CHAPTER ONE.docx

CHAPTER ONE HISTORY AND CLASSIFICATION OF EUTHANASIA DEFINITION OF EUTHANASIA AND RELATED TERMS Euthanasia is a controversial subject. It is an issue that provokes arguments among lawyers, medical practitioners, moral philosophers and theologians. It connotes an easy, quiet and painless death to a process that involves intentional ending of the life of a patient suffering from incurable or terminal illness either initiated by the patient, privy or the doctor in charge. It is somewhat ambiguous and has several possible meaning. Hence it is appropriate to explain what we mean by the term whenever it is used. Literally, the word ‘Euthanasia’ means good death as derived from the two greek word, eu which means well or good and thanatos which means death. Biggs H., Euthanasia, Death with Dignity and the Law. Oxford: Hart Publishing 2001, at p. 12 According to Blacks’ Law Dictionary, 9th Edition, Euthanasia, (also referred to as Mercy killing) is: The act or practice of causing or hastening the death of a person who suffers from an incurable or terminal disease or condition, especially a painful one, for reasons of mercy. The Oxford Advanced Learners Dictionary 5th edition, 394, (1998) also defines euthanasia as: The practice of painlessly killing without pain a person who is suffering from a disease that cannot be cured or from extreme old age so that he or she can die with dignity. Similarly, Chamber’s 21st Century Dictionary, Revised edition, holds out euthanasia as: The act or practice of ending the life of a person who is suffering from an incurable and often painful or distressing illness. From the foregoing, it can be inferred that for an act or Omission to be regarded as euthanasia, it must be done out of compassion, empathy or concern for the victim. The death must also be painless. Lastly, the person must be suffering from an irrepressible and agonizing disease. The Oxford Companion of Law defines the term ‘Euthanasia’ to mean ‘the causing or hastening of death, particularly of incurable or terminally ill patient, and at their request’ David M. Walker, The Oxford Comparison of Law. Oxford Press 1980, at pg.441. This brings the issue of who has power to request for euthanasia, which according to the definition above is the ill person. It must however be noted that there are instances where the ill person may not even be able to give consent, for example, in the case of an infant, or a critically ill or unconscious person, and Insanity. In any of the conditions listed above, the consent may be given by the legal guardian of the ill person. One thing is constant in all the definitions given above, euthanasia leads to death, ending of life, and killing of person. By whatever phrase it is referred to, the end results in the death of a human being. Confusions have arisen due to the multi-faceted nature of the term (euthanasia), and the relativeness of most of the terms used in defining it, for example, when is an act intentional or deliberate? What is painful? At what point can a disease be said to be incurable? And how can a person be put to death painlessly? Answering these questions would result in mass confusion as various people would give various answers to the questions. In some quarters, euthanasia is still legally indistinguishable from murder, especially since the introduction of ‘Nazi euthanasia’ during the 2nd world war where over 275,000 people were killed Friedlander, Henry. The Origins of Nazi Genocide: From Euthanasia on Trial, 1945-1953. Boulder: University of North Carolina Press, 1995. It is therefore important to understand what is widely understood as euthanasia, various classifications of euthanasia, all the principles and laws governing its practice. The Oxford Companion Law Ibiddescribes the attendant legal rule governing euthanasia and distinguishes it from similar legal phenomena, stating: Generally it (euthanasia) is treated as illegal and not distinguishable from murder, largely because of the difficulty in distinguishing in legal rule and in fact between criminal and justifiable causing of death. A narrowly distinguishable case is of refraining from seeking to prolong life in cases of great pain or inevitable death, which is generally considered morally and legally permissible At this juncture, it is important to differentiate between Suicide, Assisted suicide and Euthanasia. As stated earlier, euthanasia is the act or practice of ending the life of a person who is suffering from an incurable and often painful or distressing illness. Suicide on the other hand is the act of intentionally killing oneself The New Shorter Oxford Dictionary 1993, p 3135. In many jurisdictions of the world, suicide is illegal. It is often distinguished from euthanasia. Also assisted suicide occurs where the doctor assists the patient to kill himself, in which case it is known as physician assisted suicide. The assistance may also be from a relative or friend of the person wanting to commit suicide or some other persons who carry out the enabling role Kennedy & Grubb, Medical Law: Text with Materials, 1994 Festus O. Emiri tries to make a distinction between physician assisted suicide and euthanasia Festus O. Emiri, Medical Law and Ethics in Nigeria, Malthouse press ltd. 2012, p. 243: …Doctors-assisted suicide is a situation where a doctor assists the patient in bringing about his death. It is equivalent of aiding and abetting suicide by the doctor. On the other hand, euthanasia is a request to the doctor by a patient that he should be killed painless. In the case of the former the doctor is merely an accessory, while in the later he is the perpetrator. In practical terms, both can be illustrated this way: if a doctor places poison close to the patient so that he can administer on himself the doctor would have assisted suicide as an accessory. But, if rather than do so he injects the poison into the patient, he becomes a perpetrator of murder. Though, on moral grounds, the distinction is of little significance, legal punishment for both are different It can be deduced that all three acts-suicide, assisted suicide and euthanasia have the same end result where it is “successful”-DEATH; this result leads to confusion as it does not make the distinction among all these terms clear cut. Some people/jurisdictions even use these words interchangeably, most especially euthanasia and assisted suicide. According to one writer Fletcher J. “The right to choose when to die”, Hemlock quarterly, 1989 (last modified May 1998) <http.//www.euthanasia.org/quotes.html: If we set the time for dying or shorten the time for our being alive, that is suicide, not natural death; and we cause the death, the disease does not. If we help a patient to die who has chosen to stop a life prolonging treatment, we are assisting suicide. Assisting suicide is Euthanasia, the methods used are morally irrelevant; what is significant is the intention From the above, it can be safely stated that although theoretically suicide, assisted suicide and euthanasia are distinct, in practice the distinction is usually made more often between suicide and euthanasia (because in a lot of situations, euthanasia is taken to be same as assisted suicide) and as earlier stated, the end result of all three act is the shortening of life of a person (DEATH). Finally, euthanasia in this work will focus on the role of the doctor or physician even though as seen above, the act may be done by a friend or relative. HISTORICAL DEVELOPMENT OF THE CONCEPT OF EUTHANASIA The crux of dying with dignity is in retaining one’s individuality, be that in acceptance or denial, anger or serenity, without humiliation of unnecessary life-prolonging machine Claire F. Ruder, “Terminal Care - Issues and Alternatives.” Medical Journal, Jan-Feb, 1977, p24. The above quote more or less outlined the basic principle of Euthanasia otherwise known as mercy killing or dying with dignity in some jurisdictions. This concept is not a new one and it can be traced back to the ancient days, even though nobody actually recognized it as Euthanasia, it was just a simple way of putting people out of their agony and pain. A very good example can be seen in the Bible: And the battle went sore against Saul, and the archers hit him; and he was sore wounded of the archers. I Samuel 31:3. Holy Bible, KJV Then said Saul unto his armourbearer, Draw thy sword, and thrust me through therewith; lest these uncircumcised come and thrust me through, and abuse me…. I Samuel 31:4a. Holy Bible, KJV History has revealed that euthanasia has been accepted, in some or the other forms, by various groups or societies some decades back. Most of the historical facts presented in the next paragraphs of this work have been extracted from an article titled, “A General History of Euthanasia”. Retrieved from http://www.life.org.nz/euthanasia/abouteuthanasia/history-euthanasia1/ Last visted: May 6, 2016 The first recorded use of the word euthanasia was by Suetonius, a Roman historian, in his book De Vita Caesarum--Divus Augustus (The Lives of the Caesars--The Deified Augustus), when he described the death of Augustus Caesar, he said: ...while he was asking some newcomers from the city about the daughter of Drusus, who was ill, he suddenly passed away as he was kissing Livia, uttering these last words: "Live mindful of our wedlock, Livia, and farewell," thus blessed with an easy death and such a one as he had always longed for. For almost always, on hearing that anyone had died swiftly and painlessly, he prayed that he and his might have a like euthanasia, for that was the term he was wont to use. “A General History of Euthanasia”, Retrieved from http://www.life.org.nz/euthanasia/abouteuthanasia/history-euthanasia1/ Last visted: May 6, 2016 Augustus' death while termed "a euthanasia" was not hastened by the actions of any other person. Withdrawal or with-holding treatment was practiced in history, the correct term for this is orthothanasia, which means 'passive death.' In this method, the actions of curing the patient are never applied and his death is made easy in a passive form. In orthothanasia, the action of killing is not applied, but, passive actions are present in order to provide death. The place of euthanasia in the history of medical ethics The actions of easy death have been applied for hopeless patients who have been suffering extreme pain since ancient ages. These actions were forbidden from time to time. In Mesopotamia, Assyrian physicians forbade euthanasia. Again in the old times incurable patients were drowned in the River Ganges in India. In ancient Israel, some books wrote that frankincense was given to kill incurable patients. Jewish society, following the teaching of the Bible and the sixth command "thou shall not kill", had rejected centuries ago every theory on shortening the life of handicapped or disadvantaged people. Judaism considered life to be sacred and equated suicide and euthanasia with murder. Dr Immanuel Jakobovits, former Chief Rabbi of England explained: Cripples and idiots, however incapacitated, enjoy the same human rights (though not necessarily legal competence) as normal persons... One human life is as precious as a million lives, for each is infinite in value... In Sparta, it was the common practice for each newborn male child to be examined for signs of disability or sickliness which, if found, led to his death. This practice was regarded as a way to protect the society from unnecessary burden, or as a way to 'save' the person from the burden of existence. In ancient Greece, suicide of the patient who was suffering extreme pain and had an incurable terminal illness was made easy and for this reason, the physician gave medicine (a poisoned drink) to him. Plato wrote: Mentally and physically ill persons should be left to death; they do not have the right to live. Pythagoras and his pupils were completely against suicide due to their religious beliefs that the gods placed man as the protector of the earthly life and he is not allowed to escape with his own will. The first objection to euthanasia came from the Hippocratic Oath which says "I will not administer poison to anyone when asked to do so, nor suggest such a course." In ancient Rome, euthanasia was a crime and this action was regarded as murder. However, history notes that sickly newborn babies were left outside, overnight, exposed to the elements. In the Middle Ages in Europe, Christian teaching opposed euthanasia for the same reason as Judaism. Christianity brought more reverence to human beings. Accordingly, every individual has the right to live since God creates human beings and they belong to Him and not themselves. Death is for God to decree, not man. Like Judeo-Christian teaching, Islam also teaches that God is the only one who creates and the only one who may take life away. 15th - 17th Centuries Sir Thomas More (1478-1535) is often quoted as being the first prominent Christian to recommend euthanasia in his book Utopia, where the Utopian priests encouraged euthanasia when a patient was terminally ill and suffering pain (but this could only be done if the patient consented). ...if a disease is not only distressing but also agonising without cessation, then the priests and public officials exhort this man...to free himself from this bitter life...or else to permit others to free him… The problem with using this quote is that Thomas More, a devout Catholic, wrote Utopia as a work of satire. The English philosopher, Francis Bacon (1561-1621), was the first to discuss extension of life as a new medical task, the third of three offices: Preservation of health, cure of disease and prolongation of life. Bacon also asserts that, They ought to acquire the skill and bestow the attention whereby the dying may pass more easily and quietly out of life. Bacon refers to this as outward euthanasia, or the easy dying of the body, as opposed to the preparation of the soul. It appears unlikely he was advocating 'mercy killing', more likely he was promoting what we would term better 'palliative' care. 18th - 19th Centuries In Prussia, in the 18th century, 1st June 1794, a law was passed that reduced the punishment of a person who killed the patient with an incurable disease. The earliest American statute explicitly to outlaw assisting suicide was enacted in New York in 1828, and many of the new States and Territories followed New York's example. Between 1857 and 1865, a New York commission led by Dudley Field drafted a criminal code that prohibited "aiding" a suicide and, specifically, "furnish(ing) another person with any deadly weapon or poisonous drug, knowing that such person intends to use such weapon or drug in taking his own life." Until the end of the nineteenth century, euthanasia was regarded as a peaceful death, and the art of its accomplishment. An often quoted nineteenth century document is, 'De euthanasia medica prolusio', the inaugural professorial lecture of Carl F. H. Marx, a medical graduate of Jena. 'It is man's lot to die' states Marx. He argued that death either occurs as a sudden accident or in stages, with mental incapacity preceding the physical. Philosophy and religion may offer information and comfort, but the Physician is the best judge of the patient's ailment, and administers alleviation of pain where cure is impossible. Marx did not feel that that his form of euthanasia, which refers to palliative medicine without homicidal intention, was an issue until the nineteenth century. The prevailing social conditions of the latter nineteenth century began to favour active euthanasia. Darwin's work and related theories of evolution had challenged the existence of a Creator (God), who alone had the right to determine life or death. The first popular advocate of active euthanasia in the nineteenth century was a schoolmaster, not a doctor. In 1870 Samuel Williams wrote the first paper to deal with the concept of 'medicalised' euthanasia. He stated: In all cases it should be the duty of the medical attendant, whenever so desired by the patient, to administer chloroform, or any other such anaesthetics as may by and by supersede chloroform, so as to destroy consciousness at once, and put the sufferer at once to a quick and painless death; precautions being adopted to prevent any possible abuse of such duty; and means being taken to establish beyond any possibility of doubt or question, that the remedy was applied at the express wish of the patient. Though reprinted many times, the paper was seemingly ignored by the British medical profession, and in 1873, Lionel Tollemache took up his arguments in the Fortnightly Review. Writing under the clear influence of utilitarianism and social Darwinism, he described the incurable sick as a useless to society and burdensome to the healthy. Although his views were simply dismissed as radical, similar views were emerging with the new science of eugenics, as ideas of sterilising the mentally ill, those with hereditary disorders, and the disabled, became fashionable. In 1889, the German philosopher, Nietsche, said that terminally ill patients are a burden to others and they should not have the right to live in this world. The 20th Century Euthanasia was both criticised and defended in the 20th century. The efforts of legalization of euthanasia began in the USA in the first years of the 20th century. The New York State Medical Association recommended gentle and easy death. Even more active euthanasia proposals came to Ohio and Iowa state legislatures in 1906 and 1907 but these proposals were rejected. In 1920, two German professors published a small book, which advocated the killing of people whose lives were "devoid of value." This book was the base of involuntary euthanasia in the Third Reich. The authors also argued that patients who ask for "death assistance" should, under very carefully controlled conditions, be able to obtain it from a physician. Alfred Hoche, M.D. and Karl Binding, Releasing the destruction of worthless animals, 1920 Alfred Hoche also wrote an essay Alfred Hoche, Permitting the Destruction of Life Not Worthy of Life., which embraced euthanasia as a proper and legal medical procedure to kill the weak and vulnerable so as not to taint the human gene. The reduction of punishment in mercy killing was accepted in Criminal Law in 1922 in Russia. But this law was abolished after a short while. A French physician, called Dr. E. Forgue pointed out that killing an incurable patient wasn't a legal condition Dr. E. Forgue, Easy death of incurable patients, 1925. But, Liege Bar said that killing an incurable patient with his free consent had to be forgiven. The laws that accept euthanasia as a legal condition are present in two countries of South America. According to Uruguay Penal Code, a Judge must not punish a person for mercy killing. A person must also be forgiven for this kind of killing in Colombia. Adolf Hitler admired Hoche's writing and popularised and propagandised the idea. In 1935, the German Nazi Party accepted euthanasia for crippled children and "useless and unrehabilitive" patients. Before 1933, every German doctor took the Hippocratic Oath, with its famous "do no harm" clause. The Oath required that a doctor's first duty is to his patient. The Nazis replaced the Hippocratic Oath with the Gesundheit, an oath to the health of the Nazi state. Thus a German doctor's first duty was now to promote the interests of the Reich. Anyone in a state institution could be sent to the gas chambers if it was considered that he could not be rehabilitated for useful work. The mentally retarded, psychotics, epileptics, old people with chronic brain syndromes, people with Parkinson's disease, infantile paralysis, multiple sclerosis, brain tumours etc. were among those killed. The consent of the patient was absent in this type of euthanasia. This kind was applied by order. Many people don't realise that, prior to the extermination of Jews by Nazi Germany, in the so-called "final solution," as many as 350,000 Germans were sterilized because their gene pool was deemed to be unsuitable to the Aryan race, many because of physical disability, mental deficiency or homosexuality. On August 3, 1941, the Catholic Bishop Clemens August Count of Galen, openly condemned the Nazi euthanasia programme in a sermon. This brought a temporary end to the programme. In 1936 the Voluntary Euthanasia Society was founded in England. The next year the English Parliament (the House of Lords) rejected a proposal to legalise euthanasia. In opinion polls of those years, euthanasia supporters had around 60% of the votes. According to a questionnaire in 1937, 53% of American physicians defended euthanasia. Approximately 2000 physicians and more than 50 religious ministers were among the members of the American Euthanasia Society. At that time, a majority of physicians in some American cites defended this subject. A law proposal that accepted euthanasia was offered to the government in Great Britain in 1939. According to this proposal, a patient had to write his consent as a living will which must be witnessed by two persons. The will of the patient had to be accepted in the reports of two physicians. One of these physicians was the attending physician, the other one was the physician of the Ministry of Health. The will of the patient had to be applied after 7 days and most of the relatives of the patient had again to speak with him 3 days before the killing action. But this proposal wasn't accepted. In 1973 Dr. Gertruida Postma, who gave her dying mother a lethal injection, received light sentence in the Netherlands. The case and its resulting controversy launched the euthanasia movement in that country. The Dutch Voluntary Euthanasia Society (NVVE) launched its Members' Aid Service in 1975, to give advice to the dying. It received twenty-five requests for aid in the first year. Wole Iyaniwura, “Law, Morality and Medicine: The Euthanasia Dabate”, Global Journal of Human-Social Science: H Interdisciplinary Vol. 14 Issue 4 Version 1.0 , 2014 In 1976 Dr Tenrei Ota, upon formation of the Japan Euthanasia Society (now the Japan Society for Dying with Dignity), called for an international meeting of existing national right-to die societies. Japan, Australia, the Netherlands, the United Kingdom, and the United States were all represented. This first meeting enabled those in attendance to learn from the experience of each other and to obtain a more international perspective on right to die issues. In 1978, Derek Humphry, described how he helped his terminally ill wife to die Derek Humphry, Jean's Way, 1978. The Hemlock Society was founded in 1980 in Santa Monica, California, by Derek Humphry. It advocated legal change and distributed how-to-die information. This launched the campaign for assisted dying in America. Hemlock's national membership grew to 50,000 within a decade. Right to die societies also formed the same year in Germany and Canada. The Society of Euthanasia assembled in Oxford in the last months of 1980. It consisted of 200 members represented 18 countries. Since its founding, the World Federation has come to include 38 right to die organisations, from around the world, and has held fifteen additional international conferences, each hosted by one of the member organisations. In 1984, The Netherlands Supreme Court approved voluntary euthanasia under certain conditions. In 1994, Oregon voters approved Measure 16, a Death with Dignity Act ballot initiative that would permit terminally ill patients, under proper safeguards, to obtain a physician's prescription to end life in a humane and dignified manner. The vote was 51-49 percent. In 1995, Australia's Northern Territory approved a euthanasia bill. It went into effect in 1996 and was overturned by the Australian Parliament in 1997. Only four deaths took place under this law, all performed by Dr Philip Nitschke. In 1998, the Oregon Health Services Commission decided that payment for physician-assisted suicide could come from state funds under the Oregon Health Plan so that the poor would not be discriminated against. In 1999, in the United States, Dr. Jack Kevorkian was sentenced to 10-25 years imprisonment for the 2nd degree murder of Thomas Youk after showing a video of his death, by lethal injection, on national television. Kervorkian's first appeal was rejected in 2001. Kevorkian helped a number of people die and even though he had been previously prosecuted, he remained free of criminal charges until 1999. In 2000, The Netherlands approved voluntary euthanasia. The Dutch law allowing voluntary euthanasia and physician-assisted suicide took effect on the 1st of February, 2002. For 20 years previously, it had been permitted under guidelines. Into the Third Millenium In 2002 Belgium passed a similar law to the Dutch, allowing both voluntary euthanasia and physician-assisted suicide. In New Zealand in March 2004 Lesley Martin was convicted of the attempted murder of her terminally ill mother. She served seven months of a fifteen-month prison sentence, before being released on a good behaviour bond, and subsequently failed, in two attempts, to appeal against the conviction. Switzerland, once known in the tourism business for its spectacular alpine landscape, the watches and chocolate, has a new claim to fame as the world's death Mecca. Physically and mentally vulnerable patients have been lining up for a one-way trip to Zurich. In 2000, three foreigners committed suicide in Zurich. In 2001, the number of death tourists to Zurich rose to thirty-eight, plus twenty more in Bern. Most of the deaths occurred in an apartment rented by Dignitas, one of the four groups that have taken advantage of Switzerland's 1942 law on euthanasia to help the terminally ill die. Dignitas has assisted the suicides of 146 people over the last four years. The Swiss parliament has been alarmed and there is a move to ban the 'suicide tourism' and to place tougher bans on assisted suicide. When it was established in 1942, the Swiss euthanasia law was meant mainly to offer the opportunity for a dignified death to those with just two or three weeks to live. In the past few years, though, it has been applied to patients with a range of ailments-those with terminal illnesses or with acute mental disabilities, and even those suffering unbearable distress, such as a musician, for example, who has gone deaf. There are several requirements under the Swiss law. People who opt for euthanasia must be rationally capable of making the decision to die. They must perform the final act--usually the drinking of a lethal dose of barbiturates -- without assistance. And the event must be witnessed by a nurse or physician, and two other people. CLASSIFICATIONS OF EUTHANASIA There are different forms of euthanasia; Voluntary Euthanasia, Non-Voluntary Euthanasia, Involuntary Euthanasia, and Active Euthanasia. However, for the purpose of this work, these forms of euthanasia will be classified and studied under two major Heads: Voluntary, Non-Voluntary and Involuntary Euthanasia Active and Passive Euthanasia. VOLUNTARY, NON-VOLUNTARY AND INVOLUNTARY EUTHANASIA Voluntary Euthanasia means euthanasia that is performed at the will of the patient, i.e. an act done with consent of the ill person. Here, the patient specifically requests that his life be ended. This decision may be prior to the development of the illness or during its course. It must not result from any pressure from relations or those caring for the patient. Involuntary Euthanasia on the other hand occurs when the decision is made contrary to the patient’s wish or consent. For euthanasia to be Involuntary, it is important to note that the patient/ill person must be a competent person who possesses the capacity to make a meaningful decision on the subject, and the euthanasia has been carried out contrary to his decision. Involuntary Euthanasia is unlawful in most jurisdictions as it is believed to be borne out of Paternalism i.e. making a decision for the ill person even when it is against their wish, simply because you think it is the best decision for them Non-Voluntary Euthanasia refers to cases of persons incapable of making their wishes known such as those in irreversible state of coma, or for severely defective infants. For such individuals, euthanasia is done at the request of the next of kin or legal guardian who has the responsibility of making decisions on the patient’s behalf. This is differentiated from involuntary euthanasia since although it would be without the patient’s direct request, would not be contrary to his wish. ACTIVE AND PASSIVE EUTHANASIA Some prefer to use the terms Positive and Negative euthanasia respectively. Active or positive euthanasia involves the causing of death of a person through a direct action. It may be defined as a positive merciful act taken deliberately to end futile suffering. It is positive because it is an act committed by a person rather than an omission. This can be in two forms; either by direct act of termination for example injecting with a killer drug or lethal injection or by indirect action such as giving drug in amount or quantity that will clearly hasten death Ruth Russell, Freedom to Die: Moral and Legal Aspects of Euthanasia Rev. Ed, Human Sciences Press (New York) 1975. Passive or Negative euthanasia involves “hastening the death of a person by withdrawing some form of support and letting nature take its course” Robinson B.A. “Euthanasia and Physician Assisted Suicide: All sides of the issues” (last updated on July 25, 2000) <http://www.religioustolerance.org/euthanasia.html. According to Ruth Russell Ibid, It is the discontinuing or desisting from the use of extra-ordinary life support measures or heroic efforts to elongate life in hopeless cases when such elongation seems unwarranted extension of either suffering or unconsciousness. This is arguably the most supported form of euthanasia. In 1957, Pope Pius XII though still condemned any deliberate hastening of death; he gave moral approval to desisting from or terminating the use of extra-ordinary measures to prolong the life of the dying patient in certain circumstances. This includes acts of omission such as failure to resuscitate a terminally ill or hopelessly incapacitated patient or a severely defective newborn infant. It is refraining from action that would probably delay death and instead, permitting natural death to occur. Mason and Smith J.K. Mason and R.A. McCall Smith, Butherworth’s Law and Medical Ethics, Butherworth & Co (publishers) Ltd 1987 gave their own translation of the Pope’s direction as follows: Man has right and a duty in case of severe illness to take the necessary steps to preserve life and health. That duty...devolve; from charity as ordained by the creator from social justice and even from strict law. But he is obliged at all times to employ only ordinary means…that is to say those means which do not impose an extraordinary burden on himself or others In simpler terms, it means letting a person die by taking no action to maintain life or refraining from doing something to keep the patient alive. Some believe that there is moral wrong in killing (active) and that letting die (passive) is still acceptable, since killing is an act. While some claim that there is no moral difference between the two, since the end result for both is death. This arguments still exists till date. 20