Euthanasia, also called ‘Mercy Killing’ and ‘Physician Assisted Suicide; is a term in medical ethics for the practice of interfering or intervening in a natural process towards death. In other words it is accelerating the natural course of death in terminally ill patients, when all treatments become ineffective or much too painful for the patient to bear. In short Euthanasia is ending a human life with the intention of relieving the person from an unbearable pain. Haris (2001) precisely defines Euthanasia as ‘a deliberate intervention undertaken with the express intention of ending a life to relieve intractable suffering’.
The issue of Euthanasia has always remained controversial and still has failed to carry legal and constitutional support in most parts of the world. Suicide in any form and by any means is either punished or at least disapproved in human history. There is no permissibility of such a killing/suicide in Islam so Euthanasia can never be the part of Muslim law in Islamic world. Therefore the origin and development of this concept can be historically located in the non Muslim countries especially of the west.
Back in 400 BC when the father of medicine Hippocrates formulated the oath still taken by the fresh medical graduates dictates ‘I will give no deadly medicine to any one if asked, nor suggest any such counsel”., speaks against physician assisted suicide. Even in the 19th century, the US legislation proclaimed that if a suicide is committed on the advice of another person, the adviser would be guilty of a murder. In the early 20th century, the Supreme Court reevaluated its judgments concerning ‘living will’ and focusing how best to ensure the dignity and the independence for the ‘end of life’ with considerable changes in the health laws. In 1920 the book “Permitting the Destruction of Life not Worthy of Life” was published, in which the author Hoche advocated the death assistance be given under very controlled conditions. In 1935 Euthanasia society was formed in England to support mercy killing. 1939’s Nazi’s Euthanasia became very popular when Hitler ordered mercy killing of the sick and disabled. From 1995 to 2008, Euthanasia has been legalized in countries like parts of Australia, Netherland, Belgium and few states of the United States of America.
There are several forms or kinds of Euthanasia; each form has its own ethical issues.
Active Euthanasia: is the one which causes immediate death of the patient, by the direct and deliberate action of the physician. For example when a lethal injection is given to the patient or an overdose of a pain killer when the physician knows the after effects of such a dose.
Passive Euthanasia involves an indirect action by the physician for the death of the patient. This may include withdrawing or withholding the required treatment. For example switching off the life supporting machine like ventilator or not doing the required surgical procedures that can keep the person alive though for a short time.
Voluntary Euthanasia:- takes place with the will of the patient, usually on his request to the physician.
Non-Voluntary Euthanasia occurs when the patient is unconscious or in comma for a long time, or unable to make decision for example a very young child, or a mentally retarded person. Therefore someone else related to the patient makes the decision of ending the patient’s life.
Involuntary Euthanasia:- is oftentimes equated to murder because in this case the patient does not opt for death but he is killed as the doctor thinks it to be in his benefit.
Indirect Euthanasia: – does not involve the intentional killing by the physician, but the side effects of the treatment, usually given to reduce the pain accelerate the death of the patient.
Assisted Suicide:- includes cases when the patient seeks help from his physician to die. This can include making the lethal drugs available for the patients.
The most common argument given by the proponents of Euthanasia is its effective way of relieving excruciating pain. To this one argument there can be two counter arguments. Firstly the advancements made today in the field of medicine, especially in pain management weakens the justification for Euthanasia. Secondly research shows that terminally ill patients choose suicide not because of the physical pain but because of depression. A study of terminally ill patients published in The American Journal of Psychiatry in 1986 concluded:
‘The striking feature of [our] results is that all of the patients who had either desired premature death or contemplated suicide were judged to be suffering from clinical depressive illness; that is, none of those patients who did not have clinical depression had thoughts of suicide or wished that death would come early’.
Researchers believe that a person diagnosed with terminal illness should be given time and support to pass through the five stages of the process – denial, anger, bargaining, depression and acceptance, and killing them before they come to terms with the situation is nothing less than a murder.
Boston Globe survey of 1991 shows that patients with incurable illnesses who see suicide as an option are mostly those who are neither tired of pain or of restricted life style, nor the fear of machine dependency but rather the feeling of being a burden on their family. Sometimes it’s the family who advocate Euthanasia for the terminally ill patient, considering his life unworthy, and therefore a burden; which in turn throws the patient in the abbeys of depression. One should be afraid of the day when legalization of the right to die will become duty to die, pressurizing the already tormented patients to select Euthanasia as an only option.
If we look at Euthanasia from another angle it is not a right to die but gives someone a right to kill. A right given to doctors and the relatives of a person to intentionally end his life. There is a need to differentiate between suicide and killing. Suicide is an individual act, whereas Euthanasia is not a private act. It involves the will of the person or the relatives and action of the physician, and known by everyone around. It is therefore more close to public killing than suicide. Such a power to kill can be abused for the most vulnerable people in the population.
There should be a public realization that if all forms of treatments fail or become ineffective or continuation of any medical or surgical procedure would increase the pain rather than alleviating it, the suffering soul should be given support in all possible ways and all efforts should be directed toward minimizing his agony and making whatever little time he has, comfortable.
As followers of Islam such an option as Euthanasia can never cross our minds for ourselves or for our dear ones. I have a personal experience of accompanying a close kin of mine to the dialysis sessions, where patients were not only dependent on machines for their lives but were not even allowed to drink water during the warmest summers, but never did I once heard a patient or any of his relative praying for a quick demise. They would seek Allah’s blessings during the hardest of times and a kind of hope would get them going. I saw doctors trying to look for options to improve the quality of life of such patients but any thought of eliminating the patient’s pain through killing them was out of question and option.
As Muslims it is our firm belief that every life is sacred and Allah never creates and sustains anyone without purpose. In the holy Quran He says ‘And if anyone saved a life, it would be as if he has saved the life of whole people’. (Quran 5:32). Allah further commands ‘take not the life which Allah made sacred otherwise in the course of justice’.
If we equate voluntary Euthanasia with suicide, then again none of us has a right to take his own life. How can we have this right when we have not created ourselves, in fact how can we destroy something of which we are not the owners. Our bodies and souls belong to the Almighty and have been entrusted to us to be taken care of in the best ways possible. Suicide is a crime which is not only punishable in this world but also unforgivable sin in the hereafter. Prophet Mohammad warned the people against suicide by saying ‘”Whoever kills himself with an iron instrument will be carrying it forever in hell. Whoever takes poison and kills himself will forever keep sipping that poison in hell. Whoever jumps off a mountain and kills himself will forever keep falling down in the depths of hell’.
Our religion Islam not only emphasize on seeking all possible medical help during illness but further consoles the patients in pain by giving him the happy tiding for reward if he endures the pain with patience. In one of the hadith it is mentioned that when a true believer is afflicted with pain, even a prick of a thorn and he bears it with patience, then his sins will be forgiven and his wrongdoings will be discarded as the tree sheds off its leaves. Such words by the Holy Prophet can be a huge support for a sufferer of a terminal illness or of incurable and painful disease. Euthanasia cannot therefore be a part of the dictionary of a true believer.
The weak value system of the west has come up with the idea of deserting the old, weak and the sick by leaving them in the old houses and hospitals. These so called facilities also sometimes cost them huge amounts, which make them claim that people who become unproductive for the society and a burden on the productive fellows should die for the good of the people around and for their own ease. But the east has still kept its value system strong. Our religious and social values dictate us to take care with respect and dignity of the old, weak, sick and the helpless. Allah has specially stressed upon respecting and serving the parents specially when they become old. “and that you be kind to your parents. Whether one or both of them attain old age in your life, say not to them a word of contempt but address them in terms of honor. And lower to them the wing of humility out of compassion, and say: my Lord, bestow on them your mercy even as they cherished me in childhood” (Qur’an 17:25- 25). As far as the issue of heavy cost is concerned to keep a terminally ill patient alive, Islam makes it a responsibility of the state and the society as a whole to cover the health care needed.
Euthanasia might be categorized into several kinds but Islam emphasizes the intentions involved in the act. If for example physician intents to alleviate the pain of the patients but the dose somehow kill him, the doctor cannot be accused of murder, or cannot be said to have practiced Euthanasia. The doctor is expected to help the patient in the process of life and not in process of death.
Important enough is to consider the relative nature of the terms like pain, suffering and agony. It really depends on the patience and tolerance level of each individual, which of course varies. What is suffering for one person might not be the same for the other, similarly excruciating pain for one can be bearable for someone else.
Conclusion: – Humans might be the wisest form of God’s creation but still not wise enough to be given a right to decide for their own death or for the death of another of their own kind. All lives are precious and sacred and only such value system can be the basis of a human society, where the sanctity of life is maintained. Euthanasia in any of its forms, involves the intention of killing or finishing a still living human weakens the fabric of the society and gives an altogether a different lens to the members to see death as the only solution for all pains and torments, which blurs the vision to see other possibilities to fight the situation. Euthanasia should therefore be discouraged in all its forms and in all parts of the world.