The following is a presentation by Nathaniel Centre director John Kleinsman at the St John’s Public Issues Forum, held at St John’s-in-the-City (Presbyterian) Conference Centre, Wellington, on September 29. The forum was entitled “Voluntary Euthanasia: What are the Ethical, Medical, Legal, Social and Spiritual Issues?” The Nathaniel Centre is the New Zealand Catholic bioethics centre.
Let me begin by first laying my own cards on the table. I am implacably opposed to euthanasia — that is my strongly held personal view, and you will probably not be surprised by that, given my role as the director of a Catholic bioethics centre.
Now it also happens that I am implacably opposed to the legalisation of euthanasia. You might think the two statements, being opposed to euthanasia and being opposed to its legalisation, go together . . . and they do in one sense. But in another sense they need not go together, because I believe that you can be personally in favour of euthanasia while also being opposed to its legalisation.
Not many people appreciate this distinction; it relies on being able to recognise and separate the notion of individual choice from the societal consequences that might flow from certain freedoms. It’s a distinction that I will come back to.
I welcome a debate about this issue . . . but I am wary . . . I think that one of the greatest challenges centres on the terminology used to frame the discussion. I am critical of the way in which the proponents of euthanasia routinely manipulate the language — avoiding certain terms while deliberately using “soft” language (such as death with dignity) that obscures the full reality of what is happening.
At the end of the day this debate is about whether we should, as a society, allow for a person to be killed at the hands of another (euthanasia) or with the formal cooperation of another (physician-assisted-suicide). To put it bluntly it’s about the pro’s and con’s of eliminating a person’s suffering by the elimination of the person.
The argument in favour of euthanasia is not without its own logic. Why shouldn’t the terminally ill meet death on their own terms rather than at the end of prolonged agonies? Why is it considered cruelty when we allow pets to live on when their quality of life is compromised but somehow edifying or uplifting in humans?
The issue is most commonly presented as being about freedom of personal choice. The point is made that legalising euthanasia will not adversely affect the freedom of those who do not want to die in this way. On the other hand, the ongoing prohibition of euthanasia unfairly prevents some (albeit a small minority) from exercising their choice; the personal beliefs of one group are then effectively being forced onto others — or so the argument goes.
In response to that, it needs to be remembered that we don’t make our choices in isolation — our choices are also constrained by the pressures generated by cultural, societal and economic factors.
Consider the society in which we currently live — it is a society in which the sick, dying, disabled and elderly are increasingly becoming more isolated and less valued, while the average age of death climbs. In this context there is the very real danger that the “right” to die will all too quickly become a “duty” to die. Why? People who feel neglected, undervalued and invisible will understandably see themselves as a burden and will want to do the “right” thing.
Furthermore, if euthanasia were legalised there would be an increased temptation for families and society as a whole to see those who are disabled and sick as a burden to be shed rather than as persons to be cared for. In other words, legalising euthanasia will place at greater risk those whom others might be tempted to think would be better off dead.
As one commentator puts it: “The old and the sick can easily be persuaded that their lives have become burdensome both to themselves and their caregivers — that they have lives not worth living” by relatives who want to be rid of a care burden or who are anxious to accelerate or protect an inheritance.
n Health resources
And as we seek to deal with the growing problem of the fair allocation of scarce health resources, there is no doubt that legalising the removal of the infirm has the potential to solve a lot of problems. In the State of Oregon, euthanasia is already being offered as a “cheaper, quicker option” than other forms of healthcare; patients requesting expensive drug treatment regimes are routinely offered state funding for euthanasia as part of the letter of decline sent out by the state run health plan.
In other words, premature death becomes a significant risk in a society which is already ambivalent about people who are perceived as contributing little or nothing to the economy or society while using lots of resources and blocking the aspirations of younger people.
This is the darker side of the euthanasia story that no one wants to talk about.
I admit there will always be people wanting to exercise the choice to die at the hand of another no matter how much support they have, but research suggests their numbers are very small. Giving this small group the right to exercise their choice needs to be weighed up against the “cost” to society of much greater numbers of vulnerable people being exposed to the subtle and not so subtle forms of psychological coercion that flow from the factors mentioned above and which would erode the voluntary dimension of euthanasia.
To summarise: I am suggesting, on purely pragmatic grounds, that a realistic assessment of the context in which we live precludes the legalisation of euthanasia. Professor Ilora Finlay [UK — Baroness Finlay of Llandaff] puts it well when she says: “It’s not about questioning the intentions or integrity of those who want to see the law changed. I question their realism.”
The autonomy argument can only work in a perfect world.
As someone who is personally opposed to euthanasia, I am able to contemplate a world in which I could tolerate, albeit reluctantly, the legalisation of euthanasia and/or physician-assisted-suicide.
But it is a world in which I need to be reassured that the choices of that few will not impact on the choices and well-being of others, including those who are most vulnerable.
That world, however, is nothing like the world in which we currently live because no one can convince me that the choices of a few to allow themselves to be killed will not impact adversely on the choices of many others.
To conclude, no matter what people say, this debate is not about religious belief. Indeed, I am not even interested in trying to change the personal views of any of you with respect to euthanasia. Not only is it possible to be personally in favour of euthanasia and to rigorously oppose its legalisation, this position is, given the context in which we live, the only socially responsible position to take.
And when all is said and done, the key question is not about personal choice . . . it’s about protection of the vulnerable . . . it’s a matter of social justice and the common good.
And yes, that commitment to uphold the common good will mean denying a small and vocal group a choice they might think they are entitled to. More importantly, however, it will protect the choice of a much larger vulnerable group whose lives would otherwise become contingent upon the strength of their will to survive in a society increasingly inclined to question their right to be alive.
To argue otherwise would in my eyes constitute a failure of compassion and mercy to those most vulnerable.
As my mother used to say . . . “be careful what you ask for”.