Scottish Liberal Democrat MSP Liam MacArthur has proposed a bill to legalise assisted suicide in Scotland for adults. He has launched a public consultation on these proposals, which is open until Wednesday 22 December. Below, we have produced a guide for responding to these proposals. We encourage you to use the points below to write in your own words why you oppose a bill in Scotland to legalise assisted suicide.
The first section of the questionnaire requires you to give details about yourself and your organisation, if you are responding on behalf of one. The main part of the consultation is in the second section.
1. Which of the following best expresses your view of the proposed Bill?
Our view is clear. The proposed bill should be Fully opposed.
Please explain the reasons for your response.
What matters here is opposing the proposal and objecting to it in principle.
First, we are opposed to the wording of the proposed bill as relating to ‘assisted dying’. There is no such thing as ‘assisted dying’. The proposals clearly related to helping a patient to commit suicide. As will become clear below, 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 wrong to do so, and it is always a slippery slope towards further wrong and abuse.
People tend to suffer at the end of life due to lack of access to palliative care, and due to limitations on their ability to live with adequate support, both financial and social.
Making assisted suicide legal would turn it into a ‘treatment option’ when killing is not medicine – indeed it runs contrary to it. The purpose of medicine and healthcare is to save life not to end it.
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, where 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.
The proposals make the common assumption of all pro-assisted suicide campaigners, that people should have ‘control’ over when and how they end their lives. They consider such control to be a human right of which people are currently being deprived.
This fundamentally misunderstands the nature of death, which is that it is ultimately outside of our control. In this it parallels the fact that none of us have any control over the circumstances of our conception and birth. What we do have responsibility for collectively is how other people around the person who is considered at risk of dying is to be treated. The fundamental worldview inherent in this consultation document, that of proprietary individualism which considers the human body to be akin to one’s property disposable at will, is therefore shown to be completely incoherent.
2. Do you think legislation is required, or are there are other ways in which the Bill’s aims could be achieved more effectively? Please explain the reasons for your response.
No, this legislation is entirely unnecessary and counterproductive in every way possible.
What people actually require is fully-funded palliative care, and support for living with disabilities, terminal and chronic illnesses.
The consultation document dismisses such concerns by saying that in jurisdictions where assisted suicide is legal, funding for palliative care has increased, citing a few figures. This does nothing to illustrate how this funding has been earmarked and distributed. It is a cynical deflection manoeuvre.
The proposals are curiously silent about the negative effects of assisted suicide legislation on relationships within families.
3. Which of the following best expresses your view of the proposed process for assisted dying as set out at section 3.1 (Step 1 – Declaration, Step 2 – Reflection period, Step 3 – Prescribing/delivering)?
Please explain the reasons for your response, including if you think there should be any additional measures, or if any of the existing proposed measures should be removed. In particular, we are keen to hear views on Step 2 – Reflection period, and the length of time that is most appropriate.
In jurisdictions where assisted suicide is legal, such as Oregon, the phenomenon of ‘doctor-shopping’ has arisen. Patients who are refused assisted suicide by their own doctors may then be led through the procedure by other doctors who did not previously know them.
The proposed Reflection Period of 14 days is extremely short. People who change their minds about assisted suicide may well take longer than this given that it is such a major and unusual decision.
4. Which of the following best expresses your views of the safeguards proposed in section 1.1 of the consultation document?
Please explain the reasons for your response.
It is very concerning that any two doctors (not only surgeons or hospital consultants or family doctors) could be included within this definition of ‘doctors’. This would make the proposed law apply to the entire medical profession, unlike the Abortion Act. This would fundamentally change the nature of the entire medical profession in Scotland.
Why is referral to only one psychologist being proposed to help these doctors come to a decision? Psychologists are meant to help people build resilience not give in to suicidality by deciding whether they would be better off committing suicide. As with medicine, these proposals risk fundamentally changing the nature of the psychological profession in Scotland.
It is implausible to claim that two doctors can ensure that a patient makes the decision ‘without pressure or coercion’, given that there will be pressure from within the medical profession if this legislation is passed, as the Scottish Government controls NHS Scotland.
It is very concerning that ‘life-ending medication’ is referred to, as this is a contradiction in terms. Medication by its very nature pertains to medicine, the purpose of which is to save lives, not end them. Such dishonesty must not be allowed to creep into policymaking and legislation.
It is also extremely concerning that this ‘life-ending medication’ is to be stored in a pharmacy, as this draws local pharmacies across Scotland into the business of assisted suicide. As with medicine and psychology, there is a real risk of fundamentally altering the very nature of the pharmaceutical profession in Scotland. Introducing conscientious objection into legislation would not protect these professions as a whole from losing their integrity.
The ‘safeguards’ say ‘the person must administer the life-ending medication themselves’. What happens if the person changes his or her mind at the last minute? Who will come to undo the effects? Given that assisted suicide will be legal, will there be any helplines willing to take calls from such persons to help them reverse their decision? What if the ‘life-ending medication’ does not work?
By leaving such questions unasked and therefore unanswered, these safeguards attempt to get round the fact that it is assisted suicide, not ‘assisted death’ that is under consideration here.
5. Which of the following best expresses your view of a body being responsible for reporting and collecting data?
Please explain the reasons for your response, including whether you think this should be a new or existing body (and if so, which body) and what data you think should be collected.
The fundamental problem with this question is that the proposed bill would legalise ‘assisted dying’, when it is really assisted suicide that is under consideration. Legislating for ‘assisted dying’ would mean that data would record deaths as due to the terminal illnesses of the patients rather than the truth that they were helped to commit suicide by the use of drugs. This would enable concealment of the true scale of assisted suicide on death certificates.
6. Please provide comment on how a conscientious objection (or other avenue to ensure voluntary participation by healthcare professionals) might best be facilitated.
It is very concerning that it is proposed that a conscientious objection by a doctor should require a patient to be referred to a doctor agreeing with assisted suicide. This makes conscientious doctors, those keeping to the core principle that medicine is for saving lives, unable to exercise that core principle thoroughly. As explained in our response to question 4, the problem is that the very nature of the medical and healthcare professions are being undermined here, as is the very nature of psychology.
7. Taking into account all those likely to be affected (including public sector bodies, businesses and individuals etc.), is the proposed Bill likely to lead to:
A significant reduction in costs
Please indicate where you would expect the impact identified to fall (including public sector bodies, businesses and individuals etc.). You may also wish to suggest ways in which the aims of the Bill could be delivered more cost-effectively.
There is evidence that some in the medical field consider assisted suicide to be a valid means of cutting healthcare costs. This wholly cynical approach fundamentally undermines the very nature of medicine and healthcare, which is that money should be spent on saving lives not ending them. Effectively this would entail budgeting to end some lives, with the goalposts constantly having to be moved as medical research results in some illnesses ceasing to be deemed ‘terminal’. However, any such future research would inevitably come too late for those already killed by prior assumptions. In the meantime, cost-cutting exercises will have led to cheapening human life overall.
8. What overall impact is the proposed Bill likely to have on equality, taking account of the following protected characteristics (under the Equality Act 2010): age, disability, gender re-assignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, sexual orientation?
Please explain the reasons for your response. Where any negative impacts are identified, you may also wish to suggest ways in which these could be minimised or avoided.
Discrimination on grounds of age is an obvious risk with any legislation to bring in assisted suicide. Discrimination against older people is likely to increase, especially those who are retired and no longer earning an income from work. Those older people living alone are much more vulnerable to subtle pressures to succumb to assisted suicide.
It is well-established that people with disabilities are very concerned about moves to legalise assisted suicide, as a message would be sent to the health and social care sectors that their lives are not worth living, or are better off cut short.
Assisted suicide for children soon follows assisted suicide for adults and sends out the entirely wrong message that some children’s lives are not worth living.
9. In terms of assessing the proposed Bill’s potential impact on sustainable development, you may wish to consider how it relates to the following principles:
– living within environmental limits
– ensuring a strong, healthy and just society
– achieving a sustainable economy
– promoting effective, participative systems of governance
– ensuring policy is developed on the basis of strong scientific evidence.
With these principles in mind, do you consider that the Bill can be delivered sustainably?
Please explain the reasons for your response.
It is impossible to ensure ‘a strong, healthy and just society’ by legalising assisted suicide. The manifest injustice of the proposals have already been made clear. Ensuring health requires more research on illnesses currently deemed ‘terminal’, not legalising assisted suicide for those suffering from them. Ensuring access to properly-funded palliative care and means of assisted living for those with illnesses (including disabilities) considered terminal should be a first priority.
10. Do you have any other additional comments or suggestions on the proposed Bill (which have not already been covered in any of your responses to earlier questions)?
Here is an opportunity to speak from your own personal experience, e.g. as a doctor, healthcare professional, patient, relatives, carer, etc.