The Case Against the Legalisation of Euthanasia and Physician-assisted Suicide
Monday, 2 November 2015
| Denise Cooper-Clarke
All societies and cultures have laws against murder, based on the moral belief that it is wrong to kill an innocent human being. The right to life is the most basic of human rights. In the Judeo-Christian tradition, this belief is based on humans being uniquely created in the image of God. But respect for life is not just a religious value, it is a foundational value of all societies in which reasonable people would want to live.
The general wrongness of killing is based on the intrinsic value of human life, where the life of each individual has an equal claim to respect, because the value and dignity of each person is not diminished by age, disease, dependence or disability.
Nevertheless, as long as some exceptions to the general prohibition of killing are allowed, such as capital punishment, warfare or self-defence, some argue that euthanasia and/or physician-assisted suicide (PAS) might also be examples of exceptions to the general rule. The two major arguments for permitting these practices, used separately or together, are the argument from the principle of respect for patient autonomy and the argument based on the obligation to relieve suffering where possible.
The argument based on respect for the autonomy of the patient is flawed. To kill another person, even at their request, is to commit an injustice against that person, because the right to life is inalienable, since human life is the good which is fundamental to the pursuit of all other goods, including the exercise of individual autonomy. The banning of duelling and of slavery are other examples of the view that we cannot waive our right to life or freedom, or give permission to anyone to kill or enslave us.
The argument based on the obligation to relieve suffering is also flawed. There may be individual cases where patients’ symptoms are poorly managed at the end of life, but generally this is an argument for better palliative care, not for euthanasia. Rarely, physical symptoms cannot be managed, even with the best care. But these are exceptional, and hard cases make bad law.
But pain and physical suffering account for only some requests for euthanasia or PAS. Often the request is prompted not by symptoms which can be managed by medical therapies but by existential suffering. Coming to terms with impending death, dependence or disability is difficult and distressing. But it is not amenable to a purely medical solution. The real problem with euthanasia is that it is a medical solution to a non-medical problem, an existential or spiritual problem.
Euthanasia cannot and will not be limited to competent patients or to the terminally ill.
Even more importantly, when the two standard arguments for euthanasia and PAS are examined, it is clear that each, if accepted as grounds for making an exception to the general prohibition of killing, would justify a much broader practice of medical killing than is usually sought by its advocates. The two arguments are typically used together as a single justification, but they are logically separate. If the justification is respect for patient autonomy, then a request from a competent person is all that is required, and the practices could not be limited to those who are terminally ill, or to those with physical illness, since emotional suffering is often worse than physical suffering. Even those who have no present symptoms at all but simply wish to avoid the indignity of aging or future illness could ask for euthanasia.
And if the justification is the obligation to relieve suffering, it would apply equally to incompetent as to competent patients, and would justify non-voluntary euthanasia. Even before the law has been changed in Australia to allow voluntary euthanasia (at the request of a competent patient), the argument is being made that dementia sufferers should be allowed to ‘die with dignity’, meaning that they be killed by lethal injection, not at their own request, but at the request of relatives who say that that is what they would have wanted.
Legalising euthanasia and PAS will send mixed messages about suicide prevention.
The euphemism ‘assisted dying’ aims to mask the fact that euthanasia and PAS are actually forms of suicide. It is incongruous that there are moves in Australia to legalise these practices at the 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 euthanasia and/or PAS were legalised, we would on the one hand be promoting suicide prevention, and on the other, promoting suicide as a legitimate choice. 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 rather than young, disabled rather than ‘normal’, or sick rather than healthy. To approve suicide for some but not others is inherently discriminatory, and indicates that some lives are considered of more value than others.