TY - JOUR T1 - Slippery slopes in flat countries--a response. JF - Journal of Medical Ethics JO - J Med Ethics SP - 22 LP - 24 DO - 10.1136/jme.25.1.22 VL - 25 IS - 1 AU - J J van Delden Y1 - 1999/02/01 UR - http://jme.bmj.com/content/25/1/22.abstract N2 - In response to the paper by Keown and Jochemsen 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 of any euthanasia policy. The Dutch notification procedure has recently been changed to reduce the underreporting of cases. However, many questions remain. ER -