Defining euthanasia

Now someone might object: are we not cutting short a life if we don’t intervene to prolong it? But there is a difference between bringing forward a death that would otherwise have occurred later, and refusing to defer death. If we allow a patient to die from their underlying medical condition, that is, from natural causes, we allow them to die when nature so chooses, rather than when we choose. In that sense, we are not “cutting short” their life at all, but are simply refusing to prolong it. In euthanasia - the administration of a lethal substance - we override nature by bringing death about sooner than it would otherwise occur naturally. This is the reason why withholding, unlike euthanasia, is not regarded as killing.

Is the distinction morally relevant?

But is this distinction nonetheless morally relevant? Does talk of allowing someone to die “when nature chooses” make of nature some kind of moral agent and does it not have a kind of religious overtone, replacing “God” with “nature”? Some critics think so, but the point is that it is not necessary to interpret such talk in that way at all. Talk of nature’s dominion or allowing nature to take its course is merely a façon de parler, a way of distinguishing between allowing things to happen and making them happen.

But it does not follow from this that the distinction being drawn might not have moral significance. It would be reasonable for someone to believe that it is wrong to interfere with the natural course of things, without that person being committed to any religious world view. Such a position can be adopted by people who are not religious and who hold no metaphysical beliefs at all. A person might reasonably consider life itself to be “sacred”. The fact that the word “sacred” may originally have had its home in religious discourse no more means that we must be religious if we use the word, than does the fact that the word “gift” is used to talk of someone who is talented mean that we must believe in a God who “gave” the person their “gift”.

A different objection might be that we already intervene in nature in countless ways, so why should we single out intervening in nature to accelerate someone’s death as any different? But in response, we should note that in all those cases, we intervene in order to prolong life, not to shorten it. Advances in technology and medication are there because we value life and seek to prolong it as long as possible, and the provision of life-sustaining measures is an example of precisely this kind of intervention.

In a sense, it is because we value the gift of life that we seek to preserve it whenever we can. Whereas, again, where a lethal injection is concerned, the kind of intervention being contemplated is not for the prolongation of life, but rather for the purpose of cutting short the patient’s life. And it is reasonable - I do not judge whether it is correct - to see this as one step too many, as a step which expresses a Promethean will to master and control our ultimate fate, rather than surrender oneself to it.

None of this detracts from debate about whether this respect for the natural order of things should be allowed to prevail over the intolerable suffering someone may be made to endure if we do not change the law. On the contrary, this is precisely the kind of debate that we should have. My point is that we need to be clear on the differences between the two courses of conduct first and only then can we be in a position to make an assessment about whether intolerable suffering should outweigh the moral considerations I have just been outlining.

Is withdrawal different from withholding?

Does the fact that measures might be provided and later withdrawn change this analysis? Is not “switching off” an artificial ventilator a lot more like providing a lethal injection? No. The same analysis applies to withdrawal as applies to withholding. The moment of intervention takes place when the measures are provided, and the patient’s life is being prolonged. When a decision is then made to stop providing those measures, the decision is to allow nature finally to take its course.

This still differs from euthanasia because, in the case of euthanasia, the patient’s life is being cut short prematurely. So in withdrawal we are, as it were, restoring to nature her dominion after having taken it away by providing the life-sustaining measures. Whereas in euthanasia, we are overriding nature and taking control of our ultimate fate ourselves.

It follows that it is misleading to continue to call withholding and withdrawing life-sustaining measures a kind of euthanasia, or “passive euthanasia”. The use of the term is liable to bleach out these important differences and respondents of polls are liable to misunderstand what they are being asked. Accordingly, their responses to the poll are likely to be unreliable.

I want to conclude with a suggestion about how a question designed to elicit an accurate portrait of community views might be worded. It will need to be done in two stages, to ensure that the respondent actually understands the difference between the two different courses of conduct (withholding and euthanasia):

1. The law currently allows a terminally ill patient to refuse life-sustaining measures like a blood transfusion and other life-support, but not to ask a doctor to give them a lethal injection or to give them a lethal substance so they can end their own life. Why do you think we’ve so far been reluctant to take this extra step?
2. Do you think that a terminally ill patient who isn’t dependent on any life-sustaining measures, but who is suffering intolerably, should actually be allowed to request a lethal injection or be allowed to request a lethal substance so that they can take it themselves and end their own life?

Both questions are necessary because, if the respondent doesn’t actually turn their mind to the differences between the two courses of conduct, they might mistakenly think that there is no basis for a different legal position in respect of each one. On something so important, it is vital that every effort is made to ensure that a respondent is aware of what they are being invited to comment on and, ultimately, vote for.