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The ‘slippery slope’ is the gradual extension of assisted suicide to widening groups of patients after it is legally permitted for patients designated as terminally ill (Hendin, 1997a).Manifestations include Henk Jochemsen (Director, Lindeboom Institute for Medical Ethics, the Netherlands): ‘The Dutch experience shows that once the termination of patients’ lives is practised and that practice wins official toleration or approval, the practice develops a dynamic of its own that resists effective control.’ (Jochemsen, 1994) Herbert Hendin (Medical Director of Suicide Prevention Initiatives (SPI) and Professor of Psychiatry at New York Medical College): ‘Virtually every guideline set up by the Dutch—a voluntary, well considered, persistent request; intolerable suffering that cannot be relieved; consultation; and reporting of cases—has failed to protect patients or has been modified or violated.’ (Hendin, 2002) José Pereira (Head of Palliative Care at the University of Ottawa): ‘Abuse of guidelines has occurred in every jurisdiction around the world where assisted dying has been legalized.’ (Pereira, 2011) A range of euphemisms have been developed to avoid the terms euthanasia and PAS, particularly the stigma of the word ‘suicide’.
Daniel Callahan (co-founder and President Emeritus of The Hastings Center): ‘The advocates for physician-assisted suicide make use of a favourite method from the spin-tool box, that of obfuscation, defined in dictionaries as an effort to render something unclear, evasive, or confusing.’ (Callahan, 2008) Robert Twycross (Reader, Oxford University): ‘[The pro lobby’s] attempt to ‘prettify’ the language of death by not using terms such as assisted suicide, euthanasia, and killing…’ (Twycross, 1990) Wesley J.
Smith (journalist and author of Forced Exit): ‘According to Compassion & Choices, when a terminally ill patient swallows an intentionally prescribed lethal overdose of barbiturates, it isn’t really suicide. Because the word ‘suicide’ has negative connotations, and C&C wants people to feel positive about some self-killings.’ (Smith, 2013) During the last 30 years, euthanasia and/or physician-assisted suicide (PAS) have been legalized in a number of countries.
Continuous sedation until death (CSD) for the management of severe and refractory symptoms in the last days or week of life may be entirely clinically appropriate therapy, the possibility of life-shortening being acknowledged, but not intended.
In contrast, CSD performed with the intention of hastening death or ending life is no different to euthanasia—these are deaths caused by the active intervention of the physician.
In about 1990, formalized guidelines for the practice of euthanasia and physician-assisted suicide were issued (Walton, 1995).
These were: In 2002, the practices became legally regulated with the passage of the Termination of Life on Request and Assisted Suicide (Review Procedures) Act by the Dutch Parliament (see Parliament of the Netherlands).
In chronological order, these are The Netherlands, the Northern Territory of Australia, Oregon (USA), Belgium, and Canada.
Legal change was not required to allow assisted suicide in Switzerland.
These include ‘death with dignity’, ‘medical assistance in dying’, and ‘the peaceful alternative’.
But these terms do not alter the nature of the act and, where possible, are avoided.