In this blog, Senior Researcher (and Canadian) Gideon Salutin argues that those worried about a slippery slope should recognise that many other jurisdictions have well-functioning regulations on assisted dying.
“I think there is a perception around the slippery slope concept which isn’t reality” Kim Leadbeater argued recently, in defence of her assisted dying bill, which will come before parliament tomorrow. While her proposal would only permit the option for those with terminal conditions, detractors warn it could be the thin end of the wedge, and that before long we can expect to see those with disabilities or mental health issues pressured to end their lives. Similar questions are being asked of Scotland’s assisted dying bill, already progressing through the Scottish Parliament.
Such fears are understandable, but in my view misguided. To a large extent they are based on the experience of my home country, Canada, increasingly presented in this debate as a hellscape. The Spectator has called it a “catastrophe” and “horror story.” A more circumspect Times headline simply asked, “has it gone too far?”, while a leading article referenced the “unintended consequences” of assisted dying evidenced in Canada.
Much of this is exaggerated: a majority of assisted deaths in Canada are clear and valid. But Canada does offer a warning of what can go wrong if assisted dying is poorly implemented. From the beginning in 2016, eligibility restrictions were loose, lacking clear criteria to define terminal illnesses and the nature of suffering. Procedural safeguards were minimal and oversight was not required. Physicians in some provinces were expected to make life or death judgements with only a four-page pamphlet for guidance.
These issues exploded in 2021 when a judicial decision based on Canada’s constitution led the government to scrap any requirement that applicants be terminally ill, suddenly offering the option to anyone suffering from physical illnesses. One of the only bulwarks restricting eligibility, already loose and leaky, was overturned.
This has led to a number of questionable cases. Human rights organisations and disability advocates have warned that the most vulnerable in society are feeling more pressure to receive assisted dying, while those in poverty may see it as a way out. Despite cases like these, some advocacy groups are continuing to demand that policymakers widen eligibility further.
Canada’s experience is bewildering and frightening. But it is also unique. In fact, it is more common for assisted dying to remain tightly and effectively controlled.
Ten American states, alongside Washington D.C., allow for some form of assisted dying. Oregon legalised assisted dying as far back as 1998, and Washington followed in 2009. Many others did so around the same time as Canada. In Australia and New Zealand, states and territories have been legalising assisted dying since 2017.
Every one of these places limits eligibility to those with terminal conditions, and none have widened it further. They passed effective legislation, clearly defining eligibility and minimizing doctors’ discretion.
As a result, in each of them assisted dying accounts for a smaller proportion of total deaths than Canada. California introduced assisted dying legislation the same month as Canada, and despite having a similar population size, the state sees just 7% of Canadian case numbers.
Perhaps the key distinctive feature of assisted dying in Canada is that it has been driven by judicial rulings. This has made the process haphazard and unpredictable, in contrast to American, Australian, and New Zealand’s policies which have been carefully planned. The UK, absent a constitution, does not need to fear the blunt hammer of judicial rulings, and can follow the better examples.
Advocates for assisted dying in the UK should confront concerns about Canada head on, discussing them compassionately and demonstrating that they have learned the necessary lessons about protecting the most vulnerable. Many issues, such as those related to our palliative care system, are authentic, significant and practical.
At the same time, they cannot allow Canada to dominate the debate. There are numerous examples that demonstrate that there is no inevitable slippery slope, which offer better models to study and learn from. Key safeguards learned from their experience shows the need for clear and restricted criteria for eligibility, specific procedural guidelines, vigilant oversight, and requirements that applicants exhaust all reasonable treatments before their application. In addition, some countries have chosen to upgrade their palliative care system at the same time as introducing assisted dying to ensure no one chooses to die prematurely.
There are the concerns we need to confront in upcoming legislation in order to ensure assisted dying is secure and compassionate. The slippery slope is not one of them.
