Chanakya National Law University: Patna

CHANAKYA NATIONAL LAW
UNIVERSITY
PATNA
PROJECT WORK OF HEALTH LAW

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“EUTHANASIA & RIGHT TO FREEDOM OF

RELIGION”
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Submitted to :- Mr. Kr. Gaurav (Faculty of Health Law)
Submitted by :- Kumar Shiv Sidharth

Semester – X, R.No. 937
1
ACKNOWLEDGEMENT
Writing a project is one of the most significant academic challenges, I have ever faced.
Though this project has been presented by me but there are many people who
remained in veil, who gave their all support and helped me to complete this project.
First of all I am very grateful to my subject teacher Mr. Kr. Gaurav, without the kind
support of whom and help the completion of the project was a herculean task for me.
She donated her valuable time from her busy schedule to help me to complete this
project and suggested me from where and how to collect data.
I am very thankful to the librarian who provided me several books on this topic which
proved beneficial in completing this project.
I acknowledge my friends who gave their valuable and meticulous advice which was
very useful and could not be ignored in writing the project. I want to convey most
sincere thanks to all my faculties for helping me throughout the project.
Last but not the least, I am very much thankful to my parents and family, who always
stand aside me and helped me a lot in accessing resources & educational facilities.
I thank all of them !
Kr. Shiv Sidharth

R.No. 937, Sem X
B.A.L.L.B. (H)
2
TABLE OF CONTENTS
a) Introduction
………………………………………………………………. 04
b) Present Legal Position in different countries
…………………………………………………………..…... 13
c) Euthanasia in India
………………………………………………………………. 18
d) Religion & Spirituality
………………………………………………………………. 31
e) The Ongoing Debate
………………………………………………………………. 37
f) Conclusions & Suggestions
………………………………………………………………. 45
Bibliography
…………………………………………………………………. 48
3
INTRODUCTION
This research will deal with euthanasia in general, the role religion plays in how individuals
view euthanasia and physician-assisted suicide.
“Death a friend that alone can bring the peace his treasures cannot purchase, and
remove the pain his physicians cannot cure.” - Mortimer Collin
It is universal truth that death is the only certainty in this uncertain world. Everyone knows
that death will occur eventually, whether one likes it or not. It affects everyone, whichever
social group people belong to: whether they are young or old, poor or rich, the pauper or the
king, the ruler or the ruled, the sinner or the pious. In addition, one has to face the death of
loved ones, even before one have to face own death and this is what makes death poignant,
impregnable and fearsome.
Despite all this knowledge, it is very difficult for most of us to think about death of oneself
and that of loved ones. Most of us feel afraid of death, as perhaps the most basic human
response to death is flight from death but some people seem to see death as a simple solution
to their complex problems. Anthropologist Ernest Becker (1973) argued that “the idea of
death, the fear of it, haunts the human animal like nothing else; it is the mainspring of human
activity - activity designed largely to avoid the fatality of death, to overcome it by denying in
some way that it is the final destiny for man”.1
In addition everyone wants to die painlessly; but this is not the destiny of some with an
incurable illness or injury. To end their suffering, dying patients may take their own life, in
some cases violently2. In addition it is very difficult for the family members to see the agony
of the patient when everyone concerned knows that death is inevitable and there is not a ray
of hope in sight for any improvement. The issue of the right to end one’s life (Euthanasia)
has indeed caught national and international fancy and the mere utterance of these words is
sufficient to elicit fierce, divided and often passionate opinions though confidential due to
1
Becker, E. (1973). The Denial of Death. New York: Free Press
2
Retrieved from https://www.deathwithdignity.org/learn/religion-spirituality/, on 28/02/2018, at 10.30 pm.
4
legal and social sanctions. Euthanasia is increasingly being touted as a beguilingly simple
solution to the tragedy of a badly managed terminal illness. 3 It is the bringing about of a
gentle and easy death in the case of an incurable and painful disease. This issue has become
highly controversial in recent years, as it has been legalized in Holland while relatives are
being imprisoned in other countries for helping their loved ones to die. 4 These high profile
cases evince the distinct gap between those who believe that a person has the right to end
their lives if they are in pain and those who believe that euthanasia is a last resort of an
uncaring society.
MEANING AND HISTORY OF EUTHANASIA
The word euthanasia is derived from two Greek words which mean “a good death” (eu, well,
and thanatos, death). In the current debate, Euthanasia has been defined as ‘the bringing
about of a gentle and easy death for someone suffering from an incurable and painful disease
or in an irreversible coma’. Euthanasia is the intentional killing by act or omission of a
dependant human being for his or her alleged benefit. 5 Usually, ‘euthanasia’ is defined in a
broad sense, encompassing all decisions (of doctors or others) intended to hasten or to bring
about the death of a person (by act or omission) in order to prevent or to limit the suffering of
that person (whether or not on his or her request) (Gevers, 1996). Perhaps a clearer definition
is: The intentional killing by act or omission of a person, whose life is no longer felt to be
worth living.6
Historically Euthanasia was practiced 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, Platoand Seneca the Elder in the ancient
3
B. N. Colabwalla, (1987) “Understanding voluntary euthanasia: personal perspective,”
http://www.issuesinmedicalethics. org/041ed007.html
4
Burgess, S. & Hawton, K. (1998). Suicide, euthanasia and the psychiatrist. Philosophy, Psychiatry and Psychology; 5,
113-176.
5
Retrieved from www.euthanasia.com, on 10/03/2018 at 06.00 pm.
6
Becker, E. (1973). The Denial of Death. New York: Free Press.
5
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” 7
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. Thus, in 1678, the publication of Caspar Questel’s De pulvinari
morientibus non subtrahend, (“On the pillow of which the dying should not be deprived”),
initiated debate on the topic. Questel described various customs which were employed at the
time to hasten the death of the dying, (including the sudden removal of a pillow, which was
believed to accelerate death), and argued against their use, as doing so was “against the laws
of God and Nature”. This view was shared by many who followed, including Philipp Jakob
Spener, Veit Riedlin and Johann Georg Krünitz.8 In spite of opposition, euthanasia continued
to be practiced, involving different techniques i.e. bleeding; suffocation and removing people
from their beds to be placed on the cold ground.
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
Thomas More was intending to endorse the practise.9 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.
In the mid-1800s, the use of morphine to treat “the pains of death” emerged, with John
Warren recommended its use in 1848. A similar use of chloroform was revealed by Joseph
Bullar in 186610. However, in neither case was it recommended that the use should be to
hasten death. In 1870 Samuel Williams, a school teacher, initiated the contemporary
euthanasia debate through a speech given at the Birmingham Speculative Club, which was
7
8
Retrieved from http://www.pewforum.org/2013/11/21/religious-groups-views-on-end-of-life-issues/, on 10/03/2018,
at 08.00 pm.
9
Beauchamp, T.L. & Davidson, A.I. (1979). The Definition of Euthanasia, The Journal of Medicine and Philosophy, Vol. 4,
No. 3 (September), 294-312.
10
Foley, K. (1995). Pain, physician assisted suicide & euthanansia. Pain Forum, 4, 163-178.
6
subsequently published in a one-off publication entitled Essays of the Birmingham
Speculative Club, the collected works of a number of members of an amateur philosophical
society. Williams’ proposal was to use chloroform to deliberately hasten the death of
terminally ill patients.11
11
ibid
7
TYPES OF EUTHANASIA
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. However, Euthanasia may be classified
according to whether a person gives informed consent into three types: voluntary, non-
voluntary and involuntary.12
1. 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.
2. 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.
3. Involuntary euthanasia: Euthanasia conducted against the will of the patient
is termed involuntary euthanasia.
4. Passive and active euthanasia: Voluntary, non-voluntary and involuntary
euthanasia can all be further divided into passive or active variants. A number
of authors consider these terms to be misleading and unhelpful. Passive
euthanasia entails the withholding of common treatments, such as antibiotics,
necessary for the continuance of life. Active euthanasia entails the use of lethal
substances or forces, such as administering a lethal injection, to kill and is the
most controversial means. Active euthanasia results from acts of commission,
like administration of medications that hasten the process of dying such as
barbiturates, opioids, etc. Passive euthanasia involves acts of omission which
12
8
often involves withdrawing of life-supporting measures like artificial feeding
and artificial respiration.
There are various ways for euthanasia. The most popular methods include -
1) Lethal injection - Injection of a lethal dose of a drug, such as a known poison, KCl,
etc.13
2) Asphyxiation - The most popular gas used is Carbon monoxide (CO). Nerve gases like
sarin & tabun etc. are also added in small amounts to fully ensure death. 14
3) One of the methods is also Dr. Jack Kevorkian’s death machine (mercitron,
thanatron). He is also known as Dr. Death. It’s a unique method in which a person can
end his life himself. With the use of this machine a person can end his life himself
painlessly at the time chosen by the patient.15
13
113-176.
14
ibid
15
9
Physician-Assisted Suicide
An important component of the assisted suicide debate concerns the ability of medically ill
patients to make competent, informed decisions about physician assisted suicide. The
potential for such decision making to be compromised by the presence of pain, depression, or
other psychosocial factors (e.g., fear of becoming a burden) is a significant concern in any
assessment of a patient’s request for assisted suicide or euthanasia. 16
Proponents of legalization of assisted suicide suggest that interest in a hastened death may be
a rational decision for individuals with a terminal illness. Clinicians, family members, and
medically ill patients cite the potential for, and fear of, cognitive and/or physical
deterioration, pain, and emotional suffering as the basis for such requests. Other proponents
cite respect for patient autonomy as another justification for legalization of assisted suicide, 17
suggesting that patients have the right to self-determination in choosing the time and manner
of their deaths.18
Opponents of legalization, on the other hand, typically suggest that interest in hastening
one’s death is fostered by inadequate palliative care and that with pain management, social
and environmental support, and mental health treatment, requests for assisted suicide will be
markedly reduced. In addition, opponents point to the possibility that assisted suicide may be
viewed as a less expensive alternative to providing adequate end-of-life care and would
therefore be increasingly appealing to health care providers as resources become scarce. 19
These critics suggest that assisted suicide might be disproportionately requested and used by
the poor, who often lack the resources to secure adequate palliative care. 20 Finally, opponents
argue that legalization of assisted suicide will inevitably lead to legalization of euthanasia
and eventually will be extended to allow assistance in dying for patients without terminal or
even medical illness (i.e., the “slippery slope” argument).
16
113-176.
17
Emanuel, E. (1994). The history of euthanasia debates in the United States and Britain. Annals of Internal Medicine,
121 (10): 796.
18
Foley, K. (1995). Pain, physician assisted suicide & euthanansia. Pain Forum, 4, 163-178.
19
20
Filiberti, G. P., and Finlay, I. (1997). The incidence of suicide in palliative care patients. Palliative Medicine; 11, 313–
316.
10
OBJECTIVES OF THE STUDY
In the project, the researcher aims
 To study the origin and acceptability of euthanasia.

 To study the different aspects of euthanasia in the context of religion & private right
of an individual.
 To study the validity of euthanasia and protection of law (if any).
HYPOTHESIS
For the project research, the researcher assumes that euthanasia is nothing else but a permit
or license to the medical professional for ending the life of a person in question. No doubt if
it will be permitted in laws, may be the biggest threat to the creature.
RESEARCH QUESTION
For the project research, the researcher puts forward the following questions:
 Whether euthanasia is permitted & acceptable by different religious practices?

 Whether law provides for any protection for practice of euthanasia?
 Should euthanasia be governed by legal framework or by personal religious rights?
RESEARCH METHODOLOGY
For the project research, the researcher has primarily relied upon the Doctrinal method of
research.
11
A Doctrinal Research means a research that has been carried out on propositions by the way
of analyzing the existing provisions, and cases by applying the reasoning power. It includes
conventional methods of research like library based research, searching upon some texts
(writings or documents), secondary data, etc.
The quality of doctrinal research depends upon the source materials on which the researcher
depends for his study.
12
PRESENT LEGAL POSITION IN DIFFERENT
COUNTRIES
Different countries around the world have different legal set-up in this regard.21
Netherlands
The Supreme Court of Netherlands allows euthanasia. According to the penal code of
the Netherlands killing a person on his request is punishable with twelve years of
imprisonment or fine and also a assisting a person in committing suicide is punishable
with three years of imprisonment or fine. But the law of Netherlands provides a
defense of ‘necessity’ to the offence of voluntary euthanasia and assisted suicide. This
defense of necessity is two fold; one is that of ‘psychological compulsion’ and the
other is ‘emergency'.' The criteria laid down by the Courts to determine whether the
defense of necessity applies in a given case of euthanasia, have been summarized as
follows:
1. The request for euthanasia must come only from the patient and must be
entirely free and voluntary.
2. The patient’s request must be well considered, durable and persistent.
3. The patient must be experiencing intolerable (not necessarily physical)
suffering, with no prospect of improvement.
4. Euthanasia must be the last resort. Other alternatives to alleviate the patient’s
situation must be considered and found wanting.
5. Euthanasia must be performed by a physician.
6. The physician must consult with an independent physician colleague who has
experience in this field’.
Thus, following these judicial guidelines a Bill has been passed in Netherlands in 2001
legalizing this practice. It allows a doctor to end the life of a patient which is ‘unbearable’.
21
Retrieved from http://www.legalserviceindia.com/article/l118-Euthanasia-and-Human-Rights.html, on 12/03/2018 at
09.00 pm.
13
Australia
The Northern Territory of Australia became the first country to legalize euthanasia by
passing the Rights of the Terminally Ill Act, 1996. It was held to be legal in the case
Wake v. Northern Territory of Australia by the Supreme Court of Northern Territory
of Australia. But later a subsequent legislation that was the Euthanasia Laws Act,
1997 made it again illegal.
United States
Here, active euthanasia is prohibited but physicians are not held liable if they withhold
or withdraw the life sustaining treatment of the patient either on his request or at the
request of patient’s authorized representative. Euthanasia has been made totally illegal
by the United States Supreme Court in the cases Washington v. Glucksberg and Vacco
v. Quill. In these cases, the ban on assisted suicide by the physicians has been held to
be in consonance with the provisions of the constitution. In Oregon, a state in
America, assisted suicide has been legalized in 1994. Twenty seven lives were ended
in 1999 and that number is still expected to increase.
Canada
Euthanasia: Illegal Physician-Assisted Suicide: Illegal
Patients in Canada have right to refuse life sustaining treatments but they can’t ask for
assisted suicide or active euthanasia. Supreme Court in various cases has held that in
the case of assisted suicide the interest of the state will prevail over individual’s
interest.
Canadian laws on living wills and passive euthanasia are a legal dilemma. Documents
which set out guidelines for dealing with life-sustaining medical procedures are under
the Provinces control.
14
Switzerland
In Switzerland, euthanasia is illegal but physician assisted suicide has been made legal
since 1918.
In Switzerland, there is an unusual position regarding assisted suicide. Even non-

physicians can perform it. It is legally condoned although euthanasia is illegal. There
was much discussion regarding assisted suicide in United Kingdom and United States
of America but it was not so in Switzerland in the 1900s. There motive is most
important while considering the cases of assisted suicide. It is punishable only if the
motive is bad otherwise it is condoned. ‘Article 115 of the Swiss Penal Code
considers assisting suicide a crime if and only if the motive is selfish. It condones
assisting suicide for altruistic reasons. In most cases the permissibility of altruistic
assisted suicide cannot be overridden by a duty to save life.
Article 115 does not require the involvement of a physician nor that the patient is
terminally ill. It only requires that the motive be unselfish. Swiss law does not
recognize the concept of euthanasia. “Murder upon request by the victim” (article 114
of the Swiss penal code) is considered less severely than murder without the victim's
request, but it remains illegal. Following a proposal to the Swiss parliament to
decriminalize euthanasia, in 1997 the federal government commissioned a working
group which included specialists in law, medicine, and ethics to examine the issue.
This group recommended that euthanasia remain illegal. Most of the group, however,
proposed decriminalizing cases in which a judge was satisfied that euthanasia
followed the insistent request of a competent, incurable, and terminally ill patient in
unbearable and intractable suffering’.22
Belgium
Euthanasia: Legal since 2002 Physician-Assisted Suicide: Legal since 2002

22
15
The Belgian Act on euthanasia was enacted on 28th May, 2002. Belgian Law allowed
doctors to help kill patients who during their terminal illness, express the wish to
hasten their own death. Thus, the Belgian became the third jurisdiction after the
Netherlands (April, 2002) and the state of Oregon USA (1997) to legalize euthanasia.
The Belgian euthanasia law laid down the strict legal conditions and procedure under
which euthanasia and physician assisted suicide can be performed. 23
Colombia
Euthanasia: Unclear (approved by the Constitutional Court in 1997 but never ratified
by Congress) Physician-Assisted Suicide: Illegal
Euthanasia became permissible in 1997 when the highest judicial body, the
Constitutional Court, ruled that an individual may choose to end his life and that
doctors cannot be prosecuted for their role in helping the patients to end their life.
Germany
Euthanasia: Illegal Physician-Assisted Suicie: Legal since 1751
Israel
Italy
23
Chapter 11 of the Act
16
But Italian law upholds a patient's right to refuse care and the potential contradiction
has resulted in several cases which have divided Italians. The debate is especially
passionate in Italy, where the Roman Catholic Church, which is deeply opposed to
euthanasia, still holds great sway.
Japan
Euthanasia: Unclear (Illegal in the Japanese criminal code, but a 1962 court case, the
"Nagoya High Court Decision of 1962," ruled that one can legally end a patient's life
if 6 specific conditions are fulfilled) Physician-Assisted Suicide: Illegal
China and Hong Kong
Euthanasia is not legal in China and Hong Kong. It is against the Chinese concepts of
morality. According to the existing law of the country it is equivalent to murder.
Russia
Spain
17
EUTHANASIA IN INDIA
The issue of legalization of euthanasia in India can be better understood from two points of
view: (i) Reflection from cultural and historical heritage of India; and (ii) To contemporary
socio-medico-legal scenario.
Reflection from Cultural and Historical Heritage of India
In almost all societies individual and social life was governed by social customs during the
ancient and medieval ages. Social value preceded human values. India is no exception to this
rule. India had too remained under the rule of customs, how so ever; some of them might
appear as tyrant and unjustified today.24 Indian culture seems to create an ambivalent attitude
towards suicide and euthanasia, on the one hand sanctity of life was taken to be the highest
value and the violation of it including suicide was considered the highest sin. But on the
other hand suicidal acts were glorified if they occurred in defense of social values.
The customs of Sati, Jauhar, Saka (Keseria) may be taken as evidences of providing the
above arguments. Sati stood for a custom of self-immolation of a widowed woman by setting
on the funeral pyre of her deceased husband. Sati Pratha did not relaxed till the horrible
custom was abolished in 1829 by Lord William Benting, the then Governor General of East
India Company. Even in recent times a woman Roop Kanwar in the village Deorala district
Sikar of Rajasthan performed sati on the burning pyre of her husband. There were many local
people who supported her and asked everyone to do what she had done so bravely and
uphold the Hindu traditions and long followed customs of the village. Customs indeed, do
die hard sati pratha of course and obsolete custom now.25
Mass self-immolation by women was called Jauhar. This was usually done before or at the
same time their husband, brother, father and sons rode out in a charge to meet their attackers
24
25
"This Date in History: Sati in India". Atheism.about.com. (2006) 10th http://atheism.about.com/b/2006/1 0/04/this-
date-in-history-sati-inindia.htm.
18
and certain death. The upset caused by knowledge that their women and younger children
were dead, no doubt filled them with rage in this fight to the death called Saka. 26
Besides, Sati, Jauhar and Saka which were performed in defense of social values and
customs, there are umpteen stories in Purans and Vedas in which both men and women
voluntarily accepted death by immolating their mortal bodies by various means, including
fire. The power of yoga makes them oblivious of the pain of the decay of the mortal body.
V.G. Julie Rajan (1999)27 aptly writes: Hinduism does provide a means to end one’s own life
when faced with incurable illness and great pain that is fasting to death prayopavesa, under
strict community guidelines. Gandhi’s associate, Vinoba Bhave, died in this manner, as did
recently Swami Nirmalanand of Kerala. It is generally thought of as a practice of yogis, but is
acceptable for all persons. Prayopavesa is a rare option, one which the family and community
must support to be sure this is the desire of the person involved and not a result of untoward
pressures.28
Thus, Hinduism made the provision of self-willed death also. In his book ‘Merging with
Siva’ Satguru Sivaya Subramuniyaswami wrote about Hindu view of death in the following
words:
“Pain is not part of the process of death. That is the process of life, which results in
death. Death itself is blissful. You did not need any counselling. You intuitively know what’s
going to happen. Death is like a meditation, a Samadhi. That’s way it is called Maha (Great)
Samadhi”.
Jains, a leading religious and business community of India, claim same, or some time more
antiquity as Hinduism. They have an ancient custom called sallekhana or santhara, according
to this custom a person can take a vow not to drink or eat food till his last breath. Even in
modern India, it is reported that Jain resort to santhara in a sizable number. Gujrat, Rajasthan,
Maharashtra and Karnataka account for most santharas in the country. It is also to be
maintained that santhara is not the preserve of jain monks who have renounced worldly
affairs.
26
27
VG Julia Rajan (1999) “Controversy: Better Off Dead?” Hinduism Today, 07th September.
28
at 08.00 pm.
19
Another common misconception is that only people suffering from illness embrace the
practice. That’s not true. Santhara is taken up with a view to sacrifying attachments,
including one’s boby” Becides, women-men ratio of santhara practitioners stands at 60 : 40,
perhaps because women are generally more strong willed and have a religious bent of mind. 29
The cultural tradition of santhara among Jains is not an exception to its critics or opponents
who claim to be rationalists and humanists. In 2006 Human Rights activists Nikhil Soni and
his lawyers Madhav Mishra file a public Interest Litigation (PIL) with the High Court of
Rajasthan30. The PIL claimed that santhara was a social evil and should be cosidered to be
suicide under Indian legal statute. It also extended to those who facililated individuals taking
the vow of with aiding and abetting an act of suicide.
For the Jains, however, the courts or any other agency intervention in such case would be a
clear violation of the Indian Constitution’s guarantee of religion freedom. This landmark case
sparked dabate in India, where bioethics is a relatively new phenomenan. The defenders of
sallekhana or santhara argued that santhara has a religious context, whereas suicide, and
abetment to suicide fall in criminal context. Moreover, hunger strikes are a common form of
protest in India but often end with forced hospitalization and criminal charges. Besides, the
suicide is itself contentious, since it would punish only an unsuccessful attempt at suicide,
also punishable how far this provides deterrence is questionable. Lastly, suicide is usually
and outcome of acute mental depression followed by self-isolation a person may leave a
suicide note also.31 The act of suicide is instantaneous and not a prolonged ritual, where as in
santhara the person takes a vow not to have food or water and it is a slow process which
takes place admits the dear ones and other fallow co-religionists. Santhara is not practiced
with an intention to end one’s life but to end his own karmas and to achieve self purification
through act of renunciation of all worldly actions including food and water. In addition to it if
an individual feels he can continue or has a desire to live, an individual can break a vow 32.
Thus, santhara cannot be in any way considered as suicide. With sallekhana or santhara,
death is welcomed through a peaceful, tranquil process providing peace of mind for everyone
29
The Times of India (2010) “More Jains Embracing Ancient Santhara Ritual” Thursday, 18th March.
30
Times of India (2011) “Voluntary Death has Religious Nod” Tuesday, 8th March, New Delhi, pp. 14.
31
32
ibid
20
involved. In fact philosophically santhara can be rationalized by many angles and Jain
philosophers and religious leaders have actually done so. As regards the question of its
legality, it can be stated that like all religious practices the question cannot be decided on the
bases of rationality and law alone. At present it is not clear on what grounds and statistics,
santhara is to be held illegal.
Thus, the cultural heritage of Indian reflects a cultural ambivalence towards suicide and
euthanasia. In fact, it is important to make two observations here: First, that Sati, Jauhar or
Saka or Maha Samadhi by yogis or santhara among Jains is certainly more different than
euthanasia used in the modern sense. All societies including advance and developing
societies glorify the killing of enemies in a war and; secondly, the controversy over
euthanasia is of recent origin due to advancement of medical science and technology and
longevity. It is the product of almost last three or four decades.
In India the controversy gained momentum after the case of Venkatesh in 2004 33. In reality it
is related to medical context and socio-legal setting. Voluntary euthanasia and physician
assisted suicide have become the focal points. There appears no need of justifying them or
rationalizing or legalizing them on support of cultural history of India. Since the controversy
on legalizing euthanasia in India is of recent origin, it has to be resolved and settled with
reference to contemporary socio-medico-legal situation in India.
Contemporary Socio-Medico-Legal Scenario
If one looks at the contemporary Indian Society, one may certainly find it undergoing the
powerful and rapid cross currents of multi-dimensional processes of powers of social change.
It is engrossed in the process of development and modernization. Although it is a fact that its
solid edifice founded on age-old traditions of caste and religion is crumbling in the whirlpool
of change, yet it appears to be still strong enough to hold on.
Religion and caste still continue to provide main context for understanding contemporary
India. Society in India continues to be structured on the principle of social hierarchy and
33
21
precedent of group over the individual. In fact, contemporary Indian society appears to be
existing at multi level stage of civilization development simultaneously. At its apex there is a
layer advanced cosmopolitan and modern India. The elites of this layer dominate most of the
areas of social life i.e., political, industrial and beaurocratic.34
Then there is a second layer of developing India compromising of thousands of urbanizing

and back word villages reflecting the feudal systems still holding on caste community and
religion. The last layer may be identified as surviving at primitive level. There are millions of
people still illiterate. Stricken by abject poverty deprived of food, cloth and shelter, they are
still governed by the forces of customs. These layers are not interwoven in a smooth social
fabric. There exist a great hiatus among them reflecting an imbalanced kaleidoscopic scene.
The holistic reality of Indian society appears to be dismal. The society faces with a crisis of
degenerating values and character.
As regards the medical and health scenario of Indian society, it can be said that there has
been an impressive progress, the medical science and technology have made considerable
achievements. The process of immunization has contributed towards a lot in control of many
diseases like malaria, polio and smallpox which were considered to be deadly in the past.
Hence the annual death rate has been reduced and controlled. Medical facilities have
increased. The life expectancy (70 years) has also increased accordingly. The social problem
of the aged has emerged as an important problem. The medical science and technology in
India have now acquired life supporting system and medications to extend life artificially for
a long period even after the loss of brain activities and the control of bodily functions. It has
brought into relief issues which are altering the pattern of human living and societal values.
Pari passu with these changes is the upsurge of affirmation of human rights, autonomy and
freedom of choice.
These issues compel the revaluation of many social values and medical ethics. One of these
issues is that of dignified death and the related matter of legalization of euthanasia. Many
people have a fear today of being kept alive artificially by life support system with
consequent sufferings and distress to them and members of their family. 35 They may wish to
34
35
22
request the doctor to withhold or withdraw such treatment so that they may die with dignity
among their dear ones (voluntary passive euthanasia) or may request the doctor to give a
lethal dose to end their suffering (active euthanasia). Herein lies the origin of debate over the
issue of legalizing euthanasia in India.36
Opponents of euthanasia however, argue that Hippocratic Oath and International Code of
Medical Ethics insist that a doctor should alleviate the suffering and pain of his patients at all
costs. It does not make sense to consider ending the suffering of a person by putting an end to
the sufferer. The treatment of the severe headache is not the removal of the head but in
seeking ways of relieving the pain while keeping the head intact. Moreover, the disease
which is incurable today might become curable tomorrow.37
Thus, the medical situation in India does not provide an easy ground for resolution of the
issue of legalization of euthanasia. The rampant corruption in India and widening gap
between rich and poor and their accessibility of medical services make the problem more
enigmatic.
36
37
R.K.Bansal, S.Das, P.Dayal, (2005) “Death Wish” Journal of J K Science, Vol. 7, No.3, JulySept. pp. 169-171.
23
Legal Position
There is always prevailing the rival claims of the society and the individual and the question
lies that which claim should prevail. Mostly in the cases of health concerns, the claims of the
society prevail over the individual claim. But it has to be kept in mind while deciding that
which side should the balance bend that how will this decision affect the society and the
individual. In most of the health concerns, the whole society in gets affected, but here
individual himself and affect family are getting more influenced by such a decision.
Individual liberty is the hallmark of any free society. Thus, we should here consider the
rights which accrue to the individual in such cases.
The Constitution of India under Article 21 guarantees the right to every individual to live
with dignity. This is as a Fundamental Right bestowed upon every Indian by the Constitution
of India.
In India, euthanasia is absolutely illegal. If a doctor tries to kill a patient, the case will surely
fall under Section 300 of Indian Penal Code, 1860. but this is only so in the case of voluntary
euthanasia in which such cases will fall under the exception 5 to section 300 of Indian Penal
Code,1860 and thus the doctor will be held liable under Section 304 of Indian Penal
Code,1860 for culpable homicide not amounting to murder. Cases of non-voluntary and
involuntary euthanasia would be struck by proviso one to Section 92 of the IPC and thus be
rendered illegal. There has also been a confusion regarding the difference between suicide
and euthanasia. It has been clearly differentiated in the case Naresh Marotrao Sakhre v.
Union of India38, J. Lodha clearly said in this case. “Suicide by its very nature is an act of
self-killing or self-destruction, an act of terminating one’s own act and without the aid or
assistance of any other human agency. Euthanasia or mercy killing on the other hand means
and implies the intervention of other human agency to end the life. Mercy killing thus is not
suicide and an attempt at mercy killing is not covered by the provisions of Section 309. The
two concepts are both factually and legally distinct. Euthanasia or mercy killing is nothing
but homicide whatever the circumstances in which it is effected.” 39
38
1996 (1) BomCR 92
39
ibid
24
The question whether Article 21 includes right to die or not first came into consideration in
the case State of Maharashtra v. Maruti Shripathi Dubal40. It was held in this case by the
Bombay High Court that ‘right to life’ also includes ‘right to die’ and Section 309 was struck
down. The court clearly said in this case that right to die is not unnatural; it is just uncommon
and abnormal. Also the court mentioned about many instances in which a person may want to
end his life. This was upheld by the Supreme Court in the case P. Rathinam v. Union of
India41. However in the case Gian Kaur, it was held by the five judge bench of the Supreme
Court that the “right to life” guaranteed by Article 21 of the Constitution does not include the
“right to die”. The court clearly mentioned in this case that Article 21 only guarantees right
to life and personal liberty and in no case can the right to die be included in it.
By way of passive euthanasia, it is legal for doctors to withdraw life support to patients who
are in a permanent vegetative state, as per the landmark judgment in Aruna Shanbaug's case.
The law passed in the matter of Aruna Ramchandra Shanbaug v. The Union of India42, is a
landmark Judgment in respect to euthanasia in India.
The Honb'le Court opined in this case that "euthanasia is one of the most perplexing issues,
which the courts and legislatures all over the world are facing today."
The case in question was a writ petition filed under Article 32 of the Constitution that had
been filed on behalf of the Petitioner Aruna Ramachandra Shanbaug by one Ms. Pinki Virani
of Mumbai, claiming to be her next friend.
The Petitioner was a staff Nurse working in King Edward Memorial Hospital, Parel,
Mumbai. On the evening of 27th November, 1973 she was attacked by a sweeper in the
hospital who wrapped a dog chain around her neck and yanked her back with it in his attempt
to sexually assault her. Due to strangulation, the supply of oxygen to her brain stopped and
she suffered irreparable brain damage. 36 years had passed since the unfortunate incident and
the Petitioner, Aruna Ramachandra Shanbaug, had since then lived in a vegetative state.
40
1987 (1) BomCR 499
41
1994 AIR 1844
42
Aruna Ramchandra Shanbaug v. The Union of India, MANU/SC/0176/2011
25
The main premise of the Petition was that Aruna Ramachandra Shanbaug was found to be in
a persistent vegetative state (p.v.s.) and virtually dead having no sense of awareness, as she
was brain dead. There was absolutely no chance of her recovering and the only release she
had from her misery was by way of death.
The prayer of the Petitioner was that Aruna be allowed to die peacefully, i.e. by way of
passive euthanasia.
The case could have easily been dismissed in keeping with the law passed in an earlier
judgment in Gian Kaur v. State of Punjab43, wherein it was decided that the right to life as
guaranteed under Article 21 of the Constitution does not include the right to die. However,
the Court and Hon'ble Judges were struck by the unique needs of Aruna's case and re-opened
issues pertaining to the question of whether the right to die is included in the right to live.
After taking all the facts and contentions into account, as put up by the Petitioner and the
team of Doctors and Nurses who were caring for Aruna, the Hon'ble Court was of the view
that Aruna was definitely found to be in a permanent vegetative state. The question was
whether she should be denied food and nourishment in order to bring her to her death faster,
i.e. death by passive euthanasia.
This judgment passed in Aruna's case is considered to be a landmark judgment as it made

passive euthanasia legal India, but only under certain compelling circumstances and with the
sanction of the High Court. This landmark law sought to place the power of choice in the
hands of the individual, over government, medical or religious authorities for whom suffering
is seen as a person's "destiny" that must be accepted and cannot be changed.
To this end, the Supreme Court specified two irreversible conditions to permit Passive
Euthanasia Law in 2011, i.e.:
1. The brain-dead for whom the ventilator can be switched off;

2. Those in a Persistent Vegetative State (PVS) for whom the feed can be tapered out
and pain-managing palliatives be added, according to laid-down international
specifications.
43
1996 2 SCC 648
26
The judgment further prescribed a procedure to be followed in order to avoid any misuse or
abuse of the law. The Court observed that it could easily happen that people take undue
advantage of such a privilege to usurp property or to abuse those people who are unable to
fend for themselves.
So the Court proclaimed that when an application for euthanasia was 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. Before doing so the Bench should seek the opinion of a
committee of three reputed doctors to be nominated by the Bench after consulting such
medical authorities/medical practitioners as it may deem fit. The committee of three doctors
so nominated by the Bench should carefully examine the patient and also consult the record
of the patient as well as taking the views of the hospital staff and submit its report to the High
Court Bench. The High Court Bench shall also consult the State and close relatives like
parents, spouse, brothers/sisters etc. of the patient, and in their absence his/her next friend,
and supply a copy of the report of the doctor's committee to them as soon as it is available.
After hearing them, the High Court bench should give its verdict. The above procedure
should be followed all over India until Parliament makes legislation on this subject.
The Latest Law on Euthanasia
On 25th February, 2014, a law was passed by a five-judge bench constituted for the purpose
of providing a new set of guidelines on euthanasia. The court acted on a petition filed by an
NGO named Common Cause44, which argued in favour of the right to die with dignity. It was
stated that the procedure set in the Shanbaug verdict did not comply with Article 21 of the
Constitution, as the right to life guaranteed by the Article did not include the right to die with
dignity under the supreme law of the land. Despite this, the Supreme Court of India legalised
passive euthanasia under certain circumstances (as laid down a procedure for its working, as
is mentioned hereinabove).
On 7th March, 2018, the Supreme Court delivered a landmark judgment allowing “living
will” where, an adult in his conscious mind, is permitted to refuse medical treatment or
44
"Common Cause (A Regd. Society) v. Union of India – (2014) 5 SCC 338
27
voluntarily decide not to take medical treatment to embrace death in a natural way. In the
538-page judgment, the court laid down a set of guidelines for “living will” and defined
passive euthanasia and euthanasia as well.45
The court stated the rights of a patient would not fall out of the purview of Article 21 (right
to life and liberty) of the Indian Constitution.
The Bench comprising Chief Justice of India Dipak Misra and Justice A M Khanwilkar
defined advance medical directive. In case where an individual may not be in a position to
specify his wishes, an advance medical directive can be pursued by the individual exercising
his autonomy on the subject of the extent of medical intervention that he wishes to allow
upon his own body at a future date.
Defining advance medical directive, the bench said, “The purpose and object of advance
medical directive is to express the choice of a person regarding medical treatment in an
event when he loses the capacity to take a decision. The right to execute an advance medical
directive is nothing but a step towards protection of aforesaid right by an individual.”
These are the guidelines laid down by the top court:
 Who can execute the advance directive and how?
The advance medical directive can only be executed by an adult who is of a sound and
healthy state of mind and in a position to communicate, relate and comprehend the
purpose and consequences of executing the document.
It must be voluntarily executed and without any coercion or inducement or compulsion

and after having full knowledge or information. Consent of the individual is necessary
and it shall be in writing “stating as to when medical treatment may be withdrawn or no
specific medical treatment shall be given which will only have the effect of delaying the
process of death that may otherwise cause him/her pain, anguish and suffering and further
put him/her in a state of indignity.”
45
Retrieved from http://indianexpress.com/article/india/passive-euthanasia-now-legal-supreme-court-issues-
guidelines-for-living-will-5092082/, on 02/04/2018, at 07.00 pm.
28
 What should the written document contain?
It should clearly indicate the decision relating to the circumstances in which withholding
or withdrawal of medical treatment can be resorted to. Specific terms should be
mentioned and instructions must be absolutely clear and unambiguous. It should have a
clause stating that the executor may revoke the instructions/authority at any time.
The document should further disclose that the executor has understood the consequences
of executing such a document. Name of a guardian or a close relative should be specified
in the event where the executor becomes incapable of taking a decision. The said
guardian or close relative will be authorized to give consent to refuse or withdraw
medical treatment in a manner consistent with the Advance Directive.
The guidelines further directs to record and preserve the document. Signed by the executor in
the presence of tow attesting witnesses and countersigned by the jurisdictional Judicial
Magistrate of First Class (JMFC) appointed by the District judge. Adding on, one copy of the
document would be preserved by the JMFC in his office, in hard copy and digital form,
another would be forwarded to the Registry of the jurisdictional District Court, another copy
would be handed over to the competent officer of the local Government or the Municipal
Corporation or Municipality or Panchayat and the fourth copy would be given to a family
physician, if any.
Detailed pointers have been set in case the executor becomes terminally ill, in which case,
the instructions in the document must be given due weight by the doctors. A Medical Board
would be constituted by the hospital or the physician where, the executor is admitted.
In case permission to withdraw medical treatment is refused by the Medical Board, it would
be open to the executor of the Advance Directive or his family members or even the treating
doctor or the hospital staff to approach the High Court by way of writ petition under Article
226 of the Constitution.
The individual has been provided with the right to withdraw or alter the Advance Directive
as well. The court also drew a scenario in the event of the absence of an Advance Directive.
29
In such a case, a Hospital Medical Board would be constituted where the individual is
admitted.
If the patient is terminally ill and undergoing prolonged treatment in respect of ailment which
is incurable or where there is no hope of being cured, the physician may inform the hospital
which, in turn, shall constitute a Hospital Medical Board.
On the subject of administration of a lethal drug, the court held that “no one is permitted to
cause death of another person including a physician by administering any lethal drug even if
the objective is to relieve the patient from pain and suffering”.
The top court also reiterated from Gian Kaur’s case that the right to life does include right to
live with human dignity which would mean, “the existence of such right up to the end of
natural life, which also includes the right to a dignified life upto the point of death including
a dignified procedure of death.”
To sum it up, as on date, the law in India dictates that only passive euthanasia is legal in
India and that too only under certain conditions, when the procedure prescribed by law is
followed.
30
RELIGION & SPIRITUALITY
Euthanasia allows a terminally ill patient to hasten an inevitable and unavoidable death.
While many faith traditions adhere to ancient traditions and understandings of physical life’s
final journey, modern medical technology has opened the door for faith leaders to actively
reconsider some beliefs.
It offer dying individuals an opportunity to ponder an important final life question: “What is
the meaning of my life?” For many, this is a profoundly spiritual question to which answers
come, not when an individual is consumed by a flurry of doctor’s appointments, treatments
or tests, but in the comfort of solitude when an individual feels at peace. 46
Roman Catholic
The official position of the Roman Catholic Church is strict: the killing of a human being,
even by an act of omission to eliminate suffering, violates divine law and offends the dignity
of the human person. However, many Catholics - particularly in the United States - cite
various quotations by Pope Benedict XVI as a source for continued disagreement and
controversy regarding these controversial issues.47
To compound confusion, physician-assisted dying is frequently and erroneously

considered euthanasia:
o “Freedom to kill is not a true freedom but a tyranny that reduces the human
being into slavery.”
o “Scripture, in fact, clearly excludes every form of the kind of self-
determination of human existence that is presupposed in the theory and practice
of euthanasia.”
46
at 08.00 pm.
47
U.S. Conference of Catholic Bishops. 2012. “Assisted Suicide and Euthanasia: Beyond Terminal Illness.” (PDF)
31
o “Not all moral issues have the same moral weight as abortion and euthanasia.
For example, if a Catholic were to be at odds with the Holy Father on the
application of capital punishment or on the decision to wage war, he would not
for that reason be considered unworthy to present himself to receive Holy
Communion.”
o “While the Church exhorts civil authorities to seek peace, not war, and to
exercise discretion and mercy in imposing punishment on criminals, it may still
be permissible to take up arms to repel an aggressor or to have recourse to
capital punishment. There may be a legitimate diversity of opinion even among
Catholics about waging war and applying the death penalty, but not however
with regard to abortion and euthanasia.”
Pope Francis, despite being considered more liberal than past popes, has continued
statements against physician-hastened death, stating that the practice is “false compassion”
and a result of our “throwaway culture” that devalues and dehumanizes the sick. Catholic
organizations are often in the lead in organizing against Death with Dignity laws or ballot
initiatives.48
Eastern Orthodox49
Physician assisted dying is morally and theologically impermissible because of God’s

sovereignty and the sanctity of human life. “Death is seen as evil in itself, and symbolic of all
those forces which oppose God-given life and its fulfillment. Salvation and redemption are
normally understood in Eastern Christianity in terms of sharing in Jesus Christ’s victory over
death, sin and evil through His crucifixion and His resurrection. The Orthodox Church has a
very strong pro-life stand which in part expresses itself in opposition to doctrinaire advocacy
of euthanasia.”
Evangelical
48
Priests for Life. “Brief Reflections on Euthanasia.”; http://www.pewforum.org/2013/11/21/religious-groups-views-on-
end-of-life-issues/
49
at 08.00 pm.
32
While the National Association of Evangelicals (NAE) opposes physician-assisted dying, the
NAE “believes that in cases where patients are terminally ill, death appears imminent and
treatment offers no medical hope for a cure, it is morally appropriate to request the
withdrawal of life-support systems, allowing natural death to occur. 50 In such cases, every
effort should be made to keep the patient free of pain and suffering, with emotional and
spiritual support being provided until the patient dies.”
Buddhist51
The teachings of the Buddha don’t explicitly deal with aid in dying, but the Buddha himself
showed tolerance of suicide by monks in two cases. Buddhists are not unanimous in their
view of physician-assisted dying. The Japanese Buddhist tradition includes many stories of
suicide by monks; suicide was used as a political weapon by Buddhist monks during the
Vietnam War.
In Buddhism, the way life ends has a profound impact on the way the new, reincarnated life
will begin. So a person’s state of mind at the time of death is important: their thoughts should
be selfless and enlightened, free of anger, hate or fear. This suggests that suicide is only
appropriate for people who have achieved enlightenment and that the rest of us should avoid
it.
Hindu
There are several Hindu points of view on physician aid in dying. Most Hindus would say
that a doctor should not accept a patient’s request for death since this will cause the soul and
body to be separated at an unnatural time. The result will damage the karma of both doctor
and patient. Other Hindus believe that physician-hastened dying cannot be allowed because it
breaches the teaching of ahimsa (doing no harm). However, some Hindus say that by helping
50
ibid
51
Keown, D. 2005. “End of Life: The Buddhist View.” The Lancet, volume 366, pages 952-955. (PDF)
33
to end a painful life a person is performing a good deed and fulfilling their moral
obligations.52
Jainism
Jains believe that the soul has always been here and cannot be destroyed and that through the
process of death, one transitions to a new body. The Jain tradition shows how we can move
without attachment into death rather than clinging to life. In their acceptance of the
inevitable, Jains set an example that death is not an evil but an opportunity to reflect on a life
well-lived and look forward to what lies ahead. Fasting to death is a key religious observance
for Janists; those at the end of life can choose to embrace a final fast transition from one body
to another.53
Judaism
Under Jewish law, the directive to preserve human life generally outweighs other
considerations, including the desire to alleviate pain and suffering. Judaism teaches that life
is a precious gift from God. A person’s life belongs to God, he says, and therefore deciding
when it ends should be left to God.
All three major Jewish movements in the United States – Orthodox, Conservative and
Reform – prohibit suicide and assisted suicide, even in cases of painful, terminal illnesses.
“There are some minority views – that suicide might be permissible in rare, certain
circumstances – but the majority view among all [movements] is that it’s not permissible to
take one’s own life under any circumstances”.54
At the same time, Jewish teachings do allow a person to forgo medical treatment if that
person’s life is about to end and if he or she is suffering. “Jewish thinkers are pretty united in
52
at 08.00 pm.
53
54
BBC. 2009. “Euthanasia and suicide.”
Rosner, F. “Euthanasia: Jewish Biblical and Rabbinic Sources.” MyJewishLearning.com.
34
believing that a person who is near the end of [life] can stop treatment,” he says. “If that
treatment is just going to give another month or two of life, and if that time is just going to
bring more suffering, most Jewish rabbis and philosophers would say no one is required to
endure that.”
According to Jewish teachings, doctors and caregivers should not do anything to hasten death
and generally must work to keep people alive as long as possible.
Islam
Muslims are against physician-assisted dying. They believe that all human life is sacred
because it is given by Allah, and that Allah chooses how long each person will live. Human
beings should not interfere in this. This end-of-life option is, therefore, forbidden. Physicians
must not take active measures to terminate a patient’s life. The Qur’an states: “Take not life
which Allah made sacred otherwise than in the course of justice”
An essay on the web page of the Islamic Center of Southern California states that “Since we
did not create ourselves, we do not own our bodies…Attempting to kill oneself is a crime in
Islam as well as a grave sin. The Qur’an says: ‘Do not kill (or destroy) yourselves, for verily
Allah has been to you most Merciful.’ (Quran 4:29)…The concept of a life not worthy of
living does not exist in Islam.”55
Sikhism
The Sikhs rejected suicide (and by extension, euthanasia) as an interference in God’s plan.
Suffering, they said, was part of the operation of karma, and human beings should not only
accept it without complaint but act so as to make the best of the situation that karma has
given them. This is not absolute. Sikhism believes that life is a gift from God, but it also
teaches that we have a duty to use life in a responsible way. Therefore Sikhs contemplating
55
Aramesh, K., and Shadi, H. 2007. “Euthanasia: An Islamic Ethical Perspective.” Iranian Journal of Allergy, Asthma and
Immunology, volume 6, supplement 5, pages 35-38.
35
hastening their own or another person’s death should look at the whole picture, and make
appropriate distinctions between ending life and not artificially prolonging a terminal state. 56
Spiritualist
Through their Life and Death with Dignity policy, National Spiritualist Association of
Churches “affirms the right of each individual to determine for self, or through a guardian the
extent through which the medical community or family may interfere with the treatment of a
terminal, or irreversible condition, by the use of Living Wills, Advanced Directive and
Durable Power of Attorneys, available in all states in various form. We as Spiritualists are
bound to follow the law. If we, as individuals, would have the current laws changed or
extended beyond their present scope, it is our individual right to work for this through the
proper channels.”57
56
57
ibid
36
THE ONGOING DEBATE
The debate about the legalization of active steps to intentionally end life as a means to end
suffering remains controversial. Many people feel that euthanasia is no better than murder
and think that it should most definitely be illegal whereas others think that euthanasia is
acceptable and that it stops unnecessary suffering of terminally ill persons and can have
agreement to the legalization of euthanasia. People who advocate euthanasia agree that
euthanasia would be used only for those who are terminally ill but there are many definitions
of the word ‘terminal’. Others believe that euthanasia is also against one of the basic concept
of morality, that is killing is wrong. It is against religious beliefs, legal traditions and medical
ethics.58 It is also a rejection of the importance and value of human life.
Views against Euthanasia
 It may be pain and depression instead of a sane mind that makes people ask for
euthanasia.
 It may be misused to eliminate people.
 A disease incurable today may be curable tomorrow. In the age of new
technologies and discoveries in medicine, an issue has arisen over whether a
person on life-support, respirators, and feeding tubes has right to live or die.
Views in favor of Euthanasia
 Being the sole custodian of one’s life, one has the right to end his life when he
wishes: It is generally accepted that as an expression of autonomy i.e. one’s
right to make independent choices without any external influences, a competent
adult can refuse medical treatment, even in situations where this could result in
his/her death. For instance where a person has been totally incapacitated
physically and mentally who does the decision making for him. Much of the
pro-euthanasia argument is based on a commitment to the notion of personal
autonomy. Yet people with disabilities, those suffering from chronic physical
58
37
or mental pain or otherwise vulnerable are more susceptible to the power of
suggestion and therefore less autonomous. Proponents argue that euthanasia
allows terminally ill people to die with dignity and without pain and state that
society should permit people to opt for euthanasia if they so wish. Proponents
also state that individuals should be free to dictate the time and place of their
own death. Finally, proponents argue that forcing people to live against their
wishes violates personal freedoms and human rights and that it is immoral to
compel people to continue to live with unbearable pain and suffering.
 Helping some die (to relieve pain and suffering) does not amount to murder.
 It would help by reducing unnecessary financial burden.
Opponents of euthanasia, on religious grounds, argue that life is a gift from God and
that only God has the power to take it away. Others contend that individuals don’t get to
decide when and how they are born; therefore, they should not be allowed to decide how and
when they die. They also raise concerns that allowing euthanasia could lead to an abuse of
power where people might be euthanized when they don’t actually wish to die.
It has been argued that permitting euthanasia could diminish respect for life. Concerns have
been raised that allowing euthanasia for terminally ill individuals who request it, could result
in a situation where all terminally ill individuals would feel pressurized into availing of
euthanasia. There are fears that such individuals might begin to view themselves as a burden
on their family, friends and society or as a strain on limited healthcare resources. Opponents
of euthanasia also contend that permitting individuals to end their lives may lead to a
situation where certain groups within society e.g. the terminally ill, severely disabled
individuals or the elderly would be euthanized as a rule.59
59
at 08.00 pm.
38
PROS AND CONS OF EUTHANASIA
Importance of pros and cons of euthanasia: Is mercy killing humane? Do we have the right to
assess whether a life is worth living? Should euthanasia be practiced for terminally ill people
only or even for the debilitated and mentally ill too?
Euthanasia also known as mercy killing is a way of painlessly terminating one’s life with the
“humane” motive of ending his suffering. Euthanasia came into public eye recently during
the Terri Schiavo controversy where her husband appealed for euthanasia while Terri’s
family claimed differently.60 This is a classical case shedding light on the pros and cons of
mercy killing. Albania, Belgium, Netherlands, Oregon, Switzerland and Luxembourg are
some places where euthanasia or assisted suicide has been legalized. Let’s have a look at the
arguments that will help us understand the reasoning for/against mercy killing.
Pro-euthanasia Argument Legalizing euthanasia would help alleviate suffering of

terminally ill patients. It would be inhuman and unfair to make them endure the unbearable
pain. In case of individuals suffering from incurable diseases or in conditions where effective
treatment wouldn’t affect their quality of life; they should be given the liberty to choose
induced death. Also, the motive of euthanasia is to “aid-in-dying” painlessly and thus should
be considered and accepted by law. Although killing in an attempt to defend oneself is far
different from mercy killing, law does find it worth approving. In an attempt to provide
medical and emotional care to the patient, a doctor does and should prescribe medicines that
will relieve his suffering even if the medications cause gross side effects. 61 This means that
dealing with agony and distress should be the priority even if it affects the life expectancy.
Euthanasia follows the same theory of dealing with torment in a way to help one die
peacefully out of the compromising situation. Euthanasia should be a natural extension of
patient’s rights allowing him to decide the value of life and death for him. Maintaining life
support systems against the patient’s wish is considered unethical by law as well as medical
philosophy. If the patient has the right to discontinue treatment why would he not have the
60
61
113-176.
39
right to shorten his lifetime to escape the intolerable anguish? Isn’t the pain of waiting for
death frightening and traumatic? Family heirs who would misuse the euthanasia rights for
wealth inheritance does not hold true. The reason being even in the absence of legalized
mercy killing, the relatives can withdraw the life support systems that could lead to the early
death of the said individual. This can be considered as passive involuntary euthanasia.
Here they aren’t actively causing the death, but passively waiting for it without the patient’s
consent. It can be inferred that though euthanasia is banned worldwide, passive euthanasia
has always been out there which can also be called as passive killing and moreover law
doesn’t prohibit it. Disrespect and overuse of (passive) euthanasia has always existed and
will be practiced by surrogates with false motives. 62 These are the ones who don’t need a law
to decide for one’s life. Present legal restrictions leave both the incurable patients as well as
pro euthanasia activists helpless who approve euthanasia as good will gesture for patient’s
dignity.63 Health care cost is and will always be a concern for the family irrespective of
euthanasia being legalized.
Cons of Euthanasia Argument Mercy killing is morally incorrect and should be forbidden
by law. It is a homicide and murdering another human cannot be rationalized under any
circumstances. Human life deserves exceptional security and protection. Advanced medical
technology has made it possible to enhance human life span and quality of life. Palliative
care and rehabilitation centers are better alternatives to help disabled or patients approaching
death live a pain-free and better life. Family members influencing the patient’s decision into
euthanasia for personal gains like wealth inheritance is another issue.
There is no way you can be really sure if the decision towards assisted suicide is voluntary or
forced by others. Even doctors cannot predict firmly about period of death and whether there
is a possibility of remission or recovery with other advanced treatments. So, implementing
euthanasia would mean many unlawful deaths that could have well survived later. Legalizing
euthanasia would be like empowering law abusers and increasing distrust of patients towards
62
ibid
63
40
doctors.64 Mercy killing would cause decline in medical care and cause victimization of the
most vulnerable society. Would mercy killing transform itself from the “right to die” to
“right to kill”?
Apart from the above reasons, there are some aspects where there is a greater possibility of
euthanasia being mishandled. How would one assess whether a disorder of mental nature
qualifies mercy killing? What if the pain threshold is below optimum and the patient
perceives the circumstances to be not worthy of living? How would one know whether the
wish to die is the result of unbalanced thought process or a logical decision in mentally ill
patients? What if the individual chooses assisted suicide as an option and the family wouldn’t
agree?
64
41
PSYCHOLOGICAL, MEDICAL AND ETHICAL ISSUES
Relation between psychological factors, mental illness and euthanasia:
Emotional and coping responses to life-threatening illness may include a strong sense of
shame, feelings of not being wanted, and/or inability to cope. Adjustment to the loss of
previous function, independence, control, and/or self-image may be difficult. Each change
may lead to tensions within relationships that further increase isolation and misery. A host of
physical issues may accompany advanced illness. These may include pain, breathlessness,
anorexia/cachexia, weakness/fatigue, nausea/vomiting, constipation, dehydration, edema,
incontinence, loss of function, sleep deprivation, etc. Their presence, particularly if they are
unmanaged for long periods, may markedly increase suffering. The prevalence of mental
disorders, being strongly associated with an increased risk of suicidal behavior, also increases
as the primary location of the disorder or dysfunction moves closer to the brain. Depression
is the most common psychiatric disorder in the elderly. Despite it being a treatable condition
little is understood about the improvement with medication, drug adherence and the follow
up in treatment seeking elderly with depression. It has been suggested that the key to
preventing suicide is not in the study of the brain, but in the direct study of the human
emotions.
a. Psychological Sectors and Euthanasia: Not surprisingly, it is concluded that

desire for death among patients with terminal illnesses was likely a product of
depression. Several methodological issues limit the conclusiveness of these
findings. Most importantly, the diagnosis of depression was based on the same
clinical interviews in which patients expressed their thoughts of suicide or
interest in hastened death. “Depression is associated with poorer will to live
and greater desire for a hastened death”. Symptoms may include wish for
death-Feelings of worthlessness, uselessness, guilt and the belief that one is a
“burden” are common, agitation, brooding, preoccupation with thoughts of
death or suicide, difficulty thinking and concentrating, May affect capacity to
make decisions and lower resistance to outside pressure. In cancer patients with
about 3 months of life expectancy, depression was associated with requests for
euthanasia. Elderly people, especially those with dementia are equally likely to
42
be regarded as “better off dead” in Holland, whether or not they are in a
position to actively request euthanasia. People with “mental suffering” and no
physical illness have also been put to death in Holland.
b. Psychiatry and Euthanasia: The two places in the world where mercy killing
is legalized are the state of Oregon in USA and the Netherlands. The latter has
also approved of euthanasia and PAS for mentally ill patients. The laws
pertaining to euthanasia and physician assisted suicide (PAS) in both places do
not make psychiatric assessment of patients mandatory. The concerned patient
is sent for psychiatric assessment only if the physician in charge of the patient
feels that the patient may be psychiatrically ill.65
The Dutch guidelines for the termination of life of mentally ill require an
opinion from an independent psychiatrist about the incurable nature of the
illness from a prognostic point of view. However, given the current
understanding of mental illnesses nobody can truly claim the curability of any
severe mental illness such as schizophrenia, schizoaffective disorder, bipolar
affective disorder and obsessive compulsive disorder. All these illnesses are
treatable to the point of sustained remission under prophylactic medication, but
curability remains a dream.66
On the other hand, the boom in psychopharmacology has astonished the
psychiatrists and the critics of psychiatry alike, with its ability to bring about
improvement in some chronically ill patients who were resistant to all kinds of
interventions given earlier. Thus nobody can predict with any degree of
reliability that a particular patient will not improve in the future. Other issues
that complicate the Dutch guidelines include the approach of psychiatrists
towards treatment. (psychopharmacological vs psychotherapeutic), lack of
guidelines regarding length of treatment before patient’s wish is acted upon,
issues related to countertransference enactment and the professional esteem of
psychiatry. Assisting in suicide of mentally ill can send a pernicious message to
65
66
Filiberti, G. P., and Finlay, I. (1997). The incidence of suicide in palliative care patients. Palliative Medicine; 11, 313–
316.
43
those fighting against the mental illnesses. At the same time it will lead to a
slippery slope, recovery from where will be almost impossible.67
c. Medical issues: On a purely medical level, it is often argued that mental
disorders are distinct from somatic disorders, and that the reasoning and
practice adopted in somatic medicine should not therefore be simply applied in
psychiatry. This argument is supported by the fact that the causes and
psychopathology of mental disorders are often poorly understood and
multifactorial.68
d. Ethical issues: The largest part of the discussion surrounds ethical issues. The
first counter-argument against assistance with suicide in patients suffering
primarily from a mental disorder is that one of the psychiatrist’s basic
responsibilities is to advocate for the vulnerable, disabled and infirm in our
society and, when necessary, to protect them from themselves or others. A
classic manifestation of this task is the prevention of suicide. Assistance with
suicide provided by the psychiatrist implies an attitude that is radically opposed
to that medical goal.69 Another important argument concentrates on the
ambiguous notion of mental illness itself. If patients suffer in their environment
and develop a mental disorder, it is difficult to ascertain whether the mental
disorder and suffering are solely a natural reaction to an intolerable and/or
hostile environment, or whether genuine mental disorder has ensued.
67
113-176.
68
ibid
69
44
CONCLUSIONS & SUGGESTIONS
To sum up, the researcher concludes that it is well accepted fact the after all, each and every
one of us will have to die one day, later the better obviously. Current research findings have
indicated that an emergence of terminal illness is commonly experienced as having a
devastating effect on patient’s lives and that patient feels loss of control and independence. In
addition they fear being a burden to their families, experiencing emotional or physical pain,
eating disorder patients are ambivalent over changing their eating patterns and sometimes
feel not ready or able to change. An extremely ill and doesn’t want to continue suffering,
should he/she be forced to stay alive. However, there is a paucity of studies investigating the
maintaining factors of the disorder. It is emphasized to increase effort to provide continuity
of care. Presented research study plan might be effectively used to evaluate community
functioning.
Euthanasia literally means “good death”. It is basically to bring about the death of a
terminally ill patient or a disabled. It is resorted to so that the last days of a patient who has
been suffering from such an illness which is terminal in nature or which has disabled him can
peacefully end up his life and which can also prove to be less painful for him. Thus the basic
intention behind euthanasia is to ensure a less painful death to a person who is in any case
going to die after a long period of suffering. Euthanasia is also popularly known as ‘mercy
death’ as it is given to lessen the pain of the patient. Euthanasia is practiced so that a person
can live as well as die with dignity. Euthanasia ("good death" ) is the practice of terminating
the life of a terminally ill person or animal in a painless or minimally painful way, for the
purpose of limiting suffering.
Euthanasia is the idea of intentional killing by act or omission of a dependent human being
for his or her alleged benefit. It is categorized in different ways, which include voluntary,
non-voluntary, or involuntary. Voluntary euthanasia is legal in some countries. Non-
voluntary euthanasia (patient's consent unavailable) is illegal in all countries. Involuntary
euthanasia (without asking consent or against the patient's will) is also illegal in all countries
and is usually considered murder.
45
Death is one of the most important things that religions deal with. All faiths offer meaning
and explanations for death and dying; all faiths try to find a place for death and dying within
human experience. So it's not surprising that all faiths have strong views on euthanasia. Most
religions disapprove of euthanasia. Some of them absolutely forbid it. The Roman Catholic
Church, for example, is one of the most active organisations in opposing euthanasia.
Religions are opposed to euthanasia for a number of reasons: God has forbidden it, Human
life is sacred, Human life is special, etc.
Some Eastern religions take a different approach. The key ideas in their attitudes to death are
achieving freedom from mortal life, and not-harming living beings. Euthanasia clearly
conflicts with the second of these, and it interferes with the first. Hinduism and Buddhism
see mortal life as part of a continuing cycle in which we are born, live, die, and are reborn
over and over again. Jainism is based on the principle of non-violence (ahinsa) and
recommends voluntary death or sallekhana for both ascetics and srāvaka (householders) at
the end of their life. Sallekhana (also known as Santhara, Samadhi-marana) is made up of
two words sal (meaning 'properly') and lekhana, which means to thin out. A person is
allowed to fast unto death or take the vow of sallekhana only when certain requirements are
fulfilled. It is not considered suicide as the person observing it, must be in a state of full
consciousness. The process is still controversial in parts of India. Estimates for death by this
means range from 100 to 240 a year.
Furthermore, it is well-established that the presence of dysfunctional cognitions indicates a

vulnerability to psychopathology and bears strong relationships with psychological distress.
Psychiatric co-morbidity should be taken in to account when complicated treatments like
anti-retroviral drugs are required. It is equally important to treat these conditions in order to
achieve better compliance in the treatment, something that is crucial in conditions like HIV.
The given pharmacological intervention ameliorated the patient’s mental illness and
contributed to his ongoing compliance regarding the HIV associated drugs. It is important to
examine the thoughts, feelings and attitudes we have regarding death and dying, to see
whether or not they are realistic and healthy. As mentioned above, when people approach
death they will at times experience disturbing emotions such as fear, regret, sadness, clinging
46
to the people and things of this life, and even anger. They may have difficulty coping with
these emotions, and may find themselves overwhelmed, as if drowning in them.
If we carefully examine the opposition to the legalization of euthanasia, we can conclude that
the most important point that the opponents raise is that it will lead to its misuse by the
doctors. Thus, it is humbly submitted that when a patient or his relatives can willingly put his
life in the hands of the doctor trusting him, then why can’t a doctor be given such discretion
to decide what will be in favour of his patient. Another doubt that is often raised is that if the
doctors will be given discretion to practice voluntary euthanasia then surely it will gradually
lead to asking for involuntary or non-voluntary euthanasia. But it is humbly submitted that a
separate legislation should be made allowing only voluntary euthanasia and not involuntary
or non-voluntary euthanasia. As has already been pointed out earlier, we also have to keep in
mind the limited medical facilities available in India and the number of patients.
This question still lies open that who should be provided with those facilities; a terminally ill
patient or to the patient who has fair chances of recovery. As the patient himself out of his
pain and agony is asking for death, doctor should not increasing that pain of his should allow
euthanasia. It has been ruled in the Gian Kaur case that Article 21 does not include right to
die by the Supreme Court.
But one may try to read it as is evident in the rights of privacy, autonomy and self-
determination, which is what has been done by the Courts of United State and England. Thus,
we can see that as the said right has been included in the ambit of Article 21, so this can also
be included in Article 21. This question was not raised in the case earlier. Again the point
that remains unanswered is regarding the abuse of this right by the doctors. But relevant
safeguards can be put on this right and thus its abuse can be avoided.
47
BIBLIOGRAPHY
 Dowbiggin, I. (2003). A merciful end: the euthanasia movement in modern

America. Oxford University Press.
 Foley, K. (1995). Pain, physician assisted suicide & euthanansia. Pain Forum.
 Hendin, H. & Klerman, G. (1993). Physician assisted suicide: The danger of
legalization. American Journal of Psychiatry.
 Lafollette, H. (2002). Ethics in practice: an anthology. Oxford: Blackwell.
 Mannes, M. (1975). Euthanasia vs. the Right to Life. Baylor Law Review 27.
 Otani, I. (2010). 'Good Manner of Dying' as a Normative Concept: 'Autocide',
'Granny Dumping' and Discussions on Euthanasia/Death with Dignity in Japan.
International Journal of Japanese Society.
 Wreen, M, (1988). The Definition of Euthanasia. Philosophy and
Phenomenological Research, UK.
 www.repository.law.indiana.edu
 www.sanjuan.edu
 digitalcommons.law.yale.edu
 www.legalserviceindia.com
48

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CHANAKYA NATIONAL LAW

PROJECT WORK OF HEALTH LAW

“EUTHANASIA & RIGHT TO FREEDOM OF

Submitted to :- Mr. Kr. Gaurav (Faculty of Health Law)

Submitted by :- Kumar Shiv Sidharth

I thank all of them !

Kr. Shiv Sidharth

MEANING AND HISTORY OF EUTHANASIA

1. Voluntary euthanasia: Euthanasia conducted with the consent of the patient is

In the project, the researcher aims

 To study the origin and acceptability of euthanasia.

 Whether euthanasia is permitted & acceptable by different religious practices?

Euthanasia: Illegal Physician-Assisted Suicide: Illegal

In Switzerland, there is an unusual position regarding assisted suicide. Even non-

Euthanasia: Legal since 2002 Physician-Assisted Suicide: Legal since 2002

Euthanasia: Illegal Physician-Assisted Suicie: Legal since 1751

Euthanasia: Illegal Physician-Assisted Suicide: Illegal

Euthanasia: Illegal Physician-Assisted Suicide: Illegal

China and Hong Kong

Euthanasia: Illegal Physician-Assisted Suicide: Illegal

Euthanasia: Illegal Physician-Assisted Suicide: Illegal

Reflection from Cultural and Historical Heritage of India

Contemporary Socio-Medico-Legal Scenario

Then there is a second layer of developing India compromising of thousands of urbanizing

This judgment passed in Aruna's case is considered to be a landmark judgment as it made

1. The brain-dead for whom the ventilator can be switched off;

The Latest Law on Euthanasia

These are the guidelines laid down by the top court:

 Who can execute the advance directive and how?

It must be voluntarily executed and without any coercion or inducement or compulsion

To compound confusion, physician-assisted dying is frequently and erroneously

Physician assisted dying is morally and theologically impermissible because of God’s

Views against Euthanasia

Views in favor of Euthanasia

Pro-euthanasia Argument Legalizing euthanasia would help alleviate suffering of

Relation between psychological factors, mental illness and euthanasia:

a. Psychological Sectors and Euthanasia: Not surprisingly, it is concluded that

Furthermore, it is well-established that the presence of dysfunctional cognitions indicates a

 Dowbiggin, I. (2003). A merciful end: the euthanasia movement in modern

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