Alan J. Scott:
Late in 2017, State parliaments in NSW and Victoria debated assisted dying (euthanasia) legislation, with Victoria sanctioning this action and NSW opposing it. The word ‘euthanasia’ comes from two Greek words eu and thanatos that together mean a ‘good’, or perhaps a ‘gentle’, death but the way the word is used today usually involves something quite different. Basically, the term is used to indicate a death that comes from interference in the natural process, either by specific actions or specific non-action. There is nothing new about this. Communities over many thousands of years and across all continents have arrived at ways that allow for community-sanctioned death in circumstances when the community’s political security, religious beliefs or economy are threatened. Thus, it has been agreed, for example, that the killing that occurs in war is not murder. In addition, we have developed a new reason that emphasises an idea that arose in the 1970s, that individuals have rights which supersede those of the community and therefore, people have the right to choose the time and method of their own death.
There is also a different kind of problem. New technology has have left us with the dilemma of who says when a person is dead. This issue is not restricted to older people. Death can occur in utero or at any time thereafter. In addition, we now live in an increasingly multicultural and multi-faith world that multiplies the complications enormously. Knowing right from wrong is no longer a matter of choosing from a list of clear-cut sins, as was popular in the 19th century. Now we must deal with the complex interactions of factors from which it is often very difficult to say what is right and what is wrong. Death has become one of those issues.
The case for euthanasia today is usually argued on the basis that when the community or person believes someone has an unacceptable quality of life, then that life should be terminated. This may be argued from either the individual’s or society’s perspective. In the end, it means that when what is perceived to be an unacceptable situation occurs, then some action agreed by the community should be taken to cause that person’s death.
One of the factors in the debate about death is age, and this will become an increasingly important factor over the next few years. At the last Census, there were 3,673,092 people in Australia aged over 65 years. This number will continue to increase, in part at least because life expectancy is projected to increase, not only here in Australia but in every developed country and many lesser developed countries across the world. This will produce the largest older population in history ever, worldwide.
The implications of this situation have yet to be realised by most people, especially politicians. Vast changes have taken place in the technology for keeping people alive. The number of drugs and devices available, and services designed to keep older people active and mentally alert, all have the potential of extending the time to our death. Our present solutions for the care of older people will not work, and the system will begin to fail as we move through the 21st century.
Another facet in this argument, which is particularly significant in multicultural Australia, is the ethics of legislation. Is it ethical to demand legislation on this or any other issue on the basis of a Christian position, or for that matter, an Islamic, humanist, Marxist, scientific or any other position? It could be argued that religious views, and in Australia this usually means Christian views, should not be able to determine legislation, but behind every piece of legislation is a set of beliefs of one sort or another, which calls into question whether any such an argument is valid. So, on what basis do we determine legislation in a multicultural society where what is acceptable to some can be unacceptable to others?
Finally, I want to explore what I believe is becoming the real determining factor in deciding who dies and when, and that is economics. As I have indicated, we are part of an aging population, which has, as a corollary, a decrease in the proportion of people in the wealth-generating segment of the population. Imagine the costs involved in trying to maintain a retired population drawing an ever-increasing amount of scarce resources, and perhaps at the other end of the scale a growing pre-employment population also wanting to draw on these same scarce resources. It would not be a very large step for those generating the wealth to solve the problem by instituting compulsory euthanasia, perhaps at both ends of the lifespan.
Science fiction has already explored this possibility in many books and films. Such a move could easily be justified on many grounds; economic, productive, even Judeao/Christian. Psalm 90:10 clearly states that the years of our life are three score and ten, or 70. This could make a nice political excuse to justify euthanasia, and excuses for doing things politically have been found in far more flimsy things than the Bible. After all, if the Bible is God’s unequivocal word, and he has said that most of us should live for only seventy years, then we are only doing God’s will to make sure people keep to his decrees and do not sin. It doesn’t sound like a good argument now, but it may well do so to our great-grandchildren. In a wealth- and resource-deprived world that has to divert more and more resources to maintain the lives of those who could be regarded as economically unproductive, getting rid of them could seem an attractive proposition.
The question is with us already, with politicians questioning the amount of resources spent on health, education, or the environment. After an accident, heart attack, or premature birth, who decides whether a life support system is available and can be used? Who ought to make such decisions?
It seems to me that, increasingly, the people who make decisions about who lives or who dies are not doctors or ethicists, but accountants. The questions they ask are not about whether a person’s life can be saved, but how much will it cost? How does the community participate in decisions about when is it too costly to use this machine or that drug? Is it enough for us to vote for at an election and then be told we have sanctioned whatever decisions politicians have made about the priorities in the use of resources?
This would not be a problem in the U.S. where it has always been assumed that health care, and indeed life and death, is on a user-pays basis. Australia in the past has tended to go in the opposite direction, with individuals paying for minor treatments and the State for major procedures, but the American system may be getting closer.
An example of how the bureaucratic economic mind might work comes from the classic BBC TV series, Yes Prime Minister. Prime Minister Hacker is arguing with top bureaucrat Humphrey about the cost of smoking:
‘Humphrey’, Hacker says, ‘when cholera killed 30,000 people in 1833 we got the Public Health Act. When smog killed 2,500 people in 1952 we got the Clean Air Act. When a commercial drug kills fifty or sixty people we get it withdrawn from sale, even if it is doing lots of good to many patients. But cigarettes cause 100,000 unnecessary deaths a year, minimum, this is a hideous epidemic.’ Humphrey agrees, so Hacker goes for the kill. ‘It costs the National Health Service £165 million a year.’ But Humphrey had been well briefed. ‘We have gone into that’ he replied. ‘It has been shown that if those extra 100,000 people a year had lived to a ripe old age, they would have cost us even more in pensions and social security than they did in medical treatment. So financially, it is unquestionably better that they continue to die at about the present rate.’
Is your local hospital waiting for new equipment or buildings? How much will governments’ decisions not to provide these necessary things impact on the life or death of people in your locality, your town, your region? The decision will be about politics and economics, not the health of people.
I fear the issue of how and when we look at death in the future will be determined by economics. The driving force in health care will no longer be the needs of patients but the economic whims of politicians and bureaucrats. As individuals, as politically enfranchised people, we must do something about having a bigger say on the issues of life and death. If we don’t help to make the decisions on these things, our ability to contribute will continue to be taken away from us and we will have to live or die by the consequences.
Alan Scott has had a long and distinguished career as a sociological researcher working outside of universities. In 2015, he was awarded the inaugural TASA Sociology in Action Award.