Understanding the terms of the euthanasia debate

Understanding the terms of the euthanasia debate

Peter Coghlan

Following the successful passage of the Northern Territory Euthanasia Act, there has been supportive comment from Victoria's Premier Mr Kennett and approval of a Private Member's Euthanasia Bill by N.S.W. Premier, Mr Carr. It seems inevitable that pressures for Australia-wide legalised euthanasia will continue to mount.

Peter Coghlan, Senior Lecturer in Philosophy at the Australian Catholic University (Christ Campus), examines the terms of the debate which tend to be overlooked by proponents of euthanasia.

The private member's bill to legalise voluntary euthanasia, which was passed by the Northern Territory Parliament late in May 1995, and the recent public declaration by seven Victorian doctors that they had deliberately administered lethal injections to terminally ill and suffering patients at the latters' request have sparked widespread public debate. I want to examine briefly here the major terms in which that debate has thus far been conducted.

One key strand in the pro-euthanasia argument is the appeal to the civil liberties of the terminally ill and suffering who wish to die and the liberties of those doctors who are willing to help them end their lives (the liberal view). It is commonly argued that since individuals in our society are legally free to commit suicide, it is absurd that some terminally ill and suffering patients who want to die are prevented from carrying out their wish because they are physically incapable of killing themselves. A proper respect for the civil liberties of such patients would involve granting willing doctors the legal right to assist them in putting their considered and settled wish into effect. How can it be wrong for doctors to help patients do what they are legally entitled to do?

One immediate problem with this view is that it denies some patients who would otherwise be thought of as deserving of a doctor's help the 'right' to seek that help. For example, a patient in the final stages of AIDS may decide to end his life before dementia sets in; and even though he is capable of taking his own life, he may prefer a doctor to administer a lethal injection so as to ensure that his death is peaceful, swift and certain. And there might be many patients with terminal illnesses who would be in a similar position: in pain or distress, wanting a doctor's help to end their lives, but still physically able to self-administer a lethal injection or swallow a lethal dose of some drug. According to the current civil liberties argument, these patients would be denied the 'right' to an assisted suicide.

On the other hand, there are some individuals who suffer terrible disabilities and wish to die but who are not terminally ill. Some quadraplegics, for instance, who are paralysed from the neck down can see no point in going on but are physically incapable of killing themselves. Yet these individuals are not terminally ill. The current civil liberties argument appears to deny this group, too, the 'right' to a doctor's help to end their lives.

More generally, it is not clear how the civil liberties argument can avoid the extension of the 'right' to assistance in committing suicide to anyone who wishes to die for whatever reason. Given that it is lawful for any adult to commit suicide, it cannot be wrong - on the civil liberties view - for a doctor to help any competent adult end his or her life when seriously requested to do so. (The requests of children and those who are deranged would not count here.)

But where such individuals can kill themselves, the civil libertarian may reply, there is no need for doctors to become involved. However, there may well be many able-bodied potential suicides who want the skilled services of a doctor for the same reason that the terminally ill AIDS patient wants the doctor's help - to ensure a peaceful, swift, and certain death. On what grounds can the civil libertarian deny the would-be suicides this kind of assistance?

Civil libertarian

But now this means that the civil libertarian is committed to legalising voluntary euthanasia, not just for the terminally ill who are suffering, but for those who seriously wish to die because, say, they are suffering from a curable but distressing medical condition, or from loneliness, or from a failed love affair, or from feelings (justified or not) of shame or guilt or worthlessness, or from feelings of anger or despair, or from world-weariness, or from boredom - or from a thousand other conditions or states of mind that can lead individuals to want to die.

Perhaps there are some extreme libertarians who would countenance a general 'right' to assisted suicide of this kind for all sane adults. But there would be a rare few; and the reason for this is that, while we may recognise a right to suicide, we do not in fact believe that all suicides are morally justified. We understand that there are times when individuals can fail to properly respect their lives - can in fact hold their lives cheap. The person who wishes to die to spite his relatives or friends is clearly in this position. And there are times when we think that individuals, though they may be genuinely suffering, are giving up too easily. The person who is suicidal as the result of a failed love affair may be in this position. Such individuals, we feel, do not have good reason to want to die - and we would be critical of any doctor who agreed to help them kill themselves.

Similar considerations apply to other variations of the liberal view. It may be argued, for example, that the freedom of individuals to seek the assistance of a doctor to end their lives, and the freedom of doctors to help such individuals, should only be restricted if it can be shown that assisted suicide harms others. But it is clear that people can commit suicide for frivolous, reckless or perverse reasons, and in these cases there is obvious harm done to relatives and friends - and indeed to anyone who is dismayed by such senseless destruction of life. In the case of the terminally ill and suffering, however, we may feel that no one is harmed when these individuals turn to doctors to help them die; and, again, this is because we are inclined to see their decision to end their lives as a serious and reasonable one.

Thus the appeal to the civil liberties of patients is not enough by itself to justify voluntary euthanasia. That appeal only gains its moral force when the individuals who are expressing the wish to die are suffering in so grievous a way that we are moved to the deepest form of pity and compassion. In such cases - the AIDS patient facing total incontinence and dementia - we speak of suffering that seems utterly pointless and an affront to human dignity. Then the repeated and considered wish to die may seem compelling - not just because it is the expression of an individual's autonomous choice, but because it is a choice which we can see is made for profoundly serious and deeply moving reasons. Here then, perhaps, we are justified in admitting an exception to the normal prohibition on the deliberate killing of the innocent.

This, I think, is the real logic behind the 'slippery slope' argument against voluntary euthanasia: if we can judge that the suffering of a competent patient is pointless and degrading (and therefore he has good reason to want to die), we can also judge that the suffering of an incompetent patient in a similar situation is pointless and degrading and so we should be willing to relieve his suffering in the same way we relieve the suffering of the competent patient.

To do anything less would be a failure of both justice and compassion. (I am assuming here that any next of kin who have the power to speak on the incompetent individual's behalf agree that a doctor should end the patient's suffering by ending his life.)

It seems to me that supporters of voluntary euthanasia should openly recognise this point. But as soon as it is recognised, it raises the difficulty of determining which incompetent patients are in fact being degraded by pointless suffering. How should this be determined and by whom?

The key terms of the debate shift at this point from civil liberties and respect for autonomy to compassion and the relief of what appears to be pointless and degrading suffering. For many Christians, suffering is in fact never pointless even though it may seem to be: it always has a redemptive significance - it is always bound up with Christ's healing of a broken world - so that the sufferer is ennobled rather than degraded.

In this tradition, the true meaning of compassion is revealed in the derivation of the word - to "suffer with". Christians try to share with the suffering the burden of their pain and distress believing that by doing so they are joined with them in a fellowship of healing love.

Burden of suffering

Non-Christians may respect these views but insist that, since they do not share them, they should not be expected to find meaning and nobility in suffering where for them there is none to be found; nor should they be required to hold to a traditional understanding of compassion as the sharing of the burden of suffering - as opposed to its total relief through euthanasia - when that understanding is rooted in the specifically Christian idea of a fellowship of healing love. Here a legitimate plurality of views should be allowed - anything less would constitute religious paternalism at best or religious fundamentalism at worst.

This, it seems to me, is a much stronger position than the civil liberties or liberal view. But I do not think that the debate ends here. It may, for example, still be the case that the Christian view - and perhaps the views of other religious traditions - embodies a profound truth about human suffering and how we should respond to it, which non-religious people can appreciate and cherish. That truth has to do, in part at least, with the fact that many patients and those who care for them can find themselves even in the midst of terrible suffering sharing their lives in the most intimate way: the carers in freely offering their loving sympathy and support, and the patients in graciously receiving it.

This bond of fellowship need have no redemptive meaning for those who enter into it and yet it may be just as real and significant to them for all that. For this is the kind of fellowship in which each of the participants enhances the dignity of the other: the carers make the patient the focus of their utterly devoted concern and attention while the patient in turn makes that devotion possible through his or her humble acceptance. In this way, the bond of fellowship between patients and carers can itself give point and meaning to grievous affliction.

This, of course, is often a possibility that is never realised in practice - many patients can die lonely and friendless deaths. But if it is a real possibility, and the experience of the hospice movement throughout the world suggests that it is, then perhaps it is something that we should not lightly give up; perhaps it is something that we should strive to create in all our hospitals and nursing homes. The strongest argument against the legalisation of voluntary euthanasia might then be that it represents the abandonment of that fellowship of loving care with the suffering and dying which makes their pain humanly significant and enriching.

I am not, of course, suggesting that we should seek out and welcome suffering because it makes the fellowship of loving care possible - that would be perverse. Unrelieved and prolonged suffering remains a terrible affliction no matter how devoted the care and we should use all the techniques of modem palliative medicine to try to diminish it.

Given, however, that suffering is inevitable, it would be a humanly finer thing to respond to it by joining in fellowship with the patient and offering him or her our devoted and loving care, than to give in to the temptation to relieve it by killing.

Key statements from the Pope's 'Gospel of Life' encyclical

Pope John Paul II's encyclical 'Evangelium Vitae' was issued in March 1995. It contains clear statements of the Church's teaching against abortion and euthanasia.

"Therefore, by the authority which Christ conferred upon Peter and his Successors, and in communion with the Bishops of the Catholic Church, I confirm that the direct and voluntary killing of an innocent human being is always gravely immoral. This doctrine, based upon that unwritten law which man, in the light of reason, finds in his own heart (cf. Rom 2:14-15), is reaffirmed by the Sacred Scripture, transmitted by the Tradition of the Church and taught by the ordinary and universal Magisterium."

"Given such unanimity in the doctrinal and disciplinary tradition of the Church, Paul VI was able to declare that this tradition is unchanged and unchangeable. Therefore, by the authority which Christ conferred upon Peter and his Successors, in communion with the Bishops - who on various occasions have condemned abortion and who in the aforementioned consultation, albeit dispersed throughout the world, have shown unanimous agreement concerning this doctrine - I declare that direct abortion, that is, abortion willed as an end or as a means, always constitutes a grave moral disorder, since it is the deliberate killing of an innocent human being. This doctrine is based upon the natural law and upon the written Word of God, is transmitted by the Church's Tradition and taught by the ordinary and universal Magisterium."

"Taking into account these distinctions, in harmony with the Magisterium of my Predecessors and in communion with the Bishops of the Catholic Church, I confirm that euthanasia is a grave violation of the law of God, since it is the deliberate and morally unacceptable killing of a human person. This doctrine is based upon the natural law and upon the written Word of God, is transmitted by the Church's Tradition and taught by the ordinary and universal Magisterium."

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