The Guardian newspaper recently published an extensive and informative article on euthanasia and assisted suicide, Death on demand: has euthanasia gone too far?

I have written about how coercion is a subtle yet powerful thing–here and now in the United States. This vignette from the article demonstrates how all subtlety is lost after legalization and cultural acceptance.

For all the safeguards that have been put in place against the manipulation of applicants for euthanasia, in cases where patients do include relatives in their decision-making, it can never be entirely foreclosed, as I discovered in a GP’s surgery in Wallonia, the French-speaking part of Belgium.

The GP in question – we’ll call her Marie-Louise – is a self-confessed idealist who sees it as her mission to “care, care, care”. In 2017, one of her patients, a man in late middle-age, was diagnosed with dementia and signed a directive asking for euthanasia when his condition worsened. As his mind faltered, however, so did his resolve – which did not please his wife, who became an evangelist for her husband’s death. “He must have changed his mind 20 times,” Marie-Louise said. “I saw the pressure she was applying.”

In order to illustrate one of the woman’s outbursts, Marie-Louise rose from her desk, walked over to the filing cabinet and, adopting the persona of the infuriated wife, slammed down her fist, exclaiming, “If only he had the courage! Coward!”

Most medical ethicists would approve of Marie-Louise’s refusal to euthanise a patient who had been pressured. By the time she went away on holiday last summer, she believed she had won from her patient an undertaking not to press for euthanasia. But she had not reckoned with her own colleague in the practice, a doctor who takes a favourable line towards euthanasia, and when Marie-Louise returned from holidays she found out that this colleague had euthanised her patient.

When I visited Marie-Louise several months after the event, she remained bewildered by what had happened. As with Marc, guilt was a factor; if she hadn’t gone away, would her patient still be alive? Now she was making plans to leave the practice, but hadn’t yet made an announcement for fear of unsettling her other patients. “How can I stay here?” she said. “I am a doctor and yet I can’t guarantee the safety of my most vulnerable patients.”

We have come a long way philosophically since the introduction of hospice and through the Quinlan and Cruzan cases in refusing or stopping medical care that is burdensome. This has led not only to a deeper affirmation of the dignity of life and the reality of death but also the hope in eternal life.

We crossed the line when we began the push for advance directives in 1991. No longer do we decide what is burdensome in the present, but what we fear in the future. This leads to an inherent prejudice against the disabled by allowing people to declare states worse than death. This echoes the 1920 German eugenics essay The Announcement for the Destruction of Life Unworthy of Living that evolved into the Nazi T4 program.

Eugenicists made the mistake of declaring others unworthy of life by legalizing things like forced sterilization and abortion. Today euthanasia advocates have begun by playing on people’s fears and prejudices through advance directives, leading them to declare themselves unworthy of life should they become disabled. Once the barriers to PAS are removed, euthanasia will quickly follow. Those advance directives filled out to refuse care under certain conditions will then be used by physicians and courts to actively euthanize people.

The vignette above is the proof of it.