The Impact of Euthanasia on Society

Legalising euthanasia and/or assisted suicide will have a great impact on society and will affect everyone in one way or another.

  • Having personal autonomy in end-of-life decision making does not mean that family members and friends will not feel guilt, anger or bitterness 
  • The process of medical research to find cures for diseases may be threatened.
  • Many of the German doctors who participated in the T4 euthanasia programme did so initially for reasons of compassion.
  • There are fears that hospice and palliative care programmes will be a casualty of legalised EAS.
  • In the Netherlands voluntary euthanasia has led to non-voluntary euthanasia.
Just as one of the slogans used by abortion activists says 'If you don't want an abortion, don't have one'. Right-to-die activists contend that if Euthanasia and/or Assisted Suicide (EAS) are legalised, they will only impact on those who choose to use those options. In other words, those who don't want assisted suicide won't be effected, so what's the problem?

Personal autonomy
The English poet John Donne composed a Meditation, 'No Man is an Island', which goes like this:
No man is an island, Entire of itself. Each is a piece of the continent, A part of the main. If a clod be washed away by the sea, Europe is the less. As well as if a promontory were.

As well as if a manner of thine own Or of thine friend's were. Each man's death diminishes me, For I am involved in mankind. Therefore, send not to know For whom the bell tolls, It tolls for thee.
Dr Peter Saunders MBChB FRACS, a New Zealander who is now practicing in the UK, wrote in his Twelve Reasons... Why Euthanasia Should Not be Legalised:
We are not free to do things which limit or violate the reasonable freedoms of others. No man is an island. No person makes the decision to end his or her life in isolation. There are others who are affected: friends and relatives left behind, and the healthcare staff involved in the decision-making process.

Western society no longer recognises suicide as a crime, but still appreciates that a person's decision to take his or her own life can have profound, often lifelong effects on the lives of others. There may be guilt, anger or bitterness felt by those left behind. Personal autonomy is never absolute. The effect of personal decisions on others now living or in future generations must also be considered. 1
Medical research
The drive to find cures for illnesses, especially fatal ones is what has led researchers to make so many discoveries in the past, especially in the 20th century. Dr Saunders points out that "Medical research is essential if medicine is to advance further," and goes on to say:
"When the focus changes from curing the condition to killing the individual with the condition, this whole process is threatened." 2
Dr Leo Alexander, who was the Chief US Medical Consultant at the Nuremberg War Trials after World War II, wrote in Medical Science Under Dictatorship about the experiments undertaken by the Nazi doctors in the Concentration Camps:
Whatever proportions these crimes finally assumed, it became evident to all who investigated them that they had started from small beginnings. The beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians. It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as life not worthy to be lived. 

This attitude in its early stages concerned itself merely with the severely and chronically sick. Gradually the sphere of those to be included in this category was enlarged to encompass the socially unproductive, the ideologically unwanted, the racially unwanted and finally all non-Germans. But it is important to realize that the infinitely small wedged-in lever from which this entire trend of mind received its impetus was the attitude toward the non-rehabilitable sick.

It is, therefore, this subtle shift in emphasis of the physicians' attitude that one must thoroughly investigate. It is a recent significant trend in medicine, including psychiatry, to regard prevention as more important than cure. Observation and recognition of early signs and symptoms have become the basis for prevention of further advance of disease. 3
Those advocates and activists who work for the EAS legalisation vehemently deny any possibility that what happened in Nazi Germany could happen today. In doing so they ignore historical record. Many of the German doctors who participated in the T4 euthanasia programme did so for reasons of compassion for the mentally and physically handicapped.

Compassion
Dr Karl Brandt was appointed by Hilter to head the bureaucracy and implement the infanticide programme. At his trial after the war he defended his actions saying:
"My underlying motive was the desire to help individuals who could not help themselves... such considerations should not be regarded as inhuman. Nor did I feel it in any way to be unethical or immoral... I am convinced that if Hippocrates were alive today he would change the wording of his oath... in which a doctor is forbidden to administer poison to an invalid even on demand... I have a perfectly clear conscience about the part I played in the affair. I am perfectly conscious that when I said yes to euthanasia I did so with the greatest conviction, just as it is my conviction today that it is right." 4
Brandt was condemned to death and hanged following the Nuremberg War Crimes Trials.

Hospice and palliative care
Hospice teaches that a request for suicide by a patient means that a need exists that is not being met. As the history of the hospice movement demonstrates, once such unmet needs are fulfilled, suicidal desires often disappear.
In testimony given before the British House of Lords, Zbigniew Zylicz, one of the few palliative care experts in the Netherlands, attributed Dutch deficiencies in palliative care to the easier alternative of euthanasia. 

Although the Dutch government has attempted to stimulate palliative care at six major medical centres throughout the Netherlands, established more than 100 hospices and provide for training professionals caring for terminally ill patients, many physicians choose the easier option of euthanasia rather than train in palliative care. 5

The situation would appear to be similar in Oregon. A survey of Oregon physicians who received the first 142 requests for assisted suicide since the law went into effect showed that in only 13% of cases was a palliative care consultation recommended, and it is not know how many of these recommendations were actually implemented. 6

The World Health Organization has recommended that governments not consider assisted suicide and euthanasia until they have demonstrated the availability and practice of palliative care for their citizens.

Doctor/patient trust
EAS opponents frequently point out the if it is legalised it will compromise and undermine the relationship between a doctor and his or her patient. There will be doctors who will refuse to administer deadly drugs, or even refer patients to a doctor who will, as a matter of conscience. Advocates say that there will be a 'right' for doctors to refuse. 

In the abortion controversy, doctors who regard abortion as murder are expected to violate their conscious by refering their patient to a doctor who will agree to refer for abortion.

Opponents say that EAS will change the role of doctor from healers, especially for disabled patients. 

Critics also say cases such as that of UK doctor Harold Shipman, who used his position as a doctor to kill up to 250 patients, show how easy it would be to abuse a system under which doctors were given more powers.

Duty to die
Dr Saunders says, "Many elderly people already feel a burden to family, carers and a society which is cost conscious and may be short of resources. They may feel great pressure to request euthanasia." 7

One of the biggest concerns for disabled rights organisations is that, if euthanasia is legalised, the 'right to die' will soon become a 'duty to die.'

American 'Dr Death' Jack Kevorkian told a Michigan Court in August 1990:
"The voluntary self-elimination of individual and (sic) mortally diseased and crippled lives taken collectively can only enhance the preservation of public health and welfare." 8
Duty to kill
Doctors and Hospital Boards are increasingly winning Court battles that give them the right to withdraw and withhold treatment from disabled and terminally ill patients. Those opposed to EAS believe that this is happening for economic reasons.

Individual autonomy has increasingly given way to decision-making by health care professionals and bioethicists, whose "futile care theory" measures the value of human life according to the financial cost of keeping the individual alive.

In Holland where euthanasia is legal many people now carry ?anti-euthanasia passports' because they are afraid they may be killed if admitted to hospital. 9

Voluntary euthanasia leads to involuntary euthanasia

In the Netherlands, voluntary euthanasia has progressed to involuntary euthanasia. In 1990 a Dutch Government study found that over 1,000 people had been killed without their consent. In 1995 the number was 900.

The Lancet, estimated that in 2001, Dutch doctors euthanised some 3,000 patients, assisted in the suicide of about 140 patients - but ended "life without patient's explicit request" for some 840 patients. 

Professor Raphael Cohen-Almagor of the University of Haifa wrote a paper for Issues in Law & Medicine in 2003. In and interview, Dr Frank Koerselman, told Cohen-Almagor about an 85- year-old patient with pneumonia and depression. The man's family didn't want Dutch doctors to treat him. The patient's doctor was ready to take the easy way out. 

Koerselman said that he had to order security guards to remove the family so that he could question the patient in private. Then the patient opted for treatment, got it and was discharged from the hospital in very good condition, physically and mentally.

In the Netherlands the courts are now permitting euthanasia, not only for the competent terminally ill, but also for infants with serious handicaps, comatose patients, and even people suffering from severe depression. 

Society is brutalised

Professor David Richmond, in an article on Capital Punishment and Euthanasia, wrote, "...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?" He goes on to say:
"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."
One of the main reasons Capital Punishment has been abolished in many countries is, as Prof. Richmond points out, because of the cases where people have been executed and later exonerated (been found innocent of the crime). As he says, doctors also make mistakes in diagnosing patients. 

Further Reading
In May 1994, the New York State Task Force on Life and the Law published a 217 page report titled "When Death Is Sought: Assisted Suicide and Euthanasia in the Medical Context".

References:
  1. Dr P. Saunders, Twelve Reasons... Why Euthanasia Should Not be Legalised
  2. Ibid
  3. Dr Leo Alexander, Medical Science Under Dictatorship
  4. Brandt K (1948) Nuremberg Trials
  5. Herbert Hendin,M.D.,Commentary: The Case Against Physician-Assisted Suicide: For the Right to End-of-Life Care Psychiatric Times
  6. Ibid
  7. Dr P. Saunders, Twelve Reasons... Why Euthanasia Should Not be Legalised
  8. Dr Jack Kevorkian
  9. A Duty to Die