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The Empirical Slippery Slope from Voluntary to Non-Voluntary Euthanasia

Published online by Cambridge University Press:  01 January 2021

Penney Lewis
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Extract

Slippery slope arguments appear regularly whenever morally contested social change is proposed. Such arguments assume that all or some consequences which could possibly flow from permitting a particular practice are morally unacceptable.

Typically, “slippery slope” arguments claim that endorsing some premise, doing some action or adopting some policy will lead to some definite outcome that is generally judged to be wrong or bad. The “slope” is “slippery” because there are claimed to be no plausible halting points between the initial commitment to a premise, action, or policy and the resultant bad outcome. The desire to avoid such projected future consequences provides adequate reasons for not taking the first step.

Thus the legalization of abortion in limited circumstances is asserted to lead down the slippery slope towards abortion on demand and even infanticide; and the legalization of assisted suicide to lead inexorably to the acceptance of voluntary euthanasia and subsequently to the sanctioning of the practice of nonvoluntary euthanasia – even involuntary euthanasia of “undesirable” individuals.

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Independent
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Journal of Law, Medicine & Ethics , Volume 35 , Issue 1 , Spring 2007 , pp. 197 - 210
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Copyright © American Society of Law, Medicine and Ethics 2007

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References

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See Mitchell, K. and Owens, R. G., “National Survey of Medical Decisions at End of Life Made by New Zealand General Practitioners,” British Medical Journal 327 (2003): 202–3. (5.6% of respondent doctors making an end-of-life decision at the last death attended had performed active euthanasia or physician-assisted suicide; 44% of these decisions had not been discussed with the patient, almost entirely because the patient was no longer competent.) A direct comparison between this study and the most recent U.K. study is found in Seale, supra note 58, at Table 4: The rate of active euthanasia or physician-assisted suicide at the last death attended across all respondents (not simply those who made an end-of-life decision) was 3.1% in the New Zealand study (95% CI 2.1%-4.1%) and 1.4% in the U.K. study (95% CI 0.3%-2.5%).CrossRefGoogle Scholar
The empirical evidence is reviewed in Emanuel, E. J., “Euthanasia and Physician-Assisted Suicide: A Review of the Empirical Data From the United States,” Archives of Internal Medicine 162 (2001): 142–52, at 146, Table 4. (“Many studies indicate that a small, but definite, proportion of US physicians have performed euthanasia or PAS, despite its being illegal…. [T]he data provide conflicting evidence on the precise frequency of such interventions, with reported frequencies varying more than 6-fold even among the best studies.”)CrossRefGoogle Scholar
See Seale, supra note 58, at Table 2; Ward, B. J. and Tate, P. A., “Attitudes among NHS Doctors to Requests for Euthanasia,” British Medical Journal 308 (1994): 1332–4 (12% of responding doctors had taken active steps to hasten death on request); McLean, S. A. M. and Britton, A., Sometimes a Small Victory (Glasgow: Institute of Law and Ethics in Medicine, 1996): at App. III, Table 17, 31–2, discussed in Keown, supra note 34, at 61 and Freeman, M., “Denying Death its Dominion: Thoughts on the Dianne Pretty Case,” Medical Law Review 10 (2002): 245–70, at 249, note 31 (4% of responding Scottish health professionals had assisted suicide). The House of Lords Select Committee on the Assisted Dying for the Terminally Ill Bill doubted some of the U.K. survey evidence: “Bearing in mind however the trend towards death taking place in hospital rather than at home, the increasing prevalence of team-working in clinical care, the greater tendency for people to litigate where they suspect malpractice, and the potential for confusion with the legal administration of drugs to prevent restlessness and anxiety in the last hours of life, we would be surprised if covert euthanasia were being practised on anything like the scale which some of these surveys suggest.” House of Lords Select Committee on the Assisted Dying for the Terminally Ill Bill, Report, HL Paper 86-I (2005): at 239, available at <http://www.publications.parliament.uk/pa/ld200405/ldse-lect/ldasdy/86/86i.pdf> (last visited December 13, 2006).Google Scholar
This data is from van der Heide, supra note 59, at Table 2; Seale, supra note 58, at Tables 2 and 3; Kuhse, supra note 55, at Box 4.Google Scholar
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The U.K. rate of non-treatment decisions as a percentage of non-sudden deaths was 33.4% (95% CI 27.1%-39.8%). Several European jurisdictions have significantly lower rates. For example, the rate in Belgium (pre-legalization) was 22.8% (95% CI 20.9%-24.7%). Denmark and Sweden had similar rates to Belgium. Italy's rate was much lower, at 5.6% (95% CI 4.6%-6.6%). The Netherlands and Switzerland had rates comparable to the U.K. Seale, supra note 58, at Table 3, using data from van der Heide, supra note 59, at Table 2.Google Scholar
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See Seale, , id. at Table 3; van der Heide, supra note 59, at Table 2. In fact, the reverse may be true. See the data on Italy and Sweden in Onwuteaka-Philipsen, supra note 73, at Table 3.Google Scholar
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