In what organisers called a clash of the bioethics titans, Professor Peter Singer and Sydney Catholic Archbishop Anthony Fisher debated whether voluntary euthanasia should be legalised last night in front of a packed house at Sydney’s Town Hall.

The event, organised by the University of Sydney’s Catholic Society, was originally billed as an internal university event. But as word spread of the eminence of the speakers – called by debate moderator, the ABC’s Scott Stephens, “extraordinary moral philosophers of our time” – numbers ballooned. Close to 10,000 people expressed a desire to attend the event on social media. The event sold out quickly in its new Town Hall venue, with more than 2,000 tickets sold and thousands more encouraged to watch the live stream.

Professor Singer is an Australian philosopher known worldwide for his position on human life and personhood. He is currently the Ira W, DeCamp Professor of Bioethics at Princeton University in the United States. Archbishop Fisher obtained a Doctor of Philosophy in bioethics from the University of Oxford and has recently published a book titled Catholic Bioethics for a New Millennium.

From the outset, the speakers agreed on a definition of euthanasia as an “act or calculated course of omission intended to shorten life with a supposedly merciful motivation.”

Speaking first, Professor Singer outlined the agreed definition included physician-assisted suicide – where a patient could ask a doctor for a prescription that, when it was filled, would cause the patient to die.

The distinction – which has been a cause in itself for decades of debate – is that that in ‘physician assisted suicide’, the physician provides the means of death, usually by prescription, but the patient ultimately administers the medication. Voluntary euthanasia, by contrast, may see a physician act more directly, for example, through the dispensing of lethal injection or pain medication that hastens death.

“We might believe that legalising physician assisted suicide, while not permitting a doctor to give a lethal injection, makes it more difficult for the practice to be abused by extending it to patients without their consent. If we believe that – not that we should, but it’s possible – then we might think it more prudent to legalise only physician assisted suicide,” said Prof Singer. But personally, he said, “I don’t see a great deal of moral distinction” between the two. “Both are forms of euthanasia.”

Professor Singer claimed that he was not an absolutist on autonomy in the euthanasia debate. “I do not want to make it easier for someone to end their lives because of a condition that may be treatable, or from which they have a reasonable prospect of recovery,” he said.

Rather, his preference is for the standard recently used by the Supreme Court of Canada: “It should be permissible for competent adults who request it and who have a grievous and irremediable medical condition that causes enduring suffering.”

A key question in any debate on euthanasia is why we consider killing a person to be wrong, said Singer.

In answering this question, he outlined two points. The first: that killing a person is a violation of the autonomy of the person and, second, that killing deprives the person of the good things that could be expected of the rest of their life.

Both of those points, argued Prof Singer, worked in favour of voluntary euthanasia. In voluntary euthanasia, death is desired, as the “autonomous wish” of a person. The second point on depriving a person of the good things that could be expected of the rest of their life is also “in favour of voluntary euthanasia.”

“The person has judged that there is no quality of life that is acceptable to them. They are in the best position to say, ‘No, the rest of my life is not going to bring me enough good things to make it worth going through the various kinds of suffering, loss of dignity, loss of autonomy, that I regard as bad things.’ ”

In his opening remarks, Archbishop Fisher said that both his view, and those on the side of voluntary euthanasia, were “driven by mercy”. But his argument “places a higher value on human life and relationships.”

“But [my view] is more demanding,” said Fisher. “It asks more of people … It accepts the reality of pain but deals with suffering not by killing the suffering person but by giving them every reasonable assistance and accompanying them in love and care.”

“Professor Singer’s view of life is that its point is fulfilling preferences. My view says that human life has intrinsic meaning. However reduced our condition, we have a radical dignity from our first breath to our last.”

Not only would legalising euthanasia be a revolution in medical practice, argued Fisher, it would undermine the “save-heal-care” ethic and our trust in health professionals, and place a terrible burden on those health professionals.

Futhermore, legal euthanasia would create “two classes of citizens: those whose lives are inviolable, and those whose lives can be taken.”

In Fisher’s view, voluntary euthanasia reduces people’s autonomy. “[It] embeds the social expectation that certain people will elect death. People whose autonomy is already reduced by pain, fear, depression get the message that they are no longer protected by homicide laws, and might be better off dead.

Of particular interest in rebuttals from both Singer and Fisher, and in the generous, 40-minute question time that followed, was the “bracket creep” or “slippery slope” argument.

Fisher argued that no debate on legalising voluntary euthanasia could reasonably be expected to look solely at the limits currently being set on euthanasia.

“Bracket creep is built into the very logic of euthanasia,” he argued. “Once we start deciding that death is in the best interests of some people, then of course there’ll be others in the queue,” said Fisher, pointing to some of Singer’s own utilitarian writings on killing and their logical extension to the killing of disabled infants, the unconscious and those incapable of choosing whether to live or die.

Singer was unwilling to be drawn on those writings, by either Fisher or questions from the floor, consistent with his claim that it was not relevant to the debate on whether “voluntary euthanasia should be legalised”, and his stated argument in the debate for it to be legalised for “competent adults with a grievous and irremediable medical condition that causes enduring suffering”.

Illustrating the suggested “bracket creep”, Fisher pointed to the experience of The Netherlands, which, after legalising euthanasia in 2002 for adults, has legalised euthanasia for minors from the age of 12 (with the consent of parents), and babies. Doctors have also expanded what is considered “unbearable suffering with no prospect of improvement” beyond the terminally ill to the depressed, the lonely and the mentally ill.

Yet in his closing, Pro
f Singer argued that there could be “no slippery slope beyond what the legislation specifies.”

“I believe there are ways to look at voluntary euthanasia that are narrow.” He used the example of Brittany Maynard, an American woman who was diagnosed with terminal brain cancer in 2014 and sought to end her life by moving to Oregon, one of four US states which has legalised voluntary euthanasia for terminally ill patients.

“I think we should allow people like Brittany Maynard to exercise their choice, and I think that the evidence is that it can be done without posing a risk to the other members of our community.”

Fisher is not convinced that once the law is changed to enable some people to die, that other changes will not follow.

“First, [euthanasia] is for those who judge their own lives to be too burdensome for themselves. But how quickly societies who go down that path start making the judgment that those lives are too burdensome for others.

“We all want to relieve suffering; we all want to respect autonomy. Surely we can find respectful, life-affirming ways of doing that that don’t involve killing each other and, in the process, putting the most vulnerable in our community at risk.”