From Turning the Tide - Euthanasia
Euthanasia is unnecessary because alternative treatments do exist. This is not to deny that there are patients presently dying in homes and hospitals who are not benefiting from advances in palliative care, either because facilities do not exist in the immediate area or because local medical practitioners lack the training and skills necessary to manage terminally ill patients properly. The solution to this is to make appropriate and effective care and training more widely available, not to give doctors the easy option of euthanasia. A law enabling euthanasia will undermine individual and corporate incentives for creative caring.
If care is aimed at achieving 'the best possible quality of life for patients and their families' by focussing on a patient's physical, psychosocial, and spiritual suffering, requests for euthanasia are extremely uncommon. The answer is not to change the law, but rather to improve our standards of care.
Requests for voluntary euthanasia are rarely free and voluntary. Patients with a terminal illness are vulnerable and may well be suffering from fear about the future and anxiety about the effect their illnesses are having on others. They may be suffering from depression or a false sense of worthlessness which is affecting their judgment. Their decision- making may equally be affected by confusion, dementia or troublesome symptoms which could be relieved with appropriate treatment. Patients who say 'let me die' usually after effective symptom relief are most that we didn't accede to thier requests. Terminally ill patients also adapt to a level of disability that they would not have previously anticipated they could live with and come to value what life they have left. Many elderly people already feel a burden to family, carers and a society which is cost conscious and may be short of resources. They need to hear that they are valued and loved as they are. They need to know that we are committed first and foremost to their well-being.
Autonomy is important. We all value the opportunity of living in a free society, but also recognise that personal autonomy has its limits. Rights need protection, but must be balanced against responsibilities and restrictions if we are to be truly free. We are not free to do things which limit or violate the reasonable freedoms of others. No man is an island. No person makes the decision to end his or her life in isolation. There are others who are affected: friends and relatives left behind, and the healthcare staff involved in the decision-making process. Western society no longer recognises suicide as a crime, but still appreciates that a person's decision to take his or her own life can have profound, often lifelong effects on the lives of others. There may be guilt, anger or bitterness felt by those left behind. Personal autonomy is never absolute. The effect of personal decisions on others now living or in future generations must also be considered.
Voluntary euthanasia leads inevitably to involuntary euthanasia. When voluntary euthanasia has been previously accepted and legalised, it has led inevitably to involuntary euthanasia, regardless of the intentions of the legislators. This was demonstrated in Nazi Germany and also more recently in the Netherlands where as early as 1991 there were over 1,000 non-voluntary euthanasia cases reported. The Lords committee in 1994 rejected a change in the law to allow euthanasia because they knew that it would put patients under pressure, whether real or imagined, to request early death.
Calls for voluntary euthanasia have been encouraged either by the failure of doctors to provide adequate symptom control, or by their insistence on providing inappropriate and meddlesome interventions which neither lengthen life nor improve its quality. This has understandably provoked a distrust of doctors by patients who feel that they are being neglected or exploited. The natural reaction is to seek to make doctors more accountable.
Ironically, voluntary euthanasia legislation makes doctors less accountable, and gives them more power. Patients generally decide in favour of euthanasia on the basis of information given to them by doctors: information about their diagnosis, prognosis, treatments available and anticipated degree of future suffering. If a doctor confidently suggests a certain course of action it can be very difficult for a patient to resist. However it can be very difficult to be certain in these areas. Diagnoses may be mistaken. Prognoses may be wildly misjudged. New treatments which the doctor is unaware of may have recently been developed or may be about to be developed. The doctor may not be up-to-date in symptom control.
Doctors are human and subject to temptation. Sometimes their own decision-making may be affected, consciously or unconsciously, by their degree of tiredness or the way they feel about the patient. Voluntary euthanasia gives the medical practitioner power which can be too easily abused, and a level of responsibility he should not rightly be entitled to have. Voluntary euthanasia makes the doctor the most dangerous man in the state.
Killing is always wrong. Letting die sometimes is. It is wrong if we we can do something worthwhile to save a person's life and we deliberately withold treatment. But it's bad medicine to prolong someone's inevitable death. The decision depends on the reversibility of the condition and the effectiveness of the treatment.
Not embarking on inappropriate and potentially harmful treatments when we are powerless to avert death or relieve symptoms is not euthanasia. It's good medicine.
The key issue legally, ethically, biblically is intention. Did the doctor intend to kill the patient, or to relieve the pain? While it is true that in a small number of cases adequate pain relief may have the secondary effect of shortening life (double effect), usually the opposite occurs. A patient with adequate relief is able to clear their secretions more effectively and enjoy a better quality of care.