What Euthanasia Is
The word “euthanasia” comes from combining two greek words: “Eu” meaning “good”, and “thanatos” meaning “death”. So euthanasia literally means “good death.” The idea is that a death is good if it is painless. Now an important distinction must be made: not all painless deaths are euthanasia. Only those deaths in which an individual directly causes the death of another as a means of eliminating that other person's pain are euthanasia. For example, if a doctor lethally injects a paraplegic who has many years to live but asks to be put to death because he can’t stand the psychological distress of not having his full mobility--that’s a case of euthanasia. However, a case of someone who dies normally from a disease (for example, from cancer) while under sedation (so that this person does not feel pain) is not euthanasia.
In short: euthanasia involves killing the patient to eliminate the pain, while normal end-of-life care involves eliminating the pain so that the patient can die painlessly, from natural causes (e.g. disease or old age). Nobody is against eliminating the pain when a patient is dying. But everyone should be against killing the patient as a means of eliminating pain.
But what about refusing treatment?
Some people think they are for euthanasia because they are for allowing a patient to refuse treatment for a terminal illness when that treatment is judged disproportionate. For example, some would say: “If living means I have to be hooked up on life-support machines for months and months, then I would rather die.” However, refusing treatment in this case is not euthanasia. If you have cancer, and you refuse another painful chemotherapy session, and then you die, the cause of death is the cancer, not the doctor or yourself.
We call it euthanasia when your doctor or someone else intentionally causes your death, before your death is caused naturally by disease or by old age. And this is something everyone should be against, in every circumstance. Here’s why:
Nine Reasons why Euthanasia (killing the patient instead of killing the pain) Is Always Wrong
When the patient and the family get proper support, demand for euthanasia disappears. Medical practice teaches us that patients who express the wish to die usually do so because they are in need of comfort, they are depressed or their pain and symptoms are not being well managed. For the great majority, good medical care, treatment for the depression and a palliative approach are the solutions. Patients who ask to die often change their mind with time. Often the request comes not from the patients but from their exhausted families; the patients themselves have not asked that their death be hastened. Mostly, when the families get more support, the demand disappears. In the face of suffering, it is far better to look for meaning in the life that remains, develop strategies to face existential questions and strive for optimal care, than to seek shortcuts to death.
There is always a way out without euthanasia, even in the most complex cases. Ending the patient’s life is not a humane solution to tragic situations of pain and suffering: the physician’s duty is always to kill the pain, not the patient. Proposing euthanasia shows a lack of confidence in the progress of medical science. There are no limits imposed on the physician’s means of relieving pain. The means are many, accessible, increasingly sophisticated and constantly developing. In extreme cases, heavy sedation that puts patients to sleep can even be a last resort to sustain them through their suffering, until death takes place from natural causes. In treating terminal cases, there are no obstacles to ending or foregoing treatments considered useless or disproportionate by the patient or the physician. There is always a way out, even in the most complex cases. There are no taboo issues about death in the medical profession. The questioning of life-prolonging treatment, the withdrawal of useless or disproportionate treatment and the refusal of treatment by autonomous patients are daily events in clinical practice, addressed calmly and openly by practising physicians and in training programs. Doctors clearly understand the line between pain relief and euthanasia.
People who have not asked to die will be put to death. There are individuals who seriously or insistently ask for euthanasia or assisted suicide. They are very few in number. These requests are usually rooted in their personality and the need they feel to control their life—and their death. The vast majority of people in similar situations do not ask for life-shortening intervention. Individual freedom and autonomy end where they impinge on the freedom of other members of society. Changing the law to satisfy the demand of such a small number of people would imperil the lives of a much greater number who initially were not even aimed at. The experience of the few countries that have taken the route of euthanasia and assisted suicide shows that these practices soon become ungovernable despite the controls and guidelines put in place: protocols are not respected, consents are not obtained, the pressures exerted by families are strong and difficult to manage. People who have not asked to die are put to death.
Accepting that giving death could be a solution to one problem opens the door to giving death to a hundred others. Decriminalization of euthanasia is a slippery slope that will inevitably lead to a much steeper slide, hard to control. Physicians in countries where euthanasia is legal know this from experience. Once it is accepted that patients in a terminal state who so request can be put to death, physicians find themselves confronted with the requests of the disabled and the chronically ill, then with the requests of patients with psychological problems and then with the fate of severely handicapped new-borns—who have not asked to die. Even young people who are chronically ill invoke anti-discrimination laws to support their request for assisted suicide. Accepting that giving death could be a solution to one problem opens the door to giving death to a hundred others. Euthanasia becomes a “treatment option” that people can turn to to relieve their suffering, when in fact there are many other options.
Decriminalization of euthanasia and assisted suicide would create unwarranted pressure on the chronically ill, the severely disabled and those who require a lot of assistance or expensive treatments: they could begin to think that they are an undue burden on their loved ones or on society and that they should consider euthanasia or assisted suicide. The possibility of euthanasia would distort social attitudes toward the seriously ill, the disabled and the old.
A person is not valuless because he or she is chronically dependant or dying. Neither disease, nor physical or mental decline, nor pain, nor suffering, nor loss of autonomy can undermine the fundamental value of the human being. A person is not valueless because she or he is chronically dependent or dying. The solution to ensure “dying with dignity” remains first and foremost a competent palliative approach, respect, support and tenderness.
Giving patients the right to die means giving doctors the right to kill. Decriminalization of euthanasia and assisted suicide depends entirely on the participation of the medical profession. Ultimately, it is doctors who are asked to decide whether it makes more sense to preserve a life or to end it: physicians find themselves put in the position of arbitrator. The result is a loss of patients’ autonomy and a corresponding increase in the power of the medical profession over the individuals in its charge. Giving patients the right to die means giving doctors the right to kill. An erosion of the doctor-patient relationship must follow if the doctor is not simply the person who cures, relieves or comforts, but becomes as well the person who gives death. Putting to death becomes just another treatment option available to the profession, along with various medical or surgical alternatives; this would erode people’s bond of confidence in the profession as a whole.
Euthanasia promotes suicide. Even though it is sometimes asserted that suicide is a freedom, it is above all a personal tragedy that is fundamentally contrary to human nature and a failure on society’s part. Suicide is never without repercussions on other people and society as a whole. The medical response to a person’s attempted suicide has always been to come to the person’s aid; it should remain so. The physician who participates in suicide is promoting suicide at a societal level.
- Euthanasia has been prohibited by the medical profession for more than two thousand years. The Hippocratic prohibition on euthanasia and assisted suicide is more than a millennial tradition. It has been a core value for the generations of physicians who have adhered to it. It is imbued with wisdom and compassion and deserves to be vigorously defended.
(These 9 arguments are taken from a brief presented to the Collège des Médecins du Québec, on August 30 2009, by Joseph Ayoub, m.d., André Bourque, m.d., Catherine Ferrier, m.d., François Lehmann, m.d. and José Morais, m.d.. The brief --which is attached below--has also been endorsed by a significant number of physicians in the province of Québec.)