Last updated on: 7/9/2018 | Author:

Would Legalizing Physician-Assisted Suicide or Voluntary Euthanasia Create a Slippery Slope to Non-Voluntary or Involuntary Euthanasia?

General Reference (not clearly pro or con)

The BBC, wrote in a section titled “Anti-Euthanasia Arguments” in its “Ethics Guides” page of (accessed July 26, 2018):

“Many people worry that if voluntary euthanasia were to become legal, it would not be long before involuntary euthanasia would start to happen…

This is called the slippery slope argument. In general form it says that if we allow something relatively harmless today, we may start a trend that results in something currently unthinkable becoming accepted.

Those who oppose this argument say that properly drafted legislation can draw a firm barrier across the slippery slope.”

July 26, 2018

James Fieser, Professor of Philosophy at the University of Tennessee at Martin, in a Sep. 1, 2017 version of the manuscript, “Moral Issues that Divide Us,” available via his faculty profile at, stated:

“Another distinction is between voluntary and non-voluntary euthanasia. Voluntary euthanasia is when a competent adult requests or gives informed consent to a particular death-causing action. This is the scenario that we have so far been presuming with Bob’s case: he is conscious, rational, and in a proper mental state by which he can make a willful request. Often, though, people do not have the mental competence to make these decisions, such as when they are unconscious, delirious, or demented. In these situations an act of euthanasia would be nonvoluntary when the decision is made by a third party, and not the person himself who is to die. For example, if Bob fell into a coma, Bob’s wife might have made the decision to terminate his life. It is important to note, though, that the term ‘nonvoluntary’ does not mean the same thing as ‘involuntary.’ An involuntary act is one which is imposed on a person against his will, such as if Bob did not want to die and his physician gave him a lethal injection anyway. This would be a case of murder, and not mercy killing. Rather, with nonvoluntary euthanasia, a patient is incompetent to make a decision, and a third-party steps in as a surrogate to make the call on behalf of the patient’s best interests.”

Sep. 1, 2017

The BBC in a 2014 ethics guide, “Forms of Euthanasia,” available at, stated:

“Non-voluntary euthanasia occurs when the person is unconscious or otherwise unable (for example, a very young baby or a person of extremely low intelligence) to make a meaningful choice between living and dying, and an appropriate person takes the decision on their behalf.

Non-voluntary euthanasia also includes cases where the person is a child who is mentally and emotionally able to take the decision, but is not regarded in law as old enough to take such a decision, so someone else must take it on their behalf in the eyes of the law.

Involuntary euthanasia occurs when the person who dies chooses life and is killed anyway. This is usually called murder, but it is possible to imagine cases where the killing would count as being for the benefit of the person who dies.”


The BBC website’s Religion and Ethics section on euthanasia explained (accessed on Aug. 20, 2007) :

“Non-Voluntary Euthanasia: The person cannot make a decision or cannot make their wishes known. This includes cases where:

  • the person is in a coma
  • the person is too young (e.g. a very young baby)
  • the person is senile
  • the person is mentally retarded to a very severe extent
  • the person is severely brain damaged
  • the person is mentally disturbed in such a way that they should be protected from themselves.”
  • Aug. 20, 2007

    M. Cathleen Kaveny, JD, PhD, John P. Murphy Foundation Professor of Law, in her 1997 Theological Studies article, “Assisted Suicide, Euthanasia, and the Law,” explained:

    “The term ‘euthanasia’ in general refers to a situation in which one party adopts a course of action with the intention of causing the death of a second party in order to alleviate suffering…’nonvoluntary’ euthanasia is performed on patients who have expressed and can express no view on the matter.”


    Jonathan Moreno, PhD, in the introduction to the 1995 book Arguing Euthanasia, explained:

    “Passive euthanasia in the absence of knowledge of the patient’s wishes (nonvoluntary) remains controversial… Within the meaning of active euthanasia, the difference between voluntary euthanasia and nonvoluntary euthanasia is also important… active nonvoluntary euthanasia may be performed on a patient who is not competent and who has not requested it.”


    PRO (yes)


    Daniel Callahan, President Emeritus and Cofounder of The Hastings Center, in a Mar. 19, 2018 article, “Does the Future Belong to Assisted Death?,” available at, stated

    “My introduction to the Dutch scene in the late 1980s was to see a slippery slope in the making, first in the Netherlands and then in other countries. In Belgium, for example, euthanasia is now legal for terminally ill children, as well as for adults who have mental illness and dementia, and who are ‘tired of living.’ The loosening of restrictions on who qualifies for euthanasia is evidence of the high value placed on individual autonomy in determining the time and means of death. It is a concept with no inherent limits.”

    Mar. 19, 2018


    Tan Seow Hon, SJD LLM, LLB, Associate Professor of Law at Singapore Management University and Solicitor, in an Aug. 2017 Singapore Academy of Law Journal article, “The Case against Physician-Assisted Suicide and Voluntary Active Euthanasia,” stated:

    “[T]he empirical slippery slope cannot be ignored when one looks at the facts across the world… [T]here remains a real possibility of the extension of euthanasia to infants, those with mental incapacities or disabilities, and the elderly…

    Indeed, this has materialised to some degree, whether by a formal extension of categories of persons to whom euthanasia is allowed, or by loose application of criteria by personnel involved in the administration of euthanasia. For example, Belgium removed the age restriction for euthanasia in 2014; assisted death has extended beyond the line originally drawn by the law in the Netherlands to patients regarded as legally and mentally incompetent and the possibility of extension to those who are not terminally ill but feel their lives are complete is being considered; severe psychic pain in and otherwise healthy person has been thought sufficient ground for requesting euthanasia; and researchers have found cases of non-voluntary euthanasia in the form of the termination of lives of disabled infants in the Netherlands.

    Denying euthanasia honours the sanctity of life and the equal, underived, intrinsic moral worth of all persons, including the very weakest who can no longer contribute to society – principles of which so many other laws pivot.”

    Aug. 2017


    The Bioethics Observatory Institute of Life Sciences at the Catholic University of Valencia in an Aug. 15, 2017 article, “Review of Countries Where Euthanasia Has Been Legalised. Increasing Involuntary Euthanasia, without Consent by Patients,” available at, stated:

    “Euthanasia a slippery slope that ends in involuntary euthanasia

    Euthanasia was legalised in Belgium in 2002, where is defined as ‘the intentional termination of a patient’s life by a physician at the patient’s request’, so that only voluntary euthanasia may be legally carried out in Belgium. However, this legal requirement of voluntarism is not always fulfilled.

    Thus, a study conducted in Flanders in 1996 found that 3.3% of cases of euthanasia had occurred without the prior request of the patient. In other words, they were involuntary euthanasias. Another study (also in Flanders) found that there had been 1796 cases of involuntary euthanasias (3.2%). A more recent study from 2007 found that the percentage of involuntary euthanasia was 1.8%, while another in 2013 found 1.7%.

    However — and we believe this is important — the percentage of involuntary euthanasia in patients who were 80-years-old or over rose to 52.7%, while in those with diseases other than cancer, this figure reached 67.5%. The decision was not discussed with the patient in 77.9% of cases.”

    Aug. 15, 2017


    Ronald Pies, MD, Emeritus Professor of Psychiatry at SUNY Upstate Medical University, in an Aug. 2, 2016 article, “The Slippery Slope to Euthanizing Psychiatric Patients,” available at, stated:

    “Imagine that your adolescent son or daughter suffers from a serious and intractable depressive illness. Every treatment short of electroconvulsive therapy has been tried, but nothing has really worked. After years of misery, your teenage child tells you, ‘That’s enough. I’m done! I’m gonna end this, one way or another.’ How would you feel if your child’s doctor now offered to help your child commit suicide by prescribing a lethal drug?

    If you think this scenario is the stuff of Orwellian fiction, think again. So-called ‘physician-assisted dying’—even for people with nonterminal illnesses, like major depression—is now accepted practice in parts of Europe. Extending this ‘right’ to youth with intractable mental illness could eventually become legal in Canada. And if current trends favoring ‘physician-assisted suicide’ (PAS) in the United States accelerate, we could find ourselves in a similar position.”

    Aug. 2, 2016


    Wesley Smith, JD, Senior Fellow in Human Rights and Bioethics at the Discovery Institute, stated in his May 25, 2006 testimony before the US Senate Judiciary Subcommittee on the Constitution, Civil Rights, & Property Rights:

    “First, the slippery slope is very real. As Dr. [K.F.] Gunning put it, the Dutch have proved that once killing is accepted as a solution for one problem, tomorrow it will be seen as the solution for hundreds of problems. Once we accept the killing of terminally ill patients, as did the Dutch, we will invariably, over time, accept the killing of chronically ill patients, depressed patients, and ultimately perhaps, even children…

    [T]he euthanasia virus is catching. A 2000 report found that 10 percent of Belgian deaths appear to result from euthanasia [“End-of-Life Decisions in Medical Practice in Flanders, Belgium: A Nationwide Survey,” The Lancet, Nov. 25, 2000]. With Belgian doctors clearly eager to follow the lead of their Dutch neighbor, Belgium formally legalized euthanasia in 2002. Notably, the first Belgian case, the killing of a man with multiple sclerosis, violated the guidelines; and just as occurs routinely in the Netherlands, the doctor involved faced no consequences. Now Belgium is set to legalize euthanasia for children. Indeed, Belgian doctors in Flanders have been found to commit infanticide in about the same numbers as their Dutch counterparts.”

    May 25, 2006


    Eugene Volokh, JD, Gary T. Schwartz Professor of Law at the University of California at Los Angeles, stated in a Feb. 2003 Harvard Law Review article titled “The Mechanisms of the Slippery Slope”:

    “[A] sort of equality-based slippage has indeed happened in the Netherlands.

    Dutch courts began by declining to punish doctors who assist the suicides of the terminally ill. They then extended this to those who are subject to ‘unbearable suffering,’ without any requirement that they be terminally ill.

    They then extended this to a person who was in seemingly irremediable mental pain, caused by chronic depression, alcohol abuse, and drug abuse, on the theory that the suffering of the mentally ill is ‘experienced as unbearable’ by them, presumably comparably to how the physically ill experience physical suffering.

    Dutch courts then extended this to a 50-year-old woman who was in seemingly irremediable mental pain caused by the death of her two sons, again on the theory that ‘[h]er suffering was intolerable to her.'”

    Feb. 2003


    Robert M. Walker, MD, Associate Professor in the Department of Internal Medicine in the Division of Medical Ethics and Humanities at the University of South Florida College of Medicine, wrote in a Jan./Feb. 2001 Cancer Control article titled “Physician-Assisted Suicide: The Legal Slippery Slope”:

    “The current legal system allows the possibility of a legal slippery slope in moving from PAS [physician-assisted suicide] to voluntary euthanasia to nonvoluntary euthanasia… the potential for extending PAS to incapacitated patients remains. At a minimum, this scenario of case law extension of PAS to incapacitated patients should at least give pause to true advocates of patient choice. It should prompt them to reconsider the wisdom of continued efforts to legalize PAS, since doing so expands the potential for future legal decisions that will end life based not on patient choice but on the choice of others.”

    Jan./Feb. 2001


    David N. O’Steen, PhD, Executive Director of the National Right to Life Committee, stated in a Nov. 28, 2000 press release titled “Legalizing Euthanasia in Holland and the ‘Slippery Slope'”:

    “The fact that euthanasia is being re-regulated in the Netherlands does not mean that it is going to be slowed…

    Once you open the door to justify killing in some cases, the practice inevitably grows and grows as it has in Holland where there are now many patients killed who have never requested euthanasia at all.”

    Nov. 28, 2000

    CON (no)


    RMIT ABC (Australia) Fact Check, in a Feb. 22, 2018 article, “Fact Check: Has Assisted Dying Been a Legal Slippery Slope Overseas?,” available at, stated:

    “In most jurisdictions where assisted dying has been legalised, little has changed regarding what practices are allowed or who can access assisted dying.

    There have been some changes, such as in Belgium, where ‘competent minors’ can now request euthanasia.

    In the Netherlands, doctors have published guidelines for providing euthanasia to severely disabled newborns. Though these guidelines may help doctors avoid jail, the practice itself remains illegal…

    Canada’s framework is still new and may yet evolve as it is challenged in the courts.
    But despite pressure for change in the United States, there has been no further liberalisation in any of the five states involved. This includes Oregon, where the system has been operating since 1997.

    Despite these few changes, legal experts contacted by Fact Check agreed there was no evidence of restrictions being increasingly loosened.”

    Feb. 22, 2018


    Joceyln Downie, MA, MLitt, LLM, SJD, Professor of Law at Dalhousie University, as quoted in a Feb. 22, 2018 article, “Fact Check: Has Assisted Dying Been a Legal Slippery Slope Overseas?,” available at, stated:

    “The bottom line is that we have not seen evidence of the slippery slope and there is no good reason to believe that the experience on that front would be any different in Australia. [Reports by Australian groups] all conclude that the slippery slope arguments are not supported by valid and reliable evidence.”

    Feb. 22, 2018


    Robert Young, PhD, Reader in the School of Communication, Arts, and Critical Enquiry at La Trobe University, wrote in an Aug. 27, 2008 article titled “Voluntary Euthanasia” on the Stanford Encyclopedia of Philosophy website:

    “[S]ince there is nothing arbitrary about distinguishing voluntary euthanasia from non-voluntary euthanasia (because the line between them is based on clear principles), there can be no substance to the charge that only by arbitrarily drawing a line between them could non-voluntary euthanasia be avoided once voluntary euthanasia was legalized…

    [The Netherlands’] legalization of voluntary euthanasia has not increased the incidence of non-voluntary euthanasia. Indeed, such studies as have been published about what happens in other countries, like Australia, where no legal protection is in place, suggest that the pattern in The Netherlands and elsewhere is quite similar. Some have argued, further, that there may be more danger of the line between voluntary and non-voluntary euthanasia being blurred if euthanasia is practised in the absence of legal recognition, since there will be no transparency or monitoring…

    None of this is to suggest that there is no need to put in place safeguards against potential abuse of legally protected voluntary euthanasia…

    [I]f the arguments given above are sound (and the Dutch experience, along with the more limited experience in the State of Oregon and in Belgium, is not only the best evidence we have that they are sound, but the only relevant evidence), that does not seem very likely.”

    Aug. 27, 2008


    Nancy W. Dickey, MD, President of the Texas A&M Health Science Center, was quoted in a May 9, 2007 HealthDay News article titled “Dutch Euthanasia Rates Steady after Legalization” by Amanda Gardner:

    “Neither Oregon nor the Netherlands appear to have started down a slippery slope. … Also, physicians have become better equipped to offer a wide variety of palliative care, leading them to become more effective at it and very rarely having to resort to assisted death…

    The passing of the law was a formalization of a practice that the Netherlands freely admitted occurred on a less-than-rare basis.”

    May 9, 2007


    Penney Lewis, LLM, Reader in Law at the School of Law and Centre of Medical Ethics at Kings College, stated in a Spring 2007 Journal of Law, Medicine & Ethics: article titled “The Empirical Slippery Slope from Voluntary to Non-Voluntary Euthanasia”:

    “Most critics rely predominantly on Dutch evidence of cases of ‘termination of life without an explicit request’ as evidence for the slide from voluntary euthanasia to non-voluntary euthanasia. According to the three national surveys of ‘medical behaviour which shortens life’ in the Netherlands, the cases in the ‘termination of life without an explicit request’ category represent less than one percent of all deaths…

    There is no evidence demonstrating that the Netherlands has a greater rate of non-voluntary or involuntary euthanasia than other Western countries. Indeed, there is a significant amount of evidence demonstrating the prevalence of both voluntary and nonvoluntary active euthanasia in various jurisdictions in which euthanasia has not been legalized, looking at criminal prosecutions, admissions by doctors and anonymous surveys of medical professionals.”

    Spring 2007


    Agnes van der Heide, MD, PhD, Senior Researcher in the Department of Public Health at Erasmus University, in a May 10, 2007 New England Journal of Medicine: article titled “End-of-Life Practices in the Netherlands under the Euthanasia Act,” stated:

    “In 2005, of all deaths in the Netherlands, 1.7% were the result of euthanasia and 0.1% were the result of physician-assisted suicide. These percentages were significantly lower than those in 2001, when 2.6% of all deaths resulted from euthanasia and 0.2% from assisted suicide..

    Conclusions: The Dutch Euthanasia Act was followed by a modest decrease in the rates of euthanasia and physician-assisted suicide. The decrease may have resulted from the increased application of other end-of-life care interventions, such as palliative sedation.”

    May 10, 2007


    R.G. Frey, DPhil, Professor of Philosophy at Bowling Green State University, wrote in a chapter titled “The Fear of a Slippery Slope,” that appeared in his 1998 book Euthanasia and Physician-Assisted Suicide: For and Against, coauthored with Gerald Dworkin and Sissela Bok:

    “Especially with regard to taking life, slippery slope arguments have long been a feature of the ethical landscape, used to question the moral permissibility of all kinds of acts… The situation is not unlike that of a doomsday cult that predicts time and again the end of the world, only for followers to discover the next day that things are pretty much as they were…

    We need the evidence that shows that horrible slope consequences are likely to occur. The mere possibility that such consequences might occur, as noted earlier, does not constitute such evidence.”



    In Compassion in Dying v. State of Washington (decided Mar. 6, 1996), the US Court of Appeals for the Ninth Circuit, in a decision written by Circuit Judge Stephen Reinhardt, held that:

    “Known as a slippery slope argument or what one commentator has called the ‘thin edge of the wedge’ argument, the opponents of assisted-suicide conjure up a parade of horribles and insist that the only way to halt the downward spiral is to stop it before it starts…

    This same nihilistic argument can be offered against any constitutionally-protected right or interest. Both before and after women were found to have a right to have an abortion, critics contended that legalizing that medical procedure would lead to its widespread use as a substitute for other forms of birth control or as a means of racial genocide. Inflammatory contentions regarding ways in which the recognition of the right would lead to the ruination of the country did not, however, deter the Supreme Court from first recognizing and then two decades later reaffirming a constitutionally-protected liberty interest in terminating an unwanted pregnancy. In fact, the Court has never refused to recognize a substantive due process liberty right or interest merely because there were difficulties in determining when and how to limit its exercise or because others might someday attempt to use it improperly.

    Recognition of any right creates the possibility of abuse. The slippery slope fears of Roe’s [Roe v. Wade] opponents have, of course, not materialized. The legalization of abortion has not undermined our commitment to life generally; nor, as some predicted, has it led to widespread infanticide. Similarly, there is no reason to believe that legalizing assisted suicide will lead to the horrific consequences its opponents suggest.”

    Mar. 6, 1996 - Compassion in Dying v. Washington