consequentialism and the slippery slope: a response to clark

© Society for Applied Philosophy, 2000, Blackwell Publishers, 108 Cowley Road, Oxford, OX4 1JF, UK and 350 Main Street,Malden, MA 02148, USA.

Journal of Applied Philosophy, Vol. 17, No. 2, 2000

DISCUSSION ARTICLE

Consequentialism and the Slippery Slope:a response to Clark

JONATHAN HUGHES

Michael Clark has recently argued that the slippery slope argument against voluntaryeuthanasia is ‘entirely consequentialist’ and that its use to justify continued prohibition ofvoluntary euthanasia involves a failure to treat patients who request assistance in ending theirlives as ends in themselves. This article argues that in fact the slippery slope is consistent withmost forms of deontology, and that it need not involve any violation of the principle thatpeople should be treated as ends, depending upon how that principle is construed. It isconcluded that supporters of voluntary euthanasia cannot dismiss the slippery slope argumenton the basis of deontological principles but must take seriously the consequences that it postulatesand engage in factual argument about their likely extent and about the likely effectiveness ofany proposed safeguards.

Michael Clark argues in a recent article that the slippery slope argument againstvoluntary euthanasia (hereafter referred to as the SSA) is ‘entirely consequentialist’ andthat its use to justify continued prohibition of voluntary euthanasia involves a failure totreat patients who request assistance in ending their lives as ends in themselves [1].This conclusion is presented as an uncomfortable one for opponents of euthanasia,many of whom argue from an explicitly non-consequentialist perspective and attackthe consequentialism of those who take a more liberal stance. I want to suggest,however, that Clark overstates both the consequentialist character of SSA and thetension that exists between it and the principle of treating persons as ends. On the firstpoint, while the SSA is undeniably a consequence-based argument, it is not necessaryto be a consequentialist, as the term is usually understood, to employ it. The most thatcan be claimed is that there are certain kinds of non-consequentialist for whom theSSA is unavailable, but even this claim needs to be qualified. On the second point, theSSA is indeed incompatible with the principle of ends construed in the manner ofKantian absolutism. Such an absolutism is, however, rejected by Clark himself, and Iargue that the SSA is compatible with a different and arguably more plausible accountof the value of treating people as ends. I also suggest that the examples used toillustrate Clark’s argument are misleading and that he underestimates the power of acontractarian device to adjudicate between the competing interests involved.

Slippery slope arguments are invoked in a variety of contexts. The common featureof such arguments is the claim that an action or policy of type X, which may not bemorally objectionable in itself, should nevertheless be rejected because in performing

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actions of type X we make it likely or inevitable that undesirable actions of type Y willbe performed in the future; thus there is said to be a slippery slope leading downwardsfrom X to Y. The slippery slope argument against voluntary euthanasia claims that,even if voluntary euthanasia is not intrinsically wrong, it should nevertheless remainprohibited because a likely consequence of permitting it is that involuntary euthanasiaand other morally unacceptable killings will be practised more widely in the future [2].The practice of voluntary euthanasia, it is suggested, will weaken doctors’ inhibitionsagainst killing; elderly and terminally ill patients will feel pressured to accept euthanasiain order not burden their families or the health care system; and indeed families andmedical staff may exert pressure in order to save on the costs of care [3].

Consequentialism and Deontology

In one sense the SSA clearly is a consequentialist argument. It is an argument thatappeals solely to the consequences of an action in order to show that it is impermissible.It therefore presumes that the consequences of an action are among the factors thatdetermine its deontic status. Consequentialism as a doctrine, however, is usually un-derstood as the view that the deontic status of an action is determined exclusively by thevalue or disvalue of its consequences, and this is not presupposed by the SSA. Adher-ents of the SSA can allow that many factors are relevant to the morality of voluntaryeuthanasia and might be decisive were it not for the grave threat of a slippery slope.Such factors may include, for example, the fact that voluntary euthanasia is an expres-sion of a patient’s autonomy, the doctor’s duty of care for her patient, and the implicitor explicit contract between patient and doctor. All that the adherent of the SSA has toinsist upon is that in the cases to which the SSA applies, the threatened consequencesare so bad as to outweigh any of these other factors which tell in favour of a permissivepolicy. Thus adherents of the SSA must recognise that the consequences of an actioncan be pertinent to its moral evaluation and may sometimes outweigh other, non-consequentialist, considerations; they need not, however, accord them the exclusivesignificance implied by consequentialism.

It might be objected that by allowing the consequences to override other considera-tions the adherent of the SSA has effectively embraced consequentialism. This, how-ever, would be mistaken. A non-consequentialist, or deontological, theory is one forwhich the rightness or wrongness of an action is not determined solely by the value ordisvalue of its consequences. The implications of such a view emerge most clearlyfrom circumstances in which by performing one intrinsically undesirable action I mayprevent the performance by others of several similar actions. It may be for example thatby torturing an innocent child I can extract information that would enable the tortureof two other innocent children to be prevented. The consequentialist, assessing theaction solely in terms of its consequences, must say that it would be right to torture theone child to save the two. It is open to the deontologist, however, to resist thisconclusion on the grounds that I am under a non-consequentialist duty to refrain fromcommitting acts of torture. Such duties, or constraints, are often termed agent-centredor agent-relative since their content involves essential reference to the agent: my duty,on such a view, is not to ensure that torture does not happen, but that it is notcommitted by me [4]. But while deontologists are committed to the existence of such

Consequentialism and the Slippery Slope 215


duties they need not hold them to be absolute. The deontologist may allow a non-consequentialist duty to be overridden if the consequential benefits of non-complianceexceed a certain threshold. She may, for example, hold that while I should not tortureone to save two, I should do so to save twenty or two hundred. What she cannot do,while remaining a deontologist, is to allow agent-relative duties to be overridden forthe sake of marginal improvements in the consequences, as this would indeed collapseher position into consequentialism by depriving agent-relative duties of any practicalsignificance.

Returning now to the case of voluntary euthanasia and the slippery slope argumentwe can see that it is possible for a deontologist to employ the SSA in order to opposevoluntary euthanasia. Even supposing that there is, prima facie, a non-consequentialistduty to permit someone who is desperate to end their life to obtain help from a willingaccomplice, the deontologist can argue that this duty is overridden by the longer-termconsequences of such a permissive policy. The deontologist would, of course, have toargue that the net benefit of the non-permissive policy is more than marginal, and thisis complicated in the euthanasia case by two factors: first that the putative longer termconsequences of a permissive policy (i.e. the slide to involuntary euthanasia) are uncer-tain, and second that they are different in kind from the costs of a non-permissivepolicy (unjustified killings on the one hand and avoidable prolongation of suffering onthe other) and therefore are not straightforwardly comparable. The uncertainty wouldpresumably be dealt with by discounting future consequences in proportion to theirestimated probability, and I shall have more to say about the problem of comparingdissimilar consequences below. Despite these complications, however, it is clear thatthere is no reason in principle why the deontologist cannot appeal to the SSA.

Absolutism

The idea that non-consequentialist duties may be overridden by consequential considera-tions above a certain threshold is accepted by many deontologists and it is apparentlyendorsed by Clark himself [5]. However, not all deontologists accept this thresholdview, and for those who view agent-relative duties as absolute — to be complied withwhatever the consequences — Clark’s arguments will have greater force.

We should not, however, overstate the significance of this fact. First, it may be notedthat genuinely absolutist forms of deontology are less common than the use of absolutist-sounding language might suggest. Dworkin’s ‘rights as trumps’ metaphor, for example,is intended to signify that rights override considerations of marginal utilitarian benefit,but he allows the possibility of rights themselves being overridden to protect otherrights or for the sake of more substantial utilitarian benefits [6]. Even Nozick, whosetheory of rights — defended in terms of the ‘inviolability’ of individuals — is often takento be paradigmatic of absolutist non-consequentialism, declines to answer the questionof whether the moral constraints corresponding to individuals’ rights ‘are absolute, orwhether they may be violated in order to avoid catastrophic moral horror’ [7].

Secondly, it should be noted that there is more than one way in which an absolutisttheory might relate to the issue of voluntary euthanasia. Nozick’s theory, on the mostplausible interpretation, extends to each individual an absolute right to non-interferencein actions which do not involve aggression against others. Since acts of voluntary

216 J. Hughes


euthanasia fall within this protected class (aggression being by definition non-consensual)it follows that such acts cannot legitimately be prohibited. The Nozickian absolutistmust therefore reject the SSA. This, however, is unlikely to worry many absolutistopponents of voluntary euthanasia, most of whom would reject the idea that voluntaryeuthanasia falls within the class of actions protected by deontological constraints. Asecond possibility, therefore, is that while there are absolute deontological constraints(e.g. on certain kinds of involuntary killing), these neither protect nor are violated byacts of voluntary euthanasia. Someone who took this view could consistently appeal tothe SSA to argue that while voluntary euthanasia is not itself a violation of anydeontological constraints it should remain prohibited because permitting it is likely tolead to such violations in the future. The third (broadly Lockean) possibility is thatvoluntary euthanasia is itself in violation of an absolute deontological constraint. Forsomeone who takes this view, consequential arguments are, strictly speaking, redund-ant, since voluntary euthanasia will be morally impermissible irrespective of its con-sequences. According to such a view it is wrong even to set foot on the slope, irrespectiveof any danger of sliding down it. Nevertheless, adherents of this view may legitimatelyemploy the SSA as an immanent critique of the position taken by their consequentialistopponents, the claim being that a consequentialist perspective properly applied willlead to conclusions similar to their own.

The Principle of Ends

My argument so far has been directed at Clark’s claim that the SSA is a consequentialistargument, and I have argued that in fact its use is consistent with a wide variety ofnon-consequentialist perspectives. Let us turn now to the principle of ends. Clark’sargument here is that to deny assistance to those who wish to die, in order to reduce therisk of others being killed against their wishes, is to fail to treat them as ends in themselves:

If patients are denied the assistance solely to protect others from the risk ofunacceptable euthanasia then they are left to suffer purely to benefit others.They are being denied assistance in order to reduce the risk for future patientswho are not in the same desperate state; they are not being respected as endsin themselves [8].

Two claims are at issue here: first Clark’s explicit claim that to deny voluntary eutha-nasia to patient is to fail to treat her as and end, and second, the implicit claim that toact in this way would be wrong. Both claims may be challenged.

Do we fail to treat someone as an end by refusing her request for voluntary eutha-nasia? To treat someone as an end is to treat her as an autonomous individual, thearchitect of her own life and creator of her own values. But what does this require ofus? It is surely too strong to say that we only treat someone as an end when we areguided in our relations with them solely by their own wishes and values. Kant himselfallowed that treating someone as an end may be compatible with treating them as ameans, so long as we do not treat them solely as a means. Thus to treat someone as anend is to take account of their autonomous, self-governing nature, but not necessarilyto exclude other considerations from our deliberations concerning our actions withregard to them. Treating others as ends is therefore a matter of degree, and any moral



principle enjoining such treatment must specify, at least implicitly, the extent to whichwe should be guided by the wishes and values of the person concerned, or converselythe extent to which other considerations may permissibly enter into our deliberations.

Clark interprets the principle of ends, in Kantian fashion, as an agent-relative con-straint. On this account my duty is to ensure that I do not myself fail to treat othersas ends, irrespective of what others may do. Thus, in Clark’s view, we should permitvoluntary euthanasia, out of respect for the autonomy of those requesting it, even ifthis leads to increased violations of autonomy (and in particular the autonomous wishof the elderly and sick to live out their lives) in society at large over the longer term.This, however, is of questionable rationality. If the principle of ends is rooted in theimportance to an individual of being in control of his own life then surely it shouldpermit actions or policies which reduce the numbers of individuals denied that control.Indeed, to reject such policies out of deference to an agent-relative version of the endsprinciple may be counted a form of self-indulgence — a case of keeping one’s ownhands clean at the expense of the people for whom one professes concern. Moreover,it is plausible to maintain not only that we do no wrong in following a policy whichminimises such violations, but also that in doing so we do not fail to treat those towhom euthanasia is refused as ends. We take into account the interests and wishes ofall those affected by our action but decide in the circumstances that since not all suchinterests can be accommodated the right course of action is to accommodate theinterests of more rather than fewer people. What we are faced with is a tragic choice,which the agent-relative version of the ends principle evades by requiring us to takeseriously only those violations that we ourselves commit.

In defence of the agent-relative view Clark points out that the violations envisaged inthe slippery slope argument will occur, if at all, as a result of the wrongful actions ofothers. The suggestion is that since they and not we will bear responsibility for theseconsequences, we should not take them into account in deciding what to do. Thisparallels Kant’s own defence of agent-relativism in ‘On a Supposed Right to Lie fromAltruistic Motives’ [9], but, like Kant’s argument, rests on the questionable assumptionthat we have no responsibility in such circumstances to prevent the evil that may resultfrom others’ wrongdoing. This is particularly problematic in cases like euthanasia whichinvolve state regulation, since those threatened by the consequences of the slipperyslope might plausibly argue that they have a right to be protected against such wrongfulaction even at some cost to others.

Clark elaborates his case by means of two examples, supposedly parallel to the caseof euthanasia:

Suppose asylum is refused to a political refugee who is certain to be torturedand killed if sent back, on the grounds that this risks opening the door tomany fraudulent asylum seekers whose motivation is solely ‘economic’. Orconsider refusing compensation to a plaintiff who suffered nervous shock afteran accident on the grounds that, though it would be just to do so, it incurs therisk that the courts will be flooded with less worthy claimants, some of whommay nevertheless succeed, with adverse consequences for the community(legal delays increased, insurance premiums soar). In each case, if any of theadverse consequences did ensue, the fault would lie with the fra[u]dulent orunworthy claimants, not with the original victims [10].

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As far as the question of responsibility is concerned my previous comments apply. Inaddition, however, it should be noted that the two examples are poor analogues for thecase of voluntary euthanasia. In Clark’s examples the cost to individual members ofthe community of legal delays, economic migration etc. are minor in comparison withthe benefits that the granting of such claims brings to those genuinely in need. In thecase of euthanasia, however, the strength of the slippery slope argument lies preciselyin the comparable severity of, on the one hand, being kept alive in terrible pain againstone’s will, and on the other, being killed while one wishes to continue living.

Clark suggests that in fact these two harms cannot be meaningfully compared. Acontractarian approach would ask whether it would be rational under a veil of ignor-ance for me to accept the possibility of wanting and being refused euthanasia in orderto protect myself against the risk of being involuntarily killed through abuse or misuseof liberal euthanasia laws. Clark responds that this argument is hopeless:

As it stands it assumes that it is rational to be equally averse to protractedsuffering at the end of our life as to abusive euthanasia. Nor would it be anyless arbitrary to assign any other comparative weighting to the aversions of therational contractor. Moreover, even if the argument could be made to work,its probative value would be highly questionable, since it would also apply tothe asylum and nervous shock cases mentioned above [11].

This, however, is to give up too easily on rational deliberation. If we accept thatviolations of autonomy matter whether they are brought about directly by ourselves ornot, then it is incumbent upon us to compare and balance such violations as best wecan, even if mathematical precision is unattainable. A contractarian methodology isone way of trying to do that. It is not necessary to assign weights to the two kinds ofharm if we address the contractor’s question to each person engaged in the debate,asking them to answer on the basis of their own preferences. My guess is that mostpeople’s aversion to the two bad outcomes would be sufficiently similar for theirdecision to be dependent to a large extent on the relative probability of experiencingeach of the two events, a probability which depends upon the expected frequency ofeach event given a policy choice for or against voluntary euthanasia. The suggestionthat contractarian arguments should be rejected since their conclusions are unappeal-ing when applied to the asylum and nervous shock cases is mistaken: as I have alreadyargued those cases are significantly different from the euthanasia case and we maytherefore expect rational contractors to reach different conclusions [12].

Conclusion

It has been argued in this paper that the slippery slope argument is not an ‘entirelyconsequentialist’ argument, as Clark asserts. It is compatible with the most common,non-absolutist forms of deontology, and with some forms of deontological absolutism.It has further been argued that invoking the SSA need not involve a failure to treatpeople as ends. However, I do not intend this paper to be read as an argument infavour of the SSA and against voluntary euthanasia. Its claim, rather, is that supportersof voluntary euthanasia cannot dismiss the SSA by appeal to deontological principles,but must take seriously the threatened consequences of voluntary euthanasia, weigh



these against its undoubted benefits, and engage in factual argument about the likelyextent of such consequences. The latter argument must take account of any safeguardsthat may be instituted to prevent abuse or misapplication of a more liberal euthanasiaregime, but the effectiveness of such measures is itself open to argument, and the mereproposal that there should be such safeguards cannot itself constitute a satisfactoryresponse to the SSA.

Jonathan Hughes, Centre for Philosophy, Department of Government, University of Man-chester, Manchester M13 9PL, UK. E-mail: [email protected]

NOTES

[1] M C (1998) Euthanasia and the slippery slope, Journal of Applied Philosophy, 15, pp. 251–7.[2] It should be noted that although Clark refers to the various acts of unjustified killings that may result

from the permitting of voluntary euthanasia as ‘unacceptable forms of euthanasia’ much of what isreferred to here is not properly euthanasia at all. Euthanasia is defined as killing that is carried out forthe sake of the one killed, whereas the scenarios sketched here involve killings carried out for the con-venience of others. Involuntary euthanasia, strictly speaking, is killing that is done for the benefit of theperson killed though against their wishes, and is just one of the undesirable consequences predicted byproponents of the SSA to result from the social acceptance of voluntary euthanasia. Note further that Iuse ‘euthanasia’ throughout to refer to active euthanasia, since the permissibility of voluntary passiveeuthanasia is not seriously contested; see W G (1999) Right to die or duty to live? The prob-lem of euthanasia, Journal of Applied Philosophy, 16, p. 21.

[3] Clark also highlights an argument parallel to that just outlined: that permitting euthanasia will have anegative effect on the development and provision of pain relief and palliative care. Like the SlipperySlope Argument this one claims that voluntary euthanasia should be prohibited not because it is intrins-ically wrong but because of its likely consequences. I will not comment further on this argument, but Ibelieve that the points made in relation to the SSA apply here too.

[4] See for example S S (1994) The Refutation of Consequentialism (Clarendon Press, Oxford).[5] Clark, op. cit., p. 256.[6] R D (1978) Taking Rights Seriously (Duckworth, London), pp. xi, 191.[7] R N (1974) Anarchy, State, and Utopia (Oxford, Blackwell). pp. 30–32.[8] Clark, op. cit., pp. 252–3.[9] I K (1976) Critique of Practical Reason and Other Writings in Moral Philosophy, trans. Lewis

White Beck (Garland, New York), pp. 346–50.[10] Clark, op. cit., pp. 253.[11] Clark, op. cit., pp. 255.[12] In particular we may expect rational contractors to be much less swayed by the relative frequency of

outcomes in the asylum and nervous shock cases, since this will be overwhelmed by the difference inseverity. In the euthanasia case, by contrast, relative frequency is important since there is less differencein severity of outcomes.

consequentialism and the slippery slope: a response to clark

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