Professor Penney Lewis:

I am not medically qualified, so I cannot give the committee a medical opinion. I think the answer is that we do not know. I do not think there is any rigorous empirical evidence about the prevalence of obtaining that kind of drug. Having said that, there is anecdotal evidence concerning places where patients have imported drugs. There are quite a lot of cases in Australia that have been discussed in the media, with prosecutions either mooted or actually started, involving patients that have imported drugs.

I am certainly aware, anecdotally, of cases in other jurisdictions where patients have imported drugs over the Internet. The places where those drugs come from has also been discussed in the literature. There was reference to Mexico - that seems to be one of the jurisdictions. At one point, there was discussion in the literature of people going to Mexico to obtain veterinary drugs which they could apparently buy over the counter and that has moved on to people ordering drugs online from Mexico. I have also seen anecdotal evidence of ordering drugs online from China. All of the evidence is anecdotal. There certainly are cases. There is not any rigorous evidence of prevalence. We just do not know.

What we know, also anecdotally - but this is evidence that has been accepted by a number of legislatures and in a number of judicial decisions made across the world, including in the highest courts in Canada and the UK - is that people commit suicide earlier than they would have wanted to had assisted dying been available to them. The most recent evidence I have seen on this is from the Australian state of Victoria, which is probably about to legalise assisted dying. During the legislative process there, evidence was provided by a representative of the Coroners Court of Victoria who described the number of cases it sees of patients with terminal diagnoses or diagnoses of serious progressive neurological conditions whereby the patients have killed themselves earlier than they would have wanted - and sometimes in quite disturbing ways - in order to avoid being unable to do so later. There is evidence of individual cases of this kind in the literature that is being published. There is also evidence in court cases whereby patients have said, "This is what I will do," "This is what I would do," or "I know this person has done this." There is quite a lot of anecdotal evidence.