Euthanasia

In March 2003 I sent e-mails to Helen Clark, Annette King and some other MPs in regard to the imminent first debate on the introduction of the so-called "Death with Dignity" bill. My letter was a hastily written document, precipitated by the appearance of Lesley Martin on that night's Holmes programme. I was concerned as I thought the debate was to have been the next day, hence the urgency of the letter.

Now some time has elapsed, the bill was refused a further examination, and Lesley is now in prison. However I am pretty sure that this is not the last we will hear of this subject, there appears to be in the community a willingness to concede the argument to pro-euthanasia advocates, and it will undoubtedly end up being discussed in Parliament again at some future time. I still hope and trust that such legislation will never come to pass.

Here I give my reasons for my concern, adapting and improving on my original letter. At the end, I provide some URLs for internet sites of interest, I have tried to provide some sort of reference for all the major points I make.

For convenience, I give a list here of paragraphs in this article / letter, for quick reference if needed. Use the back-button on your browser to return to this list

Lesley Martin on the Holmes Show

The Sanctity of Human Life

Sufficient effective treatment and witholding treatment

Life becomes a choice

What value your family?

Holland

The quadriplegic

Religion and Humanism

Dogs

We are social beings

Further thoughts on humanism October 2004

Child euthanasia in Holland January 2005

URLs - Internet References

I write as an experienced general practitioner of some thirty years in the profession. I understand that the "Death With Dignity" bill is to be debated in the House of Representatives tomorrow, and I was reminded of this fact by the appearance of Lesley Martin on the Paul Holmes show tonight. This is an issue about which I feel very strongly. I think the introduction of voluntary euthanasia to New Zealand would be a highly retrograde step and I write to give you my arguments against passing this bill. I am concerned that the general public don't truly appreciate the issues and the likely results of such a law change. This may appear paternalistic and condescending, but the standard of debate has been so poor and the emotionalism surrounding cases such as Lesley Martins so hyped, that I hope that putting all the issues out to the widest examination might convince this same general public that the issue isn't that simple. In particular when our medical knowledge, our understanding of and training in palliative care has never been as thorough, and our pharmacological agents never more effective, any perceived need for legalising euthanasia has never been less urgent.

The principal issue can be reduced to the barest minimum as being concerned with the "sanctity of human life", which is the overriding governing principal of all advanced and democratic societies. It is evident in the laws that prevent or punish murder, assault, abuse, racial or religious discrimination ,and it is the best protection that any society has ever developed to protect all its citizens, particularly the disadvantaged, the minorities, and the physically and mentally vulnerable. It is this understanding of the sanctity of human life that relates to our laws on human rights and much of our Western regard for the importance of each individual human being and our individual responsibilities and rights. Whilst it is not illegal to actually commit suicide in most countries, probably for obvious reasons, it is certainly illegal to help or aid someone commit suicide. In fact, suicide is seen as a failure in our society, and much effort and expense is expended in suicide prevention campaigns. New Zealanders, who have the developed world's highest youth suicide figures, are not proud that so many young people take their own lives; we are spending much time and effort to improve these figures, relieving distress and saving lives, not conspiring with distress to take life. Most advanced Western societies do not have the death penalty, even for the most heinous crimes, this is because of the sanctity of human life overrides the desire or need for punishment or revenge. That sanctity doesn't just relate to life and death, it relates in every way that members of that society interact. It means for instance we don't have hard labour in prisons, or demeaning punishment, or otherwise why the shock with those pictures of American maltreatment of prisoners in the Abu Ghraib prison in Iraq. It means we all have, or should have, an innate respect for what it means to be a human being, to be treated by others as you would treat them.

What is important to understand that this philosophy is not only a religious one. Certainly in our Judaeo-Christian heritage the sanctity of human life is a fundamental feature. But secularism, atheism and humanism does not exclude this strong identification with the sanctity of human life. Taking of human life is wrong, and by extension, it is this sanctity for human life that prevents others aiding the taking of life, by anyone, anytime, even if directly requested. To those who promote euthanasia, this seems to them to be a denial of the right to choice, the right to do with one's own existence how you wish. But this misses the point that we all live in this same society, we can't just opt out of our responsibilities to ourselves, our families or our society, even if we are dying. To suggest that we could do this then disturbs that overriding principal. I think the likely cost of that is far too high. It is of interest that Dr Nischke, the Australian "Dr Death", does not agree that there is such a thing as a sanctity of human life. He denies its existence, and seems to claim, like so many euthanasia proponents, that such a concept is the result of religious scruples or philosophy, and so can be ignored in the euthanasia debate as just another religious injunction. I suppose at least this is a consistent view point, but I would deny that considering that there is a sanctity in human existence is purely the preserve of the religious. After all most people living in modern Western democracies would consider they were part of a secular society, but no-one has suggested that all the efforts outline above, whereby such states seek to preserve the sanctity of human life, are hypocritical or illogical. I add below in the my list of internet sites, some interesting articles related to humanism and the sanctity of life. I would add too, that anyone who heard the brilliant Reith lectures of Dr V Ramachandran on the radio late last year might wonder if such a feeling for the sanctity of human life, and concepts such as morals, conscience, or soul might even be hard-wired into our brain. Ramachandran certainly explores such concepts in his talks about the functioning of the human brain.

The bill is called "Death with Dignity". This is a brilliantly conceived title for anyone promoting this bill accepting the wording of this title immediately puts opponents of euthanasia at a disadvantage, for who could wish to propose that people should not die with dignity? Its use of words is as clever and misleading as "Arbeit Mach Frie" over the gates at Auschwitz. But then supporters of this bill might not rally quite so enthusiastically to a more accurate wording such as "Death with Convenience Bill". To use the term "Death with Dignity" misses the point (deliberately or not I am unsure) of what it is to be human, because there is dignity in all human life, from the development of the embryo to the state of dissolution of our corporeal remains. What shocked us about the deaths of those four Americans workers in Iraq last year? The deaths were shocking enough certainly but in the scheme of things in that part of the world, were no more than the experiences of tens of thousands of others in the last few years. But it was the treatment of the remains, the complete disregard for not just the sanctity of human life, but the sanctity of human death, of what it means to be human, what it means to respect all of humanity. After all, the dead didn't feel anything, they certainly didn't notice the desecration of their own remains. But we who still live did notice this, it was repellent and shocking.

There is an innate and indestructable dignity in being a human being. We should treat animals with dignity also, certainly, but the dignity we give to ourselves, to humankind, is of a different order. There is a dignity in the infant, in the cerebral palsied child, the intellectually handicapped. There always has been this dignity but one of the advances of our modern society is to recognise the common human dignity, in our own society, now more diverse and mutlicultural than ever it was, and also the societies of other countries, cultures, races, religions. The society that fails to recognise this is doomed to disaster, perhaps taking us with them, as did Nazi Germany. This dignity resides with us, whatever happens to us, to death and beyond. No-one in our society should ever feel, or be made to feel, that their dignity is anyway compromised by circumstance. It applies to maimed, the ill, the dying, the incontinent, to the mad, to the criminal and to the Alzheimer sufferer. That is why we care for all those who need care, and why society is happy to care for them, because it is our own dignity and humanity that is reflected in this work. When we care for the sick and the dying, we learn from them. Every patient has something to teach us. In particular we learn patience, humanity, humility, we learn how to relieve suffering, not kill it, we learn how to communicate with the withdrawn, to cheer the saddened and we can enjoy our contact with the Alzheimers patient, laughing and crying with them, learning something about how simple life is when reduced to its basics. When we care for the sick and dying we also care for their loved ones, and we help them. We help them with their distress, and to how to come to terms with their sick family member's distress. We relieve suffering by sharing it, reducing it to something manageable, to let every day have its own meaning and importance. For some families the experience of the someone dying in the family is the first time that the simple truths of that family's existence and loving relationship is acknowledged and recognised. This can be a profoundly liberating experience, for we all have to die, and if this dying can relieve fear in a relative or friend, isn't that worth something?

And what do proponents of euthanasia have to say about this? They only seem to see dignity where they wish to see it, not to discover it or to have it revealed it in the most surprising and stressful situations. I am very angry that they should so misuse and claim for themselves the word "dignity". Would they seek to deny families that opportunity for a last discourse, a last understanding? Of course, it doesn't always happen quite like this, but most of the time it does, and euthanasia kills not only the patient, but all those other aspects that make human life what it is, its imperfections, its love, it messiness, sometimes its ugliness but much more often its humour in adversity, its courage, its sublimity, it simplicity and its dignity. Euthanasia will kill the very thing that euthanasia advocates say they seek to preserve, human dignity.

The Law Lords in London have considered this matter fairly recently. Whatever you think about the rather peculiar system of justice in the United Kingdom, the Law Lords represent, in that country, the pinnacle of legal knowledge and debate. When such an august body can be so certain in their opinion against euthanasia (five to none), then it can't be easily ignored. They heard a case in 2001, the sort of case that is used by euthanasia proponents to support their calls for euthanasia. In this case, a 42 year old woman with motor neurone disease asked to the court to lay aside the criminality of her husband assisting her suicide. She brought the case as being denied her rights under the European Convention of Human Rights, and her right to privacy. You can find a summary of the Law Lords findings on the internet (see URLs) and they seem very strongly to support the notion of the sanctity of human life, in a secular way. The article continues with relating the experiences of another woman, with spina bifida, who went through years of wishing to end her existence. She ends by saying "if you are surrounded by people who make you feel as if your life has the same unfathomable value as theirs, then you are able to cope with tomorrow" What a beautiful way to put it.

Dr Nitschke, a self-aggrandising proponent of euthanasia, is a general practitioner from Australia. But isn't strange how two people such as Dr Nitschke and myself, who must have had what are likely to be very similar experiences in their professional lives, can come to such contradictory conclusions. Dr Nitschke relates how often he meets with agonising and distressing death, or unbearable suffering, and how powerless he has been to deal with this adequately, and that voluntary euthanasia is the only answer for this. Yet I have been a doctor for nearly thirty five years, and I see how infrequently patients die an agonising or distressing death. So why is my conclusion, that the need for euthanasia is rare and that to have euthanasia diminishes the sanctity of human life, so different from Dr Nitschke's conclusion, that he now has become a proselytiser of euthanasia. I could also ask, why do Dr Nitschke's patients seem to suffer so much more than mine? - but I won't.

In fact as I learn about this doctor I find out just how atypical his professional medical life is. He is clever man, no doubt. A first class honours in physics, and a later interest in medicine, so as a mature person he qualified in medicine at the age of 42. He is now 57 years old. Considering it would have taken him two to three years to finish his training, and that over the last few years he has no longer been working as a general practitioner, but as a full time self-publicist for his euthansia views, being paid by a euthanasia organisation, his actual experience of medicine is pretty limited to say the least, amounting to a few years at most. As far as I know he has no qualifications in counselling, in palliative care, psychiatry, geriatrics or any field of medicine from which he could claim some training or knowledge in his chosen field, the care of the dying. I find it extraordinary that such an inexperienced and poorly qualified practitioner should be paid any attention to all in such a contentious area of medicine and society. When you also learn that he has at various times encouraged people to get barbiturates from the local vet, has proposed fitting up a ship registered in Holland as a mobile euthanasia facility and has seen no particular difficult ethical issue in providing a "peaceful pill" to the general population, including (his own words) the depressed, the elderly bereaved and the troubled teenager, then it is plainly evident that he exhibits the same mechanistic view of human existence as Dr Kevorkian and Dr Singer (ethics professor at Princeton University). He appears to be obsessed by death to the exclusion of all other medical interests, and as such could be seen as a likely monomaniac. At the very least, his inability to see that we humans have an intrinsic worth (sanctity, spirituality, soul, dignity, call it what you will) that almost almost all other human beings have an instinctive understanding of, recognising these qualities in themselves and all humanity (and which is perhaps, as I mention above, even hard-wired into our brains), means, with his lacking that understanding, that he possibly suffers some sort of personality disorder.

There is a good deal of confusion even as to what euthanasia means. Strictly speaking two terms are used, Physician Assisted Suicide (PAS) where the final step, e.g. pressing a button, is taken by the patient, but where the physician or suicide abetter sets up or provides the means and emotional support and encouragement, and euthanasia where the physician himself takes the final step, e.g. an injection. For practical purposes there isn't a great deal of difference, nor do most euthanasia proponents seek to make such a distinction, both methods should be made legal. The medical indication for PAS or euthanasia is not important for the pro-euthanasia lobby. The public generally take this to mean something unendurably painful like terminal cancer or possibly some degenerative neurological condition, cases of great suffering, and these are the cases widely publicised by the media, and made good use of by euthanasia proponents. These cases have a great deal of emotional content, but if the law is passed, it won't be exclusive to this group. After all, would legislation actually seek to constrain the diagnoses which might be considered, the the likely length of time to death, or how much suffering constitutes the necessary legal framework for euthanasia? So we would see assisted suicide for the depressed, the bereaved, the socially isolated, the infirm, the discriminated against and the vulnerable. We may well see it for younger people, or children. Dr Nitschke certainly sees no problem with this - he signed the "Zurich Declaration on Assisted Dying" and among its tenets is this one Thus, according to right-to-die advocates, one who is experiencing physical, mental, emotional, economic, or familial problems would qualify for a fatal overdose or a lethal injection as long as the distress from such factors is considered "severe and enduring." In addition an examination of what is happening in Holland should concern us all - the so-called slippery slope is not just scare-mongering. (See URLs)

What also must be made plain in this debate, and this is where I truly believe the general public does get confused, is where treatment is used to keep a patient comfortable, knowing that such treatment might hasten or definitely will hasten a patient's death. This is NOT euthanasia. Some people call this "passive euthanasia", but I think even to mention the word euthanasia in this instance is just confusing. It would be better to say something like "sufficient effective treatment" If giving sufficient morphine near the end of someone's life to prevent pain or if giving sedatives to relieve agitation for instance, shortens life by a few days or even a few weeks, this is just treatment, sufficient and effective enough for the patient's need. If the doctor were to give more morphine than likely to be necessary with the intention of killing off the patient more quickly then this would be euthanasia. Equally witholding resuscitation in a geriatric hospital, or antibiotics in the severe Alzheimer's or severely disabled patient for a pneumonia is also often called "passive euthanasia", but again I think using this term in this situation is confusing. What is being done is trying to avoid preserving life just for the sake of it, or as has been said, not striving officiously to keep alive. Bronchial pneumonia used to be called the "old man's friend", it should still be allowed to be so. A good doctor will discuss such matters with the family (and the patient if competent enough) before the need arises, so that everyone knows exactly where they are. Witholding treatment when there is no likely benefit from using it, is just letting nature take its course. There would be quite a few times I have done this, only for the patient to recover amazingly and survive in their poorly state a while yet. This is a testament to the strength of the human constitution, but even more a testament to the excellent care that so many nurses and care givers provide in geriatric facilities, or relatives and district nurses in people's homes.

I have been in the profession long enough to know that doctors are basically pretty ordinary people, quite clever often and certainly with a lot of training. Our ranks include many good and caring practitioners, who fortunately number the vast majority, but it also includes its fair share of criminals, liars, bigots, extremists, embezzlers, sexual perverts and even an occasional mass murderer (this latter in the UK of course, my own country!). This is what you would expect in any heterogeneous collection of five or six thousand people in any country, though I would like to think somewhat less than in the rank of some other professions. Any euthanasia law that came into being would have to recognise this fact, but would probably be unable to do so. Basically any law that allowed members of my profession to make such decisions would be allowing practitioners to make decisions of life and death over patients and I am afraid that some of these practitioners would not have the training, the expertise, or more importantly the humanity or humility to do so. Dr Nitschke would be one obvious example of someone who would be incompetent in this regard. In other words you are giving to medical practitioners powers they should never be allowed to possess, which is contrary to their fundamental ethics, which they don't need and which the majority of practitioners do not want.(See URLs for medical sites below) And if medical practitioners should never be given this right, exactly which members of society would you give this right to?

I have mentioned the way that the media will quickly latch on to the occasional tragic case, the old man who killed his wife with a hammer, or recently the centenarian butcher in the UK that slit his wife's throat, and particularly here in New Zealand the case of Lesley Martin and the killing of her mother. But for the rest of the time the matter is not debated, - it is not that the subject isn't important, as what could be more important than life or death? The Lesley Martin case is a prime example of this. This self-publicising and proselytising euthanasia campaigner has manipulatively used her mother's illness to further her political aims. This may seem a hard comment on Lesley, but in her behaviour and her seeking for publicity then she must accept the brickbats that come her way. I don't doubt Lesley's genuine distress, nor do I doubt the mother was distressed and very ill too. And, at least from what came out in the trial, some aspects of the mother's medical care seemed less than satisfactory, though partly from the choice of the Lesley and her mother. But Lesley must accept that she was a professional nurse and a patient's daughter, in a position of trust both to her mother and the community, and she failed to honour this trust. If she was distressed, if her mother was distressed, then professional help was available and should have been well equipped to relieve this - if it wasn't, then this is not a case for advancing euthanasia but for advancing the easy availabilty of good terminal care in all parts of New Zealand. In this I don't totally blame Lesley, communication is a two way thing, perhaps the fact the Lesley was a professional health carer somewhat interfered, all health professionals will recognise this as an occasional problem when the carer becomes the one needing the care. But I would ask all those who support euthanasia and look to this case to support this view, just who's distress was being relieved by the death of the mother in this case? Was the mother really the distressed one here? She is dead, and perhaps we'll never really know. But I would contend the real distress was Lesley's, that it was she that couldn't cope with her mother's illness and caused her to take the action she did. And wasn't that the same with the old man and the hammer or the butcher in the UK? Is this what euthanasia proponents wish to see, euthanasia for the old or infirm or the suffering to relieve distress and unhappiness in their partners, carers or relatives?

We can return to the British Law Lords in this matter and the presumption that the state must preserve the sanctity of life; that although they recognise the occasional distressing case that can be brought to the public's attention that single or particular cases of distress do not constitute a reason for overturning that presumption of the sanctity of life. In other words, the single case makes bad law. When I hear of these cases, as a practitioner I can say that the treatment that some of these patients have experienced was less than ideal. That is why some of the most vocal critics of euthanasia are the doctors and staff who work in hospices and palliative care. In a sense therefore the perceived need for euthanasia is, in many cases, the result of failure of the doctor's treatment of the patient. Is this the result we want , that those doctors who fail in their care of the dying patient are going to able to take a short cut to a painless or peaceful death of their patients?

I would say too, that there is hardly anyone who can't in their last illness, unless they are moribund , confused or unconscious , take their own lives if they wished, all they need for a painless death are a few sleeping tablets and a plastic bag. The fact that almost everyone in a terminal illness does not do this shows the wish for death is not quite as strong as euthanasia advocates like to portray. What a patient who requests euthanasia is asking is, partly, for someone else to take that decision from them or share that decision, by being a willing collaborator. It is this collaboration that allows more people to be comfortable with the decision to takes one's own life.

If a euthanasia law is passed, whatever the safeguards, this overturns the presumption of the sanctity of human life - in other words, if death becomes a choice then, logically, life also becomes a choice. Euthanasia would completely alter the relationship of the carer and the sufferer, the doctor or nurse and the sufferer, and the community and the sufferer. Just as not all doctors are paragons of humanity and medical skills, not all families are paragons of care and charity. I think that many people who support euthanasia don't really understand the multiplicity of motives, skill and care in the public (and the medical profession), mixed up in all our messy relationships and good intentions, and sometimes not so good intentions. We cannot judge what subtle pressures might be brought to bear on the vulnerable old person, widow or widower perhaps, perhaps if they have some money, to come round to thinking euthanasia is something that might offer an easy way out or relieve relatives of the "burden" of looking after them. Intolerable situations are not always caused by disease, they can also arise with mental illness, stress, guilt and family dynamics. The availability of euthanasia could well undermine the vulnerable person's real wish to be loved and cared for.

I can't help but note the repeated surveys of public opinion, which show a majority of the public approving of some sort of euthanasia law. As a physician I must admit that this really distresses me; is it then that we are not doing a good job? That we as a profession are not able to provide that medical and spiritual support that a dying patient and his family need? Or is it more, and this is my explanation, that those distressing cases which achieve a great deal of publicity are worrying the population unescessarily and the sort of issues that I have tried to address in this letter are not being aired? There appears to be a widespread, unreasonable and unfounded fear of old age, disease and dying in the general population which is seldom realised in real life. Why is this? Why should people fear old age? What is the alternative to old age? Dying at sixty? I would ask this of anyone who does think that euthanasia is any sort of solution to a difficult medical problem to consider this. You may look on euthanasia as something to comfort you in your old age, that when you are old and feeble you won't have to feel demeaned by this situation. So you approach old age with this supposed "prop" available. But what about your family? Would you approach your old age with quite so much equanimity if your son, having gone through a severe depressive illness, had already allowed Dr Nitschke to persuade him that euthanasia was a solution to his illness? You see, Dr Nitschke has made it perfectly plain that anyone, from the age of 16 years upwards, whether dying or merely miserable with life, should be able to request euthanasia. Even children under 16 should be allowed to request this, with parental consent. What about your beautiful twenty-five year old granddaughter - she had got herself into trouble, had a debilitating drug problem, and found she could not tolerate her life? What comfort then would Dr Nitschke have provided you in your old age? None at all. Because this is what we are talking about , the destructive and unretrievable application of a simplistic and final solution to a complicated, distressing but never hopeless human problem.

What to say about Holland? A country and people that many of us look up to as an example of liberal and progressive thinking in dealing with complicated social issues. But the reality is not always quite what it is cracked up to be. Whilst Holland does not approach the USA in drug use and severe criminality and homicides (most countries don't), it is perfectly comparable with many other European countries, most of which do not emulate Holland's "way". In addition Holland is recognised as one of the leading trans-shippers and suppliers of drugs, hard and soft, in Europe. One could make the same comments in regard to pornography and prostitution. The point of this preamble is not to "bash" Holland, but merely to point out that it is easy, looking from the outside, to have one's own beliefs about the effectiveness of certain policies go unchallanged but which don't in fact stand up to more searching scrutiny. This has an obvious connection with the euthanasia debate, because euthanasia proponents continue to use the Dutch example to support their opinions. But a deeper study would reveal, for instance, there has never been in Holland any tradition of terminal or palliative care, and it remains an underfunded and cinderella part of the Dutch medical scene. Holland is a country of 16 million people where there are only 70 palliative care beds; compared with New Zealand, a country of 4 million, which has over 140 beds; that is a rate of provision of specialist palliative care beds in Holland of one eighth of that of New Zealand. Similar with the number of specialist palliative care physicians. Is it any wonder then, in this absence of such care, that the Dutch have felt obliged to resort to other methods to relieve suffering in the dying? Why then should we be so quick to try to emulate Holland when, thankfully, our social and medical situation and culture is so different in this area, and has been for many years?

January '05 - There has been quite a bit of publicity about the Dutch way of death recently; an article in the Washington Times, by Bob Barr, a former Republican congressman also makes for disconcerting reading. (This is related to the so-called Groningen Protocol, please follow the internet reference below). A further link below takes you to an article about the experience of euthanasia in Holland, including a summary of the Remmelink report of 1991. Of major concern is the thousand deaths a year from involuntary euthanasia. In addition it is reported that members of the Dutch medical profession regularly falsify death certificates in relation to euthanased patients. The purpose of writing in some length about Holland is to illustrate the real concern about the "slippery slope" of euthanasia. It is happening in Holland, as those against euthanasia predicted it would, and it will happen anywhere where similar practices or laws in regard to euthanasia are introduced. I pursue the Dutch theme in an update at the end of this article.

Although I have just stated that the single case makes bad law, it can't be denied that euthanasia advocates seem to make their best case in considering the totally paralysed - the quadriplegic where the possibility of suicide is ruled out because the mental capacity is there, but the physical ability is gone. And interestingly where also the prospect of an imminent demise is remote. These cases make particularly distressing examples. The Law Lords considered such a case. None of us could ever know what it is really like to be in this terrible situation, and not everyone has the incredibly high standard of care, or fighting personality of a Christopher Reeve . Perhaps, in this case, if society agrees that the ability to commit suicide is no longer available, then this patient should be able to petition the society for this ability to be restored. In other words, the state's presumption of the sanctity of human life can only be set aside by the state. This person would then have to argue in court, or at least in some legal forum, that he or she she be given back the right to kill themselves, which of course means the co-operation of some other person. Thus the right to ask someone to help kill one should be reserved only for this category of person, and every single decision about this should be in a legal, public forum, and under legal jurisdiction and being open to public scrutiny. If the reasons are sound, then they should be able to survive this sort of scrutiny. This is quite feasible, as the number of cases in this kind of extreme distress are actually very few. Again you will note that I do not think that this decision should be the prerogative of the medical profession, that is dangerous. Society must judge, not the individual doctor. If you allow medical practitioners this sort of Godlike power, you will have a few who will be happy to assume this power but in reality it is not a power that should be granted to anyone. I must admit here, that as an anti-euthanasia proponent, that I am not entirely convinced even by my own arguments in regard to euthanasia and quadriplegia but I offer this suggestion as a possible solution to a particularly distressing circumstance.

In all other cases the presumption should be that any one who wishes to kill themselves can legally do so, but that others are not allowed to assist or encourage this. This is the law we have now, and it should not be changed. If the law was changed to allow medical practitioners to make this sort of decision, then I would leave the practice of medicine. I don't wish to see the time when the elderly patient I visit at home, jokes with me "You've come to put me down, eh doc?" A joke like this could well contain just a snippet of genuine worry, just as the soldier facing action might make a joke about it. I strongly believe it could completely alter the perception of the profession by the elderly and the vulnerable. I don't wish to work in any profession where some of the profession are happy to kill patients. I said that the profession contains extremes, perhaps I am the other extreme, but I don't think so, it's just something I have given a lot of thought to over the years. As I said, I have thirty years of experience as an ordinary, bumbling and, so my patients tell me, kindly natured GP. My arguments are not fundamentalist or religious, they arise from the common knowledge of human nature and what it means to be a human being. Many pro-euthanasia proponents don't seem to recognise that it is not just the prerogative of the religious to object to euthanasia. Certainly one can understand the religious viewpoint that makes euthanasia so ethically objectionable, but I would argue that in a modern secular society that a religious viewpoint does not, of itself, carry any extra weight, nor do I see why pro-euthanasia advocates should necessarily have to take notice of their opponent's purely religious arguments. But pro-euthanasia advocates do have to recognise that we live in a society, that being a member of this society brings many benefits, but it also brings many responsibilities. A social humanist objection to euthanasia then is a very proper one, and social and humanist ethics are a perfectly valid argument in limiting some individual freedoms.

Euthanasia proponents will often contrast the veterinary surgeon's ability to put down a dog when it has reached the end of desirable existence, as against the present duty of medical practitioners to preserve life. Lesley Martin's book was titled To Die Like a Dog. But a dog is a dog is a dog, the same law that allows for involuntary euthanising a dog for disease or old age, also allows involuntary euthanasia for any other reason, if it is aggressive, has bitten someone, or can't do its work, or has outgrown its owner's wish to look after it , or it is an unwanted present is that what we would wish to compare with or wish for human existence? Perhaps the dog is old and disabled, arthritic, pees on the carpet, it smells. Many such dog owners would say, this is the end of a worthwhile existence, and a veterinarian might be called. But did such an owner ask the dog? Is the dog bothered by the smell or the puddles on the carpet? Actually he is quite comfortable, he has a nice warm home, comfortable mat to sleep on, and a doting owner to feed it. Why should he wish to be put down? We are not dogs. We are human beings. There is all the difference in the world. I don't know why euthanasia advocates continue to use this hoary old argument - it is specious.

There is a charge on us all to respect the sanctity of human life because we are human, but we are not just individual humans, we are members of a family and of the wider society, and being members of this society carries society's duties and responsibilities, and it is only in this society that our life has any meaning. Whatever the motives of euthanasia proponents are, they cannot deny, and they don't deny, that the result of a change in the law to allow euthanasia will be a reduction in society's regard for the sanctity of human life. I firmly believe this is far too big a price to pay for the relief of a very few, but emotionally charged, cases.

Yours sincerely

Dr J K Monro MBChB.

In my arguments against euthanasia I have tried hard to use my own medical knowledge and experience and my general experience as a member of the ordinary human society, as a human being, a husband and father, in advancing my arguments. I have also tried hard to avoid religious injunctions, as I am happy that we live in a secular society, and as such, I can understand that any religious arguments that others might wish to pursue might not sway those who are not of that religious persuasion. However I have used an appeal to humanist ethics to back up my contention that euthanasia is wrong. In this, I have to admit, I might be considered by many humanists as being a heretic, if indeed such a person can be identified in the congregation of humanists, ethical or unethical (non-ethical?).

I remark on this as I have been pursuing further information on humanism and came across a web page directly relating to a humanist view on euthanasia. This is a report, possibly a submission, in French, by the International Humanist and Ethical Union (IHEU) to the European Parliament, in connection with a debate on euthanasia in the European Parliament in 1999. The European Parliament concluded the debate by agreeing to oppose voluntary euthanasia, and this conclusion was partly based on another report that euthanasia was contrary to section 2 of the European Convention on Human Rights (ECHR). (Link below) The IHEC submission was written sometime later, in October 2002 and states that this is not the view of the IHEU, and that the IHEU does not see euthanasia as an ethical problem in certain situations nor does it consider euthanasia as being incompatible to the ECHR. It partly supports its argument by deferring to the legalisation of euthanasia in Holland and Belgium, and the examination of the issues that took place in those countries prior to the legislation being passed. However my French is very basic, and whilst I append a link below to a Google translation of this page, a computer doesn't provide much nuance of meaning either, in fact some parts might best be described as "googledygook".

But following on from this it looks as if I might be seen as being guilty here of misrepresenting humanist ethics for my own purpose, contrary to the view of many humanists.

However I have re-read my letter several times, and I certainly don't plead guilty to this. The ethics of humanism are not writ large on a tablet of stone. There are no fundamental tenets of humanistic faith, if that is an acceptable term, that aren't open to scientific or rational review, which is why we are humanists. What I have tried to do is present an argument where a fundamentally important and universally agreed ethic, the sanctity of human life, can be presented against a background of the realities of human life and human nature, of family, of society, of medicine and medical care and where the actual medical, social, legal and ethical problems associated with euthanasia can be demonstrated or argued. I have no compunction in using the principal of the sanctity of human life, whether humanist or religious, as my fundamental argument against euthanasia. If other humanists disagree, that is their prerogative, but I hope that they would not deny me my right to do so. In fact, I feel so strongly about this issue, I very much hope that my article would convince some of you reading this that my arguments have merit, and that euthanasia is not a solution to suffering at any time in anyone's life.

According to a report on the BBC Internet news site, fifteen to twenty disabled new-born babies are euthanased in Holland each year. This is nominally an illegal activity, but no doctor has even been charged, let along convicted. This practice is mostly "unreported", not surprisingly. "You are trained to save the life of a child but with these children the suffering can only be stopped by ending their lives. It takes courage to do that.", Dr De Volkskrant is reported as saying.

So much for limiting euthanasia to those that volunteer, unless doctors in Holland have developed some sort of communicative raport with their infant patients that has escaped the rest of the world's medical profession. This is precisely the sort of example of the "slippery slope" argument that euthanasia opponents have often used, myself included, and it shows those arguments are not misplaced. I am not exactly sure what sort of courage it takes to kill a child, perhaps the child might bite his finger, but it would have been nice for the article to have explored this a bit further with Dr De Volkskrant.

While every fibre of my being is against euthanasia of any sort, I would hope even those who might be sympathetic to the idea of voluntary euthanasia will be repelled by this alarming distortion of medical and social ethics. I should add that I am writing this update on the 28th January 2005, the sixtieth anniversary of the liberation of Auschwitz. Would I be alone in seeing a disturbing connection between this event and what I am writing about?

Finding suitable internet sites about euthanasia is not easy - this is such a divisive issue, that most sites are either religious sites strongly opposed to euthanasia, or euthanasia societies equally determined to promote legislative change to sanction euthanasia. Here are a few that I have looked at. There are thousands of others, which can be found by searching with Google.

http://www.bbc.co.uk/radio4/reith2003/ This BBC site has information about these fascinating lectures of Vilayanur S. Ramachandran. You can actually download the lectures to your computer, well worth the effort.

http://www.aeu.org/ericson2.html#Greatest - American Ethical Union Secular Humanism as a religion or code of ethics

http://www.kenanmalik.com/papers/engelsburg_nature2.html - "In Defence of Human Agency - arguments for humanism vs mechanistic philosophies

http://howardgarcia.com/articles.htm - secular humanism essays

http://www.myd.govt.nz/sec.cfm?i=21 - Government site about youth suicide in New Zealand, and the programme for prevention.

http://www.cnsnews.com/ForeignBureaus/Archive/200303/FOR20030331a.html CNS article about the "Death with Dignity" bill, prior to the debate in the House of Representatives

http://www.nrlc.org/news/2001/NRL12/brit.html - British Law Lords decision 2001

http://news.bbc.co.uk/1/hi/health/2968078.stm - news article about the passage of a reading of a euthanasia bill in the House of Lords.

http://www.worldrtd.net/news/world/?id=521 a short article about Lesley Martin and Dr Nitschke, on a pro right-to-die site.

http://www.ad2000.com.au/articles/2003/oct2003p6_1453.html a catholic site about a debate involving Dr Nitschke and Bishop Fisher in Sydney, Australia.

http://www.netlaw.co.nz/family.cfm - New Zealand Netlaw Site with some links, outlining the present legal position.

http://www.ava.com.au/content/press/030415.htm - an interesting snippet from the Australian Veterinary Society following advice from Dr Nitschke that people should try to get some nembutal from a friendly vet.

http://www.nationalreview.com/interrogatory/interrogatory060501.shtml - an interview with Dr Nitschke. Dr Nitschke's denial of the sanctity of human life is revealing

http://www.australasianbioethics.org/Media/20020600-MC-Perspective1.html - an different Australian perspective

http://www.cnsnews.com/ForeignBureaus/Archive/200303/FOR20030331a.html CNN article with brief but fair overview.

http://www.internationaltaskforce.org/noa.htm - this is an anti-euthanasia site but well researched - it does illustrate the "slippery slope" argument against euthasia is a genuine concern.

http://canberra.yourguide.com.au/detail.asp?class=Yoursay&story_id=151998&subclass=general&m=5&y=2002 an Australian article about the disproportionate number of women who request assisted suicide - this has been noted elsewhere - see my comment about the vulnerable.

http://www.internationaltaskforce.org/zurich.htm "The Zurich Declaration on Assisted Dying" It should be read.

http://www.rnzcgp.org.nz/NZFP/Issues/Aug2003/Baird_Aug03.pdf (downloadable pdf) this document explains the position of the Royal New Zealand College of General Pracitioners, and medical practitioners in this country generally. Tony Baird is a highly respected NZ specialist (Obstetrician), and has had a significant part to play in the New Zealand medical scene. He writes this article as Chairperson of the NZMA's Medical Ethics Committee. It should be read.

http://www.linacre.org/bma.html#anchor93211 - an overview of the BMA report on euthanasia from a medical ethics site

http://northernlife.senet.com.au/6april99.htm - thoughts about Dr Nitschke, Dr Kevorkian, and Dr Singer. Dr Singer is another contentious Australian, Professor of Bioethics at Princeton University. Dr Nitschke has admitted his admiration of Prof Singer.

http://news.bbc.co.uk/hi/english/static/health/euthanasia/basics.stm BBC site with overview on euthanasia.

http://www.estreet.com/orgs/dsi/HarmRed/HollandsHalfBakedDrugExpe.html an article critical of Dutch drug experience

http://www.homeoffice.gov.uk/rds/pdfs2/hosb1203.pdf UK Home Office international criminal justice statistics

http://www.internationaltaskforce.org/fctholl.htm What appears to be a reasonably accurate report about Dutch euthanasia statistics, including Remmelink report of 1991

http://www.psychiatrictimes.com/p950427.html - an article by an American psychiatrist about the "Dutch Experience" of euthanasia. A well researched and unsentimental clinical criticism of what is happening in Holland by a medical professional in what appears to be a professional site. The information appears to be accurate and can be found in many other internet sites, but as many have religious affilliations, I have not referenced the sites here, except the one above. A Google search eg - dutch experience euthanasia - will provide many sites on this issue

http://www.euthanasia.com/ - an anti-euthanasia site with many articles and lots of links. You will gain a lot of information by visiting this site, highly recommended.

http://www.aucklandves.orcon.net.nz/ - Voluntary Euthanasia Society of New Zealand.

http://xnet.kp.org/permanentejournal/sum01/Musings.html A beautifully written and thoughtful article, by a physician (I would like to meet him), making good use of what I would call humanist ethics, opposing euthanasia. I understand that Kaiser Permanente is the largest not for profit health benefit organisation in the U.S.

http://www.iheu.org/modules/wfsection/article.php?articleid=85 This is the article mentioned above being the submission of the Internation Humanist and Ethical Union to the European Parliament, in French.

http://homepage.mac.com/j.monro/Euthanasia/EnglishIHEUEuthanasia.html "English" version of above French web page. Your own French may do a better job.

http://news.bbc.co.uk/2/hi/europe/4198993.stm - The BBC news article on child euthansia in Holland.

http://www.washtimes.com/commentary/20041226-123251-5015r.htm Article in a recent Washington Times about the Groningen protocol, which allows the non-voluntary euthanasia of severely disable children and adults.