The following article by Michael Cook, Editor of BioEdge, appeared in their 12 July 2018 newsletter and is republished here, with his permission.
Every year, about 1.5 million cases of euthanasia take place in the United States. Does this have a negative impact on healthcare workers? Sorry, about 1.5 million cases of cat and dog euthanasia take place. But the question is still relevant. Veterinarians, veterinary assistants and shelter workers experience great stress at having to put animals down.
The emotional connection between the work of human doctors and animal doctors is closer than you might think. Owners often react to a pet’s death with the intensity of grief which appears equivalent to the loss of a beloved relative.
So the moral stress which vets experience is relevant. Suicide amongst vets has been the topic of several studies. “Veterinarians are four times more likely than members of the general population and two times more likely than other health professionals to die by suicide,” according to a 2012 study in the journal of The American Association of Suicidology, Suicide and Life-Threatening Behaviour.
Why? Performing euthanasia day in, day out, also appears to make some vets less able to resist the temptation to commit suicide. The authors of the 2012 study found that “… all else being equal, veterinarians may be more likely than members of other professions to enact a lethal attempt when they desire suicide because their exposure to euthanasia has rendered them less fearful of death.”
Aren’t there lessons in these finding which are relevant to doctors who euthanize their patients? Sometimes doctors in Belgium or the Netherlands are quoted as saying that the death they helped was beautiful or peaceful. Could that be bravado masking their own nonchalance about human death?
How many times have we all heard the argument, “You wouldn’t let a dog suffer like this…” Its logic is that if the suffering of animals and humans is essentially the same, they both should be released from suffering in the same way. But if the animal-human parallel works for the patient, why not for the doctor? If we allow euthanasia, surely we can expect the same burn-out rates and the same suicide rates as veterinarians … at least the same. That should scare us all – especially the doctors who will be responsible.
To help New Zealanders understand what David Seymour’s ‘End of Life Choices Bill’ entails, and what it would mean in Practice, MAXIMINSTITUTE hosted two visiting UK experts at their recent MIC event.
Baroness Ilora Finlay is Professor of Palliative Medicine at Cardiff University. She has been President of the Medical Women’s Federation, President of the British Medical Association, President of the Royal Society of Medicine and is President of the Chartered Society for Physiotherapy. She also chaired the Association for Palliative Medicine of Great Britain and Ireland, and since 2014 has chaired the National Council for Palliative Care.
Robert Preston worked in Whitehall as a civil servant for 30 years. In that role he examined Lord Joffe’s Private Member’s Bill, “Assisted Dying for the Terminally Ill” and he is now Director of the think-tank, Living and Dying Well, which works to examine the objective evidence surrounding the controversial end-of-life debate and publishes research to help inform Parliament and the public.
Both came to be involved in the issue of assisted suicide and euthanasia through their involvement in the 2005 British Select Committee that conducted a comprehensive investigation of the practices of assisted dying around the world. Following the conclusion of that inquiry, both have continued as advocates of improved elder and palliative care, as well as working to oppose legalised assisted suicide and euthanasia.
Both presentations were highly informative, however, the Q&A segment was extremely illuminating. Below is the list of questions asked from the floor with the timestamp on the video.
1:25 Q: Who are you to tell someone who is in pain that they can’t do what they want? If it’s their life, shouldn’t they have the right to do what they want?
4:20 Q: Can palliative care really relieve all suffering? Aren’t there going to be people who still suffer even with the best care we can offer?
5:20 Q: How do the safeguards in David Seymour’s End of Life Choices Bill compare to the safeguards required by similar laws in The Netherlands, Oregon, Belgium etc.?
8:25 Q: Do you think there’s any chance your views on assisted suicide would shift if one of your own family members was ill, in agony, and wanted help to end their pain?
13:30 Q: Purely this is too important a question to trust to just 121 MPs in Parliament. Shouldn’t we settle the issue of euthanasia with a binding referendum so the people can decide?
16:00 Q: Isn’t opposition to euthanasia just driven by religious views? How do you think religion interacts or should interact with this subject?
16:50 Q: You talk about the Hippocratic Oath – “first do no harm.” Proponents of euthanasia have made legal arguments that suggest denying people access to legal assisted suicide means that we’re essentially forcing them to continue suffering, and in essence, doing harm to them. Also, they say that people who want to die on their own terms may choose to commit suicide before they lose capacity, effectively shortening the life they could have had if they were certain someone else could end their life for them later on. How do you respond to these arguments?
20:55 Q: You talk negatively about the rising numbers of people using euthanasia and assisted suicide in the Netherlands and Oregon respectively. Isn’t this just showing that legalising it is giving people options that they want? Is it necessarily a bad thing to see rising levels of euthanasia?
23:45 Q: It seems that a lot of this debate isn’t just about levels of pain, but it’s the idea that any level of suffering or loss of autonomy is something we should have the right to avoid. How do you address those sorts of concerns?
26:20 Q: In your experience in public debate around assisted suicide in the UK, what’s one argument that you have found really resonates with people?
30:35 Q: What about situations where someone is in agony because of their condition, but simply ceasing medical treatment won’t allow them to die? Isn’t there a case for assisted suicide then?
Looking for more articles on Euthanasia and the debate in New Zealand?
What’s the difference between Euthanasia and Assisted Suicide?
Euthanasia is an intervention undertaken with the intention of ending a life to relieve suffering, for example, a lethal injection administered by a doctor
Assisted suicide is any act that intentionally helps another person kill themselves, for example by providing them with the means to do so, most commonly by prescribing a lethal medication
When David Seymour’s bill was drawn, National and Whanganui MP Chester Borrows said he was firmly against it [the bill].
We have a horrific record on suicide and I think it sends a message that sometimes it is okay to top yourself. And I disagree with that.
Economic Development Minister Simon Bridges said he was likely to vote against it, but may vote for it to go to a select committee so it could be properly debated. “Ultimately life is sacred and I think there are … ‘thin edge of the wedge’ arguments that concern me.”
What will that debate look like? The world has progressed since Maryan Street’s ‘End-of-Life Choice Bill’ was dropped. Views have changed and euthanasia laws in other countries have evolved over the past four years. Here’s a quick look at recent articles in the media if you want to consider the trajectory euthanasia laws have taken.
Did you read the first article in the list? Here are are some of the key points that need highlighting:
The Dutch are complacent about their famous law, he says. But there is no room for complacency. Under current legislation, euthanasia is only legal if a doctor believes that three conditions have been met: (1) the request must be voluntary and deliberate; (2) there must be unbearable suffering with no hope of improvement; and (3) there must no reasonable alternative to euthanasia. However, as euthanasia has sunk its roots deeper and deeper into Dutch medicine, the second and third conditions have shrivelled up. Patients define what is unbearable and they define what is a reasonable alternative. Unhappiness can be unbearable and a nursing home may not be a reasonable alternative. So, as one ethicist has observed, requirements (2) and (3) “add little to the requirement of a voluntary and thoughtful request”. Autonomy has trumped medicine. As a result, the number of euthanasia cases roughly tripled between 2007 and 2016, from 2000 to 6000.
One sign of the changing times is the rapid expansion of the services of the End of Life Clinic Foundation (Stichting Levenseindekliniek). This organisation offers euthanasia to patients whose own doctors have refused. They never offer to treat the underlying illness, whether it is physical or mental.
Last year, Dr Chabot points out, doctors from the End of Life Clinic each performed about one euthanasia every month. “What happens to doctors for whom a deadly injection becomes a monthly routine?” he asks. Now the End of Life Clinic is recruiting psychiatrists to service the mentally ill and demented. One obvious problem is that there is a shortage of good psychiatric help in the Netherland – which tends to take a long time have an effect, in any case – because of budget cuts.
Dr Chabot is deeply sceptical about euthanasia for the demented: “we are dealing with a morally problematic act: how do you kill someone who does not understand that he will be killed?” How? It turns out that sometimes a relative or doctor secretly laces their food or drink with a sedative to make it easier to give them a lethal injection. In one notorious case last year, the sedative didn’t work and relatives pinned the terrified woman to the bed while the doctor gave the lethal injection. Dr Chabot was astonished to discover that “surreptitious administration of medication has previously occurred, but has never been mentioned in an annual report.” Isn’t anyone paying attention to these developments, Dr Chabot asks.
Euthanasia is presented as a solution for those who are suffering unbearable pain, by allowing them to exercise their right to take their own life and not be forced to live with their current or progressing condition.
Is depression a medical condition?
Here’s what the New Zealand Ministry of Health says,
Depression is a mental illness.. [it] can range from being a mild illness, to a severe one – where you can lose interest in life and the things you used to enjoy.
Suicidal thoughts are a key symptom of depression.
What’s Euthanasia? Asking someone else [a physician] to intervene and take your life because you are unable to do so yourself.
“… a rose. By any other name, would smell as sweet.” ~ Romeo and Juliet, Act II Scene II
Are there other solutions to this problem?
We need to stop victimising people facing ‘unbearable pain’ or ‘extenuating circumstances’ and reach out in love. Think differently. Look for alternative solutions and, if you can’t find one, make one!
Did you catch the story in Stuff that came out the day after the bill was pulled from the ballot?
Hospice New Zealand does not support a change in the law to legalise assisted dying in any form. Nor do we consider that a change in the law would be in the best interests of the people we care for.
We believe Government should be investing in palliative care, increasing access to care and support not legalising euthanasia. Only when all New Zealanders have ready access to expert end-of-life care can a balanced debate begin. We support that all New Zealanders have the right to choose where they die.
The Nathaniel Centre played an instrumental role in the previous attempt to legalise Euthanasia in New Zealand.
It goes without saying that Family First will play a very public role in this debate, and that Maxim Institute to provide well-researched information for the country to consider.
David Seymour’s private member’s bill is based on an illusion. It assumes that it’s possible to create safeguards around assisted suicide practices that can prevent wrongful deaths. However, international evidence has shown that there is no reliably safe way to legalise euthanasia or assisted suicide.
Need more clarification around the euthanasia debate?
Check out this resource by John Kleinsman
Examples of actions which are not euthanasia are often used to argue for law change which is euthanasia. This brief article aims to clarify some of the terms and issues in the hope that we can prevent this from happening.
There is much debate and confusion about euthanasia. Examples of actions which are not euthanasia are often used to argue for law change which is euthanasia. This would be bad law. This short |Note aims to clarify some of the terms and issues in the hope that we can prevent this from happening.
What is euthanasia? An act which of itself and by intention causes the death of another person in order to eliminate their suffering.
What is assisted suicide? This happens when a person commits suicide with assistance from others, often by self-administering a lethal substance that has been obtained with the cooperation of a third party.
Withholding or withdrawing treatment is not euthanasia When a treatment is judged to be medically futile, or when it is judged that the benefits of a particular treatment are outweighed by the burdens for a particular person, it is a question of accepting the inevitability of death and allowing the person to return to their dying.
The New Zealand Code of Health and Disability Services Consumers’ Rights allows for any person to refuse services and to withdraw consent to services.
People have a right to be free of pain When a health professional administers medication with the sole intention of relieving a patient’s physical pain, that action is morally acceptable even if it foreseeably shortens the patient’s life. This is not an act of (slow) euthanasia as some claim.
Ethical and Theological Considerations
Supporters of euthanasia believe that decisions about end-of-life are essentially a matter of personal choice. Legalising such acts, it is argued, would simply provide those who wanted it with the choice about when and how to die and would not affect those who chose otherwise. This line of argument appeals to many but it fails to take into account the unintended consequences of a law change.
Acts of euthanasia and assisted suicide always involve others and affect others. They are never purely private matters. In addition, they have societal consequences; legalising euthanasia and assisted suicide will erode the general prohibition against killing in our society in a way that will over time lessen the respect for human life.
“Expanding one freedom often limits another. It does more than simply provide options … Expanding personal freedom to include assisted suicide undermines another right – to remain alive without having to justify one’s existence.”
– Mark Blocher, Author of ‘The Right to Die?’
In addition, the so-called ‘right to die’ could very quickly become a ‘duty to die’. People who feel neglected, undervalued and invisible will understandably see themselves as a burden and will want to do the ‘right thing’, especially with growing pressures on families involved in care as well as growing pressures on health care and aged care funding. Looked at like this, it is apparent that legalising euthanasia or assisted suicide will ultimately undermine real choices at the end of life.
“If euthanasia is legalised, premature death becomes a significant risk in a society which is already ambivalent about people who are perceived as having little or nothing to contribute while ‘swallowing up’ large amounts of health resources.”
– John Kleinsman
Overseas practices show that, once legalised, assisted suicide and euthanasia are inevitably made available to those who are suffering mental anguish, including persons with mental illness, even when they have not asked for it.
“Legalising euthanasia will create new pathways of abuse for the elderly and disabled.”
– John Kleinsman
People who oppose euthanasia and assisted suicide and those who support it both want to prevent intolerable suffering. Research shows that persistent requests for physician assisted suicide or euthanasia mostly arise from deep fears and concerns about not wanting to be a burden or from a sense of isolation rather than from a fear of pain.
Pope Francis has recently compared abandoning the elderly and disabled as being like a form of euthanasia. The call to discipleship demands of Christians an active commitment to holistic care for those who are suffering, elderly or disabled. Palliative care focuses on the needs of the whole person; physical, emotional, cultural, social and spiritual needs. True ‘death with dignity’ occurs when these needs are met and the person is loved and cared for and feels included.
“Once you open the door to assisted suicide and euthanasia it always becomes wider and wider and wider, and before you know it what starts as an option for a few becomes what’s expected for the many.”
– Alex Schadenberg, director of Euthanasia Prevention Coalition
Death Talk: The Case against Euthanasia and Assisted Suicide by Margaret Somerville
In addition to bioethics, John has experience in the areas of disability support as well as the drug and alcohol rehabilitation sectors. He was previously a member of the Central Region Health Research Ethics committee and serves on a number of other ethics committees and advisory committees.
On the inquiry into “public attitudes towards the introduction of legislation which would permit medically-assisted dying in the event of a terminal illness or an irreversible condition which makes life unbearable.”
From: Glyn Carpenter National Director New Zealand Christian Network 297a Church Street, Auckland Ph: (09) 525 0949 and (022) 184 7466
I am writing on behalf of New Zealand Christian Network to ask that the committee recommend that euthanasia not be legalised in New Zealand.
I do wish to speak to the committee in person.
New Zealand Christian Network is a broad-spectrum network of churches and Christian leaders, with a Board of Reference that includes leaders from all the main denominations. We present positions on issues that reflect the views of the majority of Christians in Aotearoa New Zealand.
Christians currently represent the largest faith group in Aotearoa New Zealand according to the national census with roughly half of the population indicating that they are Christian.
Christians and Christian faith have played, and continue to play, an important role in this country.
In 2014 we marked the bicentenary of the arrival of the Christian gospel in Aotearoa New Zealand which was an essential foundation for the Treaty of Waitangi and the bicultural partnership in our nation.
Christian social services are a vital component of the social fabric in this country.
Christian churches nurture spiritual faith and character based on the life and example of Jesus Christ who taught people to ‘love their neighbour’ and live in service of God and others. (According to Massey University research over 20% of the population attends church on a regular basis).
This submission is based on a desire to achieve an outcome which is good for everyone in New Zealand.
We have good connections with members of the Care Alliance and Euthanasia-Free NZ. Both of these groups are making submissions and we do not intend here to repeat here in detail the points they will be making. But we do want to register our general support for their submissions.
We also have connections into the medical profession. We are aware of their general opposition to the proposal and we support their position.
For and Against
The main arguments for and against permitting ‘medically-assisted dying’ are presented in some detail on the Care Alliance, Euthanasia-Free NZ, and Voluntary Euthanasia Society websites, and in their public statements.
Summary of the arguments Against (from the Care Alliance website):
Legal safeguards cannot protect the vulnerable from euthanasia abuses
Euthanasia and assisted-suicide are the ultimate tools for elder abuse
It sends a hypocritical message about suicide
The killing always increases
Diagnosis and prognosis can be mistaken
An easy death is not guaranteed
It compromises the hospice movement
Trust in doctors and nurses falls
Arguments For (from the Voluntary Euthanasia Society website)
The VES website has a document which contains responses to each of the arguments listed above.
In addition, while there is no comparable document presenting a separate list of arguments in favour of assisted suicide, it seems that the main argument is individual autonomy or freedom of choice.
Christians and Life
The general Christian view is that life is a gift from God. Life is sacred. It is God’s to give and take.
This belief over the centuries has contributed to the high regard that people generally have for life today
This ‘life ethic’ influences areas ranging from our health system and hospice movement, through to human rights and social justice. Everyone benefits from these developments whether they are Christians or not.
Because life is a gift from God, it is therefore not for individuals to end it (in the case of suicide), or for others to end it (in the case of assisted suicide).
Christians and Autonomy
Christians also have high regard for an individual’s right to choose, which is the main argument from proponents of a law change. But this right or freedom does not exist in isolation, nor is it absolute.
Societies have to balance the rights of the individual and the rights of the community. We recognise that the state should only limit individual rights where they interfere with the health or safety of the community. There are limitations with this view though:
It is often difficult to measure “health or safety” (the widely recognised problem with John Stuart Mill’s utilitarian philosophy)
The concept of ‘unbearable’ is also problematic (as in ‘terminal illness or irreversible condition that makes life unbearable’). . How is ‘unbearable’ determined? If it boils down to the view of the individual, the proposition will end up being reduced to “if an individual wants assisted suicide they can have it”. . With many options available to make situations ‘bearable’, isn’t society better off if we focus on those, rather than pushing for an individual right which will profoundly change the way society views life?
Clearly, something other than rights and law is needed to make a good and caring society
Caricatures of the Christian position . The Committee should be alert to caricatures of the Christian position (e.g. the document “Christians and Religious Perspectives” on the Voluntary Euthanasia Society website http://www.ves.org.nz/christian-and-religious-perspectives). . A few examples should suffice (emphasis throughout added by this author):
The document referred to begins with the phrase “Some Christians and Muslims argue that God gives us our life and hence we have no right to authorise anyone to hasten our death”. Misleading (this is mainstream teaching in both religions)
“In general, Christians believe that God has given us free will … but when we wish to hasten our dying to limit our suffering, some tell us we are not allowed to do that”. . Obfuscation (hastening dying is not the only way to limit suffering) and misleading (not hastening dying is mainstream teaching)
“God would prefer you to suffer rather than get help to end your life. God would prefer you to lose all your dignity rather than being able to say farewell to your loved ones while still conscious”. . False alternative (end life or suffer) and gross misrepresentation of God (God does not prefer people lose their dignity, and God does not present the false alternative)
“… it is difficult to find a place where God or biblical writers say that futile suffering and pain is to be desired as one approaches death …” . Straw man argument – this is not biblical, neither is it mainstream teaching. . . The general theme is that God is harsh, and doesn’t mind, or perhaps even wants people to suffer. This is not true, and with access to palliative care, is simply irrelevant.
Balancing the Gifts of Life and Freedom, of the Individual and Society
This is the issue that is at the heart of this debate. Christian belief is not only that life is a gift from God, but that this belief has directly contributed to the society we all benefit from whether or not we hold to Christian belief.
This belief obviously inclines us to see the merits in the detailed arguments listed above against permitting assisted suicide over and above the arguments for.
But we should also not minimise the significance of the fundamental shift in society when we move from total ‘ethic of life’ (creating, preserving, healing, caring), to one where ‘death’ (intentionally ending life) is part of the culture.
As the Church is significantly involved in community and social services, we are particularly concerned about the arguments involving the vulnerable and the elderly. . Elder abuse is already a significant issue in New Zealand, and it can be very hard to detect. It is easy to imagine a range of scenarios where elderly people will conceal abuse or emotional pressure, or perhaps not even be aware of it themselves. If assisted suicide is legalised, it is hard to believe that any regime will be able to fully safeguard against some people being pressured to end their own lives.
Conclusion. We recognise that many people in New Zealand, in Parliament, and probably in the Select Committee, do not consider themselves to be Christians, and that the content of this submission, particularly the points directly connected to Christian faith or teaching, may be difficult to process. . We respectfully request that the Select Committee not reject these without considering the extent and role of Christian faith in New Zealand, and the fact that if the points in this submission are correct, Parliament’s role should be to preserve the ‘life ethic’ which is foundational in our society.
We recognise that many people in New Zealand, in Parliament, and probably in the Select Committee, do not consider themselves to be Christians, and that the content of this submission, particularly the points directly connected to Christian faith or teaching, may be difficult to process.
We respectfully request that the Select Committee not reject these without considering the extent and role of Christian faith in New Zealand, and the fact that if the points in this submission are correct, Parliament’s role should be to preserve the ‘life ethic’ which is foundational in our society.