End of Life Assistance (Scotland) Bill: Stage 1
The next item of business is a debate on motion S3M-7438, in the name of Margo MacDonald, on the End of Life Assistance (Scotland) Bill.
15:46
I thank everyone who had considerable difficulty in getting here today.
I confess to a wee bit of pride in opening the stage 1 debate on the End of Life Assistance (Scotland) Bill. We, the Parliament that represents the wishes, beliefs, hopes and determination of our fellow countrymen and women, are doing something today that Parliaments are meant to do: we are trying to find an honourable, fair and equitable solution to a problem. Put another way, as an institution, we are meeting a challenging situation head on and doing so in a manner that reflects well on the inherent democracy that exemplifies Scotland and which underpins our parliamentary processes.
The idea of assisting someone to achieve a peaceful death within the law, in what that person considers to be a dignified fashion, is alive and well and is being discussed in countries all over the world. In this part of the world, the Isle of Man is in the initial stages of a bill and in England work is being done to prepare a bill for the House of Lords, but the Scottish Parliament is leading the debate.
One or two opponents of the bill say that the law of Scotland is quite clear on assisted suicide and that the bill is not needed. That is to assume that the law sits well with contemporary attitudes and beliefs about the circumstances of our own deaths. Interest in the cases in England in which people might wish assistance to end their own lives before nature decrees and seek assurance that those who help them will not be prosecuted is just as strong in Scotland. Although the law is different on either side of the border, opinion polls consistently show the same level of support for the idea on both.
In case I forget later, I acknowledge the professional commitment of David Cullum’s non-Executive bills unit and thank its staff for getting the bill to this stage. As ever, I am indebted to my colleagues Peter Warren and Mary Blackford. I am also, recently, indebted to our intern, Kush Govani, and our work experience student, Joe Somerville. We have all enjoyed the support of the Humanist Society of Scotland, Friends at the End and hundreds of individual Scots—medical and nursing professionals, clergymen and women, lawyers and people with a personal or family interest in the bill’s intentions. My pride in the Scottish Parliament’s approach to the issue derives not only from the time and effort that some MSPs and their staff have put into consulting their constituents; Parliament staff have also contributed. I especially acknowledge the unique contribution that was made by Jeremy Purvis when he started the ball rolling with a bill proposal that failed but, nevertheless, was the platform from which my bill was launched.
In the same vein of getting my retaliation in first, I cut to the chase and condemn as unworthy and cheap the contribution from the publishers and authors of the catalogue of linguistic contortions I have here, headed “Care Not Killing”. The postcard that I am holding up was distributed in churches, and it caused alarm among frail elderly and disabled people. One lady, Frances Robson, from Edinburgh, got in touch with my office to say that she had done a latter-day Jenny Geddes in her church. Someone had preached from the pulpit using the card as his text. She stood up and challenged what he was saying, which she said was political and not what a church is for. She was one of many good, churchgoing people who contacted my office to say that they could incorporate the idea that I propose today within their belief system.
The organisers of the campaign were no doubt delighted to unload 10,000 filled-in postcards into the arms of MSPs who oppose the bill. However, as most, if not all, of those concerned are churchgoers, I confess to being puzzled about how they squared their conscience with the statements in the card. Care Not Killing says:
“The Bill will”—
not maybe, might or could—
“put large numbers of sick or disabled Scottish people at risk.”
From whom? The penalties will remain unchanged for smothering someone, even when asked to do so by the person wishing to end their life, or for helping them to drink a lethal dose of opiates.
Even qualified and registered medical professionals, doctors and consultant nurses will require to follow the procedures laid down or they, too, will be breaking the law and will face prosecution. This tacky little card dismisses those safeguards as “illusory”. According to Care Not Killing, the need for witnesses to the requesting patient’s application to a doctor for assistance and the requirement for psychiatric assessment before the person concerned makes a second request are merely “so-called safeguards”.
The first claim on the card must be dismissed as heartless scaremongering. If even one MSP in the debate can prove a logical, inevitable link between people who are defined in the bill as having the legal right to seek help to end their life prematurely—provided that the safeguarding features of the bill are observed—and sick or disabled people who do not wish to comply with the bill’s procedures, whether or not they are terminally ill or suffering from a degenerative condition, I look forward to hearing their justification of the statements on the card.
If the tightly prescribed legal rights of the bill could reasonably be expected to pose such a risk to vulnerable groups, presumably a similar pattern of behaviour would exist in places where assisted suicide is legal. None of the witnesses questioned by the committee gave house room to that claim by Care Not Killing.
Care not Killing also states unequivocally that vulnerable and depressed people will
“be put at risk of self-harm.”
Who says? Where are the studies or statistics to prove that the bill, which rests on the legal right of a requesting patient to seek professional help to bring life to an end, will have any effect on the behaviour of people who do not seek help? Do the opponents of this limited, defined measure claim that more people will attempt to take their own life than at present? Why? Would they be outside medical and social-work support programmes, as many people who attempt suicide are at present? How would the bill change their circumstances?
Another claim that is made as a statement of proven fact in the leaflet is that
“(assisted suicide) will come to be seen as an easy, low-cost alternative to good care.”
Who will see it in that way? According to Care Not Killing, elderly people in care will feel that it is their duty to die. Some elderly people stuck in below-standard care homes do wish for an early death, but the bill’s provisions do not cover them. I hope that we do not hear a litany of sanctimonious remarks about improving care provision. We have had more than enough time to do that.
Margo MacDonald is aware that the committee that considered her bill had a number of criticisms of the bill. When will she address those criticisms so that we can hear her views on the committee report?
I will come to my views on the committee’s report at the end of my speech; Tricia Marwick might wish that she had not asked for that.
In his evidence to the committee, Dr Georg Bosshard said:
“Doctors will never be happy with assisted suicide and euthanasia, and it is important that they are not. As my colleague said, that is an important safeguard.”—[Official Report, End of Life Assistance (Scotland) Bill Committee, 7 September 2010; c 23.]
That is how doctors feel about it. If we are to believe Care Not Killing, however, doctors are without morals, feelings or sentiment.
Perhaps Care Not Killing was referring to the powers that be—perhaps it meant that the state, or even just doctors, nurses and hard-up health boards, will view assisted dying as an easy low-cost alternative to good care. Is Care Not Killing claiming that even hale and hearty old people, or people who are living fulfilling lives in wheelchairs, will be snuffed out even as they do their best to hang on to life for as long as is possible for them?
Perhaps Care Not Killing had in mind the caricature of greedy, heartless family members, who it is sure will change character and depart from the normal behaviour of caring relatives who do not want to let a loved one go. Doctors and nurses who have dealt with people who are in the very last stages of their life have told me that the family want the person to stay.
For the opponents of the bill’s principles to have any credibility, they will require to back up the assertions in the card with facts and numbers, and explanations of the processes that they claim will be set in motion if the bill becomes law.
Supporters of the bill can cite the evidence that the committee has heard from witnesses. For the predictions of the bill’s opponents to be credible, Oregon, the Netherlands, Belgium and Switzerland must be heartless and inhumane societies.
The card concludes with a hypocritical assertion that assisted dying is contrary to good medical practice. Members and their constituents know that, for generations, and perhaps centuries, terminally ill people have been assisted to die through the administration of a double-effect dose of—usually—opiates to relieve suffering, in the knowledge that life is likely to be curtailed too. Quite apart from the proof that doctors took that decision as an act of care, it is plain from what we have heard throughout the whole debate that the British Medical Association does not speak for all doctors when it declares itself to be against the principle of assisted dying. I refer members to the evidence that was given to the committee by medical witnesses.
Opinion among clinicians and other registered medical professionals differs on assisted dying, as it does among the general population—and why should it not? Their ethics, religiosity, beliefs and creeds will be as varied as those of the rest of society. Indeed, there is evidence that, when asked for their opinion on assisted dying, the liberal democracies in our part of the world—some Roman Catholic, some Lutheran and some Calvinist—show a remarkable similarity of attitude.
Evidence?
I believe in the goodness of people, and that is why I am bringing the bill to the chamber today. I hear a call for evidence; I regret that I have run out of time, but I have the evidence with me and I am prepared to offer it throughout the debate.
I move,
That the Parliament agrees to the general principles of the End of Life Assistance (Scotland) Bill.
15:58
The End of Life Assistance (Scotland) Bill was introduced to the Parliament on 20 January 2010, and the committee to consider and report on the general principles of the bill was established on 10 February 2010. The End of Life Assistance (Scotland) Bill Committee first met at the beginning of March and issued a 10-week call for written evidence. By the closing date in May, over 600 responses had been received, and further submissions were received throughout the duration of the inquiry.
During the period of the call for evidence, the committee decided that, in addition to the briefings that were available to it from the Parliament’s research specialists, it would seek an academic perspective. After careful consideration, the committee appointed Alison Britton of Glasgow Caledonian University as its adviser.
The committee called on the Parliament’s solicitor to brief it on relevant statute, common law and case law, and took briefings on jurisdictions outwith Scotland that are said to have legislation that is comparable with the proposal in the bill.
The committee devoted the period between the summer and autumn recesses to taking oral evidence from 48 witnesses. The committee then spent four meetings carefully drafting and finalising its report. Although there were varying views among committee members, the report was finalised consensually.
I place on the record my thanks to all who responded to the call for evidence; all who gave oral evidence; Jude Payne and the Scottish Parliament information centre team for collating the written evidence and providing research support; Lynda Towers, the Parliament’s solicitor, for her legal advice; Alison Britton, our adviser, for the context and analysis that she brought to the inquiry; and Douglas Thornton, the committee clerk, and the clerking team for all their assistance throughout the inquiry and in the preparation of the report.
The bill would decriminalise Scots law on homicide as it applies to the acts of assisting suicide and voluntary euthanasia, and it would provide a defence to any related delictual liability. The committee believes that the construct of the bill would have been improved if those two acts had been dealt with as separate provisions within it. It attributes a meaning to the phrase “end of life assistance” that does not explicitly include any notion of hastening death. The committee found that it would have been less confusing if the terms “assisted suicide” and “voluntary euthanasia” had been used instead.
The committee found no ambiguity in Scots law in the area. If someone chooses to travel to another jurisdiction to commit assisted suicide or to access voluntary euthanasia, he or she does so because certain inherent aspects of those actions are unlawful in Scotland.
Examples from other jurisdictions, particularly the Netherlands and Oregon, were cited as being comparable with the proposal in the bill. However, the committee found two important differences—first, in the cultural and legislative contexts of those places compared with Scotland and, secondly, in the breadth and scope of the bill.
An individual’s autonomy was advanced as a central argument in favour of the bill. The committee notes, however, that the bill would not accord or establish any rights. Further, the committee found instructive the courts’ interpretation of article 8 of the European convention on human rights, whereby the courts have acknowledged not only the right to respect for private life but that that right might have to be tempered in the interests of wider society. Most members of the committee believe that the wider societal concerns should prevail in the context of the bill and do not accept the principle of absolute autonomy as argued by the member in charge. One member, however, believes that, in the context of the bill, the interests of the individual should prevail.
Would the member care to elaborate on two points before we go very much further? The first is about autonomy. The bill does not talk about absolute autonomy. It talks about the autonomy of the individual concerned, and we all understand that that is bound to be constrained in certain circumstances. Why does he think that should count against—
Quickly, please, Ms MacDonald.
—the bill?
I deliberately used the phrase “in the context of the bill”. We all have an absolute right, in terms of the law of Scotland, to commit suicide. The issue is whether the person’s autonomy extends to involving and engaging other persons to assist them in that act. In so far as that is a more absolute definition of autonomy, that is the definition that we have sought, and we found instructive the definition that is used in the European convention on human rights.
The preservation of an individual’s dignity was also described as essential and central to the argument, but the committee found “dignity” to be capable of having at least two interpretations. For those who are in favour of assisted suicide, it means preserving control, self-worth and identity in the terminal stages of life. For those who are against, the key to preserving dignity in the terminal stages of life lies in the quality of care that is available and the respect that is afforded to the dying. The committee found it impossible to reconcile those two positions.
Does the argument that dignity means different things to different people not reinforce the general principle that the law ought to respect those who bring their own values to difficult decisions and who wish to make different choices?
The committee did not base its conclusions solely on the issue of dignity; indeed, I have accurately reflected the fact that we found the argument to be evenly balanced. As I will point out in the conclusion of this speech and as the member will see if he reads the whole report, the committee reached its conclusions after balancing all the issues that were highlighted in evidence.
In Scots law, a person aged over 16 is presumed to have capacity. Although the majority of evidence questioned why the bill would create an unprecedented requirement for all individuals requesting assisted suicide and voluntary euthanasia to establish capacity, the committee believes that, in such a situation, that approach would be justified.
The bill would also establish a procedure to detect undue influence requiring two meetings with a medical practitioner and another meeting with a psychiatrist, neither of whom need have had any previous contact with the requesting person. The committee doubted whether that level of contact gave sufficient assurance that there had been no undue influence on the requesting person's decision.
Will the member give way?
I regret to say that I must make progress—I will try to come back to the member.
The committee shared concerns that were raised in evidence that the bill does not specify any particular qualifications or experience for the designated practitioner and psychiatrist roles. However, it noted that that might raise competence, regulatory and legal issues.
The committee found the ostensibly objective eligibility test, based on finding life “intolerable”, to be inherently subjective. The member in charge placed great emphasis on her intention that the wishes and self-determination of the requesting person be paramount. Such a position, however, cannot be said to be objective.
A further eligibility test is based on being
“permanently physically incapacitated to such an extent as not to be able to live independently”.
Apparently that terminology was aimed at capturing a small number of people who find life intolerable. However, the committee found that it could also apply to a wider group of people with a range of physical conditions or physical incapacity. As it stands, the test is extraordinarily widely drawn.
Moreover, with regard to an eligibility test based on an inability “to live independently”, the committee found compelling the evidence from disability organisations on the way society may let an individual's life become intolerable by neglecting to provide sufficient and appropriate support. Using an inability “to live independently” as an eligibility test raises issues of definition, clarity and subjectivity similar to those raised in relation to other terminology in the bill and with the possibility of unintended consequences. The committee noted concerns about the absence of any requirement for the presence of a designated medical practitioner and believes that, during the end of life process, any medication should be administered in such a practitioner’s presence.
Although the bill would not explicitly require the participation of any particular person or class of person in assisted suicide or voluntary euthanasia, there were calls in evidence for the inclusion of a conscience clause. The committee agrees with that view.
The member should wind up.
Overall, the majority of the committee was not persuaded that the case had been made to decriminalise the law of homicide as it applies to assisted suicide and voluntary euthanasia—or what the bill terms “end of life assistance”—and, accordingly, does not recommend the bill’s general principles to the Parliament.
We move to the open debate. I ask for speeches of six minutes. I point out, however, that the debate is oversubscribed and that if every member takes only an extra 10 seconds—which, to them, might not seem a lot—the last person will not be called at all. As a result, everyone should try to come in on time.
16:08
First of all, I thank Margo MacDonald for her work on this bill. Whatever the outcome of tonight’s vote, she is to be commended for raising such an important and sensitive issue that, as she has rightly pointed out, is being discussed in many other jurisdictions and, perhaps more important, for creating the atmosphere in which the issue can be discussed in a generally mature and sensitive way.
As you have just pointed out, Presiding Officer, many MSPs want to speak in the debate, so I will keep my comments on behalf of the Government as brief as possible. Like the bill committee, the Government believes that the current law is clear—it is not lawful to assist someone in committing suicide—and has no plans to change it.
Decisions about prosecution rightly rest with the Crown Office. I think that when the Solicitor General for Scotland gave evidence to the committee he laid out the considerations that are taken into account when decisions are being made. Notwithstanding that Government view, Government ministers will, like all other MSPs, be entitled to vote on the bill according to their conscience. I know, for example, that my colleague Richard Lochhead intends to vote in favour of the general principles of the bill.
I will speak personally now. After careful consideration, I have decided that I will vote against the bill, for many of the reasons that Ross Finnie has just outlined. Those were the reasons why the committee found itself unable to support the bill. Inevitably, but strikingly, the arguments for the bill have often been made with reference to people who have very definite views about what they would want for themselves at the stage of a terminal illness that the bill would cover. It is hard for people, including me, not to have great sympathy with the views that people in that situation express. However, in reality, many, if not most, people who find themselves in that situation or face the prospect of that situation will not have such definite views. Perhaps their views and emotions will be mixed. Perhaps they will be swayed by their perceptions of the impact of their illness on their family or by the quality or lack of quality of the palliative care services that they find are available to them.
Personally, I am fundamentally concerned about the difficulty that will, I think, always and inevitably be present in determining that someone who has chosen to end their life has not been subjected to undue influence. That is the fundamental reason why I will vote against the bill.
I entirely understand the minister’s views. However, advance directives are recognised under the common law in Scotland. What protections prevent people from abusing them when people make a future request for treatment to be withdrawn?
Jeremy Purvis raises a legitimate issue, and in doing so demonstrates the complexity of the matter. Because of the complexities involved, regardless of my views or those of anybody else on the bill, it is right that such issues have been considered.
My second real concern about the bill relates to the terminology around end of life assistance, and the use of that phrase to describe a situation in which a person seeks assistance to end their life. In my view, end of life assistance—Mark Hazelwood of the Scottish Partnership for Palliative Care in particular strongly expressed this view to the committee—should be about
“enabling a person who is dying to maintain their dignity and to have a minimum of distress.”—[Official Report, End of Life Assistance (Scotland) Bill Committee, 14 September 2010; c 100.]
In other words, it should be a description not simply of a decision to die, but of the practice of palliative care generally.
The question of dignity has come up again. The minister says that she agrees with Mark Hazelwood, but does she accept that dignity is a subjective concept?
I absolutely accept that, but I am also mindful of Ross Finnie’s points about the subjectivity of many of the other terms in the bill. In some respects, that led me to have the concerns that I am expressing.
I promised to be brief, and I want to come to my final point, which is a less personal one; it is more a point on behalf of the Government. With the greatest respect to Margo MacDonald, I do not mean what I am going to say lightly or sanctimoniously. The Government and I believe that the responsibility and priority of Government should be to ensure as far as it possibly can that services and care are in place to allow everyone with a terminal or life-limiting condition to live out their last days with as much dignity and in as much comfort as possible, and for them to have as much autonomy as possible over where they die, for example. I believe that that is the primary responsibility of Government. That is why the Government has expended and will continue to expend as much effort as it has expended on implementing “Living and Dying Well”.
I look forward to the rest of the debate. Regardless of any individual’s views, Margo MacDonald is right to say that the Parliament should be proud of the debate and of the way in which it has been conducted.
16:15
In the short time that is available, it is impossible to consider in depth all of the issues that are raised in the bill and the wider implications of all the bill’s consequences. In speaking today, I have the support of my colleagues Elaine Smith, who represents Coatbridge and Chryston, and Karen Whitefield, who represents Airdrie and Shotts. They cannot be here today, due to the inclement weather, but they would have joined me in opposing the bill at decision time.
As the convener of the cross-party group on palliative care and the cross-party group on disability, I have had the opportunity to listen to a range of expertise on this matter, and can arrive at no conclusion other than that this bill should be opposed.
My main concern with the bill is that its supporters say that it is
“consistent and compatible with palliative care as an important part of comprehensive end of life care”.
Fundamentally, though, palliative care has nothing to do with euthanasia and physician-assisted suicide.
It has been made absolutely clear to me that the fact that physician-assisted suicide is currently illegal allows palliative care professionals to discuss death and dying freely with patients. In fact, the question, “Have you ever thought that life is not worth living?” is one that palliative care professionals often ask, and frank discussions about such subjects are an essential part of end of life care and helping people to move past suicidal thoughts. Changing the law to legalise assisted suicide could cause patients to see such discussions as a cue to consider ending their life, and would therefore prevent professionals from providing that integral component of palliative care to patients.
The bill assumes that autonomy is a generally accepted principle on which to base law. In fact, the law exists to protect us all, and often curtails individual autonomy in order to safeguard others.
Many of those approaching the end of their lives are vulnerable, but that does not make them weak. Vulnerability is part of a person’s humanity. It should be respected but not exploited, and as legislators we must offer protection against the situation that is emerging in which someone could be exploited.
The proponents of physician-assisted suicide constantly reference the Oregon Death with Dignity Act 1997 and cite evidence of good practice there and in Holland to support their position. However, palliative care as we know it in Scotland and the United Kingdom does not exist in Oregon and Holland. No hospice or hospital in Oregon allows physician-assisted suicide on its premises, so Oregon does not provide any evidence that physician-assisted suicide and palliative care can co-exist. That might be an uncomfortable truth for the bill’s supporters, but it is the truth nonetheless.
People look to doctors and nurses for a reflection of their worth. Dignity is not about physical perfection—everyone is worthy. As those who work in palliative care and with people who have disabilities are well aware, a high percentage of people have suicidal ideas, but those ideas change over time. Under the bill’s proposals, if a depression diagnosis were missed, all safeguards would fail.
There is a small minority of people who are currently not adequately helped by palliative care. The development of palliative drugs is very expensive, and there is a danger that money would not be spent on such development if assisted dying became an option.
Just because we cannot relieve all pain does not mean that we should change the way in which doctors and nurses work.
Many places think that they are providing the best palliative care possible, but they are not. Palliative care has much room for improvement, and the bill would undermine those improvements. As the cabinet secretary said, the living and dying well action plan is a positive measure, which requires our support and should not be undermined.
The proposed new law is dangerous and unnecessary. Society needs to know that we cannot have both physician-assisted suicide and palliative care. In reality, we can have only one or the other.
How does the member define the use of a dual-effect drug at the end, if not as physician-assisted death?
I define it in terms of intent, just as doctors do. They know the difference, which is why they can consider the issues much more clearly than we can. There is no grey area in the way that Margo MacDonald suggests. Intent is everything in that circumstance, but she ignores that fact.
Not everyone has an articulate and forceful personality, and for those who are unable to express themselves with confidence, coercion could be a real risk.
I doubt that anyone would argue that someone should have a bad life rather than a good death. What is in dispute, however, is whether allowing the legal right to choose to die at the hands of a doctor is the solution that this Parliament should give to someone who believes that they can no longer tolerate their life.
We face a momentous decision, as a bill such as the one that is before us represents an irrevocable step. As a supporter of the greater development of palliative care, I hope that colleagues will choose the positive course that is available through palliation to help people to have a good death rather than the negative alternative that is contained in this bill.
16:20
I say at the outset that I will not support the bill. I have spoken twice before in the chamber against the principle of so-called end of life assistance or dying with dignity. Nothing that I read or heard during the End of Life Assistance (Scotland) Bill Committee’s consideration of the bill persuaded me to change my mind. That said, as all members of the committee did, I gave full consideration to all the evidence that was put before us. I express my gratitude to the clerks, SPICe and our advisers for the huge amount of invaluable assistance that they gave us during our scrutiny of what is a complex bill. I also thank all those who gave evidence, for and against the bill.
Our decision not to recommend that Parliament agree to the general principles of the bill was not taken lightly. It was taken only after lengthy and careful deliberation and after sifting through a huge amount of evidence, both written and oral. I will deal first with my personal reasons for opposing the bill and then mention some of the details that concerned me as a committee member.
As a former health professional bound by the Hippocratic oath, and with training that was aimed at improving and prolonging life where possible, the idea of actively and deliberately hastening death by assisting someone to die is extremely disturbing for me. I agree with the many professional colleagues who think that legalisation of assisted suicide or voluntary euthanasia risks undermining patient trust in doctors and medical advice.
Does the member recall that that point was put clearly to the witnesses who came from the Netherlands, and that they said that there was no record at all of that trust between patient and doctor being harmed?
They indeed said that, but there remains the perception that that could happen. I firmly believe that it could, as do many medical colleagues in this country.
There have been significant improvements in palliative care in Scotland in recent years. For me, that is the way forward to ensure that the vast majority of patients experience a dignified and comfortable death when that inevitability arrives. Death is part of a continuum with life, and to achieve a good death is as vital a part of health care as any that a patient receives throughout life. I sincerely believe that good palliative care to take the fear and pain out of dying is far better than looking to voluntary euthanasia or legally assisted suicide.
I accept that for a few patients—indeed, they are few—palliative care cannot be 100 per cent effective. However, I am not convinced that that is sufficient reason for us to legislate to allow assisted death as described in the bill, and nor are the palliative care specialists who deal with those difficult cases convinced about that. For those who say that assisted death happens already when doctors give a drug to relieve suffering in a dose that, to be effective, has the double effect of causing respiratory failure, I point out that the Solicitor General stated clearly in evidence that to administer a drug with the intention of relieving suffering is different from doing so with the intention to end life, the latter being an act that is classified as homicide.
The committee felt that the bill’s title is ambiguous. In my opinion, it is euphemistic, because its intention is to decriminalise assisted suicide and voluntary euthanasia, when in fact it is palliative care that gives practical assistance to people at the end of life. Moreover, by seeking to decriminalise both those means of ending life, the bill differs significantly in breadth and scope from the examples from other cultures and jurisdictions that the member in charge of the bill cited as if they were comparable.
In the time that is left to me, I will touch briefly on a few other aspects of the bill that were of concern to the committee and to me in particular. I am not convinced that the difficulty in detecting undue influence on a person seeking end of life assistance can be overcome, especially given that the necessary approvals to proceed would be obtained after two meetings with a medical practitioner and one with a psychiatrist, neither of whom would need to have had previous contact with the requesting person.
The definitions of dignity and autonomy and the bill’s qualifying conditions of terminal illness and intolerability exercised the committee considerably. Those who are in favour of the bill’s proposals see assisted suicide as a means of preserving dignity in the terminal stages of life and at the moment of death. However, against that is the equally compelling argument that a hastened death is undignified by its hastening and that the way to preserve dignity in the terminal stages of life lies in the quality of care that is available and the respect that is offered to the dying. The committee found it impossible to reconcile those opinions.
Most committee members felt that a balance must be struck between an individual’s autonomy and the interests of society as a whole and that, in the context of the bill, society’s wider concerns should prevail.
The progress of terminal illness is extremely difficult to predict accurately and the judgment on intolerability is subjective. The eligibility requirement that is based on an inability to live independently rang alarm bells with many disabled people and their representatives who contacted the committee, because it raises issues of definition, clarity, subjectivity and possible unintended consequences. Those people also pointed out that a person’s life might be rendered intolerable by a society that fails to provide sufficient and appropriate support for people with disabilities, which is clearly an equality issue.
Under current national health service law, health service personnel cannot give the end of life assistance that the bill seeks, and nor can NHS premises be used for it. That raises the equality issue of affordability. Those who live in remote or island communities would also face issues of accessibility of such a service.
Other concerns, which I do not have time to deal with, were raised. As I said at the outset of my speech, the bill’s principles are flawed. In keeping with my sincerely held belief that the dying will be best assisted through improving palliative care, I reiterate my opposition to the bill, which I will vote against at decision time.
16:26
I am pleased that the Parliament is debating the bill this afternoon. Whatever the result of the vote at 6 o’clock, it will not be the last vote on the issue. When I brought the subject to the Parliament for the first time several years ago, one colleague said that she opposed my bringing it to the chamber. Another issued a press release that said that I would put at risk the lives of people with depression.
The subject is serious. It raises concerns and involves people’s heartfelt and sincere views. I will address three points: whether the issue is one of absolutes; the challenge between practicalities and principles; and consistency.
The issue is not one of absolutes, although some wish it to be. Some think that the issue is a black-and-white question of the sanctity of life—they think that it is only in God’s gift to give life and that only he can take it away. I understand and appreciate that argument, but for it to be valid it can be only an absolute position. Those who use the argument for the sanctity of life against the bill cannot support abortion in any circumstances and can support no deviation from the argument, so they oppose the bill, but they allow the courts to continue to have the right to end people’s lives if they are mentally incapable and living on hydration and nutrition alone.
I regret the use by some of an absolute position to suit their argument when they often seem to be more relaxed about other matters. That is because absolutist arguments are problematic in the world, although I understand the attraction of the mask of certainty that an absolute position can give some people—it can be a comfort, and some seek to cling to it in a world of moral shades of grey.
One faith in Scotland took an absolutist view to oppose categorically the use of condoms, but now that argument is not so absolutist after all.
The church leader of another faith group—the moderator—opposed the bill for reasons that I do not share but which I understand. One of his predecessors, Dr Alison Elliot, said of my proposals:
“There may be examples where the tension between life as a gift from God, and the belief that God does not want people to suffer becomes so unbearable that it leads to a re-examination of the question.”
She also said:
“I don’t believe that God wills people to suffer.”
That perspective is interesting and humane. It seeks to balance the tensions between what some people see as God’s rights and will and what others who might not hold such strong views want for their lives. One individual—whom I can only assume was tortured—felt that my 2005 proposal undermined the sanctity-of-life argument so much that he said that he would come and kill me.
We are discussing the principles of the bill. The issue is not purely practicalities. I suspect that today, most colleagues will not take the stance that they take on other bills, when they say that the principles are okay but there are major problems that we can address through the legislative process, because this is a different bill—I recognise that.
There are genuine issues about whether there may be a slippery slope, about the impact on the medical profession, about the way in which the law and the police operate and, indeed, about palliative care in Oregon—although I met the hospice association in Portland when I visited Oregon, and I do not entirely share Mr McMahon’s views on that matter. Those are important practical issues, but they are not the principal ones.
I believe, Presiding Officer, that when you or I, or any other member in the chamber, are dying, the principal question is what control we have over the precise timing, location and circumstance of our passing. I would like the law to allow me the greater right, even if I choose not to use it. However, I would not like someone who may not have the same faith views as me or who may take a different stance on other issues to deny me that right.
Many hundreds of people have got in touch with me over the years on this issue. I have always been careful about using individual cases, because the saying that hard cases make bad law is not a made up one. However, I will quote from a letter that I received in the summer from a man who wrote to me, because it is very relevant to the debate. He said:
“My mother suffered a massive brain haemorrhage on April 16 ... & at Edinburgh Royal Infirmary we were told to prepare ourselves as she wouldn’t survive the evening once the life support machine was switched off. This was not the case and my mother didn’t pass away till 21 April ... My mother had always told us that should anything happen to her & she wasn’t able to survive in her full self, she would want her life to be ended. The consultant had made the decision on April 16 that my mother’s life would come to an end as she wouldn’t be able to survive with the extent of her brain injury. My questions have now been going through my head as follows: which of the following is more humane—
Following my mother’s wishes to end her life
Allow her family to be at her bedside for 5 days watching her die. Remembering that during those 5 days she wasn’t fed or receive liquids.
This is the most upsetting part of losing my mother thinking that she starved or dehydrated to her death. The doctors claimed she wasn’t feeling pain etc but how could they guarantee this?
I think the ‘Death with dignity’ debate should be raised and fully explored for all people to have the right to die with dignity.
Once death came to my mum, I took great comfort seeing her finally at peace and have nothing but great praise for the nurses at Edinburgh Royal Infirmary for the care they gave my mum & my family during those 5 heartbreaking days.
I must apologise if my letter seems a bit of all over the place but hope you understand my points.”
Such modesty. The letter encapsulates so much of my own thoughts that I wanted to share it with members.
The law in Scotland today allows doctors and judges to remove life-sustaining treatment from people with the full knowledge that that act will end the life of the patient. The law allows that for children and for those who are not mentally capable. If we are in a state where we can ask for treatment to be withdrawn, the law allows for it to be withdrawn, knowing that that will end our life. The law allows the right to die if courts and others make that determination. I do not believe that that is consistent or fair, and that is why I want the law to change.
16:33
I, like other members of the End of Life Assistance (Scotland) Bill Committee, thank those who took the time to submit evidence to the committee or to present evidence to it directly. I also acknowledge the work that Margo MacDonald has done to get her bill to this stage.
One of the most challenging aspects of the bill has not been trying to deal with some of its technical deficiencies, of which there are many; it has been trying to address the fundamental aspects that underpin the bill, which raise substantial moral and ethical issues.
The bill has largely polarised views. The evidence that we received did not contain much in the way of, “I maybe support it or I maybe don’t.” People tended to be either for it or against it.
Before I move on to some of the technical issues with the bill, I will try to address, in the limited time available to me, two central components of the bill: autonomy and dignity.
The bill, in principle, hinges on the concept of personal autonomy, that an individual who is terminally ill should have the option to be prescribed medication to end their own life or to have it administered by another individual—assisted suicide or voluntary euthanasia. However, in my view, there is a contradiction in the concept of personal autonomy as it is presented in the bill. I will outline why that is the case.
If I accept in principle the concept that an individual’s personal autonomy should be respected in order that they be able to end their life, it seems illogical that the bill should place limitations on that autonomy. For example, why should someone who is diagnosed with a terminal illness have to wait until they are not likely to live much more than six months before their personal autonomy is respected? Why should the person’s autonomy be limited until they find life intolerable and/or are no longer able to live independently?
A variety of checks and balances in society impact on personal autonomy for us all. Over the years, the courts have acknowledged the right to a private life, but they have also acknowledged that that right may have to be tempered in the interests of wider society. I respect the fact that some individuals and groups feel that the balance is not always correct—on occasions, that might be the case—but the bill’s impact must be considered in the wider context of our society, and I do not believe that the concept of personal autonomy that it proposes is in wider society’s interest.
I reiterate my respect for the consistency of Michael Matheson’s views, but he and I differ on autonomy. I would like him to hear what Dr Jack McPhee, a retired general practitioner, said:
“At its heart, this bill is about compassion for patients and respect for self-autonomy, and opponents of the bill should therefore have very good reasons for opposing it.”
He is entirely entitled to his view, but members must make a judgment on whether they support the concept of personal autonomy in the bill.
I turn to dignity, which is the second important concept that underpins the bill. The bill makes a direct link between assisting someone to die and the concept of dignity. It was clear from the evidence that we received that there is no agreed definition of dignity. There are those who believe that the only dignified way of dealing with suffering is through ending life, but there are others who believe that dignity is inherent and remains with a person no matter the circumstances.
I, as a committee member, have to make a judgment about which side of that divide I stand on. I believe that dignity is inherent and that the key to preserving it for people who are terminally ill is to provide good-quality palliative care and to respect the individual in their dying days. It is not helpful to link dignity to the process of death in the way in which the bill does. As the committee recognises, it is impossible to achieve agreement on the definition.
As other committee members said, there is clarity in Scots law on assisted dying or voluntary euthanasia: it is illegal. The arguments on legal confusion are not justification for trying to change the legislation in Scotland.
I turn to a couple of aspects of the bill on which there are serious concerns.
The bill’s policy memorandum seeks to draw comparisons with other jurisdictions that have comparable legislation. However, the committee found that no other jurisdiction has comparable legislation.
The member in charge calculated that 100 people per annum may use the bill’s provisions if it is enacted. That figure was based on findings from Oregon. However, in Oregon, only assisted suicide, not voluntary euthanasia, is available in statute. We would be better drawing a comparison with the Netherlands, which would suggest that the number would be 10 times greater—1,000 people per annum would use the bill.
I do not believe that the bill is in Scotland’s interests. I hope that members of the Parliament will support the committee’s recommendation.
16:40
Margo MacDonald is a politician I admire and respect. When she intervened in the members’ business debate all those months ago, the tone and nature of this debate changed. We all knew then that this day would come.
I cannot pretend to know how it feels to live with a terminal illness. I also do not know how it feels to have a permanent disability—to be someone for whom life has become intolerable—but I know that the decision on the bill is one of the most important decisions that we as a Parliament will have to take. The consideration of how we as a society care for the vulnerable and dying is hugely emotive, complicated and deeply personal. The very fact that we have a free vote on the bill demonstrates that the question at stake supersedes even our party principles. How we view death and care for the sick and dying reflects the values at the heart of our society that shape who we are. We are a society of not only individuals, but families and communities. The choices that we make about death impact on our whole society.
Interwoven on our mace are the words justice, compassion, wisdom and integrity. In this debate, we need those attributes more than ever. Whether to have a choice about when and how to die has provoked much emotional and philosophical discussion among many of our constituents. That was demonstrated by the fact that over half of the responses to the committee’s consultation came from private individuals. Many members have had correspondence from constituents on the matter. I undertook to seek the views and opinions of my constituents by leafleting their homes, placing articles in my local newspapers and hosting community meetings.
I listened to family members who had nursed loved ones with a terminal illness and to people with a terminal illness. At times, it was a harrowing and difficult experience. Strong views were expressed on both sides of the argument. I will not go through all the things that I was told but, in many ways, they shaped my view on the bill. I had preconceived ideas about what people would tell me when they came to see me. One constituent had a degenerative form of multiple sclerosis. I assumed that he would support the bill, but he told me that, although that was initially his position, the more that he had thought about it, the more his view changed. He decided not to support the bill because, if it went through, the progress that had been made in finding a cure for MS would be set back. The pressure to find a cure would be removed if people such as him, who face death, found a way out. That view was not shared by others, but it was his view.
In this stage 1 debate, it seems right to focus our discussion on the legislative interpretation of the philosophical debates that frame the proposed changes. The question of dying with dignity and making an autonomous choice when life is intolerable offers significant challenges in legislative terms. The definitions are loose, subjective and malleable; they depend on a personal philosophical position or experience. I respect Jeremy Purvis’s position. I respect his right to have the views he expresses, but he must also respect my right to have a different view. As a Christian, I have views and value systems, too. As Michael Matheson articulated, where someone stands on the definition of dying with dignity is a matter of individual choice.
I thank my friend for giving way. The point is that our differing views do not enjoy equality in law.
It is up to us to make the laws, on the basis of the evidence that we receive. We are legislators. That is why we are here, and that is what we will do today. On the basis of the evidence, a committee of this Parliament has determined that there is no need for a change in the law. At 6 o’clock, it will be for each member to examine their conscience and to vote on the bill in a free vote. Just as for any other bill, we will be accountable to the people who elect us to this place—the people of Scotland. Just as they do on every other vote and every other decision that we take, they will hold us to account through the ballot box and can decide to replace us.
Margo MacDonald is right. If the bill is not successful tonight and she is re-elected, she or any other member will be able to bring it back to the Parliament—that is democracy. People have the right to vote. That is the beauty of democracy. Each of us has the right to express our views and to assess the evidence that is before us. On the basis of the evidence that I have heard, I am not yet convinced that the bill is the right thing for Scotland. I respect Margo MacDonald’s right to bring it to the Parliament, but I am not convinced that its time has come.
16:46
As a member of the bill committee, I join others in thanking the clerks to the committee and all those who gave evidence, as well as fellow committee members, who gave the bill a great deal of attention.
We heard a lot about the organisation Care Not Killing in the opening speech, and who could disagree with the general proposition in that name? However, it is a false dichotomy in the context of the debate because it implies that those who support the principle of the bill somehow do not care, and that people beg for an early death simply because care is being withheld. Yet the truth is that although enormous progress has been made in the field of palliative care—in my professional career, I have been one of its biggest supporters—there are some people whom palliative care cannot help. I found that out in my years of general practice, but members should not take my word for it.
In evidence to the bill committee on 14 September, Dr Hutchison, medical director of the Highland hospice, freely admitted that there were such patients and honestly admitted that he did not know how to help them. Elaine Stevens of the Independent Association of Nurses in Palliative Care made the same admission, but said that she would be a partner in their distress. I do not doubt the good intentions, but if I were a patient who was beyond the help of palliative care, I would want a little bit more than that, and I would not want to wait until new drugs were invented. It is because such patients exist that I support the bill’s general principles.
Let us look at some of the grounds of opposition to the principle of the bill. There are religious objections; only God should take away life. I respect those objections—although I was puzzled that some people who gave that evidence to the committee also seemed to be in favour of capital punishment—but the bill would not force anyone to do anything. I believe strongly in religious freedom as a right, but not as a right to deny others the right to follow their own beliefs.
What is the dignity, the loss of which the bill talks about? Michael Matheson said that there are two different kinds of dignity and that agreement cannot be reached on a definition. The Catholic church, among others, argued that as dignity was an inherent part of being a human, it could never be lost, but in evidence that it submitted on a different bill, it submitted that women who enter prostitution lose their dignity, and so they may. The fact is that there is dignity that can be lost, usually temporarily, but which may be lost permanently towards the end of life. Although that definition of dignity may be subjective, the belief of someone that dignity has been lost can be tested much more objectively; the same is true of finding life intolerable.
The position as regards autonomy is similar. No one has the right to absolute autonomy, as that might involve infringing someone else’s autonomy. If I commit suicide by driving a busload of pensioners over a cliff, I am infringing their autonomy. I accept that to allow someone to receive help to end their life on a mere whim would have such a negative effect on society that it should not be allowed. That answers Michael Matheson’s question. Some types of autonomy do have an adverse effect on society and should not be allowed. However, do we tell someone who is in severe, unimaginable, unrelievable and permanent distress, and whose relatives are begging for the help that the patient so ardently desires, that the needs of society are more important than their misery?
I assure members that any idea that pharmaceutical companies will stop doing research into diseases such as multiple sclerosis because one or two people avail themselves of such legislation is entirely wrong. Pharmaceutical companies do such research for profit, and there would be a large profit to be made by anyone who found a cure for multiple sclerosis.
Is it not the ethical role of the doctor to prolong life rather than to end it? Yes, most of the time. It is also the ethical role of the doctor to show compassion and, sometimes, those two roles clash. There is a widespread myth, fostered by the BMA, that the majority of doctors are against any form of help to end life prematurely. However, the BMA’s decision was based on a meeting of 500 UK doctors, of whom only 50 were Scottish, four years ago, whereas we heard evidence from the Scottish branch of the Royal College of General Practitioners, which surveyed 4,000 out of 5,000 GPs in Scotland, and found that about half are in favour of the principles of the bill. The same is true of the nurses. The Royal College of Nursing withdrew its objection to the bill because so many nurses are in favour of the principle. Compassion sometimes wins over abstract principle.
I ask members to support the principles of the bill. If they do not, I hope they do not ever have the experience that I have had of having to look into the eyes of someone who is in their terminal agony and explain that I have the means to help them but am forced to withhold it.
16:52
I echo the respect shown to Margo MacDonald as the member in charge of the bill, and that which she offered to Jeremy Purvis. Over the years, both members have moved the debate on significantly and, even if today is not the last word, the chamber should thank them.
Jeremy Purvis referred to some of the religious arguments that have been advanced on the issue, and Margo MacDonald referred to the support that she has received from good churchgoers. Of course, we are aware that many in the churches have expressed their views directly to the Parliament about how the idea of assisted suicide fits or does not fit with their belief system.
I could stand here and make a speech about my belief system and how it relates to the bill and the ideas that it contains, but surely the point is that the democratic institution of the Parliament should not privilege any particular belief system and impose it on those who do not subscribe to it. Religious belief or subscription to a doctrine can be the basis of a person’s moral life; they might value it highly, and we should all respect that. However, our society and the secular authority of the Parliament must not become a means of imposing such a religious position on everyone. Our authority does not come from a deity or a holy book, even for those of us who believe in deities and holy books. Our authority comes from the electorate.
So the only way in which I can begin my argument is with the principle that a life belongs to the person who is living it. It does not belong to anyone else. People approach difficult choices such as how to face and whether to take control of the end of their life in different ways, based on their values and beliefs. In reply to Michael Matheson, I say that I have never heard anyone argue that assisted suicide is the only way of achieving a dignified death. The only central argument is that each of us is the one who is best qualified to make that decision in respect of our own life.
On the principle of autonomy, the law is of course needed because people sometimes make choices that wider society cannot tolerate, generally because of some harm inflicted on other people. Suicide used to be regarded in that way—not tolerated and not legal—but that is no longer the case. We mourn a suicide. We question ourselves, or at least we should. We question our society about the causes and contributory factors, and we try to improve wellbeing in society. I hope, however, that none of us would want to regard suicide as an offence.
For any person to take control at the end of their own life, on their own terms, may be regretted and grieved over and may be distressing and traumatic for other people, but I cannot see why it should be criminal, even if that person needs to ask for help from someone who is willing to give it in a context of care.
Many people have argued that the law must protect people against the risk that they might feel pressure to make a choice that they do not really want to make or that they would not otherwise make. That is a genuine concern, but let us remember that by rejecting the bill we would leave people in exactly that position. People who wish to make one choice would be told that they may not. They would not be allowed to ask for help; they would certainly not be given it. People who wish to make the choice would be told that they must either go abroad to do it, if they have the money and ability to do so, or must risk criminalising the friends, family or others from whom they seek help.
Does that respect anyone’s autonomy? Does that protect people from the pressure that they come under to make a choice that they find intolerable and that they do not wish to make? The risk that someone could come under pressure to end their life prematurely when that is not their preference is very serious and we should not take it lightly, but nor should we take lightly the serious risk, and the reality, that people are under pressure to make the other choice when they would wish to take the option of assisted suicide.
Some people will no doubt continue to travel overseas to make the choice. My final comment is that the absence of any vociferous call for those people to be chased down and prosecuted for travelling overseas for an illegal purpose suggests to me that we do not consider those people to be criminals. We do not consider them to be people who pose a threat to others or wider society. If we did, as for travel overseas for other illegal purposes, we would prosecute them. We do not, so let us stop treating them as criminals.
Let us recognise that this is a debate and vote on the general principles of the bill. If we want to debate the detail and whether the safeguards should be amended, we should support the general principles at decision time tonight. I certainly will.
16:58
I am a little puzzled by the tone taken by the proponents of the bill. They seem to be arguing vociferously against the lobbying of the churches when those who are opposed to the bill are articulating their views from an individual perspective.
The first line of my notes for the debate stated that the title of the bill is profoundly misleading. While members are apparently attacking others for making misleading arguments, in my view the very title of the bill is misleading. What is proposed is not, by any stretch of the imagination, about assistance at the end of life. Being helped to kill oneself is the very antithesis of end of life assistance. Margo MacDonald would have been a bit more honest if she had simply called the bill what it is: an assisted dying bill.
I want the end of my life, whenever that might be, to be assisted, but I want to be assisted to be as comfortable as possible. I want to be well looked after and to be supported in all the ways—medical and non-medical—that are necessary and available. This bill provides for the polar opposite.
I wonder whether the member could clear up a couple of points. First, can she point to any section in the bill that says that she will not be properly supported and nursed up until the point at which she wishes to end her life? Secondly, does she find the bill morally repugnant?
With the greatest respect to Margo MacDonald, she spent her entire opening speech not assessing or discussing the bill at all. It is not for me to go through her bill nitpicking, although there are some practical points that I want to make. The fact is that the unintended consequences and negative impacts of the bill are as Michael McMahon indicated. I endorse everything that he said in respect of the potential impact on palliative care.
None of us has a great deal of time in which to speak. I will pick up a few practical points before going back to the bigger issues. If the bill were approved by the Parliament, it would make a huge number of people passively or actively complicit in every act of assisted suicide unless they opted out. That is not just about the medical practitioners; it is about everybody who is involved in processing the entire thing. Will they all be able to opt out of the process? The committee commented on the bill’s references to medical practitioners’ involvement, but the questions go far beyond that and I believe that they are being dodged by the bill’s proponents. Will every medical practice be required to have someone who is prepared to do this?
No.
If so, does that not make them all complicit? If not every practice, will every health board have to make someone available, with the same consequences? What happens if a health board or a practice cannot come up with enough willing practitioners? Will individuals then be pressured into it? Will anyone in any capacity be able to opt out of activity that would enable this activity to take place? Will I have a right to know who the willing practitioners are? Will my right to refuse treatment from any such practitioner be protected? Will doctors, nurses and others be required to proactively raise with patients the possibility and availability of assisted suicide even if they are adamantly opposed to the practice and do not wish to be involved in it?
No.
I hear Margo MacDonald say no, but that is not what the BMA thinks. The BMA thinks that that would have to happen.
Will the member take an intervention?
Many other such questions could be asked. I, for one, would not under any circumstances wish to be treated by any medical practitioner who was prepared to help someone to kill themselves, however supposedly pure their motives.
There are far bigger questions than that. There have been some thoughtful comments about the balance between an individual’s right to autonomy and the interests of society. The bill is about the social sanctioning of suicide. We are individuals, yes, but we live as individuals in society. We do not have the absolute right to elevate our individual desires above the good of society. Not even the most utilitarian of utilitarians would have argued that case.
Like the committee, I have found the use of the word “intolerable” a huge problem. Of course it is subjective and could never be anything else. Enshrining such a subjective concept in legislation is very worrying; after all, by definition, it could be argued that there would be no suicide or attempted suicide unless an individual already felt that life was intolerable. Yet we spend significant amounts of money on anti-suicide strategies. Why? Because we instinctively know that, although suicide may no longer be a crime, it is still wrong.
Is it a sin?
We, society, have failed if an individual wants to commit suicide.
Margo MacDonald’s comments out of right field indicate an unfair and prejudiced attitude towards those who argue strongly against the bill. That attitude is based on an assumption that everybody who argues against the bill is doing so from a faith perspective. That is not the case, and it is a wrong assessment to make of the arguments.
Margo MacDonald may argue that the requirements in her bill go beyond someone simply finding life intolerable, as they include reference to physical incapacity and/or terminal illness. Ian McKee spent a great deal of time concentrating on the difficult issues of extreme pain. Nevertheless, the bill does not confine itself to that. I fear that, if we open the door now, sooner or later someone with a severe mental disability or mental illness will try to argue that it is discrimination not to include that form of incapacity—and that would just be for starters. The views of Inclusion Scotland must be taken on board by the Parliament. We would be normalising a view of incapacity that, in my view, no civilised society should accept.
I am horrified at the thought that I could live in a society in which the deliberate taking of life became a public good to be publicly supported and publicly provided. No—we cannot do this.
17:05
I thank the clerks to the End of Life Assistance (Scotland) Bill Committee, and SPICe, for their excellent support. I am extremely grateful, too, to our advisers, and to Ross Finnie, for his excellent convenership of the committee.
This has been an extremely difficult issue for the committee, with strong views and emotions on both sides. I lost my mum to cancer when she was only 61. Dignity for her was refusing chemotherapy, choosing to die at home and deciding when she had had enough medication. We managed with the help of Marie Curie nurses, Crossroads and an excellent medical practice, who between them provided good palliative care.
Because of her faith, my mum would never have considered end of life assistance, but I have always wondered how I would have coped if she had. That personal experience meant that I had very mixed feelings when I was asked to be a member of the committee. I was not absolutely pro or anti the issue and I had some understanding of the conflicting viewpoints lined up on either side of the debate. Contrary to the suggestion by the member in charge of the bill, I went into the committee with an open mind. From reading the 900-plus submissions, it was clear how emotive the issue is. There were many submissions against—many of them from faith organisations—and a smaller number in favour. Some of the submissions were harrowing, describing the circumstances that led people to support or oppose the bill.
When we started to take evidence, it became clear that there were conflicting views on not just the principle of the bill, but whether the bill would achieve what it set out to do. The more evidence that I heard, the more I became convinced that if the bill proceeded as written it would be the start of a slippery slope, at the end of which end of life assistance would be the favoured approach, leaving palliative care as an underfunded and less appropriate alternative.
Will the member take an intervention?
No, I will not. The member will have an opportunity at the end of the debate to respond to my speech.
An issue that figured prominently was that of undue influence. There are real issues there, of older people feeling that they are a burden on their family and of people being persuaded to go down the route in the bill, whatever the motivation. The measures in the bill to detect undue influence are inadequate.
There is also a lack of objectivity regarding the standard for finding life intolerable. As Pam Duncan of Inclusion Scotland said, tolerability is a subjective criterion that varies from person to person and is affected by the action and inaction of others, including the failure to provide sufficient, appropriate support.
A further requirement set out in the bill would be based on being
“permanently physically incapacitated to such an extent as not to be able to live independently”.
The terminology used applies far beyond what the member sought to include in the scope of the bill. Like tolerability, it raises equalities issues, which were highlighted by organisations representing people with disabilities. The bill could lead to most of those qualifying for assistance being people with disabilities while the vast majority of those excluded would be people without disabilities. What message would that send to people with disabilities?
In evidence to the committee, Pam Duncan linked independent living to the capacity to make one’s own decisions. She said:
“Surely independent living is about me being able to decide what I need to support myself”,
but the bill does not provide for that. According to Pam Duncan, the bill says that
“if someone has to depend on someone else and they do not live independently, they could, technically, find life intolerable.”—[Official Report, End of Life Assistance (Scotland) Bill Committee, 28 September 2010; c 264.]
Johanna McCulloch of the Scottish Disability Equality Forum argued that to assist people who are physically incapable of taking their own life could put them
“on an equal footing with non-disabled people.”
She went on to say:
“However, as the bill is drafted, the criteria are so wide that the disability does not need to prevent someone from taking their own life; it just needs to impede their ability to live independently.”—[Official Report, End of Life Assistance (Scotland) Bill Committee, 28 September 2010; c 248.]
Contrary to the assertions of the policy memorandum, the bill could have a negative effect on disabled people. It makes assumptions that would have benefited from equality proofing. Lack of an equality impact assessment demonstrates little understanding of disabilities issues.
There are also potential equalities issues in relation to people who live in remote areas, where it could prove difficult to find local practitioners, medical staff and psychiatrists who are willing to participate. I note that, without a conscience clause, there would be additional pressures in such areas.
I consider the bill to be fundamentally flawed, and I do not think that the Parliament should allow it to proceed. It will of course be up to members to decide whether they wish to support the bill at 6 o’clock this evening, but, having studied all the evidence that was presented the committee, I will not support the bill.
17:10
I, too, pay tribute to Margo MacDonald. I also pay due regard to Jeremy Purvis, who first set the Parliament on the path of examining the issue, and to his thoughtful contribution as well as those from members with diverse opinions on all sides of the chamber.
I have changed my view on the issue, from being opposed in principle—I stress it is in principle, which is what stage 1 is about—-to support in principle. I wholly respect those who oppose the principle of end-of-life assistance—or assisted suicide; I do not shy away from that expression—for religious or moral reasons. I hope that they will reciprocate and respect my democratic right to hold a fundamentally different view. I make a distinction between suicide, which is surely an act of desperation, and assisted suicide, which is an act of compassion.
Why have I changed my view? The death of both my much-loved parents in recent years made me focus on my own mortality and the manner of people’s deaths, which is something many of us choose to avoid. I reflected on the marked contrast between my mother’s lingering morphine-controlled hospital death, and that of my father, with his biscuit and cup of tea by his side, in his own chair in his own home among generations of family photographs.
Incidentally, when my mother was taken as an emergency into hospital for those final weeks, my sister and I were asked out of the blue, little realising then how dire her condition was, who had authority not to resuscitate. They did not ask my mother, but her two daughters, who were put on the spot. My mother’s life and death in extremis was for us, not her, to decide on. She was resuscitated.
The family were told that with increased levels of morphine to kill the pain, her death would surely be accelerated. Controlling the awfulness of that pain, whatever it took, was all that we could think of. Other members have mentioned double-effect doses, and I accept mens rea, but, in a way, end-of-life assistance as a side effect is already an everyday occurrence in hospitals throughout Scotland.
I listened to the arguments of the member who introduced the bill, and I have considered the evidence and the committee’s report. I will touch on the concept of dignity and the divergence of views in that regard. The committee’s report states:
“whilst those in favour of assisted suicide see it as a means of preserving dignity in the terminal stages of life and in the moment of death, those against present an equally compelling argument that a hastened death is undignified by its very hastening ... The debates that took place in the evidence taken by the Committee served to demonstrate that it is impossible to reconcile these arguments.”
I have no problem with that—of course it is impossible to reconcile those arguments. Dignity is in the eye of the beholder, who is the person going through the experience; it is highly subjective. I would not expect people to have the same views on what constitutes dignity in death.
The key issue for me is the choice that is exercised by an individual in relation to his or her own continued existence. For those of certain religious persuasions there may be an absolute prohibition on accelerating one’s own death for whatever reason. I have no problem with that. They may hold that belief, but it should not be imposed on others who do not share it. I note in passing that the bill provides for an opt-in, rather than an opt-out, process. I speak as an atheist, so no such prohibition pertains to me. I must therefore consider whether I think in principle that someone with the capacity and the informed knowledge that their illness or disability is, in their judgment, intolerable—I accept that there are difficulties with that definition—and for whom the prognosis is six months or less, should have the option to choose whether to accelerate with third-party medical assistance his or her death. I must answer in the affirmative—not to say that that option should be taken, but that someone should have the option for that choice. The choice is for that person alone to make, not for others.
In life, I may choose to take medication or have a life-saving operation—or refuse. It seems, setting aside arguments of compassion, that I may reject medication when I am aware that it will accelerate death but that I cannot request such medication. That seems perverse and to defy logic and consistency. The choice as to whether a practitioner would assist would also be a matter of choice. It would be an opt in, not an opt out. For me, that is the principle, and I will therefore support the bill at stage 1—but with many caveats.
I share many of the committee’s concerns, including its concern about definitions. I say in passing that it is not an either/or; it would not be end of life assistance or palliative care, it would be both. For me, there is a point at which palliative care has to have some kind of conclusion. As I said in passing, in practical terms it is probably happening in hospitals elsewhere. However, I appreciate that the path from principle to process and practice is tortuous. I know that we will not get that far at decision time, but the member has said that, if she is re-elected, she will return to the issue afresh. It is my hope that, next time round, the proposed legislation, which endeavours to provide choice with in-built protections from abuse, will move a stage further so that we can see whether anything can possibly be put in place. I fully support a right to life. There is also a right to self-determination—which I think we are denying people at present.
17:16
I, too, put on record my thanks to Margo MacDonald for bringing the bill to the Parliament and giving people in Scotland an opportunity to discuss end-of-life issues. As others have said, the views that I will express are my personal views.
My starting point is paragraph 62 of the policy memorandum, which states:
“It is cruel to force a dying person suffering uncontrollable pain who wishes to die to continue living.”
I have read a lot over the past year—newspaper articles, et cetera—and everything that I have read tends to focus on uncontrollable pain. My first point is on chronic pain. So often in the debate, people talk about the fear of pain at the end of life. If we had better chronic pain services in Scotland, considerably fewer people would be suffering unbearably. I take Ian McKee’s point here.
I am glad that Gil Paterson is in the chamber, because he and I are the co-conveners of the cross-party group on chronic pain—a group that I have been involved with since 2000, when Dorothy Grace-Elder set it up. To be fair, there has been progress on chronic pain services in Scotland, but it is progress from a very low base and provision of services is still patchy. If we put more energy and resources into high-quality pain management and equality of access to pain services, we might not have the fear of pain that exists at present, whether related to terminal illness or not.
My second point is on the requirement in sections 6, 7 and 9 of the bill for knowledge and belief that the person is not
“acting under any undue influence in making the request.”
There is no doubt but that it can be difficult to interpret the wishes of a terminally ill patient if they are delirious, confused or, as in many cases, depressed. How can a clinician be absolutely confident that a request for a life to be ended sooner does not arise from a person’s state of mind and whether or not that state of mind is treatable? The bill also seems to assume that undue influence would come from a third party. In fact, any person who feels that they are a burden to their family, the health service or the state could be unduly influenced by those factors.
Will the member give way?
Not at the moment. I want to make this point.
Many older people who see the savings that they have built up for their families dwindling at a rate of up to £800 a week in care home fees may feel guilty that the money is being spent on them and not on their family as intended. How can a doctor, faced with an adamant patient, be sure that the patient is seeking to shorten their life because it is intolerable when there might be other reasons of greater influence? How can any doctor know the basis of an individual’s value judgments and opinions?
At paragraph 124 of its report, the committee states:
“The Committee accepts that it would not necessarily be possible, in any circumstances, to determine with absolute certainty that there was no undue influence”.
I would say that that influence might be from the individual in question as well as from a third party. I also agree with the committee’s concerns about the definition of “end of life assistance” and its view that the terms “assisted suicide” and “voluntary euthanasia” should be used. Indeed, I believe that the best end-of-life care and assistance is good palliative care. We should be talking about better end-of-life assistance, not assistance to end life. In that respect, I commend Gil Paterson for his excellent Palliative Care (Scotland) Bill and the Scottish Government for its living and dying well strategy and action plan. I am not saying that living and dying well is the answer to end-of-life assistance and care but it is fair to mark the progress that is being made and to acknowledge the fact that more progress has still to be made. At this point I should say that there is a disappointing lack of timings for many of the strategy’s action points, which I hope will continue to receive priority despite the difficult financial climate.
Last week, the cross-party group on chronic pain was told that good pain management by a pain specialist should not hasten death. That view has been confirmed in a letter from Highland Hospice, which says:
“Modern pain control is sophisticated, involving the use of a variety of drugs and non-drug measures, and is not simply a case of an inexorable increase in the dose of morphine.
Moreover, patients taking morphine in carefully prescribed doses for pain relief are resistant to side effects of the drug and the concept that life can be ended with an increased dose appropriate to the level of pain is spurious. ...
Double Effect with regard to pain relief has been overstated and provides no basis for the legalisation of assisted dying.”
We should listen to palliative care consultants. For such reasons, I cannot support the bill.
17:22
All politics is personal. At the nub of every debate—and more so this debate—lie our own values, beliefs and life experiences, and they inform how we vote on issues. As politicians, we like to try to rationalise everything, but often the bottom line is how one feels rather than how one thinks and I must confess that my heart usually rules my head.
I have found this issue difficult because I have been torn between my own instincts and beliefs and others’ personal testimony. If—and I stress that word—the big moral issues of the day can be characterised as a spectrum between individual choice and the sanctity of life, my personal pendulum swings towards the latter and I have to say that, although the debate is not yet over, I intend to vote against the bill at this stage. Before I state my reasons for doing so, however, I should say that I am nevertheless proud to have been one of the signatories who enabled the bill to be subject to parliamentary debate and scrutiny. Nothing should be sacrosanct in this Parliament and, irrespective of our personal beliefs, we should be able to debate any issue and not only be able to defend our own position but allow our beliefs to be open to challenge. That is in the interest of all our constituents and a sign of a mature democracy and—dare I say it—mature politicians. Moreover, as a society, we do not talk enough about death and dying; indeed, we tend to avoid such matters.
My other reason for supporting the opportunity to debate the bill, despite my not supporting it, is deeply personal. I apologise to members in advance for my sentimentality. My father used to say to me that he would rather die on his motorbike with the wind in his hair than suffer a debilitating or terminal decline. That may sound rather brash and matter of fact, but it was his personal and considered position as a result of seeing his brother dying of a lengthy terminal illness. As fate would have it, my father died on his motorbike at the age of 54. I was left wondering for a few days until the post mortem results were returned, but he was a healthy man who was taken before his time by an accident. That left a mark on me. Since then, I have wondered about the rights and wrongs of leaving people to take extreme action when all they want to do is exercise personal choice on how they can die with dignity, whatever that means.
There are no easy answers, and as a mother I feel differently from how I feel as a daughter. As a mother I never want to be a burden on my son; as a daughter I never want my mother to feel that she is a burden.
After much soul searching, I have come down on the side of those who have lobbied me to vote against the bill. However, I must be honest. I have at times resented the tone and tenor of some organisations, which have blistered the debate and misunderstood the intentions behind the bill. I note with interest that the opinion polls show that 80 per cent are in favour of the bill; in the correspondence that I have received thus far, 10 to one have been against it.
The area is difficult to legislate in. That is reflected in the many issues and concerns that the committee report highlights. I was formerly a mental health officer, so the discussions about establishing capacity struck a chord with me, and I take on board the evidence on that from the Royal College of Psychiatrists. I have also considered the concerns about the perception of change in the doctor-patient relationship and, of course, the difficulties in assessing undue influence. The crux of the problem is that the bill tries to deal objectively with some highly subjective issues. In many ways, the issue is simply too much for a member’s bill.
Margo MacDonald has to be commended for her political and personal courage, but I cannot support this bill at this time. However, I thank her for bringing the issue to Parliament.
17:28
I, too, thank the committee clerks, Jude Payne from SPICe and fellow committee members. Like Cathy Peattie, I thank Ross Finnie, who convened the committee very well, and I thank everyone who provided written and oral evidence.
I do not remember any occasion in the past 11 and a half years during which I have been an MSP when members have not been whipped by any political party and we have had a free vote. My friend Karen Gillon spoke eloquently about that. Our consideration today is therefore all the more onerous. No manifesto commitment was made on the issue and there was no other reason for us to consider the matter prior to coming here. Those facts make the vote challenging for every MSP.
During the past year I have served as one of the six members of the End of Life Assistance (Scotland) Bill Committee. I entered into the work very willing to be persuaded by Margo MacDonald’s case for legislative change. Like Cathy Peattie’s mum, my mother-in-law had a lingering death as a result of cancer, which was very upsetting for the whole family. As Michael Matheson rightly pointed out, the autonomy of the patient is at the heart of the matter. Hundreds of representatives contacted us by letter and e-mail to inform our decisions, particularly on the autonomy issue.
We heard arguments, advanced by well-qualified individuals, in support of Margo MacDonald’s proposition and against it. In the end, I was persuaded by the view that when an individual wants to make a choice that I feel is damaging to the society in which we live, that choice is wrong. The appeal to autonomy, although superficially seductive, fails to take into account the interconnectedness of us all—family, the community and beyond—and the fact that the concept of a person being a burden is inimical to autonomy, as somebody who is truly autonomous cannot, by definition, be a burden, as Angela Constance has just said.
Our committee considered international comparisons. Our written evidence told us that, in Australia’s Northern Territory, the legislation was introduced in 1995 and was nullified by the federal Parliament two years later. We also considered Belgium, Switzerland, Luxembourg, Oregon and the Netherlands. As Ross Finnie said, the committee focused on Oregon and the Netherlands. I shall not rehearse the other arguments that have been presented by other MSPs. Suffice it to say that, on the whole, I share the reservations that others have expressed.
My particular concern is related to the issues in the Netherlands, where work has been done in this area since the 1970s in terms of legislation, on-going monitoring and evaluation. The research shows that, in the Netherlands, 550 lives have been ended without an explicit request. Of the jurisdictions in which end-of-life assistance takes place, the Netherlands appears to be the most regulated.
My other concerns followed from the fact that, in 2007, an evaluation showed that although nine out of 10 physicians in the Netherlands have indicated that they are sufficiently au fait with the content of the legislation, their knowledge appeared to be insufficient. In response to the point that Jeremy Purvis made, I point out that that same evaluation stated that the information in the guidelines was not always comprehensive with regard to, for example, advanced euthanasia directives and the part that is played by nursing staff.
Many other concerns were raised in the evaluation. I cannot mention them all, but one is pertinent to my concerns. According to the evaluation, 20 per cent of all cases of life termination upon request are not reported, and non-reporting of cases is largely connected with the use of morphine as a means of life termination.
Oregon had a much less rigorous approach to data collection, which makes it much more difficult to scrutinise and evaluate its legislation robustly. All those points and more can be found in our committee’s report and in the SPICe briefing by Jude Payne and Sarah Harvie-Clark, which was published in September 2010.
I had special concerns about the possibility of this Parliament passing a bill that would require a GP, a psychiatrist and other professionals to carry out duties but would not contain a conscience clause. Even though the member in charge of the bill acknowledged that a conscience clause would be accepted, the Royal College of Nursing was not convinced that that provided adequate protection for nurses.
The National Health Service (Scotland) Act 1978 does not provide for end-of-life assistance, and it follows that this issue raises the spectre of people paying private practitioners. The fact that, as we are led to believe, the vast majority of GPs would not wish to undertake these responsibilities also raises the spectre of vast swathes of land across Scotland into which patients would have to import GPs or from which parents would have to travel in order to see GPs who would provide end-of-life assistance. In equalities terms, that would be a problem in relation to the denial of access on a fair and equal basis to people in every part of Scotland and in terms of the fact that those who would be able to pay would be able to access the service and those who would not be able to pay would not. The issues that were presented to us about equality in the context of disability are important as well, as has been stated by Cathy Peattie.
The ECHR has never been challenged in the Netherlands, but if the bill that we are discussing today were passed, it could conceivably be challenged in the European Court of Justice. That is part of the checks and balances in life with which this Parliament could have to contend. That is just another reason for us to reflect carefully on the issue. We also have to consider the case of Diane Pretty. That is why I will vote against the bill this evening.
17:35
As we have heard, five years ago, my friend and colleague Jeremy Purvis launched his “Dying with dignity” consultation. The paper outlined his proposal to introduce a member’s bill that would allow competent adults with a terminal illness the right to receive medical assistance to end their life. I am sure that Jeremy was disappointed, but the proposal did not receive the backing of the necessary 12 members for it to proceed and so it fell. Given the failure of the first attempt to introduce such a bill in 2005, I was rather surprised when Margo MacDonald received sufficient support from 12 members to introduce the End of Life Assistance (Scotland) Bill. Having heard Angela Constance, I must say that I am impressed by Margo MacDonald’s ability to persuade her and other members that signing the bill as supporters of it did not actually mean that they supported it and was just to allow a debate.
I am not bowled over by that argument. This is a Parliament, after all; it is not a debating society. The bill is extremely serious and would have serious consequences. When members sign in support of members’ bills, they need to appreciate the serious consequences of doing so.
Will the member take an intervention?
Jackson Carlaw (West of Scotland) (Con) rose—
Joe FitzPatrick (Dundee West) (SNP) rose—
Will the member give way?
Certainly, Margo.
Can the member name another forum in Scotland that allows people who are not elected representatives to have their voices heard directly?
I repeat that this is a serious Parliament. There has been a huge amount of effort and concentration on the bill. Ross Finnie and the other members of the committee have done a tremendous job. We have rules in the Parliament to measure whether there is sufficient support for a bill. Members must be honest about that. If they support a bill, they have to sign a piece of paper saying that they support it. It is plain from what we have heard that members did not do that.
I believe that the consequences of having introduced the bill are twofold. First, the hopes of some terminally ill people have been raised, in that they have been led to believe that the bill has a chance of becoming the law of the land. They will be incredibly disappointed when they find out that there is no such support in the Parliament for the bill and they will feel let down. Secondly, the many people whose fears have been unnecessarily raised by the threats to frail human life that are contained in the bill will feel that their values have been under attack. Just listening to Margo MacDonald’s astonishing attack on those who disagree with her, particularly Care not Killing, shows that to have been the case.
There are so many reasons why we should oppose the bill that I do not have time to list them all, but they have been set out amply, particularly by Roseanna Cunningham, who is not in the chamber at the moment. Only one out of six members of the committee that considered the bill wished to recommend it to the Parliament and I understand that the weight of evidence presented to the committee was massively against the bill.
The principal reason why I oppose the bill is for the protection of the vulnerable. I sincerely believe that all members of the Scottish Parliament have come into politics to change our country for the better. However, in so doing, we must always have at the forefront of our minds our duty to protect the interests of those in society who are most at risk. The vulnerable and the weak would not benefit from the bill because, if we passed it, we would risk helping to create an environment in which people consider it to be normal to bring human life to an end because of perceived burdens on family or society. That is not a society in which I would like to live.
Will the member give way?
I have already given way.
Margo MacDonald has claimed repeatedly, and she did so again today, that those who disagree with her are out of touch, because her bill is supported by the majority of Scots. She quotes opinion polls to back up her claims. I am astonished that, so far, no one has challenged Margo’s assertions about public opinion, apart from Angela Constance, who did well to do so. I dispute Margo MacDonald’s claims, but even if I was wrong and it was popular to support the bill, as it is popular to support the death penalty, I still would not do so.
As parliamentary representatives, we must resist the temptation to legislate because of opinion polls. In a representative parliamentary democracy such as ours, we are required to use our judgment. As long ago as 1774, the classical liberal Edmund Burke said:
“Your representative owes you, not his industry only, but his judgement; and he betrays ... you, if he sacrifices it to your opinion.”
I ask members at decision time to use their judgment on the bill and to reject it, especially as it is a danger to the weakest and the most vulnerable in our society in Scotland.
17:40
I congratulate Margo MacDonald on bringing the debate to the chamber, which cannot have been easy given her personal connection to the issue and given that she is a public figure. I know that she does not scare easily—in fact, sometimes the opposite is true—but she has received fierce and sustained criticism, which nobody enjoys. Such criticism is undeserved, because it is clear that she introduced the bill for the right reason—because she passionately believes that it is the right thing to do.
I started in the debate by agreeing with Margo MacDonald. I had some discomfort—we cannot talk about ending someone’s life without a degree of that—but my instinct was to support the bill on a point of principle. We are a secular society and the arguments when the bill was proposed centred primarily on the religious aspect. I respect people’s beliefs, but I feel strongly that our laws should not be made—or not made—on the basis of the dominant religion in the country. For me, the subject is like many conscience issues—I might not like an activity and I might want to reduce the number of instances of it, but I believe in people’s right to do as they wish with their bodies and I believe in the right of people who are suffering in the way that the bill describes to end that suffering on their own terms.
Therefore, I had planned to support the bill. However, I knew that much listening would have to be done. Enric Miralles wisely dotted about the chamber’s walls abstract figures, which I initially thought were hot-water bottles, to remind us that we are being watched by the people of Scotland all the time. I would say that we are being watched extremely closely this afternoon, and not just by people in Scotland.
I received an e-mail from someone who told me that I should vote according to opinion polls that show that the majority of Scots are in favour of the bill. I disagree. On this issue, I can vote only according to my conscience. Mike Rumbles suggested that MSPs should have made up their minds completely before signing the bill proposal, but it is crucial that we—along with the rest of Scotland—listen and question and that we voice some of our constituents’ views. As the letters came in, I listened and questioned.
I will quote some of the comments that I received. One person said:
“I consider it a basic human right to be able to choose when to end one’s life (and in a humane manner). I am certain that this will be widely available to human beings in the future and it would be good”
if Scotland led the way
“in bringing about this change”.
Another correspondent said:
“While I sympathize with Margo MacDonald and appreciate her intention, I am concerned that the passing of the Bill could have long-term undesirable consequences. Evidence from the Netherlands and the US state of Oregon where assisted suicide is currently legal, shows that it is impossible to prevent abuses from occurring.”
She did not go into detail about that evidence.
Then I received a letter from a 16-year-old girl that I read a bit more carefully, because it was handwritten and was clearly not taken from a campaign website. She said that she was against the bill because she worried that older people with degenerative conditions who were perhaps in care homes and who felt that they were a burden to their families and their country would feel under pressure to end their lives prematurely because they were no longer of use to anyone. That comment struck me. I expect that family members who would put someone under such pressure are few and far between but, in my experience, many older people do not need such pressure to be put on them—they feel it already. That was when I started to worry.
In her last year, my grandmother often apologised for what she said was us having to visit her, when there was no “having to” about it. She was an amazing woman—a great laugh and very un-granny-like. She told us brilliant stories that members would not thank me for repeating in the chamber and she was a tremendous influence on all in my family. We and everyone else in her life made that clear to her, but she had a deep-seated belief that she was a burden and was no longer of any use. Whatever we said, something inside told her otherwise.
I do not believe that my granny’s response was uncommon. I do not know whether the issue is generational, female or geographical. Whatever it is, it is real. My single biggest concern about the bill is that people like my granny and others I know would choose to end their lives not because they wanted to but because they felt obliged to.
Will the member give way?
I do not have time.
I note Professor Ganzini’s evidence on lethal injections and her experience when asking patients whether they felt that they were a burden. She said:
“I frequently see the family in the background saying that they would be honoured to take care of them and would like the opportunity, but the individual does not want it.”
She describes such people as
“a group ... for whom being independent and in control and not having other people take care of them has been a lifelong value.”—[Official Report, End of Life Assistance (Scotland) Bill Committee, 7 September 2010; c 63.]
Although I identify fully with that group of people—Professor Ganzini’s remarks really struck a chord with me—I strongly argue that enacting the bill will see a shift in societal attitudes and will put the option of assisted dying before people to whom it currently does not occur. Some of those people will be the older people I have talked about.
However, to me that is not an argument for voting against the bill at this stage; it is simply an argument for ensuring that stringent amendments are lodged when we have the opportunity to do so at stage 2. If I am still not satisfied then, I will vote against the bill. Today I will vote for it, because it is not about our telling people that their lives are not worth living but about respecting their right to tell us when life is no longer bearable for them and their right to decide whether they wish to continue suffering.
17:46
We have had a good debate today. I said that I was proud that the Parliament was dealing with the issue and have had no reason to change my opinion, although obviously differences of opinion and morality have been expressed. I sincerely hope that the Parliament can encompass all of those. I thank the people who have made an effort to be here, because some of them have made an almost superhuman effort to bear witness to our proceedings.
As I said at the start, we are not alone in our deliberations. In a Radio Europe broadcast last week, the presenter informed me that assisted death, among other end of life issues, is being discussed across Europe. Interestingly, he also told me that our poll figure of 77 per cent in favour of assisted death was consistent with similar polls that have been conducted elsewhere in Europe. I understand why members have argued that we should not be influenced too much by opinion polls, but the polls that have been conducted on the issue have been consistent—so consistent that they are guiding the deliberations of the people who are considering the matter in England.
I am glad that at the end of the debate there will be a free vote, as it signifies that each MSP is free to use his or her judgment on whether the bill would enhance or harm the whole community. In a free vote, MSPs must also balance their own conscience with the need to reflect their constituents’ wishes.
Most, if not all, MSPs who adhere faithfully to the teachings of their church, mosque, synagogue, temple or meeting place will find themselves fundamentally opposed to the bill because, according to their beliefs, it usurps the place of God, whom they believe to be the only giver and taker of life. In short, they find the bill morally repugnant and ethically unacceptable. MSPs who find the bill as I have described can never vote for assisted death without setting aside their conscience. I hope that Mr Rumbles will take note when I say that none of us has the right to expect them to do so. The correct action for them is to explain to their constituents why they could not vote for a measure with such a proven level of support among the general public.
Many MSPs are probably not opposed to the bill in principle but have been inundated with communications from faith-based organisations. My advice to any colleagues who are in that position is to vote for the bill to proceed to intensive scrutiny, during which they and I will be able to amend provisions that need to be sharpened or explained better. I am grateful to Anne McLaughlin for making that point.
Whereas colleagues whose opinions and beliefs derive from their religion will continue to oppose the bill regardless of any amendment, others whose beliefs are not based on a particular religion are free to respond to their constituents’ suggestions and ideas. That latter group of MSPs, their constituents and I know that, if they oppose the bill and neither their conscience nor their firm belief that the bill is so bad that it cannot be improved by amendment stands as a barrier to the public’s desire for the Parliament to support and act on the bill’s principles, they have opted out of offering the leadership that the electors have a right to expect of their elected representatives.
Does Margo MacDonald agree that, over the 11 years that the Parliament has existed, we have been faced with many provisions—such as those on same-sex relationships and those in the Adults with Incapacity (Scotland) Act 2000—against which the faith-based organisations begged members to vote but in relation to which members voted as they wished to, and not in the way that the faith-based organisations told or lobbied them to?
A different quality has been obvious in some of the campaigning on the bill. I quoted Care Not Killing’s card in my opening speech, and the parliamentary briefing that Inclusion Scotland circulated says:
“the ‘means of administration’ might conceivably include gas (carbon monoxide or helium), ... a bullet or a push off a cliff.”
Am I meant to think that that takes seriously a matter that, as members have admitted, causes great concern to a number of people who, as Mike Rumbles said, could be disappointed if the bill is stopped in its tracks?
Does my colleague honestly believe that any MSP will vote on the basis of the passage that she just read out?
Roseanna Cunningham said that we had to accept what Inclusion Scotland informed the committee as being the opinion of disabled and vulnerable people. That is why I quoted the publication.
I appeal to MSPs who have perhaps been overly influenced by that campaign but not convinced by its spurious claims about the bill to examine their own conscience. I urge MSPs whose beliefs allow them to contemplate improving the bill not to duck for cover but, instead, to take account of the weight of public opinion and either vote to continue the bill or abstain from voting.
The point that I made was that we should ignore and not bow to public opinion, whatever it says, and that we should make the right judgment based on the information that we have and our views.
I already explained that I fully respect the right of MSPs to individual conscience—indeed, I guard it—but if that conflicts with what appears to be a fairly obvious public point of view, it is up to the member to explain that to his constituents. That seems to me to be perfectly moral and honourable.
Jeremy Purvis went to the heart of the matter. He also talked about the difference between the practical and the moral. That is what has been difficult about the debate. Some members are more concerned with the morality of the debate, and others are concerned with the bill’s practical provisions. I freely concede that, if we go on to stage 2, amendments will be made that will improve and clarify the bill.
Mary Scanlon talked about the lack of guidance that is given to doctors, but the General Medical Council usually gives doctors good guidance on matters that involve sensitivities beyond those that they encounter in their normal, everyday practice, so I have more trust in the professions than was expressed in some of the speeches that we heard.
Members also asked how doctors would know whether a patient was coming under undue pressure. That is the sort of professional judgment that doctors—including general practitioners—psychiatrists, clinical psychologists, and consultant nurses make every day. I do not have the same fears that others have expressed. If those fears were relevant to the debate, I am absolutely certain that we would have found an echo of them in regimes where this practice has been in place for 10 years.
Anne McLaughlin argued that some people who feel under pressure under the current legislation may come under pressure if the legislation were changed. However, the point is that people who wish to make the alternative choice come not only under irresistible pressure but the threat of criminality. Does the member agree that an unfair and unreasonable judgment is made when we class one form of pressure as abuse while ignoring the other form of pressure?
The member put better than I have done the inequity of approach to the moral question that we have seen demonstrated in some cases.
The bill is about not only morals but people. A lady from Dundee whose husband died two years ago got in touch with me today. She said that
“he had insight into his condition knowing he was losing his personality, his talents and eventually his dignity. He hallucinated regularly”—
The lady gets to the quick of it. She mentions dignity, but there seems to be an unwillingness on the part of some members in the chamber to accept that dignity is a subjective notion. I fully accept that many members have a different sense of dignity from me, but who is to say that their sense should be preferred to mine in relation to legal protection? That does not seem equitable to me, and is one point that I sought to establish with the bill.
The lady from Dundee went on to tell me that her husband
“was treated like an errant child, being told the GP did not ‘do’ euthanasia but he would be treated with dignity and respect when his time came.”
She denies absolutely that that is what happened, talks of the hell that her husband experienced at his death and wonders who benefited from the law being applied in that way. The bill questions whether the present law protects sufficiently the minority of people who cannot be assured of a dignified and peaceful death.
We have heard much about palliative care in the debate. There is no conflict between palliative care and someone at the end of such care saying to a nurse or doctor, “I have had enough. I want to go now.” I believe that that is their decision to make. Opponents of the bill do not believe that. I am not at all sure that we will be able to reconcile the gap between us.
I am working on the assumption that there are MSPs who feel that there is more that has to be delved into. My appeal to them is this: do not dump the bill at this stage. We have said what we have said about opinion polls, but we all know, as do people on the street, that there is public support for the principle of autonomy in a person determining the last act of their own life. That principle may not have majority support, although I believe that it does. Opinion polls—much derided as they are—guide us on many other things. We can derive from them some feeling of decency in the questions that they asked and put some sort of faith in the answers that they came up with. If we do that, we will not kill the bill this afternoon.