Reflections on the euthanasia dilemma | Samir AbouHussein

Samir AbouHussein is a medical consultant

The euthanasia dilemma includes a lot of ambiguities and uncertainties. It starts with the definition of euthanasia, a word of Greek origin—‘eu’ which means ‘good’ or ‘well’ and ‘thanatos’, which means ‘death’. Euthanasia can be translated into ‘good death’ or ‘dying well’.

Multiple euphemistic words and statements may be used to refer to euthanasia, which, however, might be misleading to make it more acceptable and agreeable. These include assisted dying, merciful death, physician assisted death. Even international organisations such as the World Health Organisation and World Medical Association, have differing definitions. Nonetheless, all definitions or euphemisms agree that euthanasia involves a form of death under the pretence of mercy.

So far, there is no strong evidence that euthanasia is painless because of the nature of the paralytic drugs, which can be used both in euthanasia and when the death penalty is meted out in countries where it is legal. But while the death penalty is meant to be a punishment, euthanasia is meant to offer relief from unbearable suffering.

The paralytic drugs which are given in high doses in both situations are intended to paralyse the individual—the person will be unable to move even a muscle or make any facial expression or show any outward sign of pain. But this does not mean such individuals are free from pain and suffering. On the contrary, some argue it may be a very painful death.

The methodology used in execution of euthanasia varies between the limited number of the countries in the world that practice it and, in some centres, where oral doses of the drugs are used, it might take up to 100 hours until death will be achieved. In fact, there are cases of patients who regained consciousness after the procedure was finalised. This shows there is no definitive predictability in the procedure. Obviously, this lack of important information related to euthanasia raises a lot of moral, social, ethical and legal question marks.

Euthanasia not widespread

In a public debate on topics like euthanasia it is an ethical and moral obligation to present all the known facts about the subject in a transparent and easily understandable way. It is important that all people in society, regardless of their level of education, are able to discuss the matter with adequate awareness and eventually will be capable to hold an opinion with an acceptable level of confidence.

One of the basic facts which everybody has the right to know is that the adoption of euthanasia as a legal practice is only available in a very small number of countries across the world. This number might constitute only around 6% of total countries in the globe. This situation materialised after about 90 years of the official euthanasia debates kicking off. The first euthanasia societies were established in the UK and America in 1930s. Euthanasia is not part of the law or has been rejected by the absolute majority of humans on our planet.

International organisations like the United Nations (UN) and World Health Organisation (WHO) recognise the right to life and the best possible palliative care; however, they leave it up to the member states to determine in their laws whether they should also include euthanasia. The World Medical Association (WMA) firmly opposes euthanasia and emphasises that respect be maintained for human life.

The conditions

The proposal put forward by the Maltese government lays down the preconditions that have to be fulfilled before a person can avail themselves of assisted dying: The patient has to be terminally ill and given a lifespan of less than six months; they must be fully informed; mentally capable; and the decision must be entirely voluntary.

It is important to delve into these conditions.

A prognosis is defined medically as a doctor’s estimate of how long a patient is expected to live with a particular illness. The prognosis of terminally ill patients can never be definitive, so, relying on the prognoses to justify euthanasia is ambiguous and uncertain.

Secondly, the mental status of the individual who is terminally ill, will be negatively impacted by multiple factors including depression, frustration and side effects of the drugs being administered.

These factors will inevitably reduce the mental capacity of such individuals significantly so they will not be able to take any critical and significant decisions in general and specifically, make the grave decision to end their life.

Specialists who care for terminally ill people, know from real life that there are family members who express an interest in the patient’s inheritance and complaining of the cost of the health care. In these circumstances it can become quite difficult to determine whether someone is being pressured to choose euthanasia voluntarily.

Sacred human life

There are those who argue that bodily autonomy and human rights presuppose an individual has the right to die. This statement is commonly used but without adequate understanding of the terminology. A right is a moral claim. Humans do not have a claim on death. Rather, death has a claim on them. So, this means, the right to die does not exist. In fact, Article 6 of International Covenant on Civil and Political rights (ICCPR) stipulates that every human being has the inherent right to life. Even when presented in a voluntary manner, the legalisation of euthanasia is in direct violation of these provisions.

Any human life is considered to be sacred and of infinite value. This is always true regardless how ill, weak, disabled the person is in the eyes and minds of a materialistic, consumerist societies. The duty of any respectable society is to preserve all forms and phases of life in its holistic meaning and give consistently the maximum possible needed palliative care with great love and compassion.

Slippery slope

A potential risk of legalising euthanasia is the slippery slope effect. The Netherlands, where euthanasia was first legalised in 2002 after decades of discussions, the slippery slope effect is clearly visible. The Netherlands has moved from euthanasia of people who are terminally ill, to euthanasia of those who are chronically ill; from euthanasia for physical illness, to euthanasia for mental illness; from euthanasia for mental illness, to euthanasia for psychological distress or mental suffering—and now to euthanasia simply if a person is over the age of 70 and tired of living.

Dutch euthanasia protocols have also moved from conscious patients providing explicit consent, to unconscious patients unable to provide consent. This shows how the Dutch euthanasia protocols over a 23-year period have slipped down the slope with alarming speed. Legalising euthanasia can give rise to a cascade of consecutive misuses and abuses that eventually will result in undesirable and highly distressing outcomes.

In fact, the United Nations has found that the euthanasia law in the Netherlands is in violation of its Universal Declaration of Human Rights, as it poses the risk to the rights of safety and integrity for every person’s life. Furthermore, UN concern was also expressed about the potential failure of such system to detect and to prevent cases in which individuals could be subjected to invisible or/and undue pressure to access euthanasia and may circumvent the safety regulations that are in place.

Suffering as spiritual development

Considering all the above facts, death was never and can never be a medication. Suffering is a power, which when managed properly, using the latest knowledge and tools, will foster spiritual development and the strengthening of the relationship with others. In this way, suffering becomes a natural and essential component of human resilience, evolution and experience.

Society needs to focus more on investing in palliative care by substantially providing variable resources so that a compassionate alternative with practical solutions can be presented to patients in the most difficult time of their life. In this way they will be able to adequately and effectively manage their pain and suffering.

Philosophers like Immanuel Kant, the German renowned philosopher who is the central figure in modern philosophy, argue that taking life, even to alleviate suffering, undermines the moral fabric of society.