If there is any “positive” to come out of the current global pandemic, it’s that maybe now more people will reassess their view of euthanasia. For as we are tragically seeing, it is the elderly who are most vulnerable in relation to COVID-19. In my own country of Australia, The Guardian reports that the youngest fatality so far, has been a 68-year-old man. Even more significant, according to the Department of Health, the average age of Australians who have died from the virus is 81. 

During this time, as more and more elderly become infected, an increasing number of countries are opting to effectively euthanize the oldest members of their populations. For example, The Telegraph UK reports that in Italy coronavirus victims over the age of eighty will be denied access to intensive care, with some being “left to die”. As one doctor has said:

"[Who lives and who dies] is decided by age and by the [patient's] health conditions. This is how it is in a war."

The term ‘euthanasia’ comes from two Greek words, eu (‘good’) and thanatos (‘death’). But in “word speak” that would have made even George Orwell gasp in disbelief, the term ‘euthanasia’ has been given a plethora of innocuous-sounding alternatives; ‘Voluntary assisted dying,’ ‘dying with dignity’, ‘therapeutic homicide’, ‘therapeutic killing’, ‘mercy killing’, and ‘physician-assisted suicide’. 

However, in reality, there is nothing ‘good’ about it. For example, BioEdge reports that recently in Spain:

“...military units seconded to help in the [COVID-19] crisis entered various residential centres for seniors in Madrid. What they found was appalling. Some of the residents were dead in their beds. Others were wandering around ‘in a state of complete abandonment’ with poor hygiene. It sounds like a canto in Dante’s Inferno.

And worst of all, the care workers were nowhere to be seen. They appear to have fled, terrified of contracting the coronavirus.

For these residents, it must have been the worst death imaginable – alone, helpless, choking, without any accompaniment in their last moments.”

There needs to be legal protections for people in tragic situations such as these. Dr Hannah Graham, Lecturer in Criminology at the University of Sterling, and Dr. Jeremy Prichard, Associate Professor at the University of Tasmania, have produced a comprehensive report outlining the plethora of reasons as to why legalising euthanasia is so problematic.

First, there are bioethical problems with euthanasia. At the heart of this issue is the role of the medical professional. In particular, are they a healer, helper, or killer? Significantly, a national survey in the United Kingdom has shown that the majority of doctors do not support the practice of euthanasia. As Dr. Christopher Middleton, former president of the Tasmanian Medical Association, has stated:

“I think it would completely change the mind-set and the ethos of medicine [to adopt euthanasia] in Australia because in their practice, in training, doctors tend to see themselves as agents of hope and healing and comfort, and certainly not as agents of death.”

Second, is the obvious potential for elder abuse. The European Court of Human Rights has stated, “…that the risk of abuse inherent in a system which facilitated assisted suicide should not be underestimated.” As Dr. Pritchard, in an op-ed for The Examiner writes:

“In coming decades we face a rapidly aging population, a shrinking tax base and increases in health problems like dementia…euthanasia could form part of government planning for service provision for people nearing end-of-life…If that sounds far-fetched, consider two cases from Oregon where patients’ applications for medical treatment were rejected, but followed by departmental notifications informing the patients they were eligible for assisted dying.”

Third, the psychological pressure to end one’s life is problematic. Note the following table based on statistics from Oregon, which shows that since euthanasia has been made legal, there has been a significant and steady increase in people choosing euthanasia so as not to be a burden on their family and friends:

What’s more, according to the English translation of the Spanish newspaper El Pais:

“Many seniors have fallen ill in care homes without ambulances taking them to hospitals. Some family members have said that their parents or grandparents are being left to die because they are considered lost causes, as they have prior medical conditions or are of an advanced age. One worker said they had been looking for someone to help a 91-year-old man who was struggling to breathe since early Thursday morning. Last Friday, a doctor visited him and said he was a ‘possible Covid-19’ case but did not have a kit to confirm the diagnosis.

‘I see this man crying and he should be cared for in a hospital,’ said the worker, who asked to remain anonymous to protect their job. ‘We have called 112 [for emergency services] seven times and nothing. After waiting two hours, they told me in an unfriendly tone that they couldn’t help us.’ ”

Fourth, is the negative societal perception of those who have a disability and their deaths being treated as an act of ‘compassion.’ Graham and Pritchard state that: 

“The implication that some people are ‘better off dead’ and that ‘some lives are not worth living’, phrases which have been used internationally in euthanasia debates, are potentially offensive and stigmatising to those who live with the same or similar symptoms and conditions.”

Sadly, this is precisely the same argument used by proponents in regards to aborting unborn children who are identified in utero as having some form of disability: for example, Down's Syndrome or even as minor as a cleft lip and palate. 

Fifth is “bracket creep.” What has been observed in countries that have legalised euthanasia is that the wishes of family members have pressured the patient to choose to be euthanased. What’s more, there is widespread under-reporting of the practice. For instance, in Belguim ‘only one out of two euthanasia cases is reported to the Federal Control and Evaluation Committee. 

What’s more, there has also been a significant increase in the use of ‘terminal sedation’ resulting in the patient’s death. For instance, Dr. Philip Nitschke, one of the leading proponents for legalising euthanasia, has been quoted as saying:

“In the intervening 16 years since the Northern Territory Rights of the Terminally Ill Act came and went, the debate on voluntary euthanasia has been extended beyond those who are terminally ill, to include the well elderly (sic) for whom rational suicide is one of the many end of life options.”

Sixth, the “safeguards” of psychiatric referral and assessment are gradually ignored. Graham and Prichard state that, “In the Flanders region of Belgium approximately half of euthanasia cases are not formally monitored as doctors do not report them to authorities. The rate of underreporting in the Netherlands appears to be between 20%-23%.” What’s more, in Oregon, the percentage of people being referred for psychiatric evaluation has dramatically decreased, as can be seen in the following table:

Seventh is the eventual practice and acceptance of non-voluntary euthanasia. In Belgium, where euthanasia has been legal since 2002, it has been observed that people were put to death without their consent. As Pritchard and Graham explain based on the findings of one particular study:

“Of the 66 deceased non-voluntary euthanasia patients, approximately 46 of these were comatose at the time of assisted death, and 14 had dementia.”

What’s more, nurses have taken upon themselves, without the presence of a doctor, the responsibility of administering euthanasia drugs. As another peer-reviewed study found:

“The life-ending drugs were administered by the nurse in 12% of the cases of euthanasia, as compared with 45% of the cases of assisted death without an explicit request. In both types of assisted death, the nurses acted on the physician’s orders but mostly in the physician’s absence.”

Eighth, numerous countries have examined and rejected it. No country should feel that they are on the “wrong side of history” in rejecting this practice when the majority of countries around the world have decided against its legalisation.

Ninth is the associated guilt that occurs when a medical professional is involved in ending another person’s life. For instance, Dr. Kenneth Stevens, Emeritus Professor and Emeritus Chairman, Department of Radiation Oncology, Oregon Health & Science University, Portland, makes the following finding:

“The physician is centrally involved in PAS and euthanasia, and the emotional and psychological effects on the participating physician can be substantial. The shift away from the fundamental values of medicine to heal and promote human wholeness can have significant effects on many participating physicians. Doctors describe being profoundly adversely affected, being shocked by the suddenness of the death, being caught up in the patient’s drive for assisted suicide, having a sense of powerlessness, and feeling isolated. There is evidence of pressure on and intimidation of doctors by some patients to assist in suicide. The effect of countertransference in the doctor-patient relationship may influence physician involvement in PAS and euthanasia."

Tenth, there are gendered risks, especially for women. There is a growing body of academic literature which highlights the “disproportionate victimisation of women.” As Prichard and Graham explain:

“It is vitally necessary to carefully consider the potential for gendered violence and familial control to be directly or subtly influential, if not implicated, in matters of the ‘voluntary’ assisted death of women. Where there has been coercion, control and gendered violence in a woman’s life, the nature of which may often be kept hidden and secret from others (including in professional and personal relationships) in her life, it is important to ask whether this might be a factor in a woman’s death.”

Conclusion

The recent events that have occurred in Spain and elsewhere are a prescient warning as to some of the dangers that lie ahead in adopting the practice of euthanasia. Of course, it’s not what people envisage “dying with dignity” being like. But it’s a horrific example as to what many people rightly fear will ultimately take place if legal safeguards are removed.

Sixteen years ago, my mum died suddenly of a heart attack. Four years after that my dad passed away from a prolonged battle with cancer. I cherished whatever time I could with him when he was in the palliative care unit of the hospital; even to just sit in his presence and talk about our lives; to indulge in his craving for cherries, mangos, and paw-paw; to look after, and even toilet, the one who had done the same thing for me so many years before. In all honesty, it was a real honour.

Kevin Yuill, in his book Assisted Suicide: The Liberal, Humanist Case Against Legalization, makes the insightful observation that, “Those who advocate allowing assisted suicide do so not out of compassion for the actual dying but out of fear that they might meet the same fate.” It’s a good point. As Yuill goes to explain, “Self-pity motivates campaigners to call for a change in the law, and not for an increase in compassionate acts by caring individuals – the real meaning of compassion.”

At the end of the day—or maybe that should be, “our days”—there is never such a thing as a “good death.” That’s the irony of whenever someone we love, let alone we ourselves, are faced with our own mortality. It’s that when we are at our weakest physically, mentally, and emotionally that we need laws to protect us, especially from ourselves. As such, ‘euthanasia’ is ultimately a contradiction in terms and should be ethically opposed.