Before society responds affirmatively to the call for legalized euthanasia, we will need to provide the public with a more full and open explanation of the case against it. The recent Quebec National Assembly committee report Dying with Dignity fails to do that.
Like the previous report of the expert panel of the Royal Society of Canada on this same subject, the Quebec report is not balanced and reads rather like a pro-euthanasia manifesto. The fact that it strongly recommends palliative care does not negate that characterization. The Quebec report takes a purely utilitarian approach to the euthanasia question. In the committee’s estimation, legalizing euthanasia will do more good than harm — and that justifies allowing it.
It upholds respect for individuals’ rights to autonomy and self-determination as the overriding value, citing, among other examples, the current approach to abortion as showing this value predominates in contemporary Quebec society.
The committee concludes that legalizing euthanasia will not harm the value of respect for life, because euthanasia will only be used in exceptional circumstances and there will be very few cases. And in any case, “La valeur du caractère sacré de la vie a subi une transformation notable” (“The value of the sanctity of life has undergone a significant transformation”) relative to other values, which means that now respect for life itself doesn’t necessarily take priority.
The committee argues that allowing euthanasia is merely an incremental change — we all agree with palliative care and, it says, “aide medicale a mourir” (euthanasia) needs to be seen as just another “palliative-care option.”
How should we respond to these arguments?
First, many people who oppose legalizing euthanasia do so because they believe it’s inherently wrong to kill another person, except when that is the only way in which to protect innocent human life. Euthanasia does not fall within this exception and, therefore, for them, can never be ethically justified.
The clash of values involved in the euthanasia debate is between, on the one hand, respect for life, both individual human life and human life in general; and, on the other hand, individuals’ rights to autonomy and self-determination. People who reject euthanasia give priority to respect for life; people who support euthanasia give priority to autonomy and self-determination.
“Respect for life” must be upheld at two levels: respect for each individual human life and respect for human life, in general. The latter requirement is the reason that the consent of an individual to being euthanized is not sufficient to avoid damaging the value of respect for life. Authorizing doctors to kill their patients necessarily contravenes respect for human life, in general.
And, even if the committee’s reassurance that cases of euthanasia will be exceptional and, therefore, not damage the value of respect for life, indeed, even if there were only one case, legalizing euthanasia still involves crossing the line established by the fundamental rule that we must not intentionally kill each other.
In short, it would unavoidably harm the value of respect for life, which means that legalizing euthanasia involves a radical change in our society’s values.
Pro-euthanasia advocates often argue that seeing life as “sacred” is a religious value and, because of that, should not be taken into account in the public square. Whatever one’s views are in that regard, respect for life is not just a religious value; it’s a foundational value of all societies in which reasonable people would want to live.
Concern about the consequences of legalizing euthanasia raises the question of whether a utilitarian case against euthanasia can be made. Exploring that question shows that the utilitarian case for euthanasia is not nearly as strong as the committee argues it is. Many seriously harmful consequences from legalizing euthanasia could far outweigh any benefits it might have.
Apart from its harmful impact on the societal value of respect for life, it would harm the institutions of law and medicine, and the healthcare professions. Can we even imagine teaching medical students how to kill their patients?
The committee recognizes the serious danger of the abuse of euthanasia must be taken into account and proposes safeguards. However, contrary to what the committee states, experience with euthanasia in the Netherlands and Belgium is not strongly reassuring that such safeguards are effective.
The committee adopts the strategy used by advocates of legalizing euthanasia of confusing it with interventions that are not euthanasia and are ethically and legally acceptable. For instance, it tells us that in accepting, as we do in some cases, the withdrawal of life-support treatment to allow a person to die, we are already practicing euthanasia; therefore, legalizing euthanasia is just a small step forward. These are false and misleading analogies and a false and misleading line of argument. There is a radical difference between killing a person and allowing them to die of natural causes.
In proposing to replace the word euthanasia with the term “aide médicale à mourir,” the committee introduces a euphemism that both trivializes and is likely to conceal the moral and ethical issues. Terminology matters because our emotional responses and moral intuitions play an important role in helping us to decide what is ethical and what is not and the language we use affects these responses: compare “physician assisted death” with “doctors killing their patients”.
If we are to have a discussion about euthanasia, it must be an unbiased one. It’s hard for me to conclude from its report that the National Assembly committee undertook such an unbiased reflection, especially in view of the fact that two-thirds of the submissions it received argued against legalizing euthanasia.
Margaret Somerville is the founding director of the Centre for Medicine, Ethics and Law at McGill University.