Technological advances have rid humanity of many of its most malignant scourges. Some diseases, like Smallpox, have been virtually eradicated. Ancient killers like Measles, Rubella, and Polio have been tamed beyond recognition, in the ‘developed’ world at least. There are even optimistic whispers among the scientific community of the “Achilles’ heel of HIV” revealing a potential Aids vaccine. Science however, has only stretched so far. Millions of hearts will break tonight as loved ones slip from their grasp. Many families will watch in agony as those closest to them slowly crumble into a coma or vegetative state; stripped of dignity, paralysed by pain, an incapacitated shell of their former selves. Technology cannot save all. Many diseases remain simply incurable, and for sufferers of debilitating terminal diseases like Cystic Fibrosis, Dementia or Muscular Sclerosis the medical community can do no more than extend the quantity of life. Tragically, this prolonged quantity is invariably to the detriment of its quality. Medical advances still fail to unite the two. In the face of this trauma and heartbreak few answers are proposed.
As part of his pioneering vision of utopia St. Thomas More “envisaged such a community as one that would facilitate the death of those whose lives had become burdensome as a result of ‘torturing and lingering pain’.” Euthanasia–”the deliberate killing of a person for the benefit of that person”–remains a hidden theme in twenty-first century Britain, an ‘on-again off-again’ story which is rarely directly addressed in decision-making circles. It is a controversial, highly charged conjunction of moral and political arguments and inspires great passion and emotion. Everyone has an opinion on this subject. Everyone knows of someone who has suffered. Yet the debate remains relatively muffled. Some countries, in a moment of lucidity not afforded to British officials, have legalised variants of euthanasia. Switzerland, the Netherlands, and the US state of Oregon have all liberalised their assisted suicide laws. Despite the 2007 British Attitudes Survey demonstrating that 80% of the British public would favour the legalisation of voluntary euthanasia, the British government remains lamentably neutral on the subject. Embedded in emotion and subjective morality, euthanasia’s controversy stifles scrutiny and it appears a virtual taboo for medics and legislators alike.
The central ethical argument for voluntary euthanasia is that “respect for persons demands respect for their autonomous choices as long as those choices do not result in harm to others”. The belief in freedom of choice is the belief that each human being should be the ultimate arbiter of their own existence. Human beings have the right to independent self-determination, and while a right to death per se is much disputed, “For many dying patients, the major source of distress is having their autonomous wishes frustrated”. This month, 30 year old Kelly Taylor has mounted a legal case for euthanasia after her living will asking doctors not artificially feed or hydrate her was rejected. Mrs Taylor is in continuous and considerate pain from a congenital heart defect and a spinal disorder, and she is seeking relief. She says, “Enough is enough…I don’t want to suffer any more…My consultant has told me that he does not expect me to live for another year. In that time I will deteriorate and that deterioration will become quite undignified. I want to avoid that”. In the grip of unendurable suffering and pain, the terminal disease with which patients are stricken reduces their capacity to control most decisions.
Many believe that life is too precious to be dispelled under any circumstances, and are morally opposed to the curtailing of life under any circumstances. Some believe that the right to remove life is one that only greater beings can possess, and that euthanasia is violates the fundamental value of human life. This argument is eloquently outlined by Malcolm Muggeridge, who claimed that, “This life in us … is still a divine flame which no man dare presume to put out …. Either life is always and in all circumstances sacred, or intrinsically of no account; it is inconceivable that it should be in some cases the one, and in some the other”. The secular interpretation of the right to life, as represented by Bioethicist Brian Patton, argues that not only is suffering so subjective that it can never be conclusively determined as ‘unbearable’, but that when palliative care is so effective it would be impossible for doctors to sanction euthanasia, even on a case-by-case basis. Patton’s objections are curious. Firstly, it is true that pain and despair can never be objective, but that surely justifies the right of individuals autonomously dictating their own standards of quality. External judgment of the level of Kelly Taylor’s pain is facetious, and to undermine her capacity to tolerate pain is to do her a great injustice as a sovereign human being. Assuming competence, the opinions of the patient must carry the greatest weight; it adds insult to considerable injury to impose a quality of life onto them.
Secondly, it is more than just a concern to alleviate suffering that leads patients to consider their desire to die. A powerful motivation is to preserve dignity, one of the many casualties of a fiercely debilitating condition. Many people do not wish to live their lives under the continuous care of hospices, regardless of quality. It is a question of standard of living. Whether the belief in the right to life is founded in religious or atheist belief frameworks, it simply remains that it is not the decision of anyone but the patient themselves to make. Freedom to choose is fundamentally about placing the right to decide in the hands of the person who is ultimately affected the most. However wellintentioned, to restrict the choice completely is to inflict one person’s moral framework onto others. To provide the choice does not detract from those who wish to decline the option of euthanasia, or those who feel that life should not be compromised in that fashion. Euthanasia, if legalised, would allow those who share this conviction to abstain, either as doctor or as patient. To impose euthanasia would be equally wrong; nevertheless, the opposite case is our current status-quo, and does not work in the best interests of those directly concerned.
The debate that I have briefly outlined is dealing with extremely subjective application of extremely general principles, and the championing of the right to choose blankets over many caveats and considerations. The right to choose may be suited to Mrs Taylor, but what of those who have no Living Will? What of those who lose the mental and physical capability to articulate their will? What happens to those who have not articulated a long-standing commitment regarding their desire to die, and have changed their mind once the disease takes hold? Who makes the decision in the case of children? It is an area that is fraught with complications, and any move towards legalisation must not increase the vulnerability these people. Euthanasia must work to the patient’s advantage and not at their expense. There have been attempts to create a flexible framework to satisfy some of these fears, such as Stanford Encyclopaedia of Philosophy’s Five Individually Necessary Conditions. Euthanasia must be cautiously regulated, and those who oppose euthanasia raise many considerable obstacles and fears. In 2006 a poll carried out by Communicate Research indicated that 73% of the public “agreed that such a law would ‘make it more difficult to detect rogue doctors such as Dr Harold Shipman’”. The paranoia stirred by notorious cases like Dr. Shipman and Dr. Kevorkian is understandable. Fear of abuse is natural in the eventuality of any liberalisation and relaxing of existing restrictions, and must remain a key priority were any system to be introduced. The legalisation of euthanasia is bound to be fraught with complexity and controversy. That however is no reason to shy away from seeking a solution.
In the meantime, victims of catastrophic disease and disaster like Reg Crew are forced to suffer unnecessary and unwanted pain. Reg Crew died of Motor Neurone Disease in 2003. The testimony of his wife Win on the Death with Dignity website attests to “a living hell…Palliative care did little for him. His dignity was stripped away, each time the disease closed down another part of his body, and so was his independence”. Where suffering and pain is so great that our considerable medical prowess is rendered irrelevant we have no response but a retreat to palliative care and nursing the victims of catastrophic disease into the shadows of eventual death. Euthanasia would provide an answer to the patient’s torment, and would bring a compassionate end to their suffering. In the circumstances where euthanasia would be desired, “death is no longer considered to be the enemy, but rather as a friend who will deliver the patient”. Euthanasia derives from the Greek for “good-death”, and in the name of compassion, it is perhaps time to consider its introduction in Britain.