People who espouse “progressive values”, who include those advocating for the legalization of euthanasia, adopt a mantra of “choice, change and control”.
Choice maximizes respect for individual autonomy which is the preeminent value for “progressivists”. Choice also allows change to be implemented and “progressivists”, often naïvely, simply assume that change is always for the better. And power to change can give one a power to control or at least an illusion that one is in control.
Why only an illusion? There are some things that we cannot control, or indeed change, no matter how much we might like to be able to do so. Death is one of them.
It’s an innate human characteristic to search for meaning and we do that whether or not we are religious. The questions the vast majority of us ask, “Who am I? Why am I here?”, manifest and articulate our search for meaning. Many of us recognize that there is a mystery at the centre of our responses to those questions, which are asked most powerfully in seeking meaning in relation to death. Consequently, death involves a mystery which we must accommodate. We can do that in various ways.
Euthanasia seeks to take control over death. It does so by converting the mystery of death to the problem of death and offering a technological solution to that problem, namely a lethal injection. In doing so, it destroys the mystery of death and, thereby, the possibility of finding meaning in the presence of death.
I want to make clear that I am not promoting religion here, although that is one way, and until the post-modern era the most common way, to find meaning, especially in death.
Rather, I am proposing that all of us need to be able to find meaning, if we are not to become nihilists and lead lives of despair. Today, many people do that by devoting themselves to a worthy cause that benefits others, including future generations, but that doesn’t help them to find meaning in death.
One of the serious harms of legalizing euthanasia is the intangible one of serious damage to our capacity to find meaning in death, which might be a requirement for finding meaning in life, in general. This might be caused, at least in part, by euthanasia’s impact of trivializing death.
We hear many stories of “bad deaths” told in support of legalizing euthanasia. Our hearts rightly go out to the people involved and recognize that their motives of relief of suffering are good. But if we do not want to set in motion a much wider range of harms that legalizing euthanasia unavoidably causes, I propose that we must kill the pain and suffering, not the person with the pain and suffering.
This makes it imperative that fully adequate palliative care, including pain management, be readily available to all who need it.
We should also balance the stories of “bad deaths” with those of “good deaths” – or perhaps it’s better phrased as deaths from which otherwise unavailable “goods” flow, not only to the dying person, but also to many others. These include conversations that would never have taken place, reconciliations with family and long-lost friends, and joys such as holding a first grandchild. French psychoanalyst Marie de Hennezel, who has cared for many dying people, including President Francois Mitterand, describes this time and its possibilities as “intimate death”.
When we are dying, the vast majority of us also want to be remembered, to leave a legacy of our presence on this planet, and as Canadian psychiatrist Dr. Harvey Max Chochinov and his co-researchers have shown, we can help people to do this through a structured psychotherapeutic intervention which they call “dignity therapy”. This is an alternative to seeing euthanasia as necessary to respect a dying person’s dignity, a frequent justification of legalizing euthanasia.
Social psychologists propose that not just individuals but also societies have a psyche and that both can experience terror. When we have a strong free-floating fear of something, for example, death, we seek to take control of it to reduce our fear and anxiety. The social psychologists speak of responding with “terror management devices” or “terror reduction mechanisms”.
I believe euthanasia can be seen as such a device or mechanism for managing the fear of death. We can’t avoid death, but euthanasia allows those who seek it to get death before it gets them.
As individuals and a society we hide death away by euphemising the word. It is almost “politically unacceptable” to use death, died or dead in relation to a person’s “passing”. We hide from our fears, which hinders our own preparation for death. We could also see euthanasia as limiting the capacity of a dying person to help to prepare others for a “good death” by showing them what used to be called “ars moriendi” (The Art of Dying).
Our conversation about whether it’s a good or bad idea to legalize euthanasia needs to be much broader and deeper than it is at present. It’s not sufficient just to focus on an individual suffering person who wants death inflicted, much as we ought to have the most sincere compassion for them and ensure that everything possible, other than killing them, is done to relieve their suffering.
Euthanasia raises profound issues about how we find meaning in life; its impact on law and medicine, the two institutions in a secular society which carry the value of respect for life for society as a whole; and its impact on one of our foundational values as a society, namely, that we must never intentionally kill another human being, except to save human life.
Such considerations and many more must be taken into account in our decision making about legalizing euthanasia, if we are to act wisely and ethically. At present, the debate is very superficial and narrow and reduces one of the most solemn moments of life to a mere contractual undertaking.
Legalizing euthanasia would be a seismic shift in Australia’s foundational societal value of respect for human life. It is different-in-kind not just different-in-degree from medical interventions we currently regard as ethical and legal. It is not, as pro-euthanasia adherents argue, just another small step along a path we’ve already taken in respecting refusals of treatment even if that results in death and requiring full pain management to be offered to patients.
Euthanasia rebrands killing as kindness, which is very dangerous. In deciding whether to legalize euthanasia we should keep in mind the axiom that “nowhere are human rights more threatened than when we act purporting to do only good”, as that sole focus on doing good blinds us to the unavoidable risks and harms also present.
Margaret Somerville is Professor of Bioethics in the School of Medicine at the University of Notre Dame Australia. Until recently, she was Samuel Gale Professor of Law, Professor in the Faculty of Medicine, and Founding Director of the Centre for Medicine, Ethics and Law at McGill University, Montreal. Her most recent book is Bird on an Ethics Wire: Battles about Values in the Culture Wars.