Jos VM Welie argues that the Groningen Protocol in the Netherlands presents a clear example of a slippery slope in the area of physician assistance in suicide and euthanasia.

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Recently, Stuart Chambers in his commentary on physician assistance in suicide presented a forceful case against slippery slope arguments. From a strictly logical perspective, these arguments are admittedly problematic. Even if one fears that the adoption of X will lead to people next adopting Y, the mere fact that Y is an immoral practice is not sufficient reason to deem X itself immoral. But from a more pragmatic perspective, such a slippery slope should be a source of concern if Y constitutes a dramatic transgression of the legal limits that were set up to make X initially acceptable.

Chambers too easily accepts the public reports that both the Royal Dutch Medical Association and the Dutch Government present about physician assistance in suicide and euthanasia in the Netherlands. To undermine slippery slope concerns about medical assistance in dying in Canada, Chambers writes: “The Groningen Protocol established guidelines for the euthanasia of severely ill newborns. Strict criteria must be followed … In 22 cases that were reported to authorities, none of the doctors were prosecuted.” Ironically, this Protocol is itself one of the most evident examples of a slippery slope in matters of physician assistance in suicide.

Dutch law only permits competent patients to request physician assistance in suicide or euthanasia. The law does not allow the lives of newborns to be ended at the request of parents. Indeed, the law does not allow physicians to honor any third person’s request for somebody else’s life to be ended.

The Dutch government issued a regulation (not an actual law) on neonatal termination of life in 2007 and revised it in 2018. The regulation lumps the practice conducted under the Groningen Protocol together with late-term abortions. Cases of infanticide performed by doctors are reviewed by a special committee after the fact which then sends its report to the criminal prosecutor. But the practice remains de facto illegal, the governmental regulation notwithstanding.

Photo Credit: Alberto Biscalchin. Image Description: A hand covered with gloves holds another hand.

In fact, Dutch law makers maneuvered legalization of physician assistance in suicide and euthanasia through parliament precisely by arguing that both are an operationalization of the principle of respect for patient autonomy, and that a patient’s explicit and persistent request for either practice should be respected. A neonate evidently cannot make such requests. An exception was made for mature minors (between the ages of 12 and 16), but even then dual consent of both the parents and the minor is needed.

Barely one year after the new law took effect, a team of physicians at the Groningen Medical Center decided to set aside these legal requirements and adopt a protocol about termination of life of certain neonates. Chambers insists that this protocol includes strict criteria. Of course it does; I know of no advocate of physician assistance in suicide/euthanasia who does not insist on strict criteria. What matters is that the Groningen Protocol is itself a violation of an existing set of criteria. More specifically, the Protocol sets aside the single most important criterion in the 2001 Dutch law: Only patients themselves can request these services, and then only by voicing an explicit and persistent request.

The Protocol is a telling example of a slippery slope. (a) It involves a practice that opponents of legalization feared was going to happen. (b) Advocates countered that the worry was unjustified and an unfair objection because the bill only allowed physician assistance in suicide/euthanasia proper, that is, at the explicit and persistent request of the patient himself or herself. (c) This assurance then led to the adoption of the bill. (d) Once the practice of adult physician assistance in suicide/euthanasia had been decriminalized and regularized, a new proposal was launched to decriminalize the very practice that opponents had been worried about all along.

Chambers points out that the physicians engaged in neonatal infanticide have not been prosecuted. But this is not an argument against the presence of a slippery slope. Rather, it is an argument in support thereof. After decades of study and debate the Dutch parliament had passed a brand new law excluding this practice. Hence Dutch prosecutors should have gone after these physicians. That they did not underscores how slippery this slope is. Within a single year after the new law taking effect, even those charged with its enforcement decided not to enforce it, and instead chose to tolerate this expansion of the practice beyond its original limits. And now that neonatal termination of life has been regularized, it becomes possible to yet again surpass the original limits and open the door to termination of life of children below the age of 12, as proposed more recently by the Dutch Association of Pediatrics.

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Jos VM Welie is Dean at the University College Maastricht (The Netherlands) and Professor of Health Care Ethics at Creighton University (USA).