The rationale behind the euthanasia argument: is there a right to be killed?

Perhaps the most commonly identified motive behind the call for euthanasia is the fear people have of a long and lingering painful death – either their own death or that of a loved one. In light of this we might speculate that people's support for euthanasia is essentially about not having to die in pain.

The desire for a pain-free death is something that both proponents and opponents of euthanasia agree on. No-one should have to die in pain, and with advances in palliative care this need not happen. As a clinical pharmacist has noted: Uncontrolled pain in the terminally ill should be considered a medical emergency, not a justification for euthanasia. Earlier this year the First International Pain summit held in Montreal declared access to pain management as a fundamental human right.

So the debate about euthanasia does not hinge on the issue of a pain free death. While it is important for all people to have access to quality palliative care, lack of access is not an adequate reason to legalise euthanasia. Shortages in palliative care can be, and needs to be, resolved through political means.

So, what other arguments are there in favour of euthanasia? It is apparent that for some people the issue is more specifically about the alleviation of human 'suffering'. But what exactly do they mean?

The words 'suffering' and 'pain' are often used interchangeably but, pain and suffering are not the same. Suffering is a personal matter, arising from our physical, mental and emotional state of being. However, it often exists independently of our state of physical well-being. While physical pain can be a significant cause of suffering, many people who are in perfectly good health suffer tremendously because of emotional distress resulting from such things as mental illness, grief, depression or lack of self-esteem. The idea that euthanasia might be available to relieve such suffering extends the parameters well beyond the desire to alleviate physical pain.

We know only too well that suicides are often a consequence of overwhelming suffering flowing from emotional and psychological distress or undiagnosed depression. If we accept the general premise that euthanasia is an appropriate way of managing people's suffering then we effectively sanction its use to relieve all types of suffering including distress, isolation, depression or mental illness.

It surely goes without saying that we do not want to even think about emotional and psychological suffering being justifications for euthanasia? To do so would mean accepting that people's feelings of isolation, demoralisation or burden are sufficient cause for them to end their life, whether by their own hand or at the hands of another. A society in which people are prepared to standby and allow those who feel like this to kill themselves or be killed, rather than seeking to meet their existential needs, is an uncaring society and not the sort of society in which I want to live.

In my experience very few euthanasia supporters in New Zealand envisage that it would be available to provide an 'out' for persons suffering emotional or psychological distress or mental illness. In all likelihood, however, this is where a law change would take us, even if euthanasia was introduced with strict legal guidelines limiting it to people with terminal illnesses who request it (voluntary euthanasia) in the last stages of life. Since the Netherlands introduced euthanasia in 1973 with similarly strict restrictions, these restrictions have all fallen away; lethal injections are now routinely given to newborns and teenagers. In addition cases of non-voluntary euthanasia continue to occur; the latest official figures show that in 2005 550 patients were actively killed by doctors without an explicit request. [1]

It is already the case in the Netherlands that mental suffering, independent of a physical illness, can suffice as justification for euthanasia. In a further extension of this move a public referendum has recently been initiated for euthanasia to be extended to people over 70 without any form of terminal illness simply on the basis of 'uncontrollable suffering.' This would allow persons who are simply 'fed up' with life to access the means to kill themselves. Should this change be approved, it is obvious that it will only lead to further debates about why those who are 60 ... or 50 ... or even younger should be denied the same 'right'; indeed, there is no reason why it should be denied to others once granted to a particular group. Even more recently the head of Dignitas, the Swiss clinic which helps people to die, has advocated for 'family suicides' as the next logical step even when a terminally ill person's partner or family member is in perfect health. [2]

If we rule out painful death and/or suffering due to emotional and psychological distress as necessary or adequate reasons for euthanasia, it seems that the debate finally boils down to the question of whether persons should be able to access euthanasia as a matter of personal choice; 'my life – my choice,' as the slogan goes.

In arguing for the legal right to choose euthanasia it is commonly asserted that persons have a 'right to die'. In analysing this assertion we need to consider that the claim is not about the right of a person to kill her or himself but whether or not a person has the right to demand that someone else kill them. This claim deserves close scrutiny.

Christians believe that life is a gift from God and not ours to dispose of as we see fit. The Sacred Scriptures are clear about the immorality of suicide and killing. However, while this may provide satisfactory justification for believers as to why euthanasia is unacceptable, others who are not religious will argue they are not subject to such beliefs. The question, then, is whether or not there are other reasons for not allowing people to choose euthanasia.

Whether or not a person can claim the right to die at the hands of another ultimately hinges on whether or not such a right properly exists. Interestingly, because of the way in which this phrase has entered our common vernacular, many people do not even think to question such a right, simply taking it for granted. Yet, examination of the nature of human rights from an ethical perspective shows that no such right exists.

Rights talk arises in regard to those things that are considered essential for human well-being. To refer to something as a human right is to highlight its status as an 'entitlement' – as belonging to each and every person as-of-right. By definition, then, a person's entitlementto receive what is right-fully theirs exists prior to, and separate from, the person/s on whom they might depend for the right to be realised. In other words, the existence of a right is independent of the beliefs or wishes of others and therefore beyond moral dispute; assuming that a person is able to provide what-ever I need, they are obliged to give it to me or, at the very least, not prevent me from obtaining it. No other justification is needed because, morally speaking, others are not free to deny to me what is already mine. A genuine human right obliges on all people in all situations and establishes a non-negotiable claim over others.

However, it is a key principle of human freedom, and therefore human dignity, that a person's claim over another cannot extend to a claim over their conscience, i.e. to any act that might force them to go against their conscience. From this it follows that a genuine human right can only encompass certain actions – specifically actions that are inherently good, i.e. actions that cannot give rise to a counter-claim. That is to say, genuine human rights are characterised by the fact that they embody the sort of act/s that could never require any person to compromise their freedom of conscience.

Consider the right a person has to food. We often depend on others for this right, for example during natural disasters. It makes sense to speak of a person's 'right' to food because it is able to support the simultaneous claim that there is an absolute obligation on all of us to provide food to all persons in need. This obligation exists prior to, and independently of, the willingness of any person to act on it; it is binding on all people with the necessary resources. The claim that a person's right to food places on another requires no further justification and, morally speaking, is therefore not subject to a counter-claim by any person. It is the sort of act that we can describe as inherently good.

On the other hand, the killing of another person is not the sort of act that can be described as inherently good. That is why, in the small number of cases in which killing is legally permissible, special justification is required to justify it (e.g. self-defence). With respect to euthanasia, the freedom of another to demand I kill them stops where my freedom begins; [3] it cannot establish a universal claim that obliges on me without me forfeiting my freedom of conscience. In other words, such a claim is always subject to a counter-claim from my conscience; even in cases where a person is willing to assist with euthanasia, the authority for that decision rests finally with their conscience rather than in the demand that is made on them. Because euthanasia is the type of action that cannot be presented as a demand that obliges unilaterally, it cannot be classified as a genuine human right.

Thus, logically speaking, the rationale for legalising assisted suicide cannot be established on the basis that there is a fundamental right to be killed.

Ultimately, the euthanasia debate can only be decided on an honest consideration of the consequences of euthanasia for our society. Numerous arguments exist to show that its legalisation would come at great cost to large numbers of people, specifically those most vulnerable to coercion; the sort of coercion that inevitably arises (even if unintended) in a society in which the elderly are becoming increasingly isolated, the sick are being given the message that they are a burden and people with disabilities continue to experience high levels of bias and prejudice.

Factor in a health budget that is expanding because of rising numbers of elderly and more expensive treatments, and it becomes apparent that the introduction of legalised euthanasia would bring about, literally, a deadly mix. As a society we need to face the challenges of increased pressure on health resources. However, creating a context in which euthanasia (or self-inflicted death) will increasingly present as a natural solution – even a duty – is not the way forward for a civilised, caring society.

Euthanasia: we don't need it to relieve pain; we surely don't want it to relieve suffering; and, ethically speaking, there is no justification to claim it as a genuine individual right because it ultimately relies on an act that is subject to another person's freedom. Rational arguments based on the consequences of euthanasia point in one direction only: Let's not go there!

John Kleinsman
Director
The Nathaniel Centre

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[1] Source: http://communities.canada.com/calgaryherald/print.aspx?postid=346902

[2] Source: http://www.telegraph.co.uk/news/uknews/8072085/Family-suicides-may-be-the-next-step-for-Dignitas.html

[3] See, David, M. http://www.mercatornet.com/articles/view/solidarity_in_suffering/