Yes, there is a lethal slippery slope.

Screenshot_2020-08-22 Assisted dying and evidence-based law-making a critical analysis of an article’s role in New Zealand’[...]

I have an agreement with my employers that this blog should remain anonymous, but when this is published this week by a couple of advocates who seem to think that court opinions are the same as meta analyses of clinical trials, my bullshit meter goes off. Particularly when they write this.

“Slippery slopes”. The WM article claims the data support slippery-slope arguments. Because of this claim’s significance, two key sentences are extracted in full here: “In conducting this study, it was anticipated that social consequences of AD legislation may be present in terms of the slippery-slope discourse. However, it was unexpected to obtain data that painted a distinct picture of how the slippery-slope effect was unfolding in a country where AD was legal” The interviewee noted a view that there may be an expectation on people to use AD, and we understand this to be the sense in which the term slippery slope is used. (We note, however, that this is not what the “slippery-slope effect” in the “slippery-slope discourse” generally means—even in the literature the authors reference for this claim).

Claims that a “distinct picture” of this occurring (an expectation that people use AD) are unsustainable. We note the many empirical studies which rebut the common slippery-slope claim that the vulnerable are more likely to seek These studies include large meta-analyses or population-level studies (and so are at or towards the top of the reliability pyramid). They have been peer reviewed, and many have also been the subject of further external testing by courts,11 expert panels and non-partisan parliamentary committees. When this sort of research is placed beside the WM article, it is not reasonable to consider this single interview as reliable evidence of the “slippery-slope effect”.

Let me see. The Dutch criteria were originally terminal illness but now include minors and psychiatric illnesses. This article implies there is no slippery slope because the Dutch physicians refused to euthanize a very distressed and abused young woman who then starved herself to death. But it shows that there is a legal slippery slope, because it was presented as an option.

However alarmist some stories about Noa Pothoven’s death might have been, one should remember that euthanasia of a minor as young as 16 for psychiatric suffering is indeed legal in the Netherlands.

Pothoven, a 17-year-old girl in that country, had struggled with depression, anorexia, and post-traumatic stress disorder, reportedly after being sexually abused at age 11 and raped at 14. She had sought permission for medical euthanasia and announced on Instagram that she intended to die. Her passing on June 3 prompted news stories around the world, their dramatic headlines an implicit rebuke of Dutch assisted-death policies.

In most countries, the debate over physician-assisted suicide has centered on adults in the final stages of incurable physical illnesses. Pothoven’s age and mental illness made her case quite different, which is why the initial English-language news stories on her death sparked such alarm. That uproar subsided when subsequent reports clarified that Pothoven’s euthanasia request had been turned down, and that she had instead died by refusing to eat and drink.

The Atlantic

In New Zealand we have a referendum on this. The law is flawed, and (as you will see below) as a fair number of doctors don’t want to take part they are required by law to make an “effective referral” to a group who regulate and perform medically assisted dying. Apparently you can no longer have a conscience if you are a doctor. I await (not) the Catholic Bishops, the Anglican Bishops, the Moderator of the Presbyterian Church and all other leaders of our faith saying that no doctor of that faith should do that. The Muslims will beat us here by making a fatwa, but apparently their moral scruples are allowed but neither mine or my Christian friends who are doctors are. In Canada, it was considered you can just retrain.

The Doctors Say no letter

There is a longstanding and international position on any form of euthanasia: it is unethical. This tends to be fudged by those who think that it is just Kiwi doctors who are against this. It is most doctors in most countries; the exceptions are the Netherlands, Belgium, Luxembourg, Switzerland, some states in the USA and Australia, Canada, Venezuela and (if a referendum approving it passes) New Zealand. The Word Medical Association states.

The WMA Statement on Physician-Assisted Suicide, adopted by the 44th World Medical Assembly, Marbella, Spain, September 1992 and editorially revised by the 170th WMA Council Session, Divonne-les-Bains, France, May 2005 likewise states:

“Physicians-assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession. Where the assistance of the physician is intentionally and deliberately directed at enabling an individual to end his or her own life, the physician acts unethically. However the right to decline medical treatment is a basic right of the patient and the physician does not act unethically even if respecting such a wish results in the death of the patient.”

There is a letter signed by 1673 NZ physicians (as of this date).

We are committed to the concept of death with dignity and comfort, including the provision of effective pain relief and excellence in palliative care.

We endorse the views of the World Medical Association and the New Zealand Medical Association that physician assisted suicide and euthanasia are unethical, even if they were made legal.

We uphold the right of patients to decline treatment, as set out in the NZ Code of Health and Disability Services Consumers’ Rights.

We know that the proper provision of pain relief, even if it may unintentionally hasten the death of the patient, is ethical and legal. Equally the withdrawal or withholding of futile treatment in favour of palliative care is ethical and legal.

We believe that crossing the line to intentionally assist a person to die would fundamentally weaken the doctor-patient relationship which is based on trust and respect.

We are especially concerned with protecting vulnerable people who can feel they have become a burden to others, and we are committed to supporting those who find their own life situations a heavy burden.

Doctors are not necessary in the regulation or practice of assisted suicide. They are included only to provide a cloak of medical legitimacy. Leave doctors to focus on saving lives and providing real care to the dying.

The official Data sources

There are a series of official reports, and they do not make good reading. The Canadians have increased their rate of assisted dying over the last four or five years. Considerably. This graph is from their official report.

From the first Annual report Health Canada Medically Assisted Dying, 2020

Victoria has had, in the first six months of their law being in place, 52 deaths by either prescription of a lethal dose or doctors committing euthanasia.

Holland has annual reports on euthanasia, which fluctuate between 6000 and 7000, and include people with dementia and psychiatric problems. There is one clinic in the Hague that will review people who request euthanasia, and it is getting busier.

The Netherlands’ only euthanasia clinic said on Friday there had been a 22 percent jump in people wanting help to end their lives last year compared with 2018.

The Euthanasia Expertise Centre, which helps doctors to carry out assisted death, said the 3,122 requests it received last year was “far more than expected”.

The Netherlands is one of a handful of countries where euthanasia is legal and by law all Dutch people older than 12 are entitled to ask for it—but they first have to meet strict criteria.

“Every working day there are 13 people who come to us and say: ‘I cannot go on any longer’. There is a great need,” said clinic manager Steven Pleiter.

He said the number of requests remained stable in 2017 and 2018, but then accelerated last year.

Clinic spokeswoman Elke Swart told AFP one of the reasons for the spike could have been a court case against a doctor last year who euthanised a patient with severe dementia, “possibly scaring off doctors with similar requests who then referred their patients to our clinic”.

Medical Xpress

The short version: the slope exists

I could go on. Note that euthanasia is legal from a consent age of 12 in the Netherlands. I am seeing an increase in volume (perhaps a plateau over time). There are about 37 million people in Canada and 17 million people in the Netherlands: if the Dutch experience is akin to that of the Canadians we could expect a further increase in the use of euthanasia.

I am also seeing an expansion in the criteria. Almost everyone starts with intractable pain + incurable + Terminal disease. Then Terminal disease goes. Then incurable is expanded to psychiatric distress. Then to younger and younger people.

Vox is correct. These people want you dead.

Yes, there are many individual stories both for and against this bill. All deserve respect because telling them takes effort. But there’s more to good law than basing it on individual stories. It’s about the collective impact on our community. It should be good, safe law for all. That’s what MPs are there to do but didn’t.

And there’s the referendum to come. The question in it just says, “do you support this bill?” Too vague.

It’s to be hoped that the population at large can do a sound job, but that depends on the quality and range of information they get. MPs had a huge range of sound, factual information. But judging from their voting record, many clearly disregarded heaps of it. Instead leaving Janet and John Voter to do the work.

Who knows if they will get good information to enable choice. Maybe they’ll vote yes because they think this bill allows things that are already legal, like adequate pain relief. Polls on the issue show worrying levels of awareness. So I hope the information providers can do a great job for Janet and John Voter, who really need it.

I convene Not Dead Yet Aotearoa, the nationwide disabled-people-run network. We have opposed the legalisation of euthanasia for some years now. The opposition we express is consistently based on concerns that society is full of negative, biased and discriminatory attitudes and behaviours, so that people think disabled lives are less worthy. Given this attitude as a basis, the state provides really limited support for us to live well. So it’s disturbing when laws are put up that mean the state will provide the means to die, not live. But that’s where we are now. We aren’t dead yet and we don’t want state-sanctioned death support.

Wendi Wicks, The Guardian

I would rather stand with the disabled and deplorable than a parliament that considers discarding 90% of the submissions they receive as following the evidence. This act is not based on evidence but on an ideology that has no room for the broken, the hurt, or the suffering. It would offer them a nice, Kiwi, final solution.

I will not be part of such. I won’t post on this again here, because I will be going public.

One thought on “Yes, there is a lethal slippery slope.

  1. I had to take an educational philosophy class in college in order to become a teacher. The professor argued with two of us that “slippery slope” was not a real thing and provided us with all sorts of articles to read “proving” her point. Of course she was a professor of philosophy and we were two guys with minimal debating experience so she “won” the argument. Never did convince me.

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