Euthanasia

The conservative tradition treats euthanasia as one of the test cases of the broader dispute over whether the autonomy of the individual or the inviolability of human life is the foundational political and moral principle. The tradition holds that human beings are not at the disposal of their own choices in this domain — that there is a moral asymmetry between letting nature take its course and intervening to end a life, and that the asymmetry is grounded in the kind of thing a human being is rather than in any local cultural or religious convention.

What is defended is not the maximisation of life-years but the conviction that the lives of the dying, the disabled, and the suffering are not less fully human for being shortened, diminished, or painful.

Key takeaways

• Euthanasia, in the conservative tradition, is the deliberate ending of a human life on grounds of the patient’s suffering or impaired condition, and the tradition has been near-uniform in treating it as a category that the criminal law and the medical profession should refuse to authorise.
• The conservative argument distinguishes between euthanasia properly so called — the intentional termination of life — and the morally distinct decisions to forgo disproportionate treatment, to relieve pain with morphine even at the cost of shortened life, or to withdraw care once treatment has become futile.
• The expansion of legal euthanasia in Belgium, the Netherlands, Canada, and Switzerland in the late twentieth and early twenty-first centuries has, on the conservative reading, vindicated the older warnings about the difficulty of confining the practice to its original justifying conditions.

History and context

The conservative position has Hippocratic, Christian, and natural-law roots. The Hippocratic Oath, in its classical form, committed the physician explicitly: “I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect.” The Christian inheritance treated suicide as a grave offence against the gift of life, and the Thomistic natural-law tradition argued from the constitutive direction of human nature toward self-preservation to the conclusion that intentional self-killing, and a fortiori the killing of one human being by another on grounds of pity, is contrary to the moral order.¹

The modern debate took shape in the nineteenth century with the rise of medical professionalism and the early eugenic movement, both of which raised the prospect of medically administered death. The early-twentieth-century history made the conservative case in unmistakable terms: the German Aktion T4 programme of 1939–1941, in which the National Socialist regime killed approximately 70,000 disabled people under the rubric of “mercy killing,” had been preceded by Karl Binding and Alfred Hoche’s The Permission to Destroy Life Unworthy of Life (1920), which made the philosophical case for medical killing in language drawn from the autonomy-and-suffering vocabulary still in use today.² The conservative tradition has been consistently alert to this lineage without claiming that every advocate of contemporary euthanasia is its heir.

The contemporary debate has been shaped by the legal changes of recent decades. The Netherlands decriminalised euthanasia in 2002, Belgium in 2002, Luxembourg in 2009, Canada through Carter v. Canada (2015) and the Medical Assistance in Dying Act (2016), several Australian states in 2017–2021, and the U.S. state of Oregon under the Death with Dignity Act of 1997, followed by other states.³ The conservative engagement has been led by writers including Wesley J. Smith, whose Forced Exit (1997) made the practical case against legalisation; Gilbert Meilaender, whose Bioethics: A Primer for Christians (1996) gave the theological framework; and Robert P. George and Patrick Lee, whose Body-Self Dualism in Contemporary Ethics and Politics (2008) developed the philosophical anthropology underlying the tradition’s position.⁴

The empirical record of the legalising jurisdictions has become one of the central data points of the contemporary debate. The Dutch and Belgian cases have seen the gradual extension of euthanasia from terminally ill consenting adults to non-terminal patients, psychiatric patients, minors, and patients with dementia who could not consent at the time of death. Canada’s MAID programme expanded from terminal illness to non-terminal suffering in 2021 and was scheduled to expand to mental illness as a sole underlying condition (though that extension was delayed). The conservative reads this trajectory as confirmation of the “slippery slope” objection that earlier debates had treated as alarmist.⁵

The conservative position

Three claims structure the tradition.

First, intentional killing is categorically different from letting die. The conservative tradition has accepted, for centuries, that there is no obligation to prolong life by extraordinary means; that patients may refuse burdensome treatment; that physicians may relieve pain even where the relief shortens life as an unintended side effect (the principle of double effect); and that withdrawing futile treatment is morally distinct from killing. What is rejected is the deliberate causation of death as a means to the relief of suffering — the difference between accepting that a patient will die and acting so that she does.

Second, the case for the practice depends on a thin anthropology. The autonomy-and-suffering case for euthanasia presupposes a view of the human being on which the self is a project the person constructs and may at some point decide to terminate. The conservative tradition holds, by contrast, that the self is constituted by relations — to family, to community, to a moral order it did not author — and that the decision to be killed is not a private exercise of autonomy but a public act with profound consequences for the meaning of dependency, vulnerability, and care.

Third, the institutional consequences are severe. Once euthanasia is established as a medical service, the conservative argues, the situation of the disabled, the elderly, the depressed, and the chronically ill is changed in ways that the autonomy framework does not capture. The option of being killed alters the deliberative situation of every patient: the question “should I continue to ask for care?” now has, alongside its other complications, the lived weight of an available alternative. The reports from established jurisdictions of patients citing financial burden on family and inadequate care as reasons for requesting euthanasia bear out the worry.

Differing positions

The autonomy-based liberal position, in its strongest form, treats the decision to end one’s own life under conditions of suffering as the paradigm of a private decision into which the state and the medical profession have no business intruding. Ronald Dworkin’s Life’s Dominion (1993) gave the most influential philosophical defence of this view, arguing that respect for “the sanctity of life” is compatible with — and may in some readings require — recognition of the patient’s authority over the manner of her own death.⁶ The conservative reply distinguishes the question of whether suicide should be criminalised (it should not, as a matter of practical reason if nothing else) from the question of whether the medical profession should be enlisted in the provision of death, and presses on the second.

The progressive disability-rights position has, interestingly, often converged with the conservative position on euthanasia, on the ground that the autonomy-and-suffering framework is wielded against the disabled in ways that the framework itself disavows. The work of disability scholars including Diane Coleman of Not Dead Yet has made the case that legal euthanasia, in practice, expresses and entrenches a hierarchy of lives worth living.

The libertarian position is internally divided. Some libertarians treat euthanasia as the paradigm of self-ownership and oppose its prohibition on principle; others, attentive to the public-good characteristics of medical institutions and the unavoidable extension of any euthanasia regime beyond the original consenting adult, are more cautious. The conservative engages the libertarian seriously because the autonomy framework on which contemporary euthanasia rests is itself a libertarian inheritance.

References

1. Thomas Aquinas, Summa Theologiae, II-II, q. 64, a. 5 (on suicide).
2. Karl Binding and Alfred Hoche, Die Freigabe der Vernichtung lebensunwerten Lebens (Leipzig: Felix Meiner, 1920); see Robert Jay Lifton, The Nazi Doctors: Medical Killing and the Psychology of Genocide (New York: Basic Books, 1986) for the historical record.
3. Carter v. Canada (Attorney General), 2015 SCC 5; Death with Dignity Act, Oregon Revised Statutes §127.800–127.897 (1997).
4. Wesley J. Smith, Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder (New York: Times Books, 1997); Gilbert Meilaender, Bioethics: A Primer for Christians, 3rd ed. (Grand Rapids: Eerdmans, 2013).
5. Trudo Lemmens, “The Conflict between Open-Ended Access to Physician-Assisted Dying and the Protection of the Vulnerable,” McGill Journal of Law and Health 14, no. 1 (2021).
6. Ronald Dworkin, Life’s Dominion: An Argument About Abortion, Euthanasia, and Individual Freedom (New York: Alfred A. Knopf, 1993).