Euthanasia – legal, social & humanitarian aspect.pptx

THE WORD "EUTHANASIA" IS DERIVED FROM THE GREEK LANGUAGE. "EU" MEANS GOOD AND "THANATO’’ MEANS DEATH. EUTHANASIA IS ALSO CALLED AS MERCY KILLING AND IT IS AN ACT OR PRACTICE OF PAINLESSLY PUTTING TO DEATH, PERSONS SUFFERING FROM PAINFUL AND INCURABLE DISEASE OR INCAPACITATING PHYSICAL DISORDER.

1. Euthanasia – legal, social & humanitarian aspects DR. YOGESH KUMAR MEHTA [JR] FORENSIC MEDICINE & TOXICOLOGY MLN MEDICAL COLLEGE, PRAYAGRAJ

2. introduction Euthanasia – legal, social & humanitarian aspects 2 THE WORD "EUTHANASIA" IS DERIVED FROM THE GREEK LANGUAGE. " EU " MEANS GOOD AND " THANATO ’’ MEANS DEATH . EUTHANASIA IS ALSO CALLED AS MERCY KILLING AND IT IS AN ACT OR PRACTICE OF PAINLESSLY PUTTING TO DEATH, PERSONS SUFFERING FROM PAINFUL AND INCURABLE DISEASE OR INCAPACITATING PHYSICAL DISORDER. The word " euthanasia " was first used in a medical context by Francis Bacon in the 17th century , to refer to an easy, painless, happy death, during which it was a "physician's responsibility to alleviate the 'physical sufferings' of the body.

3. Definitions Euthanasia:- The Infliction Of A Painless Death On An Individual Suffering From Severe, Interactable Pain Or Discomfort, Arising Out Of A Terminal Illness Or Condition. Physician–assisted Suicide (Pas) :- Is The Physician Prescribing A Drug Or Other Action To Facilitate A Patient Taking His/her Own Life, With The Committed Action Taken By The Patient.

4. It Is Believed That Euthanasia Started In Ancient Greece And Rome Around The Fifth Century B.C. Some Did This By Abortions, And Every Now And Then Performed A Mercy Killing Even Though Doctors Were Supposed To Follow The Hippocratic Oath: “I Will Give No Deadly Medicine To Any One If Asked, Nor Suggest Any Such Counsel”. During The Middle Ages, Euthanasia Was Pretty Much Out Of The Question. If One Committed Suicide, The Law In Europe Was For The Body To Be Dragged Through The Streets Or Nailed To A Barrel And Left To Drift Downriver. History of euthanasia

5. During The Seventeenth And Eighteenth Centuries Euthanasia Was A Topic Of Discussion. However, People Continued To Reject Euthanasia And Assisted Suicide. 1478-1535: Sir Thomas More Is Often Quoted As Being The First Prominent Christian To Recommend Euthanasia In His Book Utopia, Where The Utopian Priests Encourage Euthanasia When A Patient Was Terminally Ill And Suffering Pain. 1828: The First Law Against Assisted Killing, Known As Anti-euthanasia Was Passed In New York. History of euthanasia (CONTD)

6. 1870: The Use Of Morphine And Analgesic Medications For Assisting Quick And Painless Death Was Suggested. 1885: The American Medical Association Strongly Denied The Use Of Analgesic For Euthanasia. 1994: Netherlands It Is The First Country Where Euthanasia Has Been Allowed. 2001: The Euthanasia Law Was Adopted In Belgium - This Law Defines Conditions For Doctors To Avoid Penal Punishment. 2008: U.S. State Of Washington Legalizes Assisted Suicide. History of euthanasia (CONTD)

7. The question of euthanasia arises on three occasions :- At the beginning of life (at birth) At the end of natural life (terminal stage) When a person is severely impaired as a result of brain damage (unforeseen mishap) When does the question of euthanasia arise?

8. classification of euthanasia presentation title 8

9. Active euthanasia is killing while passive euthanasia is letting die. Active euthanasia: Inflicting painless death by an act of commission , for e.g., injection of a lethal dose of barbiturates. Passive euthanasia (negative euthanasia): Inflicting painless death by an act of omission , i.e. when the patient dies because the medical professionals either do not do something necessary to keep the patient alive, or when they stop doing something that is keeping the patient alive, for e.g.: Switch off life-support machines Disconnect a feeding tube Don’t carry out a life-extending operation

10. feature Active euthanasia Passive euthanasia Definition Doing a positive act to kill, e.g. Administering a lethal dose Discontinuing a life preservation procedure Nature of act Act of commission Act of omission Procedure Administration of lethal doses of barbiturates, KCL, muscle relaxants No longer resuscitating the patient by means of artificial live saving machines , O2 etc. Characteristic Uses measures that cause death. Without these measures, patient would not have died Role of nature Nature would have allowed the person to live. But doctor interfered to cause death Acceptance in general public Less More Countries following procedure Belgium, Netherlands India , some us states

11. Voluntary euthanasia: Patient wants to die and makes a request to this effect [i.e. patient consent is there]. He must be competent to make this choice [i.e. must be mentally sound]. Voluntary euthanasia is legal in: Belgium Luxembourg Netherlands Switzerland U.S.

12. Nonvoluntary Euthanasia: The Person Cannot Make A Decision Or Cannot Make His Wishes Known. This Includes Cases Where The Person Is: In A Coma Too Young (For E.G., An Infant) Senile Mentally Deficient To A Very Severe Extent Severely Brain Damage Mentally Disturbed In Such A Way That He/She Should Be Protected From Themselves.

13. Involuntary Euthanasia : Decision by society to terminate the life of an individual. (1)Patient does not want to die, yet he is compulsorily killed. (2) Examples: ( i ) Soldier has received vital injuries on abdomen, his intestines are hanging out he is in great pain requests a doctor to save his life doctor knows he can not be saved wants to end his suffering shoots him.

14. OTHER TYPES :- Pediatric euthanasia: Euthanasia administered to seriously sick or deformed infants. Geriatric euthanasia: Euthanasia administered to seriously sick, aged individuals. Battlefield euthanasia: Euthanasia administered to severely wounded or handicapped individual.

15. What if the person doesn't want to die? What if his relatives or family members who are trusted to make a reasonable and informed decision on the patient's behalf are impregnated with malicious and selfish motives? In order to keep these possibilities at bay, many countries have adopted concept of living will. CONCEPT OF LIVING WILL

16. A living will is a document wherein a person specifies as to how would he as a patient want to be treated or what actions should be taken for their health if they become seriously ill or are no longer in a position to make decisions for themselves or communicate them because of their illness or incapacity. Living wills are also called active declarations. A living will is thus not an instrument of euthanasia, but a request to the doctors in advance to give or not to give certain medical treatments. CONCEPT OF LIVING WILL

17. Living will has certain advantages – Respects a patient's right to reject certain medical treatment. They guide family members and relatives in taking difficult yet crucial decisions. Knowing what the patient wants helps doctors give treatment accordingly. CONCEPT OF LIVING WILL

18. In India euthanasia in any form wasn't legal until the very recent Aruna Shaunbaug Case which reignited the long existing debate in India between right to life and right to die . Article 21 has been one of the most controversial elements in the Indian Constitutional history. It states that- "No person shall be deprived of his life and personal liberty except according to the procedure established by law“ The whole debate revolves around the single question whether right to life as provided under Article 21 also includes right to die? If the provision provides for right to a dignified life, then it should also include right to die. But inclusion of right to die under Article 21 would contradict with Section 309 of IPC which states- "Whoever attempts to commit suicide and does any act towards commission of such offence shall be punished with simple imprisonment of a term which may extend to one year" Legal Status of Euthanasia In India

19. Right to Die' is not a fundamental right under Article 21. Right to die is included in Article 21 of Constitution came up for consideration for the first time in Maruti Shripathi Dubal v. State of Maharashtra Case. The Court held that the right to life also includes the right to die, but did not clearly explain how, life includes death. Apparently the two cannot coexist. Death is the absence of life. On 26 April 1994 in P. Rathinam v. Union of India, a two- judge bench of the Supreme Court through Justice B.L. Hansaria invalidated section 309 of IPC , on the ground that it 'violate Article 21’. On March 21, 1996 in Gian Kour v. State of Punjab, a five judge Bench of the Court overruled Rathinam and upheld the validity of section 309. It held that 'right to life, under Article 21 of the Constitution, does not include right to die or right to be killed. The new bill removes section 309 of the IPC entirely. This means attempted suicide will no longer be a criminal offence. Legal Status of Euthanasia In India

20. The court made it clear that the 'Right to Life,' including the right to live with human dignity, would include the existence of such a right till the end of natural life. This also includes the right to a dignified life up to the point of death, including a dignified procedure of death. This may include the right of a dying man to die with dignity, when his life is ebbing out. However, according to the court, the 'Right to Die' with dignity at the end of life is not to be confused with the 'Right to Die' an unnatural death. The Court support the views of permitting the termination of life in such cases (e.g. a dying man, who is terminally ill and is totally dependent on life support systems), by accelerating the process of natural death, when it was certain and imminent Legal Status of Euthanasia In India

21. Passive euthanasia is legal in India – since 7 march 2011 after supreme court judgment in aruna Shanbaug case. (1 ) Facts - On The Night Of 27 Nov 1973, Shanbaug Was Sexually Assaulted By Sohanlal Bhartha Walmiki, A Safai Karmachari On Contract At The KEM Hospital. He was motivated partly by resentment for being ordered about and castigated by Shanbaug. He attacked her while she was changing clothes in the hospital basement. He choked her with a dog chain and tried to rape her but finding that she was menstruating, he sodomized her. To immobilize her during this act he twisted the chain around her neck. aruna Ramachandra Shanbaug v. union of India, (2011)

22. The next day [28th Nov] at 7.45 a.m. a cleaner found her lying on the floor with blood all over in an unconscious condition. The partial asphyxiation was responsible for large areas of brain being dead. It also made her cortically blind. Walmiki was convicted, and served two concurrent seven-year sentences . Aruna Shanbaug has since been in a vegetative state at the KEM Hospital [ for 40 y ]. (2) Issue - Aruna should be allowed a decent death rather than forcing to live in a vegetative state. (3) Existing law – S.89 (section 27 BNS) and S.92, IPC (BNS 30) make all forms of euthanasia illegal. (4) Judges - Markandey Katju & Gyan Sudha Misra. (5) Trial and Judgment - Passive euthanasia under proper guidelines was legalized, but the court rejected active euthanasia , which remains illegal in India. 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.

23. Guidelines for passive euthanasia were laid down – (a) A decision to discontinue life support can be taken by Parents Spouse other close relatives friend [in case none of earlier 3 available] Doctors attending the patient. (b) The decision should be taken bona fide in the best interest of the patient. (c) Such a decision always requires approval from the High Court. (d) When such an application is filed the Chief Justice of the High Court will constitute a Bench of at least two Judges who should decide to grant approval or not.

24. Guidelines for passive euthanasia were laid down – (e) A committee of three reputed doctors to be nominated by the Bench, who will give report regarding the condition of the patient . (f) Before giving the verdict a notice regarding the report should be given to the close relatives and the State (g) After hearing the parties, the High Court can give its verdict. (6) Significance and Outcome - The Supreme Court of India legalized passive euthanasia to patients in a permanent vegetative state. (7) Major criticism - It can be misused for killing unwanted old people.

25. Euthanasia provides a way to relieve extreme pain. Euthanasia provides a way of relief when a person's quality of life is low. Euthanasia frees up medical funds to help other people. It is another case of freedom of choice - the right to commit suicide. People should not be forced to stay alive. Speedy termination of physical and emotional suffering. Organs can be put to good use. Relieve mental suffering for the patient and his relatives. ARGUMENTS FAVORING EUTHANASIA

26. Humanists Are Non-religious People Who Live By Moral Principles Based On Reason And Respect For Others, Not Obedience To Dogmatic Rules. They Promote Happiness And Fulfilment In This Life Because They Believe It Is The Only One We Have. Humanist Concern For Quality Of Life And Respect For Personal Autonomy Lead To The View That In Many Circumstances Voluntary Euthanasia Is The Morally Right Course. People Should Have The Right To Choose A Painless And Dignified End, Either At The Time Or Beforehand, Perhaps In A "Living Will". THE HUMANIST VIEW

27. The Right Circumstances Might Include: Pain And Suffering Helplessness And Loss Of Personal Dignity. Permanent Loss Of Those Things Which Make Life Worth Living For This Individual. To Postpone The Inevitable With No Intervening Benefit Is Not A Moral Act. Individuals Should Be Allowed To Decide On Such Personal Matters For Themselves. THE HUMANIST VIEW(contd.)

28. If Someone In Possession Of Full Information And Sound Judgement Decides That Her Continued Life Has No Value, Her Wishes Should Be Respected. While Humanists Generally Support Voluntary Euthanasia, They Also Uphold The Need For Certain Safeguards. These May Include Counselling The Prevention Of Pressure On Patients Clear Witnessed Instructions From The Patient. The Involvement Of Several Doctors, No Reasonable Hope Of Recovery–measures. THE HUMANIST VIEW(CONTD)

29. There Is No Rational Moral Distinction Between Allowing Someone To Die And Actively Assisting Them To Die In These Circumstances: The Intention And The Outcome (The Death Of The Patient) Are The Same In Both Cases. But The More Active Means Is Probably The More Compassionate One. THE HUMANIST VIEW(CONTD)

30. Euthanasia demeans and devalues the sanctity of human life. Euthanasia can become a means of health care cost containment. Euthanasia will become non-voluntary. Euthanasia would not only be for people who are terminally ill. It amounts to murder and it is only God who can take away human life. It destroys life, which has potential that could be yet unknown to the patient, doctor or the family members. It discourages scientists who are looking for a cure for incurable ailments. An irreversible damage. ARGUMENTS AGAINST EUTHANASIA

31. DOCTOR-ASSISTED SUICIDE: Someone provides an individual with the information, guidance, and means to take his or her own life with the intention that they will be used for this purpose. When it is a doctor who helps another person to kill themselves it is called "physician assisted suicide or doctor assisted suicide". In doctor assisted-suicide, the doctor provides the patient with medical know-how (i.e. discussing painless and effective medical means of committing suicide) enabling the patient to end his / her own life. ETHICAL CONTRADICTION

32. THE HIPPOCRATIC OATH and International code of medical ethics pose ethical contradiction for the doctors. Hippocrates mentions euthanasia in the Hippocratic Oath, which was written between 400 and 300 В.С. The original Oath states: "To please no one will I prescribe a deadly drug nor give advice which may cause his death.“ According to him, a doctor is to relieve the pain of his patient on one hand and protect and prolong his life on the other. ETHICAL CONTRADICTION(CONTD)

33. The first can be used in favour of the doctrine of euthanasia but the second counters the doctrine. American Medical Association hold it inconsistent with the ethics of advanced medical technology. Legalization would cause loss of hope, fear of medical institutions, and involuntary euthanasia. ETHICAL CONTRADICTION(CONTD)

34. cases 35  Craig Ewert  59, was a retired college professor who was diagnosed with motor neuron disease (MND), a neurodegenerative kind that affects the nervous system and could lead to difficulty in gripping, walking, swallowing, speaking and breathing. He decided to end his life rather than spend the rest of his life in a “living tomb” ,Since euthanasia is still illegal in Britain, he traveled to Switzerland to die assisted by the Dignitas clinic in Zurich in September 2006. He was already 5 months paralyzed prior to his televised death, his last moments was shown on the Sky Real Lives Channel live, he first said goodbye to his wife, drank the poison, asked for an apple juice, requested for Beethoven’s symphony no.9, said thank you, and died peacefully.

35. cases 36  Frank Van  Den Bleeken was a Belgian convicted of serial murder and rape who has been imprisoned for almost three decades. He was temporarily released and convict other brutal convictions. He sought the right to die because he was "suffering unbearably" from his psychiatric condition Unable to control his urges, the convict had no prospect of living in freedom.

36. 37 "He has clearly said that he didn't want to leave prison because he didn't want to risk creating further victims," he said. Seeing himself as a danger to society, he could "no longer live like that", his lawyer said. After doctors agreed that his psychological condition is incurable, Belgium's justice minister approved his transfer to a hospital where doctors will end his life on January 11, 2015. But on January 6, the justice minister announced that Van Den Bleekin’s “right to die” was withdrawn by his doctors. He was instead transferred to a psychiatric prison ward.

37. Thank you