Euthanasing the disabled

Last week, the Supreme Court of the Canadian province British Columbia released its decision in the Carter v Attorney Geeral Canada case.  The decision lifted the ban on physician-assisted suicide, and followed a courtroom battle late last year.  While some lobby groups welcomed the decision, other groups lamented the development and encouraged residents of British Columbia to write to their politicians in protest. 

Many people assume that objections to euthanasia or assisted suicide are only grounded in religious beliefs relating to the sanctity of life and a belief in the divine breath that animates human existence.  Some supporters of euthanasia state that human life is not sacred. Other supporters of euthanasia acknowledge the mystery of life and death and see assisted suicide as a personal decision and a means of self-determination; a legitimate way to decide to end their suffering.  

But there are many objections to euthanasia or assisted suicide based solely on public policy reasoning, rather than religious belief.  Some argue against assisted suicide for based on precedent and the so-called ‘slippery slope’.  Others argue against it because it places medical professionals in a difficult ethical predicament.  And others argue against it out of concern for vulnerable groups such as elderly or disabled people. 

In fact, people with disabilities are a significant protest group in euthanasia debates.  However, their minority representation, vulnerable status and the limitations of both people with disabilities and their carers means their voice is frequently muffled in public discussion.  This is despite the compelling reasons for the opposition of many in the disability sector to euthanasia in all its forms.  

Dr Gregor Wolbring of the University of Calgary presents these reasons by refuting each of the four safeguards proposed by euthanasia advocates.  He argues that the scenario proffered by the right-to-die movement – a terminally ill, mentally competent adult patient in physical pain who seeks to make their own decision about their death – is a carefully chosen case designed to elicit sympathy for the cause.  Such a case masks the sinister implications of euthanasia for people with disabilities. 

In response to the first criterion, that euthanasia must relate to a terminal condition, Wolbring cites numerous euthanasia supporters who have broadened the definition of ‘terminal’.  Terminal patients are variously incorporated with those who are in constant suffering for which there is not hope for recovery (‘incurable’), those who are fearful of dependence and who wish to avoid possible ‘indignity’, or with people perceiving their medical condition to be ‘violating their fundamental values’. 

Wolbring also quotes right-to-die advocates arguments that euthanasia should be available to ‘severely disabled’, or ‘any competent individual who has a good reason to die’.  In Australia, South Australia’s Voluntary Euthanasia Bill 1996 characterised those requesting euthanasia as being ‘hopelessly ill’, which was defined as having ‘an injury or illness that  … seriously and irreversibly impairs the person’s quality of life so that life has become intolerable to that person.’

The second gauge proposed by euthanasia advocates and refuted by Wolbring is euthanasia being only for a person who can provide informed consent, a ‘competent’ adult.  However, Wolbring notes the Canadian murder cases successfully defended by parents who have ‘euthanased’ their disabled children.  

On the third point, that euthanasia is designed to end physical pain, Wolbring notes how emotional pain is now included by a number of jurisdictions, for astonishingly broad reasons such as ‘physical condition’ (after all, gender, race and other minority groups are ‘physical conditions.’) 

I would add the remaining irony in the inconsistency of approach to various people wishing to end their lives. A young, fit, healthy person wishing to kill themselves is offered psychiatric treatment, whereas an old, disabled or ill person who wishes to end their life is accorded the ‘right to die’, even if they are psychologically affected.  This includes grief or depression over an inability to adjust to a disability.

The final argument, that euthanasia offers self-determination, is more difficult.  On the one hand, people with disabilities would be discriminated against if they cannot make their own decisions as would others in society.  On the other hand, it is discriminatory to accept that acquiring disability is grounds to end one’s life. 

For example, the position of other people with a perceived poor quality of life such as some indigenous groups, drug addicts, prisoners and homelessness would not be acceptable as a basis for suicide.  Moreover, it would be discriminatory to not assist people to come to terms with their disability when they wish to die, just as it is discriminatory not to assist people to come to terms with their sexuality or mental illness when they are suicidal as a result.  

Interestingly, although at the end of last year a poll indicated that two thirds of Canadians supported medically-assisted dying, media polls after the British Columbia decision reflected the opposite view.  Euthanasia advocates attributed this to pro-life lobby groups stacking the poll results.  I prefer to hope that maybe Canadian people are more circumspect after physician-assisted suicide became case law.

Moira Byrne Garton has completed a PhD in politics at the Australian National University, and works part-time as a policy analyst. The mother of four special kids, including one with undiagnosed severe physical and intellectual disabilities, she is strongly engaged with disability issues.