Why doctors oppose euthanasia.

I am opposed to Euthanasia. For the same reason I am opposed to abortion and capital punishment. I consider all humans — the disabled, the criminal, including those on death row — to have an essential dignity and worth. Regardless of what they have done, regardless of their functional status.

However there is a paper in this weeks NZMJ which examines a proposed bill for euthanasia. This is quite unlikely to proceed through this parliament, because we have an election on September 20 and Parliament is about to be dissolved.

But David Richmond has analysed the draft in this weeks NZ Medical Journal (behind a paywall). His analysis is pragmatic and damning.

Grounds for the request—Section 6 entitles a person to receive medical assistance to end his or her life if he or she:

• Is mentally competent (for comment on the definition of ‘competency’ see under discussion of sections 8 and 9 below)
• Suffers from either “a terminal disease or other medical condition likely to end his or her life within 12 months” OR
• Suffers (from) an “irreversible physical or mental medical condition that, in the person’s view, renders his or her life unbearable.” 6(1) (b) (ii)

Comments—

• The Bill assumes the infallibility of diagnosis. But diagnoses are made on the basis of probability.1 Not everyone diagnosed with terminal cancer, for example, will have it. There are records of people being euthanized who did not have the “terminal disease” they were thought to have. If euthanasia is legalised, over time, many will suffer the same fate. The sponsors of this Bill are apparently prepared to accept some ‘collateral damage’ in the pursuit of their cause. Yet New Zealand prohibited capital punishment in 1961 largely on the grounds that one innocent life taken in error was one too many.
• All the experts agree that it is not possible to forecast with certainty that a person is going to die within 12 months, even in the case of terminal cancer. Even 6 months is problematic. Studies have shown that only 20% of prognostic predictions made by competent physicians were within 33% of actual survival. Prognosis is an uncertain art. Some people will be euthanized on the basis of a pessimistic or incorrect prognosis. Moreover, if lethal drugs are going to be prescribed so far ahead of an expected death, there is no mechanism for accounting for them in the event that they are not used. In Oregon, since inception of the legislation, 36% of people who received lethal prescriptions under the Death With Dignity Act as reported in 2011, died of their disease and did not take the drugs. What happened to them? No-one knows, and, as with this Bill, there is no mechanism for finding out.
• Euthanasia could be justified by the descriptors offered in 6 (1) (b)(ii) for a wide range of non-terminal human conditions, including loneliness, depression, poor family relationships, tired of living, feelings of helplessness, demoralisation syndrome, loss of dignity, post-traumatic stress disorder and fear of future pain. Many people, not all of them seriously ill will fall under this category where, as in Belgium and Holland, euthanasia becomes a panacea for all manner of social ills-including unsuccessful sex-change operations. The deciding factor is how the patient feels. In this respect, this Bill offers what it took the Dutch 30 years to accomplish.
• People contemplating suicide will have a ready state-funded avenue to achieve the end they desire. A week’s reflection before confirming a request is a very short time: one could hardly for example imagine it to be sufficient to allow the pain of a jilted teen-age lover to be alleviated. We will have the contradictory situation of being a society concerned deeply about the suicide rate on one hand,9 yet providing a state-approved means of facilitating suicide on the other.There is no definition of the term ‘unbearable.’ It is a very subjective emotion. If it is meant to be a subtle allusion to pain, it fails. There is growing awareness in the pro-euthanasia movement that modern approaches to symptom relief no longer make intolerable pain a plausible reason for euthanasia.10 In the first 10 years of Oregon’s legal assisted suicide programme, not one request was on account of actual unbearable pain.

It is one of the profound ironies of this life that lay people assume that doctors know what they are doing and want to give the profession power that the profession does not want, while at the same time challenging the profession about things where the profession does know what they are talking about and can give good advice.

The assumption that the profession has certainty on issues of prognosis or diagnosis is unwise. The assumption that such rules will not be exploited is equally unwise. The Belgian and Dutch experience indicates that euthanasia is all to often coerced.

And many a good thing has been done, nobly and with difficulty, by people who at that time were exhausted and in pain. Pain to the point of unbearable. Disavowing this courage makes cowards of us all.