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Exploring Physician-Assisted Suicide

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Presented by Ruth Maria Adria at the
Values, Ethics and Vision Conference,
Bernard Snell Hall, University of Alberta, Edmonton, AB.
March 26, 1994

Would the acceptance of euthanasia impact the moral fabric of our society?

At the Crystal Palace Aquarium not long ago I saw a crab euthanatizing a sickly fish, doubtless from the highest motives.

-Anonymous

Growing up in peaceful, rural Alberta, a descendant of European immigrants, I was horrified to learn of the atrocities that had taken place in Europe prior to and during World War II. That, somewhere in the sum of 300, 000 aged, infirmed, senile and mentally retarded and defective adults and children were put to death in hospitals and killing centers.

I was further horrified to learn that this mass extermination was totally utilitarian. It was done to save expenses at a time of economic hardship. It was for the welfare of the community as a whole. The people who were put to death were considered useless eaters.

The state actively propagandized the general populace in favor of euthanasia. In an award winning movie, Ich klage an ( I accuse ) the doctor, who had euthanized his sick wife, stands before the court and passionately states: “The Law stops the doctors from serving the people!” From there it was not far to Auschwitz.

The German people, ridden with guilt, became psychically numbed by the atrocities which they had committed against their own elderly and children. As a result, they did little to protest when the genocide of the Jewish people and others began.

In later research of the matter, I found that it was the medical profession and other academia who took a leading role in the planning, developing and carrying out of this massive euthanasia. The beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians. It started with the acceptance, that there is such a thing as a life not worthy to be lived. This entire trend of mind received its’ impetus from the attitude toward the non-rehabilitatable sick.

Defining Euthanasia

Euthanasia has a Greek origin and literally means good death. As generally used in medical and ethical literature, the term is synonymous with mercy killing.

In its’ broad sense, euthanasia embraces a variety of situations, some where the patient is capable of consenting to his death, others where he is obviously not.

Actions that are either intended to allow death to occur, or to hasten it, can be divided into several categories:

  • Active euthanasia which involves taking a direct action intended to kill the patient.
  • Passive euthanasia an act intended to allow the dyimg process to conclude, such as the withdrawal of a feeding tube, or a decision not to write a prescription for antibiotics for a patient.
  • Voluntary euthanasia a request for aid-in-dying made by the patient.
  • Involuntary euthanasia an act or similar act which allows a new born baby with Down Syndrome, duodenal atresia or mental defect to die while withholding sustenance or hydration.
  • Snowing a patient is the term used to describe increasing levels of painkillers to such a degree that the patient loses consciousness and, because respiration is depressed by the narcotics,the patient dies far more rapidly than would otherwise be the case.

Have attitudes become more civilized since World War II?

In the State of Washington, a physician-assisted initiative, Initiative 119, was put forward in 1991 by pro-euthanasia forces. It was narrowly defeated. However if this morally regressive aid-in-dying legislation had been passed, it would have made Washington State, the world’s first jurisdiction to legalize euthanasia!

In our own country, Bill C-203 was given first reading in the House of Commons (1991). The purpose of this Bill was to “protect the physician from criminal liability when he gives aid-in-dying, where he does not initiate or continue treatment or where the physician does not prolong life, except at the person’s request. It would also protect the doctor if he administers painkilling treatment to a person even though the effect of that treatment would hasten death”.

Bill C-203 was vague and did not even specify that the person need be terminally ill. It held inherent dangers and strong possibilities for abuse. Within this legislation, lies a desire to give doctors a free hand, leaving everything to their discretion and individual conscience. It would bring the whole subject within ordinary medical practice.

Patients, under Canadian law, have always had the right to accept or refuse treatment, and physicians have always been free to use the means that they consider suitable or necessary. The Canadian Medical Association Code of Ethics states that the patient has the right to refuse any treatment, medical care or physician.

The courts have also ruled that the right to refuse treatment is a constitutional right protected by the Charter of Rights and Freedoms.

To date, Section 224 of the Criminal Code makes it an offense punishable by imprisonment for fourteen years for anyone to counsel or aid a person to commit suicide.

Nevertheless in 1982, the Law Reform Commission of Canada in the WORKING PAPER 28 – EUTHANASIA, AIDING SUICIDE AND CESSATION OF TREATMENT stated:

“…one should acknowledge the undeniably humane aspects in certain cases of counselling or aiding suicide. For that reason the Commission recommends that no one be prosecuted for this offense except with the written authorization of he Attorney General.”
(1982, P.69)

The Doctor as Executioner

It is disturbing, that as a civilized people we would consider allowing a segment of our society to kill others with impunity. Under the proposed law, doctors would not be held accountable for causing another person’s death.

Health professionals could be seen as paid, hired killers. How could we trust and respect them? This would surely reverse the ethic that members of the medical profession must heal and never kill. This would result in an erosion of trust in the medical profession which would reverberate throughout all of society.

The secular media proliferates this concept, softening our objection to it. W5 and Market Place have presented a number of documentaries slanted towards euthanasia. Professional jurists promote and justify the idea. Even more disturbing is that public pollsters have determined that we, as a society, embrace this barbarous proposal!

Death by Consent

The proponents of physician-assisted-suicide are putting forth a frightening concept, considering the often depressed and heavily medicated state of individuals, who are undergoing serious illness.

Dr. Benjamin Miller, in an Article titled: “Why I oppose Mercy Killing”, stated:

“Anyone who has been severely ill, knows how distorted his judgement became during the worst moments of the illness. Pain and the toxic effects of disease, or the violent reaction to certain surgical procedures may change our capacity for rational and courageous thought.”
(1950, p.38)

Can such consent be deemed informed consent?

Palliative Care

Father Thomas Dailey, the former Director of St. Joseph’s College Catholic Bioethics Centre, has stated:

“Those favoring assisted suicide have not given adequate attention to palliative care (proper use of pain management techniques), …most pains associated with terminal illness can be controlled. Palliative care aims also at assuaging the suffering of terminal patients. Often they feel helpless, lonely, in the way and a burden to others. With empathy, comfort, care, and affirmation, palliative care givers accompany patients in their suffering and by their kindness and compassion help the patient move from depression to hope.”
(1991, pp.1,2)

Are these the kind of pressures we want to inflict on any person, let alone a sick person?

Physician assisted suicide is promoted by such euphemisms as “mercy killing”, “dying with dignity”, “aid in dying” or “good death”. In the current economic climate of health care cutbacks, “dying with dignity” could quickly become, “duty to die”, or even “fiscal responsibility”, and overshadow all terminally ill and elderly individuals.

Time Magazine reported Governor Richard Lamm of California as stating that the elderly have a duty to die! (1984). They further commented that he was praised in many quarters for broaching such a sensitive issue.

Lamm, however was not speaking of personal rights, but of societal responsibilities. The elderly according to Lamm, have a duty, not a right to die; to get out of the way for the younger generation; to free up society’s dwindling resources now being spent on medical care. According to Lamm, the death of the elderly is a service to society.

Are these the kind of pressures we want to impose on the sick, on the elderly, on families, let alone on emotionally shattered families? And if so, are they proper considerations for the crippled, the paralyzed, the quadruple amputee, the iron lung occupant and their families?

Compassion is No Justification for the Death Call

“Compassion is no justification for the death call”, stated Dr. Philip Ney, a psychiatry professor from New Zealand, who delivered a medical ethics paper at the Royal College of Physicians and Surgeons convention held in Calgary in 1983.

“Doctors don’t have the wisdom to decide when swift death is better than suffering. Such subjective judgements, about when lives no longer have value, led German psychiatrists and doctors to exterminate 300,000 patients prior to the Second World War.

Like the Nazi doctors and psychiatrists”, Ney said,“Physicians can be swayed by popular morality or political expediency. Patients trust doctors to give them the best clinical treatment, not to decide when life is no longer worthwhile. Patients know that as their value declines, so will their standard of medical care.”

He added:
“The arguments which support euthanasia, the right of the woman to abortion, the importance of not encumbering parents with retarded children. …are tainted with the obvious selfishness of those who are most likely to gain.”

He concluded by saying:
“Doctors must never abandon their Hippocratic ideals.”
(1983, B,7)

Whose Choice Is It?

A survey among 300 physicians in Holland (Kass, 1991) revealed that over forty per cent had performed euthanasia without the patient’s request.

Because government policy in Holland ignores assisted suicide, somewhere between 3,000 to 4,000 such acts are carried out annually.

At an Edmonton meeting of “Dying with dignity”, on March 19, 1991, the Executive Director, Ms. Marilyn Seguin of Toronto, stated that she had counselled two hundred and fifty persons with suicide that same year. That would work out to a death per each working day. She described nurses, who discouraged patients from wanting to take their own lives, as “obstructionist”. It would seem that Ms. Seguin is so compelled by her mission that she solicits suicides.

Our 90’s society does not guarantee that succeeding generations will be better off economically than the previous generation, as has happened in the past. As a matter of fact, it is most likely that many persons will have less disposable income, or be unemployed due to encroaching technology. Let us therefore consider a possible scenario.

Consider a man who is approaching middle age. He has a wife, children, a large mortgage and great difficulty paying his bills. But Son has a Momma who owns a modest home, all paid for, also some savings and a few Bonds. One day Momma has a stroke and becomes partially incapacitated. Because Son has been seduced by such euphemisms as “quality” or “enjoyment” of life, he, as her health care agent (Alberta Law Reform Institute, 1991) recommends to the doctor that Momma be quietly helped on her way.

If physician-assisted-sucicide were legalized, how can we be certain that the patients actually asked the doctor to terminate his/her life?

Euthanasia is Final, Fatal and Irreversible

Even those who do not subscribe to the moral base of Judeo-Christian values, must strenuously resist the decriminalizing of physician-assisted suicide, on the ground that it offers the patient far too little protection from not-so-necessary or not-so-merciful killings. What about faulty diagnosis or the prospect of new relief or cures?

Under any euthanasia program the conseqences of mistake, of course, are always fatal. Once the decision for euthanasia has been carried out, it is devastatingly final and irreversible.

The Ethic of Individual Rights

There are those, who champion the rights of individuals to die painlessly and at the time of their choosing. If we decriminalize physician-assisted suicide and allow the right of voluntary euthanasia, it undoubtably will be the opening wedge for more objectionable practices; and even within the bounds of voluntary euthanasia, the incidence of mistake, or abuse, is likely to be substantial.

It may be perceived as cruel and unmerciful to allow a patient to continue to suffer, if only for a short while. In a narrow sense, in the case of society’s offenders, we allow long term sentences for the general good, which could also be construed as cruel and unmerciful treatment.

Should not the common good overrule the rights of the individual? If we are part of society, should we not be treated as such?

Father Thomas Dailey has stated, that a reason for the current attractiveness of suicide and assisted suicide is:

“the exaggerated roll that personal autonomy has come to play in human consciousness, has erroneously developed into a concept that stresses rights but forgets about responsibilities…the dying patient, like all human beings, is a person in relationship. The patient has responsibility to family, to others and to society.”
(1991, p.2)

Dr. Menno Boldt a suicidologist, of the Department of Sociology at the University of Lethbridge states that with few exceptions suicidal persons do not want to die. He states that:

“Suicidal persons do not seek or embrace death, nor do they reject or devalue life. Rather they seek relief from the intolerable conditions and circumstances of their life. Death is the abhorred agent of their relief.”
(1985, p.7)

The Guilt Factor

In practice, would not such legislation result in unbelievable, collective, societal guilt? Today, many German nationals continue to express guilt concerning their past.

Guilt has been passed on from generation to generation; and is even expressed by those who were too young to have been participants.

In recent years a documentary dealt with the euthanasia of the 30’s. It portrayed a nun who continued to be filled with grief and guilt for having given up, under duress, the retarded children in her care to the gestapo.

Similarly, according to the CBC documentary Final Exit, aired on the 5th Estate, Ann Humphrey who, together with Derek Humphrey co-founded the Hemlock Society, recorded that she had euthanized her parents. Ann Humprey stated: “Two days later I could not live with myself and I walked away from that house thinking we are both murderers and I can’t live like that anymore. On October 2, 1991 this beautiful, vibrant woman, took her own life by taking the same substance she had given her parents 5 years earlier.

Will we attempt to change deeply entrenched, universal precepts of criminal and moral law?

Will we make the killing of another a matter of individual choice? Will we find acceptable for one human being to empower another human being to kill him? Are we about to create a society that sanctions private killings with impunity?

Is this not a repeat of the euthanasia nightmare of the nazi era rearing its’ ugly head under new euphemisms of “mercy killing” or “dying with dignity”? Ultimately, would it be the edge of the wedge which would propel us down the slippery slope to active euthanasia with its’ parade of horrors? The parade of horrors argument cannot be too lightly dismissed in this particular instance, in that the parade has taken place in our time and memory, and the order of the procession has been headed by the incurable and the useless.

There are those human beings with tatooed numbers on their arms, who have witnessed the horror of the extermination of fellow human beings.

Indeed, history speaks loudly, and we must listen.

Humankind cannot break the age old moral code of, “Thou shalt not kill”, and still remain a sane, rational, compassionate community.

Acceptance of euthanasia will impact the fabric of our society, unravelling our moral code, leaving us with a tattered conscience.

Society cannot accept euthanasia without suffering irreparable damage.


References

  1. Alberta Law Reform Institute.(1991) Advance Directives and Substitute Decision-Making in Personal Health Care. Report No.#11. November, 48.
  2. Boldt, M..(1985) Defining Suicide: Implications for Suicide Behavior and for Suicide Prevention A Paper prepared by Dr. Boldt, of the University of Lethbridge, for presentation at the 13th biennial Congress for Suicide Prevention and Crisis Intervention, Vienna,Austria, June 30 1985.
  3. CBC (1992) Final Exit, February 4.
  4. Dailey, T.D. (1991) Trends in Bioethics St. Joseph’s College Bioethics Centre.
  5. Kass, L.R. (1991) Commonweal August 9 p.473
  6. Lamm, R. (1984) Time Magazine. Medicine, April 9, p.34.
  7. Law Reform Commission Of Canada. (1982) Euthanasia, Aiding Suicide and Cessation of Treatement : Ottawa, Canada: Federal Government 69-70
  8. Miller, B.(1950) Woman’s Home Companion, June p.38
  9. Ney, P.(1983) Edmonton Journal : Southam Press. September 23, p. B7

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