Euthanasia is a slippery slope

Published by The i paper (17th April, 2023)

There are few more sensitive political issues than legalisation of euthanasia. On one hand we hear emotive pleas from patients in terrible circumstances begging for the chance to end their pain and torment when it becomes unbearable, along with rational arguments about the rights of citizens to determine their own death. On the other side there is talk about the sanctity of life, the morality of deliberately killing people and the role of doctors who are meant to be guided by the Hippocratic oath of “first do no harm”.

Behind this debate lies a reluctance to confront death in our sanitised society, along with issues over the medicalisation of mortality and even difficult financial questions over the wisdom of spending a hefty slice of our pressurised health budgets to keep people alive for a few more months in their fading twilight. France has become the latest European nation to shift towards sanctioning of euthanasia after a citizens’ assembly backed the concept, following a dozen more places that already allow some form of assisted dying. It is presented as a progressive ideal, which preys upon our worst fears and feels almost inevitable in civilised countries.

Surveys in Britain show support for letting someone suffering from incurable illness end their life. Even the former Archbishop of Canterbury Lord Carey says there is “nothing holy about agony”. Baroness Meacher, the campaigner who led a private member’s bill in the House of Lords two years ago, claims a majority of MPs in the Commons back reform – although the move was heavily defeated when last tested eight years ago.

Now the pressure grows again with an inquiry by the Health and Social Care Committee, which the chair Steve Brine says is seeking to find “a way through the many ethical, moral, practical and humane considerations involved”.

As an atheist and liberal, I have no problem with the idea. Indeed, I suspect if it was sanctioned and I suffered from some awful conditions, I might request it myself. Yet I am firmly opposed to legalisation on practical rather than moral grounds, since the evidence from abroad shows that once the door to assisted dying is opened, it gets pushed wider and wider. The criteria for eligibility extends, whether through further reforms or common practice, and those most likely to become victims – rather than beneficiaries – are marginalised citizens already being failed by support systems.

The Netherlands was the world’s first nation to legalise euthanasia in 2002 – and as one prominent Dutch ethicist says, anyone examining reform should look closely at their experience to see the inevitable direction of travel. The move was made for patients “in a state of continuous, unbearable and incurable suffering”, who had to be “of sound mind” and voluntarily request to die.

Then three years ago, Dutch courts said physicians could euthanise elderly people with severe dementia even if the patient no longer expressed desire for death, following a controversial case involving a distressed woman held down by her family as her life was ended. Last week, the rules were widened again to permit the killing of terminally ill children from one to 12 years old, who hardly seem likely to make such demands themselves.

This underlines the inevitability that such laws become more permissive. After all, if permitted for physical pain, why not for mental suffering? So the Netherlands saw a surge in psychiatric euthanasia, including one woman killed 12 months after her husband’s death on grounds of “prolonged grief disorder”. And as mercy killing is normalised, numbers rise. Latest data  shows total number of euthanasia cases surged nearly 14 per cent last year to account for more than one in 20 Dutch deaths, including 115 psychiatric patients, 288 people with dementia and 29 couples dying together. In two decades since legalisation, just 133 cases failed to meet the legal criteria.

I have spoken with a young woman seeking consent to die due to mental distress in next-door Belgium – the second country to sanction euthanasia and first to legalise it for children. “It is like physical pain,” she told me. ‘‘It feels like I am breaking apart.” Yet I have also read powerful evidence to the select committee from Ilora Finlay, a professor of palliative medicine in Cardiff who has worked in Holland. She detailed her experiences of looking after thousands of dying patients and having many conversations with people in despair, describing one patient who said he would kill himself in two weeks but was alive 11 years later. The cross bench peer insisted “that suicidal ideation disappears” if people get the right care and support.

Britain was a pioneer in the creation of the hospice movement and development of palliative care, which last year was rightly placed at the core of our health services, although far too many psychiatric services are in a lamentable state.

Yet the strongest arguments against legalising euthanasia came from another peer and medical expert Sheila Hollins, who spoke about her research in Holland finding 24 confirmed cases of people euthanised “simply because of the symptoms of having a learning disability or autism” with 15 other possibly related incidents. What a damning indictment of a society that poses as progressive while extinguishing the lives of marginalised citizens due to a sordid lack of care, concern or sympathy.

“Anyone who embarks on euthanasia ventures on a slippery slope along which you irrevocably slide towards the indiscriminate killing of defenceless patients,” wrote Bert Keizer, a prominent Dutch euthanasia doctor, three years ago. So is this really what we want in Britain?

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