Voluntary Euthanasia: Impacts on Individuals and Society

The Rev Peter Kurti is Senior Research Fellow, Culture, Prosperity & Civil Society program at the Centre for Independent Studies and an author, most recently, of Euthanasia – Putting The Culture to Death. Penny Hackett is the President of Dying With Dignity NSW and is presently legal advisor to a funds management and corporate finance business with a focus on corporate governance and compliance. On Monday 18 February 2019, Peter Kurti and Penny Hackett spoke at The Sydney Institute to give different views on the case for and against euthanasia.

VOLUNTARY EUTHANASIA: IMPACTS ON INDIVIDUALS AND SOCIETY

PETER KURTI

I would like to make a few remarks in response to Penny, and to say something about what I think the impacts of voluntary euthanasia and physician-assisted suicide are likely to be on individuals and society.

Although I am billed this evening as an Anglican minister, the argument I make is not based on my religious beliefs. The old canard that objections to PAS-E are based solely on religious belief are unfounded. And, in fact, there are many Christians who are in favour of euthanasia.

Moreover, if it were true that the only objections to PAS-E are based on religion, there would be little to warrant imposing that prohibition beyond the communities of faith. So, my argument is grounded in a different set of concerns – the concerns that in making it legal to kill another person, we will tear at the moral and cultural fabric of our society.

PAS-E is a topic of tremendous importance for our society and culture. It calls into question fundamental beliefs about the nature of human life and well-being, and it challenges some of our key moral principles about the deliberate taking of human life.

And yet, it appears to enjoy high levels of support amongst Australians. A Newspoll conducted in August 2018, for example, found 79 per cent of those surveyed favoured amending the law to allow physician-assisted suicide. Only 15 per cent were opposed.

Legalising PAS-E is going to have very significant, and serious, impacts on individuals and on society; and I believe that we need to proceed with immense caution.

In many respects, the PAS-E debate is driven by anxiety about human suffering. I understand that For the most part, it concerns those with terminal and incurable illnesses.  But the anxiety also extends to those for whom age has simply taken its toll, and who are increasingly dependent on others.

People dying a slow, painful death, we are told, are forced to endure such suffering because a cruel law prevents them obtaining the relief they seek. But this supposedly “cruel law” is actually the law that prohibits the deliberate taking of human life.

I believe that we tamper with this law at our peril. Vulnerable people can be manipulated by others who may no longer want the burden of caring, or who want to enrich themselves.

Take depressed Queensland woman, Jennifer Morant. She may have suffered from chronic pain and wanted to die. But she was not terminally ill when her husband –  the sole beneficiary of her $1.4 million life insurance policy – helped end her life. He was convicted of assisting her suicide.

Let’s be clear that the euthanasia/assisted suicide debate is not about whether or not we die, but about how we die. Proponents argue that since a patient is going to die anyway, the end should be hastened – if desired – in the name of human dignity.

But there is a crucial legal and moral difference between allowing death to occur naturally, and bringing about death deliberately and intentionally. The ends (relief of suffering) must never justify the means (killing a person).

This does not mean that those opposed to legalising euthanasia and assisted suicide are, in some perverted way, in favour of suffering. No one denies that the medical profession ought to strive for the relief of all suffering. Disagreement arises over how to bring about that relief.

But advocates say that in the name of compassion, people should not be kept alive against their wishes and should be allowed to die when they choose. And of course there are heart-rending stories of a few people who have endured difficult to relieve suffering.

But it is hardly justifiable to change the law to permit assisted suicide simply because of those few, hard cases when doing so may be at the expense of the rights and protections of others.

Of course, any person already has the right to refuse treatment, even it means an increased risk of death. And the right to refuse treatment – or to request treatment to be withdrawn – is very different from asserting the right to die or the right to be killed.

Allowing the patient to die at some point is a practical condition of the successful operation of modern medicine. Killing a patient is not. As Margaret Somerville has observed, pithily: “We must kill the pain and suffering, not the person with the pain and suffering.”

Proposing one approach to pain relief often gives way to a willingness to compromise on ends and means. For some, the issue is not about pain or dignity or suffering. It is about having the opportunity for assistance in committing suicide once life no longer has meaning.

“This is not about a person being killed which Kurti conflates with assisted suicide,” wrote one critic in response to an article I had written. It’s “about whether they should be allowed to have doctors assist them, to make the voluntary ending of their lives as humane and compassionate as possible.”

But if it is about that, I think my critic is wrong.

Although committing suicide is no longer illegal in Australia, every death by intentional self-harm still has a profound impact on others. The state has removed itself from what is fundamentally a moral question, but the social taboo surrounding suicide remains.

It is not that the state retains control of life, but that it has an interest in not acting so as to weaken the taboo surrounding suicide. Suicide is never an entirely private act. It always has an enormous impact on the family, friends, and community of the deceased.

When self-destruction is redefined as medical treatment, we lose our ability, as a society, to make a decision on the rightness or wrongness of the suicide. Whether we think that suicide is moral or immoral, we must not simply go with the cultural flow that would render it a neutral act.

In his magisterial and highly readable study On Suicide, Emile Durkheim remarked:

When society has lost its moral compass, its own uncertainty inspires in it a kind of indulgence of immoral acts which is involuntarily expressed whenever they are mentioned and which makes their immorality less appreciable.

Indulgence of what I consider to be the “immoral acts” – to use Durkheim’s term – of euthanasia and assisted suicide suggests to me that we need to heed Durkheim’s warning issued in those last years of the nineteenth century.

Today, society’s loss of a moral bearing has led us to emphasise ends over means. It sanctions the view that it is for the individual alone to decide whether or not her life has meaning.

It was my concern about the skewing of that moral compass that prompted me to write this short book and to address some of the arguments that legalisation is not only the most obvious, but the most humane response to human suffering.

Ideas about dignity, personal autonomy, and freedom from interference by the state are threads woven through the debate. But we must also attend to the possible impact of legalised physician-assisted suicide on the medical profession.

Once doctors are licensed to kill, there is surely a real danger that a patient’s trust in the authenticity of a doctor’s professional commitment to her well-being will almost certainly be undermined. Acts of mercy must not be expressed by acts of mercy killing.

Damage to the relationship between doctor and patient will also damage the standing of the profession of medicine; this, in turn, will inflict damage on the wider society. The impacts on individuals and society will be vast.

I fear that demands for legalisation of assisted suicide and euthanasia amount to a one-way ratchet effect in asserting the primacy of autonomy. But these demands need to be resisted because of the impact such autonomous choices will have on the wider society.

Continued legalisation of PAS-E in Australia will enshrine in law a rejection of the duties we owe to others and of the claims others have upon us, and will help to normalise the idea that the lives of some people are not worth living.

This is an important point made by the British peer Baroness Ilora Finlay, a distinguished professor of palliative medicine:

We should not forget that laws are more than just regulatory instruments. They also send powerful social messages. An assisted dying law sends the subliminal message, however unintended by legislators, that if we are terminally ill taking our own lives is something we should consider. Changing the social message of the law changes its dynamic.

I think Lady Finlay is correct. By changing the law, we are threatening the social, legal, and cultural norms underlying civil society.

We must also resist arguments made by proponents of euthanasia that none of these considerations can ever outweigh the supposed primacy of individual choice; indeed, it is these very considerations that must override the assertion of individual autonomy.

Demand for PAS-E is growing; and it is becoming more widely available in Europe – especially Belgium and the Netherlands – and in an increasing number of states in the United States. The surge in demand has prompted stark warnings from some who were advocates of PAS-E.

The Dutch bioethicist, Theo Boer, initially supported the legalisation of euthanasia in the Netherlands. But now he is concerned that the exceptional situations for which the law was created have evolved into an acceptance of organised death.

“A border is being crossed between individual empathy and societal acceptance,” Boer says. “A culture of euthanasia undermines our capacity to deal with suffering, and that is very bad for society.”[1] Just such a culture of euthanasia threatens to take hold in Australia.

The legalisation of assisted suicide and euthanasia in Australia will enshrine in law a rejection of the duties we owe to others and of the claims others have upon us. As such, it poses a threat to the cultural, social and legal norms underlying our civil society. As such, I believe it must be resisted.

ENDNOTE

[1] Theo A. Boer, “Recurring themes in the debate about euthanasia and assisted suicide”, Journal of Religious Ethics, (2007), 35.5:529-555.