Euthanasia is an unlockable passive item added in Afterbirth †.
- Adds a chance to fire needles which deal triple Isaac's tear damage.
- Needles will instantly kill regular enemies and cause them to burst into 10 more tears in all directions.
- The chance to fire a needle depends on luck and goes up to 100% at 15 luck.
- This item belongs to the Spun set. Collecting three items from the set will transform Isaac into a buff berserker.
- The needle tears have the ability to kill enemies that are normally invincible, such as Peep's eyes, Death's Heads, and Stoneys.
- The needle tears can kill Grimaces, allowing the player to permanently remove any obstacle in a room.
- Possible needle tears in a burst from killing an enemy do not retain the instant kill and burst-causing capabilities, but still deal triple damage. This prevents chain reactions of bursts.
- The tears in the burst are larger than normal, but do not have a damage bonus.
- Serpent's KissTears now have a random chance to apply a poison effect, causing 4 or 6 damage per tick to enemies (Similar to The Common Cold item). Isaac now deals poison damage on contact with enemies similar to The Virus item (Damage over time 4 or 6 per tick). Enemies that were poisoned have a chance to drop a black heart when killed./ The VirusInflicts poison to enemies who make contact with Isaac. Speed down.: Allows harvesting black hearts from Stone Grimaces as they can be (invisibly) poisoned by touching them, then destroyed with Euthanasia.
- HaemolacriaTears are now fired in an arc. Upon hitting the floor, an obstacle, or an enemy, they burst into many smaller tears in all directions. Increases tear delay.: Does not override the tear burst and retains the chance for triple damage, but doesn't change the tear appearance. When killing an enemy, ten Haemolacria tears are fired which can burst into smaller tears.
- LachryphagyIsaac's tears decelerate as they travel. Upon stopping or hitting an obstacle, they burst into 8 tears in all directions. Tears can be fired into other tears to feed them, increasing their damage.: Does not override the tears burst, retains the chance to do triple damage, and retains Euthanasia tear appearance. Needles from Lachryphagy bursts can activate Euthanasia bursts, and all needles fired by Euthanasia bursts can be fed and will burst.
- Monstro's LungIncreases damage and grants a charged shot that fires multiple tears in the same fashion as Monstro./ Lead PencilAfter every 15 tears fired, Isaac will fire a high-damage cluster of tears.: Each tear in the barrage may become a needle, which retains all Euthanasia effects.
- Pop!Replaces Isaac's tears with eyeballs that can bounce off of each other. The eyeballs are not limited by range, and will instead dissipate when they stop moving or when hitting an enemy or obstacle.: Does not override the tear burst and retains the chance for triple damage, but tear appearance doesn't change.
- Kidney StoneRandomly while firing tears, Isaac will stop firing and turn red, where he will charge and release a lot of 'tears' in one go. In the burst of tears is a kidney stone which deals a lot of damage.: Each tear in the barrage may become a needle; however, the stone will not.
- Varicose VeinsTaking damage releases a ring of 10 high damage tears.: When hurt, each of the 10 tears fired may become a needle.
- BrimstoneTears are replaced by a laser beam that pierces through all enemies and obstacles in its path and deals high damage. Can only be fired after a short charge-up period.: Overrides the tear burst, retains the chance for triple damage but does not change the appearance of the laser. Does not retain ability to kill normally unkillable enemies.
- Compound FractureIncreases range. Tears turn into bones, which shatter into 1-3 bone shards upon hitting an enemy or obstacle.: Bones will split up as normal, and upon touching an enemy, will burst into 10 bones which will all split. Bones and bone fragments have a chance to deal triple damage (bone fragments deal 50% of Isaac's tear damage by default), and they will instantly kill normal enemies.
- Cricket's BodyGrants -1 Tear Delay and reduces Range. When tears hit an object or deplete their range, they spawn 4 smaller tears, whose Range and Damage scale with Isaac's.: Needle tears will split into 4 small needle tears upon hitting the ground or an enemy. Split tears produced have chance to deal triple damage, but will not cause tear bursts.
- Dr. FetusTears are replaced by bombs that benefit from bomb-enhancing effects and slide a fixed range after being fired.: Overrides the tear burst, retains the chance for triple damage but does not change the appearance of the bombs. Does not retain ability to kill normally unkillable enemies.
- Epic FetusIsaac's tears are replaced with guided missiles, like those used by the Doctor's Remote.: Overrides the tear burst, retains the chance for triple damage but does not change the appearance of the missiles. Does not retain ability to kill normally unkillable enemies.
- GodheadIncreases damage and range while reducing tears and shot speed. Grants homing tears and tears gain a damaging halo.: The tears retain all properties of Euthanasia, and while the aura has a chance to do triple damage, it cannot kill normally unkillable enemies, and will not cause a tear burst upon killing an enemy.
- IpecacReplaces tears with explosive and poisoning projectiles fired in an arc from the mouth.: Overrides the tear burst, retains the chance for triple damage with large, explosive needles. Does not retain ability to kill normally unkillable enemies.
- A Lump of CoalThe more distance tears travel, the more damage they will do.: When needles are fired, they don't seem to grow in size; however, they will increase in damage as they travel. Burst needles will increase in size and damage.
- : Some needle tears gain the piercing, instant kill effect and orange glow. When these tears pass through and kill an enemy, they do not burst into more tears.
- Mom's KnifeIsaac's tears are replaced by a knife that pierces enemies, can travel through obstacles, and can hurt enemies while Isaac is holding it. Holding down the fire button before firing increases its range and power.: Overrides Euthanasia.
- The ParasiteIsaac's tears split in two when they hit something.: Both regular tears and parasite split tears will cause enemies to burst into tears, with a chance to deal triple damage and kill normally unkillable enemies.
- Tech.5Grants a unlimited range piercing laser with random rate of fire that does not replace tears. The laser might occasionally fire with the effect of a random item or trinket, such as Hook Worm, Spoon Bender or Tiny Planet.: The laser has a chance to deal triple damage, will not burst into tears, and cannot kill normally unkillable enemies. The tears retain all properties of Euthanasia.
- Tech XTears are replaced with laser rings that pierce through enemies and deal damage to enemies within them. Can be charged to increase the size of the ring.: Completely overrides Euthanasia. No triple damage, no tear burst. Cannot kill normally unkillable enemies.
- TechnologyReplaces tears with a piercing laser with unlimited range.: Overrides the tear burst, retains the chance for triple damage but does not change the appearance of the laser. Does not retain ability to kill normally unkillable enemies.
- Technology 2Decreases damage and replaces right eye tears with a unlimited range, piercing laser which fires continuously.: The tears that Isaac fire retain all properties of Euthanasia, but the laser is unaffected.
- TrisagionTears are replaced with piercing white blasts of light.: Overrides Euthanasia.
- Euthanasia is the act of intentionally ending a person or animal's life in order to end their pain and suffering. It is usually carried out by an injection, hence why this item has the appearance of a needle.
- Euthanasia is the only syringe item that points upwards; all of the other syringes point downwards.
- Euthanasia and Experimental Treatment are the only 2 syringe items that need to be unlocked.
PC VK2V ZR2J (Treasure Room adjacent to spawn)
PC S0DB 83T7 (Treasure Room adjacent to spawn)
Switch DSX3 LF12 (First Golden Treasure Room)