South Australian Voluntary Euthanasia Society
The following is from the SAVES Newsletter, The VE Bulletin, Vol 16 No 3, November 99
More on the alleged Netherlands "Slippery Slope"
John Keown, an anti-voluntary euthanasia campaigner based in the UK, gave a lecture tour in Australia
in July this year in which he vehemently attacked
voluntary euthanasia with particular reference to its
practice in the Netherlands. His views were widely
reported in the media with little or no attempt to
challenge their validity. He doubtless achieved his
clear purpose of undermining the steady progress
towards legalising voluntary euthanasia in Australia.
In the following article, voluntary euthanasia
campaigner, Fred Cohen, demonstrates the strong
bias that John Keown brings to presenting the results
of published research on the practice of voluntary
euthanasia in the Netherlands and in Australia. Fred
is President of the Hemlock Society Branch of the
Delaware Valley in Pennsylvania. Now retired, he
has had a distinguished career in business and in
academia.
Fred's article was posted to ERGO!'s electronic
mailing list on 18 July 99 and is reproduced here
with his permission. ERGO! (Euthanasia Research
& Guidance Organisation) was founded by Derek
Humphry, author of Final Exit.
A Closer Look at the "Slippery Slope"
The February 1999 Journal of Medical Ethics carried
an article entitled "Voluntary Euthanasia Under
Control? Further Data from the Netherlands." This
deftly executed paper presents a mind numbing array
of statistics which seem to support the authors'
conclusion that euthanasia in Holland is out of
control and that "the Dutch have slid down the
slippery slope."
The article is having significant impact upon the
ongoing debate. Opponents of euthanasia hail the
work as proof of their dire predictions, while many
staunch supporters of the right-to-die are shaken by
what seems to be damning evidence of widespread
abuses in the Netherlands. Indeed, many feel
compelled to stop debating the Dutch experience and
to divert attention to excellent results being obtained
in Oregon. It would therefore seem worthwhile to
invest a little time in review and thoughtful analysis
of the subject article.
The authors, Henk Jochemsen, PhD, and John
Keown, DPhil, carry credentials that command
academic respect. They properly announce that their
analysis is based largely upon data from the 1995 van
der Maas survey of euthanasia in the Netherlands,
and they note that the data and methodology of that
survey are accepted at face value.
As previously mentioned, the article is cleverly
executed. However, close inspection reveals a
number of fatal flaws. First, putting aside the fact
that most of the quoted statistics do not relate
directly to the central issue, the manner in which the
numbers are presented removes any lingering doubt
as to the authors' agenda. For instance, in dealing
with cases classified as "Life-Terminating Actions
Without Explicit Request," the following statement:
"The physicians thought that life was shortened by
one to four weeks in 3% of cases but by more than
a month in 6%."
One must immediately wonder why the authors omit
the fact that if these data are correct, then 91% of
the cases involved hastening death by less than one
week, a fact certainly as worthy of explicit
highlighting as are those quoted. This type of
presentation extends to numerous other areas, and
suggests a strong bias.
For the purpose of simplifying discussion, we will
use the term "non-voluntary euthanasia" to include
all cases of reported life terminating actions without
specific formal request, and the term "incidence of
non-voluntary euthanasia" to describe the ratio of
those deaths to the total deaths in a given year. In
this context, the most serious problem we find in the
subject paper relates to its conclusion that the
incidence of non-voluntary euthanasia in Holland
supports a logical inference that "The Dutch had slid
down the slippery slope."
A valid inference on this subject demands
consideration of the following facts:
- The definition of a slope requires, at a minimum, two points of reference.
- The only relevant data presented by the authors are the 1990 and 1995 van der Maas surveys.
- The 1995 survey showed a slightly LOWER incidence of non-voluntary euthanasia (0.7%) than did the 1990 survey (0.8%).
The only responsible inference that can be made
from the data cited is that between 1990 and 1995
the incidence of non-voluntary euthanasia in the
Netherlands decreased slightly. There is no possible
way in which the referenced data can be construed as
suggesting "The Dutch had slid down the slippery
slope." Such a claim fails to meet the most basic
requirements of logical inference. It is at best a
gross error . . . and at worst deliberately misleading.
There is additional evidence of severe bias in the
omission of important relevant data that was
available to the authors. In 1996, Kuhse et al, using
an officially authorised English translation of the van
der Maas questionnaire, conducted a similar survey
in Australia, a country in which euthanasia is illegal.
Their findings, published in the Medical Journal of
Australia (see reference), were that the incidence of
non-voluntary euthanasia in Australia during the
survey year was 3.5%. In other words, in a country
where voluntary euthanasia is illegal, the incidence
of non-voluntary euthanasia was found to be 400%
greater than in the Netherlands!
The bias indicated by failure to consider the
Australian data is pale by comparison with another
example, namely the following statement:
"It is therefore surprising that an American
commentator should observe that the similarity
between the findings in respect of 1990 and 1995
shows that the Dutch are apparently not descending
a slippery slope. This observation quite overlooks
the fact that the first survey showed that the descent
had already occurred by 1990"
This inference is mind-boggling in its utter disregard
for the rudiments of scientific inquiry. If reliable
data exist on the incidence of non-voluntary
euthanasia in the Netherlands prior to 1990 (and we
know of none), they should have been cited. In
making the offending inference, the authors presume
that prior to the decriminalisation of voluntary
euthanasia in Holland, the incidence of non-voluntary
euthanasia was substantially lower than the levels
indicated in the 1990 and 1995 van der Maas surveys
. . . a presumption utterly without foundation.
Especially when considered in the light of the
Australian data, one must wonder how the authors
dare to matter-of-factly set forth such a bizarre
proposition.
There are numerous other aspects of the subject
article that deserve criticism, but the one that we find
most distressing is the statement:
"The Dutch reaction to the survey's findings was also
revealing: the cases of non-voluntary euthanasia it
disclosed, far from being criticised, were largely
condoned. In short, the survey indicated that, in less
than a decade, the Dutch had slid down the slippery
slope."
This allegation is an insult to the good people of the
Netherlands, a people whose compassionate policies
for dealing with difficult social problems are admired
by most of the world. Because the Dutch live with
and fully understand the actions of their doctors in
end-of-life situations, they know that the shrill
accusations of opponents of euthanasia are based
upon deliberate misinterpretations of survey data.
The Dutch know from personal experience that the
vast majority of deaths officially classified as
"non-voluntary euthanasia" involve such factors as
doctors acting upon wishes previously expressed by
patients but not formalised in writing, and upon
numerous humane considerations which are not
illuminated by the rather narrow questions of
surveys. It is for this reason that an ever increasing
and already overwhelming majority of the
Netherlands' citizens supports its countries policies
on physician assistance in hastening death.
Because the people of the Netherlands refuse to
accept the specious arguments of opponents of
euthanasia, the authors accuse them of moral decay.
This writer submits that such an allegation is
academically irresponsible and morally reprehensible.
Supporters of the right-to-die should note that there
has yet to be a case reported in which any Dutch or
Australian doctor was found to have hastened death
for any other reason than compassion for the patient.
It is for this reason that the agents of the religious
right are compelled to resort to obfuscation,
distortion and sleight-of-hand. Armed with the facts
and an understanding of the methods of opponents,
we should not hesitate to cite the Netherlands
experience as a positive factor in the ongoing debate.
Fred Cohen (email - fcohen888@home.com)
Reference: End-of-life decisions in Australian medical
practice, Helga Kuhse, Peter Singer, Peter Baume,
Malcolm Clark and Maurice Rickard MJA 1997; 166: 191
Further information on these and related issues is available from the SAVES.
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