Euthanasia (Part 5)

Quantity of Life – Eugenics and Social Darwinism

This is almost always represented as a quality of life issue and wrapped up in a “compassionate” guise. Where it differs from the quality of  life decisions is that it is founded on a single criteria, often related only superficially to the quality of life issues. In fact, the thought processes involved are much more in keeping with prejudices rather than rational assessments.

For instance, there is a tendency in hospitals to use age as a criteria for resuscitation. The elderly seem to be especially prey to all kinds of discrimination but withdrawal of medical services based on age is a particularly nasty one. I reiterate here that I am not talking about futile, heroic measures on dying elderly folk that serve only to make doctors and nurses feel better about themselves. I am talking about the deliberate withholding of useful medical resources on the basis that older folk are somehow not worth it, purely because they are old.

The most troubling thing about this kind of attitude is that it seems to be most prevalent in societies that already practice a limited form of euthanasia. There is some evidence that the legalisation of euthanasia in the Netherlands has lead to discrimination against the elderly, particularly in the areas of acute, life-threatening illness and treatment of cancer. In addition there appears to be a loss of interest in palliative care. This is unsurprising considering that the preferred management of terminal disease is now termination rather than palliation

Note that the very wording of the legislation that legalises euthanasia in the Netherlands leads to this very “Quantity of Life ” problem. The law states that someone who requests euthanasia must have “incurable and unbearable suffering, competence, and consistency of request”. Yet it is questionable whether any except the last of these criteria are properly met. Little or no attempt at management of pain is likely to be attempted because there is an “easier way”. It is highly doubtful that a dispassionate, competent view of euthanasia can be taken by a patient if the patient is in severe pain. And consistency of request in the Netherlands means twice. Often one after another. The wording of the law enables doctors to fulfill the letter of it while circumventing it’s intention to provide a legal action of last resort. Much the same thing happens with our abortion laws.

Doctors are trained to heal the sick and the hippocratic principle of “first do no harm” is the very bedrock of medicine. We doctors have no business being arbiters of life and death. It endangers the very trust that patients vest in us.

Sadly, the elasticity of euthanasia laws extends to more than just the interpretation of the wording. Already in the Netherlands there are moves afoot to extend the ambit of the law to include things like loss of autonomy and increased dependency in the definition of “unbearable suffering”. Ostensibly, this is supposed to be reasonable because euthanasia is, after all, voluntary. Except that the elderly can easily feel pressurized into ending their lives because they are made to feel they are a burden and worthless. Consider this table [PDF] of reasons for euthanasia from the state of Oregon (where physician assisted suicide is legal):

Note that “Losing autonomy” and ” Decreasing ability to participate” are often surrogates for “Being a burden”. Most older folk will volunteer that they dread being a burden to their family more than anything else, if asked directly. Note also the all the reasons cited above except for the last two are part of the normal dysfunctions associated with aging. It is therefore easy to imagine euthanasia being extended “voluntarily” to simple old age, rather than terminal illness. It is hardly any stretch to then extend it to debilitating illnesses such as myasthenia and multiple sclerosis. Or cardiac failure. Or diabetes.

Think of the health budget savings. And the savings in pensions.

We have now moved into the realm of the eugenicists and social darwinists who question the very right of the disabled to continue to live.  I very much doubt that is a place where many people would like to go, yet it is precisely where the debate on euthanasia ends. When we begin to consider some life to be “not worth living”, we will always wind up in a place where no life is truly valued. No matter what criteria we decide to use to determine the value of a life, it will always end up cheapening life itself.

And life is our scarcest resource.

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