In recent years, the “Death with Dignity” [1] movements have been racking up victories. Thirty years ago, only Switzerland allowed assisted deaths. Today, no less than 12 countries and 10 states plus the District of Columbia sanction (or decriminalize) euthanasia (where the doctor administers a lethal drug) and Medical Assistance In Dying (MAID), when the patient does the deed.
Assisted dying has been legal in Canada since 2016, allowing euthanasia/MAID for those suffering chronic disability – even if not life-threatening, coupled with an “unbearable suffering” subjectively determined by the patient. Nevertheless, medical institutions are still free to ban it within their facilities. In 2019, the Quebec Superior Court found Canada’s MAID law too restrictive. While current legislation excludes eligibility for MAID for individuals with a mental illness, this will change in March 2023 when Canada will allow it for those suffering “unbearable” mental illness - even without physical distress.
We’ve come a long when from early euthanasia statutes, which allowed it only for adult patients, who were of sound mind, and diagnosed with less than six months to live. Today, three countries (Belgium, The Netherlands, and Columbia) allow it for children.
“[T]he [Netherlands] law allows [euthanasia] … if the child is capable of discernment and conscious at the time of the request for euthanasia.” [emphasis added]
European Institute of Bioethics
(One wonders whether the inclusion of “and conscious” was due to fear that children might be culled when unconscious).
By comparison, in Germany, there is a right to assisted suicide, just no right to acquire the necessary drugs. In March, Spain became the fourth European country to legalize euthanasia/MAID. In November, Portugal passed a similar law; although three weeks later, their President vetoed it.
Now prisoners are seeking this “right.”
Most authorities are reluctant, as the conventional ethical analysis regarding prisoner-use is more straightforward than for those whose liberty has not been encumbered by the criminal process.
- First, it is difficult to guarantee that prisoners are making autonomous choices. Indeed, medical research on prisoners is expressly prohibited because prisoners are deemed incapable of giving truly informed consent.
- Second, “assisted dying” is too akin to capital punishment, which is banned in most of these jurisdictions.
- Third, choosing death seems like cheating society of its power to punish with lengthy incarcerations.
As for the rest of us, the debate rages on.
“[W]hen it comes to the deliberate ending of someone’s life, we need to call it what it is.”
Recently, the UK’s Anscombe Commission commissioned research addressing the subject. One paper pointedly noted the often vague terminology used by proponents, which blurs realities by implying:
“that EAS [euthanasia or assisted suicide] is a legal or human ‘right’, that it always or typically provides ‘dignity’, that it is an authentic or beneficial ‘choice’, that it is properly ‘medical’, and that terminating someone’s life is ‘assisting’ them through the dying process…. implications [which] are not generally accepted other than by those who are already in favour [sic] of the legalization [sic] of EAS.” -David Albert Jones, Professor and Director Anscombe Bioethics Centre
Even beyond the moral objections, opponents cite the impact of euthanasia/MAID on providing optimum care:
- “To ensure patients remained eligible, medical staff have had to withhold medications which would have otherwise removed or alleviated their pain.
- “Simply mentioning the existence of MAID can be interpreted as an invitation to the patient to request this assistance to die,” complicating the relationships of palliative care providers with their patients.
- Some people believe that assisted dying is the same as palliative care
- Disability rights advocates also object to the expansion of MAID/Euthanasia because it devalues the worth of disabled persons.
Equally vexing are the rather cavalier recommendations by proponents to allow those who feel they have lived a complete life to exit- stage left, right, or whatever - whenever. In 2020, the liberal D66 party of the Netherlands proposed a law to furnish suicide pills to those over 75 who felt they were done living.
Euthanasia in Newborns:
Perhaps even more disturbing is the increased use for newborns – “for whom there is no hope of a bearable future,” a decision increasingly made by Flemish doctors. While this practice is illegal, an article published by the European Institute of Bioethics called the practice “physician infanticide” noted that no one seems to care.
“[These] children had a real chance of survival, but the medical team… considered that their lives were not worth living to the end.” European Institute of Bioethics
Yet, the practice doesn’t seem rare, at least according to one recent study:
“In 61% of all deceased infants, an ELD [end-of-life decision] preceded death. Non-treatment decisions including withholding …and withdrawing treatment …Drugs are administered in 24% of cases, including medication with a possible …and explicit life-shortening intention ….”
Euthanasia/MAID has become so accepted in Belgium that it’s now responsible for about 1 in 50 deaths. Indeed, the Belgian euthanasia commission provides a glowingly positive report claiming that miserable people, supported by their loved ones, are released from their suffering, that all the doctors comply fully with the law, and there are no difficulties or abuses.
However, a bevy of lawyers hired by the patients’ families has recently sued Belgian physicians claiming they’ve gone too far. “Most of the threats involve patients who want to be euthanized because of “unbearable” psychological suffering, confirmed by a doctor. Their relatives believe that the doctors’ assessment is wrong.”
The cases haven’t all succeeded- but it appears that even the threat of being tried for murder based on criticism by family members has had a chilling impact on medical decisions to euthanize, with 78% of physicians “less willing to perform euthanasia….” Nevertheless, according to health law specialist Christophe Lemmens, a member of Belgium’s euthanasia commission, the law is clear: the only voice that counts in choosing euthanasia is the patient’s. Relatives have no authority whatsoever to intervene.
That sounds neat and tidy. But consider the case of a Dutch woman with severe Alzheimer’s Disease. Before the woman became afflicted with dementia, she had made an advanced directive – a written request for euthanasia– which the doctor prioritized over her current state of mind. She awoke during her euthanasia and struggled as family members held her down, so the drugs act. The High Court clarified that doctors could not be prosecuted for euthanizing patients with advanced directives- even if they no longer express an explicit wish to die.
What the Future Portends
A recent commission convened by Lancet included a forecast of increased future “assisted dying” predicting that:
“Assisted dying ]will] become... a component of universal health care…available …to all people with unbearable suffering, those developing dementia, and those who are ‘tired of life’… [I]n some countries up to a quarter of people die in this way.”
Honorary Professor of Law and Politics, Dr. Celia Kitzinger
The sad truth is that many who choose this option due so out of concern (not necessarily validated) of burdening their families. Others choose it out of loneliness, exacerbated by COVID lockdowns (as I wrote about here), or because they don’t have support, financial, social, or medical. These are manifestations of a societal failure – ones that don’t devolve from the patient’s medical or mental condition – and these are problems that should invoke social assistance - not population culling. Indeed, as we legitimize – even encourage – this death strategy, we spend less money and less effort on developing palliative care.
Media coverage has worsened the problem, normalizing even hagiographizing the process, reporting on “celebrity endorsements” and euthanasia cases donating organs. While the latter is laudable, it also puts subtle pressure on older members of society “to terminate their lives for the benefit of others.”
“Once suicide via euthanasia becomes an acceptable answer to human suffering — which is the fundamental principle underlying the right-to-die movement — there is virtually no limiting principle. Over time, as people get used to the death agenda, “protective guidelines” are redefined as “obstacles” to “death on your own terms.” And the laws loosen.” Wesley J. Smith
The slippery slope is not imaginary any longer. We are treading on it. Perhaps before we continue liberalizing euthanasia/MAID, we might want to step backward, identify what can and has gone wrong, and set boundaries engraved till infinity, acknowledging there are limits to how far we should ever go.
