In a foretaste of the next big right-to-life debate in this country, a major conference was held in Dublin last week on end-of-life issues. Many of the speakers present had no qualms about defending the so-called “right to die”, often on very broad grounds.
The conference was called “Medical Ethics and Law at the End of Life ” and it was organised by the University College Dublin Centre for Ethics in Public Life . What follows is a sample of proceedings.
Peter Schaber, from the University of Zurich, maintained that assisted suicide is morally permissible if requested by someone who wants to end their life and has supposedly valid reasons for that. People should be protected from a bad future, he claimed, and it is moral to spare people from having to carry on with their life if it is not worth living anymore. Note that the person need not be terminally ill, or even physically unwell. We can straightaway see that pressure to permit assisted suicide on broad grounds would exist if allowed initially on limited grounds.
Other speakers went even further. In presenting the current legislation in Germany, Tatjana von Solodkoff said that there is nothing wrong in suicide and it should be normalised. A law introduced in 2015 allows assisted suicide when performed on an individual basis and by someone who is a relative or close to the person who dies. Nonetheless, the German law prevents individuals and groups offering assistance in suicide as a routine service, even when it is done without any profit. This is something that von Solodkoff found incomprehensible. It is a contradiction that something is legal but it cannot be facilitated, she claimed.
Heleen Weyers, from the University of Groningen, explained the recent developments in the Netherlands. Since 2002 euthanasia, defined as “intentionally ending life on request”, is not prohibited if doctors can comply with certain due-care criteria, i.e. it is a voluntary request of the patient whose suffering is ‘unbearable’, with no prospect of improvement, and there is no reasonable alternative. The legislation didn’t end the debate as some doctors are willing to euthanise deeply mentally ill patients, who cannot express any request, while other advocacy groups want to extend euthanasia to non-medical cases, when someone is simply tired of life and has no specific medical condition. A more permissive law is on the political agenda and a new bill is expected soon.
The situation in Quebec is similar and somehow paradoxical. We heard that the law adopted in 2014 allows euthanasia, but not assisted suicide, because the former is considered a medical act that happens within the context of a therapeutic relationship. Assisted suicide is not deemed health care intervention, while euthanasia is. This kind of distinction will confuse most people.
Other speakers presented more cautious opinions on these matters.
Alexandra Mullock, from the University of Manchester, explained how concern for vulnerable people seems to prevent the legalisation of some forms of assisted dying in the UK. The right to die can easily become the duty to die. Some requests that appear to be genuine can be coerced or disingenuous. In quoting some interventions in the House of Commons when the Assisted Bill 2015 was rejected, she said that the bill, if passed, would have put pressure on vulnerable and elderly people. They will increasingly see themselves as a burden to society, poor care and abuses would lead some to request to die.
Mary Neal, from the University of Strathclyde in Glasgow, was the strongest among the very few voices that opposed the “right to die” at the UCD conference.
A medical act, she claimed, must produce some benefits for the patient but ending a life extinguishes not only the suffering, which is one of the goals of medicine, but also the patient himself. How can he, or she, benefit from the act? The entity must exist to benefit from a medical procedure. Maybe others or society will get advantage from this death but if “social benefits” become a criterion for medical interventions, this would be the end of medicine.
Tom Finegan, from Mary Immaculate College Limerick, defended an expansive understanding of the right to conscientious objection at end-of-life situations, against common arguments for a restriction of this right.
Despite these voices, the consensus at the conference was in favour of euthanasia and assisted suicide on either somewhat limited or else expansive grounds. This kind of consensus among academics has a habit of quickly finding its way into public opinion, especially when we have a media which looks upon these issues with favour. (See the generally positive coverage given to Tom Curran and Exit International, which campaigns for a “right-to-die” on very broad grounds).
Now that abortion has been legalised, there is no doubt what the next right-to-life battleground will be.
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Here some quotes from the conference:
“Even with good, compassionate care, the feeling that one is a burden, linked to inevitable dependency, heightens psychological suffering, reduces quality of life and might lead to a wish to access to assisted suicide” (Alexandra Mullock, University of Manchester)
“The attempt to restrict MAID (Medical Assistance in Dying) to the end of life has proved difficult to defend. In Canada, efforts to expand access to those for whom a mental disorder is the sole underlying condition, are underway.” (Mona Gumpta, University of Montreal)
“Palliative care has an increasingly important role in healthcare systems across Europe and beyond due to an aging population, an increase in the incidence of cancer, and incurable chronic health conditions. In coming years, there will therefore be greater pressure on healthcare systems to provide high quality palliative care for such patients. In such a situation, human rights can define minimum standards of care and can serve as a powerful tool in arguing for greater resources.” John Lombard (University of Limerick)
“Sometimes it is permissible to resist the experts and engage in independent evidence-gathering, in situations where you have good reason to distrust them. In the 2017 case of Charlie Gard, whose parents more controversially resisted the doctors at Great Ormond Street Hospital, draws attention to the problem of what it means to be an ‘expert’ in situations so close to death. Given the strong fact-value entanglements in these situations, it becomes unclear whether these are disputes over facts or values, and thus ambiguous where the epistemic authority lies. This is especially salient when the Courts become involved, and must make judgments about the ‘best interests’ of those involved.” Katherine Furman (University College Cork)