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September 27th 2010 print

Bill Muehlenberg

Killer Greens

Already the Greens’ federal leader Bob Brown is telling us that our number one national priority must be the right to kill. It is a strange kind of compassion which says that the way to relieve suffering is to kill the sufferer.

Clear thinking on euthanasia

With a Labor/Green government now in power, the culture of death is being further emboldened to push its agenda. A number of states are pushing for legalised euthanasia and already the Greens’ federal leader Bob Brown is telling us that our number one national priority must be the right to kill.

Indeed, people now speak about a “right to die” and many pro-euthanasia societies have sprung up, actively lobbying on behalf of their cause. The push for legalized euthanasia is on the increase, and some nations have already headed down that path, most notably the Netherlands.

This push is often done in the name of compassion. But it is a strange kind of compassion which says that the way to relieve suffering is to kill the sufferer. With so many advances in palliative care and the treatment of pain, it really is quite unnecessary to argue for the legalised killing of patients, even if well-intentioned.

The case against legalised euthanasia needs to be spelled out in detail. I have done that in other articles, but sometimes we need to go back to basics. In order to think clearly about this issue, we must make sure our terminology is carefully and sharply defined.

Terminology

It needs to be pointed out from the outset that euthanasia is not about halting futile treatment. Nor is it about the alleviation of suffering (this is known as palliative care). Euthanasia is an act that directly and intentionally causes a person’s death. As one ethicist states, there is a “crucial difference between taking a life intentionally and allowing a death naturally. The first is homicide, and the second is a natural death”.

The distinction amounts to this: there is a huge difference between letting nature take its course and actively hastening or inducing a patient’s death. Because this is such an important point, and one which is so often confused (often deliberately by the pro-euthanasia camp), it is worth spending a bit of time on this, quoting a number of authorities.

Ethicist Daniel Callahan offers this distinction between allowing to die and intentional killing: “A lethal injection will kill both a healthy person and a sick person. A physician’s omitted treatment will have no effect on a healthy person. . . . It will only, in contrast, bring the life of a sick person to an end because of an underlying fatal disease. . . . the doctor who, at the patient’s request, omits or terminates unwanted treatment does not kill at all. Her underlying disease, not his action, is the physical cause of the death.”

As Andrew Lansdown explains, “euthanasia has little to do with refusing futile or extreme treatment. The man who rejects a heart transplant or declines a third bout of chemotherapy is not committing suicide, but rather is accepting the inevitability of his own death. The doctor who withholds or withdraws undue treatment at the request of a terminally ill patient is not killing his patient but rather is refusing to prolong his patient’s life at any cost. Properly understood, euthanasia involves an intentional act to end a person’s life. Opponents of euthanasia do not advocate the unnecessary and unwelcome prolonging of human life by artificial means. Rather, they oppose active measures to bring human life to a premature end.”

Indeed, it needs to be repeated that the refusal of treatment is not to be confused with euthanasia. Both the cause and intent of death are quite different. As ethicist Margaret Somerville explains, “In refusals of treatment that result in death, the person dies from their underlying disease – a natural death. The withdrawal of treatment is the occasion on which death occurs, but not its cause. If the person had no fatal illness, they would not die. In contrast in euthanasia, the cause of death is the lethal injection. Without that, the person would not die at that time from that cause.”

Monique David puts it this way: “Currently, there is much confusion; many accept euthanasia because they do not want their lives to be maintained artificially nor to become victims of excessive treatment. However, these practices can be legitimately refused by the patient or their family through the ethical perspective of the right to die within the limits of natural death. Euthanasia and assisted suicide advocates claim something else: the right to terminate life at the moment and in the way that the individual chooses – or that someone chooses for them.

“Therefore, we should not use these terms to refer to the right to die (because this right is intrinsic), but rather to the right to be killed. This desire, expressed as a personal right, demands the intervention of a third party and a legal system that authorizes it. In other words, euthanasia and assisted suicide imply that doctors become agents of death and that society legally recognizes a criminal act to be lawful; or even more pernicious, a medical act.”

As ethicist Leon Kass reminds us, the ambiguity of the term “right to die” blurs the “difference in content and intention between the already well-established common-law right to refuse surgery or other unwanted medical treatments and hospitalization, and the newly alleged ‘right to die.’ The former permits the refusal of therapy, even a respirator, even if it means accepting an increased risk of death. The latter permits the refusal of therapy, such as renal dialysis or the feeding tube, so that death will occur. The former would seem to be more about choosing how to live while dying, the latter mainly about a choice for death.”

Finally, George Pitcher also makes some important distinctions: “Doctors regularly discontinue futile treatment. But they don’t do it in order to end a patient’s life. They are simply recognizing that death cannot be prevented by treatment. We need to understand that end-of-life decisions, which are made every day by doctors, aren’t the same as life-ending decisions.”

One further issue in terminology needs to be addressed. This has to do with pain relief and the hastening of death. It should be pointed out that some forms of pain relief may have the unintended consequence of hastening death. When a suffering patient receives an injection of morphine to relieve pain, this may contribute to the speeding up of death.

But when pain relievers are administered, normally the intention is to relieve pain, not hasten death. In ethics this is known as the principle of double effect. The intent was to do good (relieve pain) while an unintended side effect may occur (the hastening of death). Intention, again, is an important part of this whole debate.

John and Paul Feinberg explain the principle: “We are obligated both to preserve life and to relieve pain. Sometimes it may be impossible to do both. If it is impossible to preserve the life of the terminally ill, we are not immoral if we do not. Of course, there is still the obligation to relieve pain and suffering. If we do what we can to relieve pain and in the process hasten death, there is still no moral blame, since we could not preserve life.”

Margaret Somerville points out the differences between euthanasia and pain-relief treatment: “In both cases there is an effort to relieve suffering. The difference is that the primary aim of euthanasia is to do so by inflicting death, whereas the primary aim of pain-relief treatment is simply to relieve pain – not to shorten life or cause death (although either might be a secondary effect).”

Euthanasia, then, is about one thing only: the killing of another person. The intent is to kill someone. It does not matter whether this is done with a gun or a lethal injection – the effect is the same. No civilised society can permit the legalised killing of its own citizens, even if done in the name of compassion.