What do euthanasia campaigners mean by ‘unbearable suffering’?

The assisted suicide Bill currently before the Dail is being justified on the grounds that no-one should have to suffer ‘unbearable pain’.  But this concept is extremely elastic and can and has been interpreted in the most extensive manner in order jurisdictions to include even ailments absolutely commonplace in old age, as this blog will show.

Unbearable pain is often presented as a reason to justify doctor assisted suicide but what counts as ‘unbearable’? Obviously, there is no scientific demarcation. What is deemed unbearable is, by definition, highly subjective as we all have a different capacity to bear suffering. Moreover, should pain be only physical or include mental pain as well?

Let’s consider the role that this notion plays in the Netherlands, a country where euthanasia has been allowed for years.

The Dutch legislation requires that the doctors are “satisfied that the patient’s suffering is unbearable, with no prospect of improvement.”

The law does not specify the scope of “unbearable suffering”, but a code of practice provides some clarification. This accompanying document, recently revised, tells us that “suffering is a broad concept. It can result from pain and shortness of breath, extreme exhaustion and fatigue, physical decline, or the fact that there is no prospect of improvement, but it can also be caused by growing dependence, or feelings of humiliation and loss of dignity”. (Euthanasia Code 2018 p. 21).

So, according to the code of practice, suffering does not have to be necessarily physical. The notion is so vague and broad that one might ask what form of suffering would be not included? For instance, with age many people experience a deterioration of their abilities, such as sight and hearing. Should that be a ground for euthanasia? It turns out the answer is ‘yes’.

The Dutch Euthanasia Code 2018 says: “As we have seen, for a patient’s request for euthanasia to be considered, his suffering must have a medical dimension. However, it is not a requirement that there be a life-threatening medical condition. Multiple geriatric syndromes – such as sight impairment, hearing impairment, osteoporosis, osteoarthritis, balance problems or cognitive deterioration – may cause unbearable suffering without prospect of improvement.”

To illustrate this point, the official 2019 report presents the real-life case of a man in his fifties who was gradually becoming blind and found his disability unbearable. The doctor asked the patient to contact an institute for the visually impaired and seek their advice. But “the solutions offered did not suit the patient because they were too far removed from his independent lifestyle” and he was, instead, euthanised. (2019 report, pp. 47-48).

In other words, in the Netherlands a man in his fifties killed himself with the assistance of doctors because he found losing his sight an unbearable suffering.

But some people find loneliness unbearable, or the loss of a loved one, or trauma suffered by abuse and so on. Do we really want to offer suicide as a solution to those who undergo through such difficult experiences?

“Unbearable pain” is commonly mentioned by pro-assisted suicide campaigners in their argumentation, because of the emotions it triggers but those who request lethal substances do not cite it as their primary concern.

Let’s consider the latest reports from Canada and Oregon. In Canada, applicants are asked to describe what has prompted the request. “Inadequate control of pain” came after “Loss of ability to engage in meaningful life activities”, “Loss of ability to perform activities of daily living”, and “Inadequate control of symptoms other than pain (or concern about it)”.

In Oregon we have similar results. “Inadequate pain control” (or fear of it) was mentioned by fewer people than other concerns such as being “Less able to engage in activities making life enjoyable”, “Losing autonomy”, “Loss of dignity”, “Burden on family, friends/caregivers”, and “Losing control of bodily functions”.

This shows that, in spite of the emotive appeal to terrible pain, people applying for assisted suicide fear more the loss of autonomy, as they see it. The signal sent to all vulnerable people by making assisted suicide available on grounds of ‘unbearable suffering or pain’ is terrible. It invites them all to devalue their lives.

There is no reference to pain in the Bill recently proposed by deputy Gino Kenny, even if he incorrectly claimed otherwise on the radio, but he used this emotive expression when he presented it in the Dáil.

Other campaigners in Ireland are now claiming that this Bill does not go far enough and having a terminal illness, or even being sick at all, should not be the only grounds to apply for assisted suicide.

Tom Curran represents Exit International, a group campaigning for the “right to die” of any adult of sound mind, for any reason. He told the Sunday Independent that assisted suicide should be extended to people with mental illnesses.

“For me the test should be: are they able to think rationally? There are lots of mental illnesses that don’t affect a person’s ability to think rationally. They should be included. But this Bill is a good start”.

But simply being of ‘sound mind’ means you don’t have to be mentally ill either.

Similarly, journalist Fintan O’Toole told RTE radio that everybody should be given access to assisted suicide.

Presenter Sarah McInerny asked him: “ … this is a conversation that perhaps started off in relation to people who are terminally ill and in a lot of pain, that wasn’t the case for your father for example, he wasn’t terminally ill so is it now people who are just ill or depressed perhaps or sad, unhappy. Where do you draw the line?”

Fintan O’Toole replied: “This is exactly why we need an open conversation about what happens in real life.  As you said, my dad wasn’t terminally ill. He was chronically ill, he had a couple of different chronical illnesses, but he wasn’t clinically depressed either.  I would say, what this is really about is the choice of the person, isn’t? And then it’s about what process do you have to be absolutely sure that that person is able to make the choice and is not been pressured in making the choice.“

 The logic of assisted suicide is inexorable. In the Netherlands we have just seen it extended to one year old babies.