In the news today[1] is the latest in the tragic story of Brittany Maynard, a vibrant young woman who six months ago was diagnosed with terminal brain cancer. In April, doctors gave her six months to live. She moved to Oregon with the intent to commit suicide.
In 1994 Oregon Ballot Measure 16 passed 51.3% to 48.7%. As a result on October 27, 1997 Oregon enacted the Death with Dignity Act.[2] It allows any Oregon resident with a terminal illness to request a prescription for a lethal dose of medication. Like any bureaucracy there are forms to fill out. They require both an attending physician and a consulting physician to certify that the patient is making an informed decision. They also require two witnesses, one of whom is not a relative or entitled to any part of the estate, to attest that the patient is capable, acting voluntarily and not being coerced.
The intent behind these requirements in the statue is to ensure that such voluntary euthanasia cannot become involuntary euthanasia.
A key argument against right to die legislation is that it puts on a “slippery slope.” Over time, voluntary euthanasia will inevitably become involuntary euthanasia.
In 1993, John Sopinka speaking for the majority of the Supreme Court of Canada in Rodriguez v. British Columbia (Attorney General) wrote:
“Critics of the Dutch approach point to evidence suggesting that involuntary active euthanasia (which is not permitted by the guidelines) is being practiced to an increasing degree. This worrisome trend supports the view that a relaxation of the absolute prohibition takes us down ‘the slippery slope'”.[3]
In 1997, Chief Justice William Rehnquist in WASHINGTON v. GLUCKSBERG made a similar argument.
“Thus, it turns out that what is couched as a limited right to ‘physician assisted suicide’ is likely, in effect, a much broader license, which could prove extremely difficult to police and contain. Washington’s ban on assisting suicide prevents such erosion.”[4]
But in 2007 Margaret P. Battin, in the Journal of Medical Ethics refuted the argument.
“Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured (inapplicable in the Netherlands, where all are insured), people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations.”[5]
And in 2009, Judith A. C. Rietjens, in the Journal of Bioethical Inquiry supported the conclusion.
“Two decades of research on euthanasia in the Netherlands have resulted in clear insights into the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have resulted.”[6]
But I think all the arguments suggesting that there is no “slippery slope” miss an important point. Terminal illness is often an emotionally and financially crippling burden on family and friends. I worry that good people faced with this situation will not see this new legal acceptance as their right to die but rather see it their responsibility to die.
Other links of interest:
https://www.compassionandchoices.org/
http://www.deathwithdignity.org/
http://www.carenotkilling.org.uk/
http://www.epcc.ca/
http://www.notdeadyet.org/
[1] Brittany Maynard on decision to die: Now ‘doesn’t seem like the right time’, Catherine E. Shoichet, CNN.com, retrieved October 30, 2014
[2] Death with Dignity Act, Oregon.gov, retrieved October 30, 2014
[3] Rodriguez v. British Columbia (Attorney General), [1993] 3 SCR 519, 1993 CanLII 75 (SCC)
[4] WASHINGTON v. GLUCKSBERG, 521 U.S. 702 (1997) Note: in 2006 the court ruled in favor of Oregon’s Death with Dignity Act in GONZALES v. OREGON.
[5] Legal physician-assisted dying in Oregon and the Netherlands: evidence concerning the impact on patients in “vulnerable” groups., Battin, P. et al., Journal of Medical Ethics 2007;33:591–597
[6] Two Decades of Research on Euthanasia from the Netherlands. What Have We Learnt and What Questions Remain?, Rietjens, J. et al., Journal of Bioethical Inquiry, Sep 2009; 6(3): 271–28