On Tuesday, June 22, 2010, the Tasmanian Attorney-General, Lara Giddings, announced she was to develop voluntary euthanasia legislation. The announcement was made despite the defeat of a similar bill introduced into parliament last year by Greens leader, Nick McKim. The basis for the decision to introduce similar legislation is that the majority of the Tasmanian public are said to be in favour of the legislation. Further, Lara Giddings points out that MPs who voted against McKim’s bill in November last year were opposed to the form the bill had taken, rather than the principles behind the bill.
The statement that the majority of Tasmanians support euthanasia is based on findings cited in the Joint Standing Committee on Community Development’s Report on the Dying with Dignity Bill 2009 (the Report). Those findings were that “80%” of respondents to a national poll and “78%” of respondents to a Tasmanian poll were in support of “voluntary euthanasia”. In one of the polls, the respondents were asked:
Thinking about voluntary euthanasia where a doctor complies with the wishes of a dying patient to have his or her life ended; are you in favour or against a change in the law that would allow doctors to comply with the wishes of a dying patient to end his or her life?
However, the findings are flawed. For the Report also concedes that “it is unclear whether respondents considered the withdrawal of, non-commencement of, or refusal of futile treatments as voluntary euthanasia” (at 13). It is not possible to tell, from the way the questions were framed, whether the respondents were merely reiterating their support for withholding and withdrawal of life-sustaining measures from a competent but terminally ill patient who requests it, or whether they really were in favour of legalising the administration of a lethal substance to end a person’s life. It is therefore not safe to rely on the findings as a gauge of community support.
The Report itself fails adequately to distinguish the proposed reforms from what is currently lawful. For example, Part 1 of the Report defines “euthanasia” merely as “painless death”, and “voluntary euthanasia” as “euthanasia practised at the wish of a person with a terminal illness”. “Active voluntary euthanasia” is defined as “where medical intervention takes place, at the patient’s request, in order to end the patient’s life” and “passive voluntary euthanasia” is defined to mean “where medical treatment or life support is withdrawn or withheld from a patient, at the patient’s request, in order to end a patient’s life”.
These definitions are inadequate because they all can include withholding and withdrawing life-sustaining measures, and so anyone reading the Report may mistakenly think that the debate concerns whether this should be legalised. Accordingly, consideration must first be given to clarifying the issues for debate and consulting with the community once again.
There has been much debate about whether a meaningful, or morally relevant, distinction can be drawn between withholding and withdrawal of life-sustaining measures and the administration of a lethal substance. Resolution of this issue will determine how the term “euthanasia” itself should be applied. Many philosophers and legal academics, including Peter Singer and Helga Kuhse, have doubted whether the distinction is of any moral relevance. Further, even if a distinction could be defended, there are additional worries about whether it can apply to withdrawal which, unlike withholding, requires positive steps to bring about the patient’s death, making it more analogous to the provision of a lethal substance.
My purpose here is to provide some clarification of the distinction between withholding or withdrawing life-sustaining measures and administering a lethal substance, so that people, including members of parliament, can make an informed judgement. My aim is not, however, to advocate acceptance or rejection of any proposed law. This article is not the place to review the extensive literature on the topic. Rather, my aim is to clarify what the term “voluntary euthanasia” should really be understood to include, with a view to clarifying the kinds of question that should be put to respondents in future polls.
What is the distinction between euthanasia and withholding life-sustaining measures?
What is it, exactly, that we have so far objected to in allowing doctors to administer a lethal substance? The objection is normally said to be that killing is wrong. Why, then, is administering a lethal substance assumed to be killing, but withholding life-sustaining measures is not?
The first step to understanding the difference is to look at the circumstances in which the two different courses of conduct are proposed.
In cases where the administration of a lethal substance is concerned, the patient, although dying, is not normally dependent on life-sustaining measures. If they were, the question of whether to administer the substance would not arise, for doctors could simply engage in the lawful conduct of withholding or withdrawing the measures instead. The cases where the provision of a lethal substance is at issue are always cases where, without such intervention, the patient would live on and, as a consequence, suffer intolerably (assuming all palliative care options, including pain relief, have been exhausted). The question in such a case, then, is whether to cut short a life that, without intervention, would continue.
In cases of withholding, the converse is the case. In withholding, the question is whether we should intervene to prolong the patient’s life instead, by providing life-sustaining measures. In this case, without intervention, the patient will die. Intervention is required, not to cut short a patient’s life, but rather to prolong it.