The main points I wish to make involve the moral logic underpinning the legalisation of assisted suicide and, or voluntary euthanasia. I use the term "euthanasia" to refer to both, and by that term I mean the deliberate medical co-operation in a competent person’s autonomous choice to end his or her own life. My remarks here are explained and defended in greater detail in my written submission.
The unique, distinguishing feature of euthanasia is the consensual, intentional killing of the patient. Introducing death as a legitimate healthcare intention would not be a mere expansion of healthcare. Rather, it could only be introduced by disavowing a primary healthcare norm, that of no intentional killing. The norm against intentional killing is a moral requirement necessary to protect equally the life of every person, which is of profound inherent worth, from being attacked. When the norm is sidelined to accommodate euthanasia it can no longer be maintained consistently that every human life is of intrinsic, equal, and inviolable worth. For the new law would now facilitate an individual to judge that his or her life has lost or is losing value such that death is preferable to life, and, on the basis of that judgment, to choose death and thus to treat his or her life as violable. Here, legal facilitation occurs precisely out of moral respect for both the individual’s judgment and his or her choice, the choice being contingent on the judgment.
Euthanasia, then, is a violation of the intrinsic value of life. Since a person is inseparable from his or her life, euthanasia is also a violation of persons. It ends them through death, which itself is both a harm and a loss.
Against this, the central euthanasia rationale argues that choices for death are morally protected by the respect owed to individual autonomy in so far as expressions of autonomy concern the most important, self-regarding decisions one makes in relation to one’s life. It is a rationale which, once accepted, becomes the most important and directly relevant moral standard by which euthanasia restrictions and safeguards are to be judged.
Acceptance of euthanasia’s autonomy rationale requires thinking very differently about killing and death. Outside the euthanasia framework, they are considered inherently bad. Inside the framework, however, consensual death and killing are judged positively as morally protected expressions of autonomy. As such, acceptance of the autonomy rationale requires rejecting attempts to restrict euthanasia in order to limit consensual deaths.
This poses a problem for proposals to legalise euthanasia insofar as such proposals advocate restrictions. When legalisation of euthanasia occurs per the autonomy rationale, there appears to be no consistent, non-arbitrary justification for limiting euthanasia access. Any line drawn between a legitimate euthanasia ground and an illegitimate one or between an acceptable annual number of cases and an unacceptable number thereof will appear as unfair discrimination against patients excluded from the right to access euthanasia.
Consistency demands that if euthanasia were to be legalised, it would be available on virtually all medical grounds, including, for example, chronic illness, conditions closely associated with disability, experience of suffering – which is inherently subjective and not limited to physical suffering - and mental disorders, once capacity remains. Tellingly, pro-euthanasia contributions at the committee have, in general, avoided affirming euthanasia restriction.
It thus becomes clear that the real principled moral choice is not between no euthanasia and very limited euthanasia; rather, it is between no euthanasia and largely unrestricted euthanasia. As such, euthanasia becomes more obviously a rejection of a fundamentally important ethical norm, namely, no intentional killing. The fact that restrictive euthanasia provision is arbitrary helps to illustrate how principled, coherent and protective is the norm against intentional killing. A legislative decision to reject that norm would be much more ethically momentous than any subsequent decision to widen euthanasia grounds.
It follows that a restrictive euthanasia model, such as the Oregon model, amounts to an ad hoc unstable compromise with an in-built orientation towards expansion of euthanasia grounds and increase in euthanasia cases. The orientation is demonstrated in the clear general trend towards expansion in countries that have had legalised euthanasia for five years or more. All of them have seen a substantial increase in annual euthanasia cases and, among those that legislate for grounds, all bar one have witnessed significant widening of grounds, whether occurring de facto or de jure or both. The movement is in one direction. If anything, it is accelerating. As my written submission explains, Oregon itself is subject to the trend of expansion and there is no reason to think New Zealand - which is based on the Oregon model - will prove any different. These trends support the claim that the idea of limited euthanasia is both morally incoherent and practically unstable.
A proposal to legalise euthanasia requires very careful thought about moral principles and moral consistency. Legislators should inhabit the central rationale of each of the two basic possible positions and think through whether a middle ground genuinely makes sense, or whether even a small step on a new path involves a radical reorientation away from key goods enshrined in the status quo, a reorientation which leads to a very different way of viewing healthcare, equality of human lives, killing and death, solidarity and the good.
As a matter of clear and coherent basic principle, our healthcare currently excludes choices to self-kill. Within the euthanasia framework, however, a consensual choice in favour of death becomes a principal part of good healthcare. There is no stable middle ground. The current law is the only credible safeguard on offer against the normalisation of consensual killing in healthcare.
This statement was given by Dr Finegan in opening statements to the Oireachtas Joint Committee on Assisted Dying on October 3rd 2023
Dr. Thomas Finegan is Assistant Professor, Department of Theology and Religious Studies, Mary Immaculate College, Ireland