The only choice for such patients, if voluntary euthanasia is to be denied, is sedation. A comatose state can be induced, so as to prevent the individual from experiencing any pain. It goes without saying that this existence is hardly dignified. And to maintain such a state until the patient dies of natural causes, perhaps weeks or even months away, would no doubt be quite costly. It is argued by some that if society allows voluntary euthanasia to be legally permitted, it would result in a decline in the respect we have for human life (Rachels, 1986:170).
And because of this we will have set foot on a slippery slope which, eventually, will lead society to support other forms of euthanasia, such as killing those who cannot, or will not, give consent, also known as non-voluntary euthanasia (Royal Australasian College of Physicians, 1993: 26). There are several forms of slippery slope argument, but I will limit this argument to only two. The first is the logical version. It argues that once a practice like voluntary euthanasia is accepted, logically we will have no choice but to accept other practices such as non-voluntary euthanasia.
And since non-voluntary euthanasia is clearly unacceptable, voluntary euthanasia – the first step in the process – should not be permitted (Rachels, 1986:172). But there’s quite a difference between a patient suffering in agony who requests to die, and an elderly woman with Alzheimer’s Disease who is in no pain, and does not make a request to die. It’s a ridiculous notion to think that we will have no choice but to ‘bump off’ the latter individual by way of non-voluntary euthanasia just because the former has access to voluntary euthanasia.
The second form of slippery slope argument is the psychological version. This argument claims that once a practice is accepted, people will go on to accept other more serious practices. This argument is a poor one. The supposed inevitability of sliding from voluntary euthanasia to non-voluntary euthanasia is hard to see. Why should anyone who supports the autonomy of the individual and, consequently, their right to choose voluntary euthanasia, suddenly be psychologically driven to support the practice of non-voluntary euthanasia, where there is no patient autonomy being exercised?
A suitable analogy can be found in the writing of Michael Tooley (1979). He uses the example of sexual activity to demonstrate the ridiculousness of the slippery slope argument. He argues that if somebody was to advocate sexual activity, and critics objected when only voluntary sexual activity was being advocated, the proposal would be extended to cover non-voluntary sexual activity, otherwise known as rape (Tooley, 1979:69). This having been said, there is no reason for accepting the slippery slope argument.
The doctrine of double effect is a religious principle that has been applied to end of life medical decisions, to justify medical intervention that relieves pain and suffering, and, consequently, hastens death (Kluge, 1981:16). It is when treatment relieves suffering but also indirectly brings about the death of a patient. For this to be permissible, four conditions must first be met: the act itself must be permitted; the bad effect must not be intended; the bad result must not be used as a means to achieving the good result; and the good accomplished in the good result must outweigh the evil of the bad result (Rachels, 1986:16).
If these criteria are met, then the act is ethically and legally permissible (Ladd, 1979:180). Many consider the doctrine of double effect is relevant only where a person’s death is an evil, or a harm – which can be defined as damage to a person’s interests. So if a person dies from voluntary euthanasia because they requested it and considered it beneficial, then the act cannot also be considered harmful. It follows then that the doctrine of double effect is irrelevant to the moral permissibility of voluntary euthanasia.
A final objection to voluntary euthanasia is the belief by some that we never have good enough evidence to believe that the request made by a person wanting to be helped to die is a rational, enduring and voluntary one (Glover, 1977:185). Never is too strong a word in this case. Many individuals have a lifetime to discuss and debate the issue, and come to a decision as to whether voluntary euthanasia is a path they will consider taking. Surely that is enough time for a request, if made, to be considered an enduring one. And there is also the possibility of a cooling off period.
Many believe that such a period should be allowed. There are, of course, cases where aspects of a person’s illness makes it difficult to assume their request to die is a rational, enduring and voluntary one. In cases like these it is possible for people to indicate their wishes in advance, before their illness results in their not having the capacity to do so. Living wills and advanced directives are the means through which this can be achieved, and should be thought of and respected as evidence of a decision that has been carefully considered (Foot, 1979:38).
Some then argue that this decision to be helped to die cannot be made before a person actually suffers from the illness, because they cannot really know what it is like until they experience it for themselves. This is another poor argument. Many people, before finding themselves in the same position, can be witness to the effects of such illnesses in friends and family. And consequently, can have an understanding of what it would be like to suffer from such an illness themselves.
From this they can certainly form their own opinions and exercise their autonomy accordingly. Unfortunately for some, the last stages of life hold much suffering and pain for those afflicted by a terminal illness. Anxiety and feelings associated with becoming a burden to others, especially family, are also of great concern. Strict conditions have been laid out for those wanting access to voluntary euthanasia, and the arguments against this practice have been found lacking.
If an autonomous individual feels that his or her life is no longer worth living, and, after careful consideration, a rational, enduring and voluntary request is made for assistance to die, then the rights of the patient should be respected and the request should be granted. This will allow many people affected by pain and suffering due to terminal illness, a more peaceful and dignified end to their life.
References Foot, P. (1979). ‘Euthanasia’ in Ethical Issues Relating to Life and Death, edited by John Ladd.New York: Oxford University Press. Glover, J. (1977). Causing Death and Saving Lives. London: Penguin Kluge, E. W. (1981). The Ethics of Deliberate Death. New York: Kennikat. Ladd, J. (1979). ‘Positive and Negative Euthanasia’ in Ethical Issues Relating to Life and Death, edited by John Ladd. New York: Oxford University Press. Molloy, W. (1993). Vital Choices: Life, Death and the Health Care Crisis. Ontario: Viking. Rachels, J. (1986). The End of Life: Euthanasia and Morality. Oxford: Oxford University Press. Smith, W.J. (1997). Forced Exit:
The Slippery Slope from Assisted Suicide to Legalized Murder. USA: Random House. Tooley, M. (1979). ‘Decisions to terminate life and the concept of person’ in Ethical Issues Relating to Life and Death, edited by John Ladd. New York: Oxford University Press. Voluntary Euthanasia Society of New South Wales (1993). Voluntary Euthanasia – A Choice. Broadway, NSW: V. E. S. N. S. W. Voluntary Euthanasia Society of Victoria (1998). Voluntary Euthanasia: The Right to Choose. Melbourne: V. E. S. V.