The dead-end values driving euthanasia advocacy

An expert committee of lawyers, chaired by Maitre Jean-Pierre Ménard, was set up by the Quebec government to advise it how to implement Quebec Legislative Assembly committee report on “Dying with Dignity” (QLAC report), which advocates legalizing euthanasia.
The legal committee has just recommended that the Quebec legislature recognize a collection of rights of patients at the end of life, which include rights to decision-making autonomy, palliative care and pain management, control of the time and manner in which one dies, and choice of the place. These rights can be implemented through “medical assistance in dying”, the euphemism used in the QLAC report to speak of euthanasia, or through “medical assistance at the end-of-life”, the even more vague term used by the legal committee. After all, we all want medical assistance in the form of good palliative care, when we are dying. Notably, the legal committee never once uses the word euthanasia in its 416-page report, although the report is principally about how Quebec could make euthanasia available in practice in the province, when the federal Criminal Code prohibits it.
Such developments seem to confirm what a filmmaker preparing a documentary on the euthanasia debate in Canada recently said to me, “Everyone, on both sides of the debate, with whom we’ve spoken, believes that legalization is inevitable”.
But such a belief proved wrong in the recent Massachusetts referendum on legalizing physician-assisted suicide: it was widely predicted the pro-assisted suicide side would prevail, but it didn’t, although the vote was very close.
What impact might such predictions have? Could they be a strategy used to promote the legalization of euthanasia and, in the same vein, might they be a self-fulfilling prophecy?
And what role does labeling as “progressive” values that favour legalizing euthanasia play in promoting its legalization? The implication is those who oppose such values are retrogressive, out-of-touch with current realities, people clinging to a long-gone past and its traditional, conservative values, no longer held by most people, especially young people. Just such an approach is clearly articulated in the QLAC report.
But is this correct? Many young people are lamenting that long-term, committed relationships and marriage have been made much more difficult for them to realize. Most people agree the cause, at least in part, is radical changes, since the 1960’s sexual revolution, in the values, norms and mores governing sexual relationships. Interestingly, these new sexual norms and mores rest on the same “progressive” values bases as those being used to promote the legalization of euthanasia.
They include: intense individualism; nothing's sacred; a lack of access to a transcendent reality – the experience of belonging to something larger than oneself; a philosophy of moral relativism – nothing’s right or wrong, it all depends on personal preference; utilitarianism – as long as the good outweighs the harm, the harm is justified, ends can justify unethical means; a complete rejection of authority ‑ "nobody has the right to tell me what to do"; and so on.
I suggest that these same values, which have caused damage to the lives of many of today’s young people in relation to their finding committed, life partners and establishing stable, loving families, will, if euthanasia were legalized, cause damage to their lives when they're old or disabled.
Legalization gives the value of individual autonomy priority over that of respect for human life. Its message is that personal control is the primary human good. Loss of control is equated with loss of dignity and the protections, especially of respect for life, which it provides. This is especially dangerous for old or disabled people. If euthanasia is an option, they could be encouraged to choose a lethal injection that the state will provide. We know that old and disabled people often perceive themselves as a burden on their families and society, especially, in the latter case, regarding healthcare costs, which they could feel they should relieve through euthanasia. They could even feel that they have a duty to die.
So, what are the countervailing forces?
Feminist legal scholars are proposing that we should recognize the need for some intelligent restraints on “pure individualism”. The concept of “relational autonomy” – the idea that a person is not an isolated being, but exists in a context that influences their decisions and must be taken into account when judging the validity of those decisions ‑ can operate as such a restraint. Likewise, recognizing that the impact of individuals’ decisions –especially, their collective impact ‑ is not limited to those persons, but affects others and society as a whole, which is true of euthanasia, can act as a restraint.
Young people might be rediscovering some more traditional values, which warn against euthanasia. Some surveys indicate that young people have more conservative values than their parents. They want to feel they belong to something larger than themselves, and are looking for something worth fighting for in the interests of future generations – for some that’s anti-euthanasia advocacy.
Many people seem to have lost their sense of a connection to the universe and cosmos of which they are a part. Aside from other consequences, that means they are unable to pass on that sense to their children. I believe we desperately need to re-find that sense of connection in a way that is compatible with 21st Century realities and I suggest many young people are in the process of doing just that. It is a search for purpose and meaning.
So what might all this tell us about the validity of the belief that legalizing euthanasia is inevitable?
The case for euthanasia is logical, direct and utilitarian, so it's easy to make. The case against it is much more intangible, indirect, and ephemeral, so is much harder to communicate effectively, especially in a predominantly visual culture. We need to set up “spaces” where all our human ways of knowing, especially, our moral intuition, examined emotions and ethical imagination can function in relation to all aspects of euthanasia, in making a decision whether or not to legalize it.
If we believe, as I do, that legalizing euthanasia is a very bad idea, it is necessary to argue that the pro-euthanasia advocates are wrong on the facts regarding abuses, which is where the debate has been focused so far. But it is not enough. We must face the basic question that euthanasia raises: is it inherently wrong for one person intentionally to kill another?
If something is inherently wrong, the issue of how best to manage it – how to prevent abuses – does not arise. We only manage activities that are ethically acceptable; we prohibit those that are not. As writer Peter Stockland says, the central question in the euthanasia debate is not whether the system will work as designed to prevent abuses, as pro-euthanasia activists argue it will, but what the system is designed to do. And that requires us to address geriatrician Dr. Catherine Ferrier's challenging question: "If it's not killing, what is it?"
I suggest that the push for legalizing euthanasia results from a failure of our ethical imagination both as to what euthanasia involves in practice – killing another human being – and as to where that would lead in the future.

Margaret Somerville is director of the McGill Centre for Medicine, Ethics and Law.


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