Slippery Slopes, Political Realities and Comparing British Apples with American Oranges in Assisted Suicide Debate

On Friday, July 18, the British House of Lords will be considering Lord Falconer’s bill to legalize assisted suicide yet again.  Naturally, this has resulted in a real uptick in public debate on the topic, some of which we’ll share and discuss here later.

Right now, I want to focus on a strategy being used by pro-assisted suicide advocates in the UK.   Very aware that one major criticism of legalization of assisted suicide is expansion or “slippery slope” into making nonterminally ill, old and disabled people targets of the legislation.  Naturally, this has meant that advocates try to steer clear of discussing the Benelux countries, which have embraced the euthanasia of nonterminally ill people, people with depression, old people who say they’re tired of living and the euthanasia of “severely disabled” infants – in the Netherlands, children with Spina Bifida have been the main target of medical killing according to reports.  And of course most people are aware of the group Dignitas in Switzerland, whose eligibility criteria involves mostly the ability to pay hefty fees rather than any concern about the medical diagnosis of an individual.

Instead, UK assisted suicide advocates have taken to pointing to the United States as a shining example of how assisted suicide can be contained and safeguarded.  I found a very recent example from Tom Shakespeare. a disability scholar who has written some pretty unscholarly things about assisted suicide before.  He left a comment on Neil Crowther’s “Making Rights Make Sense” most recent post “Signal Failure,” which I recommend people go and read in its entirety.  Crowther notes that while the bill attempts to rigidly define the health status and prognosis in terms of “eligibility,” there is no concern regarding the motivations for one’s wish to commit suicide.  As he notes, they are NOT medical reasons for the most part:

If an objective of ‘assisted dying’ is – as Dignity in Dying argue – to relieve suffering, the suffering most cited relates to what people feel able to be or do and to their sense of self, rather than physical pain.  As such we must conclude that their motivations are not wholly intrinsic in nature.

People should be worried about this, he says:

It is true to say as did the recent British Medical Journal editorial in support of the Bill  that ‘That much mentioned victim—the elderly lady who believes she has become a burden to others and offers herself up for assisted dying—will not qualify’ under the Assisted Dying Bill.  But one does not need to be concerned that the Bill’s internal safeguards would fail to be worried about where the motivations to end ones life come from, the signal this Bill would send in the current context, accepting as it does that feeling a burden is sufficient reason to ask to be helped to end ones life, and the potential for the laws scope to expand to encompass such a scenario in future.

None of this is of concern to Shakespeare, who submitted a reply, which concluded this way:

And the example of Oregon is a counter-example to the slippery slope fear. There has been no widening. A tiny % of people choose to take advantage of the law. People are not pressured. It seems to work fine. Even militant pro-lifers cannot find much by way of “abuses” to criticise. Of course some people want a much wider law. But I cannot see them ever succeeding, you only have to look at the opposition to this Bill to realise how difficult it would be. There have been many attempts to pass this very limited assisted dying provision. I would oppose voluntary euthanasia for people who are not dying, and so would the majority, and I am confident that it would not happen in UK.

It’s not just “some people” who want a wider law – it’s the majority of “right to die” activists.  Without going into great detail here, you can find great material regarding problems with Oregon’s assisted suicide law in the policy section at DREDF under “assisted suicide.”  Check out “Spurious Safeguards,” Flimsy Reporting, No Regulation,” and “Pro-Suicide Doctors.”

Shakespeare, when looking to Oregon and the two other states in the US with laws legalizing assisted suicide, wants people to compare apples and oranges.  Remember that there are 50 states in the US, all of them with self-governing and autonomy separate from the federal Government.  You need to get a large number of states legalizing assisted suicide before having a chance for legalization on a national scale.  In contrast, if the UK legalizes assisted suicide, then the whole country is subject to the law in one fell swoop.

That’s an important difference when trying to predict what will happen in the UK.  When other whole countries – like the Netherlands and Belgium – have legalized assisted suicide and/or euthanasia, expansion of “eligibility” has proceeded pretty rapidly.

While US groups want expansion, they’ve left the model assisted suicide statutes alone for now, until that statute or ones like it are implemented in most of the states.  There’s still expansion though.  The Final Exit Network engages in underground vigilante “help” with assisted suicide for just about anyone who wants to end their lives. Compassion and Choices is aggressively marketing VSED – voluntary stopping eating and drinking – as a “peaceful” way for even nonterminally ill people to kill themselves.

I’m not just guessing at the agenda of assisted suicide groups.

In 2002, The Hastings Center Report published an article by Martin Gunderson and David J Mayo titled “Restricting Physician-Assisted Death to the Terminally Ill.” (article is scanned PDF and not accessible to those using screen readers)

David Mayo, the second author, isn’t just some disinterested researcher. At the time of the article’s publication, he was on the board of directors of the Hemlock Society.  Currently, he’s on the board of directors of both Death With Dignity National Center, and their related political fund.  You can read the organization’s mini-bio of Mayo here.

Mayo comes at this topic as someone with long years of significant involvement in national groups promoting assisted suicide in the US.  When he talks about an incrementalist approach, it’s something worth paying attention to.  From the Hastings Center article:

In light of the current paucity of evidence, however, it is reasonable to proceed incrementally and extend physician- assisted death initially only to terminally ill patients. Doing so will grant its benefits to those who as a group are most likely to benefit and for whom it would involve no more risk than do current medical practices at the end of life, while withholding it from those less apt to benefit and about whom there is greater controversy over potential risk. Finally, opting for the incremental approach will generate further data that can subsequently make possible a more reasonable assessment of the risk.

Without using the exact wording that’s used earlier in this article, the authors assert that many – including the authors – don’t believe assisted suicide eligibility to be limited to the “terminally ill,” but it’s a good place to start, and as part of an incrementalist approach to legalization. Their conclusion:

Thus the restriction of physician-assisted death to terminally ill patients should not necessarily be regarded as a permanent restriction. Our defense of the terminal illness requirement is based not on deep principle, but rather on risk assessment in the face of uncertainty. If physician-assisted death were extended to terminally ill patients, we could decide to stop there, retreat, or advance, depending on what we found out.

Considering that assisted suicide advocates in the US are claiming that assisted suicide laws have performed spectacularly, it’s clear they’ll start working to expand the laws as soon as they reach a critical mass of states legalizing assisted suicide. One of our jobs is to stop them from reaching that critical mass.

3 thoughts on “Slippery Slopes, Political Realities and Comparing British Apples with American Oranges in Assisted Suicide Debate

  1. Great article, Stephen. Incrementalism helps explain proponents’ use of non-terminal candidates in their arguments. Prime example was over the last few days, with former Archbishop of Canterbury Lord Carey coming out in favor of the assisted suicide bill – because of his experience with Tony Nicklinson, WHO WOULD NOT BE ELIGIBLE. Once the bill is in place, and they can say that it is a success, it would only be “compassionate” to extend it to Tony and that other guy and all the rest of us.

  2. The hard realities you point out are ignored by those who want the license to “sort” hospital patients who will receive life-saving and life-extending care from those patients who will NOT receive life-saving hospital care because they are old, disabled, poor, and have no insurance –and are deemed “terminal” by the hospital physician.

    Of course, the legal description of “terminal” is not yet agreed upon and therein lies the problem. Certainly, the competent patient should have the right to agree with the “terminal” prognosis or reject it, especially in view of the fact that physicians, themselves, often disagree about when patients are “terminal” and when no hope exists for a meaningful recovery. And how do we define “meaningful” in the law?

    We see in the UK, where they have socialized medicine, that they had the problem often of offending the public because of the hastening of death of elderly/disabled on the so-called Liverpool Pathway (like Hospice?) who were were merely old and disabled but not terminal in the medical sense. Within the last year, in response to a public outcry, The UK Liverpool Pathway has been suspended and the UK is said to be opposed to unilateral euthanasia of the elderly and the disabled merely because they are old and disabled and is looking for a better way to provide end-of-life care and informed consent.

    But, of course, the assisted suicide advocates in the UK still want the State to sanction the “lethal” prescription because it is a politically popular position, or what? They must know, of course, that the legalization of “assisted suicide” with lethal prescriptions prepared by physicians does open the door wider to involuntary passive euthanasia of the elderly, disabled, and the poor to save resources by both government and family members.

    The recent uproar in the United States over the failure of drugs to compassionately EXECUTE the death penalty makes one wonder if the Legislatures would ever wonder about the innocent patients who are given lethal prescriptions by physicians that are sanctioned by the State, that accidentally might result in an agonizing and long-suffering death — that, of course, would not be witnessed by a representative of the state.


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