ACKNOWLEDGEMENT

I would like to thank my Criminal law-I teacher Father Peter Ladis F for giving me such a relevant topic.

I would also like to thank my seniors who gave me certain guidelines, the library faculty as well as the internet facility.

I would like to thank my friends who helped me with the resource materials as well as other essential requirements for the same.

And in the end I would also like to thank my parents who were always there for me as an unseen hand for my support at every step of my project.

Ratna Kumari

Roll no. 782

AIM AND OBJECTIVE

The researcher aims to-

Explore the facts about euthanasia and analyse its condition in India as well as different parts of the world.

Explain if euthanasia should be legalized in India or not.

HYPOTHESIS

The researcher believes that the decision to terminate one’s life should be at the hands of the person concerned.

METHODOLOGY

The researcher has used doctrinal method of research i.e., library based research using books, journals, internet sources etc.

SOURCES OF DATA

The researcher has used primary as well as secondary sources of data.

CONTENTS

Notion of Euthanasia

Religious dilemma involved in Euthanasia

Euthanasia different from suicide

Legalising euthanasia good or bad?

Impact of legalised Euthanasia on medicine

Jurisprudential interpretation of euthanasia.

Conclusion.

Bibliography

NOTION OF EUTHANASIAAntipathy is not a word but it is the position or it is a feeling because of which

Jurisprudence has been generated. No doubt, father of Jurisprudence, Bentham, not only describe antipathy as the deciding factor of law and legislation but also as an exercise which cause a

powerful influence over the morals of man. As Bentham defined antipathy in six distinct parts as repugnance of sense, wounded pride, individual resistance and power, confidence in future, desire of unanimity and last but not the least envy. Bentham describes it as a cause that gives rise to the feeling of sympathy in the society.

The theory of pleasure and pain is described as a test through which sanctions may be formed. Undoubtedly pleasure and pains are corresponding to each other but sometimes the pain is too severe to explain not only to a particular but also for their near and dear along with the attached part of society, this type of pain is really questionable that whether it can be perfectly cured by any law by the end of subject matter or to left the subject matter in its position to fight with its pain. In fact pain and sufferings in the way of dying is a more terrible lord of mankind than even death itself. Here, it can be said “It is not death one fears to face, but dying”. It means that one does not fear to face the darkness of death but fears to go through the sufferings in dying when everyone knows the result- that is, ultimately the end of subject matter.

To give the end to the subject matter in a spite of unbearable sufferings and pain where death is certain, is known as concept of euthanasia.

The English philosopher Sir Francis Bacon coined the phrase “euthanasia” early in the 17th century. Euthanasia is derived from the Greek word eu, meaning “good” and thanatos meaning “death,” and early on signified a “good” or “easy” death. 1Euthanasia is a deliberate act that causes death undertaken by one person with the primary intention of ending the life of another person, in order to relieve that persons suffering. Euthanasia can be either active or passive, which involves the actions of either ‘killing’ or ‘letting die’. An active form of euthanasia refers to the act of purposely taking positive measures, such as lethal injection, to bring about a person’s death. Thus, it is referred to as ‘killing’ many standards. On the other hand, a ‘passive’ form of euthanasia involves the action of either discontinuing medical treatment, or not giving treatment at all. The history of euthanasia and assisted suicide starts from Ancient Greek, physicians used to perform frequent abortions, voluntary and involuntary mercy killings. People supported voluntary death and physicians often gave their patients the poisons on their request. The ancients supported the voluntary killing, if it was done for the right reasons. Jewish and Christian thinkers opposed suicide as contradictory with the good of mankind and the responsibilities to God. For almost 700 years or even more than that, the American common law practices punished the people who assisted others in suicide.

For centuries, euthanasia had normally been understood to mean the process whereby the relief of pain for the dying was the best way to ensure an easy death. However, that changed in the late nineteenth century when euthanasia acquired its modern connotation. For the first time in history, people began defining it as actual mercy killing. In 19th century people of America considered euthanasia and assisted suicide as rebellion against God's will. By 1920s euthanasia was not a secret anymore, newspaper published the stories about it and motion picture also released a movie on the topic. Dispute against mercy killing caught fire in 1930s and these years proved to be essential juncture in the history of euthanasia in America. Speaking openly about

1 http://www.studymode.com/essays/Research-Paper-On-Euthanasia-1074533.html

death and dying had become fashionable and a majority of Americans (53 percent) believed that doctors should be allowed to end the lives of terminally ill patients by painless methods if the patients and their families requested it. An even larger majority (62 percent) supported the right of terminally ill patients to refuse unwanted medical treatment.

The euthanasia dispute was not only growing roots on the side of the Atlantic, but it also had a contradictory impact in Britain. A bill to legalize euthanasia was also kept before the British House of Lords in 1936, but it was rejected. In India Euthanasia is yet to be discussed. There are no special provisions regarding this either in law of legislation. Many advocates of euthanasia, while they value human life and respect it within given parameters, do not view it as having any intrinsic value, mystery, or meaning. Many people, institutions and NGOs have tried to legalize euthanasia and assisted suicide but they have failed in their attempt. These failures happened because of the ethical values in every society, people in every society view ethics as important as anything else.

The term "physician-assisted suicide" is often used to describe what euthanasia is really. The physician carries out the act that causes death. In physician-assisted suicide, properly so-called, physicians would give patients the means to kill themselves with the intent that patients would so use them. Legally, there is a difference between physician-assisted suicide and euthanasia. The latter is homicide, not suicide. It is either murder or manslaughter under the criminal law in the United Kingdom, Australia, Canada and each state of the United States. Criminal liability for physician-assisted suicide would lie in aiding, abetting or counseling another person to commit suicide. Assisted suicide is the most discussed topic in medical ethics and is widely contradicted. In Netherlands after years of controversial debate euthanasia and assisted suicide were legalized. There euthanasia and PAS were formally legalized in 2001 after about 30 years of public debate2. Since the 1980s, guidelines and procedures for performing and controlling euthanasia have been developed and adapted several times by the Royal Dutch Medical Association in collaboration with that country’s judicial system. Despite opposition, including that from the Belgian Medical Association, Belgium legalized euthanasia in 2002 after about 3 years of public discourse that included government commissions. Unlike other jurisdictions that require euthanasia or assisted suicide to be performed only by physicians, Switzerland allows non-physicians to assist suicide. Approximately 130000 people die in Netherlands and 49000 of them spend their last stage on life supporting machines. So the commission sat to analyze if the dose of morphine should be increased or assist in suicide or actually kill the patient. Some empirical studies were conducted on these medical cases and then the practice was legalized. 3

What has often been overlooked, however, in the political and legal machinations, is the importance of medical, social, and psychological factors (e.g., depression) that may contribute to suicidal ideation, desire for hastened death, or requests for physician assisted suicide by terminally ill patients. Fear of being left in pain is one of the major forces giving rise to calls for euthanasia. We need to compare killing people in pain and killing the pain, but not those who suffer from it. In some cases, euthanasia is proposed or used (as it sometimes is in the

2 Deliens L, van der Wal G., 362, 2003, “The euthanasia law in Belgium and the Netherlands” Lancet, 1239–40.3 Goel vaibhav, “Euthanasia- a dignified end of life”, Vol. 3 (12), 2008, international NGO journal, pp. 224-231

Netherlands1) as a substitute for compassionate and adequate treatment for pain. Some of the thinkers and writers propose that euthanasia and assisted suicide are not the bad things to practice. They think this act can be practiced to reduce the pain of a patient on life supporting machines. They think that providing life supporting machines to the dying patient is like increasing the pain of living, so why not provide him/her the relief from pain. Some of the people also support their views and create organizations to support euthanasia and assisted suicide.

Religion too determines what activities receive the sanction of law and which do not. In India, there are religious scriptures that speak of comfort in the form of death when faced with incurable diseases. Manu states that man may undertake “great departure” on a journey which ends in death, when he is incurably diseased or meets with a great misfortune. 4The codified law adopts the sanctity of life in an inflexible manner, ignoring human misery originating due to debilitating illness.

A certain case that deserves particular mention here is the recent case of Aruna Ramchandra Shanbaug v. U.O.I. and ors.5 wherein the petitioner who has been in a vegetative state for thirty seven years following a sexual assault had filed a petition for mercy killing but was denied the same. The Court however, suggested that passive euthanasia be allowed in certain situations and that the Parliament delete Sec. 309 from the IPC as people who attempt to kill themselves need ‘help and not punishment’.

RELIGIOUS DILEMMA INVOLVED IN EUTHANASIA

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. For those left behind when someone dies religions provide rituals to mark death, and ceremonies to remember those who have died. Religions provide understanding and comfort for those who are facing death. Religions regard understanding death and dying as vital to finding meaning in human life. Dying is often seen as an occasion for getting powerful spiritual insights as well as for preparing for whatever afterlife may be to come.

4 http://jils.ac.in/wp-content/uploads/2011/12/Tania-Sebastian.pdf5 2011 STPL (Web) 104 SC

So it's not surprising that all faiths have strong views on euthanasia.

CHRISTIANITY

Many Christians believe that taking a life, for any reason, is interfering with God's plan and is

comparable to murder.6 The most conservative of Christians are against even passive euthanasia.

Some religious people do take the other side of the argument and believe that the drugs to end

suffering early are God-given and should be used.7

Christians are mostly against euthanasia. The arguments are usually based on the beliefs that life is given by God, and that human beings are made in God's image. Some churches also emphasise the importance of not interfering with the natural process of death.

According to Christianity, life is a gift from God and birth and death are part of the life processes which God has created, so we should respect them. Therefore no human being has the authority to take the life of any innocent person, even if that person wants to die.8

Human beings are valuable because human life possesses an intrinsic dignity and value because it is created by God in his own image for the distinctive destiny of sharing in God's own life, saying that God created humankind in his own image doesn't mean that people actually look like God, but that people have a unique capacity for rational existence that enables them to see what is good and to want what is good. As people develop these abilities they live a life that is as close as possible to God's life of love and this is a good thing, and life should be preserved so that people can go on doing this. To propose euthanasia for an individual is to judge that the current life of that individual is not worthwhile. Such a judgement is incompatible with recognising the worth and dignity of the person to be killed. Therefore arguements based on the quality of life are completely irrelevant nor should anyone ask for euthanasia for themselves because no-one has the right to value anyone, even themselves, as worthless.

The process of dying is spiritually important, and should not be disrupted. Many churches believe that the period just before death is a profoundly spiritual time. They think it is wrong to interfere with the process of dying, as this would interrupt the process of the spirit moving towards God.

HINDUISM

6 http://www.customessaymeister.com/customessays/Euthanasia/15425.htm7 http://www.debate.org/euthanasia/

8 Baume P, O'Malley E and Bauman A, “Professed religious affiliation and the practice of euthanasia”, vol. 21, 1995, J Med Ethics, 49-54.

It has been pointed out that in Hinduism, the word for suicide, atma-gatha, has also the elements of intentionality.9

The intention to voluntarily kill oneself for selfish motives was condemned in Hinduism. Subjectively, the evil sprang from a product of ignorance and passion; objectively, the evil encompassed the karmic consequences which impeded the progress of liberation. It was in this context that the Dharmasutras vehemently prohibited suicide.

Nevertheless, Hinduism venerated enlightened people who voluntarily decided their mode of death. Thus, the Pandavas eulogized “Mahaparasthana” or the great journey through their Himalayan sojourn when they walked in pilgrimage, thriving on air and water till they left their bodies one after another. Crawford lists fasting, self-immolation, and drowning at holy places as other examples of such venerated deaths. Such deaths by enlightened persons have never been equated with the popular notion of suicide in the Indian tradition. It has been always considered that suicide increases the difficulties in subsequent lives.

Can the Hindu stance as mentioned above be extended to the question of euthanasia? Here, the Indian attitude toward life and death needs special mention.

In the Hindu tradition, death acts as a prefiguration and model, through which the ties that bind man's self or soul to cosmic impermanence can be completely broken and through which ultimate goals of immortality and freedom can be finally and definitely attained.10 Crawford considers “spiritual death” in the Indian context to be synonymous with a “good death,” i.e., the individual must be in a state of calm and equipoise. Crawford surmises that to ensure such a noble death, the concept of active euthanasia would not be unacceptable to the Indian psyche. However, this view has been criticized by authors who claim that “spiritual death” or “iccha mrityu” can only be possible when the evolved soul chooses to abandon the body at will. It is also claimed that the evolving soul cannot be equated with mental tranquility as it is at a higher level of consciousness. Thus, though less dogmatic than other religions, Hindus would traditionally remain skeptic in their view about euthanasia. It has been proposed that a strong objection to euthanasia might arise from the Indian concept of Ahimsa. However, even in the Gandhian framework of Ahimsa, violence that is inevitable is not considered as sin.11 This emphasizes flexibility of the Indian mind. Hence, though a little skeptic, the Indian mind would not consider the thought of euthanasia and physician assisted suicide as a sacrilege.

9 Coward H, Lippner J, Young K, editors. Hindu ethics: Purity, abortion and euthanasia. New York: State University of New York Press; 1995. p. 16.

10 "Euthanasia and Suicide: The Hindu View." BBC Religion & Ethics.

11 Sinha vinod, Basu s. and sarkhel s., “Euthanasia: an Indian perspective”, vol. 54(2),2012,Indian journal of psychiatry, 177-83.

ISLAM

The prohibition of the direct active euthanasia and the prohibition of suicide and assisting in bringing it about, for according to Shari’ah killing a patient suffering from a terminal illness is not permissible for the physician, the patient’s family or the patient himself. The patient whatever his illness and however sick he (or she) is shall not be killed because of desperation and loss of hope in recovery or to prevent the transfer of the patient’s disease to others, and whoever commits the act of killing will be a deliberate killer. The Quranic text confirms without a shadow of a doubt that homicide is forbidden absolutely, as Allah Almighty says: 'And take not life, which Allah has made sacred, except by way of justice and law.' (VI: 151) 12and as Allah Almighty also says: 'Because of that We ordained for the Children of Israel that if anyone killed a person not in retaliation of murder or for spreading mischief in the land—it would be as if he killed all mankind.' (V: 32)

It is unlawful for the patient to kill himself (or herself) and it is unlawful for somebody else to kill him (or her) even if he is given leave to kill him. The former case will be suicide and the latter will be aggression against the other by killing him, for his permission does not render the unlawful act lawful. The patient does not posses his own soul to permit somebody else to take it.

BUDDHISM

Buddhists are not unanimous in their view of euthanasia, and the teachings of the Buddha don't explicitly deal with it. Most Buddhists (like almost everyone else) are against involuntary euthanasia. Their position on voluntary euthanasia is less clear.

Buddhists might also argue that helping to end someone's life is likely to put the helper into a bad mental state, and this too should be avoided.

Buddhism places great stress on non-harm, and on avoiding the ending of life. The reference is to life - any life - so the intentional ending of life seems against Buddhist teaching and voluntary euthanasia should be forbidden. Certain codes of Buddhist monastic law explicitly forbid it. 13

Lay-people do not have a code of Buddhist law, so the strongest that can be said of a lay person who takes part in euthanasia is that they have made an error of judgement.14

12 http://euthanasia.procon.org/view.answers.php?questionID=000156

13 Damien Keown, "Buddhism and Suicide: The Case of Channa." Journal of Buddhist Ethics, University of London,

1996.

14 "Euthanasia: The Buddhist View." BBC Religion & Ethics.

But the Buddha himself showed tolerance of suicide by monks in two cases. The Japanese Buddhist tradition includes many stories of suicide by monks, and suicide was used as a political weapon by Buddhist monks during the Vietnam war.But these were monks, and that makes a difference. In Buddhism, the way life ends has a profound impact on the way the new 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 (and so euthanasia) is only approved for people who have achieved enlightenment and that the rest of us should avoid it.

EUTHANASIA DIFFERENT FROM SUICIDE

Legal jurisprudence states that there is a right and a corresponding duty to every action and inaction. And as all the rights that every individual possesses in the contemporary society are being defined to the greatest extent, it is also equally true that we lack a few provisions in our laws that would truly draw a balance between individual liberty and the reasonable restraints of the state and society. However, for this the state has to comprehend or realize the fact that not all things are based on reason or logic; that we are human beings, who cannot be governed by mechanical laws.

Today there is a growing debate over the contention, whether people possessing similar rights- such as the ‘right to live’ also posses the ‘right to die’. There is a divided opinion over this issue, as some argue that life is to be continued in every manner possible- be it in a natural or artificial

one. The rest believe that it being a matter of individual liberty, all of us are entitled to live and end our lives as and when we deem fit. According to these people, suicide like euthanasia should be morally permissible. Due regard must be given to every case of euthanasia before a person’s right to live and die a pain free life is denied. Whereas, it is equally necessary that the State takes interest in the preservation and protection of life, otherwise human life shall have no value.

It is crucial to draw a definitive line between suicide and euthanasia, where many are of the opinion that by permitting euthanasia we would be indirectly also be permitting suicide, therefore as against suicide the grounds on which euthanasia may be allowed should be very restrictive; and if at all allowed, be in exceptional cases, leaving no window for any mischief. 15 The difference between suicide and euthanasia shall be illustrated hereafter.

SUICIDE

Suicide as defined in Webster’s Dictionary means an act or instance of intentionally killing oneself. Therefore, suicide could be termed as the intentional termination of one’s life by self- induced means for various reasons, such as, frustration in love, failure in examinations or in getting a good job, but mostly it is due to depression.16

The genesis of the desire to live or survive springs from the motivation to live, which every human being normally posses. Such motivations may be numerous and may vary from person to person. For existence it is imperative that every human being has a reason or motivation. But when such reasons or a motivation no longer exist- along with it goes the psychological reason to exist. Therefore it wouldn’t be false to say that our will power to exist is paramount to everything else, even the laws that govern our lives.

Considering the above argument, it is still in the best interest of the society, that suicide not be permitted, however disheartened the person may be, because if permitted, it may have a negative effect on the minds of children who for different reasons may contemplate suicide. Human life is an enigma, where events and circumstances may change even in the blink of an eye. Therefore what may seem like a hopeless situation today, may well be worth living the next day; and also because happiness like depression and sadness is a state of mind, that may change according to circumstances that govern us.

Some people believe that since the life that they are ending is their own; and are thereby not harming anybody else; the law should not have any objections. It is further argued that since every individual has the right to live with dignity, he/she should also have the right to die with dignity. Also, today suicide and attempted suicide are no longer treated as criminal offences in many countries- which indicate that the central importance of individual self-determination in a closely analogous setting has been accepted.

But in India, the Supreme Court has held , “ The right to live with dignity cannot be construed to include within its ambit the right to terminate natural life, at least before commencement of the natural process of certain death.

15 http://www.legalserviceindia.com/article/l265-Suicide-&-Euthanasia.html16 Webster’s Dictionary (II) New Riverside University pg. 1159

The Supreme Court of India in  P. Rathinam’s case 17observed , “The principle is that the sole end for which mankind is warranted individually or collectively, in interfering with the liberty of action of any of their number is self protection. That the only purpose for which power can be rightfully exercised over any member of a civilized community against his will is to prevent harm to others… In the part which merely concerns him, his independence, is of right, absolute.”

But it was in Gian Kaur’s case 18, which overruled P. Rathinam’s case , the Supreme Court of India held, “Right to life is a natural right embodied in Article 21 of the Constitution of India, but suicide is an unnatural termination or extinction of life and is incompatible and inconsistent with the concept of the right to life”.

However, a person who has made up his mind and is determined to end his life at all costs and regardless of all repercussion that his actions may have on those that care about him, cannot be stopped by law because he/she is going to end his/her life sooner or later.

As was observed by the great philosopher, poet ‘Khalil Gibran’, “…you can muffle the drum and you can loosen the strings of the lyre, but who shall command the skylark not to sing?”19

Therefore persons contemplating or thinking of suicide are not in any way going to be helped, nor is the society at large going to be benefited by the provisions of the law- which seek to penalize such persons. What needs to be done is that the reasons forming the root cause of such suicidal thoughts should be ascertained and understood. And such persons should be given psychiatric and emotional help, instead of further penalizing them and adding to their agony.

Therefore, as we progress through the 21st century, with life getting to be more and more difficult with the passage of each decade, where even today in some of the most progressive countries, every second person goes to a psychiatrist- seeking help simply to be normal. The legislature and the judiciary should realize that some provisions in our laws made in the 20th century or earlier do not stand the ground of relevance so firmly today as they did yesterday.

EUTHANASIA

Euthanasia is defined as the practice of ending a life prematurely in order to end pain and suffering. The process is also sometimes called Mercy Killing. Euthanasia or mercy killing is committed on the basis of medical reasons, where the death of a terminally ill person is brought about by another person, who believes that such person’s existence is so bad that he/she would be better off dead; also when his actions are based on the conviction that unless he intervenes and ends the ill person’s life, it shall become so bad that he/she would be better off dead. Considering this observation, it may be stated that the motive of the person committing such acts of euthanasia is to benefit the one whose death is brought about.

17 P. Rathinam v. Union of India (1994) 3 SCC 39418 Gian Kaur v. State of Punjab (1996) 2 SCC 64819 The Prophet – Great Works Of Khalil Gibran

The problem of euthanasia has a long history of philosophical discussion. Ancient Greek thinkers seemed to have favoured euthanasia even though they opposed suicide.20In medieval times Christian, Jewish and Muslim philosophers opposed active euthanasia, although the Christian Church has always accepted passive euthanasia.

In the sixteenth century, English Humanist Thomas More, in describing a utopian community, envisaged such a community as one that would facilitate the death of those whose lives had become burdensome as a result of torturing and lingering pain. However, it has only been in the last 100 years that there have been concerted efforts to make legal provisions for voluntary euthanasia.

The debate over the morality and legality of euthanasia is for the most part, a phenomenon of the second half of the 20th century. Today, pro- lifers readily agree that anyone should have the right to refuse medical treatment if he/she believes that the side effects- whether pain or the burden of being tied to some machine or whatever, are worse than the disease. Even if this means that he/she will live a shorter life, but presumably a more enjoyable life.

So, basically Suicide and Euthanasia are two words in English that have to be used differently when it comes to their meaning and connotation. Following are few differences:

Suicide consists in intentionally killing oneself. Euthanasia on the other hand is mercy killing as is committed on the basis of medical reasons.

In Euthanasia the killing is brought about by another person whereas in suicide the act of killing is brought about by oneself. The other person brings about killing of somebody who is characterized by terminal illness to relieve him of suffering. On the other hand the killing is inflicted on oneself in the act of suicide in a bid to get released from problems and debts in life.

It is interesting to note that euthanasia was supported by the ancient Greek philosophers though they opposed suicide. Many other thinkers say that suicide is an act of cowardice whereas euthanasia is an act of mercy.

The legality of euthanasia is established whereas suicide is highly illegal. Anyone who attempts suicide is strictly punishable under law. On the other hand a person dealing with euthanasia is only applauded for his act. Voluntary euthanasia is that wherein a person voluntary agrees to be helped to die.

Suicide arises from the lack of motivation to live. It is a harsh and a sudden act. On the other hand euthanasia is not a sudden and a harsh act. It is a philosophical act. It takes place after a thorough deliberation with people concerned.

Suicide on the other hand does not take place after a thorough deliberation. It takes place without consideration. It takes place without a constructive thought. On the other hand euthanasia takes place with a constructive thought. It is important to note that euthanasia is applicable to human beings and animals as well. On the other hand suicide is not applicable to animals.

20 Suzanne Fields ‘The Washington Times’ October 27, 2003

LEGALIZING EUTHANASIA: GOOD OR BAD

The case for   euthanasia

There are essentially four arguments which may be used for the justification of the practice of euthanasia in its various forms. These four arguments are in fact the expression of four possible motives which may lie behind the intention which we have just seen to be the essential element in euthanasia. These motives are compassion, respect for rights, social progress and economic need.1. The argument from compassionThis argument maintains that when a patient is faced with a situation of intolerable misery and distress arising from an incurable disease, it is kinder and more compassionate to end his life

rather than allow him to live and continue suffering. Euthanasia is thus proposed out of compassion for the person whose life has become unbearable.21

2. The argument from the right to dieAccording to this argument, a person with an incurable fatal disease which is causing great pain and distress and cannot be relieved by any available means, has the right to demand euthanasia. This right to die is often regarded as part of a human autonomy by which patients have the right to make decisions about what shall or shall not be done to them by health care professionals. This emphasis on autonomy has become more insistent in recent years and has been made the basis on which demands for euthanasia have been held to be justified.22

3. The argument from social progressThis argument claims that society has a eugenic obligation to eliminate the physically and mentally unfit from among its members. This view is based on the utilitarian social theory known as Social Darwinism. It was a popular view in the earlier presentation of the case for euthanasia, but its popularity is less today since its consequences were seen in the social and racial policies of Nazi Germany. However, it may still be used to justify the euthanasia of infants born with Down’s syndrome or severe spina bifida.23

4. The argument from economic necessityAnother social argument has been added to the case for euthanasia in recent years with the recognition of the high cost of the medical and social care for those who might be candidates for euthanasia. The cost of care for this type of patient can be very high indeed, and so it has been maintained that the legalisation of euthanasia would release money which could then be used for improvement of the health services for other sections of the population.As we have already seen, the reason why euthanasia is an ethical problem is that it involves the deliberate killing of another person. It is, of course, also a legal problem and the present debate is focused on whether the practice should be legalised. However, the legalisation of euthanasia can only be agreed if its practice is ethically acceptable.24

We have now set out briefly the arguments used in favour of the practice of euthanasia, but we cannot decide for or against its use on these arguments alone. To do so would be to ignore the important assumptions which underlie its practice and to disregard the serious nature of the deliberate killing of another person. Before we consider the case against euthanasia, we must therefore look at these assumptions.

The assumptions which underlie the concept and possible practice of euthanasia are surprisingly numerous. We give them here set out in three separate categories.Philosophical:

21 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3440914/22 http://www.sanjuan.edu/webpages/rhaak/files/pros%20and%20cons%20of%20euthanasia.pdf23 Jack Schwartz, Writing the Rules of Death: State Regulation of Physician Assisted Suicide, fall 1996, 24:3, Journal of Law Medicine & Ethics, 207. 24 Doctors Struggle With Tougher-Than-Ever Dilemmas: Other Ethical Issues Author: Leslie Kane.

1. That man has a right to die.2. That the value of a human life is measurable.3. That human life can be dealt with in the same way as animal life.4. That suffering can have no beneficial function.5. That an unmixed motive of compassion can be guaranteed.6. That a request for euthanasia is always rational and reliable.25

Medical: 7. That medical diagnosis and prognosis are always certain.8. That effective alternative methods for the relief of suffering are not available.9. That euthanasia is the justifiable duty of a doctor.Legal:10. That the legalisation of euthanasia can control its abuse.11. That euthanasia can be clearly distinguished from murder.26

It is obvious from the sheer number and significant nature of these assumptions that they cannot be ignored and that any decision to legalise the practice of euthanasia is one which will have serious moral, legal, social and professional implications.

The Case Against E uthanasia

The argument which seeks to justify euthanasia on economic grounds is likewise not a very acceptable one. It reduces human life and personal happiness to the impersonal terms of money and expediency which are not terms in which the human situation should be assessed.The second argument is based on the view that man possesses a right to die and therefore anyone who wished to exercise this right may be justified in doing so in appropriate circumstances. 27However, it is clear that no man has a right to die. For one thing, all men are destined to die irrespective of any rights they may have. For another, if a man has a right to die, others must have a duty to kill him, for all rights have corresponding duties. In fact, this argument is based on a confusion of rights and liberties. Man is free to end his life when he chooses and by what means he chooses, but he cannot claim that he has a right to do so. We cannot build an argument on a right which does not exist morally, legally or socially, and so we cannot accept this argument.We are left then with the argument from compassion. This argument is specially strong when put forward on the basis of cases in which relatives have been obliged to watch a loved one suffer unbearable agony and to listen, it may be, to repeated requests for them to end it all by euthanasia.28 In other cases they may have had to watch the slow process of personality deterioration of their loved one. The question arises of whether, in many cases, euthanasia may not be too easy a way out of a situation, taken in order to avoid the future problems arising from the continued existence of the patient. It may be difficult to exclude the element of self-interest

25 Franklin G. Miller et al, Can Physician Assisted Suicide Be Regulated Effectively, Fall 1996, 24:3, Journal of Law Medicine & Ethics, 225. 26 http://www.csahq.org/pdf/bulletin/end_of_life_61_1.pdf27 Gerald Dworkin et al, Euthanasia and Physician Assisted Suicide, 1st ed, Cambridge University Press, New York, 1998, 108. 28 Harris, NM. (Oct 2001). "The euthanasia debate", J R Army Med Corps 147 (3): 367–70.

on the part of the relatives which may result from domestic, social or financial considerations. Human nature being what it is, a pure unmixed motive of compassion may be difficult to achieve by those supporting the request for euthanasia, and almost impossible to assess by those who are being requested to administer it. Even if a pure motive of compassion could be achieved, there still remains the problem of how far compassion can be allowed to override the other principles which govern human behaviour in any given situation in the present state of human nature and society.29 If an action is morally wrong, or even legally wrong, then it is clearly doubtful whether the appeal to a motive of compassion can make it morally or legally right.In the second place, let us look at the practice of euthanasia in the light of the assumptions which we have suggested underlie it. Lack of space precludes any adequate review of these, but it is clear that a number of them are of questionable validity. We have already spoken of the fact that man cannot be said to have a right to die. Some of the other assumptions are likewise doubtful, especially those we have classified as ‘Medical’. Medical diagnosis and prognosis are not always certain. Effective alternative methods for the relief of pain and other distressing symptoms are increasingly being introduced as professional skill improves and pharmacological research advances. Finally, the deliberate killing of patients cannot be regarded as the justifiable duty of a doctor30.

In the third place, let us look at some of the arguments against the practice of euthanasia.

Euthanasia is unnecessarily radical:

Euthanasia destroys the problem rather than solving it. By destroying the life of the patient, it deprives him of hope and any opportunity of regretting or reversing his decision. In cases of intolerable pain, it destroys the whole nervous system when the problem may be confined to the distribution of one or two nerves which it may be possible to deal with on a local basis.

Euthanasia is ethically undesirable:It is difficult to distinguish euthanasia from murder. In both there is an intention to kill another human being. But no one has the right to kill another human being except under the due process of law. Murder is contrary to the teaching of religion which regards it as a sin, and to the expectation of society which regards it as a crime. Also, although there is an ethical principle of totality which allows a part to be sacrificed for the benefit of the whole, there is no recognised principle that the whole may be sacrificed for the good of a part. That would be an illogical position and certainly an unethical one.

Euthanasia is legally inadmissible:No country has so far legalised euthanasia, although Holland has come very near to doing so. It is unlikely, however, that any country ever will legalise it because of the danger of abuse. Legislation on euthanasia may be expected to fail to control its abuse or to provide appropriate safeguards for its practice. The legal problem is how to distinguish euthanasia from murder. In

29 http://www.nujs.edu/workingpapers/euthanasia-regime-a-comparative-analysis-of-dutch-and-indian-positions.pdf30 Gerald Dworkin et al, Euthanasia and Physician Assisted Suicide, 1st ed, Cambridge University Press, New York, 1998, 108.

both cases the intention to kill is present, although the motive may be different.31

Euthanasia is practically unworkable:Doctors are trained to preserve life, not to destroy it, and it is probable that there are not many doctors who would wish to be known as the executioners of their patients, for this would undermine their relationship with their patients.

Euthanasia is increasingly unnecessary:When euthanasia was first publicly advocated the concept and practice of effective palliative medicine was unknown. Doctors had no guidance and little experience in the alleviation of distressing symptoms arising from incurable disease. The most effective methods for the use of analgesics and narcotics were not employed and physical measures for the relief of pain rarely used. In these circumstances, euthanasia often seemed to be the only solution to the patient’s problems.The situation is very different today and the consideration of the use of euthanasia is increasingly unnecessary and even outdated as a method of coping with distressing symptoms and situations.

EUTHANASIA AND LAWS PERTAINING TO EUTHANASIA IN DIFFERENT COUNTRIES

The laws pertaining to euthanasia and the practice of euthanasia throughout the world, has gained importance (and continues to be a significant contention for debates) for the most part, in the second half of the 20th Century. There are several instances pertaining to suicide and euthanasia in different countries, some of which have been illustrated below.

1. The Netherlands: In the nineteen seventies and eighties a series of court cases in The Netherlands culminated in an agreement being reached between the legal and medical authorities to ensure that no physician would be prosecuted for assisting a patient to die as long as certain guidelines were strictly adhered to. 32These guidelines were established to permit physicians to practice voluntary euthanasia in instances where: a) A competent patient had made a voluntary; and informed decision to die. b) The patient’s suffering was unbearable. c) there was no way of making that suffering bearable which was acceptable to the patient. d) The physician’s judgment as to the diagnosis and prognosis were confirmed after consultation with another physician. In November 2000, The Netherlands passed a legislation to legalize the practice of voluntary euthanasia. The legislation passed through all Parliamentary stages; and in early 2001 became Law. Since 2001 many patients suffering from numerous incurable diseases have been able to put an end to their misery by opting for euthanasia.33

2. U.S.A: In Oregon, legislation was introduced in 1997, to permit physician assisted suicide, when a second referendum clearly endorsed the proposed legislation. Later, in 1997 the Supreme Court of U.S in two significant cases ruled that, “There is no constitutional right to physician

31 Richard A. Posner, Reply to Critics of the Problematics of Moral and Legal Theory, May, 1998, 111 Harv. L. Rev. 1796. 32 http://www.legalserviceindia.com/article/l265-Suicide-&-Euthanasia.html33 Goel vaibhav, “Euthanasia- a dignified end of life”, Vol. 3 (12), 2008, international NGO journal, pp. 224-231

assisted suicide. ” However, the Court did not preclude individual States from legalizing in favour of physician-assisted suicide. As a result the Oregon legislation is still operative and continues to serve the purpose of many people. In Florida the legislators debated the issue of Terri Schiavo34, who had been in Persistent Vegetative State for the past fifteen years and had not left any advance directives with the help of which the matter could have been easily resolved. Her husband sought to have her feeding tube withdrawn; and had won the Courts approval to do so. However, Mrs. Shiavo’s parents opposed the said decision of the Court. Meanwhile the Florida legislature hastily enacted a law directing that the feeding tube be applied once more. In this particular case, many are of the opinion that after fifteen years in a persistent vegetative state, perhaps Mrs. Schiavo should be allowed to die.

The Iowa Law Review in October, 1989 published a “Model Aid-In Dying Act”, under which even a child above the ‘age of six’ could request Aid-in-Dying; and if his parents refused to permit him, an “Aid-in-Dying Board” could overrule them and grant the request. In 1984 the then Governor of Colorado - Richard Lamm said , “The terminally ill elders have a duty to die and get out of the way.”

Jack Kevorkian also known as the ‘Doctor of Death’ in his trial in Michigan said, “If a rational policy of planned death can be attained, the benefit for the society is incalculable .” 35Also there are many who are of the opinion that euthanasia could also be used to eliminate the defective in order to strengthen the gene pool, or to keep the growing population under check; and thus be very beneficial for the society. But such extreme measures are perhaps too irrational.

In the U.S, in cases such as Nancy Cruzan , John Doe , and that of Karen Ann Quinlan, that Supreme Court has time and again reiterated its view that, though there is a Constitutionally protected ‘right to die,’ this right is not absolute, for the State has an interest in protecting and preserving life36.

Today in America, various grants are being made to promote euthanasia by various foundations. Also, education programs are being designed to train medical personnel in the pro-euthanasia newspeak .

3. AUSTRALIA: In the nineteen nineties in Australia, the first legislative approval for voluntary euthanasia was achieved with the passage of a bill in the Parliament of Australia’s Northern Territory to enable physicians to practice voluntary euthanasia. Subsequent to the Rights of the Terminally Ill Act’s Proclamation in 1996, it faced a series of challenges from opponents of voluntary euthanasia. 37In 1997, the challenges culminated in the Australian National Parliament overturning the legislation; and prohibiting Australian Territories (The Australian Capital Territory and The Northern Territory) from enacting any legislation permitting euthanasia.It was observed in an Australian case , “The Rights of the Terminally Ill Act (as amended) (NT) is unique. It is sui generis. It is a composite whole. It establishes a regulatory regime for the intentional termination of human life in stipulated circumstances. In doing so, it removes all

34 Compassion in Dying v. Washington, Filed March 6, (1996) U.S Court of Appeals 9th Circuit Court.35 New York Times, 29 March 198436 http://www.euthanasia.com/page3.html37 http://www.medicalnewstoday.com/releases/149531.php

criminal, civil and professional sanctions otherwise applicable to a medical practitioner who intentionally terminates a patient's life or aids a patient to commit suicide in accordance with stipulated procedures. The Act institutionalises intentional killing which would otherwise be murder; it institutionalises aiding suicide which would otherwise be a crime.”

It was approximately a year ago, when an Australian citizen devised an instrument capable of holding carbon monoxide gas; it was made specifically for people who wished to put an end to their lives, without having to bear any pain in the process. The said instrument was made available for a retail price of fifty dollars only.

4. BELGIUM: The Belgian Parliament legislation favouring euthanasia in May, 2002 quite similar to that passed in The Netherlands. And in the first year of its legalization, 203 cases have been recorded, according to the newly released figures provided by the Public Health Ministry. The Public Health Ministry is now examining how patients and doctors are informed about this issue in The Netherlands compared to Belgium; also changes to checks on compliance with the legal conditions under which euthanasia is carried out are also being considered, as are simpler registration forms. Recently there was a forum held by Doctors in Brussels, wherein the doctors admitted that there could be more than thousand deaths annually via euthanasia in very first year of its being legalized, a leading spokesman opined that the practice of euthanasia should be expanded to include teenagers and more disabled people

5. INDIA: In India the contention whether the ‘right to live’ includes within its ambit the ‘right to die’ came for consideration for the first time in the year 1987. It was in the case of State of Maharashtra v. Maruti Shripati Dubal 38, wherein the Bombay High Court held that, “Everyone should have the freedom to dispose of his life as and when he desires.” The said decision of the Bombay High Court was upheld by the Supreme Court of India in the Case of P. Rathinam v. Union of India 39, where the supreme Court held, “ A person cannot be forced to enjoy life to his detriment, disadvantage or disliking.”

However, the Supreme Court rejected the plea that euthanasia (mercy killing) should be permitted by law, because in euthanasia, a third person is either actively or passively involved; about whom it may be said that he aids or abets the killing of another person.

It was in Gian Kaur’s case 40, that a five Judge Bench of the Supreme Court overruled P. Rathinam’s case , and held, “The ‘right to life’ under Article 21 of the Constitution of India does not include the ‘right to die’ or ‘right to be killed’… the right to life would mean the existence of such a right upto the end of natural life. This also includes the right to a dignified life upto the point of death including a dignified procedure of death.” The Supreme Court also held that Article 21 of the Constitution of India does not include therein, the right to curtail the natural span of life.

38 (1987) Cr LJ 54939 (1994) 3 SCC 39440 Gian Kaur v. State of Punjab (1996) 2 SCC 648

Passive euthanasia is legal in India.41 On 7 March 2011 the Supreme Court of India  in the case of Aruna Ramachandra Shanbaug v. Union of India, allowed withdrawal of medical assistance to patients in permanent vegetative state under certain conditions i.e. legalised passive euthanasia by means of the withdrawal of life support to patients in a permanent vegetative state.42 The Supreme Court has interpreted PVS to mean a vegetative state where the patient has been in a vegetative state for over one year and when the probability of recovery is very low, and where he is expected to remain in the same state. It is irreversible and results from brain damage. There is lack of consciousness, thought, and feeling, although reflex activities (such as breathing) continue. The brain damage is to the cortex of the brain and not the brain stem which controls non-voluntary and reflex activities. The patient has to be provided with food and water which is generally achieved through artificial means of a nasogastric tube while the excretory functions are regulated by a catheter and enemas.

In such cases, withdrawal of medical assistance has been permitted, provided certain conditions and safeguards are maintained.

Forms of Active euthanasia, including the administration of lethal compounds, are illegal.43

IMPACT OF LEGALIZED EUTHANASIA ON MEDICINE

We also need to consider how the legalisation of euthanasia could affect the profession of medicine and its practitioners. Euthanasia takes both beyond their fundamental roles of caring, healing and curing whenever possible. It involves them, no matter how compassionate their motives, in the infliction of death on those for whom they provide care and treatment. Euthanasia thus places the soul of medicine itself on trial. We thus need to be concerned about the impact that legalisation would have on the institution of medicine - not only in the interests of protecting it for its own sake, but also because of the harm to society that damage to the profession would cause.

41 "India joins select nations in legalising "passive euthanasia"". The Hindu. 7 March 2011.42 Supreme Court disallows friend's plea for mercy killing of vegetative Aruna". The Hindu. 7 March 2011.43 "India's Supreme Court lays out euthanasia guidelines". LA Times. 8 March 2011.

With the decline of organised religion in many modern, secular, pluralistic societies, it is difficult to find consensus on the fundamental values that create society and establish its ethical and legal "tone" - those that provide the "existential glue" that holds society together. 44Many people do not personally identify with the majority of societal institutions. There are very few institutions, if any, with which everyone identifies except for those - such as medicine - that make up the health-care system. These, therefore, are important when it comes to carrying values, creating them, and forming consensus around them. We must take great care not to harm their capacities in this regard and, consequently, must ask whether legalising euthanasia would run a high risk of causing this type of harm.Can we imagine teaching medical students how to administer euthanasia - how to kill their patients? A fundamental attitude we reinforce in medical students, interns and residents is a repugnance toward the idea of killing patients. If physicians were authorised to administer euthanasia, it would no longer be possible to instil that repugnance. Maintaining this repugnance and, arguably, the intuitive recognition of a need for it, are demonstrated in the outraged reactions against physicians carrying out capital punishment when laws provide for them to do so. We do not consider their involvement acceptable - not even for those physicians who personally are in favour of capital punishment.

We, as a society, need to say powerfully, consistently and unambiguously, that killing each other is wrong. And physicians are very important carriers of this message, partly because they have opportunities (not available to members of society in general) to kill people.

It is sometimes pointed out that many societies do justify one form of killing by physicians: abortion. This was justified, traditionally, on the grounds that it was necessary to save the life of the mother. We now have liberalised abortion laws, which reflect a justification that hinges on the belief that the foetus is not yet a person in a moral or legal sense. As well, in justifying abortion, attention is focused on the woman's right to control her body; access to abortion is considered necessary to respect this right. Besides, it is argued, abortion is aimed primarily not at destroying the fetus but at respecting women's reproductive autonomy. Indeed, when destroying the foetus is the primary aim - as it is in sex selection - even those who agree with abortion on demand often regard it as morally unacceptable. And the rarity of third-trimester abortions in most countries shows that, once we view the foetus as a "person," we do not find killing it acceptable.45

Consequently, legalised euthanasia would be unique in that the killing involved could not be justified on the grounds either that it is necessary to protect the life of another (which, as well as being the justification for some abortions, is also that for the other examples of legally sanctioned killing - namely self-defence, just war and, in theory and in part, capital punishment) or that it does not involve taking the life of a person (the justification used for some abortions). Euthanasia would seem likely to affect physicians' attitudes and values, therefore, in ways that, arguably, abortion does not.

44 http://www.abc.net.au/religion/articles/2013/05/24/3766685.htm45 Asch, DA; Dekay, ML (September 1997). "Euthanasia among US critical care nurses. Practices, attitudes, and social and professional correlates". Med Care 35 (9): 890–900.

We need to consider whether patients' and society's trust in both their treating physicians and the profession of medicine as a whole depends in large part on this absolute rejection by physicians of intentionally inflicting death.

Moreover, we cannot afford to underestimate the desensitisation and brutalization that carrying out euthanasia would have on physicians. Keep in mind that the same might be true of abortion. We should remain open-minded about this possibility - even if we believe women should have a right of access to safe, legal abortion. Sometimes, dealing with new ethical issues can cause us to review ones that we believe have already been settled ethically. It could be that rightful concerns about the impact on physicians of their being involved in euthanasia would cause us to reconsider that on physicians involved in abortion. In short, one problem with the position of those who promote abortion on demand is that it threatens to continue undermining the link between medicine and respect for life.

It is sometimes remarked that physicians have difficulty accepting death, especially the deaths of their patients. This raises the question of whether, in inculcating a total repugnance to killing, we have evoked a repugnance to death as well. In short, there might be confusion between inflicting death and death itself. We know that failure to accept death, when death would be appropriate, can lead to overzealous and harmful measures to sustain life. We are most likely to elicit a repugnance to killing while fostering an acceptance of death - and we are most likely to avoid confusion between a repugnance to killing and a failure to accept death if we seek to convey a repugnance to killing when that is the appropriate word (although it is an emotionally powerful one), instead of death. Achieving these aims would be very difficult in the context of legalised euthanasia.Finally, the researcher would propose that it is an important part of the art of medicine to sense and respect the mystery of life and death, to hold this mystery in trust and to hand it on to future generations - including future generations of physicians. We need to reflect deeply whether legalising euthanasia would threaten this art, this trust, this legacy.

JURISPRUDENTIAL INTERPRETATION OF EUTHANASIA

Legally, euthanasia is a crime in India punishable under the Indian Penal Code, 1860 (hereinafter referred to as the IPC). If there is consent on the part of the patient, it amounts to culpable homicide which is not murder under § 300 exception 5 of the IPC. It also amounts to abetment of suicide under Sec. 306. If there is no consent, it amounts to culpable homicide under Sec. 299 of the IPC.

In the case Naresh Maotrao Sakhre v. Union of India46, Lodha J. throws light upon the confusion regarding the difference between suicide and euthanasia and also points out, ‘Euthanasia or Mercy-killing is nothing but homicide whatever the circumstances in which it is

46 1987 (1) Bom CR 499

effected’. One may agree with the judge in so far as euthanasia without consent being termed as homicide is concerned. However, voluntary euthanasia, in my opinion can only be an abetment to suicide and not homicide.

The debatable issue with regard to euthanasia is whether the ‘negative connotation’ of Article 21 of the Indian Constitution (hereinafter referred to as A. 21) 47can be considered to be an interpretation of the same, i.e. does the Right to Life also include the Right to Die? J.S. Mill in his famous tract ‘On Liberty’ says:“… The only part of the conduct of anyone, for which he is amenable to society, is that which concerns others. In the part which merely concerns himself, his independence is, of right, absolute. Over himself, over his own body and mind, the individual is sovereign.”48

Relying heavily on Mill, one may say that it is the personal liberty of a person whether to live or not. In the context of euthanasia, one could argue that if a person has a right to life, he also has the right to relieve himself of pain. If the only way to do so is by dying, A. 21 also includes the right to die. Also, in the case of P. Rathinam / Naghbhusan Patnaik v. Union of India49 the apex court, while striking down Sec. 309 of the IPC said ‘it is a cruel and irrational provision violative of Article 21 of the Constitution’. Expanding the scope of A. 21, the Court upheld that, ‘right to life’ includes ‘right not to live a forced life’; i.e., to end one’s life if one so desires.

As laws have evolved from their traditional religious underpinnings wherein death was considered to be undesirable and immoral, certain forms of euthanasia have been legally accepted in countries across the globe. In general, laws attempt to draw a line between passive euthanasia (generally associated with allowing a person to die) and active euthanasia (generally associated with killing a person). While laws commonly permit passive euthanasia, active euthanasia is typically prohibited.In India, however, euthanasia continues to be illegal and punishable. It is evident from the court’s ruling in the recent case of K. Venkatesh50, a twenty-five year old boy suffering from muscular dystrophy, who was aware of his incurable predicament and hence, wanted to donate his organs to someone needy before he could die. The Andhra Pradesh High Court however, turned down the humanitarian appeal of an ailing man on deathbed. One, in this context could refer to the English case of R v. Cambridge Health Authority51 in which the doctors in the university town of Cambridge held that they could not justify chemotherapy and a second bone marrow transplant for the cost of GBP 75,000 for a ten year old girl suffering from acute myeloid leukaemia because the treatment cost could be spent in helping others, and the Court of Appeal ruled in favour of the health authority for it concerned terminally ill patients fighting for a share of limited resources. Hence, my contention with regard to the Venkatesh Case is that, perhaps it would have been apposite in the fitness of things had the Court before taking a final decision, carefully examined the merits and demerits of the issues after thoroughly studying the decided cases on the subject in different parts of the world instead of blindly relying on primitive notions, and arrived at a reasonable decision considering the humanitarian appeal of a miserable boy to fulfil his ‘last wish’ without arbitrarily rejecting the request.

47 See Constitution of India,  1950, A. 2148 john stuart mill, on liberty, 9 (1859)49 AIR 1994 SC 184450 The Financial Express, “Farewell Venkatesh”, December 18, 2004,51 [1995] 2 All ER 129

While attempting to resolve the issues relating to the growing demand for the legalization of euthanasia, one needs to challenge primitive notions and pose a question to the lawmakers with regard to the validity of A. 21- What does the article guarantee- a right to life or merely a liability of life? If it is the former, one possibly cannot be forced to live a prolonged life to his detriment. While making euthanasia illegal, the ‘right of life’ is forced upon a person for whom life is nothing but a cumbersome burden, he no longer wishes to endure. He is forced to live a ‘cursed life’ which is full of mental and physical torture, pain and agony; a life which one already knows is not going to subsist for long. Thus, the need of the hour is to put into place mechanisms to check and control the abuse and misuse of euthanasia because while most patients who opt for mercy killing may be terminally ill with absolutely no chances of recovery, there are chances of misuse like wrong diagnosis, hallucinations of patients and collusion of patient’s relatives and doctors. To tackle this problem pragmatically, all such cases should be reviewed by a panel of experts including physicians, neurologists, psychiatrists, psychologists, lawyers.52

In order to address the debate revolving around ‘Right to Die’, one needs to finally refer to the case of Cruzan v. Director, Missouri Dept. of Health53, commonly known as the Nancy Cruzan Case in which the U.S. Supreme Court held that the parents’ request to withdraw artificial life saving devices can be complied with only if there is a clear and convincing evidence of the patient’s wish to die. Since there was enough compliance with the clear and convincing evidence standard in this case, the devices were removed and the patient peacefully died. However, the Supreme Court only conceded a constitutionally protected ‘liberty interest’ in refusing unwanted medical treatment.54 The majority was careful not to suggest that competent parties have a fundamental right to refuse treatment, for if they did so, the fundamental right would have to be protected unless the State interest was shown to be compelling.

Few famous English cases are:

Helga Wanglie

Helga Wanglie was 86 when she broke her hip in December of 1989 after falling on a rug in her Minneapolis home. She was treated and released from a local hospital and moved to a nursing home. In January of 1990 she was readmitted to the hospital and placed on a respirator, due to respiratory complications. Attempts to wean her from the respirator were unsuccessful, and in May of 1990 she was transferred to a long-term care facility that specialized in treating respirator-dependent patients.

Wangfie suffered a heart attack while under the care of this facility. Resusecitation efforts were successful, although she had been deprived of oxygen for several minutes, resulting in severe and irreversible brain damage. She was readmitted to the hospital on May 31, 1990, where she continued Jo use a respjrator and was provided food and fluids through a tube implanted into her

52 The Hindu, Is Euthanasia Ethical, November  25, 2003 53 497 U.S. 261 (1990)54 Gostin, Larry, Life and Death Choices after Cruzan Law, Medicine and healthcare, 9-12 (1991)

stomach. After repeated evaluations, she was diagnosed as PVS (Persistent Vegetative State) with the complication of permanent respirator dependency.

Wanglie had left no written record of her wishes in the form of a living will or advance directive, and was no longer in a position to indicate her preferences. Because of her prognosis, the medical staff suggested that the family re-evaluate continuing the extensive care require-ad to prolong her existence. Relatives opposed termination of treatment. Doctors countered that in Wanglie's case, they would have to go beyond the limit of "reasonable care" to maintain her existence.

Since the family remained unconvinced, hospital administrators and the medical staff took the case to court, where they requested the appointment of an independent guardian. As the physician who served as the ethical consultant for the hospital argued that a physician should not have to provide medical care that does not serve a patient's medical interest, the Wanglies persisted that all medical treatment to keep Helga alive be continued.

In a ruling issued on July 1, 1991, Probate Judge Patricia L. Belois of the Hennepin County Court rejected the hospital's position and turned over full guardianship to Oliver Wanglie, Helga's 87 year-old husband. Helga Wanglie died of multi System organ failure on July 4, 1991. Her medical bill was approximately $750,000.

Karen Ann Quinlan

17 year-old Karen Ann Quinlan was admitted to a New Jersey hospital after lapsing into a coma on April 15, 1975. She had collapsed at a party that night, presumably due to a combination of drugs and alcohol. She had ceased breathing for at least two separate periods of approximately 15 minutes each. Her condition deteriorated even further after hospitalization, to the point where all examining physicians agreed she had suffered irreversible damage and was now in a persistent vegetative state, without hope of recovery.

Quinlan's parents consulted their Roman Catholic priest, who informed them that they had no moral obligation to continue "extraordinary means" to sustain life when there was no realistic hope for recovery. However, "extraordinary means" was taken in this context to only apply to the respirator and not to the tube that delivered nutrition and hydration directly into Quinlan’s stomach. The hospital agreed to the parents' request to remove the respirator, but the primary-care physician refused to fulfil the family's wishes, due to his second thoughts and moral concerns. The hospital supported the physicians decision, as Quinalan was still technically alive by all criteria, including the Harvard brain-death criteria.

The Quinlans took their case to court. Meanwhile, the hospital medical staff proceeded to wean Karen from the respirator so that she would have a chance to breathe on her own should the court decide to allow withdrawal. The New Jersey Supreme Court sided with the Quinlans. However, Karen had been effectively weaned off the respirator at the point and the court decision was essentially irrelevant.

Quinlan lived in a persistent vegetative state with artificially provided nutrition and hydration for another 8 years.

There are many cases in India like Babulal Parate v. State of Maharashtra55, Kedar Nath Singh v. State of Bihar56, and Madhu Limaye v. S.D.M. Monghyr57 where it was held that even though Section 124A of the IPC and Section 144 of the Code of Criminal Procedure, 1973 would be offending some of the fundamental rights conferred by Article 19, the Court instead of striking them down must tailor them and apply them in a manner to bring them in accordance with the relevant provisions of the Constitution. However the honourable Supreme Court in the abovementioned cases could also have laid down proper guidelines as to how and under what circumstances and consideration, what type of sentences are to be imposed in a case of attempt to suicide under Section 309 of the Indian Penal Code to prevent the confusion as well as to prevent the occurrence of obnoxious crimes like sati or abetment where the lives of other people could be in jeopardy.

A landmark Judgment was passed by Justice Markandey Katju and Gyan Sudha Mishra which tends to legalize passive euthanasia. This case was filed for grant of permission by one writer-cum-social activist Pinky Virani on behalf of Aruna Ramachandra Shanbaug, a hapless comatose victim of sexual assault who has been in persistent vegetative state for the past 37 years at Mumbai’s KEM Hospital. During Aruna’s case, the learned Judges commented on deletion of the section-309 of IPC as it has become anachronistic. It was further held in Aruna’s case that in case the patient is in competent person to decide whether life support system should be discontinued then in such situation the family member or close relatives or in their absence doctors attending patient can decide in best interest of patient with the bonafide intention. However, such a decision requires approval from the concerned High Court.

CONCLUSION

Euthanasia, too, is a controversial subject, not only because there are many different moral dilemmas associated with it, but also in what constitutes its definition. At the extreme ends of disagreement, advocates say euthanasia, also known as physician aid in dying, or physician assisted suicide, is a merciful method of death. At the other end are opponents of euthanasia, who may consider this method as a form of murder. After the detail study of various states legislations and the detail study of the Rati Ram’s case and Gyan Kaur’s case, still the matter is a question of debate that whether Euthanasia is a suicide or dignified end of life. Many state legalize Euthanasia but in the high profile state as well as in India Euthanasia is not permitted even after their broader verdict that right to life means dignified life and this right to life include dignified end of life too. On the one hand most of the countries are not legalizing the Euthanasia

55 AIR 1961 SC 884.56 AIR 1962 SC 955.57 AIR 1971 SC 2486.

and on the other hand they are providing the legislation for wish for death (for unborn living), no doubt Medical Termination of Pregnancy Act 1971 is one in India. As one of their major goals, euthanasia proponents seek to have euthanasia and assisted suicide considered "medical treatment." If one accepts the notion that euthanasia or assisted suicide is a good medical treatment, then, opponents say, it would not only be inappropriate, but discriminatory, to deny this good treatment to a person solely because that person is too young or mentally incapacitated to request it.

The real alternative to euthanasia is to provide loving, competent care for the dying. A new concept for the dying arose in England, where institutions called Hospices specialize in compassionate, skilled care of the dying. This concept has spread throughout the Western world. Once a patient feels welcome and not a burden to others, once his pain is controlled and other symptoms have been at least reduced to manageable proportions, then the cry for euthanasia disappears. Proper care is the alternative to it as soon as there is adequate instruction of medical students in a teaching hospital. Technically the concept of Euthanasia and right to die are not in themselves degrading concepts. Rather they develop the idea of contentment of human beings.

Various theories of sociologist dealing with the social aspects of suicide leads to positive conclusions that examination and correction of social condition that directly or indirectly contributes towards the incidents of suicide is essential of a society and family don’t take the trouble that the person is unhappy.

It is the duty of the family to see the social and psychological condition of the frustrated person. Our state India being a social welfare state is interested with the duty to take suitable steps. Providing punishment for an attempt to suicide and making it an offence in IPC is not only the solution of this problem. With this, some more is required to be done. What are we to do in the face of the distressing symptoms and situations from which our patients may be suffering? First, we should prevent these symptoms or situations arising by anticipating their onset and forestalling their more serious development. Second, we should keep abreast of all the current knowledge and skill in the control of these distressing symptoms. This applies especially to the effective use of the many new drugs and physical methods of control now available. Third, we should encourage the provision of facilities for the care and cure of patients who need the services of palliative medicine. Fourth, we should promote active and competent research, which is aimed at the improvement of the means for the relief of suffering, so that new methods might be discovered, and old ones made better. Finally, we must recognise that the care of the sufferer and the relief of his suffering are never purely medical concerns. We must provide for his physical, mental and spiritual welfare by involving all the caring professions in an effective and sensitive approach to the patient and his family in order to support them in their situation of need.

If and only if none of these is possible should Euthanasia be legitimised.

Will legalization of euthanasia and physician assisted suicide significantly improve the care of the millions of patients in the world who die each year? There is no compelling evidence that the

answer is in the affirmative. And the focusing of so much attention and energy on debating, campaigning, litigating, and studying euthanasia and PAS is beginning to detract from the primary goal of improving end-of-life care. There are important challenges to providing better end-of-life care. These include providing better and more mental health care, home care, and spiritual care. The health care system has scarce resources, especially scarce time, money, attention span, managerial talent, and so forth. The euthanasia and PAS debate has been useful in focusing some of these scarce resources on the dying and in galvanizing improvements in care of the dying. Much of the nation, including the medical establishment, national foundations, and the National Institutes of Health, is focused on improving end of life care. Continued attention and resources focused on euthanasia and PAS are likely to impair, not improve, the care of the million decedents by diverting valuable resources.

If we accept the use of euthanasia as the solution to the problem of suffering, that cannot be the end of the matter. Suffering still remains as the real problem to be faced. We must therefore face this problem while concluding.

If we continue to disrespect human life and its creator, God, then well destroy ourselves. A right is a moral claim and since we do not have a claim on death which itself has a claim on us, we cannot act for the right we don't have. Perilt Mother Teresa was right when she said that "if a mother can kill her own child, “is there to stop you and me from killing each other?" There is no way to slop culture of death, unless, we get back to God's law and speak out, boldly, against horrors and injustices of the day!

BIBLIOGRAPHY

BOOKS

Srivastava lily, Law & Medicine, New Delhi, Universal Law Publishing Co., 2010.

Mason J.K & Laurie G.T., Law & Ethics, New York, Oxford University Press, 2006.

Dogra J.D. & Rudra Abhijit, Medical jurisprudence & Toxicology, New Delhi, Delhi Law House, 11th edn.(2005).

ARTICLES

Baume P, O'Malley E and Bauman A, “Professed religious affiliation and the practice of euthanasia”, vol. 21, 1995, J Med Ethics, 49-54.

Joris Gielen, Stef van den Branden and Bert Broeckaert, “Religion and Nurses Attitudes to Euthanasia and Physician Assisted Suicide”, 2009, vol. 16 (3), Nursing Ethics.

Stephen Adams and George Pitcher, “Religious leader call for end to 'legal euthanasia' move”, the telegraph, Jun 28th 2009.

Athanassoulis Nafsika, “Euthanasia: Not just a matter of faith”, February 23rd, 2009, The journal.

Collins K., Gilhooly M. L., and Murray k., “Euthanasia: Attitudes are influenced by age and religion”, vol.309(6946) July 2 1994, BMJ , 52.

Sinha vinod, Basu s. and sarkhel s., “Euthanasia: an Indian perspective”, vol. 54(2),2012,Indian journal of psychiatry, 177-83.

Damien Keown, "Buddhism and Suicide: The Case of Channa." Journal of Buddhist Ethics, University of London, 1996.

"Euthanasia: The Buddhist View." BBC Religion & Ethics

Goel vaibhav, “Euthanasia- a dignified end of life”, Vol. 3 (12), 2008, international NGO journal, pp. 224-231

JOURNALS

Oxford journal

Australian medical student journal

Journal of medical ethics

SITES

http://www.legalservicesindia.com/article/article/euthanasia-in-india-787-1.html

http://www.current-oncology.com/index.php/oncology/article/view/883/645

http://www.bioethics.org.au/Resources/Online%20Articles/Other%20Articles/The%20Legalisation%20of%20Euthanasia%20-%20Brian%20Pollard's%20second%20document.pdf

http://www.abc.net.au/religion/articles/2013/05/24/3766685.htm

http://www.bbc.co.uk/ethics/euthanasia/

http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_96h02_e.htm

http://www.thehindu.com/news/national/article1516973.ece

http://www.care.org.uk/advocacy/end-of-life/euthanasia-country-comparison

http://www.differencebetween.com/difference-between-suicide-and-euthanasia/

http://www.bbc.co.uk/ethics/euthanasia/overview/introduction.shtml

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3440914/

http://www.sanjuan.edu/webpages/rhaak/files/pros%20and%20cons%20of%20euthanasia.pdf

http://www.debate.org/euthanasia/

http://www.righttolifetrust.org.uk/downloads/education-packs/KS4Euthanasia.pdf

http://www.euthanasia.com/index.html

http://www.humanismtoday.org/vol4/larue.pdf

http://www.preservearticles.com/201101183560/essay-on-euthanasia-mercy-killing.html