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Is There a Logical Slippery Slope from Voluntary to Nonvoluntary Euthanasia?

Is There a Logical Slippery Slope from Voluntary to Nonvoluntary Euthanasia?

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Published by Michael Cook

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Published by: Michael Cook on Dec 02, 2011
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Access Provided by University of Sydney Library at 12/02/11 9:45AM GMT
 Jones • Voluntary to nonVoluntary euthanasia
[ 379 ]
 Kennedy Institute of Ethics Journal 
Vol. 21, No. 4, 379–404 © 2011 by The Johns Hopkins University Press
David Albert Jones
Is There a Loical Slippery Slope from Voluntaryto Nonvoluntary Euthanasia?
ABSTRACT. John Keown has constructed a loical slippery slope arument fromvoluntary euthanasia (VAE) to nonvoluntary euthanasia (NVAE). VAE if justi-ed implies that death can be of overall benet, in which case it should also befacilitated in those who cannot consent (NVAE). Hallvard Lillehammer assertsthat Keown’s arument rests on a fallacy. However, pace Lillehammer, it can berestated to escape this fallacy. Its validity is conrmed by applyin to VAE somewell-established eneral principles of medical decision makin. Thus, either VAEand NVAE must be accepted toether or, if NVAE is rearded as unacceptable,VAE should also be rejected.
lippery slope aruments have been important in the euthanasia de-bate for at least half a century. In 1957 the Cambride leal scholarglanville Williams wrote a controversial book,
The Sanctity of Lifeand the Criminal Law
, in which he presented the decriminalizin of eu-thanasia as a modern liberal proposal takin its rihtful place alonsideproposals to decriminalize contraception, sterilization, abortion, and at-tempted suicide (all of which the book also advocated).
pposition tothese reforms was in turn presented as exclusively reliious and particu-larly Roman Catholic. Thus Williams asserted that “euthanasia can becondemned only accordin to reliious opinion” (1957, p. 312).The followin year, in response to this book ale Kamisar, then as-sociate professor of law at innesota wrote a substantial paper entitled,“Some Non-Reliious Views aainst Proposed ‘ercy Killin’ Leisla-tion.” Kamisar did not accept Williams’s assertion that euthanasia couldonly be rejected on the basis of reliious aruments. Kamisar wrote as“a non-Catholic and self-styled liberal” (1958, p. 974) and appealedexclusively to “utilitarian ethics” (1958, p. 974, n. 21). The fundamental
kennedy institute of ethics Journal • december
2011[ 380 ]
arument of his paper invoked what he called the “wede principle” andwould later be called the “slippery slope” arument. He ured that inpractice permittin “mercy killin” would not be conned to voluntaryeuthanasia but that pressure would be put on the vulnerable to end theirlives and the incompetent would be killed without their consent. Williamsreplied (1958).It would be difcult to exaerate the inuence either of glanville Wil-liams’s book or of Kamisar’s rebuttal in the debate over lealisation of euthanasia. These set the terms of the debate for much of the next ftyyears. ollowin Williams, euthanasia, and latterly physician-assistedsuicide, another form of “medically assisted dyin,” have continued tobe advocated as proressive causes, and opposition has continued to becaricatured as exclusively reliious (Battin 1998). ollowin Kamisar, thedominant political arument aainst chanin the law has been based onsome form of slippery slope (gay-Williams 1983; gelfand 1984).
 The major chane between the Kamisar / Williams debate and contem-porary slippery slope aruments on euthanasia is that since 1984, therehas been a major jurisdiction that has tolerated voluntary euthanasia: theNetherlands. This leal toleration was subsequently formalized throuhstatute, and other jurisdictions have also brouht in leislation for eutha-nasia (Belium and Luxembour) or physician-assisted suicide (reon andWashinton). These leal chanes allow the predictions of Kamisar andothers to be tested empirically. Does evidence from these countries bear outthe presence of a slippery slope, or, on the contrary, does it demonstratethat euthanasia or physician-assisted suicide can be reulated effectivelywithout adverse effects on the vulnerable, on those who cannot consent,or on standards of palliative care?In principle it would seem straihtforward to evaluate the empiricalevidence for or aainst a slippery slope. In practice this is complicatedby many factors, not least the difculty of international comparisons orof discoverin how much practice falls outside reulations and reportin(before and after lealization).
urthermore, the evidence that has beencollated provides such an embarrassment of riches (thousands of cases ayear analyzable in many different ways) that advocates and opponentsboth have some scope to see in the data the conclusions they wish to see.There is, perhaps unsurprisinly, little sin as yet of a consensus as tothe interpretation of this data. Even where opponents can show clear abuse(for example, the thousand plus deaths a year without consent uncovered

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