Advocates of euthanasia argue that it offers greater autonomy in certain end-of-life situations or where life-prolonging treatments have reached their limits. A new report by the conservative think tank MCC Brussels claims that legalizing euthanasia, on the contrary, increases bureaucratic control.
A new film directed by Pedro Almodovar – The Room Next Door – deals with a similar dilemma, assisted suicide. The film follows two friends in the US, where one of them is asked to keep the other company when she is ending her life due to terminal illness. While euthanasia is forbidden in the US, physician-assisted suicide (medical aid in dying) is allowed in some states.
The author, Dr. Ashley Frawley, a sociologist and visiting research fellow at MCC Brussels, presented the report at a public meeting in February followed by a panel discussion aiming at contributing to the euthanasia debate in Europe. The report examines what it claims to be a growing movement to legalize euthanasia across Europe.
It gives examples of manipulating language ("death with dignity"), intensifying strategic lobbying, empowering bureaucracy to take life-ending decisions, and devaluating the inherent value of human life. Euthanasia means 'easy death' in Greek. In what currently is a national competency, efforts to harmonize euthanasia laws risk undermining national sovereignty, according to the report.
Despite its harsh findings or claims, the report ends with a number of recommendations that could be accepted across political differences of opinion: The public debate should not be prejudiced by ambiguous language. Decisions on euthanasia must remain under the jurisdiction of individual EU Member States. Where euthanasia is legalized today, strict conditions should not become less-severe.
According to the report, we need to be careful with harmonisation of assisted suicide. Can you explain how that could happen? Even if there was a right to die, how could this be enforced given the principle of subsidiarity in the EU?
“As I state in the report, to date, institutions at the European level have rightly demonstrated reluctance,” Ashley Frawley replied. “The European Commission reiterates that healthcare falls under the jurisdiction of member states.”
“However, campaigners continue to pursue e.g. strategic litigation by bringing cases to the European Court of Human Rights and have petitioned European Parliament for EU legislation.”
“While the principle of subsidiarity should limit any top-down imposition, vigilance is nonetheless necessary because of attempts by advocates to exploit other competencies to ‘get their foot in the door’ through strategic targeting of particular Member States, where success in one state is used to press neighbouring states to follow suit.”
Less than a quarter of the Member States of the Council of Europe have euthanasia laws but there are active pushes for legislation in many of them, she says. “If they had all legalised euthanasia, there would be no need for this report.”
“Unfortunately, what often happens is that once something is in law, the tendency is for things to stay that way or for there to be progressive expansion. Hence that I wrote this report warning people across Europe to be wary of the movement to legalise euthanasia which is quite likely sooner or later to come home to them too.”
“To say that legalisation of euthanasia in one EU Member State is enough to push another state to do the same is a baseless claim,” a human rights lawyer who attended the debate told The Brussels Times. “Outlandish claims about politicians wanting to enact far-reaching euthanasia laws are aren’t confirmed from the debates in different countries.”
The panel discussing the report on euthanasia, credit: MCC
Do you accept that there are situations when life-sustaining and life-prolonging treatments have reached their limits? For example, in a situation when death is imminent despite the means used, it is justified to withhold treatments that would only prolong a precarious life of suffering?
“Yes, but the decision to end life-prolonging treatment is quite different from the decision to actively euthanise someone,” Ashley Frawley replied. “The ability to refuse treatment is a generally accepted principle. It’s confused with the active and direct termination of someone’s life to muddy the waters.”
“This confusion is fostered by ‘softer’ euphemisms that make it unclear what exactly is being legalised. A 2021 survey in UK found that more than half of the respondents misunderstood the term ‘assisted dying’, confusing it with already legal practices like refusal of life-prolonging treatment and providing hospice-type care for those who are dying.”
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“If you are talking about people in e.g. a coma where death is not soon foreseeable, then we aren’t talking about autonomy and choice-making anymore - the typical headline of our debate.”
Ole Hartling, a retired medical doctor and former chairman of the Danish Ethical Council, participated in the panel. A few years ago, he published ‘Euthanasia and the Ethics of a Doctor’s Decisions. An argument against assisted dying (Bloomsbury Academic 2021).
He agreed that there are situations, as defined in within the Danish health law, to withhold treatment that might only prolong suffering and meaninglessness.
“It’s a paramount duty of the doctor and other health staff to alleviate suffering, and I like to put it in this way: ‘You must not be so frightened of death that you do not alleviate, because that is an unremitting obligation’”.
But there is a difference between euthanasia and withholding treatment, in his view. “If euthanasia is seen as a ‘treatment’, it must be viewed as a failure, if the patient doesn’t die, whereas with alleviation of symptoms (or discontinuance of treatment), it’s not a failure if the patient doesn’t die, because it was alleviation not death that was the aim of the treatment.”
In other words, if life is inherently sacred, interrupting a treatment could only be acceptable if there is a chance that the patient will survive – but is not the purpose of withholding the treatment the opposite?
In a position paper in 2019, the three Abrahamic religions, Christianity, Islam and Judaism, that all sanctify life and oppose any form of euthanasia, argued that it is justified to make the decision to withhold certain forms of medical treatments that would only prolong a precarious life of suffering, when death is imminent, despite the means used.
How autonomous is a person’s decision in an end-of life situation? On what conditions would you accept a decision taken by a person who chooses euthanasia if he would find himself in an end-of-life situation because of a terrible accident with no prospect of recovery or an incurable illness causing unbearable suffering?
“There are several problems with exerting autonomy, which I have described extensively in my book,” he told The Brussels Times.
He listed a few reasons. First, a person who uses his or her presumed right of self-determination to choose euthanasia or assisted suicide definitively precludes him/herself from deciding or choosing anything forever. “Where death is concerned, autonomy can only be exerted by disposing of it for good.”
Second, the decision about one’s own death is not made in a situation where the person is in supreme self-control, because wishing for one’s own death is not a day-to-day state. It is a wish that arises against a backdrop of desperation and a feeling of hopelessness, and possibly a feeling of being superfluous.
The choice regarding one’s own death therefore becomes so completely different from the majority of other choices usually associated with the concept of autonomy. “How autonomously can the weakest people act when the world around them deems their ill, dependent and pained life unworthy?”
Third, autonomy is not the only factor or the key factor when deciding whether euthanasia should be granted. It is not only the patient’s own evaluation that is crucial. The patient’s life-value is also required to be assessed as sufficiently low. “That is to say that the justification for so-called voluntary euthanasia is borne on the premise that certain lives are not worth living.”
If asked by someone what to do in a situation like the above, can we know what the person wants us to answer? Is our answer influenced by our own fear?
“The answer will hardly be influenced by fear but rather by the legal setting in which the patient-doctor relationship takes place,” he replied. “You can never preclude that in an ethical dilemma you would act in a way that in principle you would otherwise refrain from."
He gave the example of the ‘classical’ example of the soldier stuck in a burning jeep. ‘Shoot me,’ he entreats his soldier comrade, ‘before I get burned to death!’ In that extreme case the killing would be ethically justifiable.
“I think this has to do with duty ethics (deontology). An opposition to legalized assisted death may on the other hand rely on consequential ethics, i.e. a deliberation of what legalization could mean for the culture and the general population – that is in fact for other singular cases.”
How is the legal situation in Belgium? Can any lessons be learned from Belgium, a frontrunner in euthanasia legislation? In 2002, Belgium became only the second country in the world to legalise euthanasia, two months after its neighbour the Netherlands.
Since then, Belgium and the Netherlands have been joined by a number of other countries that have made some form of assisted dying legal, including Luxembourg, Spain, Canada, New Zealand, and Australia, as well as some US states.
As previously reported, Belgium's euthanasia law covers "the deliberate termination of life by someone other than the person concerned, at that person's request". Specifically, the law states that a patient can request euthanasia when:
- they suffer from persistent unbearable physical or psychological suffering
- the suffering is due to a severe and incurable illness caused by an accident or disease
- the request for euthanasia must be voluntary, deliberate and in writing repeatedly
Euthanasia in Belgium may only be practised by a doctor, who applies drugs either intravenously or orally (although the latter is rare).
In a case on the right to life and the right to respect for private and family life (Mortier v Belgium, articles 2 and 8 of the European Convention on Human Rights), an applicant claimed that the Belgian authorities had failed in their duty to ensure that he had been informed about and involved in his mother’s euthanasia process.
The European Court of Human Rights ruled in 2022 that it considers that the applicant’s right to respect for his private and family life was not breached solely on account of the fact that his mother underwent euthanasia. The Court found that the Belgian legislation, as applied in the case, struck a fair balance between the different interests at stake.
Since the law's introduction, Belgium has recorded around 2,500 cases of euthanasia every year and the number is growing. In 2023, the number of euthanasia procedures increased by 15 % to 3,423 cases. Cancer remains the primary justification for euthanasia. Psychiatric conditions made up only 1.4% of total cases.
