The Right to Die

A popular TV programme recently re-opened the debate about euthanasia, euphemistically called mercy killing or assisted suicide.  It unfortunately only gave one side of the story.  So I thought it might be useful to highlight recent developments in medical literature on this subject.

The first is an article I have chosen is by Theo Boer, the medical ethicist who was part of the committee which motivated for, and regulated, euthanasia in The Netherlands, the country which has led the way in implementing such laws.  He had written in 2007, “There doesn’t need to be a ‘slippery slope’ when it comes to euthanasia.  A good euthanasia law, in combination with the euthanasia review procedure, provides the warrants for a stable and relatively low number of cases.” Most of his colleagues drew the same conclusion.  “But,” he wrote 7 years later, “we were wrong, terribly wrong.”

He then describes the rapid escalation of assisted suicides, to the point that “Euthanasia is on the way to become a ‘default’ mode of dying for cancer patients.”

He laments that the Dutch Right to Die Society (NVVE) has founded a network of travelling euthanizing doctors who have no established relationship with the patients, very limited background information on them and who offer only 2 options: administer life-ending drugs or send the patient away.   “The NVVE shows no signs of being satisfied even with these developments.  They will not rest until a lethal pill is made available to anyone over 70 years who wishes to die.  Some slippery slopes are truly slippery.”

There has been a rapid shift in the type of patients being killed since 2008.  To begin with euthanasia was offered only to terminally ill patients with severe pain and suffering.  Now there is a rapidly rising number of psychiatric patients, especially those who are depressed and those with dementia, and many people who are simply lonely, aged or bereaved are given assisted suicide or euthanasia.

“Whereas the law sees assisted suicide and euthanasia as an exception, public opinion is shifting towards considering them rights, with corresponding duties on doctors to act.  A law that is now in the making (in Holland) obliges doctors who refuse to administer euthanasia to refer their patients to a ‘willing’ colleague.  Pressure on doctors to conform to patients’ (or in some cases relatives’) wishes can be intense.”

“Pressure from relatives, in combination with a patient’s concern for his beloved, is in some cases an important factor behind a euthanasia request.  Not even the Review Committees, despite hard and conscientious work, have been able to halt these developments.”

He ends by concluding his appeal to the British who have been discussing the issue:  “Don’t go there.  Once the genie is out of the bottle, it is not likely to go back in again.”

Then there is an excellent contribution from Rob George, Professor of Palliative Care, Cecily Saunders Institute, King’s College, London, in an issue of the British Medical Journal.   In an article entitled ‘We must not deprive dying people of the most important protection,’ he argues that the safety of vulnerable people must take priority over the determined wishes of individuals. Hard cases are already dealt with mercifully under the law, which does not need changing” (Euthanasia is illegal in Britain).

“Elizabeth Butler-Sloss, former president of the High Court, said, ‘Laws, like nation states, are more secure when their boundaries rest on natural frontiers. The law that we have rests on just such a frontier . . . The law is there to protect us all. We tinker with it at our peril.”

“For me the real question is this: ‘Which is worse: not to kill people who want to die or to kill people who might want still to live?’ In my experience it is impossible to separate those who might want to die from those who believe they ought to die and whose view is pretty well never ‘settled.’ No one can be sure that some people not now at risk will find themselves so were the law to change.”

“A full blooded expression of autonomy includes the responsibility at times to restrain oneself on behalf of another.  When it comes to having our lives ended, let’s keep it that way. Once this line is crossed there is no going back.”

Finally, a Swiss study reported in the Journal of European Psychiatry cites the serious impact on the mental health of family members and friends who witness a death by assisted suicide.  About 20% developed full or partial post-traumatic stress disorder, and 19 months after the death, 16% were depressed and 6% had symptoms of anxiety.  “Thus witnessing the unnatural death of a significant person has a strong impact on the bereaved, which may lead to severe mental health problems at 14 to 24 months post-loss.”     That is really not surprising, especially if family members have been complicit in urging a decision for assisted suicide. It is truly alarming that the incidence they found of post-traumatic stress disorder is similar to that recorded for the US servicemen who returned from the war in Vietnam – a serious issue for a people at peace.

When all this is put together, it does seem to confirm the ancient wisdom of the Hippocratic Oath, which did not allow doctors to take life or give patients poisons to kill themselves.  And it should make us resist any further attempts to introduce euthanasia legislation in South Africa.

Dr Jon Larsen  FRCOG



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