It is concerning that The Greens and organisations such as GetUp have seen fit to re-ignite the debate about the legalisation of euthanasia. I am a doctor. I worked in palliative care and now work with the elderly. I have seen first hand the complexity of the issues at the end of life. In reality, most people who say they agree with euthanasia have little understanding of the issue at all. The term as it is intended by pro-euthanasia activists refers to the intentional termination of life by another at the request of the person who wishes to die, not the withdrawal of futile care or “life support”.
It is ironic that those with a pro-euthanasia stance refer to euthanasia as “dying with dignity”. I don’t know what is dignified about one person intentionally killing another or providing the means for their suicide. It must change the person who does the deed irrevocably. On the other hand, I have seen many dignified deaths. Dignity has nothing to do with whether a person is faecally incontinent, disfigured, emotionally disturbed or unattractive. Dignity has to do with the respect we accord every individual, regardless of personal characteristics or their current state of health. Accepting death when it naturally occurs is quite different to condoning or encouraging the intentional killing of or suicide by another.
Harvey Chochinov, a Canadian psychiatrist, has written extensively about dignity at the end of life and his views are valid in this context. He describes the all-important interpersonal dimension to dignity. Dr Chochinov’s model affirms the basic truth that human beings are relational and that what accords us dignity is how we are treated in a relationship. The legalisation of euthanasia alters the interpersonal relationship between the vulnerable patient and their carers. If the patient does not volunteer to be euthanased perhaps thepatient is being selfish by remaining burdensome to others. The idea that we can prevent subtle “coercion” through legislation shows a lack of understanding of the realities and subtleties of human relationships. History has shown that the people most commonly euthanased “voluntarily” are women, the mentally ill, socially isolated and socioeconomically disadvantaged. These are the usual victims when society fundamentally loses its respect for human life.
Having worked in palliative care, I have had requests from relatives and carers to euthanase dying people. What was evident was that these “observers” were suffering and wanted their own suffering to end. Vulnerable and sick patients often believe that they are a burden to those around them. So do elderly people. I hear it from them all the time. We know that suffering is a reality in life. Palliative care and modern medicine relieve most suffering but cannot relieve all. When carers are able to rise to the occasion with conscientious caring for a vulnerable person, the dignity of that person is affirmed. Much anxiety in the patient is also relieved. For those few who really do suffer extreme and unrelieved existential anxiety at the end of life, good palliative care offers the option of sedation.
It is widely recognised that Western Society has become detached from death. We tuck away dying people in hospices or hospitals and often don’t have effective rituals surrounding death. We shield our children from death. As a society, we are in “death denial”. We have a belief that modern medicine can, or at least should, cure every ill – this is false. If we acknowledged the certainty of death perhaps we wouldn’t be panicked into the issue of euthanasia, or into continuing with futile and uncomfortable medical treatments. We might have conversations with our relatives about our values and the situations in which we would want treatment to be withdrawn and even draw up legally binding Advance Care Directives.
There are times in life when we must give care – and times when we must graciously accept it. We must not as a society define the worth of individuals by their functional abilities or level of independence. We must not decide that the means justifies the end or that our right to make autonomous decisions trumps our instinctive understanding that it is wrong to sanction the deliberate killing of another. If we as a society and as individuals cannot accept that at times we have to face difficulty, then we cannot face the realities of life. We also will not foster the qualities in society that make us civilised: empathy, compassion and the protection of the most vulnerable.
Dr Joanne Wright