14
Euthanasia or mercy killing Moral dilemma Why in news- 1. In 2016 Government proposed a draft bill on passive euthanasia for the first time called The Medical Treatment of Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill. 2. Time and again widely debated across the media after supreme court verdict on Aruna Shanbaug case. What is euthanasia? The phrase euthanasia was coined by Sir Francis Bacon. It is also called as mercy killing. The term Euthanasia has been derived from the two Greek Words eu and thanotos, which literally means good death. Euthanasia is the practice of intentionally ending a life in order to relieve pain and suffering (provided motive should be good & death must be painless as much as possible) or A deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering." - British House of Lords Select Committee on Medical Ethics.

Euthanasia or mercy killing - Amazon Web Services · Euthanasia or mercy killing Moral dilemma Why in news- 1. In 2016 Government proposed a draft bill on passive euthana sia for

Embed Size (px)

Citation preview

Page 1: Euthanasia or mercy killing - Amazon Web Services · Euthanasia or mercy killing Moral dilemma Why in news- 1. In 2016 Government proposed a draft bill on passive euthana sia for

Euthanasia or mercy killing

Moral dilemma

Why in news-

1. In 2016 Government proposed a draft bill on passive euthanasia for the first time

called The Medical Treatment of Terminally Ill Patients (Protection of Patients and

Medical Practitioners) Bill .

2. Time and again widely debated across the media after supreme court verdict on

Aruna Shanbaug case.

What is euthanasia?

The phrase euthanasia was coined by Sir Francis Bacon. It is also called as mercy killing . The

term Euthanasia has been derived from the two Greek Words eu and thanotos , which

literally means good death .

Euthanasia is the practice of intentionally ending a life in order to relieve pain and suffering

(provided motive should be good & death must be painless as much as possible)

or

A deliberate intervention undertaken with the express intention of ending a life, to relieve

intractable suffering." - British House of Lords Select Committee on Medical Ethics.

Page 2: Euthanasia or mercy killing - Amazon Web Services · Euthanasia or mercy killing Moral dilemma Why in news- 1. In 2016 Government proposed a draft bill on passive euthana sia for

Broad classification-

1) Voluntary Euthanasia (with patients consent)- euthanasia is performed with patients

consent. It is legal in some countries like Belgium, Netherlands etc.

2) Non-voluntary Euthanasia (patient's consent unavailable)- where a person is unable to give

their consent (for example –patient is in a state of coma or are severely brain damaged) and

another person takes the decision on their behalf, often because the ill person had

expressed a wish previously to end their life in such circumstances.

3) Involuntary Euthanasia (without asking consent or against the patient's will)-Euthanasia

conducted against the will of the patient is termed involuntary euthanasia .It is also regarded

as murder

Difference between Euthanasia and physician assisted suicide.

Physician assisted suicide is often misunderstood with euthanasia .The difference being

in who administers the lethal drug.

In euthanasia-a physician or third party administers it.

In physician assisted suicide- it is the patient himself administers it, though on the

advice of the doctor.

Assisted suicide and euthanasia are sometimes called under the umbrella term

"assisted dying".

Page 3: Euthanasia or mercy killing - Amazon Web Services · Euthanasia or mercy killing Moral dilemma Why in news- 1. In 2016 Government proposed a draft bill on passive euthana sia for

All types of euthanasia can be further divided into passive or active types-

a) Active Euthanasia- where a person intentionally intervenes to end someone s life with

the use of lethal substances or forces.

For example- Administering a lethal injection to end life.

b) Passive Euthanasia-where a person causes death by withholding or withdrawing

treatment that is essential to maintain life.

For example- stoppage of antibiotics treatment in certain cases where it is necessary

for the continuance of life, removal of life support system etc

Debate- moral dilemma

Arguments For Euthanasia- According to euthanasia opponent Ezekiel Emanuel, proponents

of euthanasia have presented four main arguments:

a) That people have a right to self-determination, and thus should be allowed to choose their

own destiny.

b) Assisting a subject to die is a better option than continuing to suffer.

c) The distinction between passive euthanasia( which is frequently allowed) and active

euthanasia is not substantive (the underlying principle–the doctrine of double effect is

unreasonable) and

Page 4: Euthanasia or mercy killing - Amazon Web Services · Euthanasia or mercy killing Moral dilemma Why in news- 1. In 2016 Government proposed a draft bill on passive euthana sia for

The doctrine of double effect

The doctrine of double effect says that if doing something morally good has a morally bad side-

effect, then it is ethically acceptable to do it provided the bad side-effect wasn't intended. This

is true even if you foresee that the bad effect would probably happen.

The above principle is used to justify the case where a doctor gives drugs to a patient to lessen

distressing symptoms inspite of knowing that doing so may shorten the patient's life.

This is because the doctor is not targeting directly to kill the patient, and the bad result of the

patient's death is a side-effect of the good result of reducing the patient's pain.

d) Allowing euthanasia will not necessarily lead to unacceptable consequences. Pro-euthanasia

activists often take examples of countries like the Netherlands , Belgium, Luxembourg etc

where euthanasia has been legalized to justify that it is mostly trouble-free.

Other arguments-

Arguments based on rights

a) People got an explicit right to die

b) Death is a private subject and if there is no harm done to others then ,the state and

other people have no right to interfere (libertarian case)

Practical arguments-

a) Death is a private subject and if there is no harm done to others then, the state and

other people have no right to interfere (libertarian case)

b) Allowing people to die may free up scarce health resources (this is a possible argument,

but so far no authority has seriously proposed it)

Arguments Against Euthanasia

Similarly, Emanuel argues that there are four major arguments presented by opponents of

euthanasia:

a) All deaths are not painful.

Page 5: Euthanasia or mercy killing - Amazon Web Services · Euthanasia or mercy killing Moral dilemma Why in news- 1. In 2016 Government proposed a draft bill on passive euthana sia for

b) Termination of active treatment, combined with the effective use of pain relief are

available as alternatives to euthanasia

c) The distinction between active and passive euthanasia is morally significant and

d) Legalising euthanasia will put society on a slippery slope, which will lead to unacceptable

consequences. (In Oregon 2013, pain wasn't one of the top five reasons that people

sought euthanasia for .In fact it were a loss of dignity, and a fear of burdening others).

Other arguments-

Ethical arguments

a) Euthanasia could weaken society's respect for the sanctity of life.

b) Accepting euthanasia would mean that some lives (those of the sick or disabled) are

worth less than others.

c) Voluntary euthanasia could start of a slippery slope that may lead to involuntary

euthanasia and the killing of people who are thought undesirable.

d) Euthanasia might not be in a person's best interests.

e) Euthanasia affects rights of other people and not just those of the patient

Religious arguments- Religions are opposed to euthanasia for a number of reasons.

a) Euthanasia is against the will and word of God. (God has forbidden it)

Virtually all religions in their scriptures say 'you must not kill'. Therefore carrying out any

of these would be against God's command, and would be an attack on the sovereignity

of God

b) Euthanasia weakens society's respect for the sanctity of life .

Human life is sacred. Human lives are special because God created them. Human beings

are made in God's image. Therefore human life should be protected and preserved,

whatever happens

c) law of karma -Suffering may have value (Freedom from worldly life)

Page 6: Euthanasia or mercy killing - Amazon Web Services · Euthanasia or mercy killing Moral dilemma Why in news- 1. In 2016 Government proposed a draft bill on passive euthana sia for

Hinduism and Buddhism see mortal life as part of a continuing cycle in which we take

birth, live, die, and are reborn over and over again.

During each cycle of life and death human beings make progress towards their ultimate

aim ,which is liberation.

Thus, shortening life interferes with the the law of karma.

d) Voluntary euthanasia could start of a slippery slope that may lead to involuntary

euthanasia and the killing of people who are thought undesirable

e) Most religions disapprove of euthanasia. Some absolutely forbid it.

For example, the Roman Catholic church is one of the most active organisations in

opposing euthanasia.

f) Virtually all religions state that those who become vulnerable through illness or

disability deserve special care and protection, and proper care of life is a much better

thing than euthanasia.

g) Non-harm - the principle of ahimsa-Hinduism and Buddhism regard all life as

precious.(not just human life) .They say that we should try to avoid harming living things

and therefore this also rules out killing people, even if they want to die.

Practical arguments

Proper palliative care could make euthanasia unnecessary.

Euthanasia cannot be properly regulated

Permitting euthanasia will lead to less good care for the terminally ill.

Permitting euthanasia could undermine the commitment of doctors and nurses to save

lives.

Euthanasia may become in future a cost-effective way to treat the terminally ill.

Allowing euthanasia could discourage the search for new mode of treatments for the

terminally ill.

Euthanasia could discourage the motivation to provide good care for the dying.

Euthanasia gives too much authority to doctors.

Euthanasia exposes vulnerable people to pressure to end their lives.

Moral pressure on elderly people by selfish families.

Moral pressure to free up medical resources.

Patients may feel euthanasia is the only way out when they are abandoned by their

families.

Page 7: Euthanasia or mercy killing - Amazon Web Services · Euthanasia or mercy killing Moral dilemma Why in news- 1. In 2016 Government proposed a draft bill on passive euthana sia for
Page 8: Euthanasia or mercy killing - Amazon Web Services · Euthanasia or mercy killing Moral dilemma Why in news- 1. In 2016 Government proposed a draft bill on passive euthana sia for

Indian scenario

India s Euthanasia Timeline

In Gyan Kaur case Supreme Court held that both euthanasia and assisted suicide are not lawful

in India. The Court confusingly stated-

1) The right to life under Article 21 of the Constitution does not include the right to die.

The court held that Article 21 is a provision guaranteeing protection of life and personal

liberty and by no stretch of imagination can extinction of life be read into it.

2) The right to live with dignity does include the right to die with dignity

But court could not come up with any practical rules and passed the buck to lawmakers to

come up with laws regulating euthanasia

In 2006, the 196th report of the Law Commission of India brought out `The Medical Treatment

of Terminally ill Patients (Protection of Patients and Medical Practitioners) Bill 2006. However,

no law was made on euthanasia.

In 2011 the supreme court in Aruna Shanbaug versus Union of India case, laid down guidelines

to process pleas for passive euthanasia. It said till Parliament works out legislation, the

procedures laid down by the guidelines should be followed. It also spelt out differences

between active and passive euthanasia.

In 2012, The Law Commissions 241st

report again proposed making legislation on passive

euthanasia and prepared a draft bill called the Medical Treatment of Terminally Ill Patients

(protection of patients and medical practitioners) Bill. Bill deals with passive euthanasia and

living will. It doesn t recommend active euthanasia

In 2014, a three-judge bench of Supreme Court of India had called the judgment in the Aruna

Shanbaug case to be 'inconsistent in itself' and has referred the subject of euthanasia to its five-

judge Constitution bench.

In 2016, Health ministry uploads the draft bill for public opinion -The Medical Treatment of

Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill and wants people

to give their views, so that it can take a decision to enact/not to enact a law on passive

euthanasia.

Page 9: Euthanasia or mercy killing - Amazon Web Services · Euthanasia or mercy killing Moral dilemma Why in news- 1. In 2016 Government proposed a draft bill on passive euthana sia for

Supreme Court guidelines on passive euthanasia

The following guidelines were laid down for carrying out passive euthanasia.

1. Decision to discontinue life support needs to be taken either by the parents or the

spouse or other close relatives, or in the absence of any of them, such a decision can be

taken even by a person or a body of persons acting as a next friend.

2. Such a decision can also be taken by the doctors attending the patient as bonafide in the

best interest of the patient.

3. Every such decision needs approval from concerned High Court.

4. When a high court receives such application, the Chief Justice should constitute a Bench

of at least two Judges who should decide to grant approval or not. This bench will

nominate and need a report from a committee of three reputed doctors.

5. Before giving the verdict a notice regarding the report should be given to the close

relatives and the State. After hearing the parties, the High Court can give its verdict.

The Medical Treatment of Terminally Ill Patients (Protection of Patients and

Medical Practitioners) Bill

Key terms-

Advance medical directive-also called as living will. It means a directive given by a person

that he/she as the case may be shall or shall not be given medical treatment in future when

he/she becomes terminally ill.

Palliative care-

a) Provision of reasonable medical and nursing proceedures for relief of physical pain,

suffering, discomfort, or emotional or psycho social suffering.

b) Reasonable provision for food and water.

Competent patient- patient who is not an incompetent patient.

Page 10: Euthanasia or mercy killing - Amazon Web Services · Euthanasia or mercy killing Moral dilemma Why in news- 1. In 2016 Government proposed a draft bill on passive euthana sia for

Incompetent patient- means a minor who is below 16 years of age or of unsound mind or a

patient who is unable to-

a) understand information relevant to an informed decision about his/her medical

treatment.

b) Retain and use that information to make decisions

c) Not able to make an informed decision due to disturbance in the functioning of

the brain/mind.

d) Communicate his /her informed decision by speech ,sign, language or any other

mode.

Informed decision- means the decision as to continuance or withholding or withdrawing

medical treatment taken by a patient who is competent and who is or has been informed

about-

a) The nature of his/her illness

b) Any alternative form of treatment that is available

c) The consequences of those forms of treatment and

d) Consequences of remaining untreated

Terminal illness-such illness/injury/degeneration of physical or mental condition which is

causing extreme pain and suffering to the patients and according to the medical opinion, will

inevitably cause the untimely death of the patient concerned

Or

Meaningful existence of life is not possible due to irreversible vegetative condition.

Salient Provisions of the Draft Bill

1) Every competent patient, including minors aged above 16 years, has a right to take a

decision and express their desire to the medical practitioner attending on her or him on

whether to continue further treatment or allow nature to take its own course.

2) The Bill provides protection to patients and doctors from any liability for withholding or

withdrawing medical treatment and states that palliative care (pain management) can

continue.

Page 11: Euthanasia or mercy killing - Amazon Web Services · Euthanasia or mercy killing Moral dilemma Why in news- 1. In 2016 Government proposed a draft bill on passive euthana sia for

3) When a patient communicates her or his decision to the medical practitioner, such decision

is binding on the medical practitioner. However, it also notes that the medical practitioner

must be satisfied that the patient is competent and that the decision has been taken on

free will.

4) There will be a panel of medical experts to decide on case by case basis.

5) The medical practitioner has to maintain all details of the patient and ensure he/she takes an

informed decision. He is also required to inform the patient whether it would be best to

withdraw or continue treatment. If the patient is not in a conscious state, he/she needs to

inform family members. In the absence of family members, the medical practitioner needs to

inform a person who is a regular visitor.

6) The draft also lays down the process for seeking euthanasia, right from the composition of

the medical team to moving the high court for permission.

7) Permission to be obtained from the high court. Any near relative, friend, legal guardian,

medical doctor / staff attending the patient, any other person obtaining the leave of the

court can apply to jurisdictional high court.Such application is treated as original petition

and chief justice of the high court shall assign the same to the divisional bench without loss

of time and same should be disposed as far as practical with in a month. This bench will

nominate and need a report from a committee of three reputed doctors.

8) The Bill only portends to legalise what is called passive euthanasia , as discussed in the

judgement pertaining to Aruna Shaunbaug. Active euthanasia is not being considered as it is

likely to be used by unscrupulous individuals to attain their ulterior motives.

9) Advanced medical directive or living will shall be void and not binding on any medical

practioner.

10) Medical council of India may issue guidelines consistent with the provisions of the bill. It

may review and can also modify from time to time

Probable concerns- There have been mixed reactions to the draft bill. Some consider it as a

good start , but others didn t quite agree. Some of the probable concerns are-

1) The draft has disappointed experts who wanted complete clarity on the concept of a living

will.While there have been demands for recognizing Advance Medical Directives (also known

Page 12: Euthanasia or mercy killing - Amazon Web Services · Euthanasia or mercy killing Moral dilemma Why in news- 1. In 2016 Government proposed a draft bill on passive euthana sia for

as living will) whereby a person declares in advance whether or not treatment should be

given if he is terminally-ill and incompetent to take decisions in future, the government has

rightly shot down the proposal.

2) Child rights activists opine that in India, signing a contract or marrying before the age of 18 is

not permitted, then how can a child decide to live or die.

3) concerns for its misuse remain a major issue which ought to be addressed before it becomes

a law in our country-

a) Doctors may come under the influence of corruption and fabricate material to prove

that it is a terminal case with no chance of recovery.

b) Leaving it solely to the patient s relatives or to the doctors or next friend to decide

whether to withdraw the life support of an incompetent person ,there is always a risk

that this may be misused by some unscrupulous persons who wish to inherit or

otherwise grab the property of the patient.

What is a living will and what are debates and arguments in relation to living will?

In 2014, the Supreme Court had issued notice to all the states seeking their views on whether a

terminally ill person can execute a living will that his or her life support system be withdrawn

if he or she reaches a vegetative state with no hope of revival. The court has also appointed

amicus curiae.

A Living Will is a document which sets out a patient s wishes regarding health care and how

they want to be treated if they become seriously ill and unable to make or communicate their

own choices. Living wills are also called as active declarations.

Arguments For living will-

1) They respect the patient s human rights, and in particular their right to reject medical

treatment.

2) Creating them encourages full discussion about end of life decisions .

3) Knowing what the patient want means that doctors are more likely to give appropriate

treatment.

Page 13: Euthanasia or mercy killing - Amazon Web Services · Euthanasia or mercy killing Moral dilemma Why in news- 1. In 2016 Government proposed a draft bill on passive euthana sia for

4) They help medical professionals in taking difficult decisions.

5) A patient s family and friends don t have to take the difficult decisions

Arguments against living will-

1) Writing them may be very depressing.

2) It s difficult for a healthy person adequately to imagine what they would really want in

the situations where a living will would take effect.

3) It may be hard to translate the words of the living will into actual medical action.

4) Patients may change their minds but not change their living wills.

5) They re no use if they can t be found quickly when needed.

In India attempt to commit suicides (Section 309 of the Indian Penal Code ) and abetment of

suicide( Section 306 of the IPC) are crimes and both actions are punishable. The problem is that

to be able to make a living will, the legislation would need to decriminalize both. Though, the

court should consider the legitimacy of a will, but there are several issues. For example, if the

death of the patient is of material value to those are who close to him / her (such as property),

the suspicion over the validity of the living can become a legal issue. Thus, there is a need to

carefully set up conditions under which a living will may be executed.

Summary- There is no point in prolonging the physical agony of a terminally ill person and the

mental trauma of their loved ones. Therefore, euthanasia should be made legal in cases where

there is no scope of a patient recovering. India however requires a mix of sensitivity and

maturity for such an important decision to be taken as it involves right to life and right to die

with dignity .

He who has health has hope; and he who has hope has everything .-Arabic Proverb

How to approach for the Civil Services Examination

Essay-

Page 14: Euthanasia or mercy killing - Amazon Web Services · Euthanasia or mercy killing Moral dilemma Why in news- 1. In 2016 Government proposed a draft bill on passive euthana sia for

Death is a private matter and if there is no harm to others, the state has no right to interfere.

Human life is sacred. Irrespective of the pain and suffering ,human life should be protected and

preserved.

GS Paper II- Health related aspect (public health and safety. Welfare etc)

Practice Questions -

In Prelims-

Which of the following statement is /are correct

a) Article 21 of the constitution also deals with right to die.

b) Draft bill legalizes active euthanasia in India.

c) According to the draft bill on passive euthanasia, advanced medical directive shall be

void and not binding on any medical practioner.

d) The draft Bill also provides for active euthanasia and physician assisted suicide in certain

cases.

In Mains-

GS paper II-

a) Is passive euthanasia finally going to be a reality in India. Discuss?

b) Critics of euthanasia claim that Voluntary euthanasia is the start of a slippery slope that

leads to involuntary euthanasia and the killing of people who are considered

undesirable. Critically discuss?

c) Allowing euthanasia undermines the commitment of doctors and nurses to save

lives.Critically discuss?