Latest news with #AssistedDyingBill
Scotsman
26-05-2025
- Health
- Scotsman
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
- Health
- 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.
Scotsman
21-05-2025
- Health
- Scotsman
New law will offer the right to a good death
Liberal Democrat MSP Liam McArthur addresses the assisted dying bill debate in the Scottish Parliament (Picture:Jeff) Growing up in Canada in the 1960s, my mother had a school friend called Merry. While they lost contact for a time, decades later, travel and technology brought them back together, until in 2019 Merry received news that she had a Glioblastoma – a rare and incurable brain cancer. Sign up to our daily newsletter Sign up Thank you for signing up! Did you know with a Digital Subscription to Edinburgh News, 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... Tragically, Merry understood the terrible pathology of this cancer, because she had lost her husband to the same disease some years previously. Over time she had seen it rob him of his personality, his bodily function and his mind. She immediately knew that she would not let it do the same to her. And so it was, just a few months later in a hospice rooftop garden, Merry ended her life in the Vancouver sunshine. At that moment of her choosing, my mother and her other friends, thousands of miles away, held Merry in the light of their love until she was free of it. Advertisement Hide Ad Advertisement Hide Ad In my nine years as a member of the Scottish Parliament, there isn't a single vote or decision I've been involved in that has elicited more correspondence from my constituents in West Edinburgh than last week's vote on assisted dying. I respect the views of all of those who have written to me and I think it's important that I set out where I stand. Since before politics, I've been an advocate for a change in the law to allow terminally ill adults, who have mental capacity, the right to end their lives in dignity. For me, this is about rights and agency. In Scotland today we have both in almost every aspect of our adult life, save one – that is our departure from it. I want to know that if I'm dying in pain, beyond the reach of palliative care, that I would have the right to say, 'this far and no further' and to end my suffering at a time of my choosing. So, I was delighted when my friend and Lib Dem colleague Liam McArthur's Assisted Dying Bill, passed the first stage of the parliamentary process last week – and by a much bigger margin than expected. We aren't pioneers in this. The right to die is already offered to people in over 30 jurisdictions the world over and Liam's bill is informed by decades of best practice. He has deliberately chosen a model for this bill which offers the most stringent safeguards. To be eligible, a person would need to be diagnosed by two separate doctors as having an advanced terminal illness and the mental capacity to make the decision. They would have to be made aware of all treatment options available and tests for coercion would take place. At the same time, any medic who doesn't wish to take part, can opt out. Advertisement Hide Ad Advertisement Hide Ad The decades of experience we are leaning into here show that provision for assisted dying does not come at the expense of palliative care. If anything, it is complimentary to it and is seen as the final tool in the drawer. Many prescriptions actually go unused but provide comfort as an option should the pain become too great. Palliative care is amazing, we need more of it, and we need to make it accessible everywhere. But it alone cannot master all pain. As such too many Scots are being denied the right to a good death. Liam's bill will change that. Alex Cole-Hamilton is Scottish Liberal Democrat leader and MSP for Edinburgh Western
Yahoo
21-05-2025
- Health
- Yahoo
Changes to assisted dying bill mean 'no one is obliged to take part in process'
MPs voted to insert a new clause into the Assisted Dying Bill on Friday to say that 'no person', including social care workers and pharmacists, is obliged to take part in assisted dying and can now opt out. The Assisted Dying Bill will allow terminally ill adults, expected to die within six months, to seek help to end their lives. While the legislation passed its first stage in the House of Commons last November, the bill has been subject to amendments and is no longer the same. The clause 10 amendment was put forward by the Terminally Ill Adults (End of Life) Bill's sponsor the Labour MP for Spen Valley, Kim Leadbeater. The original bill stated that no registered medical practitioner or other health professional would be under an obligation to help in the assisted dying process and would not be discriminated against if they did not want to assist. READ MORE: All you need to know as the assisted dying Bill returned to Parliament | News and Star Under the clause 10 amendment, this has been expanded to say that there is no obligation on anyone to assist in the process, providing protections to any staff who may be involved. MPs ran out of time to vote on other changes so further debate and voting will continue on June 13. Carlisle MP, Julie Minns voted against the amendment and has voiced her opposition to the bill.
Scotsman
20-05-2025
- Politics
- Scotsman
Assisted Dying Bill: Hospices and care homes must not be forced to participate
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... It is a fair criticism of the Holyrood parliament chamber that it seldom rises to the occasion when it comes to debate. Too often we simply see a succession of backbenchers reading out highly partisan speeches, sometimes written by a researcher, which bear little relation to what has been said before. Because of timings, the opportunities for interventions to be made and taken, and a genuine discussion opened up, are rare. There can be exceptions to that rule, and last week's debate on stage one of the Assisted Dying Bill was one of them. It is extremely unusual at Holyrood for issues to be discussed which are genuinely subject to a free vote, where all MSPs have to make up their own minds without being told what to do by the party whips. Advertisement Hide Ad Advertisement Hide Ad And so it was on this occasion, with quality speeches both for and against the Bill. Both George Adam and Elena Whitham made moving contributions, drawing on their personal experiences caring for loved ones, to explain why they supported it. Campaigners from both sides of the argument demonstrate outside the Scottish Parliament (Picture: Jeff J Mitchell) | Getty Images A narrow majority On the opposition side, my Conservative colleague Edward Mountain drew on his own battle with cancer to explain why he couldn't back the Bill, whilst the Labour MSP Pam Duncan-Glancy, in the best speech of the afternoon, expressed her concern that, as a disabled person, her life would be valued less should assisted dying be legislated for. The Bill passed stage one by a narrow majority of 70 votes to 56, but a number of those voting in favour were clear that this was only to allow the debate to continue, and this did not necessarily mean they would support the legislation in its final stage. The discussion now shifts to the detail of the Bill, and whether it is capable of being improved to remove the many concerns that have been expressed about its potential consequences. Advertisement Hide Ad Advertisement Hide Ad Legal specialists have already warned that the Bill is deeply flawed as it stands, and carries with it a large number of risks. The Law Society of Scotland has said that there are significant issues that need to be carefully considered. Dr Mary Neal, reader in law at the University of Strathclyde, went further, saying: 'There is so much MSPs are going to have to address to try and mitigate some of the serious risks that the Bill poses. Some of those risks, as I see it, are just unfixable. Almost every aspect of the Bill is deeply flawed and ill-conceived.' Medical profession's concerns There are particular concerns around a number of areas, including the role of the medical profession. Many doctors and nurses are very clear they want nothing to do with offering assisted dying to patients, indeed palliative care doctors have come out strongly against the legislation in principle. There must be firm protections for those who do not wish to participate. Advertisement Hide Ad Advertisement Hide Ad Those protections also need to cover settings such as hospices and care homes. There can be no suggestion that hospices should be under an obligation to discuss assisted dying as an option with patients if they feel that is fundamentally objectionable and contrary to their ethos. Such a protection needs to be stated explicitly in the Bill. There remain concerns around the question of whether the Bill falls within Holyrood's legislative competence. The law on medical opt-outs and on the regulation of medicines is reserved, and Holyrood cannot pass laws in these areas without Westminster consent. This issue needs to be resolved if the Bill is to progress further. These legal concerns are real and serious but, as we saw in the debate, the principal arguments against the legislation remain at a more philosophical level. Both Pam Duncan-Glancy and Jeremy Balfour spoke from their perspectives as disabled MSPs, about the pressure that they feel would be put on disabled people to end their lives prematurely. Against a backdrop of a rapidly aging population and spiralling care costs which governments are unable or unwilling to meet, these concerns are real. Advertisement Hide Ad Advertisement Hide Ad Slippery slope is real There is also a very real worry that passing this legislation simply opens the door to it being expanded in future. I have met many constituents on both sides of the argument, including those pressing for a change in the law to allow assisted dying, and what has struck me in many of the cases of individuals with whom I have met is that they would not actually be eligible for assisted dying under this Bill. That means even should this Bill be passed, there will be a push for the criteria to be expanded beyond the definition of those with a 'terminal illness'. And once parliament has agreed in principle to grant a right of assisted dying to one group of individuals, there is essentially no argument in principle against extending that to others. As we have seen in Canada, the slippery slope is real. I voted against the Bill essentially because I believe that granting a right to one group of articulate well-informed individuals with agency in their lives can only in this case come at the expense of putting at risk another group who are weak, vulnerable, and potentially subject to coercion. That remains my view, but I will certainly look to work with others to build in additional protections to what is a deeply flawed piece of legislation. Already there are signs that the mood is shifting against the Bill. This week the General Assembly of the Church of Scotland, which had been widely expected to move to a neutral stance on assisted dying, instead voted to reaffirm its historic opposition, thus keeping it in the mainstream of Christian opinion. Advertisement Hide Ad Advertisement Hide Ad It seems that the more people consider the arguments, the more likely they are to be opposed. Whether that will be enough to change the votes of seven MSPs who voted in favour – all that's needed to prevent the Bill becoming law – remains to be seen.
