Euthanasia Quotations

"...it is choice alone that is being honoured, without regard for what is chosen."

The principle of respect for one's autonomy or self-determination is widely cited in

"...it is possible that the terror of the euthanasia ethic - tolerated by medicine
and an indifferent public and practiced by a few physicians - may grip many
invisible and vulnerable Americans." ... C. Everett Koop, M.D., the former
Surgeon General of the United States

"Society's prohibition of intentional killing ...is the cornerstone of law and social
relationships. It protects each of us impartially, embodying the belief that all are
equal.... ... Luke Gormally, from an article published by The Linacre Centre

"To kill them is a form of abandonment..."

Those who advocate euthanasia do so in the name of compassion. In this they are
undoubtedly sincere, but misguided. Compassion is derived from Latin and means
to 'suffer with', and in the context of dying persons, it translates as walking the rest
of life's journey beside them, seeking their comfort at every stage. To kill them is a
form of abandonment, precisely because the journey is too tough on others.... Brian
Pollard, M.D., retired Anaesthetist and Palliative Care Physician

"...it is proper and advisable to call it killing..."

Though euthanasia is the crime of murder, its advocates are justified in being
unhappy about it being described in this way. Murder is usually a malicious act,
while euthanasia is seen as merciful. But while euphemisms for euthanasia should
be avoided, it is proper and advisable to call it killing, not to be provocative but to
ensure that everyone keeps in mind what is really at stake.... Brian Pollard, M.D.,
retired Anaesthetist and Palliative Care Physician
 "The claimed justification for euthanasia first takes the moral high ground of compassion.
When a truer form of compassion is found in palliative care, the ground shifts to an appeal
to human rights, especially to the sovereignty of self- determination." ... ... Luke Gormally,
from an article published by The Linacre Centre

"Then along come doctors working for HMOs who are under pressure to cut costs, and the deed is done"  ... ...
Ralph Nader, saying he was worried that the Oregon assisted-suicide law targets terminally ill patients who suffer
from depression or who worry about being an undue financial burden to their relatives.

Introduction

Euthanasia

Euthanasia (from the Greek εὐθανασία meaning "good death": εὖ, eu (well or good) + θάνατος, thanatos (death)) refers to the practice
of ending a life in a manner which relieves pain and suffering. According to the House of Lords Select Committee onMedical Ethics, the
precise definition of euthanasia is "a deliberate intervention undertaken with the express intention of ending a life, to relieve intractable
suffering."[1]

Euthanasia is categorized in different ways, which include voluntary, non-voluntary, or involuntary and active or passive. Euthanasia is
usually used to refer to active euthanasia, and in this sense, euthanasia is usually considered to be criminal homicide, but voluntary,
passive euthanasia is widely non-criminal.

The controversy surrounding euthanasia centers around a two-pronged argument by opponents which characterizes euthanasia as
either voluntary "suicides", or as involuntary murders. (Hence, opponents argue that a broad policy of "euthanasia" is tantamount
to eugenics). Much hinges on whether a particular death was considered an "easy", "painless", or "happy" one, or whether it was a
"wrongful death". Proponents typically consider a death that increased suffering to be "wrongful", while opponents typically consider any
deliberate death as "wrongful". "Euthanasia's" original meaning introduced the idea of a "rightful death" beyond that only found in natural
deaths.

During the Second World War, the Nazis ran a "Euthanasia Programme", codenamed Action T4, which was supposed to grant "mercy
deaths" to incurable patients. In practice it was used to exterminate "lives unworthy of life" as part of their "racial hygiene" concept and,
as a result, at least 200,000 physically or mentally handicapped people were killed by medication, starvation, or in the gas chambers
between 1939 and 1945. Tony Hope, Professor of Medical Ethics at the University of Oxford, says that its problematic to apply the term
"euthanasia" do describe Action T4, as the term "implies that the death is for the person's benefit. What the Nazis did was to kill people
without any consideration of benefit to the person killed."[2]

Euthanasia is the most active area of research in contemporary bioethics.[3]

Like other terms borrowed from history, the "euthanasia" has had different meanings depending on usage. The first apparent usage of
the term "euthanasia" belongs to the historian Suetonius who described how the Emperor Augustus, "dying quickly and without suffering
in the arms of his wife, Livia, experienced the 'euthanasia' he had wished for."[4] The word "euthanasia" was first used in a medical
context by Francis Bacon in the 17th century, to refer to an easy, painless, happy death, during which it was a "physician's responsibility
to alleviate the 'physical sufferings' of the body." Bacon referred to an "outward euthanasia"—the term "outward" he used to distinguish
from a spiritual concept—the euthanasia "which regards the preparation of the soul."[5]

In current usage, one approach to defining euthanasia has been to mirror Suetonius, regarding it as the "painless inducement of a quick
death".[6] However, it is argued that this approach fails to properly define euthanasia, as it leaves open a number of possible actions
which would meet the requirements of the definition, but would not be seen as euthanasia. In particular, these include situations where
a person kills another, painlessly, but for no reason beyond that of personal gain; or accidental deaths which are quick and painless, but
not intentional.[7][8]

Thus another approach is to incorporate the notion of suffering into the definition.[7] 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",[9] and this approach can be seen as a part of other works, such as Marvin Khol and Paul Kurtz's "a
mode or act of inducing or permitting death painlessly as a relief from suffering".[10] However, focusing on this approach to defining
euthanasia may also lead to counterexamples: such definitions may encompass killing a person suffering from an incurable disease for
personal gain (such as to claim an inheritance), and commentators such as Tom Beauchamp & Arnold Davidson have argued that
doing such would constitute "murder simpliciter" rather than euthanasia.[7]

The third element incorporated into many definitions is that of intentionality – the death must be intended, rather than being accidental,
and the intent of the action must be a "merciful death".[7] Michael Wreen argued that “the principal thing that distinguishes euthanasia
from intentional killing simpliciter is the agent's motive: it must be a good motive insofar as the good of the person killed is concerned”,
[11]
 a view mirrored by Heather Draper, who also spoke to the importance of motive, arguing that "the motive forms a crucial part of
arguments for euthanasia, because it must be in the best interests of the person on the receiving end."[8] Definitions such as that offered
by the House of Lords Select Committee on Medical Ethics take this path, where euthanasia is defined as "a deliberate intervention
undertaken with the express intention of ending a life, to relieve intractable suffering."[1] Beauchamp & Davidson also highlight Baruch
Brody's "an act of euthanasia is one in which one person ... (A) kills another person (B) for the benefit of the second person, who
actually does benefit from being killed".[12]

Draper argued that any definition of euthanasia must incorporate four elements: an agent and a subject; an intention; a casual proximity,
such that the actions of the agent lead to the outcome; and an outcome. Based on this, she offered a definition incorporating those
elements, stating that euthanasia "must be defined as death that results from the intention of one person to kill another person, using
the most gentle and painless means possible, that is motivated solely by the best interests of the person who dies."[13] Prior to Draper,
Beauchamp & Davidson had also offered a definition which includes these elements, although they offered a somewhat longer account,
and one that specifically discounts fetuses in order to distinguish between abortions and euthanasia:[14]

"In summary, we have argued ... that the death of a human being, A, is an instance of euthanasia if and only if (1) A's death is intended
by at least one other human being, B, where B is either the cause of death or a causally relevant feature of the event resulting in death
(whether by action or by omission); (2) there is either sufficient current evidence for B to believe that A is acutely suffering or irreversibly
comatose, or there is sufficient current evidence related to A's present condition such that one or more known causal laws supports B's
belief that A will be in a condition of acute suffering or irreversible comatoseness; (3) (a) B's primary reason for intending A's death is
cessation of A's (actual or predicted future) suffering or irreversible comatoseness, where B does not intend A's death for a different
primary reason, though there may be other relevant reasons, and (b) there is sufficient current evidence for either A or B that causal
means to A's death will not produce any more suffering than would be produced for A if B were not to intervene; (4) the causal means to
the event of A's death are chosen by A or B to be as painless as possible, unless either A or B has an overriding reason for a more
painful causal means, where the reason for choosing the latter causal means does not conflict with the evidence in 3b; (5) A is a
nonfetal organism."[15]

Wreen, in part responding to Beauchamp & Davidson, 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."[16]

Wreen also considered a seventh requirement: "(7) The good specified in (6) is, or at least includes, the avoidance of evil", although as
Wreen noted in the paper, he was not convinced that the restriction was required.[17]

In discussing his definition, Wreen noted the difficulty of justifying euthanasia when faced with the notion of the subject's "right to life". In
response, Wreen argued that euthanasia has to be voluntary, and that "involuntary euthanasia is, as such, a great wrong".[17] Other
commentators incorporate consent more directly into their definitions. For example, in a discussion of euthanasia presented in 2003 by
the European Association of Palliative Care (EPAC) Ethics Task Force, the authors offered: "Medicalized killing of a person without the
person's consent, whether nonvoluntary (where the person in unable to consent) or involuntary (against the person's will) is not
euthanasia: it is murder. Hence, euthanasia can be voluntary only."[18] Although the EPAC Ethics Task Force argued that both non-
voluntary and involuntary euthanasia could not be included in the definition of euthanasia, there is discussion in the literature about
excluding one but not the other.[17]

Classification of euthanasia

Euthanasia may be classified according to whether a person gives informed consent into three types: voluntary, non-voluntary and
involuntary.[19][20]

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.[7][21] However, others see consent as essential.

Voluntary euthanasia
Main article:  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
Main article:  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 decriminalised under certain specific circumstances in the Netherlands under the Groningen
Protocol.

Involuntary euthanasia
Main article:  Involuntary euthanasia

Euthanasia conducted against the will of the patient is termed involuntary euthanasia.

Procedural decision

Voluntary, non-voluntary and involuntary euthanasia can all be further divided into passive or active variants.[22] A number of authors
consider these terms to be misleading and unhelpful.[1]

Passive euthanasia
Passive euthanasia entails the withholding of common treatments, such as antibiotics, necessary for the continuance of life.[1]

Active euthanasia
Active euthanasia entails the use of lethal substances or forces to kill and is the most controversial means.

History
Euthanasia debate

Historically, the euthanasia debate has tended to focus on a number of key concerns. According to Ezekiel Emmanuel, proponents of
euthanasia have presented four main arguments: a) that people have a right to self-determination, and thus should be allowed to
choose their own fate; b) assisting a subject to die might be a better choice than requiring that they continue to suffer; c) the distinction
between passive euthanasia, which is often permitted, and active euthanasia, which is not, is not substantive; and d) permitting
euthanasia will not necessarily lead to unacceptable consequences. Similarly, Emmanuel argues that there are four major arguments
presented by opponents of euthanasia: a) not all deaths are painful; b) alternatives, such as cessation of active treatment, combined
with the use of effective pain relief, are available; c) the distinction between active and passive euthanasia is morally significant; and d)
legalising euthanasia will place society on aslippery slope, which will lead to unacceptable consequences.[34]
Legal status

Map of the legality of euthanasia.

Main article:  Legality of euthanasia

West's Encyclopedia of American Law states that "a 'mercy killing' or euthanasia is generally considered to be a criminal
homicide"[35] and is normally used as a synonym of homicide committed at a request made by the patient.[36]

The judicial sense of the term "homicide" includes any intervention undertaken with the express intention of ending a life, even to relieve
intractable suffering.[36][37][38] Not all homicide is unlawful.[39] Two designations of homicide that carry no criminal punishment are justifiable
and excusable homicide.[39] 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".[40] 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.
[41]
 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.[42] The use of pain medication in order to relieve suffering, even if it
hastens death, has been held as legal in several court decisions.[40]

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.[43][44][45][46]

Physician sentiment

A survey in the United States of more than 10,000 physicians came to the result that approximately 16% of physicians would ever
consider halting life-sustaining therapy because the family demands it, even if believed that it was premature. Approximately 55% would
not, and for the remaining 29%, it would depend on circumstances.[47]

This study also stated that approx. 46% of physicians agree that physician-assisted suicide should be allowed in some cases; 41% do
not, and the remaining 14% think it depends.[47

india
 Passive euthanasia is legal in India.[1] 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.[2][3] Active euthanasia, including the administration of lethal compounds
for the purpose of ending life, is still illegal in India, and in most countries.[4]
[edit]Aruna Shanbaug case

Main article: 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.[5] 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.[2]
[edit]Supreme Court decision

While rejecting Pinki Virani's plea for Aruna Shanbaug's euthanasia, the court laid out guidelines for passive
euthanasia.[2]According to these guidelines, passive euthanasia involves the withdrawing of treatment or food that
would allow the patient to live.[4][6] 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.[4][7]

Elsewhere in the world active euthanasia is almost always illegal.[7] The legal status of passive euthanasia, on the
other hand, including the withdrawal of nutrition or water, varies across the nations of the world.[8] As India had no
law about euthanasia, the Supreme Court's guidelines are law until and unless Parliament passes legislation.
[4]
 India's Minister of Law and Justice,Veerappa Moily, called for serious political debate over the issue.[6] The
following guidelines were laid down:

1. 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.
2. 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.
3. When such an application is filed 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 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.
[edit]Response

After the court ruling The Telegraph consulted with Muslim, Hindu, Jain and Christian religious leaders. Though
generally against legalising euthanasia, Christians and the Jains thought passive euthanasia was acceptable
under some circumstances. Jains and Hindus have the traditional rituals Santhara and Prayopavesarespectively,
wherein one can end one's life by starvation, when one feels their life is complete.[9] Some members of India's
medical establishment were skeptical about euthanasia due to the country's weak rule of law and the large gap
between the rich and the poor, which might lead to the exploitation of the elderly by their families.[4]