DR. BRIAN POLLARD
Even though euthanasia is a common topic for general discussion,
its real nature and significance are complex and, not
surprisingly, it is therefore often misunderstood.
A popular view is that it would be simple to introduce a law for
change, if only there were the will. It is also often claimed that most
people in the community support the idea, and that it is chiefly due to
the opposition of those who hold and rely on their religious beliefs
that it has not already been enacted. In this and the subsequent papers
in this series, no arguments will be used that depend on religious
adherence. It will be shown that legalised euthanasia would be a denial
of justice and would be highly dangerous to many others in the community
who did not want their lives taken.
Euthanasia has moral, social, human rights, medical and legal
implications, all of which will be addressed, though not exhaustively,
in these papers. First, since the word means different things to
different people, the definitions provided here are those commonly used
in the international literature and contain all its elements.
Euthanasia is the intentional taking of the life of another person,
by act or omission, for compassionate motives. It is
- voluntary when a
person has requested it for him/herself
- non-voluntary when
there has been no request or consent, and
- involuntary when it
is carried out despite an expressed wish to the contrary.
Assisted suicide occurs when one person supplies the means of
self-killing to another, with the intention that they will be used for
Euthanasia is a form of homicide — even if legalised, it would be
legalised homicide. Intention is central to the concept. There is no
euthanasia unless the death is intentionally caused by what was done or
not done. Thus, some medical actions that are often labelled passive
euthanasia are no form of euthanasia, since the intention to take life
is lacking. These acts include not commencing treatment that would not
provide a benefit to the patient, withdrawing treatment that has been
shown to be ineffective, too burdensome or is unwanted, and the giving
of high doses of pain-killers that may endanger life, when they have
been shown to be necessary. All those are part of good medical practice,
endorsed by law, when they are properly carried out.
Though it is not always easy to make the distinction between the
intended consequences of an act and those that are foreseen but not
intended, and some people may then think there is no distinction, it is
nonetheless real, and important to make it. It provides the ethical
justification for some of the necessary actions of doctors in certain
complex situations near the end of life, for example, when appropriately
removing medical treatment that has been shown to be useless. When
continuing medical treatment would be futile, that is without any known
predictable benefit, it is both legal and ethical to withhold it or
remove it with the intention of ceasing the needless prolongation of
inevitable dying, even though death may be foreseen as a consequence.
(In passing, it can be mentioned that terminally-ill patients are rarely
attached to life-support systems, such as ventilators. The issue of the
removal of life-support is separate from euthanasia).
It is sometimes said that intention cannot be tested, but there is a
simple test to apply to clarify the matter of intent when dealing with
euthanasia . Ask the question ‘What would then be done if the patient
did not die?’ If treatment was withdrawn and the patient didn’t die, he
or she would then receive all necessary care until eventual natural
death. If a lethal injection didn’t work, further doses would be given
until the patient died. One risks death and the other seeks it.
Some object to the word ‘killing’ as applied to euthanasia as
‘emotive’, but it is simply descriptive of what is being proposed, that
is, ‘to take the life of’. Nobody becomes emotionally upset when they
read that ‘Mr So and So was killed yesterday when hit by a speeding
car’. The term ‘mercy killing’ is accurate and inoffensive. On the other
hand, while euthanasia is technically the crime of murder, this word may
be offensive because its motive is usually not malicious, but
This word is used here in its secular sense of things that are right
or wrong, and has no particular relevance to any religious doctrine. The
whole of the criminal law is devoted to things that are matters of
wrongdoing, accepted by Australians and every world community. Since
euthanasia is the taking of innocent life, innocent referring to those
who pose no present or future threat to others, it is above all a moral
issue, and to ignore this distorts the discussion from the outset.
But many in society say they have become unhappy with notions of
objective morality as a standard to which all are required to conform,
while at the same time they cheerfully accept standards in other walks
of life, since standards represent all that stands between order and
chaos. There must be some good reason why every nation in the world in
recent centuries has regarded taking the life of an innocent as the
greatest crime, deserving of the greatest penalty, and that it has been
universally realised that, in order to protect everyone equally in the
community, especially the weakest, there are no exceptions to this rule.
In fact, although the law does not attempt to define human values, it
implicitly accepts that innocent human life has the highest possible
If, as a society, we cannot agree that it is wrong to take innocent
life, that natural rights need respect and protection, and that the
frailties of mind and body imposed by serious illness render the sick
peculiarly vulnerable to manipulation by others who may resent them for
social reasons, on what can we certainly agree? If we cannot agree on
the morality of anything, then the law can be dispensed with, except in
so far as it represents self-interest or mob rule.
One of the functions of government is to take all necessary measures
to protect the lives of all its citizens, especially the lives of its
weakest members. There is no precedent anywhere for a government to take
any action to positively discriminate between its citizens or to
positively endanger any human life. A law to enable euthanasia would
select a group of people from whom the current universal protection
would be withheld, by allowing their lives to be taken legally. That
would create a precedent that does not presently exist, which, like all
precedents, may be later amended, if that were thought desirable. No
lawmaker could offer any guarantee that the new law could not or would
not be changed later, including in ways that he/she would not approve
A law to allow the taking of innocent life would undoubtedly lower
the community’s standards of respect for human life, at least in some
quarters. Once the first hurdle had been cleared by permitting some
lives to be taken, should some new factor arise to create a new crisis,
for example, if the cost of medical care for the aged or the disabled
rose to what were thought to be unsustainable levels, an easy solution
would already be to hand. It would be logical to extend the original
provisions to cover the new position. If this is thought to be
far-fetched, know that the reason why every organisation in Australia
that represents the interests of disabled people vigorously opposes
euthanasia is because they see that such logic may well prove
irresistible. This stand is justified by their sad awareness that the
disabled are already the subjects of significant levels of public and
private discrimination, abuse and contempt, and would provide an easy
and defenceless target for health economic rationalists.
WHY IS EUTHANASIA WANTED?
No-one should disregard the terrible plight of those dying people who
are now suffering uncontrollably without any prospect of relief other
than death, natural or induced. The claim that these are the very people
for whom euthanasia is wanted must be examined.
The classic picture drawn is of a person with advanced terminal
illness, probably cancer, whose pain has reached levels at which it can
no longer be controlled, and for whom there are no alternative prospects
for relief. The pain of cancer is severe to moderate in about two thirds
of its sufferers, and in these, pain can be well controlled in all but a
small fraction, often set at about 3-5%, by known methods when they are
properly used. In fact, almost this level of pain control is within the
competence of all doctors who have been trained or educated. This means
there should be, if every doctor who was caring for dying patients was
correctly using the necessary methods, only about 2-3% of patients whose
problem was really difficult, and requiring high levels of competence by
But this is not what one sees. What is observed is that many patients
are dying with poorly controlled pain, when the doctor has not known how
best to proceed and has not sought help from experts. This situation can
be wrongly used to argue for euthanasia, but euthanasia should never be
regarded as the answer to inadequate care. Whatever one’s views about
euthanasia, a satisfactory standard of care for the dying is the right
of the community to expect of all its doctors, and the responsibility of
authority to ensure is provided. What is called unrelievable pain is
usually only what an individual doctor has not been able to relieve and
has not consulted an expert.
An Australian Professor of Law and Ethics has correctly seen the real
elements in this issue, when she said that unrelieved pain does not call
for euthanasia — it calls for an expert to be brought in to relieve the
pain, and then to look at the circumstances to see whether the first
doctor(s) should be charged with negligence.
This is the present standard of medical and nursing care for
terminally ill patients. By means of team work, using a range of skills
when these are needed, it includes the management of pain, both physical
and emotional, other difficult symptoms, honest dealing, the inclusion
of family and friends, effective communication so that the patient and
his family are well informed about the illness and its possible
treatments, and are offered support across a range of issues, especially
those of most relevance to the patient. It should be clear from this
description that the commonly observed situation falls far short of what
is known to be achievable. The reasons for this shortfall are many, but
all are capable of elimination or improvement.
Palliative care seeks neither to prolong life nor to shorten it
artificially. It respects life, holding that, when death is inevitable,
the provision of comfort is the prime responsibility. It is wrong to
shorten life intentionally and to prolong it unnecessarily, without good
cause, when it is in the patient’s best interests to die. A patient’s
choice to refuse unwanted treatment, for any reason other than suicidal,
must always be respected. It is important that everyone knows that it is
their right, protected by law, to refuse any treatment they do not want.
While the usual focus is on pain, the emotional turmoil that almost
always accompanies severe pain needs also to be dealt with
energetically. Pain will seldom be well controlled in the presence of
acute anxiety, so this combination of factors should be regarded as a
medical emergency to be brought under control as quickly as possible.
Anxiety must be replaced by security and a confidence that the carers
will never abandon the patient, no matter what may lie ahead. Patients
deserve to be given the understanding of their illness and its
significance that they want, because it is their right to know.
‘Communication can make the difference between a composed,
functioning person who is able to make the best of his life and one
whose days are filled with despair...this is a formidable
People who request euthanasia often suffer from a lack of human
relationships and understanding. Simply responding to such a request may
be considered the final rejection in a series of abandonments through
lack of human attention and loving concern.
Rather than take any steps to legalise euthanasia, and certainly
before it were even considered, since it is now known that such a law
that could not be made safe from abuse so as to endanger the lives of
those who did not want to die, steps are urgently needed to see that
every doctor who treats seriously ill patients is well instructed in
modern methods of care. The community is entitled to expect that no
patients are left in unnecessary severe pain and that doctors will be
held accountable, if necessary, for this.
By the supporters of euthanasia, it is claimed that legalised
euthanasia would strengthen the doctor/patient relationship, since some
dying patients would be comforted to know that the ultimate remedy for
any problem was available — that is, by removing distress by removing
life. This may be true for the small minority of those who would take
advantage of such a law, (the advocates of euthanasia concede that only
a few would wish to avail themselves of it), but it ignores what the
rest might think. If doctors were empowered to take life, a sick patient
could never be certain what were the doctor’s views about his/her
future, especially as it is known that euthanasia laws would always be
open to abuse.
The common reasons to want legalised euthanasia are:
- the compassionate relief of pain and suffering. The more aware
supporters of euthanasia now realise that this reason has lost its
former clout, on account of the quality of good palliative care.
- respect for human rights. For many, this is now the commonest
reason to promote euthanasia.
- protection for doctors who behave ‘compassionately’, by
performing euthan- asia outside the law at present, as though they
had the corner on compassion. They wish to continue but with legal
- assist in the containment of health costs. This is the least
‘worthy’ of reasons, but it is the one with the most potential for
future abuse, if the costs of health care for the aged and the
disabled continue to rise to what may be seen as intolerable levels.
To some, it would then seem that legalised euthanasia would provide
a ready solution.
Although it may seem self-evidently logical that consideration of the
right of every person equally to respect for his/her life would be the
first matter to address in a discussion of human rights, not only is
this usually not so — it is commonly omitted altogether, in favour of
emphasis on personal autonomy. This paper will discuss both rights, in
their correct order.
In 1948, the United Nations defined and proclaimed human rights, in
the hope that they would thereby be better understood and secured in
future. Hence, its Universal Declaration of Human Rights declared that
‘the foundation of freedom, justice and peace in the world’ is the
‘recognition of the inherent dignity and of the equal and inalienable
rights of all members of the human family’. Further, ‘everyone has the
right to life’ and ‘all are equal before the law and are entitled
without any discrimination to equal protection of the law’. This
Declaration was supplemented by more specific proclamations, including
the 1966 International Covenant on Civil and Political Rights, Article 6
of which states: ‘Every human being has the inherent right to life. This
right shall be protected by law. No one shall be arbitrarily deprived of
Words such as ‘equal’, ‘inherent’, ‘inalienable’, ‘without
discrimination’ and ‘arbitrary’ were meant to define the essence of
natural rights, particularly that they do not depend on circumstance or
personal preference. Natural rights are not be taken away and, just as
importantly, are not be given away. The right to life is to be protected
by law, invariably and equally, and life is not to be taken for reasons
based on opinion. The right to one’s life is thus declared to be the
fundamental natural right, on which every other right depends for its
existence and its validity.
Autonomy is the right of every person to decide freely the course of
his/her own life, within the limits set by the competing genuine rights
of others, and it will oblige compliance only when it respects those
other rights. That is, autonomy involves both the privilege of choice
and the duty to restrain one’s choice, when that is required. Autonomy
is misunderstood or misrepresented when it is assumed to apply to
whatever an individual may happen to want sincerely, or when it is
assumed that the significance of the consensual killing of voluntary
euthanasia is a private matter, with no harmful consequences for others.
Both assumptions are wrong.
The essence of autonomy lies in what is chosen, not in the fact that
choice is being made, though the opposite is the implied understanding
of much of the current use of the word, including its use in relation to
euthanasia. Individuals have no entitlement at all to be given what they
happen to want — that would be nearer to self-indulgence than
The degree to which personal choice is to be respected is dependent
on what is chosen. An appeal to autonomy clearly does not validate a
choice to kill another person, because no-one has any right to do that.
Similarly, since the right to request death at the hands of another is
not found in any code of ethics or law, or in any statement of rights,
it also cannot be a proper exercise of autonomy. Not only that, but it
would directly conflict with the most fundamental natural right to life,
the undoubted privilege of everyone, without exception. This is not to
say that arguments for euthanasia based on other criteria do not exist,
but that they do not include an appeal to human rights in general, and
autonomy in particular.
It is often heard that euthanasia is a matter of personal choice
only, and therefore should be nobody else’s business. It is
extraordinary that, while at least two persons are involved in
euthanasia, both of whom will have to make an autonomous decision, only
the autonomy of the patient is discussed. The doctor is a separate moral
agent, with autonomous responsibility for his or her own actions,
particularly those with undoubted moral content, but his or her autonomy
totally escapes examination. What makes it extraordinary is that the
doctor’s autonomy will always be the more dominant and important, since
euthanasia will not take place without a consenting doctor.
This omission conceals two important points — first, the means by
which the doctor’s decision is reached. Since, in the same
circumstances, different doctors would come to different conclusions
about the need for euthanasia, medical agreement to carry out euthanasia
must reflect that doctor’s personal values. But because the right to
life is a universal entitlement not to be made subject to arbitrary
judgment, that could not be just.
Second, the great difference between the doctor and the suffering
patient in their capacities to make autonomous judgments. Patients with
life-threatening illness often have greatly impaired capacity to make
rational judgments about complex matters. Potent emotions, such as fear,
anguish or despair, are frequently present, though when they are
recognised and treated adequately by competent doctors, the reason for a
request to be killed will often disappear. To accept requests for death
at face value without providing adequate care would be a form of patient
abandonment, by taking advantage of their vulnerability in such states.
In so doing, their autonomy would be abused, in the name of honouring
it. By contrast, the doctor must be presumed to be rationally capable of
decision-making, prepared to have his or her decisions scrutinised, and
prepared to take both moral and legal responsibility for them.
Thus, the euthanasia debate, when it relies on human rights, is
presently distorted in two important ways — it neglects the genuine
right to life and it relies on an erroneous concept and application of
The claim that a majority of Australians want euthanasia legalised is
far from being established.
On the basis of public opinion polls, it is repeatedly claimed that
some 70-80% of Australians support legalised euthanasia. The recent
passage of the Andrews Bill in the Senate was followed by an outpouring
of hostile sentiment, on the grounds that the views of the majority had
been disregarded. Over a long period, the public had been encouraged by
the media to accept opinion poll results as a reasonable basis for this
perception. The fact was not widely known that our parliamentarians had
reached the same conclusion as every other committee of inquiry, and if
it had been known, it still would probably have been repudiated because
of a conviction that the presumed view of the majority should have been
Opinion polls were developed to test views about political issues,
but euthanasia is essentially a moral matter, since it is about taking
human life. Would anyone place credence on opinion polls about theft,
defamation, cheating or assault, and use the results to try to change
the law? When the issue is as complex as euthanasia, no valid
conclusions can be drawn from polls when the respondents’ understanding
of the subject is both unknown and unknowable. To use such results as an
argument to change the criminal law is both foolish and dangerous.
Morgan polls have been asking the following question regularly since
1962: ‘If a hopelessly ill patient, in great pain, with absolutely no
chance of recovering, asks for a lethal dose, so as not to wake again,
should the doctor be allowed to give the lethal dose?’, and the number
in favour has increased from about 50% to nearly 80%. As one commentator
said, it would be hard for an uninformed person to say ‘no’ to that
question without feeling negligent, dogmatic or insensitive.
But when the current ability of good palliative care to relieve the
severe pain of terminal illness is known, though it is also known
tragically not to be sufficiently available, the same question could be
more accurately put: ‘If a doctor is so negligent as to leave a
terminally-ill patient in pain, severe enough to drive him/her to ask to
be killed, should the doctor be able to compound that negligence by
killing the patient, instead of seeking help?’ The question is really
about medical standards, not euthanasia.
It cannot be doubted that most of the community’s views on euthanasia
have been derived from the media, which almost without exception, give a
partial, if not a distorted, picture. When public opinion polls show
that many people are in favour of euthanasia, the media, which have
created this very opinion through their advocacy and lack of balance,
then cite these figures as evidence of the need to change the law to
allow it! Such behaviour is self-serving, and contrary to both truth and
If such issues could really be settled satisfactorily by opinion
polls, parliaments could be largely dispensed with, in favour of endless
polling (and that would include referenda). Even Helga Kuhse, one of the
most prominent Australian advocates for euthanasia has said: ‘If there
are good reasons why the people shouldn’t have (legalised euthanasia),
then the government shouldn’t give in to the people, even if ninety per
cent want a change in the law’.
The many reasons why any euthanasia law would be unsafe and why the
community would be disadvantaged by it are the subject of the paper The
Legalisation of Euthanasia.
The most serious possible abuse of legalised euthanasia would be the
extension of voluntary to non-voluntary euthanasia, the so-called
‘slippery slope’. While many do not regard this as likely, or even
possible if a law were properly drafted, this is not so. The subject is
treated more fully in the paper Non-voluntary euthanasia.
Pollard, Dr. Brian. “What is Euthanasia.” NSW Website (1999).
Published by permission of Dr. Brian Pollard.
Dr. Brian Pollard is a former anaesthetist (anesthesiologist) who
founded and directed, from 1982, one of Australia’s first palliative
care services. Dr. Pollard is the author of The Challenge of
Euthanasia and is involved in active opposition to legalised
euthanasia in Australia.
Copyright © 1999
NSW Right to Life Association