Literature REVIEW ON Euthanasia Subbmitted by : Mayank Grover 19/053 Sec B PGDM-1 Euthanasia Euthanasia (from the Greek meaning “good death”:( well or good) + (death)) refers to the practice of intentionally ending a life in order to relieve pain and suffering. There are different euthanasia laws in each country. The House of Lords Select Committee on Medical Ethics of England defines euthanasia as “a deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering”. In the Netherlands, euthanasia is understood as “termination of life by a doctor at the request of a patient”.
Wreen, offered a six part definition: “Person A committed an act of euthanasia if and only if (1) A killed B or let her die; (2) A intended to kill B; (3) the intention specified in (2) was at least partial cause of the action specified in (1); (4) the causal journey from the intention specified in (2) to the action specified in (1) is more or less in accordance with A’s plan of action; (5) A’s killing of B is a voluntary action; (6) the motive for the action specified in (1), the motive standing behind the intention specified in (2), is the good of the person killed.
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The definition offered by the Oxford English Dictionary incorporates suffering as a necessary condition, with “the painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma”. 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. Euthanasia was practised in Ancient Greece and Rome: for example, hemlock was employed as a means of hastening death on the island of Kea, a technique also employed in Marseilles and by Socrates in Athens.
Euthanasia, in the sense of the deliberate hastening of a person’s death, was supported by Socrates, Plato and Seneca the Elder in the ancient world, although Hippocrates appears to have spoken against the practice, writing “I will not prescribe a deadly drug to please someone, nor give advice that may cause his death” (noting there is some debate in the literature about whether or not this was intended to encompass euthanasia). Euthanasia was strongly opposed in the Judeo-Christian tradition.
Thomas Aquinas opposed both and argued that the practice of euthanasia contradicted our natural human instincts of survival. As did Francois Ranchin (1565–1641), a French physician and professor of medicine, and Michael Boudewijns (1601–1681), a physician and teacher. Nevertheless, there were voices arguing for euthanasia, such as John Donne in 1624, and euthanasia continued to be practiced. Suicide and euthanasia were more acceptable under Protestantism and during the Age of Enlightenment, and Thomas More wrote of euthanasia in Utopia, although it is not clear if More was intending to endorse the practice.
Other cultures have taken different approaches: for example, in Japan suicide has not traditionally been viewed as a sin, and accordingly the perceptions of euthanasia are different from those in other parts of the world. Classification of euthanasia Euthanasia may be classified according to whether a person gives informed consent into three types: voluntary, non-voluntary and involuntary. There is a debate within the medical and bioethics literature about whether or not the non-voluntary (and by extension, involuntary) killing of patients can be regarded as euthanasia, irrespective of intent or the patient’s circumstances.
In the definitions offered by Beauchamp & Davidson and, later, by Wreen, consent on the part of the patient was not considered to be one of their criteria, although it may have been required to justify euthanasia. However, others see consent as essential. Voluntary euthanasia Euthanasia conducted with the consent of the patient is termed voluntary euthanasia. Active voluntary euthanasia is legal in Belgium, Luxembourg and the Netherlands. Passive voluntary euthanasia is legal throughout the U. S. per Cruzan v. Director, Missouri Department of Health.
When the patient brings about his or her own death with the assistance of a physician, the term assisted suicide is often used instead. Assisted suicide is legal in Switzerland and the U. S. states of Oregon, Washington and Montana. Non-voluntary euthanasia Euthanasia conducted where the consent of the patient is unavailable is termed non-voluntary euthanasia. Examples include child euthanasia, which is illegal worldwide but decriminalized under certain specific circumstances in the Netherlands under the Groningen Protocol. Involuntary euthanasia
Euthanasia conducted against the will of the patient is termed involuntary euthanasia. Passive euthanasia Passive euthanasia entails the withholding of common treatments, such as antibiotics, necessary for the continuance of life. Active euthanasia Active euthanasia entails the use of lethal substances or forces, such as administering a lethal injection, to kill and is the most controversial means. Legal status West’s Encyclopedia of American Law states that “a ‘mercy killing’ or euthanasia is generally considered to be a criminal homicide” and is normally used as a synonym of homicide committed at a request made by the patient.
The judicial sense of the term “homicide” includes any intervention undertaken with the express intention of ending a life, even to relieve intractable suffering. Not all homicide is unlawful. Two designations of homicide that carry no criminal punishment are justifiable and excusable homicide. In most countries this is not the status of euthanasia. The term “euthanasia” is usually confined to the active variety; the University of Washington website states that “euthanasia generally means that the physician would act directly, for instance by giving a lethal injection, to end the patient’s life”.
Physician-assisted suicide is thus not classified as euthanasia by the US State of Oregon, where it is legal under the Oregon Death with Dignity Act, and despite its name, it is not legally classified as suicide either. Unlike physician-assisted suicide, withholding or withdrawing life-sustaining treatments with patient consent (voluntary) is almost unanimously considered, at least in the United States, to be legal. The use of pain medication in order to relieve suffering, even if it hastens death, has been held as legal in several court decisions.
Some governments around the world have legalized voluntary euthanasia but generally it remains as a criminal homicide. In the Netherlands and Belgium, where euthanasia has been legalized, it still remains homicide although it is not prosecuted and not punishable if the perpetrator (the doctor) meets certain legal exceptions. Legal Status 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 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. 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 legalizing 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. Supreme Court decision While rejecting Pinki Virani’s plea for Aruna Shanbaug’s euthanasia, the court laid out guidelines for passive euthanasia. According to these guidelines, passive euthanasia involves the withdrawing of treatment or food that would allow the patient to live.
Forms of active euthanasia, including the administration of lethal compounds, are legal in a number of nations and jurisdictions, including Switzerland, Belgium and the Netherlands, as well as the US states of Washington and Oregon, but they are still illegal in India. The Euthanasia: Global Issue. Recently, the phrase “doctor-assisted-suicide” has been added to the euthanasia vocabulary. Acting in accord with the patient’s wishes, a physician provides the terminally ill individual with lethal medication. The patient decides when to take the medication, so that the physician does not participate directly in the death.
Of course, rational, but severely handicapped patients, such as those in the final stages of ALS (Amyotrophic Lateral Sclerosis), are automatically eliminated from this mode of dying because they are not able to take medication without assistance. In countries where suicide and assisted suicide are against the law, doctor-assisted-suicide would not be tolerated. Recently, plastic-bag-death has received some publicity. Plastic-bag-death permits a terminally ill patient to commit suicide without incriminating others.
The patient is supplied with sleeping pills, perhaps a glass of alcohol, such as vodka, to enhance the effectiveness of the sleeping potions, an airtight plastic bag large enough to fit comfortably over the head, a dust mask, and an elastic band. The provider leaves the premises. The patient, now alone, swallows the sleeping tablets, drinks the alcohol, dons the dust mask (to keep the plastic from adhering to the mouth and nose), pulls the plastic bag over the head and secures it with the elastic band around the neck. Any temporary breathing discomfort can be alleviated by extending the rubber band to permit air to enter.
Ultimately, the patient falls asleep and dies quietly by asphyxiation. Ethical Issues Moral, ethical and religious issues pertaining to euthanasia embrace subjects as diverse as “patient autonomy,” “quality of life,” “sanctity of life,” “death with dignity,” “patient’s rights,” and “playing God. ” Medical personnel and their patients, both old and young, wrestle with problems associated with treatment futility, informed choice, right-to-die, autonomy versus paternalism, beneficence versus maleficence, and so on, each of which impacts, either directly or indirectly, on the issue of euthanasia.
What is most important in any discussion of global euthanasia is the recognition of the varied ethnic, national and religious differences to be found and respected in communities throughout the world. At the same time, the ethical issues that are raised by the subject of euthanasia are all embracing and include the following: 1. Patient Autonomy In democratic countries, where individual freedom to choose is accepted as a civil right, end-of-life decisions should be made, primarily, by the patient.
Self-determinism pays respect to an individual’s personal values and enables the individual to be responsible for his or her own life. To deny competent individuals, and in particular elderly persons, the right to choose not only denies respect for their lifetimes of decision making but smacks of medical paternalism. Obviously, attitudes towards the process of dying will vary. Religious and cultural traditions including local customs will tend to dictate patterns to be followed. However, the empowerment of the elder and recognition of the elder’s personal values must not be denied.
In most countries, however, elderly patients who wish to exercise their autonomy and choose immediate death over lingering death, are denied their right to choose. 2. Informed Choice, Informed Consent Patient autonomy automatically includes the right to full information concerning the nature and development of the terminal illness, the choices for treatment that remain, the anticipated consequences of each form of treatment, and what will occur if the patient refuses treatment. Such information is often withheld from the elderly person.
Paternalistic physicians may seek to shield the elderly patient from the truth or from a full evaluation of a terminal disease in the belief that the elderly are less able than younger persons to handle troublesome information. When medical personnel conclude that further treatment is futile and that nothing can be done to stop the progress of the disease, all competent patients, including elderly patients, need to be fully informed. Only then can the informed patient make an informed choice between alternate treatments and comprehend the consequences of choosing no treatment.
Informed choice also provides the terminally ill patient with time and opportunity to make closure with those who matter most. 3. Playing God: Sanctity of Life, Quality of Life For some, the sanctity-of-life thesis rests upon the theological argument that life is a gift or a loan from God and that only God should determine when that gift or loan should be returned. Those who seek to end their life are, therefore, “playing God. ” The thesis has been challenged for not every person will accept a theological interpretation of life. Sanctity of life may argue biologically.
Each human life marks the end product of millions of years of evolution. Each person is absolutely unique, with a personal DNA and a lived life that can never be duplicated. As a one-of-a-kind individual life, the preciousness and sanctity of that existence is to be honored and revered. However, as we shall see below, some are born with defective genes. An encephalic infant will have a life span of a few hours or a few days. Nothing can be done to replace the missing brain. The infant will automatically die. In most instances, the newborn is place in an isolation unit, receiving a minimal amount of care.
Sustaining nourishment and health care is reserved for infants who will survive. Neither God nor nature provides for us equally. Conclusion Euthanasia is morally permissible under certain circumstances. It is also believe that people should be given the choice to voluntarily ask for some assistance in ending their own lives. We know that if we were dying with a terminal illness or even if we had some sort crippling disease we would at least like to have the right to choose my own fate. People do not see any arguments that prove to me that it should be wrong in a moral and legal standpoint to actively and voluntarily ask for euthanasia.