The Victorian government’s proposed legislation would allow doctors to act on patients’ requests for prescription drugs that, should they choose to take them, would bring about their peaceful death.
Similar legislation has existed in the American state of Oregon for 20 years, and in neighbouring Washington for 8 years. More recently, California, Vermont and Colorado have followed Oregon’s example, as has Canada. Some European countries also permit doctors to help patients to end their lives.
The details of the legislation vary. In Oregon, doctors must state that the patient has less than six months to live. In The Netherlands it is sufficient if the patient has an incurable condition that is, in the patient’s view, causing unbearable suffering. There are also other safeguards, including a requirement for a second medical opinion, a certification that the patient is of sound mind and competent to make decisions, and a cooling off period after which the patient must make a second request before the prescription can be supplied.
We don’t yet know what conditions the Victorian bill will contain, and in any case, the bill could be amended as it goes through Parliament. In my view, physician assistance in dying should be permissible for competent adults who request it and who have a grievous and irremediable medical condition that causes enduring suffering. But even if only patients who are terminally ill can use the legislation, that would enable many people to choose a better death than they would otherwise have.
Our doctors should be able to help us die peacefully, if we request it, because pointless suffering is a bad thing while giving people more control over their lives is a good thing.
Victorian Premier Daniel Andrews is one of many whose attitude to assisted dying was changed by the experience of watching one of his parents die from cancer. When we see someone we love suffering, whether the suffering is physical or from nausea, loss of dignity, or feelings of helplessness, and there is no realistic hope of improvement, we may want to help, but if we act on a request for assistance in dying, we risk going to jail. If the person we love wants to die sooner rather than later, why should a doctor not be able to provide this final act of care for the patient?
Individual freedom does sometimes need to be restricted. We cannot permit people to do things that harm others, and sometimes, as with our seat belt legislation, we consider it justified to protect people against their own carelessness. But the requirement to wear a seatbelt is a very minor restriction on our freedom of choice, and a sensible one that prevents many deaths and injuries every year. Similarly, we should not allow lovesick young adults the freedom to end their lives because the one they love has rejected them. In those circumstances we can safely predict that the present mood will pass, and the young person will, in future, consider life worth living. In contrast, patients who choose to end their lives under the legislation pioneered in Oregon and now copied in many other jurisdictions are not making careless decisions, and their lives will not improve. Under those circumstances, why should we not be able to choose how and when we die?
When, in the 1970s, I first became interested in the legalisation of voluntary euthanasia, opponents claimed that it would be the start of a slippery slope that would slide all the way down to a Nazi-like state in which the state would end up killing people considered politically and ethnically undesirable. These predictions were never very plausible, so it is not surprising that nothing like that has happened.
There was, initially, more plausibility to the claim that disadvantaged or otherwise vulnerable people might come under some pressure to end their lives. Since then, we have had many years of experience with physician-assisted dying. Careful study of the statistics from Oregon indicates that the people who make use of the legislation are, compared with the state’s population as a whole, more likely to be white, and more likely to have a university degree, while 99 percent of them have health insurance.
Finally, it is worth pointing out that no country or state that has voted for the legalisation of physician assistance in dying has ever voted to repeal the legislation. That is because it works, it is not abused, and it gives people choices that they value.
Peter Singer is Professor of Bioethics at Princeton University, and Laureate Professor in the School of Historical and Philosophical Studies at the University of Melbourne. This address was given at the “End of Life Choices” conversation of The University of Divinity Centre for Research in Religion and Social Policy (www.centrerasp.org) on 29 June 2017. A reduced version of the address was published in the Herald Sun on 4 July 2017.