Biomedical Ethics: Slippery Slope Concerns in Physician Assisted Death

This essay delves into the slippery slope argument as a significant objection to the practice of physician-assisted death (PAD). It examines how concerns about a 'slippery slope' are employed, arguing that legalizing PAD could lead to the expansion of criteria and potential abuse. The paper discusses the ethical principles of autonomy, beneficence, non-maleficence, and justice, assessing the extent to which the Canadian policy on PAD should be expansive. The essay also analyzes the existing legal framework in Canada, including the Carter v. Canada case and Bill C-14, and the role of the Charter of Rights and Freedoms, particularly Section 7. It assesses the arguments for and against PAD, considering the potential for abuse and the protection of vulnerable individuals, including minors and those with mental health issues. The paper concludes by recommending that the current PAD criteria be restricted or reformulated to address the risks associated with the slippery slope, particularly regarding minors and patients with mental illnesses, and emphasizes the need for comprehensive assessments of patient capacity and awareness.

Running head: BIOMEDICAL ETHICS
BIOMEDICAL ETHICS: SLIPPERY SLOPE AS AN OBJECTION AGAINTS PHYSICIAN
ASSISTED DEATH
Name of the Student:
Name of the University:
Author note:

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Introduction
The slippery slope argument (SSA) is a form of political and logical rhetorical model
which relies on the principle that the implementation of a significant decision is likely to result in
a cascade of associated events, eventually paving the way for an adverse and irreversible
outcome (Potter, 2019). While there continue to exist a range of ethical and moral arguments in
favor of PAD, slippery slope arguments are based upon the view that legalization will pave the
way for an inevitable decriminalization where patients with less competent are likely to be
bought under the legal scope of existing PAD criteria (Braverman et al., 2017). With respect to
the same, this paper will thus aim to demonstrate arguments in objection to the legalized practice
of physician assisted death (PAD) in Canada by drawing the theoretical perspectives underlying
the slippery slope.
Discussion
PAD in Canada
PAD and euthanasia received legal status in Canada in the year 2016 based on an
amendment of the Canadian Criminal Code. According to law, terminally ill patients who are
above the age of 18, have the capability of undertaking decisions associated with dying and
healthcare, are suffering from a medical condition with no cure and with irreversible outcomes
and have provided their consent, are eligible to avail PAD (Chochinov, 2016). Additionally, to
gain approval of PAD patients must be accompanied by two independent witnesses, must receive
consent from two medical and nurse practitioners, must demonstrate awareness and knowledge
considering the possibility of palliative care and surpass a period of waiting for ten days. The
development and implementation of PAD practices in Canada have been supported by arguments

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in favor of autonomy and beneficence with respect to the suffering and pain encountered during
terminal illnesses (Abraho et al., 2016).
Slippery Slope Arguments
The slippery slope argument is based upon the basic logical model that the
implementation of an initial decision A is likely to contribute to B – a decision which is
unacceptable and irreversible. In the case of PAD, A is the decision to enforce PAD and B has
been argument to be the inevitable outcome of decriminalization resulting in less competent
patients to gain approval to engage in PAD. This thus raises concerns on the possibility of PAD
abuse in patients who may have illnesses less complaint to the criteria of ‘grievous and
irremediable’ as per Canadian law (Ventura & Austin, 2017)
In criticism however, arguments in support of PAD state that legalization of the same
ensures adherence to ethical considerations of patient autonomy with respect to the Charter of
Rights and Freedoms Section 7 which claim the right of every individual to liberty, security and
life as well as absence of deprivation of justice (Kussmaul, 2018). However, taking insights of
the slippery slope argument, such statements do not shed light on how justice is specifically
denied in the case of an absence of PAD especially since it raises doubts on whether assisted
dying would truly be a just practice for patients who may be less competent as per Canadian law
criteria. Indeed, it is worthwhile to note that the idea of suffering and an individual’s decision to
die are highly subjective in nature and may not demonstrate competence to the actual suffering
or possibilities of remediation in any terminal illness and palliative care services (Reggler, 2017).
Further, communities in favor of PAD and against the slippery slope arguments support
their view based on the idea that PAD legalization enhances families and healthcare
professionals to engage in difficult conversations of death and dying which were once regarded

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as difficult and unnecessary (Hetzler III et al., 2019). However, in criticism, the slippery slope
argument shed light on the issue of minors aged below 20 as well as those with mental illnesses
in conjunction with terminal illnesses by raising concerns on whether these patient groups are
truly competent, knowledgeable, and aware and have the capacity to give consent and understand
the implications of death and healthcare decisions. This thus raises the possibility that such
patients may be at risk of abuse or misuse of PAD and decriminalization of their deaths - thus
strengthening the initial arguments which the slippery slope were based upon (Cholbi, 2018).
Additionally, this may in turn pave the way for a possibility of rampant usage PAD by healthcare
professionals and a defiance of the very institution which the field of healthcare is based upon –
that of a moral duty to protect and enhance an individual’s health. This is turn, paves the way for
violation of ethical principles of non-maleficence – the need to engage in decisions of the least
harm (Dugdale, Lerner & Callahan, 2019).
Lastly, the concept of ‘arbitrary line’ is key slippery slope argument which is of concern
and is based upon the view that application of a decision A, is likely to contribute to insignificant
decisions A1, A2 and A3 and finally aggravating to the irreversible decision of B. For example,
with respect to infanticide, if there lies a criteria to permit PAD for child abnormalities at birth,
the same raises possibility of criteria to be developed for abnormalities to be detected at six
months of even for less adverse abnormalities. This then strengthens the slippery slope argument
of misused practice of PAD and denial of basic rights of a child as per the Convention on the
Rights of the Child (CRC) (Ventura & Austin, 2017).
Recommendations on Expansion or Restriction
Thus, based on the above, this paper is of the view that PAD may be permitted to be
practiced sometimes in extremely critical cased where decisions are based completely on

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evidence based research and not by subjective opinions of morality and ethics. Taking insights of
the slippery slope arguments, it is recommended that the current PAD criteria be restricted in
Canadian Law especially with respect to minors and those with mental health issues and must be
accompanied by comprehensive and robust assessments of the patient’s mental capacity and
awareness to give consent and as well as understanding of implications of the same (Ventura &
Austin, 2017).
Conclusion
Based on the key insights presented above, this paper is thus based upon the slippery
slope argument in objection of the practice of PAD considering the possibility that the same may
increase the risk of decriminalization. To conclude, it is recommended that the criteria of existing
PAD policies be either restricted or reformulated to consider the possible risk of a slippery slope
especially with regards to minors and patients with mental illnesses.

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