Benjamin Bestgen: Assisted dying and slippery slopes – cause for introspection

Benjamin Bestgen: Assisted dying and slippery slopes – cause for introspection

Benjamin Bestgen

Benjamin Bestgen reflects on arguments for and against the legalisation of assisted dying.

In recent weeks, the Isle of Man and Jersey have moved closer to enacting assisted dying laws. Scotland also proposed a bill for debate. The Netherlands, a country with almost three decades of practical and legal experience in this matter, allowed the assisted suicide of Zoraya ter Beek, a 29 year-old-woman with lifelong mental health problems so severe and untreatable that she succeeded in obtaining approval for her plea to be granted.

Debates about euthanasia and assisted dying elicit strong feelings in many people: topics concerning death, personal autonomy, illness and quality or value of life tend to do that. Whatever your view on the subject itself is, it could be beneficial why you really think the way you do: you’ll learn more about yourself. This is especially interesting with slippery slope arguments that many people find intuitively persuasive even though they are fallacies.

Key arguments around assisted dying

People focus, in many variations, on the following: religion, palliative care, risk of coercion, active versus passive euthanasia and the slippery slope. I will race through the first four and focus more on the last.

Assisted dying / euthanasia

Against

In favour

Religion

Assisted dying is sinful and violates the sanctity of life.

It is not for humans to end the life that [insert deity / life-force / spirit] has given us.

Religious arguments don’t work for non-religious people.

Concepts like “sin” or “sanctity of life” are heavily debated within as well as between religions. Different religions hold different opinions on the subject.

Palliative care

Palliative care nowadays is so good that assisted dying laws are unnecessary. We should aim to improve quality of life, not focus on assisting a death.

If assisted dying was permitted, politicians would cut funding for palliative care and push people to die.

Palliative care is not a cure-all: it needs trial and error, is only available in the final months or weeks of a life and sometimes doesn’t work.

Many people value their autonomy, dignity and freedom more than managing physical pain. Focussing on a good death on one’s own terms is a fundamental quality of life point.

Politicians pushing people to die for public finance reason can happen with or without assisted dying laws. We need better politicians, full stop.

Coercion and pressure

Assisted dying laws can increase the risk that the elderly, poor, disabled or chronically ill are coerced or feel themselves pressured to opt for death and not be a burden on society or their families.

Legal and societal safeguards exist and can be cultivated to mitigate such risk.

The question must be decided on empirical grounds and results will potentially vary from society to society.

Active versus passive euthanasia

Assisting a death passively, e.g. withdrawing life-support measures or allowing the individual to refuse nutrition may be acceptable.

But actively bringing a death about by giving lethal medication or providing someone the tools to kill themselves is wrong.

“Killing” versus “letting die” is an unhelpful academic distinction. It is impossible to determine with certainty which action is morally preferable or less wrong.

The focus should be on what is most helpful to and most desired by the individual whose life and death are in question.

The slippery slope

The argument goes something like this: if assisted dying is permitted, the risk increases that in future we go further and pressure certain people into death or create a “duty to die” that may be imposed on the elderly, ill, poor or disabled. People might even permit killing the disabled (as the Nazis did during the T4 programme) or severely deformed newborns (the Groningen Protocol on child euthanasia in the Netherlands). We should therefore not allow assisted dying at all – if we do it, the floodgates will open to much worse things.

People who argue this way either claim that there is some logical connection between assisted dying and the other points, so they would inevitably have to follow eventually.

Alternatively, they claim that there is no logical connection but if people get used to assisted dying being available, they normalise that and would be more likely to entertain worse things, like killing the disabled, in future.

What’s wrong here?

Both of these variants show how difficult humans find it to reason logically, grasp causality relations or understand things contextually.

Logic: it is perfectly possible to allow assisted dying under certain circumstances but to also believe that there mustn’t be a duty to die and that non-voluntary euthanasia of the elderly, sick or disabled is wrong. Each of these things is sufficiently distinct from the other that there is no necessary logical connection.

Causality: appreciating causality, correlation, probability and context is key. We all know comments like

  • “The team won because everyone was motivated.”
  • “The school-shooters played violent videogames, so violent games cause aggression in teens.”
  • “The fund manager got me a 32 per cent return last year, he is a stock market genius.”

All of these statements woefully underestimate the complexities of real life. Motivation on its own rarely wins anything and school-shooters tend to have a significantly more complex history than playing violent games. The stock-market and what influences share prices is so hypercomplex and irrational that above-average returns have nothing to do with the alleged “genius” of an individual manager. Permitting assisted dying will not suddenly cause the floodgates to open – life is more complicated than that.

Normalisation: what people accept as normal is an empirical question that depends on context and a multitude of other factors. For example, there is a surprising number of countries that legally permit incestual sex between consenting adults. However, the vast majority of people do not push this particular boundary and also don’t consider incest as normal. Similarly, the laws of England still permit smacking one’s children but increasingly societal attitudes are shifting against it. So permitting assisted dying doesn’t automatically increase the probability that “duties to die” or “euthanising the chronically ill” would become normalised in future.

Why do slippery slope arguments stick around?

Slippery slopes come from gut-feelings: they ultimately indicate anxiety of losing control and anticipating the worst that might happen, regardless of whether that’s logical or probable. They tap into feelings that come before reason.

Evolution hardwires us to take threats, both actual and potential, seriously. It’s imperative for survival. A hefty dose of pessimism and fear is – understandably, but wrongly – often disguised as prudence and caution. After all, bad things can happen within seconds while good stuff often takes a lot of time and comes in small, incremental steps.

Humans can also become numb or used to awful conditions, potentially increasing the likelihood that we learn to live with even worse. But learning to live with something isn’t the same as morally approving it or wanting it to become legal norm: millions of people live in poverty in Britain or adjust themselves to bad employers and violent relationships. But they do not believe such circumstances are good or desirable.

So, wherever you stand on the topic of assisted dying, ask yourself why exactly you find certain arguments more convincing than others – especially if it’s slippery slopes.

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