Respond: Scottish consultation on assisted suicide

The Scottish government is conducting a call for evidence on its proposed Assisted Dying for Terminally Ill Adults (Scotland) Bill.

It’s an opportunity to stand for life by making it clear that you oppose assisted suicide and euthanasia.

There are two ways to respond to the call for evidence.

1. A ‘short survey’ merely asks whether you support the Bill and which factors are most important to you. If you have very little time, it will not take long to respond to the short survey.
2. There is also a ‘Detailed call for evidence’. This comprises eight questions and more opportunity for comments. If you have a bit more time, then please respond to the more detailed survey. Below, we suggest how to respond to the questions posed. Please use the example points provided but re-phrase them in your own words.

1. Respond to the short survey >>
2. Complete the call for evidence >>

Please respond before the deadline on 16 August 2024.

Find out more about the Assisted Dying for Terminally Ill Adults (Scotland) Bill >>

Questions in the Detailed Call for Evidence

Question 1 – Overarching question

The purpose of the Assisted Dying for Terminally Ill Adults (Scotland) Bill is to introduce a lawful form of assisted dying for people over the age of 16 with a terminal illness.

Which of the following best reflects your views on the Bill?

• Fully support
• Partially support
• Neutral/Don’t know
• Partially oppose
• Strongly oppose

Which of the following factors are most important to you when considering the issue of assisted dying?

• Impact on healthcare professionals and the doctor/patient relationship
• Personal autonomy
• Personal dignity
• Reducing suffering
• Risk of coercion of vulnerable people
• Risk of devaluing lives of vulnerable groups
• Sanctity of life
• Risk of eligibility being broadened and safeguards reduced over time

Question 2 – Eligibility

The Bill proposes that assisted dying would be available only to terminally ill adults.

The Bill defines someone as terminally ill if they ‘have an advanced and progressive disease, illness or condition from which they are unable to recover and that can reasonably be expected to cause their premature death’.

An adult is defined as someone aged 16 or over. To be eligible a person would also need to have been resident in Scotland for at least 12 months and be registered with a GP practice.

Eligibility – Terminal illness

Which of the following most closely matches your opinion on the terminal illness criterion for determining eligibility for assisted dying?

• No-one should be eligible for assisted dying
• Assisted dying should be available only to people who are terminally ill, and the definition of terminal illness should be narrower than in the Bill
• Assisted dying should be available only to people who are terminally ill, and the definition of terminal illness in the Bill is about right
• Assisted dying should be available only to people who are terminally ill, but the definition of terminal illness should be broader than in the Bill
• Assisted dying should be available to people who are terminally ill, and to people in some other categories.
• Other – please provide further detail

If you have further comments, please provide these.

We suggest you make some of the following points in your own words:

‘No-one should be eligible for assisted dying and the definition of terminal illness should be narrower than it is in the Bill’.

I am opposed to the wording of the proposed bill as relating to ‘assisted dying’. There is no such thing as ‘assisted dying’. The proposals clearly relate to helping a patient to commit suicide. This wording is designed to get round the current law and evade accusations of assisting suicide.

As a matter of principle, there is no need to legalise assisted suicide, it is morally wrong to do so, and it is always a slippery slope leading to ever increasing criteria and acceptance of assisted suicide for weak and vulnerable people.

On the whole it is lack of access to palliative care towards the end of life that leads to suffering. Also highly relevant are limitations on the ability of patients to live with adequate support, both financial and social. The Scottish Government should be focussing on provision of these needs rather than legislating to allow assisted suicide.

Legalising assisted suicide (‘assisted dying’) would result in it becoming a ‘treatment option’ in hospitals and hospices. In reality, administering a drug to enable the death of another person is not medicine, it is contrary to it. The purpose of medicine and healthcare should be to save life not to end it.

This will change the nature of the doctor-patient relationship. As things stand, doctors are obligated to minimise suffering and save lives where possible. Once assisted suicide becomes an option, doctors start to consider some people’s lives as not worth living and recommend assisted suicide to vulnerable, suffering people.

The proposals would allow assisted suicide for anyone in Scotland with a terminal illness. The legal definition of ‘terminal illness’ in Scottish law is a terminal illness that will end a person’s life from which that person is ‘unable to recover’. This definition is incredibly broad and includes illnesses with which people can by now live for decades. Back in the 1990s, requests for assisted suicide for HIV rose in the Netherlands, and doctors working with such patients tended to support assisted suicide more. Nowadays, treatment of HIV has improved markedly.

Legalising assisted suicide would affect the financing of medicine and healthcare in Scotland. There would be an inbuilt temptation to spend less on end-of-life care, but also on medical research on illnesses currently deemed to be terminal.

In practical terms, wherever laws have been passed on assisted suicide for adults, they have been extended to children, as in Belgium and the Netherlands. The conditions for which illnesses are included have also been broadened to include psychiatric illness and PTSD. The slippery slope has been clearly demonstrated in every case where assisted suicide has been legalised.

Dying is not within anyone’s control. In this it parallels the fact that none of us have any control over the circumstances of our conception and birth. What this bill calls ‘assisted dying’ is none other than assisted suicide.

Eligibility – minimum age

Which of the following most closely matches your opinion on the minimum age at which people should be eligible for assisted dying?

• No-one should be eligible for assisted dying.
• The minimum age should be lower than 16
• The minimum age should be 16
• The minimum age should be 18
• The minimum age should be higher than 18
• Other – please provide further detail

If you have further comments, please provide these.

I disagree with assisted suicide in principle so I do not think that the government should be facilitating the suicide of a person of any age.

Question 3 – The Assisted Dying procedure and procedural safeguards

The Bill describes the procedure which would be in place for those wishing to have an assisted death.

It sets out various procedural safeguards, including:

• examination by two doctors
• test of capacity
• test of non-coercion
• two-stage process with period for reflection

Which of the following most closely matches your opinion on the Assisted Dying procedure and the procedural safeguards set out in the Bill?

• I do not agree with the procedure and procedural safeguards because I oppose assisted dying in principle
• The procedure should be strengthened to protect against abuse
• The procedure strikes an appropriate balance
• The procedure should be simplified to minimise delay and distress to those seeking an assisted death
• Other – please provide further detail

If you have further comments, please provide these.

Please make some of the following points in your own words:

All patients need to feel confident that doctors are there to protect their lives not to end them. Should assisted suicide (‘assisted dying’) be legalised, unease and distrust towards doctors would increase among patients, harming the doctor-patient relationship across the population long-term.

The period of reflection is very short. There is a huge risk attached to the exception whereby two doctors may provide a period of reflection of less than 14 days should they deem the patient to die naturally sooner. The timing of death is not entirely predictable.

Question 4 – Method of dying

The Bill authorises a medical practitioner or authorised health professional to provide an eligible adult who meets certain conditions with a substance with which the adult can end their own life.

Which of the following most closely matches your opinion on this aspect of the Bill?

• It should remain unlawful to supply people with a substance for the purpose of ending their own life.
• It should become lawful to supply people with a substance for the purpose of ending their own life, as proposed in the Bill
• It should become lawful to supply people with a substance for the purpose of ending their own life, as proposed in the Bill, and it should also be possible for someone else to administer the substance to the adult, where the adult is unable to self-administer.
• Other – please provide further detail

If you have further comments, please provide these.

It is untrue to state that there is a ‘method of dying’. Dying is a passive process over which people have no control. What is really being countenanced by the bill is assisted suicide for terminally ill people.

Question 5 – Health professionals

The Bill requires the direct involvement of medical practitioners and authorised health professionals in the assisted dying process. It includes a provision allowing individuals to opt out as a matter of conscience.

Which of the following most closely matches your opinion on how the Bill may affect the medical profession? Tick all that apply.

• Medical professionals should not be involved in assisted dying, as their duty is to preserve life, not end it.
• The Bill strikes an appropriate balance by requiring that there are medical practitioners involved, but also allowing those with a conscientious objection to opt out.
• Assisting people to have a “good death” should be recognised as a legitimate role for medical professionals
• Legalising assisted dying risks undermining the doctor-patient relationship
• Other – please provide further detail

If you have further comments, please provide these.

The central question here is the need to maintain the nature and integrity of the medical profession as dedicated to healing illness, managing currently incurable illness, and preserving life, not ending life.

If this Bill were to become law, it is essential that there is provision for conscientious objection for those who in conscience believe that the medical profession should be trying to preserve life rather than end it.

Question 6 – Death certification

If a person underwent an assisted death, the Bill would require their underlying terminal illness to be recorded as the cause of death on their death certificate, rather than the substance that they took to end their life.

Which of the following most closely matches your opinion on recording the cause of death?

• I do not support this approach because it is important that the cause of death information is recorded accurately
• I support this approach because this will help to avoid potential stigma associated with assisted death
• Other – please provide further detail

If you have further comments, please provide these.

The Bill’s requirement would mean that the death certificate would not tell the truth about the person’s cause of death, as it would omit the immediate cause, namely assisted suicide (wrongly described as assisted dying).

It is very important for record keeping to ensure that the nature of the death is accurately recorded on the death certificate so that the government can track the numbers and types of assisted suicides over time.

Question 7 – Reporting and review requirements

The Bill proposes that data on first and second declarations, and cancellations, will be recorded and form part of the person’s medical record.

It also proposes that Public Health Scotland should collect data on; requests for assisted dying, how many people requesting assisted dying were eligible, how many were refused and why, how many did not proceed and why, and how many assisted deaths took place.

Public Health Scotland would have to report on this anonymised data annually and a report would be laid before the Scottish Parliament.

The Scottish Government must review the operation of the legislation within five years and lay a report before the Scottish Parliament within six months of the end of the review period.

Which of the following most closely matches your opinion on the reporting and review requirements set out in the Bill?

• The reporting and review requirements should be extended to increase transparency
• The reporting and review requirements set out in the Bill are broadly appropriate
• The reporting and review requirements seem excessive and would place an undue burden on frontline services
• Other – please provide further detail

If you have further comments, please provide these.

It is difficult to understand why the Bill proposes to omit assisted suicide as the cause of death on death certificates, whilst also proposing that Public Health Scotland record the annual number of deaths through assisted suicide.

The effects of this legislation should be reviewed much more frequently than every five years. Every two years would be more appropriate. This would be a very significant change to the healthcare system.

If assisted suicide is introduced, record keeping must also include whether good palliative care was available and had been offered. It should also include whether the patient was well-supported by friends or relatives or was lonely. The form for making a request for assisted suicide (dying) should also include details of the medical condition and the reason that the patient is requesting assisted suicide (dying). These reasons should also be recorded and analysed.

Question 8 – Any other comments on the Bill

It is disturbing that at a time when mental health conditions are increasing, and loneliness is increasing that the government is prioritising legislation to assist people in committing suicide. Surely the government should be wanting to look after vulnerable people rather than treating human life as if it is disposable.

Legislating assisted suicide will change the attitude of people from seeing all human life as sacred and worthy of respect and dignity, to thinking that some people’s lives are not worth living. This will inevitably put pressure on vulnerable people to end their lives so as not to be a burden on others. No vulnerable person should ever feel pressure to end their life.