Death on Demand: The Bottom of the Slippery Slope

This article originally appeared in the Euthanasia Prevention Coalition Blog on February 7th, 2024 and is republished with permission of the author.

For those who are skeptical of arguments that assisted suicide for the terminally ill is a clear path to euthanasia for all, I give you an article by a Toronto-area bioethics professor and consultant, Dr. Eric Mathison. 

Professor Mathison makes a passionate albeit disturbing case for what he calls the "non-medical model" for assisted suicide policy that rescinds the need for terminal illness or physician approval. He opposes needing the approval of anyone, even a doctor because people should not require "permission to die." Likewise, he calls for revoking the terminal illness and six-month life expectancy requirements altogether. Essentially, he is championing what I will truthfully and frankly call "death on demand" or literally just killing anyone who wants to die with literally no questions asked.

This is the logical conclusion of assisted suicide laws and vindication of our prediction regarding the proverbial slippery slope, making interim safeguards mere illusions. This is why assisted suicide must be prohibited, and not made accessible to anyone who wants to self-destruct.

Mathison believes the qualifications for assisted suicide are arbitrary. I agree with him completely and have observed how ineffective they are at protecting people. The criteria to qualify vary by jurisdiction, but why must someone have two physicians' approval vs. three or even just their primary care provider? Anyone who isn't given the second or third physician's approval just faces the hassle of shopping for another doctor until they have the requisite number. Why the six-month life expectancy instead of seven months or five months? Six months is the standard to qualify as terminally ill, but Mathison makes the point that it needlessly forces suicidal people to wait. I think any barrier between a suicidal person and their means to kill themselves is a good thing but concur that many safeguards are meaningless. Where we disagree staunchly is that Mathison is using the absurdity of these criteria to call for no criteria whatsoever: death on demand rather than protection for people by completely revoking assisted suicide altogether. He cheers for more deaths, not fewer, stating that more regulations mean fewer people with access. His argument is both refreshingly honest and abhorrently terrifying, because we have apparently reached the point where bioethicists like Mathison feel comfortable making modern-day Swift-style “modest proposals” like this.

Mathison calls assisted suicide "assisted dying" and employs the misnomer "medical aid in dying" or MAID because assisted suicide polls differ simply with the word suicide, a tragic act of violence that society has historically aimed to prevent, not enable. He does this despite previously admitting the disingenuous reasons for the term in another article entitled “Assisted Suicide is Suicide.” The MAID euphemism implies that those seeking help to be killed are terminally ill, meaning they have a life expectancy of six months or fewer and wish to die by lethal poison as an alternative to succumbing to their underlying condition. Mathison believes that imminent death shouldn't be the requirement to get aid in dying, and extends this practice to those who are nowhere near dying but simply no longer want to live. He considers this a right and believes people need not disclose their reasons when seeking a prescription for lethal poison. He takes the argument even further by rebuking the prescribing doctor's inquiries into why their patient is suicidal, insisting it is "none of their business"; "just write the prescription, Doc." He fears that a provider might impose their values upon the patient by talking them down from the metaphorical ledge rather than giving them the push they're after. The doctor might attempt to resolve the problems that made the patient suicidal in the first place. In one case, a man was able to reclaim the joy he lost by obtaining a powerchair to get around with ease instead of deadly Pentobarbital because his doctor cared enough to ask questions and get an answer. 

Mathison calls assisted suicide a solution to suffering longer than six months, but killing those who suffer is a violent cop-out and not an ethical answer. Palliative care is. Any problem can be "solved" by killing those who face it and frankly, it is easier to kill than to care.

Mathison decries any attempt by doctors to understand the reasons a patient might be requesting any particular prescription and cites erectile dysfunction medications like Viagra or birth control pills as examples, insisting a patient should be able to scold any doctor who asks and still obtain the drug from that doctor who is oblivious to why he prescribed it. Mathison acknowledges that death and birth control are not equivalent, but his reasoning is absurd and dangerous even for medicines that aren't intended to kill like assisted suicide drugs are. It completely disregards that there are medical considerations and potentially better treatments that a physician could recommend if they knew the reason why a patient was requesting these medications. 

As a woman with a long-standing gynecological condition called endometriosis, I found a doctor who was willing to treat my condition and fortunately, these treatments were successful, and I am now the grateful mother of children whom I was told I would never be able to bear and could not have conceived if contraception, which is what I was offered, were my only treatment. Mathison's free-for-all mindset would deny women like myself superior care options like I received. 

With assisted suicide drugs, patients would lose medical advice on pain control, antidepressants, or real help addressing the burdens that make them want to die. Without any justification, those suffering from heartbreak or grief from losing something or someone they loved would be able to end it all. It’s almost as if he thinks lethal poisons should be sold over the counter because, as he says, doctors have no right to know the reasons someone is seeking the lethal prescription. There is no opportunity to suggest antidepressants, palliative care, or new therapies. A physician cannot advise according to the patient’s unique factors or comorbidities. Furthermore, the poisons might even be intended for someone else. This reduces doctors to drug dealers where 100% of those who take the drugs will die from a poisonous drug concoction.

In conclusion, Mathison insisted he wanted to look at the pros and cons of revoking medical criteria in favor of death on demand, but offered absolutely no cons without misrepresenting them and moreover, incorrectly dismissing them. None of the concerns I raise here were mentioned, although this article is the first in a series so perhaps the professor will eventually mention these dangers. I earnestly doubt it, since there is no way to overcome my concerns and no way to make killing safe. 

Anyone who suggests that this is not the bottom of the proverbial slippery slope is lying to themselves. Assisted suicide must be abolished, not expanded.