Physician Assisted Suicide and the Slippery Slope Argument

Permitting physician assisted suicide for those with terminal illnesses seems to be becoming acceptable in some countries. However many remain opposed to assisted suicide and employ two main arguments against the practice. First, there are the Deists who believe it is wrong to help someone die because only God should be able to do so. I won’t address this argument in this posting. Secondly there are those who believe that permitting assisted suicide for the terminally ill would lead to a slippery slope which would over time lead to assisted suicide becoming accepted in areas in which it shouldn’t be permissible. In the past I have argued that prisoners serving life sentences and those who are going to suffer from Alzheimer’s disease have a right to assisted suicide. It might be suggested my own arguments show that assisted suicide does indeed lead to a slippery slope. In this posting I will argue that provided our underlying motivation for the introduction of assisted suicide doesn’t change that its introduction should not lead to a slippery slope.

Before proceeding we need to be clear about exactly what we mean by a slippery slope. According to the Cambridge English Dictionary a slippery slope is “a bad situation or habit that, after it has started, is likely to get very much worse.” The starting point of the slippery slope is itself bad. If we accept this definition it by no means clear that we can use a slippery slope argument when discussing assisted suicide. Let us agree that a terminally ill patient who desires to die is in a bad situation, but assisted suicide isn’t of necessity bad in this situation, even if assisted suicide can’t remedy the bad situation it might bring it to an end peacefully. I find this definition unsatisfactory and a better definition of a slippery slope might be employed. According to the Oxford Dictionary a slippery slope is “a course of action likely to lead to something bad or disastrous.” I will adopt this definition in the rest of this posting. Adopting this definition means that the starting point of the slippery slope need not be in itself bad. For instance it might be argued that allowing terminally ill patients to die peacefully is a good thing by itself, but if this slips into permitting assisted suicide for terminally ill children, adults who have mental illness, dementia patients and those who are simply tired of living, it becomes a bad thing, see Daniel Callahan in Hasting Centre's blog . A consequentialist might respond by arguing that provided the initial good outweighs the anticipated bad that assisted suicide can be justified even if it leads to a slippery slope. I won’t pursue this argument here. Instead I will argue that if motivation for permitting assisted suicide for the terminally ill remains constant then we have no need to worry about any slippery slope.

A proponent of the slippery slope argument might be prepared to accept that allowing terminally ill patients assisted suicide is in itself is a good thing but argue that this initial good is outweighed by the bad things it introduces. For instance he might argue whilst helping someone with terminal cancer die peacefully by itself is indeed a good thing, however if the slippery slope means helping grandma to die because she feels she is a burden to her family, it becomes a bad thing. The slippery slope means any good done is outweighed by the inevitable bad. I now want to question exactly what is slipping, changing. I am going to suggest what is slipping in such cases is our underlying motivation for supporting assisted suicide. Let us consider the above example. What motivates us to support assisted suicide for someone suffering from a terminal illness? Our motivation might be based on caring about the patient’s suffering or our sense of empathy caused by this suffering. Let next consider the motivations underlying grandma’s desire for assisted suicide. Grandma doesn’t want to be burden to anyone. It seems to me if we aid grandma commit assisted suicide that our motivation is different from our motivation for aiding someone with a terminal illness to die peacefully. Our motivation for helping someone with a terminal illness die with dignity is that we care about him if our motivation remains the same for grandma then because we care about her we aren’t going to help her commit suicide because we care about her. If we accede to grandma’s wish what has changed is our motivation. I will now argue that if the motivation for permitting assisted suicide for the terminally ill doesn’t change then permitting assisted suicide will not lead to a slippery slope.

One possible motivation for assisting someone to die is that we care about their suffering. We care about the suffering of someone who is suffering from a terminal illness. One response to our caring about might be to assist him to die peacefully. However there is another possible response, perhaps palliative care might permit him to end the last days of her natural life peacefully. I’m doubtful whether palliative care can always reduce suffering to an acceptable level. It seems to me that some supporters of palliative care try to derive ‘an is from an ought.’ For instance some might believe we ought not to permit assisted suicide, for various reasons, and because of this belief also come to believe that palliative care can always reduce suffering to acceptable levels. If palliative care cannot always reduce suffering then the fact that we care about someone’s suffering due to a terminal illness means we have reason to permit assisted suicide. Our motivation is based on our caring about someone suffering or feel empathy for her. I have argued that provided our motivations don’t slip opponents of assisted dying cannot appeal to the slippery slope argument.

However it might be objected the above conclusion flies in the face of the facts. Anywhere where assisted suicide has been introduced for the terminally ill has led to an expansion of the domain of assisted suicide, see for instance a report of the American Medical Association . Indeed I might be accused inconsistency by previously arguing that some prisoners serving life sentences should also have the right to assisted suicide. I now want to argue that simply expanding the domain of those who should be able to avail themselves of assisted suicide is not an example of a slippery slope. Let us recall our definition of a slippery slope as a course of action likely to lead to something bad or disastrous. If a prisoner has committed some terrible rape and murder which torments him and for which he will spend the rest of days in prison wishes to die is helping him to do so a bad or disastrous thing? Is preventing an unhappy 104 year scientist, see bioedge , from dying peacefully also bad and disastrous? If we accept that the above aren’t bad and disastrous then we can’t say they are examples of the slippery slope in action. It follows simple expansion of the domain in which assisted suicide might be applicable does not automatically lead to a slippery slope. For some course of action to be part of a slippery slope it must lead to some bad or disastrous consequences, mere expansion of the domain by itself won’t do the job. Of course extreme care must be taken to ensure that assisted suicide doesn’t lead to bad or disastrous consequences but this isn’t the same as a simple expansion of its domain. I have argued that our reason to permit assisted suicide is that we care about those suffering from terminal illness. Provided our motivation remains the same then any expansion of the domain of assisted suicide should not lead to bad and disastrous consequences and any attempt to apply a slippery slope argument to such an expansion is a failure to grasp fully the definition of a slippery slope.

I have argued that permitting assisted suicide does not lead to a slippery slope provided our motivation is one of caring. It follows that provided our motivations don’t change, don’t slip, the slippery slope argument is an ineffective argument against the permissibility of physician assisted suicide for the terminally ill.