One of the major reasons why societies should never go down the path of legalising euthanasia is that the doctor-patient relationship will be seriously weakened. When the medical profession becomes involved in killing, the delicate trust relationship between patient and doctor is radically undermined.
People trust their lives to doctors and health care workers in the knowledge that they are dedicated to the preservation of life, to healing, to caring. This after all is the basis of the Hippocratic tradition. The Hippocratic Oath includes the commitment not to kill a patient, even if the patient requests such a course.
Once doctors become involved in the killing game, once they become “legalised terminators” as Morris West calls them, patients will be in a state of fear and suspicion, not knowing where the doctor is coming from. Some may rightly fear whether “every injection, pill or new IV bag is designed to cure or to kill – to end the pain or the patient” as one bioethicist remarks.
But it is not just the patient who is at risk. Doctors too risk becoming desensitised, seeing the taking of life as just another routine procedure. This was exactly the case in pre-Nazi and Nazi Germany. The medical establishment played a large role in the killing of hundreds of thousands of Germans and non-Germans.
It took less than 20 years for German medicine to make the practice of the widespread euthanasia of “undesirables” acceptable. And the horrible Nazi crimes, as Leo Alexander reminds us, “started from small beginnings. The beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians. It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as life not worthy to be lived.”
Indeed, physician-assisted suicide (PAS) would inevitably harden the doctor to his traditional responsibilities. How could this not occur? By turning doctors away from caring to killing will of necessity not only change their role but change their own values and humanity. As English medical ethicist John Wyatt expresses it:
“There would also be the psychological effect on doctors who have broken deep human intuitions and cultural taboos against the intentional taking of human life. Would doctors and other staff be brutalized by the experience? Would the doctor who has just committed euthanasia fight as hard as she might have done to save the life of her next patient? What are the psychological consequences for carers, when the overriding duty of care is transformed into a duty to kill?”
Moreover, legalised euthanasia gives too much power to doctors. Doctors, not patients, are empowered by euthanasia. As Herbert Hendin says, “Euthanasia, advocated and instituted to foster patient autonomy and self-determination, has actually increased the paternalistic power of the medical profession. Physicians’ organizations protect the interests of their members like guilds or unions everywhere.”
Even for a doctor who acts only from the noblest of motives, there is a chance of making the wrong decision for the wrong reasons. And what of unscrupulous doctors? What if doctors make a straight commission from each patient they kill, as is the case with some abortionists?
As T.C. DeLacey notes, “Doctors like anyone else can be selfish and lazy. It is not unknown for doctors to take self-interested short-cuts, for example, putting a pregnant woman to the added and unnecessary strain of an induced or caesarean section birth on a Friday in order to guarantee an uninterrupted weekend for themselves. Why, then, would they never be tempted to kill as the quickest or easiest way of dealing with a troublesome case; likewise, why would they never be prepared to falsify a patient’s ‘living will’?”
Ethicist Margaret Somerville summarises the harm in this: “Doctors’ absolute repugnance to killing people is necessary to maintaining people’s and society’s trust in them. . . . It would be very difficult to communicate to doctors a repugnance to killing in a context of legalised euthanasia. Harm to medicine also harms society. We need to protect the institution of medicine not just for its own sake, but also because it is a very important value-creating, value-carrying and values-consensus-forming institution, especially in a secular society.”
The experience of the Low Countries
All this is borne out in some new studies which further highlight the dangers of legalised euthanasia. They all have to do with the situation in Belgium and the Netherlands, where euthanasia has been legal since 2002 and 2001 respectively. The findings are not very encouraging. Indeed, the safeguards that are supposed to be in play seem to be very weak indeed.
For example, a new study published in the British Medical Journal “found that nearly half of all euthanasia deaths in the Flanders region of Belgium were not reported. This study combined with the recent study that was published in the CMAJ in May 2010 that indicated that 32% of all euthanasia deaths in the Flanders region of Belgium were without request or consent suggests that the Belgium euthanasia model is out-of-control.”
Alex Shadenberg explains: “The authors of the study analysed the death certificates in the Flanders Region of Belgium. After determining that the death was related to euthanasia, the authors of the study sent a five page questionnaire to the treating physician. The physicians were guaranteed total anonymity and asked to respond to the questionnaire.
“The study determined that euthanasia deaths were reported 52.8% of the time, even though reporting is a requirement of the law. The most recent study in the Netherlands indicated that the euthanasia deaths were reported 80.2% of the time.
“The study indicates that the reason the euthanasia death was not reported was:
76.7% – the physician did not perceive their act as euthanasia.
17.9% – reporting was considered an administrative burden.
11.9% – the legal, due care requirements, had possibly not all been met.
8.7% – euthanasia is a private matter between the physician and patient.
2.3% – because of possible legal consequences.
“It is interesting that 97.7% of the reported cases were done by the physician, whereas 41.3% of the unreported cases were done by a nurse alone. This confirms the result of the other recent study that found that 45% of euthanasia deaths that were done by nurses were without request or consent.
“This study strongly challenges the Belgium government official reports. According to these reports, physicians who reported cases practised euthanasia carefully and in compliance with the law, and no cases of abuse were found. But if only 52.8% of all euthanasia deaths are reported and the physicians admitted that in at least 2.3% of the time the euthanasia death was not reported due to possible legal consequences and 11.9% of the cases were not reported because the legal requirements were not met, therefore it is clear that physicians are only choosing to report the cases that are within the parameters of the law.”
This is further evidence that legalising euthanasia is always going to be a dangerous and uncontrollable exercise. Patients will be put further at risk, and the relationship between doctor and patient will continue to deteriorate. It is clear that all civilised societies must say no to euthanasia.