EUTHANASIA - Refuting the rhetoric

ROBERT PANKRATZ, M.D.

On the issue of euthanasia, we frequently tend to be arguing the same questions and the arguments are all well laid out in the literature.  The pro euthanasia world view sees people as autonomous (self-ruling) biological entities, whose life's purpose is pleasure, and whose end is complete extinction. This logically results in viewing life as utilitarian, ie. valuable only for what it offers, and seeing no value in suffering.

According to this perspective, a life should not be continued unless it is a wanted life. Suffering is seen as an unmitigated negative; thus there are some lives not worth living.

Although the presuppositions at the basis of the debate are clear, a logical, non-emotional approach helps to maintain an open dialogue with those promoting legalized euthanasia. Following is a series of arguments and counter arguments that are helpful when discussing this issue.

1. Medical technology is now prolonging life beyond reason, resulting in increased suffering, so euthanasia is necessary to prevent unnecessary suffering.

In reality medical technology is very limited in its ability to prolong life. In those cases where life may be prolonged, physicians and family are already allowing the withdrawal of treatment in appropriate circumstances. This is good medical practice. Technology may give us the option of more time on earth, but this is not the cause of the suffering.

2. Legalized euthanasia is needed to ensure the control of an individual over the circumstances of his death.

Since the "syringe is in the hand of a physician" it is actually the doctor who is the final arbiter of death in circumstances where euthanasia is practiced. This is seen in the Netherlands where in 1990 there was estimated to be at least 1000 instances of euthanasia carried out on patients without their consent. 250 of these individuals were at least partially able to discuss this course of action (but were not given the opportunity).

3. Euthanasia is necessary to prevent the undermining of our dignity by disability or suffering.

What the proponents of euthanasia really mean by the term dignity is independence and modesty. This is a synonym for self esteem which depends on one's personal belief system and circumstances so is therefore highly variable. Someone's hatred of dependence cannot constitute adequate justification for ending their life. Illness or handicap does not reduce true dignity nor does the availability of euthanasia confer dignity upon ones existence. True "death with dignity" occurs without euthanasia in palliative or hospice setting, where treating a person with respect and tenderness is the key to helping someone retain their sense of dignity.

4. Not shortening the suffering in a terminal person is an act of cruelty, not compassion .

Compassion means literally "to suffer alongside", which could hardly mean eliminating the sufferer. As expressed by a prominent ethicist "compassion is a virtue not a principle. Morally weighty as it is compassion can become maleficent unless it is constrained by principle". True compassion provides companionship and encourages the sufferer to endure and seek meaning (a purpose for life) in their anguish.

5. Euthanasia is necessary to prevent a very poor quality of life in some circumstances .

In the Netherlands a prominent reason for euthanasia without consent is "low quality of life". Since there are no objective criteria as to what this means, in the Netherlands euthanasia is being granted to people with psychiatric illness, handicapped newborns, and many people who are unable to express their own wishes. Outside observers tend to rate a person's quality of life lower than the person himself would. And our society is full of the "worried well" who may think in advance that they would not wish to live under certain circumstances, but change their mind when actually faced with difficult situations.

6. Euthanasia proponents feel that they should have unrestricted free choice over what they do with their own lives.

Truly free consent is virtually impossible in terminally ill individuals who are generally suffering from various degrees of depression and cognitive impairment. And the taking of ones own life has marked ramifications for the rest of society since an individual's choice affects the rest of society. In particular the availability of the option of euthanasia will mean that the infirm and vulnerable will feel pressure to take that option, especially if they feel they are a burden to others.

Further, autonomy is not the dominant legal value in Canada. The Law Reform Commission states "The personal rights and freedoms listed in our constitution are never absolute. There are always qualifications and limitations to allow for the protection of other competing interests in a democratic society.

Finally, the Netherlands experience shows us that individual autonomy is not always increased by the availability of euthanasia. In 1990, 6300 of 9000 requests for euthanasia were refused and if one includes mercy killing brought about by intentional overdoses of narcotics given to palliative patients, the majority the persons who received euthanasia did not request it.

7. Safeguards could be set up that would limit euthanasia to competent, terminally ill individuals who are suffering unbearably and have no other options.

The fact is that once euthanasia is available as it is in the Netherlands, it is extended to non-terminal and non-competent persons, and people who simply claim to be suffering. Under current Canadian law what is a right for one person becomes a right for all and it can not be restricted to a subgroup of people (just as abortion became unrestricted after an initial period of restriction).

The recent New York State Task Force on Life and the Law, rejected the legalization of euthanasia stating "the number of people genuinely harmed by laws prohibiting euthanasia or assisted suicide is extremely small...Legalizing euthanasia or assisted suicide for the sake of these few, whatever safeguards are written into the law, would endanger the lives of a far larger group of individuals who might avail themselves of these options as a result of depression, coercion or untreated pain."

8. Unless euthanasia is available people will suffer undue pain.

Pain itself is never an adequate justification for ending a patient's life since pain can be eliminated in almost all cases and reduced to bearable in the remainder. Even in the Netherlands, where "hospice care is in its infancy", pain alone is the reason for physician assisted death in only 5% of cases.

9. Euthanasia is really no different than what already occurs because doctors are already shortening life with palliative care and withdrawal of treatment.

Natural death that occurs with the withdrawal of treatment is the opposite of euthanasia. Allowing someone to die and actually killing them are two vastly different things. Palliative care tends not to hasten death S in fact it probably prolongs life in most cases. In those rare circumstances where life may be shortened, it may be that the relief of pain allows people to let go of life that they were hanging on to. This is ethically permissible as long as the intent is to relieve pain, not to kill the patient.

10. Suicide is already legal so why not legalize assisted suicide?

Suicide has never been criminalized in Canada because a completed suicide leaves no one to prosecute.

Attempted suicide was decriminalized in 1972 in Canada because incarceration only increases the risk of suicide and suicide is caused in 95% of cases by reversible mental illness. Society has never seen suicide as a right or even as a good. Justice Sopinka in the Rodriguez decision said "suicide remains an act which is fundamentally contrary to human nature". The solution to attempted suicide is a medical one not a legal one. Assisted suicide involves the promotion of suicide by another party, and to legalize this would be to encourage suicide at a societal level.

11. Senseless suffering is to be avoided at all costs.

Suffering is universal in human experience and therefore we must seek the meaning of suffering. Often the terminal phase of an illness is a time of remarkable personal growth and interpersonal relationship building. Reconciliations happen and our affairs can be tidied up. The proper treatment of a dependent individual by the family or by society results in the growth of the ability to nurture, which is necessary to our society.

12. Legalized euthanasia would protect patients from cruel medical treatment.

The patient would not be protected by legalized euthanasia. Rather, the physician or other agent would be protected from prosecution. In fact, personal control would be reduced, and the vulnerable of society would lose their protection. Since physicians are the ones who fill in the death certificates, they are virtually immune from prosecution S the only other witness would already be dead.

13. Physicians could be entrusted with euthanasia; they are the most ethical professionals.

Generally physicians are poorly trained in ethics and have difficulty sorting out issues of consent, competence, and quality of life. As well, doctors are notoriously poor at diagnosing the presence or absence of depression.

The foregoing arguments, which are not comprehensive, coupled with the warmth of true humane love towards suffering individuals should help to slow the arrival of euthanasia in Canada. Retaining the law as it is protects Canada from having violence done to something that is infinitely valuable to society S the lives of its members. Those who are well informed can play a powerful role in preventing the corruption that this pervasive ideology could have in our society.