Past your "use by" date? What's next?

A private member's bill to legalize assisted suicide is being studied in the Canadian parliament. And it's been reported that police in Minnesota expect to charge William Melchert-Dinkel, a nurse, for allegedly using the Internet to encourage Ottawa resident, 18-year-old Nadia Kajouji, who committed suicide, to kill herself. So far, at least, no one has argued that this was or should be ethically or legally acceptable.

That is not the case in relation to George and Betty Coumbias, two 73-year-old British Columbia residents. George suffers from serious heart disease; Betty is healthy. But in Betty's words, "I don't think I can face life without (George), and since we read about Dignitas (a Swiss organization that assists people to commit suicide), we felt what would be better than to die together, you know, to die in each other's arms?"

Under Swiss law, because George is seriously ill, Dignitas has no problems in helping him. But it is seeking a ruling from local officials as to whether they might help Betty, as a healthy woman, to kill herself and allow her and George to carry out their suicide pact.

If, as pro-euthanasia advocates argue, respect for people's rights to autonomy and self-determination means everyone has a right to die at a time of their choosing, and the state has no right to prevent them from doing so, then Betty would have the right to choose to die with George. And that's precisely what Ruth Von Fuchs, head of the Right to Die Society, argued on CTV's Canada AM. In her words, "life is not an obligation."

Most of us, I suggest, including some people who would support assisted suicide in some circumstances, see the situation differently from Ms. Von Fuchs and would regard helping Betty to kill herself as wrong, just as they do the encouragement given the Ottawa woman. The possibility that legalizing euthanasia and assisted suicide could allow this might make some pro-euthanasia people rethink their stance.

Where is the ethical justification?

Euthanasia and assisted suicide involve extinguishing human life. Research shows that humans have a basic instinct against killing other humans, which might be a source of the widely shared moral intuition that it's wrong to do so.

People who oppose euthanasia and assisted-suicide believe these interventions are inherently wrong -- they can't be morally justified, and that even compassionate motives do not make them ethically acceptable -- the ends do not justify the means.

People who would accept euthanasia and assisted-suicide, but only in some circumstances, usually limit access to them to people who are terminally ill and in serious pain and suffering that can't be relieved (which are exceptional cases). These limitations show that these people believe each case of euthanasia or assisted-suicide needs moral justification to be ethically acceptable.

Even Ms. Von Fuchs, although she thought Ms. Coumbias should have the unfettered right to assisted-suicide, argued that it would allow Ms. Coumbias to avoid the suffering, grief and loneliness associated with losing her husband -- that is, she articulated a justification.

Is loneliness a good enough reason to seek death?

But surely the answer to loneliness and grief is not to help the person commit suicide? As I once suggested to a Dutch physician who had carried out euthanasia on an old woman in similar circumstances to those Ms. Coumbias is anticipating, and thought euthanizing this woman was justified, "Did you think of buying her a cat?"

Loneliness and social isolation are strongly associated with requests for euthanasia. Although the need for euthanasia to relieve pain and suffering is often the reason pro-euthanasia advocates give to justify it and the justification the public accept in supporting its legalization, research shows that dying people who request euthanasia do so far more frequently because of fear of social isolation and of being a burden on others, than pain.

Further, Ms. Coumbias is only anticipating her grief, not experiencing it. We give much more negative weight to -- we disvalue -- dreaded events in anticipating them, as compared with when they actually befall us. For instance, on a scale of zero to minus 10, with minus 10 being the worst affliction, sighted people put blindness around minus 8.5; blind people put it around minus 2.

That leads to wider considerations raised by this case. Most of the analysis has been at the individual level of Ms. Coumbias's right to die. But how we die is never just a private matter. It necessarily involves society and what it allows or prohibits, and some of society's most important values and institutions.

Society would be complicit in euthanasia or assisted suicide in legalizing them and in allowing medicine to be involved. Law and medicine are the two main institutions in a secular society that carry the value of respect for life. That value would be unavoidably seriously harmed.

The slippery slope of euthanasia

Even utilitarians, who base their ethics on whether benefits outweigh risks and harms, should decide against euthanasia and assisted suicide because the harms outweigh the benefits, especially on the slippery slope these interventions open up.

We can see that in the Netherlands, which has a 30-year experience of euthanasia.

The original Dutch criteria for euthanasia were that it was limited to competent adults, who were terminally ill and had pain and suffering that could not be relieved, and who repeatedly asked for euthanasia. Now none of those requirements apply.

- The recent Groningen protocol allows parents of disabled babies to request euthanasia for them.

- Children aged 12 to 16 years can request and obtain euthanasia with their parents' consent and those over 16 can give their own consent.

- There are more than 500 deaths a year from euthanasia (and possibly many more) where the adult was not competent or whose consent was not obtained.

- A middle-aged depressed woman, who was not terminally ill, was given euthanasia by her treating psychiatrist. A court ruled this was justified.

- An old man who had a dread of being put in a nursing home was given a choice by his family between a nursing home and euthanasia. He chose euthanasia. He was not terminally ill or in unrelievable pain and suffering.

- Recent research showed that in the Netherlands the rate of suicide in late middle-aged men (a group with an increased risk for suicide) had dropped, but the rate of euthanasia in this same age-group had risen.

What impact would recognizing suicide as a legitimate way to relieve suffering have on people who are suicidal?

Legalizing euthanasia and assisted suicide causes death to lose its moral context and us to lose our proper emotional response to it, a loss which recent research shows detrimentally affects our ethical judgment.

It delivers a "better off dead" message that treats dying humans as disposable products. As one Australian politician expressed this: "When you are past your 'use by' or 'best before' date, you should be checked out as quickly, cheaply and efficiently as possible."

An aging population, scarce health-care resources and legalized euthanasia or assisted suicide would indeed be a lethal combination, not only for individuals, but also for important societal values and institutions that uphold those values and the overall ethical tone of our Canadian society. But the Coumbias's campaign to die together through assisted suicide might have a silver lining for people opposed to euthanasia and assisted suicide.

In 1999, when Princeton philosopher, Peter Singer, told a Newsweek reporter that he thought there was no ethical or moral difference between abortion and infanticide, and he approved of both, he was described as the pro-choice "abortion-rights movement's worst nightmare" come true. He was expressing the logical extension of the pro-choice stance and, thereby, doing a favour to those opposed to abortion.

Now, in 2009, the same kind of "nightmare" faces the dying-with-dignity, pro-euthanasia lobby as a result of George and Betty Coumbias's campaign. They are expressing the logical extension of the pro-euthanasia stance and, thereby, doing a favour to those opposed to euthanasia and assisted suicide.

Margaret Somerville is director of the Centre for Medicine, Ethics and Law at McGill University, and author of The Ethical Imagination: Journeys of the Human Spirit.


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