Last week's debate on the Assisted Suicide (Scotland) Bill was hailed as a reasoned and respectful consideration of the proposals. Key themes included the ramifications for disabled people, the effects on the healthcare profession and the woefully deficient 'safeguards'.
The Bill was rejected by 82 votes to 36, with the leaders of the four largest parties in the 129-seat assembly - First Minister Nicola Sturgeon (SNP), Kezia Dugdale (Labour - Parliamentary leader), Ruth Davidson (Conservative) and Willie Rennie (Liberal Democrat) - all opposing the measure. Why did it fail to progress? A number of MSPs argued in the debate that even if members were uncomfortable, they should allow for further more detailed debate which they suggested could improve the Bill, but the Stage 1 debate asks a simple question: do you accept, and are you willing to legislate in favour of, the principle of the Bill. Bob Dorris (SNP, Glasgow) had told those gathered that 'the Parliament's mace at the front of the chamber bears just four words: wisdom, justice, compassion and integrity', and the Scottish Parliament's response met these demands well.
A difficult issue
Neil Findlay (Lothian) (Lab):
Assisted suicide is without doubt the most difficult issue that I have had to consider in 12 years as an elected politician. So it should be, because it is about life and death itself. It is about the fundamentals of human existence... There are important process issues and technicalities relating to the bill but, for me, it is not about technicalities. It is about human life, how we choose to treat our sick and dying and how we face up to our own mortality and that of our loved ones. Those are the most profound of issues, and simplistic answers simply will not do.
Dennis Robertson (Aberdeenshire West) (SNP):
My mother was given a few weeks to live, but that extended to many, many months. I remember sitting at her bedside when she died—I was the only person with her. In the weeks coming up to her death, she had asked to be freed and had said, "Let me go." It was not because she was in pain. Her reason for wanting to go, and wanting to be free, was that she had started to see the pain, grief and despair of her family. Her concern was not for herself but for her family: the people whom she had cared for and loved throughout her life. We, as a family, did not want to let go. It was not really her wish to die: she had said that only because she did not want to see us suffering that pain.
I also remember my daughter. We have talked about coercion today. Coercion did happen in respect of my daughter, and it was from me. She wanted to die. She said on several occasions, "Let me die—I can't live with this illness. You need to help me die. Please help me die." I did not. I held her. I held her in my arms and gave her what we in the north-east call a bosie, and I said no, I could not do that. I loved her too much, and I wanted her to live.
I did not want my daughter to live in agony, with suffering. I wanted her to get well, and to see a way through her illness. That is where I come to a dilemma. Should we embrace life to the full? Should we embrace it to the point at which our love overcomes the pain and the suffering? It is very difficult.
The principle
Alison McInnes (North East Scotland) (LD):
I come to this debate as a liberal and as a humanist. As a liberal, I seek always to balance the fundamental values of liberty, equality and community. As a humanist, I try to resolve ethical issues through reason, reflection and empathy... [The Bill] utterly fails to address the very real risk that, in vulnerable people's minds, the right to die will become a duty to die. If we value the principles of equality and community as well as that of autonomy, it seems to me that the state must not sanction assisted suicide.
Many of those who are lobbying for change have argued that allowing assisted suicide will not harm those who find it morally wrong. They have argued that it is a case of each to their own and that assisted suicide will be just one more option, but changes in the law bring about changes in the way we understand ourselves and our place in the world. In elevating the status of individual autonomy, we reduce the status of those who are dependent. Allowing assisted suicide would, over time, change the way we view and treat the elderly, the disabled and the infirm.
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Dame Cicely Saunders, who was the founder of the modern hospice movement, said:
"You matter because you are you. You matter to the last moment of your life and we will do all we can to help you die peacefully, but also to live until you die."
We should be doing everything possible to make that the reality for everyone at the end of their life.
Christian Allard (North East Scotland) (SNP):
I am a member of the secondary committee—the Justice Committee—which focused its scrutiny on the bill's criminal and civil liability aspects, particularly the legal and practical application of its provisions on human rights issues.
From the outset, I had reservations about the bill. In our report to the lead committee, we noted the bill's unusual approach in defining what is not a crime rather than what is a crime. That was always my main concern. I may not be against the honourable intentions of the many members who I am sure will support the bill, but I am definitely against its principle, which is
"an Act of the Scottish Parliament to make it lawful, in certain circumstances, to assist another to commit suicide; and for connected purposes."
...lodging amendments will not do. It is the bill itself that is not fit for purpose. The bill's principle is flawed.
Suicide perception and prevention
Murdo Fraser (Mid Scotland and Fife) (Con):
In a powerful contribution to the debate, the Scottish Council on Human Bioethics stated:
"legalising assisted suicide means that it is the whole of society, and not just the person wanting to die, which is accepting that a person has lost all value, worth and meaning in life. This would have a brutalising effect on society, and dangerously undermine the legal protection established in the concept of equal and inherent human dignity".
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The question that we have to ask is: have we really become a society that says that the best answer that we can provide and the best that we can do for those in suffering in end-of-life situations is to help them to kill themselves? Is that really the best that we can offer? That sounds to me to be a desperately cold and soulless society, and I think that, in Scotland today, we are better than that.
John Mason (Glasgow Shettleston) (SNP):
It is clear that we have problems with suicides, especially in Glasgow and the west of Scotland. Over the four years from 2009 to 2012, there were 3,059 suicides... I cannot put things better than the committee did in paragraphs 275 and 276 of its report, in which it said:
"enacting a Bill of this kind would undermine the aim of preventing suicide in two ways: (i) by seeming to contradict the wider suicide prevention message, or by watering it down with exceptions, and (ii) by 'normalising' suicide: this argument is that when law permits a practice, this is perceived as endorsement, and as society absorbs that endorsement, the general perception of the practice changes."
"[The concern is that, by allowing assisted suicide in some cases while seeking to prevent it in others, the law sends a message -] both to society at large, and to vulnerable individuals—that not all lives are equally worthy of protection, or equally valuable or worthwhile".
Elaine Murray (Dumfriesshire) (Lab):
One of my constituents, Dr Alison McKendrick, the rehabilitation consultant at Dumfries and Galloway Royal Infirmary, wrote to me last December to describe her professional concerns about the inclusion of life-shortening conditions. Most of her patients have such conditions, but the period of time involved can range from six months to 30 years. In her letter, which she has given me permission to quote, she says:
"In the last few weeks we have had a young patient on the ward wishing to die and actively considering suicide. Her disabilities meant she couldn't carry anything out, but her pain and distress at the awful situation she was in was heart-breaking. We supported her with sympathy and medication and time. It was a very hard few weeks and her requests to die were repetitive. Her situation looked bleak in terms of prognosis and it was this reality that had hit her hard.
Today I watched her slowly wheel herself down the ward in therapy with a huge smile on her face, she was so proud of her achievement. Her prognosis remains similar, her pain is still there, but she has grieved and started to adjust expectations and has found that life is still good. For all of us, patient, family and team, I am so glad that we didn't have the option to give up and take the 'easy' way out and give her what she was requesting."
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Grief is not a mental health condition but a natural reaction to loss, whether that be the loss of health and mobility, a loved one or an important relationship. Someone suffering severe grief and the anger that can go with it might feel that their life was unacceptable and might wish to die. However, in all those cases in which someone's grief was so unbearable that he or she was suicidal, our reaction would not be to help them kill themselves. Instead, we would want to assist the person through their grief and towards the realisation that although life might never be the same it could still be fulfilling. We should not treat ill health and disability any differently in that respect.
(Ms Murray went on to conclude that the Bill's provisions should rather have been 'restricted' to terminally ill patients with prognoses of six months or less, a position Care Not Killing regrets as being inconsistent with her own logic.)
Scope
Dr Richard Simpson (Mid Scotland and Fife) (Lab):
Dr Simpson's comparison of the Harvie and Falconer Bills is interesting in that official reports make clear that in Oregon, on whose law Lord Falconer based his bill, there are instances of people undergoing assisted suicide at least in part due to diabetes.
Lord Falconer's Assisted Dying Bill, debated in the House of Lords... sought to limit its application to those in the terminal stage of an illness. The bill that we are considering, in including life-shortening conditions, is far too widely drawn.
I will give a couple of examples. Diabetes is a life-shortening condition, on average, and the complications of poorly controlled diabetes are unpleasant. Amputations or even repeated amputations might make someone feel that life is intolerable, yet we know that many amputees enjoy a full life, and the improving situation with prosthetics is improving the quality of life. That is an important point. Many of these things are about improvement.
Safeguards
John Mason (Glasgow Shettleston) (SNP):
When it comes to coercion or influence from third parties, let us be blunt: there have always been people who have wanted to end other people's lives for a variety of reasons. Families stand to get an inheritance if an elderly relative dies earlier, and even the national health service and social work departments of councils stand to make financial savings in care costs if a patient dies sooner rather than later. Will every accountant who works for those organisations be totally non-pressurising on staff or patients? We do not know.
Michael McMahon (Uddingston and Bellshill) (Lab):
"Legalising assisted suicide is a slippery slope toward widespread killing of the sick".
Those are not my words, nor are they the words of any anti-euthanasia group or religious leader. They are the words of Professor Theo Boer... [who was] a member of a review committee charged with monitoring assisted suicide deaths in Holland. He is a one-time advocate of assisted suicide who, based on the evidence that he now has available to him, believes that the very existence of a euthanasia law turns assisted suicide from a last resort into a normal procedure.
Assisted suicide is now becoming so prevalent in the Netherlands, according to Professor Boer, that it is, as he says,
"on the way to becoming a default mode of dying for cancer patients".
Having monitored the situation in Holland for the past 12 years, Professor Boer now admits that he was wrong to have believed that regulated assisted suicide would work. We should not dismiss that conclusion today... Legalising assisted suicide is a retrograde and negative step that does not promote good care or challenge the lack of the medical assistance that is required to die with dignity.
Disabled people
Nanette Milne (North East Scotland) (Con):
I received [a letter] some months ago from a constituent who has been tetraplegic for nearly 40 years following a road accident. He gives a very moving account of his battles with depression and despair as he gradually adapted over time to his changed life—an adaptation that he achieved only after undergoing prolonged counselling and receiving help to find and develop new avenues of activity.
He expresses his dismay that young people with paralysis like his, following sporting injury, can resort to assisted suicide in Switzerland. He says that they still have mind and voice and probably other capacities, depending on the exact level of injury, but they would need the sort of care that he received to bring them to terms with an alternative way of life. My constituent is therefore appalled that the bill does not insist on medical and psychiatric assessment before someone starts along the path to assisted suicide, and that it provides no requirement for counselling or for filling the gap in cases where someone's only experience has been of some unsuitable medical facility without any experience of rehabilitation.
His closing words are:
"I beg you to reject this Bill. Above all, do not destroy the trust between patients and the medical profession. Hospitals must not become places where patients fear those who care for them. The aim must be to help the family in their supporting role, and to strengthen counselling, rehabilitation and hospice facilities."
Bob Doris (Glasgow) (SNP):
Dr Sally Witcher from Inclusion Scotland believed that negative attitudes toward illness, old age and disability already existed and were a factor in creating demand for assisted suicide. She told the committee:
"Much of the support for bills such as this one is driven by a profound fear of becoming disabled, ageing and becoming ill. Rather than say that we should make it easier for people with that profound fear to end their lives or let them feel confident that they could do so should that terrible thing happen ... we need to challenge those negative attitudes and have public policy that ensures that, when people are old, ill or disabled, they get the best quality of life possible, and that the right sort of support is available to enable full and independent living as equal citizens for as long as possible."—[Official Report, Health and Sport Committee, 3 February 2015; c 9, 44.]
We highly recommend the speech in full of Siobhan McMahon (Labour, Central Scotland), whose noteworthy speech drew on her own experience.
Palliative care
Opponents of the Bill made clear their commitment to realising ever-improved palliative care as the proper reponse to end of life suffering. There were also stern words where pledges of action were not seen to have been acted upon.
Nanette Milne (North East Scotland) (Con):
There have been significant improvements in palliative care in recent years, and in my view that is the way forward: to enable the vast majority of patients to experience a dignified and comfortable death in the place of their choice when that inevitability arrives.
I accept that there will be a few patients—and indeed they are very few—for whom palliative care cannot be 100 per cent effective, but I am not convinced that that is sufficient reason to legislate for what some see as a merciful act, and nor are the palliative care specialists who deal personally with those very difficult and complex cases.
Persistent requests for assisted suicide or euthanasia are extremely rare if people are given good care that addresses their physical, psychological, social and spiritual needs. I sincerely believe that to achieve a good death is as vital a part of healthcare as any care that a patient receives throughout life, and that good palliative care is far preferable to legally assisted suicide.
Unfortunately there is at present a gap in palliative care provision, and many people who would benefit from that form of holistic end-of-life care are therefore not considered for it. Like the Marie Curie organisation, I believe that palliative care should be planned as soon as an illness is deemed to be terminal, which could mean death within days, weeks, months or even years. That could apply to people with a wide variety of conditions such as chronic obstructive pulmonary disease, heart failure and dementia—and, of course, cancer and progressive neurological conditions.
Paul Martin (Glasgow Provan) (Lab):
I draw the Parliament's attention to paragraph 71 of the report, which says:
"there is a need for a thorough investigation and scrutiny of current provision and future plans for palliative care in Scotland."
Is it not a poor reflection on the Parliament that, after 15 years, we continue to have the same debate about palliative care? The cross-party group on palliative care, which is convened by Michael McMahon, has existed since the Parliament's early years. There have been many reports on how we deliver palliative care, yet we still cannot get it right.
Mary Scanlon (Highlands and Islands) (Con):
I commended Nicola Sturgeon and the Scottish Government for their living and dying well strategy five years ago. However, today, I say that that strategy is definitely not being implemented in a dignified and respectful manner with the minimum of distress, as promised. If more training, energy and resources were invested in high-quality pain management and we had equality of access to pain services, we might not have the fear of pain, whether that is related to terminal illness or otherwise.
Paragraph 4 of the policy memorandum to the bill states:
"The fear of a protracted, painful and undignified death is very real for many people, whether or not they have themselves been diagnosed with a terminal illness or condition ... not everyone can be assured of a 'good death' in which pain is kept at bay and a reasonable quality of life is maintained until the end ... their final months or years are dominated by pain or discomfort."
The policy memorandum itself is giving us the fear of pain. The Government should be focusing much more on services that bring reassurance to patients, rather than this policy memorandum heightening the fear of pain.
I heard what the health secretary said about the living and dying well strategy. I am sorry, but I must say that better palliative care was promised five years ago.
Healthcare professionals
Nanette Milne (North East Scotland) (Con):
Personally, as a former health professional, the idea of actively and deliberately hastening death by assisting someone to die is deeply disturbing. I share the view of many professional colleagues that legislating for that would risk undermining patient trust in doctors and medical advice, and I cannot come to terms with what is proposed.
Stewart Stevenson (Banffshire and Buchan Coast) (SNP):
I was brought up in a doctor's household, steeped in support for life, compassion and assistance for the dying, so it could hardly be otherwise. My father was proud to live and work under the strictures of the Hippocratic oath that he took as a medical student... It used to say:
"I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect."
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At critical times in our lives, our relationship with doctors is very asymmetric. We throw ourselves into their hands, and we may be insensible of the life-sustaining or life-threatening actions that they have taken to promote what they understand to be our best interests.
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I have found that it boils down to the simplest of questions. How would I feel if I knew that the doctor approaching me to provide treatment in my extremity had assisted another to an early exit from life when I so eagerly wanted to stay? Even the slightest appearance of a doctor's bias towards death would damage my relationship with that professional. Therefore, I will follow my instincts and vote against the bill.
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