Freedom and the right to die

The isolation of the Netherlands as the only country in which voluntary euthanasia is legal is about to end. In October 2001 the Belgian Senate voted by almost a 2:1 margin to allow doctors to act on a patient's request for assistance in dying. The legislation is expected to pass the lower house shortly. That the Netherlands' closest neighbor is likely to be the next country to take this step should provide food for thought among those who have denounced voluntary euthanasia in the Netherlands as rife with abuses. If that were really the case, why would the country that is better placed than all others to know what goes on in the Netherlands – not only because of its geographical proximity, but because most of its people are Dutch-speaking – be ready to copy the Dutch model?

The main source of opposition to the legalization of voluntary euthanasia in Belgium is the Christian Democrats, and if they fail to stop it, that will be evidence of the declining influence of traditional Christianity in that country. (Perhaps France, which also shares a common language with part of Belgium's population, and where church attendance has fallen to very low levels, will be the next to follow suit.) That Roman Catholics, Protestant conservatives, and others from traditional religious backgrounds should be against physician-assisted suicide and voluntary euthanasia is predictable. Such religions tend to be authoritarian, and to discourage critical thinking in their followers. When they have the opportunity to dominate a society, they prove themselves no friend of freedom. Starting from the position that God has put us here on earth for a purpose, they see suicide as something like desertion from the military, except that the suicide is disobeying orders from the Supreme Commander. Voluntary euthanasia they regard as even worse than suicide, since it involves the intentional killing of an innocent human being. Because the rule against such killing is not to be questioned, the fact that the person killed is suffering from a terminal or incurable illness and wants to die is, in the eyes of the religious, irrelevant.

It is more surprising when those who are not religious, and who profess to support individual freedom, attack proposals to legalize physician-assisted suicide and voluntary euthanasia. Nat Hentoff's column in the last issue of Free Inquiry is an example of such attacks, and serves to show how full of holes they are ("Challenging Singer", Free Inquiry 22(1) 2002). (Hentoff's column objects to my views about both voluntary and non-voluntary euthanasia, but here I am concerned only with his opposition to voluntary euthanasia.) How can a secular defender of human rights argue against the idea that when and how we die is primarily our own concern, and that, especially (though I would say, not only) when we are terminally or incurably ill, we have the right to choose the time and manner of our death?

Hentoff's first objection is that many physicians "are unable to recognize clinical depression, which, when treated successfully, removes the wish for death." Let's assume that this is true. It doesn't require much thought to see that it is not an argument against legalizing voluntary euthanasia, but an argument for including in any legislation authorizing voluntary euthanasia, a requirement that a psychiatrist, or someone else trained in recognizing clinical depression should examine any patient requesting voluntary euthanasia, and certify that the patient is not suffering from a treatable form of clinical depression." Such a proposal is perfectly practicable. In fact when voluntary euthanasia was legalized in Australia's Northern Territory a few years ago, the law did require that someone with a psychiatric qualification must certify that the patient was mentally competent to make the decision. (This law was overruled by the Australian Federal Parliament, in a movement led by a Roman Catholic politician.)

Hentoff also thinks that many physicians are not good at treating pain, and that sometimes good pain relief can remove the desire for euthanasia. That is also true, but most specialists in that field admit that there is a small number of cases in which pain cannot be adequately relieved, short of making the patient unconscious. Although some doctors do practise "terminal sedation", I find it hard to see why any dying patient would prefer to be unconscious for a few days, and then die, rather than die straight away. But in any case, if poor pain relief is the problem, there is again an obvious fix: ensure that candidates for euthanasia see a palliative care specialist. And there are some patients who are not in pain at all, but still want euthanasia, because they are weak, constantly tired, nauseous, or breathless. Or perhaps they just find the whole process of slowly wasting away is undignified.

Does Mr Hentoff think that a dying person shouldn't be able to make such a judgment, and act on it?

What I find most odd, in someone who has written a book called Living the Bill of Rights, is that instead of advocating that we add strict safeguards to any law that legalizes voluntary euthanasia, he instead takes the heavy-handed, illiberal route of saying that it must not be legalized. He thus aligns himself with Attorney-General John Ashcroft who in November 2001, while the Bush administration was calling for political unity to fight terrorism, nevertheless found time to issue an executive order designed to deny people in Oregon the right to physician-assisted suicide, although that state has twice voted in support of this right. Hentoff and Ashcroft agree, it seems, in wishing to deny the citizens of this country an important right now exercised by citizens of the Netherlands, and which citizens of Belgium will, in all probability, shortly be free to exercise.