Disclaimer: This article discusses themes of terminal illness, human suffering and death. Discretion is advised.
For many years, I considered myself a supporter of legalising euthanasia, provided common-sense restrictions be in place. Although, after contemplating the subject, I have concluded that legalisation is not viable. What’s more, I believe that euthanasia outlines the ultimate contradiction in liberal-social values. In this article, I will address the position of absolutism, the real-world, practical issues behind limitless and limited euthanasia programmes, and the fundamental principles behind a socially liberal political outlook.
As somebody whose political position on social issues are largely liberal, I find myself swayed by the moral arguments for the legalisation of euthanasia. I feel that an individual should have sovereignty over their decision to end their own life. To me, restrictions on that right seem inherently authoritarian and morally corrupt. That said, I often like to frame these issues through the lens of how to legislate them, and therein lies the contradiction: If we’re to base our belief that one’s right to die is their own, personal decision, how does the state sanction that without leaving room for exploitation, abuse and, essentially disguised murder to occur? Contrarily, if we are to legalise but heavily regulate, we run into the inevitable situation of patients whose decision is to end their life, but they are not allowed to, due to failure to meet certain criteria – thus, bringing the moral argument crashing down on itself. Essentially, once we legalise euthanasia, we must legalise it for all, or none. Any cut-off point is unjust.
I recognise that that opening section is extremely abstract, vaguely philosophical and does little to illuminate you of the dilemma surrounding euthanasia. Allow me to present a situation: The UK decides to completely legalise euthanasia tomorrow. This means that anybody can go to the doctor, sign a waiver, be given the requisite apparatus, and go back to their home to end their lives quietly, in the comfort of their own home. Immediately, we can see glaring issues with this. Firstly, this allows both those terminally ill (who are typically the focus of euthanasia debates), and those in fine health, to end their life. Whilst anybody can currently end their own life freely because it is not a crime, this situation would mean that the state supplies the equipment and essentially gives its endorsement. Which ultimately, does not make for a healthy social environment.
Additionally, if all people have the absolute freedom to end their own life at any given moment, with state support, we would likely run into a series of needless excess deaths, e.g. people suffering from a mental health issue, who could otherwise be treated, but decide that they want to end their life at that moment. It is well documented that, whilst issues like depression are eminently treatable, suffers often feel trapped and that they will feel that way forever. Feeling that, would likely draw hundreds, potentially thousands, to end their lives early.
There are numerous other issues attached to giving people total freedom on when to end their lives. Unless you are an absolutist libertarian who believes the state has no right to govern individual citizen’s lives, you likely believe that the state has a responsibility to protect its citizens, sometimes even from themselves. A total and complete legalisation of euthanasia would be a complete dereliction of duty by any state from its role in protecting its citizenry.
Add to that, that one can imagine any number of situations in which people could abuse this freedom. For example, were a family to have a child with undetected birth defects, they may opt to euthanise that child rather than keep it, even though it has the potential to live a happy and normal life. Similarly, it could be abused by human traffickers, whose indentured workers may fall ill or be seriously injured, leaving their traffickers to force them into euthanasia rather than helping the sick individual seek proper medical aid, and avoid the risk being detected by law enforcement. It is an extremely dark matter, but these things need to be considered when advocating an absolutist position on euthanasia.
The absolutist stuff out the way, we now have to get into the grey area of the debate. Often, with difficult social issues like euthanasia, their ideal solution is found in the middle-ground. With that in mind, let us dive into the legalisation of euthanasia, with caveats.
The first thing to note is that this article simply does not have the space to dive into every single scenario detailing the extent to which euthanasia could be legalised. So, I will provide one single picture, and allow you to contemplate what knock-on effects shifting the specific criteria one way or the other may have. If the UK were to legalise euthanasia, but only for those who meet these three criteria: (1) Has a terminal condition; (2) Has a life expectancy below one year; (3) Has a condition that causes ‘severe or unbearable pain’.
Unfortunately, these criteria, indeed any criteria I've seen suggested, seems vague. For instance, a person can live with a terminal condition for many, many years in a comfortable and otherwise normal way. Conversely, people can suffer from terminal conditions for many, many years, without knowing precisely when they are expected to pass away. Take the case of Motor Neuron Disease, most people pass away within five years of diagnosis. However, a rare few people survive for many years beyond that, in the case of Stephen Hawking, he survived for decades. Even within this tight framework, there is still room for lives to be cut short. Similarly, in the case of Dementia, in which a person’s cognitive functions can rapidly deteriorate, they would likely be excluded from accessing euthanasia treatment because they would not fit the third criteria, nor the second, because calculating the length of time a Dementia sufferer has to live is not a clear and exact science.
Many euthanasia advocacy groups have suggested ways around these legislative pitfalls. The main proposal includes setting up an independent body, whose job would be to sign off on euthanasia requests. While this still feeds into the moral contradiction by potentially limiting people’s rightful access to euthanasia, in real-world practical terms, it creates more problems than it solves. For example, if we were to appoint a kind of ‘judicial council’ of medically qualified doctors, it would soon experience a tremendous backlog of rejects. Thus, leading to the council having to either rush through requests without doing its due diligence or, building up a lengthy waiting period before each request can be reviewed – all the while leaving terminal patients suffering while the state determines whether they can end their life.
Nevertheless, the fundamental argument behind legalising euthanasia is built on a moral basis. As I stated in the opening section, the state should not be able to force you to live if you can otherwise die peacefully. However, as I have outlined, there would be many, many people who are suffering from some of the most terrifying diseases known to man, who are legally unable to end their own life. The fact is, that the fundamental reason for legalising euthanasia is to release certain suffering people from their suffering. However, attempting to determine what constitutes the requisite levels of suffering will inherently exclude some people who are suffering from their right to die. The moral argument, therefore, falls through.
Effectively, the more tightly regulated the practice of euthanasia is, the more people are excluded from being able to rightfully access it, but so too is the opportunity for abuse of the system reduced. On the other hand, the more deregulated the practise, the more opportunities are afforded to those who wish to abuse the freedoms provided to them, but also fewer people are excluded from the right to end their life. It is a sliding spectrum.
Therefore, where you stand on the issue of the legalisation of euthanasia truly depends on from which angle to approach the issue. If like me, you see the right to end your life as an individual’s sovereign right, you then find yourself in the middle of a dilemma, between what is morally just, and what is a realistic, unintended consequence. The only way, at least that I can see, that somebody could argue for the implementation of euthanasia, without having at least some influence from the moral argument, would be if your concern were solely practical (i.e. freeing up hospital beds and medical staff, reducing healthcare costs, etc.). Otherwise, any argument comes from a position of decreasing harm to those who do not deserve it, which comes from the moral argument, which inevitably places you in this dilemma.
Liberal philosopher John Stuart Mill famously argued a principle known as The Harm Principle. Which, in essence, argued that individuals should be free to do as they please, so long as their actions do not harm others. There has been a lot of debate surrounding what Mill truly meant by “harm”. However, for this discussion, we can safely assume that to harm another would mean to cause psychological and physical harm.
Although, when we are looking at euthanasia, we come to a really difficult area in defining what it is to harm another person. On one hand, we could argue that to end the life of another human being is inherently harming that person – you are quite literally taking their life, the highest form of harm. Though, another could quite easily argue the inverse; that if the person in question is in such agony, or has a severely diminished quality of life, the act of ending that person’s life is an act of mercy, and thus would not constitute harm.
Whilst I come down on the latter side, that euthanasia does not constitute harm under Mill’s Harm Principle, I do believe that the practical realities behind implementing any sort of system of legalised euthanasia discount it from ever being realised in law. I have considered the subject for years, and against my political and moral persuasions, I am forced to conclude that there is no viable way for a state to legalise euthanasia in such a way that balances both the moral argument with the practical realities – at least I am yet to hear a way. Until that day, I disagree with legalising euthanasia but remain open-minded to new proposals.