My father asked me to kill him. He was 74, had a stroke at 71, and couldn’t speak properly. He also had paralysis on his left side. He was a widower in a retirement home. We had tried home helpers who came in every day, but he was also very depressed which made it difficult. He was telling me in his scrambled voice: “You work in a lab. You have the chemicals to do it. He would also say regularly, “If I were a horse, you would shoot me.”
My dad, Kevin O’Neill, had a dark sense of humor, so I used to brush up on those conversations, but I knew he really meant it. I would cry sometimes when I left him in his room, his own hell apart.
Should I, out of sympathy and love, have pushed him away? It would have been murder. But what if the law allowed me to help him die? How would it have worked and would I have had the courage to do it?
Will there come a time when euthanasia will be as routine as childbirth, as we move towards a population where the majority are sick and old, with many elderly people who genuinely wish to die? Or will the discovery of new treatments for disease and better palliative care make euthanasia unnecessary?
The subject has been widely debated again in the UK recently, with the Assisted Dying Bill being debated in the House of Lords. We must face this issue head on.
Active euthanasia is legal in Belgium, the Netherlands, Luxembourg, Colombia and Canada. Assisted suicide is legal in Switzerland, Germany, the Netherlands, Victoria, Australia, and the US states of California, Oregon, Washington, Montana, Washington DC, Colorado, from Hawaii, Maine, Vermont and New Jersey. It is illegal in all other countries, as is involuntary euthanasia (when the patient is unable to give consent).
Although legal in the countries mentioned above, it is only allowed in certain circumstances and requires the approval of two doctors and, in some places, a counselor. Withdrawing treatment or medical support because it is considered futile will also hasten death, but is not illegal.
The Lords Select Committee on Medical Ethics defines euthanasia as “a deliberate intervention undertaken with the express intention of ending a life for the relief of insurmountable suffering”. However, in the Netherlands and Belgium it is defined slightly differently as “an interruption of life by a doctor at the request of the patient”. It doesn’t necessarily have to involve the relief of suffering, which is an important distinction.
The medical understanding of suffering can be difficult to pin down. Does psychological suffering matter, and how would it be measured? Perhaps the Dutch and Belgians simplified the definition for this reason.
A historic case of euthanasia in the UK occurred in 1936 when King George V received a lethal dose of morphine and cocaine to hasten his disappearance from cardio-respiratory failure. It wasn’t made public until 50 years later. But it does suggest that euthanasia may not have been so rare in Britain’s past.
Questions about euthanasia will arise more and more as the population ages. The debate revolves around four questions: the right of people to choose their destiny; that helping someone die is better than letting them suffer; that the ethical difference between the commonly practiced “disconnection” and active euthanasia is not substantial; and that allowing euthanasia will not necessarily lead to unacceptable consequences. This is the case in the Netherlands and Belgium.
With consent, the person may not be able to make the decision – determining jurisdiction is not straightforward. Perhaps they feel they are a burden on medical services or on their families. How do we know that unscrupulous friends or relatives are not putting pressure on them? Does hospital staff have an economic incentive to encourage consent?
There appears to be a growing acceptance of euthanasia in the UK. In a 2019 survey of 2,500 people, more than 90% believed assisted euthanasia should be legalized for people with a terminal illness. Eighty-eight percent believed it was okay for people with dementia, as long as they consented to it before losing their mental capacity.
In another poll, 52 percent would feel more positive about their MP if they supported physician-assisted dying, compared to 6 percent who would feel more negative.
So what about people other than religious beliefs?
Guidelines and guarantees are important. Doctors and counselors are all involved in the assessment of people requesting euthanasia in countries where euthanasia is practiced. In the United States, Canada and Luxembourg, the person must be over 18 years old. In the Netherlands the age is 12, while in Belgium there is no age limit as long as the person has the capacity for discernment.
In the United States, there is no need for excruciating pain or symptoms. In the Netherlands, Belgium and Luxembourg, patients must have “unbearable physical or mental suffering” with no likelihood of improvement, although the person is not necessarily terminally ill.
There is a danger that people with long-standing severe depression will want to end their life if they are terminally ill. This can be difficult to assess, as many people with terminal illness can also be clinically depressed.
In the United States, assisted suicide must involve a period of 15 days between two oral requests, and a waiting period of 48 hours after a final written request. In Canada it is 10 days and in Belgium it is a month. The Netherlands and Luxembourg do not have a waiting period.
In all places where it is legal, about 75 percent of people who experience assisted suicide have terminal cancer. Motor neuron disease is the second highest condition on the list, at 10-15 percent. Pain is not that common as a motivator, with issues such as loss of autonomy and dignity being more prominent.
The bottom line is that euthanasia, when properly regulated, can give us hope for a better death. We must also aim for scientific advances to bring better treatment or palliative care to those who are suffering.
When I think of the good and bad of euthanasia, I think of Christian de Duve, a famous Belgian biochemist who won the Nobel Prize in 1974 for the discovery of the lysosome. This is the cell waste disposal system: it destroys old or worn parts and can digest an entire cell when it becomes old or damaged. Lysosomes are a bit like a cell euthanizing machine.
Christian died by euthanasia in Belgium at the age of 95, suffering from terminal cancer. De Duve wanted to make the decision while he still could and not be a burden on his family. Christian spent the last month of his life writing to his friends and colleagues to let them know about his decision. In an interview published after his death, he said he intended to postpone his death until his four children could be with him. He was at peace with his decision, saying, “It would be an exaggeration to say that I am not afraid of death, but I am not afraid of what comes next, because I am not a believer.
The second person I think of when I think about this is my dad. During the winter of 1995-2006, Dad suffered several episodes of pneumonia and almost died once. In January 1996, her GP asked to see me. He suggested he might not prescribe another course of antibiotics and see if my dad could fight the last fight on his own. I knew what he was saying from the way he looked at me.
My father passed away peacefully from pneumonia (or “the old man’s friend” as he called him) in his sleep on February 20, 1996, with me sitting by his bed, holding his hand. Not a bad way to go, dad.
This is an edited excerpt from ‘Never mind the b # ll * cks, here’s the science‘by Professor Luke O’Neill, now available (£ 9.99, Swift)