December 01, 2011

Physician-Assisted Suicide is a Slippery Slope

By Hendrik van der Breggen
(The Carillon, December 1, 2011)

Physician-assisted suicide is a slippery slope

The question of whether physician-assisted suicide (PAS) should be legal in Canada is presently before the B.C. Supreme Court. I have argued previously that PAS is problematic (The Carillon, Aug. 18 and Sept. 29). Today I will sketch an argument for thinking that legalizing PAS puts us on a dangerous slippery slope.

What follows is based on an argument from Paul Chamberlain's excellent book Final Wishes (Wipf & Stock 2009). (Chamberlain teaches apologetics and philosophy at Trinity Western University in Langley, British Columbia.) According to Chamberlain, there is a non-fallacious slippery slope logically connected to the legalization of PAS for the terminally ill.

Chamberlain's case hinges on the notion of patient autonomy coupled with the observation that reasons for one action sometimes also justify other actions which are unintended.

In the context of legalized PAS for the terminally ill, patient autonomy becomes understood in terms of the following fundamental principle: the sufferer has the right to choose PAS to end his/her suffering.

Significantly, accepting PAS as a legal right on the basis of this fundamental principle opens up and justifies a host of new situations in which persons suffer and may request PAS. These situations include not only (a) the terminally ill but also (b) the non-terminally ill, (c) the elderly, (d) the disabled, (e) the parent suffering the loss of a child, (f) the person suffering chronic back pain, (g) the depressed teenager, and (h) so on.

So, if we accept PAS in the case of the terminally ill on the basis of the principle behind patient autonomy—i. e., the principle that the sufferer has the right to choose PAS to end his/her suffering—then logic and law will demand that we accept PAS in other cases.

Of course, we can try to set up so-called legal safeguards to limit PAS to the terminally ill, but our courts will do what courts do—they will promote consistency. But consistency demands that all of the above-mentioned suffering persons, if they request PAS (and if they hire a good lawyer), can be quite reasonably seen to have the right to PAS too. Indeed (or so the argument would go), if we have already accepted patient autonomy as a legal justification for PAS, how can we deny them PAS?

Yes, the new situations are different. But their differences are incidental, if not irrelevant. Why? Because at the core of each of these new situations we have a sufferer who requests PAS. Moreover, consistency requires that PAS's fundamental justifying principle—i.e., that the sufferer has the right to choose PAS to end his/her suffering—will carry more legal weight than the situational differences. The principle is, after all, fundamental (i.e., basic and more important).

The result: Legal acceptance of PAS for the terminally ill will put gobs of grease onto the path that leads to death as a legally permissible solution to the suffering of the non-terminally ill, the elderly, the disabled, the parent suffering the loss of a child, the person suffering chronic back pain, the depressed teenager, and so on.

In other words, the legal acceptance of PAS puts us on a slippery slope that embraces death as a solution to medical, social, and psychological problems.

We should pray that the B.C. Supreme Court realizes that medical, social, and psychological problems require medical, social, and psychological solutions—not killing.

P.S. For other arguments against the wisdom of legalizing physician-assisted suicide, see my Apologia columns On Putting Down Pets and People, Look at Pros and Cons, and  ET CETERA.

P.P.S. For further examination of slippery slope arguments in general, see my Apologia columns Slippery Slope Arguments (Part 1) and Slippery Slope Arguments (Part 2).

(Hendrik van der Breggen, PhD, is assistant professor of philosophy at Providence University CollegeThe views in this column do not always reflect the views of Providence.)


Hendrik van der Breggen said...

On the current Canadian legal situation concerning physician-assisted suicide, see this CBC News article: Should Canadians have the legal right to assisted suicide?

Jeff Wheeldon said...

Interesting articles, Dr. V (I read all of the Apologia, and the Biblical case against suicide in Focus). Since you like to respond critically to my blog... ;) (us philosophers and theologians can never resist a debate, can we?)

To your article in Focus, I would add to the phrase "The Bible merely describes suicide, it does not prescribe it" the addendum "or proscribe it." Your case there is always implied, and unfortunately probably the weakest argument from you on this topic I've seen. Yes, all of the suicides depicted in scripture are examples of "losers" (I don't mean that in a derogatory sense), but the other points are much less clear in scripture itself, and depend much more on theology and interpretation (which is much more subjective). For example, if it is wrong to destroy the image of God, then the Law's frequent death penalties are excessive. You make the point that innocence is assumed in this argument, but the Law prescribed killing an offender's entire family (e.g. Achan). We can write that off by saying that we are all guilty of sin, but that would thus seem to justify the killing of a human being. We can then make the argument that execution is only just if it is carried out by a just authority, but the best argument for just judgment in scripture is God Himself (and we condemn those who say that God deals out earthly judgment and death, e.g. the response to Haiti's earthquake); the next best argument is we ourselves, who will "judge the angels" - we are told to judge one another and to judge ourselves, which implies that we are able to impose our own death sentence. This obviously wouldn't apply in cases of suicide for medical reasons, but this is precisely my point: we can make theology and interpretation say whatever we like, but if it isn't in proper context it makes for a weak argument at best and a dangerous one at worst. I actually agree with you on most of these points, but I have a very hard time calling them biblical arguments against suicide.

As for the slippery slope, I heard a very interesting documentary on CBC in the summer about PAS in Oregon. It's been legal there for several years (under very strict guidelines) and they haven't seen any of the issues that your argument (and many others) warn about. I don't remember all of the details, but the gist of it was that someone had to apply while they were proven to be of sound mind, proven to be terminal (within the last ___ amount of time - e.g. not dying in a decade, but very soon), and had to go through a waiting period under the care of counsellors before completing the application process. Apparently, rather than seeing a rise in PAS over time (as was expected by many), it's stayed level or gone down.

The upside of PAS in Oregon was that it had raised awareness, and consequently, the quality of care, particularly palliative care. I think that's the strongest point of all of your posts, and I wholeheartedly agree: if we had quality palliative care in the first place, this wouldn't be an issue!

Thanks for the mental workout :)

Hendrik van der Breggen said...

Hi Jeff,

You’ve provided some important food for thought. Here are my responses.

1. Regarding my claim (in the Focus article)—that the Bible merely describes suicide, it doesn’t prescribe it—this claim occurs at the end of my point 7 and only has to do with point 7. Point 7 has to do with the five suicides described in the Bible. My argument for thinking that the Bible provides grounds for thinking that it is against or condemns suicide includes point 7 coupled with points 1 through 6.

2. My argument (in the Focus article) for thinking that the Bible is against or condemns suicide appeals to logical implications/entailments of biblical principles, to be sure, but that doesn’t mean automatically that the interpretation is weak and prone to subjectivity and thus is an instance of saying “whatever we like.” The case I’ve set out via the seven sub-arguments would be better understood as a cumulative case argument in which the preponderance of biblical evidence/ principles points in a particular direction, namely, that the Bible is against or condemns suicide. (The lines of evidence to which I appeal work together as strands in a rope to place a check on saying “whatever we like.”)

3. The cumulative case argument from Scripture against suicide (which I set out in the Focus article) involves seven sub-arguments that conclude with the following seven points: (1) It’s wrong for us to kill human beings because they’re made in God’s image; (2) you shall not murder (i.e., you shall not kill someone who hasn’t committed a capital offence); (3) Jesus’ example of loving others as we love ourselves by feeding, healing, caring—not killing—them, provides a moral model for our behaviour; (4) God’s encouragement of Joshua to be strong and courageous, rather than commit suicide, when facing difficulty provides a moral model for our behaviour; (5) Paul’s life in the face many difficulties, a life that at times longed for death, provides a moral model for our behaviour; (6) Jonah’s example of desperation which doesn’t include committing suicide strongly corroborates a life-affirming moral model; plus (7) five cases of suicide in the Bible are described tragic endings but without approval from God. Keep in mind that each of the lines of argument in a cumulative case argument need not provide 100% support for a conclusion, but together their support accumulates and reinforces, making a conclusion more reasonable than not. “Thus,” as I conclude (in this part of the Focus article), “it is reasonable to believe that the Bible morally condemns suicide, whether assisted by a physician or not.”

(Keep in mind too that I go on to qualify this conclusion with further biblical principles which reasonably allow a suffering, terminally-ill person to die rather than frantically cling to life when death is near. Plus keep in mind that I go on to offer seven secular reasons for thinking PAS is not wise.)


Hendrik van der Breggen said...

4. If I were to write the article again, I would add the words “prima facie” to my first biblical point: i.e., it is prima facie wrong for us to kill human beings because they’re made in God’s image. (“Prima facie” means that X is obviously true or what ought to be done, unless a more pressing consideration outweighs X.) I would add this because it seems that God allows/ prescribes the taking of human life in some instances, e.g., when someone commits a capital crime (Genesis 9:6), or when God in His wisdom determines that some people should be destroyed (e.g. the people of Sodom and Gomorrah). I think that the notion of prima facie would take care of the concerns you’ve set out in your second paragraph. (I like to think that the notion of prima facie is generally understood when we read Scripture, but I could be mistaken.) In my defence, I was under pressure not to exceed a word limit in the Focus article, so I could not deal with all possible objections or all possible clarifications.

5. About the CBC documentary on physician-assisted suicide in Oregon, we should keep in mind that the CBC tends to report favourably on PAS. (Perhaps I’m getting a bit cranky in my old age, but I’m pretty sure that the CBC has a pro-PAS bias on this issue, not to mention a few other biases on other issues.) Also, keep in mind that until recently Oregon used to be the only state in the U.S. where PAS was available. I believe that PAS is now available in two other states (Washington and Montana). Also, keep in mind the Dutch experience of the last decade or so—it’s becoming quite clear that there is a slippery slope happening there. Also, keep in mind the history of the abortion issue in Canada (abortion provides an important parallel case for the logical-legal slippery slope). Abortion used to have legal limits, now there are none. Also, “ethicists” are seriously talking about “post-natal” abortions or infanticide. Also, keep in mind the following passage from Virgil C. Blum & Charles J. Sykes, "The Lesson of Euthanasia," in Jeff Lane Hensley (ed.), The Zero People: Essays on Life (Ann Arbor, Michigan: Servant Books, 1983), 164:

“Dr. Leo Alexander, Chief Counsel at the Nuremberg trials sums up the basic course of the German experience: ‘Whatever proportions these crimes finally assumed, it became evident to all who investigated them that they had started from small beginnings. The beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians. It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as life not worth to be lived. This attitude in its early stages concerned itself merely with the severely and chronically sick. Gradually the sphere of those to be included in this category was enlarged to encompass the socially unproductive, the ideologically unwanted, the racially unwanted, and finally all non-Germans. But it is important to realize that the infinitely small wedged-in lever from which this entire trend of mind received its impetus was the attitude toward the non-rehabilitatable sick.’”

This is not to say that by accepting the arguments favouring PAS we will become Nazis, but it is to say that we risk becoming a deeply morally-calloused society. If my study of philosophy has taught me anything, it’s this: Ideas have consequences—and sometimes the consequences take a generation or two to come to fruition.

Jeff, I hope what I’ve written above is a helpful response to the concerns you raised. Best regards.

Hendrik van der Breggen said...

For another update on the current Canadian legal situation concerning physician-assisted suicide as well as a look at some arguments against the slippery slope view that I've set out in Apologia, see this Globe and Mail article: Right-to-die laws don't lead to rise in assisted deaths, experts say. (BTW, I put some responses in the comments section.)