EUTHANASIA

SNEHA RS
A3622005
MSc Clinical Psychology

Euthanasia is the act of deliberately ending a person's life to relieve suffering. Doctors
sometimes perform euthanasia when it’s requested by people who have a terminal illness and
are in a lot of pain. It’s a complex process and involves weighing many factors. Local laws,
someone’s physical and mental health, and their personal beliefs and wishes all play a role.

Euthanasia is fundamentally incompatible with the physician’s role as healer, would be

difficult or impossible to control, and would pose serious societal risks. Euthanasia could
readily be extended to incompetent patients and other vulnerable populations.

The involvement of physicians in euthanasia heightens the significance of its ethical

prohibition. The physician who performs euthanasia assumes unique responsibility for the act
of ending the patient’s life.

Instead of engaging in euthanasia, physicians must aggressively respond to the needs of

patients at the end of life. Physicians:

1. Should not abandon a patient once it is determined that a cure is impossible.

2. Must respect patient autonomy.
3. Must provide good communication and emotional support.
4. Must provide appropriate comfort care and adequate pain control.

Different countries have different euthanasia laws. The British House of Lords select
committee on medical ethics defines euthanasia as "a deliberate intervention undertaken with
the express intention of ending a life, to relieve intractable suffering". In
the Netherlands and Belgium, euthanasia is understood as "termination of life by a doctor at
the request of a patient". The Dutch law, however, does not use the term 'euthanasia' but
includes the concept under the broader definition of "assisted suicide and termination of life
on request".

HISTORY:

The opinion that euthanasia is morally permissible is traceable to Socrates, Plato, and
the Stoics. It is rejected in traditional Christian belief, chiefly because it is thought to
contravene the prohibition of murder in the Ten Commandments. The organized movement
for legalization of euthanasia commenced in England in 1935, when C. Killick Millard
founded the Voluntary Euthanasia Legalisation Society (later called the Euthanasia Society).
The society’s bill was defeated in the House of Lords in 1936, as was a motion on the same
subject in the House of Lords in 1950. In the United States the Euthanasia Society of
America was founded in 1938.
The first countries to legalize euthanasia were the Netherlands in 2001 and Belgium in 2002.
In 1997 Oregon became the first state in the United States to decriminalize physician-assisted
suicide; opponents of the controversial law, however, attempted to have it overturned. In
2009 the Supreme Court of South Korea recognized a “right to die with dignity” in its
decision to approve a request by the family of a brain-dead woman that she be removed from
life-support systems.

The potential of modern medical practice to prolong life through technological means
has provoked the question of what courses of action should be available to the physician and
the family in cases of extreme physical or emotional suffering, especially if the patient is
incapable of choice. Passively doing nothing to prolong life or withdrawing life-support
measures has resulted in criminal charges being brought against physicians; on the other
hand, the families of comatose and apparently terminal patients have instituted legal action
against the medical establishment to make them stop the use of extraordinary life support.

TYPES OF EUTHANASIA:

There are several types of euthanasia. What’s chosen depends on a variety of factors,
including someone’s outlook and level of consciousness.

Assisted suicide vs. euthanasia

Assisted suicide is sometimes called physician-assisted suicide (PAS). PAS means a doctor
knowingly helps someone end their life. Assisted suicide is the act of deliberately assisting
another person to kill themselves. If a relative of a person with a terminal illness obtained
strong sedatives, knowing the person intended to use them to kill themselves, the relative may
be considered to be assisting suicide.

In many cases, doctors will provide people with a drug they can take to end their life. A lethal
dose of opioids, for example, may be prescribed for this. In the end, it’s up to the person to
decide whether they take the drug.

With euthanasia, a doctor is allowed to end the person’s life by painless means. For example,
an injection of a lethal drug may be used.

Active vs. passive

When most people think of euthanasia, they think of a doctor directly ending someone’s life.
This is known as active euthanasia. Purposely giving someone a lethal dose of a sedative is
considered active euthanasia.

Passive euthanasia is sometimes described as withholding or limiting life-sustaining

treatments so that a person passes more quickly. A doctor may also prescribe increasingly
high doses of pain-killing medication. Overtime, the doses may become toxic.
This makes the distinction between passive euthanasia and palliative care blurry. Palliative
care focuses on keeping people as comfortable as possible at the end of their life.

For example, a palliative care doctor might allow someone approaching death to stop taking a
medication that causes unpleasant side effects. In other cases, they might allow someone to
take a much higher dose of a pain medication to treat severe pain. This is often a standard
part of good palliative care. Many don’t consider it euthanasia.

Voluntary vs. non-voluntary

If someone makes a conscious decision to seek help with ending their life, it’s considered
voluntary euthanasia. The person must give their full consent and demonstrate that they fully
understand what will happen.

Nonvoluntary euthanasia involves someone else making the decision to end someone’s life.
A close family member usually makes the decision. This is generally done when someone is
completely unconscious or permanently incapacitated. It usually involves passive euthanasia,
such as withdrawing life support from someone who’s showing no signs of brain activity.

WHO CAN CHOOSE IT?

In places where voluntary euthanasia and physician-assisted suicide are legal, they’re only
allowed if you have a terminal diagnosis. “Terminal” means you cannot be cured and doctors
expect you to die from your illness.

In order to legally end your life, you may also be asked to show that you’re suffering severely
from pain. Under the law, you may then be allowed to decide when and how you want to die.

People in many states and countries are calling for more laws that will allow them to choose
when and how to end their lives. They call this "dying with dignity." It's a topic that is hotly
debated.

While a growing number of people think assisted suicide or voluntary euthanasia should be
allowed, many others disagree. Those people say that it’s not morally or ethically right for
doctors to help people die.

In 2019, the American Medical Association (AMA) Council on Ethical and Judicial Affairs
(CEJA) sought to update their stance on assisted suicide. They revealed two divergent and
equally valued opinions on the matter.

On the one hand, many doctors argue that “physician-assisted suicide is fundamentally
incompatible with the physician’s role as healer.” Doctors should work on making terminally
ill patients comfortable, not helping them die.
On the other side, doctors argue that “a physician shall have compassion and respect for
human dignity and rights.” By responding to the request of their patient to provide a lethal
dose of medication that will relieve intractable pain and suffering of an incurable disease, a
doctor is indeed expressing the highest level of care and compassion while
supporting dignity at the end of life.

The AMA stands divided, concluding that physicians who legally participate in physician-
assisted suicide are following their professional, ethical obligations as are the physicians who
decline to participate. Most importantly, there should be full voluntary participation on the
part of both patient and physician in these sacred decisions about how to approach end of life
care.

LEGAL ISSUES

Laws for assisted suicide and euthanasia vary by state and country.

Where Assisted Suicide Is Allowed

In the United States, physician-assisted suicide is allowed in:

 California
 Washington
 Oregon
 Montana
 Colorado
 New Mexico
 Hawaii
 Maine
 New Jersey
 Vermont
 Washington D.C.

Several countries have also passed laws allowing doctors to assist with a suicide.

If a doctor or anyone else actually gives the person the lethal medication, the act is
considered euthanasia. That can be a crime even in areas that have assisted-suicide laws.

Where Euthanasia Is Allowed

Voluntary euthanasia is illegal in the United States and most parts of the world. Countries
that do allow it include:

 Belgium
 The Netherlands
 Luxembourg
 Canada
 Colombia

Involuntary euthanasia is illegal worldwide.

EUTHANASIA IN INDIA:

Since March 2018, passive euthanasia is legal in India under strict guidelines. Patients must
consent through a living will, and must be either terminally ill or in a vegetative state.
On 9 March 2018 the Supreme Court of India legalised passive euthanasia by means of the
withdrawal of life support to patients in a permanent vegetative state. The decision was made
as part of the verdict in a case involving Aruna Shanbaug, who had been in a Persistent
Vegetative State (PVS) until her death in 2015.

Aruna Shanbaug case:

Aruna Shanbaug was a nurse working at the King Edward Memorial

Hospital, Parel, Mumbai. On 27 November 1973 she was strangled and sodomized by
Sohanlal Walmiki, a sweeper. During the attack she was strangled with a chain, and the
deprivation of oxygen left her in a vegetative state. On behalf of Aruna, her friend Pinki
Virani, a social activist, filed a petition in the Supreme Court arguing that the "continued
existence of Aruna is in violation of her right to live in dignity". The Supreme Court made its
decision on 7 March 2011. The court rejected the plea to discontinue Aruna's life support but
issued a set of broad guidelines legalising passive euthanasia in India. The Supreme Court's
decision to reject the discontinuation of Aruna's life support was based on the fact that the
hospital staff who treat and take care of her did not support euthanizing her. Aruna died from
pneumonia on 18 May 2015, after being in a coma for a period of 42 years.

THE ROLE OF PALLIATIVE CARE:

Since pain is the most visible sign of distress or persistent suffering, people with cancer and
other life threatening, chronic conditions will often receive palliative care. Opioids are
commonly used to manage pain and other symptoms.

The adverse effects of opioids include drowsiness, nausea, vomiting, and constipation. They
can also be addictive. An overdose can be life threatening.

Palliative sedation is when a doctor gives a terminal patient medication that will ease severe
pain. This practice is sometimes more acceptable to people who disagree with assisted suicide
or voluntary euthanasia.

The AMA Code of Medical Ethics says it’s acceptable for doctors to give sedatives to
patients who are suffering, which are drugs that can relax the body and put you to sleep. 8 In
these instances, the patient may remain unconscious until their time of death. However, the
drugs should never be used to intentionally cause a person’s death.

Palliative sedation requires:

 Permission from the person who is sick or whoever is in charge of their healthcare
decisions if the patient is unable to understand the situation and give consent
 A health care professional who can administer the drugs
Palliative sedatives are usually given in an IV that goes directly into the bloodstream or as a
suppository. A suppository is medication that’s inserted into your rectum where it dissolves
into the body.

Because the medication is fast-acting, sedatives must be given by a physician, nurse, or other
health care professional.

People do sometimes die while under heavy sedation, but that is not the goal of the treatment.
In these cases, it may not be clear whether someone died because of the medication or the
illness.

REFERENCES:

What Is Euthanasia? Euthanasia and assisted suicide have important distinctions

By Angela Morrow, RN ; March 29, 2023
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Psychological Perspectives on Euthanasia and the Terminally Ill: An Australian

Psychological Society Discussion Paper; Ann Sanson, Elizabeth Dickens, Beatrice
Melita, Mary Nixon, Justin Rowe, Anne Tudor, Michael Tyrrell; 02 February 2011
https://aps.onlinelibrary.wiley.com/doi/abs/10.1080/00050069808257255

The Psychology of Euthanasia; Miguel Ricou; August 16, 2018

https://econtent.hogrefe.com/doi/abs/10.1027/1016-9040/a000331?journalCode=epp

OPINION 5.8; Euthanasia

https://code-medical-ethics.ama-assn.org/ethics-opinions/euthanasia

June 1, 2019; Euthanasia: Understanding the Fact

https://www.healthline.com/health/what-is-euthanasia

Euthanasia in India; https://en.wikipedia.org/wiki/Euthanasia_in_India