Grappling with the rights and wrongs of euthanasia – Professor William Reville

This article appeared in the Irish Time on 15th April 2010

I recently wrote about start-of-life bioethical issues. And now, the March visit to Ireland of the Australian euthanasia and assisted-suicide campaigner Dr Philip Nitschke (“Dr Death”) brings end-of-life bioethical issues sharply to the fore.

The term “assisted suicide” means taking your own life with the help of guidance provided by a third party. Voluntary euthanasia, which I will mainly discuss in this article, is the action of a third party to end the life of an individual with the individual’s consent. Voluntary euthanasia is legally practised in several countries and is actively debated everywhere.

The word euthanasia comes from the Greek words “eu” and “thanatos” and means “good death”. Voluntary euthanasia for older people found approval in certain ancient societies but became morally unacceptable with the rise of organised religion – Judaism, Christianity and Islam condemn euthanasia and Buddhism and Hinduism generally frown on the practice. The Hippocratic Oath (no longer widely taken by physicians since the 1970s), written between 400 and 300 BC, forbids euthanasia: “To please no one will I prescribe a deadly drug nor give advice which may cause his death”.

Euthanasia has been debated in America and Europe since the 19th century but only recently received legal sanction in a few countries. In 1993 the Netherlands decriminalised physician-assisted suicide and further relaxed restrictions in 2002. Euthanasia is legally allowed there so long as: the patient’s suffering is unendurable; the condition unimprovable; the patient persistently and voluntarily requests euthanasia; is at least 12 years old; and is fully aware of his/her condition. Belgium also approved physician-assisted suicide in 2002. In the UK and Ireland, as I understand it, although euthanasia and assisted suicide are illegal, the administration of drugs to a patient to alleviate unbearable pain is not considered murder even if death is a likely outcome.

In 1994 the State of Oregon, US, enacted the Death with Dignity Act allowing doctors to assist patients with six months or less to live to end their lives. In 2008 Washington became the second US State to legalise physician-assisted suicide.

The main arguments for euthanasia include: (A) Quality of Life and Choice – very severe physical pain coupled with loss of independence can destroy the quality of life and people should have the choice, a fundamental principle in a liberal democracy, to end their lives in such circumstances; (B) Economics – most countries have a shortage of hospital space and medical personnel. Medical resources should be targeted at lives that are able to be saved instead of prolonging life, against patients’ wishes, when they can no longer contribute to society.

The main arguments against euthanasia include: (A) There is no need to end a life to alleviate unbearable pain because the right combination of drugs can manage pain in all conceivable cases; (B) Voluntary euthanasia unduly compromises the role of medical personnel; (C) Life is a gift from God and the individual has no right to take it away; (D) Patients may feel pressurised to consent to voluntary euthanasia to avoid becoming a “burden” on their families or on the state.

I would worry about euthanasia becoming too popular. In 2003, 1.2 per cent of all deaths in the Netherlands were physician- assisted suicides, and, last February, a group of Dutch academics and politicians launched a petition – Out of Free Will – seeking legal sanction for assisted suicide for over-70s who “consider their lives complete”. The petition quickly attracted more than 100,000 signatures.

I would also worry about psychological pressures to opt for euthanasia. I have read that, for example, when the State of Oregon refuses to pay for an expensive new drug for an elderly patient, it automatically sends out a reminder that the State assisted suicide programme is available at affordable rates (Hugh Anderson, the Montreal Gazette , February 15, 2010).

It seems natural and right to me that we should support life at all stages. However, I would consider a terminal illness accompanied by unbearable pain that cannot be alleviated to be a very difficult case. Various medical people have told me that the right combination of drugs can control any such pain. If that is true, I would oppose euthanasia, but if not . . .

Cowboy films were popular when I was young. Sometimes a cowboy would get “gut-shot” in a shoot-out in a remote area, far from medical help. This is a terminal condition (perhaps an hour or two to live) accompanied by agonising pain. The gut-shot cowboy, unable to use his hands, would beg his partner to put him out of his agony. I often wondered what I would do if I were his partner. I think I would attempt to change his mind, but, if he persisted with his plea I would try to calm his mind and prepare him to meet his death. And then, in this extreme situation, I think I would carry out his wishes.

William Reville associate professor of biochemistry and public awareness of science officer at UCC – understandingscience.ucc.ie © 2010 The Irish Times