Euthanasia and the slippery slope
Encyclopedia
Critics of euthanasia
sometimes claim that legalizing any form of the practice will lead to a slippery slope
effect, resulting eventually in non-voluntary or even involuntary euthanasia
. The slippery slope argument has been present in the euthanasia debate since at least the 1930s.
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, 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.
or voluntary euthanasia
, will invariably lead to the acceptance or practice of concepts which are currently deemed unacceptable, such as non-voluntary or involuntary euthanasia
. Thus, it is argued, in order to prevent these undesirable practices from occurring, we need to resist taking the first step.
There are two basic forms which the argument may take, each of which involves different arguments for and against. The first of these, referred to as the logical version, argues that the acceptance of the initial act, A, logically entails the acceptance of B, where A is acceptable but B is an undesirable action. This version is further refined into two forms based on how A entails B. In the first, it is argued that there "is no relevant conceptual difference between A and B" – the premises that underlie the acceptance of A logically entail the acceptance of B. Within the euthanasia debate, van der Burg identifies one of Richard Sherlock's objections to Duff and Campbell as fitting this model. Duff and Campbell had presented an argument for the selective non-treatment of newborns suffering from serious defects. In responding to Duff and Campbell's stance, Sherlock argued that the premises which they employed in order to justify their position would be just as effective, if not more-so, in justifying the non-treatment of older children: "In short, if there is any justification at all for what Duff and Campbell propose for newborns then there is better justification for a similar policy with respect to children at any age."
The second logical form of the slippery slope argument, referred to as the "arbitrary line" version, argues that the acceptance of A will lead to the acceptance of A1, as A1 is not significantly different to A. A1 will then lead to A2, A2 to A3, and eventually the process will lead to the unacceptable B. As Glover argues, this version of the argument does not say that there is no significant difference between A and B, but instead argues that it is impossible to justify accepting A while also denying B – drawing a line at any point between the two would be creating an arbitrary cut-off point that would be unjustifiable. Glover provides the example of infanticide (or non-voluntary euthanasia) and severely deformed children:
The second primary form of the slippery slope argument is that of the "Empirical" or "Psychological" argument. The empirical version does not rely on a logical connection between A and B, but instead argues that an acceptance of A will, in time, lead to an acceptance of B. The process is not a logical necessity, but one which will be followed through a process of moral change. Enoch describes the application of this form of the argument thus:
Glover, however, notes that this line of argument requires good evidence that this direction will be followed, as not all boundaries are thus pushed.
More generally, it has been argued that in employing the slippery slope there can be an "implicit concession", as it starts from the assumption that the initial practice is acceptable – even though it will lead to unacceptable outcomes in the future. Nevertheless, van der Burg argues that this not a useful concession, as the outcomes are intended to make it clear that the initial practice was not justifiable after all.
In responding to the "arbitrary line" version of the slippery slope argument, it is argued that the stance relies on the "paradox of the heap
", and that it is possible to draw a line between the acceptable an unacceptable alternatives. Furthermore, in the case of euthanasia, it is possible to draw hard lines between different types of practices. For example, there is a clear distinction between voluntary and non-voluntary euthanasia, such that the arbitrary line approach cannot be applied.
, 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.
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.
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.
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. Some studies of the Netherlands after the introduction of voluntary euthanasia state that there was no evidence to support this claim while other studies state otherwise.
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". 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". 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. Countering this view, professor of internal medicine Margaret Battin finds that there is a lack of evidence to support slippery slope arguments. 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.
A study by Jochemsen and Keown, from the Dutch Lindeboom Institute, a Christian organisation, 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. 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".
A 2009 review study of euthanasia in Holland concluded that no slippery slope effect has occurred, while another study of the same year found that abuse of the Dutch euthanasia system is rare. In 2010, a study found that there is no evidence that legalizing assisted suicide will lead us down the slippery slope to involuntary euthanasia.
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. One commenter wrote that that critics who rely on this slippery slope argument often omit two important elements, thereby using flawed logic. 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; since these questions have not been addressed by critics, little attention has been paid to available evidence on causation and comparability.
Euthanasia
Euthanasia refers to the practice of intentionally ending a life in order to relieve pain and suffering....
sometimes claim that legalizing any form of the practice will lead to a slippery slope
Slippery slope
In debate or rhetoric, a slippery slope is a classic form of argument, arguably an informal fallacy...
effect, resulting eventually in non-voluntary or even involuntary euthanasia
Involuntary euthanasia
Non-voluntary euthanasia is euthanasia conducted where the explicit consent of the individual concerned is unavailable...
. The slippery slope argument has been present in the euthanasia debate since at least the 1930s.
Lawyer Eugene Volokh
Eugene Volokh
Eugene Volokh is an American legal commentator and the Gary T. Schwartz Professor of Law at the UCLA School of Law...
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, 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.
The slippery slope
As applied to the euthanasia debate, the slippery slope argument claims that the acceptance of certain practices, such as physician-assisted suicideAssisted suicide
Assisted suicide is the common term for actions by which an individual helps another person voluntarily bring about his or her own death. "Assistance" may mean providing one with the means to end one's own life, but may extend to other actions. It differs to euthanasia where another person ends...
or voluntary euthanasia
Voluntary euthanasia
Voluntary euthanasia refers to the practice of ending a life in a painless manner...
, will invariably lead to the acceptance or practice of concepts which are currently deemed unacceptable, such as non-voluntary or involuntary euthanasia
Involuntary euthanasia
Non-voluntary euthanasia is euthanasia conducted where the explicit consent of the individual concerned is unavailable...
. Thus, it is argued, in order to prevent these undesirable practices from occurring, we need to resist taking the first step.
There are two basic forms which the argument may take, each of which involves different arguments for and against. The first of these, referred to as the logical version, argues that the acceptance of the initial act, A, logically entails the acceptance of B, where A is acceptable but B is an undesirable action. This version is further refined into two forms based on how A entails B. In the first, it is argued that there "is no relevant conceptual difference between A and B" – the premises that underlie the acceptance of A logically entail the acceptance of B. Within the euthanasia debate, van der Burg identifies one of Richard Sherlock's objections to Duff and Campbell as fitting this model. Duff and Campbell had presented an argument for the selective non-treatment of newborns suffering from serious defects. In responding to Duff and Campbell's stance, Sherlock argued that the premises which they employed in order to justify their position would be just as effective, if not more-so, in justifying the non-treatment of older children: "In short, if there is any justification at all for what Duff and Campbell propose for newborns then there is better justification for a similar policy with respect to children at any age."
The second logical form of the slippery slope argument, referred to as the "arbitrary line" version, argues that the acceptance of A will lead to the acceptance of A1, as A1 is not significantly different to A. A1 will then lead to A2, A2 to A3, and eventually the process will lead to the unacceptable B. As Glover argues, this version of the argument does not say that there is no significant difference between A and B, but instead argues that it is impossible to justify accepting A while also denying B – drawing a line at any point between the two would be creating an arbitrary cut-off point that would be unjustifiable. Glover provides the example of infanticide (or non-voluntary euthanasia) and severely deformed children:
The second primary form of the slippery slope argument is that of the "Empirical" or "Psychological" argument. The empirical version does not rely on a logical connection between A and B, but instead argues that an acceptance of A will, in time, lead to an acceptance of B. The process is not a logical necessity, but one which will be followed through a process of moral change. Enoch describes the application of this form of the argument thus:
Glover, however, notes that this line of argument requires good evidence that this direction will be followed, as not all boundaries are thus pushed.
More generally, it has been argued that in employing the slippery slope there can be an "implicit concession", as it starts from the assumption that the initial practice is acceptable – even though it will lead to unacceptable outcomes in the future. Nevertheless, van der Burg argues that this not a useful concession, as the outcomes are intended to make it clear that the initial practice was not justifiable after all.
Response to the logical versions
Countering the first logical version of the slippery slope argument, it is argued that the different types of euthanasia are sufficiently distinct that it is not "logically inconsistent" to support one version while denying the others. It is possible to support, for example, voluntary euthanasia while denying non-voluntary euthanasia, just as it is possible to support both – the distinction comes not from a logical inconsistency, but a choice of principles, such that a focus on euthanasia as personal choice will support voluntary euthanasia but not non-voluntary euthanasia, while a focus on a person's "best interests" may allow for the support of both. From a more practical perspective, another option when faced with logical version of the argument is to simply accept the consequences. This was the response by Duff and Campbell to Sherlock. Rather than arguing that their premises were flawed, they argued that Sherlock was correct: their criteria could also be applied to older children, and thus it should be applied, as it was "probably the most caring policy generally."In responding to the "arbitrary line" version of the slippery slope argument, it is argued that the stance relies on the "paradox of the heap
Sorites paradox
The sorites paradox is a paradox that arises from vague predicates. The paradox of the heap is an example of this paradox which arises when one considers a heap of sand, from which grains are individually removed...
", and that it is possible to draw a line between the acceptable an unacceptable alternatives. Furthermore, in the case of euthanasia, it is possible to draw hard lines between different types of practices. For example, there is a clear distinction between voluntary and non-voluntary euthanasia, such that the arbitrary line approach cannot be applied.
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. Generally, two examples are discussed – Action T4Action T4
Action T4 was the name used after World War II for Nazi Germany's eugenics-based "euthanasia" program during which physicians killed thousands of people who were "judged incurably sick, by critical medical examination"...
, the Nazi euthanasia program in Germany between 1939 and 1941, and the Groningen Protocol
Groningen Protocol
The Groningen Protocol is a text created in September 2004 by Eduard Verhagen, the medical director of the department of pediatrics at the University Medical Center Groningen in Groningen, The Netherlands...
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.
Action T4
Euthanasia opponent Ian DowbigginIan Dowbiggin
Ian Robert Dowbiggin is an academic historian, a historian of medicine, a prominent commentator on Catholicism, and an opponent of euthanasia and physician-assisted suicide. He is a professor in the History department at the University of Prince Edward Island...
linked the Nazis' Action T4
Action T4
Action T4 was the name used after World War II for Nazi Germany's eugenics-based "euthanasia" program during which physicians killed thousands of people who were "judged incurably sick, by critical medical examination"...
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.
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.
The Groningen Protocol
Non-voluntary euthanasia is sometimes cited as one of the possible outcomes of the slippery slopeSlippery slope
In debate or rhetoric, a slippery slope is a classic form of argument, arguably an informal fallacy...
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. Some studies of the Netherlands after the introduction of voluntary euthanasia state that there was no evidence to support this claim while other studies state otherwise.
A study from the Jakobovits Center for Medical Ethics in Israel
Israel
The State of Israel is a parliamentary republic located in the Middle East, along the eastern shore of the Mediterranean Sea...
argued that a form of non-voluntary euthanasia, the Groningen Protocol
Groningen Protocol
The Groningen Protocol is a text created in September 2004 by Eduard Verhagen, the medical director of the department of pediatrics at the University Medical Center Groningen in Groningen, The Netherlands...
, has "potential to validate the slippery-slope argument against allowing euthanasia in selected populations". 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". Pediatrician Ola Didrik Saugstad
Ola Didrik Saugstad
Ola Didrik Saugstad is a Norwegian pediatrician, who is internationally recognized for his research on resuscitation of newborn children. He is the most widely cited Norwegian pediatrician....
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. Countering this view, professor of internal medicine Margaret Battin finds that there is a lack of evidence to support slippery slope arguments. 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.
A study by Jochemsen and Keown, from the Dutch Lindeboom Institute, a Christian organisation, 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. 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".
A 2009 review study of euthanasia in Holland concluded that no slippery slope effect has occurred, while another study of the same year found that abuse of the Dutch euthanasia system is rare. In 2010, a study found that there is no evidence that legalizing assisted suicide will lead us down the slippery slope to involuntary euthanasia.
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. One commenter wrote that that critics who rely on this slippery slope argument often omit two important elements, thereby using flawed logic. 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; 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". 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:- The frequency of ending of life without explicit patient request did not increase over the studied years;
- There is no evidence for a higher frequency of euthanasia, compared with background populations, among:
-
-
- the elderlyOld ageOld age consists of ages nearing or surpassing the average life span of human beings, and thus the end of the human life cycle...
- people with low educational statusEducational inequalityEducational inequality occurs where the quality of education available to pupils is closely related to their social class or status. A common view among scholars addressing this topic is that rather than succeeding in reducing societal inequality, schools and other educational establishments to...
- the poorPovertyPoverty is the lack of a certain amount of material possessions or money. Absolute poverty or destitution is inability to afford basic human needs, which commonly includes clean and fresh water, nutrition, health care, education, clothing and shelter. About 1.7 billion people are estimated to live...
- the physically disabledDisabilityA disability may be physical, cognitive, mental, sensory, emotional, developmental or some combination of these.Many people would rather be referred to as a person with a disability instead of handicapped...
or chronically ill - minorMinorMinor means "not important", and in Latin "smaller". It may also refer to:* an underage child, see Minor * Academic minor, a secondary focus of a Bachelor's degree, the primary focus being an academic major-Mathematics:...
s - people with psychiatric illnesses including depression
- racial or ethnic minoritiesMinority groupA minority is a sociological group within a demographic. The demographic could be based on many factors from ethnicity, gender, wealth, power, etc. The term extends to numerous situations, and civilizations within history, despite the misnomer of minorities associated with a numerical statistic...
.
- the elderly
-