Patients overwhelmingly refuse the option of assisted death.
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| Gordon Friesen |
President, Euthanasia Prevention Coalition
In an earlier post on this blog I began a list of key reasons to oppose euthanasia and assisted suicide (Part 1). I started with the social importance of maintaining a categorical prohibition of homicide.
Our adversaries predictably respond to such arguments with their own primary claim: that an exception must nevertheless be made because the people directly concerned truly wish to die.
I believe we may ourselves emphatically reply to this claim with one word: NO.
That leads us to my Key reason #2: People eligible for Assisted Death (meaning euthanasia in Canada and assisted suicide in US) do NOT typically wish to die, nor will they typically consent to die in that fashion.
To be more precise and according to present clinical observations: at least NINETY PERCENT of all patients eligible for assisted death DO NOT WILLINGLY SUBMIT to that procedure REGARDLESS OF MEDICAL CIRCUMSTANCES.
(N.B. Such a bold claim of fact obviously demands clear proof, and I am pleased to present that proof in the concluding section of this commentary. To preserve a fluid narrative, however, I will first jump to the practical significance of these facts, in argument and in practice.)
What does it mean for euthanasia that (statistically speaking) people don't want to die that way?
Prior to widespread legalization of assisted death, all debate was wrapped in theory and conjecture. But as hinted above, that is no longer true. From a scientific perspective we must now concede that the hypothetical identification of a natural death-wish among certain patient populations has been rigorously tested, by an extended period of experimental legalization which has conclusively refuted that hypothesis.
Considered from a majority perspective therefore: the science (as they say) would unambiguously counsel us to stop this failed experiment and repeal all euthanasia-enabling legislation at once.
None of this, to be sure, should be taken to imply that the euthanasia phenomenon is actually too small to be of consequence. Not at all. Over 15,000 people died of euthanasia in Canada in 2023. That is an astounding number of medical homicides. And yet there is an equally important difference between the absolute size of a number and its proportional meaning in context.
It is only suggested here, that a proportional request rate of 1 in 10 eligible patients (even if entirely voluntary) cannot possibly justify the prioritization of assisted death which we observe today. Indeed, there is something deeply sinister (with far reaching political implications) about imposing this utilitarian medical agenda under a justification by personal choice, but against the clearly demonstrated collective will of those concerned.
(Our adversaries, of course, will surely retort that minority desire, also, deserves expression and respect.)
The proper place (if any) for a minority accommodation of assisted death.
In the modern policy lexicon we find a very interesting concept of "centering" which speaks to the wisdom of appropriately prioritizing minority interests in the public sphere. The centering of a marginal suicidal patient death-wish, however, has nothing in common with such positive examples of minority empowerment as the centering of disabled accessibility requirements in public buildings. Nor can the majority cost of this policy be discounted as a mere passing irritation, born of novelty. The Majority of patients interest and safety are severely compromised by the practices of euthanasia and assisted suicide. There is no legitimate minority claim, therefore, for the centering of assisted death.
Unfortunately, however, the often irrational theater of political compromise (particularly in the face of of actual legalization) has made the frank rejection of assisted suicide, and euthanasia, impossible in many jurisdictions at this time.
It thus becomes imperative to insist on a coherent political understanding of the simple quantitative facts presented here. Typical patients, of the vast non-suicidal majority, should always be served (by default) in Assisted Death-free institutions, by physicians and nurses who can be trusted never to suggest or to collaborate with assisted death in any form.
Only outside of this secure clinical environment might any minority accommodation ever be contemplated, and always limited to a scale which is proportional to real observed demand
The facts and nothing but the facts: demonstrating the marginal presence of patient death-wish
Euthanasia has been practised in the Netherlands and Belgium for over 20 years. It has been practised in the Canadian Province of Quebec for 9 years, and in the whole of that country for a little more than 8 years. We therefore possess an excellent body of data to inform us of the real popular response to assisted death.
We are not talking, here, about democratic support for the hypothetical freedom to choose. We are rather talking about the real instance of choices actually made. For it is to that measure that real policy should coherently respond.
A quick indication of the popularity of assisted death (in any given jurisdiction) may be found in the rate of AD to total deaths. By this measure, the Netherlands and Canada are the most prolific countries in the world having rates of 5.3% and 4.6% respectively. This means that roughly 95% of people (one way or the other) still die a natural death. However, we can't say that all of those people have refused euthanasia, because there are accidental and sudden deaths where that choice is not possible.
In the interests of fairness, therefore, let us examine that category in which the choice of euthanasia is most popular of all, which unsurprisingly concerns the terrifying prospect of terminal cancer. Indeed, on average, for our two countries, cancer causes only 28% of all deaths but results in no less than 60% of all euthanasia. Most interesting, however, is the observation that among all patients in this extreme category, in those two countries possessing the highest acceptance of euthanasia (and where all terminal cancer patients are systematically informed of that option) only 1 in 10 will choose, or consent, to die in that manner.[i]
Hence we are rigorously correct in concluding that the highest participation rate ever recorded, in any medical circumstance, in any jurisdiction --after nearly a quarter century of trial-- is no more than 10%.
To recapitulate
1. The demand for assisted death is a marginal phenomenon arising among a small minority of patients;
2. Considering the proportion of those eligible individuals actually requesting this death it can (and should) be vigorously argued that no practice of assisted death, whatsoever, is reasonably justified;
3. In the real world of political compromise (where assisted death has already been legalized) it must be our task to lobby for the limitation of that practice to a marginal accommodation only, commensurate with the small minority who really desire it.
Above all: we must use these facts to defend our collective interest in maintaining a medical "safe spaces" which is safe for the non-suicidal majority, and thus to reject policies which would threaten that safety by artificially centering objectively marginal suicidal desires.
[i] Note on Canadian and Dutch cancer euthanasia as a fraction of all cancer deaths:
- Canada total deaths: 330,380 total deaths (Link)
- Canada euthanasia deaths: 15,280 (Link)
- Canada total cancer deaths 86,700 Cancer fraction of all deaths .26 (Link)
- Canada euthanasia fraction of all deaths .046 Cancer deaths fraction of all euthanasia deaths .63 (Link)
- Canada cancer euthanasia fraction of all deaths (.046 x .63) .029
- Canada euthanasia fraction of all cancer deaths (.029/.26) .11
- Netherlands total deaths 170,100 (Link)
- Netherlands total cancer deaths (2022) 49,790 (Link)
- Netherlands (2023) total euthanasia deaths 9068; cancer euthanasia deaths 5105; (Netherlands euthanasia reports)
- Netherlands cancer fraction of total deaths: (49,790/ 170,100) .29
- Netherlands euthanasia fraction of total deaths: (9068/ 170,100) .053
- Netherlands cancer deaths fraction of total euthanasia deaths: (5105/ 9068) .56
- Netherlands cancer euthanasia deaths fraction of all deaths (.56 x .053) .03
- Netherlands cancer euthanasia deaths fraction of all cancer deaths (.03/.29) .10
Thank you for this article which gives lots of food for thought. In Canada it's easier to get MAID then treatment to extend life and give quality of life to sufferers.
ReplyDeleteThe interesting thing is that people still refuse it, even though it is easier. And facts are stubborn things. The numbers do no lie.
ReplyDeleteI am hoping that doctors will begin to understand that the choice they are offering is not an equal choice. That it is marginal in its nature. That it is, frankly, pathological to choose to die. I am hoping that doctors will encourage the life-wish in the patient, not use their authority to attempt to talk them into giving their consent to be killed.