25 November 2013 by thaliakr
‘It is a tragedy when the human spirit dies before the body. But the answer is not to kill the body too, but to revive the spirit.’ So said Prof Margaret Somerville at a conference on euthanasia held in Wellington a couple of years ago.
On Sunday I tried to canvass the arguments on both sides of the euthanasia debate, respectfully, but being clear that I think legalising euthanasia will have far-reaching unintended effects and is a poor solution to the problem of end-of-life suffering.
It’s important to acknowledge up front that everyone arguing for or against legalised euthanasia is on the side of reducing human suffering. We just disagree about how to do it – and what effect on human suffering euthanasia will actually have. If you have been in a distressing situation as someone has been dying, I am terribly sorry that you had that experience. Unlike some of the others in this series of Matters of Life and Death, this post is not primarily about our personal responses to death and dying, but about public policy.
Probably the main reason most people support legalised euthanasia is compassion. We don’t want people to suffer unnecessarily. As Methodist leader Rev Leslie Weatherhead said:
I sincerely believe that those who come after us will wonder why on earth we kept a human being alive against his will, when all the dignity, beauty and meaning of life had vanished; when any gain to anyone was clearly impossible and when we should have been punished by the state if we had kept an animal in similar conditions.
You may be surprised to learn that very few people who request euthanasia are doing so because of physical pain. Only 7% in one Oregon study, and none at all in an Australian study.
And a Dutch study showed that half of all people requesting euthanasia were clinically depressed.
The suffering that many people experience at the end of life is not the physical distress we often think of when talking about euthanasia but existential distress. If someone without a terminal illness was similarly distressed about things like fear of death, regret or depression, we would respond with treatment, not euthanasia.
Indeed, a Canadian study found that rather than euthanasia, a very effective response to such requests, along with medical treatment of depression, was what they called ‘dignity therapy.’ It’s a specialised psychotherapy where volunteers listen to and write down a person’s life stories, then present them to the person to bequeath to their loved ones.
Dignity therapy, in one study, halved the rate of requests for euthanasia. Many people just need to be listened to and know that their lives have significance.
When we encounter someone near the end of their life who is distressed in any way, we need to respond, as a society, with friendship and good medical care, rather than euthanasia.
The next biggest argument is definitely about freedom of choice. Shouldn’t people be able to choose and control when and how they die?
This a modern argument in its popularity – it’s only recently that human beings have felt like they control their destinies. In the rich world at least, we now get to choose our marriage partners, jobs and homes in ways our ancestors never imagined. So shouldn’t we extend this freedom of choice all the way to the end of our lives?
Leaving aside for now the Christian response that, actually, no, we’re not intended to have that much control, I’m not that interested in using the law to limit people’s freedoms when they don’t affect other people. But in the case of euthanasia, one person’s freedom is another person’s shackle.
Euthanasia requires someone else to be involved in causing a person’s death. It means that family members and doctors are called upon to assume the burden of killing a loved one or patient.
Medical associations around the world are strongly opposed to euthanasia for this reason, as is the Hospice movement. It would fundamentally change the basis of the doctor-patient relationship, undermining trust.
Some people do want the freedom to choose when and how they die, but we all have our freedoms limited by the state for the sake of others. I’m convinced that euthanasia takes away more freedoms than it gives.
Being a burden
No one wants to be a burden. But that’s the problem. Legalising euthanasia is very likely to lead to some people feeling an obligation to exit early for the sake of their caregivers and loved ones.
Even the United Kingdom Parliamentary select committee looking at euthanasia said this in 1994:
We concluded that it was virtually impossible to ensure that all acts of euthanasia were truly voluntary and that any [law change] could not be abused. We were also concerned that vulnerable people – the elderly, lonely, sick or distressed – would feel pressure, whether real or imagined, to request early death.
Our friend Prof John Wyatt is a doctor in London, and now also a professor of medical ethics. He said these profound words in a conference talk:
One day some elderly saint, some good Christian person who has served Jesus for decades and is now frail, may say to you, ‘I just don’t want to be a burden to anybody. I’ve lived my good life of service, but when I can’t do all those things, I’d rather just go to Glory, than be a burden to other people.’
If someone ever says this to you, you must say to them: ‘You are wrong! We are all designed to be a burden. We are called to bear each other’s burdens!’
It’s a hard thing to be a burden to your loved ones, but learning to bear one another’s burdens brings life.
If an ill or elderly or disabled person feels like a burden, surely the answer is to value them properly, not to kill them.
Euthanasia is a poor substitute for cherishing the weaker members of our society – and letting them know they are cherished.
It’s hard to watch someone die
It’s a terrible thing to watch someone you love die. I think I can understand the impulse to help them end their life before nature does.
But this kind of law change can’t be motivated or justified by the distress of the well – especially when that distress is often out of proportion to the experience of the person who is actually dying.
Even in the Netherlands, where euthanasia is readily available, and reported deaths by euthanasia make up around 3 per cent of all deaths each year, the majority of people still do not choose it. Most people, even in the Netherlands, would rather that the time and method of their death be out of their hands.
So who are we as onlookers to say that their end of life is too distressing?
Surely rather than legalising euthanasia, the answer is to increase support for families, so that we are all able to be sad, but calm, presences around the beds of our dying loved ones, rather than anxious ones.
We need to deepen our inner resources so we are able to accept death, which is, after all, inevitable, and even with euthanasia, usually out of our control.
Euthanasia is dangerous
I’m not a fan of slippery slope arguments, which are often a combination of lazy logic and scaremongering.
We have, however, seen enough evidence from the places where euthanasia is now legal to be seriously concerned about the unintended consequences of legalising euthanasia.
If you asked most people to describe an imaginary scenario where they wish euthanasia were legal, they would probably talk about someone past middle-age, in the last stages of a terminal illness, in unbearable physical pain, asking a doctor to give them a lethal dose.
Yet, not only are most people requesting euthanasia not in physical pain, it’s also true that since euthanasia was legalised in parts of Europe, targeting that kind of scenario, a lot of people have been killed in circumstances that are very different.
The safeguards in legislation are largely ineffective in Europe.
For instance, both Belgium and the Netherlands have, on paper, strict rules on mandatory reporting. But in the Netherlands, officials estimate that over 20 per cent of cases of euthanasia remain unreported, and in Belgium the figure is more like 50 per cent.
More importantly, both countries’ legislation requires voluntary consent by the person who wants to die. But in the Netherlands, 14%, or one in seven deaths by euthanasia are now without consent or an expressed desire for it. In Belgium, 32% of deaths by euthanasia happened without a specific request.
For a full analysis of how well – or poorly, in fact – the safeguards are working around the world, see this paper.
Here are some key examples of how euthanasia is now practised in places it has been legalised. It’s not at all what most of us could have imagined.
- The Groningen Protocol is an accepted medical practice – not legal under the euthanasia laws, but openly practised and no one has been prosecuted – whereby severely disabled Dutch babies are killed at the request of their parents.
- Doctors in Europe now perform euthanasia on middle-aged people in the early stages of dementia.
- In Belgium, the parliament is debating extending euthanasia to those under 18.
- In two widely-reported Belgian cases, people without a terminal illness have died by euthanasia because they, essentially, thought they had nothing to live for. Have a look at the circumstances. The people involved would be described as suicidal if euthanasia weren’t an option.
- Belgian has also seen cases of euthanasia for blindness and anorexia.
Add to these examples the concern that people will be coerced, or feel imagined pressure to choose euthanasia, and it becomes extremely difficult, nearly impossible, to limit deaths by euthanasia to the kinds of last-resort scenarios that are initially targeted by legislation.
The other problem that has been identified in the Netherlands is that once euthanasia is legal, it’s possible to argue that withholding it is unfair or cruel. This is one reason so many people in Belgium and the Netherlands are killed without their consent – how could doctors let them suffer?
As Dr Herbert Hendin says of his research into the Netherlands situation:
Over the past two decades, the Netherlands has moved from assisted suicide to euthanasia, from euthanasia for the terminally ill to euthanasia for the chronically ill, from euthanasia for physical illness to euthanasia for psychological distress and from voluntary euthanasia to non-voluntary and involuntary euthanasia.
Once the Dutch accepted assisted suicide, it was not possible, legally or morally, to deny more active medical assistance to die (euthanasia) to those who could not effect their own deaths. Nor could they deny assisted suicide or euthanasia to the chronically ill who have longer to suffer than the terminally ill or to those who have psychological pain not associated with physical disease. To do so would be a form of discrimination.
The New Zealand situation
In New Zealand, Labour MP Maryan Street has drafted the End of Life Choice Bill. She withdrew it from the Private Member’s Bill ballot last month (so it’s not on the Parliament website anymore), to stop it being debated in an election year.
She has said she will reintroduce it as soon as the next Parliament convenes, if she is still an MP, which seems likely.
The safeguards it provides include requiring that two doctors sign off, the requests be in writing, a one-week stand-down period between request and action, and mandatory reporting. This is a relatively relaxed approach, compared to the European regimes.
The Bill allows anyone with an ‘irreversible physical or mental medical condition’ that causes unbearable suffering – in their own view – to access euthanasia, a wide enough definition to include those with dementia or depression. Dementia is specifically intended to qualify, according to Ms Street.
The New Zealand Medical Association has clarified that despite any law change, euthanasia will remain an unethical medical practice.
I heard a radio commentator talking recently, just off the cuff, about the prospect of legalising euthanasia in New Zealand. She seemed to categorise the issue alongside a basket of other socially liberal policies, like decrimininalising homosexuality and prostitution. She thought it was just a matter of time, and soon lawmakers would legalise euthanasia.
Wellington Coroner Ian Roderick Smith said in a recent case that:
Once again this death raises the vexed issue of euthanasia and, as I have recorded in past cases, this process simply will not go away, and it will be necessary for Parliament to address this matter yet again.
Given that bills attempting to legalise euthanasia have come to Parliament twice in the last two decades, and been defeated, the Coroner, too, apparently thinks that it is inevitable that it will be legalised, part of a social tide of liberalisation.
I disagree. I think there is a great deal of misunderstanding about the issue. Far fewer terminally ill people want euthanasia than we may think. Far more people are at risk of dying against their wishes than we may realise.
Euthanasia would undermine the doctor-patient relationship and probably make us less compassionate towards disabled, elderly and ill people, not more.
Legalising euthanasia would almost certainly cause more suffering than it would relieve. Society would not become more free but less.
This is the sixth post in a series on Christian approaches to bioethics, written to accompany a sermon series on the subject at Wellington South Baptist Church, and to expand the discussion to the rest of the Sacraparental community.
You may also like to read some of the others in the series:
Please feel free to comment below with your own thoughts.