I went to a talk on “end of life choices”. I didn’t realise that Victoria was considering legalising euthanasia in August. I understand now why a friend of mine was harassed by the media when his mother helped her friend kill himself, and then killed herself as part of a suicide pact – it’s a tricky subject. Especially because death is on the line, so there’s no take-backsies. It was the first time I had ever been yelled at by a protester before.
The debate was between two bioethicists: Professor Peter Singer (Princeton University) and Professor Margaret Somerville (University of Notre Dame, Sydney and formerly McGill University, Montreal). I’ll admit that the fact that it was run by the University of Divinity and the Centre for Research in Religion and Social Policy and held at a church made me think it was probably going to be incredibly one-sided, but I actually found that it was a very open discussion and found myself seeing both sides of the argument. I left my notebook at home, so I wasn’t able to capture notes as quickly as I’d have liked, and ended up missing some of the discussion, but I believe they said they were streaming it, so it might be available online somewhere.
Professor Singer spoke first, representing the pro-euthanasia side.
He started by discussing whether killing is wrong – it’s something that a lot of people inherently believe, but why? Are there circumstances upon which it isn’t wrong? Two reasons why it is considered wrong: it’s a violation of a person’s autonomy (they did not choose to die), and it deprives a person of their life, taking away all the good things that they might have had.
When you look at euthanasia from that point, it manages to address both of those aspects. The person being euthanised is choosing the death. They have presumably weighed up the pros and cons, and chosen this particular outcome, for whatever reasons they may have. One thing to consider is that the person may change their mind in the future, so the requirements to qualify for euthanasia usually involve repeated requests – it’s not something that you can just walk into a clinic and get done on the same day. It usually also requires a psychiatric assessment, to ensure that you are in the right frame of mind to be making this decision.
As to the second point, depriving people of the rest of their life is quite sad, especially when it is looked at as a loss of potential. This is why it’s usually seen as more of a tragedy for a young child to die in an accident than an elderly person. But what if the person is likely to suffer for the rest of their life, and so the future potential doesn’t outweigh the future pain?
He raised the point that it’s not just the poor people who can’t afford medical treatment, or the uneducated that desire euthanasia. In the United States, there are quite a lot of people with health insurance, and university degrees who choose to apply. (I’m not entirely sure of the relevance of that point – I may have just missed the context while typing out my earlier notes.)
One of the biggest arguments against euthanasia is that it’s a slippery slope – it starts out as being about allowing people to choose to die to reduce suffering. How long before it becomes about getting rid of “undesirables”? His argument against this was that in the areas where euthanasia has been legalised (USA, Canada, some countries in Europe), they have shown no signs of it heading in that direction. (Inconclusive argument, in my opinion. It’s hard to say how long you have to wait before you start to see the effects – plus, if it was starting to happen, I imagine it would be under the radar at first.) Plus, there would be great public outcry before it would happen. (Again, questionable.)
In fact, what’s the difference between euthanasia and deciding to pull the plug on life support? Or choosing to withhold treatment as it’s not worth it? These are things that doctors and other people do all the time.
His last point was that in the end, it is a choice, and people should be allowed to make that choice if they want to. Some people may just want to say goodbye while they’re still sane.
Next, Professor Somerville spoke for the other side.
Some consider euthanasia medical treatment, but it’s not. Medicine should be about caring, not killing.
Euthanasia is not just about the person being euthanised, it has a ripple effect on the people around them, too. 20% of Dutch doctors who carry out euthanasia were found to suffer from post-traumatic stress disorder. Families who attend euthanasia sessions also can become traumatised.
The same arguments that justify euthanasia are the same slippery slope arguments. Even if it’s legalised, people will do it illegally. 32% of doctors in Belgium said that they didn’t follow the process to the letter of the law. (I’m not entirely sure what she was leading to with this argument, and it may just be my notes that are incorrect again.)
As a counterclaim to the slippery slope counterclaim, Dr. Boudewijn Chabot is considered the “Patron Saint of Euthanasia” and now he’s having second thoughts about it. He killed a mentally ill woman, was found guilty of it, but was given no punishment. He said that the law doesn’t protect against people who are mentally ill. How do you have a proper discussion with someone about trying to find out if they want to die if the person you’re talking to doesn’t fully understand what it means? Same applies to children.
There can also be a conflict of interest when euthanasia is introduced. Perhaps a child wants their inheritance early, or no longer wants the burden of caring for a family member. Elderly people are not just a drain on their family, they are also a drain on the government – taking up funding that could be spent elsewhere. It’s in the state’s best interest to have them pass early, rather than late. Or even in the case of health insurance – a lot of health insurance plans will not pay for life-extending drugs, but will cover assisted suicide. (Maybe I’m too much of a socialist, but in my opinion, if someone wants to die, and it will make things easier for the people around them (including the government), then I see this as a good thing. I do see how it can be an issue if you have governments pushing people to choose euthanasia when they don’t really need to.)
(I just wrote here “thanotologists”, but I don’t remember why.)
When it was first introduced in Quebec, they estimated that there would be 100 cases per year, but found that the number was actually around 400. (I’m not sure what that argument was for… they didn’t expect many people wanted to die? If anything, it is a point in the other side’s favour, as it shows a lot of people do want the ability to choose to die.) There was a woman who was killed, but she wasn’t suffering a life-threatening illness – it turned out that sh e just had a urinary infection. (If you want to find out more, check out a movie called End Credits).
Why is it that the only people who are allowed the right to death are people who are disabled or ill – is this reverse discrimination against able-bodied people? (Not sure how this point helps the argument.)
Does this really belong in the realm of medicine? Would people be so open to the idea of allowing euthanasia of it were performed by corporations instead? (This question actually made me think. When I think of euthanasia, I always imagine a lethal injection kind of situation, where you’re sitting in a hospital bed with a doctor and / or your family / friends. The idea of it being commercialised seems distasteful to me, but I think that’s more to do with the idea that it’ll just become a routine thing – like the suicide booths in Futurama, and I feel like the soon-to-be-departed deserves something a bit more respectful than that.)
You can’t block a slippery slope except by using a fixed obstacle – that’s why it should remain illegal.
With the wider decline of religion, suffering seems to have no value; which is why it’s so easy to give up once you’re suffering. Give people a “why” they should live (which can be done via religion, or perhaps other means), and they’ll find a “how”. There is a growing field called dignity therapy which tries to do this.
She quotes Jeff Kennett which was something about how if you are past your use-by date, you should be checked out as quickly and cheaply as possible. (Another distasteful statement, but…… a part of me agrees.)
There’s also the problem of complicity. Doctors who do not want to perform abortion are legally bound to refer a patient to someone who is. In a lot of cases, this can be see as complicit behaviour, and is quite troubling to people.
She also made a point about how people are more accepting of it if it’s called “doctor assisted killing” rather than “doctor assisted suicide”.
She reiterates: once you step over the line, you can’t go back.
Then it was open to questions from the MC and the audience.
Could we see doctors overriding a decision that’s in the patient’s best interests?
- Peter: this happens already, and the proposed change won’t affect that
- Margaret: It’s wrong to do medical things to people without their consent, whether it’s to give or withhold treatments
- Margaret: it’s about the difference between causing someone to die, and allowing them to die a natural death.
- Peter: but you are making a decision either way, so you are still playing a part in their death.
- Margaret: It’s a tough question. If they’ve lived 20 years in misery, and nothing has worked, should it be an option? Are you able to make a decision when you are in a state like that? What if there’s never a cure, or there is a cure one day? Hard to say without a crystal ball.
Is it inherently wrong to kill others, vs reducing the suffering of other people?
- Margaret: Euthanasia = dying with dignity. But what is dignity? You have intrinsic dignity, which is the fact that you have dignity just because you’re human. Then there’s extrinsic dignity, which means you only have dignity if you have certain characteristics.
- Peter: you don’t get dignity just by being human, rather it’s a matter of how we see ourselves, and we may lose that when we become helpless or passive, so it doesn’t seem wrong to allow someone to kill themselves if they want to preserve that.
How do you prevent someone from being euthanised against their will, especially if the government thinks it’s better for them to be euthanised?
- everyone should have a choice. If you want to do it, do it, if not, then don’t
- we don’t have private health insurance, which reduces the incentive for there to push euthanasia
- if the government would make a ruling that allows insurance companies / hospitals to say you either get euthanasia or we won’t treat you, there would be a huge public outcry