Part B.    A refutation of some arguments against voluntary euthanasia

B.1   Possible abuse of euthanasia legislation

  1. Euthanasia opponents often claim that legislation would be abused. To assess whether voluntary euthanasia legislation could be abused, it is useful to consider previous legislation. Four people made use of the Northern Territory’s Rights of the Terminally Ill Act before it was overturned. There were significant measures in that Act to ensure that patients were not improperly coerced into euthanasia. 
  2. Marshall Perron neatly encapsulated some of the more important measures in the Northern Territory’s Act to ensure it was not abused. Most of these measures seem to have been, incorporated in voluntary euthanasia regulatory regimes that currently exist. Mr Perron said

 ‘Voluntary euthanasia is patient driven. The Northern Territory law dictates that the patient must personally initiate the process, consider the options for treatment and palliative care, be psychologically assessed, sign a request, obtain second opinions, consider the effect on the family, use qualified interpreters if necessary and endure a cooling off period. The patient can of course change their mind at any time and stop the process instantly. Additionally, detailed records must be kept. Government regulations must be followed. The Coroner must be informed and has a statutory responsibility to report to the Attorney General and parliament any concern regarding the operation of the legislation. To kill another without these conditions being fulfilled is to commit murder under the Northern Territory Criminal Code—penalty being mandatory life in prison.’ 

  1. Mr Perron also said that although more elaborate safeguards could have been put in place, the safeguards in the Northern Territory’s Act ‘prevent people who might opt for voluntary euthanasia simply because they are temporarily depressed, or who are being coerced by others, from being legally able to be assisted’. Any patients who request euthanasia under duress will not convince a jury of doctors that their decision has been made ‘freely, voluntarily, and after due consideration’, as the Northern Territory Act requires. Consequently, such patients will be considered ineligible for euthanasia. 
  2. No worst-case scenario is impossible, but it is unlikely that voluntary euthanasia legislation could be abused. Most Australian doctors would consider it improbable and an insult to suggest that, for example, a group of three doctors would maliciously collude to arrange the death of a terminally ill patient without the patient’s consent. 
  3. We would no more consider removing murder and theft from the criminal code because some people murder or steal. We prosecute offenders who do not meet the conditions or behavioural standards outlined in legislation. And so it would be for voluntary euthanasia, as breaches of strict guidelines would be punishable by law. 
  4. A legislated regime must be preferable to the unregulated voluntary euthanasia activity that occurs now without any controls. If voluntary euthanasia is not regulated, that will mean that politicians are effectively sanctioning the illegal activities of the thousands of Australians, and hundreds of Canberrans, who have been importing, and will continue to import, illegal drugs (to have available as a means of achieving a peaceful death).

B.2    Patients being a burden

  1. Possibly the most pervasive, but not persuasive, argument against voluntary euthanasia, in terms of popular use by those who oppose euthanasia, is that of patients ‘being a burden’. This includes people who might not want voluntary euthanasia being encouraged to request it. This argument seems to be a catch-all for voluntary euthanasia opponents. The argument comes in a number of forms. 
  2. First, there are concerns that those who are vulnerable, possibly the elderly, disabled, members of certain racial or ethnic groups, and the poor, will be under pressure to have euthanasia, possibly because these people might not have appropriate access to medical, psychological or palliative care services. This argument is unfounded, because international experience is that this does not occur. Appropriate safeguards have been established in international legislation to mitigate this risk. 
  3. Most voluntary euthanasia regulatory regimes involve a number of medical practitioners, one of whom could be a qualified psychiatrist. Medical practitioners are required to ascertain that they are satisfied that the terminally ill person’s decision to end his or her life has been made freely, voluntarily and after due consideration. It is improbable to imagine that a terminally ill person who wants to stay alive (but feels compelled to request voluntary euthanasia because society is not supporting them or that they otherwise feel pressure) could convince three medical practitioners that their euthanasia decision was made without pressure, coercion, or otherwise was not voluntary. 
  4. Second, an argument that has often been raised is that unscrupulous relatives, in attempting to rid themselves of a terminally ill parent or relative, will apply pressure to the terminally ill person to seek euthanasia. Such a scenario is highly improbable. Most people’s experience is that loving relatives are distressed by the fact that their relative is terminally ill. If unscrupulous relatives did exist, why would they provoke the possible ire of their terminally ill loved one, and possibly risk any inheritance, by implying that the person is a burden, or suggesting euthanasia when it is not wanted? In this case their loved ones would literally be unloved. The safeguards noted above still apply.
  5. Third, in current regulatory regimes, only terminally ill people can access voluntary euthanasia. Of course, whether the line ought to be drawn at terminally ill, seriously ill, or having a poor quality of life is another matter. The point is that current regulatory systems, and future systems in the short term, draw the line so that only people who are terminally ill will be able to access voluntary euthanasia.
  6. Can there be an ironclad guarantee that the legislation, if enacted, won’t be abused? As with any similar legislation, such guarantees are impossible to make. Legislation prohibiting murder does not guarantee a society free of murder. Under voluntary euthanasia regulatory regimes overseas, medical practitioners are required to keep a range of documentation. If the appropriate documentation is not retained, then there are penalties. 
  7. Why should a more stringent standard be applied to voluntary euthanasia for terminally ill people who need assistance to die? Terminally ill people on life support can request the removal of life support, and there is not the same level of regulatory oversight to confirm their mental well-being, and confirm that they are not being coerced to die. 
  8. If being a burden were really a concern that would drive terminally ill people to seek legalised euthanasia, then many people should be considering legalised suicide now because, according to some measure, they could be considered a burden. Everyone who obtains some benefit from others, whether it is people who are being cared for, children, elderly, unemployed, pensioners, etc., is theoretically a burden on other people or society. But we do not find pensioners, and nor should we, claiming ‘since I am a burden on society I should commit suicide’. It is possible to address the patient is a burden argument.
  9. Many people might say that if they are ever terminally ill, then they will evaluate all information, including whether they are a burden on family or society. If they want to stay alive, then their quality of life could be their primary concern. The key consideration is that the choice must be for patients to make. Even if somebody were to make a poor decision about their own life, it is their own life. Most people would rather all decisions about their lives, good or bad, were made by themselves, rather than having the values of other people forced on them, denying them the option of voluntary euthanasia if they were to choose it. The approximately 75% of Australians who support voluntary euthanasia have a similar view. 

B.3    International experience

  1. Some forms of voluntary euthanasia are legal in the Netherlands, Belgium, Luxembourg, Switzerland, Germany, Colombia, Japan, Canada, the USjurisdictions of WashingtonState, Oregon, Colorado, Vermont, Montana, Washington DCand California, as well as Victoria in Australia. It seems legislators are starting to respond to the needs of terminally ill patients. Importantly, the legalised use of voluntary euthanasia in these jurisdictions is not out of control as has been claimed by those opposing voluntary euthanasia. Interestingly, but not surprisingly, the rate of euthanasia in the Netherlands has decreased rather than increased. This is probably because, amongst other things, people are aware that a voluntary euthanasia option is available if they need it, so non-voluntary euthanasia, and suicide by premature access of more drastic and less dignified options, is not required.

B.4   The ‘right to life’ and ‘sanctity of life’ arguments

  1. The right to life argument in the context of voluntary euthanasia has no ethical merit. The ‘right to life’ is no more than a ‘right’. The right to life is not an obligation to live. The right to life does not demand that it must be exercised. 
  2. Similarly, people have the right to stand on their heads in their back yard if they want to, but there is no compulsion to do so. Terminally ill patients who want euthanasia for themselves choose not to exercise their right to life. The clergy and other opponents of euthanasia might not understand this choice, but it is the choice of those who want voluntary euthanasia. 
  3. An often-touted argument deals with the sanctity of life. A problem is that the word sanctity only has meaning for those with particular religious beliefs. And it seems to be applied selectively. The Christian Bible is littered with instances of murder, sacrifice and torture, including of women and children, so the sanctity of life argument is not even respected by the Christian clergy. 
  4. It could be ironic that many religious people, whose moral values permit them to worship a god that they consider has murdered thousands/millions of people (according to religious texts), want to deny others the right to take their own lives and end their suffering when they are terminally ill. Surely this is a morally perverted standpoint. 
  5. People with other beliefs, such as those who might, for example, have an objective of ‘to live my life as long as I am happy and healthy, and, if that is not possible, then to die with dignity’ are discriminated against by the sanctity of life argument. 
  6. If life were sacred, there would also be compelling arguments against the withdrawal of life support (passive euthanasia), self-defence and suicide. It would follow that society should do its utmost to ensure that everyone stays alive no matter what the circumstances. Many would find this unacceptable. Ironically, and perversely, there are right wing groups who support capital punishment but object to voluntary euthanasia.

B.5   An incorrect patient diagnosis

  1. Some euthanasia opponents claim that a terminally ill patient could be incorrectly diagnosed, and could recover, so euthanasia should be forbidden.
  2. It is foolish to claim that incorrect diagnoses and prognoses could never occur. But for all practical purposes, they can be ruled out. Dr Alistair Browne has remarked that ‘it is frequently beyond all reasonable doubt that the diagnosis is correct or some cure will not be discovered in time to help, and it is not clear why this should not be sufficient. The law has never taken a “pigs might fly” attitude towards the risks attendant on any activity. We only need to establish “guilt beyond reasonable doubt” to send a person to prison or even to his execution, and it is not possible to require more without making the enforcement of the law impossible. Why a more stringent standard should be demanded in the cases of assisted suicide and active voluntary euthanasia yet needs to be explained.’ 

B.6   The slippery slope argument

  1. The slippery slope argument is a common sensationalist argument of the clergy and other euthanasia opponents. It claims that if a right to assisted suicide and active voluntary euthanasia were instituted, it would lead to an increased rate of non-voluntary euthanasia, then euthanasia of those who are not attractive to society, those with fanatical political beliefs, extreme religious or cultural values and so on. Thus if we do not draw the line where it is, we will not be able to prevent substantial harm to others. 
  2. This argument has no merit. For there to be evidence of a slippery slope there would need to be evidence of more non-voluntary deaths within a tolerant, legalised voluntary euthanasia framework. 
  3. International studies have found that a ‘group of people being helped to die without consent existed in all surveyed countries, irrespective of whether there was an environment of decriminalisation or harsh legal sanction’. Moreover, it seems that a tolerant environment for voluntary euthanasia, decreases, rather than increases, the number of non-voluntary deaths. This has certainly been the case in the Netherlands. If there were a slippery slope, it is going the wrong way for those opposing euthanasia. 
  4. The line on what will be permitted will be drawn by the enactment of any legislation. Voluntary euthanasia will then only be available to mentally competent patients who are terminally ill under specified conditions. Despite scaremongering, there will be no slippery slope—parliaments will decide where the line is drawn. Good governance demands legislative oversight of voluntary euthanasia.

B.7   The palliative care option

  1. The clergy and other euthanasia opponents argue that assisted suicide and active voluntary euthanasia are unnecessary because of the extraordinary developments in palliative care and pain control. Angelique Flowers would have disagreed, but she suffered. She recorded a compelling videotothen PrimeMinister KevinRudd, yet her plea went unanswered, see https://angeliqueflowers.wordpress.com/angeliques-story/.
  2. Advances in palliative care are always welcome. In some, perhaps many cases, the need for assisted suicide and active voluntary euthanasia will be reduced through developments in palliative care. But these developments do not obviate the need for voluntary euthanasia nor can they control all aspects of a patient’s illness to the level desired by all patients. There are still numerous illnesses or conditions for which pain, extreme suffering, and loss of dignity are difficult or impossible to eliminate. Some patients will suffer the terror of breathlessness or vomit uncontrollably, others will be choking continuously or unable to swallow, others will be paralysed, and still others will be helpless, weak, incontinent and dependent on others. Even if pain and distress are not the major problems, there is often a strong fear of the dependency that would result if all bodily functions, mental and physical, were sufficiently impaired. 
  3. Palliative care is not an option for all people, since no amount of palliative care can relieve all distress. Voluntary euthanasia is a reasonable alternative for those who want it. Clearly, around 75% of Australians, including the many thousands of members of Exit International and the Dying with Dignity organisations, want voluntary euthanasia as an option. 

B.8    The concept of harm

  1. Some who argue against voluntary euthanasia claim that doctors must ‘first, do no harm’. Leaving a person, such as Angelique Flowers, to suffer when palliative care has not provided adequate respite from pain and suffering, is simply unacceptable. For many people, particularly terminally ill people, staying alive is doing harm. The option of a peaceful death, before one might vomit faecal matter, is preferable for many people, including for those terminally ill people with colon cancer. They should not be denied the right to have a peaceful death, a right that does not directly affect others. 
  2. It is arrogant to impose one’s belief systems on another individual, effectively denying the other the right of equality. Only individuals themselves know what harm is. Those who opt for quantity of life regardless of the pain or suffering might not want voluntary euthanasia, and they need never request it. However, as many patients, particularly terminally ill patients consider that the quality of their life is more important than staying alive, the option of a peaceful death to alleviate their pain and suffering is a more humane and desirable alternative. 
  3. Denying an individual’s right to die could be construed as arrogance. Other Australians should have the right not to have others’ values and perspectives forced on them. 

 

David Swanton