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Handbook of the South Australian Voluntary Euthanasia Society (SAVES)
THE RIGHT TO CHOOSE: THE CASE FOR LEGALISING VOLUNTARY EUTHANASIA
6. OTHER OPPOSITION
Voluntary euthanasia is objected to both on the grounds that it is wrong
in principle and that it will have harmful consequences. Objections on
principle may be based on an amorphous feeling of what is right or wrong,
but more often on religious beliefs [15]. Pragmatic objections figure prominently
in the debate and are often advanced in support of a religious belief [16].
Objections that particularly concern the medical profession were discussed
in Section 5.
Religious Views
We refer here only to objections from Christian sources and make no
attempt to explore views held in other faiths.
The Sanctity of Human Life [17]. This concept, in its absolute
form, regards human life as a gift from God, who alone may decide when
it shall end: it follows that it may not be given up, or taken by another.
Personal autonomy in this respect is overridden by God's purpose, which
is not said to be overridden if life is medically prolonged. Although most
church leaders adhere to this tradition, a majority of their adherents
appear not to (see Section 4). Although inconsistent, it is widely accepted
in Christian religious tradition that there are circumstances where it
is justifiable to take life, such as in self-defence, defence of the lives
of others, judicial execution, or a "just war". But the exceptions do not
extend to allowing an individual to choose a quick peaceful death in place
of intolerable suffering or a non-cognitive existence.
The concept takes no account of life's quality, holding that all life,
regardless of the ravages of disease or injury, even in a persistent vegetative
state and permanently devoid of meaning and awareness, is of equal worth
in the sight of God. For many this suggests a remote, even cruel God, acting
from obscure motives - far from what might be expected from a loving God.
When life becomes an unwanted burden that cannot be relieved except by
death, voluntary euthanasia shows appropriate respect for the sanctity
of life. A doctor who is regarded as God's agent in preserving life can,
in such circumstances, be thought of with equal logic as God's agent in
bringing life to an end.
The Value of Suffering. Some believe that suffering should simply
be endured, either because it is deserved in that we are sinful, or it
is ennobling, or has a redemptive value in the eyes of God, sharing the
suffering of Jesus.
It is also argued that there is scope for spiritual growth in the extended
experience of dying. This may be true for some but none should be obliged
to put the possibility to the test, and it can hardly apply if conscious
existence has ceased. It has even been said that voluntary euthanasia would
deprive others of the spiritual benefit they could derive from the exercise
of compassion towards the dying person!
Scriptural Authority. There is no Biblical reference that relates
directly to voluntary euthanasia. Principles such as the sanctity of human
life and the value of suffering are derived from doctrinal interpretations
of passages in the Bible. At one time it was argued that voluntary euthanasia
was prohibited by the sixth commandment, translated in the King James Bible
as "Thou shalt not kill". It is now accepted that the sixth commandment
prohibits unlawful killing and is correctly translated as "You shall do
no murder" (New English Bible). When voluntary euthanasia is lawful it
will be dissociated from murder and irrational suicide. In any event, it
is misleading to refer to it as "killing", with the implication of violence
against an unwilling victim [18]. In voluntary euthanasia there is no violence
and no victim, only "a gentle act of merciful clinical care" [19].
There is no scope for argument with those whose religious objections
are portrayed as "revealed truth". The objections must be respected as
part of our right to freedom of religious belief. However, a similar right
is due to those who support the principle of voluntary euthanasia. All
should be free to live and die according to their own values, provided
the rights of others are respected. No patient, doctor, or medical facility,
would be required to participate against conscience. Those who oppose voluntary
euthanasia in principle should not seek to deny the option to those for
whom it is morally right.
The commonly stated view that voluntary euthanasia is incompatible with
Christianity is not correct. Many Christian voices have been raised in
support [20].
The Right to Life
It has been claimed that because the Universal Declaration of Human
Rights says we have an inalienable right to life, it denies us the right
to choose the timing and manner of our death. This is to stand the Declaration
on its head, so that the right to life becomes instead an obligation to
go on living. The Declaration does not say that life itself is inalienable,
but that our right to it is, one that cannot be taken away or transferred
to another. In so doing, the Declaration affirms our sole right to make
decisions about our lives. The voluntary surrender of life is an exercise
of that right. The patient who seeks death remains in control, since the
doctor acts on behalf of, and in accordance with the wishes of, that person.
This differs from slavery, for example, where control over a person's life
is exercised by another, without having to take account of the person's
wishes.
Pragmatic Concerns
In Australia's democratic and multi-cultural society people are free
to adopt any system of belief, or none, but not to impose theirs upon others.
It follows that objectors to voluntary euthanasia must argue not merely
that it contravenes their beliefs, or is "contrary to the Will of God"
as an Adelaide pastor put it, but that it would harm society. The purpose
of legislation in a secular society is to protect the social order, not
to enforce a particular morality or system of religious belief.
"The Slippery Slope" (See also [21], Fact Sheet 12). It is claimed
that acceptance of voluntary euthanasia would weaken respect for life and
lead unavoidably to life-termination on grounds other than the express
wish of a hopelessly ill adult patient, and even to compulsory euthanasia
as a matter of social policy. There is no evidence to support this alarming
speculation. In fact, voluntary euthanasia shows greater respect for life,
not less. We can have scant respect for life if we require people who are
hopelessly ill and suffering intolerably, or who are permanently deprived
of conscious life, to live on in that condition against their will.
There is no "slope", slippery or otherwise, between voluntary and non-voluntary
euthanasia. They are separate issues. If the latter came to be approved
in any way, it could not be on the grounds that the former was permitted.
To bolster the argument some people have unscrupulously claimed a parallel
with the Nazi killing of "undesirables" in Germany. But this was the product
of an odious political ideology enforced in a dictatorship. It was not
preceded by acceptance of voluntary euthanasia and bore no resemblance
to it. Attempts have been made to interpret a recent study of the position
in the Netherlands (see Fact Sheets 4 and 17) as illustrating a slippery
slope, but, on the contrary, the authors of the report concluded that the
results offered no support for this claim. The departures from the voluntary
principle recorded in the Netherlands are also found in studies in Australia
and elsewhere. There is no evidence that they are a consequence of the
Dutch acceptance of voluntary euthanasia.
Proponents of the slippery slope objection show a deep distrust of human
nature and of medical practitioners in particular. Doctors are not waiting
for the chance to deprive people of life against their will, nor are Australians
eager to authorise them to do so. If there is a case for non-voluntary
euthanasia, e.g., for babies born without a brain, it must rest on different
criteria.
Harm to the Family. It is argued that the alternative of voluntary
euthanasia would make family members less inclined to support a sick relative,
whom they might even pressure to take up the option. Or the patient might
feel guilt over the burden being carried by the family and seek release
for their sake. However, a voluntary euthanasia law would require two doctors
to be independently satisfied that the request was both freely made and
rational in the light of the patient's condition. This is in contrast to
the present absence of adequate supervision in which medically hastened
deaths are quite common ([41](a), Fact Sheet 21) so that one might well
ask why these effects are not occurring now. Furthermore, the desire to
avoid being a burden on others is a valid consideration for someone who
is incurably ill and suffering without prospect of relief [22].
Society is Placed at Risk. Once voluntary euthanasia is available,
it is claimed, the sick, disabled and elderly would live in fear of becoming
victims of non-voluntary euthanasia or being disposed of as a burden. But
no one would be entitled to request, or allowed to be given, euthanasia
merely on the grounds that they were sick, disabled, or elderly. The government
and the health care profession would be responsible for ensuring that the
public and patients were fully informed of the many safeguards, so that
none need fear such abuse.
Depressed Patients are at Risk. It is alleged that doctors will
fail to recognise clinical depression and end the lives of patients whose
health could be restored. Others, whose health could not be restored, but
for whom some quality of life could be maintained, might have their lives
prematurely shortened. But doctors who ended the lives of such patients
would not be protected by any voluntary euthanasia law.
The law would require a second doctor acting independently, to confirm
the diagnosis and it is improbable that both would fail to recognise a
treatable clinical depression. Patients who are incurably ill and suffering
unbearably may quite rationally be depressed and wish to die. However,
if the euthanasia request is not appropriate to the patient's condition
or if a treatable clinical depression is suspected, the doctor will have
no mandate to proceed. The doctor could offer alternative treatment, or
referral for psychiatric assessment.
Palliative Care has the Answer (See also Section 5). It is still
argued by some that almost everyone can be helped to a calm and dignified
pain-free death through hospice and palliative care services. If that were
true no one need fear the introduction of a voluntary euthanasia bill.
It simply would not be used. This claim is made less frequently by palliative
care practitioners, many of whom accept the inherent limitations of medical
techniques and skills [23]. A position statement by the Palliative Care
Council of South Australia acknowledges that:
"while all pain and symptoms can be addressed, complete relief is
not always possible in all cases, even with optimal palliative care."
Against this, some practitioners offer the solution of "terminal sedation"
or "pharmacological oblivion". This comprises a drug- induced coma intended
to remove all distressful symptoms while life-preserving measures are withheld
until death supervenes. While the practice is accepted as within the law,
it has been appropriately termed "slow-stream euthanasia".
Contrary to popular belief, pain is not always the major problem. In
the Netherlands, although pain was mentioned in 46% of the requests for
euthanasia, in less than 5% was it given as the only reason. Modern pain
management, provided it is available, is estimated to deal effectively
with 95% of chronic cancer pain. While this may not be much consolation
for the other 5%, or for many others who will not receive state-of-the-art
pain management, there are other distressing symptoms that are more intractable
[24]. These include fatigue, weakness, cough, breathing difficulties and
confusion. Most feared are loss of control of physical and mental functions
leading to descent into total dependence on others. This can be induced
by a severe stroke, Alzheimer's Disease, or the natural degeneration of
functions that comes with age, leading to immobility and incontinence.
The praiseworthy developments in palliative care have not made it unnecessary
or unreasonable for some to wish for a hastened death. All should be allowed
the choice which they consider to be right for them. Voluntary euthanasia
is not an alternative to palliative care, but complementary to it [25].
The Problem of Regulation. In conjunction with the "slippery
slope" contention it is claimed that voluntary euthanasia could not be
effectively regulated; there would be too many loopholes and opportunities
for abuse. An irrational comparison is attempted with the legalisation
of abortion where, it is contended, a law designed to restrict the practice
to defined circumstances has resulted in abortion "on demand". The dissimilarities
are obvious. Abortion ends a life at its beginning, at the request of and
for the sake of its mother; voluntary euthanasia ends a life that has been
effectively completed, at the request of and for the sake of its possessor.
Voluntary euthanasia is proposed only in prescribed circumstances under
special safeguards; there is no support for euthanasia on demand [26].
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