Slippery Slope
One concern is what is known as the slippery slope. For all the talk about "safeguards", there really can be no safeguards in legalised euthanasia. The Dutch experience is an excellent example of this. The "guidelines" for euthanasia in Holland have often been flouted. Dr John Keown has studied the Dutch situation in great detail. For example, he found that in 1990, 52 per cent of the 10,558 cases of a doctor's intent to hasten death were done with no explicit request from the patient.
The Remmelink Report, an official Dutch government survey of euthanasia practices, found that more than one thousand patients are involuntarily euthanised each year. As one Oxford philosopher put it, the Dutch experience clearly shows that "even with stringent safeguards, once voluntary euthanasia is legalised the descent down the slippery slope is inevitable".
In South Australia, where voluntary euthanasia is illegal, a recent survey of doctors who had taken active steps to end a patient's life found that 49 per cent of them had never received a request from the patient to do so. A more recent survey of nearly 1000 Australian surgeons found that more than one third had intentionally hastened the death of a patient by administering more medication than was necessary to treat the patient's symptoms. Of this group, more than half said they did so without an explicit request from the patient.
Another survey of 683 general surgeons, conducted a year later by the University of Newcastle, found similar results: over a third had sped up the death of terminally ill patients, and over half of the patients had not explicitly asked for a lethal dose of drugs. Only a few of the patients had clearly asked for euthanasia.
It seems that abuse is inevitable. Voluntary euthanasia will lead to involuntary euthanasia. It is already happening. As one Australian expert in palliative care put it, "No proposal has ever been devised which could be guaranteed not to be abused."
But more importantly, as noted earlier, once we have opened the door to the killing of the elderly, why stop there? This is the really dangerous slippery slope. And again, it is not just theoretical. Respected Australians are actually proposing that infanticide for example be seriously considered. Peter Singer is one well known proponent of this view.
Indeed, while some argue that policies permitting the killing of patients can be strictly controlled, in the real world such controls quickly dissipate. As Wesley Smith has put it, "The carefully shaded moral distinctions in which the health-care intelligentsia and policymakers take so much pride are of little actual consequence in the real world of cost-controlled medical practice, in busy hospital settings, and among families suffering the emotional trauma and bearing the financial costs of caring for a severely brain-damaged relative. Once killing is seen as an appropriate answer in a few cases, the ground quickly gives way, and it becomes the answer in many cases."
Palliative Care
Palliative care is one of the great overlooked issues in the whole debate. What the terminally ill want is pain relief, not an end to life. In America there are 31,000 suicides annually, of which only 2 to 4 per cent are by people who are terminally ill. Although relatively new, palliative care has made tremendous advances in recent years. Yet it is still under-utilised. One medical doctor has said that between 50 and 75 per cent of cancer patients' pain is under-treated, even by specialists.
But palliative care, if used, can now relieve suffering in the majority of cases. As a pro-euthanasia doctor in Holland, Dr Peter Admiraal, has admitted, "essentially all pain can be controlled … euthanasia for pain relief is unethical". One doctor has said that "there is no pain that I cannot treat". Perhaps 95 per cent of all patients can find relief from palliative care. Dr Ian Gawler has said, "in many years of working with people facing death I have never been confronted by a situation where the urge to provide ongoing compassionate care was outweighed by the pragmatic need for a prematurely induced death." And a doctor from Western Australia has said, "there are very few symptoms indeed which cannot be controlled through the application of good palliative care".
Those who work with dying people know that the overwhelming majority want their pain controlled, but do not want to be killed. Paul Dunne, who has worked with over 1,000 dying patients in Hobart, has said that only five patients have ever said, "Kill me".
The unanimous report of the House of Lords Select Committee on Medical Ethics has recommended that there be no change to law in the United Kingdom to permit euthanasia. More and better palliative care was instead recommended.
Finally, it should be pointed out that as euthanasia becomes legal and accepted by the community, there will be an inevitable lessening of interest in palliative care and the care of the elderly. As Dr John Buchanan put it, "A risk of the denial of the right to palliative care may arise for those who do not wish to request euthanasia". Indeed, when "death is seen as a treatment, then medicine will allocate more and more resources to develop the technological advances to improve this treatment."
Australian author Lisa Birnie concurs. As she began writing her book on death and dying, she had an open mind on the issue of euthanasia, but she ended up recognising its many inherent dangers. She is now a strong supporter of palliative care, and regards the legalisation of euthanasia as "a form of social suicide". She writes, "I am … convinced that the research required to find the solution to extreme pain in all cases will never be done if euthanasia is permitted simply because it is the cheapest and easiest solution in a world where health budgets are tight, solutions are judged by practical results, and moral standards are determined, essentially, by expediency".
Conclusion
For these and other reasons, euthanasia, or assisted-killing, should never be legalised. Instead, more effort should be put into reducing pain, not killing the sufferer. With the issue of youth suicide again in the public spotlight, we need to heed the words of the 1993 Report of the British House of Lords on euthanasia: "The message which society sends to vulnerable and disadvantaged people should not, however obliquely, encourage them to seek death, but should assure them of our care and support in life."
The conclusion to the House of Lord's Select Committee on Medical Ethics (1984) is worth citing here: "There is not sufficient reason to weaken society's prohibition of intentional killing which is the cornerstone of law and of social relationships. Individual cases cannot reasonably establish the foundation of a policy which would have such serious and widespread repercussions. The issue of euthanasia is one in which the interests of the individual cannot be separated from those of society as a whole."