Dr. Miles Williams began a critique of current euthanasia laws by likening a good death to good medical treatment. The patient is acquainted with all the available options and once fully informed makes a decision about how best to proceed. But in my experience, it seldom works out like that. Many people when faced with life-threatening illness are incapable of weighing up the options. Instead they turn to their doctor and say something like: “Doc, you decide. Do what you think is best.” And the doctor working within certain well-attested guidelines does so.
Under present law, patients can be reassured that there is one option the doctor cannot take: namely, arranging their premature death. But if euthanasia is legalized, that will no longer be the case. Pro-euthanasia propaganda has succeeded in stirring up an unprecedented distrust of current approaches to suffering and dying – including palliative care – and pushing euthanasia as the 100% successful alternative. As a result there are many people out there scared that they or their nearest or dearest will be terminated before their time. And rightly so given that the power doctors have over life and death will be magnified in any new legislation. A doctor practicing euthanasia recently confessed that he was aware that the way he was feeling about life on any particular day influenced his advice to applicants. Not everyone would have that insight. Dr. Williams advocates utilizing euthanasia as a “needed counterbalance…between the good that modern therapy can provide and its failures”. It’s a drastic counterbalance that involves the destruction of the system it is supposedly supporting. No second chance on that see-saw!
“Assisted Dying” (AD) is the term Dr. Williams and others have chosen to represent what they believe in: euthanasia, or killing a patient who for the most part will not be dying at the time the poisonous drug is administered. Although chosen no doubt to make the process sound less threatening, “Assisted Dying” to my ear still carries with it a nuance of dying caused by the assist. This makes it tough for the euthanasia movement which is desperate to ‘sanitize’ its work by using the term to create a link to therapeutic measures that are not controversial. Assistance with dying is different. It’s what every good doctor seeks to do; encouraging and supporting patients until death comes naturally.
When a doctor claims to know “from experience” that “assisted dying will be of benefit to some” one wonders: “how so?” Are they already covertly using the illegal practice? What excesses might we expect from such doctors if the laws and ethical standards that have governed medical practice for centuries are discarded? What will replace them? And I wonder what “great benefit to society as a whole” Dr. Williams envisions AD bringing? Could he possibly be referring to economic benefits?
According to Dr Williams approximately 150 million people worldwide have access to this liberating system of dying. Panic! New Zealand is falling behind international trends! But he fails to acknowledge that the world’s population is close to 8 billion. Or that major countries such as England, Scotland and Ireland have recently rejected legalisation.
Some may be reassured that Dr. Williams has been unable to find any evidence of either abuse of vulnerable people or of the “slippery slope” phenomenon in jurisdictions where euthanasia is practiced. He’s in good company. The majority of experts return from tours of inspection of the BENELUX countries ecstatic at what they have been shown. Or perhaps because of what they have not been shown. Briefly, the “slippery slope” is shorthand for the ever-increasing number of conditions for which euthanasia is considered appropriate over time. Thus ever-younger children, psychiatric patients and even people with social problems get drawn into the net. Pro-euthanasiasts argue that if changes to indications are agreed by the authorities, you can’t characterise them as “slippery slope” phenomena. In my view it’s not the system that authorises or permits extensions that defines a “slope”, it’s the fact that broadening of the indications occurs for any reason.
Dr. Williams rightly has great respect for the UN Declaration of Human Rights 1948. “Its principles” he writes “give humanity the right to self-autonomy.”(sic) But he fails to acknowledge that it was formulated in response to the terrible things that the NAZIs did in Germany and its vassal states in the 1930s and 40s. That is why the Declaration focuses on the preservation of “life, liberty and the security of the person” not on a right to die. Moreover, the autonomy that it confers is not one grounded in unlimited self-interest. Article 29 places those rights and freedoms directly in the commonwealth of the community in which “everyone has duties “including “due recognition and respect for the rights and freedoms of others….” This is particularly germane to this debate because the rights that others must have respect for are those defined in Article 4: the right to life and liberty of the person; not any imagined “right to die.” Yet in Canada so skewed has the new ethic become that doctors refusing to participate in killing people on conscience grounds are being pressured to resign from government funded positions. This is hardly consistent with the theme running through the Declaration, namely that nobody may be coerced into an action against their will.
As an introduction to moving on to philosophical arguments for and against killing, Dr. Williams recommends that answering two questions will assist with the debate. They are:
- Are all the facts available to all parties so that the issue can be discussed philosophically?
His answer is “yes”. I agree. There is more than enough information available both philosophical and empirical to enable not just academic debate but enlightened debate in which philosophy is enlightened by empirical data. The problem is that few opinion leaders in Medicine and Ethics are prepared to study in depth the research data from jurisdictions where euthanasia is legal that indicate that all is not as well as it is said to be. The information is all out there, published in peer reviewed journals by the pioneers of euthanasia eager to convince the rest of us that it has a solid moral base.
So why is it that teams of investigators who visit jurisdictions where euthanasia is in use in order to be briefed on the pros and cons of practicing it, usually return having “seen no evil and heard no evil”? One reason is that having decided on philosophical grounds to recommend that euthanasia be legalised in their home country they have no desire to discover anything that would interfere with their utilitarian convictions about the greatest good for the greatest number. This effect was notable in the Royal Society of Canada and National Academy of Quebec inquiries. In addition it is likely that their hosts only demonstrate elements of their programmes that meet their ethical criteria.
Dr. Williams’ second question was: “are there conflicting ethical views giving rise to disagreement over what to do which might be amenable to “reasoning and analysis?” It could be answered “yes” if the reference is to the conflict of ideas that gave rise to the debate in the first place or “no” if the focus is on attempting to reach agreement on issues for which there appears to be no middle ground. Many erudite academics have attempted the feat. I don’t think we are going to achieve it in under 2000 words.
In the third section of his essay, Dr Williams seeks to make two points. The first is that while there are “strong ethical arguments against killing…….. these same arguments support, even more strongly the death of a rational human being who wishes to end their life.” The second is that if a doctor agrees with a patient that their life is no longer of sufficient quality to continue living, it is ethically acceptable to comply with a request for assisted dying. It is “acting in the patient’s best interests”. There is no definition of quality and nothing to encourage the patient to consider less drastic alternatives. He supports his thesis with four “major ethical arguments”. Each begins with an argument against killing people, followed by a counter argument in favour of doing so and an editorial comment.
- Since self-conscious beings are capable of fearing their own death, the killing of one of them has worse effect (sic) to those who live on.
Counter: This “doesn’t apply if a person has genuinely consented to be killed” because everyone is covered by the safety net called ‘consent’.
Comment. But are they? ‘Consent’ is a low standard for a request for euthanasia. The BENELUX countries require an ‘explicit request’ to begin the application process. Even so, thousands of people are killed each year by what they call LAWER (Life-ending Actions Without Explicit Request.) Most cases are performed by health staff and rigged to look like genuine ethical therapy. Most cases are not reported. It’s not ‘consent’ that gives potential victims comfort, it’s deception.
- 2. The thwarting of the victim’s desire to go on living is an important reason against killing them.
Counter. If one has no desire to continue living, then there is no thwarting of this desire. (Presumably he means that if one desires death, then being killed would not thwart that desire.)
Comment. It is not clear what this statement means. If it is concerned with the victim’s wellbeing the statement should surely have been:” Not thwarting the victim’s desire to go on living is an important reason against killing them”. In any case nothing in this statement supports the assertion that it more strongly supports death in response to a death – wish than it supports life in response to a life-wish. And we should not accept that the only choices are a problematic life or euthanasia. There are many more choices provided the doctor is prepared to put time and effort into providing decent care rather than surrendering to euthanasia. If the victim has no desire to live, the doctor ought to find out why.
3.To have a right one must have the ability to desire that Right. To have a right to life one must be able to desire one’s continued existence.
Counter. One can waive a right if one chooses so to do.
Comment. This dangerous hypothesis identifies three groups that have no Right to life: those who were never able to express that desire because of developmental brain disorders (e.g. Down syndrome), those who once were competent but are no longer e.g. post- stroke, and normal young babies. None of them understands that they have a Right let alone the right to waive it. Dr. Williams’ stance justifies euthanasia in a very large range of diseases and disabilities. It could justify a community hunting such as these down if it believed that that was in the community’s best interest. It has happened before. It is impossible to square this notion with the right to life and liberty propounded by the Declaration of Human Rights, which makes no exceptions.
- There must be respect for the autonomous decisions of rational beings (in this instance to continue living).
Counter: for those choosing to die, respect leads others to “assist them with their choice.”
Comment. This is a troublesome vision Dr. Williams is promoting. It’s a world that respects individuals so much that it will assist them to kill themselves even on a whim; but has no respect for its disabled citizens who it would rather be rid of. Euthanasia legislation is remarkably deficient in true compassion in that it amounts to a one-way algorithm for death. Do you get the connection? It’s Eugenics rearing its head again and we should be grateful for Dr. Williams’ insights as to what is in store for us under that regime.
Dr David Richmond is a retired professor of Geriatric Medicine and Medical Education at the University of Auckland. He was chair of the inaugural Research Ethics Committee in the Auckland Hospital and helped to set up teaching in Ethics in the undergraduate Medical course. He is also a member of the MRC Research Ethics Committee.