At any given time in the developed world there is likely to be a parliament somewhere debating euthanasia. Two weeks ago the British House of Lords, at the end of a passionate debate, voted by 148 to 100 to delay a bill permitting euthanasia that had passed through the Commons. In Canada at least three such bills have found their way into parliament in the last few years and another attempt is anticipated. In this article a Canadian ethicist reminds us of the reasons that these attempts have largely failed so far.
The two major reasons against euthanasia and assisted suicide are, first, that it is wrong for one human to intentionally kill another, except in self-defence. And, second, that the harms and risks of legalizing euthanasia and assisted suicide far outweigh any benefits. (I use the word euthanasia to include assisted suicide.)
When our values were based on a shared religion, the case against euthanasia was simple: God’s command was "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. But, in such societies the case against euthanasia is complex.
The case for euthanasia is easily made by focusing on heart-wrenching individual cases of very difficult deaths that make dramatic and compelling television footage. The case against euthanasia is much more difficult to present because it depends on harm to some of our most important societal values, to the important institutions of medicine and law, and to present and future generations and societies.
Euthanasia is intentionally killing another person to relieve their suffering. It is not the withdrawal or withholding of treatment that results in death, or the administration of necessary pain- and symptom-relief treatment that might shorten life, if that is the only effective treatment.
Social values at stake
Euthanasia is not, as euthanasia advocates argue, just another option at the end of a continuum of good palliative care treatment. It is different in kind from them. To legalize euthanasia would damage important societal values and symbols that uphold respect for human life. If euthanasia is involved, how we die cannot be just a private matter of self-determination and personal beliefs, because it involves other persons and society’s approval of their actions. It overturns the prohibition on intentional killing, which the British House of Lords called "the cornerstone of law and human relationships, emphasizing our basic equality."
Medicine and the law are the principal institutions involved in legalizing euthanasia. In a secular, pluralistic society they are responsible for maintaining the value of and respect for human life. Euthanasia would seriously damage their capacity to do so. Paradoxically, their responsibility is much more important in a secular society than a religious one, because they are the "only game in town."
To legalize euthanasia would fundamentally change the way we understand ourselves, human life and its meaning. We create our values and find meaning in life by buying into a "shared story" — a societal-cultural paradigm. Humans have always focused that story on the two great events of every person’s life, birth and death. In a secular society — even more than in a religious one — that story must encompass and protect the "human spirit." By the human spirit, I do not mean anything religious. Rather, I mean the intangible, invisible, immeasurable reality that we need to find meaning in life and to make life worth living — that deeply intuitive sense of relatedness or connectedness to all life, especially other people, the world, and the universe in which we live.
There are two views of human life and, as a consequence, of death. One is that we are simply "gene machines." In the words of an Australian politician, when we are past our "best before" or "use by" date, we should be checked out as quickly, cheaply and efficiently as possible. That view favours euthanasia. The other view sees a mystery in human death, because it sees a mystery in human life, a view that does not require any belief in the supernatural.
Euthanasia converts the mystery of death to the problem of death, to which we then seek a technological solution. A lethal injection is a very efficient, fast solution to the problem of death — but it is antithetical to the mystery of death. People in post-modern societies are uncomfortable with mystery, especially mysteries that generate intense, free-floating anxiety and fear, as death does.
Just a ‘little bit’ of killing?
Yet another objection to legalizing euthanasia is that abuse cannot be prevented, as recent reports from the Netherlands show. And they show that once euthanasia is legalized, its availability expands. Originally, euthanasia was only available to dying adults with unrelievable suffering who were competent to give informed consent and repeatedly requested euthanasia. Very recently the Groningen protocol has extended its availability to include disabled newborn babies.
To assess the impact that legalizing euthanasia might have, in practice, on society, we must look at it in the context in which it would operate: The combination of an aging population, scarce health-care resources, and euthanasia would, indeed, be a lethal one.
Euthanasia advocates often argue, in support of legalizing it, that physicians are secretly carrying it out anyway. But, even if that were true, it does not mean that it is right. Further, if physicians were currently ignoring the law against murder, why would they obey laws governing euthanasia? Physicians’ absolute repugnance to killing people is necessary to maintaining people’s and society’s trust in them. This is true, in part, because physicians have opportunities to kill that are not open to other people. Experience in both the Netherlands and Australia (euthanasia was briefly legalized in Australia’s Northern Territory in 1997) show that people stay away from doctors and hospitals because of fear of euthanasia. A serious public health problem arose in Australia’s aboriginal community because parents refused to have their children immunized.
And how would legalizing euthanasia affect medical and nursing education? What impact would physician role models carrying out euthanasia have on students and young health-care professionals? Would we devote time to teaching students how to administer death through lethal injection? (In the Netherlands a patient who was administered euthanasia but did not die, sued his doctor for medical malpractice.) It would be very difficult to communicate a repugnance to killing in a context of legalized euthanasia.
Health-care professionals need a clear line that powerfully proves to them, their patients, and society that they do not inflict death; both their patients and the public need to know with absolute certainty — and be able to trust — that this is the case. Anything that would blur the line, damage that trust, or make them less sensitive to their primary obligations to protect life is unacceptable. Legalizing euthanasia would do all of these things.
Euthanasia is a simplistic and dangerous response to the complex reality of human death. Physician-assisted suicide and euthanasia involve taking people who are at their weakest and most vulnerable, who fear loss of control or isolation and abandonment — who are in a state of intense "pre-mortem loneliness" — and placing them in a situation where they believe their only alternative is to be killed or kill themselves.
How a society treats its weakest, its most in need, its most vulnerable members tests its moral and ethical tone. To set a present and future moral tone that protects individuals in general and society, upholds the fundamental value of respect for life, and promotes rather than destroys our capacities and opportunities to search for meaning in life, we must reject euthanasia.
Margaret A. Somerville is the Samuel Gale Professor of Law, and a professor in the faculty of medicine, McGill University Centre for Medicine. She is also the author of Death Talk: The Case Against Euthansia and Physician-Assisted Suicide, published by McGill-Queen’s University Press, Montreal, 2002