Mercy killing
The ethics behind Euthanasia are among the most challenging we face. Giles Crosse looks for the answers.
Is mercy killing the most logical end to a balanced life? What about wider impacts on societies, families or children? And what role do the state and lawmakers have in governing these agendas?
These are just some of the questions at the heart of perhaps the toughest ethical dilemma facing our planet. There are no simple answers. Myriad arguments exist in favour of either side, but as media reports increasingly focus on terminally ill patients flying overseas for assisted death, it’s plain existing approaches aren’t working.
It’s not just about patients and families. Healthcare workers are massively pressurised by uncertainties, while lawmakers are plagued by difficulty in judging whether to prosecute so called offenders.
Guiding principles
“What Dignity in Dying campaigns for is assisted dying for people who are terminally ill and mentally competent,” explains Jo Cartwright, Campaigns Officer. It’s crucial to view the arguments in their correct context.
“The term euthanasia covers such a vast range of situations given that it fundamentally just means ‘good death’ and has a number of prefixes which vastly change its meaning. However, the US States of Oregon and Washington have a law which permits assisted dying for terminally ill people who have a life expectancy of less than six months, and even with their complex health care system works well, within the law they have created.”
“Considerations must be made to legislating against the abuse of potentially vulnerable people, but research in 2006 showed there was no evidence in any of the countries or States where assisted dying or voluntary euthanasia have been legalised.”
“Despite the projection of vulnerable grannies being forced to die by opponents to assisted dying, those who tend to choose assisted dying have been through a palliative care system, and are middle class, well educated people who have had control in their lives and want to take the same control about the time and manner of their deaths.”
Ethical agendas
Some argue there is never an ethical excuse to ‘take a life’ But it seems this, once again, depends on your perspective.
“The process of assisted dying only involves another person prescribing a medication, the patient takes the medication themselves at a time of their choosing,” continues Cartwright.
“We are also talking about people who are already dying, not people who are chronically ill or disabled but not dying, therefore we see it as reducing the dying process rather than ending a life. We do not advocate a duty to die, but we also think there must be a balance struck which means that there isn’t an enforced duty to suffer.”
Reducing dying rather than ending life is an intriguing way to value the arguments. “Different people draw the line in different places, both theoretically and when they face dying themselves, and this is something which will be an ongoing debate even when assisted dying is legalised.”
“Essentially, however, if the person choosing help to die is competent and wants to die because they are suffering, not because there are unmet needs which could feasibly be met, then assisted dying is justified.”
Law without fear?
Another vital consideration is whether individuals seeing real suffering will take steps into their own hands anyway, regardless of law? Is this a crime?
“People do take control when they or a loved one are suffering, and at the moment the choices [in the UK] are going abroad to be assisted to die in a jurisdiction where assisted dying is permitted for non residents, or attempt suicide in the UK.” says Cartwright
“Neither of these options are acceptable. Attempted suicides by people who don’t know what they are doing are often botched and leave people in a worse state, assisted dying in Switzerland is largely unregulated and people who need support may be assisted to die without that need being met, and people shouldn’t have to die abroad.”
“If we accept that assisted dying for terminally ill, mentally competent adults is morally ok, which we do given the lack of prosecution of people who assist people to die outside of the law, then the next and only logical step is to provide a safeguarded, practical and policeable option to those who would qualify under the safeguards.”
Internationally, the Supreme Court in Montana ruled this January that nothing in the state’s law prevents patients from seeking medical assistance to die. But worldwide, religious rules, tribal doctrines or social pressures all alter the situation wherever you live.
“There is definitely an inconsistency with some religious leaders claiming that assisted dying is always wrong because of the sanctity of life, and the other actions they take or fail to take which fail to protect life.” explains Cartwright.
“It should be noted that the large majority of people with faith support assisted dying, over 70 per cent, and their views are highly misrepresented by church leaders. It is true to say, however, that most opposition to assisted dying is faith based.”
“Some religious views suggest that suffering is an important part of life and the relationship with God, although most say that a God of perfect love would not advocate unnecessary suffering and that the prolonging of life is down to man, not God.”
“We fully respect the views of those who would choose not to end their suffering, but those views shouldn’t be imposed on others who don’t share their views.”
Peaceful endings
Cartwright reckons there is no doubt momentum is building towards a change in favour of assisted dying, and that there is an appetite for change among the general public.
“It is a slow and frustrating process however, as opposition are much more vocal and aggressive than those in support, and those who oppose will use the issue as a voting issue, whereas supporters will have a much wider and more varied set of issues which are important to them.”
And what about those embattled on the real front line of all this? “The debate helps, it will make sure that health professionals have an opportunity to discuss their experiences, and the debate has led to the UK’s GMC writing guidelines for doctors on end of life care which will be out in Spring.” says Cartwright.
“Ultimately more clarity on what practices are and aren’t acceptable in a transparent environment can only be a good thing for patients and their healthcare team. As the law and patients’ expectations change, policies need to change and health professionals need to be fully trained in dealing with the changes.”
“The current situation where assisted dying goes on underground, doctors are fearful of prescribing pain medication, patients are begging for help to die to no avail and people are taking matters into their own hands is the worst of all worlds.”
“We strongly believe that the patient alone can make the decisions. Advance decisions, which are currently legally binding documents which allow treatment refusal at the end of life in the event of a loss of capacity, are a good way of patients setting out their wishes if they are likely to have difficulty communicating when the time comes, but the decision must be based on the patients views and values alone, with information from doctors and ideally support from families.”
Resources:
Dignity in Dying, Advance decisions toolkit: Guidance for Health Professionals
