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Those advocating for the passage of the Proposition before the States Assembly ground their effort on the principles of ‘autonomy’ and ‘dignity’, both of which it was argued, necessitate a ‘right to die’. Given this, the obvious question arises as to why such a right should be at all restricted, either to the terminally ill or only those suffering from a physical condition as in the current eligibility criteria within the Proposition before the States Assembly.
Granting the premise that every person has the right to access having their doctor end their life, or have a physician assist them in committing suicide, on the basis of autonomy, and also that personal dignity requires to be made available to those suffering from a debilitating condition, leaves no rational grounds upon which this right should be limited. Moreover, to do so would be very likely to come under legal challenge.
When you accept the false idea of a ‘right to die’, you cannot rationally restrict it to only one group of people. Rights apply to everyone, or they apply to no-one, and so the logic of ‘autonomy’ extends from the terminally ill to many vulnerable types of people. If we opt to recognise the opportunity to choose the timing and manner of our deaths as a human right, then it must apply universally, consistently, and without discrimination.
The Proposition before the States Assembly heads straight down the logical cliff to euthanasia and assisted suicide not just for the terminally ill, but for those who possess “an incurable physical condition, resulting in unbearable suffering that cannot be alleviated”. Here, the phrase “unbearable suffering” is undefined, and so is completely subjective. As what is considered unbearable will differ from person to person, as long as the suffering can be said to be caused by an incurable physical condition, it would be grounds for EAS.
Even if the Proposition before the States Assembly were artificially restricted to assisted suicide for the terminally ill (as in legislation recently put before the UK Parliament, for example), it would establish the same precedent in law that would allow for incremental extension later. Oregon, the model for assisted suicide advocacy in the British Isles, is cited as a place where assisted suicide has never led to an extension of application beyond terminal illness. This is misleading for two reasons:
In the context of Jersey, as with all other jurisdictions in the British Isles, the precedent set by granting the premises of the legislation itself in allowing assisted suicide would establish a means by which that practice could be extended, including to euthanasia and to those suffering any condition, whether physical or psychological.
That this is the case is most easily appreciated when we consider the hardest cases which have been brought before UK courts, as in the high-profile paraplegia case of Tony Nicklinson, who was left ‘locked-in’ his own body after a rugby accident. The profound personal suffering involved in such situations show that many of the ‘hardest’ of cases do not actually fall under the category of terminal illness, but with those who are suffering from such extreme non-terminal conditions. As such a condition does not potentially or actually lead to the death of the person suffering from it, such an individual would not be catered for by the restrictions of assisted suicide alone, and this would leave demands to form for a new extension of the law, for which no argument in principle against such a development could be effectively made if the premise of the justifications for EAS were granted by the Proposition.
Even if the extreme proposals in the current Proposition were limited then, they would still contain the seeds of their own incremental extension; any limitation to terminal illness could not possibly last either legislatively or judicially. To limit the current proposals to terminal illness would be a short term compromise tactic, and not a line that could be preserved in the medium to long term.
Some campaign groups (e.g. My Death My Decision) which seek the legalisation of EAS in Jersey are calling for a law like that of the Proposition, including euthanasia and opening it up for those who are not terminally ill. Political pressure would undoubtedly remain to extend any Jersey law which introduced any form of restricted assisted suicide alone.
Whilst the Proposition before the States Assembly does not explicitly allow for EAS ostensibly for those with mental health disorders, nonetheless the eligibility criteria allow for this under certain conditions. Not only has the logic of the case for EAS allowed for this in places like Canada, but that and other jurisdictions have seen the abuses that arise consequently.
Both the Netherlands and Belgium licensed euthanasia and assisted suicide in the early 2000s, the Dutch and Belgian laws respectively requiring that a patient presenting for euthanasia be in a ‘medically futile condition of constant and unbearable… mental suffering that cannot be alleviated’, or be experiencing suffering that is ‘lasting and unbearable’. This has led to a number of cases in the last few years in which people have in the Low Countries been euthanised, who in current UK practice would otherwise have been given the help they need to heal the mental health problems from which they suffer:
TINE NYS (38), depressed after the break-up of a relationship, and who had suffered domestic violence and worked in prostitution, was euthanised in 2009 on the basis that she had autism. Her parents and two sisters succeeded, after nine years of effort, in having charges of ‘unlawful poisoning’ laid against the psychiatrist and two doctors who certified her euthanasia, but despite evidence one of the doctors fraudulently obtained the certification, all three were acquitted in 2020. A new trial against the doctor who committed the fraud is ongoing.
GODELIEVA DE TROYER (64), an otherwise healthy Belgian woman living with depression, was killed by lethal injection at her own request in a Brussels hospital in 2012, despite at least two of the experts who assessed her not agreeing that she was beyond treatment. Her son, Tom Mortier, was not contacted until after his mother had been euthanised, when a hospital rang asking him to retrieve her body from the morgue. He is currently pursuing legal action through the European Court of Human Rights, on the basis that the Belgian State failed in its positive obligation under Article 2 (right to life) of the European Convention on Human Rights to protect his mother’s life.
MARC AND EDDY VERBESSEM (45), a pair of deaf twins, were euthanised in 2013 due to the fear that with the onset of blindness they would be unable to communicate with each other.
NATHAN (44), born Nancy, was euthanised in 2013, after a series of failed gender reassignment surgeries.
MARK LANGEDIJK (41), a Dutch alcoholic, ended his life in 2016 by fatal injection as a means of escaping his condition.
AN UNNAMED DUTCH WOMAN in her 20s, who had suffered sexual abuse from the age of five to 15 and suffered from post-traumatic-stress disorder (PTSD) and chronic depression amongst other mental health problems, was euthanised in 2016. Doctors judged her to be “totally competent” and that there was “no major depression or other mood disorder which affected her thinking”.
AURELIA BROUWERS (29), committed assisted suicide in the Netherlands in 2018 due to psychiatric suffering. She said, “When I was 12, I suffered from depression. And when I was first diagnosed, they told me I had Borderline Personality Disorder… Other diagnoses followed – attachment disorder, chronic depression, I’m chronically suicidal, I have anxiety, psychoses, and I hear voices”. The BBC report on her case mentions another woman, Monique Arend, who suffered from serious mental health issues after sexual abuse, but avoided committing assisted suicide, having found a therapist specialising in trauma.
More such cases exist, and include people who have been given permission to be euthanised for borderline personality disorder, and chronic-fatigue syndrome. Others have publicly called for or almost had access to euthanasia:
This incremental extension to those with mental illness or depression due to physical illness or life adversity was illustrated further in March 2012, when the Dutch introduced mobile units to deal with what they call the 80% of people with dementia or mental illness currently being “missed” – again, their words – by the country’s euthanasia laws. Similarly, the 2011 annual report of the five Dutch Regional Euthanasia Review Committees found that 13 psychiatric patients were killed by euthanasia in 2011, up from 2 in 2010. This, despite a notional legal requirement that the patient should be mentally competent.
Such is the situation in the Netherlands that, whilst voluntary euthanasia is defined as ending life on request, euthanasia has been extended to occurring without request to newborn infants with disabilities. Cases where children have been euthanised have also occurred in Belgium, a development which has caused international concern.
A similar situation has developed in Canada, which introduced ‘assisted dying’ (euthanasia as well as assisted suicide) for the terminally ill in 2016. in 2021, the Canadian Parliament passed Bill C-7, which extended the law beyond those whose death is “reasonably foreseeable” (the terminally ill, to whom the original limitation of the Canadian legislation was limited) to those whose death is not foreseeable, opening up euthanasia to patients who are chronically ill, or who have disabilities. This act has been described as a “stunning reversal of the central role of the medical and legal concept of the standard of care”. The sunset clause contained in Bill C-7 which prevents MAiD from being available to those with psychiatric conditions will expire in 2023. Unless the clause is extended, those suffering with such conditions will then be able to access euthanasia and assisted suicide.
In just five years in Canada, the original limitation of the law there to those with conditions which are incurable, irreversible, causing them grievous suffering, and where death is ‘reasonably foreseeable’, was already being objected to, with efforts to expand it to those not at the end of life, who cannot consent, or are too young to consent, or who suffer from psychiatric disorders such as Alzheimer’s.
Even outside the strict construction of the law, Canada has seen euthanasia approved for a 77-year-old woman with osteoarthritis, a man with Motor Neurone Disease who ended his life due to the poor hospital care he was receiving, and a 90-year-old woman who could not accept the prospect of another COVID-related lockdown in her retirement home.
The pressure for and actual affecting of incremental extension of such laws illustrates the fundamental problem with laws permitting medicalised killing: if we grant that there exists a ‘right to die’ based on personal ‘dignity’ and ‘autonomy’, such that people have the right to have their doctors involved in their suicide, then it is rationally impossible to limit that right only to one sort of person. Such a situation is not so much a ‘slippery slope’, but a logical cliff.
It is this reality which has led to opposition to assisted suicide from organisations that represent and campaign for the welfare of the disabled and elderly in the UK, such as the British Geriatric Society, Scope, the UK Disabled People’s Council, Disabled People Against Cuts (DPAC), and Not Dead Yet UK. The same rationale applies of course to euthanasia.
Euthanasia and assisted suicide are not merely a ‘slippery slope’. They are a logical cliff down which abuse of vulnerable people gets incrementally worse.
