Gently into that Good Night

With the recent release of You Before Me, the euthanasia debate is once again a churning pool of debate. Mihaela Nicolescu dives in.

Euthanasia and assisted suicide, as concepts and as legislated possibilities, are hard to swallow for many people. The idea of willingly giving up life appears unconscionable because death is an abstraction for someone who is healthy, in body and mind.

While we all know everybody, eventually, has to totter off this mortal coil, it’s hard to accept that some people might wish to hurry up the inevitable. It seems perhaps an insult to life and to the living. We want to believe that our lives are previous and our existence significant. We do not like to be reminded of our own mortality.

We want to believe that there is always hope.

Much of the opposition to euthanasia and assisted suicide relies a combination of worst-case-scenarios and good old fashioned misinformation (more info here). There is also the assumption that someone (the person against assisted dying) knows better than someone else (the person wishing to end their own suffering). Hope and pain are personal, and we have little right to pass judgment on anyone else’s experience of either. While we, as a society, can develop systems and services that ease people’s suffering and offer support to those in need, we can not demand someone’s continued existence. We might feel that we are extending life, but we may be extending pain. For the people looking to end their existence, life has already ended. There is no hope, there is no future, only an extended unbearable present.

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A good death is as important as a good life, but let’s be clear: death is never pretty. The best we can hope for is as little pain as possible and the opportunity to say good-bye. Euthanasia and assisted dying offer people beyond hope the dignity of setting their own terms. It spares both them, and their families, undue distress.

One of the main arguments against legalising euthanasia and assisted dying is that it might be open to abuse – vulnerable people might be coerced into it or have the decision made for them. There is no denying the possibility that this might happen, but basing legislation on the assumption that it will happen denies the rights of those people who would make this choice freely and consciously.

This view enforces the presumption that legislation will somehow equal a sudden surge in rich aunts being done in. This is the suggestion that people might be tempted to use euthanasia to commit murder, as if the process would simply involve a hands-up vote followed by a glug of poison.

Places where euthanasia and assisted dying are legal have developed rigorous systems. The entry points vary from terminal illness (Oregon, US) to unbearable and untreatable suffering (Belgium and the Netherlands), but always include independent prognosis from two doctors. In Oregon, the implementation is a dose of life-ending medication, which only the patient can administer. In Belgium and the Netherlands, doctors administer a lethal injection.

Andrew Denton pointed out the obvious: these places, whatever opponents may say, have not experienced a massive surge in voluntary deaths. This accounts for the second argument against euthanasia: that its legalisation will somehow encourage people to chose death as a casual option. Not only is this suggestion completely unsupported by statistics, it also goes against the most basic animal instinct. As Andrew Denton said: “people cling to life more fiercely than you could ever imagine. Remember that, because it’s important. People do not want to die.”

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Euthanasia and assisted suicide are not the same as suicide. Suicide is a lone act of momentary or sustained despair. Frequently, it is a reaction to trauma, and, critically, it is the desperate action of someone who doesn’t actually wish die but for whom life is currently unbearable. Here, there is the hope that proper support and counseling will help see the person through. Euthanasia, on the other hand, is a choice to end life, where there is no hope and where continued life will only prolong the inevitable and extend suffering. Euthanasia, where legal, is not a lone act of momentary despair. This is not to say that the choice could ever be easy or painless, but that it is a conscious decision, willing made by a rational person, with the guidance of medical professionals and support of family.

Of course, the boundaries can be murky. It may not always be easy do define hopelessness. It might be argued that no person contemplating death could ever be considered rational. We can only do the best we can, as other places have, to ensure proper process. Euthanasia and assisted dying still take place in Australia, in spite of it being illegal. In 1997, national research into the decisions doctors make while caring for dying patients found that an estimated 1.8% of all Australian deaths were the result of euthanasia or physician-assisted suicide. Legislation will simply formalise this reality, and offer a framework and transparency to the process.

2016 film You Before Me has reignited conversation the world over on the right to euthanasia for those living with disability.

As an able bodied person, I can end my life at will. That is a basic right that stems from an undeniable ability. Nobody could reasonably stop me, should I make the decision to kill myself. This right is denied a person who lacks the physical ability. In Australia, these people are given the option of dying slowly through the denial of food, water or medical treatment.
Is that compassion? Is it reasonable to prolong someone’s pain, purely out of our own inability to accept their acceptance of death?

We cannot expect cookie-cutter sentiments and clichés to offer insight here. Yes, life is precious, and like a box of chocolates, but this does little to advance understanding, and the compassion that follows in its wake.
At the core of the opposition is the view that life is always worth living and that there is always hope. To believe that this applies to everyone is naïve; to demand that everyone, regardless of circumstance, subscribe to this is cruel. Willingness to live is not something engendered by the existence or absence of a law. But legality would give peace of mind by offering this final option through a structured, transparent process.

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