(This article was written by Dr David Richmond who, until his retirement in 2001, was Head of Geriatric Care at Auckland Hospital.)
January 2005 saw an interesting juxtaposition of calls for social action. On the one hand a young man, an avowed member of the Voluntary Euthanasia Society, aided and abetted by a representative of Exit New Zealand vowed to starve himself to death rather than wait to die naturally of his disease. This was well publicised by newspapers and TV 1 in the context of yet another call to legalise euthanasia.
On the other hand, following the particularly gruesome murder of an elderly lady in his town, the mayor of Marton made a strong plea in an interview on National Radio for the reintroduction of capital punishment for such crimes. His call was not widely publicised by other news media.
It is a measure of the inadequacy of social analysis on the part of the media in its self-imposed role as a determinant of the social agenda that these two calls could be treated so differently. For these two issues are linked much more closely than some might think at first glance. Can we logically both eschew capital punishment and endorse legalised euthanasia?
The major reasons for abolishing capital punishment in much of the Western world were three fold. One was the realisation that despite the best efforts of the legal system, innocent people could be wrongly convicted and once executed, could not be resurrected should their conviction be overturned at a later date. The history of capital punishment is replete with such events.
A second reason was a sense of revulsion that even the State should have the power to kill a member of society no matter how heinous the crime committed. There is a sense that in so doing society is brutalised. The third was a lack of evidence that capital punishment was an effective deterrent against murder.
The murder of a loved and respected member of society brings the most intense anguish to families and communities for years thereafter. And many of those thus affected, like the mayor of Marton are moved to think that only the death of the perpetrator could be a sufficient punishment and bring ?closure' for them.
Nevertheless, we have taken the view that putting an offender to death does not serve the best interests of society in the long run. Even in the unusual case where an offender overwhelmed by his or her guilt has requested the death penalty, it has been refused. The majority of us would, I suspect, think it right and proper to do so.
Euthanasia is, like capital punishment, a highly emotive topic. Those advocating its legalisation are these days less inclined to cite uncontrolled pain as the reason for ?mercy killing' and more inclined to talk of ?undignified' death ? though more often than not, any perceived lack of dignity in dying is in the mind of the beholder rather than in the experience of the dying person.
As with capital punishment, calls to legalise euthanasia invariably centre on a few particularly heart-wrenching scenarios. And like capital punishment, legalised euthanasia would bring with it its own injustices. It is well recognised for example that the diagnosis of a terminal state is subject to many uncertainties even at the hands of good medical specialists. The immanence of death is subject to yet another set of uncertainties.
In my own lifetime as a medical practitioner I have encountered at least four people who were judged by competent doctors to have terminal disease and were so informed, but turned out in the end to have a recoverable disease. In terms of the legal parallel, these are the people who have been declared guilty but are not.
Had euthanasia been an available option and the patients requested it, they would have not had an opportunity to enjoy subsequent years of good health. The literature on euthanasia holds numerous instances of this very occurrence, including one relatively recent one in Australia. Society ought to regard this alone as a very good reason to reject the call to legalise euthanasia.
Injustice will undoubtedly also emerge from pressure by family and friends on old and disabled people to request euthanasia in order to avoid "being a nuisance". Does it happen? It surely does. It is often quite subtle.
Researchers have reported that up to two thirds of requests for euthanasia in Holland contain as at least part of the rationale, the desire not to be a burden to family and friends.
The pro-euthanasia lobby talks enthusiastically about ?autonomy' and ?choice'. The truth is that when euthanasia is legalised, personal autonomy and choice are dangerously compromised. Moreover, legalising euthanasia ? like capital punishment - has the power to brutalise society.
We were reminded - also in January - that one of Hitler's own relatives, a schizophrenic, was exterminated along with thousands of other people with psychiatric illness, as a social undesirable.
Legalising euthanasia is not the simple matter that many make it out to be. Its implications as a piece of social engineering are just as profound as restoring the death penalty would be.
David E. Richmond MD FRACP