Most opposition to assisted dying is based on religious prohibitions, and consequently the expression of that opposition is often hysterical and exaggerated. The main thrust of such opposition concentrates on scary scenarios where everyone will be put at risk by the legalisation of assisted dying. Alex Schadenberg is a salient example of this trend. Over on his blog he is stating without corroboration of  any kind that “Euthanasia in the Netherlands is out-of-control.”* He also refers his readers to an article in the Windsor Star (“Ugly Issue Back Again”) by a founding VP of the Euthanasia Prevention Coalition, Jean Echlin, in which she harangues readers about the dangers of euthanasia to everyone in Canada without exception: “Who would be at risk? You are. So is everyone in this country,” she says confidently. That’s what religiously motivated hyperbole and hysteria looks like.

At the same time that she makes this impassioned and exaggerated claim, she doubts that the Expert Panel of the Royal Society of Canada, which recently released its report, has any “actual knowledge of appropriate end-of-life care.” This is, of course, nonsense, but it passes for informed commentary in Windsor, Ontario. But notice the word ‘appropriate’. That is a value term, and it means that in the opinion of this palliative care nurse, who has been in the forefront of the anti-euthanasia movement in Canada, only some kinds of care can be considered “appropriate” at the end of life, and presumably, in her view, assisted dying is not one of them. But there is something even more duplicitous about this statement, which has to do with the association of euthanasia with the end of life, as though there were an easy distinction that can be made between those who are suffering intolerably in the midst of life, and those who are suffering intolerably at the end of life, that is, when they about to die.

In one sense, of course, we are all dying as soon as we are born. As the Anglican Prayer book has it: “In the midst of life we are in death; of whom shall we seek for succour, but of thee, O Lord, who for our sins art justly displeased?” Everyone who is born has a terminal prognosis. This is why some pessimists speak of a baby’s first cry as an appropriate response to a life just beginning, for life is, as we are reminded by a well-known Christian expression, a vale of tears (valle lacrimarum). Plato says somewhere that only the dead have seen the end of war. And Schopenhauer, the 19th century German philosopher, thought of optimism itself as a matter of self-deception which still cannot hide our suffering and our sorrow.

… even under this deception [he writes], the miseries of life can very easily increase to such an extent — and this happens every day — that death, which is otherwise feared more than everything, is eagerly resorted to. In fact, if fate wants to show the whole of its malice, even this refuge can be barred to the sufferer, and in the hands of enraged enemies he may remain exposed to merciless and slow tortures without escape. [The World as Will and Representation, 325 (Dover edn.)]

Yet it is not only fate that can bar the way to easeful death. Laws will do just as well. It is, however, well known that, despite such laws, merciful doctors, and sometimes loved ones, have often helped their suffering patients (or loved ones) over the worst of their sufferings. This is something that people like Jean Echlin, trying to stir up fear about the dangers of assisted dying, simply ignore: that often people’s suffering is so great that they wish to die.

And this wish is not just, as Pope Wojtyła suggests, an appeal to others to hope when all hope is gone. It can be a genuine desire, and a reasonable decision, that their tormented lives be brought to an end. This is what people like Jean Echlin and Alex Schadenberg oppose: people’s freedom to choose the time and manner of their own deaths. Instead, they would impose, upon those who suffer, the very torments that fate has planned for them. And, despite the fact that there is no evidence that legalising assisted dying would put people’s lives at risk, such people would close the door of mercy to those who, with intolerable suffering and misery, reasonably choose to shorten life, rather than to endure the misery that their disease has mapped out for them.

Of course, the religious here can fall back on the idea that God knows best. They might even quote Paul to the effect that God will not give us more than we can bear. But this is all sheer imagination. If there is a God who does choose the way that we must die, then presumably God is always in charge, and chooses what diseases we will suffer from during our lives, and how much pain we will be made to endure. By what right, if this is the case, do we interfere with God’s purposes at any time, by using antibiotics, nuclear medicine, chemotherapy and surgery, for example, or aspirins or tylenol or opioids, to interfere with God’s plans? Suggesting that God is present in a special way at the end of life can only reasonably be held by those who hold, unreasonably, and without any foundation in what we know of the world, that death is simply a transition from one state of being to another.

We know, however, that brains are the carriers of our memories, and are the material basis for our conscious experiences. Once the brain is gone, there is nothing that can hold those memories, and transport them to another mode of being. We know this, because we have all watched as once vibrant, people, fully alive, become no more than bodies artificially kept alive. Once their brains have died the persons that they were effectively die with them. Long before they die, many people’s brains simply atrophy because of Alzheimer’s disease, or other neurological condition. They may still be able to carry out routine functions like walking and eating, but they no longer can remember who they are, and often do not recognise their loved ones or their friends. The suggestion that there is something there that, with death, passes on to the next stage of being, is simply ludicrous. This is the only world, as Wordsworth knew, in which we must find our happiness, or not at all.

I have a memory that will not let me go. An elderly woman, 99 years old, was dying. She was still lucid, and knew where she was and what was happening to her. She knew that she would soon be dead, and she wanted her grandchildren to visit her in the hospital. I spoke with one of them, and asked her why she had not visited her grandmother. Her answer was that she did not want to remember her that way. the way she was in the hospital, dying. She wanted to remember her as she had been. While I thought that unkind, I also understood. We know that we will die, and we know that that will be the end. We know that the person who is dying is going through a transition to nothingness, and we fear it. We do not want to remember those we love in that way, the way they really are, and what they really are, things of flesh and blood that will simply return to the earth from which they came.

The problem with those who oppose assisted dying is that they do not want to acknowledge this. They want to hold onto the myth that they will live forever, that death is not the end. If it is the end, then life seems to some people to have no meaning or purpose. But scarcely anyone that I have ever known lives life with eternity in mind. Even deeply religious people know that their lives and their purposes are right here in the midst of life. Some of them do try to defeat the body and its desires, but life has a way of taking its revenge on such thoughtlessness. Sexual urges still assail those who strive to subdue them; the desire for beauty and refreshment remains strong; and like our primitive ancestors, we crave sweets and fatty foods.

In the end, of course, it is we ourselves who give our lives meaning, and even through the smothering clouds of religious zeal, no matter how passionate, we know this, and cannot escape it. That’s one reason why religious people do everything in their power to share their faith with others. Given its scant foundation in the world, and even in experience, religious faith seeks some kind of external support. The fact that others do not believe is a reminder of the shaky foundations of one’s own faith, a dissonance that can be acutely uncomfortable. What better way to overcome this discomfort than by convincing and converting others to the truth of one’s beliefs? If I can convince you that what I believe is true, then it seems to stand a better chance of being true — otherwise, why would you believe it? Why else do religious people think they have the right to intervene in the lives of others? It arises largely out of cognitive dissonance, and only such interference can help to still the sense of time being out of joint.

But this character of religious belief as dissonant with our other beliefs also raises the pitch of religiously motivated language, tending towards hyperbole and the appeal to fear and emotion. That’s why believers sometimes put up roadside signs proclaiming things like: “Prepare to meet thy doom!” or “Believe on the Lord Jesus Christ and you will be saved!” or “The wages of sin is death!” And, when it comes to assisted dying, almost all opposition to it is religiously motivated, and the language is accordingly often very shrill and unqualified. So Jean Echlin says that if euthanasia is legalised we will all be at risk, and Alex Schadenberg screams that euthanasia in the Netherlands is simply out of control. Neither of them has any evidence for their claims.

What is more, Schadenberg has no idea about the extent of euthanasia in Canada. It is well-known that euthanasia happens in Canada, but there are no data to say how extensive it is. Professor Luc Deliens is a professor of medical sociology at the University of Amsterdam and the Free University of Brussels. He testified at the Carter Trial in British Columbia. According to the Farewell Foundation’s summary of days 6-8 of the trial,

Deliens said that he did not want to be provocative, but compared to Canada, Belgium has much more information about physician conduct in care at the end of life, and this knowledge allows for improvements in education and practice.  Deliens appeared to suggest that the Attorney General of Canada should be careful not to judge the success of euthanasia law in Belgium since Canada has very little information on the success of its prohibition law and has not taken steps to find out. [my italics]

This is important. According to the Rev’d. Dr. Paul Badham, an Anglican priest and professor theology and religious studies in Wales, and author of the book, Is there a Christian Case for Assisted Dying?(from which this quote is taken),

The suicide rate is far higher among doctors than among the general public. No doubt many factors contribute to this, but at least one is the fact that they know the implications of terminal illness, and have the knowledge and means to release themselves from it. [39]

Professor Badham believes, by the way, that there is a Christian case for assisted dying, but what is important just now is the fact that doctors themselves are aware of the misery that many people suffer at the end of life, know how to deliver themselves from it, and some of them use this knowledge for their own benefit. The basic assumption of the Euthanasia Prevention Coalition is that, if we don’t legalise it, there won’t be any of it; but this is simply not true. Even John Donne, the metaphysical poet, and Dean of St. Paul’s Cathedral in London, who also wrote a book about suicide (Biathanatos), in which he argued that suicide is not always contrary to the profession of Christian faith, said that it was well-know even then (in the 17th century) that doctors and loved ones knew how to relieve the sufferings of the dying by helping them to die more quickly.

The Church of England report on assisted dying, On Dying Well, while opposed to the legalisation of assisted dying, expresses the view that doctors know when a merciful release from life is necessary, and, rather than legalise assistance in dying, suggests that doctors, in those extreme cases where the authors of the report think that assistance in dying would be legitimate, should do the morally right thing and act mercifully, yet illegally; and the author of the introduction to the second edition (2000) expresses the view that there is not the slightest doubt

… that in those most exceptional circumstances, easing the passing of life at the request of the patient would attract the praise, rather than the opprobrium, of the General Medical Council and the courts of law. [xii]

But then he adds, in what might justly seem to be a contradiction:

Society would be singularly misguided, however, to change the legal framework for such exceptional cases. [xii]

He can only get this result by defining the cases in question as “most exceptional,” and there is no obvious reason for doing so, given that the request of the patient would depend upon the patient’s own perception of whether his or her suffering has reached intolerable levels. In 1936, when voluntary euthanasia legislation was before the House of Lords, the argument opposing the proposed legislation was throughout that physicians know when a patient’s suffering has reached intolerable levels, so the law should not interfere in something that is purely a matter of expert medical opinion.

In other words, opposition to assisted dying, which is, almost without exception, based on religious grounds, oversimplifies badly, but also tends to exaggerate and speak in apocalyptic terms, as though, with Chicken Little, they share the view that the sky is falling — or at least would be, if we were to legalise assistance in dying. There is not a shred of evidence that this is true. Jean Echlin puts her opposition in a strange way:

Not everyone [she says in the Windsor Star piece linked above] wants to be killed or wants assistance in being killed. If you want  to kill yourself you are free to do so. Do not force that decision on me or  anyone else!

But that is just the point! It’s not easy to kill yourself, and many people try to die by suicide and fail, doing great harm to themselves in the process. There are around 280,000 failed attempts at suicide in the United States every year! People who want assistance in dying, do not want to make their condition worse; they just want to bring it to an end. And they are not forcing that decision on anyone else. No one will be forced to assist a person to die, and, indeed, there are already many physicians who already help their patients to die. Those who support the legalisation of assisted dying regard this as a right which should be recognised and honoured, not a compulsion to be imposed upon anyone.

And there is no sign that that is what is happening in places where assisted dying has been legalised. Switzerland has had legal, assisted suicide since 1941. There is no sign that people are being killed against their will because of it, or that anyone is being forced to participate in such assistance. The only reason for Jean Echlin’s inflated language is religious belief. Most religions hold suicide to be a great offence against God, and in one way or another assisted dying is equivalent to suicide, since even those who cannot administer the means of dying themselves, are helped to die because of their own choice. So assisted dying is looked upon as a great evil. However, as a response to a proposed legal regime regulating assisted dying, religious belief is of no avail, so there must be other reasons for opposing it. The outcome is a host of supposedly “secular” reasons: that the vulnerable will be put at risk (not true), that the elderly will be pressured into requesting assistance to die, and will succumb to such pressure (not true), that doctor-patient relationships will suffer (not true), that palliative care will suffer (not true), that it is unnecessary, because palliative care can take care of all distress and suffering (not true), that there is a slippery slope, and we will end up where we don’t want to end up (not true). Of course, for the religious, assisted dying is where they don’t want to be, so we’ll end up where the religious want to avoid, with the first case of assisted dying, but for the rest of us this will seem a mercy, and not so ugly after all, Jean Echlin!

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*Noted later. What Schadenberg is calling “out of control” is a 13% increase and a 19% increase on very small numbers to start with, when, reasonably, one might assume, as the practice of physician-assisted dying becomes better known, and old stereotypes are consigned to the rubbish bin, that there would be a natural increase, especially since those born in the period following the war are now getting older. But this increase can only be called “out of control” if in fact there are no controls. But there are (controls, that is), so this is just Schadenberg’s customary hyperbole and religious shrillness speaking.