Voluntary, Non-Voluntary and Involuntary Euthanasia

Voluntary euthanasia: Euthanasia conducted with the consent

of the patient is termed voluntary euthanasia. Voluntary
euthanasia is legal in some countries. Jurisdictions, where
euthanasia is legal, include the Netherlands, Colombia, Belgium
and Luxembourg.

Non-Voluntary euthanasia: Euthanasia conducted where the

consent of the patient is unavailable is termed non-voluntary
euthanasia. Non-voluntary euthanasia is illegal in all countries.
Examples include child euthanasia, which is illegal worldwide but
decriminalised under certain specific circumstances in the
Netherlands under the Groningen Protocol.

Involuntary euthanasia: Eutanasia conducted against the will of

the patient is termed involuntary euthanasia. Involuntary
euthanasia is usually considered murder.

Passive vs Active euthanasia

Voluntary, non-voluntary and involuntary euthanasia can all be further

divided into passive or active variants.

Passive euthanasia entails the withholding of common

treatments, such as antibiotics, necessary for the continuance of
life.

Active euthanasia entails the use of lethal substances or forces,

such as administering a lethal injection, to kill and is the most
controversial means.

Euthanasia debate: Arguments in favour for

Euthanasia
Historically, the euthanasia debate has tended to focus on a number of
key concerns. According to euthanasia opponent Ezekiel Emanuel,
proponents of euthanasia have presented four main arguments:

1. that people have a right to self-determination, and thus should be

allowed to choose their own fate

2. assisting a subject to die might be a better choice than requiring

that they continue to suffer

3. the distinction between passive euthanasia, which is often

permitted, and active euthanasia, which is not substantive (or that
the underlying principlethe doctrine of double effectis
unreasonable or unsound);

4. permitting euthanasia will not necessarily lead to unacceptable

consequences. Pro-euthanasia activists often point to countries
like the Netherlands and Belgium, and states like Oregon, where
euthanasia has been legalized, to argue that it is mostly
unproblematic.

5. Other arguments:

A. Constitution of India: Right to life is a natural right

embodied in Article 21 but euthanasia/suicide is an unnatural
termination or extinction of life and, therefore, incompatible
and inconsistent with the concept of right to life. It is the duty
of the State to protect life and the physicians duty to provide
care and not to harm patients. Supreme Court in Gian Kaur
Case 1996 has held that the right to life under Article 21 does
not include the right to die.

6. Caregivers burden: Right-to-die supporters argue that people

who have an incurable, degenerative, disabling or debilitating
condition should be allowed to die in dignity. This argument is
further defended for those, who have chronic debilitating illness
even though it is not terminal such as severe mental illness. The
 majority of such petitions are filed by the sufferers or family
members or their caretakers. The caregivers burden is huge and
cuts across various domains such as financial, emotional, time,
physical, mental and social.

7. Refusing care: Right to refuse medical treatment is well

recognised in law, including medical treatment that sustains or
prolongs life. For example, a patient suffering from blood cancer
can refuse treatment or deny feeds through a nasogastric tube.
Recognition of the right to refuse treatment gives a way for passive
euthanasia.

8. Encouraging the organ transplantation: Euthanasia in terminally

ill patients provides an opportunity to advocate for organ
donation. This, in turn, will help many patients with organ failure
waiting for transplantation. Not only euthanasia gives Right to die
for the terminally ill, but also Right to life for the organ needy
patients.

Also read: Union Budget of India 2014-15 Highlights and Analysis

Euthanasia debate: Arguments against Euthanasia

Emanuel argues that there are four major arguments presented by

opponents of euthanasia:

1. not all deaths are painful;

2. alternatives, such as cessation of active treatment, combined with

the use of effective pain relief, are available;

3. the distinction between active and passive euthanasia is morally

significant; and
 4. legalising euthanasia will place society on a slippery slope, which
will lead to unacceptable consequences

5. Other Arguments include:

A. Euthanasia weakens societys respect for the sanctity of life.

B. Euthanasia might not be in a persons best interests, for

example, getting old aged parents killed for property will.

C. Belief in Gods miracle of curing the terminally ill.

D. Prospect of a discovery of the possible cure for the disease

in near future.

6. Practical arguments

Proper palliative care makes euthanasia unnecessary.

There is no way of properly regulating euthanasia.

Allowing euthanasia will lead to less good care for the

terminally ill.

Allowing euthanasia undermines the commitment of

doctors and nurses to saving lives.

Euthanasia may become a cost-effective way to treat the

terminally ill.

Allowing euthanasia will discourage the search for new

cures and treatments for the terminally. ill.

Euthanasia gives too much power to doctors.

Euthanasia in India

Passive euthanasia is legal in India. On 7 March 2011, the Supreme

Court of India legalised passive euthanasia by means of the
withdrawal of life support to patients in a permanent vegetative state.
The decision was made as part of the verdict in a case involving Aruna
Shanbaug, who had been in a Persistent Vegetative State (PVS) for 42
years until her death in 2015.

Governments endorsement of Passive Euthanasia

On December 23, 2014, Government of India endorsed and re-

validated the Passive Euthanasia judgement-law in a Press Release,
after stating in the Rajya Sabha as follows: that The Honble Supreme
Court of India, while dismissing the plea for mercy killing in a particular
case, laid down comprehensive guidelines to process cases relating to
passive euthanasia. Thereafter, the matter of mercy killing was
examined in consultation with the Ministry of Law and Justice and it has
been decided that since the Honble Supreme Court has already laid
down the guidelines, these should be followed and treated as law in
such cases. At present, there is no legislation on this subject and the
judgment of the Honble Supreme Court is binding on all.

The 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.

Also read: Sustainable Development Goals (SDGs)

As India had no law about euthanasia, the Supreme Courts guidelines

are law until and unless Parliament passes legislation. The following
guidelines were laid down:
 A decision has to be taken to discontinue life support either by
the parents or the spouse or other close relatives, or in the
absence of any of them, such a decision can be taken even by a
person or a body of persons acting as a next friend. It can also be
taken by the doctors attending the patient. However, the decision
should be taken bona fide in the best interest of the patient.

Even if a decision is taken by the near relatives or doctors or next

friend to withdraw life support, such a decision requires approval
from the High Court concerned.

When such an application is filled, the Chief Justice of the High

Court should forthwith constitute a Bench of at least two Judges
who should decide to grant approval or not. A committee of three
reputed doctors to be nominated by the Bench, who will give a
report regarding the condition of the patient. Before giving the
verdict, a notice regarding the report should be given to the close
relatives and the State. After hearing the parties, the High Court
can give its verdict.

New bill on Euthanasia

Recently, the issue was in the news, as the Govt. said it was open to
making a law on the subject. The law commission too has proposed a
legislation on passive euthanasia, it said. According to the Centre, the
decision to come out with a bill was taken after considering the
directives of the apex court, the law commissions 241st report and a
private member bill introduced in Parliament in 2014. The Centre said
that initially, a meeting was held under the chairmanship of B.P.
Sharma, secretary in the health and family welfare ministry, on May 22,
2015, to examine the draft of The Medical Treatment of Terminally Ill
Patients (Protection of Patients and Medical Practitioners) Bill and the
draft of The Euthanasia (Regulation) Bill.
This move to introduce a bill is a welcome step to clear the grey areas
in Euthanasia debate. Students can also link to this issue while
answering questions on:

1. Judicial activism: SC framing laws when the parliament hasnt. Just

like the Visaka case.

2. Ethical dilemma in Paper 4.

Right to life and Passive Euthanasia

Why in News-

Three years after a Supreme Court judgment legalised passive

euthanasia under exceptional circumstances, the government has
fully endorsed the apex courts guidelines giving High Courts the power
to decide on applications seeking permission to withdraw life support
in the best interest of the patient.

Right to Life- Indian Constitution provides Right to Life and presonal

liberty under Art.21 which reads as-

"No person shall be deprived of his life or personal liberty except

according to procedure established by law".

However regarding Right to die the Supreme Court In Gian Kaur vs.
State of Punjab, 1996(2) SCC 648, held that the right to life under
Article 21 of the Constitution does not include the right to die.

Euthanasia:-
The word euthanasia, originated in Greece means a good death.
Euthanasia encompasses various dimensions, from active (introducing
something to cause death) to passive (withholding treatment or
supportive measures); voluntary (consent) to involuntary (consent from
guardian) and physician assisted.

SCs observations regarding euthanasia:-

The SC had set out a series of guidelines for High Courts to process
applications seeking passive euthanasia by near relatives or next friend
or the doctors/hospital staff. It had observed that these guidelines
would hold good until Parliament decides or passes a law on passive
euthanasia.It laid down guidelines for euthanasia and made a
distinction between active and passive euthanasia. It said that causing
the death of a person who is in a permanent vegetative state, with no
chance of recovery, by withdrawing artificial life support is not a
positive act of killing.

The SC had ruled that the withdrawal of life support by the doctors is in
law considered as an omission and not a positive step to terminate life.
The latter would be euthanasia, a criminal offence under the present
law in UK, USA and India. Active euthanasia, on the other hand, which
could mean administering the patient a lethal drug to cause his or her
death, was illegal as it is a positive step to terminate a life.

Guidelines for passive euthanasia included such as that the matter

must be referred to the high court for a decision and that the doctor, or
the parents or spouse of the patient must be the ones to petition for
the withdrawal of life-support. In the absence of any of these, a person
or a body of persons acting as next friend can be permitted.
These guidelines were put forth while deciding the case of Aruna
Shaunbag, who was paralysed and slipped into a coma after a brutal
attack on November 27, 1973 at Mumbais King Edward Memorial
Hospital by a staffer.

The Bench defined passive euthanasia as a process when medical

treatment is withheld or withdrawn leading to the death of a terminally
ill person.

Medical science and technology have made great strides in recent years.
The medical profession has today more power over life and death than it
would have chosen to have. It has the power to prolong life where life
seems to have lost its meaning and power to terminate life without
suffering. There are many points of view on euthanasia -- legal, social and
compassionate.

The debate on euthanasia has again become a live issue in India as the
supreme court of India recently passed a verdict that attempted suicide is
not a crime. This signifies social approval of suicide and euthanasia which
is assisted suicide.

What is euthanasia?

Euthanasia is deliberately bringing about a gentle and easy death making

the last days of the patient as comfortable as possible. This is to ensure a
calm and peaceful death, within the context of relieving incurable
suffering in terminal illness or disability. Euthanasia is voluntary, when
requested by the sufferer, involuntary or compulsory if it is against the
will of the patient, passive when death is hastened by deliberate
withdrawal of effective therapy or nourishment.

The dilemma

Should one prolong the act of dying in a case of inevitable death or when
a life is effectively over? This is one of prominent dilemma. One of the
achievements of modern medical technology is the use of artificial life
support systems like artificial feeding, dialysis, controlled respiration,
pump circulation etc. In some cases it can be so dehumanising, painful,
hazardous or costly that other considerations outweigh the aim to
conserve life.

Euthanasists raise the question, how long should one sustain life? A
patient might say,I do not want a vegetative existence by drips, drugs
and dialysis. I want to die with dignity. I have a right to lay down my life
just as I have a right to live.

In a well known trial, a Dr. Arthur in U. K. had prescribed an overdose of

codeine to a baby with Down syndrome with the object of hastening his
death Dr. Arthur was charged with murder. Many eminent witnesses were
tried. Most of them justified the procedure. Finally the court acquitted Dr.
Arthur as his motive was compassion. There is an argument that if a
foetus is found to be abnormal and severely handicapped it should be
eliminated before birth as such children are socially valueless. Do not the
physically handicapped and mentally retarded have as much right to life
as others and get the needed care?

Death and dying

The concept of death is changing in the light of new knowledge. It may be

obtained by redefining life. Descriptions of life are organised at many
different levels of complexity - molecular, cellular, organ, system,
corporal, mental, spiritual etc. Human life may be described as the ability,
actual or potential to respond to others, or to be self-aware. This is based
on cerebral function. Silverman and others in 1969 have established this
by extensive studies and confirmed it by encephalogram findings. Once
cerebral death is confirmed, there is no chance for survival though heart
and lung functions continue. So it would be quite unnecessary to continue
supportive measures after cerebral death.

The Christian concept

Almighty God has created man in his image. He is the giver and sustainer
of life. He alone has the right to withdraw life. Life is not a right but a gift
of God, belonging to God and at all times in His hand. We have no right to
take away deliberately a human life, even ones own.

Euthanasia requests may be born of depression and confusion or out or a

feeling of worthlessness or due to persuasion of interested parties with
ulterior motives. Respect for the person of the patient and concern for the
family should lead us to use our resources as best as we can to promote
life. The essence of our approach to a dying patient is to give ourselves in
loving care to meet his need. A patient is not merely a biological unit but
a person before God with social family connections.

Suffering

Suffering can be redemptive and purposeful. It is as much a God- sent

opportunity as is health and provides an opportunity for a creative
outcome or an amendment of life.
Let me share with you the experience of two of my friends who faced the
issue of caring for children with disability. One was a hospital chaplain.
When a child with disability was born to him, he asked God why this
happened to him, but he could not get an immediate answer. He loved
that child but the child could not respond to his love in the normal way.
They helped the pastor to realise how God loves us inspite of our not
being responsive to His love. The other was a colleague of mine and a
highly qualified paediatrician when a child with disability was born to him
and his doctor wife. They did their very best to sustain her life. The child
became critically ill immediately after birth,needing exchange blood
transfusions. Though their colleagues questioned the wisdom of taking
such an extreme step for such a child, they choose to have the exchange
transfusions. The child recovered and subsequently brought a new
purpose to their life before she finally died at 4 months of age. Through
this the parents realised that God had a purpose in bringing her to their
home. This experience was an act of God to make them aware of the
need of caring for many neglected children with disability in our society.So
they resigned from their clinical work and offered their lives to start a
centre for children with mental handicaps and special needs. An apparent
traumatic experience became the rallying point for a new mission and for
compassion.

Our guiding principle

Ever since the time of Hippocrates in the fifth century BC, the medical
profession has been guided by the concept of the worth of each individual
human life. This was recently reaffirmed by the Geneva code in 1948,
which states,I will show the utmost respect for human life from the time
of conception.

Hitler had a utilitarian philosophy of life. He preserved any person who

had utilitarian value. The others he eliminated. We respect the unique
value of human life. Life should be cherished, supported and cared.

Some practical steps

1.Doctors should serve and care for their patients in love.

2.Deliberate attempt to end or shorten life, whether by omission or

commission, is wrong and should not be done.

3.Our society should proclaim the way of righteousness and truth and
provide compassionate care. It must take a stand against taking innocent
lives.

4.Medical personnel and the people at large must be educated in moral

and spiritual values. These should lead to sound legislation.
5.Bring in the principle of love as the mainspring.

Points in Favor of Euthanasia

Those in favour of euthanasia think that there is no reason why

euthanasia can't be controlled by proper regulation, but they acknowledge
that some problems will remain.

For example, it will be difficult to deal with people who want to implement
euthanasia for selfish reasons or pressurise vulnerable patients into dying.

This is little different from the position with any crime. The law prohibits
theft, but that doesn't stop bad people stealing things

Arguments based on rights

People have an explicit right to die

A separate right to die is not necessary, because our other human

rights imply the right to die

Death is a private matter and if there is no harm to others, the

state and other people have no right to interfere (a libertarian
argument)

Practical arguments

It is possible to regulate euthanasia

Death is a private matter and if there is no harm to others, the

state and other people have no right to interfere (a libertarian
argument)

Allowing people to die may free up scarce health resources (this is a

possible argument, but no authority has seriously proposed it)

Euthanasia happens anyway (a utilitarian or consequentialist

argument)

Philosophical arguments
 Euthanasia satisfies the criterion that moral rules must be
universalisable

Euthanasia happens anyway (a utilitarian or consequentialist

argument)

Points against Euthnasia

Ethical arguments

Euthanasia weakens society's respect for the sanctity of life

Accepting euthanasia accepts that some lives (those of the disabled

or sick) are worth less than others

Voluntary euthanasia is the start of a slippery slope that leads to

involuntary euthanasia and the killing of people who are thought
undesirable

Euthanasia might not be in a person's best interests

Euthanasia affects other people's rights, not just those of the

patient

Practical arguments

Proper palliative care makes euthanasia unnecessary

There's no way of properly regulating euthanasia

Allowing euthanasia will lead to less good care for the terminally ill

Allowing euthanasia undermines the committment of doctors and

nurses to saving lives

Euthanasia may become a cost-effective way to treat the terminally

ill
 Allowing euthanasia will discourage the search for new cures and
treatments for the terminally ill

Euthanasia undermines the motivation to provide good care for the

dying, and good pain relief

Euthanasia gives too much power to doctors

Euthanasia exposes vulnerable people to pressure to end their lives

Moral pressure on elderly relatives by selfish families

Moral pressure to free up medical resources

Patients who are abandoned by their families may feel euthanasia is

the only solution

Historical arguments

Voluntary euthanasia is the start of a slippery slope that leads to

involuntary euthanasia and the killing of people who are thought
undesirable

Religious arguments

Euthanasia is against the word and will of God.

Euthanasia weakens society's respect for the sanctity of life.

Suffering may have value.

Voluntary euthanasia is the start of a slippery slope that leads to

involuntary euthanasia and the killing of people who are thought
undesirable.

- See more at: http://www.drishtiias.com/upsc-exam-gs-resources-The-debate-of-Euthanasia-

and-India#sthash.wuZbrJvV.dpuf
 Stopping treatment does not amount to a "positive step to terminate life", as said by
SC, and The health ministrys draft Bill permitting passive euthanasia should be
welcomed on following ethical and moral grounds:

Right to die with dignity Human dignity lies in independence and self-reliance. A
terminally ill patient is dependent on others in every aspect right form changing cloths
to getting fed to bathing etc.

Right to get released from pain Suffering of people in vegetative state is immense.
Even death sentences are hurriedly executed. So an innocent person should not be
made to suffer for so long. Empathy would allow passive euthanasia.

Suffering of relatives Its not easy to see a close one suffering and lying in
vegetative state. Whole family remains in depressed state.

Utilitarianism India is a country with scarce resource. Medical infrastructure can

be better utilized for patients who have chances of survival.

Not an act of Killing - Stopping treatment does not amount to a "positive step to
terminate life", as said by SC

However the challenge would be to tackle the misuse due to moral erosion of our
society. The bill must be widely discussed so that no loophole remains.

Summary:

A year-and-a-half after strongly objecting to the Supreme Courts decision to

adjudicate a plea for making passive euthanasia legal, the NDA government has now
made a U-turn, saying that it was on the verge of framing a legislation permitting the
process but would await the courts verdict on it.

Based on the recommendations of the expert committee, the Directorate

General of Health Services (DGHS) has proposed formulation of legislation on
passive euthanasia.

What has the committee suggested?

The expert committee has suggested certain changes in the draft bill on
euthanasia.

The committee has not agreed to active euthanasia since it has more potential
for misuse and as on date it is prevalent in very few countries worldwide.

What is euthanasia?

Euthanasia is a medical term meaning easy death. It is the act of deliberate or

voluntary end of someones life to prevent any further suffering or pain to the person.
Active and Passive euthanasia:

Active euthanasia involves a doctor injecting a lethal medicine to trigger a

patients cardiac arrest.

In passive euthanasia, doctors, with the consent of relatives, withdraw the

life support system of a person being kept alive with the help of machines.

Whats the issue now?

The issue surrounding the debate is about the rights of a terminally-ill person
once doctors unanimously rule out chances of his or her survival.

Background:

In July 2014, a five-judge supreme court bench had decided to adjudicate the legality
of active and passive euthanasia and the emerging concept of living will after shying
away for decades from examining this highly emotive and legally complicated issue.

The Centre had then stoutly objected to the exercise. The government then did
not accept euthanasia as a principle. It had categorically said, In whichever
form, the court has no jurisdiction to decide this. Its for Parliament and the
legislature to take a call after a thorough debate and taking into account
multifarious views.

The court had agreed it was a matter of public policy and that Parliament and
the legislature were competent to decide it. But it wanted a countrywide
debate and had sought views of states and Union territories.

Supreme Courts views on this matter:

Previously in 2011, in Aruna Shanbaug case the Court had ruled in favour of passive
euthanasia and the law ministry had opined that the SCs directions should be
followed.

In its landmark 2011 verdict that was notable for its progressive, humane and
sensitive treatment of the complex interplay of individual dignity and social
ethics, the Supreme Court laid down a broad legal framework.

It ruled out any backing for active euthanasia, or the taking of a specific step
such as injecting the patient with a lethal substance, to put an end to a
patients suffering, as that would be clearly illegal.

It allowed passive euthanasia, or the withdrawal of life support, subject to

safeguards and fair procedure.

It made it mandatory that every instance should get the approval of a High
Court Bench, based on consultation with a panel of medical experts.
Questions now before the Court:

The question now before a Constitution Bench of the Supreme Court is based on a
petition by the NGO Common Cause. It asks whether the right to live with
dignity under Article 21 includes the right to die with dignity, and
whether it is time to allow living wills, or written authorisations containing
instructions given by persons in a healthy state of mind to doctors that they need not
be put on life-support systems or ventilators in the event of their going into a
persistent vegetative state or state of terminal illness.

Worldwide practice:

The perception of ethicality of euthanasia varies in different countries and cultures.

Laws and religious sentiments of people often play a major role in the way it is
perceived.

The deliberate act of taking away a persons life is classified as a murder and
thus a crime. Aiding and abetting someone in suicide too falls under crime.
Owing to this, various countries have greatly varying legal stance towards
euthanasia.

Euthanasia has been criminalized by the likes of Philippines, Australia, New

Zealand and the United Kingdom. These nations saw several failed attempts to
legalize euthanasia.

There are some nations which allow ending a terminally ill persons life if the
person or next of kin consents. However, several conditions govern the
definition of the term terminally ill. Legalizing euthanasia in these nations
aims at preventing any further distress and suffering to the person.

Euthanasia is legal in Colombia, Luxembourg, Canada and Belgium.

Should Euthanasia be legal?

Arguments For Euthanasia:

It provides a way to relieve extreme pain.

It provides a way of relief when a persons quality of life is low.

Frees up medical funds to help other people.

It is another case of freedom of choice.

Arguments Against Euthanasia:

Euthanasia devalues human life.

Euthanasia can become a means of health care cost containment.

 Physicians and other medical care people should not be involved in directly
causing death.

There is a slippery slope effect that has occurred where euthanasia has been
first been legalized for only the terminally ill and later laws are changed to
allow it for other people or to be done non-voluntarily.

Way ahead:

The Centre has told the Supreme Court that it was creating a legislation permitting
passive euthanasia but would wait for the SCs decision on the matter.

Conclusion:

Euthanasia is a topic which touches various aspects of our society. It requires a

focussed perspective considering all the pros and cons. The dilemmas regarding the
legal issues surrounding euthanasia are often due to the ethical aspects which raises
question about the rights of a person to take someone elses life. The debate over the
ethicality of euthanasia is a never-ending one. Hence, to resolve this conflict between
pain and death, the sooner that a comprehensive law on the subject is enacted, the
better it will be for society. Even if permitted, euthanasia should be used in deserving
cases only, that too sincerely, honestly and consciously under strict control and
supervision of a statutory body.

What is Euthanasia?

Euthanasia is the deliberate bringing about a gentle and easy death, making the last
days of the patient as comfortable as possible. This is to ensure a calm and peaceful
death, within the context of relieving incurable suffering in terminal illness or
disability. Euthanasia is voluntary, when requested by the sufferer; involuntary or
compulsory if it is against the will of the patient; and passive when death is
hastened by deliberate withdrawal of effective therapy or nourishment.

India joins select nations in legalising

"passive euthanasia"
With the Supreme Court allowing passive euthanasia under exceptional
circumstances, India on Monday joined a handful of countries which have legalized
mercy killing in some form or other.

Passive euthanasia is usually defined as withdrawing medical treatment with the

deliberate intention of causing the patients death. For example, if a patient requires
kidney dialysis to survive, the doctors disconnect the dialysis machine, allowing the
patient to die soon.

This form of euthanasia is different from active euthanasia, or simply euthanasia,

where the death is caused by the use of lethal substances.

It is widely considered to be criminal homicide, but voluntary passive euthanasia is

considered non-criminal in several countries.

Euthanasia conducted with the consent of the patient is termed voluntary

euthanasia, which is legal in Belgium, Luxembourg, the Netherlands, Switzerland,
and the U.S. states of Oregon and Washington.

When the patient brings about his or her own death with the assistance of a
physician, the term assisted suicide is often used.

If euthanasia is carried out on a patient, who is not in a condition to express his or

her desire to die, it is called non-voluntary euthanasia.

Aruna Shanbaug, the woman at the center India's euthanasia movement.

Examples include child euthanasia, which is illegal worldwide but decriminalized

under certain specific circumstances in the Netherlands under the Groningen
Protocol.

Its also legal in Albania if three or more family members consent to the decision.

Although both forms of euthanasia are illegal in Switzerland, assisted suicide is

penalized only if it is carried out from selfish motives.

In 1995, Australias Northern Territory had approved a euthanasia bill. It went into
effect in 1996, but the Australian Parliament overturned the bill the next year.

In Colombia, the Supreme Court ruled in favour of mercy killing in 1997 and
recommended removing penalties over it.
But, the ruling has not gone into effect as the Colombian Congress is yet to approve
guidelines for it.

It is illegal for anyone to actively contribute to someones death in Ireland. However,

it is not illegal to remove life support and other treatment if a person requests for it
in other words, passive euthanasia is legal.

In Mexico, active euthanasia is illegal but since 2008 the law allows the terminally ill
to refuse medication or further medical treatment to extend life.

Although active euthanasia still remains illegal in Norway, but the country has
softened its penalties if a caregiver takes the life of someone who is hopelessly
sick and consents to the act.

While the Supreme Court of India has allowed passive euthanasia under exceptional
circumstances, it has made clear that active euthanasia is illegal.

The court also clarified that until Parliament enacts a law, its judgement on active
and passive euthanasia will be in force.

A terminally ill minor has become the first child to be euthanized in Belgium since age
restrictions were lifted in the country two years ago, according to several sources.

A Belgian lawmaker told CNN affiliate VTM that the physician-assisted suicide
happened within the past week.

The child, who was suffering from an incurable disease, had asked for
euthanasia, Sen. Jean-Jacques De Gucht told VTM. The identity of the child and
age are unknown.

"I think it's very important that we, as a society, have given the opportunity to
those people to decide for themselves in what manner they cope with that
situation," said Gucht, a supporter of euthanasia legislation.

RELATED: Parents plead to be able to help terminally ill children die

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Belgium approves child euthanasia bill 03:03

Wim Distelmans, who chairs Belgium's Federal Control and Evaluation Committee
on Euthanasia, told state broadcaster RTBF that fortunately few children had
demanded mercy killing but "that does not mean we should deny them the right
to a dignified death."

Belgium legalized euthanasia in 2002 for those in "constant and unbearable

physical or mental suffering that cannot be alleviated." Minors were included in
the original proposals but removed from the final legislation in the face of
political opposition.

In 2014, the bill extended the "right to die" to those under the age of 18. But
there were additional strict conditions, including that the child was judged to be
able to understand what euthanasia means.

Consent of parents or guardians must also be given.

"This can only be in cases of serious and incurable diseases, which is the same
thing for adults ... but for minors an additional condition is that the death must
be expected in the near future," Jacqueline Herremans told RTBF. Herremans is
the president of Belgium's Association for the Right to Die with Dignity and also a
member of the federal committee on euthanasia.

Belgium is the only country that allows euthanasia for children of any age.

The Netherlands also allows mercy killings for children, but only for those 12 and
over. It became the first country to legalize euthanasia in April 2002.

Physician-assisted suicide is legal in five US states. Individuals have the option

under state law in Oregon, Vermont, Washington and California. In Montana, it is
an option given to individuals via court decision. They must have a terminal
illness as well as a prognosis of six months or less to live. Physicians cannot be
prosecuted for prescribing medications to hasten death.

Euthanasia is the act of deliberately ending a person's life to relieve suffering.

For example, a doctor who gives a patient with terminal cancer an overdose of muscle
relaxants to end their life would be considered to have carried out euthanasia.

Assisted suicide is the act of deliberately assisting or encouraging another person to kill
themselves.

If a relative of a person with a terminal illness were to obtain powerful sedatives, knowing
that the person intended to take an overdose of sedatives to kill themselves, they may be
considered to be assisting suicide.

Legal position
Both active euthanasia and assisted suicide are illegal under English law.
Depending on the circumstances, euthanasia is regarded as either manslaughter or murder and
is punishable by law, with a maximum penalty of up to life imprisonment.

Assisted suicide is illegal under the terms of the Suicide Act (1961) and is punishable by up
to 14 years' imprisonment. Attempting to kill yourself is not a criminal act in itself.

Types of euthanasia
Euthanasia can be classified in different ways, including:

active euthanasia where a person deliberately intervenes to end

someones life for example, by injecting them with a large dose of
sedatives

passive euthanasia where a person causes death by withholding or

withdrawing treatment that is necessary to maintain life, such as
withholding antibiotics from someone with pneumonia

Euthanasia can also be classified as:

voluntary euthanasia where a person makes a conscious decision to

die and asks for help to do this

non-voluntary euthanasia where a person is unable to give

their consent (for example, because they are in a coma or are severely
brain damaged) and another person takes the decision on their behalf,
often because the ill person previously expressed a wish for their life to be
ended in such circumstances

involuntary euthanasia where a person is killed against their

expressed wishes

Depending on the circumstances, voluntary and non-voluntary euthanasia could be regarded

as either voluntary manslaughter (where someone kills another person, but circumstances can
partly justify their actions) or murder.

Involuntary euthanasia is almost always regarded as murder.

There are arguments used by both supporters and opponents of euthanasia and assisted
suicide. Read more about the arguments for and against euthanasia and assisted suicide.

End of life care

If you are approaching the end of life, you have a right to good palliative care to control
pain and other symptoms as well as psychological, social and spiritual support.
You're also entitled to have a say in the treatments you receive at this stage.

For example, under English law, all adults have the right to refuse medical treatment, as long
as they have sufficient capacity (the ability to use and understand information to make a
decision).

If you know that your capacity to consent may be affected in the future, you can arrange a
legally binding advance decision (previously known as an advance directive).

An advance decision sets out the procedures and treatments that you consent to and those that
you do not consent to. This means that the healthcare professionals treating you cannot
perform certain procedures or treatments against your wishes.

Read more about your rights when approaching the end of life.

Other countries
Active euthanasia is currently only legal in Belgium, Holland and Luxembourg. Under the
laws in these countries, a persons life can be deliberately ended by their doctor or other
healthcare professional.

The person is usually given an overdose of muscle relaxants or sedatives. This causes a coma
and then death.

However, euthanasia is only legal if the following three criteria are met:

The person has made an active and voluntary request to end their life.

It is thought that they have sufficient mental capacity to make an

informed decision regarding their care.

It is agreed that the person is suffering unbearably and there is no

prospect for an improvement in their condition.

Capacity is the ability to use and understand information to make a decision. Read more
about the capacity to consent to treatment.

In some countries the law is less clear, with some forms of assisted suicide and passive
euthanasia legal, but active euthanasia illegal.
For example, some types of assisted suicide and passive euthanasia are legal in Switzerland,
Germany, Mexico and five American states.

PRO Euthanasia or Physician- CON Euthanasia or Physician-

Assisted Suicide Assisted Suicide

1. Right to Die

PRO: "The right of a competent, CON: "The history of the law's

terminally ill person to avoid treatment of assisted suicide in this
excruciating pain and embrace a country has been and continues to be
timely and dignified death bears the one of the rejection of nearly all
sanction of history and is implicit in efforts to permit it. That being the
the concept of ordered liberty. The case, our decisions lead us to
exercise of this right is as central to conclude that the asserted 'right' to
personal autonomy and bodily assistance in committing suicide is
integrity as rights safeguarded by this not a fundamental liberty interest
Court's decisions relating to marriage, protected by the Due Process
family relationships, procreation, Clause."
contraception, child rearing and the
refusal or termination of life-saving -- Washington v. Glucksberg(63 KB)
medical treatment. In particular, this
Court's recent decisions concerning US Supreme Court Majority Opinion
the right to refuse medical treatment June 26, 1997
and the right to abortion instruct that
a mentally competent, terminally ill
person has a protected liberty
interest in choosing to end intolerable
suffering by bringing about his or her
own death.

A state's categorical ban on physician

assistance to suicide -- as applied to
competent, terminally ill patients who wish
to avoid unendurable pain and hasten
inevitable death -- substantially interferes
with this protected liberty interest and
cannot be sustained."
-- ACLU Amicus Brief in Vacco v. Quill(72
KB)

American Civil Liberties Union (ACLU)

Dec. 10, 1996

2. Patient Suffering at End-of-Life

PRO: "At the Hemlock Society we get CON: "Activists often claim that laws
calls daily from desperate people who against euthanasia and assisted
are looking for someone like Jack suicide are government mandated
Kevorkian to end their lives which suffering. But this claim would be
have lost all quality... Americans similar to saying that laws against
should enjoy a right guaranteed in selling contaminated food are
the European Declaration of Human government mandated starvation.
Rights -- the right not to be forced to
suffer. It should be considered as Laws against euthanasia and assisted
much of a crime to make someone suicide are in place to prevent abuse
live who with justification does not and to protect people from
wish to continue as it is to take life unscrupulous doctors and others.
without consent." They are not, and never have been,
intended to make anyone suffer."
-- Faye Girsh, EdD
-- Rita Marker, JD
Senior Adviser, Final Exit Network,
"How Shall We Die," Free Inquiry Executive Director
Winter 2001 Kathi Hamlon
Policy Analyst
International Task Force on Euthanasia
and Assisted Suicide
"Euthanasia and Assisted Suicide:
Frequently Asked Questions,"
www.internationaltaskforce.org
Jan. 2010

3. Slippery Slope to Legalized Murder

PRO: "Especially with regard to CON: "In a society as obsessed with

taking life, slippery slope arguments the costs of health care and the
have long been a feature of the principle of utility, the dangers of the
ethical landscape, used to question slippery slope... are far from fantasy...
the moral permissibility of all kinds of
acts... The situation is not unlike that Assisted suicide is a half-way house, a
of a doomsday cult that predicts time stop on the way to other forms of
and again the end of the world, only direct euthanasia, for example, for
for followers to discover the next day incompetent patients by advance
that things are pretty much as they directive or suicide in the elderly. So,
were... too, is voluntary euthanasia a half-
way house to involuntary and
We need the evidence that shows nonvoluntary euthanasia. If
that horrible slope consequences are terminating life is a benefit, the
likely to occur. The mere possibility reasoning goes, why should
that such consequences might occur, euthanasia be limited only to those
as noted earlier, does not constitute who can give consent? Why need we
such evidence." ask for consent?"

-- R.G. Frey, DPhil -- Edmund D. Pelligrino, MD

Professor of Philosophy, Bowling Green
State University Professor Emeritus of Medicine and
"The Fear of a Slippery Slope," Euthanasia Medical Ethics, Georgetown University
and Physician-Assisted Suicide: For and "The False Promise of Beneficent Killing,"
Against Regulating How We Die: The Ethical,
1998 Medical, and Legal Issues Surrounding
Physician-Assisted Suicide
1998

4. Hippocratic Oath and Prohibition of Killing

PRO: "Over time the Hippocratic CON: "The prohibition against killing
Oath has been modified on a number patients... stands as the first promise
of occasions as some of its tenets of self-restraint sworn to in the
became less and less acceptable. Hippocratic Oath, as medicine's
References to women not studying primary taboo: 'I will neither give a
medicine and doctors not breaking deadly drug to anybody if asked for it,
the skin have been deleted. The nor will I make a suggestion to this
much-quoted reference to 'do no effect'... In forswearing the giving of
harm' is also in need of explanation. poison when asked for it, the
Does not doing harm mean that we Hippocratic physician rejects the view
should prolong a life that the patient that the patient's choice for death can
sees as a painful burden? Surely, the make killing him right. For the
'harm' in this instance is done when physician, at least, human life in
we prolong the life, and 'doing no living bodies commands respect and
harm' means that we should help the reverence--by its very nature. As its
patient die. Killing the patient-- respectability does not depend upon
technically, yes. Is it a good thing-- human agreement or patient consent,
sometimes, yes. Is it consistent with revocation of one's consent to live
good medical end-of-life care: does not deprive one's living body of
absolutely yes." respectability. The deepest ethical
-- Philip Nitschke, MD principle restraining the physician's
power is not the autonomy or
Director and Founder, Exit International freedom of the patient; neither is it
"Euthanasia Sets Sail," National Review his own compassion or good
Online intention. Rather, it is the dignity and
June 5, 2001 mysterious power of human life itself,
and therefore, also what the Oath
calls the purity and holiness of life
and art to which he has sworn
devotion."

-- Leon Kass, MD, PhD

Addie Clark Harding Professor, Committee
on Social Thought and the College,
University of Chicago
"Neither for Love nor Money," Public
Interest
Winter 1989

5. Government Involvement in End-of-Life Decisions

PRO: "We'll all die. But in an age of CON: "Cases like Schiavo's touch on
increased longevity and medical basic constitutional rights, such as
advances, death can be suspended, the right to live and the right to due
sometimes indefinitely, and no longer process, and consequently there
slips in according to its own could very well be a legitimate role
immutable timetable. for the federal government to play.
There's a precedent--as a result of the
So, for both patients and their loved highly publicized deaths of infants
ones, real decisions are demanded: with disabilities in the 1980s, the
When do we stop doing all that we federal government enacted 'Baby
can do? When do we withhold which Doe Legislation,' which would
therapies and allow nature to take its withhold federal funds from hospitals
course? When are we, through our that withhold lifesaving treatment
own indecision and fears of mortality, from newborns based on the
allowing wondrous medical methods expectation of disability. The medical
to perversely prolong the dying rather community has to have restrictions
than the living? on what it may do to people with
disabilities - we've already seen what
These intensely personal and socially some members of that community
expensive decisions should not be left are willing to do when no restrictions
to governments, judges or legislators are in place."
better attuned to highway funding."
-- Los Angeles Times -- Stephen Drake. MS
"Planning for Worse Than Taxes," Opinion Research Analyst, Not Dead Yet
Mar. 22, 2005 "End of Life Planning: Q & A with
Disabilities Advocate," Reno Gazette-
Journal
Nov. 22, 2003

6. Palliative (End-of-Life) Care

PRO: "Assisting death in no way CON: "Studies show that hospice-

precludes giving the best palliative style palliative care 'is virtually
care possible but rather integrates unknown in the Netherlands [where
compassionate care and respect for euthanasia is legal].' There are very
the patient's autonomy and few hospice facilities, very little in the
ultimately makes death with dignity a way of organized hospice activity,
real option... and few specialists in palliative care,
although some efforts are now under
The evidence for the emotional impact of way to try and jump-start the hospice
assisted dying on physicians shows that movement in that country...
euthanasia and assisted suicide are a far cry
from being 'easier options for the caregiver' The widespread availability of
than palliative care, as some critics of euthanasia in the Netherlands may be
Dutch practice have suggested. We wish to another reason for the stunted growth
take a strong stand against the separation of the Dutch hospice movement. As
and opposition between euthanasia and one Dutch doctor is reported to have
said, 'Why should I worry about
assisted suicide, on the one hand, and
palliation when I have euthanasia?'"
palliative care, on the other, that such
critics have implied. There is no 'either-or' -- Wesley J. Smith, JD
with respect to these options. Every
appropriate palliative option available must Senior Fellow in Human Rights and
be discussed with the patient and, if Bioethics, Discovery Institute
reasonable, tried before a request for Forced Exit
assisted death can be accepted... 1997

Opposing euthanasia to palliative care...

neither reflects the Dutch reality that
palliative medicine is incorporated within
end-of-life care nor the place of the option
of assisted death at the request of a patient
within the overall spectrum of end-of-life
care."
-- Gerrit Kimsma, MD, MPh

Associate Professor in Medical Philosophy

Evert van Leeuwen, PhD
Professor in Philosophy and Medical
Ethics
Center for Ethics and Philosophy at Free
University in Amsterdam (Amsterdam,
Netherlands)
"Assisted Death in the Netherlands:
Physician at the Bedside When Help Is
Requested"
Physician-Assisted Dying: The Case for
Palliative Care & Patient Choice
2004

7. Healthcare Spending Implications

PRO: "Even though the various CON: "Savings to governments could
elements that make up the American become a consideration. Drugs for
healthcare system are becoming assisted suicide cost about $35 to
more circumspect in ensuring that $45, making them far less expensive
money is not wasted, the cap that than providing medical care. This
marks a zero-sum healthcare system could fill the void from cutbacks for
is largely absent in the United treatment and care with the
States... Considering the way we 'treatment' of death."
finance healthcare in the United
States, it would be hard to make a -- International Task Force on Euthanasia
case that there is a financial and Assisted Suicide
imperative compelling us to adopt
"Frequently Asked Questions,"
physician-assisted suicide in an effort
www.internationaltaskforce.org
to save money so that others could
benefit..."
(accessed May 27, 2010)

-- Merrill Matthews, Jr., PhD

Director, Council for Affordable Health

Insurance
"Would Physician-Assisted Suicide Save
the Healthcare System Money?," Physician
Assisted Suicide: Expanding the Debate
1998

8. Social Groups at Risk of Abuse

PRO: "One concern has been that CON: "It must be recognized that
disadvantaged populations would be assisted suicide and euthanasia will
disproportionately represented be practiced through the prism of
among patients who chose assisted social inequality and prejudice that
suicide. Experience in Oregon characterizes the delivery of services
suggests this has not been the case. in all segments of society, including
In the United States, socially health care. Those who will be most
disadvantaged groups have variably vulnerable to abuse, error, or
included ethnic minorities, the poor, indifference are the poor, minorities,
women, and the elderly. Compared and those who are least educated and
with all Oregon residents who died least empowered. This risk does not
between January 1998 and December reflect a judgment that physicians are
2002, those who died by physician- more prejudiced or influenced by race
assisted suicide were more likely to and class than the rest of society -
be college graduates, more likely to only that they are not exempt from
be Asian, somewhat younger, more the prejudices manifest in other areas
likely to be divorced, and more likely
to have cancer or amytrophic lateral of our collective life.
sclerosis... Moreover, although 2.6
percent of Oregonians are African While our society aspires to eradicate
American, no African American discrimination and the most punishing
patients have chosen assisted effects of poverty in employment practices,
suicide." housing, education, and law enforcement,
we consistently fall short of our goals. The
-- Linda Ganzini, MD, MPH costs of this failure with assisted suicide
and euthanasia would be extreme. Nor is
Professor of Psychiatry and Medicine there any reason to believe that the
Senior Scholar, Center for Ethics in Health practices, whatever safeguards are erected,
Care at Oregon Health & Science will be unaffected by the broader social and
University medical context in which they will be
"The Oregon Experience," Physician- operating. This assumption is naive and
Assisted Dying: The Case for Palliative unsupportable."
Care and Patient Choice
2004 -- New York State Task Force on Life and
the Law
"When Death Is Sought: Assisted Suicide
and Euthanasia in the Medical Context,"
newyorkhealth.gov
1994

9. Religious Concerns

PRO: "Guided by our belief as CON: "As Catholic leaders and moral
Unitarian Universalists that human teachers, we believe that life is the
life has inherent dignity, which may most basic gift of a loving God- a gift
be compromised when life is over which we have stewardship but
extended beyond the will or ability of not absolute dominion. Our tradition,
a person to sustain that dignity; and declaring a moral obligation to care
believing that it is every person's for our own life and health and to
inviolable right to determine in seek such care from others,
advance the course of action to be recognizes that we are not morally
taken in the event that there is no obligated to use all available medical
reasonable expectation of recovery procedures in every set of
from extreme physical or mental circumstances. But that tradition
disability... clearly and strongly affirms that as a
responsible steward of life one must
BE IT FURTHER RESOLVED: That never directly intend to cause one's
Unitarian Universalists advocate the right own death, or the death of an
to self-determination in dying, and the innocent victim, by action or
release from civil or criminal penalties of
those who, under proper safeguards, act to omission...
honor the right of terminally ill patients to
We call on Catholics, and on all persons of
select the time of their own deaths; and...
good will, to reject proposals to legalize
euthanasia."
BE IT FINALLY RESOLVED: That
Unitarian Universalists, acting through
-- United States Conference of Catholic
their congregations, memorial societies,
and appropriate organizations, inform and Bishops
petition legislators to support legislation "Statement on Euthanasia," on
that will create legal protection for the right www.usccb.org
to die with dignity, in accordance with one's Sep. 12, 1991
own choice.

-- Unitarian Universalist Association: The

Right to Die With Dignity, 1988 General
Resolution
Unitarian Universalist Association
1988

10. Living Wills

PRO: "Living wills can be used to CON: "Not only are we awash in
refuse extraordinary, life-prolonging evidence that the prerequisites for a
care and are effective in providing successful living wills policy are
clear and convincing evidence that unachievable, but there is direct
may be necessary under state evidence that living wills regularly fail
statutes to refuse care after one to have their intended effect...
becomes terminally ill.
When we reviewed the five conditions for a
A recent Pennsylvania case shows the successful program of living wills, we
power a living will can have. In that case, a encountered evidence that not one
Bucks County man was not given a feeding condition has been achieved or, we think,
tube, even though his wife requested he can be. First, despite the millions of dollars
receive one, because his living will, lavished on propaganda, most people do not
executed seven years prior, clearly stated have living wills... Second, people who
that he did 'not want tube feeding or any sign living wills have generally not thought
other artificial invasive form of nutrition'... through its instructions in a way we should
want for life-and-death decisions... Third,
A living will provides clear and convincing drafters of living wills have failed to offer
evidence of one's wishes regarding end-of- people the means to articulate their
life care." preferences accurately... Fourth, living wills
-- Joseph Pozzuolo, JD too often do not reach the people actually
making decisions for incompetent
Professor, Neuman College
patients... Fifth, living wills seem not to
Lisa Lassoff, JD
increase the accuracy with which surrogates
Associate, Reed Smith identify patients' preferences."
Jamie Valentine, JD
Associate, Pozzuolo & Perkiss -- Angela Fagerlin, PhD
"Why Living Wills/Advance Directives Are
Core Faculty Member, Robert Wood
an Essential Part of Estate Planning,"
Johnson Clinical Scholar Program,
Journal of Financial Service Professionals
University of Michigan Medical School
Sep. 2005
Carl E. Schneider, JD
Chauncey Stillman Professor for Ethics,
Morality, and the Practice of Law,
University of Michigan Law School
"Enough: The Failure of the Living Will,"
Hastings Center Report
2004