Euthanasia and the Slippery Slope

"There is no slippery slope and the relaxing of practice is not supported by evidence from the Netherlands or from anywhere else where the law is more compassionate," 
- Terry Pratchett on euthanasia. 

It's interesting that this writer of Disc World fame, who has recently been trying to legalise euthanasia after being diagnosed with alzheimers, would say this. Most people think this. I hear it a lot. But half the time I hear it I can't help but wonder, did they look at the evidence? Or are they assuming that because there hasn't been a huge outrage, no slippery slope has been breeched?

The Remmelink Report (1991) was the first official government study into the practice of Dutch euthanasia. The document found involuntary euthanasia to be prevalent, with 45% of cases being involuntary. The study found that in 1990 an average of 3 people a day died from involuntary euthanasia. Of which 14% were fully competent and 72% had never given any indication that they would want their lives terminated. And in 8% of cases doctors performed involuntary euthanasia despite believing that other options were available.

The most frequently cited reasons given for ending the lives of patients without their knowledge or consent were: "low quality of life", "no prospect for improvement", and "family couldn't take it anymore."

In Belgium, a 10-year review found similarly that almost half of patients euthanised had not given their consent.

The thing is, make no mistake, the guidelines in the Netherlands are exactly what you'd think they'd be for there to be no 'slip' into involuntary euthanasia (such as it stating specifically that it must be voluntary). Belgium, too, with it's requirement that a patient not only volunteer but be conscious at the time of the decision.

Sadly, ultimately, if it's written down, it can be interpreted.

There's always been other elements to upholding the law as it should be read and that's: where do the incentives lie on mass? And what's the cultural attitude? And unfortunately, you can currently get a bigger buck taking a life than keeping one. Whether we're talking Dignitas's profits or how State healthcare can save much needed resources here and there. Similarly, culturally, we seem to be a little too compassionate, a little too quick to agree that a person's life must not be worth living. Is it so wrong to tell a severely disabled person that wants to die to keep trying? To figure out how to enjoy the life as they have it?

Until the incentives and the culture can support the moral interpretation of euthanasia legislation, there should be no euthanasia legislation. It is an unfortunate truth, but a necessary one. The cost so far: hundreds of thousands of lives.

The Utilitarian Cost of Free Healthcare

Oregon Health Plan is state funded healthcare, and with euthanasia legal in the state, the local government are finding interesting ways of cutting from the budget in this time of financial crisis.

The OHP no longer covers medication that slows the growth of cancer, but they do offer euthanasia in its place. The reason: price. 

If you've ever learned about the five transplant patients of any other thought experiment that tried to test the claims of utilitarianism against our moral intuitions, you might have heard them be described as 'exaggerations', or 'extreme examples', but the reality of State funded healthcare, such as the OHP, or the NHS, is they do operate on some, occasionally quite distributing, utilitarian principles. They have to. As Dr Walter Shaffer of Oregon put it, "We can't do everything for everyone." There are always more patients than resources and choices have to be made. Value judgements have to be made about what helps the greatest number, and indeed what makes the greatest number happy (after all, why help a cancer patient that has low chance if you can help a cancer patient that has a high chance?)

In the UK euthanasia isn't yet legal, but there are back-door euthanasia programs like the Liverpool Care Pathway, an NHS program where those who are 'dying' can have their medication, food and water withdrawn, hastening the process of death. Professor Patrick Pullicino recently came forward with information about thousands of elderly patients killed on the NHS prematurely every year because they've been diagnosed as terminal.  Why are the elderly picked on? Well, even if they aren't actually dying, they soon will be, right? Why waste resources?

Most good people turn up their nose at the five transplant patients. To treat life as non-sacred for the benefit of others is a disguising idea. Even if the 'others' are a larger and preferable group. Yet in real life, are we OK with a bit of utilitarianism or what?

While a Libertarian, and some conservatives, would happily argue that there are private healthcare options that'd solve this problem, it's the supporters of State healthcare that strike up my curiosity. Is this the cost they happily pay for free health care for all most?