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Euthanasia holds nasty consequences

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Is it wise to legalize euthanasia (a.k.a. physician-assisted suicide/doctor-assisted death) as Quebecers think? I doubt it, for a number of reasons.

First, the popular argument for euthanasia hinges on a false dichotomy: euthanasia or painful death. But, there's a third option: palliative care.

Palliative care is a branch of medicine the focus of which is not healing or curing but pain relief and comfort.

Significantly, Dr. Doris Barwich, president of the Canadian Association of Palliative Care Physicians, puts the popular false dichotomy out of its misery.

Barwich writes: "Pain is rarely the reason patients ask for hastened death -- it more often comes out of a desire to control the circumstances surrounding death. Fortunately, we can assure our patients that with palliative care tools and resources, pain and other distressing symptoms can usually be controlled and support provided to ensure comfort and quality of life."

We should promote palliative care, in other words.

And, instead of euthanasia for the (rare) difficult cases, there is palliative sedation.

Palliative sedation is basically a strong dose of pain relief that renders a patient unconscious as the disease -- not the doctor -- kills the patient.

Palliative sedation is not intended to cause death or shorten life, notes the Journal of the American Medical Association. But if, foreseeably, palliative sedation hastens death, it needn't be judged unethical.

McGill University ethicist Margaret Somerville contends just as death isn't the intended effect of high-risk surgery that is needed to relieve pain, such surgery isn't immoral if death occurs. So, too, if death isn't the intended effect of high-risk pain management, yet death occurs, then such pain management isn't immoral either.

There's an important moral difference between engaging in a procedure with intent to kill (euthanasia) rather than not (palliative sedation). Euthanasia takes the moral low ground.

Allowing terminally ill patients to die from their illness via termination of life-support by withdrawing/withholding extraordinary, burdensome or medically useless treatment is already a legal and ethical part of palliative care and doesn't require euthanasia.

Further, euthanasia imposes a terrible burden on the vulnerable. If life is no longer society's default position, then the most vulnerable members of our society -- the elderly, terminally ill, disabled -- must justify their continued existence.

This is just plain nasty.

Finally, as Trinity Western University philosopher Paul Chamberlain points out, a logical-legal slippery slope looms large.

Consider the notion of patient autonomy and the fact that reasons for one action sometimes also justify initially unintended actions. In the context of legalized euthanasia, patient autonomy becomes understood in terms of the following fundamental principle: The sufferer has the right to doctor-assisted death to end his/her suffering.

Significantly, accepting euthanasia as a legal right on the basis of this fundamental principle opens up and justifies many other situations in which persons suffer and request death. These situations include the non-terminally ill, the elderly, the disabled, persons with chronic back pain, the depressed teenager, etc.

Should we trust legislative safeguards for protection? Good luck. Aside from abuse -- one-third of Belgium's euthanasia deaths were illegal and lacked patient consent -- safeguards fail because courts will do what courts do: promote consistency.

Consistency demands that all of the above-mentioned persons, if suffering, and if desiring death (and if represented by a smart lawyer), can be reasonably seen to have the right to death as well. After all, at the core of these other situations is a sufferer who requests doctor-assisted death, rendering situational differences incidental.

Legalizing euthanasia, then, puts us on a slippery slope that embraces death as a solution. But medical, social and psychological problems require medical, social and psychological solutions. Not killing.

Surely, legalizing euthanasia is not wise.


Hendrik van der Breggen is an associate professor of philosophy at Providence University College in Otterburne. A version of this article was originally published in the Carillon.

Republished from the Winnipeg Free Press print edition June 19, 2014 A9

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