[Source:  - Council of Europe]

VIII.   Criticisms levelled at euthanasia and the new legislation in the Netherlands and Belgium

50.     The principal arguments against euthanasia and its decriminalisation are, first of all, that euthanasia is deemed to be incompatible with the fundamental human right to life and the concept of human dignity from which it stems.  This is the whole thrust of the argument underlying Recommendation 1418 (1999).  Prohibition on intentionally causing death is a cornerstone of all social relations, emphasising our fundamental equality. Therefore euthanasia remains a criminal offence in all Council of Europe member states, save under specified conditions in the Netherlands and Belgium.  Moreover, it would be contradictory, or at least perverse, to work for abolition of the death penalty and at the same time for acceptance of euthanasia.

51.     It is argued that euthanasia is contrary to the will of God as expressed in the Commandment: “Thou shalt not kill”. For those unwilling to introduce divine authority into the discussion, it is contrary to medical ethics, including the Roman axiom “primum non nocere” (“first of all do not harm”) and the Hippocratic Oath.

52.     Opponents also point out that the relationship of confidence that must prevail between doctor and patient would be undermined by the former’s power legally to end the latter’s life.  Moreover, most doctors have received no training in terminating life.  

53.     Those opposing euthanasia say that terminally ill and dying patients may be suffering not only physically but also mentally, in particular from depression, in which case their decision to ask for euthanasia may not be rational.

54.     Finally, from both a logical and a practical point of view, it is said that it is impossible to provide a framework for voluntary euthanasia that will prevent abuse.  Pressure may be exerted on the doctor to end the patient’s life on non-medical grounds, including lack of hospital beds, the prospect of financial gain, or even political reasons.  There will inevitably be a slide down the “slippery slope” from voluntary to involuntary and non-voluntary euthanasia. People will be killed who never asked to die and who could have been helped by palliative care.  Indeed, the development of palliative care will make euthanasia unnecessary.

IX.      Arguments in favour of euthanasia and its decriminalisation

55.     The main arguments for euthanasia and its decriminalisation relate first of all to self-determination or personal autonomy: each individual, out of respect for his or her dignity and value, has a right to take decisions concerning his or her own life and death in accordance with his or her own values and beliefs, and not to have these imposed.  It is a question of freedom and equality in the face of death.  Similarly, this right does not imply an obligation on any health worker to take part in an act of euthanasia.  Freedom of conscience in such matters should prevail.

56.     Proponents argue that nobody has the right to impose on the terminally-ill and the dying the obligation to live out their life in unbearable suffering and anguish where they themselves have persistently expressed the wish to end it.  Doctors have long accepted exceptions to the precepts of medical ethics, in carrying out abortions for example.  Abortion itself has been legal for many years.

57.     There has been a similar change of social attitudes to suicide, once a criminal offence. Now we respect a person’s choice to take their own life and avoid making value judgments about them.

58.     Whereas palliative care is absolutely essential in attempting to ease the pain of the terminally ill and the dying, unfortunately some patients find it inadequate.  Palliative care cannot in all circumstances take away unbearable pain and suffering.  In any case the issue goes beyond the alleviation of pain: the degree of patients’  suffering, including mental anguish and loss of dignity, is something that only they can assess.  Individuals suffering in the same situation may take different end-of-life decisions, but each human being’s choice is deserving of respect.  Depression should not come into it, to the extent that the doctor treating the patient has got to know the case, and the request for euthanasia has been persistently expressed.

59.     The fact that the Council of Europe favours abolition of the death penalty is not inconsistent with favouring euthanasia, since the former, barring the exception that proves the rule, is carried out against the will of the individual.

60.     Since “passive euthanasia” – withdrawing life-sustaining treatment or sustenance in the knowledge that death will result (an act of commission if ever there was one) – has been admitted as both ethical and legal in certain cases, it is difficult to see the moral distinction between this and active euthanasia.

61.     Finally, euthanasia appears to be extensively practised in secret. It is this reality that carries the greatest potential for abuse.  Decisions may be taken in a furtive and arbitrary manner.  They may depend on the “luck of the draw”: a sympathetic doctor or a malevolent nurse.  The pressures that can influence end-of-life decisions will be more pernicious if exercised in the dark.  The gap between law and practice must be reconciled if respect for the rule of law is to be maintained.  Abuse will not disappear with legislation (does any legislation eliminate abuse?), but will surely be reduced.