Euthanasia and Assisted Suicide

Defining Terms

The term “euthanasia” refers to the direct and deliberate killing of a patient by a physician. This act may be voluntary or involuntary. Voluntary euthanasia occurs when a patient makes a direct and specific request to be euthanized; involuntary euthanasia occurs when a patient has previously expressed their desire to be euthanized under certain circumstances but is unable to consent to the act in the actual moment that it is performed.

The term “assisted suicide” refers to situations in which patients explicitly ask for assistance in dying, and a physician responds by prescribing lethal medications intended for the patient to administer on their own.

Proponents of euthanasia and assisted suicide sometimes use the term “medical aid in dying” (MAiD) as a euphemism for either of these practices.

73325567_2867490403275410_3580532789486813184_n_edited.jpg

Why do people seek assisted suicide?

Advocates for the legality of assisted suicide and euthanasia are generally motivated by compassion for others. They wish to minimize human suffering, often pointing to those with conditions that cause chronic pain. This goal is understandable and, in a general sense, is shared widely across society.

Disability and Illness

However, statistics surrounding assisted suicide indicate that pain itself is not the primary reason that people request assisted suicide. Instead, it is disability that is more often cited as the foremost reason that patients wish to end their lives.

According to a study of the results of Oregon’s 2013 Death with Dignity Act, 92% of patients reported that they were “less able to engage in activities,” and that this was one of the factors that motivated them to seek assisted suicide. Furthermore, 93% of patients cited “loss of autonomy,” 68% cited “loss of dignity,” 54% cited their status as a “burden on the family,” and 47% cited the loss of “control of bodily functions.” And in 2017, research revealed that a leading cause for assisted suicide in Belgium was “poly-pathologies,” which included dementia, heart disease, incontinence, and even hearing loss.

Many of these reasons are rightfully considered to be signs of suicidal depression when they appear in healthy, young, able-bodied people. And yet, when such reasons are given by people with disabilities or chronic illnesses, they are regarded much differently.

Under certain MAiD programs, “irremediable psychiatric suffering” is an acceptable reason for assisted suicide. What exactly constitutes such suffering and how the presence of such suffering is determined is not entirely clear. But in the Netherlands, mental illnesses as common as depression are regarded as eligible for “treatment” with assisted suicide.

Everyone — including people with disabilities and chronic illnesses — deserves suicide prevention care. Society should not simply concede and accept the reality that disability and chronic illness are driving people to end their own lives.

Poverty

Horrifically, in some cases, patients report that they ask to be euthanized because they cannot afford or access the medical treatment that they need to survive with their disabilities and chronic illnesses.

In Canada, recent poll results indicated that 51% of Canadians believe that inability to access medical care is a legitimate reason for assisted suicide. Other reasons listed in the survey included disability (50% consider it a legitimate reason), homelessness (28%), and poverty (27%).

These disturbing attitudes are reflected in the Canadian healthcare system. Numerous cases have emerged in which Canadians have sought and been granted MAiD after they were unable to receive adequate care for their disabilities or chronic illnesses for various reasons, such as the lack of affordable treatment options, excessive wait times, and unbearable living conditions in medical facilities. And multiple Candians have reported that assisted suicide was recommended to them — unsolicited — in response to their attempts to obtain necessary treatment. Some have even claimed that they were coerced into ending their own lives.

In a 2020 report on the Canadian MAiD program, the Office of the Parliamentary Budget Officer calculated that the expansion of assisted suicide under Bill C-14 would result in a “net reduction in heath care costs.” The report estimated that increasing access to assisted suicide would save the Canadian government almost $87 million per year.

Under programs like the one in Canada, a cold calculus prevails. It is more expensive to administer sufficient medical care in safe, sanitary, and comfortable conditions than it is to simply eliminate the people who need that care. And so people who are impoverished and have disabilities or chronic illnesses are being told, in no uncertain terms, that they are worth more dead than alive.

Disability rights self-advocate Sophie Trist remarks that “disability and poverty should never be a death sentence. As long as the medical establishment and society more generally do not appreciate the innate human dignity of disabled people, thousands will continue to die needlessly under the guise of mercy and compassion.”

No person should be forced by indigence into ending their own lives. A society that allows for this is one that places a higher value on wealth and status than it places on the lives of its most vulnerable people.

What About Consent?

There is substantial reason to doubt whether patient consent is always considered and respected, or whether it is even possible to obtain that consent. It is also not certain that doctors always have the best wishes of their patients in mind.

Research shows that 0.4% of euthanizations in the Netherlands — roughly 24 in 2016 — occur without the “explicit request” of the patients involved. It can be difficult or even impossible to procure such explicit requests from patients with the advanced illnesses that are often associated with euthanasia. For example, in both Canada and the Netherlands, patients with advanced dementia are eligible for euthanasia. In the Netherlands in 2013, euthanasia was performed on “97 patients with dementia and 42 patients with psychiatric diseases.” While this disproportionately impacts older patients, Dutch legislation also permits euthanasia for children who are born with certain disorders.

What does this behavior say about our attitudes toward people with disabilities and chronic illnesses? Euthanasia can deprive such people of the right to make decisions about their own lives; euthanasia and assisted suicide can also communicate to people with disabilities and chronic illnesses that their lives are not worth living or sufficiently valuable to the rest of us. When we greet their hardship by offering or even suggesting death, we have utterly failed them.

With current medical technology, pain can often be managed. Suffering can often be mitigated. Steps can be taken to address the concerns of patients; home health services, which can alleviate patients’ perceptions that they are burdening their caretakers, are available. Rather than allowing doctors to work to end the life of their patients, expanding access to palliative care and assistance for those living with disabilities should be legislative priorities.

The direct and deliberate killing of human beings should never be tolerated as a solution to suicidal ideation, disability, poverty, or chronic illness.

“At the root of assisted suicide is the idea that disabled, elderly, and terminally ill people are a burden, that life is only worth living with a healthy, ‘normal’ body and mind… Combatting lethal ableism means rejecting the idea that independence is the defining factor of a life worth living. Disabled people will not be safe from lethal medicalized violence until the societal narrative shifts to reflect and acknowledge our full humanity and right to exist just as we are.”

–Sophie Trist, disability self-advocate and Rehumanize staff writer

The Philosophy

If value is inherent to each and every human life, then extrinsic traits such as age, ability, and dependence cannot deprive human beings of their value.

Proponents of legal assisted suicide and euthanasia often argue that every person has the right to “die with dignity,” and that assisted suicide and euthanasia can supply dignity to an otherwise degrading existence and death. But dignity, much like value, is intrinsic to a human life; it cannot be removed by disability, chronic illness, or dependence. Such ableist and ageist conceptions of dignity are founded upon ability, health, and independence. They incorrectly assume that disability, poor health, and dependence can strip a person of their fundamental dignity, and that euthanisa or assisted suicide can offer that dignity back.

But as advocates at the disability rights organization Not Dead Yet cogently argue, “In a society that prizes physical ability and stigmatizes impairments, it’s no surprise that previously able-bodied people may tend to equate disability with loss of dignity. This reflects the prevalent but insulting societal judgment that people who deal with incontinence and other losses in bodily function are lacking in dignity.”

Laws that allow for euthanisa often apply, at their outset, only to people with terminal illnesses. For this reason, euthanasia is sometimes called “mercy killing.” Once again, this language reveals much about the way in which society evaluates people with disabilities and illnesses. Both assisted suicide and euthanasia reinforce the idea that death is preferable to and, in some cases, the only viable alternative to the pain and suffering caused by disability and illness.

But how is it merciful to assist in ending the lives of people with disabilities and illnesses while, at the very same time, we invest in safety nets to prevent healthy, young, able-bodied people from ending their lives? Suicide prevention care should be accessible to everyone struggling with suicidal ideation, regardless of age or disability status.

Killing a human being is never merciful. The implication that it is better to die than to live with a disability or illness disproportionately affects the disabled, the chronically ill, and the elderly. It unreservedly declares that these lives are less valuable than the lives of able-bodied and “healthy” individuals. It creates two classes of people and forms a discriminatory double standard: one in which abled-bodied and healthy people are extended suicide prevention, while people with disabilities or chronic illnesses are offered suicide assistance.