National Post Barbara Kay: No one really wants euthanasia. Suffering people want an end to their pain

National Post - Wednesday February 4th, 2015

Dario Ayala / THE GAZETTE
If we were truly idealistic, expanding and improving palliative services to all who need it would be our focus of national concern, research and resources.

I return this week to the topic of my last column: Euthanasia, considered until mere decades ago an audacious, immoral notion, has shed its aura of transgression. State endorsement was pioneered in the Netherlands, then taken up by Belgium, Luxembourg and, most recently, Quebec. Assisted suicide, euthanasia with a friendlier face, is legal in the U.S. states of Washington, Oregon, Montana – and, most brazenly, in Switzerland, where ordinary citizens, not just physicians, may help one another to exit life.

As journalist Gerbert van Loenen demonstrates in his new book, Do You Call this a Life? Blurred boundaries in the Netherlands’ Right-to-Die Laws, euthanasia activism always begins with the wish to help suffering people of sound mind to achieve control in ending their torment (as in the cases featured in the Carter vs. Canada “death with dignity” Supreme Court ruling, expected to be revealed Friday). But euthanasia never stops with this “self-determination” constituency.

Barbara Kay: Euthanasia is so accepted that doctors must now justify prolonging a life

In 1994, Dutch journalist Gerbert van Loenen’s partner Niek underwent surgery to remove what was thought to be a pea-sized brain tumour. More complicated than predicted, the operation resulted in a brain injury that left Niek permanently disabled, yet still able to enjoy quality of life.

Van Loenen willingly reorganized his life to care for Niek at home. But after four years, his career needs necessitated moving Niek to a wheelchair-accessible unit across the street from a nursing home, where he was content for six more years until the tumour returned, whereupon he died a natural death.

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Once you accept the logic that suffering justifies killing, it is not easy to set boundaries. The Netherlands’ experience shows that euthanasia spreads to individuals that other people — physicians or family members — consider better off dead, and that judges’ rulings tend to bend the law to satisfy the zeitgeist. Regular physician surveys offering guaranteed anonymity since 1991 concerning all end-of-life medical decisions indicate euthanasias without request are performed 300-1,000 times a year. In cases that arrive in court, judges almost invariably exonerate physicians on a “situation of necessity” principle. (According to van Loenen, there is no similar research in other countries, which makes the Netherlands “a unique laboratory that all the world can come and visit.”)

Van Loenen’s book is informative and provocative. Many readers will appreciate his identification — with ripostes — of the 22 most common arguments activists use to keep the goalposts moving. Some examples:

  •  the “argument of advancing technology”: we shouldn’t prolong life just because we can. That argument is good if there are only two options: prolongation or termination. There is a third option: foregoing high-tech prolongation, which is not euthanasia;
  •  the “courage argument,” according to which physicians who refuse to kill are cowardly, while compassion is equated with the courage to kill. To shame physicians for fulfilling their role rather than expanding it is wrong;
  •  the “equality argument”: if people of sound mind can request and get euthanasia, then equally miserable but incompetent patients should also have the right. This is “mercy killing,” the antithesis of “self-determination,” the alleged basis for the law;
  •  the “post-Christian” argument: euthanasia activists often assume anti-euthanasists must be Christian, and therefore their views are irrelevant. But many Protestant churches enthusiastically promote euthanasia and many in opposition are secular. In any case, why should conscience-based arguments be ineligible, when emotion-based arguments are welcome?

The most passionate advocates for marijuana legalization are those who actually believe all drugs should be legal. Similarly the most passionate euthanasia activists believe euthanasia and assisted suicide should be permitted for almost any reason, and virtually at any age. In both cases the wedge’s thin edge — relatively harmless pot and relatively reasonable self-determination — holds persuasive appeal for anyone committed to the primacy of individual rights. But in their hearts, euthanasia enthusiasts are more than half in love with easeful death for all deemed to be living without “dignity” (as they define it).

Their fascination with controlled exit from life springs, ironically, from a surfeit of liberal idealism. As van Loenen insightfully writes: “This is the paradox of the high-quality care in the Netherlands. We have such lofty ideals about being human that we are dissatisfied when a person does not meet those ideals despite our best care. In this way an idealistic image of humankind, good care and a medical system that threatens people can coexist together.”

Suffering people usually don’t really want to die; they want surcease from pain. Physicians greatly influence their decision-making. In a 2001 interview Dutch physician Joke Groen-Evers noted that, when talking with a terminal patient, she would feel bound to bring up the subject of euthanasia: “And nine times out of 10 the patient would return with a request for euthanasia.” Finding herself more comfortable suggesting palliative care, she stopped using the “E-word.” “And what do you know: almost no one asks for it anymore! … If you mention euthanasia, they will ask for it. If you mention palliative care, then that is what they will choose.”

Words to live by. If we were truly idealistic, expanding and improving palliative services to all who need it would be our focus of national concern, research and resources.