Protection of the vulnerable by health care institutions

Recently, new laws that allow doctors to help terminally ill patients to end their own lives have been approved in places like Washington, D.C., and the U.S. state of Colorado. It’s essential that we look at the impact that this law will have on the patients, doctors, the government and the society. What we are considering here is not the “right to die”, but the “right to be killed by a doctor” or the right to be supported in suicide. Legalizing physician-assisted suicide (PAS) or euthanasia will damage the foundational societal value of respect for human life. It is not just a private matter because, as the philosopher Daniel Callahan says, “euthanasia requires two people to make it possible and a complicit society to make it acceptable.” In this article, I will give a brief reflection of the risks for the ill, the elderly, and people with disabilities.

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The passage of such laws might leave unprotected vulnerable people who are already at risk of abuse and coercion. In the first place, it might leave them unprotected from their own feelings of worthlessness. These people may be suffering not only from the disease, but also from fear about the future, the difficulties they believe they are causing for their families, feelings of loneliness, hopelessness, worthlessness, etc. This makes requests for PAS or euthanasia hardly free and voluntary. Their decision-making may be affected by confusion, dementia or other symptoms that can be relieved with appropriate treatment. Therefore, the correct approach to these people is giving them the means for being comfortable, rather than assisting them in dying because “their life is not worth living.” Just as in the case of a healthy person, they should be protected from these thoughts, taking into account their unique vulnerabilities. If care is aimed at achieving the best possible quality of life for patients and their families by focusing on a patient’s physical, psychosocial, and spiritual suffering, requests for euthanasia are extremely uncommon. The experience of doctors who have saved the life of someone who tried to commit suicide shows that patients almost always change their mind when they are taken care of and alleviated from their sufferings, and are most grateful that their attempted suicide was prevented.

In the second place, it might leave them unprotected from those around them. The pressure and influence that one person can have on another make this law very risky. Many terminal patients are seen as a burden and a financial strain on their families and society. In these circumstances, the terminal patient may feel obligated to request assisted dying, as a sort of sacrifice, in order to avoid inconveniencing the people caring for them. In an interview, Frank Koerselman, a Dutch doctor, he talked about an 85 years old patient whose family didn’t want the doctors to treat him. The doctor was ready to carry out euthanasia but he requested to talk with the patient in private. Security guards had to remove the family from the room so he could talk in private with the patient. Then, the patient opted for treatment. He was discharged from the hospital in a very good condition, physically and mentally. The power of suggestion exercised by one’s family and friends creates a risk that the right to die could be interpreted as a duty to die. Thus, requests for assisted dying would not be an expression of freedom but a result of pressure.

Assisted dying will exacerbate the discrimination that elderly and disabled groups are already facing at the health care institutions. These vulnerable groups are seen as less desirable for certain treatments, on the basis of a poor “quality of life” or the idea that they will die soon anyway. Though sometimes there may be medical justifications for these decisions, in many other cases the only reason is discrimination on the basis of age or disability. Many disabled rights organizations oppose assisted dying for this reason. They believe that this law would legitimize further discrimination against these already marginalized groups.

A society that allows the termination of life under some circumstances is proclaiming that there is such a thing as a life not worthy to be lived, that some lives are worthy of protection, and others are not. Is there a minimum extension of life, or quality of life that is not worth the cost involved? Is the value of a human life dependent on circumstances? When some people get suicide prevention while others get suicide assistance and the only difference is the health or disability status of each one, it shows that a society does not value all its members. Definitely, “mercy killing” is such a discriminating practice that takes away the value of equality that must underpin our society. Our right to life and our right to be cared for until nothing else can be done is inherent to our common human dignity; it depends on nothing but the simple fact that we are members of the human family. When some members of the human family are devalued, they are at serious risk of coercion or even not being consulted at all about their end of life

In Belgium and the Netherlands, government reports indicate that many people are being killed without their consent. Many others are being killed without even being terminally ill. Euthanasia is now permitted also for infants with handicaps, and even for people with severe depression. In a recent case, Dutch authorities approved a request for assisted suicide from a man suffering from alcoholism. Many people now carry “anti-euthanasia passports” stating their desire not to receive life-ending medicines because they are afraid they may be killed when they enter the hospital.

In conclusion, free and voluntary euthanasia simply does not exist. Its allowance will open the door to many forms of involuntary euthanasia. There are too many conflicts surrounding vulnerable people, and too difficult to enforce a law strong enough to protect them from involuntary death or coerced “suicide.” Assisted suicide or euthanasia is not a way to die with dignity; dignity belongs to every living human being, regardless of their health, age, or ability. There is nothing merciful about killing. What is merciful is to care of the people in need until the moment arrives when they die in peace.

WYA celebrates the life of every person under any circumstances and does not support a law implying the acceptance of the idea that in some situations a human being life may not be worthy to be lived. The answer to suffering is to improve our standards of care. These people must be protected rather than affirmed in their feelings of worthlessness. They need to hear that they are valued and loved as they are. They need to know that we are committed first and foremost to their well-being, even if this does involve spending time and money. They need to know that we will help them to live well, and will accept their death when their life has come to a natural end. As doctor and geneticist Jerome Lejeune, who discovered the link between chromosome 21 and Down syndrome, said, “the quality of a civilization can be measured by the respect it has for its weakest members.”

Written by Ines Lobo Lozano, a World Youth Alliance Europe intern and medical student from Spain.