Should physicians be open to euthanasia?

Medicine is relieving suffering more effectively than ever before. So why is there such support for euthanasia?

In 1995, the Special Committee on Euthanasia and Assisted Suicide recommended an increased emphasis on palliative care in response to this type of request. This strategy appears to have been ineffective. Could limited access to palliative care or the challenge of relieving certain types of physical and mental suffering explain this situation? Perhaps. Physicians need to ask themselves whether their own professional activities are somehow contributing. This does not appear to be borne out in recent surveys. Consequently, in the absence of clear answers, we must uphold the status quo.

Recently, the Collège des médecins du Québec opened a reflection on the subject of euthanasia. It did not, in my opinion, result in a coherent professional argument for the ethical legitimacy of euthanasia. If anything, it called attention to the medical establishment’s ambivalence around controlling death and decision making. Euthanasia, overly aggressive therapy, palliative care, and refusing to tell the truth are 4 ways of controlling death. In reality, they reflect the tension between respect for the patient’s autonomy and medical paternalism. They also call into question the way in which a physician is able to serve a patient when the patient’s physical and psychological autonomy have been undermined by disease, making him or her vulnerable to the power of the able-bodied people around the bedside. Honouring, rather than abusing, this fragile state is the most important moral challenge a physician can face, and it sets the stage for the argument against euthanasia.

Slippery slope

The statistical data from the Netherlands and Belgium do not reveal abusive practices, and so this argument is quickly trotted out. However, the criteria for approving euthanasia in these countries are continually being relaxed,4–5 and illegal practices by physicians in these countries and elsewhere are being documented directly.6–12 It is impossible not to be concerned by the undermining of the social value of our elderly, an ever increasing segment of the population that is being blamed for soaring costs in the health care system. The alarmism denounced by those who refute the slippery slope argument is matched only by their naïveté. In the face of debatable statistics being paraded as fact, we must remember that history has shown that, under the sway of ideologies, human beings are capable of ignoring the truth. Can it not be argued that the ideology of autonomy that is so dominant in our neo-liberal society is affecting the ability of the medical establishment to see the truth?

The tyranny of autonomy

The ideology of autonomy has placed responsibility for decision making in the area of health in the hands of patients, who see it as a right, not a duty. With this shift in responsibility has come a sense of entitlement, including the right to die upon request. The right to choose has become the right to demand. When a patient says, “this is what I want; this is what I demand”, all other balancing values are thrown out. A physician who refuses to comply with a technically achievable demand is accused of imposing his or her own personal values. Sound medical practice and equitable access to care are among the values being driven out. Euthanasia becomes a matter purely of personal conscience, not a matter of ethics for an entire profession. The age-old interdiction against taking another human life is being called into question. The evolution of human beings toward preservation is being sacrificed on the altar of arrogance. We can ignore the lessons of the past, the argument goes, because today we are so much more evolved.

The ideology of autonomy that is manipulating collective reality is adrift. And this is true for the medical profession as well; physicians contemplating saying no to certain procedures requested by patients fear lawsuits, and I am not just talking about euthanasia. Our professional autonomy, based on values espoused by an entire profession, is being undermined by the tyranny of individual rights. And I would add that physicians in favour of euthanasia are speaking out of beliefs more personal than professional. The following illustration will attempt to explain this.

Why is it immoral for a physician to offer euthanasia before a patient requests it?

A doctor owes a fragile patient a far more subtle response than simply, “Trust me, the best thing that I can do for you is to offer you death.” Morally, a physician cannot offer euthanasia before a patient requests it. The trust that a patient places in his or her physician is based not just on the quality of their relationship, but on the guarantee that comes with that physician’s membership in a professional body whose very raison d’être is the protection of the individuals who require that physician’s services. Opening the medical professional up to euthanasia can only exacerbate a dying patient’s sense of extreme vulnerability to power wielded by another person.