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McGill Centre for Medicine, Ethics and Law THE SECULAR CASE AGAINST EUTHANASIA MARGARET A. SOMERVILLE AM, FRSC, A.u.A (pharm.), LL.B. (hons), D.C.L., LL.D.

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Presentation on theme: "McGill Centre for Medicine, Ethics and Law THE SECULAR CASE AGAINST EUTHANASIA MARGARET A. SOMERVILLE AM, FRSC, A.u.A (pharm.), LL.B. (hons), D.C.L., LL.D."— Presentation transcript:

1 McGill Centre for Medicine, Ethics and Law THE SECULAR CASE AGAINST EUTHANASIA MARGARET A. SOMERVILLE AM, FRSC, A.u.A (pharm.), LL.B. (hons), D.C.L., LL.D. (hons. caus.) Civitas’s 10th Annual National Conference Brookstreet Resort Brookstreet Resort Ottawa Ottawa May 5 -7, 2006 Copyright©2006 Margaret A. Somerville Not to be copied or cited without permission of the author

2 Putting euthanasia in context - contentious social-ethical values issues: Abortion Abortion Access to healthcare Access to healthcare Armed conflict Armed conflict Capital punishment Capital punishment Euthanasia and physician-assisted suicide Euthanasia and physician-assisted suicide Human embryo stem cell research Human embryo stem cell research Legalizing marihuana & hard/soft on crime Legalizing marihuana & hard/soft on crime Same–sex marriage Same–sex marriage

3 Euthanasia is an important test case… because everyone because everyone personally relates to death personally relates to death euthanasia has powerful impact on euthanasia has powerful impact on personal and societal values euthanasia and PAS treated together euthanasia and PAS treated together re most ethical aspects

4 Advocates argue euthanasia is: a minor change a minor change “doing good” “doing good” respecting people and their rights respecting people and their rights relieving suffering relieving suffering compassionate and merciful compassionate and merciful just an additional option just an additional option Are they correct?

5 To answer… have to look at euthanasia on individualinstitutional and and societal levels i.e. euthanasia as part of a larger whole

6 Two major reasons against euthanasia and physician-assisted suicide: Principle-based reason: Principle-based reason: wrong to intentionally kill another person (except in self-defence). Utilitarian-based reason: Utilitarian-based reason: harms and risks legalizing euthanasia and PAS to individuals, society, and medicine far outweigh any benefits.

7 When personal and societal values consistent, widely shared and based on shared religion, case against euthanasia was simple: When personal and societal values consistent, widely shared and based on shared religion, case against euthanasia was simple: God commanded "thou shalt not kill". In secular society based on intense individualism, case for euthanasia is simple: Individuals have right to choose manner, time and place of death. In secular society based on intense individualism, case for euthanasia is simple: Individuals have right to choose manner, time and place of death. In contrast, in such societies In contrast, in such societies case against euthanasia is complex.

8 Definitions and language … Physician-assisted death Physician-assisted death - we all want such assistance Definitions a source of confusion Definitions a source of confusion in euthanasia debate - some confusion deliberately engendered by euthanasia advocates as strategy

9 Definitions and language … Euthanasia is Euthanasia is deliberate act causing death undertaken with primary intention of ending life in order to relieve suffering. in order to relieve suffering. Euthanasia is not Euthanasia is not justified withdrawing or withholding treatment to allow to die provision of pain relief, even if could shorten life, provided is necessary

10 Confusing euthanasia and palliative care… Difference in kind not degree between killing and allowing to die Difference in kind not degree between killing and allowing to die Euthanasia is not just another Euthanasia is not just another “act of good palliative care”

11 What are the secular arguments against euthanasia and PAS? i) Impact on society... Legalising euthanasia would damage important, foundational societal values and symbols that uphold Legalising euthanasia would damage important, foundational societal values and symbols that uphold respect for human life.

12 i) Impact on society... If euthanasia involved, how we die cannot be just a private matter of self-determination and personal beliefs, because euthanasia "is an act that requires two people to make it possible and a complicit society to make it acceptable”. If euthanasia involved, how we die cannot be just a private matter of self-determination and personal beliefs, because euthanasia "is an act that requires two people to make it possible and a complicit society to make it acceptable”. Daniel Callahan “The prohibition on intentionally killing is the cornerstone of law and human relationships, emphasising our basic equality”. House of Lords “The prohibition on intentionally killing is the cornerstone of law and human relationships, emphasising our basic equality”. House of Lords

13 i) Impact on society... Medicine and law are principal institutions that maintain respect for human life in a secular, pluralistic society Medicine and law are principal institutions that maintain respect for human life in a secular, pluralistic society Legalizing euthanasia involves and harms both Legalizing euthanasia involves and harms both changing norm we must not kill each other would seriously damage their capacity to carry the value of respect for human life.

14 i) Impact on society... To legalise euthanasia is To legalise euthanasia is to change way we understand ourselves human life and its meaning.

15 i) Impact on society... To explain need to paint much larger picture: We create values and find meaning in life by buying into a "shared story" We create values and find meaning in life by buying into a "shared story" - a societal-cultural paradigm. Humans have always focused that story on the two great events of each life, birth and death. Humans have always focused that story on the two great events of each life, birth and death. Even in a secular society - indeed, more than in a religious one - that story must encompass, create space for and protect Even in a secular society - indeed, more than in a religious one - that story must encompass, create space for and protect the "human spirit".

16 i) Impact on society... Human spirit does not mean anything religious (although it can accommodate religious beliefs). Human spirit does not mean anything religious (although it can accommodate religious beliefs). Rather, it is the intangible, invisible, immeasurable reality that we need to find meaning in life and make life worth living - that deeply intuitive sense of relatedness or connectedness to others, the world, and the universe in which we live.

17 i) Impact on society... There are two views of human life and, therefore, death: We are simply "gene machines”: We are simply "gene machines”: “when we are past our "best before" date, we should be checked out as quickly, cheaply and efficiently as possible”. - that favours euthanasia. Other view sees a mystery in human death, because it sees a mystery in human life, which does not require any belief in the supernatural. Other view sees a mystery in human death, because it sees a mystery in human life, which does not require any belief in the supernatural.

18 i) Impact on society... Euthanasia is a "gene machine" response. Euthanasia is a "gene machine" response. Converts mystery of death to problem of death Converts mystery of death to problem of death to which we seek a technological solution – a lethal injection Post-modern societies uncomfortable with mystery, especially if generates Post-modern societies uncomfortable with mystery, especially if generates intense free-floating anxiety and fear – as death does.

19 i) Impact on society... We seek control over that fear We seek control over that fear - terror-management /terror-reduction mechanism Euthanasia such a mechanism: Euthanasia such a mechanism: Can’t avoid cause of fear - death – but control manner, time and place of death - allows us to feel have death under control.

20 i) Impact on society... Research shows marker for people wanting euthanasia is state psychiatrists call hopelessness (different from depression) - these people have nothing to look forward to Research shows marker for people wanting euthanasia is state psychiatrists call hopelessness (different from depression) - these people have nothing to look forward to Hope is a sense of connection to the future Hope is a sense of connection to the future “hope is the oxygen of the human spirit”.

21 i) Impact on society... Hope can be elicited by a sense of connection to a very immediate future Hope can be elicited by a sense of connection to a very immediate future People need hope if they are People need hope if they are to experience dying as the final great act of life Euthanasia negates that possibility Euthanasia negates that possibility

22 i) Impact on society... Pragmatic, but very important, objection to legalizing euthanasia is abuse cannot be prevented, as the Netherlands shows. Pragmatic, but very important, objection to legalizing euthanasia is abuse cannot be prevented, as the Netherlands shows. This evidence caused some euthanasia advocates to believe it cannot be safely legalized and have spoken against doing so. This evidence caused some euthanasia advocates to believe it cannot be safely legalized and have spoken against doing so.

23 i) Impact on society... To assess impact, in practice, of legalising euthanasia look at it in context in which would operate: To assess impact, in practice, of legalising euthanasia look at it in context in which would operate: Combination of an ageing population, scarce healthcare resources and euthanasia would be a lethal one.

24 ii)Impact on medicine and nursing… Euthanasia advocates argue in support of legalisation Euthanasia advocates argue in support of legalisation physicians are secretly carrying it out physicians are secretly carrying it out Studies purporting to establish that severely criticised: Studies purporting to establish that severely criticised: respondents did not distinguish between actions primarily intended to shorten life - euthanasia and other acts or omissions with no such intention - pain-relief or refusals of treatment

25 ii)Impact on medicine and nursing… Even if studies accurate, fact physicians are secretly carrying out euthanasia does not mean it is right. Even if studies accurate, fact physicians are secretly carrying out euthanasia does not mean it is right. Further, if physicians were presently ignoring law against murder, why would they obey guidelines for voluntary euthanasia? Further, if physicians were presently ignoring law against murder, why would they obey guidelines for voluntary euthanasia?

26 ii)Impact on medicine and nursing… Euthanasia… Euthanasia… "places the very soul of medicine on trial“ Physicians' absolute repugnance to killing people necessary to maintaining people's and society's trust. Physicians' absolute repugnance to killing people necessary to maintaining people's and society's trust. True, in part, because physicians have opportunities to kill not open to other people True, in part, because physicians have opportunities to kill not open to other people

27 ii)Impact on medicine and nursing… How would legalising euthanasia affect medical and nursing education? How would legalising euthanasia affect medical and nursing education? What impact would physician role models carrying out euthanasia have on medical students and young physicians? What impact would physician role models carrying out euthanasia have on medical students and young physicians? Would we devote time to teaching students how to administer death through lethal injection? Would we devote time to teaching students how to administer death through lethal injection?

28 ii)Impact on medicine and nursing… Would they be brutalised or ethically desensitised? Would they be brutalised or ethically desensitised? Do we adequately teach pain-relief treatment at present? Do we adequately teach pain-relief treatment at present? Would euthanasia be a required procedure? Would euthanasia be a required procedure? Would be very difficult to communicate to future physicians and nurses a repugnance to killing in context of legalised euthanasia.

29 ii)Impact on medicine and nursing… Physicians and nurses need a clear line that powerfully manifests to them, their patients, and society that they do not inflict death Physicians and nurses need a clear line that powerfully manifests to them, their patients, and society that they do not inflict death Both their patients and the public need to know with absolute certainty - and be able to trust - that is the case. Both their patients and the public need to know with absolute certainty - and be able to trust - that is the case. Anything blurs that line, damages that trust, or makes physicians less sensitive to primary obligations to protect life is unacceptable. Anything blurs that line, damages that trust, or makes physicians less sensitive to primary obligations to protect life is unacceptable. Legalizing euthanasia would do all of these

30 ii) Impact on medicine and nursing… Harms to medicine harm society Harms to medicine harm society need to protect healthcare institutions because are  value-creating  value-carrying  consensus-forming

31 Conclusion… Euthanasia and PAS are simplistic, wrong and dangerous responses to the complex reality of human death. Euthanasia and PAS are simplistic, wrong and dangerous responses to the complex reality of human death. They involve taking people who are at their weakest and most vulnerable, who fear loss of control or isolation and abandonment - who are in a state of intense "pre-mortem loneliness" - and placing them in a situation where they believe their only alternative is to be killed or kill themselves. They involve taking people who are at their weakest and most vulnerable, who fear loss of control or isolation and abandonment - who are in a state of intense "pre-mortem loneliness" - and placing them in a situation where they believe their only alternative is to be killed or kill themselves.

32 Conclusion… THE EUTHANASIA DEBATE IMPLICATES: meaning of human life meaning of human life respect for human life respect for human life “ethical and legal tones” of societies “ethical and legal tones” of societies features of our societal paradigms features of our societal paradigms - local to global the society of the future the society of the future

33 Conclusion… How a society treats its weakest, most in need, most vulnerable members best tests its moral and ethical tone. How a society treats its weakest, most in need, most vulnerable members best tests its moral and ethical tone. To set a present and future moral tone that protects individuals and society, upholds the fundamental value of respect for life, and promotes rather than destroys our capacities and opportunities for meaning in life, we must reject euthanasia. To set a present and future moral tone that protects individuals and society, upholds the fundamental value of respect for life, and promotes rather than destroys our capacities and opportunities to search for meaning in life, we must reject euthanasia.

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38 THREE "WORLD VIEWS" COMPETING AS BASIS FOR NEW SOCIETAL PARADIGM i) “PURE” SCIENCE VIEW we are highly complex biological machines we are highly complex biological machines “gene machines” rational, logical, cognitive rational, logical, cognitive our most valued features FAVOURS LEGALIZING EUTHANASIA FAVOURS LEGALIZING EUTHANASIA

39 ii) “PURE MYSTERY” VIEW usually associated with usually associated with fundamentalist religious beliefs conservative conservative ANTI-EUTHANASIA ANTI-EUTHANASIA

40 iii) “SCIENCE – SPIRIT” VIEW combines respect for science with combines respect for science with respect for the human spirit respect for the human spirit - requires drawing lines in “grey areas” basic question basic question IS IT INHERENTLY WRONG TO KILL IS IT INHERENTLY WRONG TO KILL ANOTHER? ANOTHER? : EXCLUDES EUTHANASIA

41 Conclusion… Nancy Crick, a 69-year-old Australian grandmother, committed suicide in the presence of over 20 people, eight of whom were members of the Australian Voluntary Euthanasia Society. She explained: "I don't want to die alone." Nancy Crick, a 69-year-old Australian grandmother, committed suicide in the presence of over 20 people, eight of whom were members of the Australian Voluntary Euthanasia Society. She explained: "I don't want to die alone." Another option for Mrs Crick (if she had been terminally ill – she was not) should have been to die naturally with people who cared for her present and good palliative care. Another option for Mrs Crick (if she had been terminally ill – she was not) should have been to die naturally with people who cared for her present and good palliative care.

42 Conclusion… Of people who requested assisted suicide under Oregon's Death with Dignity Act (which allows physicians to prescribe lethal medication), 46% changed their minds after significant palliative-care interventions (relief of pain and other symptoms), but only 15% of those who did not receive such interventions did so. Of people who requested assisted suicide under Oregon's Death with Dignity Act (which allows physicians to prescribe lethal medication), 46% changed their minds after significant palliative-care interventions (relief of pain and other symptoms), but only 15% of those who did not receive such interventions did so. Foley and Hendin


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