2005 Annual Conference - Euthanasia - A good death?

Date: 15th Jan 05
Location: Lister Institute, Hill Square, Edinburgh

Organisers: Scottish Council on Human Bioethics, Ethics and Medicine Trust

Participants: Around 140 persons were present

SCHB participants: Several SCHB members

Programme:

• Welcome - Dr. George Chalmers

• Why the Scottish Parliament should be debating End of Life Issues - Mr. Jeremy Purvis MSP

• Euthanasia: here we go again? - Dr. Andrew Fergusson

• Is there a credible philosophical argument against Euthanasia? - Prof. John Haldane

• Can we afford to say No to Palliative Care? - Ms. Elizabeth Carroll

• Rev. Joseph Keenan

Report

After a short introduction, Dr. George Chalmers, the President of the SCHB, welcomed conference participants.

Mr. Jeremy Purvis MSP

Mr. Purvis began the conference by indicating that he was launching a consultation on a draft bill for the Scottish Parliament on assisted suicide. In this respect, he noted that Scotland had not yet experienced a wide and public debate in the field of end of life issues and indicated that the Scottish Parliament should, therefore, address this debate.

He then mentioned that he had a lot of admiration for healthcare professionals who worked in palliative care or who gave assistance to terminally ill persons. He also recognised that deeply held views existed amongst many people on end of life issues but that the debate was not as polarised as often presented by the media. Mr. Purvis went on to discuss the importance of autonomy for individuals at all the different stages of life. In addition, he indicted that many cases of assisted suicide went unreported in Scotland and that regulations similar to the Oregon legislation on assisted suicide was therefore necessary. Mr. Purvis concluded by stating that human individuals were the only persons who could determine their own human dignity and that this could not be done by anyone else. Thus we should not judge other people in what they do.

Dr. Andrew Fergusson

The next speaker was Dr. Andrew Fergusson, a GP and past member of the General Medical Council, who began his presentation by indicating that, thought it was often overlooked, life had a natural end. In addition, in contrast to past centuries, a good death in the 21st century now meant dying suddenly. With respect to euthanasia, Dr. Fergusson indicated that the following three arguments were often presented in favour of euthanasia:
- we want it! which is related to the 'rights' argument,
- we need it! which is related to the compassion argument,
- we can control it! which is related to the belief that a medical procedure could always be controlled.

Dr. Ferguson then noted that the issue of choice had become an important political topic. People want to be able to choose and control the manner in which they die which is reflected in their wish for more autonomy. In this respect, he welcomed developments in healthcare that improved the level of autonomy of patients but questioned the kind of autonomy which demanded euthanasia. He also indicated that the legalisation of euthanasia would inevitably lead to some people being killed involuntarily and that it would begin a slippery slope towards the euthanasia of children and the depressed. He ended by indicating that where there is hope, there is also life.

Prof. John Haldane

Prof. Haldane, who is Professor of Philosophy at the University of St. Andrews, then gave a brief overview of the main arguments for euthanasia. These included:

Autonomy:

That a person owns his or her life and has rights of disposal. However, he indicated that it does not make sense to suppose that one owns one's life since ownership is an alienable relationship between a party and a set of goods. This demands that the existence of the one is distinct from that of the other. However, a person is not distinct from his or her life, hence the relationship cannot be one of ownership. In addition, he questioned whether the assisting of what is morally acceptable is in itself morally acceptable. For example, it may be acceptable for a person to go on a hunger strike without it being acceptable for others to assist him or her.

Mercy:

That there is an obligation to do what one can to promote the good and diminish the bad. In addition, ending/helping to end a person's life will promote good and diminish the bad. However, it is not clear that ending the life of a sufferer does not harm a person. After all one of the reasons why murder is wrong is not that the victim is happy or in pleasure - even if he or she were unhappy or in pain it would still be true that he or she was wronged in having his or her life taken. Hence death can be a harm in and of itself.

He then continued by giving the main arguments against euthanasia. These included:

The inviolability of life:

It is always wrong to destroy and/or aid in the destruction of human life.

Nature:

Every human being desires by nature to go on living and euthanasia/suicide violates that natural desire.

The unacceptable implications:

the shifting grounds provided in justification of euthanasia/assisted suicide: terminal suffering - unbearable suffering - intolerable misery - unduly burdensome angst - existential depression - lack of worth, etc. the changing social circumstances in which decisions about ending life are made: social atomism - family disintegration - consumerism - resource demands.

Ms. Elizabeth Carroll

A presentation was then given by Ms. Elizabeth Carroll who is a lecturer in the Health Department at the Bell College of Higher Education specialising in resource allocation for palliative care. She indicated that it was important to first define palliative care and determine the different forms it could take since most people did not know what palliative care really was. In this respect, she stated that it may be more appropriate to speak of 'care for the dying' than 'palliative care'. Ms. Carroll also noted that it was not just by increasing the number of hospices that all problems would be addressed. There were still improvements to be made in the kind of care that was given at these hospices.

In addition, she suggested that challenges remained with respect to (1) specialist versus generalist palliative care, (2) extension of palliative care to non-malignant chronic diseases and (3) the cost of palliative care.

With respect to resources, Ms. Carroll noted that a just allocation of resources should be sought in relation to fairness, equity and requirements.

Rev. Joseph Keenan

The final talk of the conference was given by Rev. Joseph Keenan who is a Catholic parish priest and a lecturer in Moral Theology and Bioethics at the National Roman Catholic Seminary in Glasgow. He indicated that we needed to be careful to not let our often strong emotions make us do things which would be contrary to moral law. In this respect he noted that recent modern legislation could undermine society, as such, with an abuse of autonomy and human rights giving rise to an abuse of freedom. Thus he questioned whether euthanasia could be limited to the few people who really wanted it. For example, in the Netherlands, many elderly people were now afraid of euthanasia. Moreover, he noted that it is probable that those who seek euthanasia do so because some of their needs are not being adequately addressed.

He finished by suggesting that it would be preferable for persons suffering from depression and who seek euthanasia or assisted suicide to express their needs so that something could be done in response.