Physician-Assisted Suicide and Euthanasia: A Slippery Slope Indeed

July 29, 2015

The cover story of the June 29, 2015 weekly edition of The Economist reads “The right to die: Why assisted suicide should be legal”. In the article, the popular and influential British newsmagazine gives a number of arguments why physician assisted suicide should be decriminalized. One such reason the author cites is that “evidence from places that have allowed assisted dying suggests that there is no slippery slope towards widespread euthanasia.” Simply, this is not true.

Physician-assisted suicide is the act of a physician providing a death-causing means, such as prescribing a lethal dose of barbiturates to a patient designed to end their life. The patient then fills the medication at a pharmacy and self-administers it at their leisure. In most contexts, no healthcare professional need be present. This is currently legal in Colombia, the Netherlands, Luxembourg, and Switzerland, as well as the US states of Oregon, Montana, Washington, and Vermont. This is differentiated by voluntary euthanasia, which is the practice of a physician ending a life, typically by administering a lethal injection to the patient. It is important to note that neither term applies to a patient’s refusal of life-sustaining technology, such as a respirator or artificial nutrition. Neither do the terms apply to a patient’s request that these be withdrawn, for these have had ethical and legal sanction nationally for years.

In the past year, the push within the US by the pro-assisted suicide camp has been enhanced by the highly publicized case of Brittany Maynard, the 29-year-old woman who, after being diagnosed with brain cancer and given a grim prognosis, moved from her home state of California to Oregon in order to attain a legal right-to-die. Maynard’s story, and those similar, elicit sympathy and compassion from those on both sides of this issue. As one who is against allowing patients the right to seek a lethal prescription from their physician, I can still have compassion on those in the midst of agonizing suffering. However, I do not believe that the answer to this problem is legalizing assisted dying. One reason for this is it has been well documented (contrary to the article cited above) that in those countries where physician-assisted suicide or euthanasia has been legalized, a slippery slope gradually occurs.

April 1, 2002: The Netherlands’ “Termination of Life on Request and Assisted Suicide Act” takes effect, making it the first country to enact such legislation. Conditions of the original law included that the providing physician must be convinced that it concerns a voluntary and well considered request, and must be convinced that it concerns unbearable and hopeless suffering of a patient. Further, certain age requirements had to be met. The original law applied to competent adults, though some caveats for minors existed. If the minor patient is between sixteen and eighteen years and may be deemed to have a reasonable understanding of his interests, the physician may carry out the patient’s request for termination of life or assisted suicide, after the parents/guardians have been involved in the decision process. If the minor patient is aged between twelve and sixteen years and may be deemed to have a reasonable understanding of his interests, the physician may carry out the patient’s request, provided always that the parents/guardians agree with the termination of life.[1]
May 28, 2002: The Belgian Parliament legalizes voluntary euthanasia and physician-assisted suicide. Those wishing to end their lives must be under “constant and unbearable physical or psychological pain”. Additionally, only adults may seek assistance in dying.[2]
September 2004: The Groningen Protocol is created by the University Medical Center Groningen in Groningen, Netherlands. It stipulates criteria under which physicians may perform the euthanasia of “severely ill newborns with a hopeless prognosis and unbearable suffering” without fear of legal prosecution.[3]
June 2010: A study appears in the Canadian Medical Association Journal that discovered that out of 208 physician-assisted deaths studied in Belgium, 66 (31.7%) were administered without an explicit patient request.[4]
February 2014: Belgium becomes the first country in the world to lift all age restrictions on euthanasia. For children who request euthanasia, they must have a terminal and incurable illness, near death, and suffering great pain. Parents and healthcare professionals must agree to the choice.[5]
April 2014: An 89-year-old retired art teacher utilizes assisted suicide to end her life at a Swiss clinic after becoming disillusioned with the curses of modern life from emails to fast food. Though suffering from ill health in recent years, she was neither terminally ill nor seriously handicapped.[6]
May 2014: The Swiss organization “Exit” that helps people take their own lives officially votes to extend its services to elderly people who are not terminally ill.
February 2015: In a study published by the Journal of Medical Ethics, approximately one in three Dutch physicians would be prepared to help someone with a psychiatric disease, early dementia, or patients who are simply “tired of living” to die.[7]
March 19, 2015: An article appears in the prestigious New England Journal of Medicine revealing that in 2013, Belgian doctors hastened the death of patients “without an explicit request” at the rate of 1.7% of all deaths in the country. This equates to more than 1,000 patients each year that are euthanized without explicit request.[8] Moreover, from 2010 to 2013, the number of reported euthanasia in Belgium has almost doubled (an 89% increase) in the four-year period. Additionally, a great amount of people have asked to be euthanized when their death was not expected in the short term (13% of euthanasia).[9]
June 2015: Dutch Pediatric Association says country should follow Belgium in changing law on euthanasia and scrapping age limit for children in unbearable suffering.[10]

This is merely a small sampling to illustrate how, gradually, assisted suicide and euthanasia laws become increasingly relaxed and open to a greater amount of people for increasing reasons. What begins as only allowing for death in the case of competent, terminally ill adults, spirals into euthanasia without request and allowing children to seek their own termination. Legal scholar and Georgetown University Professor of Christian Ethics has affirmed:

Once a doctor is prepared to make such a judgment in the case of patient capable of requesting death, the judgment can, logically, equally be made in the case of a patient incapable of requesting death…If a doctor thinks death would benefit the patient, why should the doctor deny the patient that benefit merely because the patient is incapable of asking for it? If denying assistance in suicide to those physically incapable of committing it, and for whom death is thought a benefit, amounts to discrimination, why does denying euthanasia to those mentally incapable of requesting it, and for whom death is thought a benefit, not amount to discrimination? The logical “slippery slope” argument is unanswerable.[11]

Similarly, Ezekiel Emanuel, former Chief of the Department of Bioethics of the US National Institutes of Health and current Chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, writing in the Atlantic Monthly, has stated:

The Netherlands studies fail to demonstrate that permitting physician-assisted suicide and euthanasia will not lead to the nonvoluntary euthanasia of children, the demented, the mentally ill, the old, and others. Indeed, the persistence of abuse and the violation of safeguards, despite publicity and condemnation, suggest that the feared consequences of legalization are exactly its inherent consequences.[12]

The evidence from those countries that have legalized physician-assisted suicide or euthanasia is overwhelmingly in favor of a slippery slope. In our own country where we are already seeing invigorated pushes to decriminalize physician-assisted suicide, we need to approach the issue with a clear view of what it is we are asking for. Legalizing physician-assisted suicide or euthanasia would be a step in the wrong direction in comparison to our current situation. If proponents of assisted dying are going to make a strong case, they must come to terms with the facts of what has happened in those countries where it has been legalized, for glossing over the gradual liberalization is not helpful to the conversation, nor is it honest.

For the church, physician-assisted suicide and euthanasia is a very pressing issue, and the big debates loom just over the horizon. We must affirm to our churches what it means not only to have a good life but a good death. A good death is able to minimize suffering when possible, and it affirms the inherent dignity of the person. In a profound, true sense, one cannot evade all forms of human suffering. I am not arguing, of course, that people should simply accept every kind of suffering. However, the opposite position that one must intervene to alleviate all suffering, or even intervene before the suffering begins, is an extreme one. Suffering was not part of God’s original design for his creation. It is the result of the fall, just like death. However, God can use these to accomplish his greater purposes in the world. The notion of suffering and its ability to produce character and make possible a deeper experience with God is littered throughout Scripture. This is a point that opponents to our position will not be fond of, yet it is one that Christian tradition and Scripture stand upon and must not forfeit. The Christian church would do well to recover a robust ars moriendi and stand ready to articulate their position on assisted dying, lest culture attempt to redefine it for us.

[1] “Termination of Life on Request and Assisted Suicide (Review Procedures) Act,” http://www.eutanasia.ws/documentos/Leyes/Internacional/Holanda%20Ley%202002.pdf(accessed July 5, 2015).

[2] “Belgium legalises euthanasia,” http://news.bbc.co.uk/2/hi/europe/1992018.stm(accessed July 5, 2015).

[3] A.B. Jotkowitz and S. Glick, “The Groningen protocol: another perspective,” Journal of Medical Ethics, 32, no.3 (2006) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564470/(accessed July 5, 2015).

[4]Chambaere, Kenneth, et. al., “Physician-assisted deaths under the euthanasia law in Belgium: a population-based survey,” Canadian Medical Association Journal, 182, no. 9 (2010), http://www.cmaj.ca/content/182/9/895.full (accessed July 6, 2015).

[5] “Belgium passes law extending euthanasia to children of all ages,” http://www.theguardian.com/world/2014/feb/13/belgium-law-extends-euthanasia-children-all-ages (accessed July 5, 2015).

[6] “It’s adapt or die — she couldn’t adapt,” http://www.thesundaytimes.co.uk/sto/news/uk_news/Society/article1396979.ece(accessed July 5, 2015).

[7] Eva E. Bolt, et. al. “Can physicians conceive of performing euthanasia in case of psychiatric disease, dementia or being tired of living?” Journal of Medical Ethics (2015), http://jme.bmj.com/content/early/2015/01/30/medethics-2014-102150.short?g=w_jme_ahead_tab (accessed July 6, 2015).

[8] Kenneth Chambaere, et. al., “Recent Trends in Euthanasia and Other End-of-Life Practices in Belgium,” http://www.nejm.org/doi/full/10.1056/NEJMc1414527 (accessed July 6, 2015).

[9] European Institute for Bioethics, “Belgian Euthanasia Increases by 89% in four years,”

http://www.ieb-eib.org/fr/document/belgian-euthanasia-increases-by-89-in-four-years-382.html (accessed July 5, 2015)

[10] “Dutch paediatricians: give terminally ill children under 12 the right to die,”

http://www.theguardian.com/society/2015/jun/19/terminally-ill-children-right-to-die-euthanasia-netherlands (accessed July 5, 2015).

[11] John Keown, “A Right to Voluntary Euthanasia? Confusion in Canada in Carter,” Notre Dame Journal of Law, Ethics & Public Policy, Vol. 28, No. 1 (2014), p. 23, http://scholarship.law.nd.edu/ndjlepp/vol28/iss1/1/ (accessed July 6, 2015).

[12] Ezekiel J. Emanuel, “Whose Right to Die?” The Atlantic, March 1, 1997, http://www.theatlantic.com/magazine/archive/1997/03/whose-right-to-die/304641/ (accessed July 2, 2015).

Daniel J. Hurst

Daniel J. Hurst is director of Medical Professionalism, Ethics, and Humanities and assistant professor in the Department of Family Medicine at Rowan University School of Osteopathic Medicine in Stratford, New Jersey. He was previously on the faculty at UAB where he was involved in the xenotransplantation program performing studies on … Read More

Article 12: The Future of AI

We affirm that AI will continue to be developed in ways that we cannot currently imagine or understand, including AI that will far surpass many human abilities. God alone has the power to create life, and no future advancements in AI will usurp Him as the Creator of life. The church has a unique role in proclaiming human dignity for all and calling for the humane use of AI in all aspects of society.

We deny that AI will make us more or less human, or that AI will ever obtain a coequal level of worth, dignity, or value to image-bearers. Future advancements in AI will not ultimately fulfill our longings for a perfect world. While we are not able to comprehend or know the future, we do not fear what is to come because we know that God is omniscient and that nothing we create will be able to thwart His redemptive plan for creation or to supplant humanity as His image-bearers.

Genesis 1; Isaiah 42:8; Romans 1:20-21; 5:2; Ephesians 1:4-6; 2 Timothy 1:7-9; Revelation 5:9-10

Article 11: Public Policy

We affirm that the fundamental purposes of government are to protect human beings from harm, punish those who do evil, uphold civil liberties, and to commend those who do good. The public has a role in shaping and crafting policies concerning the use of AI in society, and these decisions should not be left to those who develop these technologies or to governments to set norms.

We deny that AI should be used by governments, corporations, or any entity to infringe upon God-given human rights. AI, even in a highly advanced state, should never be delegated the governing authority that has been granted by an all-sovereign God to human beings alone. 

Romans 13:1-7; Acts 10:35; 1 Peter 2:13-14

Article 10: War

We affirm that the use of AI in warfare should be governed by love of neighbor and the principles of just war. The use of AI may mitigate the loss of human life, provide greater protection of non-combatants, and inform better policymaking. Any lethal action conducted or substantially enabled by AI must employ 5 human oversight or review. All defense-related AI applications, such as underlying data and decision-making processes, must be subject to continual review by legitimate authorities. When these systems are deployed, human agents bear full moral responsibility for any actions taken by the system.

We deny that human agency or moral culpability in war can be delegated to AI. No nation or group has the right to use AI to carry out genocide, terrorism, torture, or other war crimes.

Genesis 4:10; Isaiah 1:16-17; Psalm 37:28; Matthew 5:44; 22:37-39; Romans 13:4

Article 9: Security

We affirm that AI has legitimate applications in policing, intelligence, surveillance, investigation, and other uses supporting the government’s responsibility to respect human rights, to protect and preserve human life, and to pursue justice in a flourishing society.

We deny that AI should be employed for safety and security applications in ways that seek to dehumanize, depersonalize, or harm our fellow human beings. We condemn the use of AI to suppress free expression or other basic human rights granted by God to all human beings.

Romans 13:1-7; 1 Peter 2:13-14

Article 8: Data & Privacy

We affirm that privacy and personal property are intertwined individual rights and choices that should not be violated by governments, corporations, nation-states, and other groups, even in the pursuit of the common good. While God knows all things, it is neither wise nor obligatory to have every detail of one’s life open to society.

We deny the manipulative and coercive uses of data and AI in ways that are inconsistent with the love of God and love of neighbor. Data collection practices should conform to ethical guidelines that uphold the dignity of all people. We further deny that consent, even informed consent, although requisite, is the only necessary ethical standard for the collection, manipulation, or exploitation of personal data—individually or in the aggregate. AI should not be employed in ways that distort truth through the use of generative applications. Data should not be mishandled, misused, or abused for sinful purposes to reinforce bias, strengthen the powerful, or demean the weak.

Exodus 20:15, Psalm 147:5; Isaiah 40:13-14; Matthew 10:16 Galatians 6:2; Hebrews 4:12-13; 1 John 1:7 

Article 7: Work

We affirm that work is part of God’s plan for human beings participating in the cultivation and stewardship of creation. The divine pattern is one of labor and rest in healthy proportion to each other. Our view of work should not be confined to commercial activity; it must also include the many ways that human beings serve each other through their efforts. AI can be used in ways that aid our work or allow us to make fuller use of our gifts. The church has a Spirit-empowered responsibility to help care for those who lose jobs and to encourage individuals, communities, employers, and governments to find ways to invest in the development of human beings and continue making vocational contributions to our lives together.

We deny that human worth and dignity is reducible to an individual’s economic contributions to society alone. Humanity should not use AI and other technological innovations as a reason to move toward lives of pure leisure even if greater social wealth creates such possibilities.

Genesis 1:27; 2:5; 2:15; Isaiah 65:21-24; Romans 12:6-8; Ephesians 4:11-16

Article 6: Sexuality

We affirm the goodness of God’s design for human sexuality which prescribes the sexual union to be an exclusive relationship between a man and a woman in the lifelong covenant of marriage.

We deny that the pursuit of sexual pleasure is a justification for the development or use of AI, and we condemn the objectification of humans that results from employing AI for sexual purposes. AI should not intrude upon or substitute for the biblical expression of sexuality between a husband and wife according to God’s design for human marriage.

Genesis 1:26-29; 2:18-25; Matthew 5:27-30; 1 Thess 4:3-4

Article 5: Bias

We affirm that, as a tool created by humans, AI will be inherently subject to bias and that these biases must be accounted for, minimized, or removed through continual human oversight and discretion. AI should be designed and used in such ways that treat all human beings as having equal worth and dignity. AI should be utilized as a tool to identify and eliminate bias inherent in human decision-making.

We deny that AI should be designed or used in ways that violate the fundamental principle of human dignity for all people. Neither should AI be used in ways that reinforce or further any ideology or agenda, seeking to subjugate human autonomy under the power of the state.

Micah 6:8; John 13:34; Galatians 3:28-29; 5:13-14; Philippians 2:3-4; Romans 12:10

Article 4: Medicine

We affirm that AI-related advances in medical technologies are expressions of God’s common grace through and for people created in His image and that these advances will increase our capacity to provide enhanced medical diagnostics and therapeutic interventions as we seek to care for all people. These advances should be guided by basic principles of medical ethics, including beneficence, non-maleficence, autonomy, and justice, which are all consistent with the biblical principle of loving our neighbor.

We deny that death and disease—effects of the Fall—can ultimately be eradicated apart from Jesus Christ. Utilitarian applications regarding healthcare distribution should not override the dignity of human life. Fur- 3 thermore, we reject the materialist and consequentialist worldview that understands medical applications of AI as a means of improving, changing, or completing human beings.

Matthew 5:45; John 11:25-26; 1 Corinthians 15:55-57; Galatians 6:2; Philippians 2:4

Article 3: Relationship of AI & Humanity

We affirm the use of AI to inform and aid human reasoning and moral decision-making because it is a tool that excels at processing data and making determinations, which often mimics or exceeds human ability. While AI excels in data-based computation, technology is incapable of possessing the capacity for moral agency or responsibility.

We deny that humans can or should cede our moral accountability or responsibilities to any form of AI that will ever be created. Only humanity will be judged by God on the basis of our actions and that of the tools we create. While technology can be created with a moral use in view, it is not a moral agent. Humans alone bear the responsibility for moral decision making.

Romans 2:6-8; Galatians 5:19-21; 2 Peter 1:5-8; 1 John 2:1

Article 2: AI as Technology

We affirm that the development of AI is a demonstration of the unique creative abilities of human beings. When AI is employed in accordance with God’s moral will, it is an example of man’s obedience to the divine command to steward creation and to honor Him. We believe in innovation for the glory of God, the sake of human flourishing, and the love of neighbor. While we acknowledge the reality of the Fall and its consequences on human nature and human innovation, technology can be used in society to uphold human dignity. As a part of our God-given creative nature, human beings should develop and harness technology in ways that lead to greater flourishing and the alleviation of human suffering.

We deny that the use of AI is morally neutral. It is not worthy of man’s hope, worship, or love. Since the Lord Jesus alone can atone for sin and reconcile humanity to its Creator, technology such as AI cannot fulfill humanity’s ultimate needs. We further deny the goodness and benefit of any application of AI that devalues or degrades the dignity and worth of another human being. 

Genesis 2:25; Exodus 20:3; 31:1-11; Proverbs 16:4; Matthew 22:37-40; Romans 3:23

Article 1: Image of God

We affirm that God created each human being in His image with intrinsic and equal worth, dignity, and moral agency, distinct from all creation, and that humanity’s creativity is intended to reflect God’s creative pattern.

We deny that any part of creation, including any form of technology, should ever be used to usurp or subvert the dominion and stewardship which has been entrusted solely to humanity by God; nor should technology be assigned a level of human identity, worth, dignity, or moral agency.

Genesis 1:26-28; 5:1-2; Isaiah 43:6-7; Jeremiah 1:5; John 13:34; Colossians 1:16; 3:10; Ephesians 4:24