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The right to die

- Beth Amato

Q&A: Professor of Philosophy, Kevin Behrens explains why euthanasia is not simply a matter of life and death.

Physician assisted suicide, or euthanasia, is banned in South Africa. Euthanasia is one of the most contested ethical subjects in the world, shaking our spiritual, political and social values to the core.

Assisted suicide © Carlos Amato ©

What are your thoughts about the “two sides of the story” regarding physician assisted dying? One side feels that under certain conditions, like extreme pain and terminal illness, people should have the right to end their own life. Conversely, others say that knowingly ending a life is an anathema to healthcare.  

I am strongly of the opinion that continued life is sometimes more of a harm than dying, that euthanasia and assisted dying are morally justifiable under certain conditions, and that the current South African law is wrong and should be changed to allow for these acts. Everybody ought to have the right to decide on how they die, and it should be up to them to choose a shorter life over an extended life of pain or distress. We have no choice when it comes to being brought into this world, but we should have the choice about whether or not we want to stay in this world. 

I therefore take the fairly radical position that it is a person’s right to make a choice to end their life under any circumstance in which they are honestly convinced that this is in their best interests.

This is easiest to justify in cases where patients have a terminal illness and are experiencing intractable physical pain and distress. These clear cases also serve to guide us regarding what is right in some of the more controversial cases, such as if a patient has suffered from major depressive disorder for many years. It is morally irrelevant to only justify euthanasia in terminal illness cases.

What counts morally is that a person is in pain and is distressed, and has come to a reasonable conclusion that the best way to be freed from this pain and distress is by ending their life.

Regarding health professionals participating in euthanasia at the request of patients: I do not see it as a negation of the “do no harm” principle. Harms are relative. We are often forced to do some harm to prevent greater harm. Death is not always the greatest harm that can be done to a person. Sometimes continuing to live is more harmful.

Is euthanasia just another example of how humans attempt to exert domain and control on the so-called uncontrollable and unknown?

If there is anything over which we ought to have dominion or control, it is our own life and death.  It is when we interfere with the choices and rights of others that we over-reach. I do think that death is just a natural part of life, and that it is sometimes a blessing for people. Death is not always harm, and we should sometimes welcome and embrace it as something that offers relief for others or even ourselves.

We probably have over-medicalised natural processes, including those at the beginning and the end of life. We have turned the prolonging of life into an absolute moral good, whereas it is not.  It is often our own inability to accept the reality and inevitability of death that makes us – especially physicians – blindly believe that it is always best to prolong life whenever it is possible. Such myopia can lead us to make decisions that cause far more harm than good to patients.

If euthanasia is not an option, is the answer high quality palliative care to improve the patient’s quality of life while not treating the cause of suffering?

High quality palliative care, which is meant to alleviate stress and adverse symptoms associated with a serious illness, should be available to everyone who needs it. The fact is this is not the case. Even in wealthy countries very few people have access to good palliation. However, even if it were available to all who need it, it would not put an end to the need for euthanasia. Not even the best palliative medicine can completely free all patients from pain and distress. Many patients continue to experience significant pain even under the care of palliative physicians. Furthermore, the distress patients experience is also psychological. Many patients find being dependent, helpless, incontinent, confused, etc., to be a serious threat to their dignity. Palliative care does not necessarily free patients from these indignities, and may add to them.

Are there any advocacy efforts for dignified dying through euthanasia? How are you involved?

Globally there are many organisations that advocate for euthanasia. In South Africa, probably the most well-known organisation is DignitySA. I am not involved in any euthanasia advocacy groups. I use my classroom as an opportunity to raise awareness about these issues, and I have published one article on assisted dying. I try to provide my students with the intellectual schools and cognitive skills to make their own decisions about moral issues rather than using the classroom to promote my own views.

  • Professor Kevin Behrens holds a PhD in Philosophy. He is the Director of the Steve Biko Centre for Bioethics at Wits. He answers these euthanasia-related questions in his personal capacity and his views are not necessarily those of the Centre or of the University.
  • Beth Amato a freelance writer.
  • This article first appeared in Curiositya research magazine produced byWits Communications and the Research Office.
  • Read more in the 10th issue, themed: #Mood how our mental health and wellbeing are impacted by the socio-economic, political, psychological, legal, ethical, cultural and technological interpretations of our world.