The Impact of Euthanasia on Families

Dr. Brian Pollard
Reprint with permission

Since the family is the traditional place where life begins and is nurtured, euthanasia is another addition to a growing list of social proposals which would undermine the just rights of every person. In total, these proposals add up to a powerful attempt to change the social and moral environment in which we live, to place power in the hands of the strong at the expense of the weak. Because evil is not compatible with truth, this devaluation of human life needs to be expressed in clever terms which seduce while they mislead. What is appalling is made to seem appealing, and what is awful is to become lawful. It is already more difficult than it should be to lead lives of virtue and especially is it difficult to guide those for whom we are responsible. But the wider concept of family, that every person on earth is a member of the family of mankind, is just as threatened by these new proposals, and this realization is even more sinister and dangerous, as I hope to show.

In some respects, we are having some of the same arguments over euthanasia as we have with abortion. The appeal to the need for compassion to relieve suffering is giving way to claims about an individual's right to choose the time and method of his or her death, whatever may tee the ability of modem medicine to relieve suffering. This is made to look reasonable when it is the individual's own life at stake, not the life of another, as in abortion, and when it is agreed every person already has the right to refuse medical treatment, even when that will result in the person's death.

The arguments for euthanasia are well-known to you, and I won't repeat them here. What I shall do is list some of the important points missing from the case for euthanasia. Why are we having the euthanasia debate now, when we have always been able to kill each other, and when the reasons prompting demands for it have always been part of the human condition? How can a practice which has always been thought to be seriously morally wrong now suddenly be right, even to the extent recognized by Malcolm Muggeridge that it has taken only forty years for a war crime to become a matter of choice? How can the law which has always protected every human life, the same in every country, now be overturned, without even discussing the consequences of change? Why is there no mention of the fact that no euthanasia law has been passed anywhere because no law has been devised which would be free of the possibility of abuse? What might be the effects of not just confronting the present law, but overturning it? When discussing rights, are there no other rights to be considered than the right to choose whatever one wants? Why is it assumed that a right to choose takes priority over other rights? Since the sick and disabled generally cling to life as tenaciously as other people, even when their condition is often so miserable, why do opinion polls show such apparent support for euthanasia?

Regrettably, the question which is now rarely asked, but which should not be ignored if we are to deal justly with each other, is 'Can euthanasia be right?' It is the deliberate killing of a person, for compassionate motives. It is voluntary when requested, non-voluntary when there is no request and assisted suicide when the means of self-killing are provided. In this age, we are unwilling witnesses to so much human tragedy that it is easy to become morally desensitized about the equal value of every human life, and not to be fully aware of what is happening. But mention morality and one is likely to be labelled a religious crank. Even though everyone is supposed to know right from wrong, ways of making moral judgments are now rarely taught, and the need to do so is widely ignored.

So, instead of 'Can euthanasia be right?', one hears 'What arc one's rights?' These are not variations of the same question. The first relates to morality and applies to the community of individuals, while the second focuses on separate individuals, in many cases pitting them against one another, and even against society itself. Justifying euthanasia as an exercise of freedom of choice turns the ethical understanding of freedom on its head. The various forms of freedom genuinely upheld by natural human rights are 'freedoms from', not 'freedoms to'. Thus, rights declare that persons are to be free from oppression, from discrimination, from coercion and so on, and in no way do rights intend that persons are free to have or do whatever they happen to want, however sincerely and insistently. Specifically, one has no right to have or do what is immoral.

We all need to have some understanding of human rights, because they are claimed so often now. But they can get complex and dull, so if what I am going to say is a bit heavy, just switch off for a while. Though you may think the right to life has been done to death, as it were, I want to say a few words about it. Every right ever argued, claimed, granted, or denied can be viewed as an extension of the primary right to life. This right was soundly set forth after the end of the Second World War, when the nations came together to define and codify human rights. The 1948 United Nations' Universal Declaration of Human Rights states that 'the foundation of freedom, justice and peace in the world' is the 'recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family'. 'Inherent dignity' means that the value of human life is intrinsic. 'Inalienable' means that the right should neither be taken away nor given away. The Declaration also states that 'everyone has the right to life', and that 'all are equal before the law and are entitled without any discrimination to equal protection of the law'. Article 6 of its 1966 International Covenant on Civil and Political Rights declares: 'Every human being has the inherent right to life. This right shall be protected by law. No one shall be arbitrarily deprived of his life'. Arbitrary refers to what is capricious or supported only by opinion, not proof.

Euthanasia and the Right to Die

Whatever it may mean in other settings, in the context of euthanasia, the right to die refers to the claimed right of a person to be killed on request and the right of another to kill when asked. Neither of these claimed rights are to be found anywhere in ethics or law, and they are usually asserted, not argued. Genuine natural rights place an obligation on others to respond to them, but the advocates of euthanasia always point out that a request to be killed will not be binding on anyone. There is no reason to suppose that these claimed rights are genuine, and hence they do not deserve respect.

Respect for Choice, or Autonomy

You may have seen V coverage of NT supporters of euthanasia with placards reading 'My right to choose', 'Whose life is it' and 'Keep religion out of my life'. Though autonomy is an undoubtedly important, genuine human right, its real role is distorted when it is made to appear limitless and when the rights of other individuals are ignored. Thus, right to choose invites two responses: first, 'right to choose what?' Not even the most rabid libertarian would agree that one had the right to do whatever one wanted, so there must be limits, and it is wrong to behave as though there were none. Second, because no human right stands alone and none is absolute, an individual's claim of rights must be considered in relation to other relevant rights of individuals and the community. Genuine autonomy acknowledges the true equality of all human beings, and it obliges others to comply with their choice, in justice.

If a person were to comply with another's request to be killed, it could only be because it had been decided that that person's life had lost its value. Since there are no objective criteria for valuing a human life, the decision would depend on the values of the observer, and would be arbitrary. The value of human life would be thought to reside in the circumstances of life, not in life itself. If that were correct, then killing would be justified also for other unspecified but arbitrarily decided human conditions because, where genuine rights are concerned, there can be no discrimination between persons or groups. Whatever is arbitrary is contrary to justice.

The concept of the common good accepts the reality of community life, and presumes moral concern for relationships and arrangements beyond the individual. Claims about the common good will necessarily create tensions in a culture marked, as ours is, by ethical relativism and extreme individualism. The killing of a sick person may serve the good of some, but as public policy, it needs to be explained how it can serve the common good. Particularly to be explained is how it would maintain the protection of the vulnerable in society, some of whom are already known to be unwanted, which the present law provides. However beneficent a particular reform may seem to be, good law cannot be made by simply taking no account whatever of ethics or the common good.

Euthanasia and the Law

The suggestion that attempting suicide is now legally permitted because it has been decriminalized is false. It was decriminalized because it is known that most of those who contemplate suicide have a mental disorder, and this probability must be presumed to be present until disproved. Such people need medical treatment, not legal condemnation. On the other hand, those who may wish to assist suicide are assumed to be mentally competent, so assisting suicide remains a criminal offence.

Good law, like good medicine, should be based on good ethics, and in this sense, the criminal law should be also a kind of moral code. Euthanasia is already being practiced outside the present law, so it is said we need to bring the law into line with current practices. Every part of the criminal law has always been abused, but that has never been sufficient reason to change the law to accommodate abuses. Is it the function of law to accommodate the law-breakers or the law-abiding?

We have little detail about doctors' practices outside the law, but what we do know makes it unlikely that they are either ethical or necessary. It is not necessary for doctors to kill patients to relieve pain, though sometimes the assistance or advice of an expert in palliative care will be required. Doctors are obliged by law to know how to treat the patients under their care, and if they do not know, they are obliged to find out or get assistance. Suffering is not a medical matter alone; it has many social causes also, some of which are unable to be remedied by doctors, or perhaps by anyone. It would surely not be wanted that doctors should be empowered to take the lives of persons who were simply isolated, unwanted, unloved, neglected or otherwise burdensome. But how could such groups be guaranteed to be protected from the misuse of a law that legalized euthanasia?

It is commonly said that our present laws do not allow doctors to practice merciful and humane medicine, and when they try, they may risk prosecution. In my view, that statement is wrong in fact and wrong in opinion. The current principles of medical law are adequate to guide decision-making near the end of life, and it is significant that those who want euthanasia rarely include those with the greatest responsibilities for dying patients, namely palliative care and intensive care specialists.

Medical law needs to be interpreted in the circumstances of the case. For example, early in life-threatening illness, the doctor must pursue all reasonable avenues of cure, if that is what the patient wants; but when life is in its last stages, the doctor's lawful obligations no longer require the futile pursuit of cure and oblige only the provision of comfort. Thus, if it were not medically appropriate to provide treatments with little chance of success, it would be wrong and possibly negligent not to stop them. If the patient had unrelieved severe pain, it would be wrong and possibly negligent not to relieve it. Since the evidence of poorly relieved pain still abounds, and is given as a main reason for euthanasia, it may be presumed that killing is being used to cover for ignorance or incompetence. The presence of severe pain indicates a need, not for law reform to allow killing, but for urgent reform of medical education and some aspects of practice.

It is usually assumed that doctors would carry out euthanasia. Further, some doctors and nurses say they would do so, in contravention of their ethical obligations. By contrast, I believe that if a list of possible candidates for this role were to be considered rationally, doctors and nurses would be the first to be eliminated. Their codes of practice universally declare that they should not perform euthanasia, they would incur great difficulties arising from conflict between their healing and killing roles, most doctors and nurses find the suggestion abhorrent, and their professions would probably be unable to survive intact the tensions created by the acceptance of such a role. It cannot be denied they have the neatest means at hand and it is also probable they are chosen because nobody else would want the job. In light of the behavior of some doctors in South Australia, to be mentioned later, entrusting killing to doctors could be very dangerous.

It has become common to claim that easing the dying out of their misery by easing them out of life is part of a doctor's work, though the claim is rarely accompanied by any supportive arguments. In fact, the only roles which society has traditionally given to its doctors are: the prevention of illness, diagnosis, treating by curing when this is possible and by good care when it is not, teaching, and conducting related research. Doctors cannot assume other roles without stepping outside their areas of expertise, and they receive no training in killing.

It is sometimes said that society should not try to control acts in which there is no victim, and in voluntary euthanasia there may not seem to be any victim. That takes no account of the significant effects on a doctor's character as a result of killing patients on the grounds that their lives are now thought to be without value.

Doctors disposed to think that some of their patients may lack inherent worth, and that they may therefore be justified in killing them, have seriously undermined in themselves a disposition essential to the practice of medicine, namely the willingness to give what is owed to every patient just in virtue of their possession of basic human dignity. If doctors kill some patients because they judge those patients no longer have a worthy life, they make themselves disposed to kill other patients for that reason. For the sake of everyone who, at one time or another, is likely to become a patient, society has a basic interest in maintaining a legal framework for the practice of medicine which requires respect by doctors for the basic dignity of all patients.

An important medical factor is rarely mentioned in discussions of euthanasia. The literature of psychiatry contains many articles on the close association between seeking death and mental disorder, and those with terminal illness have a higher incidence of this than other sick patients. The following are some of the facts disclosed in psychiatric articles: the great majority of patients who desire death during a terminal illness are suffering from a treatable mental illness, most commonly a depressive condition; this is not a diagnosis which can be made by the average doctor unless he or she has had extensive experience with depression and suicide, and this diagnosis is frequently missed even in those already under medical care. These facts led one group of psychiatrists to say:

'If those advocating assisted suicide prevail, it will be a reflection that as a culture we are turning away from efforts to improve our care of the mentally ill, the infirm, and the elderly. Instead, we would be licensing the right to abuse and exploit the fears of the ill and depressed. We would be accepting the view of those who are depressed and suicidal that death is the preferred solution to the problems of illness, age and depression'.

The problem of the ever present possibility of coercion is one for which no solution has been devised. If concealment was wanted, coercion would be virtually undetectable, and thus would not be preventable. Additionally, coercion would negate freedom of choice. It should not be left as a matter of opinion whether or how often this might happen, when it was the view of the Australian Human Rights Commissioner, Mr Brian Burdekin, from his experience, that the vulnerable sick were already 'the most systematically abused and the most likely to be coerced'.

While relief of suffering is proposed as the justification for euthanasia, it would do nothing to address the causes of that suffering, so that others may not be similarly afflicted. In this sense, the proposal is negative, when what is really needed is attention to the cause of the problem. For no other medical or social problem is it seriously suggested that killing the victim might be part of the solution.

Could Voluntary Euthanasia be Contained?

Providing death on request to those who suffer is said to be justified on the ground that it would be a benefit to them. Once euthanasia is regarded as a 'benefit' to relieve suffering it will not be logically possible to withhold that benefit from others in similar degrees of distress but who, for any reason, cannot ask. That would be discriminatory. The most dangerous future extension of voluntary euthanasia would be progression to non-voluntary. To many, that seems such an extreme and unlikely prospect that it is often treated as a wild exaggeration, not to be taken seriously. It is said: 'It is preposterous to suggest that doctors are or would become monsters who might kill indiscriminately'.

But it is not an extreme suggestion. Even some of the advocates of euthanasia recognize that, if there were a genuine benefit involved, it would be unjustifiable to withhold it from others in similar need, just because they could not ask. Exactly that thinking is now being used in the Netherlands to justify the frequent non-voluntary killing by doctors, which official surveys have uncovered. It has become so widespread that some of the Dutch themselves think it will be unable to be controlled. Rather than take on the task of trying to eliminate it, the Dutch have now begun to rationalize it. Consider this quote from prominent spokespersons from the Department of Public Health at the Erasmus University, in a 1993 article:

'But is it not true that once one accepts euthanasia and assisted suicide, the principle of universalizability forces one to accept termination of life without explicit request, at least in some circumstances, as well? In our view, the answer to this question must be affirmative'.

A survey conducted among doctors and nurses in South Australia, published in 1994, discovered that on half the occasions doctors admitted they had carried out euthanasia, there had been no patient consent or request. It also uncovered that some respondents thought that poor quality of life, mental disability and physical handicap should be aufficient reasons for active euthanasia, whether or not this was requested. One of the surveyors, who previously had held no particular view on euthanasia, was moved by these findings to publicly express her disquiet that the very arguments about human rights used to promote euthanasia are in fact abused by its practice. She concluded: 'There is a danger that legalization of active euthanasia, voluntary or nonvoluntary, may expand the potential for further abuses. I consider legalization could undermine the value placed on human life, and erode our sense of security. We need to ensure that the state continues to protect people.'

Once life is taken because it has lost, in someone's estimate, sufficient quality to be worth living, it will simply be consistent to apply the same yardstick to others also without request, at least sometimes. One does not have to be a monster to be rationally consistent.

It is deceitful to claim that opposition to euthanasia is based solely on religious or emotional bias. This is the opposite of the true position, in that every thorough objective analysis of the subject known to me, whether by lawyers, parliamentarians, doctors or philosophers, even those conducted by people who believe euthanasia can be ethical, has concluded that legalized euthanasia would be unwise and dangerous public policy, because abuse would be inevitable.

Public Opinion Polls

What of the claim that the public wants euthanasia, as shown by public opinion polls? Such polls are political instruments, and their use for resolution of ethical problems is highly suspect. What is to be made of the fact that 78% of respondents replied in the affirmative to this question in the last Morgan poll? 'If a hopelessly ill patient in great pain with absolutely no chance of recovering asks for a lethal dose, so as not to wake again, should the doctor be allowed to give the lethal dose or not?'

Bearing in mind the ability of current palliative care to relieve pain, a paraphrase of this question would be: 'If a doctor is so negligent as to leave a terminally ill patient in pain, severe enough to cause that person to ask to be killed, should the doctor then be able to compound his negligence by killing his patient, instead of seeking help?' Though it must be doubted that 78% of respondents would approve of that, when the Morgan organization was asked to modify its question to take into account the realities of palliative care, it refused.

When opinion polls on euthanasia are further examined, complexity grows. Is euthanasia well understood by the community? How many people think that pain in terminal illness cannot be relieved because they so often see it unrelieved? Do they know that safe laws on euthanasia have not so far been able to be devised anywhere? How many know of the extreme perversion of the law in the Netherlands, which has led to the common practice of medical murder? How many have thought through the dilemma that if doctors cannot be relied on to control pain, how might they be relied on to control killing?

Some Economic Considerations

It would be proper for a community to set its own priorities in allocating its health costs, especially when these seem to be rising rapidly and uncontrollably. In doing this, three principles are agreed to be important: resources are limited, rationing of some forms of treatment is inevitable, and fairness must be inherent in any solution.

Vulnerable groups, such as the dying, will always need the protection afforded by a strong reliance on the overriding principle of distributive justice to ensure that they get what is owed them. Justice can be defined as 'what we ought to seek in a society where each person is of equal worth and has equal opportunity to share in the sum of society's goods'. Justice would seem to require that any principled system should start at the bottom, giving priority to the interests of the least advantaged, and work upwards from them. But that wouldn't be easy. Any attempt to introduce a principled system would conflict with the ambitions of many powerful groups, accustomed to winning the battles for the health dollar.

In economic terms, dying patients have consistently negative value, and it is common for the amount of money required for their care to be highlighted. A favorite statistic of health economists is that almost half of the health costs of those over 75 years of age is spent on the 13% of that group who will die within the next two years. Very few supporters of euthanasia are so crass as to say outright: 'Dying patients cost too much, let's kill them'. But who could guarantee that that would continue if euthanasia had been legal for several years, and many people had become comfortable with the idea that killing was a suitable solution to the problem of suffering? As one writer put it: 'Legalization will seriously erode efforts to humanize the dying process and will create its own coercions. The hard work needed to humanize dying will simply become less and less worth it, at the national and family levels'. The extension of voluntary euthanasia to involuntary for the severely disabled, the comatose and the mentally ill would be seen as, and would in fact be, a logical development. I believe the message is: there can be killing or no killing of patients; there cannot be killing which can be limited.

Euthanasia has been well described as the latest form of family planning, to present threats to life, now at both its ends. Each is inherently immoral, but saying that makes little impact on anyone with a blunted sense of morality. When discussing euthanasia with such people, there is a need to provide reasons which rely on facts for their appeal, so they can be understood and discussed by anyone with a receptive mind. It is important, particularly at this late stage, not to limit oneself only to reasons based on religious dogma, because that too easily gives people who don't share those beliefs good reason to excuse themselves from having to give them serious consideration.