A Slippery Slope of Assisted Death?

A response to Tom Koch’s “A Sceptics Report”

Koch mentions several points in his paper that supposedly support the existence of an empirical slippery slope that many have feared.

1. There has been an increase in assisted deaths in a number of jurisdictions where it is legal, including Belgium, Oregon, Washington, and Canada. (p. 360–362)
2. Part of the increase is due to a loosening of the eligibility criteria and/or an expansion of the reasons for people to choose it. Koch mentions an elderly couple who chose assisted death due to fear of a future disabling illness. (p. 362)
3. Assisted death is sometimes not used as a last resort. Koch discusses a woman who was referred for assisted death due to bursitis in her shoulder that hindered activities of daily living. Koch and others determined that her condition could be easily treated. After learning this, the woman rescinded her request. (p. 362)
4. Some patients request assisted death due to incorrect diagnoses. (p. 362–363)
5. Some patients request it because they lack access to appropriate medical care and/or public services. (p. 362–365)

Response

I do not doubt these empirical claims, but they alone are insufficient to show the existence of a slippery slope.

In general, slippery slopes are successful if they show that if we allow A, then B follows, where A is morally permissible but B is not. Hence, without showing that B is morally impermissible, it would not be a successful slippery slope. In fact, if both A and B are morally permissible, then B obtaining would not be problematic.

(John Keown states that A does not have to be justified in order for there to be a successful slippery slope argument. Instead, both A and B could be unjustified. This is an interesting point. However, most slippery slopes are structured in the way that I presented them. In any case, even if we agree with Keown, showing that B follows A is insufficient in showing that B or A is bad.)

With this in mind, I will address each point Koch makes.

First, the fact that there is an increasing number of people choosing assisted death, by itself, does not show that the increase is unjustified. Koch and others who cite these statistics seem to assume that we can determine a priori the appropriate percentage of assisted deaths in a country. I do not think this is doable. Any threshold that we come up with will be arbitrary.

Consider an analogy. Suppose someone were to say that if patients are granted the right to refuse life-saving care, then there will be an increasing number of patients who will start refusing said care. And this empirical claim turns out to be true. Can we come up with a nonarbitrary appropriate percentage of refusals? No. And is the increase a strong reason to deny patients the right to refuse care? No.

Second, the justifiability of the loosening of the eligibility criteria depends on the particular criterion that was removed. For example, Canada recently removed the “reasonably foreseeable death” criterion, but I do not think this is unjustified. One does not have to be dying to choose assisted death autonomously nor does one have to be dying for death to be beneficial.

Third, since the reasons in favor of assisted death are autonomy and well-being, it follows that assisted death does not have to be the last option for it to be morally permissible. If living with the burdens of another option is unacceptable to the patient, then they should not have to continue to suffer by being denied an assisted death.

If a patient can be treated and therefore have an acceptable life as determined by the patient, great. Everybody is in favor of that. I am glad Koch helped that woman with her bursitis. But this will not be possible for everyone. For some, death is the preferred outcome.

Fourth, it is tragic that some choose assisted death due to an incorrect diagnosis, but this is not a reason to deny the option. Rather, it is a reason to improve the quality of healthcare.

The same type of reasoning applies to the fifth point that Koch mentions. The fact that some choose assisted death due to lack of access to appropriate care and/or public services is not a reason to deny people the right to an assisted death.

Should people receive correct diagnoses? Of course. Should people have access to the care and services they need? Of course. But people also have a right to an assisted death.

Think about refusing life-saving treatment again. Do people choose to refuse said treatment due to incorrect diagnoses and lack of access to care and services? Probably. Does this mean that we should not honor refusals? No.

References

Koch, Tom. “A Sceptics Report: Canada’s Five Years Experience with Medical Termination (MAiD).” HEC Forum 35, no. 4 (2023): 357–369