5. The Moral Status of Euthanasia:  Consequentialist Arguments - Continued

5.4  "Wedge", or "Slippery Slope" Arguments Against Voluntary Active Euthanasia

        There are two related, but slightly different arguments, which people refer to as the "wedge argument". Both maintain that legalizing active euthanasia would be a mistake because doing so would lead to undesirable consequences of a sort involving the legalizing of other things. But the first version of the argument maintains that these consequences would follow in virtue of a sort of logical consequence: if one legalizes voluntary active euthanasia, then logical consistency requires that one also legalize involuntary active euthanasia as well. The second version of the wedge argument, in contrast, maintains that the undesirable consequences would follow simply due to certain facts about human psychology.

        Of these two versions of the slippery slope argument, only the second one is a consequentialist argument.  It will be useful at this point, however, to consider the first version as well.
 
 

5.5  The "Logical Consistency" Version of the Wedge Argument

        This version of the argument maintains that voluntary active euthanasia is wrong in itself, in that it violates a fundamental moral principle prohibiting the killing of innocent persons.  (Or alternatively, "innocent human beings".)

        The argument then proceeds:

If one is willing to violate that moral principle in some cases, then the possibility arises that one ought to violate it in other cases as well. If there are social reasons which induce one to accept voluntary active euthanasia, why won't those reasons also be sufficient to "justify" involuntary active euthanasia too?  If it is morally permissible to kill someone who feels that his life is "not worth living", why shouldn't it also be permissible to kill severely defective infants, etc., whose lives are, according to the same standards, also "not worth living"?

5.6  A Natural Response to the Logical Version of the Argument

        This argument turns upon the assumption that the relevant basic moral principle involved here is either:

(l)  It is always wrong to kill an innocent human being.

(2)  It is always wrong to kill an innocent person.

But those who support active euthanasia would not accept either (l) or (2). They would say that the basic moral principle involved is something like:

(3)  It is wrong to kill an innocent person who does not have a fixed and rational desire for death, or who has not given permission to have his life terminated.

or else:

(4)  It is wrong to kill an innocent human being who does not have a fixed and rational desire for death, or who has not given permission to have his life terminated.

        If some such principle as (3) or (4) is the correct principle concerning killing, then acceptance of voluntary active euthanasia need not involve any violations of moral principles. And so there will be no justification for arguing that acceptance of active euthanasia will lead to other things which also involve the violation of moral principles concerning killing.

5.7  The Empirical Version of the Wedge, Or Slippery Slope, Argument

        There is, however, another version of the wedge argument that does not involve such controversial assumptions about the relevant moral principles, and it is the type of argument advanced by Yale Kamisar.

        Here it is granted, at least for the sake of argument, that voluntary active euthanasia is not wrong in itself.  It is argued, however, that acceptance of it may lead to the acceptance of actions that are wrong in themselves. Here Kamisar and others generally have in mind types of involuntary active euthanasia (and also involuntary passive euthanasia in some cases).

        Why may it have such a result?

Answer:  Simply because of the way that people actually think about moral issues: their inability to make fine distinctions, to appreciate basic moral principles, etc.

5.8  Three Types of Support for the Empirical Version

        Kamisar, in his article, offers three types of support for the empirical version of the slippery slope argument.  First, Kamisar claims that advocates of the legalization of voluntary active euthanasia often seem to hold that the case for legalizing certain types of nonvoluntary euthanasia is at least as compelling:

"Until the organization of the English and American societies led to a concentration on the voluntary type, and until the by-products of the Nazi euthanasia program somewhat embarrassed, if only temporarily, most proponents of involuntary euthanasia, about as many writers urged one type as another.  Indeed, some euthanasiasts have taken considerable pains to demonstrate the superiority of defective infant euthanasia over incurably ill euthanasia."

        Secondly, Kamisar cites a poll which measured the amount of public support for, on the one hand, euthanasia for defective infants, and, on the other hand, euthanasia for incurably and painfully ill adults, and where the result was that more people approved of the former than of the latter (45 per cent versus 37.3 per cent).

        Finally, Kamisar appeals to what happened under the Nazis, citing the description offered by Leo Alexander:

"The beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians.  It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as life not  worthy to be lived,  This attitude in its early stages concerned itself merely with the severely and chronically sick.  Gradually the sphere of those to be included in this category was  enlarged to encompass the socially unproductive, the ideologically unwanted, the racially unwanted and finally all non-Germans.  But it is important to realize that the infinitely small wedged-in lever from which this entire trend of mind received its impetus was the attitude toward the non-rehabilitatable sick."

5.9  Possible Responses to These Three Considerations?

1.  The first two considerations have relevance only if it is the case that nonvoluntary euthanasia - and, in particular, nonvoluntary euthanasia of the sort involved in the case of defective infants - is morally wrong.  But this claim has certainly been questioned.  At the very least, then, additional argument is needed at this point.

2.  As regards the appeal to the Nazi Germany, there are at least two questions that need to be raised.  The first is whether the claim that is advanced in the above passage is in fact correct.  Thus, Robert M. Veatch, in his book Death, Dying, and the Biological Revolution, points out:  "There is, in fact, a significant historical debate over whether the Nazi mass murderers really began with attitudes toward the non-rehabilitable sick. Some argue that protection and purification of the Aryan stock was the intention from the beginning." (The latter view is backed both by Marvin Kohl, in an article entitled "Voluntary Beneficent Euthanasia", and by Joseph Fletcher in an article "Ethics and Euthanasia".)

        Secondly, even if one accepted, for the sake of discussion, Alexander's contention, one would still need to go on to ask to what extent the Nazi experience, which occurred in a dictatorial society, is a good indicator of what is likely to happen in a democratic society, such as the United States.

3.  One can also respond by offering counter-evidence in the form of considerations that suggest that one can perfectly well refrain from sliding down a slippery slope.  This is done by Rachels in his argument, as he points out, first, that there is "historical and anthropological evidence that approval of killing in one context does not necessarily lead to killing in different circumstances" - e.g., the case of the Eskimos - and secondly, that in our own society killing is certainly accepted in some circumstances, such as self-defense.  So it is clear that lines drawn in this area need not be unstable.

6.  Active Versus Passive Euthanasia and the Question of Consistency

        Recall that in thinking about the morality of voluntary active euthanasia, there are two questions that need to be considered.  The first concerns the plausibility of any given argument.  The second concerns whether one an argument that one is considering may not apply to passive euthanasia as well.  So one needs to consider the following issue:

        Can an empirical version of the wedge argument be advanced against voluntary passive euthanasia?

        It seems to me that this can be done, since I think that one can construct a comparable argument in support of the claim that if voluntary passive euthanasia is legally permitted, then it is likely that society will come to allow voluntary active euthanasia, and thus wind up on the slippery slope that, advocates of the wedge argument against active euthanasia contend, is likely to lead to moral horrors.

        The structure of such a wedge argument against voluntary passive euthanasia means, of course, that it can never have quite as much force as the wedge argument against voluntary active euthanasia.  But if it can be shown that the tendency to slide from an acceptance of voluntary passive euthanasia to an acceptance of voluntary active euthanasia is quite substantial, then anyone who thinks the wedge argument against the latter is strong has good reason to assign substantial weight to the wedge argument against the former.

        What sort of case can be made out, then, in support of the claim that there is a real danger that society will move from an acceptance of voluntary passive euthanasia to an acceptance of voluntary active euthanasia?  Quite an impressive one, it seems to me.  In the first place, let us consider the state of public opinion with regard to the acceptance of active versus passive euthanasia. To what extent do people who accept passive euthanasia also accept active euthanasia?  Robert M. Veatch, in his book Death, Dying, and the Biological Revolution, refers to two public opinion polls taken in 1973.   First, there was a 1973 Louis Harris poll which asked the following two questions:

Do you think a patient with a terminal disease ought to be able to tell his doctor to let him die rather than to extend his life when no cure is in sight, or do you think this is wrong?

Do you think the patient who is terminally ill, with no cure in sight, ought to have the right to tell his doctor to put him out of his misery, or do you think this is wrong?

        The response to the first question was that 62 per cent thought such an action ought to be allowed, while 28 per cent thought that it was wrong.  As regards the second action, by contrast, only 37 per cent thought that it ought to be allowed, and 53 per cent thought that it was wrong.

        The second poll was a Gallup poll, also conducted in 1973, and it involved the following question:

When a person has a disease that cannot be cured, do you think that doctors should be allowed by law to end the patient's life by some painless means if the patient and his family request it?

        In response to this question, 53 per cent said yes, while 47 per cent said no.

        There appears to be quite a divergence between these two polls, since according to the Harris poll it seems that, in 1973, only 37 per cent of Americans thought that voluntary active euthanasia should be permissible, whereas, according to the Gallup poll, 53 per cent apparently did so.  How is this divergence to be explained?

        In discussing these two polls, Veatch comments that the question asked by the Gallup Poll "does not distinguish active killing from allowing to die as sharply as did the Harris poll",  so Veatch's view seems to be that the higher percentage who apparently accepted active euthanasia in the Gallup poll is a misleading result resulting from a carelessly formulated question.  But I'm not at all convinced that this is the correct explanation.  To begin with, the phrase "to end the patient's life by some painless means", which is used in the Gallup poll question, does not strike me as being ambiguous between killing and merely letting die.  But, in addition, there are other differences between the respective questions that seem important, and which Veatch seems not to have noticed.  First, in the Gallup poll the request is made by the patient and his family, whereas in the Harris poll the request is the patient's.  Isn't it likely that at least somewhat more people would be willing to accept such a request when it is made by both the patient and his family, than when it is made by the patient alone?

        Secondly, and more important, in the Gallup poll the question concerns what a doctor should be allowed to do, whereas in the Harris poll the question concerns what a patient can tell his doctor to do.  It seems very likely that there would be people who would feel that a patient has a right to request that his or her life be ended, but not to demand that this be done.  Such people would have responded in the affirmative to the Gallup poll question, but in the negative to the Harris poll question.

        Thirdly, and also important, the Gallup question is specifically concerned with whether there should be a law prohibiting a certain sort of act, whereas the Harris poll, by not explicitly mentioning laws, poses the question in a way that can be misinterpreted as being concerned with what it is morally right or wrong to do, rather than with what should be allowed or prohibited by law.  This difference is also one that would tend to give rise to a larger number of negative responses in the Harris poll than in the Gallup poll.

        In short, there appear to be at least three reasons for thinking that the result of the Gallup poll provides a more accurate indication, than that of the Harris poll, of the proportion of Americans, in 1973, who thought that voluntary active euthanasia should not be legally prohibited.  If this is right, then the conclusion is that the percentage who approved of voluntary active euthanasia was only slightly less than those who approved of voluntary passive euthanasia - 53 per cent versus 62 per cent.

        This fact would seem to suggest that there is a very real danger that people will slide from an acceptance of voluntary passive euthanasia to an acceptance of voluntary euthanasia, and this conclusion is further supported by other polls, both earlier and later.  Thus, on the one hand, the question that was asked in the Gallup poll in 1973 was also asked in 1950, and at that time only 36 per cent replied in the affirmative.  And, on the other, in a very recent Morgan Gallup poll, carried out in Australia and New Zealand, it was found that 73 per cent of Australians and 72 per cent of New Zealanders thought that a doctor should be allowed to administer a lethal dose to a terminally ill patient if asked by the patient to do so.

        The conclusion to be drawn from polls of public opinion, in short, is not merely that there is a significant likelihood that society will move from an acceptance of voluntary passive euthanasia to an acceptance of voluntary active euthanasia, but that the probability of that happening is increasing very rapidly.

        A second reason for thinking that acceptance of voluntary passive euthanasia is likely to lead to acceptance of voluntary active euthanasia is provided by some recent discussions of the question of whether the distinction between killing and letting die is morally significant in itself.  A number of philosophers, such as James Rachels,  have argued that the view that killing is, in itself, morally a more significant action than letting die often rests upon too casual an appeal to one's intuitions, and that, in particular, if one focuses upon cases that are the same except that the one involves killing, while the other involves letting die - so that there are no differences in motive, no differences in the sacrifices required of the agent, no differences in the probabilities of other outcomes, etc. - then it is no longer likely to seem to one that there is any moral difference between the two cases.

        If this is right, then to the extent that public discussion of these issues becomes philosophically more informed, it seems likely that more and more people will come to feel that voluntary passive euthanasia and voluntary active euthanasia are, in themselves, morally on a par, and, while such a conclusion is certainly compatible with holding that the one should be legally permitted, and the other not, it seems much more likely that most people will take the moral equivalence of active and passive euthanasia as strong grounds for holding that they should be accorded the same legal status.

        The third and final reason for thinking that acceptance of voluntary passive euthanasia is likely to lead on to acceptance of voluntary active euthanasia is that the latter is in one obvious respect superior to the former - namely, that if one is merely allowed to die, one has no control over when one dies, and the result may very well  be a prolonged and painful process, whereas, with active euthanasia, one can choose the time to die that is best, given one's own concerns and interests.

        These three considerations provide very strong grounds, I believe, for concluding that a society that allows voluntary passive euthanasia is very likely, especially if there is informed public debate on the matter, to go on to allow voluntary active euthanasia.  But then one is on the slippery slope that, according to Kamisar and others, is likely to lead to an acceptance of types of actions that are morally wrong.  The conclusion, accordingly, would seem to be that if there is a strong wedge argument, of an empirical sort, against the legalization of voluntary active euthanasia, then there is also a wedge argument, that is almost as strong, for not allowing voluntary passive euthanasia.  In the end, then, acceptance of voluntary passive euthanasia cannot be consistently combined with a rejection of voluntary active euthanasia which is based upon a wedge argument of the empirical sort.