As addressed in Religion and Medicine on the Right to Die, with the exception of Unitarianism, the world’s major religions reject euthanasia: God alone decides the length of our days.
But when assessed outside of a religious context, what are the legal and ethical pitfalls of euthanasia?
Professor of Philosophy David Benatar of the University of Cape Town, South Africa, states in Current Oncology that being forced to live a life of unbearable suffering is itself unethical.(2)
Advocates of physician-assisted death adhere to two principles:
1) patient liberty/autonomy
2) the doctor’s duty to relieve suffering.(1)
In essence, advocates argue, to deny a patient the choice to end unbearable suffering is unethical, and such a choice should fall within the purview of appropriate medical care.
Where Euthanasia Is Legal
Worldwide, euthanasia and assisted suicide are legal in the Netherlands, Belgium and Luxembourg.
Switzerland permits assisted suicide if the person assisting “acts unselfishly.” Colombia permits euthanasia.
Within the United States, California, Oregon, Vermont and Washington allow assisted dying.(7)
While not allowing for physician-assisted suicide outright, Montana did pass a Rights of the Terminally Ill Act which shields doctors from prosecution should they provide narcotics that are used by a terminally ill patient to commit suicide.
Likewise in New Mexico, doctors may prescribe lethal doses of medication to facilitate suicide in the terminally ill.(5)
Where euthanasia is legal, several safeguards are in place to prevent abuse (i.e., killing an elderly parent because the medical bills are growing insurmountable or the care unmanageable).
These safeguards include consent by the person requesting euthanasia, mandatory reporting of all cases, administration only by physicians (everywhere but Switzerland) and consultation by a second physician.(4)
However, safeguards surrounding assisted-suicide laws are regularly ignored and transgressed, according to palliative care physician Dr. José Pereira.
Pereira says that at least 900 people are given lethal doses of medication annually without having given their consent to die , and in some places, 50 percent of assisted-suicide cases are not reported.
As these transgressions become more common, the slippery slope argument — that the parameters for euthanasia will grow broader and more lax — manifests itself in reality.(4)
“Although the initial intent was to limit euthanasia and assisted suicide to a last-resort option for a very small number of terminally ill people, some jurisdictions now extend the practice to newborns, children, and people with dementia,” Pereira writes.
Euthanasia — Not Just for the Terminally Ill
Benatar says that the definition of immoral is different for different people.
“Some of us think that the suffering that a person endures need not be the product of a terminal disease in order for it to be intolerable.” He’s arguing that mental suffering is a legitimate reason to end one’s life.(2)
No, really. In the Netherlands, being “tired of living” is a valid reason to request, and be granted, an assisted death.
Researchers from Bethesda, Maryland reviewed 66 cases of psychiatric requests for euthanasia in the Netherlands between 2011 and 2014.
Fifty-five percent of the patients who underwent euthanasia had major depressive disorder. The study states that “more than a majority” were dealing with other serious illnesses, such as cancer, stroke, diabetes and heart disease, but 56 percent of patients receiving euthanasia reported loneliness and isolation.(5)
One woman said that she had “a life without love and therefore had no right to exist.”
Forty-one percent of the doctors who ended the lives of their patients were psychiatrists, and the rest were general practitioners.(5)
The study hints at a risk of a eugenics campaign in which the victims are self-selected, and a culture that doesn’t value or adequately treat the mentally ill.
Everywhere but Switzerland, a consultation by a second physician is required. But in the Dutch study, 24 percent of the cases involved disagreement among physicians as to whether euthanasia was appropriate.(5)
Pereira explains that since transgressions of the laws are not prosecuted, those transgressions become more socially acceptable.(4)
For example, Dutch advocates for euthanasia in the 1970s and 1980s argued that legalized euthanasia would be a last resort limited only to terminally ill patients encountering unendurable suffering.
Laws in the Netherlands and Belgium now include psychological suffering as grounds for ending one’s life. In 2006, the Royal Dutch Medical Association declared “being over the age of 70 and tired of living” as acceptable reason for seeking euthanasia.(4)
In 2005, the Groningen Protocol was implemented, which allows euthanasia of newborns and younger children who are expected to have “no hope of a good quality of life.” Belgium followed suit, legalizing euthanasia for infants, teenagers, and people with dementia or Alzheimer’s disease.(4)
Euthanasia has the harrowing potential to become an imperative for the elderly who fear they are a burden to their children or for stressed out caregivers to hasten their freedom or their inheritance, for society to relinquish responsibility for the mentally ill and mentally disabled, and most darkly, for infanticide.
The Threat to Palliative Care
A real, measurable decrease in access to palliative care has been observed in Switzerland. In one Dutch case, a patient was euthanized in order to free up a hospital bed.(4)
According to the World Health Organization, “Palliative care provides relief from pain and other distressing symptoms; affirms life and regards dying as a normal process; intends neither to hasten or postpone death.”(6)
When the UK held parliamentary hearings on euthanasia a few years ago, a Dutch physician dismissed such a notion: “We don’t need palliative medicine, we practice euthanasia.”(4)
When palliative care is no longer an option, there is no option, and euthanasia becomes a social mandate.
Reviewed August 8, 2016
by Michele Blacksberg RN
Edited by Jody Smith
1) Physician Assisted Death in America: Ethics, Law, and Policy Conflicts. Cato-Unbound.com. Retrieved August 4, 2016.
2)Benatar, D. PhD. A legal right to die: responding to slippery slope and abuse arguments. Current-Oncolology Vol 18, No 5 (2011). Retrieved August 2, 2016.
3) Rome, Robin B MSN, FNP-C. The Role of Palliative Care at the End of Life. Ochsner J. 2011 Winter; 11(4): 348–352. Retrieved August 2, 2016.
4) Pereira, J. MBChB MSc. Legalizing euthanasia or assisted suicide: the illusion of safeguards and controls. Curr Oncol. 2011 Apr; 18(2): e38–e45. Retrieved August 3, 2016.
5)News release: Study Examines Euthanasia, Assisted Suicide of Patients with Psychiatric Disorders. JamaNetwork.com. Retrieved August 4, 2016.
6) Euthanasia is Incompatible with Palliative Care. cbc-network.org. Retrieved August 4, 2016.
7) Death with Dignity Laws by State. Findlaw.com. Retrieved August 5, 2016.