The Right to Die ?

By Iben Gejl Valbak & Ina Andreasen

Throughout this blog article different perspectives on euthanasia will be presented. Thus the aim of the articles is not try to advocate for or against it, but instead explain and reflect over the different issues in this complex and multifaceted debate.

To be in control and to make autonomous decisions has almost become a human right. How you live your life, what you eat, what you want to study is up to you – being unable to control your life can be a sign of weakness. However, death is one of the few things left, that is not solely up to us. But maybe that is soon to be changed ? Euthanasia, the practice of administering medicine with the aim of ending a patient’s life on the explicit demand from the patient , is a way of controlling the last moments in a life. Only a few countries around the world have legalized euthanasia (The Netherlands, Belgium, Switzerland and Oregon in the US), yet it is a discussion that is wide awake and has a vivid debate in many places including Denmark.

A common feature in terminal diseases, in relation to euthanasia, is that at a certain point in time, the pain is unbearable when no curative treatment is available. The global burden of disease, resulting from the increase in urbanization and longer life expectancies, is shifting from infectious to non-communicable diseases (NCDs), therefore bringing the euthanasia debate to the forefront for policymakers worldwide. The changes result in the number of people living with impaired health increasing, and as a result more people will suffer from cancer and other non-communicable diseases, which in many cases are not curable. However, people requesting euthanasia may also suffer from other lifestyle related NCDs, such as Motor Neuron Disease, Alzheimers disease, and Parkinsons disease.  Palliative care can be offered to linger pain and suffering for patients at the various stages of the disease. However, it is still a developing field as methods and quality of treatment continue to improve. But what about the kind of pain that simply cannot be endured; the kind of pain that is unbearable and infinite and where there are no prospects of it ending before the last breath ? Could euthanasia be a good solution ?

For or Against Euthanasia ?

Euthanasia is a kind of medicalisation where natural processes such as life and death become objects for biomedical technologies. It is a highly controversial and debated subject, where many people have very strong opinions regarding it’s use.

Some argue that we should have the freedom to choose when we should die. No matter who you are or where in the world you live, there are decisions that have to be made on an everyday life basis on how to live. Why, therefore, should we not be able make decisions on how to die? Others argue that why let people suffer, if and when we have the possibility to end the pain – why prolong the suffering ? At some point, our lives will come to an end regardless.

Others argue that legalizing euthanasia will develop into a so called ‘slippery slope’ where it will be difficult to stop and that the euthanasia will get out of hand. Many factors play a role here that might make it go down a ‘slippery slope’.

First of all, economic reasons might make euthanasia get out of hand. For example, it will be cheaper for society to legalize euthanasia compared to expensive treatment costs within palliative care. This might lead to patients feeling pressured to choose euthanasia as a way to avoid burdening family members. Secondly, where do we draw the line ? By legalizing euthanasia, there is a chance that it someday euthanasia’s reach will expand to those who are mentally ill, such as having a depression or simply just “tired of days”. Will it come to a day where people who are not “normal”, or who just need extra care from society – people who do not fit in – should be persuaded to be euthanised ? Other arguments against euthanasia are related to religious beliefs or the Hippocratic oath.

Euthanasia From a Global Health Perspective ?

Euthanasia is often discussed in high-income countries, however very limited literature exists on euthanasia in low- or middle-income countries except from Colombia and India. But is the debate about euthanasia only a “high-income problem”, or is it not time it became an important global discussion ?

If we look at equity aspects of death, it is a fact that people die under very different circumstances around the world. In the UN Declaration of Human Rights the right to palliative care can be seen as included in the right to the highest attainable standard of physical and mental health. With palliative care as an already existing topic on the global agenda, it is likely that it will be a point for discussion, if palliative care should be part of the post 2015 goals.

The starting point for a global debate about euthanasia must acknowledge that perceptions of pain, suffering, and quality of life are very subjective, making it difficult to talk about. When is the pain and suffering unbearable, what defines quality of life, and what is a dignified death ? How are these perceptions different from country to country, from culture to culture ? Therefore, to make the debate about euthanasia and other kinds of end-of-life treatment global, the cultural contexts and perceptions must be considered and questioned, and we must ask ourselves about the relevance of the debate in each particular country.