Professor Richard Huxtable:

I have three or four remarks to make. First, reference was made earlier to Penney Lewis's work with Isra Black. Their review seemed to suggest that, on balance across a variety of legal systems that have taken the step to allow some form of assisted dying, the safeguards were effective and there is no evidence of incrementalism or a slippery slope. I would add that from my reading of the literature, the evidence does not all point in one direction. It is contested. The data themselves are contested as to whether there is evidence of slope. For my own part, I observe that looking to the Netherlands, for example, it is notable that provision began in the early 1970s with instances of incurable and terminal illness and moved in the early 1990s to psychiatric suffering as a ground for euthanasia. Since then, there has been a long-running debate around the status of so-called life fatigue, that is, being tired of life, as a basis for euthanasia or assisted dying. There have even been protocols applying euthanasia-type practices to critically ill children, which is a considerable distance from the application to adults originally envisaged under the law. I personally think there is some evidence of slope out there. I even query if we are seeing such evidence in Canada as well with regard to media reports around whether assisted dying or assisted suicide is being motivated by poverty, a lack of social support and so on. The data are contested and we can disagree about whether a slope is evidenced.

However, in the interests of balance, I note that more commentators seem to feel the Oregon model, which, as I understand it, is more what we might call assisted suicide with the patient taking the final fatal step and the process being restricted to those with terminal illness, has not resulted in a slippery slope.

On the question of whether we can introduce absolutely watertight legal boundaries to ensure there is no slide, I fear we probably cannot. I am struck by a remark, which I believe was made by Mr. Griffiths writing in an academic law report in the early 1990s, pointing out the human tendency to test the limits of regulation. I suspect there is something in the nature of the law that evolution might well happen.

I wonder whether we might approach the question not merely by looking at assisted dying in isolation, but by looking at a suite of laws or policies more generally. For example, if we are concerned with protecting people with disabilities, is there more we can do to protect them and to improve their situation in myriad ways? Related to that, could we introduce some sort of palliative care process or filter such as I have mentioned? Beyond that, do we have adequate provision of good quality care for the dying? I wonder if part of the answer involves not merely looking at assisted dying in isolation, but looking at a potential suite of social measures.