Bioethicists debate the merits and dangers of euthanasia

Debate comes as the Victorian Government plans to introduce euthanasia legislation this August

Professor Peter Singer (L) and Professor Margaret Somerville (R)

PHOTO: Stephen Cauchi

By Stephen Cauchi

August 16 2017Bioethicists Peter Singer and Margaret Somerville have slugged out a tough debate over euthanasia as the Victorian Government prepares to introduce legislation on assisted dying.

Collins St Baptist Church was full for the June 29 debate, with around 400 members of the public attending and asking questions.

The legislation could be tabled as early as this month.

The pair debated voluntary euthanasia and the distinction between assisted dying (when the final step in the death process is performed by the patient) and lethal injection (when the final step in the death process is performed by the doctor).

The pair also debated whether voluntary euthanasia would be a slippery slope to non-voluntary euthanasia (where incapacitated individuals, such as those in a coma, are euthanized) or even involuntary euthanasia (where individuals are euthanized against their will, as in Nazi Germany).

The Victorian Government’s proposed legislation, which has not yet been finalised, will permit assisted dying. If a patient requests a prescription drug that can end their life in a peaceful manner, a doctor will be legally able to prescribe it.

In his opening speech, Professor Singer – a Professor of Bioethics at Princeton University - said that a number of US states already had similar legislation. Oregon has had its legislation for 20 years and Washington State for eight. Canada and some European countries also had the legislation, he said.

The details of each jurisdiction’s laws were slightly different, he said, but there were safeguards with each. In Oregon, for example, a doctor must state a patient has less than six months to live.

Other safeguards included a requirement for a second medical opinion, a certificate indicating the patient is of sound mind, and a cooling-off period.

“Our doctors should be able to help us die peacefully, if we request it, because pointless suffering is a bad thing, while giving people more control over their lives is a good thing,” said Professor Singer.

“Victorian Premier Daniel Andrews is one of many whose attitude to assisted dying was changed by the experience of watching his father die from cancer.

“If a person we love wants to die sooner rather than later, why should a doctor not be able to provide this final act of care for a patient?”

The “slippery slope” argument, he said, was “never very plausible, so it is not surprising that nothing like that has happened.”

Professor Singer added that “no country or state that has voted for the legalisation of physician assistance in dying has ever voted to repeal the legislation.

“That’s because it works, is not abused and it gives people choices that they value.”

Professor Somerville, Professor of Bioethics at University of Notre Dame Sydney Medical School, completely disagreed with Professor Singer on the issue of slippery slopes.

“Once euthanasia becomes normalised, slippery slopes are unavoidable,” said Professor Somerville.

She pointed to the Netherlands, where there had been a “rapid rise in the number of people with psychiatric illness or dementia who have been euthanized.”

There were cases of such people having sedatives surreptitiously put in their coffee, putting them to sleep, said Professor Somerville. They were then euthanized when unconscious.

“We should think of this is relation to vulnerable Australians – for example, those who are elderly and fragile, especially those with dementia.”

In Quebec, she said, pro-euthanasia advocates estimated there would be about 100 cases per year. This was rapidly exceeded.

“In the first year, there were over 400 cases in Quebec and almost 1500 in Canada as a whole. Some Quebec cases breached the legal requirements: in one, the patient probably had just a urinary infection.”

“In short,” said Professor Somerville, “euthanasia has become normalised with astonishing rapidity, just one year, and that has caused calls for access to it to be expanded – indeed, for calls to have no restriction at all on access.”

Governments or industries could also face conflicts of interest, she said. Canadian healthcare economists estimate euthanasia could save Canadian Medicare over $A100 million. American healthcare insurance companies are refusing to pay for expensive life-extending drugs, she said, but will pay for physician-assisted suicide because it’s “available at a reasonable cost”.

In the second half of the session, as the pair fielded questions, they also disagreed about what the Victorian legislation would entail.

Professor Singer said that he would be “very surprised” if the legislation would permit lethal injection. Professor Somerville said she suspected the legislation would permit lethal injection if the patient was “unable to take the medication themselves”.

In response to another question, Professor Somerville said that it was possible to give suffering patients psycho-therapy so they could find a reason to live.

Austrian psychiatrist and holocaust survivor Viktor Frankl, said Professor Somerville, “said that if you can give people a “why” to live, they’ll find a “how” to live – no matter how poor the conditions they’re in.”

Professor Singer responded that “I’m all for psychiatrists or counsellors to try and encourage people to find meaning. That’s fine.” However, “I don’t want to be pushing the idea that somehow you’ve got to find meaning – there is meaning, you can’t die because I know there’s meaning even if you don’t see it.”

The pair also disagreed on the fundamental issue of whether humans had inherent dignity.

“I believe it’s inherently wrong to intentionally kill another person,” said Professor Somerville.

“You can’t afford to breach that, because if we do – and I think this is what we’re seeing in the countries that have legalised euthanasia – then you can’t control it.

“Once you step over that line – you must not kill – there is no obvious limit to where and when you will kill.”

Professor Singer replied that “I don’t see how just being a member of the human species gives you dignity.

“That does seem very much to be like a religious perspective – that you’ve got an immortal soul, as some religions teach, and non-humans don’t have immortal souls.

“I would say our dignity is a matter of how we see ourselves.

“We may feel we have dignity as long as we have some control over the way we’re living and our choices. We lose that dignity perhaps when we become helpless, passive and we feel that we are no longer capable of (doing) things that we value.”  

Euthanasia is currently illegal in Australia. For a time it was legal in the Northern Territory.

The Australian newspaper has reported that the euthanasia bill could be tabled in the Victorian parliament as early as the second sitting week of August, which starts on August 22.

The End Of Life Choices debate was hosted by the University of Divinity. The debate can be viewed on YouTube.