After the Slippery Slope: Dutch Experiences on Regulating Active Euthanasia

Abstract

“When a country legalizes active euthanasia, it puts itself on a slippery slope from where it may well go further downward.” If true, this is a forceful argument in the battle of those who try to prevent euthanasia from becoming legal. The force of any slippery-slope argument, however, is by definition limited by its reference to future developments which cannot empirically be sustained. Experience in the Netherlands—where a law regulating active euthanasia was accepted in April 2001—may shed light on the strengths as well as the weaknesses of the slippery slope argument in the context of the euthanasia debate. This paper consists of three parts. First, it clarifies the Dutch legislation on euthanasia and explains the cultural context in which it originated. Second, it looks at the argument of the slippery slope. A logical and an empirical version are distinguished, and the latter, though philosophically less interesting, proves to be most relevant in the discussion on euthanasia. Thirdly, it addresses the question whether Dutch experiences in the process of legalizing euthanasia justify the fear for a slippery slope. The conclusion is: Dutch experiences justify some caution. Despite the fact that we live in a global village, and despite the fact that values and norms are widely exchanged within the Western culture, some differences have in the past decades become larger instead of smaller. The discussions on euthanasia and assisted suicide are an example. In this paper, I intend to contribute to the discussion from an inside perspective, i.e., as a participant in a political culture in which active euthanasia is considered more or less accepted, having worked in medical ethics in a clinical setting for most of my career, and being part of a family of practicing physicians and nurses. The paper will concentrate upon one of the arguments used in the current euthanasia debate worldwide: the contention that any form of legalization of voluntary euthanasia will inevitably go from bad to worse, from euthanasia in the case of terminal diseases to assisted suicide under much broader conditions,1 to more requests, to misuse, to nonvoluntary or even involuntary euthanasia and, eventually, to an erosion of the roots of our public morale. I will concentrate on developments in Holland.2 It should be noted from the onset, however, that other countries, which have not or not yet legalized euthanasia, may be worse off than the Netherlands.3 In this paper, I will first clarify the Dutch legislation on euthanasia and comment on the cultural context from which it stems. Second, I will look at the argument of the slippery slope: What does it mean to use the argument? What function does it have in ethics? Thirdly, I will combine the two and look whether Dutch experiences since the legalization process of euthanasia give ground to the fear for a slippery slope