Assisted Death and The Economist

Permitting assisted suicide for terminally ill patients has been debated for many years in Great Britain, as in the U.S. and other countries. The Parliament has never approved such a law, but proponents think this year may give them a victory.

The respected London-based periodical The Economist, which has supported the idea since 2015, recently weighed in with an editorial that offers a convenient overview of the campaign for what the editors call “assisted dying.” While dismissing the idea of a “slippery slope” toward broader killing, their own arguments illustrate that slope.

The General Argument for Assisted Suicide

They begin with a broad claim that Britons “should have the right to choose the manner and timing of their death.” On its face, this is an argument for a “right” to suicide for everyone. The article ends with a call for a right held by all “adults of sound mind who are enduring unbearable suffering with no prospect of recovery,” noting that many people “suffer terribly with a disease that is not terminal.” Suffering, of course, is also not restricted to people with an illness.

The editorial’s insistence that people have a right to “take matters into their own hands” also misstates the issue. This is not about legalizing efforts to cause one’s own death, which have long been seen as meriting counseling and treatment rather than punishment. It is about some people—especially members of what some of us still call “the healing professions”—helping to cause the death of other people.

Dismissing the Slippery Slope: Three Factual Claims

The rest of the editorial responds to concerns about that slippery slope, claiming that experience in Oregon and elsewhere sets those to rest. In both Oregon and Washington, the second state to legalize “death with dignity” in 2008, documents such as the health department’s annual reports on the implementation of the law, summarized here, tell a different story. For example:

1. Restricted to terminal illness and other initial standards?

“Although eligibility criteria for an assisted death have expanded in Belgium and the Netherlands, they have never done so in jurisdictions whose initial laws were restricted to terminally ill adults.”

In practice, those criteria have greatly expanded in Oregon, whose law the editors say is “too restrictive.” Shortly after its law took effect in 1997, the state attorney general’s office issued a legal opinion that the law’s insistence on self-administration by the patient does not apply when the patient needs physical help from others to take the drugs. In 2017, the Oregon Health Division revealed that the criterion of “terminal” illness is met if the patient would die in less than six months without treatment, regardless of how long he or she would live with treatment. This helps explain why, in recent years, qualifying conditions have included arthritis, diabetes, anorexia (a psychiatric condition), “benign or uncertain” tumors, “medical care complications,” and “other” or “unknown.”

In Oregon and Washington, patients diagnosed as having less than six months to live have survived for years before taking the lethal drugs; these states do not report on the survival of patients who end up choosing not to take the drugs.

Other eligibility criteria have been eliminated. In 2023, the Oregon legislature rescinded the requirement that only state residents can access lethal drugs, making the state an assisted suicide “haven” for residents of nearby states. The required waiting period is eliminated if a medical provider says the patient may die before that period is over. This authorizes the immediate provision of lethal drugs, making the prognosis of imminent death a self-fulfilling prophecy.

In Washington as well, “other” or “unknown” diagnoses have made patients eligible. In fact, in at least 227 cases, the attending physician never submitted the legally required form claiming an illness or a voluntary decision by a patient of sound mind. Over half of these violations have occurred in the last four years. Yet the health department lists these as cases in which lethal drugs were provided “under the terms of” the Death with Dignity Act. Oregon does not report to the public on missing documentation.

In the name of expanded “access” to lethal drugs, seven of the nine states in the U.S. that passed legalization measures before 2024 have gone back to weaken or eliminate what they once hailed as essential safeguards against abuse. For example, waiting periods are shortened or eliminated; non-physicians can make the diagnosis and dispense the drugs; an in-person consultation with a medical provider is not required; social workers can conduct any requested psychological evaluation; and the lethal drugs can be sent by mail or messenger and received by people other than the patient.

2. No coercion?

“[T]he evidence suggests that cases of coercion are extremely rare.”

There is no such evidence. Only prescribing medical providers may report on the patient’s competence and voluntariness (when they choose to do so). The provider may request an evaluation of possible impaired judgment by a mental health professional, but almost never does so. The Oregon Health Department has said this provider’s account could be “a cock-and-bull story,” but the state must accept it at face value. In Washington, the provider has submitted no evidence that the patient ever signed a request for the drugs in at least 279 cases—and over half of these cases, as well, occurred in the last four years. Such cases violate the Act and are subject to prosecution for promoting a suicide attempt, a felony—but again, the state lists these cases as valid under the Act.

So there is little concern for competence or voluntariness when the drugs are prescribed. Assisted suicide groups maintain that many patients do not decide to take their lives at that time, but may only want the drugs as a last resort in case their suffering worsens later—and indeed, it seems that many patients never take them. So it is especially important to protect against coercion and undue influence when the decision to administer the lethal dose is actually made. But no such protection exists. The prescriber is the only person authorized to report on this, and is seldom present. The people in charge are the patient’s informal caregivers—and/or the members of an assisted suicide advocacy group. End of Life Washington has said it is directly involved in 95 percent of the cases in that state.

In 2022, the Washington legislature commissioned a study of “barriers” to “access” to the Death with Dignity Act. End of Life Washington surveyed patients and caregivers. The results revealed that caregivers were two to four times more likely to complain of “barriers” than the patients whose interests they allegedly serve: 47 percent of caregivers agreed that barriers include a healthcare facility’s unwillingness to participate (compared to 16 percent of patients); 63 percent cited the patient’s doctor being unwilling to prescribe the drugs (compared to 32 percent); and 21 percent complained about the waiting period giving a patient time to reconsider (compared to 5 percent). That year, the health department reported that 59 percent of patients request the drugs because they feel they are a “burden” to family or caregivers. Proponents’ own survey suggests where they are getting that feeling. Yet in 2023, armed with this troubling information, the Washington legislature approved the “expansion” bill.

3. Lethal drugs for mental illness

The editors are less certain about currently providing lethal drugs to patients suffering solely from mental illness, as it can be “hard to determine whether people are of sound mind.”

It is difficult to make sense of this concern once one accepts the basic premise of “assisted dying.” If the patient suffers from an illness and is of sound mind, that is accepted as a reason to provide the drugs; if not of sound mind, that is presumably an added reason to provide the drugs. Why, then, would one worry about determining which is true?

Finally, the editors dismiss the “slippery slope” not only by claiming that “no such slope exists,” but also by claiming that people with that concern are “conceding the principle” that some assisted death is acceptable—“it’s the scope that is the problem.” One might as well say that the editors have “conceded the principle” that if their factual claims are false, their position crumbles. If experience in the U.S. is anything to go by, those claims are indeed false.

A Final Note on the Slippery Slope

The idea of a slippery slope does not mean that all laws necessarily expand once enacted. It means that once a society has accustomed itself to violating a long-held moral principle—for example, that the medical profession must be dedicated to caring, not killing—further violations gradually seem less problematic, or even as sensible ways to do more good. Leaders of the assisted suicide campaign have long approved of direct killing by physicians, euthanasia for people with disabilities, proxy decisions for incompetent patients, etc. But they know how to wait for the rest of us to catch up. In the U.S., even in states that legalized assisted suicide only a few years ago, they believe they have waited long enough. Great Britain, as well, should realize that any legalization measure approved now would be only the beginning.

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