Euthanasia comes from Greek word

meaning “good or pleasant death”. It implies

that under some circumstances a person may
prefer death to life.
Euthanasia means mercy killing is a topic
surrounded by controversy. There is no
agreement on whether death is ever
preferable to life or on what constitute
euthanasia.
 Euthanasia:- Greek for “Good death;” has
evolved to mean the intentional killing by act
or omission of a dependent human being for
his or her alleged benefit.
 Euthanasia may be classified according to
whether a person gives informed consent
into three types:
 Voluntary,
 Non-voluntary
 Involuntary irrespective of intent or the
patient's circumstances.
 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.
 When the patient brings about his or her
own death with the assistance of a physician,
the term assisted suicide is often used
instead.
 Non-voluntary euthanasia:- Euthanasia
conducted where the consent of the patient
is unavailable is termed non-voluntary
euthanasia. Euthanasia conducted where the
patient is unconscious is normally called non-
voluntary euthanasia.
 Examples include child euthanasia, which is
illegal worldwide but decriminalised under
certain specific circumstances in the
Netherlands.
 Involuntary euthanasia:- Euthanasia
conducted against the will of the patient is
termed involuntary euthanasia.
 Voluntary, non-voluntary and involuntary
euthanasia can all be further divided into:
 Passive Euthanasia
 Active Euthanasia

A number of authors consider these terms to

be misleading and unhelpful.
 Passive euthanasia (Euthanasia By
Omission):- Intentionally causing death by
not providing necessary and ordinary (usual
and customary) care or food and water.
 Passive euthanasia entails the withholding of
common treatments, such as antibiotics,
necessary for the continuance of life.
 Active euthanasia (Euthanasia By
Action):- Intentionally causing a person's
death by performing an action such as by
giving a lethal injection.

 Active euthanasia entails the use of lethal

substances or forces, such as administering
a lethal injection, to kill and is the most
controversial means.
 It provides a way to relieve extreme pain
 It provides a way of relief when a person's
quality of life is low.
 Frees up medical funds to help other people
 It is another case of freedom of choice
 Euthanasia devalues human life.
 Euthanasia can become a means of health
care cost containment.
 Physicians and other medical care people
should not be involved in directly causing
death.
 There is a "slippery slope" effect that has
occurred where euthanasia has been first
been legalized for only
the terminally ill and later laws are changed
to allow it for other people or to be done
non-voluntarily.
 Laws around the world:
o There are few countries around the world in
which euthanasia is legal. There are just 3
countries in Europe where it is:
 Belgium,
 Netherlands and
 Switzerland.
Britain
At present, all forms of euthanasia is illegal
in this country. Suicide is legal but assisted
suicide is not.

New Zealand
Two attempts have been made in the
Parliament passing Bills to legalize it, but
euthanasia remains illegal in New Zealand.
 Passive euthanasia is legal in India. On 7
March 2011, the Supreme Court of India
legalised passive euthanasia by means of the
withdrawal of life support to patients in a
permanent vegetative state.
 The decision was made as part of the verdict
in a case involving Aruna Shanbaug, who has
been in a vegetative state for 37 years at
King Edward Memorial Hospital.
 The high court rejected active euthanasia by
means of lethal injection. In the absence of
a law regulating euthanasia in India, the
court stated that its decision becomes the
law of the land until the Indian parliament
enacts a suitable law.
Active euthanasia, including the
administration of lethal compounds for the
purpose of ending life, is still illegal in
India, and in most countries.
 As per the Supreme Court’s view, passive
voluntary Euthanasia can be visualized as a
fundamental right protected by Article 21
of the Indian Constitution, which assures
the right to privacy, since right to privacy
can be said to encompass the right of a
patient to refuse life saving medical
treatment.
 In other words, the right to ‘personal
liberty’ as guaranteed by Article 21 of the
Constitution includes the freedom to die
with dignity.
Active Euthanasia (voluntary or otherwise)
is of course unambiguously viewed as a
crime though convictions have not been
brought so for against any individual in
India for the commission of such an
‘offence’ 25.
 Ethics are the principles or morals in which a
person uses. Euthanasia includes the many
rights of a person which conflict with one
another.
 Therefore, as a result of several conflicting
issues, euthanasia is an ethical issue.
 Christianity: the arguments against
Euthanasia:
 Life is a gift from God that should not be
destroyed.
 God is in everyone and every living thing. If
you harm a living thing, you harm God.
 Hindu beliefs on Euthanasia:
 Anyone who helps someone to die would be
damaging their own and the other person’s
karma. Euthanasia goes against the belief of
Ahimsa. Ending the life of someone going
through great pain is helping them and
therefore fulfils a Hindu’s moral obligations.
 Euthanasia- the Buddhist view:
 Voluntary euthanasia is wrong, as it shows
that the person’s mind is in a bad state.
Meditation and pain-killing drugs help a
person to achieve a state where they are not
in mental pain. Only if you have achieved
enlightenment is euthanasia approved of.
Muslim Beliefs:
 Muslim Beliefs All life is given by Allah, so it
is sacred. Only Allah can choose when a life
will end.
 The majority of bereaved family and friends
who have lost loved ones through the means of
euthanasia are able to cope with grief and post-
traumatic stress reactions better, in comparison
to those who die due to their illness.
 However, an unnatural death is able to cause
severe grief reaction amongst those close.
Family members in euthanasia cases have the
opportunity to say goodbye, whereas this is very
rare in suicide cases.
 Do Not
Resuscitate
 DNRs are Do Not Resuscitate orders. A DNR
order on a patient's file means that a doctor
is not required to resuscitate a patient if
their heart stops and is designed to prevent
unnecessary suffering.
 The usual circumstances in which it is
appropriate not to resuscitate are:
 when it will not restart the heart or breathing.
 when there is no benefit to the patient.
 when the benefits are outweighed by the
burdens.

Although DNRs can be regarded as a form of

passive euthanasia, they are not controversial
unless they are abused, since they are
intended to prevent patients suffering
pointlessly from the bad effects that
resuscitation can cause: broken ribs, other
fractures, ruptured spleen, brain damage.
 In medicine, a "do not resuscitate" or "DNR" ,
sometimes called a "No Code", is a legal order
written either in the hospital or on a legal form
to respect the wishes of a patient to not
undergo CPR or advanced cardiac life support
(ACLS) if their heart were to stop or they
were to stop breathing.
 The term "code" is commonly used by medical
professionals as a slang term for "calling in a
Code Blue" to alert a hospital's resuscitation
team.
 This request is usually made by the patient
or health care power of attorney and allows
the medical teams taking care of them to
respect their wishes.

In the health care community "allow

natural death" or "AND" is a term that is
quickly gaining favour as it focuses on
what is being done, not what is being
avoided.
 Some criticize the term "do not resuscitate"
because it sounds as if something important
is being withheld, while research shows that
only about 5% of patients who require ACLS
outside the hospital and only 15% of patients
who require ACLS while in the hospital
survive.
 A DNR does not affect any treatment other
than that which would require intubation or
CPR.
 Patients who are DNR can continue to get
chemotherapy, antibiotics, dialysis, or any
other appropriate treatments.
 DNR (Do Not Resuscitate)
 DNI (Do Not Intubate)
 DNAR, to clarify "Do Not Attempt
Resuscitation
 NFR or Not For Resuscitation.

 Since the term DNR implies the omission of

action, and therefore "giving up", some have
advocated for these orders to be retermed
Allow Natural Death.
 Guidelines issued by the British Medical
Association say that DNR orders should only
be issued after discussion with patients or
their family.
 The UK medical profession has quite wide
guidelines for circumstances in which a DNR may
be issued:
 If a patient's condition is such that resuscitation is
unlikely to succeed
 If a mentally competent patient has consistently
stated or recorded the fact that he or she does not
want to be resuscitated
 If there is advanced notice or a living will which
says the patient does not want to be resuscitated
 If successful resuscitation would not be in the
patient's best interest because it would lead to a
poor quality of life
 The clear guidelines on DNRs had to be
firmly restated in 2000, after a number of
seemingly healthy patients discovered they
had 'do not resuscitate' or DNR orders
written in their medical notes without
consultation with them or their relatives.
 Competent, adult patients can request a DNR
order themselves.
 Patient requests can be made orally to a
physician, or in writing in the form of a living
will or advance directive prior to becoming
ill.
 If a patient is too sick to request a DNR
order for him or herself and no advance
decisions have been made, the patient's
family can request one.
 A family member's request will be honoured
if the patient is terminally ill or permanently
unconscious or if a physician has determined
that CPR would be medically futile or that
CPR would impose an unnecessary burden on
the patient given the individual's stage in
life.
 If a patient's physician disagrees with the
patient's request for a DNR order, the
physician should transfer the patient to the
care of a physician who agrees with the
order.
 Physicians can also enter DNR orders for
their patients when it is determined that
there would be no medical benefit to
administering CPR.
 Physicians must discuss the DNR order with
the patient or the patient's family as long as
there is time to do so. Many hospital policies
require that two doctors concur on a
decision to enter a DNR if the patient is
unable to consent to the order.
 Other therapeutic interventions, including
transferring the patient to an intensive care
unit, having blood cultures drawn, undergoing
central lines placement, and receiving blood
transfusions should not be influenced; DNR
orders only preclude resuscitative efforts.
 The “do not resuscitate” order is a controversial
issue. When a patient is competent to make
decisions, his or her choice for a DNR order
should be honoured, according to the principles
of autonomy or respect for the individual.
 However, a DNR order is at times interpreted
to mean that the patient requires less nursing
care, when actually these patients may have
significant medical and nursing needs, all of
which demand attention.
 Ethically all patients deserve and should
receive appropriate nursing interventions,
regardless of their resuscitation status.
ADVANCE DIRECTIVE &
LIVING WILL DNR

 Advance directives and  In contrast, it is a

living wills are physician or hospital
documents written by staff member who
individuals themselves, writes a DNR
so as to state their "physician's order,"
wishes for care, if they based upon the wishes
are no longer able to previously expressed by
speak for themselves. the individual in his or
her advance directive or
living will.
 Similarly, at a time when the individual is
unable to express his wishes, but has
previously used an advance directive to
appoint an agent, then a physician can write
such a DNR "physician's order" at the
request of that individual's agent.