Tag Archives: euthanasia

Victoria may soon have assisted dying laws for terminally ill patients

The Conversation

Ben White, Queensland University of Technology and Lindy Willmott, Queensland University of Technology

July 21, 2017

An independent group of experts set up by the Victorian government has today delivered its final report outlining 66 recommendations for how voluntary assisted dying would work in the state.

Chaired by former head of the Australian Medical Association, Brian Owler, the Ministerial Advisory Panel’s role was to work out how legislation should be drafted to allow terminally ill people to receive assistance to die. The panel based its report on the recommendations of the Parliamentary committee’s Inquiry into end of life choices in December 2016.

Legislation giving effect to the report is likely to be tabled in the Victorian Parliament within a month.

Who does the law cover?

At the heart of debates about assisted dying are eligibility criteria – who can get assistance to die and who cannot. The panel’s recommendations are broadly consistent with the report of the parliamentary committee. Access is allowed for an adult who can make their own decisions, is terminally ill and their suffering cannot be relieved. They must also be a resident of Victoria.

But the panel widens the committee’s earlier recommendation that a person must be “at the end of life (final weeks or months of life)” to be granted their request. Instead, the current report states the “incurable disease, illness or medical condition” must be expected to cause death in no later than 12 months.

While we agree eligibility should be based on a terminal illness, we don’t favour time limits as they are arbitrary and difficult to accurately predict. They can also lead to people taking harmful steps to fall inside them, such as starving themselves.

But the panel’s recommendation to extend the time to 12 months is still a better approach than the committee’s, as it is likely forming a clinical view about prognosis will be more manageable in that time. Providing a set time frame also avoids the uncertainty of the vague use of the phrase “at the end of life”.

Former AMA president, Professor Brian Owler, chaired the Ministerial Advisory Panel.

Also of note is that the panel specifically stated mental illness alone and disability alone will not satisfy eligibility requirements; but nor will they exclude access to voluntary assisted dying.

What assistance can be provided?

This is primarily a physician-assisted dying model, which means the patient is expected to take the lethal dose of medication themselves. This is a narrow approach to assisted dying as it is the person themselves who takes the final step to end life, not the doctor.

The panel’s approach is consistent with the committee’s report – both are broadly along the lines of the US assisted dying model such as the one in Oregon.

There are downsides to this and we favour a more inclusive model (like in Canada or under the European model) that permits assistance to die being directly provided by a doctor as well. This choice better reflects the autonomy that underpins these laws.

But the panel (and the committee) did recommend an exception where the person is physically unable to take the medication or digest it themselves. This may not be used often but helps address potential discrimination, for example on the grounds of physical disability which prevents someone taking the medication themselves.

What safeguards are there?

The panel has proposed a very rigorous process – comprised of 68 safeguards – that involves three separate requests for voluntary assisted dying (one which is witnessed by two independent witnesses) and two independent medical assessments.

A patient seeking assistance to die must be provided with a range of information including about diagnosis and prognosis, treatment options available, palliative care, and the expected outcome and risks of taking the lethal dose of medication. Doctors involved will have to receive special training about the law and how it operates.

Other safeguards are at the systems level, with a Voluntary Assisted Dying Review Board recommended to examine each case and also to report on how the scheme as a whole is operating. The panel has also proposed a range of new offences specifically about voluntary assisted dying to deter conduct outside the scope of the regime, such as an offence against inducing someone to request assisted dying.

Will these recommendations become law?

Strong public opinion, shifting views in the health and medical professions and international trends towards allowing assisted dying mean it will become lawful in Australia at some point. But will it be in Victoria, and soon?

The politics of assisted dying are notoriously fickle and this is the latest of over 50 bills in Australian parliaments addressing this issue over the past two decades.

But as we have argued in the past, features of this law reform effort suggest it could happen. The process of examining the issue has been very careful, inclusive and thoughtful with multiple reports and engagement with expert opinion and national and international evidence.

The ConversationThis is a narrow assisted dying model with a lot of safeguards. There is also high level and public support of senior politicians on both sides of politics. But as always, the ultimate test is what happens on the floor of parliament.

Ben White, Professor of Law and Director, Australian Centre for Health Law Research, Queensland University of Technology and Lindy Willmott, Professor of Law and Director, Australian Centre for Health Law Research, Queensland University of Technology

This article was originally published on The Conversation. (Reblogged by permission). Read the original article.

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Euthanasia and palliative sedation are distinct concepts – intent matters

The Conversation

Xavier Symons, University of Notre Dame Australia

Debate over euthanasia in Australia has been renewed by the recently failed bill to legalise it in South Australia, and the Victorian government’s announcement it will hold a conscience vote on assisted dying next year. As usual, parliamentary debates have spilt over into expert probing of current practices in end-of-life care.

From doctor and writer Karen Hitchcock to the Australian Medical Association, there seems to be broad consensus about the relevance of a doctrine called “double effect” in end-of-life care.

Double effect, in the most general sense of the term, is the view that a doctor acts ethically when she acts with the intention of bringing about a good effect, even if certain undesirable consequences may also result.

While doctors agree double effect is a useful principle, there is disagreement about how it applies in end-of-life situations.

On one account, the doctrine can be applied to both palliative sedation and euthanasia. The former is the alleviation of symptoms in terminally ill patients using sedative drugs. The latter is the active killing of a patient by administering sedative barbiturates, such as Nembutal.

Some doctors suggest that, under the double effect doctrine, palliative sedation can be applied more liberally. The relief of pain can actually result in the death of a patient, which means palliative sedation can cover many of the cases of individuals seeking euthanasia.

The argument then is, because palliative sedation does the same work as the euthanasia law is intended to cover, we needn’t create a law to legalise euthanasia; we need only clarify existing law on double effect and palliative sedation. I’ll call this the “minimalist thesis”.

But there is a strong argument to suggest the minimalist thesis is untenable. Euthanasia and palliative sedation are categorically distinct. This is because the intent – which is the operative word when it comes to moral philosophy and to legal principles – of doctors in each of the interventions is different.

In palliative sedation, doctors administer pain relief with the primary intent of relieving pain. In the case of active euthanasia, doctors administer barbiturates with the primary intent of ending the patient’s life.

What is double effect?

The so-called doctrine, or principle, of double effect is a philosophical concept often employed when evaluating the morality of actions. It rests on the basic conviction that in morality intentions matter, and that a person’s intentions are what make their actions moral or immoral.

There are various formulations of the doctrine, depending on which ethical, religious or legal tradition you are approaching it from. We can nevertheless posit a generic definition along the following lines:

The doctrine of double effect states, where certain criteria are met, a person acts ethically when acting to bring about a good or morally neutral outcome – even though her action may also have certain foreseen, though not intended, undesirable consequences.

In the end-of-life context, for example, the ethical act to bring about a morally neutral outcome would be administering pain medication. The potentially unintended consequence would be death.

An important phrase in the above definition is “where certain criteria are met”. Depending on the tradition you work in, these criteria will vary. There is, nevertheless, broad consensus about the following criteria:

  1. We cannot intend the bad effect
  2. The “bad” of the unintended consequences cannot outweigh, or be greater than, the intended “good” outcome
  3. The good effect must not be produced by means of the bad effect.
The bad of the unintended consequences cannot outweigh, or be greater than, the intended good outcome. From shutterstock.com

It is generally said doctors should have, as their primary intent, the relief of suffering and not some goal that, while perhaps acceptable, is not within the purview of the role of doctor – such as ending a person’s life.

Doctors draw on double effect in serious cases where a treatment has certain foreseen, undesirable consequences. This may be minor or major injury to the patient, or even perhaps the hastening of death.

Palliative sedation v euthanasia

Doctors typically administer palliative sedation only in the last days or hours of a patient’s life. This involves using sedative drugs to relieve acute symptoms of terminally ill patients where other means of care have proven ineffectual. These symptoms are known as refractory symptoms, and include vomiting, delirium, pain and so forth.

The sedative drugs that doctors administer – the most common of which are benzodiazepines such as Valium – render the patient unconscious or semi-conscious. Often these are administered in gradually increasing doses, depending on how long and to what extent doctors want to sedate the patient.

Sometimes the drugs administered may hasten death. Crucially, though, the primary intent of doctors is to relieve unbearable or otherwise untreatable suffering.

In the case of euthanasia, however, to state it tersely, a doctor or other health-care professional seeks to kill the patient. Medical euthanasia is administered in response to suffering, be it of a patient who is terminally ill, afflicted by intense and prolonged physiological suffering, or by psychological or existential suffering.

Muddying the waters

Monash bioethicist Paul Komesaroff
and others have suggested that, instead of legalising euthanasia in Australia, we should clarify the law on double effect and palliative sedation.

The minimalist approach has the added benefit we needn’t get involved in placing arbitrary restrictions on end-of-life care – as legislators are wont to do with euthanasia law.

Yet this argument equivocates on the nature of palliative sedation. In cases where patients still have six months to live, or where their suffering is broader than ordinary refractory symptoms, it is not permissible to provide palliative sedation – at least, not according to existing ethical guidelines.

If this were to be done, the primary intention would not be to relieve suffering but rather to hasten or actively bring about the patient’s death. Even if one wished to suggest our ultimate intent were to relieve suffering, we would nevertheless be using the bad consequence as a means to that end. This violates one of the generally agreed upon criteria employed when invoking the doctrine of double effect.

We stand to lose rather than gain from muddying the waters around double effect and palliative sedation. The real question legislators need to consider is this: should the state sanction the active killing of terminally ill patients by their doctors? We do ourselves a disservice to pretend euthanasia is anything other than this.

The ConversationXavier Symons, Research Associate, University of Notre Dame Australia

This article was originally published on The Conversation. (Reblogged by permission). Read the original article.

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Voluntary euthanasia: beware of the godly!

The Conversation

Russell Blackford, University of Newcastle

In the United Kingdom, ongoing social and political controversy over voluntary euthanasia, or (physician) assisted suicide, has reached a new stage. Labour MP Rob Marris has put forward a private member’s bill, and it will be debated in the House of Commons this month. Thus, the UK now becomes a focus of attention for those of us with an interest in the issue of assisted suicide.

I won’t defend the specific legislative scheme proposed by Marris and his supporters, since much of the opposition to it comes from parties who are opposed to any such scheme. That style of opposition will be my focus in what follows. Can it be justified?

“Faith leaders” lobby parliament

Not unexpectedly, British “faith leaders” – that is, the leaders of various religious organisations – have united to lobby parliamentarians against the bill. One of these faith leaders is Justin Welby, the Archbishop of Canterbury, who has written a piece for The Guardian to set out his version of the case against assisted suicide. It appears under the melodramatic title: “Why I believe assisting people to die would dehumanise our society for ever.”

Welby claims that “We [faith leaders] have written, not in an attempt to push ‘the religious’ viewpoint on others but because we are concerned that a change in the current law on assisted suicide would have detrimental effects both on individuals and on our society.” But that is disingenuous.

Since they have acted in concert, presenting a united front, they are lobbying parliamentarians with what can reasonably be called, in this particular context, “the religious viewpoint”. Furthermore, they want their viewpoint to be reflected in public policy and, in that sense, to be imposed on others. They are not merely attempting to persuade individuals against seeking assisted suicide when the time comes. For better or worse, Welby and the other religious lobbysists are attempting to impose their shared viewpoint on others through government policy and power.

There remains an important question as to whether, nonetheless, their position obtains independent support from compelling secular arguments. In his Guardian article, Welby offers an argument with three prongs. It does not make direct reference to any supernatural concepts, but nor (I suggest) is it entirely independent of religious assumptions. He alleges that enacting any regulatory code such as the one sponsored by Rob Marris would:

  1. cross a “legal and ethical Rubicon”;
  2. place large numbers of vulnerable people at risk; and
  3. lead to a society where it is no longer the case that “each life is … seen as worth protecting, worth honouring, worth fighting for”.

Since each of these is supposed to be undesirable, Welby is arguing, we should not go ahead with the Marris bill. So, is any of this convincing? Not at all, I submit.

Crossing the Rubicon

The more detailed claim about crossing a normative Rubicon is that “respect for the lives of others goes to the heart of both our criminal and human rights laws and ought not to be abandoned.” But this is little more than sophistry. A carefully regulated process allowing a place for assisted suicide does not require, or even somehow insinuate, that we should no longer respect the lives of others. It does not, that is, require or insinuate that we should no longer see the lives of others as demanding our consideration.

If such a process were introduced, the law would still ban the deliberate or reckless taking of human life (murder). It would still ban the negligent (or otherwise blameworthy, but less than murderous) taking of human life (manslaughter). The law would continue to give effect to important values relating to respect for the lives of other people. Indeed, careful delineation of the circumstances under which assisted suicide would be permitted would demonstrate that the lives of the individuals concerned are very much being given consideration by the law itself.

That noted, we should acknowledge that a point can be reached when someone’s continuing life has become a burden to him or her – possibly because of uncontrolled and extreme pain, but possibly even if their physical pain is controlled. Many severely and terminally ill people find themselves feeling (among other things) helpless, humiliated and unable to take part in any activities that once brought them joy. In those circumstances, they may feel that their active lives are effectively over and that they are now merely lingering.

In such narrowed and unhappy circumstances, our ordinary fear of death – whether through murder or manslaughter, or otherwise – can become entirely beside the point. Rather than fearing a premature death, and demanding the state’s protection from harm, we might quite reasonably fear going on with no ability to bring our burdensome existence to an end. If, in those dire circumstances, the criminal law prevents others from helping us to die, it is no longer protecting us from something that we fear. It is, instead, operating perversely. It’s operating to remove any remaining control of our own fates. It’s operating to add to the things that we reasonably fear.

The criminal law exists chiefly, and least controversially, to protect us from harmful actions by others. In some situations, of course, it does operate paternalistically to protect us from the results of our own choices, but I suggest we not be sanguine about the existence of paternalistic laws. Generally speaking, they insult us, infantilise us, and infringe our autonomy. We should subject them to the glare of sceptical scrutiny.

Sometimes, I accept, we have reasons to welcome specific paternalistic legislation. However, paternalistic laws should be exceptional, rather than routine, and any government interference with our self-regarding choices had better be as limited as the practicalities allow. In fact, some special features of a situation had better be adduced to justify the restriction on our choices, especially where the interference turns out to be significant in reducing our sphere of autonomy.

When state power compels us to live on well past a point where life became burdensome – perhaps humiliating and joyless, perhaps also agonisingly painful – that is a radical denial of our autonomy. Such laws are disrespectful to us. We have every reason to chafe against this kind of “protection” from our own choices.

In short, no Rubicon is crossed if, in extreme circumstances, we are allowed to make an effective choice to die. The law shows abundant respect for our lives if it offers us protections from institutional or family pressures while also leaving us genuine scope to end our lives with capable assistance.

Protecting vulnerable people

What about the need to protect vulnerable people from undue pressure? Here, Welby is on somewhat stronger ground. His claim is that a law permitting assisted suicide would place very large numbers of vulnerable people in danger. Once such a law is in place, he says, “there can be no effective safeguard against this worry, never mind the much more insidious pressure that could come from a very small minority of unsupportive relatives who wish not to be burdened.”

Really? Can there really can be no effective safeguards against undue pressure to choose death?

There are various motives that can lead to such abuse, and none of them should be dismissed as merely fanciful. It’s unlikely, however, that the existing culture of medical care in countries such as the UK and Australia could easily be changed to such an extent that assisted suicide would be embraced by institutions and medical practitioners other than as a last resort. New laws can be designed to reflect and reinforce, rather than subvert, that established culture of care.

Familial abuse might be more a realistic concern, however, given the wide range of relationships and emotions within families. Might this be a reason to resist the legalisation of a form of assisted suicide?

No, since it is possible to introduce procedures to mitigate any undue emotional pressure when patients consult with their families. Family members’ views can be somewhat buffered by other influences, such as mandatory discussion and advice from professional counsellors. The purpose here is not to divert a patient from choosing death, but to help ensure that any decision to die is not a response to emotional pressure.

It is also true, as Welby points out, that one consideration when patients choose to die is that they may feel, during their last period of life, that they are a burden to others. I see no way around this, but nor do I find it shocking. If I were in a situation of terrible helplessness, humiliation and pain, and if the time and other resources of my loved ones were largely devoted to me as I lingered near death, of course one consideration in my mind would be the effect on them. Why imagine or pretend that there is something sinister about this?

It is almost inevitable that the effect on others of my lingering would be one element in my thoughts. It would be a perfectly legitimate consideration, and its presence in my thinking would not take away the fact that I might also, and more importantly, find my life too joyless, painful, frustrating, and humiliating for me to want it to continue. Thus, it is unfair to appeal, as Welby does, to a large percentage of people who report their sense of being a burden as one factor in their decision to die with medical assistance. That should be expected.

A more legitimate worry might be the prospect that adequately protective procedures would be ineffective because they would be too demanding and complex to be workable. Thus, they could frustrate legitimate patient decisions to choose death, actually increase suffering and cause unintentional breaches. Those would be highly perverse outcomes.

Although this argument might have some force – more than the line actually taken by Welby – it seems unnecessarily pessimistic. It should be possible to design procedures that are workable, yet minimise the possibility of abuse.

For cases that do not fall neatly within any detailed procedures, it might also be possible to develop a relatively broad defence along the lines of “mercy” killing. In any event, there are currently prosecutorial guidelines in England and Wales that make it less likely that prosecution will be undertaken when the “victim” had made a settled, clear, informed decision to commit suicide and/or the assistance given was entirely motivated by compassion.

In fairness, we should note that Welby is not opposed to these. Nothing prevents similar guidelines being retained as an additional protection against harsh prosecutions, even after legislative reforms are enacted.

Down a slippery slope?

Welby’s third prong of argument has no evident merit. It is somewhat along the lines of a slippery slope approach. If we legalise assisted suicide, so it suggests, we will become a society in which we no longer “show love, care and compassion to those who at all ages and stages of life are contemplating suicide” and we no longer view each life “as worth protecting, worth honouring, worth fighting for”.

This adds little to the first prong of the argument, and it has much the same problem. The existence of a statutory scheme to legalise and regulate assisted suicide does not in any way make a society one that lacks “love, care and compassion” to those who are contemplating suicide. By allowing people who fall in a defined class of desperate situations, and for whom ongoing life is experienced as a burden, to end their lives, the society shows more compassion. More, that is, than if it required those people to linger against their will.

However, there’s a further suggestion here, that we must view each life as “worth fighting for” even past the point when the person actually living it finds it of value.

Doubtless there are many situations where individuals no longer want to live because of temporary, though deeply upsetting, circumstances. When that happens, we will, indeed, do what we can to help and comfort the individuals concerned and dissuade them from acting rashly. But it does not follow that we should do all in our power to keep alive an individual who is terminally ill and enduring a conscious existence that she experiences as agonising or miserable.

I know of no secular reason for a compassionate person to want such a life to go on even against the will of the person who is living it. A point can come where insistence on not helping to end life is arrogant and appears cruel.

The insistence would have some rationale if we accepted the supernatural hypothesis that God (or the gods or Fate) decides each person’s time of death, and that any killing, including an assisted suicide, usurp’s God’s prerogative. As it seems to me, some thought such as this must lie behind the view of the British faith leaders. It is not, however, a thought that should influence public officials charged with developing and administering the secular law.

Beware of the godly

Religious leaders such as Archbishop Welby have no particular authority – intellectual, moral, or otherwise – in respect of issues that relate to decisions at the beginning and end of life. Religious leaders are experts on the doctrines of their respective organisations, but that sort of expertise should cut no ice with the rest of us.

They are, of course, entitled to present their arguments in the public square – they have freedom of speech like everyone else in a liberal democracy – but those arguments have no additional credibility because they come from religious leaders. To the extent that they depend on otherworldly assumptions, the arguments provide a poor basis for government policy. To the extent that they are translated into secular (or this-worldly) terms of some kind, we can certainly consider them on their merits, but they will often be found unconvincing.

As I mentioned in a short post on my personal blog, there is something tiring, annoying, and self-serving about the rhetoric of “profound compassion” employed by religious advocates such as Welby. Let’s take note that you can use the word “compassion” or “compassionate” without actually being compassionate or advocating policies that will actually reduce suffering. Likewise, you can use the word “profound” without being in any way profound – though it may give your prose a certain appearance of saintliness and solemnity if you dress it up in such words. This is an old but effective rhetorical tactic.

The forthright atheist blogger Ophelia Benson goes further, seeing much of Welby’s rhetoric as a kind of emotional bullying. Although she and I have sometimes clashed over other issues, I think she’s right on this occasion. Much of the language in the Archbishop’s Guardian article is manipulative, intended to shame and impress us into agreement. Benson uses some harsh and colourful terms for this: “eyewash”, “flapdoodle”, “bullshit”.

I call it propaganda.

The ConversationRussell Blackford, Conjoint Lecturer in Philosophy, University of Newcastle

This article was originally published on The Conversation. (Reblogged by permission). Read the original article.

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Singer and Fisher preach to their flocks in euthanasia debate

The Conversation

Benjamin T. Jones, University of Western Sydney

When the University of Sydney’s Catholic Society decided to organise a debate on legalising voluntary euthanasia, it was envisaged as a modest event to be held on campus. Interest in the topic and the high profile of the speakers soon saw the debate moved to Sydney’s Town Hall, which sold out over a week in advance.

The two protagonists symbolised forces far larger than themselves. His Grace, the Most Revered Anthony Fisher, Archbishop of Sydney, represented the power and prestige of the Roman Catholic Church. He had a strong support base in the crowd, which included nuns, priests and young Catholic students.

In contrast to his stern and authoritarian predecessor, George Pell, Fisher carried himself with a relaxed charm, happy to joke about his “strange clothes” and former life of sin – he was a lawyer before studying for the priesthood.

Peter Singer is Australia’s most prominent philosopher and the current Ira W. DeCamp Professor of Bioethics at Princeton University. A key figure in the animal liberation movement and a foundational member of the Australian Greens, his advocacy, under certain circumstances, of abortion, euthanasia, infanticide – and even bestiality – has certainly courted controversy. To his religious critics, he is very much the atheist bogeyman.

Euthanasia is a sensitive topic that elicits strong emotions. The moderator, the ABC’s online editor of Religion and Ethics, Scott Stevens, urged the speakers and audience to be more civil and respectful than the Q&A norm. It was a request mostly adhered to.

The full Singer-Fisher debate.

Singer spoke first and his argument was relatively straightforward. The audience was asked:

Why do we consider killing an innocent person to be wrong?

The answer is twofold. First, killing someone is a violation of their autonomy. But in the case of voluntary euthanasia, a person’s autonomy is not taken away but supported.

Second, killing an innocent person deprives them of the good things in life they would have otherwise experienced. At this juncture, Singer makes an important qualification. He is not an “absolutist” about autonomy. If a healthy young person is lovesick or depressed, they may temporarily feel that life is not worth living. However, there is much reason to suspect these feelings will pass.

Singer endorses the Canadian Supreme Court’s recent ruling that allows euthanasia only for people with:

… grievous and irremediable medical conditions.

Fisher drew on the movie The Water Diviner, where a young Australian soldier agrees to kill his mortally wounded brother rather than let him slowly and painfully bleed to death. The question put to the audience was:

Is it better to kill someone than let them suffer?

Fisher asserted that comforting people through their suffering requires more from us, but it also places more value on humanity and endorses the intrinsic value of life.

Fisher’s main argument was concerned with bracket creep. If we accept some people who suffer should be able to end their lives, what about others who suffer? Rather than respect for all life, euthanasia would lead to two classes of existence. The terminally sick could soon be joined by the mentally ill, clinically depressed, severely disabled, the elderly and unwanted babies in a growing group considered better off dead.

Singer strongly rejected this claim. He argued that there was no evidence of a slippery slope towards euthanasia becoming a widespread practice to remove undesirable people for financial or other motives. He pointed to the US state of Oregon, where only 105 people took advantage of the Death with Dignity Act in 2014.

Fisher insisted that the example of the Netherlands where, he said, euthanasia has rapidly increased proves that bracket creep is real. Once you accept some people are better off dead a moral line is crossed.

The questions from the audience hinted at its makeup. Of the 12 questions asked, ten were openly hostile to Singer or supportive of Fisher. Singer was asked if he supported the killing of babies with severe disabilities or elderly people with dementia. He became increasingly impatient and regularly reminded the audience he was only advocating voluntary euthanasia – which automatically excludes babies and those unable to consent.

One questioner was even ejected by the moderator for trying to start an infanticide debate stemming from Singer’s 1979 book, Practical Ethics.

So who won the debate? No-one really. Had there been a show of hands, Fisher would have been the likely victor but that would only have reflected the Catholic Society’s strong presence.

For much of the debate, the two did not address the other’s arguments. Singer kept a small target, advocating voluntary euthanasia only for competent adults with a terminal illness.

Fisher, and the questioners, wanted a broader discussion on the sanctity of life. As one questioner demanded to much applause:

Mr Singer, who are you to decide that some lives are worth more than others?

Singer responded, also to applause, that he could not see the connection between the question and what he had advocated. It summed up the night; arguments flew in both directions but rarely met.

With the debate finished, supporters of each man formed an excited line to buy a signed book and take the obligatory selfie. As with the debates about the existence of God made so popular by Richard Dawkins and Christopher Hitchens, the goal was never to change anyone’s mind but to speak to an existing base. Both camps left the majestic building satisfied that they had won.

The ConversationBenjamin T. Jones is Adjunct Research Fellow, School of Humanities and Communication Arts at University of Western Sydney

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When is it ethical to euthanize your pet?

The Conversation

Bernard Rollin, Colorado State University

In the 1960s, I knew people who, before going on vacation, would take their dogs to a shelter to be euthanized. They reasoned that it was cheaper to have a dog euthanized – and buy a new one upon returning – than pay a kennel fee.

Two decades later, I was working at Colorado State’s veterinary hospital when a group of distraught bikers on Harley-Davidsons pulled up carrying a sick chihuahua. The dog was intractably ill, and required euthanasia to prevent further suffering. Afterwards, the hospital’s counselors felt compelled to find the bikers a motel room: their level of grief was so profound that the staff didn’t think it was safe for them to be riding their motorcycles.

These two stories illustrate the drastic change in how animals have been perceived. For thousands of years, humans have kept animals as pets. But only during the past 40 years have they come to be viewed as family.

While it’s certainly a positive development that animals are being treated humanely, one of the downsides to better treatment mirrors some of the problems the (human) health care system faces with end-of-life care.

As with humans, in many cases the lives of pets are needlessly prolonged, which can cause undue suffering for the animals and an increased financial burden for families.

The growth of veterinary medicine and ethics

In 1979, I began teaching veterinary medical ethics at Colorado State University’s veterinary school, the first such course ever taught anywhere in the world.

A year later, the veterinary school hired an oncologist to head up a new program on animal oncology. Soon, our clinic was applying human therapeutic modalities to animal cancer. The visionary head of the veterinary program also hired a number of counselors to help pet owners manage their grief – another first in veterinary circles.

I’d been under the impression that people would be reluctant to spend much money on animal treatments, so I was genuinely shocked when the following April, the Wall Street Journal reported individuals spending upwards of six figures on cancer treatments for their pets.

As a strong advocate for strengthening concern for animal welfare in society, I was delighted with this unprecedented turn of events. I soon learned that concern for treating the diseases of pets besides cancer had also spiked precipitously, evidenced by a significant increase in veterinary specialty practices.

One of the family

So what’s behind the shift in how pets are perceived and treated?

For one, surveys conducted over the last two decades indicate an increasing number of pet owners who profess to view their animals as “members of the family.” In some surveys, the number is as high as 95% of respondents, but in nearly all surveys the number is higher than 80%.

In addition, the breakdown of nuclear families and the uptick of divorce rates have contributed to singles forming tighter bonds with companion animals.

Such attitudes and trends are likely to engender profound changes in societal views of euthanasia. Whereas before, many owners didn’t think twice about putting down a pet, now many are hesitant to euthanize, often going to great lengths to keep sick animals alive.

Vets caught in the middle

However, veterinarians continue to experience extensive stress as they experience two opposite – but equally trying – dilemmas: ending an animal’s life too soon, or waiting too long.

In a paper that I published entitled Euthanasia and Moral Stress, I described the significant stress experienced by veterinarians, veterinary technicians and humane society workers. Many chose their profession out of a desire to improve the lot of animals; instead, they invariably ended up euthanizing large numbers of them, often for unethical reasons.

These ranged from “I got the dog to jog with me, and now it’s too old to run,” to “If I die, I want you to euthanize the animal because I know it can’t bear to live without me.”

In other cases, the animal is experiencing considerable suffering, but the owner is unwilling to let the animal go. With owners increasingly viewing pets as family members, this has become increasingly common, and many owners fear the guilt associated with killing an animal too soon.

Ironically this, too, can cause veterinarians undue trauma: they know the animal is suffering, but there’s nothing they can do about it unless the owner gives them permission.

The consequences are manifest. One recent study showed that one in six veterinarians has considered suicide. Another found an elevated risk of suicide in the field of veterinary medicine. Being asked to kill healthy animals for owner convenience doubtless is a major contribution.

How to manage the decision to euthanize

Here is my suggestion to anyone who is thinking about getting a pet: when you first acquire it, create a list of everything you can find that makes the animal happy (eating a treat, chasing a ball, etc). Put the list away until the animal is undergoing treatment for a terminal disease, such as cancer. At that point, return to the list: is the animal able to chase a ball? Does the animal get excited about receiving a treat?

If the animal has lost the ability to have positive experiences, it’s often easier to let go.

This strategy can be augmented by pointing out the differences between human and animal consciousness. As philosopher Martin Heidegger has pointed out, for humans much of life’s meaning is derived from balancing past experiences with future aspirations, such as wishing to see one’s children graduate or hoping to see Ireland again.

Animals, on the other hand, lack the linguistic tools to allow them to anticipate the future or create an internal narrative of the past. Instead, they live overwhelmingly in the present. So if a pet owner is reluctant to euthanize, I’ll often point out that the animal no longer experiences pleasant “nows.”

In the end, managing euthanasia represents a major complication of the augmented status of pets in society. Ideally, companion animal owners should maintain a good relationship with their general veterinary practitioner, who has often known the animal all of its life, and can serve as a partner in dialogue during the trying times when euthanasia emerges as a possible alternative to suffering.

The ConversationBernard Rollin is Professor of Philosophy, Animal Sciences and Biomedical Sciences at Colorado State University.

This article was originally published on The Conversation. (Reblogged by permission). Read the original article.

 

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