Going Too Far
Rod MacLeod
Issue 26, November 2008
At a recent public forum on End-of-Life choices sponsored by the Voluntary Euthanasia Society in Auckland, Jack Jones, the national president of that society suggested that "directives, right to refuse treatment and palliative care, especially as provided by the hospice movement, do not cover all situations where people have reached the stage of life when it has lost all quality". He went on in his address to the forum to suggest that those with dementia should perhaps consider seeking voluntary euthanasia. The Voluntary Euthanasia Society of New Zealand [VES] has as its object "a change to the law to allow terminally ill patients, or those whose quality of life has diminished to an unacceptable extent, the right to a peaceful death with dignity at a time of their own choosing". What was alarming about this statement was not just that it was made, but also that that many of the society's members, speaking from the floor, seemed to support that notion, that people with dementia should consider voluntary euthanasia as a way of reducing health service costs so enabling more to be spent on children and younger people.
A recent article in the British newspaper the Daily Mail quoted Baroness Warnock, the chair of the committee which during the 1980s opened the way for legal research on human embryos, as saying that that elderly people with dementia are "wasting" the lives of those who have to care for them. She is reported as saying that for the old and sick who are contemplating dying, "there is nothing wrong with feeling you ought to do so". Lady Warnock is quoted as saying "if you are demented, you are wasting people's lives, your family's lives, and you are wasting the resources of the National Health Service." Similar views perhaps to those who attended the VES meeting in Auckland. She told the Church of Scotland's magazine Life and Work "I've just written an article called A Duty to Die? for a Norwegian periodical. I wrote it really suggesting that there is nothing wrong with feeling you ought to do so for the sake of others as well as yourself." She added "I am absolutely, fully in agreement with the argument that if pain is insufferable, then someone should be given help to die, but I feel there is a wider argument that if somebody absolutely, desperately wants to die because they are a burden to their family or the state, then I think they too should be allowed to die."
It is salient perhaps that Baroness Warnock who is now 84 years old changed her stance on euthanasia following the death of her husband (who was 'helped to die' by his doctor in 1995).
This was a challenging meeting in many ways. The vast majority of those attending were supporters of voluntary euthanasia, not surprising given that the meeting was sponsored by their society. It was also challenging in that there was so much misinformation. Mr. Jones presented a number of erroneous and quite patently nonsensical suggestions about the use of morphine near the end of life. A speaker from the Medical Ethics department of Auckland University (with no clinical experience) also suggested that "doctors have an obligation to assist their patients [to die]". A speaker with a slowly progressive respiratory disorder who currently has "an excellent quality of life" believed that he also had a right to choose the timing of his death. Much of what was presented about modern palliative care was politely accepted but when talking of the sanctity of life and the intrinsic value of every person, no matter how old or infirm, I was accused of being "sentimental about old people".
What seems most alarming about all of this is that we don't seem to have moved anywhere closer towards any common ground in this debate. Calls for people with dementia, for example, who may be 'wasting' the lives of those who have to care for them brings us closer to a society where productivity and health are valued more highly than anything else. Reports in the medical literature suggest that thus far, in most cases of euthanasia, the patient's life is shortened by less than one month1 but this most recent suggestion would significantly reduce many people's life expectancy. The elderly and chronically sick often feel that they are a burden on those who care for them and on society. To add this additional burden is, in my view, an abhorrent and ill-judged move that will only serve to increase their sense of guilt, despair and suffering. If this is the direction of thinking of those who support the objectives of the Voluntary Euthanasia Society we can only wonder, what next?
Reference
1. Van der Heide A, Deliens L, Faisst K, Nilstun T, Norup M, Paci E et al. End-of-life decision making in six European countries: descriptive study Lancet 2003;362;345-50
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Rod MacLeod is Medical Director of Hibiscus Coast Hospice, Honorary Clinical Professor in General Practice and Primary Health Care, University of Auckland and Adjunct Professor in the Departments of General Practice and Medical and Surgical Sciences at the University of Otago, Dunedin School of Medicine