Close

The Hard Questions about Euthanasia

Euthanasia is one of the most important public policy issues being debated today. The outcome of that debate will profoundly affect family relationships, interaction between doctors and patients, and concepts of basic morality. With so much at stake, more is needed than a duel of one-liners, slogans and sound bites.

Doesn't euthanasia ensure a dignified death?

“Death with dignity” has become a catch phrase used by euthanasia activists, but there’s nothing dignified about the methods they advocate. For example, one euthanasia organization distributes a pamphlet on how to cause suffocation with a plastic bag. Most of Jack Kevorkian’s “subjects,” as he calls them, have been gassed to death with carbon monoxide and some have had their bodies dumped in vehicles left in parking lots.

With legalized euthanasia, wouldn’t patients die peacefully instead of violently?

No. Campaigners for euthanasia often say that, but it’s not true. In places where laws were passed to allow euthanasia, it was clear that legalizing euthanasia only legitimizes the use of plastic bags and carbon monoxide to kill vulnerable people. 

For example, immediately following the passage of Oregon’s Measure 16, those who had said that it would enable people to die peacefully with pills did an immediate about face and admitted that it would permit the types of activities carried out by Jack Kevorkian, including a plastic bag to ensure death after taking pills. 

In Australia’s Northern Territory, proponents of euthanasia painted pictures of a calm, peaceful death with the patient surround by loved ones. However, family members were warned to leave the room when the patient was being killed because the lethal injections often cause violent convulsions and muscle spasms, which was very unpleasant to observe.

A particularly chilling method of ending a patient’s life was proposed by Dr. Philip Nitschke, a leading Australian euthanasia activist, when he announced that he had developed a computer program for euthanasia so that doctors could remove themselves from the actual death scene.

Isn’t euthanasia sometimes the only way to relieve excruciating pain?

Quite the contrary. According to Euthanasia Prevention Coalition, the number one reason someone asks for assisted suicide is existential distress, not uncontrollable pain. The activists exploit the natural fear people have of suffering and dying, and often imply that when cure is no longer likely, there are only two alternatives: euthanasia or unbearable pain. For example, an official of Choice in Dying, a right-to-die organization, said refusing to permit euthanasia “would, in fact, be to abandon the patient to a horrifying death.” Such an irresponsible statement fails to note that virtually all pain can be eliminated and that — in those rare cases where it can’t be eliminated — it can still be reduced significantly if proper treatment is provided. It is a national and international scandal that so many people do not get adequate pain control. 

But killing is not the answer to that scandal. The solution is to mandate better education of health care professionals on these crucial issues, to expand access to health care, and to inform patients about their rights as consumers. Everyone — whether it be a person with a life-threatening illness or a chronic condition — has the right to pain relief. With modern advances in pain control, no patient should ever be in excruciating pain. However, most doctors have never had a course in pain management so they’re unaware of what to do. If a patient who is under a doctor’s care is in excruciating pain, there’s definitely a need to find a different doctor. But that doctor should be one who will control the pain, not one who will kill the patient. There are board certified specialists in pain management who will not only help alleviate physical pain but are skilled in providing necessary support to deal with emotional suffering and depression that often accompanies physical pain.

Where does support for euthanasia come from?

While the most visible and vocal support for euthanasia and assisted suicide comes from individuals like Jack Kevorkian or “right-to-die” organizations, groups and individuals concerned about lowering health care costs are becoming increasingly involved in euthanasia advocacy. For example, some foundations with links to profit-making health care enterprises fund programs with a distinct pro-euthanasia bias.

Isn’t opposition to euthanasia just an attempt to impose religious beliefs on others?

No. Euthanasia leaders have attempted for a long time to make it seem that anyone against euthanasia is trying to impose his or her own religion on society. But that’s not the case. People on both sides of the euthanasia controversy claim membership in religious denominations. There are also individuals on both sides who claim no religious affiliation at all. But it’s even more important to realize that this is not a religious debate. It’s a debate about public policy and the law. The fact that the religious convictions of some people parallel what has been long-standing public policy does not disqualify them from taking a stand on an issue. For example, there are laws that prohibit sales clerks from stealing company profits. Although these laws coincide with religious beliefs, it would be absurd to suggest that such laws should be eliminated. And it would be equally ridiculous to say that a person who has religious opposition to stealing shouldn’t be able to support laws against stealing. 

Likewise, the fact that the religious convictions of some euthanasia opponents parallel what has been long-standing public policy does not disqualify them from taking a stand on the issue. Throughout all of modern history, laws have prohibited mercy killing. The need for such laws has been, and should continue to be, debated on the basis of public policy, and people of any or no religious belief should have the right to be involved in that debate. 

In Washington state, where an attempt to legalize euthanasia and assisted suicide failed in 1991, polls taken within days of the vote indicated that fewer than ten percent of those who opposed the measure had done so for religious reasons. The following year, voters in California turned down a similar proposal. During the campaign, euthanasia leaders claimed that all opposition was religious, yet the groups opposing the measure that would have legalized euthanasia and assisted suicide included the California Commission on Aging, California Medical Association, California Nurses Association, California Psychiatric Association and the California State Hospice Association. In addition, all major newspapers throughout the state, including the Los Angeles Times, San Francisco Chronicle, and San Diego Union Tribune took strong editorial positions against the measure.

Isn’t “kill” too strong a word for euthanasia?

No. The word “kill” means “to cause the death of.” In 1989, a group of physicians published a report in the New England Journal of Medicine in which they concluded that it would be morally acceptable for doctors to give patients suicide information and a prescription for deadly drugs so they can kill themselves. Dr. Ronald Cranford, one of the authors of the report, publicly acknowledged that this is “the same as killing the patient.” While changes in the law would lead to euthanasia being considered a “medical intervention,” the reality would not change — the patient would be killed. Proponents of euthanasia often use euphemisms like “deliverance,” “aid-in-dying” and “gentle landing.” If a public policy has to be promoted with euphemisms, that may be because the use of accurate, descriptive language would demonstrate that the policy is misguided.

Does the government have the right to make people suffer?

Absolutely not. Likewise, the government should not have the right to give one group of people (e.g. doctors) the right to kill another group of people (e.g. their patients). Euthanasia activists often claim that laws against euthanasia are government mandated suffering. But this claim would be similar to saying that laws against selling contaminated food are government mandated starvation. Laws against euthanasia are in place to prevent abuse and to protect people from unscrupulous doctors and others. They are not, and never have been, intended to make anyone suffer.

Should people be forced to stay alive?

No. And neither the law nor medical ethics requires that “everything be done” to keep a person alive. Insistence, against the patient’s wishes, that death be postponed by every means available is contrary to law and practice. It would also be cruel and inhumane. There comes a time when continued attempts to cure are not compassionate, wise, or medically sound. That’s where hospice, including in-home hospice care, can be of such help. That is the time when all efforts should be placed on making the patient’s remaining time comfortable. Then, all interventions should be directed to alleviating pain and other symptoms as well as to the provision of emotional and spiritual support for both the patient and the patient’s loved ones.

Wouldn’t euthanasia only be available to people who are terminally ill?

Absolutely not. Recently in Newfoundland, a mother was urged by her doctor to euthanize her 25 year old daughter who lives with multiple disabilities. This was only so that no one needed to treat her daughter anymore, not because the daughter was terminally ill, or that her daughter wanted to die. Doctors’ attitudes towards people and whether or not they should live is changing because of legal assisted suicide.

There are two problems here — the definition of “terminal” and the changes that have already taken place to extend euthanasia to those who aren’t “terminally ill.” 

There are many definitions for the word “terminal.” For example, when he spoke to the National Press Club in 1992, Jack Kevorkian said that a terminal illness was “any disease that curtails life even for a day.” The co-founder of the Hemlock Society often refers to “terminal old age.” Some laws define “terminal” condition as one from which death will occur in a “relatively short time.” Others state that “terminal” means that death is expected within six months or less. Even where a specific life expectancy (like six months) is referred to, medical experts acknowledge that it is virtually impossible to predict the life expectancy of a particular patient. 

 Increasingly, however, euthanasia activists have dropped references to terminal illness, replacing them with such phrases as “hopelessly ill,” “desperately ill,” “incurably ill,” “hopeless condition,” and “meaningless life.” An article in the journal, Suicide and Life-Threatening Behavior, described assisted suicide guidelines for those with a hopeless condition. “Hopeless condition” was defined to include terminal illness, severe physical or psychological pain, physical or mental debilitation or deterioration, or a quality of life that is no longer acceptable to the individual.” That means just about anybody who has a suicidal impulse . 

In a May 1996 speech to the prestigious American Psychiatric Association, George Delury (who assisted in the 1995 death of his wife who had multiple sclerosis) suggested that “hopelessly ill people or people past age sixty just apply for a license to die” and that such a license should be granted without examination by doctors.

If death is inevitable, shouldn’t a person who is dying and wants to commit suicide have the right to do so?

It’s really important to understand that suicide in a person who has been diagnosed with a terminal illness is no different than suicide for someone who is not considered terminally ill. Depression, family conflict, feelings of abandonment, hopelessness, etc. lead to suicide — regardless of one’s physical condition. Studies have shown that if pain and depression are adequately treated in a dying person — as they would be in a suicidal non-dying person — the desire to commit suicide evaporates. Suicide among the terminally ill, like suicide among the population in general, is a tragic event that cuts short the life of the victim and leaves devastated survivors.

Wouldn’t euthanasia only be at a patient’s request?

No. As one of their major arguments, euthanasia proponents claim that euthanasia should be considered “medical treatment.” If one accepts the notion that euthanasia is good, then it would not only be inappropriate, but discriminatory, to deny this “good” to a person solely on the basis of that person’s being too young or too mentally incapacitated to make the request. In fact, a surrogate’s decision is often treated, for legal purposes, as if it had been made by the patient. That means children and people who can’t make their own decisions could well be euthanized. Suppose, however, that surrogates were not permitted to choose death for another. The problem of how free a death request would be still remains. If euthanasia becomes accepted in policy or in practice, subtle, even unintended, coercion will be unavoidable.

In January 2017 in the Netherlands, a Regional Euthanasia Review Committee decided that a forced euthanasia on a woman with dementia, where the doctor sedated the woman by secretly putting the drugs in her coffee and then had the family hold her down to enable the lethal injection, did not follow the rules but found that it was done in “good faith.”

But don't people have the right to commit suicide?

People do have the power to commit suicide. Suicide and attempted suicide are not criminalized. Each and every year, in the United States alone, there are more suicides than homicides. Suicide is a tragic, individual act. Euthanasia is not about a private act. It’s about letting one person facilitate the death of another. That is a matter of very public concern since it can lead to tremendous abuse, exploitation and erosion of care for the most vulnerable people among us. Euthanasia is not about giving rights to the person who dies but, instead, is about changing the law and public policy so that doctors, relatives and others can directly and intentionally end another person’s life. This change would not give rights to the person who is killed, but to the person who does the killing. In other words, euthanasia is not about the right to die. It’s about the right to kill.

Certainly no one would be forced into euthanasia, would they?

Physical force is highly unlikely. But emotional and psychological pressures could become overpowering for depressed or dependent people. If the choice of euthanasia is considered as good as a decision to receive care, many people will feel guilty for not choosing death. Financial considerations, added to the concern about “being a burden,” could serve as powerful forces that would lead a person to “choose” euthanasia or assisted suicide. Even the smallest gesture could create a gentle nudge into the grave. Such was evidenced in greeting cards sold at the 1991 national conference of the Hemlock Society. According to the conference program, the cards were designed to be given to those who are terminally ill. One card in particular exemplified the core of the movement that would remove the last shred of hope remaining to a person faced with a life-threatening illness. It carried the message, “I learned you’ll be leaving us soon.”

Could euthanasia become a means of health care cost containment?

Perhaps one of the most important developments in recent years is the increasing emphasis placed on health care providers to contain costs. In such a climate, euthanasia certainly could become a means of cost containment.

In January 2017, The Canadian Medical Association Journal (CMAJ) published a study by Aaron J. Trachtenberg MD DPhil, Braden Manns MD MSc titled: Cost analysis of medical assistance in dying. The researchers found that the Canadian healthcare system will save between 34.7 and 138.8 million dollars per year, depending on the number of euthanasia deaths. First: Associating euthanasia with medical cost savings creates a belief that euthanasia is a social good. People who feel that their life has lost value may now consider it altruistic to “choose” to die by euthanasia. Secondly: Associating euthanasia with medical savings creates pressure for people who choose to live until they die. 

Legalized euthanasia raises the potential for a profoundly dangerous situation in which doctors could find themselves far better off financially if a seriously ill or disabled person “chooses” to die rather than receive long-term care. 

In July 2017, an article published in the Globe and Mail appears to pressure governments to pay more for euthanasia. The article states that doctors aren’t performing euthanasia enough because they won’t make enough money off of it. According to research done by the Euthanasia Prevention Coalition, the price to kill a life for a doctor in British Columbia can be over $550.

More to think about...