Slippery slopes in flat countries - a response

In response to the paper by Keown andJochemsen in which the latest empirical data concerning euthanasia and other end-of-life decisions in the Netherlands is discussed, this paper discusses three points. The use of euthanasia in cases in which palliative care was a viable alternative may be taken as proof of a slippery slope. However, it could also be interpreted as an indication of a shift towards more autonomy-based end-of-life decisions. The cases of non-voluntary euthanasia are a serious problem in the Netherlands and they are only rarely justifiable. However, they do not prove the existence of a slippery slope. Persuading the physician to bring euthanasia cases to the knowledge of the authorities is a problem ofany euthanasia policy. The Dutch notification procedure has recendy been changed to reduce the underreporting of cases. However, many questions remain. (7ournal ofMedical Ethics 1999;25:22-24)