Euthanasia: Is it up to public opinion?
OPINION: Whatever our view on life, religious or not, most people would agree that two scenarios we greatly fear are those of suffering a painful drawn-out death, or watching someone we love suffering such a death. This is, in part, what drives the current debate on euthanasia and the growing moves to decriminalise/legalise both physician-assisted suicide (where the doctor prescribes the drugs and the patient takes them) and active euthanasia (where the doctor administers a lethal dose of drugs).
In Saturday's Nelson Mail (August 29) there was the comment that the euthanasia issue was being "hijacked by opponents armed with 'worst case scenario' assisted suicide examples from overseas" - a very inaccurate statement as those against euthanasia have been given very little public voice in the media.
The current danger is that we risk poor legislation if such a decision was left up to public opinion alone, so that the determinant of public policy becomes the lowest common denominator capable of securing public consensus. We need to remember that ultimately euthanasia is a medical issue and as the Palliative Care Council of NZ notes, "both euthanasia and assisted suicide are against the current ethical positions of the medical and nursing professions in New Zealand".
As an Anglican Minister and a member of the InterChurch Bioethics Council (www.interchurchbioethics.org.nz) I believe there is more to be considered in this debate than public opinion alone. First, there is significant ethical difference between actively/assisting in killing another person and withdrawing (or with-holding) treatment so that the person dies as a result of their illness – a difference often confused in public comments, even by the Prime Minister.
In both situations the intent of the action is critical. In forms of euthanasia, the intent is to relieve suffering by killing. By contrast, when treatment is futile and is stopped or withheld, palliative care given by skilled professionals who address the pain provides the best means to respond compassionately to terminal illness and suffering.
The intention here is to address the many needs of the suffering person and their family, and to enable a dignified pain-free death. Another ethical consideration is that health care professionals are trained and trusted to promote health and wellbeing and provide appropriate treatment for the living and dying - they are trusted not to cause death.
Secondly, many different cultures and religions agree that life is a gift and see the individual in the context of wider relationships. Much of this current debate centres on a patient's right to choose when and how to die in the face of a terminal illness. But the right to choose does not take place in a vacuum – no-one is completely free, we are embedded in family and society involving critical relationships, including future generations.
Our personal freedom is always held alongside the rights of others, and from a Christian perspective, our personal rights have to be considered alongside our responsibilities to others that reflect our love of God as indicated in the command to love both God and neighbour (Mark 12:28-32).
In the face of suffering, the Christian and humane response is to maximise care for those in most need. Therefore, we need to hear as a society that killing does not equate to compassion. Those at risk from euthanasia legislation are the vulnerable in our society, especially the elderly, and given that Maryan Street's Bill was more liberal than current laws in countries that currently permit euthanasia (eg Oregon, USA), incremental extension of euthanasia laws to new categories is inevitable as seen already overseas.
For those with terminal illness effective care is now possible through palliative care which includes modern pain management and people trained to help the terminally ill die with dignity. Furthermore, the importance of intent along with our responsibility to others also resonates with traditional Maori customary practices where physician-assisted suicide or euthanasia have no equivalent in language or practice.
Finally, beyond the desire to relieve individual suffering there are societal pressures which lead us to reflect on the reasons for this debate at this time.
We recognise the escalating costs of health care (particularly in the last year of life) and ask whether this debate is convenient in the light of socio-economic concerns. This then raises the issue of justice where the Christian response is to ensure that people who are weak and vulnerable receive compassionate care.
As international experience has shown, voluntary euthanasia quickly becomes non-voluntary euthanasia for conditions other than terminal illness (as in the Netherlands). The rights of vulnerable individuals are ignored when decisions are made without their input or consent, based on their perceived lack of value to, or burden on, society.
In light of this, I would not support legislation for the decriminalising or legalising of physician-assisted suicide or active euthanasia. Instead, I am suggesting that as a society we recognise death as a natural part of life, and that it is extremely important for skilled palliative care to be made freely available to all of those who face terminal illness, enabling them to die with true dignity.
Rev Dr Graham O'Brien, Anglican Diocese of Nelson and member of the InterChurch Bioethics Council