The Line We Shouldn’t Cross: Voluntary Assisted Dying

Voluntary assisted dying (VAD) is a difficult and profoundly emotional topic. In the same manner as abortion – if not more so – all must consider its implications, as it speaks to an unavoidable facet of the human condition: death.

Death is not an easy word to discuss, and certainly not in the context of family or friends; humans are predisposed to hate suffering and sadness. Nonetheless, this article must confront reality, and that includes the protracted, painful deaths of Australians that occur daily in NSW. This reality is horrific. It robs happiness, dignity and life. It is for this reason that personal experience (justifiably) inclines the opinions of many Australians toward the legalisation of VAD – as it does for me.

However, a perspective that reconciles individualised emotion with VAD’s greater ethical implications will reveal it is not simply ‘the humane option.’ A vote to legalise VAD is one that leads down a perilous course, undermining the value of human life itself.

It should first be clarified that most activists for VAD do not intend to diminish the inviolability of human life. The argument often raised is ‘VAD should be accessible to the terminally ill, and only if pain relief through palliative care is unavailable’. This is a reasonable argument.

Yet despite untreatable pain being the law’s priority, experience from the Netherlands indicates that it does not become the ultimate focus of VAD. First legalised in 2002, two decades of legal euthanasia have now prompted calls to allow anyone over 75, without a diagnosis of physical or mental illness, to request euthanasia. The proposal does not exist solely in the realm of speculation; some claims suggest 60-70% of the Dutch public agree.

The expansion of VAD is not some purely hypothetical slippery slope. Indeed, an alarming trend of continuously increasing participation rates has been observed across Western Europe, stemming from twenty years of data. In Belgium, annual deaths have expanded elevenfold since 2003, increasing from 235 to 2655 (2019). In Switzerland, deaths have grown from 43 in 1998 to over 1000 today, a more than twentyfold increase.

Looking beyond the laws themselves, something has indisputably changed in the mindset of the old and the ill, with progressively more Europeans ‘opting in’ to assisted suicide. Why? And why is it that Australia has only begun to genuinely consider the legalisation of VAD in the 21^st century?

Article 3 of the Universal Declaration of Human Rights states that everyone has the right to life. In the context of the Second World War and its characteristic abominable genocides, state-sanctioned disregard for human life was unprecedented. Today, nobody would dispute the statement that ‘everybody deserves the right to life.’ Yet perhaps our society has lost the perspective of the UDHR’s authors; to the survivors of indiscriminate slaughter, racial genocide and systematic eugenics, it became unconscionable to believe that anybody could reach a point where they are without value.

The value of human life, the foundational principle of human rights, applies universally. In accordance with the UDHR it is also “indivisible and inalienable”. These principles declare that our right to life cannot be revoked, surrendered or transferred.

Legalising VAD steps over a line never before crossed in New South Wales: the line at which the state begins defining which lives are worth living, and where the right to conscious human life becomes revokable. If we choose to cross this line, the consequence of a ‘right to die’ will inevitably, even if unintended, begin messaging an ‘obligation to die.’

What message will legalising VAD send to elderly grandparents who are afraid they are becoming burdens on their families? Despite constant academic denial, there are signs of a Benthamite utilitarianism surging throughout the West. Philosopher Jeremy Bentham described utility as ‘produc[ing] benefit, advantage, pleasure, good, or happiness,’ claiming these were the ideal objects of society. Bentham’s supposition contains abhorrent implications in the context of VAD. Consider the age-old line ‘I don’t want to be a burden,’ common amongst elders of western cultures. If grandparents who require additional care are no longer producing Bentham’s suggested utility, the logical progression of VAD implies that they should consider ending their lives for the sake of their children and society.

The largely ignored psychological and financial abuse of our elders must also be considered; this is exemplified by the Royal Commission into Aged Care’s findings. Undue influence placed on older Australians to end their lives will be an unavoidable by-product of VAD’s legalisation, whether from family seeking an inheritance or others hoping to lessen a societal burden.

What message will legalising VAD send to those suffering mental illness, believing their lives to be worthless? We would be hard-pressed to justify telling our friends that ‘self-harm is never worth it’ whilst simultaneously claiming there exists a benchmark of intolerable human suffering. It is said that ‘suffering is subjective’ – in the minds of the suffering, who are we to claim that, for example, their depression isn’t severe enough to qualify for VAD? One look at the case of Aurelia Brouwers, a Dutch woman euthanized when suffering no terminal illness, reveals VAD’s underlying direction. Her circumstance is not unique, with figures from Belgium disclosing over 1000 annual euthanasia cases are justified on the basis of ‘suffering caused by psychiatric conditions.’ A stance against VAD is a stance against suicide in all forms; rather than abandon people who suffer, we should seek to save them.

What message will legalising VAD also send to those with disabilities which limit their cognitive or physical activity? Studies indicate that one of the largest motivations for VAD is ‘loss of autonomy or dignity.’ Nobody anticipates a time where they can no longer cook their own meals, or perhaps require assistance from family or technology to use the bathroom or bathe. However, for many, this is the reality of daily life, often by birth or injury. Disabled Australians, in the same manner as elderly Australians, are not sub-human. There cannot be a list of dignity requirements to be ‘properly living,’ self-defined or otherwise, else we delve into the dark realm of eugenics. Human life, of all abilities, is worth preservation.

For proper preservation, palliative care is the key determinant. Whilst over the past 70 years the arguments for and against euthanasia have remained largely unchanged, the capacity of palliative care to supply pain relief to the many patients has significantly expanded. Implementing VAD will provide the NSW Government with an easy option of offering VAD to those most suffering, stunting incentive to invest in end-of-life care from both public and private sources. It should further be noted that, in future, unforeseen treatments will bring hope to those currently without the prospect of recovery.

All things considered, concluding that VAD should remain outlawed is still a difficult position to communicate. Personal experiences undoubtedly factor into public discourse on the topic, and oftentimes individual stories are harrowing. To reiterate, for those suffering untreatable pain from a terminal illness, the option to terminate their life seems reasonable, however, the outcome will be the inevitable expansion of VAD’s scope, expansion which cannot be justified. Legalising VAD will cross the debate’s only firm boundary – the irrevocable value of human life.

It’s time to begin recognising terminally ill Australians and their carers as the champions of human life’s inalienable value. Our focus should centre on the continued research and implementation of effective palliative care, enabling a future where no untreatable pain exists. Let’s do the right thing by our oft-forgotten champions and invest in an even greater palliative care capacity.