In Tuesday’s post, we looked at the history of euthanasia legislation in New Zealand, and compared it with that of Canada and the Netherlands. Let us now examine the various reasons for the legalisation of euthanasia in New Zealand. (Before you ask, yes, we’ll be examining reasons against the legalisation of euthanasia, and issues with the End of Life Choices Bill in the next post on this topic).
Unless you’re of the Calvinist bent, self-determination and autonomy will matter a great deal to you. Given that we can (largely) determine the course of our lives by our own will and daily decisions, it follows that we have the right to live our lives and determine our own course. Surely, this same self-determining capacity applies to the right to determine how and when we die.
This morning, you probably decided which type of cereal to have for breakfast. You may have decided to study neuroscience at university, or to pursue a career in plumbing instead. Our right to choose is a fundamental aspect of human life. It applies to all facets of human life, of which death is an inevitable part.
According to the principle of autonomy, each person has value and is deserving of respect, possesses basic rights and freedoms and has the right to make his or her own life choices. It thus follows that an individual should be able to choose how and when he or she will die, given that this decision does not interfere with the rights of others. To deny a terminally ill individual the right to die trespasses on her personal autonomy, and by extension, her humanity.
Indeed, to quote David Seymour,
“the difficulty is that an absolute prohibition on assistance in dying effectively creates a “duty to live” rather than a “right to life”.
Prevention of cruelty and protection of human rights
Perhaps the most important argument supporting the case for legalising euthanasia is the need to alleviate pain, misery and suffering. In circumstances wherein a person has no reasonable chance of recovering, it is far more compassionate and humane to allow that person a merciful release, rather than needlessly prolonging the suffering.
Regarding his motivation behind putting forward the End of Life Choice Bill, David Seymour said
“The motivation for this Bill is the very real anguish faced by people with terminal illness, as they anticipate the prospect of intolerable suffering, and the indignity of the final few days and weeks of their lives. While pain can be ameliorated somewhat, the suffering and indignity of that final period of life remains a profound concern to many people.”
The Hippocratic Oath
Naturally, this leads us to the Hippocratic Oath, historically taken by physicians. In its original form, the oath requires a novice doctor to swear to uphold specific ethical standards, including the principles of medical confidentiality and non-maleficence. The Hippocratic Oath is often misinterpreted as being against euthanasia.
The key element of the oath is that the physician must protect the wellbeing of their patient. A blindly literal interpretation of the oft-quoted ”do no harm” maxim ignores the fact that cases in which it is a choice between intense suffering or death, it can be argued that the physician is doing more harm to the patient by not allowing them to die.
Euthanasia is not immoral and does no harm to others
Euthanasia is often characterised as an “immoral” practice. Yet for something to be immoral, it must violate moral laws. Those who argue against euthanasia claim that human life must always be preserved and protected. However, the preservation of life should nevertheless be subject to the self-determined choice of the person in question, rather than the physician, or society at large. Murder infringes on a person’s right to life by removing the element of choice in the person’s death.
When it is the person who chooses how and when to die, no such infringement occurs. That a doctor in New Zealand can currently deny someone their right to die, when said person (such as Patricia Davison) is under intense pain and suffering, equates to forcing them to live a life without dignity; a life of pain and inevitable death. The Catholic Church in particular makes much of the ”beauty” and ”value” of human suffering. But no-one has the right to demand of another person to live a life of suffering. I’ve noticed that those who argue against euthanasia, despite a patient being terminally ill and in severe pain, are usually not the patients themselves.
It’s properly regulated
The history of euthanasia does not have a smooth and untarnished past, by any stretch of the imagination. Those who oppose euthanasia frequently bring up horror stories of patients being euthanised without their consent, in opposition to their wishes, or for deeply unethical reasons. It is evident that euthanasia really does need to be regulated properly. However, this is not to say that euthanasia cannot be properly regulated, as Oregon, has proven, for example.
In the next post on this topic, we’ll look at the regulations for the End of Life Choices Bill in greater detail, so stay tuned.
When I think of Switzerland, I think of smooth chocolate, snowy mountains, and inevitably, cuckoo clocks. I’m less inclined to think of something called “euthanasia tourism”, wherein terminally ill people travel abroad to countries where the right to end of life in terminal cases is recognised and lawful. That it is incredibly expensive to travel from New Zealand to another country where it is lawful for the terminally ill to end their lives is a form of discrimination between those who can afford legal euthanasia, and those who cannot.
Obviously, we cannot regulate the laws of Switzerland, or any other foreign country. Therefore, it is necessary that we create our own laws to regulate the issue of euthanasia within New Zealand. Moreover, we should not prosecute loved ones for helping a terminally ill person to travel abroad in order to access legalised euthanasia. The End of Life Choices Bill is only applicable to New Zealand citizens or permanent residents, so, in the event that the Bill was passed, we would not have an influx of overseas visitors coming to New Zealand to make use of our assisted dying laws.
It Save Lives?
This one’s a strange one. Not only does legalising euthanasia not significantly shorten life, it’s actually been argued to save lives. Consider the Netherlands, where progressive laws on assisted dying have been in place since 2002. In 2005, a study by the New England Journal of Medicine found that 0.4 percent of all euthanasia procedures were carried out without the patient’s explicit permission. Obviously, the fact that any such procedures are carried out without the patient’s explicit permission is deeply worrying, and needs to be addressed. However, an equivalent study conducted in 2001 (a decade before euthanasia was legalised) put this number at 0.8 percent. Essentially, legalising euthanasia in the Netherlands actually halved the number of unwanted deaths.
And while you might be tempted to argue that these findings aren’t applicable to the rest of the world, consider for a second the UK. A 2012 study found that as many as 57,000 patients in the UK die each year without being told that efforts to keep them alive have been halted. Essentially, they’re shuffled onto a pathway of palliative care (ostensibly designed to alleviate suffering), without being fully told.
Life becomes more worthwhile without fear of degenerating – a sense of relief
Personally, I am not afraid of dying. I am afraid however, of my body and my mind betraying me. I am afraid of becoming permanently confused and sad. I am afraid of my joints aching and my legs giving way under me. I do not want to become reliant on someone to feed me, change my clothes, and bathe me. I think most of us fear death because we do not know what the future holds. Perhaps if we knew when were going die, coupled with the fact that it would be painless, we wouldn’t be so scared. Indeed, one of my favourite authors, Terry Pratchett summed it up perfectly. After being diagnosed with a rare and especially debilitating form of Alzheimer’s disease, Pratchett said:
“As I have said, I would like to die peacefully with Thomas Tallis on my iPod before the disease takes me over and I hope that will not be for quite some time to come, because if I knew that I could die at any time I wanted, then suddenly every day would be as precious as a million pounds. If I knew that I could die, I would live. My life, my death, my choice.”
Indeed, to quote Sarah Elizabeth Mathieson in her thesis Live and Let Die,
“An Oregon study of patients who have sought access to assisted suicide from 1998 to 2013 shows that the principal motivations for seeking death are loss of autonomy (cited by 91.4 percent of people), loss of dignity (80.9 percent), decreasing ability to participate in activities that made life enjoyable (88.9 percent), losing control of bodily functions (50.3 percent) and fear of becoming a burden on family, friends and caregivers (40 percent).”
It won’t target the vulnerable
Understandably, those opposing the legalisation of euthanasia in New Zealand are often worried about it leading to pressure on the old, disabled and infirm to end their lives. It was only the other day that I received an email as follows:
“My issue is if it becomes legal, I can see it eventually being seen as a solution to hospitals being under resourced, or releasing families of their financial and/or emotional burden.
Middlemore hospital has for years been in a perpetual state of not having enough beds. Now imagine you have multiple people who meet the requirements for assisted suicide but wish not to, taking up those resources that could otherwise go to people who are not ‘terminally ill’ (I have a problem that with that term, but leaving that aside for now). There will be an unstated pressure on those people felt to “free up those resources”, so to speak.
Then there’s those who meet the criteria and who feel like they are a financial and emotional burden on their families. With euthanasia as a live option, they may see it as an act of benevolence, despite deep down not wanting to do it.
The current criteria proposal may be strict and narrow but I’m entirely unconvinced by arguments that suggest it will remain that way, years / generations down the track. I think it represents a massive cultural shift that will see individuals viewed (more so) through the lens of utility. And we all know who proportionately suffers the most when that happens. In this case, eventually, those who can’t afford end of life care, i.e. minorities.”
Let’s look at the precedent in other countries however, before we reject euthanasia altogether. In 1994, Oregon became the first state in America to legalise assisted dying. The law came into effect in 1998, and ten years later, the number of doctor-assisted suicides came to 341 deaths. That’s 341 people over the whole decade, so, effectively 0.2 percent of all patient deaths. Then, in 2007, the Journal of Medical Ethics examined the cases of every single patient who had opted for the service in Oregon, and found that the elderly, poor, minority – in essence, any “vulnerable” group – were represented as infrequently as everyone else. Basically, those considered “vulnerable” were no more likely to receive assistance with dying than any other demographic.
With regard to the End of Life Choices Bill, a disability does not render a person eligible to ask for assisted dying. The criteria are quite clear, involving terminal illness or a grievous and irremediable medical condition, advanced irreversible decline and unbearable suffering.
There are, of course, legitimate concerns over legalising doctor assisted dying. In the next post, we’ll consider the reasons we should be wary about legalising euthanasia in New Zealand. We’ll also tackle some niggly issues, and see what worked (and didn’t work) in other countries.
This article series was written and researched with the help of Jack Lawson, a freelance copywriter who lives in Canada and writes on tech, medicine, and law. He graduated Carleton University’s internationally acclaimed journalism program in 2014. In his free time Jack volunteers with accelerator programs, plays horrible music, and works on his web-serial, Fiddler.