A question of euthanasia
Editor’s note: The following
article was written by Professor Richmond for the NZ Herald. They
declined to publish it.
recently published the results of a survey done by the marketing
department of Massey University on the subject of euthanasia.
Specifically, one of the questions put to the survey sample
asked: Whether, in the case of a person with a painful,
incurable disease, doctors should be allowed by law to end that
patient’s life if the patient requested it.
Reportedly, over 70% of respondents replied in the
Although the exact wording of the
question was not revealed, it is in the nature of such surveys to
ask simple questions in order to maximise responses. The problem
with simple questions is that they do not encourage the
recipients to reflect in depth on the issue at point, before
This is no trivial matter, since
the issue of legalising euthanasia is actually much more
complicated, than those who espouse it would have us think.
For a start, it would impact
adversely on society’s regard for the elderly, disabled and
handicapped. “The society which embraces euthanasia even
under the strictest rules sends s subtle message to its most
vulnerable members: “We don’t mind getting
rid of you”’ wrote Dr. Richard Fenigsen a
Dutch cardiologist in a paper on Euthanasia in that country.
The message may in fact not be so
subtle: In Holland not only the Voluntary Euthanasia Society, but
also the Royal Dutch Medical Society have endorsed the concept of
euthanasia without the patient’s request. Dr. Fenigsen
noted that as a result, some groups live in fear and uncertainty.
For example, he reported that at a time when the Dutch parliament
was considering the legalisation of euthanasia, a group of
handicapped adults wrote to the Parliamentary Committee for
Health Care and Justice in the following terms:
“We feel our lives are under
threat…We realise that we cost the community a lot of
money…Many people think we are useless…Often we
notice that we are being talked into desiring death…We
will find it extremely dangerous and frightening if the new
medical legislation includes euthanasia.”
This letter highlights some
important issues. There are already, as any social worker or
general practitioner will know families that exert pressures on
their elderly or disabled kinsfolk to delegate decision-making
and thus surrender their autonomy.
Elderly and disabled people often
compromise their autonomy on the ground that they don’t
want to be a nuisance.
If euthanasia is legalised, it is
inevitable that elderly and disabled people will find themselves
being “talked into desiring death”. A report by the
Dutch Attorney General into the use of euthanasia in Holland,
published in 1991, identified that 33% of those who requested
euthanasia, did so on grounds which included being dependent on
others. Moreover it discovered that numbers of those euthanasia
by medical practitioners had not actually requested death. Hence,
despite attempts to do so over more than 25 years, Holland has
been unable to put measures in place that would ensure that its
regulations governing euthanasia are adhered to. Why is that?
Because doctors who indulge in it, do not report it. That such
circumvention of legal requirements is relatively easy is
exemplified by the fact that in the U.K., a general practitioner,
Dr. Harold Shipman, murdered over 200 of his patients, and was
brought to justice, only when he attempted to alter the will of
one of them.
It does not take much imagination
to think that legalising euthanasia could have a profound effect
on the financing of several facets of the health service in a
country, which claims to have limited resources for health.
Disability services, hospice services, elderly services and
certain psychiatric services, already the Cinderellas of the
Health Service might well suffer on the grounds that it is
cheaper to euthanase people than to provide facilities for them.
Moreover, research into areas such as pain relief, palliative
care and services for the elderly and disabled, will be seen to
be even less of a priority than it is now.
Allowing doctors to terminate
people’s lives has many other ramifications. Medical
students will have to be taught how to kill people. Holland has
demonstrated that there is indeed a slippery slope: people
diagnosed with depression, a curable disorder in the vast
majority, may now request and receive, euthanasia. Indeed, the
issue of killing people with potentially curable conditions
should surely force us to reconsider our stance as a nation on
capital punishment. On the face of it, it does seem odd that a
nation that eschews capital punishment, would flirt with the
concept of giving one professional group power to terminate life.
The issues are very similar: in the one case, uncertainty about
the guilt of the accused leading to the execution of the
innocent, and in the other, uncertainty about the accuracy of the
diagnosis of terminal disease leading to death of the curable. In
my own professional life-time I have had three patients referred
to me for palliative care for their “terminal
disease” who on further investigation turned out not to
have a terminal illness after all.
As long as the debate about
legalising euthanasia is conducted at the emotive level favoured
by much of the media, people will not be able to make an informed
choice if it ever comes to another referendum. This is too
important an issue to be caricaturised as just religious belief
versus secularism, or “playing God.”
So, if the results of surveys of
public opinion are to be of any value whatsoever, the question
being posed would have to be in the following form:
David E. Richmond
MD FRACP FRCP (London) Professor Emeritus (Geriatric Medicine)
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