The argument around euthanasia is a complicated one, and I want to add a new element to it. The current questions are about whether one has the right to choose to take a life if it is their own; whether another person has the right to take the life of a consenting person; when consent makes sense; and I want to add the question of whether we are responsible for allowing it.
Euthanasia is an issue of wellbeing. It is not an issue on the sanctity of life; no compassionate authority would compel us to live through humiliation and pain that will never get better. A compassionate authority would comply to a ‘sanctity of wellbeing’ or of conscious experience. Enforcing life, even through endless misery and suffering, is cruel. Questions of whether one has the right to take their own life, then, becomes an easy one: an authority (i.e. a body that grants us rights) which is compassionate must give us the right to end our suffering no matter what the course of action.
From a practical stand point there are many ways to end suffering: counselling, therapy, medicine, operations and other palliative care and fixing options. But certain illnesses—particularly the degenerative ones that often get us in later life—don’t permit themselves to treatment: degenerative illnesses of the nervous system, late-stage pancreatic cancer and I’m sure any doctor could name more. The current option of palliative care and waiting for death simply isn’t enough. If you have enough of your mind left to feel embarrassed that another person is caring for you, to feel guilty that you have become a financial and emotional burden on your family, to lose self-worth because of your condition then no amount of morphine and pretty nurses are going to help you. If this is the condition you are in—constantly feeling ashamed, guilty and weak and waiting for death—who is anyone to tell you you must live? The right to suicide1 seems unquestionable.
Assuming the right to choose death is granted, but the patient has lost the capacity to end their own life with dignity and will never recover it2, the right can only be realised by another person. This becomes an issue for the right of that other person; a third-party. Unlike the right to suicide, this looks very much like murder: one person taking another person’s life. There are two ways of coming at the problem: rights and wellbeing. If the right to end our life is extended to certain people, and those people are people who are likely to have a lesser capacity, that right only exists if a legal authority also extends the right to assistance. If a person with a lesser capacity wants to end their life with dignity and cannot, then they don’t have that right in any real sense. Other rights, like the right to a family, are encouraged in spite of physical limitations by the advent of adoption. Equally, the right to choose to end one’s life with dignity must have an infrastructure in place so that it can be extended irrespective of disability.
Wellbeing is also an element in this; it separates assisted suicide from murder. In the same way the law separates murder from killing, it should also do this for assisted suicide. Certain circumstances—like war, self-defence and, in some countries, retributive justice—separate murder from killing. Although I do not think anybody can defend all of these3, a similar system should be upheld to separate murder from euthanasia4. Wellbeing is the quality that should separate these two ideas. If you take someone’s life without their consent and without exploring other ways to maximise their wellbeing then you are a murderer. However, if a person consents to being killed on the grounds of minimized wellbeing, and treatment and palliative options are insufficient or not available then someone should be able to end that person’s life with their consent.
Systems like this are already in place. The person who can help a patient to realise their right to end their life with dignity is a medical professional. After the patient has made it clear they wish to end their life, an independent medical professional has to check the situation and make key decisions about treatment and palliative care options, the chances of recovery and the mental state of the patient. Then another medical professional has to confirm the decision. This is not a case of Jimmy taking his nan out behind the shed with a shotgun; this is a serious medical procedure.
The job of the medical professionals is to make sense of the consent the patient gives. If the patient has depression with no other medical conditions they can be medicated. If the patient has severe psychological or mental issues the right to consent is actually taken away from them (as it is for signing legal documents).
Our gut instinct, or our moral intuition, is to believe we are responsible for protecting all human life at any cost. This is expresses our seemingly inherent loyalty to a ‘sanctity of life’ idea. Most of the time this idea serves us well; we don’t run over the pedestrians in the road because they’d slow us down otherwise, we don’t shoot mothers who insist at swaying over a path at an asthmatic snail’s pace with a double-width pram. But occasionally our observance of ‘sanctity of life’ means betraying wellbeing. The right to choose to end one’s own life, because one is living in perpetual suffering and awaiting death, is one of the times where protecting life is betraying wellbeing. A compassionate authority (regardless of whether it is a government or a god) would centre its focus on wellbeing, so long as a focus on life still has the risk of enforcing life even when that is cruel.
If focusing on wellbeing is more compassionate than focusing on life, which it seems it is, then it is not just the case of a patient having the right to choose to end their own life. A compassionate society is responsible for helping people realise this choice because, in a moral sense, minimising suffering is our responsibility. Society cannot be free to let solvable suffering be; it is responsible for minimising suffering.
1 – I don’t mean to compel anyone to suicide. If a person can keep up their pride, fears death more than they feel bad or simply wishes to remain optimistic then palliative care and treatment are the best options. I can only defend euthanasia as freedom of choice. Enforced euthanasia, against the patient’s wishes, is first degree murder.
2 – Patients never lose their ability to do things like starve themselves to death. But this is not dignified and certainly is not the option that maximises their wellbeing.
3 – I’m thinking about retributive justice. I cannot see that the death penalty is ever defensible.
4 – I am interchanging the words “assisted suicide” and “euthanasia” for my foreign readers. The synonym practice and context clues help them understand the words.