Friday, October 17, 2014

Margaret Somerville: Should Canada permit assisted suicide.

This article was published by the Globe and Mail on October 15, 2015 as one of two articles comprising a debate between Margaret Somerville and Arthur Schafer.
Assisted suicide leads to normalization of euthanasia, harms the vulnerable and degrades our respect for the value of human life.
Margaret Somerville
By Margaret Somerville:

Euthanasia and assisted suicide go beyond personal ethics to involve social ethics. Advocates frequently resort to a personal story, often that of a suffering relative, to explain their stance. They avoid asking the question, “What does it say about a society that deals with the big problems of human existence by legalizing the ‘quick fix’ of inflicting death?” Such a society is abandoning the great philosophic traditions of Western civilization. Everything now depends only on majority opinion and technological capacity.

Moreover, euthanasia differentially implicates the most vulnerable members of a society. We can’t judge the ethical tone of a society by how it treats its strongest, most privileged, most powerful members, but by how it treats its weakest, most vulnerable and most in need.

The strongest case for legalizing euthanasia and physician-assisted suicide is at the level of the individual person, such as Sue Rodriguez or Dr. Donald Low, whose heartbreaking pleas for euthanasia rightly move us.

But we must also consider where such legalization would lead and what its impact would be on other people, the institutions of law and medicine, and the foundational values of society. And we must take into account, not just its impact in the present, but also in the future. Ask yourself: “How do you not want your great-great grandchildren to die?” As current reports from the Netherlands and Belgium, where euthanasia and assisted suicide are legal, show, euthanasia will be normalized and we will see an exponential increase in its use in ever broadening circumstances. That is, slippery slopes are unavoidable.

Initially, claims are made that euthanasia will be used only in rare cases on competent, consenting, dying adults who are in unrelievable pain and suffering. But these requirements don’t last. In the Netherlands, at least 4 percent of all deaths are by euthanasia and in Belgium on average there are five cases a day. It’s not rare. Children with disabilities can be euthanized (with their consent) as can those who are mentally, but not physically, ill or who wish to avoid future suffering. Belgium is currently debating euthanasia for people with Alzheimer’s Disease. Euthanasia is now so normalized only extreme cases make the media, such as two very recent ones, a prisoner who received euthanasia for unbearable suffering caused by imprisonment and an old lady who chose euthanasia instead of a nursing home, which she dreaded.

People are afraid to accept palliative care or necessary pain management because they fear euthanasia. We must be able to reassure them that we will kill their pain, but never intentionally kill them and we can’t do that if euthanasia or assisted suicide are legalized.

Seeing death as an appropriate response to suffering raises serious problems with respect to suicide prevention in general. It establishes suicide as an appropriate response to suffering. And society’s agreement to help elderly and vulnerable persons to kill themselves or to allow physicians to kill them sends a powerful message that their lives are not worth living. State-sanctioned suicide and euthanasia ask not that we attempt to preserve life -- the normal role of medicine and the state -- but that we accept and act communally upon a person’s judgment that his or her life is unworthy of continuance and become complicit in ending it.

And legalized euthanasia is abused. Just as we don’t report driving through a red light, doctors and nurses acting outside the law don’t report those cases. Abuse of old people with euthanasia is especially likely and should be seen as a major public-health threat. The combination of an ageing population, scarce healthcare resources and euthanasia is a lethal cocktail.

Confusion is used to promote public acceptance of euthanasia: Concealing language such as the euphemism “medical aid in dying.” An Ipsos marketing survey showed 60 per cent of 1000 Quebecers did not understand that this phrase meant a lethal injection and 40 per cent of just over 2000 Canadians did not comprehend that euthanasia meant that. Similarly, the “no difference” argument that assisted suicide is only an incremental extension of rights to refuse treatment that result in death promotes euthanasia through confusion. There is a radical difference between allowing a natural death to occur and killing a person.

This debate involves a clash of the values of respect for life and respect for individual autonomy. Anti-euthanasia advocates give priority to respect for life, pro-euthanasia to respect for individual autonomy.

But all societies in which reasonable people would want to live need to uphold respect for both each individual human life and for human life in general. The Charter of Rights and Freedoms affirms this for Canada. And legalizing euthanasia would harm the ability of medicine and law to carry the value of respect for life, as they must do for a secular society.

Just as we now realize our actions could destroy our physical ecosystem and we must hold it in trust for future generations, we must also hold our metaphysical ecosystem — the collection of values, principles, beliefs, attitudes, shared stories, and so on that bind us together as a society —likewise, in trust for them. That requires that we reject euthanasia, but always react to pain and suffering with deep compassion and assistance to relieve it -- that we kill the pain and suffering, not the person with the pain and suffering. That requires that everyone who needs it receives good palliative care. At present at least 70 percent of such Canadians have no access, which is appalling and a serious breach of ethics.

Might, however, the strongest argument against euthanasia relate not to death, but to life? That argument is that normalizing euthanasia would destroy a sense of the unfathomable mystery of life and seriously damage our universal “human spirit,” especially our capacity to find meaning in life, that which makes life worth living.

To legalize assisted suicide and euthanasia is not an incremental change. It’s a seismic and radical change in one of the most important values on which our society and civilization is founded, respect for human life and its protection. We must employ our ethical imaginations to appreciate that and act accordingly.

Margaret Somerville is the founding Director of the Centre for Medicine, Ethics and Law at McGill University and professor in faculties of Law and Medicine

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