Sunday, November 27, 2011

Euthanasia: a slippery slope

Youth in Asia?
It was 1978.  The teaching assistant of my Russian Literature seminar entered the room. He sat down at the table and said, “Today we are going to talk about youth in Asia.”  My classmates and I looked at one another, puzzled. Sensing our confusion, he stood up and wrote ‘euthanasia’ on the chalkboard. “Mercy-killing,” he said. The debate was on. More than three decades later, the debate is heating up.

Last week, the Royal Society of Canada (RSC) released its report, “End-of-life decision making.” The Parliamentary Committee on Palliative and Compassionate Care also released its report. And, there is presently a legal challenge before the Supreme Court of British Columbia that seeks to decriminalize euthanasia.

Link to RSC report:
Link to Parliamentary Commiteee Report: 

Euthanasia, an act of compassion or moral confusion?
Euthanasia, which literally means “a good death,” has come to be defined as “the intentional killing by act or omission of a dependent human being for his or her alleged benefit.”

The proponents of euthanasia seem to value life, just as those opposed to it do. At the heart of the push for the decriminalization of euthanasia is the desire to ease suffering for the dying or the terminally ill and their family. Some would argue that euthanasia is a compassionate action because the elimination of suffering helps people experience a good death. 

But, enshrining euthanasia in law is a dangerous path for a society tread. It can lead to the slippery slope of moral confusion regarding the value of a particular individual’s life. Who decides when a person’s life no longer has value or meaning? Who judges the quality of that life, and on what criteria?

The RSC report recommends that Canada adopt a “permissive yet carefully regulated and monitored system with respect to assisted death.”  Based on evidence from other countries, the RSC dismisses the slippery slope argument. The report states that the decriminalization of euthanasia is not a threat to vulnerable people, nor does it lead to non-voluntary or involuntary euthanasia. 

The Netherlands
These two claims are debatable. The experience of the Netherlands, where voluntary euthanasia has been legal since 1984, suggests otherwise. In 1999, the “Journal of Medical Ethics” published a paper reflecting on the results of a 1995 survey of physicians. The survey found that in 20%, or 900 of 4,500 reported cases, patients did not request or consent to having their life ended. Some of these patients were mentally competent at the time of their death, while others were not. In two-thirds of these cases, the patient and physician had never even discussed euthanasia as a possibility.

The study also revealed that physicians withheld or withdrew life-prolonging treatment in 41 % of 1000 cases of infants under one year of age because they felt the baby’s life would be unbearable. In 20% of these cases, parents were not consulted.

The paper concluded that “the practice of voluntary euthanasia remained beyond effective control,” despite regulated guidelines and the duty to report enshrined in law. Although it was illegal, physicians were carrying out involuntary and non-voluntary euthanasia.

The physicians surveyed were not bad, evil people. They believed they were acting in the best interests of their patients. They were deciding which human life had value, meaning, and quality.

A study published in 2010 in the "Canadian Medical Journal" looked at physician-assisted deaths in Belgium, where voluntary euthanasia has been legal since 2002. That study also found that involuntary and non-voluntary euthanasia was occurring.

Dutch Physicians Association
The Dutch Physicians Association (KNMG) released a position paper on euthanasia this fall. The KNMG paper recommends that non-medical reasons, like loneliness or financial difficulties, should qualify a person for euthanasia. The rationale is that non-medical factors also cause unbearable suffering and affect an individual’s quality of life.

It's a slippery slope
All of this points to moral confusion; the slope seems slippery to me.

In the Christian worldview, life is sacred from conception to natural death. End-of-life decisions flow from this premise. Ordinary medical interventions and treatments must always be taken to preserve life.  Therapies that deliver compassionate and palliative care are essential to preserving the dignity of the dying person and contributing to a good death.

The RSC report acknowledges that Canadians are not preparing adequately for death, and that quality palliative care is not readily available.  The Parliamentary Committee Report makes recommendations for establishing a national system of compassionate and palliative care.  This is the direction in which we should be moving.

If we want to avoid the slippery slope, we need to choose a path based on the spiritual principle that life is sacred, from conception to natural death.

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