Richard M. Doerflinger  |  17 February 2022

The debate on assisted suicide and euthanasia often becomes a dispute about the “slippery slope.” Does a policy of taking human life in certain circumstances inevitably open the door to broader permission for killing?

Exhibit A for that question is the Netherlands. A euthanasia policy initially limited to suffering terminally ill patients who freely request it has become a dramatically broader policy. It now encompasses patients with non-terminal illnesses, newborn infants with disabilities, able-bodied people with mental health conditions, and people who are only “tired of life.”[i] In 2019, legal authorities approved a doctor’s decision to kill an elderly woman who had changed her mind about wanting euthanasia: the woman’s family held her down when she struggled against the injection.[ii]

In 1993, Dutch experts commented on the country’s move toward lethal overdoses for handicapped newborns. Dr. Cor Spreeuwenberg, editor of the journal of the Royal Dutch Medical Association, editorialized: “Because newborns cannot exercise autonomy does not mean that they should be denied beneficence.”[iii] Ethicist Heleen Dupuis wrote: “I doubt now, more than ever, the validity of slippery slope arguments. I do not believe we are on a slope,” because “we are actively making careful decisions to act in the way we do.”[iv]

She seemed to think that a “slope” exists only if killing expands mindlessly and accidentally. But those who warn us about slippery slopes have long known that the slope is greased by a deadly logic: Once you decide to kill innocent people or help them kill themselves, what moral line is more fundamental than the one you have already crossed?

For example, if it is good to end a short life of suffering, why isn’t it even better to end a long life of suffering? And why assume that physical illness is the only or worst source of suffering? Many advocates for disability rights and for suicide prevention, understanding that logic, oppose legalization proposals.

But something else was also going on in 1993. Dr. Spreeuwenberg admitted that he had secretly agreed to the killing of his brain-damaged infant son Laurens by a pediatrician in 1973, the year of the first Dutch court decision accepting voluntary euthanasia for terminally ill adults. And Ms. Dupuis wrote that she had favored infant euthanasia a decade before, when she was president of the Dutch Society for Voluntary Euthanasia, but did not think it “wise” to say so publicly until voluntary euthanasia was more fully accepted.[v] Her own “careful decisions” about killing people with or without their request were made long before she felt others were ready to follow her lead.

Here in the United States, are we dealing with a “slippery slope”? Or is this a broad agenda conceived in advance, and revealed to the rest of us gradually when proponents feel we are desensitized enough for the next step? My home state of Washington presents us with Exhibit B.

In 2008 Washington became the second state to legalize physician-assisted suicide by voter initiative, modeling its “Death with Dignity Act” on Oregon’s 1994 initiative. As in Oregon, proponents assured voters that this was a limited policy with ample “safeguards” against abuse: Two oral requests and a witnessed written request, by a patient certified to be competent and free of undue influence or coercion; a diagnosis by two physicians of terminal illness and a life expectancy of less than six months; a two-week waiting period to give patients time to reconsider; and so on.

Proponents also said that these proposals allow only the prescribing of drugs that a patient must “self-administer.” How could such a law be abused by others, if only the patient can administer the drugs?

In fact, they resorted to this approach only after failed attempts to authorize lethal injections by physicians in California (1987 and 1992), Oregon (1991), and Washington itself (1991). By 1994 they had decided to try limiting the new Oregon proposal to assistance in a patient’s suicide.[vi]

By 2008 they were pushing that envelope. Washington’s initiative, like Oregon’s, said the patient must “self-administer” the drugs, but it defined “self-administer” as “a qualified patient’s act of ingesting medication to end his or her life in a humane and dignified manner.” Dictionaries define “ingest” as something passive, to swallow or absorb something, so this may not exclude active participation by others.

However, few Washington voters noticed this, and few read a 2007 news article about the prime sponsor of the initiative, former governor Booth Gardner. He had a personal interest in the issue because he had Parkinson’s disease, a chronic condition. “Gardner’s campaign is a compromise; he sees it as a first step,” said The New York Times. “If he can sway Washington to embrace a restrictive law, then other states will follow. And gradually, he says, the nation’s resistance will subside, the culture will shift and laws with more latitude will be passed.”[vii]

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Now Washington is among the targets of a national campaign to “expand” physician-assisted suicide in the ten jurisdictions that have legalized it.[viii] Now the “safeguards” are being redefined as “barriers to access.” Hawaii’s law was expanded only two years after it took effect, to allow a non-physician to diagnose the patient’s illness and prescribe lethal drugs.

Washington’s expansion bill, HB 1141, was passed by the state’s House of Representatives last year but stalled in the Senate, where it is again poised for action at this writing. It would authorize lethal prescriptions by non-physicians; allow psychological evaluations by counselors other than psychiatrists or psychologists; reduce the waiting period from 15 days to 3 days (or eliminate it entirely if one health professional thinks the patient may die earlier than that); and allow lethal drugs to be sent by mail, messenger, or parcel post to be received by people other than the patient.

This betrays the trust of voters who were persuaded to vote for the current law by assurances of “strict safeguards.” But it is not the only way this practice is expanding.

After long delay, the state Department of Health has finally released its annual reports on “death with dignity” cases from 2019 and 2020.[ix] It shows the same trends as other states: Ever-increasing deaths from the lethal drugs (now at least 252 a year, seven times the number in the law’s first year, and another 41 cases where cause of death is unreported); virtually no referrals for a psychological evaluation to check for treatable depression; expanding reliance on conditions besides predictably life-limiting illnesses like cancer, including cases listed simply as “other.”

Worst of all, the appendix of each report states that in dozens of cases, we have no indication that any “safeguards” were followed. For these two years, the Department of Health has never received the patient’s legally required Written Request for lethal drugs in the case of 86 patients, or the legally required Attending Physician Compliance Form for 73 patients. These reports are the key “safeguards” in the law and the gateway to the others. Without them, we have no reason to believe that the patient made a voluntary request, was of sound mind, or had a terminal illness (or any illness). Failure to submit these reports cancels the legal immunity physicians enjoy under the Death with Dignity Act, making them subject to administrative, civil, and criminal liability -- including a felony indictment for “promoting a suicide attempt,” punishable by up to five years in prison.[x]

Yet the state’s annual reports falsely list these as cases in which the lethal drugs were provided “under the terms of the law.”[xi]

Moreover, End of Life Washington says in testimony endorsing HB 1141 that it has been directly involved in “95%” of cases implementing the Death with Dignity Act.[xii] The cases potentially subject to criminal indictment make up over 13% of the cases during these two years. If a group that promoted the 2008 law’s “safeguards” is now involved in all but 5% of the latest cases, it seems implicated in most if not all of the cases egregiously ignoring those limits.

While HB 1141 may represent a slippery slope, it seems American proponents have also learned from the Dutch that laws can be expanded by quietly violating them, once they think the rest of us may be ready to look the other way.

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[i] See sources cited in USCCB Secretariat of Pro-Life Activities, Assisted Suicide and Euthanasia: Beyond Terminal Illness (Feb. 19, 2018), pp. 1-2, SuicideNonterminal2018.pdf (usccb.org).

[ii] D. Boffey, “Dutch doctor acquitted in landmark euthanasia case,” The Guardian, 11 September 2019, Dutch doctor acquitted in landmark euthanasia case | Netherlands | The Guardian.

[iii] C. Spreeuwenberg, “The Story of Laurens,” The Cambridge Quarterly of Health Ethics, Vol. 2, No. 3 (Summer 1993), pp. 261-3 at p. 262.

[iv] “CQ Interview with Heleen Dupuis,” Ibid., pp. 275-80 at p. 280.

[v] C. Spreeuwenberg, op. cit., pp. 261-3; H. Dupuis, p. 279.

[vi] R. Doerflinger, “Physician-Assisted Suicide: The Path to Active Euthanasia,” Charlotte Lozier Institute, On Point, Issue 27 (November 2018), pp. 3-5, Physician-Assisted-Suicide_The-Path-to-Active-Euthanasia_Richard-Doerflinger.pdf (pcdn.co).

[vii] D. Bergner, “Death in the Family,” The New York Times Magazine, December 2, 2007, pp. 38-45, 60, 76, 78, 80, and 82, at 40, Death in the Family - The New York Times (nytimes.com).

[viii] Charlotte Lozier Institute, “Assisted Suicide in the States” (April 2021), AssistedSuicideMap_04.23.2021.pdf (pcdn.co).

[ix] Washington State Department of Health, “Death with Dignity Data: Annual Reports,”  Death with Dignity Data :: Washington State Department of Health.

[x] Revised Code of Washington, 9A.36.060. The Death with Dignity Act itself, after specifying penalties for violations such as forging a patient’s request, adds: “The penalties in this chapter do not preclude criminal penalties applicable under other law for conduct that is inconsistent with this chapter” (RCW 70.245.200).

[xi] “Annual Reports” for 2019 and 2020, p. 5.

[xii] Testimony of March 17, 2021, before the Senate Health & Long Term Care Committee, watch – TVW, Washington State's Public Affairs Network, at 49:35.

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