Euthanasia, Ethics, and Public Policy: An Argument against Legalisation

By John Keown | Go to book overview

PART III
The Dutch experience: controlling VAE?
condoning NVAE?

To many, the slippery slope arguments are obviously persuasive. To others, however, they remain unconvincing, and no basis for resisting the decriminalisation of VAE in certain 'hard cases'. Why, it is asked, should the possibility of future abuse trump the certainty of present suffering?

As VAE has historically been illegal around the world, the empirical argument has, inevitably, lacked evidential support.(The logical argument, being philosophical rather than practical, does not rely on empirical evidence, though evidence of a shift in practice from condonation of VAE to condonation of NVAE would certainly illustrate its cogency.) More recently, that situation has changed. In 1984, the Supreme Court in one jurisdiction – the Netherlands – declared that doctors could lawfully carry out VAE in certain circumstances. Since that time a substantial body of evidence has accumulated which allows the empirical version of the slippery slope argument to be tested. Given the cardinal importance of the Dutch experience to the debate, the following chapters consider whether the evidence from the Netherlands indicates that VAE is, as the Dutch claim, effectively controlled, and whether there has been a shift towards condonation of NVAE.

By way of preamble, it is worth noting that the Dutch experience is a matter of some dispute. Its defenders (who are usually but not exclusively Dutch) claim that VAE has been successfully 'brought out into the open' and effectively controlled. Its critics (usually but not exclusively outside the Netherlands) dispute this and maintain that VAE remains beyond effective control. It is no easy matter for someone unfamiliar with the mass of evidence to discern where the truth of the matter lies. The difficulty is compounded by superficial and misleading reports in the mass media. This section of the book draws on the author's own research over ten years into the Dutch experience.

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Euthanasia, Ethics, and Public Policy: An Argument against Legalisation
Table of contents

Table of contents

  • Title Page *
  • Contents vii
  • Preface xi
  • Foreword xiii
  • Acknowledgments xv
  • Table of Cases xvi
  • Abbreviations xviii
  • Introduction 1
  • Part I - Definitions 7
  • 1 - 'Voluntary Euthanasia' 9
  • 2 - Intended V. Foreseen Life-Shortening 18
  • 3 - 'Physician-Assisted Suicide' 31
  • Part II - The Ethical Debate: Human Life, Autonomy, Legal Hypocrisy, and the Slippery Slope 37
  • 4 - The Value of Human Life 39
  • 5 - The Value of Autonomy 52
  • 6 - Legal Hypocrisy? 58
  • 7 - The Slippery Slope Arguments 70
  • Part III - The Dutch Experience: Controlling Vae? Condoning Nvae? 81
  • 8 - The Guidelines 83
  • 9 - The First Survey: the Incidence of 'Euthanasia' 91
  • 10 - Breach of the Guidelines 103
  • 11 - The Slide Towards Nvae 115
  • 12 - The Second Survey 125
  • 13 - The Dutch in Denial? 136
  • Part IV - Australia and the United States 151
  • 14 - The Northern Territory: Rotti 153
  • 15 - Oregon: the Death with Dignity Act 167
  • Part V - Expert Opinion 181
  • 16 - Expert Committees 183
  • 17 - Supreme Courts 191
  • 18 - Medical Associations 208
  • Part VI - Passive Euthanasia: Withholding/withdrawing Treatment and Tube-Feeding with Intent to Kill 215
  • 19 - The Tony Bland Case 217
  • 20 - Beyond Bland: the Bma Guidance on Withholding/withdrawing Medical Treatment 239
  • 21 - The Winterton Bill 260
  • Conclusions 273
  • Afterword: the Diane Pretty Case 282
  • Bibliography 292
  • Index 303
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