Of course the slippery slope argument doesn’t work, does it?

It is not just that we know from the legalisation of abortion how over time ‘two independent doctors’ have been increasingly prepared to rubber-stamp the procedure, unwilling to examine in depth (or, indeed, at all) whether the woman has, for example, come under pressure from a boyfriend to terminate the pregnancy.

It is also that in the case of euthanasia, the great majority of doctors are highly unwilling accomplices. One wrote to me: ‘As one who spends every working day caring for the terminally ill, I am acutely aware of the damage such a change would cause to vulnerable patients.’

But we don’t need a crystal ball to guess at the consequences. Last week, the Mail published comments by a member of one of the Dutch regional committees invigilating euthanasia in that country, where it was legalised in 2002.

Theo Boer now says he had been ‘terribly wrong’ in supporting that legislation, not least because the numbers of those being given lethal injections had soared beyond what he had anticipated.

The House of Lords should not be surprised by this: some years ago it took evidence from Holland and was told by a Dutch GP, Dr van den Muijsenbergh: ‘I see a growing anxiety among patients, not just the terminally ill, that they think it is not decent not to ask for euthanasia sometimes, because they feel they are such a burden.’

The undeniably well-meaning Lord Falconer insists the legislation he proposes is modelled on the more limited measure passed in the U.S. state of Oregon, rather than the Dutch law.

So, here’s what happened in Oregon a few years back: two cancer sufferers, Barbara Wagner and Randy Stroup, who were reliant on the social health programme Medicaid for their care, were told the state would not fund any more treatment — but would pay for the drugs to end their lives there and then.

No, there’s no value to the slippery slope argument at all.

36 comments on “Of course the slippery slope argument doesn’t work, does it?

  1. Well, as I sad in the last thread, anecdatally it seems to me that GPs performing euthanasia was rather commonplace until recently. It was just done informally.

  2. Tim and Matt Ridley disagree! I like this.

    There is one argument Ridley makes that meets with my total agreement, the “soemone could use this technology to…” argument.

    It is usually (usually) quite a stupid logic. Should we ban the surgeon’s knife because some sick kid could use a knife to cut somebody on the street?

  3. Should we ban the surgeon’s knife because some sick kid could use a knife to cut somebody on the street?

    Well, we have made knife possession without State permission pretty much illegal. Two fresh faced Plod once attempted to caution an engineer friend for having a Stanley in his toolbox. The old “offensive weapon” has changed from being a useful law you could use to prosecute somebody caught on his way to beat his ex with a hammer, to “anything that might conceivably be weaponisable”.

    “Somebody could…” is a pretty standard Proggie argument.

  4. I mentioned this on the earlier thread, but why is it evil and wrong for doctors to sign off people as fit for work but OK for them to sign off people to be “put down”?

  5. Said this on an earlier thread
    If you object to “pressure” to have an abortion. And object to “pressure” to euthenise. Then not objecting to “pressure” to refrain from doing either is simply hypocritical. it’s imposed “morality”.

  6. Hi Ironman

    (I haven’t worded this well, but hopefully you’ll get where I’m going)

    I think you misunderstand the subtleties of applying rules to the individual, where we should assume good intent, to rules to the state, where we should assume bad intent.

    On the side of the individual, we should be free and not have the state unnecessarily interfere in our lives.

    On the state side, rules nearly are always taken to their extreme and are used unthinkingly with bureaucratic vigour : loot at what happened with CRB checks that would ONLY ever be used on people who came into day to day contact with children or vulnerable adults; whereas in reality they were used on anyone who might in any way interact with children or their data or the building or anything (as I can vouch for from personal experience).

  7. I’m surprised to find a libertarian arguing that people should not be free to end their lives.

    In any healthcare system, there has to be some limit on the cost/benefit ratio of treatments paid for. In Oregon, this meant that the two patients featured in the article were denied State funding for expensive cancer drugs with slight survival advantages.

    Quite separately, Oregon does offer State funding for inexpensive euthanasia drugs.

    The only thing wrong here was to put the two things in the same letter. Since both these cases were first reported in 2008, it seems that Oregon doesn’t do this any more.

    (The proper target in all these drug funding cases is not the funding process but the insane patent system which causes us to make these decisions on the basis of the total rather than the marginal cost of treatment.)

  8. One question is why we think it’s right for doctors to be the ones to decide whether you can end your life. You don’t have to ask permission from a car mechanic to ditch your car. A mechanic (whether motor or biological) has no particular expertise in this field; only the individual can guage their own subjective values, and this includes their quality of life.

    Interestingly we see this error in everyday suicides, in which some person has valued their life to be “not worth living”, and others presume this to be an erroneous judgement. Why?

    All a doctor can do- like a mechanic- is offer an alternative if there is any. That is, they can offer advice. But they are not in a position to judge the merit of the decision itself. It’s a fallacy to think that they are.

  9. On the other hand, I have often been told that some cherished personal item is ‘beyond economic repair’ which amounts to the same thing.

    I fully expect to find that I become BER in the not too distant future.

  10. Rob wins the comments.

    PaulB –

    I’m surprised to find a libertarian arguing that people should not be free to end their lives.

    I think the tricky issue here is whether other people should be able to end your life, and all that would entail.

    Re: the Oregon story. Given that we already have the Liverpool Care Pathway, is it hard to envisage the NHS encouraging people to die rather than use up expensive resources?

    And is that the sort of society we want to become? One that puts our elderly and sick to sleep when they become too much of a burden?

    Really, you’d think we might have learned something from the 20th century.

  11. IanB

    Interestingly we see this error in everyday suicides, in which some person has valued their life to be “not worth living”, and others presume this to be an erroneous judgement. Why?

    Because ever more research is showing that (many/some/a few] of these people are suffering from known illnesses and can be treated. If they commit suicide while ill there’s no second chance. If they do it whilst not ill and rational then I agree.

  12. The fetters on free choice would seem to me to be the requirement for the individual to fully, FULLY, understand that choice and its implications and the capacity to learn from the mistakes we make. The latter would seem to be absent in all suicide, which is a problem for assisted death.

    As for the former, our own death is so difficult truly to fathom when we are well and with a future ahead of us that I would question whether we can ever be fully cogniscent of its implications. When we are terminally ill and in pain can our mind ever be fully ‘sound’?

    Please understand, I have the deepest sympathy for those suffering terminal or long-term painful illness and I wouldn’t begin to claim to understand their suffering. However, I would argue that rational, objective measures of ‘sound mind’ in such circumstances would be extremely difficult to find, perhaps impossibly so.

  13. Whats the odd that any given doctor will refuse to sign off the request for assisted suicide? And if one won’t that another probably will? Why do doctors seem to think they have the moral authority to be able to decide whether someone should die or not? Do they all have God complex or what? Why does knowing how the body works, and how to fix it (sometimes) make them some sort of moral philosophical giants that we should all defer to?

    You’d be better off having a jury system. Want to get assisted suicide, have to prove your case in front of 12 of your peers chosen at random. I reckon the average person would be able to come to as good a decision as a doctor, better in fact. It would also stop the NHS using it if they had to convince 12 members of the public beforehand too.

  14. Bloke with a Boat,

    Quite. The case of David Foster Wallace is interesting and very sad. A man with terrible clinical depression who had pretty much figured out how to live a happy life who killed himself due to being stuck in a rut between anti-depression medications. It takes a peculiar type of callousness to look at such people and accuse anyone who tries to help them of denying their freedom of choice in the name of authoritarian imposed morality.

    b(n)is,

    > Said this on an earlier thread
    > If you object to “pressure” to have an abortion. And object to “pressure” to euthenise. Then not objecting to “pressure” to refrain from doing either is simply hypocritical. it’s imposed “morality”.

    If you think the word “morality” belongs in scare quotes, that’s a really good point. But hardly anyone really does. Even the people who like to claim they do.

    I have no problem with telling drivers not to run down pedestrians but oppose telling drivers to run down as many pedestrians as possible. What a hypocrite! I have no problem with teachers telling pupils to try to get good exam results because they should aspire to succeed but object to teachers telling pupils not to bother even trying because they’re too stupid anyway and they may as well give up. What a hypocrite! I approve of its being illegal for the police to fabricate evidence but would object to the CPS telling the police to fabricate evidence. What a hypocrite!

    To my mind, PJ O’Rourke’s famous formulation of Libertarianism gets to the heart of it:

    There is only one human right, the right to do as you damn well please. And with it comes the one human responsibility, to accept the consequences.

    The trouble with suicide is that it dodges any crappy consequences you may leave behind for other people to deal with, as suicides often do. There may be ways around that — committing suicide with lots of advance notice, explanations and peace made with loved ones, legal shenigans in place, house-sales sorted out, etc. But assisted suicide is problematic, as it unavoidably involves foisting a big pile of responsibility onto someone else with a certain promise that you will not help them face it.

    I don’t claim to have a solution to that, but to say that the problem is exactly the same matter of personal freedom as cases where you stick around to face the music yourself is surely incorrect.

  15. @Ironman
    “Please understand, I have the deepest sympathy for those suffering terminal or long-term painful illness and I wouldn’t begin to claim to understand their suffering. However, I would argue that rational, objective measures of ‘sound mind’ in such circumstances would be extremely difficult to find, perhaps impossibly so.”
    I find it horrific you’d try & find an objective measure. It’s a subjective subject. There is no objective.

    SQ2’s raised the one element of elective suicide bothers me. The cop out motive. The tempting one. You can’t take it with you includes debt, doesn’t it? Or the consequences of a lot of things.

    But sorry, your morality play doesn’t receive rave revues. Thou should not kill, thou should not steal…? Even burglars don’t like their houses broken into.
    Bearing false witness is bearing false witness. Again, no conflict. Unless you’re a lawyer & there’s nothing more immoral than a lawyer.
    But advice on exams? No, that’s purely a value judgement. Telling a kid, who’s no hope of passing an exam, to strive anyway is nothing about the kid & everything about you. It’s with variations on that theme come misery. The fat kid who’s got to be the footballer his father wasn’t. Or the rebel, the accountant that he is.

  16. What this Bill proposes is that a terminally ill person may legally be given assistance to kill themself, provided that they make a signed declaration that they wish to do so, and that two doctors certify that the person is indeed terminally ill, is mentally competent, understands what palliative care is available, and has made a clear, informed, and wholly voluntary decision.

    It seems to me that doctors are better placed than anyone else to certify those things.

    There’s only one thing I’d change: doctors are not omniscient, and cannot accurately predict one’s date of death months in advance. The bill should specify that the patient should be informed, in so far as it’s known, of the distribution of life expectancy, not just its median.

  17. That last sentence of mine’s prompted an off-topic thought.

    I wonder what Murphy’s kid makes of his tax-denouncing, train-set playing old man? I relish the notion the lad’s an aspiring thrash metal guitarist whose idea of country-by-country reporting would be postcards sent from Europe’s more disreputable cities.

  18. PaulB-

    Anecdotally, when my mum was terminal, nobody would give any kind of estimate of life expectancy. They just said it was all too variable to do that.

  19. If you think the word “morality” belongs in scare quotes, that’s a really good point. But hardly anyone really does. Even the people who like to claim they do.

    I do, but you probably guessed that already. It seems to be a concept that is at best useless and at worst harmful, which is primarily used by people to insist on some behaviour or rule when they can’t actually justify it.

    I think I always felt this way. I was a very questioning child and generally if I was given a plausible explanation for why I should or should not do something, I’d be satisfied. If my parent/teacher/satanic cult grooming leader couldn’t give me a good reason, I’d be sceptical of it. That is, if somebody said, “X is wrong” I would say, “why is X wrong?”, which made me a pain in the arse but that’s me, you know. In which case, you don’t need the intermediate moral declarative, just the explanation.

    I’ve pretty much come to the conclusion that morality is the first refuge of the scoundrel.

  20. B(N)IS-

    WIth the current hegemonic social system being stultifyingly leftist, collectivist and puritanical, I’m predicting a major individualist, libertine backlash in a couple of decades or so. The drear of the last Progressive Era was what kicked off the 1960s shindig, after all.

  21. @Ian
    It really depends if you think there was a 1960s shindig. There certainly was in some Central London postcodes & a few outposts. Ride a few stops on the District Line & no-one had heard of it.
    You have all that freeing of cultural restrictions in the 70s-80s of course. But I’d say that was more in response to socialist, collectivist inspired abandoning of personal responsibility rather than any individualist, libertine ideals. It’s the period of the “long march through the institutions” isn’t it? Cutting people lose from “redundant establishment morality” was all part of the game plan.

  22. > [Morality] seems to be a concept that is at best useless and at worst harmful, which is primarily used by people to insist on some behaviour or rule when they can’t actually justify it.

    And yet, over the millenia, it has progressed in a generally good direction. Thanks to competing moral codes, we don’t have human sacrifice any more, we don’t have slavery, women are no longer property, rape is illegal, we have freedom of speech, etc, etc. I know, I know: you think that all would have happened anyway, for some reason that you have not explained, despite your insistence that everything be backed up by pure rationality.

  23. PaulB,

    > It seems to me that doctors are better placed than anyone else to certify those things.

    It seems to me that they’re terribly placed. They have budgets. They work for organisations which can save hundreds of thousands of pounds every time someone kills themself. The great advantage of lawyers, no matter what their other failings, is that they work for their clients. And of course the lawyers could hire independent doctors, who would then be being paid by the lawyer and their client, not by the hospital or NHS trust. But a patient’s usual doctor, who treats them, shouldn’t be allowed anywhere near the decision.

    Another problem is that we’re talking about two different groups of people under the same name, “doctors”. We should distinguish between “people who are doctors now” and “people who will be doctors in twenty years”. Any legislation that passes now will have an influence on the composition and behaviour of that second group, because incentives matter. Basing any decision about what duties to give a given group of people on what that group is like now is an error.

    I bet it seemed like a fantastic idea to guarantee positions in the Irish Senate for certain university professors. Apparently it didn’t occur to anyone that, once you’d done so, certain types of people who’d never otherwise have been interested in academia would start competing for those professorships. I also think CCTV was a sensible tool as it was used by the old generation of police officers who had learnt how to do their job without CCTV, whereas it’s been an appalling influence on the generations who’ve learnt policing since CCTV became ubiquitous.

  24. The problem with your argument is, SQ2, it has to suspend itself by it’s own bootstraps. All the things you’re claiming are “good” are good because your moral system is telling you they’re good. You can take each individual one & show how, in previous societies, the complete opposite was entirely “moral” & beneficial within that society. And there’s absolutely no way of knowing if it won’t cycle round to being the case again.
    Slavery’s a good example. It’s been used by every society to leverage itself up into what we call civilisation. The realisation it’s better to utilise the productive capability of defeated enemies* rather than simply genocide them. The surplus economic capacity gives a chance for things like lawmaking & administration. Record keeping so knowledge can be accumulated. Slaves become integrated within a generation or two & you’re moving towards a more diverse & equal society. In the long term slave keeping benefits the enslaved as much as the slave keepers.

    *And without civilisation there will always be enemies. Humanity competes.

  25. “Two doctors certify that the person is indeed terminally ill(1), is mentally competent(2), understands what palliative care is available(3), and has made a clear, informed, and wholly voluntary decision(4).”

    So I’ll give you (1), even though as many have pointed out the prediction of actual time of death is not possible, but why would an average doctor be able to certify (2)? Are they mental health experts? Or indeed know what palliative care is available to someone they don’t know from Adam in an area they have no knowledge of? And most crucially how is a doctor to arrive at a assessment of whether a person has made a clear informed and voluntary decision? Is he (or she) going to live with the patient for a while and view the family dynamic? How would any pressure being brought to bear by family members (or indeed healthcare ‘professionals’) manifest itself in a way that a doctor doing a quick assessment could in any way notice? Or would it just be a question of asking the patient ‘Have you made up your own mind on this with no outside pressure? Yes? Oh OK then, I’ll sign you off’?

    This will end up being another tick box exercise like abortion is now – no-one ever is told No by the doctors if they demand an abortion, despite there not actually being abortion on demand legally speaking. And this will result in the same thing – assisted suicide on demand, whatever the mental state of the patient, or the pressures being brought to bear from outside forces.

  26. S2: so who do you want to advise patients on their prognosis, or what their experience of dying will be if they let their disease take its course?

    Ian B: my experience also is that most doctors are reluctant to state a life expectancy. However, it’s not uncommon to read “my doctor gave me [some number of] months to live…”, which must come from somewhere.

    The Blue Badge scheme will issue a badge quickly if your doctor certifies that your life expectancy is less than six months. For that purpose, doctors have to make the same judgment as required by this Bill, and, anecdotally, they tend to err on the side of getting the badge issued.

  27. PaulB,

    > S2: so who do you want to advise patients on their prognosis, or what their experience of dying will be if they let their disease take its course?

    Yes, the first is a job for their doctors. Not the same thing at all as certifying a prospective suicide, which was what we were discussing.

    The second would be a task better suited to support groups, I’d’ve thought, containing people going through the same thing or friends of people who went through the same thing.

    b(n)is,

    > The problem with your argument is, SQ2, it has to suspend itself by it’s own bootstraps. All the things you’re claiming are “good” are good because your moral system is telling you they’re good.

    Yes, which was why I specifically referred to competing moral codes. I’m an atheist. I don’t believe in any sort of objective moral truth, but neither do I believe that the word “subjective” is pejoritive. And I believe that competition and natural selection tend to work quite well. Why on Earth do you describe this as a problem? What problem? Subjectivity makes morality adaptable. That’s a feature, not a bug. Evidence of this is clearly visible in the outcomes of societies with religious books full of internal contradictions versus those with religious books full of absolute certainty.

    > You can take each individual one & show how, in previous societies, the complete opposite was entirely “moral” & beneficial within that society. And there’s absolutely no way of knowing if it won’t cycle round to being the case again.

    Weird phrasing there: “knowing if it won’t cycle round” — as if it’s a phenomenon that we can observe but are detached from. The whole point of morality is not that we sit back and wait to see what it is but that we shape it. We don’t know whether it will cycle around: we are it, so we direct it. We have freedom of speech in Britain because of jury nullification: that wasn’t society waiting to see how things would go; that was society becoming so strongly in favour of freedom of speech that it became statistically unlikely that you could select twelve people at random who’d convict on a prohibited speech charge. Which is great, but you think it’s bad for some reason.

  28. Squnader Two-

    And yet, over the millenia, it has progressed in a generally good direction.

    And frequently, improvements in the human condition have struggled into existence despite, and in opposition to, the prevailing morality, and often been snuffed out again by it.

    A good example currently is the moralist position on sex offences which is corroding centuries of hard-won basics of due process in the justice system. Because people have abandoned cautious reason in favour of emotive moralism.

  29. Ian B,

    > And frequently, improvements in the human condition have struggled into existence despite, and in opposition to, the prevailing morality, and often been snuffed out again by it.

    Agreed. I used the word “generally”. Progress is not a straight line; it has peaks and troughs. But it still happens.

    That aside, what you’re referring to there is not moralism versus non-moralism but morality A versus morality B. Sometimes the morality that loses is the one you’d prefer to have won. That doesn’t mean it’s not a morality.

  30. In Australia there is a not too subtle urge to the old and broken to go away. If you need joint replacements you can wait up to a year to see a specialist and another year or so to get the operation if offered. If the condition is bilateral you have to go over this all again.
    How do I know this – I am 79 years old and have watched it all.
    Mark you the GPs love cholesterol testing whatever age you are.

  31. Why would the doctor care whether the boyfriend has pressured the woman to have an abortion?

    It might be that in the past doctors refused to certify for moral reasons specific to the circumstances, but their statutory role is confined to certifying (in the absence of foetal defects) that the risk of live birth is higher than that of abortion, which many believe it always is.

  32. Why do doctors seem to think they have the moral authority to be able to decide whether someone should die or not?

    That decision has already been made by the fate which has inflicted terminal illness on the patient. And it’s the patient themself who has decided on suicide. The proposed role of the doctor is not to decide what should happen, but to certify that the patient knows what they’re doing.

    If you think that doctors tend to be evil murderers, or that evil murderers would train as doctors just for the opportunity to countersign suicide requests, then you should object to the role of doctors in this proposal. I don’t.

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