This post was first published on 30 March 2012. I have placed it here to give Jerry Coyne a URL for this post, which he may use in his new book.
Alex Schadenberg, the Executive Director of the Euthanasia Prevention Coalition, a Canadian Roman Catholic pressure group opposing assisted dying of any kind — holding even that the death of the brain-dead Terry Schaivo was murder! – and takes every possible opportunity to oppose the right to assistance in dying on the basis of Roman Catholic “pro-life” dogma (but what I choose to call the Roman Catholic death cult). He and his tiresome organisation intrudes in people’s lives even when such intervention is not only unwelcome but insulting and demeaning, and despite the fact that he has no special qualifications in bioethics, has managed to get his tendentious nonsense published in the National Post. In an article entitled “Legalizing euthanasia would leave the vulnerable unprotected,” he drags the old chestnut once again out of the fire, dusts off the burnt bits, and presents it as newly minted, hot-off-the-press, information that is vital for our society. I have (for the sake of full disclosure) a focused animus against this presumptuous and despicable man who speaks with such suffocating self-righteousness, for it was he who reported me to the police after I had returned from accompanying my wife Elizabeth to the Dignitas Clinic in Zürich, where she was helped to die before what she feared — being trapped in her body by MS — would prevent her from acting as she chose. It was a fate which, in her view, would have been far worse than death itself. It is people like Schadenberg who make sure that people like Elizabeth die before they really want to, for fear of being trapped and unable to receive the help in dying which they seek.
At the time (June 2007), a physician spokesman for the Euthanasia Prevention Coalition claimed that it was important to have reported me to the police, in order to protect those who in future might be “bundled onto an airplane” (obviously implying that this was the case with my wife Elizabeth), and taken away to be killed against their will. And, the EPC said, it would do the same again, putting others on notice that if they should seek the release that only death would bring, they would make life as uncomfortable as possible for their loved ones. (At one point I sent an email to Schadenberg objecting to something which he had published in his newsletter, and he complained, of all things, of being harassed!) When the EPC received a great deal of unsympathetic coverage, in which it was suggested that it and its officers should mind their own damn business, Alex Schadenberg wrote a long, explanatory letter to the Halifax Chronicle-Herald, trying to convince people that there were very serious social issues at stake here which people routinely ignore, issues that need to be emphasised against what he considered widespread ignorance of the real significance of support for assisted dying (a term, of course, which neither Schadenberg nor other EPC officers will deign to use, preferring to see aid in dying as simply another permutation of murder), a significance expressed by Pope John Paul II (Pope Karol Józef Wojtyła) by the words “culture of death.” At the same time, the EPC lawyer, Hugh Scher, in a TV appearance, suggested that I had been guilty of the crime of assisted suicide, and at least some of the more extreme of those who heard him at the time rubbed their hands together in glee at the prospect of someone so dastardly and evil as me being locked up for a very long time indeed.
So, of course, it is not surprising to see Alex Schadenberg serving up his by now rather tiresome litany of abuses that he believes will immediately follow on any form of legalisation of assisted dying in Canada, abuses which he continues to allege to be rampant in jurisdictions in which assisted dying has already been legalised. His immediate target, of course, is the recent report by the special commission in Québec on the right to die with dignity, in which the legalisation of assisted dying is straightforwardly recommended. One of the important aspects of the Québec recommendations is that legalisation of assisted dying is not limited only to those with terminal illness. Of course, this is something that Schadenberg takes great exception to, since he believes, wrongly, as it turns out, that this would put the generic “vulnerable” at risk — which of course is the main burden of his National Post piece. Yet there is simply no evidence, in any jurisdiction where assisted dying has been legalised, that the so-called “vulnerable” are put at risk. This, as I have pointed out before, is a gratuitous bit of scare-mongering by those who oppose assisted dying on completely different grounds, usually religious ones. However, this does not stop Schadenberg. Not at all. He just serves up his scary confection once again, with practically no variation or attention to the actual detail of the reports and articles that he refers to. Referring to studies is meant to provide credibility, because he does not expect people actually to read anything which he cites in defence of his position. The scary scenario is what counts with Schadenberg, even if there is no reason to be afraid.
Besides, Schadenberg, by repeatedly speaking of the so-called “vulnerable” who will be put at risk by assisted dying legislation, seems to be unaware that these so-called “vulnerable” are quite as able as other people to campaign for their rights, and that some of them, who reported to the Carter trial before the BC Supreme Court, argue that they have as much right as other Canadians to seek the remedy of assisted dying should their suffering become too great to bear; and that to use the so-called “vulnerable” as those who will be put at risk by assisted dying legislation is to infantilise them, and to suggest that they are unable to stand up for themselves, or to turn away the blandishments, as we are to suppose, of those who think they ought to be dead. (For testimony before the Carter trial, I have depended on summaries provided on the Farewell Foundation website, of which this is the first. The rest are accessible by clicking on the link at the top right hand of the page.) An Ad Hoc Coalition of People with Disabilities Who are Supportive of Physician-assisted Dying was an intervener in the Carter Trial, and it was argued on their behalf that they
… support freedom of choice in end-of-life decisions, including the freedom to choose physician-assisted dying for qualifying adults of sound mind, as a step forward for the disability rights movement that is consistent with the principles of autonomy and self-determination.
In other words, the Euthanasia Prevention Coalition has no right to speak on behalf of the disabled and other supposedly “vulnerable” people, and their claim to speak for them is an empty one.
Moreover, as the Ad Hoc Coalition argued, unregulated assisted dying is already taking place. It would be safer to bring this out into the open, rather than keeping it behind closed doors where no one has any idea how extensive the practice is, and on what grounds assistance is provided. Indeed, on one occasion during the trial, Professor Luc Deliens, who testified from Belgium by video conference, said that, while reporting of assisted dying in Belgium was not 100%, this did not help the government’s argument that assisted dying is a risk, because, as he pointed out,
Canada has very little information on the success of its prohibition law and has not taken steps to find out.
This argument is pretty decisive against Alex Schadenberg’s article as well, for he takes almost as unquestionable the reported rate of depression amongst those receiving assisted dying in the Netherlands, as though this were a decisive argument against assisted dying, when it is simply not known to what extent — in Canada – depression and withdrawal of treatment or even assistance in dying are linked, because Canada merely has a legal prohibition, and has never enquired as to the extent to which the prohibition is respected.
Schadenberg refers to an article which he says was published in the journal Clinical Oncology in 2005, which perhaps refers to one in the same journal in 2004, entitled “In the Terminally Ill, a Wish to Die is a Manifestation of Depression and Should be Treated Accordingly.” (Clinical Oncology (2004) 16: 319-320) Yet two things should be mentioned here. Depression, or some degree of existential angst, is no doubt normal in those who are dying in miserable circumstances; and, second, even if a patient is manifesting symptoms of depression, it does not follow (a) that the patient should be required to undergo treatment (since treatment is optional and can be refused under common law); and (b) there is no evidence that depression impairs judgement. There is, in addition, no evidence whatever that depression affects people in the ways suggested by Schadenberg, making those who are depressed by the circumstances of their dying especially vulnerable to being abused. This is simply an unsubstantiated assumption.
Schadenberg, along with many other opponents of assisted dying, continue to claim that the statistics out of the Netherlands and Belgium show that laws governing assisted dying are being abused, because, in some cases, especially in those cases where people are very near death, and the trajectory of their disease turns suddenly and unexpectedly for the worse, people who are in misery are being helped to die without their explicit consent at the time that assistance is given. However, it is important to notice a number of things. In many of these cases, large doses of opiates are used to relieve pain and distress. There is some question whether or not these are cases of euthanasia, although they are apparently considered to be euthanasia for the purposes of the studies that have been conducted. In most cases, doctors had earlier consulted patients about their desire to be helped in such circumstances; in other cases, family members were consulted; and in still other cases (there being some overlap between these different scenarios) other physicians were independently consulted. And still we have no knowledge whatever about the number of patients in Canada who are being helped to die, notwithstanding the law which criminalises such assistance. Schadenberg’s claims are empty, and without substance. All that is necessary for Schadenberg is the appearance of dubious practice, and he thinks he has an ironclad case against assisted dying, but, in general, all he has shown is that, while some cases are not reported in the Netherlands and Belgium, in many of these cases there are good explanations why they are not reported (because they were not thought of as euthanasia by the doctors who used opiates to control pain whose secondary effect may have been to hasten death), and when they are studied there is no evidence of negligence or of putting patients unnecessarily at risk, and no evidence at all that the so-called “vulnerable” are chiefly at risk.
Schadenberg brings his National Post article to an end with this paragraph:
Currently, the law clearly states that no one can kill another person. If euthanasia becomes legal, killing another person becomes acceptable under certain conditions — conditions that are changeable and dependent on the ethics of others. It would be very difficult to protect a vulnerable person under these circumstances.
This is simply false. Schadenberg says that the conditions under which assisted dying would become acceptable, were assisted dying legalised, would be “changeable and dependent on the ethics of others.” It is not altogether clear what this means, although he seems to be suggesting that the law would not have any controlling function at all, and that doctors and nurses would act merely upon their own subjective values (or whims?). But this is nonsense. This is, once again, simply a scare tactic. There is no reason this should happen, because the primary decision maker in any proposed assisted dying legislation is the person him or herself, not those who will provide aid in dying. We are not asking other people to judge when someone’s life is no longer worth living. That is for the individual himself or herself to decide.
Schadenberg wants us to believe that there will inevitably be some sort of free-for-all if we legalise assisted dying. Nothing could be further from the truth. At the moment people are being helped to die in a number of ways, but inconsistently, since there are no laws governing what doctors do at the end of life. Many doctors, being compassionate people, will help their patients die when suffering becomes intolerable. Some will not. All doctors are required to withdraw treatment at the patient’s request, and so those whose lives depend upon treatment have the option to die when they wish, simply by having treatment withdrawn, though the outcome may be a miserable, lingering death. What proponents of assisted dying are claiming is that every person has a right to be in control of the end of life, whenever they choose that to be. If someone finds their condition in life intolerable, because the suffering that their condition consigns them to has become too much to bear, they should have the option of help to die. Those, like Schadenberg, and other opponents of assisted dying, say that people have the right to die by suicide if that is what they want. What they object to is involving someone else in their death. However, suicide is a chancy business, and most people who try to kill themselves fail, sometimes worsening their situation. And some, of course, like Sue Rodriguez, are unable, because of increasing disability, to die without assistance. (And then, of course, the question arises, is this “killing”, in a direct sense, or, with the consent of the suffering person, is it more like suicide? I think it is closer to the latter, and is inappropriately referred to as killing.) The circumstances are doubtless complex, but there is no reason that Schadenberg’s free-for-all should eventuate. This is simply religious scare-mongering, and though increasingly common, is remains a contemptible and vacuous form of special pleading.
I merely add, as a final comment, that it is this kind of religious intervention in issues that are none of their business, that makes it very difficult for reasonable people to give religion a charitable hearing. Religion is so often involved in actions and programmes that interfere with the lives of others, and with their human rights, that trying to understand religion in the most charitable way possible is simply to ignore issues of enormous concern to individual rights. Religious institutions are very avid to gain power and control over as much of society as possible. The emphasis placed by most religions on women, their subordinate relation to men, and on control of women’s reproductive function and sexual choices, is clear evidence of this desire for power and control. Giving religions as charitable an interpretation as possible, and trying to exist on peaceful terms with it, is to ignore religion’s tendency to arrogate power to itself. Speaking for myself, I do not think that disbelievers should seek friendly relationships with religion. What we should be doing is appealing to liberal religious voices to separate themselves from the more conservative, fundamentalist or literalist understandings of religion, and stand on their own, so that nothing that liberal religious believers do can be construed as support for the most regressive forms of religion. If religious liberals were to do this, then there might be reason to support the liberal religious project, or at least to accord it some respect, but so long as religion expresses itself in organisations like the Euthanasia Prevention Coalition in Canada, or Care not Killing in Great Britain, it is unreasonable to expect unbelievers to treat religion with either charity or cooperation. This is where people like Julian Baggini, in my view, go so far astray, for they do not seem to recognise that religions are dangerously regressive forces which seek power and control, and are perfectly willing to subvert the rights of individuals in order to see their own moral priorities transformed into law, or to preserve laws in which those priorities are still enshrined. I want no part of this submissive toadying to religious power.