A wolf in sheep’s clothing: Physician-Assisted Suicide (Euthanasia)

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Author: Jonathan Chio

A recent unanimous decision made by the Supreme Court of Canada to permit physician –assisted suicide (PAS) breathes new life into the ethical landscape of facilitating suicides amongst terminally ill patients. It begs to ask what is more important; promoting sanctity of human life or protecting autonomy? Through this Viewpoint article, I will advocate for the impermissibility of euthanasia and that permitting PAS will regrettably weaken our society’s respect for human life.

Before discussing my stance, for readers unfamiliar with this field of medical bioethics and philosophy, I’d like to define terminology relevant in this debate. Euthanasia can be categorized into different practices. If a competent patient requests for the health care provider (HCP) to end the patient’s life, it is voluntary active euthanasia (VAE).1 In contrast, if the HCP is requested by the patient to cause death by withholding or withdrawing treatment, this is voluntary passive euthanasia (VPE). Euthanasia can also be described as non–voluntary or involuntary. The former occurs when a surrogate decision maker requests active or passive euthanasia on behalf of an incompetent patient, whereas the latter describes a competent patient who is either killed or has treatment withheld or withdrawn without self consent. A slippery slope argument suggests that one exception to a law will be followed by more exceptions until a point (that would initially be perceived as unthinkable and outrageous) is viewed as acceptable.

Through adopting PAS, Canada joins an exclusive list of locations (Netherlands, Belgium, Luxemburg, Switzerland, and various selective states in the USA) where PAS is fully available to all mentally–competent patients with terminal illnesses.1 Proponents for the permissibility and righteousness of PAS (and moreover, VAE and VPE) cite three main reasons:

  1. Euthanasia gives patients the gift of self-determination.
  2. Euthanasia provides patients with a humane and peaceful death.
  3. Evidence from a series of empirical studies conducted in Netherlands suggest that responsible practice of euthanasia is practical and achievable in a country that sponsors good values and allocates appropriate levels of social and monetary resources towards creating an easily accessible and high quality educational system.

Undeniably, Canada fits the aforementioned description (reason 3) well. To prevent misuse and abuse of the euthanasia practices, Canadian legislative bodies have established laws and safeguards which must be met for PAS to be eligible. However, these barriers are futile at protecting the moral aspects of euthanasia practices. More importantly, they distract us from a grave reality where society harbors rapidly decaying levels of respect for human life.

In the argument against permitting PAS, VAE and VPE, one of my biggest allies is Daniel Callahan.1 He condemns the act of euthanasia through a series of skillful arguments. Callahan simultaneously targets the first two reasons (where euthanasia gives patients autonomy towards self-determination and access to a humane death) by the following analogy:

“If it is not permissible for another person to make you their slave despite your personal desire to live in misery, then it is unacceptable to award the HCP with the right to kill despite obtaining patient’s explicit written consent.”

With the aforementioned analogy, Callahan further argues that the right to self–determination and to have greater control over a more peaceful process of dying are insufficient towards sanctioning HCP with the right to kill. His assault on euthanasia continues when he advocates that permitting PAS (and furthermore, VAE and VPE) will unfairly place blame on the physician in having moral and physical responsibilities in a patient’s death. Specifically, it implies that death is wholly due to medical malpractice and views the failure for a physician to administer treatment (as in VPE) as identical to killing a terminally ill patient.

To address the third argument in favor of euthanasia, Callahan views that legislature governing euthanasia will create a slippery slope that ultimately, though inadvertently, leads to IE. Despite empirical studies suggesting that euthanasia can be legalized without fear of abuse,1 results and conclusions cannot be applied universally. In fact, recent grim evidence demonstrates that in locations where euthanasia is legalized, the contrary is becoming an unfortunate reality.

In the Netherlands, reports suggest that more than 500 people experience involuntary euthanasia annually.2 Administration of lethal substances without explicit consent accounted for 0.4% of all deaths. Furthermore, the slippery slope is rapidly developing, as euthanasia for anyone over age of 70 who is “tired of living” is now being considered. In Belgium, the rate of non-volunary or involuntary euthanasia are three times higher than in the Netherlands.3 Furthermore, since attempts at bringing these cases to trial have failed, this suggest that the judicial system has become more tolerant and lenient over time of such transgressions.2, 4 Permitting PAS will cause us to perceive that lives of the terminally ill are less valuable than healthy individuals and that VAE and VPE are cost–effective methods for treating terminally ill patients.1,2 What’s more, cases have been reported in Netherlands where dying patients were euthanized to liberate hospital beds.2,5 Thus, ample evidence demonstrates that minor benefits gained by legalizing PAS, VAE, and VPE, cannot remotely compensate for its severe and far–reaching consequences.

Despite Canada’s new legislative decisions, I strongly urge our law makers to thoroughly discuss and ensure that statutes governing PAS, VAE, and VPE are as immune to abuse as possible. Belgium and Netherlands are prominent examples where euthanasia practices are exploited due to faulty legislature. For history to not repeat itself, it is imperative that we learn from their mistakes. If PAS is to remain legal in Canada, I vehemently recommend that it be secondary to palliative care even though it will require additional time and emotional commitments from the physicians.2 Strict guidelines describing the non–subjective evaluations used to determine the extent and quality of suffering experienced at which PAS, VAE, and VPE are options must be introduced, enforced, and obeyed.

References

  1. Fisher J. Biomedical Ethics: A Canadian Focus. 2nd ed. Oxford University Press; 2009.
  2. Pereira J. Legalizing euthanasia or assisted suicide: the illusion of safeguards and controls. Curr Oncol. 2011;18(2):e38-e45.
  1. Van den Block L, Deschepper R, Bilsen J, et al. Euthanasia and other end-of-life decisions: a mortality follow-back study in Belgium. BMC Public Health. 2009;9:79.
  1. Smets T, Bilsen J, Cohen J, et al. The medical practice of euthanasia in Belgium and the Netherlands: legal notification, control and evaluation procedures. Health Policy. 2015;90(2-3):181-7.
  1. George R, Finlay I, Jeffrey D. Legalised euthanasia will violate the rights of vulnerable patients. BMJ. 2005;331(7518):684-5.