PAS, Slippery Slope & Pain – by Dr. Richard B. Fife

The case studies of Karen Ann Quinlan, Nancy Cruzan, Terri Schiavo and others show that the courts were moving toward a greater acceptance of the right-to-die long before any legislation was passed that allowed physician-assisted suicide. As I indicated at the beginning of these blogs, only one state had approved physician-assisted suicide by 1995. That was the state of Oregon; and, it has now been joined in similar legislation by five other states.

One of the main arguments against legalizing physician-assisted suicide was the “slippery slope” argument. Essentially, this argument is that if physician-assisted suicide is allowed, euthanasia would not be far behind. This is primarily a reaction to the experience in the Netherlands. In contrast to attitudes of American physicians, assisted suicide was supported by a majority of Dutch physicians. Moreover, most Dutch pharmacists are also supportive of euthanasia as well as assisted suicide and are prepared to fill prescriptions written for this purpose. Although euthanasia is officially a crime in Holland, it has been accepted there for almost 15 years before physician-assisted suicide became legalized in Oregon. In fact, euthanasia is supported by guidelines issued by the Royal Dutch Medical Association in 1984 and endorsed by a government-appointed commission.

One reason that many people have changed their minds about physician-assisted suicide is that there has been no “slippery slope effect” in the states that have legalized it. In the 20 year period that the law has been in effect in Oregon, only 991 patients have died after being legally prescribed drugs that were to be used for the purpose of ending their lives. In Washington state that number is 772 since 2009; and, in Vermont, the number is 24 after 3 years.

A second reason is that the medical community has been unable or unwilling to provide the support necessary to end a patient’s unbearable suffering. Of course, this is not true in the majority of cases; but, it is certainly true of a considerable number of cases. When Governor Brown signed into law the law in California permitting assisted suicide, he stated that as he considered signing the law he considered his own death. Then he said that he was not sure what he would do if he were dying, but, if he were faced with pain and suffering that could not be controlled, he was glad that this law was available to give him an option.

I close with another case study for consideration. It is from Ralph Baergen in which he speaks of a patient named Barbara. Barbara has Lou Gehrig’s disease. The disease has progressed to the point that Barbara is unable to eat, walk, talk, toilet herself, or engage in any of the activities she once valued. Using a specially adapted computer she has repeatedly requested that her physician help her in committing suicide. He has refused, but after much argument has said that he would be willing to withhold nutrition and hydration, which would lead to death in a matter of days. Barbara is reluctant to be “starved to death,” as she describes it. She is worried that the process would increase her suffering and result in the loss of what dignity and control she has left. What should the physician do in this case and why? What moral principles are relevant, how do they conflict, and how should the conflict be resolved?

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