Western University Scholarship@Western Electronic Thesis and Dissertation Repository 4-14-2016 12:00 AM The Euthanasia Debate: International Experience and Canadian Policy Proposals Lorna M. Fratschko The University of Western Ontario Supervisor Dr. Gary Badcock The University of Western Ontario Graduate Program in Theology A thesis submitted in partial fulfillment of the equirr ements for the degree in Master of Arts © Lorna M. Fratschko 2016 Follow this and additional works at: https://ir.lib.uwo.ca/etd Part of the Bioethics and Medical Ethics Commons, and the Public Affairs, Public Policy and Public Administration Commons Recommended Citation Fratschko, Lorna M., "The Euthanasia Debate: International Experience and Canadian Policy Proposals" (2016). Electronic Thesis and Dissertation Repository. 3673. https://ir.lib.uwo.ca/etd/3673 This Dissertation/Thesis is brought to you for free and open access by Scholarship@Western. It has been accepted for inclusion in Electronic Thesis and Dissertation Repository by an authorized administrator of Scholarship@Western. For more information, please contact [email protected]. Abstract This thesis examines the problematic prospect of the introduction of euthanasia and physician-assisted suicide into Canadian society. The thesis argues that euthanasia is too simplistic an approach to address the complexities of end of life issues. The policy proposal under active discussion is profoundly mistaken. The language of euthanasia is examined in relation to the choice of words used, drawing attention to how words, when used loosely, can distort reality in this matter. Historical experience from other jurisdictions is presented to provide a context for this discussion. A "slippery slope" argument emerges via the claim that, in practice and in principle, euthanasia can neither be contained nor managed upon its introduction into a society. A theoretical model based on virtue theory is then used to interpret these findings and to frame a constructive response. The policy alternative of enhanced resources for palliative care is presented. It is concluded that the risks associated with euthanasia are momentous and grave while the benefits are few. Keywords: euthanasia, physician-assisted suicide, virtue theory, palliative care ii Acknowledgements My deepest gratitude is expressed to Dr. Gary Badcock, thesis supervisor. Dr. Badcock was instrumental in assisting this paper to find its shape and tenor as the many disparate strands of thought and consideration were distilled into a cohesive document. Dr. Badcock’s expert and nuanced observations based in philosophy and our 21st century reality contributed greatly to this emotional, intricate and very important topic. Huron University College extends rigorous academic and personal expectations to their graduate students. It is hoped that this thesis is a demonstration of such standards of excellence. Special acknowledgement also needs to be extended to my family and friends whose support and encouragement was constant as I worked towards the completion of this Masters level designation. iii Table of Contents Abstract ii Acknowledgements iii Table of Contents iv Chapter One Introduction 1 1.1 Question of Values 4 1.2 Summary of the Argument 10 Chapter Two Euthanasia: The Importance of Words 13 2.1 Euthanasia: A Term in Transition 14 2.2 Euthanasia: Let’s Call It What It Is 15 2.3 Loose Language: Loose Concepts: Loose Boundaries 18 2.4 The Romanticization of Euthanasia 23 Chapter Three Euthanasia in Historical Perspective 29 3.1 The Philosophy of Suicide 31 3.2 Changing Views of the Human Body 35 3.3 The Birth of Eugenics 37 3.4 Euthanasia and the Holocaust 39 3.5 The Resurgence of Euthanasia 44 3.5.1 Watershed Medical Cases 46 3.6 After the Holocaust 53 3.7 Alternatives to Euthanasia 55 iv Chapter Four Euthanasia: The Slippery Slope Argument 58 4.1 A New Moral Boundary – Abortion 59 4.2 Euthanasia: The European Experience 63 4.3 Proposed Canadian Legislation: Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying 74 4.3.1 Conscientious Objection 74 4.3.2 Waiting Period 77 Chapter Five The Virtuous Alternative of Palliative Care 80 5.1 Euthanasia Through the Lens of Virtue Theory 81 5.1.1 Virtue Theory 83 5.1.2 The Language of Virtue Theory 84 5.2 Virtuous Behaviour and the Profession of Health Care 89 5.3 The Alternative: Palliative Care 94 5.3.1 History of Palliative Care 97 5.3.2 Contemporary Canadian Status of Palliative Care 99 5.4 Euthanasia: An Immoral Act 102 Chapter Six Conclusions 111 6.1 Euthanasia: Radical Social Policy 112 6.1.1 Euthanasia Represents a Departure from the Healing Commitment of Health Care Professionals 112 6.1.2 Euthanasia Establishes a Continuum of Worthiness In Society 114 6.1.3 Euthanasia: Absolute Power Corrupts Absolutely 115 6.1.4 The Social Price of Euthanasia 118 v 6.2 Euthanasia: Worth the Risk? 121 Bibliography 129 Figure 1: Organizational Chart: Terms of Euthanasia 16 Appendix A: Archbishop of Canterbury Justin Welby Letter to the British Parliament Why I believe assisting people to die would dehumanise our Society for ever 134 Appendix B: Canadian Nurses Association: Physician-Assisted Dying Brief for the Special Joint Committee on Physician-Assisted Dying January, 2016 138 Appendix C: Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying. Final Report. November 30, 2015 154 Curriculum Vitae 267 vi Chapter 1 Introduction It is better for humans to shape rather than to be shaped by their circumstances. Humans do this mainly through the use of technology, and yet paradoxically, today there needs to be limits on the power of technology, in view of its own dehumanizing potential. Technological efficiency, in and of itself, is not the goal of human life, and we encounter its limitations in a myriad ways in our world. In higher education, to take one case in point, there is no substitute for the humanizing role of face-to-face interactions between teacher and student in traditional classroom and seminar settings, however much the efficiencies of impersonal on-line media might be trumpeted by government and industry. The list of problem areas could be multiplied, but one particular question arising in relation to current policy debates about the use of medical technology in Canada provides the particular rationale for this thesis. In our time, advances in medical technology and scientific knowledge are providing humanity with an unprecedented ability to actually manipulate life and death.1 The current euthanasia and physician-assisted suicide debate is a result of these medico-technological advances. The argument of this thesis is that the proposed introduction of euthanasia and physician-assisted suicide in contemporary Canada places us at risk of becoming the servant of 1 Kevin Yuill, Assisted Suicide. The Liberal, Humanist Case Against Legalization (UK: Palgrave Macmillan, 2013), 65. 1 technology, and in the position of needing to clarify the centrality of our common humanity in medical ethics. A key point is that alternatives to euthanasia and physician-assisted suicide exist. These have proven successful in other jurisdictions, and their use could be extended in Canada in response to most, if not all, of the issues that the demand for assisted death involves. Scientific innovation has placed people in our society in the position of being “technological giants but ethical infants.”2 We have an almost infinite capacity to uncover new knowledge but only limited wisdom concerning how best to apply this knowledge. New medical situations and innovations pose unfamiliar problems for which traditional ethical principles and historical moral standards are ineffective. End of life issues, specifically euthanasia and assisted suicide, raise such questions in a particularly acute form. Humanity can, however, apply its wonderful resourcefulness, creativity and compassion to finding solutions and alternatives to end of life issues. Our resourcefulness, which has brought about this debate in the first place, can thwart this circumstance of medical technology placing humanity in the dangerous position of being its servant. Current medical technology means that death is now preceded by an ever- lengthening period of physical and mental decline.3 Scrupulous attention to this balance of technology and the issue of end of life is demanded. The euthanasia debate is momentous and necessitates honest dialogue. Consequently, the language employed in this debate is extremely important. The importance of our language and consequent understanding of our intent is underscored by the philosopher Ludwig Wittgenstein’s 2 George H. Kiefer, “Whither Bioethics” (paper presented at the U.S. Student Pugwash Conference, University of California, San Diego, June 19-26, 1979). 3 Samuel I. Greenberg, Euthanasia and Assisted Suicide. Psychosocial Issues. (Springfield, Illinois: Charles C. Thomas Publisher Ltd., 1997), 90. 2 quote “The limits of my language means the limits of my world.”4 The language of the euthanasia debate may well define the earthly limits for our most vulnerable; the ill, the elderly, the poor and disabled amongst us. Clear and concise words are needed so that clear thinking and accurate critical analysis may be applied to this complex issue. The proposed legalization of euthanasia and physician-assisted suicide represents a potential sea change in the foundation of our society. Such action will alter key aspects of the normative foundation of Canadian society. Part of the normative foundation of our society is found in the principle that it is wrong to kill. In fact, one of the most important rules on which we base our societies and their legal systems is that we must not kill each other.5 This is, at bottom, the reason that capital punishment is no longer legal in Canada, and yet we now propose to introduce forms of medicalized killing that conflict with that prohibition. Yet there is an important parallel between the two: as with capital punishment, euthanasia, were it to be legalized, would fall outside the traditional justification for taking life.