Euthanasia to relieve suffering?

Mostly we see suffering as a subjective and private experience leading to the invocation of individual rights to do away with one's life should it become unbearable, as of no consequence to others.

When looking closer however we see that this private domain is an illusion. Suffering is often not an individual, isolated experience. No one is an independent, autonomous entity. Suffering, and its amelioration, is mostly a dynamic process involving others.

The Greens' Robin Chapple's Private Member's Bill, Voluntary Euthanasia Bill 2009 (WA) aims to provide euthanasia to persons of sound mind in response to “pain, suffering or debilitation” that is judged “considerable” in the presence of a terminal illness. Vague and broad as this description is, it invites anyone with a heart to say “yes”, of course we should help. But what is suffering? And what is the difference in killing the sufferer or attending to the sufferer's needs?

It is in the interactions between people, injurious events, our values and practices that suffering is created and experienced. Pain is experienced differently when under conditions of good care or abandonment. Mental anguish can arise from unresolved conflicts in close relationships, perhaps far in the past. Feelings of unbearable dependence or loss of dignity are associated with the attitudes of others as well as our own.

Being inherently social, human beings feel best under conditions of positive, caring relationships. For example, in a study that I conducted involving people with quadriplegia, it was only those who were without such supportive relationships who wanted euthanasia for themselves (Leipoldt, 2010).

This idea of suffering as a social, rather than a purely private, experience can help us decide what, as a society, to do about it. We can address the person's suffering by caring for them. We can do away with the suffering by killing the sufferer. Or, we can perhaps have both as options.

The Chapple Bill appears as an attempt to have both. It tries to respect “consumer” rights to choose assisted death while acknowledging palliative care. It attempts to address concerns often raised against state-sanctioned euthanasia, including through provisions against profiting from a euthanasia death; against having euthanasia for reasons of being burdensome or at an immature age (set at 21); against euthanasia “tourism” to WA. And it involves a multi-tiered application and compliance process.

But no safeguards are strong enough to hold out against an inevitable call from the public for a relaxation of the law to cover the “considerable suffering and debilitation” of people now excluded by this Bill from euthanasia. And is a doctor really able to assess whether someone wants euthanasia to stop being a burden to others? In the Netherlands safeguards have not stood in the way of, for example, 12-year-olds applying for euthanasia, and where people who are not terminally-ill have ended their lives under euthanasia provisions.

At the same time people fear slow deaths on machines or after heroic treatments. And anomalies under the present regime do exist where medical staff actively hasten death illegally. Does that mean we should simply make this legal? Since suffering is ameliorated through caring relationships maybe the best sway to view this is through an ethics of care.

As many Greens and others might agree, the dominant values in our society are not those of caring relations, but are associated with a decline in civil society. Values of individual autonomy, contractual relations between rationally choosing consumers, and limitless pursuit of material progress get in the way of us acting as social, caring, human beings.

These are also the values underlying this Bill. This Bill, as such, does not address the suffering that underlies many requests for euthanasia: dependence on others, pain, and loss of dignity, which can be ameliorated under conditions of good care. It kills the sufferer. But dependence on others is only undignified in absence of caring support. Of course there may always be some instances of pain that cannot be treated other than by sedation, but extreme cases make bad law. In the end, there are no perfect solutions.

Mr Chapple, in his second reading speech, says he believes that our society is “more compassionate” than letting people take matters into their own hands and suffer more as a result - among reasons for a large majority for euthanasia legislation. But compassion requires personal engagement with the suffering of another - the “cares” of care - something which euthanasia practice does not do. Euthanasia is predominantly a contractual arrangement between detached individuals, within certain rules, to end a life - a technical procedure.