research paper on euthanasia in india

Euthanasia: Global Scenario and Its Status in India

Affiliations.

• 1 Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, India. [email protected].
• 2 Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, India.
• 3 Department of Forensic Medicine, Nepal Medical College Teaching Hospital, Kathmandu, Nepal, India.
• 4 Department of Anthropology, Panjab University, Chandigarh, India.
• PMID: 28726026
• DOI: 10.1007/s11948-017-9946-7

The legal and moral validity of euthanasia has been questioned in different situations. In India, the status of euthanasia is no different. It was the Aruna Ramachandra Shanbaug case that got significant public attention and led the Supreme Court of India to initiate detailed deliberations on the long ignored issue of euthanasia. Realising the importance of this issue and considering the ongoing and pending litigation before the different courts in this regard, the Ministry of Health and Family Welfare, Government of India issued a public notice on May 2016 that invited opinions from the citizens and the concerned stakeholders on the proposed draft bill entitled The Medical Treatment of Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill. Globally, only a few countries have legislation with discreet and unambiguous guidelines on euthanasia. The ongoing developments have raised a hope of India getting a discreet law on euthanasia in the future.

Keywords: Aruna Shanbaug; Euthanasia; Indian law; Physician-assisted suicide (PAS).

Publication types

• Euthanasia / ethics
• Euthanasia / legislation & jurisprudence*
• Legislation, Medical*
• Patient Rights / legislation & jurisprudence*
• Suicide, Assisted / ethics
• Suicide, Assisted / legislation & jurisprudence*

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Ann Med Surg (Lond)
• v.75; 2022 Mar

Euthanasia and assisted suicide: An in-depth review of relevant historical aspects

Yelson alejandro picón-jaimes.

a Medical and Surgical Research Center, Future Surgeons Chapter, Colombian Surgery Association, Bogotá, Colombia

Ivan David Lozada-Martinez

b Grupo Prometheus y Biomedicina Aplicada a las Ciencias Clínicas, School of Medicine, Universidad de Cartagena, Cartagena, Colombia

Javier Esteban Orozco-Chinome

c Department of Medicine, RedSalud, Santiago de Chile, Chile

Lina María Montaña-Gómez

d Department of Medicine, Keralty Salud, Bogotá, Colombia

María Paz Bolaño-Romero

Luis rafael moscote-salazar.

e Colombian Clinical Research Group in Neurocritical Care, Latin American Council of Neurocritical Care, Bogotá, Colombia

Tariq Janjua

f Department of Intensive Care, Regions Hospital, Minnesota, USA

Sabrina Rahman

g Independent University, Dhaka, Bangladesh

End-of-life care is an increasingly relevant topic due to advances in biomedical research and the establishment of new disciplines in evidence-based medicine and bioethics. Euthanasia and assisted suicide are two terms widely discussed in medicine, which cause displeasure on many occasions and cause relief on others. The evolution of these terms and the events associated with their study have allowed the evaluation of cases that have established useful definitions for the legal regulation of palliative care and public policies in the different health systems. However, there are still many aspects to be elucidated and defined. Based on the above, this review aimed to compile relevant historical aspects on the evolution of euthanasia and assisted suicide, which will allow understanding the use and research of these terms.

• • The history of euthanasia and assisted suicide has been traumatic.
• • The church and research have been decisive in the definition of euthanasia.
• • The legal framework on the use of euthanasia and assisted suicide has been strengthened.

1. Introduction

Euthanasia and assisted suicide are two topics discussed throughout history, mainly because they fall within the scope of life as a human right, which has been universally defended for many years [ 1 ]. However, the mean of the word euthanasia as good death generates conflicts at social, moral, and ethical levels. Mainly because death is a loss, it is difficult to understand it as something positive and; additionally, several historical events such as the Nazi experiments related the term euthanasia more to murder than to a kind and compassionate act [ 1 ]. More current texts mention that euthanasia is the process in which, through the use or abstention of clinical measures, the death of a patient in an incurable or terminal condition can be hastened to avoid excessive suffering [ 2 ].

The difference between euthanasia and assisted suicide is that in the latter, the patient takes the final action; however, both practices can be combined in the term assisted death [ 2 ]. At present, several countries authorize assisted death, including Holland, Luxembourg, and Canada [ 3 ]. Belgium and Colombia have regulations that decriminalize only euthanasia; other places where assisted suicide is legal are Switzerland and five states of the United America states, specifically Oregon, Vermont, Washington, California, and Montana [ 2 , 3 ]. Spain recently joined the list of countries that have legislated on euthanasia through the organic law March 2021 of March 24 that regulates euthanasia in that state in both public and private institutions [ 4 ]. The fact that more and more countries were joining the legislation on euthanasia and assisted suicide has brought to light the opinion of thinkers, politicians, philosophers, and physicians. Several nations have initiated discussions on the matter in their governmental systems. Latin America is trying to advance powerfully in this medical-philosophical field. Currently, in Chile, the “Muerte digna y cuidados paliativos” law, which seeks to regulate the issue of euthanasia and assisted suicide in the country, is being debated in Congress [ 5 ].

It is essential to know the point of view of physicians on euthanasia and assisted suicide, especially taking into account that these professionals who provide care and accompany patients during this moment, which, if approved, would involve the medical community in both public and private health systems. Although it seems easy to think that physicians have a position in favor of the act of euthanasia because they are in direct and continuous contact with end-of-life situations, such as palliative care, terminally ill, and critically ill patients. It is important to remember that the Hippocratic medical oaths taken at the time of graduation of professionals are mostly categorical in mentioning the rejection of euthanasia and assisted suicide [ 6 ]. Furthermore, it is also important to note that many of the oldest universities in the Western world originated through the Catholic Church; and just this creed condemns the practice of euthanasia and continues to condemn it to this day. This situation generates that many medical students in these schools have behaviors based on humanist principles under the protection of faith and religion and therefore reject the possibility of euthanasia [ 7 , 8 ].

The relevance of the topic and the extensive discussion that it has had in recent months due to the COVID-19 pandemic added to the particular interest of bioethics in this topic and the need to know the point of view of doctors and other health professionals on euthanasia and assisted suicide.

2. Origin and meaning of the term euthanasia

The word euthanasia derives from the Greek word “eu” which means good, and the word “thanatos” which means death; therefore, the etymological meaning of this word is “good death”. Over time the evolution of the meaning has varied; even as we will see below was considered a form of eradication of people categorized under the designation of leading a less dignified life. Assisted suicide is a condition in which the patient is the one who carries out the action that ends his life through the ingestion of a lethal drug but has been dispensed in the context of health care and therefore called assisted. This care is provided by a physician trained in the area. However, it requires the prior coordination of a multidisciplinary team and even the assessment by an ethics committee to determine that the patient is exercising full autonomy, free from coercion by the situation he/she is living and free from the fatalistic desires of a psychiatric illness [ 9 ]. In a more literary sense, the word euthanasia meaning of “giving death to a person who freely requests it in order to free himself from suffering that is irreversible and that the person himself considers intolerable” [ 9 ].

Some authors go deeper into the definition and consider that for the meaning of euthanasia, are necessary to consider elements that are essential in the word itself; such as the fact that it is an act that seeks to provoke death and that carried out to eliminate the suffering in the person who is dying. Other elements with a secondary character in the definition are the patient's consent (which must be granted respecting autonomy and freedom in the positive and negative sense; that means the fact must be not be coerced in any way). Another element is the terminal nature of the disease, with an irreversible outcome that generates precariousness and a loss of dignity. The third secondary element is the absence of pain of the death through the use of drugs such as high-potency analgesics, including opioids, high-potency muscle relaxants, and even anesthetic drugs. Finally, the last element is the health context in which the action is performed (essential in some legislations to be considered euthanasia) [ 10 ]. According to the World Health Organization, the union of these two components is the current definition of euthanasia, which describes as “the action performed by a person to cause the painless death of another subject, or not preventing death in case of terminal illness or irreversible coma. Furthermore, with the explicit condition that the patient must be suffering physical, emotional, or spiritual and that affliction is uncontrollable with conventional measures such as medical treatments, analgesics, among others; then the objective of euthanasia is to alleviate this suffering” [ 11 ]. Unfortunately, the term euthanasia has been misused over the years, and other practices have been named with this word. An example of this situation occurred during the Nazi tyranny when the word euthanasia concerned the murder of people with disabilities, mental disorders, low social status, or gay people. At that time, euthanasia was even a simultaneous practice to the Jewish genocide [ 11 ].

Not only has the term been misused; also exists an enormous variability of terms to refer to euthanasia. For example, the laws created to regulate euthanasia have different names around the world; in the Netherlands (Holland), the law that regulates this practice is known as the law of termination of life; in Belgium, it is called euthanasia law, in France, it is called euthanasia law too. In Oregon (USA), it is called the death with dignity act; in California, it is the end of life option act. In Canada is called the medical assistance in dying act. Victoria (Australia) is the voluntary assisted dying bill, but all these denominations refer to the already well-known term euthanasia [ 11 ].

3. Evolution of euthanasia and assisted suicide: digging into historical events

To understand the evolution and relevance of these concepts should analyze the history of euthanasia and assisted suicide; from the emergence of the term, going through its first manifestations in antiquity; mentioning the conceptions of great thinkers such as Plato and Hippocrates; going through the role of the Catholic Church; mainly in the Middle Age, where following the thought of St. Thomas Aquinas, self-induced death or death contemplated by own will, was condemned. Later, with the renaissance age and the resurgence of science, technology, and the arts, the term euthanasia made a transition to a form similar to what we know today from thinkers such as Thomas More and Francis Bacon. Finally, the first signs of eugenics were known in London, Sweden, Germany, and the United States in the twentieth century. There was a relationship with the term euthanasia that was later used interchangeably, especially in the Nazi regime, to denote a form of systemic murder that sought to eradicate those who were not worthy of living a life.

Since the sixties, with emblematic cases, the path towards the decriminalization of euthanasia began in some countries, especially concerning the cessation of extreme support measures in cases of irreversible illness or a terminal condition. The practice has progressed to the appearance of laws on euthanasia in several countries.

4. Euthanasia and assisted suicide in ancient times

In book III of Plato's “The Republic”, the author stated that those who live their lives amidst illnesses and medicines or who were not physically healthy should be left to die; implying that it was thought that people in these conditions suffered so much that their quality of life diminished, which seemed understandable to these thinkers. However, other authors such as Hippocrates and his famous Hippocratic oath sought the protection of the patient's life through medicine, especially in vulnerable health conditions prone to fatal outcomes. This Hippocratic oath is the same oath that permeates our times and constitutes an argument among those who mark their position against euthanasia and assisted suicide [ 12 , 13 ].

Other texts that collect thoughts of Socrates and his disciple Plato point out that it was possible and well understood to think of ceasing to live in the face of a severe illness; to consider death to avoid a long and torturous agony. This fact is compatible with the conception of current euthanasia since this is the end of this health care procedure [ 13 ].

In The Republic, the text by Plato, the physician Heroditus is also condemned for inventing a way to prolong death and over manage the symptoms of serious illnesses, which is currently known as distanasia or excessive treatment prolongs life. This kind of excessive treatment prolongs the sick person's suffering, even leading him to maintain biological signs present but in a state of alienation and absolute dependence on medical equipment such as ventilators and artificial feeding [ 13 ]. However, the strongest indication that Euthanasic suicide was encouraged in Greece lies in other thinkers such as the Pythagoreans, Aristotelians, and Epicureans who strongly condemned this practice, which suggests that it was carried out repeatedly as a method and was therefore condemned by these thinkers [ 12 , 13 ]. According to stoicism, the pain that exceeded the limits of what was humanly bearable was one of the causes for which the wise man separates himself from life. Referring to one of the nuances that euthanasia touches today, that is, at a point of elevated suffering, the dignity and essence of the person are lost, persisting only the biological part but in the absence of the person's well-being as a being. In this sense, Lucius Seneca said that a person should not love life too much or hate it; but that person should have a middle ground and end their life when they ceased to perceive life as a good, worthy, and longed-for event [ 1 , 12 ].

During the Roman Empire and in the territories under its rule, it was believed that the terminally ill who commit suicide had sufficient reasons to do so; so since suicide caused by impatience and lack of resolution to pain or illness was accepted, when there was no access to medicines. In addition, there was little development in medicine during that time, and many of the sick died without treatment [ 12 ]. This situation changed later with the emergence of the Catholic church; in this age, who attempted against own life, was deprived of burial in the ground. Saint Augustine said that the suicide was an abominable and detestable act; from 693 AD, anyone who attempted against his physical integrity was excommunicated. Rejecting to the individuals and their lineage, depriving them of the possibility of attending the funeral and even expelled from cities and stripped of the properties they owned [ 12 , 13 ].

4.1. Euthanasia and assisted suicide in the Middle Age

During the Middle Age, Catholicism governed the sciences, arts, and medicine; the sciences fell asleep. Due to this solid religious tendency and the persistence of Augustinian thought, suicide was not well seen. It was not allowed to administer a lethal substance to a person to end the suffering of a severe or terminal illness [ 9 , 12 ]. People who took their own lives at this time could not be buried “Christianly”; therefore, they did not have access to a funeral, nor to the accompaniment of their family in a religious rite. Physical suffering and pain were then seen as a path to glorification. Suffering was extolled as the form that god purified the sin, similar to the suffering that Jesus endured during his Calvary days. However, a contrary situation was experienced in battles; a sort of short dagger-like weapon was often used to finish off badly wounded enemies and thus reduce their suffering, thus depriving them of the possibility of healing and was called “mercy killing” [ 12 ].

5. Euthanasia in renaissance

With the awakening of science and philosophy, ancient philosophers' thoughts took up again, giving priority to man, the world, and nature, thus promoting medical and scientific development. In their discourse, Thomas More and Francis Bacon refer to euthanasia; however, they give a eugenic sense to the concept of euthanasia, similar to that professed in the book of Plato's Republic. It is precise with these phylosophers that the term euthanasia got its current focus, referring to the acceleration of the death of a seriously ill person who has no possibility of recovery [ 12 ]. In other words, it was during this period that euthanasia acquired its current meaning, and death began to be considered the last act of life. Therefore, it was necessary to help the dying person with all available resources to achieve a dignified death without suffering, closing the cycle of life that ends with death [ 13 , 14 ].

In his work titled “Utopia”, Thomas More affirmed that in the ideal nation should be given the necessary and supportive care to the dying. Furthermore, in case of extraordinary suffering, it can be recommended to end the suffering, but only if the patient agrees, through deprivation of food or with the administration of a lethal drug; this procedure must be known to the affected person and with the due permission of authorities and priests [ 12 , 13 ]. Later, in the 17th century, the theologian Johann Andreae, in his utopia “Christianopolis”, contradicts the arguments of Bacon and Moro, defending the right of the seriously ill and incurably ill to continue living, even if they are disturbed and alienated, advocating for the care based on support and indulgence [ 15 , 16 ]. Similarly, many physicians rejected the concepts of Plato, Moro, and Bacon. Instead, they focused on opposing euthanasia, most notably in the nineteenth century. For example, the physician Christoph Hufeland mentioned that the doctor's job was only to preserve life, whether it was a fate or a misfortune, or whether it was worth living [ 16 ].

5.1. Euthanasia in the 20th century

Before considering the relevant aspects of euthanasia in the 20th century, it is vital to highlight the manuscript by Licata et al. [ 17 ], which narrates two episodes of euthanasia in the 19th century. The first one happened in Sicily (Italy) in 1860, during the battle of Calatafimi, where two soldiers were in constant suffering, one because he had a serious leg fracture with gangrene, and the other with a gunshot wound. The two soldiers begged to be allowed to die, and how they were in a precarious place without medical supplies, they gave them an opium pill, which calmed them until they died [ 17 ]. The second episode reported by Licata et al. [ 17 ] was witnessed by a Swedish doctor named Alex Munthe; who evidenced the pain of many patients in a Parisian hospital. So he decided to start administering morphine to help people who had been seriously injured by wolves and had a poor prognosis; therefore, the purpose of opioid use was analgesia while death was occurring.

It is also important to highlight the manuscript entitled “Euthanasia” by S. Williams published in 1873 in “Popular Science Monthly”, a journal that published texts by Darwin, Edison, Pasteur, and Beecher. This text included the report for the active euthanasia of seriously ill patients without a cure, in which the physicians were advised to administer chloroform to these patients or another anesthetic agent to reduce the level of consciousness of the subject and speed up their death in a painless manner [ 16 ].

Understanding that euthanasia was already reported in the nineteenth century, years after, specifically in 1900, the influence of eugenics, utilitarianism, social Darwinism, and the new currents of thought in England and Germany; it began in various parts around the world, projects that considered the active termination of life, thus giving rise to euthanasia societies in which there were discussions between philosophers, theologians, lawyers, and medical doctors. Those societies discussed diverse cases, such as the tuberculous patient Roland Gerkan, who was considered unfit and therefore a candidate to be released from the world [ 16 ]. The scarcity of resources, famine, and wars were reasons to promote euthanasia as a form of elimination of subjects considered weak or unfit, as argued in texts such as Ernst Haeckel's. However, opponents to the practice, such as Binding and Hoche, defended the principle of free will in 1920 [ 16 ].

5.2. Euthanasia in the time of the Nazis

As mentioned above, the term euthanasia was misused during this period; approximately 275,000 subjects (as reported at the Nuremberg International Military Tribunal 1945–1946), who had some degree of physical or mental disability, were killed during Adolf Hitler's Euthanasia program [ 13 ]. However, the Nazis were not the first to practice a form of eugenics under the name of euthanasia, since the early 1900s in London had already begun the sterilization of the rejected, such as the blind, deaf, mentally retarded, people with epilepsy, criminals, and rapists. This practice spread to different countries like Sweden and the United States [ 13 , 16 ].

For the Nazis, euthanasia represented the systematic murder of those whose lives were unworthy of living [ 13 ]. The name given to this doctrine was “Aktion T4”. At first and by law, from 1939, the hospitals were obliged to account for all disabled newborns, which led to the execution of more than 5000 newborns utilizing food deprivation or lethal injection [ 12 , 18 ].

A year before that law, in 1938, one of the first known cases of euthanasia in children arose in Germany. That history called the story of child K, in which it was the father of the minor who asked Hitler in writing for euthanasia for his son because the child had a severe mental disability and critical morphic disorders. Hitler gave his consent to carry out the procedure on child K, and thus the program began to spread throughout the Aleman territory. Since then, physicians and nurses had been in charge of reporting the newborns with alterations, arising the “Kinderfachabteilugen” for the internment of children who would be sentenced to death after a committee's decision [ 12 , 18 , 19 ]. A list of diseases and conditions that were considered undesirable to be transmitted to Hitler's superior Aryan race was determined; thus, any child with idiocy, mongolism, blindness, deafness, hydrocephalus, paralysis, and spinal, head, and hip malformations were eligible for euthanasia [ 19 ].

Subsequently, the program was extended to adults with chronic illness, so those people were selected and transported by T4 personnel to psychiatric sanatoriums strategically located far away. There, the ill patients received the injection of barbiturate overdoses, and carbon monoxide poisoning was tested as a method of elimination, surging the widely known gas chamber of the concentration camp extermination; this situation occurred before 1940 [ 12 , 19 ]. Again, physicians and nurses were the ones who designated to the patients to receive those procedures; in this case, these health professionals supported Nazi exterminations. They took the patients to the sanatoriums, where psychiatrists evaluated them and designated with red color if they should die and with a blue color if they were allowed to live (this form of selection was similar in children) [ 12 , 13 , 19 ]. In this case, the pathologies considered as criteria for death were those generating disability such as schizophrenia, paralysis, syphilis with sequelae, epilepsy, chorea, patients with chronic diseases with many recent treatments, subjects of non-German origin and individuals of mixed blood [ 19 ]. Once in the sanatoriums, they were informed that they would undergo a physical evaluation and take a shower to disinfect themselves; instead, they were killed in gas chambers [ 12 , 13 ]. Despite the church's action in 1941 against Nazis and after achieving suspension of the Aktion T4 project; the Nazi supporters kept the practices secretly, resuming them in 1942, with the difference that the victims were killed by lethal injection, by an overdose of drugs, or left to starve to death, instead of the use of gas chambers. This new modified form of euthanasia, which did not include gas chambers, became known as “savage euthanasia” [ 12 , 13 , 19 ].

5.3. Euthanasia since the 1960s

In September 1945, trials began for crimes perpetrated by Nazi supporters; the victorious Allied forces conducted these trials at the end of the war. During these tribunals, cases of human experimentation were identified and the public exposure of the Nazi euthanasia program. After the Nuremberg trials and the abolition of Nazi experiments, a series of seven documents emerged, among which the Nuremberg code containing the ten basic principles for human research stood out [ 20 , 21 ].

After these judgments, biotechnology was accelerated, with the apparition of new techniques to intervene in the health-disease process. Additionally, the increase in life expectancy and the appearance of diseases that chronically compromise the state of health of people generated a change in the conception of the critically ill patient and the terminal state of life [ 20 , 21 ]. Cases such as Karen Ann Quinlan brought to the forefront the issue of euthanasia and precisely the control of extreme treatment measures. Karen, a young American woman, was left in a vegetative state due to severe neurological damage following alcohol and barbiturate intoxication. After six months in that state and under the guardianship of a Catholic priest, Karen's parents requested the removal of the artificial respirator, arguing that in her state of consciousness prior to the incident, she had stated that she disagreed with artificially maintaining life in comatose patients. The hospital refused to remove the ventilator, arguing the legal issues for the date, and the parents went to court, which in the first instance granted the hospital the right. Nevertheless, the New Jersey Supreme Court granted Karen Ann's right to die in peace and dignity. Despite the withdrawal of the artificial respirator, he continued to live until 1985, when he finally died [ [21] , [22] , [23] ].

Another important case was Paul Brophy, which also occurred in the United States. Paul was a firefighter in Massachusetts and went into a deep coma due to the rupture of a basilar artery aneurysm; initially, his family advocated for support measures but later requested the hospital to disconnect these means to allow death, as Paul had indicated when he was still conscious. The hospital refused to carry out this procedure, so the family went to court, where the removal of the support measures (gastrostomy) was initially denied. Hence, the family went to the state supreme court, achieving the transfer of Paul to another medical center where the gastrostomy was removed, leading to his death within a few days [ 23 ].

The case of Arthur Koestler, an influential English writer and activist diagnosed with Parkinson's disease and later with leukemia, who served as vice-president of the voluntary euthanasia society (Exit) and wrote a manual book with practical advice for euthanasia called “Guide to Self-Liberation”. He stood out because he applied one of his advice and ingested an overdose of barbiturates, causing his self-death. According to his writings, Koestler was not afraid of death but of the painful process of dying [ 23 ]. In this sense, it was a relevant case because it involved someone who held an important position in an association that advocated euthanasia, in addition to being the author of several works, which made him a recognized public figure [ 23 ].

Baby Doe was a case that also occurred in the United States; it was a small child with Down syndrome who had a tracheoesophageal fistula and esophageal atresia; in this case, surgery was necessary. On the advice of the obstetrician, the parents did not allow surgery, so the hospital managers took the case before a judge who ruled that parents could decide to perform or not the surgery. The case was appealed before a county judge who upheld the parents' power to make the decision, in the course of which the case became public and many families offered to take care of the child; however, before the case reached the supreme court, the child died at six days of age [ 23 ].

In the case of Ingrid Frank, a German woman who was in a quadriplegic state by a traffic accident, who initially sought rehabilitation but later insisted on being allowed to die; it was provided with a drink containing a cyanide solution that she drank. At the same time, she was filmed, which shows a kind of assisted suicide. For that reason, this is another case that deals with this issue and is important to know as background in the development of euthanasia and assisted suicide [ 22 , 23 ].

6. Current and future perspectives

The definition of brain death, the rational use of the concept of euthanasia and assisted suicide, and scientific literacy are the objectives of global bioethics to regulate euthanasia and assisted suicide, which can be accessible in all health systems [ [24] , [25] , [26] , [27] , [28] , [29] , [30] ]. End-of-life care will continue to be a subject of debate due to the struggle between biomedical principles, the different existing legal frameworks, and the general population's beliefs. Medical education and preparation in the perception of death, especially of a dignified death, seems to be the pillar of the understanding of the need to develop medical-legal tools that guarantee the integrity of humans until the end of their existence [ 31 , 32 ]. This is the reason why the new generations of physicians must be trained in bioethics to face these ethical conflicts during the development of their professional careers.

In addition, although the conception of bioethics belongs to the Western world, it is crucial to take into account the point of view of other cultures and creeds, for example, a study carried out in Turkey, where nursing students were questioned, found that many of them understood the reasons for performing euthanasia; however, they know that Islam prohibits it, as well as its legislation, and therefore they would not participate in this type of procedure [ 33 ]. Furthermore, Christianism and Islam prohibit euthanasia, but Judaism also prohibits it; in general, the so-called Abrahamic religions are contrary to any form of assisted death, whether it is active euthanasia, passive, or assisted suicide [ 34 ].

7. Conclusiones

The history and evolution of euthanasia and assisted suicide have been traumatic throughout human history. The church, politics, and biomedical research have been decisive in defining these concepts. Over the years, the legal framework and bioethical concepts on euthanasia have been strengthened. However, there is still much work to educate the general population and health professionals about end-of-life care and dignified death.

It is also important to remember that life is a concept that goes beyond biology. Currently, bioethics seeks to prioritize the concept of dignity, which must be linked to the very definition of life. Although the phrase is often heard that it is not necessary to move to be alive, what is important is that person feels worthy even if they have limited movement. The person's treatment must be individualized in bioethics since each individual is a unique unit. Therefore, medical paternalism must be abandoned. Instead, the subject must be more involved to understand their context and perception of life and dignity.

Ethical approval

It is not necessary.

Sources of funding for your research

Author contribution.

All authors equally contributed to the analysis and writing of the manuscript.

Provenance and peer review

Not commissioned, externally peer reviewed.

Research registration Unique Identifying number (UIN)

• 1. Name of the registry: Not applicable.
• 2. Unique Identifying number or registration ID: Not applicable.
• 3. Hyperlink to your specific registration (must be publicly accessible and will be checked): Not applicable.

Sabrina Rahman. Independent University, Dhaka, Bangladesh. [email protected] .

Declaration of interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Academia.edu no longer supports Internet Explorer.

To browse Academia.edu and the wider internet faster and more securely, please take a few seconds to  upgrade your browser .

Enter the email address you signed up with and we'll email you a reset link.

• We're Hiring!
• Help Center

AN ANALYTICAL STUDY ON EUTHANASIA AND ITS POSSIBLE IMPACT IN INDIA; WITH SPECIAL REFERENCE TO RECENT APPROVAL OF PASSIVE EUTHANASIA

Related Papers

Indian Journal of Psychological Medicine

Farooq Ahmed Khan

Mitali Jain

Rouf Ahmad Bhat

International Res Jour Managt Socio Human

Indian Journal of Psychiatry

Suravi Patra

Dr. U V Singh

isara solutions

Within Buddhist groups, the discussion over euthanasia is hesitant. This is widely accepted by Dr. Raja Jayaweera's in Raft, the Buddhist Hospice Trust publication. He writes, "There is no official Buddhist viewpoint on Euthanasia or other related moral issues." Seekers of the Buddhist stance must apply Dhamma's precepts and principles to construct their position. They prefer hospice care to euthanasia in two distinct ways. The first one is failing to admit that any treatment will have karmic implications; the second is failing to acknowledge that any treatment will have consequences. Buddhism seeks the root of the human problem by acknowledging that Karma is what binds us to the enslaving wheel of Samsara. An individual directs him or herself to particular conscious acts. Where intention thus plays a pivotal role in determining the moral status; an action is immoral when it springs from mental states dominated by greed, hatred or delusion, moral values, etc., when it proceeds from the mental practice of Mindfulness, which condition presents action. It motivates us and quickly understands the difference between good and bad karma; as a result, intentions are purified. The moral quality of an act is to be determined by the individual's internal state. This worldly religion believes in moral action and meditative practice, which are complementary ways of coming to terms with the radical impermanence at the heart of human existence. Life is a process of coming to be and passing away; where dying are its most obvious manifestations. Hence, every individual should be careful for the moment of death, the quality of which will determine the next birth. Buddhists may also claim that assisting at the end of someone's life is likely to place the helper in a terrible mental state and should be avoided. They are split on the question of euthanasia, and the Buddha's teachings make no direct mention of it. Ending one's life to relieve pain and suffering is known as euthanasia. It's broken down into three types: voluntary, non-voluntary, and involuntary. Francis Bacon coined this "euthanasia" term. 'Mercy killing' is another term for it. "Euthanasia" is derived from the Greek words "eu" and "thanotos," both of which mean "happy death." "Good death" refers to the practice of ending the life of a terminally ill person in a painless or minimally painful manner in order to minimize suffering. The euthanasia issue is part of a more extensive discussion concerning the right to die. The practice of ending the life of a terminally sick individual in a painless or minimally painful manner in order to reduce suffering is known as "good death." The issue of euthanasia has been debated philosophically for a long time. From a purely moral stance, James Rachels, a well-known writer, claims that there is no moral difference between deliberately murdering a patient and passively allowing the patient to die.

Each person ought to appreciate right to life. Article 21 of the Indian Constitution as well as under article

Rohini Shukla

This review is about the discussion that followed my presentation at the UNESCO Bioethics Forum, Manipal. To contextualise, I begin with a brief account of the legal status of euthanasia in India, and then summarize the main argument of my presentation-if the moral objective of euthanasia is to end a patient's suffering by ending his or her life in the best possible way, then the form of euthanasia legal in India is inconsistent with this moral objective owing to the consequences it entails for the patient. Given this background, I elaborate on two issues that came up in the discussion-the missing framework of patients' rights, and the medical fraternity's reluctance to espouse multidisciplinary approaches in understanding the morality and legality of euthanasia. Contrary to popular belief as voiced at this forum, developing the framework of patients' rights, and simultaneously espousing multidisciplinary approaches, as I hope to show, would take the discussions of euthanasia in better informed directions.

Science and Engineering Ethics

alok atreya

RELATED PAPERS

Gershom Scholem ז״ל

Journal of Universal College of Medical Sciences

Marina Chatziioannou

Daniel Sombra

Arthritis research & therapy

Yuqing Zhang

Eduardo Mancera

Tér és Társadalom

Attila Fábián

Mayang Dwi Lestari

Journal of Evolution of medical and Dental Sciences

deepa masand

ALMEIDA, Helena Maria. Minas e Memórias da Urgeiriça: contributos da arte para a sensibilização ambiental. Dissertação (Mestrado em Animação artística). Instituto Politécnico de Viseu, Escola Superior de Educação de Viseu, Viseu, 2015

Maruzia Dultra

CHEST Journal

Terrence Conway

JCR: Journal of Clinical Rheumatology

Revista Brasileira de Milho e Sorgo

Marcos Ventura Faria

Lecture Notes in Computer Science

Mona Soliman

The American journal of tropical medicine and hygiene

Bridget Okoeguale

Ali Javadmanesh

Nicolas Perrin

Journal of Personalized Medicine

Jose Vicente Castell Ripoll

Revista Direitos Culturais

Eduardo Pscheidt

AIChE Journal

Miltiadis Hiskakis

Substantive Justice International Journal of Law

Ariman Sitompul

Depiction of Health

Bita Shalani

Winston Vickers

Proceedings of the Vldb Endowment

Minos Garofalakis

Fisioterapia Brasil

See More Documents Like This

RELATED TOPICS

•   We're Hiring!
•   Help Center
• Find new research papers in:
• Health Sciences
• Earth Sciences
• Cognitive Science
• Mathematics
• Computer Science
• Academia ©2024

EUTHANASIA: A STUDY INTO THE ETHICAL AND LEGAL DIMENSIONS

• Cite This Article as
• Corresponding Author

Euthanasia, or physician-assisted suicide, raises several questions regarding legality and ethics. On one hand, patients should have the right to control their demise- (the right to die with dignity is an intrinsic facet of the right to life under Article 21), whereas terminal illness which brings not only an enormous amount of pain but also emotional suffering and psychological agony, questions the worth of such a life- shouldn’t patients have the option to avoid this trauma? Consequently, is individual will to die more significant than the state’s restrictions on the same? On the other hand, practices such as active euthanasia raise legal concerns as a policy, since legalizing euthanasia gives surrogate decision-makers the ability to decide in case of incompetent patients based on nebulous tests, while power structures threaten the patients too. As a result of promoting euthanasia in a society as complex and diverse as India’s, will patients from vulnerable communities such as women, Dalits, girl children be subjected to discriminatory’ or forced’ euthanasia? Does the Slippery Slope Argument’ (which predicts the same that legalizing euthanasia will lead on to more number of nonvoluntary cases of euthanasia) hold?. Previous studies on e uthanasia have evaluated the effects of it as a public policy, as well as, its necessity as an individual right. Further, studies have also been conducted on active and passive euthanasia, the philosophy behind euthanasia, and the problems raised by this practice. Through my study, I aim to contribute to these areas of research by focusing on the need for euthanasia, its various types, its effects on the individual in question, as well as, society as a whole. With the fulfillment of this research, I would like to answer some of the questions I have raised, and reach conclusions regarding the morality of euthanasia, and whether it should or should not be legalized. The goal of this research project is to evaluate euthanasia as a legal, ethical, and personal practice, taking into consideration the history of such cases, the legal status of the concept in various countries, and a comparative analysis of the same with India. Moreover, through this research, I hope to address legal, as well as, ethical and moral issues, raised by e uthanasia, analyze them, and, combine them into one line of thought. In this regard, the innovative use of a unique questionnaire designed for various categories of stakeholders, as well as, completed a literature review of the research that has taken place so far have enabled this research. As a result, the results have been analyzed and comprehended in an interesting yet simple language for the study to reach maximum readers. Moreover, the research is an attempt to break down multiple facets of e uthanasia, and question the ethicality of euthanasia, the certain harms it poses to society as a public policy and regulation that would be required to legalize active euthanasia. Furthermore, should alternatives such as hospice care and palliative care should be considered before opting for euthanasia? Thus I will first analyze the ethicality or ethical portion regarding euthanasia, followed by its possible impacts, benefits, and fallouts in society, supported by appropriate logical reasoning. This will help understand the two dimensions of both passive as well as active forms of euthanasia. I will proceed to compare and contrast euthanasia with other alternatives, such as palliative care and conclude with the help of my understanding and views on the matter.

[ Armaan Gandhi (2020); EUTHANASIA: A STUDY INTO THE ETHICAL AND LEGAL DIMENSIONS Int. J. of Adv. Res. 8 (Sep). 155-164] (ISSN 2320-5407). www.journalijar.com

Article DOI: 10.21474/IJAR01/11645       DOI URL: http://dx.doi.org/10.21474/IJAR01/11645

Download Full Paper

Share this article.

ISSN 2581-5369

HeinOnline, MANUPATRA, Google Scholar Indexed

A Comparative Study of Euthanasia in India and Canada: A Critique

• Akanksha Surana and Pooja Kothari
• Show Author Details

Akanksha Surana

Research Scholar (Ph.D.) at Nirma University, India

Pooja Kothari

Advocate at Odisha High Court, India

• img Download Full Paper
• img Export Citation

Export citation

Euthanasia has been one of the most debated topics in the field of law as it lies between the ethics of medical practitioners, freedom of choice and self determination of the people. The Supreme Court has always tried to interpret the provisions of the Constitution in widest possible manner to ensure utmost welfare of the citizens of the country. Parallelly, the Apex Court has included Right to die as an important facet of Right to life under the Constitution of India. The Supreme Court through its various judgements closely analysed the applicability of Euthanasia and finally legalized passive euthanasia in Aruna Shaunbaug case thereby providing big relief to terminally ill patients. The paper deals with application of Euthanasia and its legal perspective in India and Canada. The researchers have tried to compare the procedure of administration of Euthanasia in both the countries and critically analyse its practical application. The focal point of the research paper is to examine whether is it practically possible to administer Euthanasia while being sure that no one will take undue advantage of such right.

• Mercy-killing
• Supreme Court of India
• Constitution of India.

Research Paper

Information

International Journal of Law Management and Humanities, Volume 4, Issue 2, Page 757 - 773

Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution -NonCommercial 4.0 International (CC BY-NC 4.0) (https://creativecommons.org/licenses/by-nc/4.0/), which permits remixing, adapting, and building upon the work for non-commercial use, provided the original work is properly cited.

Copyright © IJLMH 2021

I. Introduction

Each person has right to live his life fully and appreciate the products of life. Be that as it may, some of the time an individual is willing to end his life by utilization of unnatural means. To end one’s life in an unnatural way is not a normal case. At the point when a man decides to end his life by his own willingness and actions we call it “suicide” however to end life of a man on the demand of the person itself with the help of others, is known as “euthanasia” or “mercy killing”. Euthanasia is a very gentle and painless death which takes place to free the patient from all their painful and unending sufferings. It can be termed as death with dignity.

It is basically to weigh between empathy and humankind. It stands on the notion that a man should have the opportunity to live his life on his terms. Euthanasia is for the most part connected with individuals with terminal disease or who have progressed towards becoming crippled and don’t have any desire to experience whatever is left of their remaining life. An extremely impaired or at death’s door individual ought to have the privilege to choose either to live or to die. The idea behind this is that the person gets death with dignity and to put an end to ongoing misery and unbearable trauma. It is to be in the best interest of the patient to be relived of consistent pain and suffering. Euthanasia is an arguable issue which is based on ethics, morality and convictions of people.

Euthanasia has been a much discussed subject all throughout the world. The discussion has turned out to be progressively huge in light of the on-going improvements in various countries where Euthanasia has been permitted e.g. India, Canada, and England and so on. Recently our Supreme Court delivered a landmark judgement thereby legalising passive euthanasia wherein with the consent of the individual and family members, life support system can be withdrawn [1] . The honourable court also added the concept of living will so that no one can take undue advantage from the same [2] .

Meaning of Euthanasia

Euthanasia has different meanings depending on different situations and its usages. In layman’s term it can be defined as a painless or happy death or alleviation of physical suffering from an incurable pain or a painful disease. Euthanasia is otherwise termed as ‘Mercy Killing’. According to Cambridge Dictionary it has been defined as “ the act of killing someone who is terminally ill and do not want to suffer anymore. [3] The most important factor which encompasses euthanasia is suffering from an incurable pain or a person been kept on life support for a long time wherein suffering is an integral element of Euthanasia. Speaking particularly about Euthanasia it means releasing a person from all his suffering for his/her betterment, it is a situation where a person kills another person out of no personal gain but for reliving the patient from his unending and incurable pain.

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.” [4]

Euthanasia is limited to killing patients who have been in a permanent vegetative state for long and it can be done so only by doctors with the permission of the patient or by their kin. Euthanasia comprises of another element which is of utmost importance is ‘ Good Intention’- there must be intention of death and the intention must be a merciful death with no personal gain but putting an end to intolerable torture and misery.

For long, euthanasia has remained a controversial subject in the healthcare arena as many term it as ‘suicide’ if done so by the patient itself or ‘murder’ if done so by others. The debate over it has been going on for many years all over the world wherein some countries like UK it is still illegal and in countries like Netherlands, Canada, Colombia, and in three federal states of USA it is legal. In 2018, the Supreme Court of India also made Passive Euthanasia legal by passing some guidelines under it [5] . Thus, to sum up Euthanasia or mercy killing is to provide a less painful death to the person who has been suffering from a prolonged period and there is not even a slightest chance of him to get cured in anyway possible.

II. The history of euthanasia movement

The Euthanasia movement has deep roots and a dark history for over more than 700 years. “The Father of medicine”, the Greek physician Hippocrates also opposed the concept of Euthanasia. He regarded this act of killing as an impediment between the physicians and the patients for this reason he took an oath which is famously known as “ Hippocractic oath” – ‘I will give no deadly medicine to any one if asked, nor suggest any such counsel’. [6] Before Hippocrates the physicians considered it correct and assumed that to ease the pain of the patients they could kill them without asking their permission upon whom they have given up hope for recovery and was for the betterment of the patient.

In Ancient Greece and Rome on the island of Kea, Hemlock- a highly poisonous plant was used as a means to speed up the process of death of a person. This process of quickening the death of a person was supported by great philosophers Socrates & Pluto but Hippocrates opposed the same.

In the early 19 th  Century in USA the concept of Euthanasia was argued by many with a view that when someone is suffering from incurable disease or terminal diseases then such patients should have the right to end their life through suicide with the assistance of a doctor. Henry Hunt on the instruction of Anna Sophina Hall took the first step in introducing legislation in the General Assembly of Ohio. She was a major figure in the euthanasia movement as when she saw her mother suffering from terminal illness and dying a painful death then, she decided to end the suffering of other terminally ill patients and so she got engaged into the campaign and conducted annual meeting of the American Humane Association in 1905 which was described by as the first significant public debate on this topic in the 20th century. [7]

During the reign of Hitler in Nazi Germany in 1939, he signed a decree to allow mercy killing and to start Nazi Euthanasia program Code named “Aktion T4, which was meant to eliminate incurable or mentally disabled persons. [8] He administered physicians to focus and kill new-borns or children who are less than three years are suffering from mental retardation, or born blind or physical deformity. This program was not only limited to infants but also to older disabled children and adults. Through this program Genocide was disguised as Euthanasia where thousands of people were killed on the grounds of disabilities and religious beliefs.

Euthanasia does not support killing of people on religious grounds or because of disabilities but it is a system by which a person gets painless death from its long term illness. Many religions support it and many oppose it till today.

III. Religious belief in india on euthanasia

Euthanasia is a Greek word which is a combination of two words ‘eu’ – good or well and ‘thanatos’ – death. [9]

Euthanasia actually implies putting a man to effortless demise particularly if there is an occurrence of serious affliction or when life winds up purposeless because of mental or physical handicap.

India is nowhere behind in accepting voluntary death or mercy killing like other ancient civilisations. The concept of nirvana and samadhi are a part of Indian culture which dates back during the period of Mahabharata and Ramayana when Pandavas gave up their kingdom and embarked on the path to meet death. The words ‘Nirvana’ and ‘Samadhi’ do not hold place in English Dictionary but that doesn’t mean they don’t exist in India. For instance, the Manusmriti says: “When the head of the house is old enough and has seen all the happiness in life and is contended by his achievement then he should leave everything to find eternal peace and should consume only air and water until his body finally gives up.” [10]

In modern times, the most well-known example is of freedom fighter and spiritual teacher Acharya Vinoba Bhave who, when he fell ill in 1982, decided to end his life and refused to accept any food or medicine during his last days. He starved himself and died on November 15, 1982. [11]

In Jainism Voluntary Death or also known as “Santhara” is practiced by Jains where a person voluntarily gives up on food and drink so that he is starved till death. This form of practice is highly applaudable among the Jains, which also means that after death they would get a place in heaven.

IV. Classification of euthanasia

Euthanasia can be divided on the basis of act being done:

• Active Euthanasia is a situation where the doctor directly ends someone’s life by giving by giving a lethal dose of sedatives to such persons who are suffering from terminal cancer or other terminal illness and is in terrible agony.
• Passive euthanasia is sometimes described as withholding or limiting life-sustaining treatments so that a person passes more quickly. A doctor may also prescribe increasingly high doses of pain-killing medication. Overtime, the doses may become toxic. [12]

Euthanasia divided on the basis of Consent which are:

• Voluntary Euthanasia is where a person himself makes the decision to end his life with his full conscience to end his life which is full of unending and incurable suffering. It includes cases where the patient voluntarily refuses medical treatment or refuses to eat or drink even refuses to be kept on life support.
• Non-Voluntary Euthanasia refers to ending life of a person when a person is not mentally competent to make an informed request to die, such as a patient in coma. In Non-Voluntary euthanasia the patient has left no such living will or given any advance directives, as he may not have had an opportunity to do so, or may not have anticipated any such accident or eventuality. In cases of non-voluntary Euthanasia, it is often the family members, who make the decision.

EUTHANASIA VS SUICIDE:

The ongoing debate over the issue whether every person who possess ‘right to live’ also possess the ‘right to die’ too. There are numerous and contradictory opinions over the same. Some argue by supporting euthanasia as it allow people to die with dignity and it relieves them from their unending illness while some argue that when God has given us life he is the one to decide when to take life and we as human beings have no right to decide about our death.

Arguments are also when we are given life to live then we should live it in every possible way and face any form of difficulties whatever comes in our way as it is part of life. It is also opined that by allowing euthanasia we would indirectly be allowing suicide therefore certain strict guidelines should be made before allowing Euthanasia which should be made very restrictive in nature.

There is a very thin line between Euthanasia and Suicide. There is no particular definition to explain Euthanasia which is a derivation of Greek Word which means good death. Euthanasia is an act which is done with the permission of the patient but executed through doctors. It is done so with good faith for the welfare of the person suffering from terminal illness. Whereas, Suicide is more of a negative term which has been defined by Merriam Webster Dictionary as – “the act or an instance of taking one’s own life voluntarily and intentionally” [13] . Suicide is attempted mainly by people who are depressed from their failures in life such as failure in career or love life etc. These persons become so depressed that they think suicide is the best way to end their problems. In one way people tend to run away from their failures which they are afraid to face. Both Euthanasia and Suicide needs ‘Intention’ to do but Mercy Killing is done to alleviate a person suffering from terminal illness whereas suicide is a form of death which can be avoided if that person is motivated in life.

The Bombay High Court in Maruti Shripati Dubal [14]   has endeavoured to make a distinction between suicide and mercy killing. As indicated by the court, suicide in nature is an act of self-executing or ending one’s own life without help from others. Whereas,  euthanasia implies the intervention of others human factors to end the life. Euthanasia thus can’t be considered different from suicide. Mercy killing is only a form murder, whatever be the condition in which it is executed.

The Supreme Court of India in Gian Kaur v. State of Punjab [15] clearly held that mercy killing is not legitimate in our nation. The court, in this case, referred to the decision given by the House of Lords in Airedale [16] case, where it acknowledged that withdrawal of life supporting frameworks based on complete medical opinion, would be legal in light of the fact that such withdrawal would just permit the patient for whom it is impossible to die a normal death, where there is not anymore any reason to delay death.

V. Legal perspective on euthanasia in India

Indian Constitution has been inspired by various countries all over the Globe. Our Constitution is considered to be the Supreme lex of the land. It is an umbrella which covers underneath various rights, duties and laws. Every nation comprises of a society where its citizens tends to follow various social and religious principles. The people are governed through these principles. Among such different principles one such principal is universal in nature which governs every person on earth and i.e., The Principal of Sanctity of human life. Euthanasia has been a debated subject in legal arena for a long time.

This article in the Indian Constitution guarantees “Right to life” [17] . It is the heartbeat of our Constitution and occupies an integral place as a fundamental right. The main ideology behind bringing this article was to prevent encroachment of personal liberty of the individuals and not to deprive them of their basic right to life under certain exceptions. This article has a very broader sense and thus has invited a lot of arguments and opinions on it. With the passage of time the Supreme Court has time and again interpreted this article and made certain changes to it as needed by time and has expanded its interpretation post Maneka Gandhi era. It has been argued by some that right to life also includes the right to die. Some argue that Right to life means to live a dignified life and thus does not include death. It is even argued that this article is meant to protect life and the concept of euthanasia is contrary to it.

In Gian Kaur v. State of Punjab [18] court overruled the P. Rathinam’s case and held that the “right to life” is protected by the Constitution and does not include the “right to die”. In this case the Supreme court did not look into the issue of Euthanasia and distinguished between right to die (unnaturally) and right to die with dignity (naturally). The court even upheld the constitutional validity of S. 306 & 309 of IPC.

In P. Rathinam’s case the Supreme Court held that Attempt to Commit Suicide [19] as unconstitutional as it violated Right to life [20] because it includes right to die. The civilised society needs to deal with such a delicate issue not by providing punishment to the person but providing them mental support and encouragement and bringing out ways to deviate their mind.

Judicial Trends in India

In India the contention whether the ‘right to live’ includes within its ambit the ‘right to die’ came for consideration for the first time in the year 1987. It was in the case of State of Maharashtra v. Maruti Shripati Dubal , wherein the Bombay High Court held that, Everyone should have the freedom to dispose of his life as and when he desires. [21]

There had been conflicting decisions of various courts all over India where the Andhra Pradesh High Court in Chhena Jagadesswer v State of Andhra Pradesh [22] held that an attempt to commit suicide [23] is legal and constitutionally valid.

But then, in P. Rathinam v Union of India [24] the Supreme Court of India for the first time formulated fifteen questions and raised the issue “whether an Indian citizen residing in India has a right to die?” At the end of judgment, it was held that “Attempt to commit suicide” is outdated, cruel and an irrational provision [25] . Therefore it is violative of Article 21 of the Constitution of India and it is void and unconstitutional.

In Gian Kaur vs State of Punjab [26] which is a landmark judgement in the Euthanasian history as the decision which was made in P. Rathinam’s case was overruled in this case. It was held by the Apex Court that ‘Right to life’ does not include the ‘Right to die’ and also explained that Article 21 does not allow to cut short the natural span of life of a person. It included providing a dignified life till death which included a dignified form of death.

In Naresh Marotrao Sakhre v. Union of India , [27] it was held that, Euthanasia and suicide are different. Mercy killing thus is not suicide and an attempt for mercy killing is not covered by the provisions of S.309 IPC. The two concepts are both factually and legally distinct. Euthanasia or mercy killing is nothing but homicide whatever the circumstances in which it is committed.

In Aruna Ramchandra Shanbaug vs Union Of India & Ors [28] case being an epic case where a revolution was brought in the medical world by allowing Passive Euthanasia with some restrictive guidelines. This landmark case made passive euthanasia legal in India. Our judiciary has dealt with the issue of euthanasia in a very extensive manner wherein various controversial aspects have been closely examined and dealt with possible solutions for the same so that no undue advantage is taken.

The Supreme Court has itself clarified and directed that passive euthanasia is allowed on the condition that if the doctors act on the basis of expert medical opinion which has been appointed by the Apex Court and on the green signal of the court they could withdraw life support which is in the patient’s best interest. Invoking the Parens Patriae principle (Latin for “parent of the nation”, where the Court can step in and serve as a guardian) it held that the Court will be the ultimate decider of what is best for the patient. [29] This power of allowing passive euthanasia is not only limited to the Apex Court but has also been extended to High Courts under Article 226 of the Constitution which empowers the court to issue directions or order to any person.

Another epic judgement in Common Cause vs Union of India [30] wherein the five judge bench held that right to die with dignity is a fundamental right and comes within the ambit of Article 21 of the Constitution. It also laid down that an individual has every right to decide when to remove life support and pressed on the need of creating a living will.

The Apex Court further brought certain proposal regarding the procedure for execution of living will and also provided the guidelines thereof to give effect to passive euthanasia.

Therefore, this judgement brought a great relief for the patients who have been suffering from long term illness, chronic diseases and incurable diseases which is meant to prolong life through medications. Thus, the court is in right direction by declaring the Right to die with dignity as a fundamental right which would bring an end to the long term pain and sufferings of the people.

Recommendations of Law Commission of India: The 196th Report of the Law Commission on ‘Medical Treatment to Terminally Ill Patients (Protection of Patients and Medical Practitioners) was chaired by M. Jagannadha Rao. [31] This report was made for patients suffering from terminal illness or who are in persistent vegetative state by allowing them to die a natural death.

The principles laid down in this report is universal in nature as the Courts in countries like UK, USA, Ireland, Scotland, Canada, Australia and New Zealand also follow the same for Competent Patients.

Every terminally ill patient who is competent enough to make a decision regarding his health while he is terminally ill then they have the right to refuse the treatment and the doctors are bound by it and according to law they wont be liable for ‘Attempt to Commit Suicide’ [32] nor is the doctor guilty of ‘abetting suicide’ [33] under Indian Penal Code.

The Report laid down certain guidelines for incompetent patients too who are not capable enough to make decision on their own are as follows:

• It is not on the discretion of the doctor to withdraw or withhold the medical treatment of the terminally ill patients unless they have obtained the opinion of three experts and if required a ‘Bolam Test’ [34] could also be conducted to justify the condition of the patient.
• Secondly, the doctors at their own discretion cannot select the experts but they are bound to choose the experts from the panel made by the Director General of Medical Services for Union Territories and the Directors of Medicine (or other authorities holding equivalent posts) in the States. [35] The doctor is bound by the decision of the expert panel and cannot work on their own terms.
• Thirdly, the doctors dealing with terminally ill patients have to maintain a register of incompetent patients with details including their age, sex, name, address and what is the best interest of the patient and the reasons for withdrawing medical treatment from the patient. Further, it is the duty of the doctor to inform either the patient (if they are conscious) or their family about his decision to withdraw the medical support and if they desire they could be given 15 days’ time to move to High Court to get further orders and if no order is received he can proceed with the same.
• Lastly, the authorities like Director General of Medical Services for Union Territories and the Directors of Medicine shall be served with a copy of the register which contains information about terminally ill patients by the doctor maintaining it and the information has to be kept confidential even after the closure of the case.

VI. Euthanasia in Canada

Euthanasia in Canada is called medicinally assisted dying and became lawful alongside assisted suicide in June 2016 to end the pain of terminally ill patients and relieve them of never ending pain, trauma and suffering. The Court gave its historic judgement and made physician assisted Euthanasia and physician assisted suicide legal in Canada. The court further amended the Section 241(b) and Section 14 of the criminal code which prohibited assisted dying and concluded that it is the choice of the individual to live and die with dignity.

The Supreme Court of Canada in Cater vs. Canada [36] held that euthanasia is to be made legal in the country as it does not violate Charter of rights. As judiciary legalised Euthanasia, the Parliament further passed Bill C-14, in June 2016 and amended the Canadian Criminal Code to legitimize both physician assisted euthanasia (PAE) and physician assisted suicide (PAS), and the methodology to administer them in Canada. It further introduced laws to make sure that it is not misused as it is concerned with life and death of the individual.

Neither euthanasia nor assisted suicide is accessible to minors, nor on the grounds of terminal illness, or any condition which can be treated in due course. To avert its misapplication in the country, it is made accessible just to citizens qualified for Canadian medicinal services. Any official request for mercy killing shall not be permitted and patients cannot plead for Euthanasia in advance if their condition worsens in future (for example, in instances of Alzheimer’s ailment where patients want to die after they achieve advanced state of illness and suffering).

The legalization of Euthanasia in Canada was influenced by various factors including the free will to end one’s life so that consisted pain and suffering can come to an end and die in peace and with dignity. Canada’s assisted dying law incorporates legitimate protections for anticipating misuse and guaranteeing informed assent. Neither the law, nor the doctors included, can have any lawful say regarding mercy killing as it will be solely decided by the patient only. Assent must be more than once communicated, must be expressed and not implied even if it is one minute before death. Consent can be revoked any time and there will be no consequences for revoking and no restrictions as to how many times it may revoke.

In a leading judgement [37] of euthanasia where Canadian Court faced dilemma as to the accused party is actually responsible for the taking life of the patient or acted humanely by relieving her from endless pain and suffering. In this case father took his daughters life by administering her carbon monoxide and end her misery. Her father contended that she was in immense pain and torture. It was in her best interest to free herself from consistent torture so he did nothing wrong ion his part. After series of trials and appeal jury convicted him of first degree murder by saying that he cannot avail defence of necessity and is liable for killing her own daughter.

Another landmark case [38] where it was appealed to struck down the section 241(b) of the code, which prohibits a terminally ill individual to commit physician assisted suicide. The court rejected the argument by quoting that revoking the prohibition would be a weapon in hands of vulnerable individuals which will prove fatal for the citizens as whole. The prosecution appealed that the individual should have the freedom to decide when to die and control the method through which death can be achieved. The court also stated that allowing physician assisted suicide will crumble belief in humanity and will erode its faith.

In Whitler vs. Canada [39] the Court reconsidered their judgement given in previous cases and held that prohibiting physician assisted suicide is unjustified to people with disabilities. It is a burden and unacceptable as they have to suffer the effects of such prohibition for their entire life.

Quebec being the capital of Canada has legalized Euthanasia in their city in 2009. They weighed all the pros and cons thereby allowing assisted suicide in the province. They amended criminal laws and inserted clauses which define the right to die and craved proper penalties to ensure no abuse of such right given to the citizens. The judiciary have also played very important role in interpreting the right to die to conform to the set laws and regulations.

In Malette vs. Shulman [40] the court held that the patient has full right to refuse a particular treatment even in an emergency situation. The court directed that the doctors must adhere to the written instruction by the patient even if it proves harmful for the health of the individual. The court emphasized on the fact that right to die in based on the principle that will of the people is of utmost priority.

In Nancy B. v. Hotel – Dieu de Quebec [41] court contended that it is the final discretion of the patient regarding whether they wish to continue the treatment or not. The court again emphasized the principle that the patient’s wishes are to be given priority while deciding on which method patient has agreed to. It further added that illness should take its natural course and unreasonable behaviour shall not be tolerated from the doctor’s side.

Proper guidelines have been issued under the bill passed in Canada so that no one can misuse this right and can be used in the best interest of the patients. To avail euthanasia under the Canadian laws, terminally ill patients have to submit written request to the doctors conveying his intention to die through physician assistance. The patients should be able to confirm that he is undertaking Euthanasia without any coercion and pressure. Furthermore he must clearly state that he is acting on his own will and no one is influencing his decisions regarding the same. The written communication must be done at least 10 days before to the doctor. Then, doctor and two medical experts will scrutinize the condition of the patient and will confirm that his health will not improve in the future and there is no alternate solution to save the terminally ill patient. The team of doctors will then inform the patient about all the possible choices available to him and has the option to revoke his consent at any stage even before a minute of administering Euthanasia.

VII. Comparative analysis between India and Canada

Euthanasia has been legalized both in India and Canada thereby reliving the terminally ill patient of pain, misery and suffering. The main idea underlying legalization is to let individual decide what is best for them during their last days. Few comparison have been drawn between administration of Euthanasia in India and Canada.

• The Supreme Court of India allowed passive euthanasia as it considered right to die an essential element of right to life [42] . The court gave its historic verdict after highlighting the fact that as per the prevailing condition in the nation, it is legally not possible to grant approval for active euthanasia. They further emphasized that the right will not be absolute and shall be subject to restrictions. On the contrary the Canadian Court allowed both active and passive euthanasia in the country. They believed that if the patient’s condition is not going to improve at a later stage, then it is of no use to let them bear all the suffering and never ending pain thereby legalizing physician assisted euthanasia and assisted suicide.
• In India, there is no time limit specified as to within which High court has to approve the application for euthanasia. The guidelines given by the court are silent regarding the time frame within which application is to be sanctioned and the time period within which Euthanasia can be administered to the concerned patient. On the opposite the Canadian laws have been very clear regarding the time frame within which application is to be submitted to the doctors and the approval time. The 10 days time period has been framed to ensure that the procedure is carried out properly by analysing all the other alternate options available and to ensure that the process is not conducted negligently.
• The procedure of administering Euthanasia stated by the Apex court of the country is too complex and time consuming which can prove fatal for the terminally ill patient. Permission is to be taken from high court which in itself can delay the entire process. In Canada, the process is simplified as there requires approval from the concerned doctor and a medical expert. Thereby the process is easy and it can be executed without waiting for longer period.
• Euthanasia in India and Canada has been made legal but making it legal is not enough a proper law in this regard has to be made which is absent in the case of India. The Judiciary in India have taken the step forward to legalize it but to pass a bill and make it a law is the power of the parliament. As there is no proper law regarding euthanasia it is very difficult for the society to exercise their right in this regard because mere laying of guidelines does not bring a concrete solution to any problem thus a law needs to be passed for the betterment of the society. Whereas, in Canada the scenario is different and systematic as a proper bill (C-14) has been passed in the Canadian parliament to make it a law for the smooth functioning of the society.
• A medical directive which is made in advance by the person who is in a good condition makes such document in which they specify what action should be taken regarding their health when they are suffering from terminal illness or are in coma than such Advance Directives is known as living will. The access to such document or medical directive has been allowed in India by the Apex Court allowing patients to be passively euthanized if they suffer from terminal illness in future. But it is not so in the case of Canada where both passive and active euthanasia has been allowed. Living will is not allowed here as it has laid down proper laws in this regard and had given ample power to exercise the right of Euthanasia.

VIII. Conclusion & suggestions

Euthanasia can be cited as the best example for freedom of choice of an individual where it has invited a lot of arguments for and against it. While some support euthanasia as the best procedure to relive a person from its unending suffering and on the other hand it is objected that it devalues human life. To choose life over death is very painful and with time the society has been trying to accept this radical change not just with the support of the judiciary but also bringing change in their mindset which can be found more often in older generations.

The Judiciary through its various verdicts finally allowed right to die as an integral part of right to life. They highlighted the fact that it is of no use to let terminally ill patient bear all the ongoing pain, trauma and suffering. The main idea behind this is to respect one own choice’s and the freedom to decide for oneself in their best interest.

The apex court agreed to legitimize passive euthanasia for those patients who are in persistent vegetative state and will not recover anytime in future. The court also considered the legal position of mercy killings in other countries i.e. United Kingdom, United State of America and Canada. The bench unanimously agreed that dignity is the basic foundation of an individual’s integrity and a man should have the freedom to choose between acceptance of medical treatment and rejection of it.

They further introduced the concept of Living Will in India so that no one can misuse the right given under the law and it is being executed properly. Through living will they have protected the interest of the patient in order to make sure that no one takes undue advantage of it. Canada also legalized Euthanasia a few years back and they have crafted fully fledged law backing the legitimization. The procedure to be observed has been safeguarding by several measures to ensure best utilization of the right.

Few suggestions to improve the process of Euthanasia in India are as follows-

• It is the dire need of the hour for the legislature to draft a law on Euthanasia as legal backing is required which will provide a strong footing to right to die in the country. The legislature has been neglecting their duty since a very long time and which forced judiciary to step forward and legalize it to end the consistent pain and suffering of patients in permanent vegetative state.

Scholars suggest that our country should make legislation by taking ideas from the models of other countries where Euthanasia has been made a law. Such laws would give us guidelines or proper measures on what should be practiced and what should be avoided. It is possible to legalize euthanasia effectively if proper laws have been enacted by the legislature of the country.

• Proper guidelines must be drafted regarding the procedure as to how Euthanasia shall be administered. The rules issued by Supreme Court are not concrete enough to assure that this right will not prove disastrous for any individual fighting between life and death. If the process if not executed properly, there are chances that people may use it to fulfil their personal interest. The guidelines are vague and does not provide for neither any specific time frame within which application has to be sanctioned nor states any preventive measures to make sure that due care and caution is observed.
• The sole opinion of the doctor regarding the administration of Euthanasia is dangerous as there are chances that he may misuse the powers given which may put an individual’s life in danger. The Court has always analysed doctors decision very carefully to ascertain that no negligence was observed on the account on them. On the contrary, the sole deciding element in execution of the process of mercy killing is one them only which may lead to deadly consequences.

A medical expert shall be appointed by the court who will scrutinize the doctors decision regarding Euthanasia so that no loopholes can be found at a later stage. After scrutinizing by the expert, then it should go for approval to the concerned High Court.

• Another issue that stems out is – making euthanasia a law because if it has been legalized then who or what factors would decide the criteria of suffering of an individual to bring an end to their pain. Should it be the sole opinion of the doctor or the relatives because giving sole power on the hands of the doctors or the relatives is quite risky too as it would not be clear whether they are acting in the best interest of the patient or not.

So, what should be done in such case? To bring an end to such a dilemma it is important to bring a Proper Redressal Mechanism which would deal solely with this issue of Mercy Killing only. A committee of two or more members should be setup where the members would comprise one from the judiciary and the other two would be senior and experienced doctors who would be bias on their decision and would weigh all the pros and cons before allowing euthanasia. Any aggrieved person could go directly to such a committee without even knocking the doors of the judiciary for faster and smoother functioning of the process because such cases are one in thousand and the judiciary being already overburdened with other issues would delay the process of euthanasia and would increase the suffering of the patient.

• To keep a check on the misuse of the power by the doctor or the relatives and to ensure transparency, post mortem should be made mandatory after the procedure of Euthanasia has been conducted. Once completed and the patient is dead, post mortem should be carried out to administer the facts of the case and if any violation or misuse has been found then proper action should be taken to punish the offenders.
• India being the second most populous country in the world [43] has more number of illiterates than compared to literates which is also a driving factor on the legalization of Euthanasia because literate people are more practical than compared to illiterate people who are more emotional and thus the deciding factor cannot be on the grounds of emotions and sentiments. It is to be also noted that literates tend to choose the path of corruption more easily than compared to illiterates which is also one of the factors for transparency of the whole process of Euthanasia because corruption is like a termite which is present everywhere even in the healthcare sector which is eating up the whole system and thus endangering the life of the patients. Thus, for the best interest of the society we should leave this issue on the hands of the judiciary. The need of the hour is not just making it a law but we Indians need maturity to handle such a fragile issue by understanding its pros and cons thoroughly.

[1] Aruna Ramchandra Shanbaug v. Union of India, Writ Petition (Criminal) No. 115 Of 2009

[2] Common Cause vs Union of India, 2014 SCC 5 338

[3] Cambridge Dictionary

[4] Jadon Bhanwar Aditya, Euthanasia viz-a-viz right to life (Unpublished dissertation-Indian Law Institute, New Delhi) ( last visited May 11,2020).

[5] Aruna Ramchandra Shanbaug v. Union of India, Writ Petition (Criminal) No. 115 Of 2009

[6] History of Euthanasia, http://www.euthanasia.com/historyeuthanasia.html (Last visited May 11,2020)

[7] Robert Jay Lifton, GERMAN DOCTORS AND THE FINAL SOLUTION , New York Times Magzine (September 21, 1986), https://www.nytimes.com/1986/09/21/magazine/german-doctors-and-the-final-solution.html (Last visited May 12, 2020)

[8]   Kusum R Gandhi, Euthanasia: A Brief History and Perspectives in India, 105 ResearchGate https://www.researchgate.net/publication/320829903_Euthanasia_A_Brief_History_and_Perspectives_in_India, (Last visited May15, 2020)

[10] Rema Nagarajan, Indian culture had place for voluntary death (Jul 17, 2014) Times of India https://timesofindia.indiatimes.com/india/Indian-culture-had-place-for-voluntary-death/articleshow/38504764.cms (Last visited May 15, 2020)

[12] Kimberly Holland, Euthanasia: Understanding the Facts , Healthline, https://www.healthline.com/health/what-is-euthanasia#types, (Last visited May 15, 2020)

[13] Meriam Webster Dictionary

[14] Maruti Shripati Dubal v. State of Maharashtra, Criminal Appeal No. 130 of 1987

[15] Dhruv Desai, Suicide and Euthanasia , Legal Service India http://www.legalserviceindia.com/article/l265-Suicide-&-Euthanasia.html (last visited May16,2020)

[16] Airdale NHS Trust v. Bland, 1993(1) All ER 821 (HL)

[17] Article 21 of the Indian Constitution

[18] Gian Kaur v. State of Punjab 1996 (2) SCC 648

[19] Section 309 of Indian Penal Code, 1860

[20] Article 21 of the Indian Constitution

[21] Supra note 15

[22] Chhena Jagadesswer v State of Andhra Pradesh, 1988 Crl. L.J. 549.

[23] Supra note 19

[24] P. Rathinam v Union of India, 1994 SCC (3) 394

[25] Dr. Sonali Abhang, A Socio-Legal Impact of ‘Euthanasia’ In India-Suggested Reform , 5, International Organisation of Scientific Research http://www.iosrjournals.org/iosr-jhss/papers/Vol.%2022%20Issue9/Version-5/A2209050111.pdf (Last visited  May 16, 2020)

[26] Supra note 18

[27] Dr. Shaikh Sahanwaz Islam, Indian Judicial Approach Regarding Right to Die, Legal Service India http://www.legalservicesindia.com/article/1846/Indian-Judicial-Approach-Regarding-Right-to-Die.html (Last visited May 20,2020)

[28] Supra note 1

[29] Right to Die , Supreme Court Observer, https://www.scobserver.in/court-in-review/right-to-die?slug=aruna-ramachandra-shanbaug-v-union-of-india (Last visited May 20, 2020)

[30] Supra note 2

[31] Law Commission of India, https://en.wikipedia.org/wiki/Law_Commission_of_India, (last visited May 20, 2020)

[32] Section 309 Indian Penal Code, 1860

[33] Section 306 Indian Penal Code,1860

[34] Law Commission of India Reports, https://www.latestlaws.com/library/law-commission-of-india-reports/law-commission-report-no-196-medical-treatment-to-terminally-ill-patients-protection-of-patients-and-medical-practitioners-2006/,  ( last visited May 21, 2020)

[36] Cater vs. Canada , 2012 BCSC 886

[37] R vs. Latimer, 2001 SCC 1

[38] Rodriguez vs. British Columbia, [1993] 3 SCR 519

[39] Withler vs. Canada, 2011 SCC 12

[40] Malette vs. Shulman, 1990 CanLII 6868 (ON CA)

[41] Nancy B. v. Hotel – Dieu de Quebec, 86 D.L.R. (4 th ) 385 (Que. S.C.)

[42] Supra note 1

[43] Internet World Stats, https://www.internetworldstats.com/stats8.htm, (last visited May 22, 2020)

Total number of HTML views: 3313

Total number of pdf downloaded: 924, open access.

http://doi.one/10.1732/IJLMH.26162

Recent content

1 between voices: a linguistic study of scaroa v. union of india.

By Vedashree Avinash Adsule and Jatin Singh

Volume: 7 Issue : 2 Page: 1773 - 1783

2 Child Labour in India: Antecedent, Consequences and Preventive Measures

By Raushni Ranjan Pradhan and Ambar Srivastava

Volume: 7 Issue : 2 Page: 1762 - 1772

3 Harnessing the Potential of Artificial Intelligence in Marketing: A Paradigm Shift towards Enhanced Consumer Engagement

By Rohit Kaul

Volume: 7 Issue : 2 Page: 1753 - 1761

4 A Law Maker should not be a Person who is Law Breaker: A Critical Analysis

By Dr. Rajesh Kumar Dube

Volume: 7 Issue : 2 Page: 1744 - 1752

5 Navigating India’s Evolving Foreign Direct Investment Landscape: Trends, Regulatory Reforms, and Implications

By Sakshi Thakkar

Volume: 7 Issue : 2 Page: 1734 – 1743

International Journal of Law Management & Humanities

Typically replies within 24 hours.

Any questions related to the journal or your submission?

WhatsApp Us

🟢 We will respond within 24 hours, maybe less.

WhatsApp us.