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In Holland and Belgium, euthanasia is defined as being at the patient’s request, so cases of ‘ending of life without the patient’s explicit request’ have to be counted separately.
Intensified treatment of pain and symptoms may be entirely clinically appropriate, the possibility of life-shortening being acknowledged, but not intended.
In contrast, intensified treatment of pain and symptoms 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.
‘The 1960s and 1970s were a watershed for Dutch society.
From a conservative, tradition-bound country, the Netherlands transformed itself into a hotbed of social and cultural experimentation’ (Weyers, 2012).
If it is performed at the dying person's request, it is voluntary; otherwise, it is non-voluntary.
The terms ‘active’ and ‘passive’ may be misleading (Walton, 1995).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).Paul van der Maas (Department of Public Health, Erasmus University, Rotterdam): ‘…whether the acceptance of euthanasia or assisted suicide when it is specifically requested by a greatly suffering, terminally ill, competent patient is the first step on a slippery slope that will lead to an unintended and undesirable increase in the number of cases of less careful end-of-life decision making and to the gradual social acceptance of euthanasia performed for morally unacceptable reasons.’ (van der Maas et al, 1996).The data for the period 1990 to 2015 show The Dutch view One of the better descriptions of the ‘slippery slope’, written in 2017, went as follows: ‘The core of this argument is that as soon as euthanasia is allowed at all, even if only under certain conditions, it will necessarily follow that euthanasia will in future be performed under less stringent conditions and will eventually degenerate into an absolutely abject form of euthanasia, such as killing people involuntarily.’ The alternative view It is not possible to list all the publications attesting to the existence of a slippery slope, but I include several good reviews that I have seen (Hendin, 1997a; Jochemsen and Keown, 1999; Hendin, 2002; Keown, 2002; Ten Have and Welie, 2005; Randall and Downie, 2009; Keown, 2012 & 2013; Sprung et al, 2018; Keown, 2018).Any opinions are those of the author and not necessarily those of IAHPC Copyright © 2019 Roger Woodruff © All rights reserved.IAHPC permits educational and scientific use of this publication.IAHPC prohibits the commercial use or reproduction and distribution of this material without authorization.Published by IAHPC Press 5535 Memorial Drive, Suite F- 509, Houston TX, 77007, USA Euthanasia is ‘a deliberate intervention undertaken with the express intention of ending a life so as to relieve intractable suffering’ (House of Lords, 1994; Walton, 1995).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.