Euthanasia and assisted suicide are two practices that are growing in popularity worldwide, with the Netherlands having seen a recent surge in the demand for euthanasia, as reported in The Guardian last month.
Although euthanasia and assisted suicide are now legal in only a small number of countries, debate is ongoing in many countries, and starting in Ireland, on legalising these practices. In many cases, medical and public opinion favours such a change in the law.
The Catholic Church is opposed to euthanasia and assisted suicide on ethical grounds, as am I.
The word euthanasia, from the Greek, means ‘good death’ – death without pain – and entails deliberately ending a person’s life in order to relieve suffering, e.g. by a lethal injection administered by a doctor. Assisted suicide, on the other hand, means to deliberately assist or encourage another person to kill themselves, e.g. giving a lethal medication to a terminally ill person knowing that they will use the medication to commit suicide.
Assisted dying is currently legal in four European countries: The Netherlands, Belgium, Luxembourg and Switzerland; two North American countries: Canada and the USA (States of Oregon, Washington, Montana, Vermont and California); and Colombia, South America.
The Netherlands, Belgium, Luxembourg and Canada permit both euthanasia and assisted suicide. Colombia permits euthanasia and Switzerland and the States of Oregon, Washington, Vermont, Montana and California permit assisted suicide.
The Netherlands, Belgium and Luxembourg require that candidates for euthanasia and assisted suicide must be suffering unbearable pain, with no prospect of improvement.
This suffering need not be related to a terminal illness and is not limited to physical suffering, for example the case of a 60-year-old man suffering from obsessive compulsive disorder.
He would spend hours each day cleaning a cupboard and then self-harm with a razor. He successfully applied for euthanasia to end his nightmarish obsession.
In the five US states, the patient must be terminally ill and suffering greatly to be granted permission for assisted suicide. All assisted dying regimes require that the patient makes a voluntary request for euthanasia or assisted suicide.
The patient must be competent and well-informed. All assisted dying regimes also require medical certification that requests for euthanasia are valid and that the suffering is unbearable.
Only the Netherlands and Belgium permit euthanasia for patients under the age of 18. Competent patients as young as 12 may qualify, but only if parents or guardians consent.
One argument against legalising euthanasia and assisted suicide is that the incidence will increase rapidly and inappropriately once people get used to it, and experience to-date seems to bear this out.
In Belgium, prior to enabling legalisation in 2002, euthanasia incidence (illegal but not prosecuted) was between 0.3% and 1% of all deaths but after 2002 the rate steadily rose to 4.6% of all deaths (2013).
The number of people euthanised in the Netherlands in 2017 will exceed 7000, a 67% increase since 2012.
The Levenseinde Kliniek, the only Dutch medical clinic specialising in euthanasia, has had 2500 requests for help to die this year and is struggling to recruit enough doctors to satisfy demand.
The clinic director Steven Pleiter describes the increased demand as the end of a “taboo” on killing patients who want to die.
Some Dutch professionals think things have gone too far. Theo Boer, a professor of ethics who supported the 2002 assisted dying legislation said: “Starting from 2007 the numbers increased suddenly. It was as if the Dutch people needed to get used to the idea of an organised death. I know lots of people who now say that there is only one way they want to die and that is through injection. It is getting too normal. In the beginning 99% of cases were terminally ill patients, with perhaps days to live, that’s now down to 70%.”
Those who object to assisted dying on moral grounds believe that human life is so intrinsically valuable that it is always morally wrong to kill. It can also be reasonably predicted that many other bad consequences will flow from legalising assisted dying.
For example, normalising euthanasia and assisted suicide in cases of terminally ill patients in severe pain leads on to employing euthanasia in many other far less extreme cases and even to using euthanasia for social convenience, e.g nudging elderly people dependent on care from their children or relatives, towards euthanasia in order to remove the burden of their care from their carers.
Pressure to legalise assisted dying is growing in many countries. In the UK for example the majority of the population, including much of the medical profession, is in favour of assisted suicide. Pressure to legalise assisted dying has also begun in Ireland and will surely grow.
The argument for legalising assisted dying to deal with unbearable pain in terminally ill patients is motivated by the understandable desire to ease suffering and is a substantial argument. However I believe that the deliberate termination of a human life is unethical.
But, ethics aside, I also believe that assisted dying is a mistaken and unnecessary intervention.
I understand that palliative medicine can now successfully control just about any form/level of physical pain and psychiatry/psychology supplemented by pharmacology can ameliorate much psychological distress. This greatly dilutes the conventional argument for assisted dying.
Only absolute respect for the intrinsic value of human life can hope to withstand the liberal forces now calling for the universal availability of abortion on demand and assisted dying. In my opinion, if these liberal forces prevail, the acknowledged value of human life could well be reduced to the value we ascribe to any other useful commodity and that would seriously degrade the general quality of civilised human living.
William Reville is an Emeritus Professor of Biochenmistry at UCC.