Confessions of an Estate Planner: Part 9 - Easy Death

“I’m not afraid of dying… I just don’t want to be there when it happens” Woody Allen.

It is not surprising (after reading Confessions Part 7 and being exposed to some of the real life stories from the (other) Royal Commission into Aged Care Quality and Safety) that we are hearing more and more about Euthanasia (a term derived from the greek word ‘euthanatos’ which means ‘easy death’.

The fear of death is ingrained into all of us (natural selection dealing with those who were, unfortunately, not naturally averse to death many millions of years ago) but we all accept that at some point it inevitable.  The acceptance grows as we grow older.  When we were young it was never going to happen to us.

I think it is fair to say that most people accept that they will die but what they fear the most is that they won’t get lucky and die in their sleep peacefully or otherwise quickly and painlessly. 

They dread a long illness and dying alone, in hospital connected to all sorts of very expensive machines and computers, in severe pain, suffering immeasurable indignities daily under sedation and without any privacy or empathy. 

To put it another way “a living hell”.

What is an ‘easy death’ or ‘good death’ is a matter of debate.  The authors of The Future of Health and Care of Older People [London: Age Concern, 1999] set down 12 principles of a good death:

• to know when death is coming, and to understand what can be expected
• to be able to retain control of what happens
• to be afforded dignity and privacy
• to have control over pain relief and other symptom control
• to have choice and control over where death occurs (at home or elsewhere)
• to have access to information and expertise of whatever kind is necessary
• to have access to any spiritual or emotional support required
• to have access to hospice care in any location, not only in hospital
• to have control over who is present and who shares the end
• to be able to issue advance directives which ensure wishes are respected
• to have time to say goodbye, and control over other aspects of timing
• to be able to leave when it is time to go, and not to have life prolonged pointlessly

All of these things should be aspired to and planned for at time in your life when you are able to properly do so.  In most cases this is easier said than done in that at the time you should be taking some steps you might have lost capacity or all of your money. 

Once someone has found themselves in a living hell the easy death option is thought about and in some cases serious consideration is given to it.

The starting point with any discussion on Euthanasia are the legal and religious positions.

The legal position in Queensland (and most jurisdictions in the World) is:-

CRIMINAL CODE 1899 - SECT 311

311 Aiding suicide

Any person who—

(a)           procures another to kill himself or herself; or

(b)           counsels another to kill himself or herself and thereby induces the other person to do so; or

(c)           aids another in killing himself or herself;

is guilty of a crime, and is liable to imprisonment for life.

You don’t have to be a lawyer to understand what these simple words mean.  This section and others in the Criminal Code (dealing with wrongful killing, manslaughter and murder) are, not surprisingly, consistent with the Sixth Commandment “Thou shall not kill”.   Nearly all religions around the world unite on this topic.  Pope John Paul II offered this in 1984:-

"Down through the centuries and generations it has been seen that in suffering there is concealed a particular power that draws a person interiorly close to Christ, a special grace".

Essentially, to kill oneself, or to get someone else to do it for you, is to deny God, and to deny God's rights over your life and his right to choose the length of your life and the way your life ends.

There are some compelling and not so compelling ethical, philosophical, and practical arguments for and against Euthanasia. 

Leaving aside the legal and religious position for one moment let’s start with the some Pros (there are others):-

• people have the right to die;
• death is a private matter and if there is no harm to others the state and others have no right to interfere;
• allowing people to die may free up scarce health resources;
• euthanasia happens anyway;
• it is in the patient’s best interests;
• it is possible to regulate Euthanasia.

The Cons include:-

• it weakens society’s respect for the sanctity of life;
• accepting it accepts that some lives (i.e. those of the disabled and infirm) are worth less than others;
• voluntary (you chose) euthanasia may lead ultimately to involuntary (someone else chooses) euthanasia becoming acceptable;
• it affects the rights of others not just the patient’s;
• there is no way of properly regulating it;
• there is no guarantee it will not be abused (by the sorts of people discussed in Confessions Part 7);
• it exposes vulnerable people to pressure (real or imagined) to end their lives (i.e. moral pressure by selfish families, and moral pressure to free up medical resources)
• the elderly, lonely, abandoned, sick or distressed may feel it is the only option;
• it gives too much power to doctors (most doctors would not I suggest want this responsibility);
• what was thought to be in the patient’s best interests was wrong (i.e. the diagnosis was wrong – it happens);
• competent palliative care should prevent a person feeling any need for euthanasia;

Double Effect

Is doing something morally good that has a morally bad side effect ethically okay? 

The concept of double effect is relied upon by doctors to justify the commonly encountered situation where the doctor prescribes drugs (usually morphine) to a terminally ill patient to relieve distressing symptoms even though the doctor knows that doing so may shorten the patient’s life.  It is reasoned that this is justified and acceptable as the doctor is not aiming at directly killing the patient – the bad result of patient’s death is only a side-effect of the good result of reducing the patient’s pain.

Without getting too philosophical it all sounds to be a convenient if not circuitous way of saying it is tolerable to do the wrong thing for the right reason. 

In the vast, vast majority of cases who could argue against it.

Certainly, this situation can be dealt with in an Advance Health Directive to at least make things easier for your loved ones and doctors. 

Conclusion

For a variety of reasons, I doubt very much the law will change on this very controversial topic in the near or distant future.  My advice is to plan for the worst and hope you are one of the lucky ones (who have painless and quick departure from this world).