Euthanasia is a weighty subject—a subject that cannot be broached without reflecting upon human suffering, harm, and death. Since the proposal of the End of Life Choice Bill (ELCB), euthanasia has been the subject of extensive public and private debate here in Aotearoa. For those unfamiliar with the bill, it proposes the legalisation of voluntary euthanasia for any person over the age of 18 who has a “grievous and irremediable medical condition”, who “experiences unbearable suffering that cannot be relieved in a manner that he or she considers tolerable”, and who can “understand the nature and consequences of assisted dying”[i]. In December 2017 the bill passed its first reading, and the second reading will be held once the Justice Committee have finished receiving public submissions. In this post, I will argue that the ELCB is flawed in such a way that renders it unacceptable as public policy. Briefly, my argument is that the safeguards in the bill are unable to sufficiently minimise the risk of patient manipulation, and, since the government should not accept legislation for euthanasia that fails in this regard, the bill should not be accepted.
Section 8(h) states that attending physicians must do their best to ensure that patients’ requests for euthanasia are free from external pressure, and three primary safeguards are outlined[ii]. The physician must:
- Talk to “other health practitioners who are in regular contact with the person”
- Talk with “members of the person’s family approved by the person”
- Fill out a form detailing the actions he or she took to ensure that these obligations were fulfilled.
My contention is that although these safeguards offer some protection against manipulation, they do not sufficiently minimise the risk. As an example, consider this situation:
A family stands to benefit from the death of a terminally-ill relative. As such, they manipulate their ill relative into requesting euthanasia, even though it is not a choice she wants to make. Nonetheless, she informs her health practitioner of the “decision”, and requests euthanasia. The physician talks to the patient, as per the safeguards, who falsely affirms that the request was autonomous. The physician then converses with the family, who do not admit to having manipulated the patient. Consequently, the physician sends the necessary forms to the Registrar, which approves the request, and the patient is euthanised.
This example indicates that, even when the safeguards are followed, patients can nonetheless be manipulated into requesting euthanasia against their wishes.
There are two obvious rejoinders that would nullify this argument. Firstly, someone might contend that it is all very well and good to theorise about these kinds of abusive situations, but, in reality, no one would ever do such a thing. To this objection, I would quote ethicist J. D. Velleman: “no one would ever do such a thing as abuse his own children or parents—except that many people do”[iii]. In light of the atrocities that have occurred and do regularly occur in our society, the aforementioned scenario hardly seems unlikely. But, if it is not unlikely, then it deserves to be seriously considered, and should be a significant factor in our assessment of the worthiness of this bill.
Secondly, many people argue that there is no evidence of significant abuse or error occurring in countries and states where assisted-dying is currently legal. As one study indicates, “rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for [vulnerable groups]”[iv]. When considering an increase in euthanasia among elderly persons, other researchers state “we deem it less plausible [than other explanations] that the trends indicate more vulnerable groups feeling increasingly forced to choose euthanasia”[v].
Two responses come to mind. Firstly, interpretation of these findings is mixed. Though some researchers conclude that there is no indication of abuse, others question both their methodologies and conclusions[vi]. In some cases, the data is consistent with error and abuse. For example, a study of euthanasia in Belgium found that life-ending measures were frequently enacted without an explicit request, and that in these situations “family burden and the consideration that life was not to be needlessly prolonged were more often reasons for using life-ending drugs”[vii].
However, a more fundamental consideration is this: if manipulation were occuring, it is not clear that we should expect to find evidence. After all, the abused person is deceased, and therefore cannot testify, while those who committed the abuse are unlikely to admit their wrongdoing. Since these are probably the only parties privy to the abuse, a lack of evidence is what we should expect both if manipulation is occuring, and if it is not. Therefore, absence of evidence does not equal absence of abuse.
In sum, I do not believe that the ELCB provides adequate safeguards against manipulation, and therefore it should not be accepted. If euthanasia is to be legalised, we as a society have a duty to make sure it does not adversely affect vulnerable people. As such, any proposed legislation must be subjected to rigourous scrutiny to determine whether it achieves this end. In this regard, I believe the End of Life Choice Bill fails.
[i]ELCB Section 4: http://www.legislation.govt.nz/bill/member/2017/0269/latest/DLM7285950.html
[ii] ELCB Section 8: http://www.legislation.govt.nz/bill/member/2017/0269/latest/DLM7285956.html
[iii] Velleman, J.D. (1992). Against the right to die. Journal of medicine and philosophy, 17(6), p. 675.
[iv] Battin, M. P., van der Heide, A., Ganzini, L., van der Wal, G., & Onwuteaka-Philipsen, B. D. (2007). Legal physician-assisted dying in Oregon and the Netherlands: evidence concerning the impact on patients in “vulnerable” groups. Journal of Medical Ethics 33, p. 591.
[v] Dierickx, S., Deliens, L., Cohen, J., & Chambaere, K. (2016). Euthanasia in Belgium: trends in reported cases between 2003 and 2013. Canadian Medical Association Journal 188(16), p. 412.
[vi] E.g. Finlay, I. G., & George, R. (2011). Legal physician-assisted suicide in Oregon and The Netherlands: evidence concerning the impact on. Journal of Medical Ethics 37, pp. 171-174.
[vii] Chambaere, K., Bilsen, J., Cohen, J., Onwuteaka-Philipsen, B. D., & Mortier F, D. L. (2010). Physcian-assisted deaths under the euthanasia law in Belgium: a population-based survey. Canadian Medical Association Journal 182(9), pp. 896-897.