“Euthanasia would be a negative answer to a problem that can
be solved by positive action.” (Cicely Saunders)
disease the patient’s interests and rights mainly concern how
he lives his remaining days and how he dies. The doctor’s duty
is to care for the patient in good faith and in the patient’s
best interests. In the case of a patient near death, stopping
certain treatment (but never treatment to relieve pain
and other distressing symptoms) may be appropriate to the
patient’s best interests.
The well known medical aphorism still applies:
“Thou shalt not kill,
but shalt not strive,
officiously to keep alive.”
discussion focuses on the issue of voluntary euthanasia (when
a patient requests death and someone else kills him). A
conscious competent patient has the right to refuse
life-sustaining treatment, but does not have the right to be
withdrawal of life support machines is a separate issue, and
is not “passive euthanasia”, as it is too often
mislabeled by those who advocate voluntary euthanasia.
Advocates of voluntary euthanasia occasionally even argue that
adequate pain control somehow constitutes “passive euthanasia”
because use of morphine allegedly “shortens life”. There is
simply no credible medical evidence for this assertion. (The
appropriate use of morphine in titrated doses to reduce or
abolish pain can on occasion extend life by releasing a
patient from his physical suffering.)
facing death or dependence sometimes ask “Can’t you put an end
to it all?” It is often a question asked by those who most
fear dying. On further discussion it rarely means “Please kill
me”, but rather “Will I get pain?” or “Do you understand how
awful it is to be dependent on others?” or “Am I being a
burden?” Sometimes it is a way of introducing a specific fear
that the patient finds difficult to discuss, or a plea for
some control over his situation, or for some understanding.
Very rarely is it a request to be killed.
is illegal. Those in favor of legalizing voluntary euthanasia
argue that individuals have the right to self determination
and a right to make choices about how and when they die.
Hospice care also emphasizes giving control back to patients
and allowing them (and helping them) to make their own
decisions. A person’s right to die cannot be translated
into a right to be killed, nor into a duty upon someone to
kill him. Euthanasia may sometimes appear a helpful way to
put an end to everyone’s suffering. In fact, legalized
euthanasia would increase suffering.
The main arguments against euthanasia are:
1. It is
morally wrong to kill. Any other rule or law in a society is
open to abuse.
Legalized euthanasia would put pressure on the elderly, the
disabled and the dependent. (“I’m such a burden, maybe I ought
to ask for it.”) A human being is infinitely precious. None of
us can judge our own or other people’s lives as worthless.
Legalized voluntary euthanasia would be open to abuse. In
theory the person would repeatedly and voluntarily request
death, but pressure could be brought to bear on that person in
many subtle ways to consider doing this, both by family
members and professionals.
Legalized euthanasia would promote the attitude that an
illness may get so bad that “I may end up asking to be
killed.” With genuinely compassionate and competent care that
need never be the case.
a patient would become a therapeutic option. The basic
principle of the medical profession is as a servant of life,
and the public has a right to absolute trust in that
6. No one
has pure motives (and some people have bad intentions). Even
caring family members sometimes say “We just can’t cope.”,
when with a bit of extra support they cope very well and (on
looking back) are proud of their achievement. Persuading a
person to request euthanasia might appear a tidy solution to
an emotionally painful or practically inconvenient situation,
but it would bring great guilt to the family, just as a
suicide in a family brings guilt and suffering, because any
act of killing is wrong.
are vulnerable and open to persuasion by a doctor they trust.
Doctors who practiced euthanasia could bring considerable
non-verbal pressure to bear on patients by their attitudes,
and unscrupulous doctors might deliberately put pressure on
patients to consider this option.
actively killing a patient became a therapeutic option, the
unthinkable would become all too thinkable. There already have
been very occasional incidents where health professionals
(singly or jointly) have taken it upon themselves to end the
lives of elderly and comatose patients (without consent), in
effect to relieve their own suffering.
would do it? Most doctors and nurses would not want to be
involved with active killing. Indeed, nurses often feel very
guilty if a terminally ill patient dies shortly after a
perfectly appropriate injection of drugs given to relieve
10. We do
not know the future. Important things can happen to a person
in the last few days of his life, and important things can
happen to the whole family, too. It is often a time of
reconciliation, reaffirmation and growth. For those who work
in hospice and palliative care this is one of the strongest
arguments against euthanasia.
Extracts of a letter from a nurse:
"I’d like to share with you my experience of dealing with
physicians at the hospital where Sandra P. was admitted
(after requesting euthanasia), having attempted suicide. She
was in mental torment, curled up in the fetal position, not
communicating. The resident physician said he did not feel
it was worth getting psychiatric help. I asked to see the
attending physician who told me, (quote) ‘We don’t usually
refer these people to a psychiatrist’. I asked what he meant
by “these people” and he said ‘She’s got cancer’. I kept
insisting Sandra needed some kind of help, and she was
finally transferred to the hospice. I went there to see her
before she died. She was very pleased to see me . . . She
was smiling, relaxed and more at peace than I had seen her
for a long time. . ."
secure environment of an in-patient hospice Sandra was
encouraged to express her fears and anguish, and her sense of
worthlessness. A combination of good physical care and
counseling helped her regain her self control. She was visited
and taken out for walks in a wheelchair by her son (whom she
had previously refused to see). She died peacefully and
naturally about a week later.
The author and publisher have taken
precautions to ensure that the information in this book is
error-free. However, readers must be guided by their own
personal and professional standards of good practice in
evaluating and applying recommendations made herein. The
contents of this book represent the views and experience of
the author, and not necessarily those of the publisher.