About slippery slopes: A philosopher critiques a sociologist

APOLOGIA
By Hendrik van der Breggen
March 25, 2020

About slippery slopes: A philosopher critiques a sociologist

[This is a letter I sent this week to my local newspaper The Carillon.]

Dennis Hiebert's recent letter (“MAID more complex,” Carillon, March 12, page 7A) shows that he misunderstands the logic of slippery slope arguments. His letter deals with medical assistance in dying; I will focus only on his understanding of slippery slope arguments.

Before I provide my reasons for thinking Dr. Hiebert misunderstands the logic of slippery slope arguments, let me note that I have taught first-year university courses on critical thinking (including at Providence University College, where Dr. Hiebert teaches sociology) and I have studied critical thinking and logic at the graduate level (I have a PhD in philosophy).

Dr. Hiebert writes the following: “[A]ny first year university course on critical thinking will explain why slippery slope arguments are logical fallacies. The slippery slope fallacy is the erroneous belief that a particular position, if taken, will set off a chain of events that will inevitably lead to an undesirable outcome. As one kind of the larger category of fallacies of causation, it constitutes failure to understand cause. Whenever we can refuse, resist, or prevent B from occurring after A, then A cannot be said to produce B inevitably, inalterably, or unequivocally. All slippery slope arguments also involve the fallacy of hasty conclusion, because they fail to consider the complexity of factors in causal chains. ”

Dr. Hiebert's understanding of slippery slope arguments is problematic for (at least) three reasons.

First, Hiebert assumes (in his first sentence) that all slippery slope arguments are logical fallacies. The fact is, however, that this assumption is false. Some slippery slope arguments are logically fallacious, but some are non-fallacious—they can be reasonably strong.

Here is an example of the slippery slope argument that is fallacious (it's slightly silly, but helpful for illustration). A parent tells his daughter not to chew gum, because if she does, she'll probably begin to smoke cigarettes, which will lead to dancing, then drugs, then theft and murder, and then a lifetime in jail—so don't chew gum.

Clearly, the causal connections between the events on this alleged slippery slope are dubious. Hiebert is correct that such an argument constitutes a failure to understand cause.

Significantly, however—and Hiebert misses this—not all slippery slope arguments are fallacious merely because they are slippery slope arguments. Consider the following non-fallacious slippery slope argument.

If I build a huge bonfire directly under the low hanging branches of a large dry dead tree in a dry dense forest (during a fire ban), there will probably be a domino effect—the bonfire will cause the low hanging branches to ignite, which will cause the tree to ignite, which will cause other trees to ignite, and so on—so I shouldn't build the bonfire.

Or consider this: If I slam on the car brakes and come to a sudden and complete stop on Highway 401 near Toronto during rush hour (the 401 has been referred to as “Canada's busiest highway”), there will probably be a domino effect resulting in perhaps hundreds of collisions—so I shouldn't slam on the brakes and come to a sudden and complete stop on the 401 during rush hour.

So some slippery slope arguments are fallacious, and some are non-fallacious. Careful thinking is required to discern the difference. A slippery slope argument isn't fallacious simply because it's a slippery slope argument, contrary to Dr. Hiebert's assumption.

Second, there is a deeper problem that Hiebert misses. Some non-fallacious slippery slope arguments are more complex than slippery slope arguments based merely on physical causal connections, contrary to what Hiebert seems to think. Rather, they are better understood as arising probabilistically out of connections of what may be called a legal-logical sort.

Such non-fallacious slippery slope arguments hinge on the notion that reasons for one action sometimes also justify other actions that are unintended to be justified by those reasons. (I get this insight from Paul Chamberlain's book Final Wishes: A Cautionary Tale on Death, Dignity, and Physician-Assisted Suicide, which is a book I highly recommend. Dr. Chamberlain is a philosopher at Trinity Western University.)

Here's a fun fictional illustration that I used in my critical thinking courses (before my retirement from Providence as a philosophy professor) which helps students better understand the slippery slope at hand.

Let's say that (before my retirement) I approach my college president and propose that our school should make a policy of giving philosophy students the right to free tuition if they choose to accept it. My reason: philosophy students are people who must think very hard and aren’t guaranteed jobs after graduation. There would be a slippery slope here, for sure!

Once the rest of the student body heard about this policy, students would appeal to a principle of fairness (and would be motivated by greed perhaps) and would argue that all students should receive free tuition, not just philosophy students. Why? Because all students must think very hard and none are guaranteed jobs.

In other words, if thinking hard and having no guarantee of a job after graduation are accepted as sufficient grounds for a student to receive free tuition, then whether a student is taking anthropology, business, history, philosophy, psychology, sociology—or whatever—doesn’t make a relevant difference. The principle of fairness is fundamental, and the differences between academic disciplines, though real, are incidental. Fairness demands consistency.

Thus, if my college makes a policy (the “legal” bit of the legal-logical slippery slope) that gives philosophy students free tuition on the basis of hard thinking and lack of a job guarantee, then, in the name of fairness and consistency (the logical bit of the legal-logical slippery slope), the college should ensure that all students receive free tuition.

If my boss doesn't want to be unfair or inconsistent (and doesn't want our university to go broke), then he shouldn't give philosophy students the proposed deal.

Our lesson: The above non-fallacious, logical-legal slippery slope argument ensues because the reason behind my proposal justifies much more than intended. Alleged safeguards (e.g., philosophy students only) fail, because they are incidental—out-weighed by the major logical-legal principle that's been accepted.

(In the context of MAID/medical assistance in dying, the primary principle that a sufferer has the right to end his/her life will also outweigh safeguards such as terminal illness only, because suffering isn't limited to terminal illness. The alleged right to end one's life because of suffering justifies not only the situation of the terminally ill, but also those situations of the elderly, the disabled, the parent suffering the loss of a child, the person suffering chronic back pain, the depressed teenager, the person suffering existential despair/ meaninglessness/ feelings of being a burden, etc.)

Third, in view of my previous two reasons it's simply not true, as Hiebert claims, that “All slippery slope arguments also involve the fallacy of hasty conclusion, because they fail to consider the complexity of factors in causal chains.”

Why? Because Dr. Hiebert's understanding of slippery slope arguments fails to consider the complexity of such arguments. Some, such as the legal-logical slippery slope, do not commit the fallacy of hasty conclusion—they reasonably show that some social policy changes make an outcome more probable. They add grease to the slope.

For additional criticism of Hiebert's letter, I recommend Michael Zwaagstra's March 19 Carillon column, “Straight talk on assisted suicide.”

For additional criticism of MAID, please see my February 18 article available online at MercatorNet: “Putting the pros and cons of euthanasia under the microscope: A Canadian philosopher examines the euphemism of 'medical assistance in dying'.”

Hendrik van der Breggen is a retired philosophy professor who lives in Steinbach, Manitoba, Canada.

For additional reading on slippery slopes by Hendrik van der Breggen:

• Slippery slope arguments (part 1)
• Slippery slope arguments (part 2)
• Physician-assisted suicide is a slippery slope

Additional writings on physician-assisted suicide by Hendrik van der Breggen:

• The image of God: Why life is worth defending against physician-assisted suicide
• On putting down pets and people
• Physician-assisted suicide: Look at pros AND cons
• Physician-assisted suicide is a slippery slope
• Are we ignoring a philosophical lesson from history?
• Physician-assisted suicide (interview with Christian Week)
• Doubting euthanasia
• Physician-assisted suicide
• Physician-assisted killing
• Resisting the culture of death

Articles on physician-assisted suicide by other authors:

• Ryan T. Anderson, “Always Care, Never Kill: How Physician-Assisted Suicide Endangers the Weak, Corrupts Medicine, Compromises the Family, and Violates Human Dignity and Equality”
• John Keown, “The euthanasia slippery slope is real”
• John Maher, “Why legalizing medically assisted dying for people with mental illness is misguided”
• Margaret A. Somerville, “Killing as Kindness: The Problem of Dealing with Suffering and Death in Secular Society”

Books on physician-assisted suicide by other authors:

• Blaise Alleyne & Jonathon Van Maren, A Guide to Discussing Assisted Suicide
• Paul Chamberlain, Final Wishes: A Cautionary Tale on Death, Dignity, and Physician-Assisted Suicide
• Margaret Somerville, Death Talk: The Case Against Euthanasia and Physician-Assisted Suicide

Videos on physician-assisted suicide:

• The Euthanasia Deception (53 minute documentary)
• Fatal Flaws: Legalizing Assisted Death (3 minute trailer)

Medical Assistance in Dying (MAID): Pros AND cons

Photo credit: Medgazette24.com

Medical Assistance in Dying (MAID): Pros and Cons

By Hendrik van der Breggen

Canada's government has decided to expand the scope of medical assistance in dying (MAID). MAID has been legal in Canada since June 2016. During the next few months the restriction that natural death must be reasonably foreseeable will be removed, and this summer the possibility of offering MAID to mature minors (children) and people with mental illness will be seriously considered.

Unfortunately, public discourse on MAID has been skewed: arguments in favor of MAID seem more prevalent than arguments against. Call me old-fashioned, but I think citizens—informed citizens—should look at pros and cons, not just pros. Let's do that.

(Spoiler alert: I think the cons outweigh the pros.)

Clarification

First, some clarification. “Medical assistance in dying” is a euphemism—and thus is misleading at the get-go.

When certain words are considered too blunt, harsh, painful, or offensive, people sometimes substitute a euphemism, that is, a more acceptable term, a term with fewer negative connotations or with more positive connotations, than the blunt, harsh, painful, or offensive term.

Here are some examples of useful but harmless euphemisms. “I’m sorry that Sam passed away.” These words allow us to be sensitive to Sam’s grieving wife and are infinitely kinder than saying, “I’m sorry about Sam’s getting slowly crushed to death by the gravel truck.”

Another example: “May I use the washroom?” Yes, as any parent knows, these words allow children to be sensitive to those around the dinner table. Respect and politeness are good, to be sure.

Euphemisms are sometimes helpful (as in my examples), but they can also desensitize us emotionally and hide reality—including moral reality.

Interestingly, the dangers inherent in euphemisms were almost prophetically envisioned by George Orwell in his famous novel 1984 and in his lesser known essay “Politics and the English Language.” Orwell put forward the idea that an effective mechanism of political control is the manipulation of euphemisms employed in public discussion.

Back to MAID: Yes, of course, we all want medical assistance in dying. Please, doctors and nurses, provide us with clean sheets, proper nutrients, and morphine (as needed) as we die. Please, doctors and nurses, provide us with comfort as natural death takes its course. But, wait, when politicians and policy makers are talking about MAID, they're actually talking about doctors and nurses actively causing death. MAID is physician-assisted suicide—killing.

Dying and killing are not the same. It's important to be clear about this distinction and not be bamboozled by euphemisms.

Pro MAID: Personal autonomy

A major pro for MAID (physician-assisted suicide/killing) is the exercise of personal autonomy, that is, the individual's choice in general and, in particular, the individual's choice in response to suffering. Suffering can be terrible, to be sure. And freedom is precious, truly. So—yes—personal autonomy is important.

But, and this often gets neglected, the freedom to exercise one's autonomy is not absolute. For example, I enjoy smoking a pipe. But it turns out that I do not have the freedom to smoke my pipe in my local pub (at least not in Canada). Also, I do not have the freedom to drink beer while I drive my car. Also, I do not have the freedom to drive my car on the sidewalk. Nor do I have the freedom to swing my fist without regard for the tips of other people's noses.

In other words, although personal autonomy is important, the individual does not live in a social vacuum. In public policy matters we should think about the individual's freedom AND the possible consequences—possible negative consequences—for our neighbors, that is, for our larger society (more on MAID's possible negative consequences later).

Upshot: Merely appealing to personal autonomy as a justification of MAID is not enough. We've got to step out of our self-centered bubbles.

Pro MAID: Unbearable suffering

Another major pro for MAID is the popular argument that either we have MAID or we face an unbearably painful death, but an unbearably painful death is horrible, so we should have MAID.

A counter-consideration is that this popular argument is fallacious. It presents us with a false dichotomy. It presumes that there are only two options: death by assisted suicide, or death with unbearable suffering. But there's a third option: palliative care.

In my years of teaching ethics (I'm a recently-retired philosophy professor) I've noticed that many people—young and old—simply don't know what palliative care is. Behold, then: palliative care is a branch of medicine that focuses on relief of physical and mental pain without curing the disease.

Enter Doris Barwich, M.D., President of Canadian Association of Palliative Care Physicians: “Pain is rarely the reason patients ask for hastened death—it more often comes out of a desire to control the circumstances surrounding death. Fortunately, we can assure our patients that with Palliative Care tools and resources, pain and other distressing symptoms can usually be controlled and support provided to ensure comfort and quality of life.” (Focus magazine, April 2013, p. 17.)

Along with palliative care, there is something called dignity therapy. According to Dr. Harvey Chochinov, a psychiatry professor at the University of Manitoba and a Canada Research Chair in palliative care, “Dignity therapy really tries to look at what are the sources, what are the things that might cause or undermine dignity toward the end of life,” and it works to alleviate those things. (Blaise Alleyne and Jonathon Van Maren, A Guide to Discussing Assisted Suicide [Toronto: Life Cycle Books, 2017], p. 83.)

What about the difficult cases? First, keep in mind that with advances in palliative care and dignity therapy, difficult cases are becoming rare. Second, keep in mind that focusing only on rare cases doesn't make for good general policy decision-making. Third, keep in mind that instead of MAID—active killing—there is, for the rare difficult cases, palliative sedation.

What is palliative sedation? According to the Journal of the American Medical Association, “Palliative sedation is the use of sedative medications to relieve extreme suffering by making the patient unaware and unconscious (as in a deep sleep) while the disease takes its course, eventually leading to death. The sedative medication is gradually increased until the patient is comfortable and able to relax. Palliative sedation is not intended to cause death or shorten life.”

Significantly, if, foreseeably, palliative sedation hastens death, it needn't be judged unethical. According to ethicist Margaret Somerville, just as death isn't the intended effect of high risk surgery (needed to relieve pain), and so such surgery isn't immoral if death occurs, so too if death isn't the intended effect of high risk pain management, yet death occurs, then such pain management isn't immoral either. (Margaret A. Somerville, “Euthanasia is never necessary,” Citizen, June 1999, p. 6.)

Here's the rub: There's an important moral difference between engaging in a procedure with intent to kill (i.e., MAID's active killing) rather than not (palliative sedation). MAID takes the lower moral ground.

Pro MAID: Extraordinary and burdensome medical technology

Another major pro for MAID is that when we're dying we (including myself!) don't want to be forced to live because of all the marvelous albeit extraordinary and burdensome medical technology that's now available.

A con or counter-consideration here is that allowing terminally ill patients to die from their illness via termination of life support by withdrawing/withholding extraordinary, burdensome, or medically useless treatment is already a legal and ethical part of palliative care—and doesn't require MAID. And we can make advance requests for this.

Ethicist Scott Rae: “Physicians need not always 'do everything' to stave off death, especially when it involves no more than simply delaying an inevitable death…. Choices about CPR, respirators, and intravenous procedures in the last weeks of life should not be viewed as choices for death.” (Scott B. Rae, Moral Choices: An Introduction to Ethics, 3rd edition [Grand Rapids, Michigan: Zondervan, 2009], p. 221.)

Authors Blaise Alleyne and Jonathon Van Maren: “No one is obligated to undergo burdensome treatment. This is to be distinguished from providing the basic necessities of life, like water and nutrition—it's not okay to starve someone to death.” (Alleyne and Van Maren, Guide to Discussing Assisted Suicide, p. 76.)

MAID's possible negative consequences

What about the possible negative consequences of MAID for our neighbors and the larger society that I mentioned? These possible consequences are especially important for thinking about any decision to expand MAID. Here are seven to ponder.

Possible negative consequence 1: Got a problem—get MAID.

With the acceptance and expansion of MAID, our society will see suicide more and more as a legitimate way of solving an individual's problems. Got a problem that makes you suffer? Don't forget you can get help to kill yourself!

At one of the universities I attended (not too many years ago), I worked as a teaching assistant in an ethics course for a fellow doctoral student who told the class (a) he had advised his roommate that suicide was an option as a solution to the roommate's problems and (b) subsequently the roommate committed suicide. My fellow doctoral student displayed no qualms about the advice. Nor did most of the students in the ethics course. Some of those students planned to become doctors and lawyers.

Possible consequence 2: Life will no longer be seen as society's default position.

This means that our most vulnerable—the elderly, terminally ill, disabled, and whoever else is suffering—must justify the continuation of their lives. Why, after all, should we spend so many healthcare dollars on you—the elderly, terminally ill, disabled, and whoever else is suffering—when you've become unproductive? This may not be stated explicitly, but will be an unspoken assumption (it is already, I believe) and, as law professor Carter Snead correctly points out, a “subtle coercion.”

In other words, into the darkness of suffering, we add more darkness. But surely this is a nasty burden to place on people when they're already down. In fact, it's a kick in their teeth.

Possible consequence 3: Adding insult to injury.

When we decide not to accept life as our society's default position, say, by expressing out loud (e.g., via public consultations in Canada) that we want MAID if we were to become handicapped or infirm, we insult the most vulnerable by communicating this message to them: We would rather be dead than be like you! If that isn't an insult, what is?

Possible consequence 4: A big chill.

If the choice or autonomy of the sufferer constitutes acceptable personal and legal grounds for the sufferer to end his/her life—a legal right—then will suicide interveners have to add to their script some directions as to where MAID is available? Will National Suicide Prevention Week include some Suicide Promotion Days? Will Bell Let's Talk encourage referrals to MAID? Will suicide intervention or counseling against suicide become grounds for a lawsuit against the intervener or counselor?

Possible consequence 5: Slippery slope.

With the acceptance of MAID, a non-fallacious, logical-legal slippery slope looms large—in fact, we're sliding down the slope already.

Reasons for one action sometimes also justify other actions that are unintended to be justified by those reasons.

Here's a fun fictional illustration that I used in my ethics and logic courses which helped students better understand the slippery slope at hand.

Let's say that I approach my college president and propose that our school should make a policy of giving philosophy students the right to free tuition if they choose to accept it. My reason: philosophy students are people who must think very hard and aren’t guaranteed jobs after graduation. There would be a slippery slope here, for sure!

Once the rest of the student body heard about this policy, students would appeal to a principle of fairness (and would be motivated by greed perhaps) and would argue that all students should receive free tuition, not just philosophy students. Why? Because all students must think very hard and none are guaranteed jobs.

In other words, if thinking hard and having no guarantee of a job after graduation are sufficient grounds for a student to receive free tuition, then whether a student is taking anthropology, business, history, philosophy, psychology—or whatever—doesn’t make a relevant difference. The principle of fairness is fundamental, and the differences between academic disciplines, though real, are incidental. Fairness demands consistency.

Thus, if my college makes a policy (the legal bit of the legal-logical slippery slope) that gives philosophy students free tuition on the basis of hard thinking and lack of a job guarantee, then, in the name of fairness and consistency (the logical bit of the legal-logical slippery slope), the college should ensure that all students receive free tuition.

If my boss doesn't want to be unfair or inconsistent (and doesn't want our university to go broke), then he shouldn't give philosophy students the proposed deal.

Our lesson: The above non-fallacious, logical-legal slippery slope argument ensues because the reason behind my proposal justifies much more than intended.

Back to MAID: The alleged right to end one's life because of suffering justifies not only the situation of the terminally ill, but also those situations of the elderly, the disabled, the parent suffering the loss of a child, the person suffering chronic back pain, the depressed teenager, the person suffering existential despair/ meaninglessness/ feelings of being a burden, etc.

Enter: So-called safeguards—and their failure. Significantly, if we have already accepted individual autonomy as a legal justification for MAID, how can we deny anyone MAID? (Think of the experience of Belgium and The Netherlands and, again, The Netherlands.)

Courts will do what courts do: promote consistency. But consistency requires that MAID's fundamental justifying principle—i.e., that the sufferer has the right to choose MAID to end his/her suffering—will carry more legal weight than the situational differences. The situational differences will (with the help of a good lawyer or activist judge) be seen to be incidental.

In other words, legal acceptance of MAID puts gobs of logical-legal grease onto the path that leads to killing as a solution to suffering. The result: eliminating sufferers becomes equated with eliminating suffering, and legality becomes an accomplice to normalization of practice.

What, then, should we do? The best safeguard, it seems to me, is to eliminate the autonomy principle as paramount and instead have our doctors and nurses return to the Hippocratic Oath: “I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.” And we should provide excellent palliative and hospice care (without killing) for all.

Possible consequence 6: Caring becomes killing.

If we kiss good-bye the above portion of the Hippocratic Oath, then we invite a deep change of character to the practice of medicine.

Healers will be asked to be killers. Health care becomes careful killing. And those conscientious persons who refuse to kill will be discouraged from practicing medicine. Sound far-fetched? It isn't. To those doctors who merely refuse to provide information about MAID as an option, highly-respected University of Manitoba ethicist Arthur Shafer says this: “perhaps you should be practicing in a different branch of medicine or perhaps you shouldn't be practicing as a doctor.” (CBC News Manitoba, July 16, 2016.) Keep all this in mind when you think about the next possible consequence.

Possible consequence 7. Sometimes history repeats itself.

Consider these insights from Dr. Leo Alexander, medical consultant for U.S. Chief Counsel for War Crimes at Nuremberg, in his summation of the Nazi 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.” (The New England Journal of Medicine, 14 July 1949.)

By accepting and widening the scope of “medical assistance in dying” (a euphemism if there ever was one!), I don't think we Canadians will become Nazis, but I do think we significantly increase the risk of becoming a dark, morally-calloused, death-embracing society.

Conclusion

Ideas have consequences—and sometimes the consequences of bad ideas can be disastrous.

In view of the above pros and cons, I think it would be wise for Canadians not to embrace or expand medical assistance in dying. Instead, we should do a better job of providing excellent palliative care—pain relief and life-enhancing dignity—for all who suffer.

We should embrace a culture of life, not a culture of death, for goodness' sake.

Hendrik van der Breggen, PhD, retired last year as Associate Professor of Philosophy at Providence University College, Manitoba, Canada. The views he expresses do not always reflect the views of Providence.

Postscript

Dr. Harvey Chochinov— Canada Research Chair in Palliative Care, Distinguished Professor of Psychiatry at the University of Manitoba, Director of the Manitoba Palliative Care Research Unit—wrote what follows in 2015. In view of the fact that MAID became legal in Canada one year later and as of the end of 2019 approximately 13,000 Canadians have died via MAID, Canadians should ask: Was our government morally and criminally negligent?

Despite the impressive strides that palliative care has taken—in areas such as pain and symptom management, and sensitivities to the psychological, existential and spiritual challenges facing dying patients and their families—at their time of licensure, physicians have been taught less about pain management than those graduating from veterinary medicine. Once in practice, most physicians have knowledge deficiencies that can significantly impair their ability to manage cancer pain.

Doctors are also not generally well-trained to engage in end-of-life conversations, meaning that goals of care often remain unclear; and patients may not receive the care they want or the opportunity to live out their final days in the place they would want to die. …

To be clear, dying badly in Canada will rarely be the fallout of not having access to a lethal overdose or injection, and will almost invariably be the result of inadequate or substandard end-of-life care…. For 70 to 80 percent of Canadians, palliative care is not available and hence, not a real choice.

Harvey Max Chochinov, “Canada failing on palliative care,” The Star, February 18, 2015.

Suggested resources for further thought

Additional writings by Hendrik van der Breggen:

○ The image of God: Why life is worth defending against physician-assisted suicide

○ On putting down pets and people

○ Physician-assisted suicide: Look at pros AND cons

○ Physician-assisted suicide is a slippery slope

○ Are we ignoring a philosophical lesson from history?

○ Physician-assisted suicide (interview with Christian Week)

○ Doubting euthanasia

○ Physician-assisted suicide

○ Physician-assisted killing

○ Resisting the culture of death

Articles by other authors

○ Ryan T. Anderson, “Always Care, Never Kill: How Physician-Assisted Suicide Endangers the Weak, Corrupts Medicine, Compromises the Family, and Violates Human Dignity and Equality”

○ John Keown, “The euthanasia slippery slope is real”

○ John Maher, “Why legalizing medically assisted dying for people with mental illness is misguided”
○ Margaret A. Somerville, “Killing as Kindness: The Problem of Dealing with Suffering and Death in Secular Society”

Books by other authors

○ Blaise Alleyne & Jonathon Van Maren, A Guide to Discussing Assisted Suicide

○ Paul Chamberlain, Final Wishes: A Cautionary Tale on Death, Dignity, and Physician-Assisted Suicide

○ Margaret Somerville, Death Talk: The Case Against Euthanasia and Physician-Assisted Suicide

Videos

○ The Euthanasia Deception (53 minute documentary)

○ Fatal Flaws: Legalizing Assisted Death (55 minute documentary)

The Image of God: Why life is worth defending against Physician-Assisted Suicide

The article below was originally published in FOCUS Magazine, Christian Medical and Dental Society (Spring 2011), 8-13.  I present it here with the hope that it may be helpful to readers wishing to think carefully about physician-assisted suicide, now euphemistically called "physician-assisted dying" (I say euphemistically because we all want physicians to assist us as we die by giving us clean sheets, morphine, and comfort care, whereas the actual topic at hand, which the euphemism hides, is whether they should kill us).  On the topic of biblical reasons against suicide, see the section "Bible vs. Suicide."  Of course, not everyone takes the Bible seriously, so concerning secular reasons against physician-assisted suicide—reasons aimed at the public good—see the section "Respecting the image of God in the secular physician-assisted suicide debate."

The Image of God:

Why life is worth defending against Physician-Assisted Suicide

By Hendrik van der Breggen, Ph.D.

Associate Professor of Philosophy

Providence University College, Otterburne, Manitoba, Canada

In April 2011 the B.C. Civil Liberties Association, along with a woman who arranged to have her ill elderly mother commit suicide in Switzerland with the help of medical professionals, announced a lawsuit to legalize physician-assisted suicide in Canada. The Globe and Mail reports: "In a notice of claim filed in B.C. Supreme Court, the parties argued that Criminal Code provisions against physician-assisted death are unconstitutional because they deny individuals the right to control their physical, emotional and psychological dignity."[1]

Canadians must now ask: Does the right to control one's physical, emotional, and psychological dignity entail the right to kill oneself (whether with a physician's assistance or not)? But this question presupposes an answer to a more fundamental question: Is human dignity actually a matter over which one exercises control? We must be careful here. The question is not: Can we choose to treat each other with dignity, whether that dignity is understood physically, emotionally, or psychologically? Surely we can. Nor is this the question: Can I choose to treat myself with such dignity? Surely I can. The question is this: Is human dignity per se actually under our control?

As a response to this question in the context of what no doubt will be an important public discussion about physician-assisted suicide (PAS), I will set out three arguments. First, I will argue that, according to the biblical Christian worldview, human dignity is an essential part of human nature—i.e., a built-in reflection of God. This means that human dignity per se is not under our control. Second, I will argue that Christian Scripture condemns suicide and, by implication, PAS. This means that the life of those who suffer is not theirs to end according to their choice, whether with or without a physician's assistance. Significantly, Scripture also teaches us to provide physical, emotional, and psychological care for those who suffer. Third, because most readers of this publication live and work in a secular society, I will set out an argument that casts secular doubt onto the wisdom of legalizing the choice for PAS. This doubt, which is substantial, should encourage our secular society to respect true human dignity—by rejecting PAS.

Image of God: The non-negotiable basis for human dignity

Whether understood wholly literally or not, the biblical account of God's creation of humankind makes it clear that human dignity is part of human nature, i.e., a built-in reflection of God, and therefore human dignity per se simply is—and so is not under our control. According to Genesis 1:26-27, God created humans, male and female, "in his own image."[2] According to Genesis 2:7, "the LORD God formed the man of dust from the ground and breathed into his nostrils the breath of life, and the man became a living creature." Subsequently, according to Genesis 2:18-23, God took a rib from the man, "and the rib that the LORD God had taken from the man he made into a woman." Interestingly, according to Genesis 1:30, the various beasts and birds also have "the breath of life"; significantly, however, humankind has such breath uniquely. An ESV Study Bible commentator explains: "God breathes life—physical, mental, and spiritual—into the one created to bear his image...While human beings have much in common with other living beings, God gives them alone a royal and priestly status and makes them alone 'in his own image.'"[3]

Disability advocate Joni Eareckson Tada and bioethicist Nigel M. de S. Cameron add some helpful insights:

"[I]n Genesis 1 we read of God making the various 'kinds' of animals and birds and sea creatures. They reproduce 'after their kind.' The implication is that humankind is made 'after God's kind.' We are made within the confines of space and time to image—to mirror, to model—the nature of God. That decides our view of human nature. All human beings are created equal, and equally precious, in the sight of God...Every member of our species, Homo sapiens, are image bearers of God and thus reflect the dignity of God."[4]

To further drive home the significance of the moral status of humankind, Genesis also tells us that just before humans come onto the scene, God proclaims that the creation is good (Genesis 1:25), and then immediately after humans are on the scene, God proclaims that the creation is very good (Genesis 1:31). Although the creation contains many and various living creatures that all have worth, Genesis clearly informs us that, unlike the other creatures, humankind is unique in its worth: because humans are made in God's image, humans are the moral pinnacle of the creation.

But there is even more. On the Christian view, as Eareckson Tada and Cameron point out, because God took on human flesh in the man Jesus, "God has twice placed his stamp on human dignity."[5]

The biblical bottom line: Each and every member of the human species has real dignity—real intrinsic moral worth—which is non-negotiable. We do not control human dignity itself, because each human life is sacred, period. And so we should treat every human being with respect.

Bible vs. Suicide

But what about suicide? So far I have established that, biblically, human beings are unique in that they are made in the image of God and thus there exists a theological basis for the great respect we should give human beings. But perhaps the Bible allows us to respect human dignity via suicide?  The answer seems very much to be No.

Here is a list of seven reasons for thinking that the Bible condemns suicide (and, by logical implication, physician-assisted suicide).

1. That God is the highest good, that humans are created in God's image, and that God's image is a reflection of this good—these facts logically imply that the deliberate destruction of God's image is an evil. The deliberate destruction of the highest good is an evil, suicide is the destruction of a being made in God's image, i.e., a being that reflects the highest good, so suicide is an evil.

2. The sixth commandment says, "You shall not murder" (Exodus 20:13). It is reasonable to think that this command applies to human persons who are innocent, that the individual considering suicide is a human person who has not committed a capital offence, and hence that the command prohibits self-murder.[6]

3. The facts that God reveals Himself most clearly in Jesus (the incarnation of God), that Jesus' teaching in word and deed provide us with a moral standard, that Jesus taught that we ought to care for others by feeding, healing, clothing, and sheltering them—not by encouraging them to self-destruct—these facts logically imply that suicide is wrong. Moreover, Jesus commands us to love others as we love ourselves (Matthew 22:37-39). Implicit is the assumption of self-love. Christ's acts of love show that they are acts for the betterment of the individual, not the individual's destruction. Therefore, self-love is not self-destructive. [7]

4. The facts that God advises Joshua to be strong and courageous in the face of danger and difficulty (Joshua 1:6-9), that Joshua carries out this advice not by self-destructing but by working hard in the face of the danger and difficulty, and that God very apparently approves of Joshua's response to God's advice—these facts logically imply that we ought to be alive to do God's work on earth, that doing God's work is right, and that suicide is not only morally wrong but also an act of cowardice.

5. Paul's life and teaching also logically imply that suicide is wrong. According to Paul, we are to spend our lives in service to others (Galatians 6:9-10). Clearly, Paul's example shows that this requires us to be alive as we serve others. Paul suffered immensely (see 2 Corinthians 11), and he wished to be with Jesus (i.e., be physically dead), yet he continued to serve without committing suicide.

6. Referring to Jonah, philosophers Francis Beckwith and Norman Geisler observe: "even the most desperate believer in the Bible who desired death never considered suicide a morally valid option. Take for example Jonah's prayer: 'O LORD, please take my life from me, for death is better to me than life' (Jonah 4:3 NASB...)."[8]

7. Beckwith and Geisler also point out that "the Bible records five cases of suicide: Abimelech (Judg. 9:50-56); Saul and his armor bearer (1 Sam. 31:1-6; 2 Sam. 1:1-15; 1 Chron. 10:1-13); Zimri (1 Kings 16:18-19); Ahithophel (2 Sam. 17:23); and Judas (Matt. 27:3-10; Acts 1:15-19)."[9] Significantly, as philosopher Robert Wennberg points out, "in each case of suicide recorded in Scripture, death represents a tragic end to a life that did not (at least in its latter stages) meet with God's approval."[10] In other words, the Bible merely describes suicide; the Bible does not prescribe it.

Thus, it is reasonable to believe that the Bible morally condemns suicide, whether assisted by a physician or not. Moreover, the examples and teachings of Jesus and Paul make it clear that instead of encouraging suicide, we should work to enhance the physical, emotional, and psychological well being of those who suffer.

At this juncture, Christians should pause and ask: Does the biblical case against suicide mean that there are never circumstances in which a suffering, terminally-ill person should simply be allowed to die? The biblical answer seems very much to be No. Ethicist Scott Rae explains:

"[T]he Bible also affirms that death is a normal and natural part of a person's life 'under the sun,' or on this side of eternity (Eccl. 2:14-16; 2:19-21; 5:15-16; 9:1-6). Death is seen as both an enemy and a normal part of life, due to the pervasiveness of sin in the world. But from the perspective of the cross and resurrection of Jesus, for the Christian, death is also a conquered enemy, having been vanquished by the death and resurrection of Christ. Thus, since death for the Christian is a conquered enemy, it need not always be resisted."[11]

In other words, the Bible condemns suicide, but, as Rae rightly points out, the Bible also recognizes that earthly life is "a penultimate good," whereas the ultimate good is "eternal fellowship with God."[12] There is a time for death.

Respecting the image of God in the secular physician-assisted suicide debate

Of course, Canada is religiously pluralistic, and so many (most) Canadians do not look to the Bible for moral guidance—and so public discussion of PAS requires arguments that appeal to a secular, publicly accessible common ground. Significantly, for the Christian, this is not problematic. Such a common ground exists and consists of God-given knowledge concerning human worth plus reasoning that can promote this knowledge (or at least refute faulty ideas that thwart this knowledge). On the Christian view, whether or not one explicitly acknowledges the reality of God, these facts remain: general moral knowledge has been written by God onto the human heart, and the human ability to reason is part of our constitution as God's image-bearers.[13]

Here, then, are seven secular reasons for casting doubt onto the wisdom of PAS.

1. To think that we face an option only between PAS and a painful death, and so we should legalize PAS, is to commit the false dichotomy fallacy (the mistake of limiting our options when more options are available). John Scott, a palliative care specialist, explains:

"We are being told [by the media] that the only real choice facing a person with terminal illness lies between a quick and easy death by assisted suicide or a slow, painful, and meaningless death by disease progression…. Canadians who support some form of physician-assisted death do so only because they believe that significant numbers are being forced to face death in unrelieved pain."[14]

Scott quickly adds, however:

"In reality, there is solid evidence that: [a] the pain of advanced disease can be relieved with existing drugs and techniques; [b] the other psychological and physical problems of dying can be well managed by palliative care; [c] the dying are not being kept alive, by means of tubes and machines, against their wishes; [d] most deaths occur gently without agitation or distress."[15]

In other words, PAS is not needed.

2. In those rare cases wherein suffering terminally ill patients do not respond to standard palliative care, instead of deliberately killing the patient, there is palliative sedation. Physician Erin Brender explains:

"Palliative sedation is the use of sedative medications to relieve extreme suffering by making the patient unaware and unconscious (as in a deep sleep) while the disease takes its course, eventually leading to death. The sedative medication is gradually increased until the patient is comfortable and able to relax. Palliative sedation is not intended to cause death or shorten life."[16]

If it turns out that, foreseeably, palliative sedation hastens death, it is important to realize that palliative sedation need not be judged unethical. Just as death is not the intended effect in a high risk surgery (needed to relieve pain), and so such surgery is not immoral if death occurs, so too if death is not the intended effect in high risk pain management, yet death occurs, then such pain management is not immoral either.[17] In other words, there remains an important moral difference between engaging in a procedure with the intent to kill (e.g., PAS/euthanasia) rather than not (e.g., palliative sedation).[18]

Again, PAS is not needed.

3. Contrary to public opinion, termination of life support by withdrawing or withholding extraordinary, burdensome, or medically useless treatment from a terminally ill patient and thereby allowing the patient to die of his/her illness is both a legal and ethical part of palliative care—and does not require PAS. Rae correctly observes:

"Physicians need not always 'do everything' to stave off death, especially when it involves no more than simply delaying an inevitable death. In general, when the dying person's prognosis is very poor and further treatment is futile or more burdensome than beneficial, death can be welcomed as the 'doorstep to eternity.'"[19]

Indeed, as Scott explains, "Choices about CPR, respirators, and intravenous procedures in the last weeks of life should not be viewed as choices for death....One can affirm and treasure life to the last moment without frantically trying to prolong the days."[20]

Again, PAS is not needed.

4. The call for PAS misinterprets the plea for death. Scott explains:

"Yes, the cries 'Let me die,' 'Help me die,' or 'I wish I would die,' are real and deep, but they can be interpreted only in the context of lamentation [i.e., the expression of sorrow/grief; weeping]. Bedside doctors and nurses frequently care for patients who yearn to discuss their highly ambivalent feelings about death. These patients need a place of safety in which to pour out their total pain. For us to interpret such a cry as a request for a lethal overdose is to miss the mark completely. Lamentation is a call for support and relief, a search for meaning, and an invitation for relationship. It is a cry of life."[21]

PAS, then, misinterprets patient need.

5. PAS tends to weaken a society's respect for human life. Life no longer is society’s default position. This is a fundamental shift of attitude in a less life affirming direction. In view of the general life-affirming foundations of civilization, such a shift should be questioned.

PAS, then, runs counter to civilized society.

6. Following closely on the heels of the previous reason, PAS imposes a terrible burden on the most vulnerable members of society. Because life will no longer be the default position, the most vulnerable members of our society—the elderly, terminally ill, and disabled—will feel a need to justify their continued existence. This is an awful weight to place on someone’s shoulders when that someone is already in a weakened state. Surely, legal policy that imposes such a weight on the weak is wrong—morally wrong.

PAS, then, is morally wrong.

7. Also, there is a logical-legal slippery slope argument that looms large.[22] Philosopher Paul Chamberlain sets out an argument that hinges on the notion of patient autonomy coupled with the crucially important observation that reasons for one action sometimes also justify other actions which are unintended.[23] In the context of legalized PAS, 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 the terminally ill but also 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.

Yes, we can set up so-called legal safeguards against abuses of PAS, but our courts will do what courts do—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. At the core of each of these new situations we have a sufferer who requests PAS. And consistency requires that PAS's fundamental justifying principle—that the sufferer has the right to choose PAS to end his/her suffering—will carry more legal weight than the situational differences.

Clearly, the legal acceptance of PAS puts us on a non-fallacious slippery slope that embraces death as a solution. But medical, social, and psychological problems require medical, social, and psychological solutions—not killing.

PAS, then, is dangerous.

In sum, we have strong secular reasons for thinking PAS is definitely not needed, PAS misinterprets patient need, PAS runs counter to civilized society, PAS is morally wrong, and PAS is dangerous.

Conclusion

Therefore, we can reasonably conclude the following: (1) Human dignity is grounded in the image of God and thus not under our control, personally and legally; (2) Christian Scripture condemns suicide and, by implication, physician-assisted suicide, plus tells us that we must strive to enhance the physical, emotional, and psychological well being of those who suffer, instead of assisting them in their choice to die; (3) there are strong secular reasons not to legalize the choice for physician-assisted suicide.

Contrary to what the B.C. Civil Liberties Association would have us believe, physician-assisted suicide is not a good idea. Biblical and secular wisdom tell us that we should reject the choice for suicide—and choose life instead.[24]

(Hendrik van der Breggen, Ph.D., is associate professor of philosophy at Providence University College, Otterburne, Manitoba, Canada.)

  

Notes

[1]Sunny Dhillon, "B.C. civil liberties group sues to legalize euthanasia in Canada," The Globe and Mail, April 26, 2011; http://www.theglobeandmail.com/news/national/british-columbia/bc-civil-liberties-group-sues-to-legalize-euthanasia-in-canada/article1999454/ [accessed May 2, 2011].

[2]Unless indicated otherwise, Scripture references are to the English Standard Version (ESV).

[3]ESV Study Bible (Wheaton, Illinois: Crossway Bibles, 2007), 53.

[4]Joni Eareckson Tada and Nigel M. de S. Cameron, How to be a Christian in a Brave New World (Grand Rapids, Michigan: Zondervan, 2006), 51-52.

[5]Eareckson Tada and Cameron, How to be a Christian in a Brave New World, 53.

[6]Whether one cannot be forgiven for this sin, since it is difficult to repent afterward—at least in this life—is another issue. I believe God is just and merciful and gracious. Ultimately, of course, the forgiveness decision is up to God.

[7]It may be helpful to keep in mind that Jesus' death by crucifixion was not a suicide. Although Jesus had the resources of heaven at His disposal and foresaw His death, the fact remains that Jesus was unjustly tried and murdered.

[8]Francis J. Beckwith and Norman L. Geisler, Matters of Life and Death: Calm Answers to Tough Questions about Abortion and Euthanasia (Grand Rapids, Michigan: Baker Book House, 1991), 159. See also Job 3.

[9]Beckwith and Geisler, Matters of Life and Death, 159.

[10]Robert Wennberg, Critical Choices: Euthanasia, Suicide, and the Right to Die? (Grand Rapids, Michigan: Eerdmans, 1989); cited in Beckwith and Geisler, Matters of Life and Death, 159.

[11]Scott B. Rae, Moral Choices: An Introduction to Ethics, 3rd ed. (Grand Rapids, Michigan: Zondervan, 2009), 218.

[12]Rae, Moral Choices, 221.

[13]Admittedly, our moral knowledge and our reasoning abilities are fallible and non-exhaustive. Nevertheless, I submit, we have some moral knowledge and we can reason quite well (if we are honest and careful).

[14]John Scott, "Fear and False Promises: The Challenge of Pain in the Terminally Ill," in Euthanasia and Assisted Suicide, Ian Gentles, ed. (Toronto: Stoddart, 1995), 101.

[15]Scott, "Fear and False Promises," 101.

[16]Erin Brender, Alison Burke, and Richard M. Glass, "Palliative Sedation," The Journal of the American Medical Association , Vol. 294, No. 14 (October 12, 2005): 1850. JAMA Patient Page: http://jama.ama-assn.org/content/294/14/1850.full [accessed May 2, 2011].

[17]This example is from MGill University law professor Margaret A. Somerville, "Euthanasia is never necessary," Citizen, Focus on the Family, Vol. 8, No. 5 (June 1999), 6.

[18]This is an appeal to the principle of double effect, which Norman L. Geisler describes more generally as follows: "When an act has both good and bad consequences, it can be preferred if (1) the act is good or indifferent, (2) a good effect also follows from the act, (3) one intends the good effect and only tolerates the evil effect, and (4) the good effect is at least equal to the evil effect." (Norman L. Geisler, Christian Ethics: Contemporary Issues and Options, 2nd ed. [Grand Rapids, Michigan: Baker Academic, 2010], 187-188.) For more on the principle of double effect, see Chuck Colson and Robert George, Doing the Right Thing: Participant's Guide (Grand Rapids, Michigan: Zondervan, 2011), 55-57. See too Rae, Moral Choices, 230-232.

[19]Rae, Moral Choices, 221.

[20]Scott, "Fear and False Promises," 100.

[21]Scott, "Fear and False Promises," 103.

[22]Yes, many slippery slope arguments are fallacious: e.g., if you play cards, you’ll next be dancing, then you'll be drinking alcohol, and soon you’ll be a drug addict. But not all are fallacious: e.g., if you light a campfire directly under a tree in a dense dry forest, the tree will probably catch fire, which will probably cause the neighbouring trees to ignite, which will probably set the whole forest aflame.

[23]What follows is a summary of pages 108-126 of Paul Chamberlain’s Final Wishes: A Cautionary Tale on Death, Dignity, and Physician-Assisted Suicide (Eugene, Oregon: Wipf & Stock, 2009).

[24]For further reading I recommend Chamberlain's Final Wishes and Rae's Moral Choices. I also recommend viewing "What Does It Mean to Be Human?" which is Part 4 of the DVD series Doing the Right Thing: A Six-Part Exploration of Ethics with Chuck Colson and Robert George, moderated by Brit Hume (Washington, D.C.: BreakPoint Inc., 2011).