1) What is euthanasia?

Euthanasia is the deliberate ending of the life of a person, either by act or omission

Voluntary euthanasia is when the person makes the decision to ask his doctor to end his life for him

Non-voluntary euthanasia is the deliberate ending of the life of a patient whether or not he is able to ask for or reject euthanasia

In-voluntary euthanasia is the deliberate ending of the life of a person even though it is against his wishes

2) What are the dangers of legalising euthanasia?

• All human beings are worthy of dignity and respect
• The law provides protection for our right not to be killed, why should this protection be removed for those who are sick or disabled? Vulnerable people need more not less protection
• The right to life is a fundamental human right that cannot be given away
• Legalised euthanasia may undermine the development of high quality care services for people who are terminally ill or incurably disabled
• Patients may feel unable to trust their doctors out of fear for their motives
• Euthanasia would create an atmosphere in which some vulnerable people may feel threatened

3) Isn’t passive euthanasia acceptable?

Terms like “active” and “passive” euthanasia are not really helpful in deciding what actions are acceptable. It is the intention of the person (usually a doctor) that is important. If the doctor gives a particular treatment, or deliberately withholds it, with the intention of causing death, it is euthanasia. If, for instance, he gives it to relieve pain, even if it may have the side-effect of hastening death, it is not euthanasia.

4) Isn’t euthanasia acceptable when pain cannot be controlled?

Hospice doctors, who are experts in pain control and have experience of many different types of severe pain, estimate that 95% of physical pain can be completely relieved; in the majority of other cases the pain can be controlled1. Pain has a strong psychological element caused by fear and anxiety; hospice care also addresses the emotional needs and fears of the patient. The World Health Organisation recognize that “Palliative care has promoted wider application of the principles of pain and symptom control. However, more work is needed to train all professionals in assessing, monitoring and treating pain and distressing symptoms in all settings.”2 Part of the answer to helping those seeking euthanasia is better training of health professionals in providing appropriate end-of-life care.

Despite the fact that most people think physical pain is the main indication for euthanasia, in the Netherlands only 5% of those requesting it cite pain as their most important reason for wanting to die3. It was reported in The Lancet medical journal in 2001 that “Although the traditional idea is that such deaths are wished for as a means to avoid pain and suffering, studies suggest that this explanation is insufficient. In fact, depression, hopelessness, psychological distress, and need for social support are all factors.” The authors reported that although this study was confined to HIV/AIDS patients, it nonetheless reflected the research on patients with other types of illness4. Legalising euthanasia would only encourage and support feelings of depression and hopelessness, which are very common, instead of helping people facing such problems to understand and appreciate their value and worth as human beings. Humiliation lies not in the condition, but in people's attitudes to it, and it is these that need to change to reflect the dignity and worth of suffering people.

There are still a small number of people whose pain cannot be completely relieved. What about them?

All human beings are worthy of dignity and respect and all people should be cared for until the time of their natural death. Euthanasia abandons the individual in their suffering.

Doctors who survived the Nazi holocaust spoke afterwards of their surprise at how much relief they brought to suffering fellow inmates simply by human contact, talking with them, and demonstrating just by their presence how much they cared, at a time when there was no medicine available. We can do very much more than that now; in this country there is a high standard of pain control and palliative care.

5) Isn’t euthanasia acceptable providing there are strict safeguards to prevent abuse of the law?

We believe that euthanasia is unacceptable regardless of any supposed "safeguards". However, those who advocate euthanasia claim that the law would not be abused because there would be strict safeguards on who can and who cannot be killed.

The criteria they suggest are usually that:

• The person must be terminally ill and/or incurably disabled.
• The person must have repeatedly asked to be killed
• Two doctors must agree that the person’s suffering is "unbearable and cannot be relieved"

Laying down criteria by which only those with terminal or incurable illnesses can have euthanasia may lead to those with such conditions feeling threatened. They may feel a burden on society in that the law considers their lives to be expendable. Vulnerable individuals may therefore feel obliged to ask for euthanasia and so come under threat from such legislation and criteria rather than being protected by it. Such criteria are in fact designed to ensure that only certain people, those considered "better off dead", will be able to "choose" euthanasia. The implication of this is that only those who are "wrong to want death", that is the able-bodied, would be protected by such criteria and so this discriminates against the sick and disabled, considering their lives to be of lesser worth.

In the Netherlands individuals have to have made a repeated and durable request for euthanasia. However the law does not state how many times a person has to ask or over what period of time. There is therefore no way of ensuring that the request does not come from constantly changing influences such as depression, feeling a burden, pressure from family, carers or doctors, a lack of good care services etc.

The idea that a person’s suffering must be unbearable and cannot be relieved ignores the fact that most physical pain can be controlled. Also, research from the American Journal of Psychiatry suggests that most requests for euthanasia stem from depression rather than physical pain5. In the Netherlands where euthanasia is legal, there have been cases of euthanasia to relieve psychological distress and in Oregon where assisted suicide was legalised in 1998, one of the very first cases, the case of Kate Cheney, involved a woman diagnosed as being depressed.

6) Isn’t voluntary euthanasia simply a matter of personal choice

The right to life is a fundamental human right that international human rights charters recognise cannot be given away and therefore voluntary euthanasia is not simply a matter of personal choice.

As stated above there is no way of ensuring that an individual’s request for euthanasia is truly voluntary and a matter of personal choice free from the influence of depression, a lack of care services, feeling a burden or the pressure of family demands. None of us make choices or decisions in isolation, there are always factors that influence the choices we make. Internal and external pressures on an individual may make them feel that they have no choice but to ask for euthanasia. The legalisation of euthanasia gives in to such pressures rather than addressing and relieving the burden on the individual. Reviewing the individual's care arrangements, pain management as well as addressing their emotions and fears may be enough to relieve these pressures. Euthanasia would discourage the practice of really caring for vulnerable people and ensuring that they live in an environment which considers their lives to be of true value.

It is interesting to note that in the Netherlands, where euthanasia is freely available, the development of hospice care has lagged behind that of other European countries such as Britain6. Residents of the Netherlands therefore do not have the same choice of care options. Evidence from the Netherlands also shows that 80% of deaths were not requested by the patient, it is therefore very often the doctor who makes the “choice” rather than the patient7.

In Britain the courts have allowed doctors to remove food and fluids from patients in a PVS (persistent vegetative state) resulting in death through starvation and dehydration. A person in a PVS cannot request or reject euthanasia and therefore this is non-voluntary euthanasia and is not simply a matter of personal choice. Many people argue that we should not deny "compassion" to someone just because they cannot or do not ask for euthanasia when the reality of such deaths is that euthanasia is being performed in response to the choice of others, not the choice of the individual.

Above all, some choices are never legitimate and euthanasia is always unethical.

7) Don’t those who oppose euthanasia want to prolong life indefinitely? Don’t they care if people suffer?

Nothing could be further from the truth. We support wholeheartedly the Hospice movement, whose main aim is to alleviate suffering and enable those with terminal illness and/or incurable disabilities to enjoy what is left of their lives.

As Dame Cicely Saunders, founder of the Hospice movement says:
"Hospices are not about dying. They are about living until you die."

The decision to withhold or withdraw treatment should be made when it is recognised that it is no longer helpful in dealing with the person's condition, and not so that the patient’s life can be ended.

Once a person is irremediably dying, medical care should aim to keep the patient comfortable and pain-free until the moment of natural death rather than being aimed at keeping people alive as long as possible using every means available.

8) Doesn’t the Dutch experience show that safeguards work and that legalising voluntary euthanasia does not lead to the practice of involuntary euthanasia?

We oppose the legalisation of voluntary euthanasia because we believe that all life should be valued and treated with dignity and respect. However, those who believe legalised voluntary euthanasia is acceptable argue that it would only be voluntary euthanasia that would be legalised and that safeguards would ensure that it would not lead to the practice of involuntary euthanasia.

However, in the Netherlands it has been found that this is not in fact the case.
In 1991 the Dutch government Remmelink Committee reported that in 1990 there were

In 1995 only 41% of cases of euthanasia were reported despite the fact that the law requires the reporting of all cases5. Cases of non-voluntary euthanasia can go unreported where doctors give what is known as “life-ending treatment” in the absence of a request for euthanasia8. As reported by the Remmelink Committee, in 1990 there were 1000 such cases. These are cases of non-voluntary euthanasia.

In June 1994 the Dutch Supreme Court ruled that euthanasia could also be "necessary" to relieve "mental suffering" after the euthanasia death of a depressed 50 year old woman who was not physically ill9.

Once killing is an acceptable response to human suffering, there is no end to the number of potential victims.

9) Doesn’t euthanasia give people peace of mind that there is a way out when they want to die?

Far from this being the case, widely accepted euthanasia may mean that many ill and vulnerable people would live in fear. A poll carried out among residents of homes for old people in the Netherlands in 1991 showed that 93% were opposed to euthanasia and 68% were afraid they might be killed without their consent10.

Once euthanasia is deemed acceptable, vulnerable people may be afraid to express unhappiness or discontent for fear they would be regarded as "better off dead" and killed because they fall within the law for acceptable killing, this is shown by the cases where doctors in the Netherlands give “life-ending treatment” without request to those who are terminally ill.

Some people may write what is known as a "Living Will” or "Advance Directive”. A living will tells a doctor what type of treatment a patient does or does not want under certain circumstances. This would be used when a patient cannot communicate so that the doctor considers the patient’s wishes in deciding on their treatment. There are many dangers with such documents becoming legally binding because this would require the doctor to act exactly as the living will states, leaving aside his clinical judgement about the best way to treat the patient. No one can predict in advance what they would want in a totally unknown situation never previously experienced. Also, by the time they are in that situation, it might be impossible to tell anyone that they have changed their mind. The idea that we can make our own decisions about our medical treatment requires that we act in our own best interests and therefore do not cause ourselves deliberate harm, yet by following a living will a doctor may be required to withhold treatment that would serve our best interests and prevent harm.

By specifying certain conditions as so awful that death is preferable, it perpetuates the myth that being helpless or dependent is a failure, and too awful to contemplate.

10) Shouldn’t people in a ‘persistent vegetative state’ be ‘allowed to die with dignity’ as they are no longer truly alive?

In the debate on euthanasia the term "death with dignity" is used by some to mean euthanasia itself. However, we believe that real dignity in death is a natural death, made as comfortable and pain free as possible.

"Persistent Vegetative State" is also an unfortunate term, because it implies that the person is "a vegetable", when no human being can be described as such. The term Persistent Non-responsive State is both preferable and accurate.

People in a "PVS" breathe independently, and their hearts beat unaided. People in a PVS are not dying or clinically dead.

They are not on "life support machines" but may be tube fed simply because this method of food delivery is safer and more efficient than spoon-feeding. Doctors do not know what the outcome of this condition will be; some individuals do recover or are responsive to some extent, laughing and smiling appropriately.

The case of Tony Bland (who was injured in the Hillsborough football stadium disaster and as a result of successive court rulings was denied both food and water until he died) brought the treatment of people in the "PVS" to public attention. The decision to withdraw Tony Bland’s food and fluids was based on his “quality of life”. Quality of life is a subjective judgement; we cannot know what it is like to be another person. There is no place for quality of life judgements in decisions about medical treatment; these decisions should be based on a clinical judgement about the best medical treatment or care for a particular individual.

11) Don’t we have a ‘right to die’?

Death is not a ‘right’ but a natural event that happens to everyone.

Those who say there should be a ‘right to die’ really mean a ‘right to be killed’. However, rights have corresponding duties. A ‘right to be killed’ would mean someone else has a ‘duty to kill’ – which is contrary to the protection against being killed that the law should give to all human beings.

Those who are depressed and despairing should be helped to value their lives, and every effort should be made to control pain and other distressing symptoms to enable people truly to ‘live until they die’.

Killing people is an abuse of our duty to care for and protect the weak and vulnerable. It has no place in a civilised society.

Euthanasia is contrary to the right to life of all human individuals, and may result in an atmosphere in which vulnerable people feel pressured to ‘get out of the way’ and ease the ‘burden’ on their carers and society’s resources.

We accept that there comes a time when we must "let the dying die" – this should be done not by pushing them into death through euthanasia but by respecting the course of natural death.

Caring must never be allowed to become a euphemism for killing.

Why do we have to bother about euthanasia?

Because it threatens YOU!

That’s just scaremongering! I trust my doctor.

That’s because you live in a country where euthanasia is NOT legal

In the Netherlands, where euthanasia IS legal, in 1998 it was revealed that 10,000 Dutch people were carrying ‘anti-euthanasia passports’ saying they do NOT wish to be killed!11

In 1989 a group of severely disabled people wrote to a Dutch Parliamentary Commission saying, “ we are being talked into desiring death.”12 In 1991 it was found that 30% of Dutch cancer patients were refusing to take morphine, or taking lower doses than they needed out of fear that their doctors were trying to kill them.13

Hospice doctor Robert Twycross says that at least 95% of physical pain can be completely and easily relieved, and that Hospices “can help 100% of patients.”14

The fact that it is hard to control pain does not mean that the patient cannot be helped.

1. cf Statement by Dr Robert G Twycross, Macmillan Clinical Reader, Oxford University, 23 July 1997.
2. WHO Palliative Care – The Solid Facts, Elizabeth Davies and Irene J. Higginson Eds., 2004.
3. Van de Wal G, van Eijk J ThM, Leenen HJJ, Spreeuwenberg L “Euthanasia and other medical decisions concerning the end of life”, Health Policy, 1992; 22 (suppl 1&2) in British Medical Journal, 21 May 1994.
4. Origins of the desire for euthanasia and assisted suicide in people with HIV or AIDS: a qualitative study The Lancet 2001; 358:362-367.
5. The Sunday Telegraph, 27 August 1995, reporting research published in the American Journal of Psychiatry.
6. Mark Kennedy “Canada must help dying to go with dignity” at the Second Joint Clinical Conference and Exposition on Hospice and Palliative Care, "Palliation and Passion in End of Life," held in Orlando, Florida, 23-26 March 2001.
7. Herbert Hendin MD, Chris Rutenfrans PHD and Zbigniew Zylicz MD, “Physician Assisted Suicide and Euthanasia in the Netherlands”, JAMA, June 4, 1997 vol.277, No.21, p.1720
8. Alexander Morgan Capron, "Euthanasia in the Netherlands - American Observations," Hastings Centre Report March, April 1992, p. 31.
9 . Chris Docker “Dutch Euthanasia Law 1990-2000”. The Scottish Voluntary Euthanasia Society, 1996, www.euthanasia.org.
10 . Medical Journal of Australia, May 1991.
11. "Dutch carry cards that say: Don't kill me, doctor", Rachel Bridge, Sunday Telegraph, 18 October 1998.
12. "The Dying Dutchman: Coming Soon to a Nursing Home Near You", Michael Fumento, The American Spectator, October 1991.
13. Letter, The Lancet , 2 November 1991.
14. cf Statement by Dr Robert G Twycross, Macmillan Clinical Reader, Oxford University, 23 July 1997.

SPUC Scotland Paper 1
The Case Against Euthanasia
Revised June 2005

Copyright © 2002-2008 The Society for the Protection of Unborn Children. All Rights Reserved. Tel: 0141 221 2094. E-mail: Web Design & Development by CSS Web Design