Euthanasia: Key Disputes, Countries Where It’s Legal, ‘Death Tourism’ & Indian Law

The case of a Dutch woman who has chosen to end her life on account of mental illness has once again brought into focus the controversial concept of euthanasia.

The case of a Dutch woman who has chosen to end her life on account of mental illness has once again brought into focus the controversial concept of euthanasia.

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Come May, a 28-year-old Dutch woman is set to end her life by choice. Zoraya ter Beek doesn’t suffer from any physical ailments but has been suffering from mental health issues, including depression and borderline personality disorder, that her doctors have declared are beyond alleviation.

Her case has once again brought into focus the concept of euthanasia, which allows people – usually those who are terminally ill or with a prognosis that threatens to destroy their quality of life and bodily autonomy – to end their lives at a time of their choosing.

It’s a deeply controversial subject, but supporters argue that it offers people the option to have a dignified death and mitigate their suffering.

Those who oppose it often question the concept on moral and religious grounds. An overview of anti-euthanasia arguments published in the BBC’s Ethics guide also lists some practical concerns: Will wider acceptance of euthanasia compromise the will to find a cure? Will it create pressure on the terminally ill to end their lives? Will it give doctors too much power?

That euthanasia is prone to misuse became all too clear when Nazi Germany, under Adolf Hitler, perpetuated its use to kill the disabled in its bid to boost racial purity. 

But what has been described as the ethical use of euthanasia – one approved by physicians, after a thorough review – is fast gaining traction. 

Euthanasia or assisted death is legal in several countries – Australia, Belgium, Canada, Colombia, Luxembourg, Netherlands, Spain, Switzerland, and New Zealand – and 11 of 50 US states.

Several Swiss organisations like Dignitas, in fact, actively advocate for it and help people seeking “assisted” death to travel to the country.

A survey published on BMC Psychiatry regarding understanding the attitudes of Belgian psychiatrists and their readiness to engage in euthanasia assessment procedures while dealing with adults with psychiatric conditions (APC) revealed that 74.5 percent agreed that euthanasia should remain a permissible option for APC. 

However, only 8.4 percent said they would assist in carrying out euthanasia on their own patients.

In Switzerland, the amount of people who chose assisted suicide increased from 187 in 2003 to 965 in 2015, the Guardian reported.

In the Netherlands, the 2017 Regional Euthanasia Review Committees (RTE) reported 6,585 cases of voluntary euthanasia or assisted suicide, which was about 4.4% of the total deaths.

About 96% of these cases involved euthanasia, out of which less than 4% were cases of assisted suicide, and the largest proportion of cases involved people with cancer.

What is Euthanasia & Is It Similar To Assisted Suicide?

Euthanasia is the practice of deliberately ending the life of a patient to alleviate their suffering. However, the patient in question must be terminally ill or experiencing great pain and suffering. 

The word ‘euthanasia’ comes from the Greek words ‘eu’ (good) and ‘thanatos’ (death).  

Although euthanasia and assisted suicide are often used interchangeably, there are certain key differences. 

While euthanasia involves a third party, usually a medical professional, directly administering a lethal dose of medication to end a patient’s life, assisted suicide involves providing a person, who may or may not be ill, with the means to end their own life, such as a prescription for lethal medication, which he or she self-administers. 

In art, the concept has been dealt with in several movies and books, including the 2010 Bollywood film Guzaarish and the 2016 novel Me Before You by British author Jojo Moyes, also adapted for the big screen.

Key Disputes 

Most proponents of euthanasia argue that killing a terminally ill patient is not worse than letting them die. Patients, they say, must have the right to decide what they wish to do with their own lives. 

While these arguments are for voluntary euthanasia, it is also argued that patients in a vegetative state with no hope of recovery can be euthanised in order to prevent futile treatment efforts. 

Most arguments in favour are based on freedom of choice, dignified death, quality of life, utilising resources for those who can recover and wish to live rather than for those who wish to die as they are terminally ill, and helping the patient and their loved ones put an end to their suffering.

Critics of euthanasia argue that killing is wrong. They argue that non-voluntary euthanasia, where euthanasia is done based on the consent of a person on behalf of a patient who can’t do so themselves, violates the rights of the patient. 

They also argue that physician-assisted suicides violate doctors’ obligation not to harm their patients.

Some arguments are based on moral and religious grounds, and the mental competence of the patient while providing consent, and the possibility of the decision being driven by guilt of patients on account of the financial, emotional, and mental burden of illness. Critics also cite the possibility of recovery and wrong diagnosis, and the option of palliative care. 

Another argument is that legalising euthanasia is a slippery slope – that wider acceptance of the concept may lead to involuntary euthanasia or situations where people are forced to take the step on account of treatment costs.

In cases involving mental health, in particular, it is argued that euthanasia undermines the efforts to improve access to mental healthcare, and that mental illness is often episodic and thus, if the patients receive appropriate treatment and support, they may regain the desire to live.

Death Tourism In Switzerland & Belgium

Switzerland has emerged as a destination for individuals seeking euthanasia, allowing foreigners to access these services under certain conditions.

In 2018, Dignitas said more than 90 percent of its members were foreigners.

Ever since euthanasia was legalised in Belgium, several patients from neighbouring countries, particularly France, have been visiting to end their lives there.

Belgium's euthanasia law is quite unique as it allows foreigners to submit a request to end their lives in the country.

In 2022, over 70 French people crossed the border to die in Belgium, eronews reported.

Euthanasia In India

In India, both euthanasia and assisted suicide are illegal. 

The matter caught the nation’s imagination particularly with regard to the case of Aruna Shanbaug, a Mumbai nurse in her 20s who was brutally assaulted and raped by a ward boy in 1973. The attack caused severe brain damage and left her in a vegetative state.

The Supreme Court refused the euthanasia plea filed by writer-activist Pinki Virani for Shanbaug, and she finally passed away in 2015, relegated to a hospital bed for the better part of her life. However, as part of the Shanbaug judgment, the court allowed passive euthanasia based on certain conditions. 

In 2018, the Supreme Court legalised passive euthanasia by permitting ‘living wills’, allowing people to decide in advance about the course of treatment in a situation where they can no longer express consent.

The court ruled that “a person having the mental capacity to make an informed decision has the right to refuse medical treatment, including withdrawal from life-saving devices”.

In January 2023, the Supreme Court eased norms for passive euthanasia.