Euthanasia “Safeguards” and the Slippery Slope

For all the talk about “safeguards”, there really can be no really effective safeguards in legalised euthanasia. Countries which have legalised euthanasia speak much about stringent conditions and strict safeguards, but the reality is quite different than the rhetoric.

The Dutch experience is a prime example of this. The “guidelines” for euthanasia in Holland have often been flouted. Dr John Keown has studied the Dutch situation in great detail. For example, he found that in 1990, 52 per cent of the 10,558 cases of a doctor’s intent to hasten death were done with no explicit request from the patient.

The Remmelink Report, an official Dutch government survey of euthanasia practices, found that more than one thousand patients are involuntarily euthanised each year. As one Oxford philosopher put it, the Dutch experience clearly shows that “even with stringent safeguards, once voluntary euthanasia is legalised the descent down the slippery slope is inevitable”.

Keown, a Cambridge University medical ethicist, summarises the effectiveness of the Dutch euthanasia guidelines: “The Dutch claim that their guidelines for VAE [voluntary active euthanasia] are precise and strict and therefore capable of ensuring effective control fails to pass muster. The elasticity of the guidelines and the absence of a rigorous independent oversight of the doctor’s decision-making suggest the contrary.”

Callahan and White offer this assessment of the Dutch experience: “Euthanasia is not at all effectively regulated in the Netherlands. As with laws proposed in the United States, the Dutch guidelines depend upon the willingness of doctors voluntarily to report what they do. It is evident that most doctors do not – certainly not those substantial numbers who engage in non-voluntary euthanasia. The Dutch have failed to monitor and regulate euthanasia and physician-assisted suicide. Can we expect to do any better?”

And the most recent government report from Holland found that euthanasia and PAS cases there rose by 13 per cent in 2009. That figure represents two per cent of all deaths in Holland for the year. Based on such figures, pro-euthanasia groups there want to set up an “end-of-life clinic” (euthanasia hospital) to further move in this direction.

Indeed, the situation in Holland has become so bad in this regard, that the minister responsible for legalising euthanasia there now is full of regret, wishing she had never gone down that path. Els Borst, who was the Health Minister for the Netherlands (1994 to 2002) was instrumental in getting it legalised in 2001.

But now she has had a change of heart and acknowledges this was the wrong direction for the nation. She admits that the country’s rulers did not give enough attention to palliative care as a clear alternative to euthanasia. “Obviously, this was not in the proper order,” she said.

And it is not just Holland that is experiencing major problems with supposed safeguards. In 2002 Belgium also legalised euthanasia. That nation also had what was considered very strict safeguards in place. But that is not preventing patients being killed against their will.

For example, research recently undertaken there found that almost half of all Belgian nurses have admitted to killing patients without their consent. The study was reported in the Canadian Medical Association Journal. The report’s authors said, “The nurses in our study operated beyond the legal margins of their profession”.

The situation in Australia appears to be no better. In South Australia, for example, where voluntary euthanasia is illegal, a recent survey of doctors who had taken active steps to end a patient’s life found that 49 per cent of them had never received a request from the patient to do so.

And a more recent survey of nearly 1000 Australian surgeons found that more than one third had intentionally hastened the death of a patient by administering more medication than was necessary to treat the patient’s symptoms. Of this group, more than half said they did so without an explicit request from the patient.

Another survey of 683 general surgeons, conducted a year later by the University of Newcastle, found similar results: over a third had sped up the death of terminally ill patients, and over half of the patients had not explicitly asked for a lethal dose of drugs. Only a few of the patients had clearly asked for euthanasia.

It seems that abuse is inevitable. Voluntary euthanasia will lead to involuntary euthanasia. It is already happening. As Australian expert on palliative care Brian Pollard puts it, “Every proposal to legalise euthanasia has been shown to be flawed, and they have been widely abused when put into practice elsewhere. No proposal has ever been devised which could be guaranteed not to be abused.”

But more importantly, as noted earlier, once we have opened the door to the killing of the elderly, why stop there? This is the really dangerous slippery slope. And again, it is not just theoretical. Respected Australians are actually proposing that infanticide for example be seriously considered. Peter Singer is one well known proponent of this view.

Indeed, while some argue that policies permitting the killing of patients can be strictly controlled, in the real world such controls quickly dissipate. As Wesley Smith has put it, “The carefully shaded moral distinctions in which the health-care intelligentsia and policymakers take so much pride are of little actual consequence in the real world of cost-controlled medical practice, in busy hospital settings, and among families suffering the emotional trauma and bearing the financial costs of caring for a severely brain-damaged relative. Once killing is seen as an appropriate answer in a few cases, the ground quickly gives way, and it becomes the answer in many cases.”

Or as renowned ethicist Sissela Bok has observed, “No society has yet worked out the hardest question of how to help those patients who desire to die, without endangering others who do not.”

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9 Replies to “Euthanasia “Safeguards” and the Slippery Slope”

  1. Hi Bill, great article.

    Is it possible that you could provide a reference for the Sissela Bok quote at the end of your piece. Is it “Euthanasia and Physician-Assisted Suicide (1998); if so, would you recommend this book?

    Kind Regards
    Matt Harris

  2. Yes you are right:

    Bok, Sissela, “Physician-assisted suicide,” in Gerald Dworkin, R.G. Frey, and Sissela Bok, Euthanasia and Physician-Assisted Suicide: For and Against. Cambridge: Cambridge University Press, 1998, pp. 83-139, p. 139.

    It is a debate book, with Bok against euthanasia, and the other two writers in favour. It is not bad. There are many other good volumes as well.

    Bill Muehlenberg, CultureWatch

  3. Many thanks Bill, can I encourage you to give a few clues as how to join up with groups such as the Australian Family Association?
    Stan Fishley

  4. It’s interesting that in a number of comments that I read about this issue in the newspaper, some people are advocating, not just euthanasia WHEN the suffering is unbearable, the diagnosis impossible to dispute etc, but they want access to euthanasia BEFORE it gets to that point.

    The slippery slope has already started and it hasn’t even yet been legalised.

    Oh and I had to laugh (and at the same time be sad) at one person saying that they demanded the right to a “safe” method of euthanasia…war is peace, love is hate, good is evil and evil is good.

    Paul Strecker

  5. Alex Schadenberg of the Euthanasia Prevention Coalition is speaking in Sydney this weekend. He is an excellent speaker and a hero in the fight against Euthanasia. The EPC web site is
    Anne Hartwell

  6. Just writing to alert you to the euthanasia bill that is being debated in the Senate at the moment. Assuming you are anti euthanasia, I have taken the liberty of sending you these links in case you have not had a chance to see them.
    allows you easily bulk email all your state senators.
    is an online petition against euthanasia

    Please forward this information onto anyone you think might be interested.
    Patricia Madigan

  7. I just wish there was more I could do to defeat this terrible legislation. Australians as a whole are so apathetic and ignorant as to what is going on. Church leaders are not giving leadership.
    Patricia Madigan

  8. Bill
    Just read a wonderful story on page 9 in the Herald Sun posted yesterday under the heading ‘Here’s to the love of a Mum’. The people involved were already obviously under enough pressure to “turn off the machines” without euthanasia legislation being at play. The push for all this is very worrying and just what on earth is the ‘safe’ method???
    I know who I’m voting for today……and just signed the petition, thank you Patricia.

    Dianne McMahon

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