1.0 Introduction It has been argued that euthanasia is one of the most pressing social concerns of our times.

The term euthanasia is derived from the Greek word euthanatos which means easy death and it has come to mean the deliberate killing of sick or disabled persons for supposedly merciful reasons or mercy killing. Euthanasia also raises a number of agonising moral dilemmas: Is it ever right to end the life of a terminally ill patient who is undergoing severe pain and suffering? In under what circumstances can euthanasia be justifiable, if at all? Is there a moral difference between killing someone and letting them die? Should human beings have the right to decide on issues of life and death?

At the heart of these arguments are the different ideas that people have about the meaning and value of human existence. Euthanasia has become a topic that never fails to evoke a response, be it an exhaustive analysis of its justification or non-acceptability, or an immediate halt of disapproval. For the individual, it is a topic which touches not only ones emotion, but also ones religious beliefs and culture. Those in favour of euthanasia argue that a civilised society should allow others to help them do so if they cannot manage it on their own. They say that our bodies are our own, and we should be allowed to do with them. So its wrong to make anyone live longer than they want. Religious opponents of euthanasia on the other hand believe that life is given by god, and only god should decide when to end it For nations as a whole, the legality or otherwise of euthanasia exposes the policies and the political stance of societies on the issue of self- determination. They fear that if euthanasia was to be made legal, the laws regulating it would be abused, and people would be killed who didnt really want to die. From the physicians perspective, the practice of euthanasia is entangled with difficult questions of ethics and, at the very core, challenges the primary duty of physicians, which is that of saving lives as opposed to the deliberate termination of ones life. This paper provides a discussion on various types and forms of euthanasia and also the religions perspective on euthanasia. 2.0 Types and forms of euthanasia Euthanasia comes in several different types and forms of euthanasia and each of which brings different set of rights and wrongs. Euthanasia is generally classified as either active or passive, and as either voluntary or involuntary euthanasia. Similar to euthanasia is assisted suicide. 2.1 Active and passive euthanasia In active euthanasia, a person directly and deliberately causes another person death. In passive euthanasia they dont directly take the patients life, they just allow them to die. This is morally unsatisfactory distinction, since even though a person doesnt actively causes another person death, they are aware that the result of their inaction will be the death of the other person. Active euthanasia is when death is brought about by an act for example when a person is killed by being given an overdose of pain-killers.

Passive euthanasia is when death is brought about by anomission that is when someone lets the person die. Passive euthanasia occurs when the patient dies because the medical professionals either dont do something necessary to keep the patient alive, or when they stop doing something that is keeping the patient alive by: Switching off life-support machines Disconnect a feeding tube Dont carry out a life-extending operation Dont give life-extending drugs

The most common method of euthanasia used is by withholding food and fluids. In other words, the person is starved to death. This is routinely classified as passive euthanasia. 2.2 Voluntary and involuntary euthanasia Voluntary euthanasia is when the patient request that action be taken to end his or her life, or that life-saving treatment be stopped, with full knowledge that this lead to his or her death. This includes cases of: Asking for help with dying Refusing burdensome medical treatment Refusing to eat

Non-voluntary euthanasia occurs when the person is unconscious or otherwise unable to make a meaningful choice between living and dying, and an appropriate person takes the decision on their behalf. This includes cases where: The person is in coma The person is too young for example a very young baby The person is severely brain damaged The person is mentally disturbed in such a way that they should be protected from themselves

Involuntary euthanasia occurs when the patients is provided with a treatment usually to reduce the pain that has the side effect of speeding the patients death. Since the primary intention is not to kill, this is seen by some people although not all as morally acceptable. A justification along these lines is formally called the doctrine of double effect. This doctrine says that if doing something morally good has a morally bad side-effect its ethically acceptable to do it providing the bad side-effect wasnt intended. This is true even if you foresaw that the bad effect would probably happen. The principle is used to justify the case where a doctor gives drugs to a patient to relieve distressing symptoms even though he knows by doing this may shorten the patients life. This is because the doctor is not aiming directly at killing the patient. The bad result of the patients death is a side-effect of the good result of reducing the patients pain. Many doctors use this doctrine to justify the use of high doses of drugs such as morphine for the purpose of relieving suffering in terminally-ill patients even though they know the drugs are likely to cause the patient to die sooner.

2.3 Assisted suicide This usually refers to cases where the person who is going to die need the help of others to kill themselves and asks for it. In assisted suicide, a doctor or another person provides a patient with the means to end his own life, but does not administer it. For example, if a doctor gives you an injection of morphine sufficient to cause your death, this is involuntary euthanasia. But if the doctor puts the hypodermic needle beside the patient bed, explains to the patient what it is, and leaves, and the patient later inject his or her self, this is considered assisted suicide. 3.0 Religion and euthanasia Most religions disapprove of euthanasia. Some of them absolutely forbid it. Muslims are against euthanasia. They believe that all human life is sacred because it is given by Allah, and that Allah chooses how long each person will live. Human beings should not interfere in this. The Jewish tradition regards the preservation of human life as one of its supreme moral values and forbids doing anything that might shorten life. However, it does not require doctors to make dying last longer that it naturally would. Sikhs have a high respect for life which they see as a gift from God. Most Sikhs are against euthanasia, as they believe that the timing of birth and death should be left in Gods hands. Christians are mostly against euthanasia. The arguments are usually base on the beliefs that life is given by God, and that human beings are made in Gods image. Some churches also emphasise the importance of not interfering with the natural process of death. The Roman Catholic Church, for example is one of the most active organisations in opposing euthanasia. Virtually all religions state that those who become vulnerable through illness or disability deserve special care and protection, and that proper end of life care is a much better thing than euthanasia. Religions are opposed to euthanasia for a number of reasons. God has forbidden it Virtually all religion with a supreme God have a command from God in their scriptures that say you must not kill This is usually interpreted as meaning you must not kill innocent human beings This rules out euthanasia as well as murder, as carrying out any of these would be against Gods orders, and would be an attack on the sovereignty of God

Human life is sacred Human lives are special because God created them Therefore human life should be protected and preserved, whatever happens Therefore we shouldnt interfere with Gods plans by shortening human lives

Human life is special Human beings are made in Gods image Therefore they have special value and dignity This value doesnt depend on the quality of a particular life Taking a life violates that special value and dignity even if its ones own life or even if that life is full of pain and suffering

3.1 Eastern religions Some eastern religions take a different approach. Buddhist is not unanimous in their view of euthanasia, and the teachings of the Buddha dont explicitly deal with it. Most Buddhists like almost everyone else are against involuntary euthanasia. Their position on voluntary euthanasia is less clear. The most common position is that voluntary euthanasia is wrong, because it demonstrates that ones mind is in a bad state and that one has allowed physical suffering to cause mental suffering. Meditation and the proper use of pain killing drugs should enable a person to attain a state where they are not in mental pain, and so no longer contemplate euthanasia or suicide. Buddhists might also argue that helping to end someones life is likely to put the helper into a bad mental state, and this too should be avoided. Hinduism is less interested than western philosophers in abstract ideas of right or wrong. Rather it focuses on the consequences of our actions. For Hindus, culture and faith are inextricable. So although many moral decisions taken by Hindus seem more influenced by their particular culture than by the ideas of their faith, this distinction may not be as clear as it seems. Hindus believe in the reincarnation of the soul known as karma through many lives which doesnt necessarily all human. The ultimate aim of life is to achieve moksha, liberation from the cycle of death and rebirth. A souls next life is decided by karma, as the consequence of its own good or bad action in previous lives a souls karma is represented by net worth of its good and bad actions. The key ideas in both Hinduism and Buddhists are that their attitudes to death are to achieve freedom from mortal life, and not-harming living beings. Euthanasia clearly conflicts with the second of these, and it interferes with the first. Freedom from mortal life Hinduism and Buddhism see mortal life as part of a continuing cycle in which we are born, live, die, and are reborn over and over again The ultimate aim of each being is to get free of this cycle, and so be completely liberated from the material world During each cycle of life and death human beings make progress toward their ultimate liberation How they live and how they die play a vital part in deciding what their next life will be, and so in shaping their journey to liberation Shortening life interferes with the working out of the laws that govern this process known as the laws of karma, and so interferes with a human beings journey to liberation

The principle of ahimsa Hinduism and Buddhism regard all life and not just humans as involved in the process above Therefore they say that we should try to avoid harming living things This rules out killing people, even if they want to die

4.0 Ministry of Health In the past 30 years, the question whether euthanasia should remain punishable offense has been the subject of debate. In the Netherlands, where euthanasia was legalized in 2001, a physician may euthanize a patient or assist in that patients suicide if the physician is convinced that the patients request is voluntary, is well-considered and lasting, and that the suffering is unremitting and unbearable. The physician must also agree with the patient and another physician that there is no reasonable alternative. These criteria imply that the competence and autonomy of the patient and the beneficence of the physicians intent are essential to a decision in favour of euthanasia. 4.1 Competence Determination of the patients competence can be neither consistent nor standardized in a legal sense. Competence in bioethics means as the mental ability to distinguish right from wrong and to manage ones own affairs. The functional definition, however is that the patient is competent until incompetence is demonstrated. Two issues arise from this approach. On the one hand, competence is decision-specific in practice; a person may possess the mental capacity to make his or her last will or to stand trial, and yet be found incompetent to make treatment decisions. On the other hand, the legal criteria for competence are cognitive: as long as a person is able to reach a logical decision, the law is unconcerned with whether the decision is reasonable. 4.2 Autonomy Euthanasia also violates the principle of autonomy, or self-determination, and therefore contradicts the claim of euthanasia proponents who say we all have the right to die. Allowing euthanasia does not mean that the patient is allowed to die at his or her own choosing but merely means that the physician is allowed to cause the death of the patient. In other words, it is not a right that an individual enjoys, but the granting of permission to another to transgress. First, the patient is inherently vulnerable because of his or her position within the medical hierarchy. The patient relies on the physician not only for the evaluation of competence after the prognosis, as explained above, but for the prognosis itself. For example, the physicians declaration that no hope exists for improving the patients pain management will determine what happens, regardless of whether the possibility of pain relief exists, unknown to the physician 4.3 Beneficence Euthanasia is not an act of beneficence, even if it may have benefits. Regardless of the extent of palliative care measures, some suffering will continue to be unbearable for individuals who have less capacity to cope with the experience than others, especially those in socially vulnerable positions. Euthanasia offers great financial incentives for those who take care of the suffering, including the patients family and the health care system. Legalization of euthanasia not only increases the likelihood that the practice of euthanasia will be abused for economic gain, but also that a patient may feel obligated to die.

5.0 Recommendations Efforts to change government policies on euthanasia in the 20th century have met with a limited success in the western countries. Euthanasia policies have also been developed by a variety of non government organizations, most notably medical associations and advocacy organizations. My recommendation is by using and recognizing the use of a written living wills and with the help of medical power of attorney regarding the euthanasia of a person. 5.1 Living wills A living will is a document that sets out a patients 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 active declarations. Such a document may be helpful to relatives and to medical professionals in the case of a seriously ill and incapacitated patient. In fact, a living will need not block treatment, but could specify that physician must continue treatment until the patient is dead, regardless of pain or suffering. 5.2 Medical Power of Attorney An alternative to the living will is the medical power of attorney which is available in some places. This lets a person delegate to someone else the authority to make medical decisions on their behalf if they become unable to make or communicate such decisions. Unlike a living will, a medical power of attorney allows the principal to have a wide array of health care decisions made by their agent, not just those directed towards death. The medical power of attorney only takes effect when a doctor has certified that the patient can no longer take or communicate their own decisions. Before taking any decision, the chosen agent is expected to discuss things with the patients doctors, and to take into account their knowledge of the patients wishes, including their religious and moral beliefs. 6.0 Summary I believe that there are some circumstances when euthanasia is the morally correct action. I also understand that there are real concerns about legalizing euthanasia because of fear of misuse or overuse and the fear of the slippery slope leading to a loss of respect for the value of life. We do need to proceed with caution. We need full and open discussion, improvements in terms of research, the best palliative care available, and above all we need to think about the topic together. Our best approach at this time may be to modify homicide laws to include motivational factors as a legitimate defence. Just as homicide is acceptable in cases of self-defence, it could be considered acceptable if the motive is mercy. Obviously, strict parameters, would have to be established that would include patients request and approval, or, in the case of incompetent patients, advance directives in the form of a living will or family and court approval.