The Australian public supports legalising euthanasia and bills are introduced into state parliaments every year. Yet Australian governments continue to resist legalising euthanasia or its cousin, assisted suicide.
Some of the concerns at the heart of this resistance can be addressed with carefully drafted legislation. But others, such as how we value life, remain key challenges for policymakers.
When euthanasia (I use the term here to include assisted suicide) is debated, both sides tend to raise “slippery slope” and vulnerability concerns.
Opponents of legalisation say: once we take the significant step of allowing doctors to kill patients (or to help patients end their lives) in narrowly defined circumstances, there will be pressure to increase the range of circumstances with amending legislation. And it’s easier to amend existing legislation than enact it in the first place (the slippery slope concern).
Or, patients who do not really want to end their lives might feel they are a burden and so feel a subtle pressure, real or imagined, to end their lives when this is not what they want (the vulnerability concern).
Proponents – such as broadcaster and television producer Andrew Denton – generally respond by claiming there is no evidence of either concern being realised in places where euthanasia is lawful.
The issue about evidence is controversial, and so the debate about these two well-known concerns goes on. But it seems that both concerns can be alleviated.
The vulnerability concern, in particular, can largely be dealt with by providing safeguards in legislation. We can require qualified, independent third parties to check whether the decision is genuinely voluntary, rather than coerced, and provide a minimum period of time during which the patient’s decision must be an unwavering one.
Although there is scepticism about whether these safeguards would always be complied with or effective, this is no less a concern with the status quo, such as with decisions to withdraw life-sustaining measures or give pain relief which may hasten death. These are just as susceptible to abuse as euthanasia, but are already lawful.
So why is there an abiding resistance to euthanasia, and is there anything that can be done about it?
Question of access
The main difficulty in combating resistance to euthanasia has been deciding who should have access: should it be restricted to the terminally ill?
Should it extend to people who have an unbearable physical condition which does not make them terminally ill?
Or should it even extend to people who aren’t physically ill at all, but are experiencing unbearable mental suffering?
Andrew Denton suggests it should not be restricted but based simply on “unbearable suffering”, as it is in Belgium. This means that it could extend to people who have no physical ailment.
A case discussed in a recent episode of the SBS program Dateline illustrates just what a dilemma the access question is. The program presented the case of a woman in Belgium, Simona de Moor, 85. She wanted to take the opportunity to end her life under what the program describes as “the most liberal euthanasia laws in the world”.
Simona was not terminally ill. But under Belgian law it is not necessary to be terminally ill for euthanasia or assisted suicide. It is sufficient to be experiencing unbearable mental suffering that cannot be alleviated.
Someone who is depressed, where that depression is not responsive to attempts at alleviation, can ask for euthanasia or assisted suicide, provided the request is voluntary and well thought through (it doesn’t impair capacity), and the desire to die is unwavering.
In the program, Simona tells viewers she lost the will to live after her daughter, with whom she was very close, died – just three months before the day Simona would herself choose to die by lethal poisoning.
One worry here is that Simona’s judgement is clearly being made while she is still grieving for her daughter.
However, we can draft legislation to ensure that Australians would not be able to make such a choice so soon after the loss of a loved one. So this concern is not fatal to the case for euthanasia.
The deeper worry is this: if we allow people with no terminal illness to have help to end their lives, what avenues for survival and recovery are closed off?
Value of human life
Legalisation this broad inevitably brings about a shift in how we think about our lives. In Belgium, someone who is depressed but otherwise well, such as Simona, is able to enter a train of thought that is allowed to gather momentum because euthanasia is a genuine option.
Alternative ways of thinking about her situation become unavailable. If you keep thinking about ending your life, just as if you keep thinking about failure, it can become a self-fulfilling prophecy. Other possibilities are not even entertained.
This is what opponents worry about when they say euthanasia could “erode” the value of human life. This is one horn of the dilemma about euthanasia for patients who are not terminally ill.
We can try to resolve this worry by enacting a law that allows euthanasia only for “terminally ill” people.
But this lands us on the other horn. There are always those rare cases of someone – such as Tony Nicklinson in England – whose suffering is by all objective standards unbearable but there is no terminal illness. And this is the very case that prompted the UK Supreme Court to encourage parliament to consider legislation.
Nicklinson had a physical condition (locked-in syndrome), unlike Simona who had no physical ailment at all. So we could limit euthanasia to those who at least have a physical condition. But then, why should the option be limited to people with a physical condition?
There is no easy answer to this dilemma. But, to use a famous phrase, hard cases make bad law. I don’t take this phrase to mean we should never legislate to cover the rare cases such as Nicklinson’s, but only that we need to be really sure, and get it right, before we do.
As for the less rare cases, we should think instead of ways of helping people who suffer which don’t involve encouraging them to end their lives.