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Character appearance
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Curse Room Curse Room
Devil Beggar Devil Beggar
Treasure Room Treasure Room
Greed mode only Treasure Room Treasure Room
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(page 5, column 11, row 1)
Euthanasia Defeat Delirium as LilithEuthanasiaEuthanasia
Added in Afterbirth †

Euthanasia is an unlockable passive item added in Afterbirth †.

Effects[edit | edit source]

  • 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. At base luck (0), it is 3.33% and goes up to 100% at 15 luck.

Notes[edit | edit source]

  • 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.

Synergies[edit | edit source]

  • Haemolacria HaemolacriaHaemolacria Icon.pngTears 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.
  • Lachryphagy LachryphagyLachryphagy Icon.pngIsaac'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.
  • Pop! Pop!Pop! Icon.pngReplaces 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.
  • Serpent's Kiss Serpent's KissSerpent's Kiss Icon.pngTears 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 Virus The VirusThe Virus Icon.pngInflicts 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.

Interactions[edit | edit source]

  • Brimstone BrimstoneBrimstone Rebirth Icon.pngTears 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 Fracture Compound FractureCompound Fracture Icon.pngIncreases 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 Body Cricket's BodyCricket's Body Icon.pngGrants -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. Fetus Dr. FetusDr. Fetus Icon.pngTears are replaced by bombs that benefit from bomb-enhancing effects and slide for a fixed time 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 Fetus Epic FetusEpic Fetus Icon.pngIsaac'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.
  • Godhead GodheadGodhead Icon.pngIncreases 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.
  • Ipecac IpecacIpecac Icon.pngReplaces 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 Coal A Lump of CoalA Lump of Coal Icon.pngThe 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.
  • Little Horn Little HornLittle Horn Icon.pngAdds a chance to fire a piercing tear that instantly kills any enemy that it touches.: 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 Knife Mom's KnifeMom's Knife Rebirth Icon.pngIsaac'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 Parasite The ParasiteThe Parasite Icon.pngIsaac'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.5 Tech.5Tech.5 Rebirth Icon.pngGrants 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 X Tech XTech X Icon.pngTears 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.
  • Technology TechnologyTechnology Icon.pngReplaces 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 2 Technology 2Technology 2 Icon.pngDecreases 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.
  • Trisagion TrisagionTrisagion Icon.pngTears are replaced with piercing white blasts of light.: Overrides Euthanasia.

In-game Footage[edit | edit source]

Trivia[edit | edit source]

  • 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.

Seeds[edit | edit source]

 Switch  Greed mode only DSX3 LF12 (First Golden Treasure Room)

Lilith  Unlocks Lilith Unlocks Lilith  Unlocks
IncubusIncubusDefeat Hush as LilithBox of FriendsBox of FriendsDefeat Ultra Greed as LilithBig BabyBig BabyDefeat Mega Satan as LilithRune BagRune BagDefeat Isaac as LilithCambion ConceptionCambion ConceptionDefeat ??? as LilithSerpent's KissSerpent's KissDefeat Satan as LilithSuccubusSuccubusDefeat The Lamb as LilithImmaculate ConceptionImmaculate ConceptionComplete the Boss Rush as LilithGoat Head BabyGoat Head BabyDefeat Mom's Heart on hard mode as LilithDark BabyDark BabyEarn all hard mode completion marks as Lilith EuthanasiaEuthanasiaDefeat Delirium as LilithDualityDualityDefeat Ultra Greedier as Lilith
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