Professor Anthony Fisher's argument in the life debate
Tuesday, August 12, 2003
Mr Chairman, ladies and gentlemen, might I say what a delight it is to be back in the Great Hall of the University of Sydney. I’ve been here many times as a student, hearing greater lecturers and debaters than me, and also twice to graduate here. And might I say also what a delight it is to be back home in Sydney at what will be now my first public engagement in my new home, my return home to Sydney.
Perhaps we should be clear from the start since we are debating “Euthanasia: Yes or No†today, about what we mean by euthanasia. Euthanasia is an act or calculated course of omission intended to shorten life with a supposedly merciful motivation. Now notice it’s very much about intention, intended to shorten life. There are a great many other things that might look like euthanasia, that some people might mistake for euthanasia but which are not.
For instance when doctors withdraw burdensome treatments from patients, either at their direction or direction of others, without any intention to shorten their life, that’s not euthanasia. I’m not saying whether it’s good or bad, that’s another debate. Likewise when doctors give people pain relief of one kind or another, with a view only to addressing their pain, to managing their pain, without any intention of shortening their life, that’s not euthanasia. Again we could debate another day when and if and how to do that. What makes it euthanasia is that we intend to shorten the patients life, and what makes that different to other kinds of homicide is that we say it is with a merciful motivation, its for the patients sake.
There are many methods of euthanasia on the table at the moment here in Australia: giving people over doses of drugs, or lethal injections, exit bags, even Dr Nitschke’s suggested a ship that might float beyond the barrier reef. But the lethal injection is probably the best example, in terms of being the least sensational and easiest for us to focus on. So one way we might look at the question today is this: should we give people who want them or people who we think would be better off dead a lethal jab, a lethal injection? Now note, that could be voluntary or not, that could be for the terminally ill, or not, that could be for competent aware patients, or for others, that’s part of the debate. What they all have in common, all these kinds of euthanasia, voluntary and involuntary, for terminally ill, or for the otherwise sick or for the not even sick, what they all have in common is the intention to kill, to shorten life with a merciful motive. And I want to argue the case against, the NO case for that today, in case any of you are in any doubt, despite my collar.
Perhaps the most common argument that we hear in our community for euthanasia is that its about freedom of choice, autonomy, voluntariness, empowerment. Now note that this argument is not restricted to the terminally ill, or even to people who are sick at all. It doesn’t matter as Dr Nitschke has said himself whether the cancer patient really has cancer or not, or if the sick person is sick or not. The issue – euthanasia on demand, the right to die, when I want, how I want, if I want. As the good doctor told Linda Motram on the ABC, euthanasia pills should be made available in the supermarket, and suicide recipes made available even to teenagers. All people, he told Catherine Lopez, should qualify: the depressed, the elderly, the bereaved, the troubled teenager. We should not erect any artificial barriers.
So lets be clear where the argument from autonomy takes us. The freedom for anyone who wants to die to die when they want, how they want, in the manner of their choosing. And you don’t have to dig very far I think with many euthanasia campaigners or the experience of places like Holland where it’s been practised openly for many years to find that the real agenda includes not just voluntary euthanasia, but euthanasia of children and disabled people and unconscious people - non voluntary euthanasia. Euthanasia of people who can’t be asked, who haven’t been asked. But even if we accept for a moment, which I don’t, that all the crusaders for euthanasia want is truly voluntary euthanasia, for competent adults, fully informed, who’ve been offered all the alternatives, who really understand what they are doing, and that’s a lot of ifs, the case I suggest to you has still not been made.
The fact is that no right to be killed has been known to common morality, secular or religious, of our civilisation, or to the common law tradition, or to any of the international human rights documents to which Australia is a party, or to the codes of medical and nursing ethics of the past few thousand years. Its been rejected by every major medical and nursing association and by government enquires as diverse as the House of Lords, the Australian Senate, the several state parliaments in Australia, the New York State Task Force, the Senate of Canada and so on.
What’s more, the fact is that very few euthanasia campaigners or practitioners will in fact offer euthanasia on demand to just any one who comes in off the street. They want to know who you are and why and what else you’ve thought of and tried. Amongst other things then, they recognise that some people who think they have terminal illnesses, don’t; some people who think they want euthanasia, don’t; some people who say they want euthanasia are really saying “wont somebody care about me please, just for a momentâ€. They might be depressed, or socially isolated.
As it turns out some of those who were killed under the euthanasia act in the Northern Territory were, according to the study in the Lancet. Some might be looking for publicity or just lonely or confused. So unless the enthusiast for euthanasia is so enthusiastic for that project that they’ll just give it to anyone, in the end it falls back on him or her to decide who and how and when.
For all the talk of empowering others and offering freedom to others, in the end the euthanasist will decide. What’s more, euthanasia I’d suggest to you actually reduced the autonomy of terminally ill, and handicapped and frail elderly people, because it sends out the message to our community that these people are expendable. And because any community that adopts that message will be likely to further reduce the opportunities and the self-esteem of those frail elderly and sick and dying people.
Any community that says to you “ You’re a special group. You’re the people no longer protected by our homicide laws but who we think are better off dead, or better off deciding for yourself if you want to be deadâ€. That little group, surely, more and more is going to think of themselves as no longer valued the way that the rest of us are and protected the way the rest of us are. And once that becomes routine it puts tremendous pressures upon those patients, who come to think of themselves as burdens on their families, on their health carers, on their community; tremendous pressure on them to seek euthanasia. In the name of autonomy then people’s freedom is actually being narrowed, and their very lives, the premise of their freedom, put at risk.
The evidence from societies that have practised this and doctors that have practised this is clear: it is gradually extended to more and more people: from the competent to the incompetent, from the terminally ill to the not even ill at all, from the sick to the depressed, from competent adults to children and the rest. That’s not about autonomy.
Well, someone might say it wasn’t really about autonomy in the first place, it was about compassion for people who are sick or in pain. What we want to do is address their pain by killing it, and if needs be, killing them. But surely if that’s what drove us, our first concern would be to do everything possible to deal with their pain, whether it’s physical or psychological, existential. We’d be ensuring that all the terminally ill and handicapped and frail elderly have access to high quality health care and hospital and community care in the home, to the whole range of non-medical social and human supports as well. At the very least that they were being kept as free as possible of pain.
But what in fact has happened where euthanasia has been campaigned for, in the Northern Territory, palliative care is still to this day barely available and certainly it was made available, euthanasia, before there was any real effort to make alternatives like good pain relief and good care for the dying available throughout the Northern Territory. For all the compassion talk it seems to me very often what this is really about is not putting granny out of her misery but putting her out of our misery. Its for our sake, the bystanders, who want the way out of caring for her because caring can be really hard. And no one should pretend there’s quick fixes in some of these situations.
It will take an enormous investment of ourselves, of our love and our care and all our energies to really give people the best of dying, the best of deaths. When we offer them the best we can, investing all of ourselves in them I think it calls for some of what is most noble in the human spirit, and often we find there is much more we can do than first we guessed. Above all we give those people a sense that they are still loved and respected. They are not in that special group, the social lepers, no longer protected by our laws and our ethics.
Dignity for the terminally ill is not about telling them that we think they’d be better off dead, and we’re willing to help that to happen. That we think that being old or incontinent or burdensome on others is somehow so awful that we want to help hurry up your death. Rather it is to say that even amidst all that, we still love and support and protect you till the end. That no one may kill an innocent person, even one who is at such a low ebb.
When people talk about protecting the sanctity of life it’s not just some abstract principle out there that they’ve heard from their grandmothers, what they are talking about are human beings, other ‘yous’ and ‘mes’, who we believe should always be loved and protected and respected, no matter how low or unconscious or old or incontinent or anything else.
By supporting them we affirm that their life, their person still matter, and matter very much, that they are still the image of God. We conform with our basic duty to respect every human life however wounded or handicapped. We express our love and respect for that particular person. Dignity is not told, compassion is not told, respect for autonomy is not told by telling the old and infirm and the terminally ill or the young and depressed and lonely through our laws and practises that we think they’d be better off dead. Surely we can find a more positive, creative way forward than that.
Tuesday, August 12, 2003
Mr Chairman, ladies and gentlemen, might I say what a delight it is to be back in the Great Hall of the University of Sydney. I’ve been here many times as a student, hearing greater lecturers and debaters than me, and also twice to graduate here. And might I say also what a delight it is to be back home in Sydney at what will be now my first public engagement in my new home, my return home to Sydney.
Perhaps we should be clear from the start since we are debating “Euthanasia: Yes or No†today, about what we mean by euthanasia. Euthanasia is an act or calculated course of omission intended to shorten life with a supposedly merciful motivation. Now notice it’s very much about intention, intended to shorten life. There are a great many other things that might look like euthanasia, that some people might mistake for euthanasia but which are not.
For instance when doctors withdraw burdensome treatments from patients, either at their direction or direction of others, without any intention to shorten their life, that’s not euthanasia. I’m not saying whether it’s good or bad, that’s another debate. Likewise when doctors give people pain relief of one kind or another, with a view only to addressing their pain, to managing their pain, without any intention of shortening their life, that’s not euthanasia. Again we could debate another day when and if and how to do that. What makes it euthanasia is that we intend to shorten the patients life, and what makes that different to other kinds of homicide is that we say it is with a merciful motivation, its for the patients sake.
There are many methods of euthanasia on the table at the moment here in Australia: giving people over doses of drugs, or lethal injections, exit bags, even Dr Nitschke’s suggested a ship that might float beyond the barrier reef. But the lethal injection is probably the best example, in terms of being the least sensational and easiest for us to focus on. So one way we might look at the question today is this: should we give people who want them or people who we think would be better off dead a lethal jab, a lethal injection? Now note, that could be voluntary or not, that could be for the terminally ill, or not, that could be for competent aware patients, or for others, that’s part of the debate. What they all have in common, all these kinds of euthanasia, voluntary and involuntary, for terminally ill, or for the otherwise sick or for the not even sick, what they all have in common is the intention to kill, to shorten life with a merciful motive. And I want to argue the case against, the NO case for that today, in case any of you are in any doubt, despite my collar.
Perhaps the most common argument that we hear in our community for euthanasia is that its about freedom of choice, autonomy, voluntariness, empowerment. Now note that this argument is not restricted to the terminally ill, or even to people who are sick at all. It doesn’t matter as Dr Nitschke has said himself whether the cancer patient really has cancer or not, or if the sick person is sick or not. The issue – euthanasia on demand, the right to die, when I want, how I want, if I want. As the good doctor told Linda Motram on the ABC, euthanasia pills should be made available in the supermarket, and suicide recipes made available even to teenagers. All people, he told Catherine Lopez, should qualify: the depressed, the elderly, the bereaved, the troubled teenager. We should not erect any artificial barriers.
So lets be clear where the argument from autonomy takes us. The freedom for anyone who wants to die to die when they want, how they want, in the manner of their choosing. And you don’t have to dig very far I think with many euthanasia campaigners or the experience of places like Holland where it’s been practised openly for many years to find that the real agenda includes not just voluntary euthanasia, but euthanasia of children and disabled people and unconscious people - non voluntary euthanasia. Euthanasia of people who can’t be asked, who haven’t been asked. But even if we accept for a moment, which I don’t, that all the crusaders for euthanasia want is truly voluntary euthanasia, for competent adults, fully informed, who’ve been offered all the alternatives, who really understand what they are doing, and that’s a lot of ifs, the case I suggest to you has still not been made.
The fact is that no right to be killed has been known to common morality, secular or religious, of our civilisation, or to the common law tradition, or to any of the international human rights documents to which Australia is a party, or to the codes of medical and nursing ethics of the past few thousand years. Its been rejected by every major medical and nursing association and by government enquires as diverse as the House of Lords, the Australian Senate, the several state parliaments in Australia, the New York State Task Force, the Senate of Canada and so on.
What’s more, the fact is that very few euthanasia campaigners or practitioners will in fact offer euthanasia on demand to just any one who comes in off the street. They want to know who you are and why and what else you’ve thought of and tried. Amongst other things then, they recognise that some people who think they have terminal illnesses, don’t; some people who think they want euthanasia, don’t; some people who say they want euthanasia are really saying “wont somebody care about me please, just for a momentâ€. They might be depressed, or socially isolated.
As it turns out some of those who were killed under the euthanasia act in the Northern Territory were, according to the study in the Lancet. Some might be looking for publicity or just lonely or confused. So unless the enthusiast for euthanasia is so enthusiastic for that project that they’ll just give it to anyone, in the end it falls back on him or her to decide who and how and when.
For all the talk of empowering others and offering freedom to others, in the end the euthanasist will decide. What’s more, euthanasia I’d suggest to you actually reduced the autonomy of terminally ill, and handicapped and frail elderly people, because it sends out the message to our community that these people are expendable. And because any community that adopts that message will be likely to further reduce the opportunities and the self-esteem of those frail elderly and sick and dying people.
Any community that says to you “ You’re a special group. You’re the people no longer protected by our homicide laws but who we think are better off dead, or better off deciding for yourself if you want to be deadâ€. That little group, surely, more and more is going to think of themselves as no longer valued the way that the rest of us are and protected the way the rest of us are. And once that becomes routine it puts tremendous pressures upon those patients, who come to think of themselves as burdens on their families, on their health carers, on their community; tremendous pressure on them to seek euthanasia. In the name of autonomy then people’s freedom is actually being narrowed, and their very lives, the premise of their freedom, put at risk.
The evidence from societies that have practised this and doctors that have practised this is clear: it is gradually extended to more and more people: from the competent to the incompetent, from the terminally ill to the not even ill at all, from the sick to the depressed, from competent adults to children and the rest. That’s not about autonomy.
Well, someone might say it wasn’t really about autonomy in the first place, it was about compassion for people who are sick or in pain. What we want to do is address their pain by killing it, and if needs be, killing them. But surely if that’s what drove us, our first concern would be to do everything possible to deal with their pain, whether it’s physical or psychological, existential. We’d be ensuring that all the terminally ill and handicapped and frail elderly have access to high quality health care and hospital and community care in the home, to the whole range of non-medical social and human supports as well. At the very least that they were being kept as free as possible of pain.
But what in fact has happened where euthanasia has been campaigned for, in the Northern Territory, palliative care is still to this day barely available and certainly it was made available, euthanasia, before there was any real effort to make alternatives like good pain relief and good care for the dying available throughout the Northern Territory. For all the compassion talk it seems to me very often what this is really about is not putting granny out of her misery but putting her out of our misery. Its for our sake, the bystanders, who want the way out of caring for her because caring can be really hard. And no one should pretend there’s quick fixes in some of these situations.
It will take an enormous investment of ourselves, of our love and our care and all our energies to really give people the best of dying, the best of deaths. When we offer them the best we can, investing all of ourselves in them I think it calls for some of what is most noble in the human spirit, and often we find there is much more we can do than first we guessed. Above all we give those people a sense that they are still loved and respected. They are not in that special group, the social lepers, no longer protected by our laws and our ethics.
Dignity for the terminally ill is not about telling them that we think they’d be better off dead, and we’re willing to help that to happen. That we think that being old or incontinent or burdensome on others is somehow so awful that we want to help hurry up your death. Rather it is to say that even amidst all that, we still love and support and protect you till the end. That no one may kill an innocent person, even one who is at such a low ebb.
When people talk about protecting the sanctity of life it’s not just some abstract principle out there that they’ve heard from their grandmothers, what they are talking about are human beings, other ‘yous’ and ‘mes’, who we believe should always be loved and protected and respected, no matter how low or unconscious or old or incontinent or anything else.
By supporting them we affirm that their life, their person still matter, and matter very much, that they are still the image of God. We conform with our basic duty to respect every human life however wounded or handicapped. We express our love and respect for that particular person. Dignity is not told, compassion is not told, respect for autonomy is not told by telling the old and infirm and the terminally ill or the young and depressed and lonely through our laws and practises that we think they’d be better off dead. Surely we can find a more positive, creative way forward than that.