This is the first of three articles on the dangers surrounding the legalisation of euthanasia.  

The Covid-19 virus pandemic is a threat to our physical and mental health and wellbeing, as both individuals and societies.

The euthanasia “virus” pandemic is, likewise, a threat to our physical and mental health and wellbeing, as both individuals and societies. Most seriously, it is a threat to our “human spirit”, the intangible, invisible, immeasurable reality that all of us need to find meaning in life and to make life worth living.

In other words, the “human spirit” is that deeply intuitive sense of relatedness or connectedness to all life, especially other people, to nature, the world, the universe and the cosmos in which we live. It gives us access to the metaphysical reality we need to experience to flourish and to live fully human lives. The “human spirit” does not require a belief in the supernatural. Everyone has and needs to be in contact with their “human spirit”, whether or not they are religious, as I have argued in my book The Ethical Imagination.

Like the Covid-19 virus, euthanasia seems to be contagious, at least in postmodern, Western democracies. (Note: I use the word euthanasia to include medically assisted suicide.) Jurisdiction after jurisdiction has considered or is considering its legalization, although some have expressly rejected it, at least so far, most notably, the United Kingdom and France. From one perspective, this spread is not surprising, because we know that suicide is contagious. In fact, general suicide rates – that is, exclusive of euthanasia – have risen in most and possibly all jurisdictions, which have legalised euthanasia.

As well, there is a well-established pattern, as we have seen in Australia, of pro-euthanasia advocates returning to legislatures and courts, time after time, until they achieve their initial goal of the legalization of euthanasia. Subsequently, as can be seen in the Netherlands, Belgium and, most recently, Canada, pro-euthanasia advocates persistently seek reduction or even abolition of the requirements for its availability, that is, the initial safeguards, and expansion of the people who may have access to it.

In order to stem the euthanasia pandemic, those of us who view this as a history making disaster and human tragedy must understand how it has arisen and where it is going. To do that we need to ask and seek answers to a multitude of questions. I can only very briefly mention a few of them here. I have spent over four decades researching and writing on them and still have many to address and new ones constantly emerge. We can think of this research as searching for an “anti-euthanasia vaccine”.

Before I do that, however, I want to emphasize that the people on both sides of the euthanasia debate are well intentioned and believe they are fighting for the greater good, it is just that we do not agree on what that is.

None of us on either side wants to see people suffer and the euthanasia debate is not about if we will die – we all will at some point. The debate is about how we will die and whether some ways of dying, namely euthanasia, are unethical and dangerous, especially to vulnerable and fragile people, and destructive of important shared values on which we base our societies.

I propose that, as with research to help us to deal with the Covid-19 pandemic, we need to take a “questioning approach” to understanding the euthanasia pandemic. This means we should start our exploration of it by asking the many questions, which could provide us with insights that will lead to understanding why this pandemic has erupted and, thereby, how we might best deal with it. In the following text, I identify some of those questions.

Why has the pro-euthanasia case been so successful and the anti-euthanasia case so unsuccessful?

People have always become ill, suffered and died and, for millennia, our laws have expressly and clearly prohibited killing them, especially having doctors, who promise in their Hippocratic Oath “to cure where possible, care always and never to intentionally kill”, doing so. So why now, when there is so much more we can do to relieve pain and suffering, is euthanasia thought to be necessary and a good idea?

There is a perfect storm of causes functioning at all the levels of decision-making from that of individuals in relation to their own experience of suffering, to that of governments formulating health policy and social and public policy.

The case for legalizing euthanasia is easy to make in contemporary post-modern Western democracies, especially those in which moral relativism and utilitarianism are the main philosophies informing the dominant worldview of a society.

Moral relativism takes a stance that nothing is absolutely or inherently wrong, rather what is right or wrong all depends on the circumstances and the individual person’s preferences. Utilitarianism in the context of euthanasia proposes that euthanasia is a means that has an outcome or end goal of reducing or eliminating suffering and, therefore, can be justified and is ethical.

The discussion and analysis of the impact of legalizing euthanasia is limited to only the present time – I call this restriction “presentism” – and its impact on the individual person who seeks it. What we could learn from our “collective human memory” (the past or history) and through employing our “collective human imagination” (the likely future outcomes of legalizing euthanasia) are ignored or rejected as irrelevant or invalid considerations.

In postmodern societies, so-called “progressive values” have become ubiquitous. These values favour legalizing euthanasia and dominate the more traditional or conservative values, which oppose that. The progressive values advocates’ mantra is, “control, choice, change”.

Control. In the context of euthanasia, control translates to taking control of death. We cannot avoid death, but euthanasia allows a person to get it, before it gets them. This eliminates uncertainty about the time, place and manner of death. It is psychologically difficult to live with uncertainty about outcomes that we dread, including because we do not know which psychological coping mechanisms we need to employ to deal with the fear we experience in anticipating those outcomes.

Taking control is what social psychologists call a “terror-reduction” or “terror management” device. Intense fear of death can be linked to a fear of mystery, the latter of which evokes profound free-floating anxiety. People who experience this can deal with their fear and anxiety by converting the mystery to a problem and seeking a technological solution to the problem. The mystery of death becomes the problem of death and the technological solution is a lethal injection – euthanasia.

Choice. Euthanasia is justified by its advocates claiming a right to choose to end one’s life, an overriding right to individual autonomy. “Intense or radical individualism” means the right to self-determination is given priority over any other considerations, such as what protecting the “common good” requires or the risks and harm to vulnerable people, such as fragile elderly people or those with disabilities. These harms include that euthanasia sends a message to them that they have “lives not worth living”.

Change. To have control and be able to choose death, the law must be changed to permit euthanasia. Advocates have a naïve view that change is always for the better.

The pro-euthanasia case is promoted and buttressed by stories of “bad” natural deaths – those where great suffering is experienced – and “good” euthanasia deaths – those where suffering is promptly and completely eradicated through the intentional extinguishing of life, itself, by using euthanasia. The media, which overall has a bias towards legalizing euthanasia, are especially prone to presenting euthanasia as a topic for discussion in the public square in this manner. That is their reporting focuses on an individual suffering person and only takes into account the immediate impact in the present of providing that person with euthanasia.

The complex case against euthanasia

The case against euthanasia is much more difficult to promote, not because it is weak – it is not – but because it is much more complex.

To convince people, who do not believe that euthanasia is inherently wrong, to reject it, requires looking, not just to the present, but also to our “collective human memory” for lessons from the past and to our “collective human imagination” to try to anticipate the full, wider and long-term consequences of legalizing euthanasia.

Many non-Indigenous Australians, especially younger ones, are increasingly recognising how fortunate they are to have the over 60,000-year old Aboriginal culture, the world’s oldest continuous culture, from which to learn about seeking wisdom by looking to the past and to the future and not just the immediate present. Likewise, as Indigenous Australians also teach, we must consider both individuals and the “mob”, the “common good. Nowhere is this more important than in relation to decisions about legalizing euthanasia.

Politician and Aboriginal Elder Senator Patrick Dodson has made an outstanding contribution in this regard. His speech to the Australian Commonwealth Parliament opposing repeal of the law that prohibited euthanasia in the Northern Territory will sound down future generations. Likewise, the scholarship of retired Catholic priest and archaeologist Eugene Stockton is a unique contribution. It helps us to understand the role that Aboriginal spirituality could play in enriching our ethical consciousness in 21st Century Australia.

In short, while the individual person and their wishes and respect for their right to autonomy are always important considerations, they are not alone sufficient considerations, if we are to make wise decisions as a society with respect to the legalization of euthanasia or, if legalized, its governance. That requires, for example, taking into account the immediate and long-term, wider ramifications of  authorizing physicians, and in some cases nurses, to end the life of another person through administering lethal medications with a primary intention to cause death.

These ramifications include the effects on healthcare professionals and the healthcare professions; on the institutions in which they practice, such as hospitals and aged care homes; on society and the shared values on which it is based and which create the glue, which bonds us as a community; and even on our global reality. There is a dearth of literature in these regards. A 2020 book, Euthanasia: Searching for the Full Story: Experiences and Insights of Belgian Doctors and Nurses, recounting stories from frontline healthcare professionals in Belgium where euthanasia has been normalized as a way to die, makes an important contribution to starting to fill these lacunae.

Of particular concern in relation to the wider impact of legalizing euthanasia is the possibility of its being “thrust on” or “seeping into” the lives of fragile and vulnerable people – those who are poor, uneducated, or least vocal. For example, doctors in Belgium have admitted to euthanizing people in a coma on a ventilator, without any family present to defend their best interests. We cannot afford to trivialize or underestimate the dangers of the abuse of legalized euthanasia, especially in relation to vulnerable and fragile people. 

The Australian Law Reform Commission in its research and report on Elder Abuse (2017) found and emphasized this danger. It concluded that between 4 and 14 percent of elderly people are abused, most often by a close relative. The Commission was concerned in particular about “early inheritance syndrome”, where a person, usually a child of the elderly person, obtains a power of attorney and uses the financial assets of their parent for themselves. Many people worry about the cost of residential care for their elderly relatives and presumptive heirs see “their” inheritance, to which they feel entitled, dissipating. Imagine adding euthanasia, “early death syndrome”, to “early inheritance syndrome” – it would certainly be a lethal cocktail.

We must also keep in mind that in a secular society, such as Australia, law and medicine carry the value of respect for life for society as a whole. Euthanasia destroys their capacity to do that because the law is changed to allow intentionally taking life and medicine implements that permission in practice. If euthanasia is legal, it should be kept out of medicine and a new profession created to undertake it. Euthanasia is not medical treatment and it should have no role in palliative care. Indeed, the philosophical bases of palliative care – to live as well as possible until we die a natural death – and euthanasia – to choose death, rather than life – are in direct conflict.

It is also essential to recognize that the value of respect for life must be upheld at two levels: for the life of each individual person and for human life, in general, in society. Euthanasia damages respect for life at both these levels.

In Part 2, Professor Somerville sets out the facts about euthanasia

© 2021 Margaret Somerville

Margaret Somerville AM, DSG, FRSC, FRSN, DCL is Professor of Bioethics at the University of Notre Dame Australia School of Medicine (Sydney campus). She is also Samuel Gale Professor of Law Emerita, Professor...