Euthanasia and doctor assisted suicide are not fit for purpose

• Published date: 06 January 2022

Involuntary euthanasia, without patient consent, is illegal everywhere. Where voluntary euthanasia/PAS is legal, patients must be medically certified as suitable candidates - usually suffering from a terminal illness, in severe distress and close to death

Whether or not to legalise euthanasia/PAS is a difficult and intense bioethical debate. I believe the principal arguments for euthanasia/PAS are mistaken, although sincerely and compassionately formulated.

Euthanasia/PAS is illegal in Ireland but the Dying with Dignity Bill 2020, sponsored by People Before Profit/Solidarity TD Gino Kenny, sought to legalise PAS here. The Oireachtas decided this Bill was fatally flawed and Kenny plans to introduce an End of Life Choice Bill in 2022.

Ole Hartling, Danish Council of Ethics member (2000-2007) and nuclear medicine specialist, is opposed to legalising euthanasia/PAS. He summarised his arguments in a book, Euthanasia and the Ethics of a Doctor's Decisions (Bloomsbury Academic, 2021).

Noting 70 per cent to 80 per cent of the general public favour euthanasia in opinion polls, he points out that most people surveyed are healthy and cannot really imagine being crippled, blind, suffering from dementia and dependent on care. They think they would rather die than experience this - but would they? Hartling cites surveys showing that support for euthanasia is much lower amongst very sick people then among healthy people.

Two principal arguments for euthanasia/PAS are patient autonomy (right to choose when and how they die) and avoiding unbearable suffering. Together with beneficience, non-maleficience and justice, autonomy is a universal ethical principle. Autonomy has a strong Anglo-American flavour, is dominant in consumer societies and sits uneasily with cultures such as Latino and indigenous peoples regarding end-of-life decisions.

But, no patient opting for euthanasia/PAS can command full autonomy because physicians are gatekeepers of this decision. The patient's life quality must be medically assessed as sufficiently low to qualify for euthanasia. Patient autonomy is never independent of other things; a fact insufficiently acknowledged in this debate.

Hartling argues cogently that euthanasia/PAS is very often an illusory exercise of autonomy. When euthanasia/PAS is available, terminally-ill patients in severe distress feel pressured to make a choice. This has been called "the prison of freedom". The patient choosing euthanasia/PAS may simply be translating...