Does a slippery slope exist when legalizing assisted suicide?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr Mark Komrad

Two weeks I published an article titled: Is assisted suicide a suicide? based on the ongoing debate in the Psychiatric Times between Psychiatrist, Dr Mark Komrad and long-time euthanasia activist Margaret Battin PhD.

Komrad's response to Battin's assertion that there is no proof of a slippery slope in jurisdictions that have legalized euthanasia or assisted suicide was published in the Psychiatric Times, on August 27. Komrad responds:

The letter objects to my use of a slippery slope argument. Unfortunately, the slope is very real. We have chilling observations of these practices outside the halls of political debate and philosophical discourse. When MAID laws are first passed, they initially have limited conceptions and eligibility, but the eligibility always expands over scope and time. Even now, many US states with legalized assisted suicide are trying to expand eligibility criteria and decrease waiting times. These creeping thresholds of acceptability, propagating the emerging new tier of supposedly good and noble suicide —celebrated with goodbye parties and lauded by the press—may be having the effect of suicide contagion. For example, the success of the Netflix television series 13 Reasons led to a marked increase in googling methods of suicide. By 2012, Oregon’s suicide rate rose 41% higher than the national rate. In Canada, children and teenagers are starting to ask their pediatricians about receiving euthanasia, though this option is not available for minors, for now. So, references to slippery slopes are not philosophical casuistry. The reality is that such slopes lessen the traction of suicide prevention. A taboo (not stigma) against suicide is an instrumental piece of suicide prevention.

Of course, the absence of evidence is not evidence of absence. Though many disability organizations have strongly objected to MAID practices (and provided disturbing anecdotal evidence of how a euthanasia option may short circuit the care of the disabled) no one has systematically studied the effects of euthanasia on individuals with disabilities. We have very few data regarding any outcomes of this practice, although we know that suicide loss survivors have profound secondary trauma.

Komrad then comments on Canada's upcoming experiment with permitting euthanasia for psychiatric reasons:

Furthermore, there is no validated empirical method or agreed-upon standard for determining that any psychiatric illness is irremediable; or when it would be reasonable to so conclude. There is tremendous controversy over futility in psychiatry and prognostication regarding psychiatric illness is highly unreliable. An absence of response to treatments already provided is in no sense, and by no stretch of logic, a demonstration that the patient’s condition is irremediable. Canada will be struggling mightily to figure this out in the next 2 years.

Komrad completes his response by refering to the research by psychiatrist Robert J Lifton:

When we lower the threshold for killing other human beings, disaster can follow. The celebrated psychiatrist, Robert J. Lifton, MD, author of The Nazi Doctors: Medical Killing and the Psychology of Genocide, warned of “malignant normality,” times when what we put forward as self-evident and normal may be deeply dangerous and destructive. “When normality becomes malignant, professionals can be all too ready to serve that version of it as well. Indeed professionals are required for maintaining that malignant normality and bringing others into it.”

Thank you Dr Komrad for continuing the debate on whether psychiatrists should be involved with killing their patients.