Margaret Somerville is the founding director of the Centre for Medicine, Ethics and Law at McGill University. She originally published this column in The Gazette. It is reprinted on VMO with the permission of the author.

 
by Margaret Somerville

 

Why, after millenniums of prohibiting the intentional killing of another human being, in particular by physicians, did Quebec politicians think euthanasia is a “progressive” idea that must be implemented without delay? Bill 52, originally introduced by the Parti Québécois government, was rapidly reintroduced by the Liberals and passed earlier this month.

Why did Quebec politicians fail to give sufficient weight to the dangers and harms of legalizing euthanasia, especially to vulnerable people — those who are old and fragile or disabled, and whose lives are denigrated by euthanasia’s message they’re not worth living?

Why have their ethical imaginations, human memories (knowledge of history) and examined emotions failed to warn them that they are on the wrong path? Did they fail to distinguish between obligations to kill people’s suffering through good palliative care and pain management, and killing the person with the suffering? Did they fail to heed an old warning: “Nowhere are human rights more threatened than when we act purporting to do only good”? A desire to do good blinds us to the harms.

Are Quebec politicians so focused on giving priority to individual autonomy — “choice” — they don’t see the harm to the value of respect for human life at the societal level that legalizing euthanasia unavoidably causes?

How will legalizing euthanasia affect law’s and medicine’s capacity to carry the value of respect for life for society as a whole? They are the main institutions carrying this value in a secular society.

Has the media’s almost sole focus on heart-wrenching cases of suffering individuals asking for euthanasia blinded us to the larger-picture consequences of legalizing it?

Why do politicians use obfuscating language — “medical aid to die” — for euthanasia? An Ipsos Marketing survey found only one-third of Quebecers understood this meant a lethal injection.

Can we imagine physicians teaching medical students how to carry out euthanasia and clinically role-modelling it for them?

Will many physicians decline work in institutions in which colleagues administer euthanasia? Imagine sitting down to lunch with a colleague who 10 minutes before killed a patient.

Will patients refuse admission to institutions that provide euthanasia? Will they refuse palliative care and pain management for fear of being euthanized? The Netherlands and Belgium both show these are valid concerns.

Why did Quebec politicians cite Belgium’s law as a felicitous example when there’s ample evidence of its abuse (the practical slippery slope) and rapid and broad expansion of its application (the logical slippery slope)?

Would serious mental illness or anorexia nervosa be an “end of life condition” allowing euthanasia in Quebec, as in Belgium and the Netherlands? Likewise, as in those countries, once we become accustomed to euthanasia will children become eligible for it? What about people with dementia?

Will euthanasia be used as a cost-saving mechanism? Was it just a coincidence that Bill 52’s passage immediately followed the budget bill?

As Quebec politicians claim, will euthanasia be rarely used? In Belgium, five people die each day by euthanasia. In the Netherlands, four per cent of all deaths are now by euthanasia, which is an underestimate and does not include deaths through “continuous terminal sedation (CTS)” (Bill 52’s term for “slow euthanasia”), which is being increasingly used, as its requirements are less onerous.

Is euthanasia just an incremental expansion of current ethically and legally accepted end-of-life decisions, such as refusals of life-support treatment, as pro-euthanasia advocates argue, or is acting with an intention to kill different-in-kind from allowing a natural death?

Is euthanasia medical treatment? What are the dangers to patients, the trust-based physician-patient relationship, and medicine of defining it as such? Should we take the “medical cloak” off euthanasia and have some specially trained persons other than physicians mandated to administer it?

If euthanasia remains permitted, how do we think our great-great-grandchildren will die? What kind of society will we have left to them? Will it be one in which no reasonable person would want to live?

Why don’t most politicians and many Canadians recognize the momentousness of a decision to legalize euthanasia? It’s not an incremental change, but a radical and massive shift in our society’s and civilization’s foundational values.

I predict history will see each society’s decision about euthanasia as its turning-point values decision of the 21st century.