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Euthanasia and the 'Slippery Slope'

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Critics of euthanasia sometimes claim that legalising any form of the practice will lead to a slippery slope effect, resulting eventually in non-voluntary or even Wikipedia:involuntary euthanasia. The slippery slope argument has been present in the euthanasia debate since at least the 1930s.[1]

Lawyer Eugene Volokh argued in his article The Mechanism of the Slippery Slope that judicial logic could eventually lead to a gradual break in the legal restrictions for euthanasia,[2] while medical oncologist and palliative care specialist, Jan Bernheim, believes the law can provide safeguards against slippery-slope effects, saying that the grievances of euthanasia opponents are unfounded.[3]



The empirical argument

Glover argues that the empirical argument needs to be backed by evidence, as there are situations where we do not seem to push boundaries.[4] Generally, two examples are discussed – Action T4, the Nazi euthanasia program in Germany between 1939 and 1941, and the Groningen Protocol in the Netherlands, which has allowed for non-voluntary euthanasia of severely deformed newborns.

Lewis notes that the focus has been on voluntary to non-voluntary euthanasia, rather than physician-assisted suicide to voluntary euthanasia, as there have been no instances of the latter: in jurisdictions where physician-assisted suicide have been legalised, there have been no moves to legalise voluntary euthanasia; while jurisdictions that have legalised voluntary euthanasia also allowed physician-assisted suicide at the same time.[5]

Action T4

Euthanasia opponent Ian Dowbiggin linked the Nazis' Action T4 to the resistance in the West to involuntary euthanasia. He believes that the revulsion inspired by the Nazis led to some of the early advocates of euthanasia in all its forms in the U.S. and U.K. removing non-voluntary euthanasia from their proposed platforms.[6]

Nevertheless, it has been argued that Action T4 is not an example of the empirical slippery slope. Euthanasia was still a criminal act in Germany during that time, and there is no record of doctors engaging in voluntary euthanasia or in physician-assisted suicide.[7]

The Groningen Protocol

Non-voluntary euthanasia is sometimes cited as one of the possible outcomes of the slippery slope argument, in which it is claimed that permitting voluntary euthanasia to occur will lead to the support and legalization of non-voluntary and involuntary euthanasia.[8] However, studies of the Netherlands after the introduction of voluntary euthanasia state that there was no evidence to support this claim[9][10] while other studies state otherwise.[11]

A study from the Jakobovits Center for Medical Ethics in Israel argued that a form of non-voluntary euthanasia, the Groningen Protocol, has "potential to validate the slippery-slope argument against allowing euthanasia in selected populations".[12] Anesthesiologist William Lanier says that the "ongoing evolution of euthanasia law in the Netherlands" is evidence that a slippery slope is "playing out in real time".[13] Pediatrician Ola Didrik Saugstad says that while he approves of the withholding of treatment to cause the death of severely ill newborns where the prognosis is poor, he disagrees with the active killing of such newborns.[14] Countering this view, professor of internal medicine Margaret Battin finds that there is a lack of evidence to support slippery slope arguments.[15] Additionally, it is argued that the public nature of the Groningen Protocol decisions, and their evaluation by a prosecutor, prevent a "slippery slope" from occurring.[16][3]

A study by Jochemsen and Keown, from the Dutch Lindeboom Institute, a Christian organisation,[17] published in the peer reviewed Journal of Medical Ethics, argued that euthanasia in the Netherlands is not well controlled and that there is still a significant percentage of cases of euthanasia practiced illegally.[11] Raanan Gillon, from the Imperial College School of Medicine, University of London commented that "what is shown by the empirical findings is that restrictions on euthanasia that legal controls in the Netherlands were supposed to have implemented are being extensively ignored and from that point of view it is surely justifiable to conclude, as Jochemsen and Keown do conclude, that the practice of euthanasia in the Netherlands is in poor control".[18]

A 2009 review study of euthanasia in Holland concluded that no slippery slope effect has occurred,[19] while another study of the same year found that abuse of the Dutch euthanasia system is rare.[20] In 2010, a study found that there is no evidence that legalizing assisted suicide will lead us down the slippery slope to involuntary euthanasia.[21]

Most critics rely predominantly on Dutch evidence of cases of "termination of life without an explicit request" as evidence for the slide from voluntary euthanasia to non-voluntary euthanasia.[22][23] One commenter wrote that that critics who rely on this slippery slope argument often omit two important elements, thereby using flawed logic.[22] First, the argument is only effective against legalization if it is legalization which causes the slippery slope; and secondly, it is only effective if it is used comparatively, to show that the slope is more slippery in the Netherlands than it is in jurisdictions which have not legalized assisted suicide or euthanasia;[22] since these questions have not been addressed by critics, little attention has been paid to available evidence on causation and comparability.

Research review studies

In the most recent review paper on euthanasia in the Netherlands, namely the 2009 paper entitled Two Decades of Research on Euthanasia from the Netherlands. What Have We Learnt and What Questions Remain? written by researchers from the Department of Public Health in the Netherlands, it was found that "public control and transparency of the practice of euthanasia is to a large extent possible" and that "[n]o slippery slope seems to have occurred".[19] The researchers find that the legalization of euthanasia in the Netherlands did not result in a slippery slope for medical end-of-life practices because:[19]

  1. The frequency of ending of life without explicit patient request did not increase over the studied years;
  2. There is no evidence for a higher frequency of euthanasia, compared with background populations, among:

References

  1. ↑ Demetra, (1996). "Recent historical perspectives regarding medical euthanasia and physician assisted suicide," British medical bulletin, 52, 389.
  2. ↑ Eugene Volokh, 'The Mechanisms of the Slippery Slope', 116 Harvard Law Review 1026 (2003) [1] Template:JSTOR
  3. ↑ 3.0 3.1 Laws can safeguard the dying. www.theaustralian.com.au. URL accessed on 2010-12-24.
  4. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named Glover1977p167
  5. ↑ Penney, (2007). "The empirical slippery slope from voluntary to non-voluntary euthanasia," The Journal of Law, {{{volume}}}, 197–198.
  6. ↑ (2002) A merciful end: the euthanasia movement in modern America, p. Template:Page needed, New York: Oxford University Press.
  7. ↑ Demetra, (1996). "Recent historical perspectives regarding medical euthanasia and physician assisted suicide," British medical bulletin, 52, 390.
  8. ↑ Voluntary Euthanasia. Stanford Encyclopedia of Philosophy. Stanford University. URL accessed on June 13, 2010.
  9. ↑ C.J., (1998). "Pulling up the runaway: the effect of new evidence on euthanasia's slippery slope," Journal of Medical Ethics, 24, 341–344.
  10. ↑ P.J., (1991). "Euthanasia and other medical decisions concerning the end of life," The Lancet, 338, 669–674.
  11. ↑ 11.0 11.1 Jochemsen H, Keown J, (1999). "Voluntary euthanasia under control? Further empirical evidence from The Netherlands," J Med Ethics, 25, 16–21.
  12. ↑ Alan, (2008). "A Case Against Justified Non-Voluntary Active Euthanasia (The Groningen Protocol)," The American Journal of Bioethics, 8, 25.
  13. ↑ William, (2007). "Physician Involvement in Capital Punishment: Simplifying a Complex Calculus," Mayo Clinic Proceedings, 82, 1043–1046.
  14. ↑ OD., (2005). "When newborn infants are bound to die.," Acta Paediatr, 94, 1535–7.
  15. ↑ Margaret P., (2008). "Physician-Assisted Dying and the Slippery Slope: The Challenge of Empirical Evidence," Willamette Law Review, 45, 107–108.
  16. ↑ Pieter J.J., (2009). "The Groningen Protocol, Unfortunately Misunderstood," Neonatology, 96, 11.
  17. ↑ Lindeboom Instituut Studiecentrum voor medische ethiek vanuit de christelijke levensbeschouwing. www.lindeboominstituut.nl. URL accessed on 2011-01-01.
  18. ↑ Raanan Gillon, (1999). "Euthanasia in the Netherlands - down the slippery slope ?," J Med Ethics, 25, 3–4.
  19. ↑ 19.0 19.1 19.2 19.3 Rietjens JA, van der Maas PJ, Onwuteaka-Philipsen BD, van Delden JJ, van der Heide A, (2009). "Two Decades of Research on Euthanasia from the Netherlands. What Have We Learnt and What Questions Remain?," J Bioeth Inq, 6, 271–283.
  20. ↑ F., (2009). "Vulnerability and the 'slippery slope' at the end-of-life: a qualitative study of euthanasia, general practice and home death in The Netherlands.," Fam Pract, 26, 472–80.
  21. ↑ H., (2010). "Should it be legal to assist suicide?," J Eval Clin Pract, 16, 330–4.
  22. ↑ 22.0 22.1 22.2 P., (2007). "The empirical slippery slope from voluntary to non-voluntary euthanasia.," J Law Med Ethics, 35, 197–210.
  23. ↑ The empirical slippery slope from voluntary to non-voluntary euthanasia.. business.highbeam.com. URL accessed on 2011-01-01.

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