A Critical Choice, Euthanasia: Facts and Myths
15-16 September 1995
No one doubts the good will and compassion of those who favour euthanasia in certain circumstances. Yet it is often claimed that those who oppose it, including Christians and especially Catholics, have a hard and inhuman morality in this area, that they determined to impose these unfeeling views upon everyone else, and that they are therefore properly disqualified from expressing a view on such an issue. In recent times a number of ‘experts’, politicians and media moguls have sought not only to silence the Christian voice and disenfranchise Catholic citizens in this area, but they have also all too commonly misrepresented the classical, including Christian, position on end of life decisions.So we should be absolutely clear about what it is we really do say: any claims to the contrary notwithstanding, Christians support the right of the terminally ill and others to refuse overly-burdensome treatments. We also favour provision of best of palliative care, even when this risks shortening patient’s life, as long as killing is not why we use the drug. What we do not support is the adoption of intentional killing as healthcare. To do so runs contrary not only to the Christian, Jewish and Muslim religions, but also to the common morality of the great civilisations and many secular philosophies, to the great common law tradition, to international law, and to the best traditions of medicine as expressed in all the codes of medical and nursing ethics for the last several thousand years to today. For the fact is: killing cures no one, is not therapy, not medicine, not nursing care.
What is euthanasia? Euthanasia is the direct killing of a person so as to relieve suffering. We can do this either by action—doing something such as overdosing or poisoning a patient so as to bring about death—or by omission—failing to give appropriate care, failing to do something we would otherwise have done for patient we did not wish dead. There is, of course, no moral difference between euthanasia by act and euthanasia by omission: it is only a matter of strategy; the intention in both situations is to hasten the patient’s death. This is always a harm to the victim, to the killer and to the common good. It runs quite contrary to the sanctity of life ethic which has been the cornerstone of ethics, medical practice and law in our civilisation.
Why then did the Northern Territory parliament become the first democratic government to have legalised this practice in modern times? Why are several other legislatures in our country now contemplating doing the same?
It seems to me that there are essentially two arguments for euthanasia: that it is the kindest thing to do for some people (the argument from compassion) and that it is the respectful thing to do (the argument from autonomy), and I will seek to address these two arguments in the remainder of my paper.
Is euthanasia really the compassionate way to deal with terminal or chronic illness?
Most people regard killing someone simply for advantage or convenience of others as obviously immoral. The hard cases are where a patient keeps asking to be killed, or is in excruciating pain, or is very dependent, or is a great strain on the financial and personal resources of others, or is living in a state of permanent unconsciousness. Then we may well sympathise with the person who feels drawn, even driven, to killing; for their motive is very possibly a kindly one; they believe that killing in this hard situation is the only ‘merciful’ or ‘compassionate’ response. The question is: are they right?
If compassion for the suffering person is our real concern, we would expect that addressing their suffering head on would be our first response. We must ensure that terminally ill, handicapped and frail elderly people are given access to high quality healthcare, to adequate relief of pain and other distressing symptoms, and to a range of non-medical social and human supports which are necessary if people are to maintain hope, meaning, a sense of being loved; at the very least we must ensure that people are kept free of pain, which palliative care specialists insist can almost always be done. We therefore call upon our leaders to guarantee the provision of high quality therapeutic, palliative and hospice care, as well as assistance to allow people to be cared for at home and in the community. We need to look for creative responses to illness, disability and dying, and be very loathe to embrace destructive ones, such as discrimination, abandonment and homicide
Yet strangely in the Northern Territory euthanasia was enacted before anything was done about providing adequate care for the terminally ill: it is still practically impossible to get effective palliative or hospice care in that state…which leaves one wondering about the bona fides of those who argue that compassion is what drove them to support euthanasia. Mr Marshall Perron, the author of the medical homicide legislation, when asked about the failure of the Northern Territory government to provide adequate care for the dying in that state, said that it what too expensive and that some people would want euthanasia anyway. I will return to “the some people who would want it anyway” argument; but at this point we might ponder the power of the economic imperative in the current debate, with even our Governor-General arguing for euthanasia as a cost-cutting measure in an ageing society. I would argue that in a society as affluent as ours we can afford and should provide high quality care for our sick and elderly people, and that we ought not to resort to the strategy of cutting costs by killing the expensive any more than we should resort to ‘curing’ misery by killing the miserable. We should kill pain not patients.
A mature and authentic compassion does not seek ‘quick fixes’ where there are none. Rather it entails standing by the sides of those who suffer and investing our time, our energy, ourselves in them, sharing in their suffering, offering the best care we can, and helping them to recover hope, meaning, self-respect, and a sense of being loved and respected. For we will be judged by history and our God by this simple standard: when I was sick, lonely and shut-in, did you help me? For whatever you did or neglected to do for these desperate ones, you did for me.
Is euthanasia really an expression of personal autonomy?
Having failed to demonstrate that genuine compassion supports the call for euthanasia, some of its proponents argue that respect for personal autonomy requires that people be allowed to decide when and how they want to live and die. As one major capital daily which has taken up the cause of promoting euthanasia headed its editorial: Whose life is it anyway?
Freedom or autonomy are never absolute: any reasonable and loving person will only choose within the confines of what is morally responsible and serves well the good of the person, of others, and of the community as a whole. Autonomy, properly understood, is not whimsy, but rather an opportunity to do the good; with freedom comes responsibility; no liberty is absolute.
Yet some people assert that autonomy includes a ‘right to die’, i.e. right to kill oneself, a right to seek and expect assistance from others in achieving that end, and a ‘right’ to have others choose one’s death when one is no longer competent but one would or should have wanted to die in the circumstances. We should be quite clear about this matter: no such right has ever been recognized by the common morality—secular and religious—of our civilisation which I referred to earlier, nor by our common law tradition or any of the international human rights instruments to which Australia is a party, or by codes of medical ethics of last few thousand years. Euthanasia has in fact been rejected by every Australian medical and nursing association and by government inquiries such as those of the House of Lords, the Victorian and South Australian parliaments, the New York State Task Force, and most recently, the Canadian senate. The supposed ‘right’ to euthanasia is an invention, and a very recent invention at that.
The right to refuse treatment, on the other hand, has long been recognized by our law and ethics. People ought not to be kept alive but at a very low ebb at all costs by all sorts of machines and interventions and against their will, and recent legislation has re-emphasised this point. But this is very different matter to legalizing direct killing of patients by acts or calculated abandonment.
Terminally ill, handicapped and frail elderly people have the same worth and dignity as everyone else and deserve equal protection of our laws. But legalised euthanasia sends out a clear message that such people are expendable. Any culture which adopts this message is likely soon further to reduce the opportunities and self-esteem of the sick, elderly and dying, to undermine the trust between patient and healthworkers, and puts tremendous pressures upon both patients and health professionals to seek and engage in euthanasia. In the name of ‘autonomy’ such people’s real freedom would be narrowed further and their very lives—the premise for all autonomy—put at risk.
Doctors and societies which have practised euthanasia in a few ‘hard’ cases have gradually extended it from voluntary to non-voluntary, from the terminally ill to the physically sick, from the sick to the depressed and lonely, from competent adults to the unconscious and children, from being a course of last resort to an increasingly common course for many patients. The evidence from ancient societies to modern ones such as Holland is conclusive: the practice of euthanasia is profoundly corrupting and ultimately uncontrollable
This concern not to undermine the high ethical standards, socially-essential taboos and caring ethos of our healthcare professions raises an even more fundamental question: why do we bother to care for people who are persistently unconscious, or who are profoundly intellectually handicapped, who have Alzheimer’s disease or AIDS dementia? why do we care for the elderly and the dying? For some might hold out some hope of recovery or improvement; but many we know will not. Why do we care for them?
We do so because by supporting them we affirm that their life, their persons, still matter and matter very much: they are the image of God. We do so because we thereby conform with our basic duty of respect for every human life and person however wounded or handicapped. We do so because we thereby express our love and respect for that particular person, we maintain our human solidarity or communion with them. This is a kind of respecting and loving which no one should pretend is easy: but it can call forth from us all that is most noble in the human spirit.
For all the polemics about ‘mercy’ killing and ‘dignified’ death we can forget that dignity is not recognised by telling the old, infirm or terminally ill through our laws how ‘undignified’ we think their condition is, or how we think they would be better off dead, or how willing we are to hurry their deaths along. Love is not expressed by adding killing to the series of rejections already heaped upon many of the sick and dying by our community. Dignity in old age, handicap, unconsciousness, and suffering are above all a matter of knowing you are respected and loved: surely we can find more creative ways of demonstrating love and respect than by killing.
Australian Catholic University, Melbourne