The film “The Room Next Door” deservedly received the Golden Lion award at this year´s Venice Fim Festival for its portrayal of the painful observation by one woman (Julianne Moore) of the last days of her friend (Tilda Swinton) who has terminal cancer and wishes to end her life through the door of euthanasia. In his acceptance speech, the veteran Spanish cineast Pedro Almodóvar found the words to summarise the theme of his moving work by emphasising that “people have the fundamental right to say goodbye to this world in a clean and dignified way. This is not a political issue; it is a human privilege. Religions which belie that God is the only source of life should refrain from interfering in individual decisions”.

In 2021, the ever-controversial French actor Alain Delon declared to Paris Match that he had suffered an AVC and also had been diagnosed as suffering from B-cell lymphoma. In consequence of this savage deterioration in his health, he declared his support for euthanasia declaring it to be “the most logical and natural thing” and that he wished to be removed from life support should he fall into a coma. However, when cognitive tests were made by Swiss doctors the results were contested by his three quarrelsome children causing Delon to become a recluse at his Douchy estate where he died on 18 August 2024. This was one year after his family had instructed the withdrawal of treatment for lymphoma.

The British television presenter Esther Rantzen, who turned 84 years this year, disclosed in December 2023 that she had joined the Swiss clinic Dignitas following diagnosis of lung cancer having reached stage IV. She has been an advocate of euthanasia for many years having followed the “That´s Life” TV series with the foundation of Silver-Line to bring comfort to the elderly in their twilight. Presciently, she presented in 2000 the BBC2 programme “How to have a good death” and now finds herself making preparations for her own.

The terminal histories of these three celebrities have attracted the media spotlight on a painful medical dilemma which tragically affects several million European souls now in their ninth or tenth decade. They are either without the resources to utilize the facilities of Dignitas in Switzerland or they live in the Netherlands, Belgium or Luxembourg where limited and costly degrees of medically assisted dying are permitted by law.

Opinion polls taken within the countries of the EU show generally that public opinion is now in favour of reforms subject to safeguards being put in place to counter abuse. In England, the Nuffield Council on Bioethics has gone a step further by commissioning a Citizens Jury for which thirty have been selected from a base of 7,000. These jurors then participated in a form of trial lasting 24 working hours where counsel presented the arguments for and against the termination of life by both assisted suicide and voluntary euthanasia. The eventual decision showed twenty for the law being amended and seven against. Both sides recommended that improvements in palliative care were urgently required.

Despite this confirmation of a public will for reform, there remains in England a determined opposition from the more conservative politicians and clergy of all faiths. The CEO of the movement Care Not Killing said that “the safeguards imposed by countries where euthanasia is permitted are being eroded so that chronically sick or mentally ill people of all ages are being killed without supervision to enforce a dangerous and ideological policy.

In Portugal, we have the bizarre position whereby a law which was approved (for the fifth time) by Parliament on 12 May 2023 is unregulated and will remain so until thirty days after its publication. Such procrastination has been blamed on the previous socialist government who, in turn, blame successive amendments which were made by the Establishment to weaken the proposals for changed legislation. In this there is truth because the new law defines its application only to patients suffering with diseases of great intensity, injuries of extreme gravity and incurable illnesses. There then follows a complicated bureaucratic procedure whereby patients firstly submit a minutely detailed petition to their family doctors who then pass this on to specialist consultants. In turn, they prepare their own recommendations for submission to a special Commission which alone has the authority to grant a licence for euthanasia. At all stages, the patients are repeatedly asked to confirm their full understanding of the intended procedure. In the event of patients entering coma or deteriorating in their mental faculties, the process is to be annulled.

On 09 September the government was presented with an open letter signed by 250 prominent “personalities” representing a wide political spectrum and professionals in law, the Arts and healthcare. Included were some who had previously been cautiously neutral on the subject but all were now of the opinion that obstacles had been deliberately created to delay legislation which had been democratically approved.

How effective this pressure maybe should be known by Christmas. A completely revised presentation of an equitable change in this faulty legislation would be a deserving gift.

It should be said that any changes to an ethical approach for life-giving and life-taking are susceptible to abuse by vultures waiting in the wings to prey upon the weak and defenceless by seeking control of estate assets including intellectual rights. In this respect, the inevitable application of Artificial Intelligence to the entire process may result in greater speed and accuracy in reaching that final stage where human empathy must rule in granting the petitions made by those who are enduring the immensely disturbing vicissitudes of exit from life.

Readers of this essay may be interested to read the prequel titled “Euthanasia and AI Ethics” published in TPN - Opinion on 29-09-2023

By Roberto Cavaleiro Tomar. 17 September 2024