[Open Access] Lerner BH, Caplan AL. Euthanasia in Belgium and the Netherlands: On a Slippery Slope?. JAMA Intern Med. Published online August 10, 2015. http://archinte.jamanetwork.com/article.aspx?articleid=2426425
Part of the problem with the slippery slope is you never know when you are on it. Is the use of euthanasia or physician-assisted suicide appropriate for 1 of 20 to 25 dying patients? What if the next round of data indicates that the number has increased to 1 of 10 or 15 patients? Careful, independent studies are crucial to ensure that the safeguards put in place in the Netherlands and Belgium are working and that these end-of-life strategies remain ones of last resort for desperate individuals, not the wrong response to frailty and loneliness.
The European data are particularly relevant for the United States. Although proven interventions that ease the suffering of dying patients, such as hospice and palliative care, remain underused, 25 state legislatures and the District of Columbia have considered legislation related to physician-assisted dying during 2015.10Versions of physician-assisted dying are already allowed by legislation in Oregon, Washington, and Vermont and by court decisions in Montana and New Mexico. A 2014 Gallup poll found that 7 of 10 Americans believe physicians should be allowed to “legally end a patient’s life by some painless means.”6Meanwhile, the Supreme Court of Canada ruled in February 2015 that terminally ill patients in that country have the right to physician-assisted suicide.
Although the euthanasia practices in the Netherlands and Belgium are unlikely to gain a foothold in the United States, a rapidly aging population demanding this type of service should give us pause. Physicians must primarily remain healers. There are numerous groups that are potentially vulnerable to abuses waiting at the end of the slippery slope—the elderly, the disabled, the poor, minorities, and people with psychiatric impairments. When a society does poorly in the alleviation of suffering, it should be careful not to slide into trouble. Instead, it should fix its real problems.
Part of the problem with the slippery slope is you never know when you are on it. Is the use of euthanasia or physician-assisted suicide appropriate for 1 of 20 to 25 dying patients? What if the next round of data indicates that the number has increased to 1 of 10 or 15 patients? Careful, independent studies are crucial to ensure that the safeguards put in place in the Netherlands and Belgium are working and that these end-of-life strategies remain ones of last resort for desperate individuals, not the wrong response to frailty and loneliness.
The European data are particularly relevant for the United States. Although proven interventions that ease the suffering of dying patients, such as hospice and palliative care, remain underused, 25 state legislatures and the District of Columbia have considered legislation related to physician-assisted dying during 2015.10Versions of physician-assisted dying are already allowed by legislation in Oregon, Washington, and Vermont and by court decisions in Montana and New Mexico. A 2014 Gallup poll found that 7 of 10 Americans believe physicians should be allowed to “legally end a patient’s life by some painless means.”6Meanwhile, the Supreme Court of Canada ruled in February 2015 that terminally ill patients in that country have the right to physician-assisted suicide.
Although the euthanasia practices in the Netherlands and Belgium are unlikely to gain a foothold in the United States, a rapidly aging population demanding this type of service should give us pause. Physicians must primarily remain healers. There are numerous groups that are potentially vulnerable to abuses waiting at the end of the slippery slope—the elderly, the disabled, the poor, minorities, and people with psychiatric impairments. When a society does poorly in the alleviation of suffering, it should be careful not to slide into trouble. Instead, it should fix its real problems.
