Against the right to die
The repercussions of introducing euthanasia could drastically affect the value of life in our society, writes Fionnán Long
Dignity is not found at the bottom of a glass of pentobarbital, only death. Human dignity is a constant that one holds by virtue of being human. Since the discovery of Auschwitz and the firebombing of Dresden, this is the standard of moral reasoning that western civilization has aspired to hold itself to.
The philosophers that framed post-war constitutions and treaties concerning human rights understood the horrors that happen when the life of a person is treated as a means rather than as an end. The dignity of life should never be conditional on anything, not even one’s own consent.
It does not matter if a person is bedridden, in a state of Alzheimer-induced infancy, or does not even recognise their own dignity. Their life still has an intrinsic inalienable value. Recognising a right to die erodes that value.
It may seem that when a person chooses euthanasia they are making a private decision that only matters to them. The problem is that there are wider consequences to this individual act. When a person chooses to end their own life they are communicating to others in similar circumstances that their life is not worth living.
Over time social discourse will be shaped by this belief. Through it is one individual’s decision, many more will eventually feel compelled to no longer be a burden. Public understanding of any issue is merely a construct of the circumstances of the time.
If a right to die is recognised, society’s understanding of death and the process of dying will change. There will eventually come a point where society will come to regard suicide as normal. People don’t exercise free will so much as conform to social expectations. Japan, which has a long established culture of suicide, has a disproportionate level of suicide per capita.
While it may be possible to introduce an obligatory psychiatric assessment as a precondition to the provision of euthanasia, a psychiatrist can only make a decision on the basis of what they are told. An individual may not be honest about factors influencing their mind or even be aware of those factors.
Healthcare is a scarce resource. It will always be true that euthanasia will be the less draining alternative to palliative care. As attitudes to death change patients who receive socialised palliative care may be pressured to euthanize themselves. Even if a person is never directly pressured, people will believe they have a duty to die to allow others to receive healthcare.
Palliative care, seen as wasteful, could be withdrawn from welfare programmes. Insurance providers will seek to avoid the cost of paying for palliative care when an alternative is available. This situation that encourages some to end their own lives is unconscionable. Legalising euthanasia will disproportionately affect people from lower socioeconomic backgrounds. They will be unable to pay for palliative care.
In the Flanders region of Belgium, a study published by the British Medical Journal found that 47% of cases of euthanasia were not reported. A study published by the Canadian Medical Association Journal found 32% of cases of euthanasia in Flanders were done without explicit consent. These examples show that there is room for abuse, even within a well-established system.
There is a danger in allowing death to become a commodity. Dignitas is an assisted suicide organisation that allows foreigners to take advantage of Swiss suicide law. The organisation purports to be non-profit, but in spite of this, Dignitas does not publically disclose its accounts.
The founder of the organisation, Ludwig Minelli has become a millionaire since Dignitas began in 1998 according to an investigation by the Swiss magazine, the Beobachter.
Former employee Soraya Wernli, though still a right to die activist, has alleged that psychiatric evaluations performed by the organisation are minimal. She claims clients have arrived in the morning and are dead by the afternoon. She alleges client’s possessions have been sold by Dignitas.
In 2010 Swiss police recovered 300 urns from Lake Zurich believed contain the remains of Dignitas clients. The pursuit of profit leads to a race to the bottom. Organisations like Dignitas will become powerful lobby groups.
The process of dying is one of the most profound experiences of life. It is through being a helpless burden on loved ones that both the dying and their family realise the love that holds them together. It is through cognitive regress that one understands the transience of human experience.
The dependency that the prideful see as an indignity underlines the interconnected nature of human existence. This is the heart of the process of dying. It is a process of growth that suicides never experience. Though they have the courage to face death they fear the process of dying. They never learn the lessons dying has to teach.
The idea of dying as entailing physical suffering is out of date. Modern palliative care in Ireland is effective and free. The HSE even provides treatment in the patient’s own home.
It is true that sometimes opiates may shorten the patient’s life expectancy. The curtailment of life expectancy is presently an unfortunate possibility. It is disingenuous to argue that this is the ethical equivalent of euthanasia.
When ethically evaluating such an action, it must be understood that the intention is not to euthanise, but rather to alleviate suffering while respecting the value of human life. The difference is that one action is done with the intention to stop the patient’s pain while the other is done for the sole reason of ending a life.
Under the status quo people can refuse lifesaving treatment and are passively euthanised. The argument set out above is, based on human rights reasoning, holds that this ought not to happen. What happens or does not happen under the status quo is no basis for any ethical argument.
While individual cases may feel compelling, what is at stake is too important to concede a right to die.
For the right to die
Arguing the pro-euthanasia aspect of the debate, Robert Dunne discusses the ramifications of legalising such actions
Euthanasia is illegal in the UK and Ireland. In the UK, if one helps a person to go abroad in order to receive euthanasia, they are criminally liable for assisting the suicide of that person.
Recently, physicist Stephen Hawking said that he believed in the right to die, saying that “I think those who have a terminal illness and are in great pain should have the right to choose to end their lives and those that help them should be free from prosecution.”
His reasons for believing in the right to die were to prevent suffering. “We don’t let animals suffer, so why humans?” Hawking argued, admitting that there needed to be restrictions.
“There must be safeguards that the person concerned genuinely wants to end their life and they are not being pressurized into it or have it done without their knowledge or consent, as would have been the case with me.” He said.
The issue of euthanasia is controversial, because it entails giving people the right to commit suicide, which is considered a social taboo and a sin by most religious institutions. Many Supreme Court judges and government ministers worldwide have refused to grant euthanasia requests for this reason, or because they have internalised the belief that euthanasia should not be allowed under any circumstances.
However, this issue is simply not black and white. People who suffer from degenerative diseases such as Parkinson’s, multiple sclerosis and muscular dystrophy will, over time, lose their ability to manage in daily life without a helper. While the law would permit them to commit suicide, they are physically incapable of doing so.
Eventually the disease will render them unable to move or enjoy life, before they die. They do not want to endure the agony that will come before their natural death, they don’t want to be remembered by their relatives as sickly and weak in their final moments, and although healthcare should be free, they don’t want to leave their families with expensive medical bills.
In a situation such as this, where we can be in full knowledge that the patient is going to die soon, there is definitely a moral argument to be made that the patient should have the right to choose death if that is their wish. At this stage of an illness the dichotomy of life or death no longer applies, rather the choice is between extended suffering, and ending suffering.
Our medical system allows patients to take strong painkillers that may kill them. It allows patients to refuse life-saving treatment. We do not prevent people from stopping medical treatment for a relative in a persistent vegetative state, but our system does not allow them to exercise autonomy to alleviate their suffering.
The two most important medical oaths, the Hippocratic Oath and the Declaration of Geneva, stress the importance of preserving life, but when that life is no longer viable, and the person is going to die anyway, we are hurting the patient.
There is also a belief that if we legalise euthanasia it will lower the value of human life. This is based on a logical fallacy, namely that of the slippery slope. It fails to take into account the reasons for introducing consensual euthanasia, which is to act in their best wishes and with the consent of the patient.
If one is seeking euthanasia due to family or financial pressure, then we should strive towards a society in which this doesn’t have to be the case or introduce welfare schemes to help people affected by our welfare system. Arguing otherwise entails saying that many different types of medical treatment should be denied simply because they are not financially viable.
In order to prevent a situation in which patients are being euthanised against their wishes, consent must be the paramount issue. Euthanasia cannot just be the decision of the doctor. Before allowing someone to die, there are many factors that need to be taken into account.
The capacity of the patient to give consent should be considered, as should any pressure from other sources to undergo the procedure. We would have to create a robust system of laws, drawing on what works in countries that already allow euthanasia. These laws include undergoing psychological assessment, getting permission from two different doctors, and talking patients through their options.
This would be the only way to prevent people who may be suffering from mental problems such as depression or degenerative mental conditions from seeking euthanasia for the wrong reasons. Where the patient no longer has the required mental capacity, they are no longer capable of making the decision. A committee could also prevent a patient from trying to receive euthanasia due to familial pressure, as mentioned previously.
Before we as a society can even begin to legislate for euthanasia, we must first recognise that we can no longer decide to deny people the right to die for reasons that are completely irrational. Arguments from religious authorities that resort to basic logical fallacies must be rejected.
If euthanasia were to be implemented it would have to take place within the public healthcare system. Euthanasia within the private healthcare system would be subject to abuse as the entire business model is designed with the main aim of making profit as opposed to helping patients.
Private healthcare is not appropriate for administrating euthanasia, or any medical procedure for that matter. A dignified death is difficult to define, as dignity is a subjective term. What may be regarded as a dignified death should be up to the individual to decide.
While for some dying may be virtuous and widen that person’s experience of life, we should not fetishise the process of dying and the suffering that comes with it. To many people, complete mental and physical decay, spending months in pain, and being remembered as sickly is not a dignified death, and it is not for us to force them to ‘learn the lessons’ of dying.