Answering Kenymanthri Moodley (SAMJ June 2015)

Rebutting medical euthanasia argument

The following reply was sent to an article containing multiple factual inaccuracies published in the June 2015 SAMJ South African Medical Journal. They have not as yet published our response or made a correction.

Arguments presented in the June 2015 SAMJ for medical euthanasia are rebutted. Medical intervention to extend life is not ‘playing God’, while actively taking life is ‘playing God’. There is no new ‘modern crisis’ requiring euthanasia. If anything, modern palliative care takes away arguments previously used to motivate it. Sound statistical evidence shows the South African public strongly opposed to euthanasia. Attempts to dismiss the ‘slippery slope’ argument by citing Oregon as a positive case example as opposed to Benelux euthanasia are not valid. Oregon does have abuses, although these are less than Benelux firstly because it does not allow euthanasia but only assisted suicide, and secondly due to strong pro-life advocacy which is not present in Benelux. The Stransham-Ford judgement legalises euthanasia following a Benelux model.

A recent article in the South African Medical Journal (SAMJ) dated June 2015, ‘The Fabricius decision on the Stransham-Ford case – an enlightened step in the right direction’, by Kenymanthri Moodley (Director of the Stellenbosch University Centre for Medical Ethics and Law) undermines medical ethics and uses arguments that are factually incorrect and misleading on a number of points.

PLAY GOD ARGUMENT: Firstly, extending life through medical intervention cannot be ethically equated as does the writer, with actively terminating human life, which is murder (Deuteronomy 5:17). The phrase used ‘play God’, infers the Judeo-Christian ethic which means that only God has the right to actively take a human life, except in the exceptional instances specified in scripture, where the state acts to take life via authority delegated from God, for example by the military or after due process of law for a capital offence. The medical profession, unlike law enforcement and military has not been granted the authority to ‘bear the sword’ (Romans 13:4). The ‘play God’ phrase is not relevant to the extension of life. A patient has always had every right to refuse extra-ordinary medical treatment, which cannot be ethically equated with active killing. We have no issue with euthanasia of dying animals, but human beings are created in the image of God (Genesis 1:27), and thus each human life has inherent value. In the same way printed money notes and minted coins have value because of the image on them, far beyond the worth of the paper or metal and money may not be destroyed by the temporary owner. The same applies to human life.

MODERN CRISIS ARGUMENT: Secondly, the writer argues new medical developments allowing extension of life, for example in Oncology motivate a change in ethics to allow assisted suicide. Nevertheless, the ancient Hippocratic oath itself indicates that there have always been certain patients that exert extreme pressure on doctors to assist suicide and the ethical requirement is to resist such pressure. If anything, medical advancements in the field of palliative care substantially reduce the level of suffering as compared with the past. The Nazi’s used a ‘modern crisis’ argument for euthanasia that the survival of mentally handicapped people had increased due to modern medicine and thus there was a new need to euthanase them to avoid their numbers growing and using up resources of the healthy.

STATISTICAL EVIDENCE: Thirdly, the writer alleges there is no empirical evidence for majority of the South African population opposing assisted suicide & euthanasia. This is incorrect. An analysis of the opinion polls conducted to date shows that those following scientific method indicate an overwhelming majority of South Africans opposed to euthanasia. The only statistically credible polls in South Africa were conducted by the ‘World Values Survey’. A referendum on this subject as suggested by the writer is likely to yeild at least a two thirds majority in opposing, allowing for those without strong opinions who would likely not vote. The media polls claiming support for assisted suicide are all ‘phone in’ and ‘web site click vote’ based, which are being manipulated by a lobby group, the advocacy of certain media outlets, and the target readership of those publications and web sites and carry no scientific credibility. The ‘partly-scientific’, media polls consistently show opposition to euthanasia. The scientific statistics correlate well with related issues on the Sanctity of Human Life such as abortion and death penalty for which more data is available. That said, we would welcome a referendum on the subject, to clarify these matters, but the outcome of referendums can be fairly well predicted using scientific surveys.

SLIPPERY SLOPE: Fourthly, the ‘slippery slope’ argument is dismissed firstly citing Oregon as opposed to the Benelux precedent and secondly recommending safeguards in law to mitigate abuses. These defences fail.

– While abuses in Oregon are considerably fewer than Benelux, there are abuses in Oregon for example patients are committing suicide using two year old prescriptions, while the law only allows prescriptions where the patient has six months to live. It is mainly wealthy patients who are being killed supporting the view that they are being pressured to suicide because relatives want their money. An oncology patient in Oregon received an application declined letter from her medical aid, offering to pay for assisted suicide instead.
– Oregon allows for assisted suicide (doctor prescribes lethal medication) and not euthanasia (doctor kills patient). Benelux allows euthanasia.
Statistics and other evidence from Benelux indicate most of their medical killings overall and abuses relate to euthanasia. The Stransham-Ford court order, currently on appeal, permits euthanasia and not just assisted suicide, following the Benelux model and not the Oregon model. The misnamed Dignity SA lobby group is advocating for euthanasia and not just assisted suicide.
– Problems in Benelux include a growing number of deaths without consent, killings outside the criteria of the law, widening criteria under the law including now euthanasia of dementia patients and otherwise healthy patients with depression. Further, the principal euthanasia advocate Shaun Davidson, has expressed a positive view of a in a letter to the Cape Argus that a ‘slippery slope’ expands the right to die similarly to voting right expansion. He has confessed to assisting the suicide of a patient who was not terminally ill, against the criteria of terminal illness which he previously advocated. The same scenario is likely to occur if assisted suicide is legalised in South Africa.
– Further, assisted suicide abuses and scope creep in Oregon and elsewhere in the USA have been slowed by the active opposition of the strong Pro-life movement, paralleled by restrictions on abortion. Few doctors wish to be associated with killing people. In Benelux, there is no such strong opposition movement. It is problematic for medical killing advocates to claim credit for fewer abuses due to the work of their opposition.

– Firstly, the Benelux countries, despite their very low crime rates, have been unable to control either scope creep or abuses of the law in medical killing. How does South Africa, with its stretched police resources intend doing so? Euthanasia is impossible to control because the victim is weak and afterwards dead.
– Secondly, assisted suicide and euthanasia in many cases is not painless or even successful at first attempt. There is medical risk involved.
– Thirdly, medical prognosis for example a six month criteria proposed is impossible to predict, with many such patients living up to two years afterwards.
– Fourthly, medical practitioners who cross the line of active killing, very easily become ethically numb to other ethical considerations. They become very difficult to identify or prosecute, based on arbitrary criteria such as a six month threshold.
– Fifthly, activist judges continue to expand the criteria to allow
euthanasia regarding prognosis, health and consent.
– Sixthly, the writer argues professional bodies should regulate members.
The Health Professions Council is attempting to do exactly that and has done so for decades, but the Stransham-Ford case requested the judge to limit their powers from doing so. The medical profession has drawn an ethical line from both the Greek Hippocratic medical ethics tradition and the Judeo-Christian tradition against assisted suicide and euthanasia. It is not reasonable to expect them to regulate on an arbitrary alternative basis.

The Benelux assisted suicide/ euthanasia experiment is looking more and more similar to the Nazi German euthanasia experiment of the 1930s which initially required stricter medical controls than either Benelux, the Stransham-Ford decision or the SA Law Commission proposed legislation but developed into the holocaust of the 1940s. We don’t want to go that way.

Yours sincerely,

Philip Rosenthal