Euthanasia: the topic that will not die
Many of us are not strangers to the voice of an individual, pleading to be allowed to die because of their unbearable pain or incurable disease. The euthanasia debate has centred on individuals such as these. But this does not recognise that the call for legalising euthanasia often comes from people not yet debilitated, but anticipating the need to maintain their options if ever they reach a state of unbearable pain, mental incompetence or physical indignity.
The euthanasia debate explores the limits of personal freedom, political power, limited health dollar, an ageing population, and the ethical challenges of an increasingly secular and pragmatic society.
Dr Roger Magnusson, of the University of Sydney, recently contributed to the debate by publishing research demonstrating that euthanasia already occurs within Australia, albeit illegally. The study focused on the occurrence of euthanasia within the gay, HIV/AIDS community, and sought to demonstrate how the presence of conditions such as HIV, which impact on a previously strong and healthy individual, have influenced the call for euthanasia. The findings, published in Angels of Death: Exploring the Euthanasia Underground (Melbourne University Press, 2002), reveal troubling occurrences of euthanasia, including “botched” attempts, euthanasing patients previously unknown to the doctor, patients bringing their death forward to fit in with doctors’ holidays and, in one case, where a doctor killed his patient because he had a cold and wanted to go home.
Apart from these reports regarding the nature of illicit euthanasia, it may be of more concern that this study reveals an informal though highly organised “euthanasia underground” within Australia.
The current euthanasia debate is centred on hypothetical “ifs”; the impact of Magnusson’s study is that it identifies the reality of the situation—that people are being euthanased not only illegally, but inappropriately, and in a less than humane manner.
While acknowledging that the debate is difficult because of the strong arguments on either side and the difficulty in predicting the outcome of any change, he expresses concern that people with a wish to die aren’t receiving the peaceful death they’ve chosen.
And while legislation might not eradicate informal and illicit euthanasia, it would at least provide a safety valve of informed choice for patients seeking euthanasia, preventing grotesque and highly unprofessional death.
Magnusson suggests that “euthanasia policy is not a choice between having no euthanasia and making euthanasia legal. It is a choice between driving it underground and seeking to make it visible.” This may seem to be side-stepping the issue for those who have a moral objection to personal involvement and believe even mercy killing to be inherently wrong.
Despite these individual inhibitions, the question of harm-minimisation policy should be considered in the face of current illicit practice. “It is important to consider the distinction between wise social policy and individual morality,” suggests Magnusson.
Opposition to euthanasia policy from professional medical bodies may not be on the grounds of moral objection but the desire for professional autonomy. Within the medical community, there is a general resistance to the regulation of practice.
Magnusson suggests that it may be of benefit for medical professionals to discuss concerns and issues from the varying points of view regarding euthanasia. He would like the Australian Medical Association and the Royal College of Nursing Australia to recognise that their members are involved in these activities and compile a list of issues that need to be explored by someone who may be assisting a patient to die. This would be better than the current “non-existent, impaired assessment,” which allows “fundamental mistakes” to be made.
“Professional bodies which do not support legalisation have a responsibility to contribute to the debate by discussing how to prevent abuse,” he says.
Medical professionals are confronted with death regularly. The emotional trauma of constantly caring for the dying can result in the “projection of feelings.”
Patients with a terminal illness may ask about euthanasia as an opening to discuss their grief, their decline and the choices available to them. A medical professional who is not coping may misread these requests and project their own feeling that euthanasia is preferable to decline onto the patient.
This raises the question, If medical professionals were better cared for psychologically, would palliative care be more effective? Personal and profession boundaries of health-care workers create further emotional issues, states Magnusson. Because a close relationship is formed with a patient as one provides intimate care, health-care workers need to develop highly sophisticated coping mechanisms in order to carry out their role. Some professionals may feel it is less emotionally draining to kill their patient than to watch them die naturally.
Current laws and the pressure that litigation has placed on the health-care profession have resulted in a double bind in regard to treatment of patients who are dying. Health professionals are legally required to take all measures unless a “not for resuscitation” order has been signed. Because of this, patients may be on life-support against the wishes of the family and, in such circumstances, treatment is ceased.
Magnusson points out that it is disingenuous for the law to differentiate between turning a ventilator off and administering a lethal injection as the intent and the result of both actions are the same.
Along with the issue of projection of feelings, opponents of euthanasia have cited the “slippery slope” argument, which suggests that legalising voluntary euthanasia may lead to involuntary euthanasia among our elderly and disabled.
“It would be a tragedy if the long-term effect of euthanasia legislation was to push self-effacing and despondent patients over the edge, perhaps to relieve their loved ones from the worry of looking after them, or to conserve family assets,” he writes. However, “It remains to be shown that people will kill patients because it is too expensive to keep them.”
While there is legitimate concern over the risks of introducing euthanasia, and while the cost can’t be predicted, Magnusson feels it is important for people to be aware of what is happening currently. “If you can accept that consequences matter, then you can have a debate about whether legalising euthanasia would be better overall, or not.”
One of the loudest opponents of euthanasia is the Roman Catholic Church; other Christian denominations have remained to less and lesser degrees, silent. This reflects the declining role that religious institutions have as a moral agent.
Magnusson feels that the opinion of religious bodies is highly relevant and would like to see Seventh-day Adventist [publishers of Signs of the Times] bio-ethics made public as a counterweight to the debate, particularly in light of its stake in health care.
Regardless of changes in society, Christian churches have a responsibility to be visible and vocal within the euthanasia debate. In a postmodern world where society finds “no absolute truth,” Christianity needs to draw a line in the sand that, while not alienating society, places an emphasis on God’s Word.
Those who don’t wish to see euthanasia legalised may feel that an appropriate response to Magnusson’s findings is to seek out and prosecute those involved. “If you start prosecuting doctors and having hawkish oversiting of everything they do, particularly with the use of drugs which might be given in overdoses, all you’re going to do is undermine palliative care,” he says.
Apart from negatively impacting palliative care, it would be difficult to ascertain who is involved in euthanasia and in what way. He refers to those in the study as “savvy” and able to keep their practices hidden. As such, prosecution would not achieve the desired end; rather, it would create a strong negative impact on what end-life care we do have.
Dr Magnusson remains ambivalent of his own point of view. He does identify the fact that a euthanasia policy may be a comfort to patients in that they know there is always an alternative. It could also have a positive impact as thorough evaluation could protect those who are depressed or being pressured toward euthanasia by external factors.
“Within the values of compassion for someone who is suffering in their terminal stages, respect for that person’s autonomy argue in the favour of right to die. If it were ever to be legalised you would hope that it would only occur, or would only be intended, for that minority of those very difficult cases,” he says.
Through his extensive study of death, Magnusson has found that human life is complex, and the topic of euthanasia very difficult because of the emotive nature of the debate. But the issues need to be faced with honesty and passion nevertheless: “I didn’t write the book to try and make up people’s minds for them.
“I would hope that people on both sides of the euthanasia debate could be challenged to reassess their views in light of the reality of the kind of informal killing that goes on at the moment.
“I think it’s harder for opponents of euthanasia to accept a book like this because opponents of euthanasia say, ‘If we legalise euthanasia, things will get really bad,’ and a book like this comes along and says ‘Hey, things are really bad already.’ I would hope this book enriches the debate, as the hidden secrets of health professionals provide a missing piece of it.”
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