What is Euthanasia?

“Euthanasia” comes from a Greek word meaning “a good death”.

WHAT IS IT?

  • Euthanasia is the deliberate use of a procedure or drug with the intention to end a person’s life.
  • Euthanasia does not occur when a patient takes an overdose of drugs that have been prescribed for pain relief.
  • Euthanasia does not occur when a patient’s life support is switched off once it becomes clear that they will not recover.
  • Euthanasia does not occur when a patient refuses treatments such as chemotherapy.

WHO IS IT FOR?

  • People who are suffering. The elderly, terminally ill, the disabled; those with serious and incurable medical conditions. Without proper safeguards, even those who are suicidal.

EUTHANASIA VS ASSISTED SUICIDE

  • Assisted suicide occurs when a doctor prescribes a lethal dose of drugs for a person to take in their own time.
  • Euthanasia occurs when a doctor, hopefully with the patient’s consent, administers a procedure intending to induce death.

IS EUTHANASIA ASSOCIATED WITH ANY PROBLEMS?

  • When countries legalise euthanasia, the incidence of death by euthanasia steadily increases. For example, euthanasia deaths make up 3.7% of death in the Netherlands.[1]
  • A study published in 2010 found that 32% of all euthanasia deaths in the Flanders region of Belgium were without request or consent.[2]
  • Similar research found that hundreds of euthanasia deaths in the Netherlands occurred without an explicit request.[3]
  • In Belgium, 47% of euthanasia deaths are not reported.[4]
  • Research has found that people with a depressed mood are 4 times more likely to request euthanasia.[5]
  • Many people request Euthanasia because of the burden their condition places on their family and because proper medical treatment is too expensive. It isn’t fully possible to protect vulnerable people from being coerced into requesting euthanasia.[6]
  • The side effects of lethal drugs (such as vomiting, or slow and painful death) have kept a dignified death from many undergoing euthanasia.[7]

OTHER OPTIONS

  • New Zealand’s palliative care has been ranked as the third-best in the world after the United Kingdom and Australia,[8] with over 50 million dollars invested into it annually.[9]
  • Palliative care is capable of providing a “good death”, and with more funding and research it can be further improved.


REFERENCES 

[1] McGee, A. (2017, March 3). In places where it’s legal, how many people are ending their lives using euthanasia? The Conversation. Retrieved from https://theconversation.com/in-places-where-its-legal-how-many-people-are-ending-their-lives-using-euthanasia-73755[2] Chambaere, K., Bilsen, J., Cohen, J., Onwutukea-Philipsen, B. D., Mortier, F., & Deliens, L. (2010). Physician-assisted deaths under the euthanasia law in Belgium: a population-based survey. Canadian Medical Association Journal, 182(9), 895-901. https://doi.org/10.1503/cmaj.091876
[3] Onwuteaka-Philipsen, B. D., Brinkman-Stoppelenburg, A., Penning, C., de Jong-Krul, G. J. F., van Delden, J. J. M., & van der Heide, A. (2010) Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey. The Lancet, 380, 908-915. https://doi.org/10.1016/S0140-6736(12)61034-4
[4] Smets, T., Bilsen, J., Cohen, J., Rurup, M. L., Mortier, F., & Deliens, L. (2010) Reporting of euthanasia in medical practice in Flanders, Belgium: cross sectional analysis of reported and unreported cases. The BMJ, 341. https://doi.org/10.1136/bmj.c5174
[5] Van der Lee, M. L., van der Bom, J. G., Swarte, N. B., Heintz, A. P. M., de Graeff, A., & van den Bout, J. (2005) Euthanasia and Depression: A Prospective Cohort Study Among Terminally Ill Cancer Patients. Journal of Clinical Oncology, 23(27), 6607-6612. https://doi.org/10.1200/JCO.2005.14.308
[6] Public Health Division, Center for Health Statistics. (2018) Oregon Death with Dignity Act Data summary 2017. (OHA 8579 (01/18)). Retrieved from http://www.oregon.gov/oha/ph/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/ar-index.aspx
[7] Groenewoud, J. H., van der Heide, A., Onwuteaka-Philipsen, B. D., Willems, D. L., van der Maas, P. J., & van der Wal, G. (2000) Clinical Problems with the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands. The New England Journal of Medicine, 342(8), 551-556. https://doi.org/10.1056/NEJM200002243420805
[8] Economist Intelligence Unit. (2010). The quality of death Ranking end-of-life care across the world [White paper]. Retrieved from http://www.eiuperspectives.economist.com/healthcare/2015-quality-death-index
[9] Ministry of Health. (2017) Review of Adult Palliative Care Services in New Zealand. Retrieved from https://www.health.govt.nz/publication/review-adult-palliative-care-services-new-zealand

Issues With Euthanasia & Assisted Suicide

THE TERM EUTHANASIA (DERIVED FROM THE GREEK FOR GOOD DEATH) HAS COME TO MEAN THE DELIBERATE KILLING OF SICK OR DISABLED PERSONS FOR SUPPOSEDLY MERCIFUL REASONS OR MERCY KILLING.

Although as an organisation ProLife NZ have decided to focus on the abortion issue, we believe it is important that people are informed on the issue of euthanasia and assisted suicide and therefore we have put together this section of the website.

Generally people object to euthanasia and assisted suicide on the following grounds.

  • it is the deliberate killing of innocent human beings – a violation of the right to life
  • it is contrary to medical ethics, putting doctors in the role of killers
  • it assumes that the lives of the gravely ill and disabled are of less value than the lives of others.


PATIENT AUTONOMY AND THE RIGHT TO LIFE

The case for euthanasia is often argued on the basis of autonomy – the patient’s freedom to make decisions about his or her own treatment. However, to invoke autonomy in this way involves a misunderstanding of the concept of autonomy, overlooking the principle that the patient’s freedom entails a responsibility to act ethically. While a patient is capable of giving valid consent, a doctor has no authority to treat the patient unless that consent is given. However, the patient cannot ethically refuse treatment with the intention to bring about his own death.

The ethical objection to suicide is reflected in law. In New Zealand, for compassionate reasons, there are no legal penalties for a person who attempts suicide, but assisting a suicide remains an offence. Parliament recognised that people who have tried to kill themselves need help rather than punishment.

There is therefore no legal right to suicide, and certainly no right to involve others in killing oneself. This is because the right to life is an inalienable right. No one may dispose of an innocent person’s life, and so one cannot, in justice, intentionally deprive oneself of life.

If the law were to allow some individuals to volunteer for euthanasia, this would also threaten the right to life of others, especially the elderly, the gravely ill and the disabled. Legalisation of euthanasia would make a clear statement to society that it was permissible for private citizens (e.g. doctors) to kill because they accepted the view that a patient’s life was no longer worthwhile.

If it is seen as a benefit to kill patients who consent to euthanasia, it is easy to argue that others should not be denied death simply because they cannot ask for it. Courts in Britain and other countries have already judged that some incapacitated patients may be starved to death and this challenges the notion that euthanasia would remain voluntary if allowed by statute law.


EUTHANASIA VERSUS GOOD MEDICAL PRACTICE

Opposition to euthanasia does not mean that the society insists on medical treatment at all costs. The alternative to euthanasia is good medical practice, which requires doctors to recognise when it is appropriate not to continue treatment.

Sometimes a distinction is made between active euthanasia (e.g. a lethal injection) and passive euthanasia, which involves withholding or withdrawing treatment. However, it is misleading to describe withholding or discontinuing treatment as euthanasia unless this is done with the intention of killing the patient.

Sometimes a treatment may properly be withdrawn even though the patient has consented to it, for example, when it is futile, merely prolonging the dying process in a terminally ill patient.The doctor’s intention is the critical distinction between euthanasia and good palliative care (treatment to relieve distressing symptoms).

The dosage of painkillers necessary to control a patient’s pain may have the side effect of shortening his life. No moral objection arises as long as the drugs are not given with the intention of hastening the patient’s death, but only in order to control the pain.

Killing Me Softly: a New Zealand report on euthanasia

Image reference: A group protests against euthanasia in France.

Over the past 20-odd years New Zealand has seen three legislative attempts to legalise euthanasia. Only the first (1995) went through the legislative process – where it was defeated by 61 to 29 votes. The third, introduced only last year by Labour MP Maryan Street, was withdrawn by her from the private members’ bill ballot to prevent it becoming a “political football” in the general elections being held this year.

There is no doubt, however, that if Labour was able to form a government after the September elections the Street Bill would reappear. They and the Green Party (their likely coalition partner) regard it as their mission to advance “progressive” causes – as the passing of New Zealand’s same-sex marriage law in April last year showed.

It is particularly easy to push such controversial issues through the New Zealand legislative system since it is unicameral (there is no upper house) and has only 120 members. Similarly there are few national news outlets of significance and they are all typically progressive in mentality.

Watch the NZ media in action…

With this in mind Family First NZ commissioned a report that would be a comprehensive resource for anyone wanting to study the issue and prepare themselves for the next round of debate.

The report, Killing Me Softly, was prepared by Professor Rex Ahdar of the Faculty of Law at the University of Otago. The 34-pager is an excellent resource, reviewing the issue in its New Zealand context, and examining the arguments both for euthanasia and against. Up to date information about the practice of euthanasia in The Netherlands, Belgium and a few other jurisdictions where it is legal demonstrates the “bracket creep” of euthanasia to include people other than the terminally ill.

MercatorNet asked Rachael Wong, a postgraduate student in bioethics and health law at Otago University, to canvass a few of the questions surrounding euthanasia with Professor Ahdar. Here is a summary of their conversation.

Is this an issue that should be settled democratically, say, by a referendum?

I’d only be happy with a referendum after extensive public discussion and education. You have to be clear what it is. Opinion polls in newspapers usually don’t ask about euthanasia as such but about withdrawal of futile treatment or the double effect of administration of drugs. So we would need a thorough public discussion and there is no rush to do this. It could be spread out over a year or two. It’s not an urgent issue. You can have TV debates, debates on the internet.

You have shown in your report that most public opinion polls in New Zealand show a majority in favour of this move…

Yes, this is the case in most countries but often the questions are misleading because they are really asking about withdrawal of treatment or the double effect of increasing pain relief, rather than intentional killing. Also they are usually not scientific polls but mostly phone-in or text your yes or no, so you get a self-selecting sample of the population.

Having said that, it is true that even the more scientific polls usually favour euthanasia – that is, even where the wording is more precise. For example, when people are asked if they favour “the intentional administration of a lethal drug to kill a person” – probably a small majority still favour that.

I am ultimately a democrat and if the majority of people want it I would have to go along with that. I certainly favour a referendum more than a conscience vote by legislators. It should not be up to 120 MPs to decide, especially since there’s often unofficial pressure to conform to party position. David Cameron has said that he will allow a conscience vote in his party, but at least in Britain you have 400 MPs.

How can we get an informed public?

I admit most people won’t read a report, including mine — at most the executive summary — but what they are most likely to tune into and benefit from is a few good rollicking TV debates. There’s probably about 10 percent on either side who are not going to change their minds, but perhaps 60-70 precent in the middle could go either way if they have convincing reasons put before them. Most debates tend to work like that.

Given the serious ethical issues that society is confronting, do we need to teach ethics, or moral philosophy, in schools?

It would be nice if people had some philosophical education at school, but the value of that depends on the content of the programmes. I would want to see the content before allowing my kids to go through any ethics programme. I would not want them just getting a utilitarian perspective on ethical issues.

Are ordinary people capable of understanding the principle of double effect – that is, the importance of intention in administering painkillers like morphine?

Oh I think so. I use some common analogies in the report such as the D-Day campaign in WWII. The commanders could of course foresee that many hundreds if not thousands of men would die during that onslaught but their primary intention was to seize control of the French mainland from the Germans. I think that most people can grasp the point that they did not intend the deaths of any of their men. Certainly the criminal law has always accepted the difference between intending something and merely foreseeing it as a possible unintended consequence.

People scoff at the slippery slope argument, but is it valid?

There’s enough evidence from the Netherlands and Belgium to show that the ethical slippery slope is real. The availability and extension of euthanasia to new groups and to people who have not fully consented – there are independent empirical studies that show that. It’s not on a huge scale and the percentage looks quite small, but the actual number of deaths, 150-200, is still significant. And that’s in a small population; if you extend that across a country like the US there would be huge numbers.

Aside from that, there is a more subtle psychological change to the way people in a society begin to think about the issue. Once “therapeutic killing” is available as a legal option the onus of proof tends to shift, so that if you are old and suffering from a severe terminal disease you are more likely to think, “Why am I not taking advantage of this? I’ve had a good innings. I’m using up my children’s inheritance, and valuable public resources.”

People are capable of thinking sacrificially and they may see themselves as the ones who are unreasonable, eccentric and stubborn in not using this opportunity. Importantly, others also will think of them in that way, their own families may.

The bedside scene may not look like a Dickens novel with the nephews twiddling their moustaches as they impatiently await the end. But we all know human nature, and for every good family who want their mum or grandmother to hang in there as long as possible there’s going to be a bunch of others who are all too keen to see their elderly relations exit this world – whether to inherit their money or to be relieved of the burden of care if they have been looking after them.

This sounds very speculative in a country like New Zealand, but doctors in the Netherlands, for example, have written about the effects of the “climate change” that euthanasia brings to society over a number of years.

How do advocates respond to the evidence of involuntary or non-voluntary euthanasia in countries where euthanasia is legal?

There’s the old tactic of trying to discredit the methodology of studies showing these effects. But a lot of the time they simply ignore the evidence and keep playing their usual cards, such as the need for compassion, arguments about autonomy and people’s right to choose, how we treat animals better and so on. Or they’ll cite a contrary study that found a smaller percentage of abuses and so on. But even if five or ten people have their lives ended without their consent it’s too many.

The other side would say the same of course: even five or ten cases of people suffering with uncontrolled pain is too many. And you have to concede that there are a small percentage of people who just can’t have their pain completely controlled by palliative and hospice care, and who may suffer fairly lonely and painful deaths. I see from letters I have had from strongly anti-euthanasia people that they find it hard to accept that.

However, the fact that there is still scope for improvement of palliative care does not justify bringing in a whole regime that allows us to kill people.

Cross-posted from Carolyn Moynihan at MercatorNet.