Stuart Chambers critiques the latest crop of slippery slope arguments against the expansion of eligibility for medical assistance in dying.

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As the federal government prepares to amend the law on medical assistance in dying (MAiD), some members of Canada’s mainstream media have adopted a pessimistic attitude towards the possible expansion of eligibility criteria.

A National Post editorial suggests that “the words ‘slippery slope’ are more than mere alarmism … In every state or country in which the practice [euthanasia and/or assisted suicide] has been normalized, it has also, to some degree, become banalized, with eligibility criteria increasingly relaxed.”  The editorial was referring to the possibility that Quebec might extend its assisted dying legislation to include those suffering from psychiatric conditions.

Writing for the Calgary Herald, Postmedia opinion columnist Licia Corbella reminds her readers that “with every year that passes since Feb. 6, 2015 — when the Supreme Court of Canada ruled unanimously to allow physicians to kill their patients — the slope in Canada keeps getting steeper and slicker.”

In a Globe and Mail opinion piece, Andrew Coyne insists that, when it comes to MAiD, “the slope is proving every bit as slippery as feared.”

Any slippery slope argument requires two premises, one causal and one normative.  The causal premise suggests that if we allow MAiD for terminally ill, consenting adults, it will inevitably lead to further exceptions.  The normative premise states that extending eligibility requirements would be reckless.  For any slippery slope assertion to be credible, both premises must be true.

Photo Credit: Keith Horton. Image Description: A burned tree with new leaves.

Slope crusaders, however, make no effort to prove that extensions of the original law are dangerous. They want the public to believe that MAiD, as well as further extensions to its eligibility requirements, places vulnerable populations at risk; however, they refuse to consider evidence that contradicts their assumptions.

Concerning the extension of eligibility requirements for MAiD, other countries have adopted safeguards to prevent widespread abuses.  In the Netherlands, The Groningen Protocol established guidelines for the euthanasia of severely ill newborns.  Strict criteria must be followed, including the presence of hopeless and unbearable suffering, parental consent, consultation with an independent physician and his or her agreement with the treating physicians, and the carrying out of the procedure in accordance with accepted medical standards.  In 22 cases that were reported to authorities, none of the doctors were prosecuted.

In terms of advance directives for dementia sufferers, a Dutch study noted that patients with dementia who received euthanasia were “deemed competent and able to communicate their wishes.”  In other words, these individuals were in the initial stages of dementia and still possessed decisional capacity.

In a Belgian study, 100 psychiatric patients who made persistent requests for euthanasia were eligible if they experienced unbearable suffering and were without any prospect of improvement.  In these case, the patients were deemed legally competent.

In 2013, Belgium permitted requests for the euthanasia of a minor, assuming the individual was terminally ill, experienced “constant and unbearable suffering,” and possessed the “capacity of discernment.”  Parental consent was also mandatory.

However, as with any changes in medical policy or law, procedural inconsistencies are inevitable, but this does not mean that medical practitioners acted with criminal intent, nor does it mean that extensions to the eligibility requirements for MAiD pose a major risk to vulnerable populations.  Safeguards either require more oversight or further clarifications.

Extending MAiD guidelines may also entail nuanced modifications.  For instance, the Canadian Council of Academies (CCA) notes that additional safeguards are needed for people seeking MAiD with mental disorders, mostly to ensure competency.  According to the CCA, these individuals “may be required to satisfy more eligibility criteria or procedural requirements than people with physical disorders who qualify under the current law.”  The requirement that death must be “reasonably foreseeable” would also have to be removed for non-terminally ill conditions.

An open system with safeguards has already proven effective.  According to the Fourth Interim Report on Medical Assistance in Dying in Canada, those receiving MAiD are consenting, terminally ill adults.  More than nine in ten who died through the intervention of a doctor or nurse practitioner had cancer-related illnesses, neurodegenerative conditions, or respiratory failure.

Because of this transparency, the public has gained confidence in the medical system’s handling of MAiD.  Hence, there is no reason to think that we cannot widen the existing eligibility requirements, monitor these changes in medical settings, and protect other vulnerable populations against abuses.

Yet some members of the mainstream media continue to use the term “slippery slope” carelessly.  If these skeptics could locate credible evidence of frightening scenarios, their slippery slope thesis would find a more receptive audience.  For instance, involuntary euthanasia (MAiD administered against the will of the patient) would qualify, as would the systematic erosion of informed consent for competent patients.  In the absence of such evidence, we are only left to speculate.

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Stuart Chambers teaches a course on death and dying in the Interdisciplinary School of Health Sciences at the University of Ottawa. @StuartChambers9