As a person in favour of euthanasia and assisted suicide, I consider it essential to take into account not only the arguments that incline one to a certain stance, but especially those that can reasonably make us doubt it. Some of this can be collected from both empirical evidence and those who have reflected deeply on the subject.
Thus, interesting findings and propositions of the Belgian experience is shown by a group of researchers in a recent article in The Journal of Medicine and Philosophy as a way to draw attention not only to politicians and decision-makers in their country, but internationally because of the growing tendency to promote the right to die. In particular, it should be of interest to Chile that it is in the midst of legislative discussion on this issue, and a few months after starting its first democratic constituent process.
Belgium legalized euthanasia and assisted suicide in 2002, being one of the first countries in the world to do so, becoming a benchmark on the subject worldwide ever since. Its legislation establishes a series of procedures that must be completed in order to apply for euthanasia (the application must be made voluntarily and repeatedly, with the person consciously and legally competent to do so), however, the authors of Euthanasia in Belgium: Shortcomings of the Law and Its Application and of the Monitoring of Practice, declare that the practice has made some requirements skid without necessarily breaking the law without necessarily breaking the law , stretching beyond the norm the possibilities for the voluntary term of life.
A first point in question, according to the study, is that not only are cases of «serious and incurable diseases» being authorized as stipulated in the legislation for the eligibility of euthanasia, but cases have been authorized for «exhaustion of living». While this is not explicitly authorized, some doctors have diagnosed their patients with polypathology, which then allows them to be legally authorized. According to the study, 19% of euthanasias were reached for this reason in 2019.
Secondly, the authors question the control procedure between doctors since, although the applicant must have the opinion of one or two independent doctors, finally the decision is the treating physician, being able to authorise the application anyway, even if the third professional opinion is not favourable to the application. One way to skip the norm, the researchers point out as an example, is that if the application for euthanasia is for psychiatric illness, a psychiatrist should be consulted. However, if the person has any other conditions, he or she may be diagnosed with polypathology, and then consult a general doctor instead of the psychiatrist.
Finally, a third aspect in question of Belgian reality is an alleged conflict of interest in the body which must ensure the proper fulfilment of all euthanasia applications in the country, with this evaluation committee being the one who can investigate that any procedure has been carried out under the established rule. Of the 16 members, eight must be doctors, of whom several, including their president, actively perform euthanasias. According to the authors, the latter is at least questionable, as they end up assessing each other, even if they should refrain from participating where appropriate, which apparently does not happen. More than that, in the 18 years of existence of legal euthanasia, it had never been reached in court until now. Just over a year ago, a court acquitted three doctors accused of helping Tine Nys die in 2010 at the age of 38 allegedly for reasons other than those allowed. The deceased’s sisters noted that he would have wanted to die not from an incurable illness but from a recent sentimental breakdown.
The last two points are undoubtedly relevant when designing the instruments that would enable the right to die in a dignified manner, whatever the understanding of death worthy of each person. The Belgian experience must bring lessons and learnings, even though they are not necessarily those raised by the authors indicated, because at least it gives light of the real possibilities that must be faced seriously and accountably. However, both or more relevant is the first point, where evidence of the quest to end life by exhaustion, tiredness or boredom of living positions an argument of enormous dimensions in the debate and which can open up flanks of doubt even in those in favour of euthanasia or assisted suicide.
The Netherlands also legalized these options in 2002, just a few months before its neighbouring country. After almost 20 years, today it is in national debate whether this possibility should also extend to people over the age of 75 tired of living, or as some point out «when life is considered to be complete». According to a 2005 study, 17% of people requesting euthanasia were tired of living, and according to a survey of more than 3600 people in 2018, 55% believe it is something that should be requested for this reason. However, this is not allowed yet.
This did not stop Kees Kentie, who at 87 died on July 23, 2020 with the help of Pegasus, a Swiss non-profit organization that offers assisted suicide service to those who wish to die from being tired of living. This organization, the first to offer a «peaceful, caring and dignified assisted death», as stated on its website, allows anyone independent of their nationality, and thanks to Swiss law, to request a voluntary assisted death only by presenting the reasons for doing so, their marital status, their biography, their family’s written support, their health report , a contact person, his birth certificate, his residence certificate, instructions for the funeral and, of course, pay 10 thousand euros. Pegasus’ philosophy is that a request for aid for a dignified and peaceful death should not be exclusive to terminal illnesses, but «it is a human right that every rational person and in his right mind, regardless of his state of health, can choose the way and time for his death.»
The argument of tiredness, boredom or exhaustion of living should come as no surprise to us, except today that we are as close to prolonging the longevity of the human being as ever before, thanks to – or despite – the advances in biotechnology. Suicide can have a connotation of freedom and true autonomy when the permanence of life becomes an eternal condemnation. This is what Bernard Williams is talking about in Problems of the Self. Philosophical texts: 1956-1972 when he refers to tedium to immortality, arguing that «death is not necessarily an evil, and not only in the sense that almost everyone would accept it, when death seeks an end to great suffering, but in the most intimate sense that it may be a good thing not to live too long». While the development of this argument is around immortality, who can establish what is too long?
During the hundreds of conversations about the death I have had with Project Mokita, I have never met anyone who wants to live forever. Quite the opposite. Rather, the focus has been on having a quiet death, no pain, no suffering, no distress, no loneliness. But dying in itself seems to be something finally desirable. This is precisely why it is so important to think and talk about death, both of others and of oneself, because it allows us to reflect on life itself, and everything around it from start to finish. Without these conversations, there is no law or regulation that is able to interpret and cover exactly the vital yearnings of people to achieve a good death in peace and dignity, respecting what each person understands for good death.
These experiences should help us make sure we make the best possible decisions as a society. Having legislation for euthanasia and assisted suicide necessarily requires ensuring all the palliative care that can be afforded to those who require them, as well as the appropriate procedural safeguards to carry out unimpeachably and without defects or legal difficulties each request for help to end a life. As the experience of other countries shows, much of the complexity of these dilemmas will go through a policy implementation that is respectful, transparent and fair.
However, it is necessary to understand from the outset as a society that, if a law like this is passed on the basis of the right to death from the argument of human autonomy, it cannot be positioned under the eaves of compassion for those who suffer only, but it must be understood that, in the absence of extreme pain, there may be cases of people who want to exercise the autonomy of giving up their lives for different reasons. This may make some people doubt to support law enforcement, but experience shows us that people seeking help to die make use of their autonomy incluse outside of those cases of extreme suffering. Complex may be to understand or empathize for some people who want to die, but as Albert Camus rightly said, suicide is the great philosophical question of the human being, and what may be more complex than trying to answer that question for another.
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