In bioethics, the topic of end-of-life issues often revolves around Euthanasia.

The word
Euthanasia originates from the Greek words "eu," which means "good," and "thanatos," which
means "death." Essentially, it refers to a "good death." Euthanasia encompasses the discussions
on the right to die and physician-assisted suicide. Typically, euthanasia involves a deliberate
action carried out by someone else, often a medical professional, to bring about the death of an
individual. This act is sometimes known as "mercy killing." According to the Oxford dictionary,
Euthanasia is defined as "a gentle and easy death, especially in cases of irrevocable and
irreversible painful diseases."

Voluntary Euthanasia
Voluntary euthanasia is the act of ending a person's life painlessly, with their consent, usually to
relieve suffering from a terminal illness or unbearable pain. This differs from assisted suicide,
where a person self-administers the lethal medication. It's a highly debated ethical issue, with
arguments revolving around patient autonomy, compassion, quality of life, and potential for
abuse. Critics raise concerns about the sanctity of life, potential for coercion, and slippery slope
towards involuntary euthanasia. Legal frameworks vary globally, with some countries allowing it
under strict conditions.

Involuntary Euthanasia
Involuntary euthanasia is the act of ending a person's life without their explicit consent. This
means that the decision to end the person's life is made by someone else, typically a caregiver or
a medical professional, without the person's consent. Involuntary euthanasia is considered
unethical and illegal in most countries because it violates the individual's right to make decisions
about their own life and health. It is important to distinguish involuntary euthanasia from other
forms of euthanasia, such as voluntary euthanasia, where the person has given explicit consent
to end their life, and passive euthanasia, where life-sustaining treatment is withheld or withdrawn
with the person's consent.

ACTIVE EUTHANASIA
Active euthanasia is the intentional act of causing the death of a patient who is suffering from a
serious illness or medical condition. This is typically done by administering a lethal substance or
medication with the explicit intention of ending the patient's life. Active euthanasia is often
carried out with the consent of the patient, especially in cases where the patient is terminally ill
and experiencing unbearable suffering.

One of the key distinctions of active euthanasia is that it involves a deliberate action taken to
bring about the patient's death, as opposed to passive euthanasia which involves withholding or
withdrawing life-sustaining treatment. Active euthanasia is a highly controversial and ethically
complex issue, with debates surrounding questions of patient autonomy, quality of life, medical
ethics, and the role of physicians in ending a patient's life.

Passive Euthanasia

It is referred to as “letting die”. In this case, there is no action or “negative” action undertaken
consciously to let someone die. In other words, the health care professional deliberately
withholds the treatment, to let the patient die through the natural course of the illness.
The central question in Biomedical ethics revolves around legalizing euthanasia. Whether it
should be legalised or not? There are strong arguments from both the segments of people, for
or against euthanasia. Those who are against it, argue from the perspective of the “sanctity of
life” principle. For them life is sacred per se. Further, they argue by upholding the codes of
medical ethics; principle of beneficence and nonmaleficence. These codes are binding on
doctors, to do no harm to their patient and preserve their life. Moreover, there remains a fearthat
by allowing euthanasia may lead to devaluation of human life. It may take the form of a
slippery slope to stigmatize and abuse chronically ill patients. On the other side are those who
believe that it should be the right of an individual to decide when to end life. They argue for
the inclusion of “right to die” as an extension to “right to life”. The right to life with dignity is
the threshold of the entire debate. Merely by being alive in a vegetative state is contrary to the
very essence of “life with dignity”. The supporters are of the opinion that biological existence
without any quality of life is contrary to having a good life. If the person is suffering and
cannot perform his basic biological functions himself/herself, illness is untreatable,
irreversible, then merely prolonging the life is outrightly unacceptable to the principles of
medical ethics.
These are some strong debates from both the segments. As we have observed, such issues
are conflicting and overlapping and hence leads to ethical dilemmas.
Debate on Euthanasia
The debate on euthanasia is a complex and highly controversial issue that revolves around the
moral, ethical, legal, and social considerations of intentionally ending a person's life to relieve
their suffering. There are generally two main sides to the debate:

1. **Supporters of Euthanasia**:
- **Autonomy and Compassion**: Advocates argue that individuals should have the right to
make decisions about their own lives, including when and how they die. They believe that
euthanasia can be a compassionate choice for terminally ill patients who are enduring
unbearable suffering.
- **Quality of Life**: Proponents of euthanasia often emphasize the importance of maintaining
quality of life and dignity for patients. They argue that allowing individuals to choose euthanasia
can help them avoid prolonged suffering and maintain control over their end-of-life care.

2. **Opponents of Euthanasia**:
- **Sanctity of Life**: Opponents typically argue that life is inherently valuable and should not
be intentionally ended under any circumstances. They believe that allowing euthanasia
undermines the sanctity of life and sets a dangerous precedent.
- **Slippery Slope**: Critics of euthanasia raise concerns about the potential for abuse and the
slippery slope effect, where the practice may be extended to vulnerable populations such as the
elderly, disabled individuals, or those with mental health issues. They fear that legalizing
euthanasia could lead to a devaluation of human life.
- **Medical Ethics**: Some opponents argue that euthanasia goes against the Hippocratic
Oath, which forbids doctors from causing harm or intentionally ending a patient's life.

The debate on euthanasia also encompasses various practical and legal considerations, such as
how to ensure informed consent, safeguards to prevent abuse, the role of medical professionals,
and the impact on families and society at large. Different countries and jurisdictions have
adopted varying laws and regulations regarding euthanasia, with some permitting it under strict
conditions (such as in the case of voluntary euthanasia with proper safeguards) and others
maintaining a blanket ban on the practice.

Overall, the debate on euthanasia is highly nuanced and involves balancing competing values
such as individual autonomy, quality of life, sanctity of life, medical ethics, and societal concerns.
It continues to spark passionate discussions among policymakers, healthcare professionals,
ethicists, religious groups, and the broader public.
2.5.2 Case Study
“Aruna Shanbaug was an Indian nurse who was at the centre of attention in a court case on
euthanasia after spending nearly 42 years in a vegetative state as a result of sexual assault. In
1973, while working as a junior nurse at King Edward Memorial Hospital, Parel, Mumbai,
Shanbaug was sexually assaulted by a ward boy, and remained in a vegetative state following
the assault. On 24 January 2011, after Shanbaug had been in this state for 37 years, the
Supreme Court of India responded to a plea for euthanasia filed by journalist Pinki Virani,
setting up a medical panel to examine her. The court rejected the petition on 7 March 2011.
However, in its landmark opinion, it allowed passive euthanasia in India. Shanbaug died of
pneumonia on 18th May, 2015, after being in a persistent vegetative state for nearly 42
years.”

It is to be noted that this case revived the debate on euthanasia in India. It led to some
changes in the existing legislation and as a result, passive euthanasia was legalised for
exceptional cases only. It could be allowed in extreme cases on the request of the family and
doctors, considering the best interest of the patient. While active euthanasia still stands
illegal, passive euthanasia requires to be administered cautiously in order to avoid any abuse
of this law.