We should end the suffering of patients who know they are dying and want to do so peacefully
The Victorian and New South Wales governments are considering whether to introduce legislation to allow voluntary assistance in dying. I support legislation, with adequate safeguards against abuse, to achieve this objective. People often ask me what connects the various issues I have written about over the years – issues like global poverty, the way we treat animals, and the way we die. My answer is simple: I am seeking to reduce pointless suffering. The world is rich enough to give everyone clean water, basic healthcare and enough to eat, so why do we let people in extreme poverty continue to go without these necessities? We have no need to confine billions of animals on factory farms, causing them lifelong misery, and ending up with less food for ourselves than we feed to them.
But the easiest suffering of all to end would be the suffering of patients who know they are dying and who do not want to go through the last days, weeks or months of the dying process. If a doctor is willing to help a patient to die peacefully when the patient has made a careful and reasonable request for that assistance, whose interest is furthered by turning that doctor into a criminal?
Forty years ago, when I first began to ask that question, I received two different answers. Some said that it is always wrong to take an innocent human life, or to be complicit in patients taking their own lives (by, for example, writing a prescription for a drug that the patient can use to bring about a peaceful death). There are religions that believe this, but if we do not accept the authority of those religious teachers, why should we support that belief? It makes good sense to hold that it is wrong to kill an innocent person who wants to go on living. We might also agree that it is wrong to kill an innocent person who has some prospect of a future life of acceptable quality. Why, though, should we think that it is wrong to help someone to die if they, after careful thought, ask you for that help, and have good reasons for making that request?
Others – or sometimes the same people – argued that once we legalise assistance in dying for some people in some circumstances, we will start sliding down a slippery slope of more and more killing that ends in something like the atrocities committed by the Nazis.
This scenario never seemed plausible to me, but in the 1970s it was not easy to definitively refute it. Legalised assistance in dying was then a step into the unknown. No modern country had done it. Forty years on we have a much better basis for saying that allowing doctors to act on considered requests from their terminally or incurably ill patients will not take us down to places we do not choose to go. In the United States, voluntary assistance in dying is now legal in the states of California, Oregon, Washington, Montana, Vermont and Colorado, as well as in Washington DC. It is also legal across all of Canada. In Europe, it is legal in the Netherlands, Belgium, Luxembourg and Switzerland and in South America, in Colombia.
We can now draw on 30 years’ experience with the open practice of medical assistance in dying in the Netherlands, and 20 years in Oregon. These jurisdictions have been carefully studied, especially by opponents of assistance in dying seeking evidence of abuse, but they have been unable to demonstrate any slippery slope to disaster. Perhaps the most convincing evidence of this is that no legislature that has legalised assistance in dying has subsequently voted to repeal the legislation. Even when the Dutch had a Roman Catholic prime minister leading a Christian Democrat government, there was no attempt to rescind the legislation.
It is no coincidence that two of the Netherlands’ neighbouring states, Belgium and Luxembourg, have, after some years of observing the practice there, decided to adopt similar legislation themselves. They knew better than any other country how well the legalisation of voluntary assistance in dying was working in the Netherlands.
Oregon was the pioneer in the US, passing its Dying with Dignity Act in 1997. The numbers using the law are still quite small, but it is interesting that each year only about two thirds of those who obtain a prescription under the act for a lethal drug use it to end their lives. For many, it seems, the fact that they have a way out, should things become unbearable, is already a significant benefit. Contrary to claims that when assistance in dying becomes legal, the poor and vulnerable will be pushed into ending their lives, Oregon statistics show that those using the legislation were overwhelming white (96%) and well-educated (half had a university degree).
Objections to legalising assistance in dying come mainly from those with religious beliefs contrary to this practice. To them I would say that, just as with same-sex marriage, if they do not want something for themselves, they are free to avoid it. But we live in a pluralistic society. Not everyone holds religious views, and many who are religious do not accept that it is always wrong to assist someone to die. I cannot see why the minority who have religious objections to voluntary assistance in dying should try to deny it to others who do not share their beliefs.
Peter Singer is professor of bioethics at Princeton University and laureate professor at the University of Melbourne