Euthanasia

Introduction

Many individuals who regularly follow the news or seek to stay informed about current events are likely familiar with the term “euthanasia.” Therefore, let us explore this topic in a more detailed way.

The term euthanasia is derived from the Greek language, combining “Eu,” which signifies “good,” and “Thanatos,” meaning “death.” Essentially, it translates to “a peaceful passing” or “a good death.”

Sometimes, a person may struggle with serious illnesses for an extended period, experiencing significant pain with no treatment options available to improve their condition.

In such situations, we encounter the term “euthanasia,” which refers to the practice of intentionally ending a person’s life to relieve their suffering. National Cancer Institute defines this process as “easy or painless death or the intentional ending of the life of a person suffering from an incurable or painful disease at his or her request.”

The purpose of euthanasia is to provide relief to patients who have been enduring severe illnesses and unbearable pain for a long time. When all treatment options have been exhausted and the patient’s suffering continues to increase, euthanasia may be considered as a viable option to end their pain and suffering.

Known by other names such as assisted death, mercy killing, or painless death, euthanasia is considered unethical by the World Medical Association.

Types of Euthanasia

1. Active euthanasia: Active euthanasia means intentionally ending a patient’s life to relieve their suffering, usually when they are terminally ill, with little to no chance of recovery This is done by administering a toxic substance or lethal medications that directly result in death. At present, active euthanasia is not permitted in India, as the government has not sanctioned its practice.
2. Passive euthanasia: Passive euthanasia means letting a person, with a long-term illness, who is unlikely to recover, die naturally by removing life-supporting medical equipment. When life support is removed, the patient gradually dies because they are no longer kept alive by artificial means. The Supreme Court of India has approved this practice.
3. Voluntary euthanasia: In voluntary euthanasia, a very sick patient who is suffering a lot may wish to die. They might ask doctors to stop their medical treatment or refuse to eat and drink. By doing this, they try to take control of their situation and end their pain and suffering. This way, the patient aims to relieve the unbearable distress caused by their illness in a way they choose.
4. Non-voluntary euthanasia: In non-voluntary euthanasia, the patient is unable to decide on their end-of-life care due to various circumstances. This inability to decide may arise if the patient lacks mental competence, is underage, or has suffered significant cognitive impairment. In these situations, the responsibility for deciding on whether to proceed with euthanasia typically falls to the patient’s close relatives or a qualified medical professional, who will determine if ending the patient’s life is in their best interest.
5. Involuntary euthanasia: In involuntary euthanasia, the patient wants to live but is still put to death against their will. The person who does it doesn’t get any personal benefit from it, hence this cannot be considered murder. Instead, they believe they are ending the patient’s suffering out of a sense of duty, not for their gain.

The History and Varied Perspectives on Euthanasia

In ancient Greece and Rome, philosophers like Socrates and Plato discussed euthanasia but had different views. Socrates believed in living a good life and dying with dignity, thinking a peaceful death could free someone from suffering. Plato agreed, saying euthanasia might be okay for people with incurable illnesses since death could be better than a painful life. However, Hippocrates, referred to as the father of medicine, disagreed with euthanasia. His Hippocratic Oath said doctors must never harm patients and should always try to keep people alive, no matter what. So, while Socrates and Plato were open to euthanasia in some cases, Hippocrates strongly opposed it, setting a principle of preserving life that doctors still follow today.

Hindu Views

In Hinduism, karma holds significant importance, with the belief that individuals will experience the consequences of their actions in their next life. Based on this belief, if a doctor practices euthanasia (helping someone die), it may be viewed as wrong. This stems from the idea that causing someone to die early or an unnatural death could lead to negative karma for the person involved, resulting in adverse outcomes in future lives. Additionally, an untimely death can disrupt the natural cycle of life and death and negatively impact the spiritual progress of the soul.

However, Hinduism also presents an alternative perspective, suggesting that relieving someone from a painful existence can be seen as a compassionate and moral act. From this viewpoint, euthanasia could be considered a morally acceptable choice.

Islamic View

The Qur’an states that no one can die without Allah’s permission, at a predetermined time (Qur’an 3:145). This verse forbids suicide, euthanasia, and any form of homicide.

Life is considered a sacred gift from Allah, and taking it through euthanasia is strictly prohibited in Islam. The Quran highlights the importance of preserving life, making it clear that taking any human life, including one’s own, is not allowed. As a result, both suicide and assisted dying or euthanasia are considered major breaches of Islamic principles.

Christian Views

The church holds that every human life reflects God’s presence and glory. They believe that life is a divine gift, through which God shares a part of Himself with His creation.

Christians often view euthanasia as murder, which is prohibited by the sixth commandment: “You shall not commit murder” (Exodus 20:13). In the early 1900s, the Catholic Church emerged as a prominent critic of the modern euthanasia movement.

In light of Jesus healing the ailing and the suffering, the focus should be on providing care for those with severe illnesses rather than ending life too soon.

Points in Favor

1. Just as people have the right to live, they should also have the right to end their own life.
2. When a patient has been suffering from a severe illness for a long time and their pain is increasing, it can be considered humane to grant them euthanasia to relieve their suffering, rather than keeping them alive in pain.
3. When animals are in severe pain with no hope of recovery, they are given euthanasia to relieve their suffering, which is seen as humane. Similarly, some believe humans should have the same right to end their suffering from serious illness.
4. If a patient is kept alive by medical equipment without improvement, euthanasia could relieve their suffering and allow the equipment to help another patient in need.
5. If someone is suffering with no hope of recovery, euthanasia could end their pain, and their organs could be used to save others.

Points Against

1. Allowing euthanasia might reduce the quality of care for terminally ill patients and weaken healthcare professionals’ commitment to saving lives.
2. There may be a situation where if euthanasia becomes an accepted option, it might reduce the motivation for researchers and doctors to find new treatments and cures for serious illnesses.
3. Making the act of ending one’s life to avoid suffering more common could lead others to view suicide as a reasonable way to handle their difficulties.

Role of Mental Health Professionals in Euthanasia

When looking at what psychologists can do for people who want to choose euthanasia because of a terminal illness, they can:

1. Discuss Effects and Options: Talk to the client about what could happen if they go through with their request and look at other choices they may have.
2. Check Mental Ability: Determine if the client is mentally capable of making informed decisions about their request.
3. Examine Request Consistency: See if the client’s wish for euthanasia remains the same over time and isn’t just a response to temporary emotions.
4. Support the Family: Provide help to the patient’s family so they can deal with the emotional difficulties of the situation.

Impacts on Patients Well Being

Impact on the Families of Patients

1. Families may feel deep sadness because euthanasia is an unnatural way to say goodbye, which can make their grief more complicated.
2. Family members might feel guilty about being part of the decision, making it harder for them to cope with their loss.
3. Families may feel a lack of connection with their loved ones after euthanasia, which can lead to feelings of loneliness and sadness.
4. Family members may question their choices and wonder if they did enough to help their loved ones, leading to feelings of regret.

Laws and Countries Where Euthanasia is Legal

The Supreme Court of India has legalized the use of passive euthanasia. It supported the withdrawal of life support for patients in a permanent unconscious condition who cannot be recovered.

Euthanasia, other than in India, has been legalized in a growing number of countries and territories around the world. As per the 2024 report, active voluntary euthanasia is legal in Belgium, Canada, Colombia, Ecuador, Luxembourg, the Netherlands, New Zealand, Portugal (pending regulation), and Spain.

In India, the laws around euthanasia are quite specific. Passive euthanasia, which means ending life support for patients in certain conditions, is allowed. However, active euthanasia and assisted suicide are illegal. According to Section 309 of the Indian Penal Code, trying to commit suicide is punishable, which aims to discourage such attempts. Section 306 states that helping or encouraging someone to commit suicide can lead to severe penalties, including long-term imprisonment and fines. These laws show the legal boundaries around euthanasia in India.

DNR Policies in Some Countries For the Legalization of Euthanasia

Do Not Resuscitate order is a treatment decision taken before an event of cardiac or respiratory arrest with the consent of the patient or the next of kin, where caregivers will not be provided requests for restoring the cardiac or pulmonary function back to normal, fully or even partially after the cardiac or respiratory arrest without stopping any normal care being provided to the patient.  The DNR policies have different conditions for different countries, in Netherlands, euthanasia and physician-assisted suicide are legal, the legalization was done in order to provide the right to die with dignity, the conditions that Netherlands require in order to execute a DNR order is especially for patient in a terminal or hopeless condition , whose requests for euthanasia  are voluntary and persistent, is an adult or minor aged between 12-16, with consultation of a second independent physician. 

The ‘Case of Groningen Protocol’ in Netherlands is a protocol that deals with allowing euthanasia for severely ill newborns under strict conditions, one of the cases involved a baby born with severe spina bifida and hydrocephalus, the baby’s negligible chance to survive and extreme suffering led to the ending of baby’s life with parental consent.

While in Belgium similar conditions are required in order to allow DNR, the only additional requirement is the consultation of two physicians, including a psychiatrist or specialist in cases of non- terminal illness. The case of Marieke Vervoort, a Belgium Paralympic athlete suffering from an incurable degenerative muscular disorder, who signed her euthanasia papers in 2008, in order to end her life peacefully, while still competing from the disorder, Vervoort chose euthanasia and died in 2019.

 The countries that have recently legalized euthanasia are Spain and New Zealand in 2021, under this patients can refuse resuscitation ( restoring) efforts willingly, it is clearly mentioned under End of Life Choice Act in New Zealand that the patient must be at least 18 years old and the suffering from the terminal illness  is likely to end their life within six months along with similar conditions as mentioned above.

Cases That Reignited The Debate Around Euthanasia

Chantal Sebire, a french woman who suffered from an aggressive form of cancer, that caused facial disfigurement, pain and blindness publicly pleaded in 2008, for euthanasia, although her request was denied under the French Law, Chantal ended her life shortly after the disagreement of her request and was found dead in her home, the case led to end of life care reforms in France, yet euthanasia, remains illegal in France.

In India too the psychological impact of going through the legal process of euthanasia whilst suffering is very draining  for the witness as well as the patient , one of the most legally pivotal and ethical cases in India, which led to India’s first formal recognition of passive euthanasia was ‘The Aruna Shanbaug case’,

Aruna Shanbaug, who worked as a nurse at King Edward Memorial Hospital in Mumbai was sexually assaulted on 27th November,1973 ,and strangled by a ward boy named Sohanlal Bhartha Walmiki, the rape left her in a persistent vegetative state( chronic state where individual shows no signs of awareness) due to severe brain damage as a result of oxygen deprivation, unable to speak, move or perceive the surroundings around her, Aruna was in coma for 42 years, till her death in 2015. Her hospital staff cared for her throughout the prolonged pain , in 2009 journalist and author Pinki Virani petitioned on behalf of Aruna, in the supreme court, in order to seek approval of euthanasia, the reasons behind Virani’s appeal were, aruna’s persistent vegetative state for over three decades without any sign of recovery, she claimed that allowing her to live in that state would be violating her right to live with dignity (under Article 21 of the Indian Constitution), Verani also stated that there is a significant lack of response and consciousness from Aruna and due to which there has been no hope of recovering, adding to it she claimed that the years put on her treatment and care has left an emotional and financial strain on the caregivers even though they were giving their best and cared for her throughout the 42 years. On March 7, 2011, the supreme court rejected the plea for active euthanasia for Aruna, as the hospital staff who cared for her opposed the request, however, the court recognized and laid down guidelines for permission for Passive Euthanasia i.e withdrawal of life support allowing a natural death under cases where the patient is in a permanent vegetative state with the consultation of medical experts, close family members or caretakers.

This case was a turning point under laws made for end of life care in India and also shed light on improving the medical care facilities for terminal illness and granting access to the comfort of dignity that doctors, healthcare have to deal with emotionally along with family members in cases where life-ending decisions are taken.

Why is Psychological Support Necessary After Euthanasia?

Euthanasia is trapped in a stigma web, due to which families of the patient will be confronted with external judgements, and could face societal stigmatization, as well as people tend to treat them with biases of “ not giving their best for their loved ones” rather than empowering them for taking such a hard decision for the peaceful death of their loved one and to not let them die with unbearable pain.

The Aftermath of Euthanasia

In a systematic review of grief and mental health outcomes of people bereaved by euthanasia and Physician- Assisted Suicide, a study done in 2019 by K. Andriessen, K. Krysinska , Dransart, Dargis and Mishara in Australia, included 10 articles published between 1995 – 2017, included bereaved family members and half of them included close friends, the qualitative study explored  that there was prevalence of anxiety, depression, post- traumatic stress disorder among such individuals, it also exclaimed that having  experienced low social acknowledgement as a bereaved individual, correlated strongly with complicated grief and post traumatic stress disorder symptoms. Although other psycho social outcomes of this study state that family members, caregivers bereaved by euthanasia and PAS felt more prepared and were able to be more accepting of the death of their family members than those who were bereaved by natural causes, participant in qualitative study also reported that the decision making process helped them to anticipate death before hand and it also did not occurred to them as a shock rather they felt that they were able to honor the needs of their family members facilitating an easier grief reaction.

The aftermath of Euthanasia constitutes a challenging journey for the family members of the decision making individual, there is a need of creating a therapeutic space through counselling or therapy which would serve as a pathway, for the individuals to articulate their sentiments as well as address their adversities and the emotional strain that they have been feeling in the process of euthanasia. Trained professionals can provide grief and bereavement counselling, support groups can be manifested as a helpful resource as connecting with others dealing with similar challenges can lead to shared empathy, a feeling of being heard due to the mutual support and reassurance. The coping strategies include a range of techniques such as relaxation techniques, mindfulness techniques, ensuring effective communication skills to facilitate discussions within the family which could help each of the members understand their emotions with the passing of the loved one.

Conclusion

Euthanasia is a challenging topic that involves more than just legal aspects; it also includes religious, spiritual, and personal beliefs. It is important to consider what is permitted by law. At the same time, the value of life is significant, and we should strive to overcome illness and difficult situations to live a happy and meaningful life.

Sejal Yadav

Content creator at PsychOnPoint, Sejal is a devoted psychology enthusiast currently pursuing M.Sc. Clinical Psychology from National Forensic Sciences University (NFSU), Delhi. She is passionate about mental health awareness and committed to normalizing therapy. As a mental health trainee she focuses on embracing change and fostering an environment of empathy over sympathy.

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