Euthanasia is back on the agenda in Canada. The first hour of debate on a “euthanasia bill”, Bill C-384, has already taken place in Parliament and a second hour is scheduled for November 16. As a “private member’s bill”, it is limited to two hours of debate and is expected to go to a second reading vote on November 18. If passed, it would be referred to committee for detailed discussion.
There has been an increasing mobilization of opposition to this bill which, if enacted, would allow euthanasia and physician-assisted suicide. This opposition ranges from the Canadian Medical Association distributing a letter opposing the bill to members of Parliament, to Steve Passmore, a person with a disability, protesting it on Parliament Hill during the debate. His message is that Bill C-384 threatens his life and the life of people with disabilities.
So, why now are we considering legalizing euthanasia (a term I use here to include assisted suicide) when we have prohibited it for millennia?
Not one of the bottom-line conditions usually linked with calls for legalizing euthanasia – that a person is terminally ill, wants to die and we can kill them – is new. These factors have been part of the human condition for as long as humans have existed. And our capacity to relieve pain and suffering has improved remarkably. So, is some other cause the main one?
I suggest it’s profound changes in our post-modern, secular, Western, democratic societies, and their interactive and cumulative effects. To make wise decisions about whether or not to legalize euthanasia, we need to identify and understand these changes in relation to euthanasia.
Individualism: “Intense individualism” (sometimes called “selfish individualism”), which needs to be distinguished from “healthy individualism”, dominates our society. This entails giving pre-eminence to rights to personal autonomy and self-determination, which favour acceptance of euthanasia.
“Intense individualism” also tends to exclude developing any real sense of community, even in connection with death and bereavement, where that sense is an essential need and coping mechanism for most people. Almost all the justifications for legalising euthanasia focus primarily on the dying person who wants it. Its harmful impact on society and its values and institutions are ignored.
In our society, death is largely a medical event that takes place in a hospital or other institution and is perceived as occurring in great isolation. It’s been institutionalised, depersonalised, and dehumanized. Asking for euthanasia can be a response to the “intense pre-mortem loneliness” of the dying person that results.
Mass media: Today we create our collective story – the store of values, attitudes, beliefs, commitments, and myths – that informs our collective life and through that our individual lives and helps to give them meaning, through mass media and the internet.
Failure to take into account societal and cultural level issues related to euthanasia is connected with “mediatisation” of the debate. We consider only the issues presented by the mass media – and those only as presented by them. It makes dramatic, personally and emotionally gripping television to feature Sue Rodriguez, an articulate, courageous, 42-year-old, divorced woman, dying of amyotrophic lateral sclerosis, begging to have euthanasia made available.
The arguments against euthanasia based on the harm that it would do to society, both present and future, are very much more difficult to present. Viewers do not personally identify with these arguments that come across as just abstractions. Society cannot be interviewed on television and become a familiar, empathy-evoking figure to the viewing public.
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.
Denial and control of death, and “death talk”: Ours is a death-denying, death-obsessed society. Those who no longer adhere to the practice of institutionalised religion have lost their main forum for engaging in “death talk” – whether church, synagogue, mosque or temple. We need to engage in that “talk” if we are to accommodate the inevitable reality of death into the living of our lives. And we must do that if we are to live fully and well.
Our extensive discussion of euthanasia in the mass media may be our contemporary “death talk.” So, instead of being confined to an identifiable location and an hour or so a week, “death talk” has spilled out into our lives in general. This makes maintaining the denial of death more difficult, because it makes the fear of death more present and “real.” One way to deal with this fear is to believe we have death under control. The availability of euthanasia could support that belief. Euthanasia moves us from chance to choice concerning death. Although we cannot make death optional, we can create an illusion that it is, by making its timing and the conditions and ways in which it occurs a matter of choice.
Fear: We can be frightened not only as individuals, but also as a society. For instance, collectively, we express the fear of crime in our streets. But that fear, though factually based, might also be a manifestation of a powerful and free-floating fear of death, in general. Calling for the legalisation of euthanasia could be a way of symbolically taming and civilising death, thus reducing our fear of its random infliction through crime, that is, it functions as a “terror reduction” mechanism or “terror management” device.
Legalism: We tend to use law as a response to fear, often in the misguided belief that this will increase our control of that which frightens us and hence augment our safety. It is not surprising, therefore, that we have to varying degrees become a legalistic society. The reasons are complex and include the use of law as a means of ordering and governing a “society of strangers”, as compared with one of “intimates”.
Matters such as euthanasia, which would once have been the topic of moral or religious discourse, are now explored in courts and legislatures – especially through concepts of individual human rights, civil rights, and constitutional rights.
Man-made law (legal positivism), as compared with divinely ordained law or natural law, has a very dominant role in establishing the values and symbols of a secular society. In the euthanasia debate, it does so through the judgements and legislation that result from the “death talk” that takes place in “secular cathedrals” – legislatures and courts.
Materialism and consumerism: Another factor favouring euthanasia is that our society is highly materialistic and consumerist. It has lost any sense of the sacred, even just of the “secular sacred”. That favours a pro-euthanasia position, because a loss of the sacred fosters the idea that worn-out people may be equated with worn-out products; both can then be seen primarily as “disposal” problems. As one Australian politician put it: “When you are past your best-before or use-by date, you should be disposed of as quickly, cheaply and efficiently as possible”. Euthanasia implements that approach.
Mystery: We are frightened of mystery, because we don’t feel we have control when faced with mysteries. We convert mysteries into problems in order “to deal” with them and reduce our anxiety in doing so. If we convert the mystery of death into the problem of death, euthanasia (or, even more basically, a lethal injection) can be seen as a solution to that problem.
A sense of mystery might be required also to “preserve room for hope.” Hopelessness – nothing to look forward to – is strongly associated with a desire for euthanasia.
Rejection of any sense of mystery often correlates with a belief that reason (logical, cognitive, rational mentation) is the only valid way of human knowing, and a rejection of other ways, such as intuition, especially moral intuition, examined emotions, experiential knowledge and so on. Such an approach favours euthanasia – it can make logical sense, even though humans have a deep moral intuition against killing each other and we have thousands of years of history (human memory as a way of knowing) in all kinds of societies that it is wrong to do so, except where it is unavoidable to save human life.
What it means to be human: At the heart of many of the current debates on ethics, including in relation to euthanasia, is the issue of whether humans deserve “special respect” as compared with animals or robots, which links to whether we have absolute obligations to protect and preserve the essence of out humanness.
I believe we deserve “special respect” simply because we are human. But some people don’t agree that there’s anything intrinsically special about being human. For instance, Princeton “animal rights” philosopher Peter Singer, would not differentiate animals from humans in the kind of respect they are owed. So, if we see it as acceptable to euthanase our suffering dog or cat, likewise, we should be able to offer euthanasia to humans.
Impact of scientific advances: Among the most important causes of our loss of a sense of the sacred, in general, and regarding human life, in particular, is our extraordinary scientific progress and the mistaken view that science and religion are antithetical. New genetic discoveries and new reproductive technologies have given us a sense that we understand the origin and nature of human life and that, because we can, we may manipulate – or even “create” – life. Transferring these sentiments to the other end of life would support the view that euthanasia is acceptable.
Competing world views: Though immensely important in itself, the debate over euthanasia might be a surrogate for yet another, even deeper, one. Which of two irreconcilable world views will form the basis of our societal and cultural paradigm?
According to one world view, we are highly complex, biological machines, whose most valuable features are our rational, logical, cognitive functions. This world view is in itself a mechanistic approach to human life. Its proponents support euthanasia, as being, in appropriate circumstances, a logical and rational response to problems at the end of life.
The other world view (which for some people is expressed through religion, but can be, and possibly is for most people, held independently of religion, at least in a traditional or institutional sense) is that human life consists of more than its biological component, wondrous as that is. It involves a mystery – at least the “mystery of the unknown” – of which we have a sense through intuitions, especially moral ones. It sees death as part of the mystery of life, which means that to respect life, we must respect death. Although we might be under no obligation to prolong the lives of dying people, we do have an obligation not to shorten their lives deliberately.
The euthanasia debate is a momentous one. It involves issues that range from the nature and meaning of human life to the most fundamental principles on which societies are based. This debate involves our individual and collective past (the ethical, legal, and cultural norms that have been handed down to us as members of families, groups, and societies); the present (whether we will change those norms); and the future (the impact that this would have on those who come after us).
In debating euthanasia we need to ask many questions, but three of the most important are: Would legalisation be most likely to help us or hinder us in our search for meaning in our individual and collective lives? How do we want our grandchildren and great grandchildren to die? And, in relation to human death, what memes (fundamental units of cultural information that are inherited by being passed from generation to generation) do we want to pass on?
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.