There is a trend in western democracies these days of increasing activism to legalize euthanasia and physician-assisted suicide. In Canada we have seen a private member's bill (C-562) introduced in April by Bloc Québécois MP Francine Lalonde, which would amend the Criminal Code to allow a physician to "aid a person to die with dignity". So, understanding the arguments both for and against these interventions is of crucial importance. But that is not easy to accomplish, if my own experience holds true more generally.
I teach a course, "Ethics, Law, Science and Society," to upper year and graduate law students at McGill and, at the end of last semester, the topic was euthanasia.
I've researched euthanasia, physician-assisted suicide, the ethics and law of palliative care and pain relief treatment, decision-making at the end of life, and related topics, for nearly three decades and published a 433-page book, Death Talk: The case against euthanasia and physician-assisted suicide.
Yet, I came away from the class feeling that I had completely failed to communicate to most of my students what the problems with euthanasia were, that I was hitting a steel wall. This was not due to any ill-will on their part; rather, they seemed not to see euthanasia as raising major problems — at least any beyond preventing its abuse — a reaction I found very worrying.
The one student who tried to express a contrary view, although normally very articulate, ended up by saying, "Well, it's what I believe and I guess my background has something to do with that."
So I emailed my students explaining I felt "that I had not done a good job in presenting the euthanasia debate … [and] decided to see if I could work out why not by writing about it." I attached an early draft of this article and asked for comments; I received several, very thoughtful replies.
My concern went beyond failing to convince my students that there was, at the least, a strong case to be made against euthanasia. It included the fear that their response was likely to be true also for the wider society. The difficulty of communicating the case against euthanasia and the ease of communicating the case for it, is a serious danger, especially if, as seems likely, we are headed into another debate about whether we should legalize euthanasia in Canada.
Individual rights v. social harm
Why is the case against euthanasia so hard to establish?
When personal and societal values were consistent, widely shared and based on shared religion, the case against euthanasia was simple: God commanded, "Thou shalt not kill." In a secular society based on intense individualism, the case for euthanasia is simple: Individuals have the right to choose the manner, time and place of their death. In contrast, in such societies the case against euthanasia is complex. It requires arguing that harm to the community trumps individual rights or preferences.
One student explained that she thought I was giving far too much weight to concerns about how legalizing euthanasia would harm the community and our shared values, especially that of respect for life, and too little to individuals' rights to autonomy and self-determination, and to euthanasia as a way to relieve people's suffering. She emphasized that individuals' rights have been given priority in contemporary society, and they should also prevail in relation to death. Moreover, legalizing euthanasia was consistent with other changes in society, such as respect for women and access to abortion, she said.
To respond to such arguments, we need to be able to embed euthanasia in a moral context without resorting to religion — that is, formulate a response that adequately communicates the case against euthanasia from a secular perspective. That requires, first, countering the belief that individual rights should always prevail — a task I failed at in class.
We must show, as well, there are solid secular arguments against euthanasia, for example, that legalizing euthanasia would harm the very important shared societal value of respect for life, and change the basic norm that we must not kill one another. It would also harm the two main institutions — law and medicine — that paradoxically are more important in a secular society than in a religious one for upholding the value of respect for life. And, it would harm people's trust in medicine and make them fearful of seeking treatment.
The meaning of death
So, why has this issue has arisen now? There is nothing new about people becoming terminally ill, suffering, wanting to die, and our being able to kill them. Why now, after we have prohibited euthanasia for millennia, are we debating whether to legalize it?
Although the euthanasia debate usually centres on a dying, identified person, who wants euthanasia, I believe the answer to what has precipitated the debate lies in understanding a complex interaction of certain unprecedented changes in society. Identifying these factors can also help us to see what is needed to make the case against euthanasia clearer and stronger.
Dying alone or unloved seems to be a universal human fear. In democratic western societies many people have a sense of loss of family and community: relationships between intimates have been converted into relationships between strangers. That loss has had a major impact on the circumstances in which we die. Death has been professionalized, technologized, depersonalized and dehumanized. Facing those realities makes euthanasia seem an attractive option and easier to introduce. Euthanasia can be seen as a response to "intense pre-mortem loneliness".
We engage in "death talk" in order to accommodate the inevitable reality of death into the living of our lives. That talk helps us to live reasonably comfortably with that knowledge, which we must do if we are still to be able to find meaning in life.
"Death talk" (and other morals and values talk) used to take place in religion and its churches, synagogues, mosques and temples and was confined to an hour or so a week. Today, it has spilled out into our daily lives, especially through media. The euthanasia debate is one example of such talk.
Moreover, "secular cathedrals" — our parliaments and courts — have replaced our religious ones. That has resulted in societal ethical and moral debates being cast in a legal framework. It is not surprising, therefore, that the euthanasia debate centres on its legalization.
The mass media also have major impact on such debates. The media focus on individual cases: people such as Sue Rodriguez — an ALS sufferer who took her fight to die to the Supreme Court of Canada — pleading for euthanasia make dramatic, personally and emotionally gripping television.
The arguments against euthanasia, based on the harm that it would do to individuals and society in both the present and the future, are very much more difficult to present visually.
Moreover, the vast exposure to death that we are subjected to in both current affairs and entertainment programs might have overwhelmed our sensitivity to the awesomeness of death and, likewise, of inflicting it.
The problem of suffering
But, one of my students responded, "If anything, I think many of our reactions come not from an overexposure to death, but from an aversion to suffering, and an unwillingness or hesitancy to prolong pain."
Finding convincing responses to the relief-of-suffering argument used to justify euthanasia is difficult in secular societies. In the past, we used religion to give value and meaning to suffering. But, now, suffering is often seen as the greatest evil and of no value, which leads to euthanasia being seen as an appropriate response.
Some answers to the "suffering argument" might include that:
* even apart from religious belief, it's wrong to kill another human;
* euthanasia would necessarily cause loss of respect for human life;
* it would open up an inevitable slippery slope and set a precedent that would present serious dangers to future generations. Just as our actions could destroy their physical environment, likewise, we could destroy their moral environment. Both environments must be held on trust for them;
* recognizing death as an acceptable way to relieve suffering could influence people contemplating suicide.
Might the strongest argument against euthanasia, however, relate not to death but to life? That is, the argument that normalizing it would destroy a sense of the unfathomable mystery of life and seriously damage our human spirit, especially our capacity to find meaning in life.
Margaret Somerville is director of the Centre for Medicine, Ethics and Law at McGill University, and author of The Ethical Imagination: Journeys of the Human Spirit.