Dying with Dignity
The final item of business is a members' business debate on motion S2M-1673, in the name of Jeremy Purvis, on dying with dignity. The debate will be concluded without any question being put.
Motion debated,
That the Parliament acknowledges the commencement of the select committee of the House of Lords' consideration of physician-assisted dying and euthanasia; further acknowledges the publication of an NOP opinion poll that showed that 82% of respondents in Scotland favour a change in the law to permit people with an incurable terminal illness close to death to seek help to die with dignity; is concerned that 39% of respondents in Scotland said that they would break the law if a loved one who became terminally ill and was suffering unbearably asked them to help them die; recognises the huge benefit to society and individuals of professionals, volunteers and carers working in palliative care and the hospice movement who work tirelessly with compassion and commitment but recognises that there are some people who will not be helped and that they will seek the right to die with dignity, and calls for a wide debate on end of life issues and consideration of a change in the law.
I thank the Parliamentary Bureau for giving me the opportunity to debate my motion. I also thank members who are resisting the lure of the politician of the year awards dinner this evening so that they can attend the debate, and I thank others who said that they wished to be here but could not.
My motion raises a wide range of complex and sensitive issues and asks for reconsideration of some people's most deeply held moral views. It also raises medical ethics questions. In calling for reconsideration of the law, I start a process that Parliament is suited to progressing, although we cannot, of course, address all the issues in the debate this evening.
My motion acknowledges the Executive's commitment through its investment in health care and the resources that are being directed towards palliative care. I pay tribute to the work of members who have been consistent and dedicated in their advocacy of more support for palliative care and for the hospice movement.
At the outset, I stress my admiration for all those—whether they are consultants, nurses, doctors, support staff, carers or others—who are dedicated to caring for patients and their families, alleviating pain, offering support and providing compassion and understanding at the most difficult times of patients' lives. Nothing that I say should be interpreted as undermining their work or as questioning the real benefits that they provide. However, my view—and the reason why I initiated the debate—is that even with the support of palliative and other forms of care, some people who have terminal illness seek greater control of their lives at the difficult times at the end of their lives.
Several rights regarding our medical treatment are open to all of us. The British Medical Association recognises that a debate continues about autonomy—the patient's ability to have greater say over his or her treatment. I created a living will, or advance directive, 15 years ago, when that was rarely regarded as a reliable way to determine patients' views on their treatment. Today, advance directives are respected by the common law in Scotland and by guidance from the BMA and the General Medical Council. To disregard a valid advance directive that has been made when an adult was mentally capable and which is relevant to their medical condition is viewed as battery or assault.
After a landmark case in 1996, the then Lord Advocate, Lord Mackay, issued the statement that he would not authorise the prosecution of a doctor who—acting in good faith and with the Court of Session's authority—withdrew life-sustaining treatment from a patient with the result that the patient died. On that case, Professor Sheila McLean of the University of Glasgow's institute of law and ethics in medicine said:
"What our law does, therefore, is to endorse decisions which will result in the deaths of certain patients (most notably those who cannot express a preference) but not those who are competent to ask for aid in dying."
The law in Scotland is not precise on physician-assisted suicide and euthanasia. For example, the authors of "Scots Criminal Law" state:
"Suicide is not a crime in Scots law and it is therefore not a criminal offence to attempt suicide. Encouraging or assisting another to take his own life is another matter, as the sympathy which the law has for the suicide does not necessarily extend to those who facilitate suicide. There is no Scottish authority on this issue; in other jurisdictions it is not unusual to find statutory provisions which penalise the provision of any assistance to the would-be suicide."
In Belgium, Switzerland, Germany, France, Sweden, Finland and—where assistance is provided by a medical practitioner—the Netherlands, assisted suicide is not an offence. In other countries such as Denmark and Norway, the penalties for such offences have been downgraded to as few as 60 days.
In Oregon in the United States, assisted suicide has been law since 1997 with the Oregon Death with Dignity Act, which allows for a patient to request medical assistance to die when there is a diagnosis of terminal illness and a prognosis of death within six months. Two oral requests separated by 14 days must be made, and doctors and care staff are not forced to act against their consciences if they do not want to adhere to the measures in the act.
Furthermore, in Oregon there is a reporting mechanism, as there is in the Netherlands. One of the main criticisms of the experience in both Oregon and the Netherlands has been that it would be the start of a slippery slope of abuse that would draw in the most vulnerable people in society. Another criticism that I want to address is that it would take society's attention away from celebrating life to concentrating on death.
In almost every discussion and meeting I have with people in the medical professions—doctors, nurses and consultants—I ask the same sensitive questions: does assisted suicide happen today, and in what numbers? Invariably the answers are "Yes," and "We don't know."
None of us can ask parliamentary questions in this Parliament as our counterparts in Oregon can about how many requests for assisted dying there were last year or how many patients took a lethal dose of medicine. There is no transparency in the reporting of very sensitive cases and, when we consider the Catholic doctrine of double effect, there exists no means of finding out about the prevalence of such incidents. That is not a satisfactory state of affairs and, other than the charge of murder, there are few if any safeguards to protect the most vulnerable patients at the end of their lives.
To change the law and to bring in a law on assisted suicide would not introduce an environment that encourages the likes of Shipman. That environment exists today. What assurances are there for vulnerable people in society that another Shipman with another 215 victims cannot happen? Indeed, it is the case that by introducing a measure that has a clear reporting mechanism in which a patient makes a request to die, we would add to the multidisciplinary team of staff that will review cases and offer support. Removing what could arguably be called underground euthanasia or assisted suicide would be a social good.
I do not believe that a debate on the issue or a proposal to change the law is somehow to focus on death rather than to celebrate life. The testimony of some people in Oregon who have chosen to request medical assistance to die shows that they did so because their lives, as they chose to live them, were being robbed from them by illness and their conditions; seeking assurance that they had regained control of their life was itself a life-enriching experience.
The debate has also shifted preconceived ideas about quality of life. In the many meetings that I have had with local faith groups and others, it has been argued that human dignity is a gift that cannot be taken away, but I do not share that view. Furthermore, there has been a gradual but firm growth in respect for individuals determining their own dignity and quality of life. As far as possible, individuals should be able to determine dignity in their death; it should not be determined by a court, a doctor, a nurse or a family member. Individuals should define the quality of their own lives.
Doctors in Oregon who have written or spoken publicly about physician-assisted suicide also speak of a new appreciation of what their patients experience. I quote one, who said:
"I have also redefined intolerable suffering. I now believe that it may occur in ways quite different from those that we as physicians normally consider and that intolerable suffering is best defined by the patient. My patient was suffering at the core of her being without agonizing pain, anorexia, or night sweats. She had become increasingly dependent on others for virtually all activities. Her dignity, her self esteem had been stripped away. The vitality of her being had passed. Yes, her life, as she defined it, had become futile."
How I define my quality of life might be different from how other members define theirs. Doctors, nurses, carers and loved ones who have spoken to me about their many experiences demonstrate clearly in my view that we cannot generalise on the difficult and complex reasons why people wish to end their lives when they suffer terminal illness.
Finally, I thank all the individuals who have brought their personal experiences to me, both in opposition to what I am proposing and in support of it. I know that my call for a wide debate has stimulated one. I received an e-mail today from a lady who wanted to tell me about her mother. She told me that her mother
"had a mastectomy in early 1966, having had a lump for some time which no-one took seriously. In 1969 she had a non-malignant brain tumour with complications. The socket filled with fluid and a permanent drain had to be inserted".
She went on to tell me—I quote from her e-mail—that
On the Saturday she went with her husband (my father) to her GP—he took one look at her and made an urgent appointment with her cancer consultant.
Monday was a bank holiday. My father was at work and my younger brother and his medical student wife were visiting the house. She locked away her diamonds, settled the grocery bill, left a note about the completion of some knitting for her grandson, and so on.
She then went up to an attic spare bedroom with some of her late mother's sleeping tablets, a jug of water, a glass, a bucket, a pad of paper and a pen. She took the tablets and died writing a note to her husband saying how wonderful he was.
She was found, as planned, by her son and his medic wife.
The coroner decided that it was not suicide whilst of unbalanced mind and cancer is on her death certificate.
She was 54."
Her e-mail ends:
"If your bill had been in existence, she could have seen her grandson (she was in Croydon, I in North Argyllshire), and we could all have said our goodbyes."
A considerable number of members wish to speak, so we will have three-minute speeches. Michael Matheson will be followed by Michael McMahon.
I congratulate Mr Purvis on securing time for the debate. Members will be aware that I lodged an amendment to Mr Purvis's motion and I am grateful to the 15 members who have now signed that amendment, compared with the seven members to date who supported the motion in Mr Purvis's name.
Believe it or not, those who take an opposing view share some common ground with those who support the view that is expressed in Mr Purvis's motion. We all believe that someone who suffers from a terminal illness should be able to die with dignity. However, we differ in respect of how that should happen.
Members should have little doubt that massive strides have been made in the capacity of palliative care to deal with many of the complicating factors that recur in terminal illnesses. I have witnessed that first hand in relatives who have suffered from terminal illness and also in my professional capacity when dealing with individuals who have suffered from such illnesses. In every case I can vouch that they have suffered very little, but have died with dignity. Therefore it is wrong to try to give individuals the impression that dying with dignity is in some way linked to their choice of how to die.
Central to the argument in support of euthanasia is personal autonomy and self-determination. Diane Pretty took her case to the United Kingdom and European courts and stated that she should have the right to choose when she should die. She took her case as far as the European courts, which stated that the right to refuse treatment is far removed from the right to request assistance in dying.
There is an important distinction to make in the debate: euthanasia is not about deciding whether to switch off the life-support machine; rather, it is about actively deciding whether a person should die. It is a form of assisted suicide when the person might be able to live considerably longer.
If the Executive were minded to go down the route of supporting assisted suicide or euthanasia, there would be a major cultural change in our society that would impact on professionals, nurses, doctors and on the individuals concerned. To date, the Royal College of Nursing and the British Medical Association remain opposed to the idea of assisted suicide.
I refer to an e-mail that I received today from Mr Braine, a 64-year-old paraplegic in Aberdeen. He states:
"It is vital that people should not think of doctors, nurses, and hospitals with fear as if"
their going there at a certain stage in their lives might mean that their lives might be put to an end by others.
Doctors and nurses should not have any pressure put on them to make such decisions, nor should they put pressure on patients to decide whether they should end their lives. It is important that the Executive be clear that euthanasia does not have a place in our society today, and it is important that it make that message clear at the end of this afternoon's debate.
I would appreciate members trying to keep their speeches to three minutes. It is difficult for me to try to stop you when you are speaking in this debate.
This is the second occasion this week on which we have discussed individual rights and freedoms. However, unlike the debate that we had yesterday, this debate puts the emphasis on a negative perspective on the value of life. Yesterday, Margaret Smith correctly told us that we should support a smoking ban because we should not support somebody's right to kill somebody else and because we should be doing what we can to protect people. That is a positive view of life that is full of hope for a better society.
I have worked closely with doctors and nurses in the palliative care and hospice movement, so I have come to understand just how difficult it is for anyone to make a judgment about what constitutes a worthwhile or worthless life. I have met lots of doctors who have had patients who valued their lives and who fought to preserve their lives in circumstances that the doctors viewed as being insufferable. Every palliative care professional can tell of a patient who has said that they often wished for the end of their life to come. It is my view that that leads, more often than not, to a valuable discussion about the various issues and allows an opportunity to deepen doctor-patient trust.
It is universally acknowledged that patients are reassured when they are told that expressing such thoughts will not result in action to terminate their lives. Experience also shows that it has been extremely rare for patients to make determined and persistent requests for their lives to be terminated. The doctor-patient relationship would be seriously compromised if patients could not express their distress lest it lead to euthanasia.
There is good evidence that a desire for death in terminally ill patients is closely associated with clinical depression. The desire for death can also vary with time and depression is, potentially, treatable. Delirium or confusion is common in palliative care patients and is sometimes so subtle that it is difficult even for clinicians to recognise it. It is impossible to be absolutely confident that a request for a life to be ended does not arise from a disordered state of mind, whether treatable or not.
Most doctors believe that any obligation on them to consider carrying out euthanasia or, if they have a conscientious objection to it, to refer the patient to a willing colleague, would be fundamentally at variance with their duty as doctors to honour the sanctity of life. I also think that the effect of such action on doctors would be enormous. The taking of life would diminish them as individuals and it would lead to psychological problems for many doctors in the long term.
Palliative care doctors tell me that clinical care is effective in alleviating suffering. That would be undermined by the practice of euthanasia. Obviously, there will be times when a doctor cannot help a patient clinically; not all problems can be fixed. However, even if we could be sure that a doctor was dealing with a competent and mentally sound patient with intolerable and untreatable suffering, the overwhelming majority still believe that the taking of life is wrong because of the clinical principle of non-abandonment.
Sometimes, all that a doctor can do is accompany the patient as a caring and even loving clinician who does not give up on them, even when they cannot remove the problem. It is precisely because humans are never worthless that we should attempt to alleviate suffering or, where we cannot do any more, still care.
For the avoidance of doubt, I advise anyone who noticed that my name was on record as a supporter of the motion that that was due to a mistake on my part with an e-mail button. I meant to support the amendment in the name of Michael Matheson.
I accept the fact that people should be able to die with dignity, but that concept is already embedded in good health care. Death is a continuum of life, and the concept of a good death is as vital a part of health care as the care and treatment of patients throughout life. In common with the BMA, I cannot accept that deliberately causing an individual's death is a valid or essential part of that concept. I am, therefore, opposed to euthanasia and physician-assisted suicide, and I do not wish there to be a change in the law to make that permissible. I can, however, accept the withholding or withdrawal of life-prolonging treatment from a terminally ill patient if the patient refuses such treatment or if it fails to be of benefit to the patient, even though death is known to be inevitable as a result. In my opinion, that is quite different from using medical skills actively to kill or to assist suicide and is, rather, an admission that medicine can do no more.
For me, a former health professional who is bound by the Hippocratic oath and trained to improve and prolong life where possible, the idea of actively and deliberately ending a human life is disturbing. I agree with the BMA that changing the law to permit assisted suicide would, in some cases, undermine patient trust in doctors and medical advice. A licence to kill or to assist in so doing would give the doctor a role that does not sit comfortably with that of healer and carer. In this country, especially after the notoriety of Dr Shipman, such a move would risk impairing the doctor-patient relationship, which is founded on trust.
I would far rather see palliative care stepped up and perfected in line with the gold standard framework, which, when implemented across the country, should allow patients in the final stages of life to live well and ultimately to have a good death that is physically free of symptoms, gives them a sense of safety, security and support and comes with care that responds to their needs. Such a framework will give support and information to carers and should boost staff confidence and aid communication between members of the health team.
Caring for palliative care patients and their families in such a special way will ensure that their issues are more likely to be dealt with properly and sensitively and that more people will be able to die in their place of choice. The gold standard framework already operates successfully in England and, thanks to generous funding from the New Opportunities Fund, Macmillan Cancer Relief and NHS Scotland, will soon be rolled out across Scotland. That is how we should improve palliative care and take the fear and pain out of death. Such an approach is infinitely preferable to going down the route of euthanasia and physician-assisted suicide.
I am very happy to take part in this debate. However, I should apologise in advance for having to leave slightly early, because I have to attend the event that was referred to earlier. I should also declare that I am a member of the BMA but, as members will hear, my position on this matter is rather different from the position that the association takes. This is a conscience issue for the Green group in the Parliament, although I believe that we agree broadly on the principle.
I support Jeremy Purvis's motion, because I believe that the more that medicine advances, the more that grey areas appear between withholding treatment, withdrawing treatment or actively hastening a patient's end. I want to be clear that Jeremy Purvis's proposals cover neither the withholding of treatment by mutual agreement between the patient or their next of kin and the people who care for them, nor the withdrawal of treatment, which would include shutting off a ventilator on someone who has no hope. Both practices already happen and are quite accepted. Disputes sometimes arise, but they can be dealt with in the current system.
I signed the motion because I felt that the proposals would not mean that a patient's life would be ended without their consent. We must make that absolutely clear, as members have raised the question of trust between the patient and the health professionals who care for them.
I agree that palliative care in Scotland has to be improved and that facilities of the highest quality must be made available and supported. However, any palliative care package should, if appropriate, allow the patient to choose when they can end their life. Full consent for any such step must have been given when a patient was able to do so, or must be detailed in a living will that sets down in advance the circumstances in which a patient would want that course of action to be taken. I do not think that such an approach would undermine treatment. For example, a dying patient's depression is more likely to be actively treated if their express wish to end it all becomes an option. The issue will have to be explored thoroughly.
In any case, professional relationships with patients change as they move from the stage at which the health professionals are aggressively treating a serious and potentially life-threatening illness to the palliative care stage. The proposals simply represent one more progression in that relationship and can be handled in that way. That said, I respect the views of the BMA and the Royal College of Nursing on this matter. There needs to be a lot of discussion about the matter, but I do not think that the proposals undervalue human life. Instead, they value and respect human life, the autonomy of human beings and their right to have the quality of life that they want to have up to the end. That is why I continue to support the proposals.
The motion calls for a wide debate. We are starting that process. A wide range of views will have to be taken into account, but this is a healthy debate for the public and health professionals to have and I am very glad that Jeremy Purvis secured tonight's debate.
There is no question in my mind about the importance of this debate and I congratulate my friend and colleague Jeremy Purvis on securing it. Like many other members, I welcome this opportunity to make a contribution and certainly agree with the Moderator of the Church of Scotland that it is entirely appropriate that a debate on the subject should be held in the Scottish Parliament and in wider Scottish society.
I am very suspicious of people and organisations that attempt to portray moral issues in easy, dogmatic, black-and-white terms. As a Christian, I believe in the sanctity of human life but, as a Liberal, I believe fervently that I cannot impose my moral beliefs on others. I follow John Stuart Mill's philosophy that people should be free to take actions and be responsible for those actions, as long as they do not cause serious harm to others.
That is where I have real difficulty with Jeremy Purvis's motion and the issue of assisted dying for the terminally ill. If the law were to be changed to make suicide legal in certain circumstances, as Jeremy Purvis and others wish, I believe that immense pressure would be brought to bear on the most vulnerable people in our society—those who know and fear that they are near the end of their time here. Would people in those circumstances really be making a free choice? I do not think so. What message would we be sending to people—that they had outlived their usefulness and were a burden on society?
The question of free choice is central to the debate. In our civilised society, everyone has a right to life. We are talking about changing Scots law to reflect the provisions of the Assisted Dying for the Terminally Ill Bill in the House of Lords. The purpose of the bill is:
"to provide an option for terminal patients who are suffering unbearably to bring an end to their suffering at a time of their choosing, in a way that will not place vulnerable members of society at risk".—[Official Report, House of Lords, 10 March 2004; Vol 658, c 1316.]
Those are admirable principles, but in my view it would be totally impossible to put them into practice. I do not believe that any proposals could deal with the indirect and even direct coercion that could and, I am sure, would occur in such circumstance.
I have no doubt that the change in Scots law that Jeremy Purvis and, I hope, not too many others are championing has been proposed for the best of reasons. Jeremy Purvis wants to change the law to help people in the direst circumstances. However, as a Liberal, I cannot support the proposals to change the law. I see the arguments for doing so, but I believe firmly that if we made such a change, we would breach John Stuart Mill's fundamental principle of freedom. We cannot allow people to do this, because it would precipitate real harm to the most vulnerable people in society. I urge members not to support a change in Scots law if, in due course, proposals come before us.
I, too, congratulate Jeremy Purvis on securing the debate. It is important that our new Parliament should debate one of the few ethical issues that have been devolved to it and to Scotland.
I view sympathetically the introduction of legislation to allow physician-assisted dying or voluntary euthanasia. This is a challenging issue for politicians, as we must put our party-political baggage to one side and address seriously the legal and moral complexities. As individuals, we must both keep to our strongly held views and do our best to reach a rational, considered view. Finally, we must pay heed to public opinion. Recent opinion polls indicate that there is growing support for a change in the law.
In essence, this is a debate about the right to life. It is also a debate about the right to die, and the right to die with dignity. As Mike Rumbles said, it is a debate about supporting the principle of individuals' autonomy and freedom of choice. It boils down to whether someone who is terminally ill and whose physical and mental well-being is such that they have no quality of life, or prospect of that, may seek assistance to end their life because they are unable to do so themselves. As has been mentioned, it is legal in Scotland for someone to commit suicide but illegal for them to get help to end their life if they are unable to do so because of their illness.
I remember reading the very powerful, moving article that BBC Radio Scotland's Derek Bateman wrote in July 2001, just two months after the death of his wife from cancer. In the headline, he said that he believed that he could perform no greater duty for his wife than to end her life. The article outlined the heartache and difficulties that face the loved ones of people with terminal illnesses.
Any legislation permitting physician-assisted suicide would have to be very tight. We would have to ensure that any request for assisted death was serious, rather than the result of a temporary emotional state, and that people were not making the request because they felt that they were a burden on their relations. We would also have to ensure that there was no let-up in the development of terminal care, to enable us to do our best to ease suffering for people with terminal illnesses.
Legislation would offer protection to general practitioners and physicians, who sometimes have a conflict of duties. They see their role as being to prolong life, but sometimes that means prolonging suffering. They would have to be at the heart of developing any policy change. I have noticed that the police, increasingly, support a change in the law because they sometimes find themselves in the difficult position of having to consider the prosecution of doctors or the loved ones of the deceased.
The issue has been addressed and legislated on in many countries throughout the world and we must learn lessons from what has happened in those countries.
Yesterday we debated a smoking ban in Scotland. That debate was about saving lives, but today's debate reminds us that there may well be a case for introducing legislative change that, in very specific unfortunate circumstances, may mean helping people to end their life.
The most cherished day of my life was 25 February this year—the day of the birth of my baby daughter, Abbie. I do not know whether I will be saying that at 3 o'clock tomorrow morning, but there is no greater gift to anyone than the gift of life. It is not up to Jeremy Purvis, any other MSP or any other person to decide that the gift of life should end.
I disagree with Jeremy Purvis's motion in the strongest possible terms. I do not think that he set out the argument compassionately; he set out a legalistic view.
The birth of life is a natural process and death should also be a natural process. Members have all said that the process of death is difficult; many of us have seen close relatives experience that process in very difficult circumstances. However, that process is not helped by a legal document such as the one that Jeremy Purvis says he set out for himself 15 years ago. The process is assisted by the hard work of those who provide support and attention to people during that difficult time of their lives. I pay tribute to the Marie Curie hospice that is based in my constituency, which provides valuable support for people during that difficult process. I add my support to those people.
The focus of today's debate should be on the work of Michael McMahon and others in the cross-party group on palliative care and how we can support people properly during the process, instead of on a legal document that aims to ensure that we can assist people to die. There are many medical and legal arguments about which I hope we will hear no more during the debate; I do not want that debate to take place.
I do not always agree with Mike Rumbles. He and I are not known to share a platform in the Lib-Lab coalition, but he set out clearly the arguments against Jeremy Purvis's motion. I will stand shoulder to shoulder with Mike Rumbles for the first time ever as part of the coalition against the principles in Jeremy Purvis's motion.
Given the motion that Jeremy Purvis has lodged, I do not think that this is a proud day for the Parliament. I ask Jeremy Purvis to accept that the majority of Scottish people do not support the motion and that, certainly from what I have heard so far, other members do not support the motion. I ask every member in the Parliament to oppose Jeremy Purvis's motion in the strongest possible terms.
The most basic of all human rights is the right to life. I trust that we all agree with that, but the motion before us seems to be based on the assumption that there is a corresponding right to die. As Michael Matheson said, the European Court of Human Rights has ruled that under the European convention on human rights there is no such right to die. After careful consideration, the court came to that conclusion because of the need to protect life and avoid the risk of abuse.
I agree with the judgment of the European Court of Human Rights. I also agree with the BMA and the General Nursing Council, both of which are opposed to euthanasia or clinically assisted suicide. The BMA and the Royal College of Nursing believe that it would undermine the relationship between patients and their doctors and nurses if their members were involved in assisting suicides. It would also frighten vulnerable people.
Legislators may attempt to define the legislation tightly to ensure that the consent of the patient would have to be obtained. However, as Mike Rumbles said, there would nevertheless be enormous pressure on vulnerable people to consider using the legislation—for example, to avoid being a continuing burden on their families. Any such legislation would also enshrine in law the concepts that some lives are more valuable than others and that some lives are simply not worth living. I cannot accept that, and I cannot accept that there is no alternative. Indeed, the alternative is referred to in the motion, which
"recognises the huge benefit to society and individuals of professionals, volunteers and carers working in palliative care and the hospice movement".
If high-quality palliative care were made available to all who needed it, it would overcome many of the reasons why people call for clinically assisted death.
I speak from experience within my own family. My son died in Strathcarron Hospice at the age of 16. He died prematurely but, thanks to the high quality of care, he died peacefully and with dignity. Nobody can ever claim that his life had no meaning or no value.
I congratulate Jeremy Purvis on bringing the motion to Parliament. Although I agree with the substance of Paul Martin's argument, I disagree that it is not right to bring such a motion before Parliament. We have to face difficult issues and we have to debate them openly and honestly in Parliament.
I do not come at the debate from an especially religious point of view, but from a humanitarian and pragmatic point of view. Jeremy Purvis said that the introduction of euthanasia would not open up a new world of Harold Shipmans, but I disagree. It might not motivate people to mass murder, but the few people who might be motivated towards mass murder of the Harold Shipman kind would have a very easy excuse if we introduced such a law. Too often in recent years, we have seen cases—not only the Shipman case, but many others, particularly in nursing homes where there are old and frail people, and sometimes even in children's hospitals, both in this country and in North America—in which nurses have engaged in a kind of mass murder over a period of time. In their own minds, they have often thought that they were doing favours by bringing people's lives to an end. They believed that people's quality of life was no longer tolerable, or that the people were terminally ill and suffering too much. At the end of the day, I believe that life is life, even when issues around a person's quality of life are very difficult. Sometimes people who are thought to be terminally ill actually make some kind of recovery.
If a person is dosed up to the eyeballs with morphine, for example, it is understandable that he or she will want to end their life because they are suffering so much. If a person is lying in a hospital bed and they see the pangs of pain on the faces of their dearest loved ones when they come to visit, it is perfectly understandable that that person will want to relieve their loved ones' suffering, as much as their own suffering, by ending their own life as quickly as possible. In many cases, that would not be a rational decision, and accepting such decisions would not be a humanitarian approach to life.
People often talk about the classic case of a person being kept alive on a life-support machine. There is no similarity between deliberately ending someone's life and switching off a life-support machine. I think that we would all agree that if someone is dependent on a life-support machine, switching it off at the right time is a tolerable and kindly act that is very different from euthanasia, which in my view is a cruel deception of humanity.
The people of Scotland expect us to face up to debating such serious issues. As a Christian, I am quite happy to participate in such a debate. I only hope that when the debate expands, it does not become too black and white. We sometimes assume that we in Parliament can act as God; I do not want a situation to arise in which a general practitioner or a clinician of any form can act as God by withdrawing life.
As a child, I watched my grandfather go through agonies as he died at home, using whatever palliative care was available at that time. I have never forgotten those memories. My father died of cancer in a hospital and suffered no pain—in fact, he died smiling. By the time my mother died, palliative care had again improved and she was able to live in her own home with the support of her family and all the local care workers. She died happily; in spite of her pain, she never said that she wanted to end her life. She rejoiced in what had gone on in her life and she told stories about things that I had not previously known about and all the happiness that she had experienced. That is the ideal picture of gold-standard palliative care; that is what we should aim for.
The hospice system is brilliant. It is underfunded and it is not properly provided for, so we should make far more attempts to increase the support that it gets.
The issue that we are debating involves huge pressure on families and patients. People who make living wills in their early 20s when they are fit and healthy might change their minds when they become very ill. Will they be fit enough to be able to get out of such a will? I do not know the answer to that question because I am not a lawyer, but it raises serious issues to do with individuals' ability to change their minds.
I agree with Alex Neil about the withdrawal of treatment when medical science can do nothing more to prolong a life, but members of the caring professions cannot be put in situations in which they are asked to help people to die. As Nanette Milne said, they take oaths and they are trained to improve and prolong life. They work themselves to death—please pardon the pun—trying to save life. That is the model that we should be considering. My grandchild is home having suffered a very serious illness in the West Indies. She is a joy, but if the medical people had given up on her, she would not have the life that she has, or anything else.
I do not agree at all with where Jeremy Purvis is coming from. I have for him a quote about a report that was commissioned by the Dutch Ministry of Justice:
"there were over 3,000 deaths from euthanasia in the Netherlands in 1990. More than 1,000 of these were without an explicit request."
We must learn lessons from such matters. Quite simply, we do not need to tinker with the legislation we have; I see no reason to change it. We should be spending more of our time and effort on prolonging the quality of life for everyone on God's earth.
I am grateful to have the opportunity to respond on behalf of the Executive to a debate on a motion that is of the deepest interest to all members who are present.
End-of-life issues introduce a complex array of considerations that give rise to widely differing, but sincerely held, views and convictions that range from the ethical, the theological and the philosophical to cherished views on the sanctity of human life, and which embrace concepts of human dignity, as well as issues of choice and personal autonomy. Fundamentally, the subject touches on the relationship between doctor and patient and on the trust and confidence between them that is so essential to appropriate treatment and care.
I congratulate Jeremy Purvis and the other members who have participated in the debate on their measured, compassionate, sometimes heartbreaking but always thoughtful speeches. The time that is available does not allow us to do full justice to a subject of such intricacy and depth, but I will seek to address the points that are made in the motion and, if possible, some of the issues that members raised.
First of all, it would be helpful if I briefly outline the law as it stands in Scotland. Under Scots law, an act of euthanasia by a third party, including physician-assisted suicide, is regarded as the deliberate killing of another and would be dealt with under the criminal law relating to homicide. The consent of the victim would not be a defence and no degree of compassion on the part of the person who carried out the act would amount to a legal justification. There might be cases in which the circumstances of the offence would make a charge of culpable homicide more appropriate than one of murder, and a court would take all the circumstances of the case into account before sentence was pronounced. However, if the accused was convicted of murder, a sentence of imprisonment would be mandatory. I add that doctors are bound by both the law and professional ethics and cannot take or be required to take any action that conflicts with either of those duties.
As any proposal for a member's bill would involve issues of conscience, the Executive's stance would be neutral. We will listen carefully to the public debate and offer advice on what we consider to be the key issues and implications in the context of our present laws, which we have no plans to change.
On the detail of the motion, as Jeremy Purvis has described, a select committee of the House of Lords is currently considering a bill—the Assisted Dying for the Terminally Ill Bill—which was introduced by Lord Joffe and seeks to enable a competent adult who is suffering unbearably as the result of a terminal illness to receive medical help to die at his own considered and persistent request. The select committee's report will no doubt provide helpful further analysis and perspectives that will inform further consideration of the issues that are involved.
The motion refers to the publication of the NOP opinion poll that was commissioned by the Voluntary Euthanasia Society and to some of its findings. As with all opinion polls, the results are of interest, but we need to recognise that the sample size was limited and that many organisations, such as the BMA and the Royal College of Nursing, as well as individuals, remain opposed to euthanasia. Nanette Milne referred to the BMA's position, which sets out cogently the reasons why it opposes euthanasia and physician-assisted suicide, including the issue of trust between doctors and patients to which I have referred and the potential effects on vulnerable people, such as the elderly, the dependent, the disabled or the extremely ill. Those are powerful points.
The motion properly acknowledges the huge contribution of those who work in palliative care and the hospice movement, and I echo the motion in commending them for their unflagging and compassionate commitment. Many members have acknowledged the importance of palliative care, and we in Scotland can be proud of our work in that area, with its sensitive provision of emotional, social and spiritual support and pain relief, which enables patients to achieve the best quality of life during the final stages of their illnesses.
The Scottish Executive encourages the dissemination of the principles of palliative care throughout the national health service in Scotland, as well as in the voluntary sector, and recognises the role of palliative care from the time of diagnosis onwards, not only in the terminal phase of illness. As an illustration of our commitment to palliative care, I tell members that, of the £25 million recurring, ring-fenced funding for cancer in Scotland, some £5.3 million was invested in palliative care services in the three years from 2001 to 2004, and almost £2.4 million is available on a recurring basis from 2004-05 onwards. That investment has been used for staffing, training and equipment to support improvements in patient care in the community, but our policy is broadly one of palliative care for all, and that means making the palliative care approach available not only to those with cancer, but to anyone who suffers from a progressive, incurable illness. We are committed to that approach and will ensure that effective palliative care services are supported.
The motion also calls for
"a wide debate on end of life issues and consideration of a change in the law."
It is clear from the range of members' comments that euthanasia is a hugely complex and controversial area that raises a raft of difficult moral, ethical and practical issues on which strong, widely differing views are held. As I have said, the Executive has no plans to change the law. However, we will take note of what has been said in the debate, just as we will consider with interest the report of the House of Lords select committee when it emerges.
This is not an issue on which it would be appropriate to rush to hasty, ill-considered proposals or conclusions. The subject has immense implications and consequences for the whole of society. The debate has been valuable in illustrating just how deeply the views on all sides are held.
Meeting closed at 17:50.