Dan Gardner is the New York Times best-selling author of Risk, Future Babble, Superforecasting (co-authored with Philip E. Tetlock), and How Big Things Get Done (co-authored with Bent Flyvbjerg). His books have been published in 26 countries and 20 languages. Prior to becoming an author, Gardner was an award-winning investigative journalist. More >

Euthanasia Is Not A Slippery Slope

With the release of an important new report, and the launch of another Charter challenge, the debate about euthanasia is flaring up again. It will be passionate. You will hear emotional claims from both sides. Many people will listen to nothing else. But for those who want to be rational, those who want to learn as much as they can and draw a conclusion based on evidence, there is one essential fact to bear in mind.

The Dutch are more honest than we are. Remember that.

If you've read anything about euthanasia, pro or con, chances are you have seen references to the Netherlands. And for good reason. The Dutch effectively legalized euthanasia in the early 1980s, and formally legalized it in 2002. Other countries - and two American states - have done the same, but the Dutch have had the most experience.

And that matters because the key argument against permitting euthanasia is the "slippery slope."

Yes, opponents of euthanasia say. There are articulate, intelligent and thoughtful people, afflicted with terminal diseases, who say they want to decide when and how they will die. It's easy to be sympathetic. It's easy to think doctors should have the legal right to prescribe a lethal dose of sedatives so that, when the time comes, they can die at home, without pain, surrounded by loved ones. It's even easy to think doctors should be able to inject them, if they are physically incapable of taking the overdose themselves.

But it won't stop there, they say. If we permit that, we will slide down a slippery slope.

What about people who aren't terminally stricken? What about the depressed and the mentally ill? What about elderly patients pressured by relatives who want to be relieved of the burden of their care? What about the mentally incompetent, who cannot consent? What about the disabled?

Every act of euthanasia will cheapen the value we put on life, they say. Every advance will make the next advance easier. Where will it end? Opponents of euthanasia are nothing if not passionate. They often conclude their arguments with references to the Nazis' murder of the disabled and other "undesirables." That's where it will end, they say.

If this is true, and the Dutch have had de facto legalized euthanasia for more than a quarter-century, the Netherlands must be well down that slippery slope by now.

So they are, claim opponents of euthanasia. "By 1995, almost three per cent of all deaths were the result of euthanasia or assisted suicide," wrote Barbara Kay in the National Post, and there were hundreds of cases in which "doctors had acted without the consent of the patient, mainly for reasons of dementia."

That's the sort of claim you will see more of. Which is why you have to remember: the Dutch are more honest than we are.

Notice what Kay simply assumes? What she implicitly leads the reader to conclude? That there was no euthanasia in the Netherlands before it was legalized. She makes the same assumption about Canada and other countries that now forbid it. Euthanasia? Here? Impossible. It's forbidden.

But it happens. All the time. A 2001 survey of physicians in the Netherlands and five other European countries, including four that banned euthanasia, found that the deliberate hastening of death in some form - whether euthanasia (prescribing drugs for someone to end their own life), physician-assisted suicide (the doctor injects the drugs), or ending life without explicit patient consent - occurred in every country. Granted, the reported Dutch rate of euthanasia (2.6 per cent) was higher than the rate in the other countries (which ranged from a low of zero in Italy to a high of 0.3 per cent in Belgium). But the rate at which lives were ended without explicit patient request was roughly the same in the Netherlands (0.7 per cent) as elsewhere (ranging from 0.1 per cent to 1.5 per cent).

And yes, it happens here, too. "Assisted dying presently goes on in various medical contexts in Canada," concluded the report of an expert panel convened by the Royal Society of Canada (RSC),( (www.rsc.ca┬╗) ) released this week. But we're not as honest as the Dutch. We won't say it's happening. We won't say it will continue to happen whether the law permits it or not. And we certainly won't talk about how to control and regulate it. No, we prefer to have a law forbidding euthanasia and simply pretend it doesn't happen.

Of course, as a consequence of that hypocrisy, critical decisions about end-of-life care are made in private, quietly, by the people involved. And this inflicts "anxiety, uncertainty, and needless suffering" on everyone, as the Royal Society of Canada report noted. And it means that end-of-life decisions "are governed by arbitrariness and lack of clarity rather than transparent, democratically enacted norms."

But an awful lot of Canadians prefer that to being honest.

Fortunately, the Dutch are blessed with a far more open social and political culture. It's also a more pragmatic culture. The Dutch frankly acknowledge the existence of difficult problems and they don't try to do what cannot be done. This honesty and practicality - not liberal anything-goes permissiveness - is the source of their drug and prostitution policies. It's also the reason why the Dutch legalized and regulated euthanasia. And why they rigorously studied the results.

In the first Dutch study, conducted in 1990, the rate of voluntary euthanasia was 1.7 per cent of all deaths. In 1995, it was 2.4 per cent. In 2000, it was 2.6 per cent. In 2005, the most recent year for which data are now available, the rate was 1.7 per cent - exactly the same as it was in 1990.

The rate of assisted suicide was 0.2 per cent in 1990. In 2005, it was 0.1 per cent.

The rate of "life-terminating acts without explicit request of the patient" was 0.8 per cent in 1990. In 2005, it was down by half to 0.4 per cent.

The research also showed that most patients who choose euthanasia would have died soon anyway: Almost half had a life expectancy of less than a week; only eight per cent had a life expectancy of more than a month. As for those cases of "life-terminating acts without explicit request of the patient," the RSC report notes they "typically involve patients who are very close to death and are presently incompetent but where there has been an earlier discussion about hastening death with them and/or their relatives."

And, no, the vulnerable are not being singled out. A 2009 summary of research by Dutch scientists concluded "there is no evidence for a higher frequency of euthanasia among the elderly, people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial and ethnic minorities, compared with background population."

In sum, there is "no evidence of a slippery slope." The RSC report came to the same conclusion.

That's good to know. And we know it thanks to the honesty of the Dutch.