GESTIÓN EN SALUD PÚBLICA: BioEdge: Dutch euthanasia doctor agrees that there is a ‘slippery slope’

BioEdge: Dutch euthanasia doctor agrees that there is a ‘slippery slope’

Bioedge

Dutch euthanasia doctor agrees that there is a ‘slippery slope’

by Michael Cook | 29 Aug 2020 |

“Anti-euthanasia lobbyists want the public to believe in the inevitability of the slippery slope, but their fears are unwarranted," wrote a Canadian doctor earlier this year.

Where better to test this than the Netherlands?

In 2019, according to the official figures, there were 6,361 cases of euthanasia – 4.2 percent of all deaths. In other words, one out of 25 people are killed by doctors in the Netherlands. And those are just the official figures. It is widely accepted that a good number of euthanasia deaths are not reported, mostly because doctors don’t like the extra paperwork involved.

How do Dutch euthanasia doctors feel about this?

Pretty good, actually. Well, at least one of them.

Writing in the NTGV, the Dutch Medical Association Journal, Dr Bert Keizer reflects on the history of Dutch euthanasia. Somewhat surprisingly, he endorses the notion that euthanasia is a “slippery slope”. Better said, he embraces it.

Dr Keizer is a Grand Old Man of Dutch euthanasia. A philosopher and a geriatrician, he now works for Expertisecentrum Euthanasie, the new name for Levenseindekliniek (the End of Life Clinic). It was born as a project of the NVVE, the Dutch Right to Die Society. He writes:

“After the turn of the [last] century, what our British colleagues had predicted years earlier with unconcealed complacency happened: those who embark on euthanasia venture down a slippery slope along which you irrevocably slide down to the random killing of defenceless sick people.”

This does not upset him too much. In his eyes, expanding the criteria for euthanasia eligibility is the path of progress. After all, it happened with abortion, too.

“With every limit we set ourselves, there is the possibility to cross it. This also applies in the peripheral areas of ethical conduct. Abortion was once not allowed, then hardly, then until 12 weeks and now even up to 20 weeks. That ‘even’ says it all. Something similar is now underway in the field of human embryo research, where we are starting to leave the ‘never’ stage.”

He describes the progress of euthanasia in the Netherlands.

“And so it was with euthanasia. Every time a line was drawn, it was also pushed back. We started with the terminally ill, but also among the chronically ill it turned out to be hopeless and unbearable suffering. Subsequently, people with incipient dementia, psychiatric patients, people with advanced dementia, (high) elderly who struggled with an accumulation of old-age complaints and finally (high) elderly who, although not suffering from a disabling or limiting disease, still find that their life no longer has content. The unfortunate term ‘completed life’ was used for the problem of the latter group.”

What Dr Keizer has witnessed in his long career is the gradual but inevitable change in what doctors are willing to do for their patients. Perhaps “slippery slope” sounds too harsh, because it evokes the image of a headlong tumble down a cliff. He prefers to think of it as a gradual erosion of boundaries.

“In retrospect, it is true that we now provide euthanasia to people to whom we had said, a little indignantly, 20 years ago, ‘Come on, that is really impossible’. And looking ahead, there is no reason to believe that this process will stop in case of incapacitated dementia. What about the prisoner who has a life sentence and desperately longs for death? Or doubly disabled children who, although institutionalized, suffer unbearably and hopelessly according to their parents as a result of self-harm? I don’t believe we are on a slippery slope, in the sense of heading for disaster. Rather, it is a shift that is not catastrophic, but it does require that we continue to get involved as a community.”

This passage from Dr Keizer’s article suggests that the two sides of the euthanasia debate have zeroed in on the wrong word. Instead of arguing about whether a slippery slope exists – because they agree on that — they should focus on the meaning of “disaster”.

Michael Cook is editor of BioEdge

Like the Democratic candidate, Joe Biden, Republican President Donald Trump touched upon a number of bioethical issues when he accepted his nomination this week.

I found it surprising that Trump devoted so much time to broadcasting his anti-abortion, pro-life message. It's not surprising -- his Administration has worked against Planned Parenthood and backed nominees to the Supreme Court who appeared to be anti-abortion.

But Trump did so boldly and without equivocation when he could have just settled for some boilerplate, His team must have calculated that it is an election-winning issue, no matter how polarising it appears to be. Is this a sign that public opinion is changing on this key bioethical issue?

Michael Cook
Editor

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