Euthanasia and public perceptions

Experience has shown that people asking to be killed are saying they are fearful of pain and neglect. A request to be killed is usually a call for help - a call for more loving and caring treatment. With compassionate care most people regain the desire to live.

Death is a process that takes place over a period of time. It involves several stages. The death process has reached an irreversible state when there is lack of brainwave activity over a specific period of time. Prior to that state, breathing, or the heart, or both, may stop but the death process may not be irreversible at this time.

If the death process has already reached an irreversible stage, then active resuscitation is not needed and should be withheld. Nevertheless, no person should be permitted to kill or hasten the death process in such a patient. Ordinary care such as warmth and nourishment and general nursing care should be provided until the patient is pronounced 'dead'.

Euthanasia is the deliberate and intentional killing of a human being by a direct action, such as a lethal injection, or by the failure to perform even the most basic medical care such as the provision of nutrition and hydration, necessary to maintain life. For euthanasia to occur, there must be an intention to kill.

Euthanasia has usually been proposed only for those with terminal illness with severe suffering, but more recently the concept has been extended to include persons who wish to die for some relatively trivial social reason, such as being depressed or tired of life.

Those who care fulltime for the dying rarely encounter a request to be killed, and when they do it is almost always associated with depression or an intractable social problem. The advocates of euthanasia give the impression that there is a great need for it, but they never provide any evidence to support this view. The reasonable conclusion is that when dying persons are well cared for they have no need to ask to be killed.

These circumstances are not euthanasia

The ceasing of medical treatment which is unwanted, or is imposing excessive burdens on the patient, or is incapable of providing any benefit, or

The use of drugs in doses sufficient to relieve very severe pain. The use of pain-relieving drugs is limited only by the side-effects produced by those drugs. Such drugs rarely endanger life unless used deliberately in extremely high doses to those unaccustomed to receiving those drugs.

Medical actions intended to relieve suffering are ethical and lawful, as are the withdrawal of treatments that are only unnecessarily prolonging dying. Though the patient may later die of his terminal illness and though such death was foreseen, death was not intended by what was done. To describe these practices as euthanasia is misleading. Good medical practice is NOT active killing.

It is extremely important to understand the difference between killing and letting die, when the person has expressed a preference to die, but it is a difficult concept for some, and can give rise to confusion.

When life-sustaining treatment is withdrawn for the reasons listed earlier, where the intention is to relieve suffering, the natural course of the underlying illness which has been temporarily stayed is thus allowed to run. If the diagnosis is correct death will then result from this illness which was always going to be the eventual unavoidable cause, and this cause is recorded on the death certificate. Until death occurs, every means of providing comfort must be maintained.

Euthanasia is different in its nature and its intention. Death is now the sole intended and the sole possible outcome, and is not due to any natural cause, even in those with terminal illness. It is chemically induced so that a new and otherwise impossible cause of death has been substituted for the one that was to be expected.

From both the ethical and legal viewpoints, making a person die is different from letting a person die when it is medically proper to do so. If the death certificate is honestly completed, it will tell the story. Even the nature of the person’s request is different; one risks death and the other seeks it. Prescribing for death would be unlike any other medical action.

What practices would be involved?

Voluntary euthanasia – refers to patients who are mentally competent and who ask to be killed in order to relieve either physical or emotional distress that they declare unacceptable. In response, someone would intentionally kill them. Although those who advocate euthanasia do not like the use of the word ‘kill’ it is the only accurate, non-emotional word to describe the reality, and it is the word which the law uses. (A term such as ‘self-deliver’ is preferred by euthanasia advocates.)

Assisted suicide – refers to a situation where a person would be provided with the means of committing suicide and then would personally perform the act.

Involuntary euthanasia – less commonly discussed - refers to people whose consent is not sought or given, or who cannot express their wishes, because of immaturity (a newborn infant), mental disability, mental or physical illness or coma. In these instances it is decided by others that the person would be better off dead.

Euthanasia has been proposed because it is not widely known that modern care of the dying, called palliative care, can now effectively relieve almost all severe pain and significantly relieve emotional distress. Both those who wish to relieve distress by appropriate care and those who propose killing through ignorance are motivated by compassion. But there are enormous differences in the two approaches, involving morality, medicine, the law, and the good of society.

Euthanasia is said to be an expression of such things as death with dignity, the right to die, autonomy and so on. For the most part these are used as slogans without understanding their true meanings. Dying persons are treated with true dignity when their genuine needs are met by providing effective, loving care which values the worth of every fellow human, in distress or not.

Although a right to die is claimed, what is meant instead is a right to be killed. There has never been a right to be killed in any code of ethics. It is a spurious concept, and no argument is ever made to support it. The right to respect for one’s autonomy is different, in that it is a genuine human right, but one which is often misunderstood. In the context of euthanasia, it is implied that a person’s wish to die must be so respected as to give it power to bind others to act.

That is both simplistic and wrong, since nobody may have anything in life just because he or she asks for it, no matter how sincerely. Since there is no right to be killed, others are not required to kill, nor should they do so.

The voluntary euthanasia movement reflects that part of our society that cannot accept or understand illness, suffering or death. Euthanasia might seem to solve the problems of troubled individuals in its own way, but would do nothing to prevent others from falling victim to similar problems.

What is needed is better care for all, so that no one will feel the need to ask to be killed. It is unbalanced thinking to propose the elimination of the person in distress in preference to the elimination of distress in the person.

Who would do the killing?

It is usually assumed that the medical profession would do the killing despite the fact that almost every medical association in the world forbids euthanasia as being unethical.

In the context of any illness, the doctor’s role is to alleviate suffering, not to kill. The doctor/patient relationship that is based on trust would be severely damaged. If euthanasia were available, the motivation to improve patient care and to see advances in medical science would be lessened.

If doctors don’t do it – then who would? Seeking an answer to this question would involve the community in a great deal of useful soul-searching, as it would have to focus on the grim realities of the proposal. At present it can hide from the unpleasant facts - it pretends that it would be a simple clinical exercise, done by someone else in a white coat, out of sight.

General public attitudes towards euthanasia

Since 1962 a Morgan Poll has asked: “If a hopelessly ill patient, in great pain, with absolutely no chance of recovering, asks for a lethal dose, so as not to wake again, should a doctor be allowed to give a lethal dose, or not?”

In October 1962 the response to this question was that 47% responded that the doctor should give a lethal dose, 39% responded that the doctor should not give a lethal dose and 14% undecided.

By June 1995 the figures were 78%, 14% and 8% respectively with support for the doctor giving a lethal dose having risen steadily in the interim.

It would be hard for an uninformed person to answer NO to the question without feeling negligent, dogmatic or insensitive.

But what if the question was rephrased as follows: “If a doctor is so negligent as to leave a terminally ill patient in severe pain, for whatever reason, severe enough to drive that person to ask to be killed, should the doctor then be able to compound his negligence by killing his patient, instead of seeking help?”