interest of the press of Chile
and also of foreign media.

On March 4 of the same year, the Peruvian legislator Roberto Angulo Álvarez,
membership of Dignity and Democracy parliamentary group, motivated by this
case, presented a bill that proposed to allow assisted death in case of terminal
or degenerative disease, with the objective of "avoid the physical and
psychological pains of the patient, as well the unnecessary expenses for the
family members and the State". Angulo Álvarez also argued that his legislative
project "would contribute to respect for individual freedom and human dignity"

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Luxembourg parliament passed a bill legalizing euthanasia on 20 February
2008 in the first reading with 30 of 59 votes in favour. On 19 March 2009, the
bill passed the second reading, making Luxembourg the third European Union
country, after the Netherlands and Belgium, to decriminalise euthanasia.
Terminally ill patients will have the option of euthanasia after receiving the
approval of two doctors and a panel of experts.

The Japanese government has no official laws on the status of euthanasia and
the Supreme Court of Japan has never ruled on the matter. Rather, to date,
Japan's euthanasia policy has been decided by two local court cases, one
in Nagoya in 1962, and another after an incident at Tokai University in 1995.
The first case involved "passive euthanasia" (i.e., allowing a patient to die by
turning off life support) and the latter case involved "active euthanasia" (e.g.,
through injection). The judgments in these cases set forth a legal framework
and a set of conditions within which both passive and active euthanasia could
be legal. Nevertheless, in both of these particular cases the doctors were found
guilty of violating these conditions when taking the lives of their patients.
Further, because the findings of these courts have yet to be upheld at the
national level, these precedents are not necessarily binding. Nevertheless, at
present, there is a tentative legal framework for implementing euthanasia in
Japan.

In the case of passive euthanasia, three conditions must be met:

1. The patient must be suffering from an incurable disease, and in the final
stages of the disease from which he/she is unlikely to make a recovery;
2. The patient must give express consent to stopping treatment, and this
consent must be obtained and preserved prior to death. If the patient is

84
 not able to give clear consent, their consent may be determined from a
pre-written document such as a living will or the testimony of the
family;
3. The patient may be passively euthanized by stopping medical treatment,
chemotherapy, dialysis, artificial respiration, blood transfusion, IV drip,
etc.

For active euthanasia, four conditions must be met:

1. The patient must be suffering from unbearable physical pain;

2. Death must be inevitable and drawing near;
3. The patient must give consent. (Unlike passive euthanasia, living wills
and family consent will not suffice.)
4. The physician must have (ineffectively) exhausted all other measures of
pain relief.

The problems that arose from this, in addition to the problem faced by many
other families in the country, has led to the creation of "bioethics SWAT
teams". These teams will be made available to the families of terminally ill
patients in order to help them, along with the doctors, come to a decision based
on the personal facts of the case. Though in its early stages and relying on
"subsidies from the Ministry of Health, Labor and Welfare" there are plans to
create a nonprofit organization to "allow this effort to continue.

In Ireland, it is illegal for a doctor (or anyone) to actively contribute to

someone's death. It is not, however, illegal to remove life support and other
treatment of miserably ill patient on their request or on the request of their next
close relative. A September 2010 Irish Times poll showed that a majority, 57%
of adults, believed that doctor-assisted suicide should be legal for terminally ill

85
patients who request it. Doctors can stop giving a patient life sustaining
treatments such as ventilators, feeding tube etc. after being sedated, allowing
the patient to die peacefully in their sleep. This only occurs in certain
circumstances.

Assisted suicide and voluntary euthanasia remain illegal in New

Zealand under Section 179 of the New Zealand Crimes Act 1961, which
renders it a criminal offence to "aid and abet suicide." There have been two
prior decriminalisation attempts- the Death-With-Dignity Bill 1995 and the
Death-With-Dignity Bill 2003. Both failed, although the latter only did so by a
three-vote margin within the New Zealand Parliament.

In May 2012, Labour Party of New Zealand MP Maryan Street introduced a

private member's bill into the ballot box, the End of Life Choices Bill, which
was taken over by MP Iain Lees-Galloway when she failed to get re-elected in
the 2014 General Election. The bill was dropped in Dec 2014 under the request
of Labour Party of New Zealand leader Andrew Little as the issue was deemed
to be distracting from bigger issues that concerns the party. In December
2017, ACT MP David Seymour's End of Life Choice Bill, which will legalise
assisted suicide for a select group of people if successful, passed its first
reading in Parliament in a 76-44 personal vote.

Euthanasia is strictly forbidden in Turkey. The aide who helped a person to

suicide or other ways to kill oneself is punished for assisting and encouraging
suicide under the stipulation of article 84 of the Turkish Criminal Law. In
condition of active euthanasia, article 81 of the same law sets forth that any
person who carries out this act will be judged and punished for life
imprisonment just like a simple murder.

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In 1997, Oregon legalized physician-assisted-suicide. The Oregon Death with
Dignity Act allows terminally ill state residents to receive prescriptions for
self-administered lethal medications from their physicians. It does not permit
euthanasia, in which a physician or other person directly administers a
medication to a patient in order to end his or her life. To obtain a prescription
for a lethal medication, the law requires that the patient be an adult resident of
Oregon who is “capable” (able to make and communicate decisions about his
or her health care) and who has an illness that is expected to lead to death
within six months. The patient must make one written and two oral requests to
his or her physician. The two oral requests must be separated by at least 15
days. The patient's primary physician and a consultant are required to confirm
the diagnosis of a terminal condition and the prognosis, determine that the
patient is capable, and refer the patient for counseling, if either believes that
the patient's judgment is impaired by depression or some other psychiatric or
psychological disorder. The primary physician must also inform the patient of
all feasible alternatives, such as comfort care, hospice care, and pain-control
options. To comply with the law, physicians must report all prescriptions that
they write for lethal medications to the Oregon Health Division. Reporting is
not required if patients begin the process of requesting a prescription but do not
actually receive it. Physicians and patients who adhere to the requirements of
the act are protected from criminal prosecution.

Efforts to change government policies on euthanasia of human lives in the 20th

and 21st centuries have met limited success in Western countries. Human
euthanasia policies have also been developed by a variety of NGOs, most
notably medical associations and advocacy organizations. As of March 2018,
human euthanasia is legal in the Netherlands, Belgium, Colombia,
Luxembourg, Canada and India. Assisted suicide is legal in Switzerland,

87
Germany, South Korea, Japan, and in the US states of Washington, Oregon,
Colorado, Hawaii, Vermont, Montana, Washington DC, and California. An
assisted dying scheme in the Australian state of Victoria will come into effect
in mid-2019.

3.2 INDIAN LEGAL ASPECT

The legal position of India cannot and should not be studied in isolation. India
has drawn its constitution from the constitutions of various countries and the
courts have time and again referred to various foreign decisions. In India,
euthanasia is undoubtedly illegal. Since in cases of euthanasia or mercy killing
there is an intention on the part of the doctor to kill the patient, such cases
would clearly fall under clause first of Section 300 of the Indian Penal Code,
1860. However, as in such cases there is the valid consent of the deceased
Exception 5 to the said Section would be attracted and the doctor or mercy
killer would be punishable under Section 304 for culpable homicide not
amounting to murder. But it is only cases of voluntary euthanasia (where the
patient consents to death) that would attract Exception 5 to Section 300. Cases
of non-voluntary and involuntary euthanasia would be struck by proviso one to
Section 92 of the IPC and thus be rendered illegal. The law in India is also
very clear on the aspect of assisted suicide. Right to suicide is not an available
“right” in India – it is punishable under the India Penal Code, 1860. Provision
of punishing suicide is contained in sections 305 (Abetment of suicide
of child or insane person), 306 (Abetment of suicide) and 309 (Attempt
to commit suicide) of the said Code. Section 309, IPC has been brought under
the scanner with regard to its constitutionality.

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Right to life is an important right enshrined in Constitution of India. Article 21
guarantees the right to life in India. It is argued that the right to life under
Article 21 includes the right to die. Therefore the mercy killing is the legal
right of a person. After the decision of a five judge bench of the Supreme
Court in Gian Kaur v. State of Punjab it is well settled 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 of the imagination can extinction of life
be read into it. In existing regime under the Indian Medical Council Act, 1956
also incidentally deals with the issue at hand. Under section 20A read with
section 33(m) of the said Act, the Medical Council of India may prescribe
the standards of professional conduct and etiquette and a code of ethics
for medical practitioners. Exercising these powers, the Medical Council of
India has amended the code of medical ethics for medical
practitioners. There under the act of euthanasia has been classified as unethical
except in cases where the life support system is used only to continue the
cardio-pulmonary actions of the body. In such cases, subject to the certification
by the term of doctors, life support system may be removed.

From the moment of birth, a person is clothed with basic human rights. Right
to life is one of the basic as well as fundamental right without which all rights
cannot be enjoyed. Right to life means a human being has an essential right to
live, particularly that such human being has the right not to be killed by
another human being

‘Right to life’ including the right to live with human dignity would mean the
existence of such right up to the end of natural life. This may include the right
of a dying man to die with dignity. But the ‘right to die with dignity’ is not to

89
be confused with the ‘right to die’ an unnatural death curtailing the natural
span of life. Thus the concept of right to life is central to the debate on the
issue of Euthanasia. One of the controversial issues in the recent past has been
the question of legalizing the right to die or Euthanasia. Euthanasia is
controversial since it involves the deliberate termination of human life. Patient
suffering from terminal diseases are often faced with great deal of pain as the
diseases gradually worsens until it kills them and this may be so frightening for
them that they would rather end their life than suffering it. So the question is
whether people should be given assistance in killing themselves, or whether
they should be left to suffer the pain cause by terminal illness.

When a person ends his life by his own act it is called “suicide” but to end life
of a person by others though on the request of the deceased is called
“euthanasia” or “mercy killing”. This paper seeks to discuss what
euthanasia is and its possible application in three different occasions
of a living person since very birth. In ancient societies of the countries like
Greece and India how the practice of self-destruction was a customary, what
was the attitude towards the annihilation of life of different religions
like Hindu, Muslim, Christian and Sikh. Though the purpose of suicide and
euthanasia is self-destruction but there is clear difference between the two.
Although the Supreme Court has already given its decision on this point but
still some doubts arise in our point which we need to analyze carefully. Lastly,
arguments are put forward for and against legalizing euthanasia and this article
has been concluded with a definite comment in favor of legalizing
passive euthanasia in India.

Death is not a right, it is the end of all rights and a fate that none of us can
escape. The ultimate right we have as human beings is the right to life, an

90
inalienable right not even the person who possesses it can never take that away.
It is similar to the fact that our right to liberty does not give us the freedom to
sell ourselves into slavery. In addition, this right to die does not equal a right to
‘die with dignity.’ Dying in a dignified manner relates to how one confronts
death, not the manner in which one dies since history recounts many situations
of individuals facing degrading deaths in a dignified way.

The question whether Article 21 includes right to die or not first came into
consideration in the case State of Maharashtra v. Maruti Shripathi Dubal.
It was held in this case by the Bombay High Court that ‘right to life’ also
includes ‘right to die’ and Section 309 was struck down. The court clearly said
in this case that right to die is not unnatural; it is just uncommon and abnormal.
Also the court mentioned about many instances in which a person may want to
end his life. This was upheld by the Supreme Court in the case P. Rathinam v.
Union of India. However in the case Gian Kaur v. State of Punjab it was held
by the five judge bench of the Supreme Court that the “right to life” guaranteed
by Article 21 of the Constitution does not include the “right to die”. The court
clearly mentioned in this case that Article 21 only guarantees right to life and
personal liberty and in no case can the right to die be included in it. In India,
like almost in other countries, euthanasia has no legal aspect. In India there is
no difference between active and passive euthanasia and no penal law yet
introduced in I.P.C, which specifically deals with euthanasia. The every act of
aiding and abetting the commission of suicide Naresh Maratra Sakhee vs
Union of India, observed that, “suicide by its nature is an act of self-killing or
self-destruction, are punished under the section 306 of the I.P.C.
Distinguishing euthanasia from suicide, Justice Lodha in an act of terminating
one’s own act and without the aid or assistance of any other human agency.
Euthanasia or Mercy killing on the other hand means implies the intervention

91
of other human agency to end the life. Mercy killing is thus not suicide and the
provision of section 309 does not cover an attempt at mercy killing. The two
concepts are both factually and legally distinct. Euthanasia or Mercy killing is
nothing best homicide whatever the circumstances in which it is affected.”

The legal position of India cannot and should not be studied in isolation. India
has drawn its constitution from the constitutions of various countries and the
courts have time and again referred to various foreign decisions. In India,
euthanasia is undoubtedly illegal. Since in cases of euthanasia or mercy killing
there is an intention on the part of the doctor to kill the patient, such cases
would clearly fall under clause first of Section 300 of the Indian Penal Code,
1860. However, as in such cases there is the valid consent of the deceased
Exception 5 to the said Section would be attracted and the doctor or mercy
killer would be punishable under Section 304 for culpable homicide not
amounting to murder. But it is only cases of voluntary euthanasia (where the
patient consents to death) that would attract Exception 5 to Section 300. Cases
of non-voluntary and involuntary euthanasia would be struck by proviso one to
Section 92 of the IPC and thus be rendered illegal. The law in India is also
very clear on the aspect of assisted suicide. Right to suicide is not an available
“right” in India – it is punishable under the India Penal Code, 1860. Provision
of punishing suicide is contained in sections 305 (Abetment of suicide
of child or insane person), 306 (Abetment of suicide) and 309 (Attempt
to commit suicide) of the said Code. Section 309, IPC has been brought under
the scanner with regard to its constitutionality. Right to life is an

Important right enshrined in Constitution of India. Article 21 guarantees the

right to life in India. It is argued that the right to life under Article 21 includes
the right to die. Therefore the mercy killing is the legal right of a person. After

92
the decision of a five judge bench of the Supreme Court in Gian Kaur v. State
of Punjab19 it is well settled 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 of the imagination can extinction of life
be read into it. In existing regime under the Indian Medical Council Act, 1956
also incidentally deals with the issue at hand. Under section 20A read with
section 33(m) of the said Act, the Medical Council of India may prescribe the
standards of professional conduct and etiquette and a code of ethics for
medical practitioners. Exercising these powers, the Medical Council of India
has amended the code of medical ethics for medical practitioners.
There under the act of euthanasia has been classified as unethical except in
cases where the life support system is used only to continue the cardio-
pulmonary actions of the body. In such cases, subject to the certification by the
term of doctors, life support system may be removed. In Gian Kaur’s case
section 309 of Indian Penal Code has been held to be
constitutionally valid but the time has come when it should be deleted by
Parliament as it has become anachronistic. A person attempts suicide in a
depression, and hence he needs help, rather than punishment.

‘Right to life’ is a natural right embodied in Article 21 but suicide is an

unnatural termination or extinction of life and, therefore, incompatible and
inconsistent with the concept of ‘right to life’. It is the duty of the State to
protect life and the physician's duty to provide care and not to harm patients. If
euthanasia is legalised, then there is a grave apprehension that the State may
refuse to invest in health in working towards Right to life. Legalised euthanasia
may led to a severe decline in the quality of care for terminally-ill patients.

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Hence, in a welfare state there should not be any role of euthanasia in any
form.

The right to life and personal liberty is guaranteed by the Indian Constitution in
Part III under the category of Right to Freedom (Articles 19–22). The right to
life and personal liberty in accordance with the procedure established by law is
guaranteed by Article 21 of the Indian Constitution. In the Gopalan case, the
court held that personal liberty relates to the person or the body of the
individual. The scope of personal liberty was made wider in 1973 and was held
to remain despite executive and legislative directives. From this flows the right
to informed consent or refusal, which applies to all medical interventions. This
alone would suffice for a foregoing of life sustaining treatments (FLST)
decision.

Section 300 IPC for murder states as follows: “Except in the cases hereinafter
excepted, culpable homicide is murder, if the act by which the death is caused
is done with the intention of causing death, or if it is done with the intention of
causing such bodily injury as the offender knows to be likely to cause the death
of the person to whom the harm is caused”.

Thus, according to Criminal Law either of two conditions must be met-

intention and knowledge. The petitioner must prove motive on the part of the
physician for act construed as murder. In a doctor-patient relationship, the
motive is to offer cure or care unless established to be otherwise, the burden of
proof resting with the appellant. The principle of prior knowledge is
inapplicable as an FLST decision is considered only when treatment options
are found to be ineffective to prevent death or intolerable disability. Therefore,
the agency of death is attributable to the underlying disease condition rather
than the withdrawal of artificial support. This is indeed a “failure to struggle”

94
or a “letting die” rather than a positive act to end the life of the patient. In as
much as medical interventions are artificial and accepted by the patient through
informed consent on the understanding that they would be beneficial, there is
no imperative to continue, when the consent is withdrawn when no longer
beneficial. Therefore, these actions on the part of the physician observing due
medical processes are to be decriminalized.

The Delhi High Court in State v. Sanjay Kumar Bhatia, in dealing with a
case under section 309 of IPC observed that section 309 of I.P.C. has no
justification to continue remain on the statute book. The Bombay High Court
in Maruti Shripati Dubal v. State of Maharashtra examined the constitutional
validity of section 309 and held that the section is violative of Article 14
as well as Article 21 of the Constitution. The Section was held to be
discriminatory in nature and also arbitrary and violated equality guaranteed
by Article 14. Article 21 was interpreted to include the right to die or to take
away one’s life. Consequently it was held to be violative of Article 21.

In P. Rathinam case Supreme court directed against the constitutional validity

of Section 309 IPC, which deals with punishment for attempt to commit
suicide. The Supreme Court ruled in favor of the petitioner, thereby legalizing
suicide and rendering as unconstitutional punishment for abetting of suicide. In
this case a corollary was drawn between euthanasia and suicide. The judgment
stated that in cases of passive euthanasia, the consent of the patient (if he be in
sound mental condition) is one of the pre-requisites. So, if one could legally
commit suicide, he could also give consent for being allowed to die. However
progress came to a grinding halt in 1996, when the same court now upheld the
constitutional validity of Sections 309 and 306 thereby legalizing the same. A
judgment totally contradictory to the earlier one, this presented a picture of the

95
confusion that prevails in our apex judiciary as far as euthanasia is concerned.
The primary basis for taking such a contention was Article 21, which states
that all Indians have a right to life and personal liberty. The judgment accepted
the view that in a terminally ill patient (one in a Permanent Vegetative State -
PVS), mercy killing does not extinguish life, but accelerates conclusion of the
process of natural death that has already commenced. But it goes on to say that
the scope of Article 21 cannot be widened enough so as to include euthanasia.
In the concluding remarks, assisted suicide and abetting of suicide were made
punishable, due to "cogent reasons in the interest of society”.

Earlier majority of people dies before they reached the hospital but now it is
converse. Now sciences had advanced to the extent, life can be prolonged but
not to that extent of bringing back the dead one. This phenomenon has raised a
complex situation. Earlier diseases outcome was discussed in terms of ‘CURE’
but in the contemporary world of diseases such as cancer, Aids, diabetes,
hypertension and mental illness are debated in terms best ‘CARE’, since cure
is distant. The principle is to add life to years rather than years to life with a
good quality palliative care. The intention is to provide care when cure is not
possible by low cost methods. The expectation of society is, ‘cure’ from the
health professionals, but the role of medical professionals is to provide ‘care’.
Hence, euthanasia for no cure illness does not have a logical argument.
Whenever, there is no cure, the society and medical professionals become
frustrated and the fellow citizen take extreme measures such as suicide,
euthanasia or such other step to finish oneself.

‘Right-to-die’ supporters argue that people who have an incurable,

degenerative, disabling or debilitating condition should be allowed to die in
dignity. This argument is further defended for those, who have chronic

96
debilitating illness even though it is not terminal such as severe mental illness.
Majority of such petitions are filed by the sufferers or family members or their
caretakers. The caregiver's burden is huge and cuts across various domains
such as financial, emotional, time, physical, mental and social. Hence, it is
uncommon to hear requests from the family members of the person with
psychiatric illness to give some poison either to patient or else to them.

The judgment of our Supreme Court in Aruna Ramchandra Shanbaug v.

Union of India opened the gateway for legalization of passive euthanasia
Aruna Shanbaug was a nurse working at the King Edward Memorial Hospital,
Parel, Mumbai. On 27 November 1973 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". 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 that the hospital staff who treat
and take care of her did not support euthanizing her.She died from pneumonia
on 18 May 2015, after being in a coma for a period of 42 years.

While rejecting Pinki Virani's plea for Aruna Shanbaug's euthanasia, the court
laid out guidelines for passive euthanasia.[3] According to these guidelines,
passive euthanasia involves the withdrawing of treatment or food that would

97
allow the patient to live.the judgment of our Supreme Court in Aruna
Ramchandra Shanbaug v. Union

While rejecting Pinki Virani's plea for Aruna Shanbaug's euthanasia, the court
laid out guidelines for passive euthanasia. According to these guidelines,
passive euthanasia involves the withdrawing of treatment or food that would
allow the patient to live. As India had no law about euthanasia, the Supreme
Court gave some guidelines for euthanasia and ordered to follow these
guidelines as law until and unless Parliament passes
legislation. India's Minister of Law and Justice, Veerappa Moily, called for
serious political debate over the issue. The following guidelines were laid
down:

1. 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.
2. Even if a decision is taken by the near relatives or doctors or next friend
to withdraw life support, such a decision requires presence of two
witness and countersigned by first class judicial magistrate. To be
approved by medical board set up by hospital.

In this case question comes before the Court is under which provision of the
law the Court can grant approval for withdrawing life support to an
incompetent person. Then the Court held that it is the High Court under Article
226 of the Constitution which can grant approval for withdrawal of life support

98
to such an incompetent person. The High Court under Article 226 of the
Constitution is not only entitled to issue writs, but is also entitled to issue
directions or orders. According to the instant case, when such an application is
filed 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. Before
doing so the Bench should seek the opinion of a committee of three
reputed doctors to be nominated by the Bench after consulting such medical
authorities/medical practitioners as it may deem fit. Preferably one of the three
doctors should be a neurologist; one should be a psychiatrist, and the third a
physician. The committee of three doctors nominated by the Bench should
carefully examine the patient and also consult the record of the patient as
well as taking the views of the hospital staff and submit its report to the
High Court Bench. After hearing the State and close relatives e.g. parents,
spouse, brothers/sisters etc. of the patient, and in their absence his/her next
friend, the High Court bench should give its verdict. The above procedure
should be followed all over India until Parliament makes legislation on this
subject. The High Court should give its decision assigning specific reasons in
accordance with the principle of ‘best interest of the patient’ laid down by the
House of Lords in Airedale’s case .

In March 2018, the Supreme Court of India, passed a historic judgement-law

permitting Passive Euthanasia in the country. This judgment was passed in
wake of Pinki Virani’s plea to the highest court in December 2009 under the
Constitutional provision of “Next Friend”. It’s a landmark law which places
the power of choice in the hands of the individual, over government, medical
or religious control which sees all suffering as “destiny”. The Supreme Court
specified two irreversible conditions to permit Passive Euthanasia Law in its
2011 Law: (I) The brain-dead for whom the ventilator can be switched off (II)

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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.

The same judgement-law also asked for the scrapping of 309, the code which
penalises those who survive suicide-attempts. In December 2014, government
of India declared its intention to do so.

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 CHAPTER-4

RELIGIOUS VIEWS ON EUTHANASIA

The concept of euthanasia is not new. It’s being debated since seventeenth
century. However, the ideas of euthanasia have a significant persuasive effect
on the public. Politically active, right to die movements dedicated to euthanasia
or physician-assisted suicide reform have sprung up in many western countries.
A necessary condition to public support for such reform, and one which
continues to fuel the euthanasia debate, is the emerging ethic of what might be
called "liberal individualism." According to Somerville, “We are now
societies based on intense individualism possibly individualism to the
exclusion of any real sense of community, including in situations facing death
and bereavement. Matters such as euthanasia, that would have been largely the
subject of moral or religious discourse are now explored in our courts and
legislatures, particularly through the concepts of individual human rights, civil
rights and constitutional rights”.

In almost all societies individual and social life was governed by social
customs during the ancient and medieval ages. Social value preceded human
values. India is no exception to this rule. India had too remained under the rule
of customs, how so ever; some of them might appear as tyrant and unjustify
today. Indian culture seems to create an ambivalent attitude towards suicide
and euthanasia, on the one hand sanctity of life was taken to be the highest
value and the violation of it including suicide was considered the highest sin.
But on the other hand suicidal acts were glorified if they occurred in defense of
social values.

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An analysis of the ethics of euthanasia is a daunting task. It requires the
application of philosophical ethics, the consideration of the doctor patient
relationship, arguments convening the state's responsibility and the limits
thereof, and the interplay between the factors. The axiom that one should
preserve life above all else cuts the Gordian knot. It is not surprising that the
notion of sanctity of life is promoted as an ethical principle, a guide to
professional practice a legislated requirement. Nonetheless, debate continues
concerning the justification of exalting
the sanctity of life above other ethical considerations, such as welfare and
wishes of the patient. The sanctity of the life principle has an abstract,
universal character, in contrast to an actual patient with particular wishes and
individual needs.

Historically, religious communities have sought to appropriate death within the

life cycle through rituals of remembrance and religious teachings have
emphasized that death brings meaning to mortality. The process of dying is
often portrayed as an invitation to spiritual insight and a key moment in the
cultivation of spiritual identity. The world’s great traditions of moral wisdom
all begin with a strong predisposition to favor the preservation of life, although
the specific reasons for this conviction vary from tradition to tradition21. In this
age of life prolonging medicine, the deliberate decision to end a life generates a
significant amount of religious discussion. Ethical concerns from a religious
perspective likely will become even more central when and if euthanasia enters

21
NamitaNimbalkar,Euthanasia:TheHinduPerspective,(March1,2012,04:30PM)http://www.vpmthan.org.

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the mainstream of medical practice and society struggles to achieve consensus
on this issue22.

Euthanasia: The Hindu View

Beliefs about life after death are derived both from the ancient Hindu texts and
from popular belief. Most Hindus believe that there is a soul in all living
beings, which transmigrates from one life to another, including animal life. In
the Upanishads the soul within man is identified with ultimate reality,
Brahman. Liberation from birth and death can be obtained through austerity
and meditation leading to mystical realization of unity with Brahman in the
life, and absorption into Brahman in the next. In the Bhagavad Gita, the
Supreme Lord Krishna has assured that no one can destroy the soul: “Weapons
do not cleave this self. Fire does not burn him; waters do not make him wet;
nor does the wind. Make him dry…For to the one’ that is born death is certain,
and certain is birth for the one that has died”23.

The concept of willed death is common among Jain monks and Hindus
whobelieve in re-incarnation. Hindus believe that if someone dies it is just a
transformation. There are several Hindu points of view on euthanasia. In
Hinduism a person who commits euthanasia does not attain moksha i.e.
salvation.24 The central belief of Hinduism is in Sanatana Dharma or eternal
religion. According to Hindu philosophy, dharma is essential for
accomplishing material and spiritual goals and for the growth of the individual

22
7THOMAS BREWNE, BIOETHICS, EUTHANASIA AND PHYSICIAN ASSISTED SUICIDE 41(Jones and
Barlett Publishers, USA 2001).
23
S. RADHA KRISHNAN, BHAGAVAD GITA 49 (Harper and Bros, USA 1957).
24
S.K.Kapoor, Gray Matter, ‘Right to Die’? Hindustan Times, April 8, 2007, at A.8.

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and society. Dharma here means both law and religion. It is the guiding
principle of life according to which Hindus live their lives. This school
of thought which believes in the Karma theory feels that the doctor should not
accept a patient’s request for euthanasia as the soul and body will be separated
at an unnatural time. The result of it will damage Karma of both doctor and
patient.25 Hindu views of euthanasia and suicide are grounded in the doctrines
of Karma, moksha and ahimsa. Karma is the net consequence of good and bad
deeds in a person’s life, which then determines the nature of the next life.
Ongoing accumulation of bad karma prevents moksha or liberation from the
cycle of rebirth which is the ultimate goal of Hinduism.26

Thus, generalization about Hindu patients at the end of life is difficult because
their beliefs and attitudes will depend so much on education, class and
religious tradition. From one perspective a person who helps other to end a
painful life and thereby reducing suffering is doing a good deed and will gain
good Karma. From the other perspective, euthanasia interrupts the timing of
the cycle of rebirth and both the doctor and patient will take on bad karma a
result. But despite all this Hindus good death provides a valuable model for
how death can be approached positively and without apprehension.

The Buddhist View

Buddhism has a lot to say about death and what comes after and while not all
of its markedly different from the monotheistic religion, it is overall more
flexible in its doctrine than nearly all religions.27 In the case of Buddhism,

25
11NamitaNimbalkar,Euthanasia:TheHinduPerspective,(March1,2012,4:35PM)http://www.vpmthan.org
26
12S.S.Das, Religious Postulates of Euthanasia in India, THE LEGAL ANALYST, 2011, at 121
27
13Carolynn Marie, Understanding Death through Religion, (March7,2012,11:45AM) http://www.caroly

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respect for life is grounded not in its divine origin but in its spiritual destiny,
namely the state of final perfection known as nirvana. From this affirmative
valuation of life flows percepts forbidding its intentional destruction. No
euphemism such as ‘euthanasia’ is found in early Buddhist canonical sources,
nor is the morality of the practice discussed specifically in the discourses of the
Buddha. As an act or omission involving the
intentional destruction of life, however it would undoubtedly be prohibited by
Buddhist percepts. Confirmation of this can be found in the Monastic Rule, a
corpus of canonical literature which sets out the regulations governing
monastic life.28

Buddhism and Hinduism are indicative of some of the many ancient eastern
cultural and religious philosophies that inform alternative approaches to death,
dying and euthanasia. Contemporary Buddhists have extensively questioned
whether euthanasia has a role to play within Buddhist philosophy. As a result it
is suggested that there is much more to Buddhist thinking on euthanasia than a
purely pragmatic concern to keep the first percept – not to take life while
practicing the virtue of compassion. It has, for example been argued that in
Buddhism volition constitutes a man “essential boringness” which implies that
the intrinsic value of human life lies in the capacity for conscious choice. So, at
least in principle, the Buddhist should be in favor of voluntary euthanasia
provided it applied within narrowly defined limits. The intentional hastening of
death is however morally unacceptable in all circumstances.

nnmarie.com.
28
Damien Kewon, Killing, Karma and caring: Euthanasia in Buddhism and Christianity, 27 Journal
of Medical Ethics, 23 (1995).

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The Islamic View
Islamic bioethics is an extension of Shariah (Islamic law) based on the Qur’an
(the holy book of all Muslims) and 426 the Sunna (Islamic law based on the
Prophet Muhammad’s words and acts). For Muslims, everything possible must
be done to prevent premature death. Not at any cost, however, and life-
sustaining treatments can be withheld or withdrawn in terminally ill Muslim
patients when the physicians are certain about the inevitability of death, and
that treatment in no way will improve the condition or quality of life. The
intention must never be to hasten death, only to abstain from overzealous
treatment. This is based on the Islamic principle “la darar wa la dirar” (no harm
and no harassment). Basic nutrition, however, should not be discontinued,
because such a withdrawal would in effect starve the patient to death—a crime
according to the Islamic faith. The decision to withdraw futile treatment is seen
as allowing death to take its natural course. However, it should be a collective
decision taken on the basis of informed consent, following a consultation with
the patient’s family, and involving all those involved in providing health care,
including the attending physician (three for the case of withdrawing life
support for brain death, for example). This also applies to patients in a
persistent vegetative state. Most, but not all, Islamic countries now accept brain
death, after which intensive care equipment can be withdrawn. This decision
came as a result of the Third International Conference of Islamic Jurists in
1986, and the Fourth Session of Council of the Islamic Jurisprudence Academy
in 1988 allowed (under certain conditions) the retrieval of organs from
brainstem-dead patients. Regarding pain, the Qur’an states that “Allah does not
tax any soul beyond that which he can bear” and pain and suffering is not a
punishment but rather a “kaffarah” (expiation) for one’s sins. But relieving
pain or providing a sedative drug with the aim of pain relief is still allowed

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even if death is hastened (double effect), provided death was definitely not the
intention of the physician. The Qur’an also emphasizes that “it is the sole
prerogative of Allah to bestow life and to cause death”, and therefore
euthanasia is never allowed. The two major branches of Islamic faith, the Shia
and the Sunni, may differ somewhat in interpretations, methodology and
authoritative systems, but not fundamentally in bioethical rulings. It should be
noted, though, that most Islamic communities will defer to the opinion of their
own recognized religious scholars because the Islamic faith is not monolithic
but rather a diversity of views exist.

Islam emphasizes the importance of maintaining one’s health and preventing

illness but when prevention fails all efforts must be made to restore the health.
One way of saving lives of people is to treat them when they become sick. It is
a mutual responsibility of the patient and physician. In other words, seeking the
treatment is a duty for the patient himself and everybody in the society is
obliged to help the patient in treatment. On the other hand, healing people is
considered as a sacred job. The physician must do his best to heal the illness
but at the same time he must know that the real healer is God. The physician
must also treat the patient with respect and compassion. The oath of the
Muslim doctor includes undertaking to protect human life in all stages and
under all circumstances, doing utmost to rescue it from death malady, pain and
anxiety. To be, an instrument of God’s mercy all the way, extending medical
care to near and far, virtuous and sinner, friend and enemy is necessary.

For Muslim, death marks the transition from one state of existence to the next.
Islam teaches that life on earth is an examination- the life to come is the eternal
abode where one will reap the fruit of one’s endeavors on earth. Death is

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therefore not to be resisted or fought against but rather something to be
accepted as part of the overall divine plan.

THE SIKH VIEW

The Sikhs have a duty based rather than rights based approach to ethical
decision making and both Hinduism and Sikhs believe in Karma, a casual law
where all acts and human thoughts have consequences: good karma leads to a
good rebirth, bad karma leads to bad rebirth. The tendency towards the death-
wish is fostered by present day tensions and the conflicts of our competitive
society. Mental illness is on the increase and some people in a fit of depression
may welcome death as a relief from the torture of living.

The rapid advances of medicine and biology present new challenges for the
sikh faith. There is general agreement on topic such as euthanasia and the
making of a living will or advance directive life is seen as a gift from God and
an opportunity to strive for enlightenment. Illness, suffering and pain are a
result of one’s actions in this or previous life and should be endured with moral
courage and fortitude. The ultimate point of release from this life is the will of
God (hukum) and should not be interfered with. Thus assisted suicide and
euthanasia are forbidden.18

Sikhism believes that whatever and whoever exists in this world is the creation
of God and whatever happens in this world including the birth and death of a
human is under the will of God. God is not only the creator of all but also
permeates all. Thus, the human body is the house of the divine particle within.
Torturing and harming the body in any way implies harming and injuring the
creator within. Sikhism clearly states that man is essentially one with God and

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the ultimate aim of his life is to realize this oneness. This is what we call god
realization or self -realization and this state of liberation also marks an end to
the process of transmigration. There
are several scriptural hymns where in a human being is chided for not having
worked towards the realization of this objective and for having wasted life in
worldly pursuits. This no doubt implies that this human life is a gift from God
and it has been endowed with a specific aim before it. This gives birth to the
doctrine of sanctity of human life.

GENERAL CHRISTIAN VIEW

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 the
image of God. Life is a gift from God. All life is God-given. Birth and death
are part of the life processes which God has created, so we should respect
them. Therefore no human being has the authority to take the life of any
innocent person, even if that person wants to die.29

Human beings are valuable because they are made in God’s image. Human
life possesses an intrinsic dignity and value because it is created by God in his
own image for the distinctive destiny of sharing in God’s own life. Saying that
God created humankind in his own image doesn’t mean that people actually
look like God, but that people have a unique capacity for rational existence that
enables them to see what is good and to want what is good. As people develop
these abilities they live a life that is as close as possible to God’s life of love.
This is a good thing, and life should be preserved so that people can go on
doing this.

““Declaration on Euthanasia”, The Sacred Congregation for the Doctrine of the Faith, May
29

5, 1980

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Christian believes that to propose euthanasia for an individual is to judge that
the current life of that individual is not worthwhile. Such a judgement is
incompatible with recognising the worth and dignity of the person to be
killed. Therefore arguments based on the quality of life are completely
irrelevant. Nor should anyone ask for euthanasia for themselves because no-
one has the right to value anyone, even themselves, as worthless.

VIEWS OF CATHOLIC CHRUCH

Nothing and no one can in any way permit the killing of an innocent human
being, whether a fetus or an embryo, an infant or an adult, an old person, or
one suffering from an incurable disease, or a person who is dying.
Furthermore, no one is permitted to ask for this act of killing, either for himself
or herself or for another person entrusted to his or her care, nor can he or she
consent to it, either explicitly or implicitly, nor can any authority legitimately
recommend or permit such an action. For it is a question of the violation of the
divine law, an offense against the dignity of the human person, a crime against
life, and an attack on humanity.

It may happen that, by reason of prolonged and barely tolerable pain, for
deeply personal or other reasons, people may be led to believe that they can
legitimately ask for death or obtain it for others. Although in these cases the
guilt of the individual may be reduced or completely absent, nevertheless the
error of judgment into which the conscience falls, perhaps in good faith, does
not change the nature of this act of killing, which will always be in itself
something to be rejected. The pleas of gravely ill people who sometimes ask
for death are not to be understood as implying a true desire for euthanasia; in

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fact, it is almost always a case of an anguished plea for help and love. What a
sick person needs, besides medical care, is love, the human and supernatural
warmth with which the sick person can and ought to be surrounded by all those
close to him or her, parents and children, doctors and nurses.

JUDAISM VIEWS

Euthanasia, physician-assisted suicide, and all other types of suicide are almost
unanimously condemned in Jewish thought, primarily because it is viewed as
taking something (a human life) that belongs to God for “only He who gives
life may take it away.” For Judaism, human life is, “created in the image of
God.” Although life is considered to be God’s creation and good, human life is
related to God in a special way: it is sacred. The sanctity of human life
prescribes that, in any situation short of self-defense or martyrdom, human life
must be treated as an end in itself. It may thus not be terminated or shortened
because of considerations of the patient’s convenience or usefulness, or even
sympathy with the suffering of the patient. Thus euthanasia may not be
performed either in the interest of the patient or of anyone else.30

Jewish law strongly condemns any act that shortens life and treats the killing of
a person whom the doctors say will die in any event to be an act of murder.
Positive euthanasia is thus ruled out. Even individual autonomy is secondary to
the sanctity of human.

There are three broad Jewish denominations: reform, conservative and

orthodox, with orthodox Jews being the most religious. The Jewish legal

30
“Religion and Spirituality” The Death with Dignity National Center (DDNC), Oct. 13, 2009

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system or Halacha, developed from the Bible (Tanach), Talmud and rabbinic
responsa, differentiates between active and passive actions and between
withholding and withdrawing life-sustaining therapies. Halacha does not allow
the hastening of death even in the terminally ill, but there is no obligation to
actively prolong the pain and suffering of a dying patient or to lengthen such a
patient’s life. Therefore, Halacha allows the withholding of a life-prolonging
treatment, provided that it pertains to the dying process, but forbids the
withdrawing of life-sustaining therapy, if it is a continuous form of treatment.
Active euthanasia or physician-assisted suicide is prohibited even if the patient
has requested it. A new Israeli law strikes a balance between the sanctity of life
and the principle of autonomy. The law forbids the withdrawing of a
continuous life-sustaining therapy but allows withholding further treatment if it
is an intermittent life-sustaining treatment—and if this action is in accordance
with the clear wish of the patient. This is based on the assumption that each
unit of treatment is an independent and new decision, hence it is permissible to
withhold it. This includes withholding any life-prolonging activities such as
intubation, ventilation and surgery, and also chemotherapy or dialysis, even
after initiation, because such action is viewed as omitting the next treatment
rather than committing an act of withdrawal. Respirator therapy is a continuous
form of treatment, and its withdrawal is forbidden because this act will shorten
life. Such a decision, however, may cause unwanted and prolonged suffering.
Therefore, the law and Halacha allow the changing of the ventilator from a
continuous form to an intermittent form of treatment by connecting the
respirator to a timer. Such an action changes the respirator, from a conceptual
point of view, into an intermittent therapy. The end result, the death of the
patient according to his/her wishes, thereby becomes morally acceptable
because the aim is achieved by omission rather than commission. This

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innovative, practical solution is also helpful to health-care providers who have
psychological problems fulfilling the wishes of the patient. Food and fluids are
regarded as basic needs and not treatment. Withholding food and fluids from a
dying patient (or patients with other disorders) is unrelated to the dying process
and therefore is prohibited and regarded as a form of euthanasia. This mostly
concerns incompetent patients, who make up the majority of intensive care
patients. Nevertheless, if the dying patient is competent and refuses treatment,
including food and fluids, he/she should be encouraged to change his/her mind
regarding food and fluids, but should not be forced against his/her wishes. The
situation changes, however, when the patient approaches the final days of life,
when food and even fluids may cause suffering and complications. In such an
event, it is permissible to withhold food and fluids if it is known that this was
the patient’s wish. Based on the moral requirement to alleviate pain and
suffering, the law and Halacha require providing palliative care to the patient
and to his/her family. Treatments include palliative therapy that might
unintentionally shorten life, based on the principle of double effect. The
classical Jewish definition of death is when spontaneous respiration ceases.
Halachic authorities permit harvesting of vital organs from a brain-dead
person, if a strict set of medical criteria are met to verify absolute and
irreversible cessation of respiration (strict brain-death criteria). Some Halachic
authorities, however, also require the cessation of heart action, and many
ultraorthodox Jews do not accept brain criteria and insist on the cessation of
cardiac activity.

“Modern medical technology has produced unprecedented forms of death or

conditions of painful survival incompatible with life, leading to new dilemmas
and bringing forth unanswered questions”. This statement by the bioethics

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committee of the Church of Greece highlights what many religious leaders
during the last 25 years have faced. They have had to contemplate and agree on
epoch-making decisions concerning end-of-life choices. Statements have been
issued by the Pope, Islamic international conferences have been held, the
Jewish legal system has issued rulings on ventilator therapy so that cessation of
therapy becomes legally possible within the framework of Jewish religious
law, and Western Buddhists accept organ donation. So far, critical care
medicine has essentially been a discipline of Western medicine because it
demands a highly developed medical system. Consequently, Far Eastern
religions have not had the same need to develop distinct attitudes on
withholding or withdrawing care in the ICU setting, but it is more than likely
that Far Eastern religions will also have to adjust or express their religious
rulings on these issues during the 21st century.

However, not only the general rulings of the various churches are important. In
a study of actual behaviour in the clinical setting, it has recently been
documented that physicians’ religious beliefs have a major impact on their ICU
decisions. Withholding, withdrawing and median time from ICU admission to
first limitation of therapy varied by religious affiliation. It is noteworthy,
however, that although religion plays an important part in decision-making,
regional differences among physicians of the same religion have also been
documented, and these differences are most probably due to acculturation [8,
50–53]. Religious beliefs can easily lead to clashes and discussions between
patients and their families and among med- 428 ical professionals, but
physicians can help to prevent these conflicts by becoming knowledgeable and
respecting their patients’ faiths and beliefs. It is not enough, however, to look
at religious issues, because for many laws and public policies on end-of-life

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decisions, it is difficult to ascertain what stems from the religious stance, the
secular law, or the cultural background. This is most evident in the question of
patient autonomy. One of the main themes of the Protestant Reformation was
that earthly authorities are not infallible. This emphasis on personal freedom
contributed to articulating and promoting the concept of autonomy, which
today is so widely accepted in Western countries that it is no longer considered
a unique feature of Protestant (religious) bioethics. In contrast to the view on
patient autonomy found in most western European countries is Greece, where
96% of adherents to the Greek Orthodox Church believe that communication is
important in the final stage of a disease, but only 23% agree that the patient
should be informed of the prognosis. This must be due to culture, because no
such a statement has been issued by the Orthodox Church. Also, it should be
noted that in many Asian cultures patient autonomy is an agenda based not on
culture, but on religious principles or thinking. In the Confucian concept of
relational personhood, it is the family or community who should be given the
information, coordinate the patient’s care and protect the patient from the
burden of knowledge. Likewise, in the Hindu ethos death is a concern not only
for the dying person, but also for those close to him, and it is the physician’s
task not to inform the patient of imminent death, but to nurture the will to live .
This is probably the reason that limitations of therapy only precede 22–50% of
all ICU deaths in India and physicians are generally reluctant to discuss
sensitive issues with patients and relatives . Even when there is a clear-cut
statement from church leaders, it may be difficult to incorporate the religious
perspectives into modern medical decision making. The Catholic Church states
that withholding or withdrawing of “extraordinary” therapy is allowed, but the
development in medical science raises the question: what is extraordinary?
Mechanical ventilation could be ordinary at one stage of an illness, yet

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extraordinary at a later stage of the same illness. Also, even clear-cut
statements are not necessarily accepted culturally. According to Islamic law
one is allowed to abstain from overzealous treatment, but in Lebanon and
Oman withdrawing of treatment and do-not-resuscitate orders are less frequent
than in Western Europe—and in both papers this is mainly explained by
cultural differences. Strict ethnic and religious background is not the only
factor that must be taken into account when dealing with end-of-life decisions.
Recent immigrants will generally adhere rather strictly to the rules of the
religion and culture of their place of origin, whereas second- or third
generation immigrants will often have acculturated to the dominant bioethics
of their new country. In addition, it must be recognized that when facing death,
many individuals tend to fall back on their traditional cultural or religious
background [46, 59]. On the other hand, people who classify themselves as
belonging to a religion do not necessarily attend their church or follow any of
the religion’s rulings.

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 CHAPTER-5

RECOMMENDATION OF LAW COMMISSION

The Law Commission of India, in its 196th Report, in its opening remarks
clarified in unmistakable terms that the Commission was not dealing with
“euthanasia” or “assisted suicide” which are unlawful but the Commission was
dealing with a different matter, i.e., “withholding life-support measures to
patients terminally ill and universally in all countries, such withdrawal is
treated as lawful”. Time and again, it was pointed out by the Commission that
withdrawal of life support to patients is very much different from euthanasia
and assisted suicide, a distinction which has been sharply focused in Aruna’s
case as well. Aruna’s case preferred to use the compendious expression –
“passive euthanasia”.

In the 17th Law Commission of India it took up the subject for consideration at
the instance of Indian Society of Critical Care Medicine, Mumbai which held a
Seminar attended by medical and legal experts. It was inaugurated by the then
Union Law Minister. The Law Commission studied a vast literature on the
subject before the preparation of report.

In the introductory chapter, the Law Commission clarified that, in this Report,
we are of the view that ‘Euthanasia’ and ‘Assisted Suicide’ must continue to be
offences under our law. The scope of the inquiry is, therefore, confined to
examining the various legal concepts applicable to ‘withdrawal of life support
measures’ and to suggest the manner and circumstances in which the medical
profession could take decisions for withdrawal of life support if it was in the

117
‘best interests’ of the patient. Further, question arises as to in what
circumstances a can refuse to take treatment and ask for withdrawal or
withholding of life support measure, if it is an informed decision.”

Then Chairman of the Law Commission made the following observation in his
addressing letter: “A hundred years ago, when medicine and medical
technology had not invented the artificial methods of keeping a terminally ill
patient alive by medical treatment, including by means of ventilators and
artificial feeding, such patients were meeting their death on account of natural
causes. Today, it is accepted, a terminally ill person has a common law right to
refuse modern medical procedures and allow nature to take its own course, as
was done in good old times. It is well-settled law in all countries that a
terminally ill patient who is conscious and is competent, can take an ‘informed
decision’ to die a natural death and direct that he or she be not given medical
treatment which may merely prolong life. There are currently a large number
of such patients who have reached a stage in their illness when according to
well-informed body of medical opinion there are no chances of recovery. But
modern medicine and technology may yet enable such patients to prolong life
to no purpose and during such prolongation, patients could go through extreme
pain and suffering. Several such patients prefer palliative care for reducing
pain and suffering and do not want medical treatment which will merely
prolong life or postpone death.”
The 17th Law Commission of India took up the subject for consideration at the
instance of Indian Society of Critical Care Medicine, Mumbai which held a
Seminar attended by medical and legal experts. It was inaugurated by the then
Union Law Minister.
The Law Commission made the following statement: “In this Report, we are
of the view that ‘Euthanasia’ and ‘Assisted Suicide’ must continue to be

118
offences under our law. The scope of the inquiry is, therefore, confined to
examining the various legal concepts applicable to ‘withdrawal of life support
measures’ and to suggest the manner and circumstances in which the medical
profession could take decisions for withdrawal of life support if it was in the
‘best interests’ of the patient. Further, question arises as to in what
circumstances a patient can refuse to take treatment and ask for withdrawal or
withholding of life support measure, if it is an informed decision”

Passive Euthanasia has been advocated by the Law Commission of India in the
196th Report both in the case of competent patients and incompetent patients
who are terminally ill. In the case of incompetent patients, the attending
medical practitioner should obtain the opinion of three medical experts whose
names are on the approved panel and thereafter he shall inform the Patient (if
conscious) and other close relatives. Then he shall wait for 15days before
withholding or withdrawing medical treatment including discontinuance of life
supporting systems. This 15 days’ time was contemplated with a view to
enable the patient (if conscious) or relatives or guardian to move an original
petition in the High Court seeking declaratory relief that the proposed act or
omission by the medical practitioner /hospital in respect of withholding
medical treatments is lawful or unlawful. High Court will then give a final
declaration which shall be binding on all concerned and will have the effect of
protecting the doctor or hospital from any civil or criminal liability. The
Supreme Court in Aruna’s case has put its seal of approval on (non-voluntary)
passive euthanasia subject to the safeguards laid down in the judgment. In the
arena of safeguards, the Supreme Court adopted an approach different from
that adopted by the Law Commission. The Supreme Court ruled in Aruna’s
case that in the case of incompetent patients, specific permission of the High
Court has to be obtained by the close relatives or next friend or the doctor /

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hospital staff attending on the patient. On such application being filed, the
High Court should seek the opinion of a Committee of three experts selected
from a panel prepared by it after consultation with medical authorities. On the
basis of the report and after taking into account the wishes of the relations or
next friend, the High Court should give its verdict. At paragraph 135, it was
declared: “the above procedure should be followed all over India until
Parliament makes legislation on this subject.” Earlier at para 124 also, the
learned Judges stated “we are laying down the law in this connection which
will continue to be the law until parliament makes a law on the subject.”

The 196thReport of the Law Commission stated the fundamental principle that
a terminally ill but competent patient has a right to refuse treatment including
discontinuance of life sustaining measures and the same is binding on the
doctor, “provided that the decision of the patient is an ‘informed decision’ ”.
‘Patient’ has been defined as a person suffering from terminal illness.
“Terminal illness” has also been defined under Section 2(m). The definition of
a ‘competent patient’ has to be understood by the definition of ‘incompetent
patient’. ‘Incompetent patient’ means a patient who is a minor or a person of
unsound mind or a patient who is unable to weigh, understand or retain the
relevant information about his or her medical treatment or unable to make an
‘informed decision’ because of impairment of or a disturbance in the
functioning of the mind or brain or a person who is unable to communicate the
informed decision regarding medical treatment through speech, sign or
language or any other mode (vide Section 2(d) of the Bill, 2006). “Medical
Treatment” has been defined in Section 2(i) as treatment intended to sustain,
restore or replace vital functions which, when applied to a patient suffering
from terminal illness, would serve only to prolong the process of dying and
includes life sustaining treatment by way of surgical operation or the

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administration of medicine etc. and use of mechanical or artificial means such
as ventilation, artificial nutrition and cardio resuscitation. The expressions
“best interests” and “informed decision” have also been defined in the
proposed Bill. “Best Interests”, according to Section 2(b), includes the best
interests of both on incompetent patient and competent patient who has not
taken an informed decision and it ought not to be limited to medical interests of
the patient but includes ethical, social, emotional and other welfare
considerations. The term ‘informed decision’ means, as per Section 2(e) “the
decision as to continuance or withholding or withdrawing medical treatment
taken by a patient who is competent and who is, or has been informed about –

1. The nature of his or her illness,

2. Any alternative form of treatment that may be available,
3. The consequences of those forms of treatment,
4. The consequences of remaining untreated”

The Consultation Paper of the Law Commission of U.K. has adopted a similar
approach in dealing with the subject of “Mental Capacity” and this has been
referred to by Butler Sloss L.J. The definition of ‘informed decision’ given in
the 196th Report of Law Commission of India is almost on the same lines as
what Butler Sloss L.J. said and the Law Commission of U.K. suggested in
1995.5.8 The Law Commission of India clarified that where a competent
patient takes an ‘informed decision’ to allow nature to have its course, the
patient is, under common law, not guilty of attempt to commit suicide (u/s 309
IPC) nor is the doctor who omits to give treatment, guilty of abetting suicide
(u/s 306IPC) or of culpable homicide (u/s 299 read with Section 304 of
IPC).5.9 As far as (i) incompetent patients as defined above and (ii) competent
patients who have not taken ‘informed decision’, a doctor can take a decision

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to withhold or withdraw ‘medical treatment’ if that is in the ‘best interests’ of
the patient and is based on the opinion of a body of three medical experts.

The Law Commission in its 42nd Report25 recommended the repeal of

section 309 of IndiaPenal Code. The Indian Penal Code (Amendment) Bill,
1978, as passed by the Rajya Sabha, accordingly provided for omission of
section 309. Unfortunately, before it could be passed by the Lok Sabha, the
Lok Sabha was dissolved and the Bill lapsed. The Commission submitted
Punjab, recommending retention of section 309.Later the Law Commission in
its 210th Report28 its156th Report26 after the pronouncement of the judgment
in Gian Kaur v. State of submitted that attempt to suicide may be regarded
more as a manifestation of a diseased condition of mind deserving treatment
and care rather than an offence to be visited with punishment. The Supreme
Court in Gian Kaur focused on constitutionality of section 309. It did not go
into the wisdom of retaining or continuing the same in the statute. The
Commission has resolved to recommend to the Government to initiate steps for
repeal of the anachronistic law contained in section 309, IPC which would
relieve the stress of suffering.

The 196th Law Commission has given the following recommendations:

1. Obviously, the first thing that is to be declared is that every ‘competent

patient’, who is suffering from terminal illness has a right to refuse
medical treatment (as defined i.e. including artificial nutrition and
respiration) or the starting or continuation of such treatment which
has already been started. If such informed decision is taken by the
competent patient, it is binding on the doctor. At the same time, the
doctor must be satisfied that the decision is made by a competent
patient and that it is an informed decision. Such informed decision

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 must be one taken by the competent patient independently, all by
himself i.e. without undue pressure or influence from others. It must
also be made clear that the doctor, notwithstanding the withholding or
withdrawal of treatment, is entitled to administer palliative care i.e. to
relieve pain or suffering or discomfort or emotional and
psychological suffering to the incompetent patient (who is
conscious) and also to the competent patient who has refused medical
treatment.
2. We propose to provide that the doctor shall not withhold or withdraw
treatment unless he has obtained opinion of a body of three expert
medical practitioners from a panel prepared by high ranking
Authority. We also propose another important caution, namely,
that the decision to withhold or withdraw must be based on
guidelines issued by the Medical Council of India as to the
circumstances under which medical treatment in regard to the
particular illness or disease, could be withdrawn or withheld. In
addition, it is proposed that, in the case of competent as well as
incompetent patients, a Register must be maintained by doctors who
propose withholding or withdrawing treatment. The decision as well as
the decision-making process must be noted in the Register. The
Register to be maintained by the doctor must contain the reasons as to
why the doctor thinks the patient is competent or incompetent, as to
why he thinks that the patient’s decision in an informed decision or not,
as to the view of the experts the doctor has consulted in the
case of incompetent patients and competent patients who have not
taken an informed decision, what is in their best interests, the name,
sex, age etc. of the patient. He must keep the identity of the patient and

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 other particulars confidential. Once the above Register is duly
maintained, the doctor must inform the patient (if he is conscious), or
his or her parents or relatives before withdrawing or withholding
medical treatment. If the above procedures are followed, the medical
practitioner can withhold or withdraw medical treatment to a
terminally ill patient. Otherwise, he cannot withhold or withdraw
the treatment.
3. A patient who takes a decision for withdrawal or withholding medical
treatment has to be protected from prosecution for the offence
of ‘attempt to commit suicide’ under sec. 309 of the Indian Penal
Code, 1860. This provision is by way of abundant caution because
it is our view that the very provisions are not attracted and the
common law also says that a patient is entitled to allow nature to take
its own course and if he does so, he commits no offence. Likewise, the
doctors have to be protected if they are prosecuted for ‘abetment of
suicide’ under sections 305, 306 of the Penal Code, 1860 or of culpable
homicide not amounting to murder under sec. 299 read with sec. 304 of
the Penal Code, 1860 when they take decisions to withhold or
withdraw life support and in the best interests of incompetent patients
and also in the case of competent patients who have not taken an
informed decision. The hospital authorities should also get the
protection. This provision is also by way of abundant caution and in
fact the doctors are not guilty of any of these offences under the above
sections read with sections 76 and 79 of the Indian Penal Code as of
today. Their action clearly falls under the exceptions in the practitioner
acts in accordance with the provisions of the Act while withholding or

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 withdrawing medical treatment, his action shall be deemed to be
‘lawful.
4. We have therefore thought it fit to provide an enabling provision under
which the patients, parents, relatives, next friend or doctors or hospitals
can move a Division Bench of the High Court for a declaration that the
proposed action of continuing or withholding or withdrawing
medical treatment be declared ‘lawful’ or ‘unlawful’. As time is
essence, the High Court must decide such cases at the earliest and
within thirty days. Once the High Court gives a declaration that the
action of withholding or withdrawing medical treatment proposed by
the doctors is ‘lawful’, it will be binding in subsequent civil or criminal
proceedings between same parties in relation to the same patient. We
made it clear that it is not necessary to move the High Court in every
case. Where the action to withhold or withdraw treatment is taken
without resort to Court, it will be deemed ‘lawful’ if the provisions of
the Act have been followed and it will be a good defense in subsequent
civil or criminal proceedings to rely on the provisions of the Act.
5. It is internationally recognized that the identity of the patient, doctors,
hospitals, experts be kept confidential. Hence, we have
proposed that in the Court proceedings, these persons or bodies
will be described by letters drawn from the English alphabet and
none, including the media, can disclose or publish their names.
Disclosure of identity is not permitted even after the case is disposed
of.
6. The Medical Council of India must prepare and publish Guidelines in
respect of withholding or withdrawing medical treatment. The said
Council may consult other expert bodies in critical care medicine and

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 publish their guidelines in the Central Gazette or on the website of the
Medical Council of India.

Due to development of Science and technology in the last century the concepts
of life and death has been changed. Nowadays, a person who is in a
persistent vegetative state, whose sensory systems are dead, can be kept alive
by ventilators and artificial nutrition for years. In the light of these
developments, legal, moral and ethical issues have arisen as to whether a
person who is under ventilator and artificial nutrition should be kept alive for
all time to come till the brain-stem collapses or whether, in circumstances
where an informed body of medical opinion states that there are no
chances of the patient’s recovery, the artificial support systems can be
stopped. If that is done, can the doctors be held guilty of murder or abetment
of suicide? These questions have been raised and decided in several
countries and broad principles have been laid down. ‘Withdrawal of life
support systems’ is different for ‘Euthanasia’ or ‘Assisted Suicide’.
Withholding or withdrawing life support is today permitted in most countries,
in certain circumstances, on the ground that it is lawful for the doctors or
hospitals to do so. Courts in several countries grant declarations in individual
cases that such withholding or withdrawal is lawful.

It is a well settled principle at common law that a patient has a right to accept
medical treatment or refuse it. This is called the principle of self
determination. In Airedale30, Lord Goff of Chiveley stated that “it is
established that the principle of self determination requires respect must be
given to the wishes of the patient, so that if any adult patient of sound mind
refuses, however unreasonably, to consent to treatment or care by which his
life would or might be prolonged,” it shall be obeyed. The doctors “must give

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effect to his wishes even though they do not consider it to be in the best
interests to do so.” If a competent patient wants life support system to be
withheld or withdrawn, it is binding on the doctors unless they come to the
conclusion that the patient’s decision is not an ‘informed decision’. In such
cases, the doctor has to take a decision in the ‘best interests’ of the patient. In
England and other countries, the doctors or hospitals approach the
Court for a declaration that any decision by hem for withholding or
withdrawing medical treatment be declared lawful. Again, parents of a patient,
whether the patient is minor or not, can also move the Court, if they disagree
with the doctor. The parents may want the artificial treatment be still continued
or in some cases discontinued.

The Law Commission in its 196th Report annexed the drafted Bill namely
“Medical Treatment of Terminally Ill (Protection of Patients and Medical
Practitioners) Bill, 2006 relating to the law applicable to terminally ill patients
(including patients in persistent vegetative state) who desire to die a natural
death without going through modern Life Support Measures like artificial
ventilation and artificial supply of food.

The case of Aruna Ramachandra Shanbaug [(2011) 4 SCC 454] is the first
case in India which deliberated at length on ‘euthanasia’. The Supreme Court,
while making it clear that passive euthanasia is permissible in our country as in
other countries, proceeded to lay down the safeguards and guidelines to be
observed in the case of a terminally ill patient who is not in a position to
signify consent on account of physical or mental predicaments such as
irreversible coma and unsound mind. It was held that a close relation or a
‘surrogate’ cannot take a decision to discontinue or withdraw artificial life
sustaining measures and that the High Court’s approval has to be sought to

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adopt such a course. The High Court in its turn will have to obtain the opinion
of three medical experts. In that case, Aruna Shanbaug was in Persistent
Vegetative State (PVS for short) for more than three decades and the Court
found that there was a little possibility of coming out of PVS. However, the
Court pointed out that she was not dead. She was abandoned by her family and
was being looked after by staff of KEM Hospital in which she worked earlier
as staff nurse. The Court started the discussion by pointing out the distinction
between active and passive euthanasia and observed that “the general legal
position all over the world seems to be that while active euthanasia is illegal
unless there is legislation permitting it, passive euthanasia is legal even
without legislation provided certain conditions and safeguards are maintained”.
The distinctive feature of PVS, it was pointed out, is that brainstem remains
active and functioning while the cortex has lost its function and activity. The
Supreme Court addressed the question when a person can be said to be dead .It
was answered by saying that “one is dead when one’s brain is dead”. Brain
death is different from PVS. Reference was made to American Uniform
Definition of Death, 1980. Then it was concluded: “Hence, a present day
understanding of death as the irreversible end of life must imply total brain
failure such that neither breathing nor circulation is any more”.

After referring extensively to the opinions expressed in Airedale case, the

Supreme Court stated that the law in U.K. is fairly well-settled that in the case
of incompetent patient, if the doctors act on the basis of informed medical
opinion and withdraw the artificial life support system, the said act cannot be
regarded as a crime. The question was then posed as to who is to decide what
the patient’s best interest is where he or she is in a Persistent Vegetative State
(PVS). It was then answered by holding that although the wishes of the
parents, spouse or other close relatives and the opinion of the attending doctors

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should carry due weight, it is not decisive and it is ultimately for the Court to
decide as parens patriae as to what is in the best interest of the patient. The
High Court has been entrusted with this responsibility, following what Lord
Keith said in Airdale case. The Supreme Court referred to the dicta in the
Court of appeal decision in J. (A minor) (Wardship: medical treatment) 9, that
the Court as a representative of sovereign as parens patriae will adopt the same
standard which a reasonable and responsible parent would do. The same is the
standard for a ‘surrogate’ as well. But, there is no decision-making role to a
‘surrogate’ or anyone else except the High Court, as per the decision in
Aruna’s case.

Referring to the U.S. decisions and in particular the observations of Cardozo J.,
the Supreme Court pointed out that the informed consent doctrine has become
firmly entrenched in American Tort Law. The logical corollary of the doctrine
of informed consent is that the patient generally possesses the right not to
consent i.e., to refuse treatment”. The court relied on the observation of
Rehnquist C.J. that “the notion of bodily integrity has been embodied in the
requirement that informed consent is generally required for medical treatment”.
The Supreme Court referred extensively to Cruzan’s case , wherein the
U.S. Supreme Court affirmed the view of the State Supreme Court that the
permission to withdraw artificial feeding and hydration equipment to Nancy
Cruzan who was in a PVS state ought not to be allowed. It was observed that
there was a powerful dissenting opinion by Brennan J. with whom two Judges
concurred. The Supreme Court then highlighted the fact that in Cruzan case,
there was a statute of the State of Missouri unlike in Airedale case (where there
was none), which required clear and convincing evidence that while the patient
was competent, had desired that if she becomes incompetent and enters into a
PVS, her life support system should be withdrawn. There was no such

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evidence in that case. It was in that background, in Cruzan’s case, the Court’s
permission was refused

The government on 16 January told the Supreme Court that it was considering
a Law Commission report which supported passive euthanasia—withdrawing
life support based from a terminally-ill patient. The Law Commission in its
241st Report under the chairmanship of P.V. Reddi had said that withdrawing
life support for certain categories of people—such as those in persistent
vegetative state (PVS) or in irreversible coma or of unsound mind, who lack
mental faculties to make decisions for themselves—should be allowed.

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 CHAPTER-6

PROS AND CONS OF EUTHANASIA

Euthanasia is known as many different things like mercy killing, physician

assisted suicide, and the right to die, but they all mean the same thing.
Euthanasia is administering a lethal dosage of a certain medication, or ending
all life support means, and letting a person who is terminally ill pass away at
their own will. Many different things charge the debate surrounding this hot
button issue. Terminal diseases and illnesses are painful, especially when the
person inflicted is nearing the end of their battle. Unimaginable pain,
uncertainty, and a loss of control are things that no one should have to endure
when they are nearing their death. However, the opposition believe that
religious, moral, and ethical values all must take importance and that death
should come naturally as it is intended to.

The death and dying debates, especially where they focus on Physician assisted
suicide (euthanasia and suicide) involve some central arguments which
includes arguments in favour of and arguments in against the legalization and
practice of euthanasia (Physician-assisted suicide). The debate over euthanasia
and physician-assisted suicide emerged into public consciousness in the mid-
1970s and the debate got off to a rousing start as philosophers, doctors,
theologians, public-policy theorists, journalists, social advocates and private
citizens became embroiled in the debate. On the one side were liberals, who
thought physician-assisted suicide and perhaps voluntary active euthanasia
were ethically acceptable and should be legal and on the other side were

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conservatives, who believed assisted dying was immoral or dangerous to
legalize as a matter of public policy. Proponents of euthanasia and physician-
assisted suicide (PAS) contend that terminally ill people should have the right
to end their suffering with a quick, dignified, and compassionate death. They
argue that the right to die is protected by the same constitutional safeguards
that guarantee such rights as marriage, procreation, and the refusal or
termination of life-saving medical treatment. Whereas the Opponents of
euthanasia and physician-assisted suicide contend that doctors have a moral
responsibility to keep their patients alive as reflected by the Hippocratic Oath.
They argue there may be a "slippery slope" from euthanasia to murder, and that
legalizing euthanasia will unfairly target the poor and disabled and create
incentives for insurance companies to terminate lives in order to save money.

Recent developments in medicine and associated technologies have changed

the concept of death. Most of the medical technologies are effective on
changing life process and people are able to live a long time despite the
diseases. Using technology in medicine and consequently giving and saving
lives or reducing their suffering, the issue of where and how to die has been
particularly important in recent years. Euthanasia is the most important issue
which has been discussed in this context. The important points about
euthanasia are more the ethical issues. Some fundamental questions have been
suggested; e.g., is there any right to facilitate death based on someone's will? Is
it an ethical issue to end another person's life which has no hope to live for
saving life of others and so on.

Euthanasia has been divided into two active and passive types. In the active
type, the patient himself is the decision maker and would ask the physician to
end his life which is done by an "act" like injection of a lethal medication. In

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the passive type, the patient would refuse his treatment for hastening his death
without any specific activity. For instance, the patient with discontinuation of
the treatment process, discontinuation of the medications, and removing the
equipments puts himself in a situation which would be impossible to survive
from. The pros and cons of euthanasia traditionally distinguished the active and
passive types. But, there are debates and uncertainty about the ethical and
moral differences of the two types.

Distinguishing between active and passive euthanasia is based on moral

difference between "killing" and "letting die". This analysis also could not
solve the euthanasia puzzle; because some believe that distinction between
"killing" and "letting die" is not clear and even if it is, morally it is not
important. One of the concerns and arguments of the euthanasia opponents is
the "slippery slope". The proponents of this theory state: when a society can
accept ending the life, there would be no rational and logical approach to limit
euthanasia and deter from its abuse.

Immanuel Kant’s Moral Theory is relative to addressing a deontological

theoretical approach to euthanasia. Kant viewed humans as rational beings,
which distinguishes them from animals and is the main basis of their status as
moral agents. Nothing is good except when it is done for a good will, and an
individual’s moral duty directly correlates with good will. Kant purported that
no one has the right to take his or her life in whatever condition. To do so can
be disastrous because it disrespects the individual life and the lives of fellow
human beings.

The death and dying debates, especially where they focus on Physician assisted
suicide (euthanasia and suicide) involve some central arguments which

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includes arguments in favour of and arguments against the legalization and
practice of euthanasia (Physician-assisted suicide). The debate over euthanasia
and physician-assisted suicide emerged into public consciousness in the mid-
1970s and the debate got off to a rousing start as philosophers, doctors,
theologians, public-policy theorists, journalists, social advocates and private
citizens became embroiled in the debate. On the one side were liberals, who
thought physician-assisted suicide and perhaps voluntary active euthanasia
were ethically acceptable and should be legal and on the other side were
conservatives, who believed assisted dying was immoral or dangerous to
legalize as a matter of public policy. Below are some of the principal
arguments for and against the legalization and practice of euthanasia and
physician-assisted suicide

6.1 Arguments For Euthanasia: Why Euthanasia Should Be

Generally euthanasia means “good death”, but has become to mean a

‘hastened’ or ‘assisted’ death. Terminally ill people must give “right to die”
when they want to end their lives. No one else should be allowed to make the
decision if a patient should go on living or should be killed, only the ill people
themselves. “The right to die with dignity” is the main phrase in this
controversial topic. The patients should choose if life-prolonging machines
should keep them alive or not. Generally the patient should have a
‘comfortable’ death, which means, that they should be released form great pain
and unless suffering.

The strongest argument in favour of active voluntary euthanasia is based on

respect for individual autonomy. The claim of autonomy involves that we all
possess a right to self-determination in matters profoundly touching on such

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religious themes as life, death, and the meaning of suffering. On this view, it is
a matter of basic human dignity to be given the right to decide about the
circumstances of our own lives and our deaths. “The principle of autonomy is
an expression of the essentially Kantian idea that what is of paramount
importance for my life is that it consists of my own choices, for good or ill.”
According to Kant, it is not permissible to treat people as a means rather than
as ends-in- themselves, even if this will involve attempting to use them as a
means to their own well-being. “Taking autonomy (literally‘Self-governance’)
seriously means acknowledging individual sovereignty over all purely self-
regarding acts. Determining the circumstances of one’s own death, according
to this Margaret P. Battin, Rosamond Rhodes, and Anita Silvers (1998),
Physician assisted suicide: expanding the debate, pg. 281 42 Dickenson, D.,
Johnson, M. and Katz, J.S (2000), Death, dying and bereavement, pg. 272 25 |
Page principle, should be allowed provided that it is a self-regarding act, and if
so like other self-regarding acts, it should be exempt from the interference of
others”.

Physician assisted suicide and euthanasia are merciful acts, that deliver
terminally ill patient from a painful and protected death. “If the Physician is
unable to relieve the patient’s suffering in other ways acceptable to the patient
and the only way to avoid such suffering is by death, then as a matter of mercy,
death may be brought about”.

Proponents argue that legalizing euthanasia/ assisted suicide is a necessary

"insurance policy" that will ensure that no one dies in painful agony or
unremitting suffering. Legalized euthanasia would protect the vulnerable from
wrongful death and enables peaceful death with dignity. Furthermore,
proponents of euthanasia and physician assisted suicide identify three main

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benefits to legalization: Realizing individual autonomy, reducing needless pain
and suffering, and providing psychological reassurance to dying patients.

The arguments in favor of legalizing physician assisted suicide are weighty,

and compelling individual cases of suffering are distressing. Among the most
important reasons for euthanasia include medical arguments, such as great
suffering and pain caused by incurable diseases in the terminal phase,
persistent vegetative state, possibility of organ transplantation in special cases,
and conditionally, equitable distribution of healthcare costs.

Among the landmark case of euthanasia, famous case is Terri Schiavo from
Florida, USA. She collapsed in her home in full cardiac arrest on February,
1990. She suffered massive brain damage due to lack of oxygen and, after two
and a half months in a coma, her diagnosis was changed to persistent
vegetative state. At the request of her husband, County judge ordered the
removal of Terri Schiavo's feeding tube in February 1995, and she died one
month later.

Interesting is the case of American Sidney Cohen, who was diagnosed with
cancer and given three months to live. He asked for euthanasia to be
administered. He was suffering agonizing pain and was bed-ridden, but was
refused euthanasia because it was illegal. Eight months later, he was still
living, and said: "I now know that death is inevitable and since coming under
hospice home care I now enjoy a full life." His fears of an agonizing death had
been allayed and he was now staunchly opposed to euthanasia.

Euthanasia or physician-assisted death should only be a last resort when all

medical treatments have failed. In support of euthanasia is rational to stop
medical treatment when the patient is in a terminal condition. The most

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important arguments supporting euthanasia include ending suffering, freedom
of choice to decide how and when one dies, and being able to die with dignity.
A terminally ill patient can have a terrible pain. Such a patient also can have
difficulty with sleeping. Medications used in the treatment of pain have the
potential to alter consciousness, change the state of mind, and even cause
death. It should be noted that without physician assistance, patients may
commit suicide in a messy, horrifying, and traumatic way. When the patient is
unable to speak, the decision regarding treatment becomes more complicated.
The instruction to the physician must be as close as possible to that which the
patient, if able, would give. In such a case, the physician must find out any
wishes the patient had expressed previously. If the patient is unable to
communicate on their own, the physician is obligated to communicate with the
family. Then, the physician must try to obtain consent from a proxy. Almost
always the patient has a close family tie with a spouse, a parent or a child.
Pertinent information from relatives and close friends is extremely helpful at
these times.

According to the utilitarian, acts are morally right in so far as they promote
happiness and alleviate unhappiness, and wrong in so far as they cause or allow
others to suffer needlessly. “Even according to the traditional ethic of the
medical profession, physicians have a solemn duty not merely to extend life
whenever possible (and desirable), but also to alleviate pain and suffering
whenever possible”. Hence, those in view of this argument think that
euthanasia and Physician-assisted suicide should be legalized and in relation to
the golden rule “do as you would be done” requires that we provide aid and
help to those in distress and in particular provide appropriate relief from
suffering and a corollary of the harm principle is that the denial of a right to die

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is unfair and cruel and no one should be obliged to endure unbearable
suffering.

6.2 Arguments Against Euthanasia: Why euthanasia should be forbidden?

It must be noted that not everyone who oppose to the legalization of euthanasia
is opposed to the practice of euthanasia. Those who oppose euthanasia in
principle will of course oppose its legalization, but there are some who, while
supporting euthanasia in principle have misgivings about its
institutionalization. Thus, there are some who defend the right of people to
choose the time and circumstances of their death but who find the requirement
of satisfying a medical bureaucracy that their decision is sound both onerous
and offensive.

The taking of a human life is wrong and since suicide too is killing, then
suicide is also wrong because the Holy commandment states that “Thou shall
not kill”. Most members of this group with this same view tend to harbor
distinctly religious objections to suicide and euthanasia, viewing them as
violations of God’s dominion over human life. Killing in itself is simply
wrong, whether or not it is done out of respect for the patient’s autonomy or
out of concern for her suffering, “killing is understood as morally wrong in
virtually all cultures and religious system. Judaism, Christianity, Islam,
Hinduism, Buddhism, Confucianism, and many other religious traditions
prohibit killing; so do the moral and legal codes of virtually all social systems.”
Although almost all major world traditions share this view about the intrinsic

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wrongness of killing, the Roman Catholic has been most active in the Political
debate over physician-assisted suicide.

“According to the teachings of Catholicism, suicide violates the biblical

commandment “Thou shall not kill.” Self-killing can never be permitted, even
in painful terminal illness, although if it is caused by depression or other
psychopathology, it may be excused from ecclesiastical penalties like denial of
funeral rites.”

Doctors and Physicians are prohibited by the Hippocratic Oath not to kill
because the Physician is bound to save life and not to take it and the
participation of Physicians and doctors in such practices undermines their role
as healer and fatally compromises the physician-patient relationship. This
again will undermine the patient’s trust in the Physician because patients trust
their physicians more when they know that their physicians will help them, not
desert them as they die.

Permitting physicians to assist in suicide, even in sympathetic cases may lead

to situations in which patients are killed against their will. “Slippery-slope
arguments involve predictive empirical issues about possible future abuse”.
According to the Dutch cardiologist by name Richard Fenigsen, he intimated
that quiet a number of people were being killed against their will due to various
reasons which includes their (patients) families seeing them to be a burden
both financially and socially and they being a cost to governmental funds
especially with the terminally ill patients from which that same fund could
have been used on other patients with a higher recovery rate.

One of the strongest objections to euthanasia is that the autonomy which if is

our duty to respect is not enjoyed by everyone. Even if it is granted that respect

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for individual autonomy is of paramount importance, it nonetheless applies
only to socially empowered individuals or groups within society. There may be
serious problems and issues with the application of this principle to
marginalized groups and especially to individuals who are or can be exploited.
Legalizing euthanasia, according to some, ignores the social reality of
marginalized groups and persons who might be exploited by unscrupulous
relatives or unscrupulous doctors. This is an essentially utilitarian argument
drawing attention to grave social consequences of legalizing the practice. With
Mill’s harm principle which is explicitly also for restrictions on an individuals
freedom to act in cases where their act harms others, opponents of euthanasia
do acclaim that individual acts of self-destruction and the medical assistance
for such acts do in fact affect others and therefore are not pure self regarding.

6.3 Reasons against euthanasia

 Euthanasia devalues human life
 Euthanasia can become a means of health care cost containment
 Physician and other medical care people should not be involved in
directly causing death
 Euthanasia makes life disposable – it could be the first step on the
slippery slope. Slippery slope effect that has occurred where euthanasia
has been first been legalized for only the terminally ill and later laws are
changed to allow it for other people or to be done non-voluntary. Many
pain killing drugs can now help a patient die with dignity.
 A patient may have said they want euthanasia when they were nowhere
near death; however, when faced with death they may change their mind
but be incapable of telling anyone.

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  A dying patient may not be able to make a rational decision. Many
people recover after being “written off” by doctors.
 Hippocratic Oath: doctor must try to preserve life. If euthanasia was
legalised, the relationship of trust between doctor and patient can be
destroyed.
 If there were better facilities for caring for dying, there would be less
need o euthanasia
 People might be pushed into saying they want euthanasia by relative
who do not want to look after them.

6.4 Pros of Euthanasia\

 People should be allowed to choose – there could not be a more

fundamental issue of individual liberty than the right to decide whether to
live or to die. Control over one's own body should be a fundamental right.

 Euthanasia can reduce or prevent human suffering by relieving people

who are suffering extreme pain. Forcing people to suffer against their will
is wrong.

 It can also relieve suffering where someone’s quality of life has become
drastically low.

 It can free up health care resources to help someone else who is severely
ill.

 Modern medicine can often keep people alive indefinitely, even if they are
not conscious, it is therefore imperative that rules for when it is right to

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 end a life are explored, rather than a blanket ban on termination under
certain circumstances.

 Euthanasia does not mean a lack of caring or compassion, on the contrary,

the patient's needs are put first.

 Allowing living wills opens up the possibility of people determining

themselves whether their life is artificially extended after encountering
serious illness or health issues.

6.5 Cons of Euthanasia

 The idea that every human life is precious and has value is undermined by
euthanasia.

 Most medical professionals do not want to be involved with killing

patients, as it is the total opposite to what they see as their purpose, which
is healing people and saving lives.

 There is a danger that euthanasia could be used to control health care

costs, with the patient’s needs and wishes taking second place.

 Whatever the theory, disputes over mercy killings can often be very
difficult in practice, as it is not always clear what the patient wants, or is in
their interests. It is likely that more euthanasia requests would result in
more extended legal battles. Take, for instance, the case of the Florida
woman, Terri Schiavo, who was in a coma for years. Her husband wanted
the hospital to remove her feeding tube and her parents fought a legal
battle to try to stop that happening.

 If voluntary euthanasia is allowed, then there is a danger of it developing

into a slippery slope situation where say, sick elderly people end up

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 having their lives terminated because selfish relatives don’t want to look
after them, or out of greed for inheritance money.

 Euthanasia has a dark history and was used in Nazi Germany for the
extermination of children and adults that the government found
undesirable, such as the disabled. Keeping it illegal means that no
government can ever use it for political means.

Euthanasia deals with ending of life not giving life to someone. The religious
views say that life ends when soul leaves the body. But these views are not
considered I scientific context. Science is based on the facts. Soul cannot be
seen moving out of the body. Previously one was considered to be dead when
heart stopped beating. But new medical appliances keeps the heart beating for
long period. Heart beating can be stopped within minutes after removing those
equipments. New concept of death is “brain death”. Till brain stops electrical
activity, a person is considered to be alive. Though even after brain death heart
may keeps on beating and rest of the organs keep on functioning. Most of the
monotheistic religion of the world say lie is precious, it should be preserved,
protected and efforts should be made to prolong it.

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 CHAPTER-7

SUGGESTIONS AND CONCLUSION

My opinion on euthanasia is that in most of the cases it is morally right to

relieve a person of their suffering and pain instead of just appeasing them with
medicines. It is cruel to prolong intense suffering of one who is mortally ill and
desire to die. The choice of life or death should always be with the individual
concerned, and that the choice of what happens to him should be in accordance
with his values and not the values of others. It is not wrong for the terribly ill
person to ask another to help him in carry out his desire, neither it is wrong in
the part of other in doing so.
The term "right to die" is in fact a misnomer. People do die, and will continue
to do so whether the "right" is given or not. It hardly seems necessary to enact
legal measures to enforce the right to bring about one's death, since anyone
who wants to commit suicide is not likely to be prevented. What is really
sought when the phrase "right to die" is used, is that it be made respectable to
commit suicide and to involve others in that decision.

Passive euthanasia or physician-assisted suicide (PAS) should be granted to

such patients who are in completely terrible state such that, his recovery is
impossible and he will die sooner or later. By allowing euthanasia or PAS to
such patient will give relief to the patient as well as his family members
emotionally, physically as well as financially.
Many of those advocating euthanasia believe that it is a very cruel law which
prevents sufferers from achieving a quick death, or that forces other people

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who care for them to helplessly watch their pointless pain. However, there are
certain deceptive elements that one must be cautious of in this approach. The
first is our emotional response to a situation. A visitor entering an intensive
care unit may feel revulsion at the sight of all the equipment assembled to keep
the patient alive. The natural desire to be rid of such ugliness can lead to the
desire for the death of the afflicted. Conversely, the onlooker may be motivated
by feelings of sympathy and pity which manifest themselves in a desire for the
death of the patient. However, the emotional reaction of the patient may be
quite different.
Much of the appeal surrounding the move to legalize euthanasia centres on the
belief that it would be voluntary. Since "voluntary" implies that it would be
available only to those who freely and knowingly request it, there arises the
issue of mental competence. If the test of competence is as intangible and
uncertain as it is with respect to capacity to execute a will, there is cause for
concern, especially in light of the irreversibility of mistakes. The effect of
drugs and disease, or violent reactions to surgical procedures may undermine
the capacity for rational and independent thought. Too often the case for
euthanasia is built around carefully constructed abstract and hypothetical
presentations.
The concepts of PAS are not new. Within the past two or three decades,
however, these ideas have had a significant persuasive effect on the public.
Politically active, right to die movements dedicated to PAS reform have sprung
up in many western countries. A necessary condition to public support for PAS
reform, and one which continues to fuel the euthanasia debate, is the emerging
ethic of what might be called "liberal individualism." 9 According to
Somerville, We are now societies based on intense individual is impossibly
individualism to the exclusion of any real sense of community, including in

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situations facing death and bereavement. Matters such as euthanasia, that
would have been largely the subject of moral or religious discourse are now
explored in our courts and legislatures, particularly through the concepts of
individual human rights, civil rights and constitutional rights.
Euthanasia is a highly emotive and sensitive subject, causing disputes and
misunderstandings. As many authors have pointed out, the term euthanasia,
despite its frequent exposure in public media and in academic literature, does
not reflect a clear set of concepts and definitions to be used in euthanasia
debates. Thus, such debates often wind up inadequately formed and
ineffectual, causing more frustration than solutions. It has become clear that
any euthanasia discussion should be preceded by clarifications of the
terminology to be used; semantics followed by ethics. Nevertheless the concept
of euthanasia is not a new topic; our interest in the issue has only been renewed
due to the effects of contemporary medical technology. It has been
demonstrated that both the concept of euthanasia and the euthanasia discourse
have their roots in Antiquity. The diverse notions of euthanasia as they have
appeared through history were described and their relevance to present day
discussions was highlighted. Altogether 15 diverse notions (typologies) of
euthanasia have been identified by this study. Many of them can be found in
contemporary euthanasia debates. Out of the many typologies of euthanasia,
voluntary (active) euthanasia (typology 11) has been selected as the most
relevant concept for the conceptualization of euthanasia to the current medical
context. As the preferable concept of euthanasia the following definition was
taken from this source: euthanasia is a deliberate act of terminating the life of a
competent (autonomous) patient in the terminal stage of an illness, performed
by a

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physician upon the explicit and lasting request of this patient and that patient’s
sake. So euthanasia, being different from both assisted suicide and physician
assisted suicide, also differs from other instances of end-of-life decisions such
as the withholding or withdrawing of life support or terminal sedation.
There are no better words for an apt conclusion than those echoed by Dr. Jack
Koverkian
“For those who are facing a terminal illness, who are in irremediable pain and
suffering, and wish to exercise their right to die with dignity, a system should
be available to them”. Sanctity of human life does not imply the forced
continuation of an existence in pain and suffering. Given that a person has the
right to lead a dignified existence, he cannot be forced to live to his detriment.
If a person suffers from an incurable disease, it would be inhuman to compel
him to live a painful life. A terminally ill person should be permitted to
terminate his pain and suffering by choosing to do so. In fact, these are not
cases of extinguishing life but only of accelerating the process of natural death,
which has already commenced. The proposition merely is that the legislation
must provide for an alternative, if the terminally ill patient so desires, having
complied with the requisite conditions, to substitute his slow and painful death
with a quick and painless one. Medical science is progressing in India as in
the rest of the world, and hence currently we are having devises that can
prolong life by artificial means. This may indirectly prolong terminal suffering
and may also prove to be very costly for the families of the subject in question.
Hence, end-of-life issues are becoming major ethical considerations in the
modern-day medical science in India. Allowing euthanasia exclusively in
the case of terminally ill patients is desirable. The term “terminal”, though a
broad one has been consensually narrowed down by medical experts to mean
and include “a disease that cannot be cured nor has any remedy”. In fact, the

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final remedy is death. Death, being the only relief from the intolerable pain and
unbearable suffering connected therewith, criminal laws must not act with
misplaced zeal. Only where they can prove to be an appropriate and efficient
tool, to address the concerned evil, should they be resorted to. Also it is time
that the courts reconsidered the interpretation of the phrase “right to life” as
mentioned in Article 21 of the Constitution, to include within its ambit the
“right to die peacefully with medical assistance for the terminally ill”

In the opinion of the Supreme Court, while giving great weight to the wishes
of the parents, spouse, or other close relatives or next friend of the
incompetent patient and also giving due weight to the opinion of the attending
doctors, the approval of the High Court should be taken. This would also be in
consonance with the doctrine of parens patriae. The Supreme Court observed
that Article 226 gave abundant power to the High Court to pass suitable orders
on the application filed by the near relatives or next friend or the
doctors/hospital staff praying for permission to withdraw the life support to an
incompetent person of the kind above mentioned. When such an application is
filed 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. Before doing
so the Bench should seek the opinion of a committee of three reputed doctors
to be nominated by the Bench after consulting such medical
authorities/medical practitioners as it may deem fit. Preferably one of the three
doctors should be a neurologist, one should be a psychiatrist, and the third a
physician. The committee of three doctors nominated by the Bench should
carefully examine the patient and also consult the record of the patient as well
as taking the views of the hospital staff and submit its report to the High Court
Bench. Simultaneously with appointing the committee of doctors, the High
Court Bench should also issue notice to the State and close relatives e.g.

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parents, spouse, brothers/sisters etc. of the patient, and in their absence his/her
next friend, and supply a copy of the report of the doctors committee to
them as soon as it is available. After hearing them, the High Court bench
should give its verdict. The above procedure should be followed all over India
until Parliament makes legislation on this subject. The views of the near
relatives and committee of doctors should be given due weight by the High
Court before pronouncing a final verdict which should not be summary in
nature. With these observations, the petition was dismissed.

If we carefully examine the opposition to the legalization of euthanasia, we can

conclude that the most important point that the opponents raise is that it will
lead to its misuse by the doctors. Thus, it is humbly submitted that when a
patient or his relatives can willingly put his life in the hands of the doctor
trusting him, then why can’t a doctor be given such discretion to decide what
will be in favor of his patient. Another doubt that is often raised is that if the
doctors will be given discretion to practice voluntary euthanasia then surely it
will gradually lead to asking for involuntary or non-voluntary euthanasia. But
it is humbly submitted that a separate legislation should be made allowing only
voluntary euthanasia and not involuntary or non-voluntary euthanasia. As has
already been pointed out earlier, we also have to keep in mind the limited
medical facilities available in India and the number of patients.

This question still lies open that who should be provided with those facilities; a
terminally ill patient or to the patient who has fair chances of recovery. As the
patient himself out of his pain and agony is asking for death, doctor should not
increasing that pain of his should allow euthanasia. It has been ruled in the
Gian Kaur case that Article 21 does not include right to die by the Supreme

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Court.

But one may try to read it as is evident in the rights of privacy, autonomy and
self-determination, which is what has been done by the Courts of United State
and England. Thus, we can see that as the said right has been included in the
ambit of Article 21, so this can also be included in Article 21. This question
was not raised in the case earlier. Again the point that remains unanswered is
regarding the abuse of this right by the doctors. But relevant safeguards can be
put on this right and thus its abuse can be avoided.

One of the safeguards can be that a proper quasi-judicial authority having a

proper knowledge in the medical field can be appointed to look into the request
of the patient and the steps taken by the doctor. To make it more foolproof
some two or three assistant officials including one from the legal field can also
be appointed. This will avoid any abuse of this right granted to the terminally
ill patients. Here, we have to regard the painful situation in which the patient is
and top priority should be lessening his pain. Now when we already know that
he is anyways going to die today or tomorrow and he himself is asking for
death, there is no point that he should be denied with this right of at least
leading a life with minimum dignity and willingly. Otherwise his life will be
no better in that situation. Thus, considering the financial and medical facilities
also, the question still lies open that what will be better-allowing euthanasia or
not allowing euthanasia.

The UN Human Rights Committee has emphasized that laws allowing for
euthanasia must provide effective procedural safeguards against abuse if they
are to be compatible with the State’s obligation to protect the right to life. In

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2002 the UN Committee considered the euthanasia law introduced in The
Netherlands. The Committee stated that:

“where a State party seeks to relax legal protection with respect to an act
deliberately intended to put an end to human life, the Committee believes that
the Covenant obliges it to apply the most rigorous scrutiny to determine
whether the State party’s obligations to ensure the right to life are being
complied with (articles 2 and 6 of the Covenant).”

The UN Human Rights Committee expressed concern about whether the

wording of the conditions under the Dutch law for legally terminating a life
provided adequate safeguards. The Committee commented that the large
numbers of cases referred to the Dutch review committee in 2000 (and the very
low proportion of negative assessments by that committee) ‘raise doubts
whether the present system is only being used in extreme cases in which all the
substantive conditions are scrupulously maintained.’

The UN Committee recommended to the Netherlands that it:

“re-examine its law on euthanasia and assisted suicide in the light of these
observations. It must ensure that the procedures employed offer adequate
safeguards against abuse or misuse, including undue influence by third
parties.”

When the Netherlands came up for review again by the Human Rights
Committee in 2009, the Committee again expressed concern about its
euthanasia law, noting:

Under the law on the Termination of Life on Request and Assisted Suicide,
although a second physician must give an opinion, a physician can terminate a
patient’s life without any independent review by a judge or magistrate to

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guarantee that this decision was not the subject of undue influence or
misapprehension (art. 6)

The euthanasia debate takes place against a background of rapid medical

advancement. The drugs and machines of modem medicine can keep the heart
pumping and blood circulating far longer than nature could unassisted. But
such life, frequently lived without privacy within the goldfish bowl of a
hospital ward, comes at a cost. There are real concerns within the community
that human dignity will become a casualty of the goal of prolonging longevity.
The euthanasia movement is also a protest against medical bureaucracy and
technological determinism.

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 BIBLIOGRAPHY

ARTICLES:
1. Kuře, J. (2011). Good Death Within Its Historical Context and as
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BOOKS:
1. Earle, M. (2017). A Short History of Euthanasia-A Brief Look
into the Centuries Old Debate over an Individual’s Right to Die.
2. Ratanlal, R., & Dhirajlal, K. T. (1972). The Indian penal code.
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DICTIONARIES:
1. Merriam-Webster's Law Dictionary. 2011.
2. Oxford dictionaries. Oxford University Press. April 2010.

DISSERTATIONS and THESIS:

1. Shapiro, B. (2013). Physicians' views and practices regarding
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patients (Doctoral dissertation, Saybrook University).
2. Lindblad, A. (2013). End-of-life decisions: studies of attitudes
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Shaping Conceptualizations of Assisted-Death (Doctoral
dissertation, Université d'Ottawa/University of Ottawa).
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 5. Young, S. (2017). A right to die? Examining the centrality of
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WEBSITES:
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2. http://www.vpmthan.org
3. https://euthanasia.procon.org

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