Shortly after announcing the introduction of her Terminally Ill Adults (End of Life) Bill, Kim Leadbeater MP told Sky News that “allowing terminally ill people to end their lives would not lead to a “slippery slope” of widening eligibility criteria”. She stressed that “wherever a law has been introduced in other countries, and it’s got strictly limited criteria with proper safeguards and protections, it hasn’t been widened.”
Her statement most likely referred to the assisted suicide law in the state of Oregon, USA, where the 1997 Death with Dignity Act allows patients with a terminal illness, defined as ‘‘an incurable and irreversible disease”, and prognosis of six months or less to live, to seek assisted suicide. The Oregon case has been looked upon as exemplary by proponents of assisted suicide because, at first glance, it appears not to have expanded the criteria since its introduction. In contrast, Canada quickly expanded eligibility by removing the requirement for a “reasonably foreseeable” death only five years after legalising assisted suicide. Canada is also due to introduce assisted dying for people with mental illnesses in 2027.
However, the example of Oregon as providing narrow criteria which remain stable is paper-thin. Thomas Finegan’s recent analysis of annual Official Data Summaries of the Oregon Death and Dignity Act reveals a significant shift in what is considered to be a “terminal illness” under the law. Finegan noted that, whilst the first three official reports between 1998 and 2000 listed illnesses such as cancer or AIDS as terminal illnesses for which patients sought and obtained assisted suicide, reports in 2020 and 2021 revealed that chronic but non-terminal conditions for which people sought assisted suicide under the vague ‘other illnesses’ category. These ‘other illnesses’ include, but are not limited to, endocrine/metabolic disease (e.g. diabetes), gastrointestinal disease (e.g. liver disease), anorexia, complications from a fall, medical care complications, or sclerosis as reasons for assisted suicide. Additionally, cancer accounted for only 62% of deaths in 2021 compared with 81% in 1998.
This reflects the normalisation of suicide in the state of Oregon, which the report also describes. Assisted suicide deaths almost doubled within the first two years of the law being introduced. Although it took 17 years to reach over 100 assisted deaths a year (2014), the figures then nearly tripled within less than ten years, reaching 280 deaths in 2022. Culture is influenced by law, and the significant increase in death from assisted suicide and the broadening of the interpretation of the legislation demonstrates this – the idea that a doctor might assist in the killing of a patient becomes ever-more normalised.
Moreover, expansion of the scope of assisted suicide is evident in the reasons for which assisted suicide is chosen, which is not simply ‘unbearable suffering’. Alarmingly, individuals have increasingly chosen assisted suicide because they feel they are a burden on their families and society (54 % in 2021 versus 26% in 2011). These reasons highlight the complex emotional, psychological and social pressures at play when people seek assisted suicide, as most choose this path for reasons other than physical pain.
The reality of assisted suicide in Oregon thus seems to differ significantly from the scenario presented by proponents of the bill presented by Kim Leadbeater, whereby assisted suicide would only be used in limited cases of unbearable pain and terminal illness. Consequently, despite apparently robust safeguards and laws, Oregon has not succeeded in protecting those who might feel coerced into making such a decision or who simply want assisted suicide because they believe themselves to be a burden on their families.
The experiences in Oregon demonstrate the inevitability of a slippery slope. The broadening of eligibility criteria and the normalisation of assisted suicide for reasons beyond physical suffering indicate that even well-intentioned laws can have dreadful consequences. Everywhere else in the world where assisted suicide has been made legal has an even more depressing story to tell. Already, proponents of assisted suicide in the UK have cited dementia as being a reason for supporting assisted suicide legislation. No doctor should be able to take the life of somebody who is mentally incapacitated, but, once we open the door to assisted suicide, we will quickly arrive at this situation.
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