A new Bill to legalise ‘assisted dying’ in Scotland may soon be passed by Holyrood. It has been drafted by Lib Dem MSP Liam McArthur and is intended to provide more legal clarity around the issue, which has been previously debated in the Scottish Parliament in slightly different ways but which effectively ‘fell at the first hurdle’ due to lack of support from other MSPs. A free vote would be cast in the event of the Bill surviving scrutiny; First Minister Humza Yousaf has indicated he will vote against.
It has been stressed that there would be stringent safeguards to deter misuse of the law in practice, including the agreement of two medical professionals that someone’s request to end their life is voluntary and not coerced. Those who support the Bill feel that the overall attitude towards assisted dying has changed. Indeed a Scottish poll in 2023 showed that 77% of those asked agreed with it becoming legal. However, this has not won over the support of everyone.
Assisted dying as an act of compassion
McArthur believes that Scotland should legally provide the means to a “safe and compassionate” assisted death, which would end unnecessary suffering experienced by those with a terminal illness. He argues that many other countries around the world have this right enshrined in law and that general opinion in Scotland has shifted over the years towards support for a similar model here. McArthur believes that the law in Scotland at present is not clear on what does and does not constitute a criminal offence regarding assisting someone to die; people can be prosecuted for the act despite no official legislation around it.
The Bill proposes that only those who have “advanced stage” terminal illness are eligible for having an assisted death, along with additional criteria; the person should have lived in Scotland for at least 12 months and be registered with a Scottish medical practice. They also must have the ‘capacity’ to fully comprehend the process and the procedures involved in any treatment, whilst ‘retaining memory of’ it.
The person, having provided proof of identity, must then make a “first declaration” which must be signed in the presence of the “coordinating registered medical practitioner” and another witness. Next, the medical practitioner must carry out an assessment to explain the procedures involved in the assisted death, detailing the person’s illness, prognosis and any substance(s) used in the process, explaining any treatment and palliative care available. The practitioner can refer someone to a specialist, or a psychiatrist, if they have any doubts about the “terminal” nature of the diagnosis, or whether a mental health problem could be influencing the decision.
A second medical practitioner must subsequently do an independent assessment of the individual. If both practitioners are satisfied that the person is eligible, and there has been no coercion from others to pressure them into the decision, then and only then can official statements be made that the patient wishes to have an assisted death. This decision can also be cancelled at any time if the individual changes their mind.
Is assisted dying a slippery slope?
These additional ‘safeguarding’ procedures have not changed or settled everyone’s minds. Unsurprisingly religious groups, which see all human life in all circumstances as sacred, have come out against the proposals stating that society has a duty to care for the terminally ill rather than to help them end their lives, and that making it legal would be a ”slippery slope”. It is worth noting that at the same time as support for assisted dying has gone up, identifying with a religion has dropped; the Humanist Society claims that in 2018 59% of Scots said they had no religion. Some may argue that once assisted dying is legal there is no going back, and future governments may be able to ‘tweak’ the legislation to accommodate their political views. Additionally, there is the risk of doctors being unable to identify possible coercion of terminally ill people. Covert abuse of the vulnerable can often go undetected, even by multiple medical professionals.
The current state of Scottish palliative care
Writing in the Glasgow Times, former First Minister Nicola Sturgeon states concern about the devaluation of palliative care and the much-needed assistance currently available for the seriously ill. She also fears there may be a “shift in collective mindset” on the parameters of the Bill if it is passed. Disability groups such as the Glasgow Disability Alliance have stated that it could lead to disabled people feeling like a ‘burden’. Some already do and no amount of safeguards could guarantee that the vulnerable would never be coerced or pressured to die. Concurrently, a consultation process is underway regarding the legal provision of palliative care to anyone with a terminal illness living in Scotland.
The proposals state that at present many people do not have access to appropriate support and cite problems with the system through personal accounts of individuals, families and carers who have had dealings with it. The proposals highlight that those who most need health care are often least likely to receive it. According to the proposals, this is an issue that also needs to be addressed in palliative care services. Specific groups that are at risk of not receiving appropriate support include those who are financially worse off, ethnic minorities, people from the LGBTQ+ community, and people with learning disabilities. The proposal notes that those from rural and island communities are also at a disadvantage and that 8,200 people a year who need access to end-of-life care are living in poverty.
It is important to point out that the Assisted Dying Bill has not been introduced as a means of reducing the cost incurred by the provision of end-of-life care, and doctors must inform those who have expressed a wish to die of the options available to them through palliative support. However, it would be naive to assume that assisted dying may not be seen as an attractive proposition to future political parties which are more focused on ‘balancing the books’ than seeing the value of every single life.
If there are certain groups which are already at a disadvantage in accessing palliative support, then these same groups could feel choosing to die is easier than fighting for support from already stretched care services, despite being just as entitled to and worthy of them. The report also states that the majority of people needing palliative care by 2040 will be aged over 85 and that many of them may be located in rural and island communities. Given the strength of religious beliefs in these locations, and despite, currently being at a disadvantage, it is surely reasonable to predict that there will continue to be a high need for palliative support. Ultimately, even with the option of assisted dying, there is no reasonable excuse for poor end-of-life care.
McArthur is hopeful that the new law will contribute to a more “compassionate Scotland”. This of course is not guaranteed, and some might argue it will do the opposite by devaluing lives, especially those of certain communities already at a disadvantage. Time will tell how the Bill progresses and whatever the outcome, the debate will be fiercely contested inside and outside Holyrood.
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