PROJECT REPORT ONACTIVE AND PASSIVE EUTHANASIA

UNDER THE TOPIC OF LAW AND MEDICINE

Submitted By:Amrita

Euthanasia

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 school of thoughts is 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.

The term ‘euthanasia’ is derived from the Greek words- ‘eu’ meaning "good“ and ‘thanatos’ meaning "death".

One meaning given to the word is "the intentional termination of life by another at the explicit request of the person who dies."

In the modern day context euthanasia means causing painless death of a person suffering from an incurable and painful disease. It is limited to the killing of patients by doctors at their own request in order to free them of excruciating pain or from terminal illness.

Review

Review (History) According to the historian N. D. A. Kemp, the origin of the contemporary debate on euthanasia started in 1870. Nevertheless, euthanasia was

debated and practiced long before that date -- Hippocrates (ca. 460 BC - ca. 370 BC)- Euthanasia was practiced in Ancient

Greece and Roman civilizations as they 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.

1300s- According to the English jurisdiction of the suicide as well as helping people to kill themselves were considered as a criminal act. Mercy killing was also not supported by the ascendancy of Christianity (12th till 15th century). 1828- The first law against assisted killing, known as anti-euthanasia was passed in New York.1870- In this year, Samuel Williams suggested the use of morphine and analgesic medications for assisting quick and painless death. 1885- Exactly 15 years after Samuel Williams raised the proposal, the American Medical Association strongly denied the use of analgesic for euthanasia. Beginning of 20th century - mercy killing and assisted killing already entered the minds of the public.

1905- A bill for making it legal was circulated in Ohio, but it failed. A similar bill was introduced in the next year, which also failed.1935- The first group for legalization of euthanasia, called Voluntary Euthanasia Legislation Society (VELS), was founded by a group of doctors in London. 1938- A similar organization, known as National Society for the Legalization of Euthanasia (NSLE) came into existence. Till date, many cases of physician-assisted suicide have been fought in the court. 1940- Non-voluntary euthanasia was practiced for the first time by German physicians, to eliminate the diseased and disabled Germans in closed gas chambers. The main purpose of the program was to get rid of handicapped children and people with psychiatric problems.1945- It was estimated that 300,000 Germans had been killed. 20th century- Marked the formation of several organizations for addressing the concerns regarding euthanasia.

1986- Doctor Joseph Hassman was charged guilty for administering a lethal dose of Demerol to his mother-in-law. He was fined and sentenced to two years imprisonment for the act. 1999- Euthanasia became a public issue, with the imprisonment of Dr. Jack Kevorkian for conducting voluntary euthanasia on Thomas Youk (52), who was in the final stage of ALS (amyotrophic lateral sclerosis). Kevorkian was charged with second-degree murder, and he served eight years in prison (from 1999 to 2007). It was claimed that he had exercised euthanasia for at least 130 other patients (in this case, patients took lethal injections themselves).The debate on euthanasia and assisting suicide is still going on, and is expected to continue in the coming years. There are both pros and cons of euthanasia and whether to stand for or against mercy killing depends on the ideology and understanding of each individual. In a survey, approximately 60 - 80 percent people in the western countries favor physician-assisted suicide for terminally ill patients.

Euthanasia can be classified:-(a) On the basis of the nature of act being done, as:Active or Positive: It is a positive merciful act, to end useless suffering or a meaningless existence. It is an act of commission, e.g. by giving large doses of drugs to hasten death.Passive or Negative: It means not-using or discontinuing the use of extraordinary life-sustaining measures to prolong life. This includes an act of omission, such as failure to resuscitate a terminally ill or hopelessly incapacitated patient or severely defectively newborn infant. It involves non-use of the measures that would probably delay death and permit natural death to occur.(b) On the basis of consent, as:Voluntary: It covers cases where the person himself requests the commission of euthanasia (active or passive).Involuntary: It covers cases where the person on whom euthanasia is committed is mentally incompetent to make a choice and euthanasia is committed on the basis of the assessment made by others.In general, countries attempt to draw a line between passive euthanasia (generally associated with allowing a person to die) and active euthanasia (generally associated with killing a person). While laws commonly permit passive euthanasia, active euthanasia is generally prohibited.

Active Euthanasia Active euthanasia is defined as inducing the death of a person who is undergoing intense suffering, and who has no practical hope of recovery. Since the motive is to release one from misery, active euthanasia is often called “mercy killing.” Here we will discuss five reasons why active euthanasia is wrong. The reason why active euthanasia is wrong is because:

(1) There are other options to stop a patient from suffering, such as great advances in pain management , palliative care and the development of hospices to assist people who are dying. (2) Active euthanasia is unethical, because it is a form of murder.

(3) Euthanasia is also wrong because it’s against God’s will.

(4) Euthanasia is a violation of the right to life (article-21 of constitution of India); and

(5) Active euthanasia deprives one the right to die naturally. Overall, active should not be allowed, because it is morally wrong. Although many people may feel that their loved ones are ready to die, that doesn’t necessarily mean that one should choose active euthanasia. There are other options to stop a patient from suffering. Pain management, palliative care and the development of hospice care are always a preferable solution.

Passive Euthanasia

Like all forms of euthanasia,it involves the intention to hasten death in the patient’s interests (because of their expected negative quality of life).

What is standard taken to mark off passive as opposed to active euthanasia is that the former hastens death by not providing something which would, if provided, delay death—that is, passive euthanasia involves withdrawing or withholding life-prolonging medical treatment.

So there are (at least) three necessary conditionsfor the occurrence of passive euthanasia:

(1)There is a withdrawing or withholding of life-prolonging treatment

(2) The main purpose (or one of the main purposes) of this withdrawing or withholding is to bring about(or ‘‘hasten’’) the patient’s death

(3) The reason for ‘‘hastening’’ death is that dying (or dying sooner rather than later) is in the patient’s own best interests.

Conti…

The term "passive euthanasia" used by the Supreme Court in its verdict on Aruna Shanbaug's case is defined as the withdrawal of medical treatment with the deliberate intention to hasten a terminally ill-patient's death.Various medical and legal dictionaries say passive euthanasia is the act of Hastening the death of a terminally-ill patient by altering some form of support and letting nature take its course.Passive euthanasia can involve turning off respirators, halting medications, discontinuing food and water so the patient dies because of dehydration or starvation.Passive euthanasia can include giving the patient large doses of morphine to control pain in spite of the likelihood that the painkiller can cause fatal respiratory problems.

Active and Passive Euthanasia in India

Passive euthanasia is legal in India.On 7 March 2011 the Supreme Court of India legalized 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 has been in a vegetative state for 37 years at King Edward Memorial Hospital. The high court rejected active euthanasia by means of lethal injection. In the absence of a law regulating euthanasia in India, the court stated that its decision becomes the law of the land until the Indian parliament enacts a suitable law. Active euthanasia including the administration of lethal compounds for the purpose of ending life is still illegal in India, and in most countries.

Active Vs Passive Euthanasia - An Argument

According to the first argument, euthanasia is always morally wrong. But the behavior which is described in the standard taxonomy as “passive euthanasia” is notmorally wrong.Therefore, it cannot really be a form of euthanasia and so there is no such thing as passive euthanasia.•Put like this, the argument seems simplistic and implausible.However, there is perhaps a slightly better way of articulating it. Some concepts,so the argument goes, are moral concepts, or at least have amoral dimension. For example, “murder” (understood here as a moral rather than a legal term) is typically defined as wrongful killing.• Or, to put it another way, one necessary condition for an act being a murder is that it is wrong. So perhaps euthanasia is like murder and part of its definition is that it is a wrongful act.

There are, however, a number of objections to this argument. To being with, it assumes too much. It starts from the claim that euthanasia is never justified, and builds this into the definition of euthanasia, excluding on grounds of conceptual incoherence The possibility of there being a permissible form of euthanasia. This not only excludes the possibility of passive euthanasia (assuming this morally permissible) but also excludes the possibility of a moral debate about the ethical standing of euthanasia.This point is further strengthened if we consider two ‘‘real life’’ counterexamples. Firstly, of course, many people think that active voluntary euthanasia is (sometimes) permissible. What if we were to discover somehow that the view of the ‘‘pro’’ active voluntary euthanasia organizations was the correct one and that active euthanasia is in fact morally permissible. Ought we to conclude from this that there are not any cases of euthanasia, because all of the apparent cases have turned out not to be wrong, and hence not euthanasia? Surely not!

Conversely, some moral conservatives believe that even passive euthanasia is wrong.. So the argument is, to say the least, strange insofar as it makes the very existence of euthanasia (both active and passive) dependent on its moral status.

A fundamental problem with the wrongness of euthanasia argument then is that the evaluation is driving the conceptualization.

Passive Euthanasia, Is It Morally Permissible?

No, when performing passive euthanasia, no matter the intentions , someone still dies. There is no moral distinction between letting die and killing someone because the action’s result is the same. If letting a person die is morally permissible then killing someone is also, and vice versa. Apart from this, there are many plausible moral rationales against the legalization of euthanasia. Utilitarianism-an ethical theory which emphasizes the greatest happiness to the greatest number aims to act to provide maximum benefit. But, according to Utilitarianism, we cannot focus exclusively on the patient and, even if euthanasia would be in the best interest of the patient, it may be wrong because of the bad effect on the patient’s relatives. Deontology-a view that some kinds of actions are unconditionally prohibited where it may seem natural to assume that killing must be one of them. With respect to human beings, this doctrine is very strict and applies to all human beings, including fetuses and embryos, suicide and murder. However, it is encouraging that euthanasia is still not legalized in many, parts of the world.

Arguments on Voluntary Passive Euthanasia

Favor Against

It relieves unnecessary suffering It goes against the human natural tendency to live. Killing innocent people is always wrong

It provides all of us the comfort of knowing we can choose to die rather than suffer.

Such a policy will put pressure on patients to choose to die even when they want to live.

It allows the exercise of a competent patient’s autonomy (freedom, self-determination)

It will lead doctors (slippery slope) not to work as hard to preserve life (consequentiality). It contradicts the purpose of the medical profession (non consequentiality)

It is not morally different from what we appropriately permit now (withdrawal of Life-sustaining treatment)

There is a fundamental moral difference between acting with intent to kill and not providing life-sustaining treatment

Main Difference between Active Euthanasia And Passive Euthanasia In active euthanasia the doctor takes an action with the intention that it will cause the patient's death where in passive euthanasia the doctor lets the patient dieActive euthanasia is a positive act of commission, such as a lethal injection where passive euthanasia implies an act of omission, such as the withholding or withdrawal of treatment.Active is usually a quicker means of causing death. All forms of active euthanasia are illegal. However, active euthanasia should be treated differently from passive euthanasia. Where Passive is usually slower and more uncomfortable than active.There is a moral difference based on the fact that active euthanasia leaves no room for a miracle, is outwardly similar to murder and so would be more difficult to distinguish from murder than passive, and does not require the patient to be as ill as passive. In active euthanasia, something is done to end the patient's life; in passive euthanasia, something is not done that would have preserved the patient's life.

Is active euthanasia morally better?

Some (mostly philosophers) go even further and say that active euthanasia is morally better because it can be quicker and cleaner, and it may be less painful for the patient.

What practices would be involved?

The most common suggestion is for voluntary (or "active") euthanasia, where the person asks to be killed. Although those who advocate euthanasia do not like the use of the word "kill", it is the only accurate, non-emotional word to describe the reality, and it is the word which the law uses.Assisted suicide is also now being proposed, where a person would be provided with the means of committing suicide, and would then himself or herself perform the act.Less commonly discussed is involuntary euthanasia. This concerns the killing of persons who cannot express their wishes because of immaturity (such as a newborn infant), mental retardation or coma. Here it is decided by others that that person would be better off dead.

By current law, all forms of euthanasia are murder and assisting suicide is a criminal offence.

Present Scenario of Euthanasia In India

Like almost in all other countries, euthanasia has no legal status in India. The practice of euthanasia is a clear act of offence, either a suicide or assistance to commit suicide or a murder. The latest judgment of Supreme Court declares that: Right to DIE is not included in the Right to LIFE under Article 21 of Indian Constitution. Article 21 is a provision guaranteeing protection of life and personal liberty and by no stretch of imagination can imply ‘EXTINCTION OF LIFE’.

‘Right to life’ is a natural right embodied in Article 21 but suicide is an unnatural termination of life and therefore not compatible and inconsistent with the concept of ‘right to life’.

Aruna Shanbaug case

Aruna Shanbaug was a nurse working at the KEM Hospital in 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 the hospital staff who treat and take care of her did not support euthanizing her.

Globally Euthanasia

Efforts to change Government policies on euthanasia in the 20th century have met limited success in Western Countries. Euthanasia policies have also been developed by a variety of NGOs, most notably medical associations and advocacy organizations. As of 2011, active euthanasia is only legal in the three Benelux countries: the Netherlands, Belgium and Luxembourg. Assisted suicide is legal in Switzerland and in the US states of Washington, Oregon and Montana.

CONCLUSION

Views, ideas and 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 seems polar opposites in this debate. Opponents of euthanasia maintain that there is a clear moral distinction between merely allowing dying 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. As far as we are concerned, considering its moral and ethical values of the concept and also its legal conviction, we are of firm belief and opinion that India must never practice euthanasia by law.In this regard it would be quite worthwhile to remember the words of Lord Edmund Davis – “killing both pain and patient may be good morals, but is far from CERTAIN that it is good law.”