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The Youth in Asia Aren't Sliding: An Empirical Look at Slippery Slopes
In the thread fathered by Cjet, @EverythingIsFine raised the classic concern about assisted suicide: sure, it sounds compassionate in principle, but won't we inevitably slide from "dignified death for the terminally ill" to "economic pressure on grandma to stop being a burden"? This is the kind of argument that is very hard to adjudicate one way or the other without, in the end, appealing to observed reality.
After all, some slopes are slippery. Some slopes are sticky. Some are icy for five feet then turn into sand. The real question isn’t “is there a slope?” but “what kind of slope is this, and can we put friction on it?”
Fortunately, in 2025, which is well past its best-by, we can look at said reality in the many countries where a form of euthanasia is legal, and see how that's panned out. I think that settles the question far better than arguing over philosophy (I started the argument by arguing about philosophy). The best way to overcome Xeno’s paradox is to show that yet, things move.
The Welfare State Reality Check
Let's start with a basic empirical observation: the countries that have legalized assisted dying are not, generally speaking, ruthless capitalist hellscapes where human life is valued purely in economic terms.
The UK, where I currently work in healthcare, is hemorrhaging money on welfare policies that would make American progressives weep with joy. I can personally attest that a substantial number of people drawing unemployment or disability benefits aren't, if we're being honest, actually incapable of productive work. We have an influx of immigrants who aren't economically productive but receive extensive support anyway. As the public (or at least British Twitter) has realized, we spend gobs of money on Motability cars for people who look suspiciously able to jog for the bus (I can't make a strong claim on how widespread said fraud is, but several instances seemed highly questionable to me).
This is not a society poised to start pressuring vulnerable people into death chambers to save a few pounds. Our doctors are, if anything, a meek and bullied bunch who err on the side of aggressive treatment even when it's clearly futile. I regularly see resources poured into advanced dementia patients who have no quality of life and no prospect of improvement. The NHS is many things, but “relentlessly utilitarian” is not one of them.
If I had a dollar for every dementia patient who has straight up asked me to kill the, well, I wouldn't quite retire (and I'd ask why I'm being given dollars), but it would be enough for a decent meal. Enough for a fancy French dinner, were I to include family pleading on their behalf. And I think those people have a point. Most of these claims arise in the rare periods of lucidity that bless/curse the severely demented. You get a few good minutes or hours to realize how your brain is rotting, often before your body has, and you realize how awful things have become. Then you slide back into the vague half-life of semi-consciousness, and I hope your mind is choosing to devote its last dregs of cognition to happier memories, instead of the living hell you currently dwell in. Meanwhile, your loved ones have no such recourse. All the memories of good times are unavoidably tarnished by seeing the people you love shit themselves and not even care.
Even the supposedly heartless United States has far more social safety nets than people give it credit for. Reddit memes about medical bankruptcy notwithstanding, it still spends around 6-8% of GDP on public healthcare and another roughly 5% on Social Security. I'm not sure how to tease apart Medicare, Medicaid, Social Security Disability, food stamps, housing assistance. That doesn't exactly look like a Darwinian free-for-all.
In other words, both countries already have welfare states that leak money in every direction except the one we’re worried about. So the empirical track record is: we’re bad at saying no. If we legalised assisted suicide tomorrow, I expect the dominant failure mode would still be “keep Grandma alive at enormous cost,” not “shove Grandma off the cliff.”
The Empirical Record
But let's not rely on anecdotes or gut feelings. We have actual data from places that have implemented assisted dying:
The Netherlands legalized euthanasia in 2002. Belgium in 2002. Switzerland has allowed assisted suicide since 1941. Canada introduced Medical Assistance in Dying (MAiD) in 2016. If the slippery slope argument were correct, we should see clear evidence of these societies pressuring vulnerable populations into premature death.
Instead, what we see is:
In the Netherlands, for example, support for euthanasia remains at ~90% in both 1997 and 2017 in the general populace. I lifted said figure from this study
I would consider it rather suspicious if it was 95% in a country where 5% of people get offed annually by MAID. Fortunately, that's not the case.
(Yes, I know that it's 5% of all deaths, not 5% of the total population. I couldn't resist the joke, sue me)
The most common criticisms of these systems aren't "too many people are being pressured to die" but rather "the bureaucratic requirements are too onerous" and "some people who clearly qualify are being denied."
Designing Better Incentives
That said, EverythingIsFine's concerns aren't completely unfounded. Any system can be corrupted by perverse incentives. The question is whether we can design safeguards that are robust enough to prevent abuse while still allowing genuinely autonomous choice. I spend an ungodly amount of time juggling hypotheticals, so I have Opinions™.
Here are some mechanisms that could work:
Competing Advocates System
Structure the tribunals with explicitly competing incentive structures. Pay psychiatrists or social workers bonuses for every person they successfully talk out of euthanasia after demonstrating that their suffering can be meaningfully ameliorated. Simultaneously, have patient advocates who are rewarded for ensuring that people with genuinely hopeless situations aren't forced to endure unnecessary suffering.
This creates a natural tension where both sides have skin in the game, but in opposite directions. The "life preservation" team has incentives to find creative solutions, provide better pain management, connect people with resources they didn't know existed. The "autonomy" team ensures that paternalistic gatekeeping doesn't trap people in unbearable situations.
Red Team Testing
Implement systematic "penetration testing" for the oversight system. Create fictional cases of people who clearly should not qualify for assisted dying - someone with treatable depression, a person under subtle family pressure, an elderly individual who just needs better social support. Have trained actors present these cases to euthanasia panels. (E.g., 25-year-old grieving a break-up, fully treatable depression, no physical illness)
A modest proposal for the composition of such a panel:
7 people, randomly selected for each case):
2 psychiatrists, paid only if the panel declines the request.
2 social-workers/advocates, paid only if the group approves the request.
1 “neutral” physician (salary fixed).
2 lay jurors, paid a flat fee.
The psychiatrists and advocates must publish a short written justification (≤500 words). The neutral physician and lay jurors read both sides and vote. Majority rules. The adversarial structure means the psychiatrists have skin in the game if they rubber-stamp a case that later looks fishy, and the advocates have skin in the game if they brow-beat a clearly salvageable patient. The lay jurors are there to keep the professionals honest.
(Alternative models might be splitting the psychiatrists and advocates across both teams)
Any panel that approves inappropriate cases faces serious consequences. This creates strong incentives for rigorous evaluation while identifying systemic weaknesses before they cause real harm.
We already use similar approaches in other domains. Government agencies test whether stores are properly checking ID for alcohol sales. Tax authorities use mystery shoppers to verify compliance. Financial regulators use stress tests to identify institutional weaknesses.
Temporal Safeguards
Build in meaningful waiting periods with multiple check-ins. Not the perfunctory "wait two weeks" that can be gamed, but structured reassessment over months. Require people to demonstrate that their decision remains stable across different contexts - good days and bad days, when surrounded by family and when alone, after various treatment interventions have been attempted. At any time the patient can unilaterally revoke the request (one phone call suffices), at which point the whole timeline resets. Finally, lethal medication is dispensed only on the day of the procedure, and only if the patient re-asserts consent on camera, without the advocate or psychiatrist in the room.
This serves multiple purposes: it prevents impulsive decisions, allows time for circumstances to change, and creates multiple opportunities to identify and address external pressures.
More Watching of the Watchers
All decisions (with names redacted) are published in a searchable database. Independent academics can run regressions on approval rates vs. patient age, diagnosis, postcode, etc. Outlier panels get flagged automatically. (If Panel #7 approves 90% of 25-year-olds with psoriasis, maybe look into that). The tribunal system becomes a public good: researchers learn what actually predicts irrevocable suffering, and policy can adjust.
Economic Firewalls
Perhaps most importantly, create strong institutional barriers between economic interests and euthanasia decisions. Healthcare systems, insurance companies, and family members should have no financial incentive for someone to choose death over continued treatment.
This might mean that euthanasia decisions are handled by completely separate institutions from those bearing the costs of care. Or it might mean generous death benefits that make someone more economically valuable alive than dead. Or mandatory cooling-off periods after any discussion of treatment costs.
EverythingIsFine’s deepest worry is emotional pressure: Grandma feels like a burden even if no one explicitly says so. The adversarial tribunal can’t eliminate that feeling, but it can reduce the plausibility of the belief. If Grandma knows that two professionals will lose money unless they are convinced she is beyond help, the thought “my family would be better off without me” loses some of its sting. The process itself becomes a costly signal that society is not eager to see her go.
The Comparative Harm Analysis
But here's what I think clinches the argument: we need to compare the risks of legalized assisted dying against the status quo.
Right now, people who want to end unbearable suffering have several options, all of them worse:
Each of these approaches involves more suffering, more uncertainty, and more potential for things to go wrong than a well-designed assisted dying system.
Meanwhile, the people we're supposedly protecting by prohibiting euthanasia - those who might be pressured into unwanted death - are already vulnerable to abuse in countless other ways. Family members can pressure elderly relatives to sign over property, refuse beneficial medical treatment, or accept substandard care. Healthcare systems already make implicit rationing decisions based on cost considerations (but this is a necessary tradeoff for any system that doesn't have literally infinite amounts of money. The Pope doesn't spend all of the Church’s budget on a single drowning orphan)
Creating a transparent, regulated system for end-of-life decisions doesn't create these pressures - it makes them visible and addressable.
The Autonomy Principle
Ultimately, this comes back to the fundamental question of autonomy that cjet79 raised in the original post. If we don't trust competent adults to make informed decisions about their own deaths, even with appropriate safeguards and cooling-off periods, then we don't really trust them to be autonomous agents at all.
We let people make all sorts of life-altering decisions with far less oversight: whom to marry, whether to have children, what career to pursue, whether to undergo risky medical procedures, whether to engage in dangerous recreational activities. Many of these decisions are statistically more likely to cause regret than a carefully considered choice to end unbearable suffering.
The paternalistic argument essentially says: "We know better than you do whether your life is worth living." That's a pretty extraordinary claim that requires extraordinary justification.
Conclusion
Legalising assisted suicide beyond the “imminent death” cases does open a channel for pressure and abuse. But the same could be said of every other high-stakes civil right: police shootings, child custody, involuntary commitment, even driving licences. The solution has never been “ban the activity”; it has been “create adversarial oversight with transparent metrics and random audits.”
If we can audit restaurants for rat droppings and banks for money-laundering, we can audit tribunals for premature death. The price of liberty is eternal paperwork (woe is me, I do more than my fair share already) but at least the paperwork can be designed by people who actually want the patient to live if there’s any reasonable chance of recovery.
I'm not arguing for euthanasia-on-demand or a system with minimal safeguards. I'm arguing for thoughtfully designed institutions that balance individual autonomy against the genuine risks of coercion and abuse.
(To put an unavoidable personal spin on it, I've been severely depressed, I've had suicidal ideation. I would have a very easy time indulging in that feeling, and I refrained not just from thanatophobia, but from a genuine understanding that my brain is/was broken. My advocacy for the right for people to make this choice is informed by a deeply personal understanding of what being there is like. Don't worry, I'm mostly better.)
The slippery slope argument assumes that any movement toward assisted dying will inevitably lead to systematic devaluation of vulnerable lives. But this treats policy design as if it's governed by some inexorable natural law rather than conscious human choices about how to structure institutions.
We can choose to create robust safeguards. We can choose to separate economic interests from end-of-life decisions. We can choose to err on the side of caution while still respecting individual autonomy.
The question isn't whether a poorly designed system could be abused - of course it could. The question is whether we're capable of designing better systems than the brutal status quo of forcing people to suffer without recourse or resort to violent, traumatic methods of ending their lives.
I think we are. And I think the evidence from jurisdictions that have tried suggests that the slippery slope, while worth watching for, isn't nearly as slippery as critics claim.
I mostly agree with you, but the trajectory of the things like the dissolution of marriage certainly makes me worried. If you looked 10 years after any one legal or social change, it would have looked like the conservatives were unnecessarily worried, but nevertheless when I nowadays bluntly state that modern marriage is entirely meaningless in varied company, most people agree with me (after an initial slightly scandalized look). This is a category change compared to the past, when marriage was both considered sacred and had a clear purpose (the creation of family). While most still say it was worth it for individual liberty, few disagree that we have lost something that we won't get back. And I suspect that there is at least some social desirability bias in what people say, but that part is obviously hard to prove.
These changes can take multiple generations to fully take effects. The first generation grew up under the old system and will often replicate it through simple inertia, especially if the change was explicitly sold as a emergency measure only reserved for extreme cases and there is a clear moral framework on why it should be so. The second already grows up with the measure existing, albeit rare enough that not everyone has had direct contact with it, and they will often extend the application of the measure in incremental ways for what they think is personal benefit (which they aren't always correct on). By the time of the third generation it is fully normalized so that it can be extended to large swathes of the population.
For this reason, I'd like a strict criterion of using MAID exclusively for cases where death is foreseeable in the near future (called Track 1 in Canada). It's still somewhat slippery - what is "foreseeable"? what is "near future"? - but it's imo much less slippery than estimating some nebulous quality of life cutoff that is sufficient for the state to help you kill yourself. I know Track 2 is still only a small percentage, but that needn't stay so.
It has been a generation! In some cases, multiple:
If this a slippery slope, then at the current rate of progress we might have Dyson Swarms before the Netherlands breaks double digits for proportion of deaths conducted by MAID.
Switzerland has octogenarians
runninghobbling around who don't remember a regime before euthanasia. It also has a rather high proportion of the elderly, which suggests they're not being culled when inconvenient.Can I make guarantees that societal norms won't change, and in a direction either you or I will disapprove of? Who can? The legalization of gay marriage hasn't, as far as I'm aware, causally produced a legalization of pedophilia or beastiality as some feared. I consider my claims very strong evidence, it's harder to get stronger.
You can't launch many rockets if your standard for rocketry is that we must perfect the design before putting a single nozzle on the pad. You will not enact any social change at all, out of an overabundance of caution. I consider this regrettable.
I'll grant you Switzerland. Netherlands and Belgium are still too recent imo. Marriage developments also took decades, as well as multiple specific law changes, to fully take effect.
And as I said, it's not that I want to outlaw it; But I just want to make the slope a little bit less slippery. It's notable that in Switzerland, it's merely legal by omission, it's illegal for organizations or people to earn any money or get any other benefits through it, and the substance can only be provided, but it has to be administered by the person themselves. All of these seem like sensible limitations to me. And there have been almost no changes to either practice or law since then. Contrast Canada, where it has only become legal recently, is explicitly legalized as a service by the health care industry, it already got extended significantly only a few years in, and is in the process of getting extended yet again. At least to me, it seems like it's reasonable to worry about a slippery slope being possible if it's done the wrong way; That doesn't mean it's impossible to find a correct way, though.
I will note that this is a concern I have intentionally and prominently addressed. I am personally okay with euthanasia as a cost-saving measure, keeping someone on the verge of brain death in the ICU is both expensive and futile. Doubly so if the savings are used to extend more lives on net.
As it stands, I am willing to compromise on my fantasy of euthanasia booths next to children's parks if that's the cost of making it available in more jurisdictions. What I proposed is a version specifically designed to appease the squeamish, while still being something I am content with myself. This involves removing or minimizing financial incentive to individuals or even most parts of the system.
To the extent that this calls for amendments in places with legal euthanasia, well, it does do that. It's just not as pressing as elsewhere.
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