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Interview With Dr. Margaret Somerville of Montreal

MONTREAL, MAY 20, 2006 (Zenit) - In the battle for the legalization of euthanasia, two tactics used by proponents are redefinition and confusion -- and these point to a larger societal issue, says a Catholic pharmacist-ethicist-lawyer.

Dr. Margaret Somerville, founding director of the Center for Medicine, Ethics and Law at McGill University in Montreal, spoke at the recent annual Seminar on Bioethics sponsored by the Catholic Organization for Life and Family. The seminar focused on euthanasia and end-of-life issues.

In this interview with us, she speaks on the ethical issues at hand and the wider social-cultural implications.

Q: Why is there such pressure to redefine euthanasia, and what would such a new definition entail?

Somerville: Redefinition is a particular strategy to promote euthanasia. It confuses euthanasia with other medical interventions that are acceptable, such as consenting to withdrawal of life-support treatment.

The pro-euthanasia advocates are using the term "physician-assisted death" -- we can all agree we want physicians to care for us when we're dying -- and saying that physician-assisted suicide and euthanasia are just different modes of all such treatment. The common "neutral" phrase is euthanasia's just a "last act of good palliative care" which sounds fine, and many people are buying it as a viable option.

In fact, those who argue for euthanasia are proposing to make a continuum of all end-of-life interventions, and arguing they are all of the same kind, just different in degree. Thus to be consistent we must either accept all of them or reject all of them. No one wants to do the latter -- it could mean not having access to necessary pain relief -- so the only option is to choose to accept everything.

The people who take the other side of the debate state that euthanasia and physician-assisted suicide are different in kind, not degree, from other end-of-life measures.

As to why there are these pressures, at one level it is personal belief in rights to self-determination, a need for control, a reaction after having seen a terrible death, fear of many things, terror management and so on.

Q: What is the implication of the proposed legalization of euthanasia on the greater society?

Somerville: At a more general societal level it is an important battle. In these culture wars we are experiencing, there is a battle about the nature of the societal cultural paradigm, the worldview that should govern us in the future, which new values we should adopt and which older values we should reaffirm as part of it.

There are, I propose, three competing possibilities for this new worldview, each of which has a very different relationship to the new science.

The first is the ''pure science'' view, which takes a position that science does or will be able to explain everything, including those characteristics such as altruism and morality, that we regard as distinguishing us from other animals and most clearly identifying us as human.

It seeks meaning in human life mainly or only through science and, likewise, seeks to exercise control through this. There is no recognized space for the spirit. It supports the view that one's own death is a purely personal matter involving only individual values and preferences.

In contrast, the second view, the ''pure mystery'' view, often decries science or is expressly anti-scientific. This view adopts an intense sanctity-of-life stance, which can be compared to respect or reverence for life, and most importantly, to respect or reverence for death.

For instance, many people who hold this view believe that all medical treatment must be continued until no vestige of life remains. These same people could also have difficulties with providing necessary pain-relief treatment that might shorten life.

The ''science-spirit'' view, the third view, seeks a structure to hold both science and the human spirit. For some people this view is expressed through religion, but it can be, and possibly for most persons is, held independently of being religious at least in a traditional sense.

It recognizes that human life consists of more than its biological component, wondrous as this is. This worldview includes a sense of a space for the human spirit and of the secular-sacred.

It recognizes that human life consists of more than its biological component, wondrous as this is. This worldview includes a sense of a space for the human spirit and of the secular-sacred. Most importantly, it's a bridge between all people who care about being moral and ethical whether or not they religious.

This view experiences our new science as eliciting wonder at both what we know, and, as a result of this, what we now know that we do not know. It seeks meaning through a combination of science and spirit, which could create a different reality from the other two views.

Q: How would legalized euthanasia change the way we understand ourselves and the meaning of human life?

Somerville: We come closer to being disposable products: The attitude taken by some who support euthanasia is, "When we are past our 'best before' or 'use by' date we should be checked out as quickly, cheaply and efficiently as possible."

Q: What elements in Canadian culture contribute to the present conflict over legalizing euthanasia?

Somerville: We run into trouble due to the sole reliance on reason -- especially when we see science as the only way to know, not just one way; intense individualism; loss of a shared religion; and secularism.

Our Parliament and highest courts are the new high cathedrals, while the media in general is expressing approval of euthanasia and disapproval of resisting it. I speak at length on this subject in my book "Death Talk: The Case against Euthanasia and Physician-Assisted Suicide."

Q: What suggestions would you make to the average lay person, faced with this issue? Would you encourage people to make a fundamental decision about where they stand on euthanasia?

Somerville: Yes. Ask yourself how you want your great-great-grandchildren to die if we legalize euthanasia now. It radically affects the values, especially of respect for life, that we pass on to future generations.

For those who want to stand up against it, they must make a secular case against euthanasia. They must talk to the people who are not convinced it is a bad idea, not just reassure each other they are correct to be against it, as I find most anti-euthanasia Christians do.

Q: How is confusion used as a means of making a case for euthanasia?

Somerville: If the word "euthanasia" is redefined to contain everything within a continuum of options for dying people, then many will think that everything, including real euthanasia, should be accepted and legal.

People are asked questions in euthanasia surveys that make a clear answer impossible -- for example, Are you for or against euthanasia for dying people who are in terrible pain?

The answer "I'm for all necessary pain relief treatment and against euthanasia" is impossible. Most people will answer "for" -- thereby supporting euthanasia -- because they do not want to be left without pain-relief treatment.

Q: Would you say then that it is a fear of suffering that motivates support for euthanasia?

Somerville: Yes, but to seek control over suffering is also a natural response to it.

We know that suffering is reduced when we feel we have control over it. We look for suffering reduction mechanisms or terror management devices; I think euthanasia is seen as both.

We have intense free-floating anxiety in our societies. We focus on death as the source of our fears. We seek control over those fears by seeking control over death, and that feeling of control reduces our experience of suffering.

What we really need is to search for other ways to reduce fear of dying and death and give a sense of control to people.

What motivates people to consider assisted suicide? Fear of pain, abandonment and being a burden. Sometimes people see physician-assisted suicide as a rational response to those fears.

Sometimes it is depression. But some well-conducted research published in the New England Journal of Medicine found it was a condition the research psychiatrists called hopelessness -- nothing to look forward to -- a condition they differentiated from depression.

Dying people need hope, a sense of connection to the future. They can have this sense even with a very short future to connect to -- for example, looking forward to seeing the sun come up or hearing the birds sing the dawn chorus tomorrow.

As I wrote in "The Ethical Canary": "Hope is the oxygen of the human spirit; without it our spirit (which encompasses the will to live) dies."

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Keywords

Euthanasia, Somerville, Life

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