A few years back, armed with a mic and our courage, a colleague and I headed out to Pitt Street Mall to accost members of the Great Australian Public for a podcast we were recording and to ask them: Do you think euthanasia should be legal?
Overwhelmingly, people said yes. When asked why, they talked about choice and dignity. Several people said something like: you can put down your pets so they’re not in pain. Shouldn’t humans have the same option?
From memory, of the few people who said no, every one of them mentioned God. It’s not our call to make, they reckoned.
What more is there to say? If it’s only religious people who are opposed to assisted dying, and their only reasons for opposing it are religious ones – a common assumption – then the two sides will just have to agree to disagree, and whoever has the numbers will carry their point, legislatively speaking.
Not so fast, though. Deep down, people’s commitment to autonomy, or to the sacredness of life, might be non-negotiable. But closer to the surface, there’s a lot of common ground where we can meet to talk through the issues.
With the NSW Parliament now debating whether to legalise assisted dying – the last state in Australia to do so – this seems like a good moment to pause and at least attempt those conversations. Here are three areas that matter a lot from both religious and secular perspectives.
What do we know about dying? We can agree that we owe those who are facing the end of life the best care and support we know how to give. So, what does that look like? The process of dying has become highly medicalised over the decades; a majority of Australians die in hospital. That means it’s also an unfamiliar process to most of us, which makes it all the more daunting.
It makes sense, then, to ask questions such as: how painful is dying? Conversely, how peaceful is the process of assisted dying? Also, if it’s generally only medical professionals who are familiar with what dying looks like, it’s worth asking why doctors oppose euthanasia at higher rates than the general public, and why palliative care doctors oppose it at higher rates again than their colleagues in other fields. What do they know about death that we don’t?
What makes a life worth living? We can agree that every life is valuable. We pour resources into suicide prevention, supporting people with disability to live full lives, keeping COVID-19 out of aged care. We fiercely affirm, to those burdened by illness or chronic pain or the debilities of age: you are not a burden. You are full members of this society. You are not expendable.
We carefully distinguish assisted dying from suicide, avoiding terms like PAS (physician assisted suicide), commonly used in the literature.
Yet in Oregon, where assisted dying has been legal since 1997, 2020 figures show that for more than 90 per cent of patients accessing PAS, the main reasons were not pain-related but “losing autonomy” and being “less able to engage in activities making life enjoyable”.
In the Netherlands and Belgium, euthanasia is now legal not only for those who are terminally ill but also for those with mental illness; a recent amendment in Canada has also seen Medical Aid in Dying (MAiD) extended to psychiatric disorders, though they were explicitly excluded in previous legislation.
Ultimately, how are doctors to decide which deaths should be sanctioned, and which we should strenuously try to prevent? If psychological distress, chronic pain, reduced capacity and dependence on others are increasingly seen as legitimate reasons to end a life, what is the subtext for members of our community who face these challenges every day, and find ways to build a meaningful life out of them?
We can agree that healthcare should be patient-centred and, where possible, individualised. Not everyone’s experience or needs are the same. If assisted dying is legal, then that puts an important option on the table for those who want it, and if you object – well, you’re free to reject that option in your case. Everyone makes their choice. Right?
Following COVID-19, this sounds worryingly naive. You can choose not to get vaccinated too, but that choice will affect the community as a whole, and especially those whose health is already precarious. We can hoard vaccines for our country, but as the virus keeps circulating in populations with low vaccination rates, the risk of a more potent variant rises. We really are all connected.
For an early death to be on the table – legally and medically sanctioned – it changes the “table” for everyone. The evidence from other jurisdictions suggests that adding it to the mix does not leave other elements unaffected: the resources available for palliative care; the patient-doctor relationship; family dynamics at the end; our understanding of dementia, disability, suffering in general. And as is so often the case, it’s the already vulnerable who have most to fear.
The truth – a truth none of us is very keen to say out loud in this discussion – is that illness and dying involve suffering, and we don’t know how to eliminate it entirely.
Assisted dying legislation takes one kind of death and aims to make it easier. It’s a deeply sympathetic goal. It also opens the door to new kinds of suffering and abuse, unintended but not unforeseeable.
So, the question cannot be: how do we eliminate suffering? The law can’t do that. The question must be: what kind of society are we? What are our bedrock values? And who do they advantage – or disadvantage – the most?
Dr Natasha Moore is a senior fellow at the Centre for Public Christianity and author of The Pleasures of Pessimism.