Euthanasia in Tasmania - Assisted suicide in Tasmania - Dying with Dignity in Tasmania

Philosophical viewpoints
Viewpoints from eminent Tasmanians...
Philosophical viewpoints

Leading Tasmanian philosophers reflect on the dignity of all humans, the concept of autonomy and the fact that the dignity of the human person is not bound to their ability to be autonomous

Video interview
Q and A
with Dr Kristi Giselsson

Dr Kristi Giselsson, a Doctor in Philosophy and Honorary Research Associate at UTAS, argues that legalising euthanasia or assisted suicide would establish a dangerous principle that some lives are not worth living and that some humans do not have the same worth as other humans

Written article
Kristi Giselsson

Diminishing the very concept of human worth and dignity

Dr Kristi Giselsson

Doctor of Philosophy and Honorary Research Associate, UTAS

 

 

 

Key Reasons why Euthanasia should never be legalised:
  • The dignity of the human person is not bound to their ability to be autonomous – should that be the case then every infant, every sick and ailing person, every human suffering mental illness or cognitive damage is effectively without dignity.
  • Legalising the killing of people at their most vulnerable will only serve to increase people’s fear of dying.
  • Legalising euthanasia will eventually extend to those who cannot make rational decisions as shown in overseas experience.
  • Research shows that doctors and nurses consistently underrate the quality of life of their rational and non-rational patients – this may lead to patients making a decision to die based on a belief, according to their doctor, that their life may not be worth living.
  • Research has shown that care for the elderly, particularly women, is affected by attitudes of “ageism” – these dismissive views of the elderly and those suffering from dementia will only be affirmed by the legalisation of euthanasia.
  • Legalising euthanasia would affirm that people are right to fear the loss of dignity and the experience of pain.
  • A fear of what might happen is not an adequate excuse for killing yourself or another human being.

 

 

 

Terms of Reference: The Dying with Dignity Bill, 2009

 

To the Committee,

 

I am a resident of Tasmania and have been a PhD candidate at the School of Philosophy at the University of Tasmania for the past two and a half years. My PhD thesis has just been approved and I will be soon graduating with a Doctorate in Philosophy on August 8th, 2009. My research focused on the field of ethics, assessing arguments as to what ethical grounds best justify universal and equal respect for all humans.

 

In the course of my research, I have looked at some of the current arguments for euthanasia, which are mostly based on the utilitarian concepts that pain and pleasure are the only true measures of whether a human life is worth living. I have found that such grounds inevitably exclude not only other aspects of human being as contributing to a fulfilling life – such as spirituality and our relationships with others – but also that such grounds effectively diminish the very concept of human worth and dignity.  For reasons that I will outline below, I am deeply concerned at the prospect of euthanasia being legalised in Tasmania and strongly urge the committee to recommend against such a Bill.

 

Firstly, if this Bill is passed, it will be effectively legalising suicide and sending the message to the Tasmanian public that it is perfectly acceptable to take your own life should life become too painful. It is affirming that palliative care is useless, that pain-killing drugs are ineffective, and that it is undignified to lose your autonomy and have other people care for your needs. In affirming all of these assumptions, the Bill ignores the fact that palliative care has never been better, that modern medicine can indeed effectively take care of most pain, and that the dignity of a human being is not bound to their ability to be autonomous; should this be the case, then every infant, every sick and ailing person, every human suffering from mental illness or cognitive damage – such Down syndrome and Alzheimer’s – is then effectively without dignity. Rather than promising people that we will kill them when they are at their most needy, what we need instead is to assure them that they will be treated with the utmost dignity and care; that, despite the fact that they can no longer care for themselves, they and their lives are still of invaluable worth. To legalise the killing of people at their most vulnerable will only serve to increase peoples’ fear of dying, rather than allay it.

 

Legalising euthanasia will also adversely affect those who can no longer make their own rational decisions; people who have lost consciousness or who suffer from some form of cognitive damage, such as Alzheimer’s. As the legalisation of ‘voluntary’ euthanasia in Holland has clearly shown, once euthanasia is legalised, people who cannot make rational decisions for themselves have the decision as to whether they are to live or die made for them by doctors or other health professionals; that is, without their consent. In fact, on average, 1000 people a year are killed in Holland without their consent. Moreover, as the brief legalisation of euthanasia in the Northern Territory has shown, the very question of whether an illness is terminal or not has been and obviously will continue to be a matter of dispute amongst doctors, inevitably leading to people with non-life threatening illnesses being killed. Even the existence of an advance directive or a living will, by which a patient can let their wishes be known before they become ill or perhaps too ill to respond rationally, cannot be reliable, as such directives do not allow for the fact that people, when truly faced with the reality of death, can actually change their minds. As just one example, for many years my mother tried to make me promise that I would assist her to take her own life should she ever be in the position of experiencing too much pain. However, after having nursed many members of her own community while they were dying, she changed her mind; deciding to not insist on assisted suicide but to rather face whatever experience dying might bring her. However, she neglected to inform me of her new decision and it was not until some years later, when I brought up the issue again myself, that I discovered her new wishes. Had she had a stroke or an accident before this conversation, I would still have been under the impression that she would have wanted to be helped to die, when really the opposite was the case.

 

Further, in the case of non-rational humans, placing the decision as to when and whether another human being should die in the hands of another fallible human is an extremely dangerous matter. Research has shown that:

Medical and nursing professionals consistently  rate the quality of life of their patients lower than patients do themselves and they base such judgements on medical or disease criteria rather than ‘non-medical’ criteria, such as happiness, relationships and financial security, that their patients consider more important.

As doctors and nurses consistently underrate the quality of life of both their rational and non-rational patients, they can hardly be seen as providing ‘objective’ advice or even the ‘best’ advice to their patients. This means that not only their non-rational patients would be affected by their subjective assessment as to the quality of their lives, but even their rational patients would be unduly influenced by their supposedly objective summation as to the quality of their present and future lives. This could lead to a patient making a decision to die on the basis that they believe that their future lives (according to their doctor), would be not worth living.

Such human fallibility shows itself in more ways than one. Dr. Leila Toiviainen, lecturer at UTAS, has documented the fact that Alzheimer’s and dementia are not only widely prevalent, but that the number of people they affect is rising sharply. In Australia alone this number is expected to rise from 162,000 in 2002, to 500,000 by 2040; with dementia becoming “the primary cause of major chronic illness” by 2016. Toiviainen also points out that care for these particular elderly is chronically understaffed and adversely affected by attitudes of ageism that undervalue elderly lives, with Australian research showing that “particularly women with confusion and frail emotional health are vulnerable to physical, emotional/psychological, financial/material abuse, abandonment and neglect.” Such attitudes reflect the fact that the elderly – particularly elderly women who suffer from dementia – are increasingly regarded as being of little worth and therefore of little moral consideration. These dismissive views of the elderly and those suffering from dementia will only be affirmed and indeed acerbated by the legalisation of euthanasia. As Katrina George, lecturer in criminal law and researcher on euthanasia has stated;

When euthanasia is tolerated or even legal, the message that “some lives are not worth living” rings loud and clear. There will be elderly, lonely or distressed people who feel pressure – real or imagined – to “do the right thing” and request death. Sometimes family members will have financial and personal motives for supporting suicide.

The reality of George’s latter view is confirmed by a recent case she cites, where an Australian woman, Shirley Justins, was convicted as being an accessory to the unlawful death of her de-facto husband, Graeme Wylie. Wylie, who was suffering from dementia, had just the week previously changed his will, leaving Justins more than two million dollars. Justins was also alleged to have had a lover a Germany, and, despite the fact that the pro-suicide group Dignitas had declined Wylie’s request for assisted suicide on the grounds that they had uncertainties concerning his mental state, was eventually assisted by Philip Nitschke’s group, Exit International. Even after the case verdict was given, Nitschke still defended the unlawful death, despite not having any knowledge of Wylie’s medical records. As George points out, Nitschke went on to unequivocally endorse assisted suicide for the “troubled” or “depressed” and to encourage the elderly not to test for Alzheimer’s or dementia. As George further notes, other experts, such as psychiatrist Professor Brian Draper, have been highly critical Nitschke’s approach, Draper stating that, “[t]he vast majority of [Alzheimer’s sufferers] are able to enjoy their lives for years and those opting to end it early are a tiny minority who don’t have the support, care and comfort they need.” In other words, suicide is sometimes chosen as a means of escaping the pain resulting from the marginalisation and lack of care some sufferers experience, rather than the pain they might feel from the ailment itself. This of course is also true for others suffering from terminal illnesses; if people either fear that they will not receive or in reality are not receiving the sort of adequate care or support they need, then they may well be tempted to see suicide as the only way out.

 

Pain or even a terminal illness in itself is not an adequate measure of the quality or worth of a person’s life. In May this year, Rob Cordover stated that “The rule by fear - (the fear) that euthanasia will be abused - should not be the path for a humane society.” However, Cordover’s decision to kill himself on June 22nd was actually motivated by fear; the fear that his motor neurone disease would eventually rob him of  dignity and a fear of experiencing pain (Cordover insisted that the issue was one of controlling the “agony” of his death, as opposed to the death itself). To legalise euthanasia would inevitably affirm to people that yes, they are indeed right to fear such things; sentiments which would actually foster a climate of fear and distrust – as opposed to the apparently more ‘humane’ society where fear is apparently dispelled via the legalised killing of other humans, as suggested by Cordover. And surely a fear of what might happen is not an adequate excuse for killing yourself or another human being, for we may never actually experience that which we fear as the horror or agony we will anticipate it to be – as we often experience in our daily lives and as clearly evidenced in the case of the Honourable Justice Sam Filer. Justice Filer, an American, suffered from Amyotrophic lateral sclerosis (ALS); a degenerative disease of the spinal cord that leads to total paralysis and where the sufferer can eventually only breath artificially via a ventilator. It has been argued that allowing such sufferers to continue living via a ventilator is futile, given that the patient will eventually die nonetheless, but Justice Filer himself spoke publicly – via a voice synthesiser – at a conference regarding his condition. He is quoted as having said that: “Throughout the ALS process, I have learned many things. I have learned that ALS does not necessarily mean a death sentence, that I am not living with a life-threatening disease, but rather with a life-enhancing condition.” Clearly, a terminal illness does not automatically mean that the sufferer will be in such intolerable mental or physical agony that the only option is to have them ‘put down’ as we might an animal, and legalising euthanasia would only serve to enshrine as law the erroneous fear that this is indeed so. Rather than enhancing a person’s dignity, worth and humanity, I suggest that such a move would actually reduce humans to the status of animals.

 

In light of the above objections, I urge you with all my heart to oppose the legalisation of euthanasia in Tasmania.

 

Sincerely,

 

Kristi Giselsson

 

Footnotes:

 

Biography
Author bios
Dr Kristi Giselsson

Dr Kristi Giselsson graduated in 2009 with a PhD from the School of Philosophy, UTAS, where she is an Honorary Research Scholar.

 

She also teaches Ethics at Tabor College, Hobart, and is a member of the Executive Committee of the Australian Association for Professional and Applied Ethics.

 

Her research interests are broadly within the field of moral philosophy and bioethics and her forthcoming book, Grounds for Respect: Particularism, Universalism, Accountability is being published later this year.

Viewpoints

Viewpoints on euthanasia and assisted suicide from eminent Tasmanians