The Stance of Euthanasia in Pakistan: A Comparative Analysis

Euthanasia, as a word, is derived from the Greek language. “Eu” (εὖ) means “good” and “Thanatos” means “death” (θάνατος). Therefore, the term “euthanasia” means “good death” or “easy death.”In modern times, however, euthanasia is often referred to as “mercy killing”. It is a profoundly complex and ethically encumbered issue that touches upon the sanctity of life, individual autonomy, and societal values. Globally, the stance on euthanasia varies significantly, influenced by cultural, religious, and legal factors. This article will explore the position of Pakistan on euthanasia and compare it with the stance in the United Kingdom (UK), and examine their stance with various countries [1].

Euthanasia can predominantly be broken down into subsequent classifications as seen in a study by the School of Medicine in University of Missouri [2]. Voluntary euthanasia occurs when a person makes a conscious decision to die and seeks assistance in doing so. Involuntary euthanasia is performed without the individual’s consent, often because they are unable to provide it. Active euthanasia involves deliberately causing a person’s death through direct actions, such as administering a lethal dose of medication. In contrast, passive euthanasia is when a person is allowed to end their life by withholding or withdrawing life-sustaining treatment.

Pakistan, as an Islamic Republic, bases much of its legal framework on Islamic principles or as often referred to as the Sharia Law, which holds life to be sacred and inviolable. The concept of euthanasia, particularly active euthanasia, is generally considered incompatible with Islamic teachings. According to Islamic jurisprudence, life is a trust from God, and only he has the authority to give or take it. Consequently, the deliberate ending of a life, even to alleviate suffering, is considered impermissible. This stems from a quotation in the Qur’an, ‘”And do not kill the soul which Allah has forbidden (to be killed) except by (legal) right.” (Qur’an 17:33)

Public opinion in Pakistan is largely against euthanasia, reflecting the country’s religious and cultural values. There have been numerous surveys and studies conducted regarding euthanasia in Pakistan, the target audience of whom has often been students. For example, a study was carried out at the Shifa International Hospital Islamabad in 2006 [3] (January to November) where questionnaires were distributed to doctors to gauge their attitude towards euthanasia. The results indicated a small percentage of the doctors (2%) were in favor of the legalization of euthanasia and assisted suicide but most of them (86%) were against this idea.

Another study was conducted at Faisalabad Medical University (FMU) [4], Pakistan, from April 2023 to May 2023 which assessed the attitudes of medical students regarding euthanasia and physician-assisted suicide (PAS). The data was collected using the NOBAS (Norwegian Bioethics Attitude Survey) Questionnaire. In this study, 66% of students opposed euthanasia, which is consistent with results obtained in studies conducted at other medical universities in Pakistan. This trend was also seen in a study conducted in Hong Kong, although a contrast was seen in India where acceptance of euthanasia was 61%. However, students supported palliative care and passive euthanasia and believed that legalizing euthanasia and PAS could result in abuse. Palliative care was favored by 205 (64%) students because, regardless of the prognosis, the ultimate goal is to improve the quality of life for the family and the patient.

There was also a survey conducted by the World Health Organization (WHO) [5] in Pakistan amongst university students, regarding their beliefs about euthanasia. Only 25.6% of students agreed that euthanasia should be legalized in Pakistan. The most common reason cited for the legalization of euthanasia was to relieve patients’ suffering, though conditional on approval from a special committee of physicians. Students who opposed legalization (74.4%) mainly considered the impediments to future medical research, followed by the risk of misuse by physicians or family members. Only 8.9% of students cited religious beliefs as a reason against legalization.

In contrast to Pakistan, where the stance has largely remained stagnant, the United Kingdom has a more progressive and evolving stance on euthanasia, although it remains illegal. The UK’s approach is shaped by a combination of legal precedent, public opinion, and high-profile cases that have tested the boundaries of the law, leading to a few changes that perhaps Pakistan may learn from.  Euthanasia is illegal in the UK, and assisting someone to die is a criminal offense under the Suicide Act 1961. Under this act, assisting or encouraging suicide is punishable by up to 14 years in prison. However, the law distinguishes between euthanasia and the withdrawal of life-sustaining treatment, which is permissible under certain circumstances.

There have been landmark cases where parties have argued against the law which criminalizes euthanasia as infringing upon private life or human liberties. Such circumstances arose in the cases of Diane Pretty (2002) [6]  and Tony Nicklinson (2012) [7]. However, in both cases, the European Court of Human Rights for the former and the High Court for the latter, United Kingdom’s laws were upheld. 

On the other hand, in the case of Debby Purdy (2009) [8], the House of Lords ruled in her favor, leading to the Director of Public Prosecutions (DPP) publishing guidelines on how decisions to prosecute cases of assisted suicide would be made. The claimant was a British woman with multiple sclerosis, regarded by many as the one person who could lead and dominate the demand for assisted dying in Britain. While her condition deteriorated, she sought legal clarity on whether her husband, Omar Puente, would be prosecuted if he accompanied her to Switzerland for an assisted suicide. Assisting another to commit suicide was, and remains to this day, a criminal offense under UK law, and the lack of clear prosecutorial guidelines left Purdy uncertain about her husband’s legal risk.

It was in 2009 that Purdy took her case to the House of Lords, claiming that this ambiguity was a violation of her right to a private and family life under Article 8 of the European Convention on Human Rights. The House of Lords ruled in her favor, forcing the Director of Public Prosecutions (DPP) to issue guidelines outlining the factors influencing decisions to prosecute in assisted suicide cases. These guidelines, published later that year, stressed motives (e.g., compassion) and the individual’s mental capacity seeking help. Although Purdy did not actually go to Switzerland, her case greatly accelerated the debate on assisted dying in the UK. Although it did not alter the law, it clarified the discretion of the prosecution and focused national attention onto issues of autonomy and end-of-life care. She died in 2014; she then took palliative care rather than continuing with further life-extending treatments.

Public opinion in the UK is increasingly supportive of assisted dying, particularly in cases involving terminal illness and unbearable suffering [9]. A 2019 survey by YouGov found that 84% of the British public supported the legalization of assisted dying for terminally ill adults. Another survey conducted by Professor Dominic Wilkinson, Professor Julian Savulescu, and colleagues from the Oxford Uehiro Centre for Practical Ethics found that out of a sample size of 500 adults, 79% of those surveyed said they would like to have the option of euthanasia [10]. According to Professor Wilkinson, ‘Previous surveys have shown that a large proportion of the UK public wish to have the option of euthanasia. This study shows an even larger number wish to have the choice of being heavily sedated or even receiving a general anesthetic if they were dying.’

A recent article by BBC [11] has covered the latest developments in the realm of the law concerning euthanasia. The next vote on the law proposing the legalization of assisted dying for terminally ill adults in England and Wales will be a plebiscite of MPs November 29. The Terminally Ill Adults (End of Life) Bill would allow adults with less than six months to live to end their lives under strict safeguards, including assessments by two independent doctors and a High Court judge. The patient must administer the life-ending substance themselves, and coercion would be punishable by up to 14 years in prison. This law was introduced by Labor MP Kim Leadbeater who stated, ‘now is the time’ for MPs to vote on assisted dying. 

Concerning the bill above,  Phillip Murray in his recent article [12] gave his thoughts regarding this bill. He scrutinizes ECHR’s actions in assisted suicide cases, with a major focus on Articles 2 and 8 of the European Convention on Human Rights. He raises inconsistencies wherein the Court has taken an overly cautious deference to states’ legislative discretion in issues of autonomy versus vulnerability. Within those discussions, he points to recent judgments such as Mortier v. Belgium, where there is a tension between respect for personal choice and protection of vulnerable groups. He further argues that the ECHR avoids implementing clearness in legislative obligations when arguing, “The Court continues to tread a fine line between deference and rights protection.

Similar legislation is being considered in Scotland but has already run into legal problems concerning the Holyrood powers. The law, campaigners and others including Dame Esther Rantzen argue would provide dignity and choice for terminally ill people. Baroness Grey-Thompson and others fear it poses risks to vulnerable people and proposes inadequate safeguards, arguing that palliative care should be improved instead.

Internationally, assisted dying or euthanasia is legal in countries like Switzerland, Canada, Spain and some U.S. states. Advocates argue that the current UK law leaves many terminally ill patients with no choice but to endure agony or seek help across borders. Detractors, however continue to air their doubts regarding coercion and heavy health service burden.

Drawing a comparison between Pakistan and the United Kingdom’s stance on euthanasia highlights the influence of cultural, religious, and legal factors on this complex issue. Pakistan’s strict prohibition on euthanasia is rooted in Islamic teachings, which view life as a divine trust. In contrast, the UK’s stance is shaped more by secular ethical considerations, although religious views still play a role in public debate. Both Pakistan and the UK prohibit active euthanasia, but the UK has a more developed legal framework that allows for the withdrawal of life-sustaining treatment in specific cases. Pakistan’s legal system does not explicitly address passive euthanasia, leading to uncertainty and a lack of clear guidelines.

Globally, the stance on euthanasia varies widely, with some countries adopting progressive policies that allow for assisted dying under strict conditions, while others, like Pakistan, maintain stringent prohibitions.

One such country that still prohibits euthanasia is India legalized passive euthanasia in 2018 under strict guidelines. The supreme court in the case of common case v the union of India[13] recognized the right to die with dignity as a fundamental right but maintained a clear distinction between active and passive euthanasia. Euthanasia is also illegal in Singapore, where the government has emphasized palliative care as an alternative to euthanasia. The Penal Code imposes severe penalties for acts related to euthanasia, including assisted suicide [14].

On the other side of the spectrum, some countries have already begun to show acceptance towards this matter. Netherlands was the first country to legalize euthanasia in 2002 [15]. The Dutch law allows for both voluntary euthanasia and physician-assisted suicide, provided that certain criteria are met, including the patient’s voluntary and well-considered request, unbearable suffering, and a lack of reasonable alternatives. Belgium also legalized euthanasia in 2002, and in 2014, it became the first country to allow euthanasia for minors, under strict conditions [16]. The law requires that the patient be in a medically futile condition with constant and unbearable physical or psychological suffering.  Additionally, Canada also legalized medical assistance in dying (MAID) in 2016 [17]. The legislation allows eligible adults to request and receive medical assistance under specific circumstances, such as a grievous and irremediable medical condition causing enduring suffering.

Euthanasia remains a deeply contentious issue worldwide, with countries adopting a range of approaches based on their cultural norms, state religion, and legal traditions. For Pakistan, moving forward, it is crucial to address end-of-life care within the framework of its deeply held religious and cultural values. As discussions on euthanasia evolve, prioritizing the enhancement of palliative care services is essential. By investing in comprehensive pain management and support systems, Pakistan can provide compassionate care that aligns with its ethical and religious standards, offering comfort to those facing terminal illnesses without compromising deeply rooted principles. Engaging in open dialogue and discussion will help bridge gaps in care and address patient needs more effectively rather than leave the law uncertain. 

Bibliography:

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