‘Assisted dying’ - assisted suicide and/or euthanasia by any other name
Monday, 3 October 2016
| Denise Cooper-Clarke
Before the end of this year, the Victorian Parliament must decide which of the recommendations of the report of the Legal and Social Issues Committee Inquiry into End of Life Choices it will take up. Of special interest is the recommendation to introduce a legal framework for ‘assisted dying’, which the report says should
in the vast majority of cases involve a doctor prescribing a lethal drug which the patient may then take without further assistance. The singular exception is where people are physically unable to take a lethal drug. … In this case, a doctor should be able to assist a person to die by administering the drug. (p.220)
This is what we normally call (doctor) assisted suicide, when the patient takes the drug themselves; or euthanasia, where the doctor administers the drug. But the report avoids using these terms, preferring the euphemism ‘assisted dying’. We probably would all like to have assistance as we are dying, but that’s not the same thing as being assisted to die.
Moral discussion around assisted suicide and euthanasia usually centres around balancing the principles of the sacredness of human life, justice (will vulnerable people be put at risk?), alleviation of suffering and respect for individual autonomy.
The sacredness of human life is a fundamental principle in many traditions, but it is also a core Christian doctrine that derives firstly from the Genesis 1 account of humankind being created in the image of God. The imagery is of Eden as the temple of God, but, in contrast to pagan temples, there is no statue to represent the god, rather humankind is the image or ikon that represents God. Every human being regardless of gender, race, sexual orientation, age or state of health is consecrated by God. Thus to destroy a human life (even one’s own) is a symbolic attack on God himself, and this is the basis of the prohibition of murder in Genesis 9:5-6 and in the Decalogue. In the New Testament, the incarnation of Christ and his redemptive death affirms the extraordinary value He places in each human life. The sacredness of human life is the basis for all human rights and should be the basis for our thinking in areas as diverse as immigration policies, treatment of indigenous peoples, capital punishment and the conduct of war, as well as euthanasia. The right to life is the most basic of human rights.
I believe that, while the obligation to relieve suffering and to respect people’s choices are powerful arguments, they are not winning arguments. In other words, the first two principles – the sacredness of human life and justice - outweigh the other two, and impose limits or boundaries on them.
The committee balanced the arguments differently. For them, the relief of suffering and, even more importantly, the provision of choices for patients were the winning arguments. I don’t think we need to look far to see why the balance has shifted in our society - why certain principles /arguments which used to be decisive are now outweighed by others. It has to do with our contemporary cultural context. Here in Australia, that context can be described as Post-Christendom aggressive secularism. As Mark Sayers puts it in Disappearing Church (2016), many now believe that ‘Western culture will flourish once orthodox religion is jettisoned’, and that ‘the relegation of Christianity to history’s garbage dump will result in a kind of utopia’. This idea has its roots in the 18th century Enlightenment, but is coming to full flower today. So, whereas secularism used to mean that no one religion was privileged over another in public life, many now argue that a truly secular society is one where religion has no place at all in public institutions. Hence the moves to get rid of Christian religious education and chaplains in state schools; and, it seems, the moves to rid public policy of any vestiges of Christian values, such as in the matters of abortion, same sex marriage and now ‘assisted dying’.
Closely related to this aggressive secularism, which forms the context of the euthanasia debate in Australia, is the fact that our culture is a culture of choice. The highest good in our Post-Christian culture is individual freedom and self-expression. This, for some, logically entails a right to suicide.
Suicide is the elephant in the room in discussions of ‘assisted dying’. Each of Andrew Denton’s podcasts in Better Off Dead (2016), where he advocates strongly for the legalisation of ‘assisted dying’, begins with a voiceover:
This podcast is not about suicide. If you are interested in increasing your understanding of suicide and how to support someone experiencing suicidal ideation, visit the Conversations Matter or beyondblue websites.
But no disclaimer can alter the fact that the debate is about suicide.
Euthanasia campaigner Dr Philip Nitschke is more honest than Denton. Originally, he argued for euthanasia and assisted suicide only for terminally ill patients who were suffering unbearably. But then he met Lisette Nigot, a 79 year old retired academic living in Perth, who was neither ill nor in pain but simply wanted to die. Nitschke decided that ‘a person of sound mind has a right to end their life at a time and place of their choosing’, and that he would help such people too, by providing them with the means to end their lives.
Let’s not be mealy mouthed: Nitschke is talking about suicide. Euphemisms such as ‘assisted dying’ or ‘death with dignity’ aim to mask the fact that euthanasia and doctor-assisted suicide are actually forms of suicide.
Legalising ‘assisted dying’ will send mixed messages about suicide prevention. In fact, it could be said that it will make suicide prevention measures incoherent. Suicide is suicide whether a patient takes drugs or uses another means. Suicide is still suicide if a doctor has prescribed those drugs. Suicide is suicide whether you are young, fit and healthy, or old, sick or demented - even when you are dying.
It is utterly incongruous that there are moves in Australia to legalise assisted suicide and euthanasia at the very same time as there is so much emphasis on suicide prevention. Suicide is a major social problem, and we rightly spend resources aimed at reducing the suicide rate. Usually, when someone is suicidal, we try to help them to live, not to die. If ‘assisted dying’ were legalised, we would on the one hand be promoting suicide as a legitimate choice while, on the other hand, continuing to promote suicide prevention. Effectively both the state and the medical profession, both very powerful institutions, would legitimise and sanitise suicide. The strength of a sense of obligation on the part of doctors and other professionals to try to prevent suicides will be significantly weakened. Suicide is no less tragic when a person is old or young, sick or healthy, disabled or not. To approve suicide for some but not others is inherently discriminatory, and indicates that some lives are considered of more value than others.
Denise Cooper-Clarke has special interests in professional ethics, sexual ethics and the ethics of virtue. She teaches medical ethics at the University of Melbourne and is the Zadok bioethics editor.