On 29 March 2024, Liam McArthur, MSP, announced his ‘Assisted Dying for Terminally Ill Adults (Scotland) Bill’ to the Scottish Parliament. This will now be debated and scrutinised by the Parliament. If passed, it would mean the legalisation of doctor-assisted suicide for those with an advanced illness who choose it, within the Scottish NHS.
The key features of the Bill would mean that a ‘terminally ill’ patient of 16 years and above, with mental capacity, registered with a Scottish GP, and resident in Scotland for one year, will be eligible.
Terminal illness is defined remarkably broadly as:
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.
This will likely include advanced heart, respiratory, liver, and renal disease, progressive neurological conditions, and advanced cancer. There is no time limit (such as six months) nor any stipulation that there should be the presence of physical or psychological suffering. Two NHS doctors will be involved in the assessment and advisory process, but the patient will self-administer the medication.
There will be a two-week reflection process to allow the patient to change their mind. We know this is not long enough to get a psychology assessment on the NHS nor even to assess response to an antidepressant. The reflection period can even be reduced to 48 hours if thought necessary.
The Bill does require that death certificates list the underlying illness as the cause of death rather than the planned ingestion of a lethal substance.
The Association of Palliative Medicine conducted an opinion poll of its members in Scotland in 2022 and found that 95 per cent would not prescribe these lethal drugs, even if patients asked for them. Forty per cent would leave their jobs if it was introduced in their clinical setting. They know that patients may not have a real choice if they don’t get access to the right care. Marie Curie estimates that one in four patients in the UK don’t get the palliative care they need.
Instead, palliative care physicians want to give the best palliative care to those who need it. Palliative care provides for physical symptoms (eg pain and breathlessness), but also psychological, social, and spiritual care too. Much is done by GPs, district nurses, and hospital teams, but if things are more complex, then a hospice or specialist palliative care team can transform the last few months of life. Palliative care teams are committed to neither hastening nor prolonging death but to helping people live well for the time they have. This care is not even fully funded as a core service on the NHS.
Our Duty of Care is a campaign of healthcare professionals who are opposed to the introduction of assisted suicide and euthanasia across the British Isles. We are working to raise awareness of the realities of the debate going on in the Parliaments, but we also equip healthcare professionals to express their concerns to their elected representatives.
Previous Bills were defeated in the Scottish Parliament in 2010 and 2015, but many are considering this Bill much more likely to pass, with many MSPs already stating their support for it. However, there was a mixed response in the press at the launch, with the Bill coming under much more criticism than might have been expected. Some commentators, such as in the Scotsman, expressed concern for those who might feel a pressure to die and the unintended consequences on those who are most vulnerable – ie those with mild learning disabilities and autism, those who are homeless, or those with early dementia.
The next step in Scotland is for the appointment of a Committee to review the Bill. This will take written and oral evidence before a vote in the Chamber. If the Bill passes at this first stage, it proceeds to a second stage where it will be reviewed clause by clause and amendments will be taken. A second vote will be held at that stage – if in favour, the Bill will become law.
Please join Our Duty of Care (ODOC) to oppose the Bill and receive our newsletter. Let ODOC know how we can best help you in your situation. Someone from ODOC can meet with you one-on-one or arrange a meeting for your region or specialty group. Please email info@ourdutyofcare.org.uk for further information.
Please write to your MP or MSP to explain your concerns about assisted suicide. Nicola Sturgeon, MSP, wrote in the Herald this week about how she is ‘veering away’ from voting for the Bill but urged constituents to come to speak to her about their views. Other MSPs are undecided, and wise words from a doctor or other health professional about this can be significant.
The ODOC website has ten papers or links to help you write a letter. The CMF response to the Scottish consultation on the Bill can also be found on the CMF website.
Your voice matters – we all need the right care at the right time in the right place, not medicalised killing.
Dr Gillian Wright was a palliative medicine registrar in Wessex and Glasgow but then changed to work as a senior researcher in medical ethics for the Scottish Council on Human Bioethics. She now works for Care not Killing as the Director of the ‘Our Duty of Care’ campaign. She is a CMF member.