Euthanasia might be motivated by compassion, but it’s not the most compassionate answer

Thirteen years ago, Philip Nitschke found it hard to find an Irish venue for his talks on assisted suicide. This month he addressed a Joint Oireachtas Committee on Assisted Dying. It barely raised an eyebrow. It’s progress, of a kind.

Nitschke believes in a human right to rational suicide and that assisted suicide should be available to anyone of sound mind who wants it, including spouses or partners who are perfectly well but who wish to die with an unwell spouse. He burned his medical licence rather than comply with restrictions imposed on him by the Australian Medical Board regarding his advocacy of assisted suicide.

Nitschke has invented two machines to enable people to kill themselves. The latest, the Sarco, resembles a space capsule and kills people through inhalation of gas. His books include explicit instructions on how to access drugs and other suicide methods.

Nitschke is in no way representative of most campaigners on euthanasia, most of whom advocate strict controls.

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Indeed, most assisted dying advocates actively distance themselves from it having anything at all to do with suicide. For example, Deputy Gino Kenny, who brought in a private member’s Bill on assisted dying, says that the conflation of suicide and assisted dying is deeply unhelpful.

Australia’s Federal Court recently disagreed that there is a clear distinction between suicide and assisted dying. Australia has long-standing, strict laws criminalising those who counsel or instruct people about suicide by telephone or the internet. These laws were introduced in 2005 to counteract the proliferation of websites and chat rooms that actively encouraged people to die by suicide.

Some referred to this 2005 legislation as the “Nitschke amendment”, believing it was designed to curtail his rational suicide advocacy.

Dr Nicholas Carr, a GP, took the federal case to establish that Australia’s Voluntary Assistance in Dying is not suicide and, therefore, not subject to the 2005 ban on using telemedicine to promote it. In her November judgement, Justice Wendy Abraham found that “the term ‘suicide’ is not defined in the Criminal Code. Consequently, the term is to be given its ordinary and natural meaning.” Dictionaries define suicide as “the intentional taking of one’s own life” and as “the action or an act of taking one’s own life”. She found that this applied to Voluntary Assistance in Dying.

The words we use matter. This year, the Danish Council of Ethics voted 16-1 against legalising euthanasia and assisted suicide.

The Danish Report says that “if others begin to think about the subject in the words that you yourself want, it helps to increase the likelihood that they will think the same as you do”.

People abhor suicide and want resources invested in prevention. No wonder euthanasia advocates don’t want to use the term.

The Danish Report is worth reading in full. It states that voluntary death is rare – the vast majority have no control over the where and how of their deaths. Even apparently voluntary deaths, such as soldiers in war, are not exactly chosen, while suicide is often an expression of despair.

There have to be compelling reasons (and no reasonable alternatives) for anyone to be able to die voluntarily with society’s approval. Having thoroughly examined the facts rather than value judgements, the Danish Report believes that euthanasia and assisted suicide should not be legalised because “the very existence of an offer about euthanasia will decisively change our ideas about old age, the coming of death and what it means to take others into account”.

In Ireland, there is consensus among medical personnel and their representative bodies that, despite people being motivated by compassion to introduce them, euthanasia and assisted suicide are not the most compassionate answers and risk creating societal pressure to avail of them.

Prof Desmond O’Neill, the respected chair of the Irish Society of Physicians in Geriatric Medicine, talked of the particular threat to dementia patients. He described how “a nursing home doctor in the Netherlands failed to recognise the refusal of euthanasia by a person living with dementia” because she had made a prior advance directive.

The doctor had the patient’s family hold her patient down so that she could administer the euthanasia drugs. What Prof O’Neill found most worrying was that “the professions and courts in the Netherlands sided with the doctor rather than the person who had been killed”.

Prof Theo Boer who believes in assisted dying in some cases, also appeared before the Oireachtas Committee. Although originally a supporter of euthanasia, he believes that the Dutch legalisation of it has been a disaster. Instances of euthanasia and assisted dying have quadrupled and in some areas, “assisted deaths account for between 15 per cent and 20 per cent of all deaths”.

[ Should Ireland legislate for assisted dying? A doctor and a professor of healthcare ethics debate this difficult topic ]

We are constantly reassured that strict controls will be enforced in Ireland. (We are so good at enforcement.) The Dutch thought so, too. We don’t need more suicide, just this time with state approval and the assistance of medical personnel. We need a functioning health service where the compassionate insights and practices of palliative care are available to all. That would truly guarantee death with dignity.