Assisted Dying Bill: Why is it so different now, and have MPs changed their minds?
UK Editor Paul Brand explains what's happened to the Assisted Dying Bill - and the wider debate - since the historic first vote on the legislation in November.
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Q&A: Do we have 'Farage Derangement Syndrome'? Plus the team reveal their most awkward interviews
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Assisted Dying Bill Scotland: Why fears about coercion of vulnerable people are misguided
Sign up to our daily newsletter – Regular news stories and round-ups from around Scotland direct to your inbox Sign up Thank you for signing up! Did you know with a Digital Subscription to The Scotsman, you can get unlimited access to the website including our premium content, as well as benefiting from fewer ads, loyalty rewards and much more. Learn More Sorry, there seem to be some issues. Please try again later. Submitting... Coercion was on everyone's minds in Holyrood's dramatic debate on assisted dying earlier this month. Liam McArthur's Assisted Dying Bill offers terminally ill, mentally competent Scots the option to end their own lives, allowing a dignified death when someone regards their own suffering as too great or their life no longer worth living. Its multiple protections include strict eligibility requirements and the sign-off of two independent doctors. Opinion polls show that a large majority of Scots – across different demographics – support assisted dying. Advertisement Hide Ad Advertisement Hide Ad While the Bill passed its first reading, it is by no means certain that it will become law. MSPs from both sides of the debate referenced worries about patients being pressured into a premature death. Colin Smyth MSP invoked 'people's deepest concerns… about patients potentially feeling like a burden or about the possibility of their being coerced'. Liam McArthur MSP with supporters of his Assisted Dying Bill outside the Scottish Parliament (Picture: Jeff J Mitchell) | Getty Images Fear and speculation MSPs are right to ask questions about the Bill's protections against coercion, especially for vulnerable people. We can answer them by looking at the evidence. Examining data from countries that permit assisted dying – some with decades of experience – cuts through the fear and speculation that otherwise characterise these discussions. One thing is clear: there is no evidence that people are coerced into assisted dying. Parliamentary committees in Holyrood and Westminster specifically sought such evidence. None was forthcoming. Advertisement Hide Ad Advertisement Hide Ad Instead, Dr Ryan Spielvogel testified that 'in the 25 years that aid in dying has been legal in jurisdictions in the United States, there has never been a single substantiated claim of coercion', and Dr Alison Payne wrote 'I have not yet seen evidence of coercion [in New Zealand] – more often the family are reluctant for it to happen'. Julian Gardner, chair of the Australian state of Victoria's Voluntary Assisted Dying Review Board, said: 'The only reports that we have had have been the reverse, in that people have experienced coercion – that might be too strong a word – or undue influence not to go ahead with ending their life, generally from relatives who have objections or from faith-based institutions.' Even focusing specifically on vulnerable groups, such as disabled people, there is no sign of coercion. Indeed, there is less uptake of assisted dying in such groups – the opposite of what we'd expect if vulnerability were a factor. Advertisement Hide Ad Advertisement Hide Ad Taking concerns seriously This evidence will settle the matter for some. Others might worry that a risk of coercion persists. Bob Doris MSP argued that 'coercion can be subtle and difficult to detect', while Sue Webber MSP said 'subtle pressure and coercion… are not always visible'. Absence of evidence isn't always evidence of absence. These concerns are speculative, but the potential risks should be taken seriously. How can they be addressed? First, this is a problem medical professionals deal with all the time, right now. Competent adults can already refuse life-saving treatment, including through written, advance directives. They might be pressured by family members to end their lives early or, indeed, to request care they don't really want. As Rona McKay MSP said, 'it is part of doctors' everyday practice to recognise coercion – for example, in abortion care or in cases of the withdrawal of treatment.' The Bill's safeguards build on existing good medical practice. Doctors must ensure that patients have capacity, check that their choices represent what they really want, and give them time, information, and support. Advertisement Hide Ad Advertisement Hide Ad Greater protection We should respond to risk not by disempowering people in the name of 'protection', but by empowering them to make decisions aligned with their values. The Bill does this and provides greater protections for assisted dying than any of the other ways in which people can already hasten their own deaths. Second, the risk of feeling pressured into a premature death isn't the only one that matters. As Karen Adam MSP asked, 'is it not a form of coercion to force someone to endure pain that they do not want and to deny them peace when their death is already certain?' Under the status quo, the risk of unnecessary suffering is 100 per cent. The Bill – a logical extension of our hard-won right to refuse curative treatment and opt for palliative care if we see fit – balances competing risks. Third, the dangers that concern MSPs already exist, and this Bill reduces them. People with terminal illnesses already choose to end their lives – whether by refusing treatment, killing themselves without help, or going to Switzerland. If there is a problem with hidden coercion, it already happens. Advertisement Hide Ad Advertisement Hide Ad As Liam McArthur said, 'at present there are often no safeguards for many people who feel a burden, are subject to coercion or abuse, or feel unsupported'. The Bill gives legal clarity to doctors and family members, and strengthens protections with a new criminal offence of coercion. An evidence-based approach helps resolve concerns around assisted dying. Worries that legalisation will damage palliative care have been refuted, including by the Health and Social Care Committee at Westminster. Our own research on disability shows widespread support for legalisation among disabled people, and that assisted dying laws neither harm nor devalue disabled people's lives. The same approach can help MSPs determined to ensure that terminally ill people won't be subject to coercion. There is no evidence that coercion occurs in countries where assisted dying is legal. Advertisement Hide Ad Advertisement Hide Ad We should take seriously fears of coercion and aim for legislation that manages and minimises risks for all. With its evidence-based safeguards, this Bill will achieve that goal.
Scotsman
26-05-2025
- Scotsman
Tiny number of people who choose assisted dying shows it's no 'panacea'
Sign up to our daily newsletter – Regular news stories and round-ups from around Scotland direct to your inbox Sign up Thank you for signing up! Did you know with a Digital Subscription to The Scotsman, you can get unlimited access to the website including our premium content, as well as benefiting from fewer ads, loyalty rewards and much more. Learn More Sorry, there seem to be some issues. Please try again later. Submitting... The assisted dying debate in Scotland has been running for many decades, but its latest chapter has been particularly acrimonious and heated. I write this as someone who has been studying the debate for 20 years. However, one thing that both proponents and opponents of the Assisted Dying Bill at Holyrood do appear to agree on is that more investment is needed in end-of-life care. There has also been broad agreement that, as a society, we need to have more informed conversations about what it means to die well. Advertisement Hide Ad Advertisement Hide Ad In the words of Neil Gray MSP, 'irrespective of the outcome of this vote, we must use the momentum to ensure that Scotland is a place in which we can have open, honest and supportive conversations about living and dying well'. Supporters of the Assisted Dying Bill stage a rally outside the Scottish Parliament (Picture: Jeff J Mitchell) | Getty Images Conversations about dying Assisted dying as a debating topic has always taken up far more airtime, column inches and, nowadays, social media posts, than the phenomenon rightly warrants if we simply look at the numbers. In jurisdictions which have passed assisted dying laws with equivalent eligibility criteria to those proposed for Scotland – a terminal illness and self-administration of the lethal dose – less than 1 per cent of those dying each year make use of the legislation. In California, for example, it is 0.3 per cent. As a proportion of the approximately 62,000 Scots who died last year, this would equate to very small numbers in the grand scheme of end-of-life care. It is perhaps better to see the true impact of the legislation through its effect on conversations. In jurisdictions which have legalised assisted dying, more people discuss the option with their doctor than make an application, and more people make an application than ever ingest the lethal drugs. 'Euthanasia talk' can be a way of discussing end-of-life concerns and wishes more generally. Advertisement Hide Ad Advertisement Hide Ad Up and down the country right now, the news stories about assisted dying are initiating conversations amongst families and friends, and there is the hope that these discussions might spill over into talking about other end-of-life scenarios. Perhaps at a certain point in time, the controversies and heightened passions on display in the assisted dying debate might convert into a more measured and broader spectrum conversation about dying in general. False impression But it is also possible that assisted dying might end up being seen as the panacea for all the problems of dying in the 21st century. If the law is passed, it might give the false impression to individuals contemplating their own or a family member's demise that they no longer need to worry about what will happen to them at the end of their life. Instead, they may imagine that if things get too bad they can apply, via the new legislation, to bring their suffering to a swift end. But while assisted dying may start a conversation about end-of-life choices, it does not provide a realistic answer to the questions such conversations are likely to raise. In fact, the current debate has revealed considerable public and political misconceptions about what the end of a life in Scotland is like right now, as well as projected trends for the decades ahead. Advertisement Hide Ad Advertisement Hide Ad The profile of dying is changing. It now takes far longer to die than ever before in human history. It may happen over many months and even years. This means people are living longer in a terminal state – in poor and declining health, and with a declining quality of life and an increasing burden of symptoms. Some people who experience this may want to bring an end to this period of time sooner and they may actively apply for assisted dying and may be willing to self-ingest the lethal medication. But many will not have this option or will not want it. Frailty and cognitive decline People are dying at increasingly older ages and the proportion of those with complex symptoms of frailty and cognitive decline is also increasing. Assisted dying is never going to be an option for the current 10 per cent of people dying of dementia because they will not fulfil the mental capacity requirement laid out in the bill being discussed in the Scottish Parliament. What about older people dying of frailty who retain mental capacity? Currently, frail older people living with multiple diseases are rarely told in any explicit way that their condition is 'terminal'. They would therefore be unaware that they were even in a position to request assisted dying. Advertisement Hide Ad Advertisement Hide Ad While many people will never be in a position to request it because of the nature of their illness, many others will simply not choose to make use of any new legislation. They would prefer to live on until natural death or to defer medical decisions to others. All in all, assisted dying is not the panacea for all the problems associated with the end of people's lives and will only ever be just one part of our national story about end-of-life care – and a small part at that. More reckoning with the reality of contemporary dying is needed across the board. This debate should be the starting point, not the end point, of sensible political discussions about how we can reorganise our health and social care system so that it is fit for the growing number of dying Scots and the illnesses they will be dying of.
