Attitudes concerning Euthanasia: Australia at the Turn of the 21st Century
Sikora, Joanna, Lewins, Frank, Health Sociology Review
The recent bitter and anguished debate over the fate of Terry Schiavo, the US woman who spent years in a coma, is but one example of the consternation surrounding the issue of euthanasia. Such debates raise the question of whether death should be a choice and, if so, for whom and under what circumstances? Even before the Schiavo debate, life prolonging technologies, substantial increases in average life expectancy and activists' efforts have gradually made more transparent, public, and legitimate, a practice which had previously been less visible (Riley 1983:192-193). Some recent examples include Lesley Martin's admission of the 'mercy killing' of her terminally ill mother in New Zealand, the suicide of Australia's Nancy Crick (committed in the belief she had cancer, see Daily Telegraph 2004; Paget 2004) and the pro-choice campaign of the Australian euthanasia activist, Dr Phillip Nitschke, who publicises the 'Peaceful Pill' (King 2004).
Euthanasia: Conceptual complexities
The complex nature of situations in which acts of euthanasia occur necessitates an analytical approach involving varying degrees of human agency and intent. Therefore, we compare and contrast moral evaluations of active, passive as well as voluntary and non-voluntary euthanasia, which reflect the different levels of a patient's agency or autonomy (Lewins 1996:113-114).
In common discourse, the distinction between active and passive euthanasia is often reduced to a difference between 'killing' and 'letting die'. Voluntary euthanasia is a consensual act of an individual, in full awareness of the nature and likely consequences of their action. Although voluntary euthanasia is not always considered synonymous with assisted suicide (Dworkin et al. 1998), we treat these two concepts as equivalent for the purpose of this analysis, due to the nature of our data. Involuntary euthanasia refers to situations when life is ended against the person's will which are outside the scope of this article. However, we describe attitudes concerning nonvoluntary euthanasia, which may be considered in cases involving newborn babies with serious medical conditions, individuals experiencing severe dementia or senility, and unconscious patients. It is this type of situation, where it is debatable whether the wishes of the person are known or knowable, that is most likely to present significant ethical problems.
Differences in perceived proscriptions from acts of euthanasia and the tension between supporters and opponents of the decriminalisation of voluntary euthanasia have spawned an extensive literature in moral philosophy, law, bioethics and sociology. Most of this literature belongs in applied ethics; only a small part addresses public opinion, which calls for an explanation of the purpose and value of attitudinal studies in this area.
Policy and public opinion concerning euthanasia
Studies stemming from democratic theory consistently find that public opinion is salient in policy development in Western industrialised countries (Brooks and Manza 2006; Burstein 1998, 2003, 2006). The public, however, is more likely to form meaningful opinions about some issues than others, and thus the influence of attitudes varies in particular areas of policy. Attitudinal studies concerning euthanasia, which is an issue usually somewhat marginalised in the political discourse, lead to a better understanding of the social contexts in which euthanasia may become politically salient. The contrast between the dynamics of public opinion and actual policy implementation is likely to reveal the extent to which the regulation of the social practice involving end-of-life decisions reflects attitudinal changes (Burstein 2003). Identifying the structure and trends in attitudes to euthanasia, which we undertake in this article, is a preliminary step in this process. Our account extends and complements earlier survey-based analyses of public perceptions regarding euthanasia in Australia (Kuhse 1995; Hassan 1996; Kuhse et al. …