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Euthanasia: A Brief History and Perspectives in India

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DOI: 10.5005/jp-journals-10056-0047

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Review article
Euthanasia: A Brief History and Perspectives in India
Kusum R Gandhi
ABSTRACT
Passive euthanasia (Good death, easy death, right to die,
mercy killing) is one of the major issues developed with prog-
ress of human race. Euthanasia elicits strong emotions as it
is concerned with life and death issues. Euthanasia has been
practiced in most of the countries for more than twenty years
and focuses mainly on the fact that patient suffering ought to
be prioritized over the patient life. The quality of life shall be
taken care of in critically ill patients. Euthanasia is not killing a
patient but allowing the critically ill person to end his life on his
own wish to die peacefully. This controversial topic is debated
because it violates codes of medical ethics and patient care
which exists since antiquity.
The euthanasia, its types, guidelines for implication in
various countries and perspectives in India are discussed in
this article.
Keywords: Euthanasia, Medical ethics, Mercy killing, Passive,
Patient care.
How to cite this article: Gandhi KR. Euthanasia: A Brief
History and Perspectives in India. Int J Educ Res Health Sci
2017;3(2):105-108.
Source of support: Nil
Conflict of interest: None
INTRODUCTION
Helping a critically ill person to die according to his
will is the most debatable topic in today’s contemporary
health care. Like cloning and body donation, euthanasia
has also generated intense controversy because of new
attitudes developed in medicine. The ability to keep a
dying person alive with the help of new equipment has
raised a question for the critically ill patient, his physician,
policymakers, and the public regarding his right to die.
However, does the responsibility to protect life involve
the duty to prolong life for as long as possible, even if
the quality of life is very poor? This ethical dilemma is
discussed in this article.
Associate Professor
Department of Anatomy, RKDF Medical College Hospital &
Research Centre, Bhopal, Madhya Pradesh, India
Corresponding Author: Kusum R Gandhi, Associate Professor
Department of Anatomy, RKDF Medical College Hospital &
Research Centre, Bhopal, Madhya Pradesh, India, e-mail:
gandhikusum.r@gmail.com
International Journal of Education and Research in Health Sciences, April-June 2017;3(2):105-108
IJERHS
Euthanasia: A 10.5005/jp-journals-10056-0047
Brief History and Perspectives in India
EUTHANASIA
Every individual strives to live a “good life” and hopes
to die with dignity, a “good death” or an “easy death.”
Euthanasia is a compound of two Greek words, “eu’”
and “thanatos,” referred to as “euthanasia” in English.
Euthanasia is described as the deliberate and intentional
killing of a person, for the benefit of that person, in order
to relieve him from pain and suffering. According to the
British House of Lords Select Committee on Medical Ethics,
it is defined as, “a deliberate intervention undertaken with
the express intention of ending a life, to relieve intractable
suffering.”1-4 Euthanasia has been legalized in Switzerland
(1942)4 Australia (1996),4 the Netherlands (2001),4,5 Belgium
(2002),4,6 and Luxembourg (2009). The legislation allowing
physician-assisted suicide (PAS) exists in Switzerland as
well as outside of Europe, in three federal states in the
United States: Oregon, Vermont, and Washington.4
HISTORY OF EUTHANASIA
Euthanasia has deep historical roots. Before Hippocrates,
euthanasia was a routine procedure and physicians
assumed that they had the authority to kill patients for
whom they gave up the hope of recovery, without asking
for their permission (Ney 1997). They accepted euthanasia
as a part of their medical practice. Hippocrates regarded
this act of killing as a hindrance to the establishment of
confidentiality between physicians and patients. Probably,
this led to the use of these words in The Hippocratic Oath,
“I will give no deadly medicine to anyone if asked, nor
suggest any such counsel.”7
Euthanasia also has a dark history, tainted by the Nazi
past. The euthanasia program – also called Aktion T4 –
targeted residents of institutions and hospitals caring for
the mentally disabled and psychiatric patients. In October
of 1939, Hitler signed a decree enabling doctors to grant
“mercy death” to patients judged “incurable,” repre-
senting the ideology called “life unworthy of life.” The
program began with the killing of children under three
with “serious hereditary diseases” including “suspected
idiocy,” Down syndrome, and those born with deformi-
ties of all kinds. At first, consent was sought from parents
and legal guardians, but this was couched in euphemisms
that their children would be sent to “special sections and
treatment centers” to receive better care. These centers
included psychiatric or care facilities specially modified
for the killing and disposing of bodies. Once there, the
105
Kusum R Gandhi

children would be quickly assessed and given lethal
injections. Parents were told their loved ones had died of
pneumonia or other illness. The program was extended to
include older children and those with no disability, when
the war broke out, but who were troublesome or juvenile
delinquents. Jewish children were also rounded up. After
that, the program was expanded to include adults; also,
the areas outside of Germany and more conditions, such
as epilepsy, Huntington’s chorea and advanced syphilis
were included. In addition, the program began to utilize
improved methods of killing, using carbon monoxide
gas for more efficient and quicker results, first utilized
in 1940. The killings were all conducted and supervised
by doctors, and the brain samples of the deceased were
sent to research centers. According to many authors, this
was to maintain the concept that these were medical
measures rather than cold-blooded murder. In all, about
70,273 people were killed under this program. In Nazi
Germany, where people were killed against their will,
people were not suffering pain or facing any terminal
illness. They were killed – murdered – for the supposed
“good of the country” rather than for their own good.5
These incidences started debates on mercy killing,
among the public and health providers, which resulted
in legalization of euthanasia in some countries. The pro-
ponents of euthanasia argue that decisions concerning
life and death should be up to the individual who is con-
cerned. People have the right to determine the moment
of dying, if they are in a situation which is unbearable
and without the prospect of improvement.
Australia’s Northern Territory was the world’s first
jurisdiction to legalize euthanasia in 1996.7 On April
10, 2001, the Dutch upper house of parliament voted to
legalize euthanasia, making the Netherlands the first,
and at that time, the only country in the world to legalize
euthanasia.11 In order to provide guidance to the profes-
sion, as to under which conditions euthanasia could be
permissible, it formulated a set of criteria that mirror
the criteria developed by the courts: (1) The request for
euthanasia must come from the patient and be entirely
free and voluntary, well considered, and persistent,
(2) the patient must experience intolerable suffering
(physical or mental), with no prospect of improvement
and with no acceptable solutions to alleviate the patient's
situation, (3) euthanasia must be performed by a physi-
cian, after consultation with an independent colleague
who has experience in this field.6
Euthanasia has been followed by the legislation in
Washington (2008), Vermont (2013), and California (2015);
it is currently being debated in New Jersey. In Montana,
a court ruling, finding no constitutional objection to
assisted suicide, has opened the way for similar practices
in 2009, and a similar court ruling in New Mexico in 2014
is currently under appeal. In contrast to the legal require-
ments in European countries, in Oregon, Washington,
and Vermont, patients must have a terminal physical
illness in order to qualify for PAS.
There are few strict rules which govern euthanasia in
different countries (Table 1).

Table 1: Different kinds of Euthanasia with distinctive definition

Sl. no. Type of euthanasia
8
1 Active euthanasia
2 Passive euthanasia8,9
3 Voluntary (statutory)
euthanasia10,11
4 Involuntary euthanasia10,11
5 Physician-assisted
euthanasia9-13
6 Legitimate medical
euthanasia
Definition
Is identical to mercy killing and involves taking action to end a life. Active euthanasia is defined
as any treatment initiated by a physician, with the intent of hastening the death of another
human being, who is terminally ill, with the motive of relieving that person from great suffering.
For example, intentionally giving a person a lethal dose of a drug to end a painful and
prolonged period of dying.
Passive euthanasia is allowing the patient to die when he or she could have been kept alive
by the appropriate medical procedures. Passive euthanasia is defined or considered as
discontinuing, or not starting a treatment at the request of the patient.
Voluntary euthanasia is when the decision to terminate life by the physicians corresponds with
the patient’s desire to do so and the patient willfully gives consent of its implementation.
Involuntary euthanasia is when the decision to end life is implemented against the patient’s
wishes. Nonvoluntary euthanasia refers to cases where patients are unable to make their
decisions, for example, a person who is brain dead and in a permanent or irreversible coma.
The deliberate termination of life, by someone other than the patient, at the patient’s request
and PAS as intentionally helping a patient to end his or her life at his or her request.
This means providing treatment (usually to reduce pain) that has the side-effect of speeding
the patient's death. It is based on the doctrine of “dual effect” and concerns the use of lethal
dosing, or terminal sedation, by some medical professionals. Administration of terminal
sedation, i.e., lethal dosing, to a competent, terminally ill patient by the physician, which by its
“dual effect” may hasten the patient’s death, is both ethical and legal as long as the terminal
treatment is intended to relieve the pain and suffering of an agonizing terminal illness (editorial
classification of euthanasia).

106

BELGIAN EUTHANASIA LAW
Belgium’s Senate approved the law proposing euthanasia
by a significant majority on October 25, 2001. On May
16, 2002, after two days of debate, the lower house of the
Belgian parliament endorsed the bill by 86 votes in favor,
51 against, and 10 abstentions. The legislation established
the conditions under which doctors may end the lives of
patients who are hopelessly ill and suffering unbearably.
The candidates for euthanasia need to reside in Belgium
to be granted this right. The age of patients should be
at least 18 years and specific, voluntary, and repeated
requests are needed that their lives be ended. The exact
number of “repeated requests” is not provided and open
to interpretation. Section 3 of the law speaks of patients
who are adults or emancipated minors, capable, and
conscious at the time of their request. The “Emancipated
minors” states an autonomous person capable of making
decisions.5,6
EUTHANASIA IN THE NETHERLANDS
The Netherlands was one of the first countries to permit
active euthanasia and PAS in postwar period with the
passage of the Euthanasia Act in 2002. In this law, eutha-
nasia was defined as the administration of drugs with
death of the patient as the ultimate result, at the explicit
request of a patient. The law of PAS was mentioned as
the prescription of drugs by a physician, for the purpose
of self-administration by the patient.4 The law stipulated
four criteria for granting a euthanasia request:
• The patient’s request shall be voluntary and well-
considered;
• The patient’s suffering should be unbearable and
hopeless;
• The patient shall be informed about their situation
and prospects;
• There are no available reasonable alternatives;
• Further, another physician should be consulted; and
• Euthanasia should be performed with due medical
care and attention.5,7
EUTHANASIA IN JAPAN
Euthanasia is defined in Japan as “an act to relieve an acute
physical pain of the patient, whose time of death is immi-
nent, on his/her sincere request and to make the patient
meet his/her own peaceful death.” Euthanasia is normally
classified into five categories: (1) Pure euthanasia – this is
a type where the act of doctor does not make the time of
death of the patient sooner by removing suitably the pain
of the patient. This act is lawful in Japan. (2) Indirect eutha-
nasia – this is a type in which giving an analgesic drug
hastens incidentally the time of death of the patient. This
act is lawful in Japan. (3) Active euthanasia – this is a type
International Journal of Education and Research in Health Sciences, April-June 2017;3(2):105-108
IJERHS
Euthanasia: A Brief History and Perspectives in India
in which the doctor or close relatives remove the physical
pain by means of active killing with lethal drugs and so on
by complying with the request of the patient. It is disputable
whether the act is lawful or unlawful. (4) Passive eutha-
nasia – the doctor does not perform active life-prolonging
measures (e.g., an IV drip injection) by complying with a
request of the patient. This omission is generally lawful in
Japan. (5) Physician-assisted suicide – this is a new type
in which the physician assists the suicide of the patient by
providing a so-called suicide machine or lethal drug. This
active, assisted suicide is unlawful in Japan.
The criteria for passive euthanasia in Japan:
• The patient should be in such a terminal condition
that he or she is suffering from an incurable disease,
has no chance to recover, and death is unavoidable.
• The patient must be informed properly and decide
voluntarily. There has to be the patient’s expression
to stop medical treatment at the time of stopping it.
• Stopping medical treatment and all the measures for
cure and life sustaining including medication, arti-
ficial dialysis, artificial ventilator, blood transfusion,
artificial nutrition, and rehydration and so on.
• There are no possible alternative treatments.
• Another physician should be consulted; and
• The procedure of termination-of-life should be per-
formed with due medical care and attention.8
EUTHANASIA IN INDIA
Euthanasia is still new to India and there are no special
provisions regarding this either in law or legislation. In
recent years, few medical cases signify the necessity of
euthanasia in India. In the absence of legal euthanasia
in India, patients are deprived of receiving organs from
a donor. Venkatesh, a boy, died in his sleep on December
17, 2004, and his plea to donate his organs prior to his
death was not accepted by the Andhra Pradesh High
Court. The hospital stated on the question of donation
of organ, in the very case, it amounted to euthanasia or
mercy killing, which is illegal in India. High Court judges
Devender Gupta and Narayan Reddy said "the existing
law has no such provision and the request cannot be con-
ceded." His mother, K. Sujatha, was not ready to give up.
She has vowed to fight it out in the court, so as to make
mercy killing legal in India. Since there is no law regard-
ing euthanasia in India, the following things happened:
• The boy’s final wish to help someone in need has
remained unfulfilled.
• The mother and the relatives felt hurt, as they could
not fulfill the boy’s final wish.
• The few needy patients, who could have been saved
by the boy’s healthy organs, have been deprived of
the chance to live a healthy life.10
107
Kusum R Gandhi
In 2006, the 196th report of the Law Commission of
India brought out The Medical Treatment of Terminally ill
Patients (Protection of Patients and Medical Practitioners)
Bill, 2006. The health ministry had opted not to make
any law on euthanasia. However, on March 7, 2011, while
hearing the Aruna Shabaug vs Union of India case, the
Supreme Court laid down guidelines to process pleas
for passive euthanasia. It said that until the Parliament
works out legislation, the procedures laid down by the
guidelines should be followed. During August 2012, the
Law Commission again proposed making legislation on
passive euthanasia and prepared a draft bill called the
Medical Treatment of Terminally Ill Patients (protection
of patients and medical practitioners) bill. It does not
recommend active euthanasia. In May 2016, the health
ministry uploaded the draft bill and wanted people to
give their views via e-mail to passiveeuthanasia@gmail.
com, so that it can take a decision to enact or not to enact
a law on passive euthanasia.11
We propose that implementation of passive euthana-
sia shall be made under certain conditions:
• The death shall be requested by a person who is ter-
minally ill and genuinely wishes to die. The autonomy
of patient is the prime concern.
• The death is for the good of the patient who is well
aware of the consequences and wishes to die and not
for the “greater good” of the country, family, or anyone
else. Beneficence component of bioethics is covered
herewith.
• The death is to relieve the unbearable pain and suf-
fering, i.e., not treatable in any other way. The patient
is benefited by withdrawal of pain.
• Decision for euthanasia shall be decided only in the
absence of any other reasonable alternative.
• Patients shall be allowed to prepare their living will.
• All physicians are not allowed to practice euthanasia.
Some medical practitioners of reputed background
shall be trained in euthanasia to prepare them as
specialists of euthanasia.
We, in the process of evolution, should acknowledge
quality of life over quantity. The physician’s duty is to
alleviate pain and suffering. If there is no other option,
the doctor, in fulfilling this duty, should be allowed to
passively end the patient’s life. This statement is not based
on autonomy, but on beneficence.9
It has been felt that permitting euthanasia could
diminish respect for life. Concerns are raised that allow-
ing euthanasia for terminally ill individuals could result
in a situation where all terminally ill individuals would
108
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feel pressurized to avail euthanasia. The caretakers fear
that such individuals might begin to view themselves
as a burden on their family, friends, and society, or as
a strain on limited health care resources. However, the
proponents of euthanasia shall confirm that legalizing
euthanasia would not devalue life or result in pressure
being put on individuals to end their lives, but would
allow those with no hope of recovery to die with dignity
and without unnecessary suffering. I conclude by saying
that euthanasia shall be practiced while keeping the
patients’ well-being in mind. Above all, real compas-
sion cannot kill and a dignified end-of-life is the right of
every individual. Euthanasia shall be legalized in India
too, under the strict supervision of trained physicians,
judiciary bodies, and family members.
However, the result of implication of euthanasia needs
to be reexamined again at regular intervals depending
upon the evolution of society with regard to providing
health care to disabled and terminally ill patients. The
survey results will help in forming rules of euthanasia.
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