What’s the Background on the Slippery Slope Argument?

Much of the opposition to assisted death is based on the fear that voluntary requests for aid-in-dying would soon move to these surrogate decisions and then to involuntary euthanasia of incompetent patients whom physicians or others felt no longer had any quality of life. As I described above, the surrogacy argument seems to bear some weight as court decisions from Quinlan to Cruzan have upheld the request of surrogates to withhold or withdraw life-sustaining treatments when these patients made their philosophical intentions known prior to loss of competence.

Much of the opposition to assisted death is based on the fear that voluntary requests for aid-in-dying would soon move to these surrogate decisions and then to involuntary euthanasia of incompetent patients whom physicians or others felt no longer had any quality of life. As I described above, the surrogacy argument seems to bear some weight as court decisions from Quinlan to Cruzan have upheld the request of surrogates to withhold or withdraw life-sustaining treatments when these patients made their philosophical intentions known prior to loss of competence. This indeed is the basis of living will provisions that presently exist. In essence, the courts might eventually see no difference between “allowing to die” and easing suffering by providing death more quickly.

In terms of moving to non-voluntary euthanasia, opponents of assisted death point to both the Netherlands and Nazi Germany as examples to be avoided. These arguments, however, ignore the facts. In the Netherlands qualified patients can request and receive either lethal prescriptions or direct euthanasia (lethal injections). Government studies have found that some 1,000 patients a year meet death in such an involuntary manner. What is lost in this argument is that the Dutch make no distinction between passive and active euthanasia, and that many of these “life terminating acts without explicit request” (LAWER) result from withholding or withdrawal life-sustaining treatment — a practice that is widespread in America, and that many other deaths involved prior discussions between patients and physicians. These LAWER cases have come to public attention only because the Dutch have created a system that allows qualified patients to request and receive assistance, and requires physicians to report them. Also ignored is the fact that non-voluntary euthanasia is quite common in American hospitals but go unreported as they are often sheltered under the wider umbrella of “double effect,” even though it’s often obvious to all involved that the intention of massive pain relief has indeed been to end life, not just pain. Furthermore, in my own research I uncovered instances of physicians also providing significant others with lethal medications to be used for one who was dying, but who was no longer competent due to AIDS dementia or end-of-life sedation in cancer cases. Although these are all anecdotal reports, they suggest that the slippery slope already exists. Legal controls can do much to make this slope explicit, and bring existing abuses to light.

In terms of Nazi Germany, what opponents seem to forget is that official programs for euthanasia were designed from above with the intention from the very beginning of gradually creating a system of genocide rooted in the concept of racial purity. This was never voluntary or based on freedom of choice. The true slippery slope in Nazi Germany was the loss of civil liberty and freedoms. The current call for assisted death legislation is! Restricting freedom of choice and enforcement of a public health model which protects individuals from harming themselves is far more dangerous than an approach which provides guarantees of broad freedoms to the individual.