The euthanasia debate is an emotive and contentious one. The arguments are usually focused on the ethics and legalities of allowing people who are terminally ill to request and receive assisted dying. Often the biggest problems exist around who should decide if euthanasia should be carried out, especially if the persons in question are not in a fit state to make their own decision for reasons of illness or injury. Euthanasia, or “mercy killing” as it can also sometimes be called, is legal or partially legal in some countries. These include Switzerland, Belgium and the Netherlands. So what about Malta? Is it time that we seriously and openly discuss what till now has been a taboo and prohibitive subject?
The answer is not easy at all. Of all the arguments against voluntary euthanasia, the most influential is the “slippery slope”. Once we allow doctors to kill patients, we will not be able to limit the killing of those who want to die. The killing of a person, however terminally ill or in pain, can never be compassionate. It is not “euthanasia” but murder. But, on the other hand, do we not have excellent palliative care that provides dignity in dying? The Church has multiple valid and legitimate reasons for taking an ultra-conservative stand and perhaps even the position taken by a number of local NGOs and political organisations. Only the Labour Movement seems to be taking the unprecedented approach of eventually bringing euthanasia up for an open and holistic discussion.
Even putting aside the Christian morality upon which the Constitution and our nation's culture are based, the notion of forced euthanasia would contradict the long-held body of medical ethics to which all Maltese doctors must adhere. Assisted suicide is where a doctor helps a patient to kill themselves by prescribing a lethal drug for the patient to take. This becomes euthanasia when the doctor administers the drug directly. There will be identified at least three allegedly legitimate and justifiable reasons for euthanasia. First, possibly, it is needed. This is “the compassion argument”. Supporters of assisted suicide believe that allowing people to “die with dignity” is kinder than forcing them to continue their lives with suffering. Secondly, there will be those people who want it. This is known as “the autonomy argument”. Some believe that every patient has a right to choose when to die. Third, there are those who believe that it can be controlled. I would describe this as “the public policy argument”, believing that assisted suicide can be safely regulated by government legislation.
Undoubtedly, euthanasia would put the emphasis on the personal decision in a way that was blissfully alien to the whole problem of dying in former times. It will make death even more subjectively intolerable, for people will feel responsible for their own death and morally obliged to rid their relatives of their unwanted presence. Objectively thinking, opening the doors to voluntary euthanasia and assisted suicide could lead to involuntary euthanasia, by giving doctors the power to decide when a patient’s life is not worth living. Also, even where euthanasia and physician-assisted suicide are legal, there is the real danger that doctors will not always report it. Taking the argument further, if we are to assert that patients should have a right to die would that impose on doctors a duty to kill, thus restricting the autonomy of the doctor? Yes, dear readers, there is much more to debating this delicate subject than meets the eye.
Surely, however, the debate should not be about the right to die but about the right to help patients obtain pain relief when terminally ill. Instead of giving freedom to patients, euthanasia and assisted suicide are about giving other people the legal power to end another person’s life. Assisted suicide is not a private act. Nobody chooses assisted suicide in isolation. Euthanasia and assisted suicide are matters of public concern because they involve one person facilitating the death of another. Any change in our law would have profound effects on the social fabric of our society, on our attitudes towards each other’s deaths and illnesses, and on our attitudes towards those who are ill and have disabilities. The pro-euthanasia and assisted suicide lobby emphasises the importance of personal choice and autonomy. Should not patients have the right to end their lives? Any specific criteria laid down by law would never be enough to prevent abuse or misdiagnosed cases. Suppose we are referring to a disease where the prognosis is not straightforward, dementia or a chronic but not terminal disease. In that case, there should absolutely be no room for euthanasia or assisted suicide.
Changing the law to allow euthanasia or assisted suicide will inevitably put pressure on vulnerable people to end their lives for fear of being a financial, emotional or care burden upon others. This would significantly affect people who are disabled, elderly, sick or depressed. Some would face the added risk of coercion by others who might stand to gain from their deaths. Fear and anxiety would be promoted rather than individual autonomy. There have been tragic cases of people suffering from terminal illnesses who wanted other people to help them end their life. It is important however that we do not lose sight of the large number of people who are terminally ill and have exceptionally found richness and purpose in life despite the pain and hardship.
We already played God in legislating for parents to have control over how their offspring arrive in the world. Let us not also give control over how one should leave it, as we would be devaluing life. One of the inevitable aspects of debates about euthanasia is the reluctance on the part of advocates to confront the essence of what they propose.
Euthanasia and assisted suicide are never acceptable acts of mercy. They always gravely exploit the suffering and desperate, extinguishing life in the name of the “quality of life” itself.
Dr Mark Said is an advocate