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Let’s be clear about what we mean when we say euthanasia

In the current era of hi-tech medicine, the word euthanasia has been stretched to encompass a broad range of interventions. Guian Bolisay/Flickr, CC BY-SA

Debate about euthanasia flares up in Australia every few months but, for some reason, it never gets very far.

The latest round started late last month, when urologist and campaigner for voluntary euthanasia Rodney Syme confessed to an act of mercy killing, and said he was prepared to be charged and jailed for it. Dr Syme said he believed:

creating a court challenge could set a useful legal precedent and accelerate the public debate on euthanasia.

No doubt, this is an act of individual bravery – a kick at the hornet’s nest. But will it really advance the euthanasia debate?

A contaminated word

As in this instance, the debate usually starts with a demand to “legalise euthanasia”, invoking a “right to die”. But any law permitting mercy killing would be complex as it would have to provide a safe and feasible set of exceptions to the Crimes Act.

More fundamentally, “euthanasia” itself is poorly understood, being not one thing but many. And there is, strictly speaking, no “right to die” in that we can’t oblige other people to kill us.

The modern notion of euthanasia was, in fact, born in the latter half of the nineteenth century, a tumultuous time that saw the birth of modernity and, courtesy of philosopher Friedrich Nietzsche, the death of God.

In Australia, the debate fizzled in the twentieth century, re-emerging 20 years ago when the world’s first law permitting euthanasia in many of its guises was passed in the Northern Territory.

This short-lived act (the Rights of the Terminally Ill Act) unsurprisingly did not use the term “euthanasia”, since its misuse to describe the eugenic Aktion T4 activities of the Nazi regime had by then profoundly contaminated the word.

This might, in itself, be a good reason for abandoning the term altogether, but nowadays there’s an equally cogent motive to do so: nobody agrees on what it means. It’s clearly time to clarify what we mean when we say euthanasia because the debate will neither go away nor progress without it.

Defining our limits

As it happens, this is not a uniquely Australian issue; the definition of euthanasia is evolving rapidly. The simplest comes from philosopher Baruch Brody:

where one person (A) kills another person (B) for the benefit of the second person, who actually does benefit from being killed.

But there are now many more criteria qualifying this broad(ening) concept. In fact, euthanasia is actually a spectrum of interventions, each with unique moral and legal considerations.

The modern notion of euthanasia was born in the latter half of the nineteenth century, a tumultuous time that saw the birth of modernity. Jens/Flickr, CC BY-NC

In the current era of hi-tech medicine, it has been stretched to encompass a broad range of interventions ranging from mercy killing (with or without explicit consent) through the shades of assisted suicide (by doctors and others), into the use or abuse of sedation (terminal sedation, double effect) and decisions to withdraw life-prolonging treatments (burdensome ones such as mechanical ventilators, or harmless ones such as pacemakers). And finally, to decisions not to start treatments that might prolong life.

The law has intervened in all jurisdictions to put a bright line in this spectrum, identifying the point at which we should see an activity as “illegal”. But the position of this bright line differs widely across the globe.

In Australia, it currently lies somewhere in the area between terminal sedation and the double effect (the use of a drug knowing it may kill, but not intending death by its use). The use of opiates and sedation at the end of life with the knowledge that they may shorten life but not intending death is widely accepted in law as an exception to the crime of murder.

And it seems clear from polls that the Australian public would be comfortable if this point moved further up the spectrum, though there would be much disagreement about where it should finally rest.

There’s also good evidence that the overall comfort zone surrounding the allowing of death, the envelope in which this debate is nested, is moving quite quickly, so pressure to change conservative laws will inexorably build.

Saying what we mean

The debate about allowing or encouraging people to die is clearly on – the only question is about the rules. In the spirit of a genuine agnostic, I offer the following:

  • Let’s get rid of the word. If we don’t know what it means, and it carries unfortunate baggage, let’s give euthanasia a fitting death, and instead say exactly what we mean.

  • Let’s all acknowledge where our comfort zone lies, and how arbitrary and easily changed this is. There’s evidence that a bad personal experience of someone’s death will make us enthusiasts for euthanasia, irrespective of our religious backgrounds.

  • Let’s not get side-tracked by media interest in high-profile mercy killings, such as the one by Rodney Syme. This polarises opinion and stifles debate – the very essence of wedge politics.

  • Let’s not focus on the few who would benefit from mercy killing or assisted suicide (in Oregon where there is physician-assisted suicide, this constitutes half a percent of deaths), and instead attend to the remaining 99.5% and their need to be heard.

Regardless of its legality, mercy killing is for a tiny minority. In endlessly poring over the morality or legality of ending the lives of a handful, let’s not forget the experience of everybody facing death in a scary, hi-tech medical world where we rightly fear loss of all control at the end.

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