The majority of discussion around euthanasia and assisted suicide laws tends to focus on the more practical questions around its implementation. 

Those promoting and debating euthanasia laws concentrate on questions such as how long a person should be expected to live before they can access lethal drugs, whether there should be a cooling-off period and how long it should last, whether the doctor signing off on the request needs to be a specialist etc.

It is almost that it has been accepted, as a fait accompli, that the laws will pass, and that all that is left to be done is to haggle over the detail.

However, a recent paper from Dr Lucy Thomas, a public health consultant and palliative care specialist, raises the broader questions that sometimes get left unasked, and unanswered. 

Dr Thomas writes that while advocates of euthanasia and assisted suicide focus on the prospect of intolerable pain, their reasons for requesting death often have nothing to do with pain:

“[A] large body of research demonstrates that the reasons why patients with advanced and terminal illnesses seek to hasten death are as complex and varied as they are among other people considering ending their lives prematurely, and they are heavily influenced by psychosocial and existential issues—such as feelings of being a burden, hopelessness and loss of meaning, a lack of social support, depression, and loss of autonomy and a social role.”

The consequences of not asking the deeper questions affect the type of society we want to be.  For example, there is the institutionalisation of unconscious discrimination, with a different healthcare response offered to a suicidal patient depending on whether a patient has an eligible medical condition.  Dr Thomas writes:

“In the absence of such a condition, doctors are expected to address issues amenable to intervention; to support patients in their struggle to rediscover meaning, value, and purpose; and to do everything possible to prevent suicide. By contrast, for eligible patients with a chronic or terminal illness or disability doctors are expected to assist them in ending their lives, thus formally validating the patients’ assessment that their lives are no longer worth living.: 

Dr Thomas notes that this leads to “deeply discriminatory attitudes” that equate value with ability, and disempowers those living with illness and disability, and embeds this discrimination within the medical solution.

Dr Thomas asks whether there should be a process of “demedicalisation” of euthanasia and assisted suicide, because lethal drugs are not therapeutic and their administration not a medical procedure.

Adopting a demedicalisation approach leads us to ask the important questions about how society should respond to anyone with mental capacity and a consistent desire to end their life, she writes.  These include questions like:

• What constitutes a rational decision to end one’s life, and is there any way we can objectively assess this without relying on some external assessment of whether we deem a person’s life worth living?
• Is the decision to end life so personal that the state should never intervene?
• Is it possible to detach an individual’s decision to die with the impact it will have on people around them?
• How do we decide if a person’s desire to end life should be challenged rather than accepted, “including addressing the physical, social, and economic factors that contribute to human suffering and despair?”
• How does the way society responds to a person’s desire to end their life influence how people feel about the value of their own lives and the lives of others?

These questions are not the sole or even the primary domain of medical professionals, but of anyone who has a view on what makes a “good” society.  They are questions we all need to be asking.