This article is taken from the February 2025 issue of The Critic. To get the full magazine why not subscribe? Right now we’re offering five issues for just £10.
“The title of the bill is very, very clear,” said Kim Leadbeater MP in the run-up to a Commons vote in November. “It’s called the Terminally Ill Adults (End of Life) Bill.” As reassurance that her proposed breach of the legal taboo on helping another person commit suicide would remain strictly limited to “terminally ill adults”, this appeal to nominative determinism lacked a certain persuasiveness.
Leadbeater was responding to Shabana Mahmood, another Labour MP, who fears that the bill is a “slippery slope towards death on demand”. Such arguments consist of claiming that after a first, fateful step, it will prove impossible to avoid tumbling all the way down to a place so awful that, had you foreseen what would happen, you would have refused to move at all.
Those pooh-poohing such fears dismiss them as the “slippery slope fallacy”, arguing that each successive step can be accepted or rejected independently.
Yet policy-making slopes are often slippery. You don’t have to look hard for examples: doctor assisted dying is one. Take Canada, which passed a law in 2016 that, like Leadbeater’s draft bill, was restricted to the terminally ill. Just three years later it was broadened to cover non-fatal illnesses that are “grievous and irremediable”. An expansion to mental suffering, though delayed twice, is slated to come into force in 2027.
Or take Netherlands and Belgium, both of which legalised assisted dying early this century and have since expanded eligibility. Both now allow it for adults with broadly defined non-terminal physical conditions or mental distress — including depression — and in some circumstances for children, too.
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One reason slopes are slippery is that people are often less high-minded than legislators imagine. Typically, healthcare spending is highest in the final year of life, and you don’t have to be unusually cynical to predict that managers in the cash-strapped NHS will let that influence their lobbying of politicians and interactions with patients. In Canada, healthcare staff have been caught suggest-selling assisted death to people with costly medical conditions who have no desire to die.
Another is that supposedly strict eligibility conditions often turn out to be easily satisfied by the application of a rubber stamp. That is the likely fate of the requirement in Leadbeater’s bill for two doctors and a High Court judge to sign off each request for assisted dying, which is intended as a protection against beneficiaries of wills exerting undue influence on elderly relatives to stop their inheritances being spent down on elder care.
For an example see abortion, which since 1968 has required two doctors to attest that continuing with a pregnancy would pose greater “physical or mental” risk to the woman than terminating. The law was aimed at keeping desperate women out of the clutches of backstreet abortionists at a time when contraception was limited and unreliable. But whatever you think of abortion, it is undeniable that it is now available pretty much on demand, with 250,000 terminations a year in the UK (for comparison, the number of live births is 600,000).
A third reason for tumbling down a slippery slope is human rights law, which can often be used to strike down any restriction that can be framed as “discrimination”. Leadbeater’s bill is vulnerable on several points. If its purpose is to allow people to avoid suffering, why are only people expected to die within six months covered, whilst people in similarly dire circumstances who are expected to live longer must grin and bear it?
Why exclude people with disabilities that make them incapable of self-administering the lethal dose? Why must the cause of suffering be physical when, in the end, all suffering is mental? If assisted dying is about the “right to choose”, as Liz Kendall, another Labour MP, has said, why restrict it at all?
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Claiming discrimination is how lobby groups have persuaded credulous judges around the world to remove all conditions for legal “gender recognition” — allowing people to be deemed in law to have changed sex.
The first step down that slippery slope came more than half a century ago, when gender clinics started telling the men they diagnosed with “gender identity disorder” that they should use female toilets, changing rooms and so on in order to test whether they really wanted to spend the rest of their lives pretending to be women. Those who went all the way to getting castrated might, if they wished, get the sex on legal documents such as birth certificates and passports changed.
Those doctors discounted concerns about women’s safety and privacy because such men were a tiny minority, and all were on a drastic treatment pathway that led to castration.
Then came a series of test cases in national and international courts, which struck down the requirement to undergo genital surgery before legal sex change on the grounds that it causes sterility. (The obvious solution — don’t lie to patients that such gruesome surgery will change their sex; indeed stop offering it — was somehow not considered.)
Then came the effort to open up single-sex spaces to trans-identifying people who hadn’t had their paperwork altered. The trick here was to choose test cases that avoided alerting judges to inconvenient consequences. The most high-profile concerned Gavin Grimm, an American girl who sued her Virginia school to gain access to boys’ spaces. In 2019 a federal judge ruled that denying trans-identifying pupils access to opposite-sex spaces constituted unlawful discrimination.
It’s not a stretch to think the judge was influenced by Grimm’s appearance, which has been masculinised by testosterone and mastectomy. In girls’ spaces she would have looked out of place; in boys’ she is putting herself rather than others at risk, as a boy in girls’ spaces would be. Perhaps the judge might have been jolted into common sense by a non-passing boy demanding access to girls’ facilities. But that is not what was in front of her.
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Human rights law is particularly prone to such abuses when it is blind to genuine differences. America is well on its way down the slippery slope to commercial surrogacy, with successive shoves down the slippery slope coming from false parallels between male and female reproductive biology.
Consider a case in New York City taken by a gay man, who is arguing that the city’s health insurance plan discriminates unlawfully against gay male employees by tying coverage for IVF to a definition of infertility as inability to conceive through either unprotected male-female intercourse or intrauterine insemination.
He and his husband say the definition is discriminatory, based on stereotypes that see gay men as unfit parents. They want it replaced by “the state of requiring medical intervention, including donor gametes, to achieve a successful pregnancy”. Note what’s missing: a person with a uterus, that is, a woman.
If the couple wins, health insurance schemes across America will be under pressure to define all gay men as automatically infertile, regardless of their sperm quality. They say they aren’t expecting their insurers to pay a surrogate’s fees, but that will surely come in a future case.
The end-point of this slippery slope is commercial surrogacy covered by medical insurance — or perhaps even a state-run surrogacy service. It would be discriminatory to allow those greedy uterus-havers to hoard the baby-growing facilities, after all.
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How much will people care? In countries that have legalised abortion or assisted dying, the cautiousness of the first step has been essential to get the law passed. But few people have prioritised hauling themselves back up the slippery slope afterwards. Most people in the UK think the law on abortion is about right, and there is little clamour about assisted dying in Canada, Belgium or the Netherlands.
Even so, it’s reasonable to wonder how deep public support truly runs for a position that was arrived at because special interest groups are good at choosing test cases and legislative safeguards prove easy to circumvent. It takes a great deal of mental energy to continue to think that abortion on demand, doctor-assisted dying or commercial surrogacy are absolute evils if they are normalised and there is no prospect of a reversal.
First steps, it turns out, really are momentous. To claim otherwise is the slippery-slope fallacy fallacy.
