Right: Nancy Crick, who suicided under the guidance of pro-euthanasia supporters in 2002. Although she was not terminally ill, Ms Crick chose to end her life because of pain from an inoperable bowel condition.
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Arguments against the legalisation of voluntary euthanasia
1. Patient consent may not be freely given
It has been claimed that consent to euthanasia may not be freely given by a patient.
Firstly, there is the question of the power of the physician to influence a patients judgement. In an article published in Quadrant magazine on January 1, 2011, Brian Pollard wrote, Euthanasia draft bills require doctors to inform patients about the medical details of their illness and future alternatives. Since such discussions will usually occur in private, one could never know whether such information was accurate, adequate, non-coercive and impartial. If the doctors personal view was that euthanasia was appropriate for a patient, we may be sure some would not be deterred from advocating it.
Secondly, concern has also been expressed that some ailing people may feel a burden to their family and loved ones and therefore seek to end their lives out of a sense of guilt or obligation. In a discussion paper prepared for the Australian Psychological Society updated in April 2008 it was stated, Public recognition that euthanasia is available might lead to assaults on individual autonomy. People may be subjected to pressure to ask for their own death by being made to feel guilty for the burden they impose on family and carers. Euthanasia may be offered as an option even when the patient had not previously raised it.
Thirdly, it has been noted that depression is a significant complicating factor when considering whether the choice to end ones life has been freely made. Patients suffering from untreated depression as a co morbidity of a terminal illness are less likely to request euthanasia once their depression has been successfully treated.
The 2008 discussion paper prepared for the Australian Psychological Society stated, A persons expression of a desire to end his or her life may be influenced by a state of depression, uncontrolled pain or dysphoria, conditions which may be relieved by proper treatment. If given such treatment, it is argued that the person may no longer desire to die.
2. Doctors may ignore legal restrictions limiting the application of euthanasia
It has been claimed that legalising voluntary euthanasia creates an environment in which doctors become more likely to practise euthanasia outside the legal restrictions.
In all jurisdictions where physician assisted suicide is legal, the request for euthanasia has to be voluntary, well-considered, informed, and persistent over time. The requesting person must provide explicit written consent and must be competent at the time the request is made. A report by Dr José Pereira, Division of Palliative Care, University of Ottawa; Department of Palliative Medicine, Bruyère Continuing Care; and Palliative Care Service, The Ottawa Hospital, Ottawa, has stated, Despite those safeguards, more than 500 people in the Netherlands are euthanized involuntarily every year. In 2005, a total of 2410 deaths by euthanasia were reported, representing 1.7% of all deaths in the Netherlands. More than 560 people (0.4% of all deaths) were administered lethal substances without having given explicit consent. For every 5 people euthanized, 1 is euthanized without having given explicit consent. Attempts at bringing those cases to trial have failed, providing evidence that the judicial system has become more tolerant over time of such transgressions.
Dr Pereira has also found that despite supposed mandatory reporting of all acts of euthanasia in both The Netherlands and Holland, In Belgium, nearly half of all cases of euthanasia are not reported to the Federal Control and Evaluation Committee. Legal requirements were more frequently not met in unreported cases than in reported cases: a written request for euthanasia was more often absent (88% vs. 18%), physicians specialized in palliative care were consulted less often (55% vs. 98%), and the drugs were more often administered by a nurse (41% vs. 0%)... In the Netherlands, at least 20% of cases of euthanasia go unreported. That number is probably conservative because it represents only cases that can be traced; the actual number may be as high as 40%.
3. The circumstances under which euthanasia is applied tend to expand
It has been noted that in some jurisdictions where euthanasia is legally available, it has been administered to those outside the categories originally deemed eligible. Referred to as the slippery slope argument, those who oppose voluntary euthanasia claim that once it has been made legal for physicians to assist patients to end their lives the practice then tends to extend until it is used on those who have not requested euthanasia and who are not suffering an immediately fatal disease. In opposing euthanasia, former Australian Prime Minister Kevin Rudd has stated, If you changed the laws in this area, I do become concerned about the way in which these things can drift over time.
This expansion of the terms under which euthanasia can be regarded as legitimate has been claimed to have occurred in The Netherlands. Critics note with concern the extension of euthanasia in to include disabled newborns and the non-terminally ill.
In July 1992, the Dutch Paediatric Association announced that it was issuing formal guidelines for killing severely handicapped neonates. Dr. Zier Versluys, chairman of the associations Working Group on Neonatal Ethics, said that Both for the parents and the children, an early death is better than life. Dr. Versluys also indicated that euthanasia is an integral part of good medical practice in relation to newborn babies. Doctors would judge if a babys quality of life is such that the baby should be killed.
In April 1993, a landmark Dutch court decision affirmed euthanasia for psychiatric reasons. The court found that psychiatrist Dr. Boudewijn Chabot was medically justified and followed established euthanasia guidelines in helping his physically healthy, but depressed, patient commit suicide. The patient, 50-year-old Hilly Bosscher, said she wanted to die after the deaths of her two children and the subsequent breakup of her marriage.
In The Netherlands euthanasia was originally proposed to be available at the request of the terminally ill, however, current guidelines have been expanded such that those who do not give explicit consent can be euthanised as can those who are not suffering from a terminal illness. Critics argue that euthanising those who have not requested the intervention is beyond any doctors professional prerogative while euthanising those without a terminal illness is simply assisting suicide.
Similar developments have also occurred in Belgium where initially euthanasia was only available at the request of competent adults suffering intolerable, incurable pain. Belgiums government has since tabled a new amendment to the laws that would allow euthanasia of children and Alzheimers sufferers. Thierry Giet, the countrys leader, has stated, The idea is to update the law to take better account of dramatic situations and extremely harrowing cases we must find a response to.
In July 2014, Australian euthanasia advocate Dr Philip Nitschke was suspended from practising medicine after he admitted to assisting a depressed, non-terminally ill 45-year-old man to end his life. Nitschkes actions have been condemned as demonstrating the distortions to established medical practice which are likely to occur were euthanasia to be made legal.
4. Palliative care can generally make pain tolerable
It has been claimed that good palliative care can generally relieve the pain of terminal illnesses such that euthanasia is not necessary to avoid physical distress.
In 1990, a World Health Organization (WHO) Expert Committee found that ...with the development of modern methods of palliative care, legalisation of euthanasia is unnecessary. Now that a practical alternative to death in pain exists, there should be concentrated efforts to implement programs of palliative care, rather than yielding to pressure for legal euthanasia.
British studies have indicated that no more than one to three percent of terminal cancer patients will present with pain that cannot be managed. In these few cases sedation is the preferred treatment.
Dr Pieter Admiraal, a leading advocate of voluntary euthanasia in the Netherlands, has stated that pain is never a legitimate reason for euthanasia because methods exist to relieve it, though these are not always available within his country.
It has also been claimed that most instances of severe depression associated with terminal illness are treatable. It is claimed that patients with clinical depression need appropriate treatment, not euthanasia in order to help them overcome their condition.
Further, critics of voluntary euthanasia are concerned that legalising this practice is likely to mean that inadequate resources will be directed toward alleviating pain and depression among the terminally ill.
It has been noted, for example, that palliative services in The Netherlands are not well developed. In 1988, the British Medical Association released the findings of a study on Dutch euthanasia conducted at the request of British right-to-die advocates. The study found that, in spite of the fact that medical care is provided to everyone in Holland, palliative care (comfort care) programs, with adequate pain control techniques and knowledge, were poorly developed. As of mid-1990, only two hospice programs were in operation in all of Holland, and the services they provided were very limited. Dr Els Borst, the former Health Minister and Deputy Prime Minister of The Netherlands who guided the law through the Dutch parliament, said in December 2009 that she regretted that euthanasia was effectively destroying palliative care in her country.
The unanimous report of the British House of Lords Select Committee on Medical Ethics has recommended that there be no change to law in the United Kingdom to permit euthanasia. Rather, more and better palliative care was recommended.
5. Euthanasia places the physically, mentally, socially and economically vulnerable at risk
It has been claimed that voluntary euthanasia places those with any vulnerability particularly at risk. The concern is that those within these groups may be psychologically coerced into requesting that their lives be ended or, if they are not judged competent, the decision may actually be made for them.
In an article published in The Daily Mail Australia on October 7, 2014, it was noted that in The Netherlands in 2013, a total of 42 people with severe psychiatric problems were killed by lethal injection compared to 14 in 2012 and 13 in 2011. It was also noted that 97 people were euthanised by their doctors because they were suffering from dementia.
This concern about euthanasia being imposed on the vulnerable has been voiced by lobby groups for the disabled who see their members as particularly at risk. Among other things, these groups are concerned that disabled children will increasingly be killed at birth. Provisions to allow disabled newborns to be euthanised already exist in The Netherlands and there are philosophers and medical ethicists such as Peter Singer who argue that this practice should be available generally.
In his book, Practical Ethics, Peter Singer argues, At present parents can choose to keep or destroy their disabled offspring only if the disability happens to be detected during pregnancy. There is no logical basis for restricting parents' choice to these particular disabilities. If disabled newborn infants were not regarded as having a right to life until, say, a week or a month after birth it would allow parents, in consultation with their doctors, to choose on the basis of far greater knowledge of the infant's condition than is possible before birth.
Concern has also been expressed that in jurisdictions where universal health insurance is not available or where its terms are restricted, financial considerations may cause the poor to seek euthanasia or to be denied other treatments. Disability advocate Stella Young noted, Barbara Wagner, a 64-year-old Oregon woman diagnosed with terminal lung cancer, received a letter from her health insurance company saying that they were unable to pay for the chemotherapy she needed to treat her cancer, but they would cover the cost of physician-assisted death. [Physician-assisted suicide is legal in Oregon.] The same thing happened to Randy Stroup and presumably many others. In a health system stretched and cost-focussed, people are supported to die, but not to live.
In Australia there are currently discussions centred on reducing the availability of free health care. The cost of funding hospitals is also a recurrent issue. In these circumstances it could become possible that financial pressures lead to euthanasia.