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These include ‘death with dignity’, ‘medical assistance in dying’, and ‘the peaceful alternative’.
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Paul van der Maas (Department of Public Health, Erasmus University, Rotterdam): ‘…whether the acceptance of euthanasia or assisted suicide when it is specifically requested by a greatly suffering, terminally ill, competent patient is the first step on a slippery slope that will lead to an unintended and undesirable increase in the number of cases of less careful end-of-life decision making and to the gradual social acceptance of euthanasia performed for morally unacceptable reasons.’ (van der Maas et al, 1996).
The data for the period 1990 to 2015 show The Dutch view One of the better descriptions of the ‘slippery slope’, written in 2017, went as follows: ‘The core of this argument is that as soon as euthanasia is allowed at all, even if only under certain conditions, it will necessarily follow that euthanasia will in future be performed under less stringent conditions and will eventually degenerate into an absolutely abject form of euthanasia, such as killing people involuntarily.’ The alternative view It is not possible to list all the publications attesting to the existence of a slippery slope, but I include several good reviews that I have seen (Hendin, 1997a; Jochemsen and Keown, 1999; Hendin, 2002; Keown, 2002; Ten Have and Welie, 2005; Randall and Downie, 2009; Keown, 2012 & 2013; Sprung et al, 2018; Keown, 2018).
They are an approximation, given the limitations of the published data, but they suggest of the order of 450,000 people may have been involved in the Dutch experiment.
Henk ten Have (Professor of Medical Ethics at the University Medical Centre of Njmegen) and Jos Welie (Professor of Health Policy and Ethics, Creighton University, Omaha): ‘The important lesson to be learned from the Dutch experiment is the virtual impossibility of regulating the practice of euthanasia and PAS through public debate, laws and policies.’ (Ten Have and Welie, 2005) Neil M Gorsuch (Associate Justice of the Supreme Court of the United States and author of The Future of Assisted Suicide): Does a regime dependent on self-reporting by physicians who have no interest in recording any case falling outside the guidelines adequately protect against lives taken erroneously, mistakenly, or as a result of abuse or coercion? (Gorsuch, 2006) The ‘slippery slope’ is the gradual extension of assisted suicide to widening groups of patients after it is legally permitted for patients designated as terminally ill (Hendin et al, 1997a).Intensified treatment of pain and symptoms may be entirely clinically appropriate, the possibility of life-shortening being acknowledged, but not intended.In contrast, intensified treatment of pain and symptoms performed with the intention of hastening death or ending life, is no different to euthanasia—these are deaths caused by the active intervention of the physician.The ‘slippery slope’ is the gradual extension of assisted suicide to widening groups of patients after it is legally permitted for patients designated as terminally ill (Hendin, 1997a).Manifestations include Henk Jochemsen (Director, Lindeboom Institute for Medical Ethics, the Netherlands): ‘The Dutch experience shows that once the termination of patients’ lives is practised and that practice wins official toleration or approval, the practice develops a dynamic of its own that resists effective control.’ (Jochemsen, 1994) Herbert Hendin (Medical Director of Suicide Prevention Initiatives (SPI) and Professor of Psychiatry at New York Medical College): ‘Virtually every guideline set up by the Dutch—a voluntary, well considered, persistent request; intolerable suffering that cannot be relieved; consultation; and reporting of cases—has failed to protect patients or has been modified or violated.’ (Hendin, 2002) José Pereira (Head of Palliative Care at the University of Ottawa): ‘Abuse of guidelines has occurred in every jurisdiction around the world where assisted dying has been legalized.’ (Pereira, 2011) A range of euphemisms have been developed to avoid the terms euthanasia and PAS, particularly the stigma of the word ‘suicide’.It is similarly a deliberate act with the express intention of ending life and is not ethically or morally distinguishable from euthanasia.The performance of assisted suicide by persons other than physicians, as occurs in Switzerland, is ethically and morally equivalent to PAS.‘The 1960s and 1970s were a watershed for Dutch society.From a conservative, tradition-bound country, the Netherlands transformed itself into a hotbed of social and cultural experimentation’ (Weyers, 2012).Amongst these were the ideals of patient autonomy and assisted dying (Angell, 1996).There are a number of good accounts of the saga of Dutch euthanasia (Hendin, 1997b; Hendin, 2002; Ten Have and Welie, 2005; Griffiths et al, 2008; Youngner and Kimsma, 2012; Keown, 2018).